Retinal detachment

Article

May 20, 2022

Retinal detachment is a rare eye disease that is manifested by separation of the retina from the outer membranes of the eyeball with which it normally comes into contact. It can lead to blindness if not treated quickly (relative ophthalmological emergency). This disease mainly affects people aged 45 to 60, nearsighted people and diabetics.

Epidemiology

Its annual incidence is 1 in 10,000, affecting both sexes equally, with a peak around the age of sixty. It seems that a history of cataract surgery increases the risk of occurrence of retinal detachment. Similarly, myopia, by increasing the rate of posterior vitreous detachment, significantly increases the risk of this disease. In young people, one of the most frequent causes is eye trauma.

Mechanism

Most retinal detachments begin with tearing of the latter allowing vitreous fluid to penetrate under the retina, detaching it. These tears are often the consequence of normal aging of the eye, with a detachment of the vitreous from the retina and are, most of the time, unimportant. These vitreous detachments are particularly common in the myopic elderly. Retinal tears often give only few signs and quite rarely progress to true retinal detachment.

Symptoms

They include phosphenes, flashes, flying flies or myodesopsies, reduction of the visual field, sudden drop in acuity. Phosphenes are secondary to posterior vitreous detachment. They are present in 20 to 40% of cases. Blurred vision of part of the visual field may be due to vitreous condensation phenomena.

Screening

If the symptoms evoke a detachment, we proceed to a fundus examination, we then observe a large yellow spot.

Treatment

In the event of a retinal tear for which the risk of secondary detachment is considered significant, laser photo-coagulation around the tear makes it possible to make a fibrous scar and thus prevent future detachment. If the detachment is constituted, the repair is more complex, of the surgical type, the final result being inconstant, all the more so if the macula was affected and the repair was delayed. There are three types of repair: directed ocular cerclage allows the reapplication of the retina by external compression of the eyeball. This technique does not require the opening of the eye. It is an effective technique in more than three-quarters of cases. The most frequent complication remains the recurrence of the detachment; vitrectomy consists, after opening the eye, in removing part of the vitreous which tends, by its retraction, to pull on the edges of the tear. The extracted vitreous is replaced by a resorbable gas. Healing is controlled by positioning the head for a few hours following the procedure. There is an increased risk of cataract (clouding of the lens after this procedure), due to the specific effect of the injected gas. The success of the intervention is also good; Pneumatic retinopexy consists of injecting a gas or a gel into the eye allowing the re-application of the retina which must be directed by a correct orientation of the head. It is a simple technique with few side effects. However, it is not suitable for large or complex detachments. It can be followed or associated with the other two techniques in case of insufficient results.

Notes and References

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