Retinal
Detachment
4th
Presented by
Medical student
Faculty of medicine, Ramathibodi
Hospital, Mahidol University
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Points of
presentations
1.
1. Definition
Definition
2.
2. Risk
Risk Factors
Factors
3. Types of Retinal Detachment
3.1 Rhegmatogenous retinal detachment (RRD)
3.2 Tractional retinal detachment (TRD)
3.3 Exudative, serous, or secondary retinal detachmen
Points of Discussion
4.
4. Sings
Sings &
& Symtomps
Symtomps
5.
5. Prognosis
Prognosis
6.
6. Treatment
Treatment
Cryopexy
Cryopexy and
and laser
laser photocoagulation
photocoagulation
Scleral
Scleral buckle
buckle surgery
surgery
Pneumatic
Pneumatic retinopexy
retinopexy
Vitrectomy
Vitrectomy
Retinal Detachment
Definitions
A disorder of the eye in which the sensory
retina peels away from its underlying layer
of support tissue (retinal pigment
epithelium; RPE).
Initial detachment may be localized or
broad, but without rapid treatment the
entire retina may detach, leading to vision
loss and blindness.
It is a medical emergency.
Potential causes or risk factors
AIDS
Cataract surgery
Diabetic retinopathy
Eclampsia
Family history of retinal
detachment
Homocysteinuria
Malignant hypertension
Trauma
Metastatic cancer,
which spreads to the
eye (eye cancer)
Retinoblastoma
Severe Myopia
Smoking and Passive
smoking
Stickler syndrome
Von Hippel-Lindau
disease
retina (called a retinal tear) that allows
fluid to pass
from
vitreousdetachment
space
Types
ofthe
Retinal
into the subretinal space between the
sensory retina and the retinal pigment
epithelium.
Retinal breaks are divided into three
types holes, tears and dialyses.
Holes form due to retinal atrophy
especially within an area of lattice
degeneration.
Tears are due to vitreoretinal traction.
Types of Retinal detachment
Tractional retinal detachment
(TRD)
A tractional retinal detachment occurs
when fibrous or fibrovascular tissue,
caused by an injury, inflammation or
neovascularization, pulls the sensory
retina from the retinal pigment
epithelium.
TRD most often occurs in proliferative
diabetic retinopathy (PDR), proliferative
vitreoretinopathy (retinopathy of
prematurity; ROP).
Exudative, serous,
or secondary
retinal
Types
of Retinal
detachment
detachment
ERD occurs due to inflammation, injury or vascular
abnormalities that results in fluid accumulating
underneath the retina without the presence of a
hole, tear, or break.
In evaluation of retinal detachment it is critical to
exclude exudative detachment as surgery will make
the situation worse, not better.
Although rare, exudative detachment can be caused
by the growth of a tumor on the layers of tissue
beneath the retina, namely the choroid.
This cancer is called a choroidal melanoma.
Signs & Symptoms
flashes of light (photopia) very brief in the
extreme peripheral (outside of center) part of
vision
a sudden dramatic increase in the number of
floaters
a slight feeling of heaviness in the eye
Signs & Symptoms
a dense shadow that starts in the peripheral
vision and slowly progresses towards the
central vision
the impression that a veil or curtain was drawn
over the field of vision
central visual loss
straight lines (scale, edge of the wall, road,
etc.) that suddenly appear curved (positive
Amsler grid test)
Signs & Symptoms
Folds of retina extending into the macula inferolateral to the disc.
Diagnosis
Diagnosis
Retinal detachment can be examined by fundus
photography or ophthalmoscopy.
Fundus photography generally needs a considerably larger
instrument than the ophthalmoscope, but has the
advantage of availing the image to be examined by a
specialist at another location and/or time, as well as
providing photo documentation for future reference.
Modern fundus photographs generally recreate
considerably larger areas of the fundus than what can be
seen at any one time with handheld ophthalmoscopes.
[Link]
Epidemology
The incidence of retinal detachment in
otherwise normal eyes is around 5 new
cases in 100,000 persons per year.
Detachment is more frequent in middleaged or elderly populations, with rates of
around 20 in 100,000 per [Link]
lifetime risk in normal individuals is about
1 in [Link] retinal breaks are
present in about 6% of eyes in both
clinical and autopsy studies.
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[Link]
Epidemology
Retinal detachment is more common in people with
severemyopia(above 56diopters), in whom the retina is
more thinly stretched. In such patients, lifetime risk rises
to 1 in [Link] two-thirds of cases of retinal
detachment occur in myopics. Myopic retinal detachment
patients tend to be younger than non-myopic ones.
Retinal detachment is more frequent after surgery for
cataracts. The estimated long-term prevalence of retinal
detachment after cataract surgery is in the range of 5 to
16 per 1000 cataract operations,but is much higher in
patients who are highly myopic, with a prevalence of up
to 7% being reported in one [Link] study found that
the probability of experiencing retinal detachment within
10 years of cataract surgery may be about
5 times
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Prognosis
Up until the early 20th century, the prognosis for RRD was very poor,
and no effective treatments were available.
Currently, 95% of cases of retinal detachment can be repaired
successfully.
Treatment failures usually involve either the failure to recognize all
sites of detachment, the formation of new retinal breaks, or
proliferative vitreoretinopathy.
Involvement of the macula portends a worse prognosis.
In cases where the macula is not involved (detached), 90% of patients
have 20/40 vision or better after reattachment surgery.
Some damage to vision may occur during reattachment surgery, and
10 % of patients with normal vision experience some vision loss after
a successful reattachment surgery.
Treatment
There are several methods of treating a
detached retina, each of which
depends on finding and closing the
breaks that have formed in the retina.
All three of the procedures follow the
same three general principles:
Find all retinal breaks
Seal all retinal breaks
Relieve present (and future)
vitreoretinal traction
Treatment
Cryopexy and laser
photocoagulation
Cryotherapy (freezing) or
laser photocoagulation are
occasionally used alone to
wall off a small area of
retinal detachment so that
the detachment does not
spread.
Treatment
Scleral buckle surgery
Scleral buckle surgery is an established treatment in
which the eye surgeon sews one or more silicone
bands (bands, tyres) to the sclera (the white outer
coat of the eyeball).
The bands push the wall of the eye inward against the
retinal hole, closing the break or reducing fluid flow
through it and reducing the effect of vitreous traction
thereby allowing the retina to re-attach.
Cryotherapy (freezing) is applied around Pneumatic
retinopexy
interface seals the hole in the retina, and
allows the retinal pigment epithelium to
Treatment
pump the subretinal space dry and "suck
the retina back into place".
This strict positioning requirement makes
the treatment of the retinal holes and
detachments that occurs in the lower part
of the eyeball impractical.
This procedure is usually combined with
cryopexy or laser photocoagulation.
Pneumatic retinopexy has significantly
bubble (SF6 or C3F8 gas) or silicone
oil.
Treatment
An advantage of using gas in this
operation is that there is no myopic
shift after the operation and gas is
absorbed within a few weeks. Silicon
oil (PDMS), if filled needs to be
removed after a period of 28
months depending on surgeon's
preference.
[Link]
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