Retinal detachment is a separation of the retina from the choroid. This illness can end in blindness within some time. Blindness develops as a result of a retina dystrophy and optic nerve atrophy.
The incidence of the illness in different countries is from 10 to 25 cases per 100,000people a year. Retinal detachment is more often diagnosed among the people who suffer from myopia (nearsightedness).
Based on the etiologic factor retinal detachment can be of the following types:
Risk factors that can contribute to the retinal detachment are:
When the retina breaks a patient is complaining about a “dim out” in front of the damaged eye. This can be associated with the partial loss of visual field. Derangements are gradually worsening and further lead to the loss of vision acuity.
Other possible complaints are:
Partial loss of vision field happens on the side opposite to the place of retinal detachment.
At the beginning stage of diagnostics doctors check the vision acuity, perform a perimetry (evaluate peripheral vision), and measure intraocular pressure.
Main diagnostics method is ophthalmoscopy(fundus examination with the help of a special device). If view has been obstructed, they perform ultrasound. Low informativeness of ophthalmoscopy can be caused by corneal opacity, vitreous humor or the eye lens.
If detachment is old, specialists will also check for the stage of retinal dystrophy and state of the optic nerve. Procedures are done through electrophysiological study.
Retinal detachment can only be treated with the help of surgical intervention. Operation should be done as soon as possible. It is desirable that surgery is performed right after the diagnosis establishment since early detachment responds to treatment much better.
Extrascleral buckling is carried out as an independent surgery as well as a part of vitreo-retinal surgical intervention. Surgeon uses a fine-meshed silicone sponge as a material for buckling. Sponge is sewed on the eyeball from the external side and thus pressing the eye wall and moving the vascular membrane closer to the detached retina. A break is blocked under the dimple.
Buckling can be local or circumferential. Local sclera buckling can be radial or sectoral. Radial buckling is performed for the single retinal break with the early detachment. Sectoral buckling is applied for patients who have several closely located breaks and also, for the large-sized single breaks with separation from ora serrata.
Cerclage is applied for the treatment of severe cases. Cerclage is a circular buckle of sclera. Procedure is performed when there are numerous areas of retina degeneration, big number of breaks on different areas. Cerclage is performed with the help of either silicone tenia or osculiferous constrictor.
Vitreoretinal surgery is applied in the most severe clinical cases. The goal of the operation is to move the retina closer to the vascular membrane and fix it.
Vitreoretinal surgery is used in such cases as:
Cryopexy can be done as an independent surgery as well as combined with the buckling. Goal of this method is to freeze a posterior wall of the eye right after the place of retinal break. This will stimulate the process of the scarring and will block the further detachment.
Laser photocoagulation is applied more often as an addition to the extrascleral buckling for the better control of retinal detachment. Laser photocoagulation provides its moderate adjacency right after the procedure and doesn’t cause any inflammatory reactions. One of the benefits for the use of this method is a short period of rehabilitation.
Pneumatic retinopexy. Retina is being pressed towards the eye wall with the help of the air bubble that is inserted into the vitreous humor.Afterwards, the fluid flows out from underneath. Air bubble stays in the eye until the retina is healed (up to several weeks). The use of method is restricted to cases when the single break is located in the upper part of the retina.
Retinal transplantation. In case of retinal dystrophy development its transplantation can be done. To complete this procedure specialists use prosthesis. A perspective direction is the transplantation of the retina cultured from the patients’ stem cells.
When a patient refers to the doctor, retinal detachment can be early or old. Early detachment is considered to be a break that happened no more than 30 days ago. Then prognosis is favourable for the retina restoring.
Old detachments are also treated by surgery. Meanwhile, a good anatomic result can be achieved. But functional outcome of the surgery can vary and depends on the specific course of the illness and age of retinal detachment.
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