Retinal detachment

Tri A Week 1

Epidemiology of retinal detachment

More common in

-Men>women

-Pseudophakes

-Myopes

-Right eye>left eye

-Affluent>poor

Types of retinal detachment

-Rhegmatogenous

-Traction

-Exudative

Types of rhegmatogenous retinal detachment

-PVD present

-No PVD

Rhegmatogenous retinal detachment: PVD present

-Horseshoe tear

-Giant tear

-Progresses rapidly

-Urgent treatment required

Rhegmatogenous retinal detachment: No PVD

-Atrophic hole

-Dialysis

-Progresses slowly

-Early treatment

Atrophic hole

-Almost always myopes

-Young

-No PVD

-Often asymptomatic

-Tide mark

Retinal dialysis

-Young patients

-No PVD

-May be large

-Usually infero-temporal

-May be related to trauma

-Slow progression

Giant retinal tear

-Starts with PVD

-Large break

-High risk of complications

-Rapidly progressive

-Worst prognosis

Pathology of retinal tears

-Outer segments of photoreceptors lost, cell bodies survive supplied by retinal vessels

-Foveal photoreceptors have no alternative oxygen supply, irreversible damage following foveal detachment

Symptoms of retinal detachment

-Floaters and flashes, caused by PVD

-Shadow or curtain, usually only noticed when close to macula

-Sudden loss of vision, macula affected

Differential diagnosis of retinal detachment

Retinoschisis

-Thin inner retinal layer, no pigment, hypermetropic

Exudative detachment

-Shifting fluid, no breaks, tumour/inflammation

Treatment of retinal detachment

-Close break

-Internal, PPV& tamponade, pneumatic retinopexy

-External, buckle and cryo

-Create permanent adhesion between RPE and retina

Outcome of retinal detachments

-Approx 85% of retinal detachment will be repaired with one operation

Approx 1% will remain detached, despite multiple surgeries

-Visual function may be permanently impaired despite successful repair (distortion, micropsia, reduced acuity)

Referral for rhegmatogenous retinal detachment

-Urgent referral if symptoms

-Asymptomatic non PVD retinal detachment may be monitored rather than treated

-Timing of surgery will depend on available resources, and urgency of other cases, as well as urgency of your patient