Retinal detachment is the separation of the neuroepithelial layer and pigment epithelial layer of the retina. There is a potential gap between the two layers, and after detachment, the gap increases and the supply of nutrients to the optic cells becomes impaired. If not reset in time, the entire neuroepithelial layer will atrophy and degeneration, resulting in irreversible damage to visual function.
Retinal detachment is divided into three categories according to the cause: pore origin, exudative and pulling.
Pore-derived.
That is, lacunar, which refers to retinal detachment caused by primary retinal lacunae. Retinal degeneration and vitreous traction are the basis for the formation of retinal lacunae. The peripheral part of the retina and the macula have less blood supply and are relatively susceptible to retinal degeneration. Once a retinal fissure is formed, liquefied vitreous thus enters the subretinal space, and when the incoming fluid exceeds the pigment epithelium’s ability to transport it backward, fluid gradually accumulates and eventually retinal detachment occurs.
Exudative.
Due to inflammation caused by choroidal exudate or leakage of fluid through the bruch membrane and pigment epithelium separating the neuroepithelium from the pigment epithelium, the detachment is mostly located in the lower fundus due to the gravitational effect of fluid, forming a hemispherical bulge without a fissure.
Pulling:
The detachment is usually seen in proliferative vitreoretinopathy, diabetic retinopathy, retinal perivasculitis, central retinal vein obstruction, ocular trauma, etc. After the accumulation of blood in the vitreous, the hemorrhagic degeneration and inflammatory reaction form the mechanized membrane or cords, which strongly pull on the retina, leading to retinal detachment.
Clinical manifestations
1.Flying mosquitoes and flashes of light: the earliest appearance. It is actually a symptom of posterior vitreous detachment. Middle-aged and elderly people, especially highly myopic patients, should be alerted to the possibility of retinal detachment when a large number of flying mosquitoes and persistent flashes in a certain direction suddenly appear.
2, central vision loss: when the peripheral part of the initial detachment, there is no effect on the central vision or very little effect. If the posterior pole retinal detachment occurs, the central visual acuity will drop sharply.
3.Visual distortion: When the peripheral retinal detachment spreads to the posterior pole or shallow detachment occurs in the posterior pole, in addition to the decrease of central vision, there is also visual distortion.
4. Visual field defects: When retinal detachment occurs, some sensitive patients may find visual field defects in one quadrant.
surgical treatment of retinal detachment with retraction and fissure.
The surgical modalities are as follows.
1.Extra-scleral condensation, fluid release, pad pressure, ring ligation . Advantages: simple operation, and the retina can be restored after failure, only for relatively simple retinal detachment.
2, vitrectomy, retinal repositioning surgery, postoperative inflation or silicone oil. The operation is complicated and can be used for all retinal detachments.
Pre-operative and post-operative precautions.
Patients with retinal detachment need to rest in bed before surgery, wrap both eyes and choose different positions according to the location of the fissure to avoid increasing the scope of detachment and to facilitate the preoperative search for the fissure and the choice of surgery.
Most people adopt a prone position, keeping the face parallel to the ground to facilitate retinal repositioning; avoid shaking to avoid affecting the effect of surgery.
During the rehabilitation period, in addition to using medications on time as prescribed by the doctor, eat nutritious and easily digestible food; eat more fruits and vegetables to prevent constipation; wine, irritating and hard foods should not be eaten; avoid sewage flowing into the eye when washing hair; exercise in moderation, do not overexert yourself, do not dive or dive, and avoid carrying heavy objects.
Follow up regularly as prescribed by the doctor.