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Retinal Detachment

Retinal detachment is an eye disorder in which the retina (light receptive layer of tissue at the back of the eye) is pulled away from its normal position. In retinal detachment, the retina gets separated from the underlying choroid (layer of blood vessels that supplies oxygen and nutrients to the retina), and leaves the retinal cells deprived of oxygen. Certain risk factors, such as aging, severe nearsightedness, an eye injury, cataract surgery and family history, can increase the chances of retinal detachment. If not treated early, this condition can cause permanent vision loss.

Certain symptoms appear as warning signs and almost always appear before retinal detachment can occur or become more severe. The characteristic signs and symptoms that indicate the onset of retinal detachment include:

  • Sudden onset of blurred vision
  • Partial vision loss (as if a gray curtain is moving across the field of vision)
  • Eye floaters (tiny specks or strings floating in the field of vision)
  • Eye flashes (illusion of flashing lights in the side vision)
  • Shadows or blind spots (areas of darkness) in the field of vision

Depending on the cause, three types of retinal detachment are observed:

  • Rhegmatogenous retinal detachment (RRD): This is the most common type of retinal detachment and is associated with a hole or tear in the retina. Fluid from the vitreous humor (jelly-like center of the eye) seeps through the retinal hole and accumulates in the space between the retina and the underlying retinal pigment epithelium (RPE), thereby lifting the retina. RPE, located between the retina and the choroid layer, is a pigmented cell layer that nourishes the retinal cells.
  • Tractional retinal detachment (TRD): It is the second most common type of retinal detachment. TRD occurs due to the formation of scar tissue or growth of other abnormal tissue on the surface of the retina, separating the retina from the underlying RPE. TRD is commonly observed in people with uncontrolled diabetes, previous retinal surgery, or chronic inflammation.
  • Exudative retinal detachment:  This type occurs when blood or fluid from the choroid leaks into the space between the retina and the underlying RPE, causing a detachment. This is an uncommon complication of conditions such as hypertension, eye tumors and rare blood vessel disorders.

To diagnose retinal detachment, a comprehensive eye examination is performed; wherein the physical appearance of your eye, vision, eye pressure and your ability to see colors is tested. Your doctor instills eye drops to dilate your pupil in order to see your retina properly. An ultrasound may also be ordered in certain cases.

There are several methods to treat retinal detachment. These include:

  • Scleral bulking: Scleral buckling is a common treatment modality to fix a retinal detachment.
  • Suture less vitrectomy: Vitrectomy refers to the removal and replacement of the vitreous (clear gel that fills the back of the eye) with saline.
  • Tamponade: Retinal detachment usually requires surgery (vitrectomy) during which a tamponade agent is used.  Tamponade is the material that is injected into the vitreous cavity (the cavity located behind the lens of the eye and in front of the retina) to hold the retina in place.
  • Silicone oil: Silicone oil is one of the tamponade agents used during the surgery for retinal detachment. This tamponade is particularly useful when retinal traction (pulling on the retina) cannot be completely relieved and for patients who are unable to maintain the head positioning required for a gas tamponade of the retina.
  • C3F8/SF6: C3F8 (Octafluoropropane) / SF6 (Sulfur hexafluoride) are gases that are commonly used as tamponade agents during surgery to repair a retinal detachment
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