What is the retina?
It is the seeing layer of the eye, plastered like wallpaper on the inside wall of the eyeball.
What is retinal detachment?
This is when the retina peels off the wall of the eye. The detached part loses function and causes a shadow or defect in the patient’s field of vision.
How does retinal detachment occur?
The main cavity of the eye is filled with a gel called vitreous. As we age, the vitreous liquefies. At some point, the gel collapses away from the retina in an event known as posterior vitreous detachment (PVD). In 90% of cases, the gel falls away smoothly from the retina. This therefore just causes floaters (shadows cast by the back surface of the gel), and occasionally, fleeting flashes of light in the outside corner of vision of the affected eye. But in 10% of cases, the gel is abnormally stuck to some part of the retina, so when the gel detaches, it pulls a break in the retina. This break allows fluid to enter the space behind the retina and peel the retina off the back of the eye as well – this is retinal detachment.
What happens if retinal detachment is not treated?
In most cases, the retina will progressively detach over days or weeks and eventually the eye will lose all vision.
How is retinal detachment treated?
In very simple terms, the retina needs to be re-attached to the wall of the eye, and this is achieved either from outside the eyeball (by sewing a sponge tightly onto the outside of the eye to create an indent – called scleral buckling surgery) or from inside the eye (by replacing the gel with gas to keep the retina flat – called vitrectomy). Most surgeons in the UK are now moving towards treating almost all retinal detachments with vitrectomy. There is a lot more complexity to retinal detachment surgery than this, but a good starting point is to read the page on pars plana vitrectomy.
What does vitrectomy for retinal detachment look like to the surgeon?
The vitreoretinal surgeon benefits from a much better view at the operating microscope than any operative photo or video can represent, owing to the microscope optics and of course the binocularity of the surgical view (the surgeon sees everything in 3D). However, below is a video demonstrating the key stages in a vitrectomy performed by Mr Shah for retinal detachment.