Retinal Detachment

Question 1

RD Risk Factors?

Answer 1

• More common in men than women (at all ages)
• More common in pseudophakes (previous cataract surgery – particularly if the surgery was complicated)
• More common in myopes
• More common in right eyes (~55%) than left
• More common in affluent than poor (myopia associated with higher levels of education)

Question 2

3 Main types of RD? What causes these?

Answer 2

• Rhegmatogenous RD (RRD)
  o Most common
  o Caused by a retinal break
• Traction:
  o Caused by contraction of fibrovascular tissue on surface of retina
  o Due to severe proliferative diabetic retinopathy
• Exudative:
  o Caused by breakdown in blood-retinal barrier
  o Melanoma
  o Benign and metastatic (spread from part of body where started to other parts of body) tumours can also cause exudative RD
  o Choroidal inflammation may lead to exudative detachment

Question 3

Rhegmatogenous RD (RRD) types?

Answer 3

o Horseshoe tear (HST)
o Giant Retinal Tear (GRT)
o Atrophic hole
o Dialysis

• PVD present:
  o About 90% of RD occur in association with PVD
  o As vitreous is separated, free fluid between posterior hyaloid face and retina – passes through the break easily, leading to rapid increase in SRF and progression of the detachment
  o Horseshoe tear (HST)
  o Giant Retinal Tear (GRT)

URGENT TREATMENT – due to rapid progression

• Vitreous remains attached (no PVD)
  o Atrophic hole
  o Dialysis
   Progresses more slowly
  o SRF leaks under retina slowly, so treatment is less urgent
   but early treatment still required

Question 4

RD Symptoms?

Answer 4

• Floaters and flashes
  o Symptoms of the PVD rather than RD
  o If no PVD, there will no symptoms of floaters
• Shadow or curtain over peripheral vision
  o Usually only noticed when close to macula
• Sudden loss of vision
  o Macula (&fovea) affected

Question 5

Differential Diagnosis - Retinoschisis - describe this?

Answer 5

o Separation of layers of retina leading to a peripheral retinal cyst – thin inner retinal layer
o Immobile
o Pigment demarcation lines are rare – no pigment
o Hypermetropic
o If see a retinoschisis in a myopic eye, it is usually a chronic RD

Question 6

Differential diagnosis - exudative detachment - describe this?

Answer 6

o Management completely different to that of rhegmatogenous RD
o SRF is mobile – if px lies on side, fluid will shift to dependant part of eye – shifting fluid
o No breaks
o Tumour/inflammation – carefully examine to reveal underlying cause

Question 7

RD Treatment?

Answer 7

• Close break
• Internal:
  o PPV and tamponade
  o Pneumatic retinopexy
   Bubble of gas or oil
• External:
  o Buckle & Cryo – stitching plastic buckle to inside of eye creates indent which closes the break
• Create permanent adhesion between RPE and retina (once break closed) – use freezing treatment or laser

Question 8

Who to Refer (RD)? Who do you not refer?

Answer 8

• All patients with:
  o Horseshoe tear
  o PVD associated with pigment or blood in vitreous
  o Visible retinal detachment
  o Refer to EYE EMERGENCY DEPARTMENT (ARC)
   These pxs should be seen same day by ophthalmologist
• Do Not Refer:
  o Peripheral retinal degeneration – lattice degeneration
  o PVD without high-risk features