RETINAL DETACHMENT
OR
ABLATIO RETINA
Dr. Yanuar Ali, Sp.M
FK Uncen/ RS Dian Harapan
DEFINITION
• A retinal detachment (RD) describes the
separation of the neurosensory retina (NSR)
from the retinal pigment epithelium (RPE).
This results in the accumulation of subretinal
fluid (SRF) in the potential space between the
NSR and RPE.
The main types of RD are:
• Rhegmatogenous (rhegma – break)
• Tractional
• Exudative (serous, secondary)
• Combined tractional-rhegmatogenous,
Rhegmatogenous RD/ RRD
• Occurs secondarily to a full-thickness defect in
the sensory retina, which permits fluid derived
from synchytic (liquefied) vitreous to gain
access to the subretinal space
• Rhegmatogenous RD affects about 1 in 10 000
of the population each year and both eyes
may eventually be involved in about 10% of
patients.
RRD
Vitreous adhesions
• Normal. The peripheral cortical vitreous is
loosely attached to the internal limiting
membrane (ILM) of the sensory retina.
Stronger adhesions occur at the following sites:
- Vitreous base, where they are very strong
- Around the optic nerve head, where they are
fairly strong cont…………..
Vitreous adhesions cont…
-Around the fovea, where they are fairly weak,
except in eyes with vitreomacular traction and
macular hole formation
-Along peripheral blood vessels, where they are
usually weak.
Vitreous adhesions cont…
• Abnormal adhesions at the following sites
may be associated with retinal tear formation
as a result of dynamic vitreoretinal traction
associated with acute PVD
-Posterior border of islands of lattice
degeneration
-Retinal pigment clumps
-Peripheral paravascular condensations
-Vitreous base anomalies such as tongue-like
extensions and posterior islands
-White with pressure’ and ‘white without
pressure’
Syneresis
U Tear
Symptoms of RRD
• Photopsia is the subjective sensation of a
flash of light
• Floaters are moving vitreous opacities which
are perceived when they cast shadows on the
retina
• A visual field defect is perceived as a ‘black
curtain’
Signs of RRD
• Marcus Gunn pupil (relative afferent pupillary
defect) is present in an eye with an extensive
RD irrespective of the type.
• Intraocular pressure is usually lower by about
5 mmHg compared with the normal eye
• Iritis is very common but usually mild.
• ‘Tobacco dust’ consisting of pigment cells is
seen in the anterior vitreous cont…….
Signs RRD cont…..
• Retinal breaks appear as discontinuities in the
retinal surface
RRD
Therapy
• Prophylaxis: Laser photocoagulation around
the break
Laser Photocoagulasi
Therapy cont
• Bedah
Pneumatic Retinopexy
Tractional
• in which the NSR is pulled away from the RPE
by contracting vitreoretinal membranes in the
absence of a retinal break.
The main causes of tractional RD are
(a) proliferative retinopathy such as diabetic
and retinopathy of prematurity
(b) penetrating posterior segment trauma
Exudative
• Is caused neither by a break nor traction; the
SRF is derived from fluid in the vessels of the
NSR or choroid, or both.
Symptoms
• Photopsia is absent because there is no
vitreoretinal traction, although floaters may
be present if there is associated vitritis
Signs
• The RD has a convex configuration, just like a
rhegmatogenous RD, but its surface is smooth
and not corrugated
• The detached retina is very mobile and
exhibits the phenomenon of ‘shifting fluid’ in
which SRF responds to the force of gravity and
detaches the area of retina under which it
accumulates cont……
Signs cont…..
For example, in the upright position the SRF
collects under the inferior retina , but on
assuming the supine position for several
minutes, the inferior retina flattens and the SRF
shifts posteriorly detaching the superior retina
Combined tractional-
rhegmatogenous,
• As the name implies, is the result of a
combination of a retinal break and retinal
traction. The retinal break is caused by
traction from an adjacent area of fibrovascular
proliferation and is most commonly seen in
advanced proliferative diabetic retinopathy.
Thank you
