eye disorders
Retinal Detachment
Treatment of Retinal Detachment
Sealing retinal breaks Scleral buckling Pneumatic retinopexy Vitrectomy Although often localized, retinal detachments due to retinal breaks can expand to involve the entire retina if they are not treated promptly.Any patient with a suspected or established retinal detachment should be examined urgently by an ophthalmologist. If patients have a sudden increase or change in floaters; photopsias; a curtain or veil across the visual field; any sudden, unexplained loss of vision; or if vitreous hemorrhage obscures the retina, arrange for an ophthalmologist to do urgent indirect ophthalmoscopy to diagnose retinal detachment. Rhegmatogenous detachmentis treated with one or more methods, depending on the cause and location of the lesion. These methods involve sealing the retinal breaks by laser or cryotherapy. In scleral buckling, a piece of silicone is placed on the sclera, which indents the sclera and pushes the retina inward, thereby relieving vitreous traction on the retina. During this procedure, fluid may be drained from the subretinal space. Pneumatic retinopexy (intravitreal injection of gas) and vitrectomy are other treatments. Retinal breaks without detachment can be sealed by laser photocoagulation or transconjunctival cryopexy. Nearly all rhegmatogenous detachments can be reattached surgically. Nonrhegmatogenous detachmentsdue to vitreoretinal traction may be treated by vitrectomy; transudative detachments due to uveitis may respond to systemic corticosteroids or systemic immunosuppression (eg,methotrexate,azathioprine, anti-tumor necrosis factor [TNF] drugs). Alternatively, transudative detachments due to uveitis can be treated locally with a periocular corticosteroid injection, intravitreal corticosteroid injection, or an intravitrealdexamethasoneimplant. Primary and metastatic choroidal cancers also require treatment. Choroidal hemangiomas may respond to localized photocoagulation or photodynamic therapy. 