Retinal Detachment
Risk Factors
Retinal tears are the primary cause of retinal detachment. Retinal tears occur when the vitreous gel separates from the retina as we age. While this separation is normal and usually does not cause any problems, about 10-15% of the time, there may be a tear in the retina. When the gel separates abruptly and a patient notes new symptoms of flashes and floaters. Patients who are active in contact sports or those who have had head trauma are at increased risk of developing retinal tears. Prior retinal tear or detachment is a risk factor for a new retinal tear. Patients with high myopia are at increased risk for retinal tears and therefore detachment. Traumatic injuries can also result in retinal detachment. Less commonly, traction or pulling on the retina that can occur in late stage diabetic retinopathy can cause retinal tears.
Retinal detachment is primarily a condition that requires surgery. Some types of detachments that do not invlove the central vision and are isolated to one area may be addressed by office based laser treatment in the same way that retinal tears are treated. Other types of detachments that cannot be repaired in the clinic require operating room based surgery. Two primary procedures carried out under local anesthesia may be employed. One is vtirectomy that involves removing the vitreous and sometimes temporarily replacing with a reabsobable gas and the other involves placement of a scleral buckle around the eye, typically made of a silicone band. Both procedures work well. On occasion, certain detachments can be repaired using the combination of a gas that is injected into the eye followed by laser or freezing. This can be done in the clinic. If not satisfied with the results of this procedure, the operating room based procedure can be used for more definitive treatment. The office based procedure can work quite well in the right patient and is called a "pneumatic retinopexy". Vitrectomy for retinal detachment and scleral buckle generally require a well equipped operating room with specialized equipment. This is typically not available at every ocular operating room as the equipment is more specialized.