Causes of retinal detachment and how to treat it

The retina is a thin layer of light-sensitive nerve tissue located at the back of the eye. Retinal detachment refers to the condition where the retina separates from its normal position. This separation prevents the retina from receiving an adequate supply of blood and nutrients, which are essential for its function.

If not treated promptly, retinal detachment can lead to permanent vision loss.

The symptoms of retinal detachment can vary, but there are common signs that may indicate the presence of this condition. It is important to recognize these early symptoms to seek immediate medical attention.

Common early symptoms of retinal detachment include:

• Flashes of light (photopsia): A sensation of flashes or bright lights in the visual field, especially at the periphery. These flashes may be more noticeable in dark environments.
• Floaters (myodesopsia): The appearance of small dark spots, specks, or strands that seem to float in the visual field. Floaters can appear suddenly and in large numbers.
• A sensation of a shadow or "curtain": A feeling of a shadow or dark veil moving across part of the visual field. This "curtain" may start on one side and progressively cover a larger portion of the visual field.
• Loss of peripheral vision: A reduction or loss of side vision, often described as tunnel vision. The loss of peripheral vision can be gradual or sudden.
• Blurred vision: A decrease in visual clarity or distorted vision in part of the eye. It may feel as if you are looking through a cloudy filter.

The main causes of retinal detachment include:

• retinal tear or hole;
• aging: a natural process that can lead to vitreous degeneration, causing tears. This cause of retinal detachment is most common in the elderly;
• high myopia (nearsightedness);
• ocular trauma;
• inflammatory diseases: inflammatory conditions of the eye, such as scleritis or chorioretinitis, can contribute to retinal detachment;
• vascular conditions: these can cause fluid leaks from blood vessels beneath the retina, leading to detachment;
• eye tumors (e.g., choroidal melanoma).

The classification of retinal detachment is based on its causes and characteristics. The main types of retinal detachment include:

• Rhegmatogenous retinal detachment, the most common type of retinal detachment;
• Tractional retinal detachment, common in people with conditions such as proliferative diabetic retinopathy or following inflammation or infections;
• Exudative (or serous) retinal detachment, caused by fluid accumulation under the retina.

The treatment and management of retinal detachment begin with an accurate diagnosis, which requires a clinical and instrumental assessment that includes the patient's medical history and symptoms, a physical eye examination, and other possible tests evaluated by the ophthalmologist, including:

• slit-lamp examination;
• indirect ophthalmoscopy with scleral depression;
• B-scan ultrasound;
• Optical Coherence Tomography (OCT).

This is followed by a detailed assessment of the type of retinal detachment and differentiation from other retinal pathologies.

Other imaging tests, such as CT (computed tomography) or MRI (magnetic resonance imaging), are also available, though these techniques are generally not necessary for the evaluation of retinal detachment unless there is a suspicion of an intraocular mass or malignancy.

The treatment and management of retinal detachment are typically surgical. The three main techniques used to treat retinal detachment are:

• Pars plana vitrectomy
• Scleral buckle
• Pneumatic retinopexy

These techniques can also be combined.

For serous or exudative retinal detachments, management is non-surgical.

Vitrectomy

Vitrectomy is the mechanical removal of the vitreous gel using a vitrectomy machine. The surgeon removes the vitreous that is causing traction on the retina and uses cryotherapy or laser treatment around retinal tears or breaks.

Scleral Buckle

A scleral buckle is a silicone band that closes retinal tears. Often, the surgeon combines this with a retinopexy procedure (reattaching the retina to the back of the eye).

Pneumatic Retinopexy

Pneumatic retinopexy uses an intraocular gas bubble to repair the retinal detachment.

The prognosis of retinal detachment can vary greatly depending on the type of detachment, the timeliness of the intervention, and other clinical variables such as:

• The condition of the macula;
• The timing of the intervention;
• The extent and location of the retinal detachment;
• Proliferative vitreoretinopathy, a complication that can arise after retinal detachment surgery;
• Associated conditions such as diabetes or high myopia.

Recovery Time

The ability to recover good visual acuity largely depends on the condition of the macula and the speed of the intervention. Visual recovery continues for several months after surgery. Vision may improve gradually for up to a year after the operation.

Patient education and prevention are crucial. Patients need to be informed about recognizing the symptoms of retinal detachment and seeking immediate medical help. They should understand that timely treatment is essential for preserving vision. Patients with high myopia or a family history of retinal detachment should have regular eye check-ups.

These steps are vital and significantly enhance the chances of achieving optimal visual recovery.