Retinal detachment detected in a routine eye exam.

Case study ( 5445 views as of March 19, 2024 )

David is a 45 year old male who came in for routine eye exam. He had no visual complaints and had laser refractive surgery 4 years previous. Uncorrected vision remains 20/20 and no correction was suggested.

Dilated retinal exam including digital scanning ophthalmonoscopy found a retinal detachment in the mid periphery of the right eye. He was immediately referred to a retinal specialist who completed successful surgery that afternoon.

Not all retinal detachments come with the classic signs of floaters, flashed and veiling of vision. The retina has no pain fibres, so many detachments are asymptomatic.

David will have to continue seeing an optometrist and possibly an Ophthalmologist for routine exams to screen for other eye conditions such as glaucoma, macular degeneration, cataracts and diabetic retinopathy as he ages.

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Conversation based on: Retinal detachment detected in a routine eye exam.

Retinal detachment detected in a routine eye exam.

  • This will imply the need to keep your head in a particular position during the days to weeks after your operation. Many patients when told of the need to keep their head in a particular position ask “How will I do this, doctor?” In order to achieve optimal results with retinal detachment repair, patients will require particular positioning. There are companies that provide and can sell or lease to you equipment that will facilitate your recovery by ensuring that you maintain the position that your surgeon requires for your repair. After pars plana vitrectomy to repair the retinal detachment, there are certain restrictions. In addition to the head position, one cannot be at an elevation of higher than 3,000 feet or airplane travel. These are strict restrictions as the gas bubble that is in your eye will expand and cause pressure problems if one does not heed these restrictions.
  • This will imply the need to keep your head in a particular position during the days to weeks after your operation. Many patients when told of the need to keep their head in a particular position ask “How will I do this, doctor?” In order to achieve optimal results with retinal detachment repair, patients will require particular positioning. There are companies that provide and can sell or lease to you equipment that will facilitate your recovery by ensuring that you maintain the position that your surgeon requires for your repair. After pars plana vitrectomy to repair the retinal detachment, there are certain restrictions. In addition to the head position, one cannot be at an elevation of higher than 3,000 feet or airplane travel. These are strict restrictions as the gas bubble that is in your eye will expand and cause pressure problems if one does not heed these restrictions.
  • I would be interested to know about this ?
    • Many patients understandably wonder how they'll manage this requirement post-operation. Fortunately, there are specialized companies that offer equipment to assist patients in maintaining the necessary positioning recommended by their surgeon. These companies typically provide equipment such as adjustable beds, reclining chairs, or positioning aids specifically designed to support the head and body in the required position for post-operative recovery. Patients can either purchase or lease this equipment, depending on their preferences and financial circumstances. By utilizing such equipment, patients can ensure that they adhere to their surgeon's instructions regarding head positioning, which is essential for the success of the retinal detachment repair procedure, particularly after pars plana vitrectomy. This proactive approach can significantly contribute to a smoother recovery process and better long-term outcomes for patients undergoing retinal detachment repair.
  • I would be interested to know about this ?
    • Recovery from pars plana vitrectomy indeed often involves maintaining a specific head position, as directed by the patient's surgeon. The exact positioning required can vary depending on factors such as the location of retinal tears or breaks addressed during the surgery. In some cases, patients may need to position one side of their head downward, while in others, strict facedown positioning may be necessary. During vitrectomy, different gases may be used to help reattach the retina. The choice of gas can affect how long the patient needs to maintain a certain head position and may also impact restrictions such as air travel. Gases used in vitrectomy have varying durations of action, and patients will typically be advised by their surgeon on the specific instructions for post-operative care based on the type of gas used and the location of retinal tears. While the success rates for retinal detachment repair procedures such as pneumatic retinopexy, scleral buckle, and vitrectomy can be high, ranging from 80 to 90 percent, there is still a risk of recurrence. Patients should be aware of the potential symptoms of recurrent detachment, such as sudden onset of flashes, floaters, or vision changes, and seek prompt attention from their retinal surgeon if they experience any such symptoms. Recurrent detachment may require additional procedures or interventions to address, and close monitoring by an ophthalmologist is essential for managing the condition effectively.
    • Retinal detachments can indeed be repaired using three main procedures: Pneumatic retinopexy: In this procedure, the surgeon injects a bubble of gas into the eye to push the detached retina back into place. The surgeon then treats the retinal tear with cryotherapy (freezing) or laser therapy. This method is often suitable for certain types of detachments and tears. Scleral buckle surgery: This procedure involves placing a silicone band (scleral buckle) around the eye, which indents the eye wall. By doing so, it relieves traction on the retinal tear and allows the retina to reattach. Scleral buckle surgery is typically performed in an operating room setting. Vitrectomy: Vitrectomy is the most common method for repairing retinal detachments. During this procedure, the surgeon enters the eye with specialized instruments including an infusion line, light source, and a vitrector (cutting device). The vitreous gel inside the eye, which may be pulling on the retina and causing detachment, is removed. This allows the surgeon to access and repair any retinal tears, and sometimes additional procedures like membrane peeling or gas or oil injection may be performed to aid in reattachment of the retina. Each of these procedures has its indications and potential risks, and the choice of which method to use depends on factors such as the type and severity of the retinal detachment, as well as the patient's overall eye health and medical history. Your ophthalmologist will determine the most appropriate treatment approach based on your individual circumstances.
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