Retinal Anatomy
Dr. Miratashi
1R.D.
Posterior Vitreous Detachment
(PVD)
 Vit: collagen+ hyaluronic acid
(mucopolysaccharide)
 Loss of gel
contractile force
defect in
posterior vit. Face
liquid escape
posteriorly
 exam:
 Biomicroscopic, B-scan ultrasonography, OCT
 Autopsy study:
 <10% under age of 50years but 63%over age of 70
Dr. Miratashi
2R.D.
P.V.D.
 Patient’s age
 Aphakia
 Inflammatory disease
 Trauma
 Myopia
Dr. Miratashi
3R.D.
Symptoms of PVD
 Flashing lights
 Floaters
 Acute PVD have 15% netinal tear
 PVD with vit. Hemorrhage 50%-70% have
retinal tears
 PVD without vit. Hemorrhage 10%-12% have
retinal tears
Dr. Miratashi
4R.D.
Dr. Miratashi
5R.D.
Dr. Miratashi
6R.D.
Dr. Miratashi
7R.D.
PVD and Cataract Surgery
 66% - 100% PVD
 ICCE 84%
 ECCE with open capsule 76%
 ECCE intact capsule 40%
Dr. Miratashi
8R.D.
Retinal Breaks
 Full-thickness defect in the neurosensory
retina
 Provide access for liquid to enter potential
space between sensory retina & RPE
 Flap or horseshoe tear
 Giant retinal tear 90 or more
 Operculated hole
 Dialysis (ora serrata)
 Atrophic retinal hole (no traction not R.D)
 Macular hole
Dr. Miratashi
9R.D.
Dr. Miratashi
10R.D.
Dr. Miratashi
11R.D.
Dr. Miratashi
12R.D.
Dr. Miratashi
13R.D.
Trauma In Eyes
 12% are found immediately
 30% are found within 1 month
 50% are found within 8 months
 80% are found within 24 months
Dr. Miratashi
14R.D.
Dr. Miratashi
15R.D.
Lattice Degeneration
 6%-10% of general population
 Is bilateral in1/3-1/2 of affected patients
 More in myopic eyes
 Familial predilection
 Small number of lattice develop R.D.
 But 20%-30% of R.D. have lattice
Dr. Miratashi
16R.D.
Histopathology of Lattice
 Discontinuity of I.L.M.
 Liquified vitreous
 Atrophy of inner layers of retina
 Condensation and adherence of vitreous at
the margin
Dr. Miratashi
17R.D.
Dr. Miratashi
18R.D.
Dr. Miratashi
19R.D.
Aphakia and Psuedophakia
 1%-3% have risk of R.D. compare to phakic
 Should be warned of potential symptoms
Dr. Miratashi
20R.D.
Dr. Miratashi
21R.D.
Fellow eye in patient with R.D.
 10% of phakic 20%-36% of aphakic will
develop R.D. in second eye
 An other risk factor is present prophylactic
treatment
Dr. Miratashi
22R.D.
Indication for Treat of retinal tears and
holes in symptomatic patients
Horseshoe tears
Dialysis
Operculated tear
Atrophic hole
Lattice degeneration
without horseshoe tears
Almost always
Almost always
Sometimes
Rarely
Rarely
Dr. Miratashi
23R.D.
Dr. Miratashi
24R.D.
Sub Clinical R.D.
 Asymptomatic R.D.
 Fluid extends more than 1DD from the break
but not more than 2DD posterior to the
equator
 30%will progress to R.D. so treat is
recommended
Dr. Miratashi
25R.D.
Retinal Detachment
 Rhegmatogenous, most common, rhegma
means break
 Tractional
less common
 Exudative or secondary
Dr. Miratashi
26R.D.
Dr. Miratashi
27R.D.
Dr. Miratashi
28R.D.
Symptom and Sign of R.D.
 Photopsia or floater
 vision
 Visual field defect
 IOP
 Shafer’s sign (tobacco dust) in vitreous or
anterior segment
 Corrugated appearance
 In long standing R.D. P.V.D., fixed folds
Dr. Miratashi
29R.D.
Dr. Miratashi
30R.D.
Dr. Miratashi
31R.D.
Management of R.R.D.
Find all breaks
Create a chorioretinal irritation around each break
1.
2.



Laser
Cryo
Diathermy
Bring the retinal and choroid into contact to close
the break
3.


Scleral buckle, pneumatic retinopexy for superior break
Vitrectomy in selected cases
Dr. Miratashi
32R.D.
Dr. Miratashi
33R.D.
Dr. Miratashi
34R.D.
Anatomic Reattachment
 Overall rate is 90%
 Aphakia and psuedophokia less prognosis
 Giant tear, PVR, uveitis, choroidal
detachment
 Posterior break has worst prognosis
Dr. Miratashi
35R.D.
P.V.R.
 Cause of failure to repair
 RPE., glial, other cells an inner and outer
retinal surface forming membrane
 Contraction
fixed fold, new break, reopen
old break A, B, C, anterior, posterior
Dr. Miratashi
36R.D.
Dr. Miratashi
37R.D.
Dr. Miratashi
38R.D.
Post Operative Vision
 The status of macula
 1week macula detach. 75% obtain 20/70 or
better
 1-8 weeks 50% same vision
 Even with on macula preoperatively post
operation may develop macular edema or
pucker
 Intra operative complication may also limit
visual recovery
Dr. Miratashi
39R.D.