Retinal surgery
The good news first: retinal detachment is rare. But if not treated immediately, the affected eye may become blind.
For this reason, it is important that you consult a specialist as soon as the first signs appear. Only an ophthalmologist can determine the severity of the disease and take the necessary next steps.
Scope of vitreous body and retinal surgery
The term vitreous body and retinal surgery covers a large number of surgical procedures on the eye. As the retina and vitreous body are adjacent to each other, both parts together are often affected by diseases and therefore both undergo surgery at the same time too.
The retina is part of the inner skin of the eye and is primarily responsible for converting incoming light into electrical pulses. The optic nerve then transmits these pulses to the brain, where they are interpreted as images of the environment. The retina is therefore the first point of contact for processing visual impressions. On the inside, the retina is directly adjacent to the vitreous body; on the outside, it lies on the choroid, which supplies the retina with blood.
The centre of the retina, known as the macula, has the highest density of sensory cells, so this is where vision is sharpest. Various diseases can affect the individual layers of the retina or the entire retina and require surgery on the eye.
Symptoms and causes
Holes or tears in the retina are usually caused by degenerative changes in the retina or by a vitreous body detachment that pulls on the retina. Sometimes small blood vessels are damaged, leading to bleeding into the vitreous body. These changes in the eye do not cause pain, but patients see distinct flashes of light caused by the vitreous body pulling on the retina. If bleeding occurs, it appears to the patient like a kind of dark rain; if the bleeding is more severe, this can lead to a significant impairment of vision. When holes or tears occur in the retina, fluid gets behind it. This in turn causes the retina to detach itself from the underlying tissue.
Exudative (fluid-induced) retinal detachment is a form of the condition in which fluid from the choroid vessels flows between the two layers of the retina. This may cause the two layers to separate from each other. This form of retinal detachment usually occurs through inflammation of the choroid or tumours. In many cases, a disease of the vitreous body is also the cause of damage to the retina. Inflammation can cause damage to the retina too. However, short-sightedness of more than three dioptres, cataract surgery, previous injuries to the eye, a family history of retinal detachment, blunt blows to the eye or long-term diabetes are also risk factors for retinal detachment.
The clearest indications of retinal detachment include:
- sudden flashes of light in the eye, which can also be seen when the eyes are closed,
- swarms of black spots in the eye (like soot raining down or a swarm of black mosquitoes),
- a restricted visual field, not unlike a black shadow or curtain, and
- general deterioration of vision.
It is important to stress that if you experience the initial symptoms of retinal detachment, you need to act quickly, as you will usually need to undergo surgery at short notice in such cases to reattach the retina and ensure an oxygen supply to the centre of the retina. The earlier an ophthalmologist is able to detect a detachment of the retina, the less likely the a surgical procedure or damage to your vision will be. Because if no treatment is given, or if treatment is too late, the damage to the eye is usually permanent and irreversible. This results in a significant deterioration of vision, including blindness.
Diagnosis
Since the retina is located in the back of the eye, it cannot be examined with the naked eye. The ophthalmologist must therefore inspect the retina with an ophthalmoscope. To this end, the specialist first administers eye drops to the patient containing a substance that dilates the pupil.
They then look through the dilated pupil with a magnifying glass and a light source to detect possible changes in the retina. If the retina has come loose, grey contours are often visible. Tears and holes also have characteristic structures.
If bleeding in the vitreous body obscures the view of the retina, the specialist can also use an ultrasound device to detect changes in the retina.
Treatments
Laser therapy
Neither a tear nor a detachment of the retina can be controlled with medication. If the retina is torn but not yet detached, the affected eye can be treated using a special laser (photocoagulation) or a cold probe (cryopexy). Lasers or cold probes trigger an inflammatory reaction at the site of the injury, causing the tissue to scar and thus “sealing” the hole in the retina (scarring to isolate the issue). This usually prevents complete detachment of the retina.
Operation
However, if the retina has already detached, the patient should be operated on by a specialist eye surgeon as quickly as possible. Which method is used depends on the form of retinal detachment on the one hand and on how far the detachment of the retina has progressed. The aim of the operation is always to reattach the detached retina and to correct the factors that triggered it, such as changes to the vitreous body.
In the case of a single hole or tear, a dent is made in the eyeball in the area of damage with a foam inlay, which is sewn onto the sclera from the outside. If there are several holes, a so-called scleral buckle operation must be performed. This involves placing a band around the entire eyeball, which is then tightened by a certain amount to cause a degree of circular constriction. The fluid is removed by puncturing the space containing the fluid between the retina and the choroid. The holes or cracks in the retina now lie against the inlay or tape and are sealed in the process. This procedure lasts between 30 and 60 minutes and can be performed under local or general anaesthesia.
The vitreous body may also be removed to counteract retinal detachment (known as vitrectomy). This operation can also be performed under local anaesthesia and again lasts between 30 and 60 minutes on average. During vitrectomy, the fluid from the vitreous body is sucked out and replaced with a special fluid (e.g. silicone oil, gas or Ringer’s solution). This displaces the accumulated fluid between the layers of the retina and thus joins them back together.
However, if retinal detachment is caused, for example, by a tumour of the eye, the tumour must be treated to stop any further retinal detachment. Tumour treatment includes laser and chemotherapy as well as irradiation of the eye.
Aftercare
After the operation, the retina should be reattached and the sensory cells should resume their function.
After the operation, the patient is initially unable to see with the operated eye. There may be a number of reasons for this. After successful reattachment, the detached retina needs a certain amount of time to fully recover. This means that you will need to adjust to some deterioration of your vision for an undetermined period of time after the operation. This in turn means, for example, that you are not allowed to drive or – depending on the vision in your other healthy eye – may have to rely on the help of others.
Depending on the surgical procedure used, there may be postoperative pain, which can generally be easily controlled with painkillers. In addition, eye drops or eye ointment will be required after the operation. How long you need to use these will depend on your individual case.
During vitrectomy, the eye is often filled with an air-gas mixture, which requires the head to be held in a certain position after the procedure. This in turn depends on your individual case, i.e. your specialist will tell you whether and for how long you need to adopt this special position.
Regular ophthalmological follow-ups are necessary after the operation.
FAQs
What can be done with detachment of the retina?
There is currently no drug-based way to treat retinal detachment, which means that surgical intervention is always necessary. The eye is usually treated with a laser. Laser treatment can rectify detachment of the retina. However, if this is not possible, surgery must be performed. Preventive measures for retinal detachment include annual check-ups by an ophthalmologist.
How can you tell if the retina is detaching?
Typical symptoms of retinal detachment include seeing flashes of light, a swarm of black spots in front of the eye or a dark curtain or shadow in the visual field. If these symptoms occur, you should consult an ophthalmologist as soon as possible.
What are the consequences of retinal detachment?
Retinal detachment is a rare condition of the eye in which the retina at the back of the eye becomes detached. If left untreated, retinal detachment can lead to blindness, which is why it is considered an emergency in ophthalmology terms.
