What is the treatment for retinal detachment?
Once the diagnosis is established, usually the patient is put on complete bed rest.
This has the advantage of settling the retina down and decreasing the height of the detachment. At the same time a detailed examination is done for holes or tears in the retina, as they all have to be detected in advance and the position of each plotted on a chart or retinal map for successful treatment.
Surgery is usually done using heat (diathermy) to weld the retina to the overlying choroid and cryotherapy (intense cold at -40° C). If the detachment is excessive, a silicon band is tied around the eye (encirclage) with a small extra silicone piece (plombage) kept at the maximum height of the detachment to “buckle” the retina properly.
When is the laser or the photocoagulator used?
Both the laser and the photocoagulator are sources of extreme light energy used for welding the retina from inside. Their main advantage is to seal the retina off from a tear the moment a shallow detachment is detected, or if a degenerated retina is visible, to seal off the retinal area ahead of it as a safety (prophlactic) measure.
This only works when the detachment is flat or shallow. It is also very useful in stopping any leakage from the vessels, or to block off any improper new vessels formed in the retina, especially in diabetes.
The laser has now been supplanted by the photo-coagulator which is its new form in an extremely effective and sophisticated instrument, with a high degree of accuracy and in the hands of an expert, success.
How can detachments be prevented?
Detachments, unless due to a violent direct or indirect injury to the eye, are caused by a weak retina giving way. The classical cause of detachment is the triad of myopia and aphakia (after cataract removal) plus sudden movement or strain.
Ideally the eyes should be examined every year and the periphery of the retina inspected. If it is found in any way to be degenerated or there are any changes which may lead to problems later on, a prophylactic (for safety sake) photocoagulation can be done which would decrease the possibility of a detachment later.
What is the success rate of a detachment operation?
A small detachment in one quadrant detected early has a good chance of recovery. However, if it is an old case, of more than 6-8 months, and the detachment extends to more than two quadrants (4 quadrants make a circle) then the chances are comparatively poor.
What safety measures should be taken by myopes and aphakic people to decrease the chance of a detachment?
(1) Do not lift anything heavy and do not physically strain unduly. A typical cause would be to change the tyre of a car, a common reason for a detachment.
(2) Do not rest your head against any vibrating machinery (resting the head on the rest of a window seat of a bus).
(3) Do not do any riding or boxing—a simple thing to avoid, but do remember to also avoid elbows and hands in a crowd or while trying to get in or out of a train or a crowded cinema theatre.
(4) The sudden occurrence of flashes of light, especially if they are accompanied by floating black specks in the eye must be taken most seriously and necessitate an immediate visit to your eye doctor.