Retinal Tears And Detachments The retina is the layer that lines the inner surface of the back part of the eye. Light rays are focused at the retina and transmitted to the brain. The retina consists of a multitude of layers with intricate nerve fibers. In a retinal tear or detachment, these layers are separated, causing significant and at times, swift vision loss. A retinal tear or detachment therefore requires immediate medical treatment. The exact procedure used to treat a retinal tear or detachment varies depending on the patient's condition and the type of tear or detachment.
Detached Retina The most common form of retinal tears or detachments occur when fluid seeps through the leaks in the retina. This is often caused by injury, eye surgery, or nearsightedness. Retinal tears or detachments may also occur when the scar tissue from bleeding adheres to the retina and pulls the retina away from the back of the eye; this occurs most frequently in patients with diabetes. In rare cases, a retinal tear or detachment can also be caused by disease-related swelling or bleeding.
Symptoms Of Retinal Tears Or Detachments Symptoms may include the followings: flashes of light, wavy or watery-like vision, appearance of a veil or curtain obstructing vision, or a sudden drop in vision. If you experience any of these symptoms, call your doctor immediately. Early treatment is essential in maintaining and restoring vision.
Retinal Surgical Treatment More extensive retinal tears or retinal detachments will need to be treated surgically. Depending on the type of retinal tear or detachment, face-down positioning may be needed post-operatively for the retina to reattach. Surgical options may include the injection of a gas or air bubble or a scleral buckle to reattach the retina. The gas or air bubble will slowly be re-absorbed by the eye as the eye heals.
Scleral Buckle Procedure A scleral buckle is a thin silicone band that is used to put pressure on the eye to re-attach the retina and help drain the excess fluid from the eye. This procedure is often permanent and is only removed if the area around it becomes infected. These surgeries are usually performed as an outpatient procedure under local or general anesthesia and may be performed in conjunction with vitrectomy (removal of vitreous), cryotherapy (freezing treatment), and/or laser.
Macular Hole A macular hole is a hole in the macula. The macula is the part of the retina that is responsible for central vision. This is the part of the eye that we assess when checking your visual acuity, or “20/20” vision. Macular holes almost always develop during the natural aging process, when the vitreous (the gel that fills most of the eye) thins and separates from the retina. Since the macula is part of the retina, if the vitreous is too tightly adhered onto the macula, the traction can pull on the macula and cause a hole to form. Less commonly, macular holes are caused by eye injury, intraocular inflammation, retinal detachment and other diseases. Most cases occur in people over the age of 50.
Macular holes may be asymptomatic in the early stages, but as the macular hole progresses, the symptoms will become apparent as blurred or distorted vision. In advanced cases, the vision will drop significantly. Peripheral vision is not affected. A vitrectomy is performed to remove the vitreous gel, and then a gas bubble is injected into the eye to help seal the macular hole. As the eye heals, the fluid is naturally replaced. There is currently no non-surgical alternative.
Macular Pucker An epiretinal membrane, also called a macular pucker, is a thin layer of tissue that forms over the macula. Epiretinal membranes often develop on their own as a part of the natural aging process. Particles that have drifted into the vitreous (the gel that fills the eye) settle onto the macula and begin to obscure vision. Membranes may also result from eye conditions or diseases such as retinal detachments, inflammation, injury or vascular conditions. These are called secondary epiretinal membranes.
Many epiretinal membranes do not disrupt vision. Thicker membranes, however, can create wrinkles or puckers in the macula, resulting in blurry or distorted areas in the central vision. Vision loss increases as the membrane thickens. Peripheral vision is not affected. For the epiretinal membranes that disrupt your vision, surgery is recommended. A vitrectomy is performed to remove the vitreous gel, and then the membrane is lifted from the macula. There is no non-surgical alternative.
Vitrectomy Vitrectomy is an operation to remove the vitreous gel from the inside of the eye. This is necessary in order to carry out procedures that cannot be performed with the fluid in its place. The vitreous is a clear jelly-like substance which occupies about two-thirds of the eye, lying between the lens and the retina. Composed of over 99% water, it also contains collagen fibres, proteins and hyaluronan. A vitrectomy is required for a variety of eye conditions, the most common are;
Vitreous hemorrhage: occurs when there is a bleed into the vitreous gel, usually resulting in blurred vision. It is most common in proliferative diabetic retinopathy, though may also occur with other diseases of the retinal blood vessels such as vein occlusions and complications with age-related macular degeneration. Serious injury to the eye may also result in a vitreous hemorrhage.
Preretinal membrane: the name given to scar tissue that has formed on the retina. Scarring can cause distortion, blurring or double vision. A vitrectomy involves the removal of the vitreous gel and the peeling of scar tissue off the retinal surface.
Infection of the eye: an infection called endophthalmitis can develop within the eye, after eye surgery or injury. A vitrectomy is performed in some cases followed by an injection of antibiotics.
Trauma to the eye: traumatic injury to the eye may cause vitreous hemorrhage or retinal detachment.
A dislocated lens: occasionally during cataract surgery the natural lens of the eye (or part of) falls into the vitreous cavity causing inflammation and high eye pressure. The dislocated lens can be removed by a vitrectomy.