retinal detachment Flashcards
definition of retinal detachement
acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium, sub-retinal fluid accumulates, and retinal function is lost.
what is tractional retinal detachment
abnormal vasculature -> contraction of virteous -> pulls on underlying retina
most common in dm retinopathy
what is exudative retinal detachment
develops due to the sub-retinal accumulation of fluid, other than that originating in the vitreous cavity.
Leaking retinal blood vessels or discontinuities in the retinal pigment epithelium are the usual cause,
with haemorrhagic RD mostly observed after trauma.
due to inflammation or malignancy
signs and sx of retinal detachment
suspect if:
* New onset of floaters.
* New onset of flashes.
* Sudden-onset painless and usually progressive visual field loss.
* A reduction in visual acuity, blurred or distorted vision, causing persistent and progressive visual loss.
RF for retinal detachment
posterior vitreous detachment
age
myopia
previous cataract surgery
trauma
previous opthalmic surgery
intraocular tumour
vitreous haemorrhage
affected fellow eye
DM
retinopathy of prematurity
Ix for retinal detachment
visual acuity assessment - reduced
slit lamp - retinal detachment, retinal break, vitreoretinal pathology
indirect ophthalomoscopy - retinal detachment, retinal break, vitreoretinal pathology
what is rhegmatogenous retinal detachment
commonest form
vitreous shrinks and partly separates form retinal surface -> retinal tear or break
continuing traction -> fluid enter subretinal space
-> retinal detachment
mx of retinal detachment
- arrange for urgent specialist referral - same day
- retinal tear/break: laser therapy or cryotherapy
- virectomy/scleral buckling/pneumatic retinopexy
wnhat is virectomy
relieves traction by removing vitreous attached to retinal breaks
what is scleral buckling
a silicone ‘buckle’ is placed on the scleral surface over the retinal breaks;
this indents the eye wall to make contact with the detached retina.
The aim is to close off retinal breaks and reduce vitreal traction.
what is pneumatic retinopexy
a small expansile gas bubble is injected into the vitreous cavity.
expands over 3 days - so person has to lie down for most of that time
bubble fills the break
complication from surgery to repair retinal detachment
cataract formation,
glaucoma,
endophthalmitis (overwhelming infection of the eye),
astigmatism,
double vision,
ongoing visual impairment.
complications of retinal detachment
visual impairment / loss - detachemnt quickly leads to degeneration of photoreceptors due to ischemia
what affects the px of retinal detachment
the extent of macular detachment and duration
