The only effective treatment is surgery. Retinal detachment does not cure automatically or by drugs and surgery should be done as soon as possible. Kind of surgery is based on place, size, type and kind of retinal detachment, two main things in retinal detachment treatment are:
Closing of holes
Approximating of retinal to down layers and outer wall of eye in a way that retinal can stick on its place.
Based on these, there are different treatment methods for retinal detachment:
This method is an effective method for closing retinal holes but it couldn’t treat retinal detachment alone. In cases that retinal has hole but retinal isn’t detach, this method can prevent from retinal detachment by closing hole. In this method that is with local anesthesia or with laser (from inside of eye) or by using cryotherapy (from outside of eye) burns created around hole. These burns give adhesion to textures, creates powerful connection between retinal and eye wall. As a result around hole is closed and entrance of liquid to retinal posterior is closed. (Laser creates burning and cryotherapy cold texture and burns it.)
In this method after local anesthesia, doctor injects a little gas bubbles eyes. This gas bubble dilated inside eyes and push from inside to retinal and put it in its place. Also by putting pressure on edge of retinal holes makes it close and prevent from liquid leakage to retinal posterior. Because gas moving up inside eye, this method is effective when retinal detachment happens in upper part of eye. Because we put gas bubble in right place, we usually recommended patients to put his/her head smooth and sleep in sitting way. Gas bubble usually absorbs in 10 days to two weeks. After this time usually by laser or cryotherapy pen all part of retinal holes burn that hole will not open again.
This method is common method in curing retinal curtain detachment. In this method one buckle (a sponger or soft silicon strip by suture sewn to scleral (scroll or eye whiteness) and like a light belt push out wall to inside and make it to go near detachment retinal that retinal can stick in its place. If there is much liquid behind retinal during surgery this liquid discharges that retinal stick fast to outer wall.
In addition during surgery, edge of retinal holes closed by laser or cryotherapy pen. Sclera buckle remains all the time in its place and there is no need to put it out except there is a special problem. Buckle doesn’t see from out and there is no obvious change in eye but because of pressure and change in eye can create myopia.
In situation that simple methods can’t cure retinal curtain detachment they use a complex surgery by the name of vitrectomy. In situation that holes are very big or very much or a large part of retinal detached, in situation that was blooding inside eyes or retinal is stretched. Usually simple methods are not effective and we should use vitrectomy (it means discharging of vitreous from eyes). In this method first, vitreous with a special instrument discharges from the eye. This special instrument with blade puts vitreous fibers down and discharges them from eyes, and stretch was not on retinal. Also if there is blooding inside eyes, blood washed in this way. Then they inject sterile salt serum inside eyes. At last retinal holes closed by laser. Sometimes for better placing of retinal, heavy liquids (like Perfluoron) injects inside eyes to put retinal in its place. Then this liquid changes with salt serum. Sometimes in addition with salt serum a gas bubble inject in eyes to put upper part of retinal. Sometimes with vitrectomy surgery we use scleral buckle that outer pressure help to closing retinal. In special cases that upper methods are not effective after vitrectomy a special material by the name of silicon oil injects to fill eyeball from inside and put retinal. When it is inside eyes, sight severely disrupted. After some months that retinal sticks with another surgery oil discharges and salt serum injected.
After surgery especially scleral buckle and vitrectum up to several days, eyes are painful and sensitive. Usually it is needed to use anti-biotic drops up to one to two week and anti-inflammatory drops up to several weeks after surgery. Sometimes other drops (like drugs which decrease eye pressure or drops of pupil). If gas bubble injects inside eyes, person should put his/her head place and for sleeping be in half sitting situation. Altogether after retinal surgery it is necessary that a person regularly goes to doctor for controlling retinal situation and preventing from possible complications.
Surgery result of retinal stick is dependent on two factors:
- Amount of time that retinal was cut from its place.
- Situation of sight center (macula)
Macula or sight center is central part of retinal that is responsible for direct sight. If before surgery, macula wasn’t removed from its place, surgery result is good in a way that more than 2/3 of patients after surgery had enough sight for seeing. But if macula was removed from its place, after surgery patients has weak sight. The best result of surgery is when retinal curtain sticks in its place for one to two weeks. In situations that retinal curtain detachment takes a long time, after surgery the result is not good.
Altogether in 90 to 95% with one or several surgery, retinal sticks in its place, but we should regards that retinal sticks in its anatomy place didn’t improve person sight. As we said sight situation after surgery is dependent on macula and time that retinal was removed from its place.
Generally, whatever retinal curtain detachment were little and was far from retinal Centre, surgery result is better and whatever detachment is bigger and was closer retinal Centre the results is worse.
Prevention from retinal curtain detachment
Rapid recognition is a key of successful cure in retinal detachment. Knowing sight quality in two eyes is very important. It is recommended that all people who are in danger (myopia person, diabetic person, people who has family history of retinal detachment) control their eyes every day.
for doing it they should control each eye sight separately by closing other eye and if there is any change in eye sight they should go to doctor in 24 hours . If you have these signs go to doctor in 24 hours:
Felling of existence of curtain or shadow in front of eyes
Seeing light sparks.
Existence of floater and increase of floater
Seeing grid like things in front of eyes.
Each decrease in sight that is sudden.
Rapid recognition of retinal curtain detachment is the most important factor of successful cure.
Postoperative retinal surgery (retina) care
Retinal surgery is done due to the detachment of the sensory-neural layer of the eye from its underlay and attaching these two layers together.
After surgery,use a protective plastic shield for 2 to 3 weeks to protect the eye and prevent any impact to the eye. You can use glasses during the day and shields at night. The plastic shield is washable. Wash it daily and put on your eyes after drying.
How to use and place the shield and how to rest after retinal surgery are very important in the success of the retinal surgery.
The resting position varies different depending on the location of the tear and type of retinal surgery, which is explained to you by the surgeon and must be carefully observed. Sometimes, the prone position resting is recommended depending on the type of surgery. In this case, the patient should sleep on his abdomen while resting. In this position, the forehead and face are looking down.A few days after retinal surgery, the eyelids are usually swollen naturally. Sometimes, especially in the morning, sticky discharge or pinkish serous fluid withdrawal are seen in these patients.To remove the eye dried secretions, first use a few physiologic drops or a drop of chloramphenicol on the eyelids. Then, after softening the secretions,gently and without putting any pressure on the eye itself, cleanse the secretions with cotton or a sterilized gauze.
- Postoperative anti-inflammatory drugs or corticosteroids
The sedatives and anti-inflammatory pills are sometimes used according to the surgeon’s diagnosis, which are often discontinued after one week to ten days after the surgery. The corticosteroids are used to reduce the inflammation and increase the patient’s healing course. Be sure to take your doctor’s advice on how to use them.
Traveling with cars and trains is allowed. For traveling by plane, you should consult with your surgeon if the eye contains gauze.
From the day of operation, praying with tayammum is only allowed on the stone.
- Study, watching television and usual activities
Study, watching television and usual activities of life not associated with intense physical activity are allowed.
With attention to the correct way of placing the head, you can wash all of your body except your head and face.If the retinal surgery is not accompanied by a complication, you can get a bath a week after the surgery; but when washing your face and face, you should keep the eyes closed and do not make any pressure on the eyelids. Also,you must use baby shampoo and soap.
This disease and its operation do not need a particular diet nutritionally. If the patient had a special diet before the operation (diabetes, hypertension, stomach ulcers, etc.), he should continue the same diet after the surgery.
Strongly avoid the use of cosmetics (mascara, synthetic eyelashes, colored lenses, oily materials, etc. around the eyes) and ask your doctor when you can begin again to use them. After surgery, retinal re-detachment is possible. In the event of reduced visibility, the elongation of the objectsimage or the blurring of an area from the field of vision or seeing a spark in the eye, immediately refer to your surgeon in the emergency department. The best vision will usually be achieved about 3-4 months after the surgery provided that the retina has been attached and the resulted refractive error has been corrected. Visit your doctor on appointed dates.
Using eye drops may be needed 1 to 2 months after the surgery. Strongly avoid taking or stopping drugs arbitrarily.Try to use the drops at the time prescribed by your doctor.At intervals of sleep (5-6 hours), you do not need to wake up for using the drops; however, you should ask this from your doctor as well. Read the instruction on how to keep the eye dropson the drug brochure. However, normally, the opened eye drop should be kept at normal temperature (25-30 °C) and use it up to 3 weeks after opening its cap. Thus, avoid the droplets from freezing or extreme heat.
First, wash your hands thoroughly with soap and water.Bend your head slightly back, pull your lower eyelid down with your pointer finger to create a small hole.Drop a droplet in the created hole.After dropping the drop, keep your eyes gently closed for two to three minutes.This will help to better absorb of the medicine and reduce its effects.If you need to use two different drops at a time, make an interval of at least five to ten minutes between them. If you notice symptoms such as redness, tenderness, pain, purulent sections and intense eye irritation, see your doctor.