Detached Retina

[berrywoo]

Several week ago I had surgery to correct an almost completely detached retina, and was treated with both a sceral buckle and a gas bubble injectioin. However the retina specialist I go to is worried that my retina is starting to detach again, but all the tests that were done proved inconclusive, so I was told to return for a visit in a week and in the mean time should I see any floaters in my vision I should call the doctor's office immediately. My question then is this: Aren't floaters still present even after corrective surgery, so how would I be able to tell if my retina is detaching again?

[John C Hagan III, MD, FACS]

Your question has been answered below by 'circumspect' a physician member of the American Academy of Ophthalmology. Sorry for the delay, part of getting this new forum up and running.

[Frankie68]

Hi. I had a detached retina when I was 20 years old. I had the buckle as well. I have always had floaters and still do. I go for regular checkups and aside from having cataract surgery 18 months ago I havent had any problems with the detached retina. I waited too long before I went to have it checked originally so I lost the top part of my vision in that eye but with both eyes open I don't notice it. It's been 18 years since I had it done. It still could re-occur and because it was already detached once it has a higher chance of happening but I've had no problems. Keep your scheduled check up appointments!

[SueAlex]

Does anyone know of a specialist, affiliated with either Mt Sinai or NY Presbyterian in NYC that specializes in retina problems. My mother has been going to a doctor in NJ and has had the laser and steroids injections to correct loss of vision in one eye due to a leak that resulted from hardening of the arterties- she is 77 years old. The doctor told me that she has a condition called macular edema but when I researched on the internet, it says that it is related to diabetes, which she doesn't have. Any suggestions are welcomed.

[circumspect]

I am a board certified ophthalmologist but not the forum physician. Floaters are common, by age 50 half of us have them, but age 70 its three out of four of us. Floaters are more common in highly nearsighted people (myopic).

Retinal detachment surgery does not remove floaters unless an operation called a vitrectomy is done at the same time.

The sympetoms of a retinal detachment (or redetachment) include a sudden increase of floaters (often in showers of small black particles looking like soot), flashes of light like lightening and perhaps loss of peripheral vision.

Seeing one or two big floaters, especially if they've been around for quite a while is not a danger signal. Swarms of new black spots can be a danger signal.

Retinal detachment is relative unusual occuring in perhaps one in 3-4,000 people. However after cataract surgery the risk of a retinal detachment increases 10 fold even with the new small incision, no stitch techniques. Other risk factors include positive family history, high myopia, history of trauma to eye, thin spots on the retina (lattice degeneration).

Retinal specialists sometimes ask their retinal detachment patients to do "finger counting fields" at home. This tests the peripheral vision by closing one eye looking straight ahead then wiggling the fingers in the peripheral vision to the left, right, up, down and the diagonals in both eyes.

JCH Board Certified Ophthalmologist

[Rustre1]

Dear Circumspect - My 21 yr old daughter had a buckle/vitrectomy 6 weeks ago.  It was a pars plana vitrectomy for a lattice-related tear.  This was her first detachment surgery.  She didn't even know it was detached and saw 20/20 out of that eye. Three days later at the post-op, she had no light reflex. One week later - no change.  The surgeon says he doesn't know what could be wrong.  We go to another Dr. who tells us it atrophied and that there are noticable tracks on the posterior of the retina and around the nerve area.  We have done MRI's, blood tests and now prednisone.  She can see shadows from that eye - and at best is 20/400 with +10 lens.  

What could have happened?  Was the nerve hit?  Were blood vessels removed?  How do we prevent this from happening to the fellow eye?  What can we do to protect the fellow eye?  What can we do to get improvement out of the operated eye?

[circumspect]

A retinal detachment is a condition that will lead to blindness in the part of the retina that is detached. A scleral buckle/vitrectomy is a huge operation that involves major risks including: infection, bleeding, re-operation, inablility to re-attach the retina and loss of sight. The operation and/or retinal detachment can cause optic neuropathy in which the optic nerve either "dies" (optic atrophy) or is severely impaired.  The recovery from this type of problem can take 6-12 months in some cases.

The person best able to answer your questions would be the operating surgeon and/or the second ophthalmologist (EyeMD) that saw her in consultation.

You should not be reluctant or embarrassed to ask either surgeon to review again the post operative problems she's had. If you are still not certain or would feel better there's certainly nothing wrong with getting a third opinion. You should be sure that the person you see is a retina surgeon.

The overall incidence of retinal detachment in people that have not had cataract surgery is between 1 in 2,000 to 5,000.  The rate is much higher in people that have had cataract surgery, are extremely nearsighted (myopic), relatives of someone that has had a retinal detachment, those born premature and who were in an incubator and in eyes that have sustained major trauma.

The fellow eye of your daughter is at an increased risk of a retinal detachment. If she is quite near-sighted even more so. The non-operated eye should be checked carefully for lattice and holes or tears or vitreous traction. If such areas exist the surgeon may consider preventive laser or freezing (cryotherapy) to seal and strengthen these areas.  (All your children should be check by an ophthalmologist (EyeMD) who should be told that a sister had a spontaneous retinal detachment.

Your daughter additionally should have her eyes checked by an ophthalmologist (at least once each 6-12 months) the rest of her life. With her one good eye status she needs to avoid all acitivities that are hazardous to the eye if at all possible (mowing, weed-eaters, power tools, firearms, firecrackers, racquet sports, etc). If she must do these, she should wear safety GOGGLES. All other times unless the operative eye recovers "good" vision, she should wear impact resistant glasses for her prescription.

It would also be good to avoid activities like amusement car rides that jar or create shear forces on the retina.

I hope this helps and that things take a turn for the better in your daughter's serious eye problem.

JCH MD

[jaja.p]

I have an oppointment next week with an opthamologist, and i am scared because i believe i'm going to need some kind of surgery.I'm 33 years old I wore glasses for 25 years very nearsighted (myopia) @ 25 I had Lasik surgery on both eyes. My vision was really good until now. I need glasses but not as bad as before.  My optamitrist says that my right eye looks very strange in the back, it apears to be an almost retinal detachment. My right eye is larger than the other eye.
. My questions are ; Does the surgery hurt to get that fixed? How long does it take for one to recover? I'm in a program to become a nurse but now it worries me, am I going to be able to finish school?  If anyone knows the answers please write back thankyou.

[Mary Thomas]

I I had reported to eye emergency on 22nd October 2006 with history of pain and decreased vision in my right eye following an injury with a metallic sharp spring from a kitchenware while working in the kitchen.

At presentation,  visual acuities were HM in right eye and 6/6 in left eye. The right eye was injected with conjuctival congestion. There was an open eye globe injury in the form of an irregular scleral full thickness wound starting from the limbus extending posteriorly for 3 mm at 12 o’clock position. Anterior chamber was filled with blood resulting in dispersed hyphema. Vitreous was seen prolapsed through the scleral wound . There was no fundal view. X-ray of the orbits did not reveal any foreign body. The left eye was normal.

I underwent primary repair of scleral wound after removing the prolapsed vitreous and anterior chamber washout on the same day under GA. I received intensive topical and IV antibiotics postoperatively as an inpatient for 5 days. My postoperative course was satisfactory. The visual acuity improved to 6/6 with resolution of hyphema. Fundus examination showed  1+ vitreous haze and subhyaloid hemorrhage.  There were no retinal tears or intraocular foreign body.

I was readmitted on 10 November 2006 with features suggestive of endophthalmitis in the right eye {i.e., history of pain, redness and loss of vision of one day duration, grade 4 AC reaction and vitreous exudates}. Anterior chamber wash with pars plana  vitrectomy  with intravitreal injection of vancomycin 1 mg and amikacin 0.4mg was carried out on the same day. The Gram’s stain and culture of AC and vitreous aspirates  were all negative. Postoperatively, the anterior chamber reaction and vitreous exudates/membranes recurred along with formation of dense pupillary membrane.

Lensectomy along with removal of vitreous exudates and membranes was carried out on 15 November 2006. Since intraoperatively, retina was found to necrotic, silicon oil was injected for internal retinal tamponade. Culture of vitreous specimen was again negative. Following this procedure, through the infectious process was brought under control, I developed inferior retinal detachment with retinal holes and thinned retina. The detached retina appeared stiff.

I underwent encircling band and scleral buckle {180degree} and inferior retinectomy and reinjection of silicone oil on 28 November 2006. My postoperative course has been uneventful since then.

I was seen last on 12 February 2007. My visual acuity in right ey was 2/60, IOP was 6mmHg. Cornea showed signs of early band keratopathy. Rentina remained flat with sclerosed retinal vessels and pale optic disc. I am advised to install Decadron eye drops q.i.d. in my right eye and have a regular follow up.      

And now  8 months passed and my IOP is not maintaining. Some times its 6, sometimes 3, like that.
So the doctors are scared to remove the silicon oil bcoz of low IOP.As they say the eye will loose its shape if they remove the oil.
And i want to ask will I get full vision back and is there any thing to do to increase the IOP.
waiting for ur valuable reply at the earliest.
Thanking you
Mary

[detached]

In October of 04 I ran to my well respected eye surgeon with what seemed to be a detaching retina. He had previously done cataract surgery for me on both eyes and laser surgery for possible glaucoma.

He tried to do a surgery on my eye in the office which did not work sufficient so the major overnight was scheduled for the surgery with the gas bubble and  buckle and the face down experience for an extended period of time. It looked like it had worked but then the buckle let go. This made my vision weak and so day surgery was scheduled to fix it.

In the day surgery the eye got infected and the procedure was aborted. Massive antibiotics were necessary to save the eyesight. It worked to the extent that I have limited sight in the eye and can function. Of course I am always afraid of the same thing happening in the other eye.

I was seeing this well respected world famous doctor for regular appointment every six month and yet when it happened it was an emergency.

I have no way of knowing whether I am lucky to have any sight in the eye or if something was done wrong.

[dinuka]

A related discussion, can i improve my vision was started.