DIS - Retinal Detachment - Week 8 Flashcards by B H

Define retinal detachment, including the layers affected.

Separation/cleavage between the photoreceptors and the RPE

How well did you know this?

Not at all

Perfectly

What does retinal detachment result in the opening of? what accummulates?

Results in the reopening of the subretinal space and accumulation of fluid in this space

How well did you know this?

Not at all

Perfectly

What happens to the subretinal space during embryonic development?

It closes as optic vesicle invaginates to form the optic cup

How well did you know this?

Not at all

Perfectly

Is retinal detachment sight threatening? Is it considered an ocular emergency?

Yes

How well did you know this?

Not at all

Perfectly

List the two forms of retinal detachment.

Rhegmatogenous RD
Non-rhegmatogenous RD

How well did you know this?

Not at all

Perfectly

Define rhegmatogenous retinal detachment. What is it held open by? What does it facilitate the spread of and where?

Results from a retinal tear/hole
Break is held open by traction
Facilitates the spread of fluid from the liquefied vitreous to the subretinal space

How well did you know this?

Not at all

Perfectly

Where are breaks more likely with rhegmatogenous retinal detachment?

More likely within a zone of degeneration

How well did you know this?

Not at all

Perfectly

What forms around the hole/tear in rhegmatogenous retinal detachment? What happens to this and due to what(2)?

Localised detachment (cuff)
-usually spreads towards the macula, usually by subretinal fluid

How well did you know this?

Not at all

Perfectly

What is meant by secondary non-rhegmatogenous retinal detachment? What can it be caused by?

Retina is pulled from the RPE in the absence of a tear
-caused by major internal disturbance (trauma)

How well did you know this?

Not at all

Perfectly

What is meant by tractional non-rhegmatogenous retinal detachment? List three causes.

Shrinkage of fibrovascular vitroretinal membrane
-diabetes, CRVO, BRVO

How well did you know this?

Not at all

Perfectly

What is meant by exudative non-rhegmatogenous retinal detachment? What does it occur subsequent to and what is the pathogenesis?

Subsequent to a damaged RPE which permits leakage from the choroid into the subretinal space

How well did you know this?

Not at all

Perfectly

List 5 possible causes of exudative non-rhegmatogenous retinal detachment.

AMD
CSR
Choroidal tumour
Intraocular inflammation
Toxaemia of pregnancy

How well did you know this?

Not at all

Perfectly

What happens to the incidence of retinal detachment with age? Which age has the highest incidence?

Increases with age, most in mid-50s

How well did you know this?

Not at all

Perfectly

Is retinal detachment more common in males, females, or equal?

More in males

How well did you know this?

Not at all

Perfectly

Compare the incidence of retinal detachment among caucasians vs asians.

Caucasians&raquo_space; asians

How well did you know this?

Not at all

Perfectly

Which age group does trauma related rhegmatogenous retinal detachment tend to occur?

<50

How well did you know this?

Not at all

Perfectly

Is there a genetic component to rhegmatogenous retinal detachment?

Yes, 2.6x greater risk if relative diagnosed

How well did you know this?

Not at all

Perfectly

List four genetic conditions associated with rhegmatogenous retinal detachment.

Syndromic myopia
Wagner syndrome
Stickler syndrome
Erosive retinopathy

How well did you know this?

Not at all

Perfectly

Does myopia increase or decrease the risk of retinal detachment?

Increase

How well did you know this?

Not at all

Perfectly

Does cataract surgery increase or decrease the risk of retinal detachment? Explain.

Increases linearly over time due to vitreous structure collapse
-decreased support

How well did you know this?

Not at all

Perfectly

Is a retinal hole considered safe once it has pigmented?

Yes

How well did you know this?

Not at all

Perfectly

List three abnormal vitreous adhesions that are risk factors for retinal detachment.

Meridional folds
Enclosed oral bays
Granular tissue

How well did you know this?

Not at all

Perfectly

Describe how posterior vitreous detachment is a risk factor for retinal detachment, noting which type it can cause (5).

The collapsing vitreous exerts mechanical pull on the retina, causing traction, resulting in haemorrhage or tears -> rhegmatogenous retinal detachment

How well did you know this?

Not at all

Perfectly

Summarise the risk factors for retinal detachment (4).

Fellow eye has RD
Positive family ocular history
High myopia
Past cataract surgery

How well did you know this?

Not at all

Perfectly

List retinal degenerations that have a high incidence of retinal detachment. Note the most important one first.

Lattice degeneration Snail track Snowflakes Cystoid degeneration Retinoschisis White without pressure

Note which of the following degerations have an association with retinal detachment: Pavingstone Reticular Peripheral drusen

None

How should lattice degenerations be assessed when suspecting retinal detachment? Include a comment on tears within the degeneration.

Search for tears/holes near the edge or outside of the lattice Those inside the lattice are often pigmented over and safe

Is rhegmatogenous retinal detachment symptomatic?

Yes, 93% first time will have symptoms

List three symptoms associated with rhegmatogenous retinal detachment. Note the most common first.

Loss of vision/blurry vision Shadows New floaters

What is a strong indicator of a retinal tear?

Sudden onset (<6/52) -most present within a week

What is essential for individuals with fewer symptoms on repeat rhegmatogenous retinal detachment?

Regular reviews

List four causes of sudden increases in floaters or new floaters.

Haemorrhage Retinal tissue Vitreous floaters Pigment

What is photopsia caused by and how do patients perceive it? How long do they last and where in the visual field is it projected relative to the retina? What can initiate/worsen it?

Mechanical stimulation of the photoreceptors by traction/pressure A yellow, white, silver arc/lightning bolt or vertical flash Frequent but momentary Projected into the opposite visual field Worsened/initiated by head movement

Does photopsia recur in the same position?

Yes

What is metamorphopsia and why does it occur?

Distorted vision -caused by the retina not being flat

What is a pre-retinal haemorrhage and what is it often near?

Vitreous traction tears retinal blood vessels Often near retinal tears

What is a patient likely to have if they have pre-retinal haemorrhage and posterior vitreous detachment?

Rhegmatogenous retinal detachment

True or false Posterior vitreous detachment is found in most retinal detachments and/or tears

True

What is the focus of the retina often like on fundus examination of a retinal detachment case?

Out of focus, billows forward

What are retinal folds? What happens on eye movement? Is it a sign of retinal detachment?

A sign of retinal detachment Yellow, crinkle cut or pleated appearance Moves with eye movement

What is a convex curve and what does its apex point towards? Is it a sign of retinal detachment?

A sign of retinal detachment It indicates the leading edge Apex towards the macula

How can the colour of the retina vs blood vessels be a sign of retinal detachment?

Difference in colour Paler retina Darker blood vessels

Are unusual tortuousity of retinal blood vessels a sign of retinal detachment?

Yes

Can visual field defects indicate a retinal detachment?

Yes a relative VF defect

What is meant by a high watermark and what is it an indication of?

Pigmentation and fibrosis along the convex edge of long-standing retinal detachment

Is retinal oedema and/or anoxia a sign of retinal detachment?

Yes

Where does the detachment spread toward with time?

The macula

Describe if RAPD can occur with retinal detachment.

Only if very extensive -i.e. the whole eye

What is shafers sign and what causes it? What does it look like?

Tobacco dust Comes from exposed RPE and subretinal space at the tear -looks like little brown specks

What is the likely outcome if a patient is positive for shafers sign in symptomatic posterior vitreous detachment?

High risk tear

What does the red free filter do when assessing retinal detachment?

Shows the RPE dark, increasing contrast of the detachment

What is considered a retinal hole or tear?

Any full or partial thickness discontinuity in the sensory retina

What is a primary retinal hole?

Atrophic break without traction

Can fluid enter the subretinal space even if the hole/tear is full thicknesse?

Yes

Are all holes equally dangeroud?

What shape do retinal tears often have (those that break with tension)?

U or horseshoe shaped

What is considered a giant retinal tear (2)?

A break in up to 90 degrees or along the edge of the vitreous base

What is a retinal dialysis?

Circumferential tears along the ora serrata over 90 degrees

Do primary holes have symptoms?

Is there risk of retinal detachment with primary holes?

Do primary retinal holes have an operculum?

Do primary retinal holes have smooth or rough edges?

Smooth

Do primary retinal holes have vitreous traction?

When should primary and secondary retinal holes be referred?

Primary - refer if suspicious Secondary - refer

What are two associations of secondary retinal holes?

Retinal degeneration Vitreal degeneration

What does the presence of operculum i nsecondary retinal holes suggest? What can it proceed to?

Indicates local vitreous traction -can proceed to retinal detachment

Are cuffs common in rhegmatogenous retinal detachment and what is it due to?

Common -subretinal fluid

What percentage of retinal holes are secondary?

93%

What shape do secondary retinal holes tend to have (3) and do they have an overlying operculum?

Oval, round or horseshoe shaped ± overlying operculum

What is a horseshoe tear, and what does it always point towards?

Partial hole operculum Always points to the macula (round side)

What quadrants often have secondary retinal holes the most (2)? Do these quadrants have the greatest or least danger?

Temporal/superior -more common and greatest danger

What may be associated with secondary retinal holes?

PVD

What seven things are associated with a high risk of retinal detachment? List the three most common first.

Symptomatic horseshoe hole Symptomatic operculated hole Recent acute symptomatic posterior vitreous detachment Presence of vitreous haemorrhage or shafers sign Large tears Tears in superior quadrants Demographic and features

Do tears in superior quadrants spread more quickly or slowly? Explain.

Spread quickly due to gravity Produce higher/bullous detachments

What is associated with a low risk of retinal detachment?

Asymptomatic breaks within retinal degeneration -lattice

What is the management for retinal detachment? When is urgent referral needed?

Refer to a retinal specialist Urgent referral if the RD is recent

What is considered an old retinal detachment and should they be referred? Explain the expected outcomes.

>1 month - have little chance of visual recovery but still refer

What are five things that should be considered when retinal detachment is seen or suspected?

Is the macula on or off? Extent of visual field loss Onset Is a tear visible High myopia, aphakia, degenerations, disease, primary vs secondary

How are retinal holes and degenerations normally treated? What about more anterior lesions?

Laser - photocoagulation seals the break Cryopexy for more anterior lesions -cold metal probe against the eye

Wat is the intention of treating retinal holes? What does it prevent?

Seals off the subretinal space from the vitreous and prevents spread to the macula

What may be done if vitreous traction is still present when treating retinal holes?

Laser alone may not be enough -may add scleral buckling procedure

List 5 complications of retinal hole treatment.

Macular pucker Vitreous haemorrhage PVD Retinal tear Retinal detachment

What is the aim of retinal detachment surgery and what are 4 things it achieves?

To reappose detached sensory retina and RPE -reduce vitreous traction on the retina -close retinal breaks -prevent further spread of subretinal fluid -facilitate reabsorption of subretinal fluid

Retinal detachment surgery has to be done before what three things occur?

Tissue death Macula involvement Fibrosis on or under the retina

List three surgical options for retinal detachment.

Scleral buckling Pneumatic retinopexy Pars plana vitrectomy

What is vitrectomy and 7 things was it originally used for?

Replacing the vitreous humour Originally used for: -continuing vitreous traction -vitreous haemorrhage -tractional RD -more complicated detachments -if retinal breaks not seen -if hole/tear cant be closed by scleral buckling

Describe how scleral buckling is used to treat retinal tears. What happens to the RPE? How is the break permanently closed? What happens to the tear and the SRF?

Indenting the globe near the equator gets apposition between the retina and the vitreous RPE is pushed/indented inwards Permanent closure of the tear is achieved with cryopexy/laser Chorioretinal scar around the tear forms SRF is pumped out by the RPE -can be removed by syringe

Following scleral buckling, within what timeframe do most detachments flatten or reattach after hole closure?

Within 24 hours

What is pneumatic retinopexy and when is it considered? When is it not considered?

Ophthalmologist in-office procedure Injection of small volume expandable gas into the vitreous chamber Considered for uncomplicated retinal detachments with small tears Not considered if vitreous traction is a major factor

How is the patient positioned with pneumatic retinopexy? How long is the patient required to stay in this position for?

Positioned so that the gas bubble settles over the hole like a tamponade -required to stay in this position until reattachment occurs, 20-30 days

What happens to IOP with pneumatic retinpexy? List two risks associated with this.

Forced very high -ONH damage -retinal vascular occlusions