Retinal detachment





A separation of the neurosensory retina from the retinal pigment epithelium.

In the acute phase of posterior vitreous detachment traction may cause tears in the retina.

Classified as rhegmatogenous, exudative, or tractional.

Rhegmatogenous detachment ihas an annual incidence of 6-18 per 100 thousand persons, and is the most common type.

Rhegmatogenous retinal detachment occurs bilaterally in approximately 7.26% of cases.

Rhegmatogenous retinal detachment occurs when a tear in the retina allows for vitreous fluid to flow into and separate the sensory retina from the retinal pigment epithelium.

A history of myopia, cataract surgery, or trauma in elderly symptomatic patients should alert that the process of rhegmatogenous retinal detachment.

Retinal tears can allow fluids to gain in entry to the subretinal space and lead to separation of the neurosensory layer of the retina from the underlying retinal pigmented epithelium and cause retinal detachment.

Myopia results in a four fold increase of retinal detachment with a refractive error of -1to -3 compared with non-myopic eyes.

Occurs when liquified vitreous fluid enters the sub retinal space via a full thickness retinal break.

Retinal breaks or tears occur in areas of strong vitreoretinal adhesion.

Separation of the vitreous from the retina may cause retinal tears.

Retinal detachments present with a veil or curtain of impaired vision.

Approximately 33-46% of retinal tears can lead to retinal detachment.

If the macula remains attached vision may be preserved, and is an ocular emergency

Estimated incidence of 0.8-1.8 per 10,000 persons per year.

Estimated prevalence is 0.3% of the population.

Active use of quinolones may be associated with retinal detachment.

Associated with higher risk with heavy lifting.

Risk factors for developing a retinal detachment include: age due to age related posterior vitreous detachment, high myopia, trauma, diabetes, lattice degeneration, previous cataract surgery, family history, and personal history of previous detachment.

Congenital development anomalies such as Marian syndrome and Ehlers-Danilo’s syndrome are associated with retinal attachments.

Use of fluoroquinolones strongly associated with retinal detachment with a 4.5 fold increased risk for ongoing drug exposure ( Etminan M et al).

In a Danish study the use of oral fluoroquinolones was not associated with increased risk of retinal attachment (Pasternak B et al).

Symptoms include decreased vision and a progressive monoocular visual field defect.

Patients may present with bright flashes peripherally in one eye, followed by a shower of black dots or a swarm of bees and decreased visual acuity.

Other patients may have brief, or recurrent flashes and floaters or a dark curtain or shadow moving from the peripheral to central vision.

If the macula is affected patients may lose central vision or total light perception.

Prompt diagnosis and surgery can prevent vision loss or can restore vision.

Treatment methods for fixing a retinal detachment: pneumatic retinopexy, scleral buckle, cryotherapy, laser photocoagulation and pars plana vitrectomy.

Prior to improved cataract surgery and the use of phacoemulsification, a history of cataract surgery resulted in an estimated 5.5 times higher probability of retinal detachment and this number has since decreased.

Incidence of retinal detachment following phacoemulsification has been 0.25% and declining over time.

Traditional retinal detachment has an insidious onset in occurs when adhesions develop between the vitreous gel and the retina.

The fibrotic adhesive tissue forms as a result of previous hemorrhage, injury, surgery, infection, or inflammation and allows mechanical forces to separate the retina from the retinal pigment epithelium without causing a retinal tear or break.

Exudative retinal detachment occurs when subretinal fluid accumulates and causes separation without a retinal break.

Exudative retinal detachment is usually caused by hydrostatic factors, tumor growth or inflammation.







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