What treatment options are available for a detached retina affecting vision?

Treatment for Retinal Detachment Affecting Vision

A detached retina requires immediate surgical intervention by a vitreoretinal surgeon, with treatment options including pars plana vitrectomy, scleral buckling, or a combination of both, achieving anatomical success rates of 85-90%. 1, 2

Immediate Action Required

This is an ophthalmologic emergency—patients must be evaluated by an ophthalmologist skilled in binocular indirect ophthalmoscopy on the same day symptoms appear. 1, 3, 2 The earlier the intervention, the greater the chance of preserving macular attachment and visual acuity. 2

Warning Signs Requiring Emergency Evaluation:

• New floaters with flashes of light (photopsias) 3
• Peripheral visual field loss (the "dark curtain" phenomenon) 3, 2
• Sudden decrease in visual acuity 3
• Shower of new floaters or "smoke" in vision (suggesting vitreous hemorrhage) 3

Surgical Treatment Options

Primary Surgical Approaches:

Pars plana vitrectomy and scleral buckling show equivalent anatomical and visual outcomes according to systematic review evidence, with the choice depending on the specific characteristics of the detachment. 1

• Vitrectomy: Removal of the vitreous body, particularly useful for complex detachments 1, 2
• Scleral buckling: External approach to reattach the retina 1, 2
• Combined approach: Both techniques used together for challenging cases 2

Surgical Success Rates:

• Anatomical reattachment: 85-90% 2
• Modern smaller-gauge (23-gauge) vitrectomy systems have reduced complication rates compared to older 20-gauge systems 1

Critical Examination Components

Before surgery, the ophthalmologist must perform: 3

• Visual acuity measurement to establish baseline
• Pupillary assessment for relative afferent pupillary defect
• Vitreous examination for hemorrhage and pigmented cells (Shafer's sign)
• Thorough peripheral fundus examination with scleral depression
• B-scan ultrasonography if media opacity prevents direct visualization

Treatment of Retinal Breaks (Pre-Detachment)

For retinal tears without detachment, laser photocoagulation or cryotherapy creates chorioretinal adhesion to prevent progression to full detachment. 1

• Treatment must extend to the ora serrata if the tear cannot be completely surrounded 1
• The most common cause of treatment failure is inadequate treatment at the anterior border of horseshoe tears 1
• Acute symptomatic horseshoe tears have sufficient evidence to warrant immediate treatment 1

Post-Operative Management

Follow-Up Schedule: 1

• Postoperative day 1 examination
• 1-2 weeks following surgery (or sooner if complications arise)
• Earlier visits required for: high/low intraocular pressure, wound leak, pain, worsening vision, or suspected retinal complications

Expected Complications:

The majority of phakic patients develop progressive nuclear cataracts following vitrectomy (>70% of cases). 1, 2

Other complications include: 1

• Retinal breaks during surgery: approximately 1% with 23-gauge systems
• Postoperative retinal detachment: 1% with 23-gauge vitrectomy, 3.5% with 20-gauge
• Endophthalmitis: <0.05%
• Macular hole formation

Long-Term Prognosis

Visual acuity often decreases over time even after successful reattachment, primarily due to cataract formation and macular degeneration. 4

• Chorioretinal atrophy with pigment changes develops in reattached retina long-term 4
• Duration of detachment before surgery directly correlates with degree of visual recovery 4
• Macular involvement at time of detachment significantly impacts final visual outcomes 2, 4

Critical Pitfalls to Avoid

• Never delay referral: Retinal detachment without treatment leads to blindness 2
• Don't assume trauma-related detachments occur immediately: Symptoms can develop up to 6 weeks post-trauma 5
• Don't miss the 6-week window: Even patients with normal initial exams can develop retinal breaks within 6 weeks of symptom onset 3, 5
• Recognize that 8-22% of patients with acute posterior vitreous detachment symptoms have a retinal tear at initial examination 3, 5

Provider Requirements

Only ophthalmologists with specialized training in vitreoretinal surgery should manage retinal detachments, as this requires expertise in binocular indirect ophthalmoscopy, surgical skills, and specialized equipment. 1