Retinal detachment - Causes, types and surgery 1

What is retinal detachment

The retina is the delicate layer of cells at the back of the eye that captures external light, sending it to the brain, enabling sight. The retina is normally attached to the wall of the eye. Retinal detachment is a separation of the retina from the wall of the eye, akin to wallpaper peeling off a wall. If untreated, this can lead to permanent loss of vision or blindness due to interruption of blood and oxygen supply.

Once retinal detachment occurs, retinal detachment surgery can be carried out to reattach the retina.

Causes and types of retinal detachment

There are 3 types of retinal detachment:

1. Rhegmatogenous retinal detachment

This is the most common type of retinal detachment. It can cause rapid loss of vision and often requires emergency surgery within 24 hours.

Rhegma in Greek means rupture or rent. A break in the retina occurs, most commonly either in the form of a retinal tear or hole. The break allows fluid that normally stays in front of the retina, to flow through the break behind the retina, leading to separation of the retina from the wall of the eye.

Causes of rhegmatogenous retinal detachment:

A retinal tear (also called a horseshoe or ‘U’ tear) develops due to posterior vitreous detachment and a focal point of vitreous pulling on the retina. Posterior vitreous detachment occurs in the majority of people by the age of 70, but can occur earlier with short-sightedness and prior surgery
A retinal hole (also called a round or atrophic hole) develops due to thinning of the retina most commonly found in short-sighted people
Significant eye injury is also a cause

2. Tractional retinal detachment

This is due to scar tissue formation on the surface of the retina, which gradually contracts, pulling the retina off the wall of the eye in the absence of a retinal break.

Causes of tractional retinal detachment: Diabetes is the main cause.

3. Exudative retinal detachment.

This is due to blood vessels within the retina leaking fluid underneath the retina, and is the least common type of retinal detachment.

Causes of exudative retinal detachment: A range, including inflammation (uveitis).

Symptoms and signs of retinal detachment

Symptoms of retinal detachment include:

Sudden onset of visual floaters and/or a shadow (dark or grey curtain) in the peripheral vision (most common)
Onset of flashing lights
Loss of central vision as a result of the peripheral shadow increasing rapidly

Some patients may not immediately notice a loss of peripheral or central vision if it occurs in their non-dominant seeing eye.

How to prevent blindness from retinal detachment?

The key is early diagnosis and treatment by a retinal surgeon when the retinal detachment is limited to the peripheral retina before central vision is affected, known as macula-on or macula-sparing retinal detachment. Once central vision is involved, there is no treatment that can return vision completely back to normal.

It is thus important to have your eye examined urgently by a retinal surgeon within 24 hours of developing any sudden change or loss of vision.

Retinal detachment surgery and treatment

Treatment depends on both the type of retinal detachment and age of the patient.

Vitrectomy surgery (vit, meaning vitreous; -ectomy, meaning to remove in Greek) is the treatment of choice for the majority of retinal detachments. It involves microsurgery inside the eye, with removal of the vitreous gel, followed by draining of fluid from under the retinal detachment, sealing of the retinal break with laser or cryotherapy and placement of a bubble of special gas or silicone oil to push the retina onto the inside wall of the eye, aiding retinal reattachment.
Scleral buckling surgery is generally preferred in patients with retinal holes. It involves surgery on the outside of the eye wall instead. A silicone band is placed to push the wall inwards against the retinal break alongside cryotherapy or laser to seal it.
Pneumatic retinopexy is occasionally used, involving a gas bubble injection without vitrectomy, with cryotherapy or laser which may need to be performed at a later time point.
Laser surgery alone is occasionally considered for small peripheral retinal detachments.

Risks of retinal detachment surgery

While retinal detachment surgery has risks just like any surgery, it is a bigger risk to leave retinal detachment untreated as it can lead to a complete and irreversible loss of vision. The risks associated with retinal detachment surgery include:

Infection or bleeding to cause blindness: less than 1 in 1000 chance
An increase in pressure inside the eye: usually temporary
Increased chance of developing cataracts, which is treatable with additional surgery

Success rate of retinal detachment surgery at OCL Vision

The success rate depends on a number of factors, including type and duration of retinal detachment. For the most common type of retinal detachment (rhegmatogenous), the UK national average among a large cohort of vitreoretinal surgeons in a research study of 4231 patients published in 2020 (Ferrara et al, American Journal of Ophthalmology. 2020 Sept) demonstrated a retinal reattachment success rate of 85-88%. At OCL Vision, our equivalent success rate is >90%, with a 0% infection rate.

Why chose OCL Vision for your retinal detachment treatment?

Emergency same-day surgery

Our team of expert retinal surgeons provide emergency same-day sight-saving surgery. If you require urgent retina care please call us on 0203 369 2020 and we will book you in to be seen immediately by our team.

Expert complex retinal detachment surgery

Mr Chien Wong and
Ms Rabia Bourkiza are our retina surgeons, both highly experienced in complex retinal detachment surgery. Chien Wong heads the de facto UK national centre for retinal detachment surgery in premature babies at Great Ormond Street Hospital for Children.

Leaders of retinal surgery innovation

Our team of retinal specialists are leaders in their field, pioneering technical advances in vitreoretinal surgery. Their expertise is sought internationally by vitreoretinal surgical companies to advise on improvements of current and future technologies in order to optimise the safety and effectiveness of surgery.

Treatment tailored for you

You are always at the centre of everything we do. We do not offer a one size fits all approach but rather customise every single treatment to your individual visual needs, so you’ll always get the best procedure for your eyes and your vision.