FYI: Retinal Detachments 101

[berrywoo]

I’ve decided to compile a list of sorts to inform people about RDs, its treatments, and effects.

Retinal detachments: who’s at risk
Those w/ a family history of RDs, high myopia, previous eye surgery, previous eye trauma/injury, weak spots in the peripheral retina, having an RD in the fellow eye, as well as those w/ certain conditions such as Diabetes, Marfan’s, ROP, etc. are at greater risk for developing an RD

Retinal detachments: symptoms
flashes of light, which may look like camera flashes, or lightning bolts, visible during the day, but more likely to be seen at night or dim lighting
floaters, these come in many shapes and sizes, if you notice an INCREASE or sudden onset of these than take warning
black curtain or veil, if you notice any sign of visual loss go see an eye doctor immediately

Retinal detachments: treatments
laser or cryotherapy, both seal holes by creating scar tissue, may be done in office or in the OR combined w/ other treatments
scleral buckle, is done under anesthesia in an OR, a silicone band is sewn around the eye
PPV, in a pars plana vitrectomy the vitreous gel inside the eye is removed to help alleviate traction on the retina or to clear debris from the eye; often done in conjunctions w/ pneumatic retinopexy
Pneumatic retinopexy, is the insertion of a gas bubble to push the retina against the back of the eye, there are two types of gas SF6 which gets absorbed very quickly or C3F8 which takes 6-8 weeks to get absorbed by the body. may be done in the doctors office or in the OR
A variation of pneumatic retinopexy uses silicone oil instead of gas, in this case a PPV must be done prior to insertion of oil

*Note: PPV, scleral buckling, laser, cryotherapy, and pneumatic retinopexy can be done in various combinations to help ensure a stable attached retina

Retinal detachments: effects
*If not treated the result is blindness in the affected eye
*Depending on the extent of the detachment and whether or not the macula was off will determine final visual outcome
Laser: if this method was used to seal breaks in the retina along the periphery you may notice some peripheral vision loss; also, you may notice a temporary loss of vision which should only last a few minutes after treatment if done in office
Scleral buckle: pain and swelling may occur which can be treated w/ OTC meds. possible side effects include double vision, strabismus, ptosis, infection. Will cause a myopic shift in vision so if you’re already myopic you’ll be even more myopic afterwards
PPV and pneumatic retinopexy: head positioning may be necessary, vision will be terrible w/gas or silicone oil inside the eye. travel to high altitudes will be restricted if you have a gas tamponding agent, risks include increase in intraocular pressure, vitreous hemorrhage, cataract formation

**Please note that this is a simplified info sheet I’ve compiled. Talk w/ your doctor about any concerns you have and know the risks involved w/ any procedure before you sign that consent form!!!**

Retinal detachments: post-op
               After any surgery, your eye will be patched. You may experience some discomfort and the eye may be red. This will subside w/ time.
After surgery, you will be given drops: a steroid, to help w/ inflammation; a antibiotic for obvious reasons, and maybe a cycloplegic agent to keep the eye dilated and comfortable while the eye gets used to a scleral buckle
Floaters and flashes of light may still be present after surgery.
Flashes of light should stop w/time, if they persist see your doctor asap. Keep in mind that flashes of light are not localized, which means if you see flashes of light in the center of your vision it does not necessarily indicate that the macula is in danger, just that there is a problem w/ the retina.
Floaters may NOT be removed completely w/ vitrectomy. Eventually they may settle to the bottom of the eye or your brain will learn to ignore them.
Vision will be horrible if you have a gas bubble or silicone oil inside the eye.

Retinal detachments: complications post-op
Know the signs of rapidly increasing IOP: headache, usually located above the brow of the operated eye; naseousness, dizziness, and loss or worsening of vision
Sometimes the initial treatment may fail and additional procedures may need to be done. So be on the watch for returning symptoms of a RD. Generally, the riskiest time for re-detachment is in the first few days to weeks after surgery. If the retina remains attached for 3-6 months the chances of a recurrent detachment reduces significantly.
The success rate for retinal detachment surgery is high. Anatomically speaking, most retinas remain attached, some just take multiple attempts. Visually speaking, the success rates, especially for complex detachments, are less then ideal.

Retinal detachments: resources
Look through this forum and its archives. The doctors and other members of this forum have provided thorough answers to many RD related questions.
Talk w/ your doctor. He/She is in the best position to guide you and keep you informed.
If financial assistance is needed contact the hospital or doctor’s office they may have aid programs available. Or locate a Lion’s Club or Knights Templar office near you they have programs to help those who can not afford the costs of surgery.
Take advantage of support groups on the web or contact your local Services for the Blind, they have wonderful programs to help you.

Retinal detachments: final thoughts
Remember vision may take a while to return. Final visual acuity may not be known for up to a year after surgery. Be Patient.
Take care of your vision, especially the non-RD eye as it has now at increased risk for developing an RD.
I can’t stress this enough: Don’t be afraid to talk w/ your doctor. If you feel uncomfortable around your doctor seek another one. It never hurts to have a second opinion.


***Am I missing anything? If you’ve gone through an RD and feel that there is something missing please feel free to add to this, as I was just trying to be as brief as possible.***

This will probably be my last post for a few weeks as I go back to the OR on Tues. for yet another RD surgery. Bringing my total to 10 surgeries (5 left eye, and now 5 right eye)

Good luck to everyone. Take Care

[JodieJ]

Thank you for summarizing this information.  And best of luck with your upcoming procedure.  Let us know how things go for you.

[John C Hagan III, MD, FACS, FAAO]

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[katika29]

Thank you for your informative post on retinal detachments.  I must emphasize what you wrote about retinal detachments - one main symptom that people tend to ignore is the flashing lights, we all have floaters once in a while, but when you see the flashing lights, it indicates problems with a possible retinal detachment. See your doctor if you have flashes don't ignore them, like I did, you may get permanent vision loss.  
Thank you once again for your consideration of others in posting your knowledge and research on retinal detachments.  Good luck with your operation.

[John C Hagan III, MD, FACS, FAAO]

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[Seagaul]

Thank you so much for all the information on RD's.  I go back tomorrow for my third re-attachment.  I was told about 1-1/2% of the patients that have had the scleral buckle method placed on their eye it will still detach.  Well, I am one of that percent.  This time the silicone oil will be put back in and it will probably stay permanently.  I will eventually need to have the lens which is implanted now taken out and changed to one that works long term with the oil.  Only time will tell.  But once again, thanks for all the information you gave.  

[John C Hagan III, MD, FACS, FAAO]

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[AnnaE]

I am so sorry that I did note your surgery sooner. Best of luck. We will all be thinking of you. I believe your surgery is this morning.

You have given so much to many of us on this forum. I am sure that we all wish that we could be there with you and help you.

Anna

[berrywoo]

A huge thanks to everyone for the well wishes!!!!

A quick update: surgery went ok and it is now 2 weeks post-op. I've got silicone oil in my eye now, so vision is extremely fuzzy and faint. I'm trying to get more adept at using screen readers and the like but it's slow going so I won't be posting too much yet.
If all stays stable the oil may be removed in four months.

AnnaE, I really hope things are going well for you and that you still have your left eye intact.

Again, thanks everyone and take care.

[John C Hagan III, MD, FACS, FAAO]

Yes, thanks for sharing. Only one that has been through multiple operations from the patient side of things can really understand what an ordeal it is. Good luck and God bless.

JCH MD

[berrywoo]

bump

[berrywoo]

Just thought I'd bump this up once again, plus a quick update.

Update: I'm due to get the silicone oil out of my eye in a few hours, so things have gone well. In addition to the silicone oil removal, there will be a small portion of scar tissue removed and a SF6 bubble inserted. I'm excited as it finally seems the PVR process has pretty much arrested. Hopefully, this will be the first and last surgery for me in 2009! (I think I'll remain aphakic and hold off getting an IOL for a few years!).

Take care everyone and I'll resume posting in a few weeks!

[Carl_Mendez]

Hi, I have a blob in the corner of my right eye on the left side above the lacrimal gland. When I blink I see like a lacuna or some liquid expanding, a bit bright but trasluscent with no vision loss just like seeing thrue water, and leaves a short afterimage. I thought and was told here also that could be a pressure phospene entopic phenomena. I went to a retinologist and he saw lattice on the peripheral of the retina of both eyes being more servere in that one. Could be that symptom be the flash?, I always thought the flash would be brighter, way brighter and like a bolt or a dot, something way more sharp and intense. Also I only see this when I blink with the eye looking upward or downward and blinking. Im afraid of going laser to treat the lattice because the macula pucker risk.

Also, how can I know how big is my lattice?. Any online reference?


Thanks for the guide of RD, it will help a lot of people.

[broadway96]

I have had 2 reattachment now and i think both didnt work and my DR has given up on me because he keeps saying it is still detached and to just come back in 4 weeks.I am so mad. I am a young female Veteran so the VA is taking care of it but I have no insurance to go to other Dr.s

[berrywoo]

bump

[kathryn241]

I had RD surgery 8 weeks ago.  I had no signs of a detachment, except for slight blurring of my vision.  The doc did the buckle, laser and a vitrectomey, and now I see blur and black and a little light.  Nothing substantial.

My eye looks like it got smaller, does not open as wide as my other one, and is still bloody red on the white of it.

The doc said I popped a blood vessel during surgery and that blood is now behind the retina.  

I am very upset...now she says that I have a cataract that formed because of the surgery and that can not be taken care of until 3 months post retinal surgery.

[kathryn241]

Oh yeah I have the gas bubble too.  Doctors don't seem to be too truthful.  My vision is non existant in the saved eye so far.

[berrywoo]

In cases where a blood vessel breaks during surgery the blood may or may not clear up immediately. If it doesn't clear up immediately, your only option is to be patient and wait to see if it does clear up which may take months. It is a complication that can occur during vitrectomy, even when a surgeon is careful and cauterizes vessels immediately a leak can still occur.
As for the cataract, it is a very common occurrence after surgery for a RD. Generally, it is best to wait until the retina has completely healed and is stable before going ahead with cataract removal/IOL implant. This is because cataract surgery can cause RDs, CME, etc. If however, you require further treatment for RD then you can discuss the removal of the cataract with your surgeon and a refractive surgeon.
As far as your eventual visual prognosis it's going to be hard to determine. You've still got blood in the eye and the gas bubble which currenty makes your vision rather poor, but as these things subside your vision may improve. As noted in the original post, if the macula was detached you will not regain your original vision back.
The most important thing is be patient. Recovery from a retinal detachment is a long drawn out process and takes plenty of time.
The success rate is generally high and most people end up with very good final visual acuity in the effected eye.

[kathryn241]

Well, NOW my doc says that I need another re attachent surgery on the same eye...this time another vitrectomy, laser and also a lensectomy, cataract removal with no lens replacement yet, and inserting silicone oil in my eye which stays for at least 6 months.

I feel like I am living in a horror movie.

[AppleBr]

I 'm praying for you. Hope it helps...
Good Luck!!!

[berrywoo]

been there, done that....so I completely understand what you're going through.
Good luck with the surgery.

[kathryn241]

Anyone have their eye change shape?  Get SMALLER?  Make you look strange?
How long was your eye red after buckle surgery, vitrectomy and laser?

Anyone have 20/20 vision at RD?  

What is the POINT of re attaching the retina if SIGHT is not the ultimate goal....it is like saying

"Oh your broken leg has been nicely fixed, but you won't be able to ever walk again."

Is it so you won't lose your entire eye to a glass eye?  

I don't get why each of our experienced surgeons can not tell us zippo.

[AppleBr]

Yes I guess my eyes is now a little smaller.But it doesnt make me look strange - no one notice except me...
I didnt have the buckle, got silicone oil instead and my eyes won't get red for long.Laser only caused me to feel relieved - I did it both eyes - cos I was really afraid thing could be start happening the fellow eye,I had floters on that( still have some, but few and Retina continues atacched)
About that "why do reatacch if ..." its a try! I dont know you, but I do believe a small possibility of success being not only surgical but also funtional is better than NO possibilities. I knew nothing about RD til a week after my vitrectomy when I came back to computer and met this community by chance.But wont have hesitated if knew bad statistics - after a week waking up afraid of being blind all I wanted was some rest...

[berrywoo]

Yes, my left eye did look a bit sunken in after surgery number 3. Also, now eyes look weird because, the left eye slants down and is much smaller, while the right eye has a very slight upward slant. But like I said previously, it's not the end of the world.

Also, you seem to be under the impression that vision is an all or nothing phenomenon. That is you can see perfectly, 20/20, or you can't see anything at all. Vision, lies on a continuum. So while you may not achieve "normal" 20/20 (or whatever vision you had prior to the RD), with the retina attached there is a greater possibility that you will have some vision, even if it is only hand motion. With the retina detached your only outcome would be no vision, that is not even having any light perception.

The point of attempting to re-attach the retina is to PRESERVE vision.

Most people in this world can function normally with only one "good" eye. However, if worse comes to worse, and you lose all vision in your good eye, you've got a "spare tire". (not the best analogy, but it was the one I was given by 2 different doctors nonetheless)

[berrywoo]

The redness will clear up slowly. Make sure to avoid lying on your back for long periods of time as the oil will come in contact with the front of the eye, this is especially important since you're aphakic.
Also, I agree with AppleBr any chance for vision is better than none at all.
Most people with RD do end up with "normal"/pre-RD vision. However, in complex cases or if the macula was detached, the prognosis for having vision return to pre-RD levels is slimmer.