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Retinal detachment |
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What is a retinal
detachment?
A retinal detachment is a separation of the retina from its
attachments to its underlying tissue within the eye. Most retinal
detachments are a result of a retinal break, hole, or tear. These
retinal breaks may occur when the vitreous gel pulls loose or
separates from its attachment to the retina, usually in the
peripheral parts of the retina. The vitreous is a clear gel that
fills 2/3 of the inside of the eye and occupies the space in front
of the retina. As the vitreous gel pulls loose, it will sometimes
exert traction on the retina, and if the retina is weak, the
retina will tear. Most retinal breaks are not a result of injury.
Retinal tears are sometimes accompanied by bleeding if a retinal
blood vessel is included in the tear.
Once the retina has torn, liquid from the vitreous gel can then
pass through the tear and accumulate behind the retina. The
build-up of fluid behind the retina is what separates (detaches)
the retina from the back of the eye. As more of the liquid
vitreous collects behind the retina, the extent of the retinal
detachment can progress and involve the entire retina, leading to
a total retinal detachment. A retinal detachment almost always
affects only one eye. The second eye, however, must be checked
thoroughly for any signs of predisposing factors that may lead to
detachment in the future.
What are the results of
surgery for a retinal detachment?
The surgical repair of retinal detachments is successful in about
80% of patients with a single procedure. With additional surgery,
over 90% of retinas are reattached successfully. Several months
may pass, however, before vision returns to its final level. The
final outcome for vision depends on several factors. For example,
if the macula was detached, central vision rarely will return to
normal. Even if the macula was not detached, some vision may still
be lost, although most will be regained. New holes, tears, or
pulling may develop, leading to new retinal detachments. If a gas
or air bubble was inserted in the eye during surgery, maintaining
proper positioning of the head is also important in determining
the final outcome. Close follow-up by an ophthalmologist,
therefore, is required. Long-term studies have shown that even
after preventive treatment of a retinal hole or tear, 5% to 9% of
patients may develop new breaks in the retina, which could lead to
a retinal detachment. Overall, however, repair of retinal
detachments has made great strides in the past 20 years with the
restoration of useful vision to many thousands of patients.
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