Retinal detachments

‘Time to theatre’ is crucial in successful retinal detachment treatment

Priscilla Lynch

Posted: Thursday, February 1, 2018

Mr Ian Dooley MD

‘Time to theatre’ is crucial in successful retinal detachment treatment, according to Mr Ian Dooley MD, Consultant Ophthalmologist and Vitreoretinal Surgeon, Mater Misericordiae University Hospital, Dublin, who gave the European Society of Ophthalmology (SOE) Lecture 2017 on ‘Retinal Detachment – Past, Present and Future’ at the Irish College of Ophthalmologists 2017 Annual Conference in Cavan, Ireland.

Retinal detachment develops in approximately one-in-10,000 people per year, and scleral buckle surgery/vitrectomy, cryotherapy and laser (photocoagulation) remain mainstays of treatment, he said.

The sooner the patient is treated, the less invasive treatment can be and the better the visual outcome, as patients lose about a line of vision for every three days a retinal detachment remains untreated, Mr Dooley explained. For primary retinal detachments, the reattachment success rate is about 85-to-90%, and in secondary detachments it is about 75%, he said.

The key symptoms for retinal detachment are the ‘four Fs’ – floaters, flashes, foggy vision and visual field loss, he explained. Vitreous haemorrhage is relatively common. More than 60% of spontaneous severe vitreous haemorrhage cases would benefit from early vitrectomy, as there may be an underlying retinal tear, detachment or vascular problem – and pain is quite rare.

The earlier patients seek treatment, the less invasive treatment has to be and the higher the success rate

Retinal detachment is more common in older people (often following posterior vitreous detachment complicated by small tears), those who have high myopia, pseudophakes, those with diabetic retinopathy and those with a family history of the condition. It can also be associated with previous cataract surgery and trauma, therefore taking a good patient history is key to correct diagnosis said Mr Dooley.

In the past 10 years, there have been noteworthy improvements in treatment (small-gauge surgery, better tamponades, stains and viewing systems) and earlier detection of retinal detachment, Mr Dooley stated.

“The earlier patients seek treatment, the less invasive treatment has to be and the higher the success rate, and they are less likely to develop the nastier aspects of retinal detachment, such as proliferative vitreoretinopathy (PVR), re-detachment and permanent loss of vision. It is a very treatable condition and I nearly spend half my time dealing with it, but getting the patient
in quickly is the key,” he told EuroTimes.

Ian Dooley: