From the Guidelines
Retinal tears are a medical emergency that requires prompt treatment to prevent vision loss, and symptoms include flashes, floaters, and vision loss.
Symptoms of Retinal Tears
- Flashes
- Floaters
- Vision loss
Treatment Options for Retinal Tears
- Laser photocoagulation or cryotherapy to create a chorioretinal adhesion around the tear, reducing the risk of retinal detachment to less than 5% 1
- Pars plana vitrectomy or scleral buckling for retinal detachments, with low to very low certainty evidence indicating little or no difference between the two procedures in anatomical and visual acuity outcomes 1
- Pneumatic vitreolysis to induce a posterior vitreous detachment, with similar release rates to pars plana vitrectomy and more effective than ocriplasmin by day 28 1
Important Considerations
- Early diagnosis is crucial, as the rate of successful retinal reattachment is higher and visual results are better when repaired early, especially before the retinal detachment involves the macula 1
- High-risk patients, such as those with lattice degeneration, myopia, or a history of retinal detachment in the other eye, should be educated about the symptoms of retinal tears and detachment and the importance of prompt reporting 1
- Regular follow-up is essential for patients with retinal breaks or detachments, as well as those with risk factors for retinal detachment 1
From the Research
Symptoms of Retinal Tear
- Symptoms of retinal tear include flashes and floaters, and persistent vitreous traction upon the retina in the region of the retinal break 2
- Patients with symptomatic floaters and flashing lights should be referred to an ophthalmologist for a dilated funduscopic examination to evaluate for a retinal tear or detachment 2
Treatment Options for Retinal Tear
- Treatment options for retinal tear include laser photocoagulation or cryotherapy to create an adhesion surrounding retinal breaks and lattice degeneration 3
- Argon laser retinal photocoagulation is a treatment option for retinal ruptures, with a success rate of 94% in one study 4
- Transconjunctival cryotherapy approach with topical anesthetic drops is also used to treat retinal tears 5
- Scleral buckling procedure and pars plana vitrectomy are surgical options for retinal detachment after laser treatment 4
Complications and Risks
- Complications of treatment include vasovagal reactions, retrobulbar hemorrhage, and scleral perforation from a bridle suture 5
- Recurrent vitreous hemorrhage from bridging or avulsed vessels is a significant problem following treatment 5
- The presence of vitreous hemorrhage and subretinal fluid are associated with an increased risk of progression to retinal detachment 6
Follow-up and Prognosis
- Frequent follow-up, especially within the first three months following treatment, is necessary to anticipate new tears and detachments 5
- The question of macular pucker (pre-retinal fibrosis) as a high risk of treatment is not shown by one study, and in fact was more common in the untreated group than the treated group 5