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Jumat, 28 Oktober 2011

Retinal Detachment

The definition of Retina

The retina is a tissue (tissue) is very thin wall that separates the inside of the back of the eye. When we look around, the light from objects that let's look into the eyes. The light from the image focused on the retina by the cornea and lens. This light striking the retina causes a complex biochemical changes within layers of the retina and this in turn stimulates an electrical response in the other layers of the retina. Nerve ending in the retina sends signals to the brain via this optic nerve. In typical areas of the brain, electrical energy is processed to allow us to see and understand what we are seeing. The retina has been compared with the film from the camera. However, the film, once used, has a permanent image thereon. The retina is continuously renews itself chemically and electrically, allowing us to see millions of different pictures every day without the buildup of the images.

Retinal size about the size of a postage stamp. He consists of a central area called the macula and retinal circumference (peripheral retina) is much larger. The light receptor cells in the retina there are two types, called rods and cones. Rods allow us to see in the dark. Cones give us sharp eyesight. Peripheral retina allows us to see objects on both sides (peripheral vision) and, therefore, provides the vision necessary for a person to move safely. However, because this part of the retina contains a lesser concentration of cones, it does not allow for the perception of visual detail. Greater concentration of rods provides a better vision in dark conditions.

In contrast, the macula is a smaller, central area of the retina that contains a high concentration of cones. Therefore, it allows clear central vision to see the fine details for activities like reading or threading a needle. Macula is very sensitive to changes in circulation especially that occurs with aging, such as reduced blood flow. The retina contains a network of branching arteries, which supply blood carrying oxygen and nutrients necessary to the retina, and the veins that accompany him, which then carry the blood along with waste products of metabolism of the retina.

Definition of Retinal Detachment

A retinal detachment is a separation of the retina from its underlying tissue within the eye. Most retinal detachments are a result of cracking the retina (retinal break), holes, or tears. Retinal breaks can occur when the vitreous gel pulls loose or separates from its attachment to the retina, usually in the peripheral parts of the retina. The vitreous is a (gel) that fills the clear 2 / 3 inside the eye and occupy the space in front of the retina. When the vitreous gel pulls loose, he sometimes uses the pull on the retina, and if the retina is weak, the retina will tear. Most of the cracks are not a result of retinal injury. Retinal tears are sometimes accompanied by bleeding if retinal blood vessels involved in this tear.

Once a retinal tear, fluid from the vitreous gel can pass through the tears and gathered behind the retina. Buildup of fluid behind the retina is that separates (detaches) the retina from the back of the eye. As more liquid vitreous collects behind the retina, an extension of retinal detachment (retinal detachment) may progress and involve the entire retina, leading to a total release of the retina. A retinal detachment almost always affects only one eye. The second eye, however, must be checked thoroughly for any signs of the factors that influence that could lead to the release in the future.

READ MORE - Retinal Detachment

Cataract surgery increases the risk of Retinal Detachment

Cataract surgery, especially if you have complications, increasing the risk of a retinal detachment. Cataracts are cloudy areas (opacities) are formed on the lens. Following the introduction of extracapsular surgery (extra capsular surgery), a modern method which is now used almost exclusively for the removal of cataracts, the risk of retinal detachment has been further reduced. In extracapsular cataract surgery, part of the lens capsule was left in place so that the vitreous gel is not disrupted. Phacoemulsification is a type of extracapsular cataract surgery using an ultrasonic instrument is very high speed to break up and suck out the foggy lens of the eye. Capsules can be left inside the eye becomes cloudy then, requires the opening of the capsule by using a laser. Opening the capsule increases the risk of retinal detachment.

In intracapsular cataract surgery (intracapsular cataract surgery), the main operating method used from 1965 to 1990, the entire lens is removed. Capsule on the back of the lens, therefore, no longer there to hold the vitreous gel in place. As a consequence, the vitreous gel to move forward, and the retina had an increased withdrawal or appeal to the retina from the vitreous, which resulted in tearing of the retina. Now, if the capsule rupture, which can be a complication of extracapsular cataract surgery time, the vitreous gel in the same way to move forward and pull on the retina. This circuit can lead to a retinal tear and release, especially in the first year after surgery.

Other factors related to with Retinal Detachment

  • Blunt injuries, such as hit a tennis ball or a fist, or a stab wound by a sharp object in the eye can cause retinal detachment.
  • A family history of a release of the retina that naturally does not come from the wound seems to indicate on a genetic predisposition to develop retinal detachments.
  • As much as 5% of patients who experienced the release of the retina in one eye that is not of a wound, a release on the other eye happened afterwards. Therefore, the second eye of patients with a retinal detachment should be examined carefully and strictly followed, by both patients and ophthalmologists (ophthalmologist).
  • Diabetes can cause retinal detachment caused by traction on the retina itself, without a tear. Because the abnormal blood vessels and scar tissue on the surface of the retina in some patients with diabetes, the retina can be lifted (detached) from the back of the eye. In addition, blood vessels may bleed into the vitreous gel. This release may involve the edge of the area or areas of the central retina.
READ MORE - Cataract surgery increases the risk of Retinal Detachment

Selasa, 18 Oktober 2011

Signs and Symptoms of a Retinal Detachment

Flash of lights and floaters may be early symptoms of a retinal detachment or tear of the retina (retinal tear), which precedes the release (detachment) itself. Anyone who begins experiencing these symptoms should go to the eye doctor (ophthalmologist) for an examination of the retina. On examination, eye drops are used to widen the patient's pupil to facilitate a more detailed examination. Symptoms of flashes of light-light and floaters can be often associated with a tear or release and may result solely from an order of a separation of the vitreous (vitreous gel) of the retina. This condition is called a posterior vitreous detachment (PVD). Although a PVD occurs commonly, there are no tears are associated with these conditions in most of the time.

Flashing lights (flashing lights) is caused by the vitreous gel pulls on the retina or a respite from the vitreous, vitreous gel that allows crashing on the retina. Lights are often described as lightning trajectories short on the outer edges (periphery) of the eye. Floaters are caused by condensation (small freeze) in the vitreous gel and are often described by patients as spots, strands, or little flies. Some patients even want to use a fly swatter to eliminate these annoying floaters. No treatment is safe to remove floaters. Floaters are usually not associated with retinal tears.

If the patient has a shadow or curtain that affects any part of a vision, it can indicate that a retinal tear has progressed to a release of the retina. In this situation, should immediately consult a doctor because it could become a critical eye. Purpose to an ophthalmologist is to make a diagnosis and treat retinal tears before the middle area of ​​the macula of the retina detached.

Risk Factors Developing a Retinal Detachment

Studies have shown that the incidence of the release of the retina (retinal detachments) caused by tears in the retina is quite low, affecting approximately one in 10,000 people every year. Many retinal tears do not continue on the release of the retina (retinal detachment). Nevertheless, many risk factors for developing retinal detachments identified, including certain diseases of the eye, cataract surgery, and injury to the eye. Retinal detachments can occur at any age. The most commonly occurs in young adults (ages 25 to 50 years), patients with myopia and older people after cataract surgery.


 

READ MORE - Signs and Symptoms of a Retinal Detachment

Senin, 17 Oktober 2011

Retina and vitreous

OPERATION VITREO RETINAL
to meet the needs of technological advances in eye care, as well as the needs of those cases requiring vitreoretinal surgery is happening in society is increasing.
Understanding of vitreoretinal surgery is eye surgery to cope with retinal disorders (eye nerve membranes) or vitreous (clear tissue that fills the form to the eyeball). This operation is done, among others, on:

  1. Ablatio Retinae (retinal detachment)
    Retinal detachments are generally caused by a tear in the retina as a result: congenital factors, collision, etc.. Retinal detachment can cause blindness if the retina is attached to back in a relatively short time.
  2. Macular Pucker
    The macula is part of the retina used for reading and fine vision. In these patients, connective tissue grows on the surface of the macula that causes wrinkling the macula.
  3. Diabetic Retinopathy
    Is a disease of the retina caused by diabetes mellitus (diabetes). In the initial phase, diabetic retinopathy can be treated with laser alone, in advanced cases surgery is sometimes necessary vitrektomi to clean up the cloudy vitreous hemorrhage caused by, or for peeling the connective tissue on the surface of the retina.
  4. Infections of the eyeball (endophthalmitis)
    Bacterial infections that enter into the cavity of the eyeball are very dangerous for the vision and require quick handling.
  5. Eye trauma (collisions or injuries to the eyeball)
    In case of eye trauma in which the vitreous hemorrhage or retinal detachment surgery may be required vitrektomi to cleanse the blood and re-attach the retina.

Objectives vitreoretinal surgery:

  • Re-attach the retina loose and peeling the connective tissue on the surface of the retina
  • Clean up the cloudy vitreous hemorrhage or infection
  • Allows the laser action in the retina that were previously blocked by blood or connective tissue

Type of Operation

  • Pneumoretinopeksi: a short operation to re-attach a loose retina (retinal detachment).
  • Scleral buckling: Surgery to re-attach the retina loose.
  • Vitrektomi: This operation requires a special tool, the surgeon will perform surgery within the cavity of the eye balls to clear a cloudy vitreous, embedding re-experiencing vitreous detachment, peeling the connective tissue from the surface of the retina, and other measures are necessary.


 

The success:
Sharp eyesight after vitreoretinal surgery depends on many things, among others:

  • Retina detachments: sharper vision after surgery depends on the state of retinal detachments macula before surgery.
  • Diabetic retinopathy: Improved vitrektomi sharp vision after surgery for diabetic retinopathy depends on:
  1. State of the macula and optic nerve prior to surgery
  2. history of prior laser surgery
  3. general state of the patient
  4. and success in maintaining blood sugar levels within normal limits after surgery
  5. Vitrektomi successful operation for diabetic retinopathy was higher in patients who have undergone prior surgery and lasers enough in patients with good blood sugar control.


 

Complication
A frequent complication after general anesthesia is nausea and vomiting.

Complications due to surgery:
Complications can occur in all operations including vitreoretinal surgery. Operations will only be done if previously thought that the risk of complications from surgery is small compared with the possible rescue of vision if the operation succeeded.

Examples of complications that may occur after vitreoretinal surgery:

  • infection
  • bleeding
  • New retinal detachments, as a complication of surgery
  • Glaucoma
  • cataract
READ MORE - Retina and vitreous

Ablatio retinae can affect anyone

Release of the retina can attack one of 10,000 people every year in the United States. This incident is a serious eye problems and can occur at any age, although it usually occurs in middle age or older. This incident is more likely in people who suffer from nearsightedness (myopia) or minus glasses and in people who are members of their family who have experienced loss of retinal retina.Lepasnya can also occur due to hit hard. In addition, although somewhat rare, this condition is a hereditary disease and even occur in infants and children. If no action is taken soon, the release of the retina will result in defective vision or blindness. The retina is a thin, transparent tissue that is sensitive to light, which consists of cells and nerve fibers. The retina lines the inner wall of the eye like wallpaper lining the walls of the house. The retina functions like film in the camera image: light passing through the lens to be focused onto the retina. Cells of the retina that is sensitive to capture the "image" and channel it to the brain via the optic nerve.

The loss causes and symptoms of Retina

Most of the release of the retina are the result of one or more small tears or holes in the retina. Sometimes the normalpun aging process can cause the retina to be thinner and less healthy, but more often lead to damage and tear in the retina is the shrinking of the corpus vitreum, clear materials such as jelly that fills the center of the eye. Corpus vitreum is closely attached to the retina at several locations around the back of the eye wall. When the corpus vitreum shrunk, he can pull some of the retina with him, causing a tear or hole in the retina. Although some types of shrinkage of the corpus vitreum are some things that normally happen to increasing age and usually does not cause damage to the retina, corpus vitreum can also shrink the eyeball which grew into a huge (sometimes this is a result of nearsightedness), by inflammation , or because of trauma. In most cases the new retina loose after a major change in the structure of the corpus vitreum. If the existing retinal tears are watery fluids such as water can enter from the corpus vitreum kelubang in the retina and can flow between the retina and the back wall. This fluid will separate the retina from the back wall of the eye and cause the retina loose. Retinas part will not function properly and in the area arising blurred vision or blind areas.


 

Keep in mind that there is some kind of release of the retina caused by other eye diseases, such as tumors, inflammation, severe or as a complication of diabetes. This is called secondary retinal detachments. In this case found no rips or holes in the retina and retinal position could only return to normal with treatment of retinal diseases that lead to the release. Those middle-aged and older sometimes see floating black spots and flashes of light. This situation is usually more rarely found in children or young adults. In most cases these complaints do not indicate a serious problem. But in some of the eye spots and flashes of light that appears suddenly may show shrinkage of the corpus vitreum enough to cause tears diretina. To determine whether there are retinal tears the ophthalmologist should examine the inside of the eye and do a thorough eye examination. These audits should be performed immediately after the complaint was found, because it is still new retinal tears may still be treated without surgery and long before he developed into a more severe retinal loose. Some release of the retina may occur without any black spots or flashes of the real. In this case the patient may realize their vision as a wavy or watery vision or on the edge there is a black shadow. Developments off the retina that will further blur the vision in one eye severe retinal loose unless it is repaired. There are some retinal detachments that occur suddenly and the patient tibaa totally blind in one eye with a sudden. Rapidly emerging vision defects such as these can also be caused by bleeding into the corpus vitreum when retinal tear.


 

The discovery and diagnostics

Retina can not be seen separated from the outer eye. Therefore, if there are complaints like the above, the patient should immediately went to the ophthalmologist. The doctor will thoroughly examine the retina and the inner eye with an instrument called ophthalmoscope. With bright light and magnification of these tools, physicians can determine the location of the retina that are torn or weak areas that need improvement in treatment. Specific diagnostic tools that may need to be used is a special contact lenses, microscopes, and examination ultrasonograpi (USG)

therapy

If the retinal tear but not out, then the escape of the retina that can be prevented by immediate action. When the retina has separated the retina that should be fixed with surgery by an ophthalmologist. Successful re-attachment of the retina, consisting of the attachment of retinal tears and retinal are not interested in prevention in order to escape again. There are several surgical procedures that can be used. The procedures selected depend on the severity of the retina loose and consideration of a doctor.

Laser photocoagulation: If found small tears in the retina with little or no escape of the retina, then this can be glued together again tear with a laser beam. The laser will place burns-minor burns around the edge of tears. This burn will cause scar tissue that binds the edge of the tear and prevent fluid passing and gathered beneath the retina. Ophthalmology laser surgery is now usually performed as an act in ambulatory patients and do not require surgical incisions.

Freezing (kriopeksi): Freeze the rear wall of the eye located behind the retina tears, it can stimulate the formation of scar tissue and glue the edge of the retinal tears with the back wall bolamata. Freezing is usually done with outpatient procedure but requires local anesthesia on the eye.


 

Surgical action: If enough fluid has accumulated under the retina and separates the retina with the back of the eye, it would require a more complicated surgery to treat retinal loose it. Technique of operation vary, depending on the extent of the retina's layers. Technique of operation vary, depending on the extent of the loose layer of the retina and damage done, but all are designed to determine the wall of the eye retina kelubang, holding that the two networks that remain attached until the scar tissue attach more tears. Sometimes the fluid must be removed from under the retina to allow the retina back against the back wall of the eye. Often a silicone band or pressure pad placed outside the eye to gently push the wall of the eye onto the retina. In this operation done also acts to create scar tissue that will glue a torn retina, for example by freezing, by laser or with heat diathermy (electric current are injected with a needle).


 

In more complex retinal detachments may be required technique called vitrektomi. In this operation the corpus vitreum is released from the fibers of connective tissue in the retina, and the shrinking of the corpus vitreum of the eye removed. In some cases if the retina itself is very wrinkled and shrunk the retina may be pushed to the wall of the eye for a while to fill the cavity that had contained the corpus vitreum with air or gas. More than 90% loss of the retina can be reattached with surgical techniques modern eyes. Sometimes it takes more than one operation. When the retina successfully reattached eyes will get back as a function of vision and blindness can be prevented. But how far vision can be restored within six months after successful surgery will depend on a number of general visual function faktor.Pada will be fewer restored when the retina has been detached or appear long enough tissue growth on the surface of the retina.


 

Forty percent of the successful escape of the retina reattached will be able to produce good vision. Moderate remaining cases are still getting enough vision to read and or walk in various degrees. Unfortunately corpus vitreum that continues to shrink and the emergence of growth on the surface layer of retina, not all retinas can be reattached. If the retina can not be reattached, the eye will continue to decline and eventually went blind eyesight. The surgery can be performed either with local anesthetic or general anesthetic, depending on the health of patients and the estimated time required to re merakatkan retina. Rarely need to restrain retinal detachments not to move in the long run before or after surgery. But patients who require an injection of air or gas must mempertankan certain head positions until a few days after the operation. Patients with a simple release of the retina usually allow people to walk on the day after surgery and were discharged from hospital a few days. Usually after coming home from the hospital so that it takes is an ointment and eye drops. Sometimes needed glasses or contact lenses after surgery if the retina was necessary vision correction.


 

Who treating retinal detachments?

Competent ophthalmologists treat retinal detachments. An ophthalmologist is a physician who has been educated, trained and licensed to provide comprehensive eye care, which includes measures of medical eye examinations, prescription eye make corrections, diagnose various diseases and disorders of the eye, as well as medical procedures and operations to determine appropriate and necessary for treatment. There is also a pediatric ophthalmologist who received additional training in caring for and treating diseases of the corpus vitreum and retina, including retinal detachments. Patients with symptoms of retinal release needs to be addressed by a doctor who will thoroughly examine the inner eye and advise the necessary treatment. People who suffer from nearsightedness (myopia) with high minus glasses or whose family members had experienced retinal detachments, should have periodic eye examinations to the doctor so that changes in the corpus vitreum can be detected as early as possible, so that in addition to diagnosis, doctors can prevent the release of the retina probably will happen.

READ MORE - Ablatio retinae can affect anyone

ABLATIO RETINAE

Ablatio retina is a state of loss of sensory retina from the retinal pigment epithelium (RIDE). This situation is a serious eye problems and can occur at any age, though usually occurs in middle age or older.

Retinal ablatio retinas are more likely to occur in people who suffer from nearsightedness (myopia) and in people who have family members who have had retinal ablatio retinas. Retinal ablatio retinas can also be caused by other eye diseases, such as tumors, severe inflammation, caused by trauma or as a complication of diabetes. If no action is taken promptly, retinal ablatio retinas can lead to defects of vision or blindness that persisted. The retina is a thin, transparent tissue that is sensitive to light, which consists of cells and nerve fibers. The retina lines the inner wall of the eye, acts like film in the camera image, the light will be focused through a lens onto the retina. Retinal cells are sensitive to light is what captures the "image" and channel it to the brain via the optic nerve.


 

Cause :


 

Most retinal ablatio retinas are the result of one or more tears or holes in the retina, known as retinal ablatio retinas regmatogen (Rhegmatogenous Retinal Ablatio retina). Sometimes the normal aging process can cause the retina to be thinner and less healthy, but more often lead to damage and tear in the retina is the shrinking of the corpus vitreum, clear materials such as jelly that fills the center of the ball mata.Korpus vitreum firmly attached to the some locations. When the corpus vitreum shrunk, he can pull some of the retina is attached in place, causing a tear or hole in the corpus vitreum retina.Beberapa type of shrinkage is a normal thing happening in the elderly and usually does not cause damage to the retina. Corpus vitreum can also shrink the eyeball which grew into a huge (sometimes this is a result of nearsightedness), by inflammation, or due to trauma. In most cases the new retina loose after a major change in the structure of the corpus vitreum.Bila existing retinal tears, fluid from the corpus vitreum can get into the hole in the retina and can flow between the layers of the sensory retina and retinal pigment epithelium. This fluid will fill the potential gap between the two layers above the retina, resulting in loose. Retinas part will not function properly and in the area or areas arising blurred vision buta.Bentuk other retinal ablatio retinas namely traction retinal ablatio retinas (Traction Retinal Ablatio retina) and exudative retinal ablatio retinas (Exudative Retinal Ablatio retina) generally occur secondary to other diseases. Traction retinal ablatio retinas caused by scar tissue (fibrosis) are attached to the retina. Contraction of the scar tissue may pull the retina, causing retinal ablatio retinas. Exudative retinal ablatio retinas can occur because of damage to the retinal pigment epithelium (the normal state of functioning as an outer barrier), because of the increased permeability of blood vessel walls by various causes, or accumulation of fluid that occurs in the inflammatory process.


 


 

Symptom :

Symptoms are often complained of the patient are:

Floaters (floating object visibility). which occurs because of the turbidity in the vitreous by the presence of blood, pigment degeneration of the retina or the vitreous separated itself. Photopsia / Light flashes (flashes of light). in the absence of light sources in the vicinity, which generally occurs when the eye is moved in the dim light or in darkness. Sharp decline in vision. patients complained of his eyesight partially closed curtains as more and more widespread. In a state that has been advanced, can decrease the weight of sharp vision.
There is a kind of parabolic thin curtain that rises slowly from the start the bottom of the eyeball and eventually close the view.


 

Diagnosis

To determine whether there are retinal detachments then the ophthalmologist will perform a thorough eye examination, especially the inside of the eye. Several checks are performed to determine the integrity of the retina:

Direct and indirect ophthalmoscopy
sharpness of vision
refraction test
Pupillary reflex response
Impaired color recognition
Slit lamp examination
intraocular pressure
ultrasound eye
fluorescence angiography
Elektroretinogram.


 

Treatment


 

  • Operation

    Various kinds of engineering operations, depending on the extent of the loose layer of the retina and damage done, but all designed to get closer to the hole wall of the eye retina, holding that the two networks that remain attached until the scar tissue is formed and attach more tears. Sometimes the fluid must be removed from under the retina to allow the retina back against the back wall of the eye. Often a silicone band or pressure pad placed on the outer wall of the eye to gently push the back wall of the eye onto the retina. In this operation done also acts to create scar tissue that will glue a torn retina, for example by freezing, by laser or with heat diathermy (electrical flow with a needle is inserted). In more complex retinal ablatio retinas may be required technique called vitrektomi. In this operation the corpus vitreum and connective tissue in the retina of the eye that contract issued. In some cases if the retina itself is very wrinkled and shrunk the retina may be pushed to the wall of the eye for a while to fill the cavity that had contained the corpus vitreum with air, gas or silicone oil. More than 90% loss of the retina can be reattached with surgical techniques modern eyes, although sometimes it takes more and one-time operation.

  • Prognosis

    When the retina successfully reattached eyes will regain some function of vision and total blindness can be prevented. But how far vision can be restored within six months after surgery depends on several factors. In general visual function will recover if fewer retinal ablatio retinas have been long enough or appear on the surface of the retinal tissue growth.

    Corpus vitreum that continues to shrink and the emergence of tissue growth on the surface of the retina, not all retinas can be reattached. If the retina can not be reattached, the eye will continue to decline and eventually went blind eyesight.


 

Prevention

  • Use protective glasses to prevent trauma to the eye.
  • Diabetics should control blood sugar levels closely.

If you have a risk of suffering from retinal ablatio retinas, eye check at least once a year.

READ MORE - ABLATIO RETINAE