Retinal detachment

Detachment of the retina ( retinal detachment, retinal detachment ) refers to the replacement of the inner portions of the retina ( neural retina ) of the eye from its supply layer, the retinal pigment epithelium ( pars pigmentosa, RPE). It represents an ophthalmologic emergency, as a progression occurs in most cases in the direction of the visual center, which increases the extent of the necessary intervention and the prognosis of the final obtainable vision with reaching the visual center ( macula) deteriorates radically.

• 4.1 Pneumatic retinopexy
• 4.2 Laser Treatment
• 4.3 Surgical treatment by lead or cerclage
• 4.4 Cryosurgery ( cryopexy )
• 4.5 Further treatment approaches

Formation and forms

The neuroretina is usually the pigment directly on, however, is only the optic nerve head ( papilla of the optic nerve, optic disc ) and in its outermost periphery behind the iris firmly with him. In addition, the close contact by an active pumping power of the pigment epithelium and the teeth of the rods and cones is maintained with the pigment. The intact neural retina is thus, as it sucked in by pigment epithelium.

Crack -related retinal detachment ( rhegmatogenous retinal detachment )

Tensile forces of attachment sites of the vitreous to the neuroretina can lead to cracks. These cracks allow the penetration of liquid between neural retina and pigment epithelium and thus lead to a local collapse of the suction between the two layers. It comes to a local retinal detachment, which can expand by further inflow of fluid within hours across the entire retina surface.

Tractional retinal detachment ( tractional retinal detachment )

On the retinal surface can form such as diabetic retinopathy connective tissue membranes located in various diseases. These membranes adhere to certain points firmly to the retina. They tend to shrink and thus drag the retina like a tent from their support from.

Due to accumulation of fluid induced retinal detachment ( retinal detachment Serous retinal )

When damage to the retinal vessels eg in the context of inflammation and a reduction of the pumping function of the pigment epithelium may lead to an accumulation of fluid under the neuroretina, a detachment of the retina causes ( Serous retinal detachment or central serous retinopathy ).

Such an accumulation of fluid that leads to detachment of the retina may also be congenital (eg, Coats' disease ).

Tumor -related retinal detachment

A tumor of the retina can cause by its mass and an accompanying serous retinal detachment also a detached retina.

Pressure wave induced retinal detachment

Frequent use of firearms with ammunition larger caliber (eg .50 BMG) and with muzzle brakes can lead to gradual, selective retinal detachment. Towards the back for protecting the deflected combustion gases of the propellant charge generating pressure waves vorschädigen the retina in the corresponding eyeball.

Symptoms

Symptoms particularly of rhegmatogenous retinal detachment are seeing flashes ( photopsia ) as a result of Glaskörperzugs, the sudden onset of dense black or red spots in the visual field ( Rußregen ) as a result of associated with the retinal tear circulation as well as curtain and beam-like visual field when the retinal detachment has reached greater proportions.

However, the detachment can also occur without any symptoms and are only on reaching the macula visible, for example, by a distorted representation ( metamorphopsia ), comparable to an error in a glass.

Follow

If the retina is no longer supplied with their nerve cells and photoreceptors by contact with the pigment epithelium, may the affected retinal areas depending on the duration to an irreparable loss of function ( blindness ). After reinvestment can occur weeks to months of improvement.

If it persists, a complete retinal detachment in the long term threatens a painful shrinkage of the eyeball ( phthisis bulbi) and thus the loss of the eye.

Therapy

A retinal detachment is usually treated surgically. The procedure depends on its cause, location and extent. In particular causes (holes, traction, etc. ) in the lower hemisphere of the eye require above-average frequency surgical treatment with silicone oil tamponades, since due to the floating properties of gases, but also individual silicone oils often not sufficient retina conditioning and hole sealing can be achieved in lower proportions.

Pneumatic retinopexy

By introducing a gas mixture into the interior of the eyeball ( eyeball ) and corresponding head pose, the detached retina can be reapplied to the pigment epithelium. The gas is absorbed after a few weeks. Pneumatic retinopexy is always combined with the cryopexy and / or laser treatment.

Laser treatment

In a localized, not too large detachment of a laser can be used, who can stop the progression. The assumption to be able to permanently weld the retina at the source layer with the laser, is common but incorrect in the therapeutic effect does not occur immediately. It will be produced by the laser action in the not yet lifted off around scars that firmly connect after about five days neuroretina and pigment epithelium.

Operative treatment by lead or cerclage

Operational measures for reinvestment of the retina have the closure of the causative retinal detachment and relaxation of the vitreous coating to the target. This may, for example, by sewing on specially molded plastic cushions ( seals ) or by the circular wrap the bulb with flexible silicone tapes or reels ( cerclage ) are outside reached on the eyeball, the press it so that the contact between the pigment epithelium and neuroretina restored and counteracted the Glaskörperzug is ( " scleral buckling surgery "). With the improvement of surgical technique of vitrectomy increasingly ( supplemental ) intervention from the inside of the eyeball ago but are now being carried out. Here, the vitreous and tractional (see above) membranes as completely removed and achieved a hole closure by tamponierende gases or liquids. However, especially in young patients is often tried (yet) clear lens of the eye to come without vitreous surgery to success, as all tamponades draw a significantly accelerated lens opacity (cataract ) to itself.

Cryosurgery ( cryopexy )

If the crack is too big or too far in the periphery of the eye, so it can be treated by a cryosurgical procedure. In this method, a cold pin at the outside of the eye is placed, while the effect is observed on the retina through the pupil. The procedure takes about 20 minutes.

Other treatment approaches

With a serous detachment the underlying inflammation, if possible, treat. In a tumor-related retinal detachment treatment usually is directed first to the tumor.

Provision

In particular, people with risk factors for retinal detachment, such as high myopia, poorly controlled diabetes, retinal detachment in the other eye or with family increased incidence of the disease should have their retina examined by an ophthalmologist for vulnerabilities on a regular basis. The routine examination of the retina of premature infants in the first weeks of life is to discover early stages of retinopathy of prematurity, which if left untreated for retinal detachment. The cryopexy is a measure of cold application in conjunction with surgical procedures other retinal damage in order to reduce the risk of accidental detachment of the retina.