RETINAL DETACHMENT
•RETINAL DETACHMENT IS THE SEPERATION OF THE SENSORY RETINA FROM THE RETINAL
PIGMENTARY EPITHELIUM BY SUBRETINAL FLUID.
CLASSIFICATION-------
TWO TYPES OF RETINAL DETACHMENT---
1.
RHEGMATOGENOUS (PRIMARY)
2.
NON-RHEGMATOGENOUS (SECONDARY)
NON-RHEGMATOGENOUS
RETINAL DETACHMENT ALSO TWO
TYPES—
A. TRACTIONAL
B. EXUDATIVE
RHEGMATOGENOUS RETINAL DETACHMENT
•RHEGMATOGENOUS RETINAL DETACHMENT USUALLY
ASSOCIATED WITH RETINAL BREAK.
•SUBRETINAL FLUID, DERIVED FROM THE FLUID
VITREOUS GAINS ACCESS INTO THE SUBRETINAL SPACE THROUGH A RETINAL BREAK.
•RHEGMATOGENOUS RETINAL DETACHMENT MAYBE
TRAUMATIC OR SPONTANEOUS.
ETIOLOGY
1.AGE- MOST COMMON IN 40-60 YEARS
2.SEX-MORE COMMON IN MALES
3.MYOPIA- 40% CASES OF RHEGMATOGENOUS RD ARE MYOPIC.
4. APHAKIA AND PSEUDOPHAKIA PATIENT ARE MORE COMMON.
5. RETINAL DEGENERATION.
6.TRAUMA
7.POSTERIOR VITREOUS DETACHMENT.
8.CATARACT SURGERY
PATHOGENESIS
SENILE ACUTE POSTERIOR VITREOUS DETACHMENT/ PREDISPOSING RETINAL DEGENERATION/APHAKIA/TRAUMA
↓
RETINAL BREAK
↓
THE DEGENERATIVE FLUID VITREOUS SEEPS THROUGH THE RETINAL BREAK AND COLLECTS AS SUBRETINAL FLUID(SRF) BETWEEN SENSORY RETINA & PIGMENTARY EPITHELIUM.
↓
RETINAL DETACHMENT
CLINICAL FEATURESSYMPTOMS-------
1.PHOTOPSIA- FLASHING OF LIGHT
2.FLOATERS– LARGE RING, SMALL BLACK SPOTS
3.VISUAL FIELD DEFECT
4.LOSS OF CENTRAL VISION
SIGN-------
1.MARCUS GUNN PUPIL (RAPD) PRESENT.
2.INTRAOCULAR PRESSURE LOW.
3.RETINAL THINNING
4.MULTIPLE OPAQUE STRANDS OF SUBRETINAL FIBROSIS
5. PROLIFERATIVE VITREORETINOPATHY DEVELOPS.
INVESTIGATION------
1.INDIRECT OPHTHALMOSCOPY
2.SLIT-LAMP EXAMINATION
3.USG– A-SCAN & B-SCAN
4. ELECTRORETINGRAPHY(ERG)
TREATMENTS
THE TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT IS ESSENTIALLY SURGICAL.
THE PATIENT SHOULD TAKE REST AS MUCH AS POSSIBLE.
THERE ARE SEVERAL METHODS OF TREATING A DETACHED RETINA, EACH OF WHICH DEPENDS ON RETINAL BREAKS. THE PRINCIPLE ARE:
1.TO FIND OUT RETINAL BREAKS
2.TO SEAL THE BREAKS
3. TO RELIVE PRESENT VITREORETINAL TRACTION.
PROCESS-
1.SEALING OF THE RETINAL BREAKS
2. VITRECTOMY
3. SCLERAL BUCKLING
4. PNEUMATIC RETINOPEXY
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TRACTIONAL RETINAL DETACHMENT
TRACTIONAL RETINAL DETACHMENT(TRD) OCCURS DUE TO RETINA BEING MECHANICALLY PULLED AWAY FROM ITS BED BY THE CONTRACTION OF FIBROUS TISSUE IN THE VITREOUS.
ETIOLOGY
1.POST-TRAUMATIC RETRACTION OF SCAR TISSUE.
2.PROLIFERATIVE DIABETIC RETINOPATHY
3.RETINOPATHY OF PREMATURITY
4.SICKLE CELL RETINOPATHY
5.RETINAL DYSPLASIA
CLINICAL FEATURES
•SYMPTOMS---PHOTOPSIA AND FLOATERS ARE USUALLY ABSENT. SLOW AND PROGRESSIVE LOSS OF VISUAL FIELD.
•SIGN---
RETINAL BREAKS ARE USUALLY ABSENT. RETINAL MOBILITY IS SEVERLY
REDUCED SUBRETINAL DEMARCATION LINES
ARE ABSENT.
TREATMENT-------
•SURGERY
•PARS PLANA VITRECTOMY
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EXUDATIVE RETINAL DETACHMENT
•SRF DERIVED FROM THE CHOROID GAINS ACCESS TO THE SUBRETINAL SPACE
THROUGH THE DAMAGE RPE. EXUDATIVE RD MAY BE DUE TO CHOROIDAL TUMORS
AND INFLAMMATION.
ETIOLOGY-------
1.SYSTEMIC DISEASE– TOXEMIA OF PREGNANCY, RENAL HYPERTENSION ETC.
2. OCULAR DISEASE– CHOROIDAL NEOVASCULARIZATION.
CLINICAL FEATURES------------
•SYMPTOMS– FLOATERS ARE PRESENT
PHOTOPSIA IS ABSENT
SUDDEN AND RAPID LOSS OF VISION
•SIGN– RETINAL BREAKS ARE ABSENT
THE EXUDATIVE RETINAL DETACHMENT IS SMOOTH AND CONVEX.
INVESTIGATION--------
1.INDIRECT OPHTHALMOSCOPY
2.SLIT-LAMP EXAMINATION
3. USG– A-SCAN & B-SCAN
4. ELECTRORETINGRAPHY(ERG)
TREATMENT
TREATMENT FOR EXUDATIVE RETINAL DETACHMENT DEPENDS ON THE CAUSE,SO FIRST TREAT THE CAUSE.
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