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Retinal Detachment: Treatments

Retinal detachment is a medical emergency. When the retina separates from the back of the eye, it's called retinal detachment. If you see new floaters or light flashes, or if it seems like a curtain has been pulled over your eye, go to your eye care professional right away. With surgery or laser treatment, doctors often can prevent loss of vision.

PubMed Health Glossary
(Source: NIH - National Institute on Aging)

About Retinal Detachment Treatments

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina.

If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye).

Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye... Read more about Retinal Detachment: Treatments NIH - National Eye Institute

What works? Research summarized

Evidence reviews

The Clinical Effectiveness and Safety of Prophylactic Retinal Interventions to Reduce the Risk of Retinal Detachment and Subsequent Vision Loss in Adults and Children with Stickler Syndrome: A Systematic Review

Stickler syndrome, also known as hereditary progressive arthro-ophthalmopathy, is an inherited progressive disorder of the collagen connective tissues. Manifestations include short-sightedness, cataracts, retinal problems leading to retinal detachment and possible blindness. This is principally the case among individuals with type 1 Stickler Syndrome. It is the most commonly identified inherited cause of retinal detachment in childhood. However, there is no consensus regarding best practice and no current guidelines on prophylactic interventions for this population.

Interventions for prevention of giant retinal tear in the fellow eye

A giant retinal tear is a full‐thickness retinal break that extends for 90 degrees or more around the circumference of the retina, in the presence of posterior vitreous detachment (when the vitreous comes away from the retina). Giant retinal tears cause visual loss as a result of the associated retinal detachment. They can be difficult to treat due to the large area of retinal involvement and the high risk of re‐detachment following vitreoretinal surgery, often related to the development of proliferative vitreoretinopathy (a scarring process that can happen on the inner or outer surface of the retina and in the vitreous cavity after retinal detachment). As the fellow eye has an increased risk of developing giant retinal tear and retinal detachment, prophylactic 360‐degree treatments with laser photocoagulation, cryotherapy or encircling scleral buckling have been proposed to reduce this risk. This review did not find any strong evidence in the form of prospective randomised controlled trials or case‐control studies to support or refute these prophylactic treatments.

Anti‐vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a vascular disorder of the immature retina that can result in impairment of vision and even blindness in preterm infants. It is treated primarily by ablation of the avascular retina, the removal of the part of the retina without any blood vessels by cryotherapy or laser therapy. Though these treatments result in a significant improvement in long‐term outcomes, the results are far from perfect. In addition, they cause permanent loss of the peripheral visual field. Recently, studies have been done to evaluate the use of anti‐VEGF agents to treat ROP. These agents inhibit the action of vascular endothelial growth factor (VEGF), a key regulator of new vessel formation in foetal life. Animal studies had shown significant reduction in the neovascular response following injection of anti‐VEGF antibodies into the vitreous cavity of the eyes ('intravitreal' therapy).

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Summaries for consumers

Interventions for prevention of giant retinal tear in the fellow eye

A giant retinal tear is a full‐thickness retinal break that extends for 90 degrees or more around the circumference of the retina, in the presence of posterior vitreous detachment (when the vitreous comes away from the retina). Giant retinal tears cause visual loss as a result of the associated retinal detachment. They can be difficult to treat due to the large area of retinal involvement and the high risk of re‐detachment following vitreoretinal surgery, often related to the development of proliferative vitreoretinopathy (a scarring process that can happen on the inner or outer surface of the retina and in the vitreous cavity after retinal detachment). As the fellow eye has an increased risk of developing giant retinal tear and retinal detachment, prophylactic 360‐degree treatments with laser photocoagulation, cryotherapy or encircling scleral buckling have been proposed to reduce this risk. This review did not find any strong evidence in the form of prospective randomised controlled trials or case‐control studies to support or refute these prophylactic treatments.

Anti‐vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a vascular disorder of the immature retina that can result in impairment of vision and even blindness in preterm infants. It is treated primarily by ablation of the avascular retina, the removal of the part of the retina without any blood vessels by cryotherapy or laser therapy. Though these treatments result in a significant improvement in long‐term outcomes, the results are far from perfect. In addition, they cause permanent loss of the peripheral visual field. Recently, studies have been done to evaluate the use of anti‐VEGF agents to treat ROP. These agents inhibit the action of vascular endothelial growth factor (VEGF), a key regulator of new vessel formation in foetal life. Animal studies had shown significant reduction in the neovascular response following injection of anti‐VEGF antibodies into the vitreous cavity of the eyes ('intravitreal' therapy).

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