Retinal detachment

Dr Roopa Rokhade

Retinal detachment
Definition: separation of the neurosensory retina
(NSR) from the retinal pigment epithelium (RPE).
3 types of RD :
1Rhegmatogenous : caused by a break
2Tractional :when pathologic vitreoretinal
adhesions mechanically pull away retina from
the RPE
3Exudative : secondary to tumour, inflammation
or a systemic disease

Rhegmatogenous RD
Fluid gains access
through rhegma/
break
Essential
prerequisites
1. Vitreous
liquefaction
2. Presence of a
retinal break (tear,
hole)

Epidemiology
Phakic, nontraumatic RD: 1 in 10,000 per
year
Following cataract surgery: 1-3%
Vitreous loss during cataract surgery: up
to 10%
Fellow eye: up to 15%
Patients with high myopia: 5%
Age: 40-80 years
Slight male preponderance

Risk factors

Myopia
Lattice degeneration
Cataract surgery
Trauma
History of RD in other eye
Family h/o RD
Combinations of these risk factors

Symptoms and signs

Symptoms:
Photopsia
Flaoters
Visual field defect black
curtain
Signs:
Marcus gunn pupil
Low intraocular pressure
Iritis
Tobacco dust

 Detailed indirect
ophthalmoscopy
Localise primary break
as well as other breaks
50% have more than 1
break
Meticulous drawing
Helps to plan surgery
Key to sucess

Lincoffs rules

Retinal detachment
Simple RD
Good visibility
Single anterior
breaks
Multiple breaks in
same anterior
location
Absence of
advanced PVR

Complex RD
Giant retinal tear
Posterior break,
macular hole
Large multiple
tears
Media opacities
Choroidal
detachment
Coloboma
Complicated by
PVR

Retinal detachment
-Management
Simple RD
Scleral bukling
Pneumatic
retinopexy

Complex RD
Pars plana
vitrectomy
+/- buckle
Tamponade gas or
oil

Scleral buckling

Sclera pushed inward

Reapposes RPE to break
Break supported by buckle
Precise external localisation
Key to sucesss

Pneumatic retinopexy
For RD with single
break or breaks
within 1 clock
hour
Break in superior
half of retina
Early grades of
PVR

Pars plana vitrectomy

Complex RD
Relieves the
vitreous traction
Additional
encircling band
Tamponading
agents- Gas (C3F8,
SF6), Silicone oil,
PFCL

Management of fellow eye

As important as RD eye
Prophylactic treatment for breaks
and lattice
Laser or cryotherapy
Done pre op or intraop