RETINAL DETACHMENT
NEELESH & PRITAMBAR
5 COURSE
4 GROUP
INTRODUCTION
• Retinal detachment is a disorder of the eye in which the retina peels
away from its underlying layer of support tissue.
• A detached retina is a serious and sight-threatening event.
• And unless the retina is reattached soon, permanent vision loss may
result.
Anatomy Of Eyeball
Retina
• The retina is the inner
most layer of the eye. It is
composed
of
nerve
tissue. The optical system
of the eye focuses light
on the retina much like
light is focused on the
film in a camera
Layers of retina
 The retina is composed of 10 layers :
• Pigmented epithelium
• Photoreceptors; bacillary layer (outer and inner segments
photoreceptors)
• External (outer) limiting membrane
• Outer nuclear
Epidemiology
• 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 year
• The lifetime risk in normal individuals is about 1 in 300
• Retinal detachment is more common in people with severe myopia (above
5–6 diopters), in whom the retina is more thinly stretched. In such patients,
life time risk rises to 1 in 20.
• About two thirds of cases of retinal detachment occur in myopics. Myopic
retinal detachment patients tend to be younger than nonmyopic ones.
TYPES OF RD
• Four types:
1. Rhegmatogenous
2. Traction
3. Combined form of rhegmatogenous and traction
4. Exudative
Rhegmatogenous Detachment
• A hole or tear develops
in the sensory retina
allowing some of the
liquid (vitreous) to seep
through the sensory
retina and detach it
from the RPE.
Exudative, serous, or secondary retinal
detachment
• It occurs due to
inflammation, injury or
vascular abnormalities
• Fluid accumulating
underneath the retina
without the presence of a
hole, tear, or break.
Traction – a pulling force is responsible
• Traction can be occur due to any
scars or bands of fibrous material
providing traction to the retina
• Vitreous hemorrhage, retinopathy
can cause traction effect
• Exudative – due to production of
serous fluid under the retina.
(uveitis, degenerative disorders)
Symptoms
• Floaters
• Cobwebs
• Bright light flashes
• shadow or curtain over a portion of visual field
• blur in vision
• No complain of pain
Risk Factors
• Severe myopia
• Retinal tear
• Family history
• Other eye diseases or disorders, such as retinoschisis, uveitis,
degenerative myopia, or lattice degeneration
• Eye injury
• Tumors
• Systemic diseases such as diabetes & sickle cell diseases
• Complications from cataract surgery
Diagnosis
• Fundus photography or ophthalmoscopy.
Fundus photography : larger instrument than the
ophthalmoscope
• Ultrasound
Treatment
• General principles of treatment:
• 1. Find all retinal breaks
• 2. Seal all retinal breaks
• 3. Relieve present (and future) vitreo retinal traction
Surgical Methods
• Retinal tear :
laser surgery (photocoagulation) – with the help of laser rays the
tears are being joined or sutured.
freezing (cryopexy) – cryoprob will freeze and join the retinal tears
• Retinal detachment:
pneumatic retinopexy
scleral buckling
vitrectomy
Cryopexy
• Cryotherapy (freezing) is
used to wall off a small area
of retinal detachment
• Uses nitrous oxide to freeze
the tissue behind the retinal
tear
• This prevents fluid passing
through the hole.
Laser Photocoagulation
• If the retina is torn or the
detachment is slight
• Laser burn the edges of the tear
and halt progession.
• Stimulates the scar tissue
formation to seal the edges of
the tear
Scleral buckle surgery
• Surgeon sews silicone bands to the sclera (the white outer coat ofthe
eyeball)
• The bands push the wall of the eye inward against the retinal hole
• Cryotherapy (freezing) is applied around retinal breaks prior to
placing the buckle
• Subretinal fluid is drained as part of the buckling procedure
• The buckle remains in situ
• The most common side effect of a scleral operation is myopic shift.
Myopic shift: the operated eye will be more short sighted after the
operation
Pneumatic retinopexy
• Generally under local anesthesia
• Gas bubble (SF6 or C3F8 gas) is
injected into the eye after which
laser or freezing treatment
• The patient's head is then
positioned
• Have to keep their heads tilted
for several days
• The surface tension of the
gas/water interface seals the hole
in the retina
• Combined with cryopexy or laser
photocoagulation
Vitrectomy
• Tiny incision in the sclera
• Remove vitreous
• Gas is often injected to into the eye
• During the healing process, the eye makes fluid that gradually
replaces the gas and the eye.
• Using gas in this operation : no myopic shift after the operation
• Silicon oil (PDMS), if filled needs to be removed after a period of 2–8
months
Complications After Surgery
• Discomfort
• Watering
• Redness
• Swelling
• Itching
• Blurred vision
Prognosis
• 85 percent of cases will be successfully treated with one operation
• 15 percent requiring 2 or more operations
• After treatment patients gradually regain their vision over a period of
a few weeks, although the visual acuity may not be as good as it was
prior to the detachment, particularly if the macula was involved in the
area of the detachment.
• Currently, about 95 percent 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 vitreo retinopathy
• Involvement of the macula portends a worse prognosis
• Damage to vision may occur during reattachment Surgery
• 10 percent of patients with normal vision experience some vision loss
after a successful reattachment surgery.
Conclusion
• Visual impairment is more than a physiologic deficit.
• It is a loss that has physical and emotional effects on the person
afflicted.
• So as far as possible prevent those causes of blindness.