3. Introduction
• Retinal detachment is a disorder of the eye in
which the retina separates from the layer
underneath. Symptoms include an increase in the
number of floaters, flashes of light, and
worsening of the outer part of the visual
field. This may be described as a curtain over part
of the field of vision. Without treatment
permanent loss of vision may occur.
4. • The mechanism most commonly involves a break in the
retina that then allows the fluid in the eye to get
behind the retina. A break in the retina can occur from
a posterior vitreous detachment, injury to the eye, or
inflammation of the eye. Other risk factors include
being short sighted and previous cataract surgery.
Retinal detachments also rarely occur due to achoroidal
tumor. Diagnosis is by either looking at the back of the
eye with an ophthalmoscope or by ultrasound
5. 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 middle-aged or elderly populations, with rates of
around 20 in 100,000 per year. The lifetime risk in normal
individuals is about 1 in 300. Asymptomatic retinal breaks are
present in about 6% of eyes in both clinical and autopsy studies.
• Retinal detachment is more common in people with
severe myopia, in whom the retina is more thinly stretched. In
such patients, lifetime risk rises to 1 in 20.
• Retinal detachment is more frequent after surgery for cataracts.
6. Contd…
• Although retinal detachment usually occurs
in just one eye, there is a 15% chance of it
developing in the other eye, and this risk
increases to 25–30% in patients who have
had a retinal detachment and cataracts
extracted from both eyes.
7. Risk factors
• Severe myopia,
• Retinal tears,
• Trauma,
• Family history,
• Complications from cataract surgery.
• Injury
• Advanced diabetes
8. • Activities that increase intra ocular pressure
can cause retinal detachment:
• High-impact sports or in high speed sports.
• Diving and skydiving
• As bungee jumping or roller coaster rides.
• Valsalva maneuver
• Weightlifting
9. • Aging — retinal detachment is more common in
people over age 50
• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury
• Previous other eye disease or inflammation
10. Genetic factors promoting local inflammation
and photoreceptor degeneration may also be involved in the development of
the disease.
Glaucoma
AIDS
Cataract surgery
Diabetic retinopathy
Eclampsia
Family history of retinal
detachment
Homocysteinuria
Malignant hypertension
Metastatic cancer, which
spreads to the eye (eye
cancer)
Retinoblastoma
Severe myopia
Smoking and passive
smoking
Stickler syndrome
Von Hippel-Lindau disease
11. Signs and symptoms
• A rhegmatogenous retinal detachment is commonly
preceded by a posterior vitreous detachment which
gives rise to these symptoms:
flashes of light (photopsia) – very brief in the
extreme peripheral (outside of center) part of vision
a sudden dramatic increase in the number
of floaters
a ring of floaters or hairs just to the temporal (skull)
side of the central vision
12. • Bright flashes of light, especially
in peripheral vision
• Blurred vision
• Floaters in the eye
• Shadow or blindness in a part of the visual
field of one eye
13. Diagnosis
• Retinal detachment can be examined by:
Ultrasound.
Fluorescein Angiography
Tonometry
Ophthalmoscopy
Refraction Test
Color Vision Test
Visual Acuity
Slit-lamp Examination
14. Types
RHEGMATOGENOUS RETINAL DETACHMENT –
• A rhegmatogenous retinal detachment occurs due to a break in the
retina (called a retinal tear) that allows fluid to pass from the
vitreous space into the subretinal space between the sensory retina
and the retinal pigment epithelium. Retinal breaks are divided into
three types – holes, tears and dialyses. Holes form due to retinal
atrophy especially within an area of lattice degeneration. Tears are
due to vitreoretinal traction. Dialyses are very peripheral and
circumferential, and may be either tractional or atrophic. The
atrophic form most often occurs as idiopathic dialysis of the young.
15. Exudative, serous, or secondary retinal detachment –
• An exudative retinal detachment occurs due to
inflammation, injury or vascular abnormalities that results in
fluid accumulating underneath the retina without the
presence of a hole, tear, or break.
• Although rare, exudative detachment can be caused by the
growth of a tumor on the layers of tissue beneath the retina,
namely the choroid. This cancer is called a choroidal
melanoma.
16. Tractional Retinal Detachment –
• A tractional retinal detachment occurs when
fibrous or fibrovascular tissue, caused by an
injury, inflammation or neovascularization,
pulls the sensory retina from the retinal
pigment epithelium
17.
18. Treatment
• There are several methods of treating a
detached retina, each of which depends on
finding and closing the breaks that have
formed in the retina.
19. Cryopexy and Laser Photocoagulation
• Cryotherapy (freezing) or laser
photocoagulation are occasionally used alone
to wall off a small area of retinal detachment
so that the detachment does not spread.
20.
21. Scleral Buckle Surgery
• Scleral buckle surgery is an established treatment in which the
eye surgeon sews one or more silicone bands to the sclera. The
bands push the wall of the eye inward against the retinal hole,
closing the break or reducing fluid flow through it and reducing
the effect of vitreous traction thereby allowing the retina to re-
attach.
• Cryotherapy (freezing) is applied around retinal breaks prior to
placing the buckle. Often subretinal fluid is drained as part of
the buckling procedure. The buckle remains in situ.
22.
23. Pneumatic Retinopexy
• This operation is generally performed in the doctor's office
under local anesthesia. It is another method of repairing a
retinal detachment in which a gas bubble is injected into the
eye after which laser or freezing treatment is applied to the
retinal hole. The patient's head is then positioned so that the
bubble rests against the retinal hole. Patients may have to
keep their heads tilted for several days to keep the gas bubble
in contact with the retinal hole.
24. Vitrectomy
• Vitrectomy is an increasingly used treatment for retinal detachment.
It involves the removal of the vitreous gel and is usually combined
with filling the eye with either a gas bubble or silicone oil (PDMS).
An advantage of using gas in this operation is that there is no myopic
shift after the operation and gas is absorbed within a few weeks.
PDMS, if used, needs to be removed after a period of 2–8 months
depending on surgeon's preference. A disadvantage is that a
vitrectomy always leads to more rapid progression of a cataract in
the operated eye.
25. Prognosis
• 85 percent of cases will be successfully treated with one
operation with the remaining 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.
26. • 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
vitreoretinopathy.
Prognosis
27. Prevention
• Use protective eye wear to prevent eye
trauma.
• Control of blood sugar in diabetic patients.
• Frequent visits to eye specialist.
