retinal detachment
play

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

RETINAL DETACHMENT PROF. DR. ENGL ZDEK Histoloji Anatomy RETINAL DETACHMENT Separation of the neurosensory retina from retinal pigment epithelium. Incidence 1 / 10.000, Risk is 3% until the age of 80 Bilaterality 10% Most


  1. RETINAL DETACHMENT PROF. DR. ŞENGÜL ÖZDEK

  2. Histoloji

  3. Anatomy

  4. RETINAL DETACHMENT • Separation of the neurosensory retina from retinal pigment epithelium. • Incidence 1 / 10.000, Risk is 3% until the age of 80 • Bilaterality 10% • Most common: 40-70 year-old

  5. TYPES • RHEGMATOGENOUS RD • TRACTIONAL RD (PDR, VENOUS OCCLUSIVE DISEASE…) • EXUDATIVE RD (ECLAMPSIA, KMM)

  6. The powers holding retina in place • 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, osmotic)

  7. RRD D evelops in three stages • Posterior vitreous detachment • Retinal break / tear • Retinal detachment

  8. Posterior Vitreous Detachment Stronger adhesions: • Vitreous base • Around the optic nerve head • Macula • Retinal big vessels • Around the retinal degenerations areas

  9. ACUTE PVD A fter development of synchisis in some persons, small breaks occur in posterior vitreous cortex and liquefied vitreous passes to retrohyaloid space

  10. 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

  11. 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 opacities: Floaters (flight of fly)

  12. Acute PVD Complications • Retinal Tear • Macular Hole • Epiretinal Membrane

  13. Acute PVD’s Complications • Vessel avulsion • Vitreous hemorrhage

  14. Peripheral retinal degenerations

  15. Lattice degeneration (lattice = wire netting) • Most important peripheral degeneration • It is a band-shaped retinal thinning, in front of the equator, parallel to the ora 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

  16. Retinal break Horseshoe tears Holes Disinsertion ( dialysis )

  17. HORSE-SHOE TEAR The most common reason for RD • The apex located toward to central • Photopsia + Floaters + • If accompanied by the rupture of blood vessels: blurred vision

  18. Retinal Holes • Asymptomatic • Within lattice dehgeneration areas • Punched out circular holes

  19. Mechanism of RD

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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.

  25. RD Symptoms • The first sings of acute PVD are fotopsia and floaters • Peripheral visual field defect: like a black curtain one side of the eye • After macula is affected, VA will decrease to hand motions only

  26. RRD signs • IOP: 5 mmHg lower • Retinal break • Detached Retina has a convex configuration and an opaque appearance

  27. 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

  28. 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

  29. Scleral Buckle • Silicone band or with local sponge • Intraoperative cryotherapy around the tear • Drainage of Subretinal fluid. • IV Air-Gas

  30. Internal retinopexy: Tamponade • Gas: SF6, C3F8 • Air

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

  32. Tractional RD 1. PDR: Proliferative diabetic retinopathy 2. ROP prematurity of retinopathy 3. Penetrating trauma 4. Sickle cell anemia, Vein occlusions, PFV • Retina is immobile, surface is concave. • Tractions may cause tears... COMBINED FORM RD

  33. Traksiyonel RD

  34. Trauma

  35. PFV

  36. ROP

  37. ROP Stage 5: Total RD-Leukocoria

  38. Tractional RD • Photopsia and floaters (-) • Vision loss occurs slowly • Treatment: PPV

  39. Exudative RD • Malign hypertension • Hypertensive crisis/Eclampsia • Vascular: Coats desease • Tm: CMM, Metastases, choroidal hemangioma • Uveitis: Vogt-Kayanagi- Harada • Central serous chorioretinopathy

  40. Exudative RD • Exudative RD: fluid leaks from retinal vessels and RPE • there is no tear and traction. • May move with gravity and head movements

  41. 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.

  42. SSKR

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

Recommend


More recommend