retinal detachment


The retina is the network layer of our eye, and the image from the objects we see is transmitted to the brain by being processed into electrical conduction by processing. Approximately 1.2 million nerve fibers emerging from this layer transmit images to the image center of the brain (occipital cortex) via the optic nerve. The same image information coming out of both eyes is processed in the visual center of the brain, superimposed, and a three-dimensional image emerges. The area of ​​the retina that is responsible for our central vision and provides our sharp vision is called the macula and is popularly known as the yellow spot. For good vision, the retina must be healthy. The separation of the retinal layer from the layer below it is called retinal detachment. Retinal detachment is an emergency. In order to avoid vision loss, the retinal layer must be surgically repaired and replaced. If the retina is not replaced, complete blindness develops. It is possible to have the same vision again and this depends on how soon after the retinal detachment develops the surgery is performed. Therefore, retinal detachment is very important and when vision loss occurs, an emergency eye examination is required to determine whether such a situation exists.

Retinal detachment can develop for 3 different reasons.

  1. Exudative retinal detachment: Fluid accumulation under the retina due to some diseases
  2. Tractional retinal detachment: The separation of the retina from its place by being pulled into the eye by some membranous formations on it. This situation mostly occurs as a result of not being treated in time and progressing of retinal damage due to diabetes, which we call diabetic retinopathy.
  3. Ruptured retinal detachment: This occurs due to the shrinkage of the gel-like fluid, which we call the vitreous in the eye, with the effect of aging and the retinal tear that occurs as a result of the shrinkage of the retina during the separation process from the retina. When there is a retinal tear, the liquefied vitreous material passes through the retinal tear and lifts the retina, leading to retinal detachment.

The most common of these three causes is retinal detachment. It is often seen in the age of over 40 years. The vitreous in the eye is in the form of a gel at birth and begins to liquefy after the age of 40, liquefied areas form in it, then these fluid areas merge and pass under the posterior surface of the vitreous. With this development, the vitreous begins to separate from the retina in the form of peeling. During this separation, black dots, filaments, and spider web-shaped shadows can be seen in the eye. When these complaints occur, they are usually uneasy and prompt to go for an eye examination. It is good to come for an inspection. Because this development is mostly an innocent process, but sometimes it can cause some problems in the eye.

The process of separating the vitreous is usually completed in everyone until the age of 90. Although the incidence of vitreous detachment or detachment increases with aging, it is seen at an earlier age in some people. It may occur at an earlier age in highly myopic patients. Again, acute vitreous detachment can be triggered after eye trauma. After cataract surgery, this process may occur earlier. The important point is that as a result of this physiological event, which we call acute vitreous detachment, a retinal tear may occur in some patients, albeit rarely. A retinal tear is very important because after the tear occurs, the liquefied vitreous passes under the retina through the tear, lifts the retina from the underlying layer, and retinal detachment develops. While this process is possible for everyone, there are some conditions that pose a risk for retinal rupture.

The most important of these is the presence of weak areas in the peripheral regions of the retina, which we call degeneration. When the vitreous detachment progresses to these weak areas, the risk of retinal tear at this weak point is high. For this reason, it is very useful to come to eye screening immediately when complaints with vitreous detachment are seen. As we mentioned, these complaints are black spots that suddenly appear in our visual field, and the appearance of shadows like flying flies and butterflies.

It should not be confused with the pre-existing appearance of sporadic filaments or black spots caused by the loss of transparency of the collagen fibers in the vitreous. However, if these black spots suddenly increase and appear as a butterfly-fly flight, this may be a sign of vitreous separation. The shrinkage of the vitreous detached from the retina around the retina is perceived by the retina, and during this shrinkage, a flash of light similar to a lightning flash is seen. Flashes of light in the form of lightning flashes are a more serious complaint than floaters. Patients often feel the flash of light at night in the dark or when moving from a bright room to a dark room. An eye examination should be performed immediately, especially in the presence of intense fluctuations such as veiling or clouding, or in case of flashes of light. During the examination, the retinal periphery is scanned with lenses and it is examined whether there is a tear in the retina or any retinal degeneration that poses a risk for tear formation.

Most patients do not have any problems, but if peripheral retinal degeneration, which poses a serious risk for tear formation, is detected, laser treatment can be recommended. This laser treatment is performed as a barrier around the area of ​​retinal degeneration, and if a tear or tear occurs, a precaution is taken to transform it into retinal detachment. This procedure is not a guarantee in terms of preventing retinal detachment, as there is a possibility of tearing due to shrinkage of the vitreous from any shadow that is not laser applied; however, the risk is significantly reduced.

Some patients may not see any of these complaints and do not realize that they have a tear in their retina. In these patients, the retinal tear progresses to retinal detachment. Retinal detachment starting from the peripheral area can be recognized as the inability to see a part of the visual field. Many patients do not realize this either and realize that there is a problem when the retinal detachment reaches the macular region and the central vision starts to disappear.

It is possible for everyone to have retinal detachment with the above-mentioned mechanisms. However, some people are at greater risk. The risk is higher in those with predisposing retinal degeneration, especially in the peripheral retina. High myopes are in a particularly risky group, both because degenerations are more common and because they develop vitreous detachment at an earlier age than others. Therefore, high myopic patients should have annual retinal examinations, especially after the age of 40, along with eyeglass examinations. In normal individuals who have had cataract surgery, the risk is increased compared to the past. If the above-mentioned complaints occur suddenly after cataract surgery, emergency retinal examination should not be neglected. In these patients, annual retinal examination is appropriate. An important risk factor is eye trauma. Even if there is no direct damage to the eye after blunt blows to the eye, peripheral retinal examination should be performed.

After retinal detachment develops, the only treatment method is surgery. Different surgical methods are applied, taking into account where the retinal detachment occurs in the eye. Considering many factors, it is decided which method is appropriate.

Among these methods, there is a chance of applying the head position by giving gas to the eye and then performing a retinal laser, especially in detachments due to upper half retinal tear of the eye. It can be applied in appropriate cases that have come on time and not progressed, and even if it is unsuccessful, it will not have a negative effect on the success of the surgery. In order for this method to be successful, it is very important that the patient’s desired head position is compatible. If the retinal detachment is relieved by gas application, laser treatment is completed around the tear. Another method among the surgical options is the surgery of the localized tear or circumferential 360-degree buckling with extraocular methods. In this method, either a buckling is applied to the eye with a piece of silicone just outside the eye in the tear area, or a buckling is applied all around by placing a silicone band from the outside of the eye. If success is achieved with these methods, there is no need for intraocular surgery. If this method fails, it will not harm the intraocular surgery, on the contrary, it may contribute. Only if this method is successful will the patient’s eyeglass number change. Not every patient is suitable for this method.

In cases where this method is not suitable, the intraocular vitreous material is completely cleaned with the intraocular surgery method we call vitrectomy, the retina is soothed, and the appropriate silicone or gaseous material is injected into the eye. When the gas is given, the central vision is blocked until the gas is drawn from the eye, at least until it rises above the middle level, and after the gas is drawn more than half, the central vision emerges. When silicone is given, the silicone does not impair vision, the patient can begin to see after the surgery and can see more clearly with a temporary eyeglasses trick. The silicone is taken back from the eye after a certain period of time. After the intraocular surgery, it is important to adhere to a head position for a period of time recommended by the physician, face down or in the desired direction. In this method, surgery is performed with instruments that pass through the incision so small that stitches are not needed, but as a precaution, one stitch can be placed at the entrance to the eye.

Postoperative visual gain depends on many factors. The most important of these factors are the time elapsed after the detachment development until the surgery, the size of the detachment, the number of tears, whether the yellow spot area is involved or not. It is important for vision gain to be operated before the yellow spot area is removed. In delayed cases, the retinal layer thickens, shrinks, sticks to each other, and therefore the surgery is more difficult. Repeated surgeries may be required. It is important to be under close follow-up of the ophthalmologist after these surgeries.