RETINAL DETACHMENT

ZALDI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2013
ZALDI

RETINAL DETACHMENT

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Dengan menyebut nama Allah

Yang Maha Pengasih Maha
Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa ablasio retina
dengan
melakukan
anamnese
dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik dan
benar .

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II. TUJUAN INSTRUKSIONAL KHUSUS

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Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktor
resiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus ablasio retina
sesuai dengan kompetensinya

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ANATOMY
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FUNDUS
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ANATOMY
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ANATOMY
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RETINAL BREAKS
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DEFINITION
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It is the separation of neurosensory

retina proper from the pigment
epithelium.

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CLASSIFICATION
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Clinico-etiologically retinal detachment

can be classified into three types:
1. Rhegmatogenous or primary retinal
detachment.
2. Tractional retinal detachment
3. Exudative retinal detachment
2 & 3 Secondary retinal detachment

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RHEGMATOGENOUS RETINAL
DETACHMENT
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It is usually associated with a retinal

break (hole or tear) through which
subretinal
fluid
(SRF)
seeps
and
separates the sensory retina from the
pigmentary epithelium.

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RHEGMATOGENOUS RETINAL
DETACHMENT
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Etiology
It is still not clear exactly.
A. Predisposing factors include:
1. Age. The condition is most common in
40-60 years.
2. Sex. More common in males (M:F3:2).
3. Myopia. About 40 percent
4. Aphakia. The condition is more common in
aphakes than phakes.
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PREDISPOSING FACTORS
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5. Retinal degenerations predisposed to retinal

detachment are as follows:
Lattice degeneration
Snail track degeneration.
White-with-pressure and white-without-or occult
pressure.
Acquired retinoschisis.
Focal pigment clumps.
6. Trauma. It may also act as a predisposing factor.
7. Senile posterior vitreous detachment (PVD).
It is associated with retinal detachment in many cases.
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PATHOGENESIS
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The retinal breaks responsible for RRD are caused by the

interplay between the dynamic vitreoretinal traction and
predisposing degeneration in the peripheral retina.
Dynamic vitreoretinal traction is induced by rapid eye
movements especially in the presence of PVD, vitreous
synersis, aphakia and myopia.
Once the retinal break is formed, the liquified vitreous may
seep through it separating the sensory retina from the
pigment epithelium.
As the subretinal fluid (SRF) accumulates, it tends to
gravitate downwards. The final shape and position of RD is
determined by location of retinal break, and the anatomical
limits of optic disc and ora serrata.

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CLINICAL FEATURES
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Prodromal symptoms
dark spots
floaters
Degeneration
photopsia, i.e., sensation of flashes of light
(due to irritation of retina by vitreous
movements).

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SYMPTOMS OF DETACHED RETINA

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1. Localised relative loss in the field of vision (of

detached retina) is noticed by the patient in
early stage which progresses to a total loss
when
peripheral
detachment
proceeds
gradually towards the macular area.
2. Sudden painless loss of vision occurs when
the detachment is large and central. Such
patients
usually
complain
of
sudden
appearance of a dark cloud or veil in front of
the eye.
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PHYSICAL EXAMINATION
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1. External examination, eye is usually normal.

2. Intraocular pressure is usually slightly lower
or may be normal.
3. Marcus Gunn pupil (relative afferent pupillary
defect) is present in eyes with extensive RD.
4. Plane mirror examination reveals an altered
red reflex in pupillary area (i.e., greyish reflex
in the quadrant of detached retina).
5. Ophthalmoscopy should be carried out both
by direct and indirect techniques.
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COMPLICATIONS
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These usually occur in long-standing

cases
and
include
proliferative
vitreoretinopathy (PVR), complicated
cataract, uveitis and phthisis bulbi.

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TREATMENT
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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.

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TRACTIONAL RD
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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.
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. 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.
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TREATMENT TRACTIONAL RD
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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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SEROUS & HEMORRHAGIC RD

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Serous and hemorrhagic retinal detachment occurs in the

absence of either retinal break or vitreoretinal traction.
They form as a result of accumulation of fluid beneath
the sensory retina and are caused primarily by diseases
of the retinal pigment epithelium and choroid.
Degenerative, inflammatory, and infectious diseases,
including
the
multiple
causes
of
subretinal
neovascularization, may be associated with serous
retinal detachment and are described in an earlier
section of this chapter.
This type of detachment may also be associated with
systemic vascular and inflammatory disease.

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LATTICE DEGENERATION
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Lattice degeneration is the most common vitreoretinal degeneration.

The estimated incidence in the general population is 610%, of which
up to 50% have bilateral disease. It is more commonly found in
myopic eyes with some familial tendency.
It produces localized round, oval, or linear areas of retinal thinning,
with pigmentation, branching white lines, and whitish-yellow flecks,
and firm vitreoretinal adhesions at its margins.
Lattice degeneration results in retinal detachment in only a small
percentage of affected eyes, but 2030% of eyes with retinal
detachment have lattice degeneration.
Strong family history of retinal detachment, retinal detachment in
the fellow eye, high myopia, and aphakia require the patient to be
informed of the risks of retinal detachment and the relevant
symptoms but rarely warrant prophylactic treatment with
cryosurgery or laser photocoagulation.
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MACULAR HOLE
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Macular hole is a full-thickness absence of the sensory retina

in the macula. This disorder occurs most often in elderly
patients and is typically unilateral.
Biomicroscopy of the symptomatic eye reveals a fullthickness, round or oval, sharply defined hole measuring
one-third disc diameter in the center of the macula, which
may be surrounded by a ring detachment of the sensory
retina
Visual acuity is impaired, and metamorphopsia and a central
scotoma are present on Amsler grid testing.
The Watzke-Allen slit beam test correlates well with the
presence of a full-thickness macular hole. A slit beam of light
positioned across the macular hole is described by the
patient as being either thinned or broken.

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REFERENCES
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American Academy of Ophthalmology, Retina

and Vitreous, Section 12, 2011-2012
Khurana AK, Comprehensive Ophthalmology,
Fourth Edition , New Delhi, New Age
Internasional (p) Limited Publisher, 2007.
Vaughan & Asbury's : General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May
2007

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Segala puji bagi Allah, Tuhan semesta

alam.

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THANKS YOU

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