 Central Florida Retina Institute, Specializing
in diseases and surgery of the retina, macula, and vitreous,
 877-245-2020
Retina FAQs | Glossary
of Ophthalmologic Terms | Description
of a Retina | Diabetic
Retinopathy | Epiretinal
Membranes | Flashers &
Floaters | Macular Degeneration
| Macular Holes | Retinal
Detachment | Retinopathy
Of Prematurity | Clinical Trials
Q: Description of retinal detachment?
A: Retinal detachment is caused
by a combination of factors including retinal holes, retinal
breaks or retinal tears, liquefaction of the vitreous humor,
and mechanical forces on the retina, often referred to as "traction".
A variety of factors can cause
retinal holes, retinal breaks or retinal tears including:
• hereditary abnormalities
of the peripheral retina often associated with myopia (near-sightedness)
• eye trauma.
• complications of eye surgery for cataract.
• glaucoma.
• various retinal and macular diseases.
• vision correction.
Q: Symptoms of Retinal Detachment
A: A suddden decrease invasion,
sometimes described as a "shade or curtain" coming
down over your vision.
Q: What is the relationship between near-sightedness
and retinal detachment?
A: Simply having a longer eye
associated with myopia probably does not cause retinal detachment,
tears, holes, or breaks. A variety of peripheral retinal degenerations
such as lattice degeneration are often genetically linked to
myopia and may cause retinal holes, breaks, or tears.
Q: If a retinal detachment occurs after
eye surgery, does it mean that the surgeon made a mistake?
A: No. Retinal holes, breaks,
or tears can occur after uncomplicated eye surgery performed
at the highest level of excellence. This complication is probably
related to normal alterations in the vitreous humor (jelly) that
often occur during or after eye surgery.
Q: What kind of trauma can lead to retinal
detachment?
A: Direct trauma to the eye
can lead to retinal breaks, holes, or tears that occur days,
weeks, months, or even years after the incident. Trauma severe
enough to cause a black eye, hemorrhage on the white part of
the eye, hemorrhage within the eye, a penetration or laceration
of the eye, cataract, light flashes, floaters, or decreased vision
can be related to subsequent retinal detachment.
Q: What injuries typically cause retinal
detachments?
A: Bottle rockets, BB guns,
and paint balls lead to injuries often causing retinal detachment
and should be outlawed or controlled. Bottle, fist, or elbow
injuries associated with child abuse, abuse of women, or fighting
can lead to retinal detachment. It is our hope that society will
recognize the epidemic of child and partner abuse and take action.
Racquetball, tennis, golf, soccer, boxing, and diving injuries
can lead to retinal detachment. Patients and their lawyers often
ask if falling down, automobile accidents, or being struck in
the head without direct eye injury can lead to retinal detachment.
While this may be possible, the relationship cannot be proven
and is highly improbable.
Q: What can cause pulling on the retina?
A: A variety of conditions can
cause it, including:
o posterior vitreous separation,
and
o scarring on the surface of the retina.
Q: I thought that only retinal breaks,
tears, or holes cause retinal detachment. Not true?
A: Actually another form of
retinal detachment called traction retinal detachment can occur
as a complication of diabetic retinopathy, Retinopathy
Of Prematurity | Clinical Trials, inflammatory disorders, or trauma.
The more common type of detachment associated with retinal holes,
breaks, or tears is called rhegmatogenous.
Q: Can retinal detachment cause total blindness?
A: Yes, even a slight blockage
of the vision caused by partial retinal detachment can result
in blindness if not treated expeditiously.
Q: How common is retinal detachment?
A: Relatively uncommon. About
6-8 people out 10,000 experience retinal detachment.
Q: Are eye strain, nutrition, general health,
smoking, or emotional stress related to retinal detachment?
A: No. There is no known relationship
between retinal detachment and any of these problems.
Q: If one eye develops retinal detachment
will the other develop it as well?
A: Detachment is more likely
to occur if the other eye has the condition (such as lattice
degeneration) associated with retinal detachment in the first
eye. If only one eye suffers a serious injury or requires eye
surgery then, of course, the chance of detachment in the other
eye is not increased by the event.
Q: What treatments are used for retinal
detachment repair?
A: Vitrectomy (removal of the
vitreous humor), scleral buckles, gas bubbles, silicone oil,
lasers, cryo (freezing), temporary balloons, and diathermy (thermal
energy created by radio waves) can all be used to repair retinal
detachments. These treatments are often used in combination.
Typical combinations are:
1. Vitrectomy, gas, and laser
to repair retinal detachments that occur after cataract surgery
and other moderately complex detachments
2. Gas followed by laser (pneumatic
retinopexy) for less complex retinal detachments
3. Scleral buckling and cryo
(freezing) with drainage of the fluid under the retina for less
extensive to moderately difficult retinal detachments
4. Vitrectomy, membrane peeling,
laser, and silicone oil for difficult retinal detachments and
recurrent detachments.
Q: What is a vitrectomy and why is it used
for the treatment of retinal detachment?
A: Vitrectomy means to remove
the vitreous humor. Although vitreous humor is often referred
to as vitreous jelly, the collagen fibers in the hyaluronic acid
gel (jelly) are the component that causes retinal detachment.
Vitreous pulls on the retina creating retinal tears or breaks.
The vitreous never regenerates if it is removed, and the eye
will have perfect vision and a normal shape without the vitreous.
Patients often are concerned that the eye will collapse if the
vitreous is removed or wonder what is used to replace it. Aqueous
humor fills the former vitreous space within hours after surgery
replacing the artificial aqueous humor (saline with additives
called balanced salt solution) that is used to maintain eye pressure
during and immediately after surgery. Vitreous removal reduces
pulling (traction) on the retina, improves the surgeon's view,
and provides space for a gas or silicone oil bubble.
Q: Are other techniques used during vitrectomy
procedures?
A: Yes, scar tissue referred
to as epiretinal membranes can be removed from the retinal surface
using various methods of membrane peeling. Scar tissue can be
removed from underneath the retina (subretinal surgery). A portion
of the retina can be intentionally resected (cut) if it is contracted
too much to become reattached. This is called retinectomy. Laser
or cryo (freezing) treatment is usually used to make an intentional
scar to seal retinal holes, breaks, and tears. This effect takes
7-10 days to be effective in preventing fluid from flowing through
the retinal defect. Most laser or cryo applications are in the
non-seeing far peripheral retina and do not cause significant
loss of peripheral vision.
Q: What is a scleral buckle?
A: Scleral buckles are permanent
components usually made of silicone rubber or silicone sponge
material which are sutured to the outside surface of the back
half of the eye in order to create a permanent indentation. Sometimes
the components are shaped like an arc and are placed < to
> of the way around the eye. In other situations the buckle
is placed all the way around the eye (encircling buckle). The
indentation acts inside of the eye much as a gasket is used to
seal a radiator or the cylinder head of an automobile engine.
In other words, the retinal pigment epithelium, choroid, and
sclera, which are the three layers of tissue under the retina,
are pushed inward against the retina. The buckling effect is
placed adjacent to the retinal breaks, holes, and tears to help
seal or support them. A secondary purpose of scleral buckles
is to reduce pulling on the retina due to contraction of the
collagen fibers in the vitreous humor. This works by pushing
the retina inward.
Q: What is the purpose of the gas bubble?
A: Gas (and silicone oil) bubbles
act via their surface tension to prevent the aqueous humor or
saline solution from flowing through defects in the retina increasing
the detachment. In other words, gas or oil is used to restore
the pressure difference that is normally present across the retina.
Either a gas or silicone oil bubble must be used if the vitreous
is removed to repair retinal detachment because aqueous humor
or saline solution readily flows through retinal defects. A gas
bubble will be replaced by aqueous humor over a period of one
to three weeks or more as the bubble absorbs. Gas bubbles (and
silicone oil) float in the eye fluids and therefore migrate to
the highest part of the eye. If the patient lies on his back,
the gas bubble will come to the front of the eye, and will cause
a cataract if the human lens is present. If the bubble is not
on the trouble, it will not be effective in repairing the retinal
detachment. If the patient lies with his right side down, the
bubble will move to the left side of the treated eye, and vice
versa. A patient can be seated with head bowed as if in prayer
if the retinal defect(s) are on the upper part of the retina
(or he has a macular hole). He must be face down in the bed with
the head turned slightly left or right if the side or lower part
of the retina is affected by tears, holes, or breaks. This is
similar to the back rub position.
A patient cannot fly or travel
via train, bus, or car to higher altitudes if there is a bubble
in the eye unless the bubble is very, very small. If this rule
is broken, the bubble will expand, causing severe pain and potentially
permanent loss of vision.
Patients often ask, "Can
I drive with a gas bubble in my eye?" If the other eye is
perfect, it is legal to drive. Glare and obstructed vision from
the bubble may make driving more difficult for certain individuals.
Most of the prescribed positions after surgery are not compatible
with driving. If a patient has a perfect non-operated eye and
must drive in an emergency situation it is probably permissible
for a short period of time.
Q: Are gas bubbles ever used without vitrectomy?
A: Sometimes gas bubbles are
injected in the office to repair the retinal detachment without
going to the operating room. This technique is called pneumatic
retinopexy and is used for less complicated retinal detachments.
This technique is usually used for detachments on the upper part
of the eye because bubbles float to the top. The eye is anesthetized
with drops or an injection and sterilized with a special disinfectant.
A small bubble is injected and then fluid is removed from the
front of the eye to equalize the pressure in the eye. Often the
vision dims out for a few seconds until this fluid removal step
is completed, normalizing the eye pressure. Sometimes cryo (freezing)
is used before the gas bubble is injected but more often laser
is applied to the retinal hole, break, or tear after the gas
bubble reattaches the retina.
Q: Is there a laser only treatment for
retinal detachment?
A: Yes, small retinal detachments
can be treated by walling them off with laser treatment.
Q: Is there a medication or eye drop for
the treatment for retinal detachment or is surgery the only option?
A: No. There is no medicine,
eye drop, vitamin, herb, or diet that is beneficial to patients
with retinal detachment.
Q: Do retinal detachments ever disappear
without surgery?
A: Only if the detachment is
due to a successfully treated medical condition such as toxemia
of pregnancy or rare forms of eye inflammation.
Q: How long does the surgery take?
A: Surgical procedures usually
take our doctors less than one hour. Gas injection alone takes
ten to twenty minutes.
Q: Is the surgery performed on an inpatient
or outpatient basis?
A: The surgery is performed
on an outpatient basis in all cases unless there is a medical
reason to stay overnight in the hospital.
Q: What is the success rate?
A: The surgical success rate
for retinal detachment depends greatly on the type of retinal
detachment and repair method but is typically between 70% and
90%.
Q: Are there any complications?
A: There can be: there is a
significant incidence of cataract progression after vitreous
surgery. Some doctors believe that patients with an absolutely
clear lens develop cataracts as a result of vitreous surgery,
but our doctors are skeptical. Many of the patients requiring
vitreous surgery for retinal detachment already have nuclear
sclerotic cataracts (yellowing of the center of the lens), which
often worsen after vitreous surgery. Surgeons differ widely on
the percentage of patients that suffer cataract progression due
to vitreous surgery. Our doctors believe that the progression
rate is about 10%; others believe that it is 100%.
Retinal detachment can occur
after vitreous surgery performed for any reason, including repair
of retinal detachment. Sometimes this is due to the method used
but more often it is due to increasing traction on the retina
from further contraction of the vitreous.
Proliferative vitreoretinopathy
(PVR) is the most common cause of failure of retinal detachment
surgery and often requires vitrectomy and silicone oil. Epiretinal
membranes (EMM)occur after about 2.5% of otherwise successful
retinal detachment procedures.
Pressure elevation (glaucoma)
can occur after all forms of eye surgery including surgery for
retinal detachment.
Infection is very rare after
retinal detachment surgery (about 0.02%).
Q: What care is required after surgery?
A: Precautions regarding gas
bubbles and silicone oil are noted above.
In general, the retina becomes
adherent to the undelying tissue, "sealing" the retinal
holes/breaks/tears in 7-10 days. Normal activity can be resumed
after the retina has been completely attached for two-three weeks.
Older practices prohibited many activities such a bending over,
lifting, etc.; avoiding these activities is no longer necessary.
An eye patch is no longer needed after the first post-operative
day.
Antibiotic drops are usually
used for five to seven days, dilating drops for one to three
weeks, and steroid drops for two to three weeks. Steroid drops
are not used if it is thought the patient is genetically susceptible
to steroid glaucoma. If the patient notices any new shadow or
blockage of vision after the gas bubble is gone, it should be
reported to the doctor.
Reattaching retinas often produce
light flashes and floaters similar to those noted when detachment
began.
Vitrectomy, laser, gas bubbles
and silicone oil produce little if any pain. Antibiotics injected
at the end of surgery are usually responsible for post-operative
pain. Increased pressure can result from gas bubbles and occasionally
silicone oil and other surgical techniques. Pain should be reported
to the doctor. Scleral buckling surgery can produce moderate
pain but most pain is from the antibiotics.
If you have
any further questions about the service provided by Central Florida
Retina Institute or if you would like to make an appointment,
please call (863) 682-7474 or call toll-free at 877-245-2020.
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