Retina 2 - Retinal detachment

Question 1

Risk factors of RD

Answer 1

•More common in:
- Men than woman
- Pseudophakes
- Myopes
- Right eyes than left
- affluent than poor (due to higher education levels + myopia)
•Peak incidence is 60’s

Question 2

What are the 3 types of retinal detachments?

Answer 2

•Exudative
•Traction
•Rhegmatogenous

Question 3

What are exudative detachments caused by?

Answer 3

•Breakdown in RPE (blood retinal barrier)
•Choroidal inflammation

Question 4

What is traction detachment caused by?

Answer 4

• Contraction of fibrovascular tissue on surface of retina

Question 5

what are the types of Rhegmatogenous retinal detachment’s? (RRD)

Answer 5

•Most common type
•PVD present : 90% cases
- Horseshoe tear
- Giant tear
Progressives rapidly, needs urgent treatment.
•No PVD
- Atrophic hole
- Dialysis
Progresses slowly

Question 6

How does horseshoe tear develop with PVD?

Answer 6

•Starts with PVD
•Traction partly relieved by operculum
• Persistent vitreous traction
•Increasing sub-retinal fluid
•Rapidly progressive

Question 7

Atrophic hole detachments epidemiology?

Answer 7

•Myopic
•Young
•No PVD
•Often asymptomatic - incidental
•Tide mark found

Question 8

What is a tide mark?

Answer 8

•Indicates detachment has been present for years

Question 9

What is Retinal Dialysis?

Answer 9

•Younger patients
•No PVD
•Can be large - entire quadrant
•Usually infero-temporal
•May be related to trauma

Question 10

What is a Giant retinal tear?

Answer 10

•Least common type of rhegmatogenous retinal detachment
•Starts with PVD
•Large break
•High risk of complications
•Rapidly progressive
•Worst prognosis - can fold over completely

Question 11

What damage occurs to retina during retinal detachments?

Answer 11

•Outer segments of photoreceptors lost
- Photoreceptor cell bodies survive - Supplied by retinal vessels

•Foveal photoreceptors have no alternative oxygen supply
- Irreversible damage following foveal detachment

Question 12

History if retinal detachment?

Answer 12

•Floaters and flashes
- Caused by PVD
•Shadow or curtain
- Usually only noticed when close to macula
•Sudden loss of vision
- Macula affected

Question 13

Differential diagnosis of retinal detachment

Answer 13

•Retinoschisis
- Thin inner retinal layer
- No pigment
- Hypermetropic eyes
•Exudative detachment
- Shifting fluid
- No breaks
- Tumour/inflammation

Question 14

Treatment of RD

Answer 14

•Close the break
•Internal
- Pars plana vitrectomy and tamponade
- Pneumatic retinopexy
•External
- Buckle and Cryo
•Creat permanent adhesion between RPE and retina

Question 15

Outcome of RD repair?

Answer 15

•Approx 85% of RD repaired in one operation
•Approx 1% will remain detached, despite multiple surgeries
•Visual function may be permanently impaired despite successful repair
- Distortion
- Micropsia
- Reduced VA

Question 16

Who should be referred?

Answer 16

•All patients with :
- Horseshoe tear
- Pigment or blood in vitreous
- Visible retinal detachment
•Refer to ARC or not at all
•Please dont refer:
- Lattice degeneration
- PVD without high risk features