What is a Detached Retina?
My story is in italics.
What is the retina and what happens when it detaches?
The human eye is roughly the size of an egg. As light enters the eye through the pupil, it passes through a clear jelly-like substance called vitreous. This vitreous is similar to the egg white inside of the egg.
The retina is a light sensitive membrane that lines the inside of the eye and converts light energy into nerve impulse energy. This nerve energy is then transmitted to the brain via the optic nerve.
A retinal detachment exists when this light sensitive membrane which lines the inside of the eye separates or peels from the underlying inner wall of the eye, similar to wallpaper pulling away from your wall. The detached retina thus becomes separated from its underlying nourishing blood supply and the retina may suffer irrevocable damage as a result. If the central vision area of the retina (macula) is detached, then central vision will be lost.
How do you know if you have a detached retina?
Individual symptoms of retinal detachment may vary and can include some or all of the following: Flashes of light, "Floaters" or specks that may drift in your vision, a curtain or veil of gray or black that may obscure a portion of your field of vision, and blurred vision are common symptoms of retinal detachment. I had floaters and a gray veil initially. Then I saw the light flashes. Good thing I called the doctor when I did. If I had waited another 24 hours, I probably would have lost sight in that eye. If you see flashes, don’t wait.
Treatments:
1. Scleral buckling
Scleral buckling entails sewing a piece of solid silicone or silicone sponge to the outside wall of the eye. This material may be sewn to a section of the outside eye wall, or it may go around the eye for 360 degrees forming a "belt" around the eye. This silicone material indents the wall of the eye (buckles) and pushes the wall of the eye closer to the retinal tear. The tear is treated with freezing therapy which causes local tissue damage. This damage heals by scarring, and the scarring seals the tear and prevents further fluid from getting under the retina. The fluid that has already gotten under the retina is either absorbed or drained from under the retina and the retina is thereby reattached. This type of surgery can be done under local anesthesia with the patient sedated but awake, or it can be done under general anesthesia when the patient is asleep.
2. Vitrectomy
Pars plana vitrectomy is a method which entails placing tiny instruments inside of the eye ball and removing the jelly like substance (vitreous) inside and replacing it with a salt solution. This procedure allows us to operate on the retina directly, from the inside of the eye. One may or may not do a vitrectomy in conjunction with scleral buckling. Sometimes it is necessary to place a gas bubble inside of the eye. The patient may have to maintain a certain head position for several days or weeks after surgery in order to achieve the appropriate reattachment. This procedure can be done under local or general anesthesia.
3. Pneumatic Retinopexy This is what I had done.
In certain retinal detachments, when the offending tear or tears are located in the upper half of the retina, it is sometimes possible to reattach the retina with this technique. This procedure is frequently done in the office and eliminates the need for the patient to go to the operating room. A local injection of anesthetic is placed in the eye socket. A small gas bubble is placed in the eye itself. This is very weird, but painless. The tear is treated with either freezing or laser therapy. I had the laser. This was quite painful, because of the location of my tear. Hopefully, yours will be different. The patient then positions their head so that the injected gas bubble goes to the area of the tear, closing the tear and pushing the tear against the wall of the eye. The previous freezing or laser treatment causes local tissue damage. This tissue damage heals by scarring and when the tear is touching the wall of the eye, the tear seals as a result of this scarring. The patient is required to maintain the proper head position for approximately one week after the surgery.
4. Laser Surgery
In certain selected cases it may be advisable to "wall off" the detachment to prevent the retinal detatchment from spreading within the eye. In cases such as these, a barrier of scar tissue forms as a result of laser (or freezing treatment) and the detachment remains fixed in its position. This technique is most often used when the area of detachment is way off on the side and may not even be noticed by the patient. This technique may also be used when the patient is not capable to undergo any of the above noted procedures.
Surgical and Visual Results
Results of retinal reattachment surgery are divided into two categories: anatomic results and visual results. Most forms of retinal detachment have an anatomic success rate of approximately 90%. This means that we can put the retina back into place about 90% of the time. Sometimes more than one procedure is required to achieve the appropriate anatomic success. The visual result is dependent upon the patient's pre-operative vision. If the macula (center vision area) is attached prior to the surgery, then there is an approximately 90% chance that the patient will have the same vision post operatively. However, if the macula is detached prior to the surgery and thereby away from its underlying nourishing blood supply, then there may be irrevocable permanent visual loss even in the face of successful reattachment surgery.
My anatomic results were good. The tear was sealed and the retina reattached. My visual results were not as good. I still have cobweb-type floaters that they tell me will disappear with time. Some days the cobwebs are worse than others.
There is a support group at http://groups.yahoo.com/group/detached-retina on Yahoo. I have found it very comforting and informative.
Good luck and don’t fool with issues regarding your vision.
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