Retinal Detachment

(Retainal Detachment surgeries in Ekolgoz are performed by Prof. Dr. Cem Fehmi Küçükerdönmez)

Posterior Vitreus Detachment

retinal-detachment-pic1

Eye globe is filled with an interior transperant gel-fluid called “vitreus”. Frequently, as the age gets older, vitreus fluid loses its gel texture and gets wrinkled. With this wrinkling vitreus moves off the posterior eye wall. This incident is called “posterior vitreus detachment”.

Besides aging, posterior vitreus detachment may emerge earlier due to the impacts, eye concussions, high level myopy, a series of familial hereditary diseases, and the process after undergoing ophthalmic surgeries.

What are the symptoms of posterior vitreus detachment?

Posterior vitreus detachment’s sympyoms can be defined as below:

  • Floaters, particles, spiderwebs seen while looking particularly at white, bright grounds.
  • Photopsy (can be seen while eyes are open or closed)

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Floaters in posterior detachment and shrinkages on the retina causing photopsy

Posterior vitreus detachment is not same as retinal detachment which emerges as a result of a detachment on the eye. Besides that, the retinal detachment risk increases slightly, during and after the emergence of posterior detachment, especially within the first 12 months. Therefore, the patient having the symptoms of posterior vitreus detachment should never avoid a retinal examination.
If the emergence of a retinal detachment is observed, it may result in visual loss unless it is treated in a short time. That’s why it is of utmost importance to known about the symptoms of retinal detachment. These symptoms are listed below:

  • Having photopsy while the eyes are open or closed (just like in posterior vitreus detachment)
  • Sudden emergence of floaters in more numbers.
  • Grey – black shade developing inside the visual field (on any angle)
  • Visual loss or haze that is not getting better when blinked

If one or a few of the symptoms are being felt, a retinal examination should be made without losing time.

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In retinal detachment, intraocular fluid leaks from the retinal break through the place between the eye wall and retina.
RETINAL DETACHMENT
As a result of the wrinkling of the vitreus fluid filled insisde the eye globe, this gel-like fluid leaves posterior wall of the eye globe. This situation is called posterior vitreus detachment. During the posterior vitreus detachment there may occur a break in the nerve layer called retina in a series of situations. The symptoms of retinal detachment are almost the same as posterior vitreus detachment mentioned in the previous section. After the emergence of retinal break intraocular fluid moves to the place between retina and posterior wall through this break and causes the disease called “retinal detachment”.
What Are the Symptoms of Retinal Detachment?
Retinal detachment is a disease that may result a visual loss and it requires urgent treatment. Therefore its symptoms are important. These symptoms are as follows:

  • Having photopsy while the eyes are open or closed (just like in posterior vitreus detachment)
  • Sudden emergence of floaters in more numbers.
  • Grey – black shade developing inside the visual field (on any angle)
  • Visual loss or haze that is not getting better when blinked
Standart Vision

Standart Vision

Shade emerging in retinal detachment

Shade emerging in retinal detachment

 

If one or a few of the abovementioned symptoms are felt, a retinal examination should be made wtihout losing time.

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Retinal examination
in terms of retinal break with
the method called indirect
ophthalmoscopy

How Is Retinal Break Treated?

It is extremely important to treat retinal detachment before its progression by early diagnosis. The symptoms of retinal break are photopsy and floaters. When these symptoms occur, a retinal examination should be made as soon as possible.
If the retinal break is determined during the examination and this break is suspected to cause retinal detachment, treatment should be implemented.
The break is closed by laser in the treatment.

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Treatment of retinal break by laser

How Is Retinal Detachment Treated?

If there is a progression of retinal detachment, surgery is required. The method of surgery can vary depending on the number of retinal breaks causing the retinal detachment, its size, location, shape and the time of the emergence of retinal detachment.

  • External buckling method (scleral buckling method):

It is the oldest method used in detachment surgery. Buckling is applied by placing a piece from solid silicone to the external wall of the eye globe by matching it with the region of retinal break and with this external intervention this break is closed. When the retinal break is closed with this external intervention, retinal detachment fluid (fluid accumulating under the retina) is soaked by the eye in a short time and treatment is completed.

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Closure of retinal break by skleral buckling method

  • Vitrectomy:

There may be a need for vitrectomy surgery if; the breaks, causing retinal detachment, are in a great number, huge size, undetermined, occupy unusal places, accompanied by other diseases (like intraocular hemorrhage) or remained for a certain amount of time. In vitrectomy surgery retinal detachment is intervened through the intraocular. To do that, little holes are opened inside the eye globe, and by using group of incisory and aspiratory probes and light sources, the fluid accumulating under the retina is aspirated, the breaks are closed, laser treatment is implemented. At the end of the surgery, a buffer substance should be placed on intraocular for sustaining the effect of the attachment of the retinal break region by laser treatment. Depending on the situation this buffer substance can be gases like air and similar, or silicone oil. After the surgery the patient should use protective eye dropper for a while and should rest in a certain position

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Treatment of retinal detachment with vitrectomy method
Who should get under a retinal examination considering the risk of Retinal Break and Retinal Detachment?
People having photopsy and sudden floaters should necessarily be examined considering retinal break. Especially the people having high level myopy, people who received a blow to their eyes, people who underwent ophthalmic surgeries like cataract surgery, people of whom family member(s) underwent laser treatment or retinal surgery, should take these floaters and photopsy seriously and should certainly have a retinal examination as soon as possible.