Most retinal detachments do not require emergency surgery. I operated this Saturday morning, however, to repair a retinal detachment for a patient who should not wait through the weekend for the operation. In this case it was an “emergency.”
First Symptom of Retinal Detachment
Often, as with my patient (RR), there is a history of flashes and/or floaters preceding eventual loss of vision. RR had some vague symptoms over the past two weeks, but did not become too concerned until he started to lose some of his peripheral vision.
His central vision was unaffected. He could see well at distance, read and watch TV, but objects located down and to the right in his peripheral vision were missing…and it was getting worse.
“Macula On, Superior Off” Retinal Detachment
There are really only two emergencies faced by a retinal surgeon. Endophthalmitis, or infection inside the eye is the most devastating and is the biggest eye emergency.
A retinal detachment not including the macula, but is in danger of detaching the macula is a relative emergency. Fluid located “above” or “superior to” could shift downward, thus detaching this crucial area and decreasing central vision.
In the diagram, the macula (small brown spot in the center of the picture) is still attached. If the area of retinal detachment were to enlarge, the macula might become affected. Central vision would be lost and permanent visual loss is possible.
Fluid underneath the retina often obeys the laws of physics…and moves with gravity.
The Decision to Operate is Based on Attachment of the Macula
The timing of retinal detachment surgery is basically determined by the state of the macula. There are three possibilities;
- Attached and not likely to detach by waiting.
- Attached yet may detach with waiting.