Retinal DetachmentRetinal Detachment

Learning AimLearning Aim

Definition of Retinal Detachment

Predisposing factors

Symptoms, signs, and evaluation

Treatment of retinal detachment

Retinal DetachmentRetinal Detachment

Seperation of neurosensory retina from the

retinal pigment epithelium (RPE) is called

retinal detachment.

Types of Retinal DetachmentTypes of Retinal Detachment

Rhegmatogenous

Tractional

Exudative

Rhegmatogenous RDRhegmatogenous RD

Results from liquid vitreous seeping into

the potential space between neurosensory

retina and the RPE through degenerative or

traumatic break in the retina.

Tractional RDTractional RD

Tractional RD results from retina being

pulled away from its bed by the vitreous

membranes in conditions like, penetrating

injuries and diabetic retinopathy.

Exudative or secondary RDExudative or secondary RD

Exudative RD results from:

Choroidal neovascularisation

Exudative choroiditis

Toxaemia of pregnancy

Pathophysiology of RDPathophysiology of RD Retinal atrophy Traction PVD Exudation + Formation of break + vitreous liquefaction

Seepage of liquid vitreous between Retina and RPE

Separation of retina/RD

Predisposing factorsPredisposing factors

MyopiaAphakia /pseudophakiaFamily history of RD/detachment in fellow

eyeTraumaInflammationAcute retinal necrosis and CMV retinitis

Clinical featuresClinical features

Shallow detachment symptom may be absent

Floaters,flashes,curtain/veil in front of eyesDiminution of visionField defect Retinal detachment is a cause of painless

loss of vision.

DiagnosisDiagnosis

Ophthalmoscopy Diagnosis is likely to be missed in a

shallow detachment

Methods of examinationMethods of examination

Preliminary examination by mirror Indirect ophthalmoscopy -in eyes with

clear mediaUSG B-scan in eyes with hazy media

Retinal detachment (RD)

Rhegmatogenous - caused by a retinal break

Non-rhegmatogenous - tractional or exudative

ProphylaxisProphylaxis

Cryotherapy

Laser therapy in predisposed

Principles of managementPrinciples of managementIdentify retinal breaks,vitreous or,preretinal

tractionSeal the break with

diathermy,cryotherapy,Laser Release of vitreous/preretinal traction Drainage of SRFChorioretinal apposition by internal or

external temponade

Chorioretinal appositionChorioretinal apposition

External temponade

Scleral buckling or local plombage by sponge,tyre or encircling band

Internal temponadeSF6 gas, C3F8 gas,Silicon oil

Configuration of scleral buckles

Sponge

Buckle

Release of vitreoretinal Release of vitreoretinal tractiontraction

Pars Plana Vitrectomy(PPV)

Complications of RD surgeryComplications of RD surgery

Failure to reattach and recurrence

Diplopia due to EOM damage

Anterior segment ischaemia

PVR and macular pucker

PrognosisPrognosis

Untreated RRD: unfavourable

Anatomical success rate 95%.

Visual prognosis depends upon duration Poor

in gross degeneration of retina,choroid and

vitreous,PVR,high myopia and detachment

present for more than 9 mo.

Points to RememberPoints to Remember

Retinal detachment results in painless loss of vision.

High myopia and eye injuries are important predisposing events.

Examinations include indirect ophthalmoscopy, or ultrasound B-scan of the eye.

Treatment requires vitreoretinal consultation.