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?

[JohnHaganMD]

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

[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?

[JohnHaganMD]

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

[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!

[ik88]

Dear doctor,
I am goin in for a surgery today..- had injured my eye which lead to a retina detachment in my right eye..I already have a cataract surgery done in this eye due to an earlier accident so this is goin to be my 4th operation in the same eye..this detachment has not affected my macular area and the doctor said that due to the earlier complications we will decide which procedure to go ahead with on the table itself. Now I have a lot of questions regarding this:
1.Whether redetachment occurs in cases due to trauma and does the detachment take place at the same spot or different ones on the retina
2.detachment is a viscous cycle,does that mean it will reoccur even though my case was due to a trauma/accident.
3.Is there no chance my vision may improve?as I had very low vision in that eye from before.
4.Does cataract reoccur due to this sometimes?

I know these are too many questions but I'm freaking out as I'm undergoin my operation in a few hours from now.

[dinuka]

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

[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.

[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

[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.

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

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.

[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.