RETINAL

DETACHMENT
dr. BUDU,PH.D, Sp.M-KVR
DEPARTMENT OF OPHTALMOLOGY,
FACULTY OF MEDICINE, HASANUDDIN UNIVERSITY,
MAKASSAR
NORMAL FUNDUS
3
Retinal layer

4
EMBRIOLOGY OF THE EYE
SUBRETINAL SPACE
Direct ophthalmoscopy
RETINAL DETACHMENT
Separation of the sensory part of the retina from
the retinal pigment epithelium (RPE).
There is an accumulation of fluid in the space
between the neural retina and the RPE known as
Subretinal fluid.


Pathogenesis
There is an embryological explanation for retinal detachment
in that the separating layers open up a potential space that
existed during the early development of the eye.
The inner lining of the eye develops as two layers.
The outer of the two layers remains as a single layer of
pigmented cells, known as the pigment epithelium. The inner of
the two layers becomes many cells thick and develops into the
sensory retina.

CLASSIFICATION
Rhegmatogenous Retinal Detachment
Tractional Retinal Detachment
Exudative Retinal Detachment
Rhegmatogenous
Retinal Detachment

This is the most common form of
retinal detachment, caused by the
recruitment of fluid from the vitreous
cavity to the subretinal space
via a full-thickness discontinuity (a
retinal break) in the sensory retina.
Retinal degeneration of peripheral retina
(lattice degeneration in high myopia >>>.
Vitreous change ( posterior vitreous
detachment/PVD. Vitreous traction).
Trauma
Etiology
Vitreus traction



prediposes to
retinal breaks
PVD
Tractional
Retinal Detachment

This form of retinal detachment
develops as a result of tractional
forces within the vitreous gel
pulling on the retina, causing
the retina to be tented up from
the RPE. No retinal breaks.
The retinal detachment can be pulled away by the contraction of fibrous
bands in the vitreous, advanced proliferative diabetic retinopathy is the
common cause of tractional retinal detachment.
Etiology
Exudative
Retinal Detachment

The fluid gains access to the subretinal space through an abnormal
choroidal circulation can be found from a choroidal malignant melanoma or,
rarely, secondary to inflammation of the RPE or deeper layers of the eye (e.g.,
scleritis).
Flashes (Photopsiae)
The patient usually says those flashes probably present all the
time but are only noticeable in the dark.
Floaters
Black spots floating in front of the vision are commonplace but
often called to our attention by anxious patients.
Shadow
a black shadow is seen encroaching from the peripheral field. If the
detachment is above, the shadow encroaches from below and it
might seem to improve spontaneously with bedrest, being at first
better in the morning.
Visual loss occurs when the fovea is involved by the detachment, or
the visual axis is obstructedby a bullous detachment
Signs and Symptoms Retinal Detachment
(esp. Rhegmatogeneous RD)

Ophthalmoscopy :

- Grey retinal bullous seen in
the part of retinal
detachment. Retinal
vasculatures were join the
bullous retina. In
rhegmatogenous RD, retinal
break can be identified.



Tractional ret. Detachment in PDR
Large retinal tears
MANAGEMENT
Rhegmatogenous retinal detachment
Prophylaxis

Retinal tears without significant subretinal fluid
can be sealed by means of light coagulation. A
powerful light beam from a laser is directed at
the surrounds of the tear.
Retinal tears
Laser spots
Retinal Surgery

Modern retinal reattachment surgery is carried out using either the
cryobuckling or vitrectomy technique. Addition treatment are
unrarely performed with scleral buckling/vitrectomy are internal
drainage, endolaser photocoagulation, or gas/silicon intravitreal
injection.
Cryobuckle

This involves the sewing of small inert pieces of material,
usually silicone rubber, onto the outside of the sclera in such a
way as to make a suitable indent at the site of the tear.
This is combined with cryopexy to the break.
It is often necessary to drain off
the subretinal fluid and inject air
or gas into the vitreous. In more
difficult cases, the eye can be
encircled with a silicone strap to
provide allround support to a
retina with extensive
degenerative changes.

Scleral
buckling
Retinal detachment surgery: retinal tear surrounded
by cryopexy and covered by indent

Vitrectomy

The detached retina is reattached from within the vitreous
cavity.
Cannula infusion is inserted to the globe
for maintaining the intraocular pressure.

A light probe is used to illuminate the
operative field

Vitrectomy cutter is used to remove the
vitreous,
hence relieving the abnormal vitreous
adhesions that produced the retinal tear
in the first instance
Infusion cannula
light port
vitrectomy cutter port
Injecting air or
gas into the
vitreous.
Laser endophotocoagulation Cutting fibrous membrane
Tractional Retinal
Detachment

Fibrous tissues pulling retinal layer
are cut away till retinal re-attach.
Sometime combined with silicon
injection or endolaser
photocoagulation.

Serous Retinal
Detachment

Depend on the cause of the retinal
detachment.

Prognosis
The retina can now be successfully reattached by one operation
in about 85% of cases.
Those in which the macular region was affected by the retinal
detachment do not achieve a full restoration of their central
Vision.
The main cause of failure of surgery is proliferative
vitreoretinopathy.This is characterised by excessive scarring
following initial retinal reattachment surgery
When retinal surgery has failed, further surgery might be
required and for a few patients a series of operations is
necessary.
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