Retina 5 retinal detachment 09.06.16 - dr.k.n.jha

1. Retinal DetachmentRetinal Detachment

2. Learning AimLearning Aim
Definition of Retinal Detachment
Predisposing factors
Symptoms, signs, and evaluation
Treatment of retinal detachment

3. Retinal DetachmentRetinal Detachment
Seperation of neurosensory retina from the
retinal pigment epithelium (RPE) is called
retinal detachment.

4. Types of Retinal DetachmentTypes of Retinal Detachment
Rhegmatogenous
Tractional
Exudative

5. Rhegmatogenous RDRhegmatogenous RD
 Results from liquid vitreous seeping into
the potential space between neurosensory
retina and the RPE through degenerative or
traumatic break in the retina.

6. Tractional RDTractional RD
Tractional RD results from retina being
pulled away from its bed by the vitreous
membranes in conditions like, penetrating
injuries and diabetic retinopathy.

7. Exudative or secondary RDExudative or secondary RD
Exudative RD results from:
Choroidal neovascularisation
Exudative choroiditis
Toxaemia of pregnancy

8. Pathophysiology of RDPathophysiology of RD
 Retinal atrophy Traction PVD
Exudation
 +
 Formation of break + vitreous liquefaction
 Seepage of liquid vitreous between Retina and RPE
Separation of retina/RD

9. Predisposing factorsPredisposing factors
Myopia
Aphakia /pseudophakia
Family history of RD/detachment in fellow
eye
Trauma
Inflammation
Acute retinal necrosis and CMV retinitis

10. Clinical featuresClinical features
Shallow detachment symptom may be
absent
Floaters,flashes,curtain/veil in front of eyes
Diminution of vision
Field defect
Retinal detachment is a cause of painless
loss of vision.

11. DiagnosisDiagnosis
Ophthalmoscopy
Diagnosis is likely to be missed in a shallow
detachment

12. Methods of examinationMethods of examination
Preliminary examination by mirror
Indirect ophthalmoscopy -in eyes with clear
media
USG B-scan in eyes with hazy media

14. Retinal detachment (RD)
Rhegmatogenous - caused by a
retinal break
Non-rhegmatogenous -
tractional or exudative

15. ProphylaxisProphylaxis
Cryotherapy
Laser therapy in predisposed

16. Principles of managementPrinciples of management
Identify retinal breaks,vitreous or,preretinal
traction
Seal the break with
diathermy,cryotherapy,Laser
Release of vitreous/preretinal traction
Drainage of SRF
Chorioretinal apposition by internal or
external temponade

17. Chorioretinal appositionChorioretinal apposition
External temponade
Scleral buckling or local plombage by
sponge,tyre or encircling band
Internal temponade
SF6 gas, C3F8 gas,Silicon oil

18. Configuration of scleral buckles
Sponge
Buckle

19. Release of vitreoretinalRelease of vitreoretinal
tractiontraction
 Pars Plana
Vitrectomy(PPV)

20. Complications of RD surgeryComplications of RD surgery
Failure to reattach and recurrence
Diplopia due to EOM damage
Anterior segment ischaemia
PVR and macular pucker

21. PrognosisPrognosis
Untreated RRD: unfavourable
Anatomical success rate 95%.
Visual prognosis depends upon duration Poor
in gross degeneration of retina,choroid and
vitreous,PVR,high myopia and detachment
present for more than 9 mo.

22. Points to RememberPoints to Remember
Retinal detachment results in painless loss of
vision.
High myopia and eye injuries are important
predisposing events.
Examinations include indirect
ophthalmoscopy, or ultrasound B-scan of the
eye.
Treatment requires vitreoretinal consultation.