I am giving the following information to provide my patient and his family members the basic facts in relation to an eye disease. In ophthalmological practice, which includes both medical and surgicaltreatment, there are great differences in these eye diseases from one patient to another. There are also variations in the accepted ophthalmological techniques for the assessment and treatment of ocular diseases. The following material must be seen only as a general introduction to the topic. Remember that you may ask your questions regarding diagnosis, treatment and everything referring to your illness in all confidence; I will be very happy to give you a solution for your enge.

An explanation of retinal detachment
The retina is a thin membrane covering the interior of the eye.
It adheres to the internal surface of the ocular globe and plays a role similar to that of film in a camera. When the light enters the eye, it passes through the cornea and the crystalline lens focuses it on the retina. The retina transforms the luminous energy into visual impressions and transmits the information to the brain through the optic nerve. In order to function well, the retina must receive nutrition from the choroids, the layer behind it. In retinal detachment, this membrane is separated from the choroids and floats in the vitreous, located in the centre of the eye. Due to its separation from the choroids, it no longer functions, and when the entire retina is separated, the eye becomes blind.

Causes and symptoms
The greater part of retinal detachments are caused by tear or a hole in the retina itself. Some of the liquids that fill the interior of the eye pass through this hole and detach the retina, producing its separation from the choroids. Not all tears or holes end up in retinal detachment.
Apart from a tear, generally there is traction between the retina due to bands made of the gelatinous material that we call the vitreous, which fill up the greater part of the ocular cavity, and the traction itself may be the cause responsible for the tear and/or retinal detachment. This mechanical stretching of the retina may cause the eye to perceive flashes of light.

The borders of the tear may bleed, producing shadows on the retina that cause the sight of floating particles.
As the retina detaches, it may produce the feeling of a dark curtain that covers a part of the visual field.

Generally, a retinal detachment is due to a combination of factors.
The vitreous, which fills up the greater part of the volume of the eye, tends to shrink with age; if a cataract has been extracted, this retraction of the vitreous accelerates. If the retina is thin because of age, high myopia, traumatism, or hereditary reasons, the traction of the shrinking vitreous may cause a tear, which in turn may advance to produce retinal detachment.

Surgery
To cure retinal detachment, tears or holes must be closed to avoid the passage of liquids below the retina.
Since this membrane is extremely thin and delicate, retinal tears are impossible to suture and close directly.
The reapplication of the retina depends on the indirect closing of the hole by producing a depression or fold of the external layer of the eye in that place. Generally the depressions are created suturing small parts of plastic (silicon) on the surface of the eye over the region of the retinal hole. A slight inflammation is produced with cautery, intense cold, or photocoagulation, such that the retina adheres to the scleral depression and the hole is permanently sealed.
The liquid under the retina is evacuated by making a small aperture in the outer layer of the eye. Sometimes it is necessary to inject saline solution, air, or any other element such as special gases or liquid silicon into the eye in order to flatten the retina. These procedures are effective in over 90 % of the enges; nonetheless if the macula (the part of the retina in charge of fine central vision) has been detached, it may not be possible to recover sufficient eyesight to read, despite the perfect reapplication of the retina.

This situation may occur because the cells in charge of central vision suffer more owing to detachment and it is possible they do not recover as well as the cells of the peripheral retina. If the surgery is done immediately after the symptoms begin, eyesight totally recovers. If the surgery is done a long time (months or years) after the onset of the symptoms, or it is necessary to undertake various surgical procedures, it is probable that eyesight partially recovers.

Laser and photocoagulation
Light rays have been used to treat retinal diseases for many years; currently we have the laser and other types of photocoagulators. They may be used in the preventive treatment of retinal tears before a detachment develops; in the direct treatment of limited retinal detachment, or in combination with other techniques.

Cryotherapy
Therapy using cold (cryo) or freezing is another modality in the treatment of retinal tears. Cryotherapy results in the scarification of the area of the tear, thus preventing retinal detachment. This treatment is used alone or in combination with scleral depression procedures. It is used in enges where treatment with laser cannot be adequately applied.

Vitrectomy
When there is a scarification or a haemorrhage, the retina may be stretched inward and detached from its normal position.
Vitrectomy may be used in combination with other procedures for retinal surgery, but it is generally reserved for patients who cannot be treated by conventional methods. Vitrectomy is used to extract the diseased, opaque or bloodstained vitreous. Small instruments (microsurgery) are introduced into the eye through small lateral openings. The diseased vitreous is extracted from the eye and replaced with liquid or gas. With this technique, it is possible to reapply many retinas that would have been impossible to operate on before. If it is necessary to inject air or gas into the eye, the patient is kept in special postures for some days after the operation, to permit the bubble to push the retina and remain in the adequate position. This gas is generally spontaneously reabsorbed.

Complications
The plastic materials used in retinal surgery are left there permanently and are covered by the ocular tissues that make them invisible in the large number of enges. On rare ocengions, these materials may erode towards the exterior through the tissues covering them and cause discomfort. In other enges, external infections resulting from the plastic implants may arise sooner or later. In any enge, the plastic materials may be extracted without risk before they produce serious harm. Thus, patients who have had surgery due to retinal detachment must undergo a periodic ophthalmological checkup with the frequency I indicate. Infection in the interior of the eye, although rare, may occur, and if treated in time it is possible to save something of the eyesight, including the eye itself. Haemorrhages inside the eye that would probably diminish visual expectations could also arise.

As it is usually necessary to work below the muscles that move the eye, some disorder in the eye movements could occur after surgery, resulting in double vision even after a successful retinal reapplication, due to the passing weakness of the muscles. Generally, this problem disappears spontaneously. Except for some types of patients to whom I decide to give general anaesthesia, majority of my operations are done under regional and local anaesthesia, with minimum anaesthetic risk to the majority of my patients – generally acceptable in view of the seriousness of loss of eyesight.