Retinal Detachment Treatment & Management
- Author: Gregory L Larkin, MD, MS, MSPH, FACEP; Chief Editor: Robert E O'Connor, MD, MPH more...
Prehospital Care
Protecting the globe in cases of traumatic retinal detachment may be important to prevent extrusion of intraocular contents (ie, uveal tissue), and can be achieved with goggles or a metallic eye shield, if available. It is imperative to avoid pressure on the globe.
Emergency Department Care
ED treatment of retinal detachment consists of evaluating the patient and treating any unstable vital signs, preparing the patient for possible emergency surgery.
The repair technique is dependent on the type, location, and size of the detachment.
- Laser therapy and cryotherapy are ambulatory outpatient procedures.
- Use of intraocular gas (ie, pneumatic retinopexy) to tamponade the detachment can be an outpatient procedure with close follow-up of the intraocular pressure.
- Scleral buckling, in which a silicone band indents the eye to approximate the retina and RPE, is possible as an outpatient procedure. The tear is closed with supplemental cryotherapy or laser.
- Intraocular repair with pars plana vitrectomy may be necessary in complicated tractional and exudative detachments. This procedure once required hospitalization but is now being performed on an outpatient or short-stay basis because of insurance restrictions.
- Inflammatory retinal detachments (RDs) usually are treated medically.
- An important study in 25 European centers comparing scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study) may answer questions as to the better therapy.
A recently conducted study of a large Medicare population showed that scleral buckle patients had far fewer recurrent RDs than patients who underwent retinopexy.[4] This study also showed that patients undergoing pars plana vitrectomy (PPV) had higher rates of complications, but these data must not be misinterpreted. Since these are nonrandomized convenience samples, these results are not definitive; they do not control for differences between treatment groups, surgeons, settings, or important baseline differences between subjects. Nonetheless, scleral buckle approaches emerge as an important consideration in eligible patients and should be subject to further testing in properly controlled randomized trials.
Consultations
- When diagnosed or highly suspected, retinal detachment (RD) requires an emergent ophthalmologic consultation for confirmation and treatment. This is particularly true for RDs that threaten the fovea or central vision.
- Ideally, patients with RD should be referred to a retinal-vitreous specialist as soon as they are suspected. However, immediate retinal-vitreous specialist consultation is not necessary in all cases because many general ophthalmologists are capable of performing indirect ophthalmoscopy and determining the need for further intervention.
- Frequently, time is critical; however, the time frame is hours and not minutes, and many cases do not require emergency surgery. Inflammatory retinal detachments, for example, usually are treated medically. Acute retinal breaks should be surgically repaired within 24 hours if at all possible.
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