This document discusses retinal breaks and retinal detachment. Some key points: - Retinal breaks can cause retinal detachment and occur in about 6% of the population, with retinal detachment occurring in around 0.07% of people in their lifetime. - Common causes of retinal breaks include trauma, vitreous traction, and increasing age. Symptoms may include floaters, photopsias, and vitreous hemorrhage. - Examination involves slit lamp biomicroscopy and sometimes B-scan ultrasound or vitrectomy. Certain lesions like retinal dialysis, horseshoe tears, and operculated tears often warrant treatment to prevent retinal detachment, while smaller lesions may not require intervention

2.  Retinal breaks- any full- thickness
defect in the neurosensory retina
 Can cause RD
 6% of population have break
 1/10,000-15,000 per year- RD
 0.07% chance of developing RD in a
lifetime

4.  Directretinal perforation, contusion,
vitreous traction
 Coup
 Contrecoup
 Usually multiple
 Inferotemporal and superonasal quadrants
 Most common- dialyses + avulsion of
vitreous base= ocular contusion
 Others: horseshoe-shaped tears,
operculated holes

6.  Young patients- higher incidence of eye
injury
 Rarely develop acute rhegmatogenous RD
 Vitreous acts as tamponade
 12%- immediately
 30%- 1 month
 50%- 8 months
 80%- 24 mos

7.  Vitreous base- 2 mm anterior and 4 mm
posterior to the ora serrata
 Optic disc, macula, along major vessels,
margins of lattice degeneration, sites of
chorioretinal scars

10. Increasing age- 63% in > 70 y/o
axial length
Aphakia – 66-100%
ICCE- 84%
Inflammatory disease ECCE w/ open capsule- 76%
Trauma ECCE w/ intact capsule- 40%
myopia

11.  Photopsias
 Multiple floaters
 Curtain or cloud
 Vitreous hemorrhage
 Retinal tear present in
 15% w/ acute PVD
 50-70% w/ acute PVD + vitreous hge

12.  IO w/ scleral depression
 Slit lamp biomocroscopy w/ 3- mirror
lens
 Hemorrhage or pigment?
 Reexamine in 3- 4 weeks
 patching, bed rest, head elevation for
45⁰
 B- scan
 vitrectomy

13.  6-10% of general population
 1/3-1/2- bilateral
 Myopia, familial predilection
1. Atrophy of the inner layers
2. Overlying pocket of liquefied vitreous,
3. condensation and adherence of vitreous at
the margin of lesion
 Progressesto RD- tractional tear or
atrophic hole

14.  Areas of elevated glial hyperplasia
 Noncystic retinal tufts
 Cystic retinal tufts may predispose
 Zonular traction tufts to RD

15.  folds of redundant retina
 Superonasally
 Associated w/ dentate processes
 Tears occur at the most posterior limit
of the folds

16.  Oval islands ofpars plana epithelium
located immediately posterior to the ora
 Almost/completely circumscribed by the
peripheral retina
 Tears can occur at or near the
posterrior margins of enclosed ora bays

17.  Paving-stone or Cobblestone
•22% over 20 y/o Degeneration
•Proliferation of RPE cells
••Atrophy approximatelyretina > 20 RD,
 RPE areas of inflammation100% trauma,y/o retinal
Old hyperplasia
•Present in of the outer and of
•Enlargement of RPE cells
•3.Atrophy of the
Temporal
 RPE hypertrophy RPE and outer retinal layers
tear
•Congenital or acquired
•4.Attenuation or absence lossthe
•1. TYPICAL may cause field of
Aging and but Cystoid Degeneration
Benign,
Peripheral the outer plexiform layer
• • •Cysts degenerative change
in
Appears as black
choriocapillaries spherical melanin granules,
•Large cells and large,
•2. RETICULAR
5.Adhesions b/n the remaining neuroepithelial
•very•dark, well demarcated
Nerve fiber layer
•BENIGN amd bruch’s membrane
layers
•Posterior to typical cystoid
•Inferior quadrant,full-retinalto the equator
•May develop into anterior break
•NEVER the site of PRIMARY retinal break

18.  Reduce the risk of RD
 Risk outweigh the benefit
 May not eliminate the risk of new tears
or detachment
 GOAL: create a chorioretinal scar around
the break
 Acute symptomatic break are more
dangerous than the old ones

19.  Acute symptomatic flap tear
 Acute operculated holes
 + persistent vitreous traction
 Large hole
 Superior location
 Vit hem
 Atrophic holes
 + traction

20.  Flap tears
 Emmetropic, phakic eyes
 Lattice degeneration
 Myopia
 Subclinical detachment
 Aphakia w/ detachment in the other eye
 Operculated holes
 Atrophic holes

21.  Treat the entire lesion
 Posterior and lateral margins
 6-10% of eyes
•High myopia
 20-30% of eyes w RD
•RD in the fellow eye
 1%- RD in untreated lattice degeneration
•flap tears
•aphakia

22.  1-3 % incidence of RD
 Asymptomatic breaks – prophylaxis?
 Flap tears
 Subclinical detachments

23.  Asymptomatic retinal detachment
 Detachment in w/c subretinal fluid
extends more than 1 DD from the break
but not more than 2DD posterior to the
equator.
 Traction on the break

24. TYPE OF LESION TREATMENT
Horseshoe tears Almost always
Dialysis Almost always
Operculated tear sometimes
Atrophic hole Rarely
Lattice degeneration w/o horseshoe Rarely
tears
Zorab et.al., American academy of Ophthalmology Section 12 p. 290 2008-2009

25. Type of lesion phakic Highly myopic Fellow eye Aphakic or
pseudophakic
Retinal Almost always Almost always Almost always Almost always
dialysis
Horseshoe sometimes sometimes sometimes sometimes
tears
Operculated no rarely rarely rarely
tears
Atrophic holes rarely rarely rarely rarely
Lattice deg’n no no sometimes rarely
w/ or w/o
holes
Zorab et.al., American academy of Ophthalmology Section 12 p. 291, 2008-2009

26. http://one.aao.org/CE/Practice Guidelines