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Posterior vitreous detachment | Retinal detachment |
Retinopathy of prematurity
RETINAL DETACHMENT
Other
Names:
Detached retina, and retinal tear.
What is
retinal detachment?
The
retina is the light-sensitive layer of tissue that lines the inside of the
eye and sends visual messages through the optic nerve to the brain. When the
retina detaches, it is lifted or pulled from its normal position. If not
promptly treated, retinal detachment can cause permanent vision loss.
In some
cases there may be small areas of the retina that are torn. These areas,
called retinal tears or retinal breaks, commonly occur when there is
traction on the
retina by
the
vitreous
gel inside the eye. In a child’s eye, the vitreous has an egg-white
consistency and is firmly attached to certain areas of the retina. Over
time, the vitreous gradually becomes thinner, more liquid and separates from
the retina. This is known as a posterior vitreous detachment (PVD).
PVDs
are typically harmless and cause floaters in the eye; but in some cases, the
traction on the retina may create a tear. Retinal tears frequently lead to
detachments as fluid seeps underneath the retina, causing it to separate and
detach.
What
are the symptoms of retinal detachment?
Symptoms include a sudden or gradual increase in either the number of
floaters, which are little "cobwebs" or specks that float about in your
field of vision, and/or light flashes in the eye. Another symptom is the
appearance of a curtain over the field of vision. A retinal detachment is a
medical emergency. Anyone experiencing the symptoms of a retinal detachment
should see an eye care professional immediately.
What are
the different types of retinal detachment?
There
are three different types of retinal detachment:
Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the retina allows
fluid to get under the retina and separate it from the retinal pigment
epithelium (RPE), the pigmented cell layer that nourishes the retina. These
types of retinal detachments are the most common.
Tractional -- In this type of detachment, scar tissue on the retina's
surface contracts and causes the retina to separate from the RPE. This type
of detachment is less common.
Exudative -- Frequently caused by retinal diseases, including inflammatory
disorders and injury/trauma to the eye. In this type, fluid leaks into the
area underneath the retina, but there are no tears or breaks in the retina.
Who is
at risk for retinal detachment?
A
retinal detachment can occur at any age, but it is more common in people
over age 40. A retinal detachment is also more likely to occur in people
who:
Are extremely
nearsighted
Have had a
retinal detachment in the other eye
Have a family
history of retinal detachment
Have had
cataract surgery
Have other
eye diseases or disorders, such as retinoschisis, uveitis, degenerative
myopia, or lattice degeneration
Have had an
eye injury
Detection and Diagnosis
Retinal
detachments are usually found because the patient calls the doctor’s office
with a symptom mentioned above. It is critical that these problems are
reported early, because early treatment can greatly improve the chance of
restoring vision.
The
doctor makes the diagnosis of a retinal detachment after thoroughly
examining the retina with ophthalmoscopy. The retinal surgeon’s
first concern is to determine whether the
macula
(the center of the retina) is attached. This is critical because the macula
is responsible for the central vision. Whether or not the macula is
attached determines the type of corrective surgery required and the
patient’s chances of having functional vision after the operation.
Ultrasound imaging of the eye is also very useful for the doctor to see
additional detail of the condition of the retina from several angles.
How is retinal
detachment treated?
Small
holes and tears are treated with laser surgery or a freeze treatment called
cryopexy. These procedures are usually performed in the doctor's office.
During laser surgery tiny burns are made around the hole to "weld" the
retina back into place. Cryopexy freezes the area around the hole and helps
reattach the retina.
Retinal
detachments are treated with surgery that may require the patient to stay in
the hospital. Pneumatic retinopexy is one type of procedure to reattach the
retina. After numbing the eye with a local anesthesia, the surgeon injects
a small gas bubble into the vitreous cavity. The bubble presses against the
retina, flattening it against the back wall of the eye. Since the gas
rises, this treatment is most effective for detachments located in the upper
portion of the eye. In order to manipulate the bubble into the ideal
location, the surgeon may ask the patient to keep his or her head in a
specific position. The gas bubble slowly absorbs over the next 2-6 weeks.
In some
cases a scleral buckle, a tiny synthetic band, is attached to the outside of
the eyeball to gently push the wall of the eye against the detached retina.
The scleral buckle is not visible and remains permanently attached to the
eye. This technique of reattaching the retina may elongate the eye, causing
nearsightedness.
If
necessary, a vitrectomy may also be performed. During a vitrectomy, the
doctor makes a tiny incision in the sclera (white of the eye). Next, a small
instrument is placed into the eye to remove the vitreous, a gel-like
substance that fills the center of the eye and helps the eye maintain a
round shape. Gas is often injected to into the eye to replace the vitreous
and reattach the retina; the gas pushes the retina back against the wall of
the eye. During the healing process, the eye makes fluid that gradually
replaces the gas and fills the eye. With all of these procedures, either
laser or cryopexy is used to "weld" the retina back in place.
With
modern therapy, over 90 percent of those with a retinal detachment can be
successfully treated, although sometimes a second treatment is needed.
However, the visual outcome is not always predictable. The final visual
result may not be known for up to several months following surgery. Even
under the best of circumstances, and even after multiple attempts at repair,
treatment sometimes fails and vision may eventually be lost. Visual results
are best if the retinal detachment is repaired before the macula (the center
region of the retina responsible for fine, detailed vision) detaches. That
is why it is important to contact an eye care professional immediately if
you see a sudden or gradual increase in the number of floaters and/or light
flashes, or a dark curtain over the field of vision.
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Please call your local eye care
professional for more information.
There are several ways of reaching the ophthalmologists of the
EYE REPUBLIC Ophthalmology Clinic:
-
Visit the EYE REPUBLIC
Ophthalmology Clinic website at
EyeRepublic.com.ph.
-
Visit the Ophthalmic
Consultants Philippines Co. website at
OCP.com.ph.
-
Email
help@EyeRepublic.com.ph for
general inquiries. After writing down your comments,
suggestions, problems and/or questions, kindly tell us how
to get in touch with you by providing your name, email,
home/office numbers, and mobile phone.
-
Place a blog
comment at the
EYE REPUBLIC Blog.
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EYE REPUBLIC
Ophthalmology Clinic
Manila
3/F Don Santiago
Building (DSB) Units 309-310
1344 Taft
Avenue, Ermita
Manila,
1000 Philippines
Direct and Fax: +63 (2)
536-2398
Trunk line: +63 (2) 523-8271 to 79 local 30
Cellular line: +63 (917) 899-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
Asian Hospital
and Medical Center
5/F Medical Office
Building (MOB) Suite 509
2205 Civic Drive,
Filinvest, Alabang
Muntinlupa City,
1781 Philippines
Direct: +63 (2) 771-9253
Direct and Fax: +63 (2) 771-9254
Cellular line: +63 (917) 795-2020
Map and Directions
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EYE REPUBLIC
Ophthalmology Clinic
Medical City
6/F
Medical Arts Tower (MATI) Suite 602
MERALCO Compound, Ortigas
Ave.
Pasig City,
1604 Philippines
Direct and Fax: +63 (2) 632-7846
Cellular line: +63 (917) 537-2020
Map and Directions
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
6/F
Cathedral Heights Building Complex (CHBC) North
Tower Suite 614
279 E. Rodriguez
Sr. Boulevard
Quezon City, 1102
Philippines
Direct and Fax:
+63 (2) 407-3883
Cellular line: +63 (917) 855-2020
Map and directions
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CLINIC HOURS
Monday to Saturday 9:00 AM to 6:00 PM
All clinics are
closed on
Sundays and Holidays
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