Retinal detachment is the separation of the retina from the underlying layers of the eye. It occurs when fluid accumulates between the retina and these layers.

There are three types: rhegmatogenous (the most common), tractional, and exudative.

CausasCausasCauses

Causes

For a rhegmatogenous retinal detachment to occur, three factors are necessary:

  • A tear or break in the retina
  • A liquefied (degenerated) vitreous (the gel-like substance that normally fills about three-quarters of the eye)
  • Traction on the retina

Predisposing Factors

  • Myopia (nearsightedness): Vitreous degeneration and peripheral retinal degeneration are more common in myopic patients.
  • Previous cataract surgery
  • Retinal detachment in the other eye
  • Ocular trauma
  • Peripheral retinal degenerations (lattice degeneration): areas of retinal weakness
  • Family history of retinal detachment (e.g., Stickler syndrome)
  • Certain diseases that cause fibrous bands in the vitreous leading to tractional detachments (proliferative diabetic retinopathy, retinopathy of prematurity, infections)

SíntomasSíntomasSymptoms

Symptoms

  • Retinal detachment is painless.
  • Floaters (myodesopsia) and flashes of light (photopsia), which precede detachment in about 60% of cases.
  • A shadow or dark curtain in the visual field, typically on the side opposite to where the detachment occurs.
  • Loss of central vision if the macula (the central area responsible for detailed vision) becomes involved.
DiagnósticoDiagnósticoDiagnosis

Diagnosis

Diagnosis is made through a dilated fundus examination using indirect ophthalmoscopy.
If the retina cannot be visualized clearly, an ocular ultrasound may allow diagnosis.

Optical coherence tomography (OCT) may also be performed to assess the height of the retinal detachment, detect cystoid macular edema (inflammation of the central retina), or identify an associated macular hole.

TratamientoTratamientoTreatment

Treatment

Visual prognosis is better when surgery is performed within the first week after diagnosis.

The main goal of treatment is to close retinal tears and reposition the retina.

Several surgical techniques are available:

  • Pneumatic retinopexy: A gas bubble is injected into the eye, and the patient maintains a specific head position. The retinal tear is then sealed with laser treatment.
  • Scleral buckle surgery: A silicone band (buckle) is placed around the eye, like a belt, to indent the sclera and close the tears while reducing vitreous traction.
  • Pars plana vitrectomy: The surgeon enters the eye to remove vitreous traction and reposition the retina. Retinal breaks are sealed with laser or cryotherapy (freezing).

In all cases, treatment must be prompt, and it is urgent when the detachment threatens the central vision area (macula).

Specialties:
  • Oftalmology