Retinal detatchment

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      • Retinal detatchment
        • It is the separation of neurosensory retina proper from the pigment epithelium. the term retinal detachment is a misnomer and it should be retinal separation.
        • Classification
          • Primary
            • Rhegmatogenous or primary retinal detachment.
          • Secondary retinal detachment
            • Tractional retinal detachment
            • Exudative retinal detachment
      • Rhegmatogenous or primary retinal detachment
        • It is usually associated with a retinal break (hole or tear) through which subretinal fluid (SRF) seeps and separates the sensory retina from the pigmentary epithelium.
        • Predisposing factors include:
          • Age. The condition is most common in 40-60 years
          • Sex. More common in males (M:F—3:2).
          • Myopia. About 40 percent cases of rhegmatogenous retinal detachment are myopic.
          • Aphakia. (MCQ)
          • Retinal degenerations predisposed to retinal detachment are as follows:
            • Lattice degeneration (MCQ)
            • Snail track degeneration.
            • White-with-pressure and white-without-or occult pressure.
            • Acquired retinoschisis.
          • Focal pigment clumps.
          • Trauma
          • Senile posterior vitreous detachment (PVD).
        • Clinical features
          • Prodromal symptoms.
            • dark spots (floaters) in front of the eye (MCQ)
              • occur due to rapid vitreous degeneration
            • photopsia
              • sensation of flashes of light
              • occur due to irritation of retina by vitreous movements  (MCQ)
          • Symptoms of detached retina.
            • Localised relative loss in the field of vision (of detached retina)
              • noticed by the patient in early stage
              • it progresses to a total loss when peripheral detachment proceeds gradually towards the macular area.
            • Sudden painless loss of vision
              • occurs when the detachment is large and central.
              • Such patients usually complain of sudden appearance of a dark cloud or veil in front of the eye.
          • Signs.
            • Marcus Gunn pupil (relative afferent pupillary defect)
            • Plane mirror examination reveals
              • an altered red reflex in pupillary area
              • greyish reflex in the quadrant of detached retina
            • Ophthalmoscopy
              • Retinal detachment is best examined by indirect ophthalmoscopy using scleral indentation
              • It enhances visualization of the peripheral retina anterior to equator
            • On examination
              • freshly-detached retina gives grey reflex instead of normal pink reflex and is raised anteriorly (convex configuration).
              • It is thrown into folds which oscillate with the movements of the eye.
              • retina becomes funnel-shaped, being attached only at the disc and ora serrata.
              • Retinal vessels appear as dark tortuous cords oscillating with the movement of detached retina.
              • Retinal breaks associated with rhegmatogenous detachment
                • most frequently found in the periphery
                • commonest in the upper temporal quadrant (MCQ)
            • Visual field charting reveals scotomas
            • Electroretinography (ERG) is subnormal or absent.
            • Ultrasonography confirms the diagnosis.
              • It is of particular value in patients with hazy media especially in the presence of dense cataracts.
          • Complications
            • proliferative vitreoretinopathy (PVR)
            • complicated cataract
            • uveitis
            • phthisis bulbi. (MCQ)
        • Treatment
          • Sealing of retinal breaks.
            • sealed by producing aseptic chorioretinitis, with cryocoagulation, or photocoagulation or diathermy.
            • Cryocoagulation is more frequently utilised
          • SRF drainage.
            • done very carefully by inserting a fine needle through the sclera and choroid into the subretinal space
          • To maintain chorioretinal apposition for at least a couple of weeks.
            • Scleral buckling
              • inward indentation of sclera to provide external
              • Scleral buckling is achieved by inserting an explant (silicone sponge or solid silicone band) with the help of mattress type sutures applied in the sclera
            • Pneumatic retinopaxy is a simple outpatient procedure
              • used to fix a fresh superior RD with one or two small holes extending over less than two clock hours in upper two thirds of the peripheral retina.
              • In this technique after sealing the breaks with cryopaxy, an expanding gas bubble (SF6 or C3F8) is injected in the vitreous.
              • break is uppermost and the gas bubble remains in contact with the tear for 5-7 days.
            • Parsplana vitrectomy, endolaser photocoag lation and internal temponade.
              • All complicated primary RDs
              • All tractional RDs.
              • Presently, even in uncomplicated primary RDs (where scleral buckling is successful),
        • Prophylaxis
          • Occurrence of primary retinal detachment can be prevented by timely application of laser photocoagulation or cryotherapy in the areas of retinal breaks and/or predisposing lesions like lattice degeneration.
          • Prophylactic measures -Indications
            • myopia,
            • aphakia,
            • retinal detachment in the fellow eye
            • history of retinal detachment in the family.
      • Exudative or solid retinal detachment
        • It occurs due to the retina being pushed away by a neoplasm or accumulation of fluid beneath the retina following inflammatory or vascular lesions.
        • Common causes
          • Systemic diseases.
            • toxaemia of pregnancy
            • renal hypertension
            • blood dyscrasias
            • polyarteritis nodosa.
          • Ocular diseases.
            • Inflammations
              • Harada’ s disease
              • sympathetic ophthalmia,
              • posterior scleritis,
              • orbital cellulitis
            • Vascular diseases
              • central serous retinopathy
              • exudative retinopathy of Coats
            • Neoplasms
              • malignant melanoma of choroid
              • retinoblastoma (exophytic type
            • Sudden hypotony due to perforation of globe and intraocular operations.
        • Clinical features
          • Exudative retinal detachment can be differentiated from a simple primary detachment by:
          • Absence of photopsia, holes/tears, folds and undulations.
          • The exudative detachment is smooth and convex
          • At the summit of a tumour it is usually rounded and fixed and may show pigmentary disturbances.
          • Occasionally, pattern of retinal vessels may be disturbed due to presence of neovascularisation on the tumour summit.
          • Shifting fluid characterised by changing position of the detached area with gravity is the hallmark of exudative retinal detachment. (MCQ)
          • On transillumination test a
            • simple detachment appears transparent
            • solid detachment is opaque.
        • Treatment
          • the treatment should be for the causative disease.
          • Presence of intraocular tumours usually requires enucleation.
        • Tractional retinal detachment
          • It occurs due to retina being mechanically pulled away from its bed by the contraction of fibrous tissue in the vitreous (vitreoretinal tractional bands).
          • Etiology
            • Post-traumatic retraction of scar tissue especially following penetrating injury.
            • Proliferative diabetic retinopathy.
            • Post-haemorrhagic retinitis proliferans.
            • Retinopathy of prematurity.
            • Plastic cyclitis.
            • Sickle cell retinopathy.
            • Proliferative retinopathy in Eales’ disease.
          • Clinical features
            • charcterised by presence of vitreoretinal bands with lesions of the causative disease.
            • configuration of the detached area is concave.
            • The highest elevation of the retina occurs at sites of vitreoretinal traction.
            • Retinal mobility is severely reduced and shifting fluid is absent.
          • Treatment
            • It is difficult and requires pars plana vitrectomy to cut the vitreoretinal tractional bands and internal tamponade
          • Prognosis in such cases is usually not so good.


Retinal-Detachment – evrs
If there is a strong adhesion between the retina and the vitreous, the posterior vitreous detachment can cause a traction on the retina. If the retina itself is fragile at that particular point, this can lead to a retinal tear, which will allow the intraocular fluids to go through and detach the retina.
Retinal Detachment
Detachment of the Retina begins with a Retinal Tear. Each has particular symptoms to look for. Surgical Repair by Laser, Scleral Buckle, Gas Bubble, or Vitrectomy. Usually caused by changes in the Vitreous.
Scleral Buckle and Vitrectomy for Retinal Detachment
This video shows how I repair a retinal detachment using a scleral buckle and a vitrectomy. The combination of these two techniques yields a high chance of success for re-attaching the retina. The operation was performed with the patient awake, but completely comfortable and as an outpatient.
Eye Floaters, Retinal Tears and Retinal Detachments
This video demonstrates why we see floaters and how retinal tears and retinal detachments develop.
Retinal Detachment Repair Part 1
Retinal Detachment Surgery-Alltebfamily.com.flv
ophthamology Videos

Retinal Detachment….{A Complimentary from Rushabh Eye Hospital,India}
Retinal Detachment WHAT IS THE RETINA? The retina is a nerve layer at the back of the eye that senses light and sends images to the brain. WHAT IS A RETINAL DETACHMENT? The retina is attached to the inner back surface of the eye. Detachment is the pulling away of the retina from its normal position. 
Retinal detachment surgery – Scleral buckle and vitrectomy
Patient with retinal detachment and multiples retinal tears who underwent scleral buckle fixed with scleral tunnels and vitrectomy with laser retinopexy and C3F8 exchange.
Surgeons: Dr. Francisco Buenestado. Dr. Felipe Ruano.
Hospital General Universitario de Ciudad Real. Spain.
Music: Forrest Gump Suite. Alan Silvestri.