Disease Description (Causes and Symptoms)
- Definition summary: Retinal detachment is a condition in which the retina (the neural membrane where photoreceptors are located) separates from the inner wall of the eyeball. If the retina’s nutrient supply is interrupted, photoreceptor function may be impaired, potentially leading to decreased vision or blindness.
- Main pathophysiology:
- Rhegmatogenous (retinal tear/break): A hole develops in the retina due to vitreous contraction or liquefaction, and intraocular fluid enters through the hole, detaching the retina.
- Tractional: The vitreous or fibrous proliferative tissue pulls on the retina, causing detachment (e.g., diabetic retinopathy).
- Exudative/serous: Fluid accumulates beneath the retina due to choroidal or vascular/inflammatory lesions.
- Main symptoms:
- Floaters, flashes, a curtain over the field of vision (partial visual field loss or gradually expanding obscuration), distorted vision (metamorphopsia), and sudden decrease in vision (when the macula is involved).
- Risk factors: High myopia, age (middle-aged or older adults), a family history of retinal disease, previous eye surgery (especially cataract surgery), eye trauma, diabetic retinopathy, uveitis, and others.
Treatment Methods
- Treatment principles: Retinal detachment is an emergency condition. Immediate specialized treatment (usually surgery) is required, particularly when the macula (central retina) is involved or the detachment is progressing.
- Non-surgical treatment and mild cases:
- Laser photocoagulation or cryotherapy is used to seal the area around a retinal tear and prevent progression (for early, localized tears).
- Exudative detachment may improve when the underlying cause (inflammation, tumor, vascular disease, etc.) is treated (medication and management of the underlying disease).
- Surgical treatment (standard and main methods):
- Scleral buckling: A buckle is placed on the outside of the eyeball to bring the retina into apposition (used mainly for rhegmatogenous detachment).
- Vitrectomy + internal treatment (closure of the retinal tear, cryotherapy/laser) + injection of gas or silicone oil: Used mainly for complex or extensive detachment and tractional detachment.
- Air/gas injection (pneumatic retinopexy): May be used for small tears and detachments in specific locations.
- Tractional detachment (e.g., diabetes-related): Vitrectomy is performed to remove fibrous membranes and release adhesions.
- Drug treatment:
- For exudative causes (such as inflammation), medications treating the underlying cause, including steroids or immunosuppressants, may be used.
- Antibiotics, anti-inflammatory drugs, and others may be used depending on complications.
- Postoperative and lifestyle management:
- When gas is injected, a recommended position (face-down or maintaining a specific direction) may be necessary for several weeks depending on the surgical method and the location of the tear.
- Do not travel by airplane or rapidly ascend to or descend from high altitudes (risk of gas expansion) while gas remains in the eye.
- Avoid strenuous exercise, lifting heavy objects, and activities involving a risk of eye trauma.
- Control systemic diseases such as blood sugar and blood pressure (management of diabetes and hypertension) to reduce the risk of tractional detachment and affect surgical outcomes.
- Precautions and risk of complications:
- Accelerated progression of cataracts during or after surgery, increased intraocular pressure, recurrent detachment, proliferative vitreoretinopathy (PVR), bleeding, infection (endophthalmitis), and limitations in meaningful visual recovery (when the macula has been detached for a long time).
- Even if a longstanding chronic detachment is surgically reattached, visual recovery may be limited.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Items to bring:
- A list of all medications currently being taken (including prescriptions, OTC medicines, and supplements), along with dosages and administration times.
- Records of previous eye surgeries (cataract surgery, laser treatment, etc.) and their dates.
- Copies of recent ophthalmic examination results, if available (fundus photographs, OCT, ultrasound examination, etc.).
- The date symptoms began and the timeline of symptom changes (e.g., when floaters/flashes began and how quickly they progressed).
- Photos related to the symptoms (such as a photo showing the visual field blocked by a hand) or notes.
- Key information to tell the doctor during the outpatient visit:
- Whether the symptoms started suddenly or progressed gradually.
- Whether one eye or both eyes are affected, and whether the same symptoms have occurred before.
- Whether there has been recent eye trauma and whether systemic diseases are present (especially diabetes and hypertension).
- Examination preparation:
- Pupil dilation examination may be necessary, so returning home may be inconvenient (prepare alternative transportation if you plan to drive).
Examples of General Questions to Ask the Doctor
- How urgently do I need treatment for my condition?
- What type of treatment (surgery/laser) is recommended, and why?
- What are the expected risks and side effects of each treatment?
- What is the likelihood of visual recovery after surgery (prognosis)? How does it differ depending on whether the macula is involved?
- How likely is recurrence (redetachment) after surgery, and how likely would repeat surgery be?
- When can I resume daily activities (driving, returning to work, and exercise) after surgery?
- What position should I maintain if gas is injected, and what restrictions (such as flying or diving) apply?
Examples of Disease-Specific Questions
- Has my retinal detachment involved the macula (central retina)? If it has, what degree of visual recovery can be expected?
- Which surgery is recommended for me (scleral buckling vs. vitrectomy), and what is the basis for that choice (such as the location and size of the retinal tear and whether traction is present)?