What is Retinal Detachment?
The retina is a thin, delicate tissue lining the inside back wall of the eye, essential for vision. It captures light and converts it into signals sent to the brain. Retinal detachment occurs when layers of the retina separate, which can lead to blindness if not addressed promptly.
Retinal Detachment: Causes
Causes include developmental issues, inflammation within the eye (such as uveitis or chorioretinitis), glaucoma, cataracts, trauma, eye tumours, infections, and cardiovascular diseases.
Types of Retinal Detachment
- Rhegmatogenous Detachment: Usually occurs due to a tear or hole in the retina, allowing fluid from the vitreous (the gel-like substance filling the eye) to move beneath the retina, increasing detachment.
- Traction Detachment: Caused by the vitreous pulling forward on the retina, causing separation.
- Exudative (Bullous) Detachment: Fluid accumulates beneath the retina without a tear. This type may respond well to steroid treatment.
- Traumatic Detachment: Results from severe injury to the head or eye, often accompanied by bleeding within the eye.
Detachments can be focal (small area), multifocal (several areas), or total (complete).
Signs of Retinal Detachment
Retinal detachment often leads to blindness. Partial detachments may initially cause subtle vision changes that aren’t easily noticeable, as pets often adapt well until detachment becomes severe. Other signs, such as bleeding, redness, or cloudiness in the eye, may indicate an underlying eye condition.
Diagnosing Retinal Detachment in dogs
A thorough examination of the back of the eye (fundus) by an ophthalmologist is essential. Specialist equipment is typically required for a clear view. If cloudiness or other issues prevent direct observation, additional imaging such as an ocular ultrasound may be recommended.
Retinal Detachment Treatment options
Treatment depends on the underlying cause and severity of detachment. In cases of bullous retinal detachment, addressing the primary condition or using anti-inflammatory medications can help the retina reattach and restore vision. In cases of rhegmatogenous retinal detachment, where the retina has been completely detached from its normal position, surgical treatment is necessary. In certain cases where the problem is recognised early, surgery can significantly improve or restore vision. Our clinic is among the few centres nationwide offering this advanced procedure. If your pet has retinal detachment, a specialist ophthalmic examination is recommended to evaluate suitability for surgery.
Pre-operative considerations
Before we consider your pet as a candidate for the surgery, we need to be able to examine them thoroughly and they have to be amenable to allow the application of eye drops at home. Aggressive patients who can’t be handled by their owners are not good candidates for the procedure, as the inability to apply drops can increase the complication rate post-operatively. Depending on if your pet is suffering from additional eye problems, such as cataract, additional tests may need to be performed (i.e., an ultrasound scan of the eye to assess the retina). This can be performed during your appointment with one of our ophthalmologists. Retinal re-attachment surgeries are lengthy procedures and require a significant time under anaesthesia. For that reason, a health screening is recommended prior to the procedure, including a comprehensive blood test, which is included in our prices. Other conditions that have to be addressed in some cases include bad dental hygiene (a dental procedure might be required prior to surgery), a heart scan or underlying inflammation/infections (i.e., urinary tract infections, skin infections etc).
Surgical repair and prognosis for vision
The surgical procedure usually can take between 1 to 3 hours for each eye that is operated. The success rate of the procedure assesses two main outcomes:
1. The ability to place the retina back to its normal position (this is called restoration of the normal anatomical position)
2. The ability of the retina to function following its repositioning. The retina is a very fragile structure that has high demands for nutrition. These nutrients are provided by the structures that are, in normal conditions in direct contact with the retina. Whenever the retina is detached for a prolonged period, the lack of nutrients can lead to its degeneration and even if its position is restored, vision might not be restored in some cases.
Complications of retinal re-attachment surgery
Retinal surgery has a wide range of complications. These can be minor complications which will be addressed with topical eye drops, oral medications or injections into the eye; however, severe complications may lead to recurrent blindness and pain. Most of the complications are summarised below:
Inflammation develops in all cases after intraocular surgery and is managed with topical drops, oral anti-inflammatories or, when necessary, injection of drugs into the eye.
Infection, although a very rare complication, can occur after surgery and can require adjustment of the antibiotic cover used for your pet.
Glaucoma is the medical term used for increased pressure in the eye. This complication is sight threatening and can lead not only to blindness but also pain. Part of the routine, post-operative checks involve measurement of the pressure after the surgery to ensure this is normal.
Repeat detachment following surgery can be seen in some cases where the retina has either not adhered properly to its normal position at the back of the eye and fluid or fluid substances (like oil) move under the retina and cause detachment. In addition, membranes can be formed over the retina (epiretinal membranes) which can lead to repeat detachment or tearing of the retina
Migration of oil. Retinal re-attachment surgery requires, in most cases, the injection of oil material to the back part of the eye (the posterior segment). This replaces the fluid removed during the surgery (vitreous) and aims to maintain the position of the retina. In some cases, the oil can move either to the front chamber of the eye or under the conjunctiva (the pink part of the eye) and can lead to irritation. In some cases, surgical removal of the oil is required
Cataract development is a complication seen after retinal surgery, if the lens of the eye is not extracted. The lens of the eye is very sensitive to damage caused by the instrumentation inserted in the eye during the surgery, the heat generated by the instruments, the materials (i.e., oil substances) injected into the eye or the laser treatment performed for the retina. In some cases, cataract can develop within the lens and, whenever this leads to subsequent compromise of eyesight, cataract surgery is necessary.
Post-operative after care and rechecks
The post-operative care is equally as important as the surgery itself. The most important considerations are summarised below:
Exercise must be limited for the first 6 weeks after the surgery. This includes restriction of walks off the lead, jumping on/off furniture, climbing downstairs, playing roughly with other dogs, swimming or throwing toys to them. Cats undergoing cataract surgery must be kept indoors for a period of 4 weeks after the surgery.
The first week after the surgery requires intense application of eye drops. For example, most dogs will be discharged with 4 (or more) different eye drops which must be applied up to 6 times daily, or in some cases more. This will gradually reduce after the first week.
Pets undergoing retinal re-attachment surgery combined with cataract surgery will require lifelong treatment. This will be at least one eye drop, usually administered once or twice a day long term.
Re-examination appointments for frequent monitoring are required. For uncomplicated cases, these are expected to be within 48 hours of the surgery, one week, three weeks, three months and six months after the surgery. Depending on your pet’s progress, more (or less) appointments might be indicated. A re-examination fee (please refer to our pricelist) applies for some of these rechecks.
What is the cost of the surgery?
Depending on if the condition is affecting one or both eyes and if additional surgeries are required (for example cataract extraction) the cost ranges between £4,500 to £5,500. This includes the cost of the pre-operative tests which need to be performed (including the blood tests prior to the surgery, ultrasound scan of the eye or electroretinography of the eye), hospitalisation to our facilities, the medication needed while in the hospital and the drugs for your pets after care, and the first and second re-examination appointments.
Our mission at Vet Eye Care is providing the best care for your pets. Our ophthalmologists are able to diagnose and treat all ophthalmic conditions promptly, following a referral request from your vets. If you feel your pet will benefit from a consultation with one of our
specialists, ask your general vet for a referral. Contact us today and benefit from our competitive prices.