RETINAL DETACHMENT PROF. DR. ENGL ZDEK Histoloji Anatomy RETINAL - - PowerPoint PPT Presentation

RETINAL DETACHMENT

• PROF. DR. ŞENGÜL ÖZDEK

Histoloji

Anatomy

RETINAL DETACHMENT

• Separation of the neurosensory retina from

retinal pigment epithelium.

• Incidence 1 / 10.000, Risk is 3% until the age
• f 80
• Bilaterality 10%
• Most common: 40-70 year-old

TYPES

• RHEGMATOGENOUS RD
• TRACTIONAL RD (PDR, VENOUS OCCLUSIVE

DISEASE…)

• EXUDATIVE RD (ECLAMPSIA, KMM)

• Vitreous pressure
• Passive fluid flow from vitreous to

choroid

• RPE tight junctions
• RPE active ion transport
• Bruch membrane (flow from RPE to

choroid)

• Concentration gradients (ionic,
• smotic)

The powers holding retina in place

RRD

Develops in three stages

• Posterior vitreous detachment
• Retinal break / tear
• Retinal detachment

Posterior Vitreous Detachment

Stronger adhesions:

• Vitreous base
• Around the optic nerve head
• Macula
• Retinal big vessels
• Around the retinal degenerations areas

ACUTE PVD

After development of synchisis

in some persons, small breaks

• ccur in posterior vitreous

cortex and liquefied vitreous passes to retrohyaloid space

ACUTE PVD

• The remaining solid vitreous

collapse down and retrohyaloid space filled with sinchitic fluid: PVD

• Sensorial retina lacks

protection

• Sensorial retina is vulnerable

to vitreoretinal traction

PVD

• More in elderly, myopics, aphakic /

pseudophakic patient and people exposed to trauma

• Mostly asymptomatic
• Photopsia (flashes of light)
• Gliotic tissue which adheres to the posterior

hyaloid membrane where papilla and vitreous

• pacities: Floaters (flight of fly)

Acute PVD Complications

• Retinal Tear
• Macular Hole
• Epiretinal Membrane

Acute PVD’s Complications

• Vessel avulsion
• Vitreous hemorrhage

Peripheral retinal degenerations

Lattice degeneration (lattice = wire netting)

• Most important peripheral

degeneration

• It is a band-shaped retinal thinning, in

front of the equator, parallel to the

• ra serrata, which contains lines in the

form of wire netting.

• atrophy starts from the inner limiting

membrane and spreads to the other lines

• In the middle of degeneration vitreous

is liquefied but at the edge of degeneration vitreous is attached

Retinal break

Horseshoe tears Holes Disinsertion ( dialysis )

HORSE-SHOE TEAR

The most common reason for RD

• The apex located toward to

central

• Photopsia + Floaters +
• If accompanied by the rupture
• f blood vessels: blurred

vision

Retinal Holes

• Asymptomatic
• Within lattice dehgeneration areas
• Punched out circular holes

Mechanism of RD

DISINSERTION (DIALYSIS)

• In severe blunt trauma
• Usually in inferior temporal

quadrant

• Severe photopsia
• Detachment may not occur for

many years in young patient if vitreous can remain gel formation

PVR

• Proliferative Vitreoretinopathy (PVR)
• The proliferation of RPE cells and gliotic cells
• Long term RD
• Giant and a multible number of breaks
• Penetrating injury
• Vitreous hemorrhage
• Fast wound healers

PVR Stages

Grade A : Vitreous haze, pigment clumbs in vitreous and inferior surface of the retina ( tobacco dust ) Grade B : creases on the face of inner retina, decreased mobility of vitreous gel and retina, irregular tear edges, tortuosity of blood vessels Grade CP: behind equator local, diffuse or peripheral retinal creases, subretinal cords Grade CA: Same appearance in front equator and cords in condensed vitreous

Myopia - RD

• 10% of the general population: Myopic
• 40% of all RDs occur in myopic eyes.
• Lattice deg. is more common in -6.0 -9.0 myopes
• Vitreous degeneration and PVD are more common

in myopes

Trauma - RD

• 10% of RD occurs following trauma.
• The most common cause of RD in children
• Severe blunt trauma: retinal dialysis, macular

hole

• Penetrating injury: Both tractional and RRD.

RD Symptoms

• The first sings of acute PVD are fotopsia and

floaters

• Peripheral visual field defect: like a black curtain
• ne side of the eye
• After macula is affected, VA will decrease to

hand motions only

RRD signs

• IOP: 5 mmHg lower
• Retinal break
• Detached Retina has a convex

configuration and an opaque appearance

Treatment

• PROPHYLAXIS IS VERY IMPORTANT

– Acute PVD’s Symptoms: Photopsia, floaters: peripheral retinal examination! – Myopia or trauma or family history or fellow eye history of RD: detailed fundus examination! – Symptomatic or dangerous peripheral retinal degenerations and retinal tears: laser

Retinal Detachment Surgery

• 1. External buckling: Peripheral or local

scleral buckling: Classic Technique

• 2. İnternal retinopexy: PPV-tamponade

– laser or cryo to tears – Gas-Silicone oil

Scleral Buckle

• Silicone band or with local sponge
• Intraoperative cryotherapy around the

tear

• Drainage of Subretinal fluid.
• IV Air-Gas

Internal retinopexy: Tamponade

• Gas: SF6, C3F8
• Air

PPV

• Associated Vitreous Hemorrhage,
• PVR,
• Multible/giant tears
• Macular holes

Tractional RD

• 1. PDR: Proliferative diabetic

retinopathy

• 2. ROP prematurity of

retinopathy

• 3. Penetrating trauma
• 4. Sickle cell anemia, Vein
• cclusions, PFV
• Retina is immobile, surface is

concave.

• Tractions may cause tears...

COMBINED FORM RD

Traksiyonel RD

Trauma

PFV

ROP

ROP Stage 5: Total RD-Leukocoria

Tractional RD

• Photopsia and floaters (-)
• Vision loss occurs slowly
• Treatment: PPV

Exudative RD

• Malign hypertension
• Hypertensive

crisis/Eclampsia

• Vascular: Coats desease
• Tm: CMM, Metastases,

choroidal hemangioma

• Uveitis: Vogt-Kayanagi-

Harada

• Central serous

chorioretinopathy

Exudative RD

• Exudative RD: fluid leaks from retinal

vessels and RPE

• there is no tear and traction.
• May move with gravity and head

movements

Exudative RD

• Vision is very low in the morning due to the liquid which

reason to detachment becomes the subject of gravity. When patient seats, vision begins to improve.

SSKR

Exudative RD

• No Photopsia,
• Floaters (+/-): becauase of vitritis
• Visual field defect suddenly
• No surgical treatment.
• Treatment of the underlying condition.