RETINAL DETACHMENT

RETINA
• light-sensitive tissue layer
• sends visual messages
through the optic nerve
Retina have 2 layers
• Sensory retina – rods and
cones are present
• Retinal pigment epithelium
(RPE)
• Retinal detachment is the separation of the
retinal layers (sensory layer from RPE) due to a
break or tear over the retinal layers
Four types
• Rhegmatogenous
• Traction
• Combined form of rhegmatogenous and
traction
• Exudative
Rhegmatogenous detachment –
• Most common one
• A hole or tear develops in the sensory retina
allowing some of the liquid (vitreous) to seep
through the sensory retina and detach it from
the RPE
Traction – a pulling force is responsible
• Traction can be occur due to any scars or
bands of fibrous material providing traction to
the retina
• Vitreous hemorrhage, retinopathy can cause
traction effect
Exudative – due to production of serous fluid
under the retina. (uveitis, degenerative
disorders)
 Pathophysiology
• Due to etiological factors (a torn or break in
retina)
• Vitreous fluid or serous fluid leaks in between
the layers of retina or behind the retinal layers
• Detachment of retinal layer
• Retina can peel away from the underlying
layer of blood vessels
• Lack of oxygenation in tissues of retina
• Vision disturbances
SYMPTOMS
• Floaters
• Cobwebs
• Bright light flashes
• shadow or curtain over a portion of visual field
• blur in vision
• No complain of pain
• floaters - bits of debris in field of vision that
look like spots, hairs or strings
Etiology
• Trauma
• Advanced diabetes
• shrinkage of the jelly-like vitreous that fills
the inside of the eye
• Myopia
• Degenerative disorders
• Inflammation and infections
• Scarring and fibrous material due to
retinopathy and hemorrhages
• Ocular tumors
 Factors that may increase risk of
retinal detachment:

• aging - more common in people older than 40

• previous retinal detachment in one eye
• family history of retinal detachment
• extreme nearsightedness
• previous eye surgery
• previous severe eye injury or trauma
 Diagnostic findings
• Visual acuity
• Ophthalmoscopy
• Slit lamp microscopy
• Unltrasound
Surgical management
Retinal tears:
• laser surgery (photocoagulation) – with the
help of laser rays the tears are being joined or
sutured.
• freezing (cryopexy) – cryoprob will freeze and
join the retinal tears
Retinal detachment:
• pneumatic retinopexy
• scleral buckling
• vitrectomy
PHOTOCOAGULATION
CRYOPEXY
 Scleral buckling
• Compression of sclera to indent the scleral
wall from the outside of the eye and bring the
two retinal layers in contact with each other
• High success rate
• It uses silicone sponge, rubber, or semi-hard
plastic for buckling
• It will provide a traction on the retina and
allow the retinal tear to settle against the wall
of the eyes
SCLERAL BUCKLING
 Vitrectomy
• It is the surgical removal of the vitreous gel from
the eye. It can also remove blood in the vitreous
gel
• Three incisions are made
• One incision allows the introduction of light
source
• Other incision for vitrectomy instrument
• The third incision for the instrument to refill the
vitreous substitute (silicone oil)
• Duration is 2 to 3 hours
VITRECTOMY
• This procedure can be used to remove foreign
bodies, vitreous opacities such as blood
• Traction on the retina can be relieved
 Pneumatic retinopexy
• Least invasive
• A gas bubble, silicone oil, or perflurocarbon
may be injected into the vitreous cavity to
help push the sensory retina up against the
RPE
• Patient must be in prone position to hold the
injected bubble in postition
PNEUMATIC RETINOPEXY
 Care
• Complications – bleeding under retina, cataracts,
recurrence or infection
• Home care – short recovery , can resume normal
activity after two weeks, traveling should be
avoided for a month, avoid increase altitudes
• Pain and eye protection – eye drops and eye patch
may be necessary to keep the eye moist, no soap
should enter into eye during bathing, if air bubble is
injected- prone position should be provided for one
to two weeks
• Exercise – close concentration and TV
watching should be avoided, heavy lifting over
20 pounds and strenuous activities should be
avoided, Driving should be avoided
• Follow up should be done accordingly.