RETINAL DETATCHMENT

BY DR NITISH

RETINAL DETATCHMENTSeparation of neurosensory retina from retinal pigment

epithelium

Caused by breakdown the forces that attatch the NSR to the RPE

TYPESRhegmatoenous RD

Tractional RD

Exudative RD

RHEGMATOGENOUS RDOccurs due to full thickness defect in neurosensory

retina which permit fluid from synchytic vitreous to enter into subretinal space

RISK FACTORSAge - MC in 40-60 yrs age

Sex - MC in males M:F -3:2

Myopia

Aphakia

Retinal degenerations – lattice degen , snail tract degen , retinoschisis

Trauma

Senile PVD

CLINICAL FEATURESSYMPTOMS-

Loss of vision

Floaters – weiss ring

- cobwebs

-sudden shower of minute dark

spots

Flashes

SIGNS

Marcus gunn pupil

IOP - lower

Tobacco dust - anterior vitreous

Mild irits

FUNDUS EXAMINATIONFresh tear –

-Grey reflex instead of normal pink reflex

-Convex configuration

- Thrown into folds which move with movement of eye

Long standing RD –

-Retinal thinning

-Intraretinal cyst- 1 year

-Subretinal demarkation line – 3 months

INVESTIGATIONSPERIMETRY – scotomas corresponding to

detatchment

ERG - subnormal or absent

B SCAN –in case of dense cataract

COMPLICATIONSProliferative vitreoretinopathy

Complicated cataract

Uveitis

Phthisis bulbi

TREATMENTMainly surgical

INDICATIONS OF URGENT SURGERY

Position of break

Size of break

State of vitreous gel

SURGICAL TECHNIQUESPneumatic Retinopexy

Scleral Buckling

Sub retinal fluid drainage

PROPHYLAXISLaser photocoagulation

Cryotherapy

TRACTIONAL RDNSR pulled away RPE by contracting vitreoretinal

traction bands in absence of retinal break

ETIOLOGYProliferative Diabetic Retinopathy

Retinopathy of Prematurity

Penetrating injuries

Sickle cell retinopathy

Eales disease

CLINICAL FEATURESVitreoretinal tractional bands

Configuration of detatched area is concave

TREATMENTPars Plana Vitrectomy

EXUDATIVE RDCaused neither by a break nor traction

Sub retinal fluid derived from fluid in vessels of NSR or choroid

ETIOLOGYChoroidal tumours - melanomas , haemangiomas ,

metastasis

Inflammation – VKH , posterior scleritis

CSR

Choroidal neovascularisation

Hypertensive choroidopathy

Idiopathic

CLINICAL FEATURESSYMPTOMS-

Floaters

Photopsia is absent

Visual field defect

SIGNS-

RD - convex configuration but smooth surface

Shifting fluid

Leapord spots

TREATMENTSpontaneous regression

Treat the cause

Intra ocular tumours - Enucleation

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