The Retina lines the back wall of the eye and is responsible for receiving light stimulus and converting it to an electrical signal which is then sent to the brain. Many conditions can lead to a retinal detachment, in which the retina peels off the back wall of the eye similar to wallpaper peeling off a wall.
Retinal detachments can be divided into 3 types:
Rhegmatogenous retinal detachments are the most common type. These develop from holes or tears in the retina that allow fluid to pass through and collect under the retina. Retina tears develop as the vitreous gel inside the eye separates from the retina as part of aging or in patients with thin patches of retina known as lattice degeneration. Infrequently they can be associated with trauma.
The most common risk factors for this type of retinal detachment are lattice degeneration (thin patches in the retina), high myopia (being very near-sighted) and a history of prior retinal detachment.
Tractional retinal detachments develop when scar tissue grows over the surface of the retina and pulls the retina from the back wall of the eye. This type of detachment is less common and usually associated with diabetic retinopathy.
Exudative retina detachments are caused by retinal diseases including inflammatory disorders or injury/trauma to the eye. In this type, fluid leaks under the retina causing it to detach, but no holes or tears are present.
The goal of treatment is to re-attach the retina to the back wall of the eye and seal any tears that caused the detachment. The most common repair method is a vitrectomy in which three micro-incisions are made into the eye and fine instruments are used with an operating microscope to remove the vitreous gel that fills the eye and drain fluid from under the retina. The surgeon uses laser to seal the holes/tears and then fills the eye with either a gas bubble or silicone oil to support the retina while it heals.
Sometimes a scleral buckle (a silicone band placed around the circumference of the eye) is placed in order to push the wall of the eye up against the retinal tear, effectively closing it. This treatment method can be used by itself or in conjunction with a vitrectomy.
In the case of small retinal detachments, encircling laser can be applied around the area of the detachment to stop it from spreading.
Based on the characteristics of the detachment, a retina specialist will make a recommendation for treatment. In general, retinal detachment repair is successful in 9/10 patients, although sometimes more than one procedure is needed for the retina to stay in place. The visual results depend on many factors. In general, when the central retina (macula) has not detached before surgery, the vision does better. If the central retina is detached prior to surgery, re-attachment often leads to improved vision, however, some permanent vision loss occurs.