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RETINAL

DETACHMENT
Chikita Artia Sari / I 11109014
Definition
Retinal detachment is the separation of the
sensory retina, ie, the photoreceptors and inner
tissue layers, from the underlying retinal pigment
epithelium.
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
Morphology of Tears

Rhegmatogenous Retinal
Detachment
Rhegmatogenous retinal detachment is
characterized by a full-thickness break (a
"rhegma") in the sensory retina, variable degrees
of vitreous traction, and passage of liquefied
vitreous through the break into the subretinal
space.
A spontaneous rhegmatogenous retinal
detachment is usually preceded or accompanied
by a posterior vitreous detachment and is
associated with myopia, aphakia, lattice
degeneration, and ocular trauma.

Rhegmatogenous Retinal
Detachment
Binocular indirect
ophthalmoscopy
with scleral
depression reveals
elevation of the
translucent
detached sensory
retina with one or
more full-thickness
sensory retinal
breaks, such as a
horseshoe tear,
round atrophic hole,
or anterior
circumferential tear
(retinal dialysis).

Rhegmatogenous Retinal
Detachment
The location of retinal
breaks varies according
to type; horseshoe
tears are most common
in the superotemporal
quadrant, atrophic
holes in the temporal
quadrants, and retinal
dialysis in the
inferotemporal
quadrant.
When multiple retinal
breaks are present, the
defects are usually
within 90 degrees of
one another.

Rhegmatogenous Retinal
Detachment
The principal aims of detachment surgery are to
find and treat all the retinal breaks, cryotherapy
or laser being applied to create an adhesion
between the pigment epithelium and the sensory
retina, thus preventing any further influx of fluid
into the subretinal space, to drain subretinal fluid,
internally or externally, and relieve vitreo-retinal
traction.
Various surgical techniques are employed.
o Pneumatic retinopexy air or expandable gas
o Scleral buckling
o Pars plana vitrectomy
Rhegmatogenous Retinal
Detachment
The visual results of surgery for rhegmatogenous
retinal detachment primarily depend on the
preoperative status of the macula.
If the macula has been detached, recovery of
central vision is usually incomplete. Thus,
surgery should be performed urgently if the
macula is still attached.
Once the macula is detached, delay in surgery
for up to 1 week does not adversely influence
visual outcome.


Traction Retinal Detachment
Traction retinal detachment is most commonly
due to proliferative diabetic retinopathy. It can
also be associated with proliferative
vitreoretinopathy, retinopathy of prematurity, or
ocular trauma.
In comparison to rhegmatogenous retinal
detachment, traction retinal detachment has a
more concave surface and is likely to be more
localized, usually not extending to the ora
serrata.
Traction Retinal Detachment
The tractional forces actively pull the sensory
retina away from the underlying pigment
epithelium toward the vitreous base.
Traction is due to formation of vitreal, epiretinal,
or subretinal membranes consisting of fibroblasts
and glial and retinal pigment epithelial cells.
Initially the detachment may be localized along
the vascular arcades, but progression may
spread to involve the midperipheral retina and
the macula.

Traction Retinal Detachment
Focal traction from cellular membranes can
produce a retinal tear and lead to combined
traction-rhegmatogenous retinal detachment.
Proliferative vitreoretinopathy is a complication of
rhegmatogenous retinal detachment and is the
most common cause of failure of surgical repair
in these eyes.
Traction Retinal Detachment
Pars plana vitrectomy allows removal of the
tractional elements followed by removal of the
fibrotic membranes.
Retinotomy and/or injection of perfluorocarbons
or heavy liquids may be required to flatten the
retina.
Gas tamponade, silicone oil, or scleral buckling
may be used.



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