Retinal Detachment Flashcards
Define retinal detachment and name the 3 types
Separation of the neurosensory retina from the underlying RPE by sub-retinal fluid
Tractional
Exudative
Rhegmatogenous
what happens in tractional retinal detachment
Vitreoretinal membranes pull on retina
membranes in vitreous adheres to the retina and slowly pulls it off
what happens in exudative retinal detachment
Fluid from choriocapillaris passes through damaged RPE and lifts retina (pushes it off)
what happens in rhegmatogenous retinal detachment
Full thickness retinal break allows liquefied vitreous to collect under retina
list 3 features of the symptoms of a tractional retinal detachment
- Not acute
- Floaters and flashes usually absent
- Field defect progresses slowly may become stationary
list the 4 signs of a tractional retinal detachment
- Concave retina
- Breaks absent
- SRF shallow
- Retina immobile
list 4 possible causes of a tractional retinal detachment
- Proliferative diabetic retinopathy
- Sickle cell retinopathy
- Retinopathy of prematurity
- Penetrating posterior segment trauma
list 3 features of the symptoms of an exudative retinal detachment
- Flashes absent
- Floaters if associated with virtitis
- Field defect can progress rapidly
list the 3 signs of an exudative retinal detachment
- convex
- smooth
- retina very mobile
list 5 possible causes of an exudative retinal detachment
- Choroidal tumours
- Exopytic retinoblastoma
- Posterior scleritis
- Subretinal neovascularisation (new blood vessels below the retina that cause it to be elevated)
- Severe hypertension
list 3 possible causes of a rhegmatogenous retinal detachment
- Round holes/tears found in young myopes
- Usually from vitreous traction and retinal degeneration
- Posterior vitreous detachment PVD
How can the mechanism of a PVD cause a rhegmatogenous retinal detachment
the vitreous collapses on itself and pulls the retina off away from the RPE, this can cause traction.
The collapsed vitreous is liquefied and can separate the vitreous base through the internal limiting membrane and hence pulls the retina away from the RPE
list 6 risk factors of the rhegmatogenous retinal detachment
- Age
- Myopia > 6.00D
- Severe ocular trauma
- Cataract surgery
- Previous retinal detachment
- Retinal degenerations
list 5 possible symptoms of a rhegmatogenous retinal detachment
Any combination of:
- Photopsia/Flashes
Traction on retina (vitreous pulling on retina) - Floaters
Associated PVD - Visual field loss
Detachment of neurosensory retina (retina peeled away from blood supply = shadow) - Reduced visual acuity (subretinal fluid spreads to macula)
- Occasionally asymptomatic
Retinal holes in young myopic patients
list 3 features of the photopsia experienced with a PVD
- Temporal, vertically orientated, momentary flashes
- More noticeable in the dark?
- White, silver, yellow or golden
how will a px describe floaters from a retinal detachment and list 2 things that can be the cause of these floaters
Sudden onset of shower
suggests:
- Red blood cells
- Pigment cells, or pigment granules in vitreous
list 6 investigations you will carry out in practice with suspicions of a retinal detachment
- Measure visual acuity
Reduced in RD if macula affected
If VA still good, can still have an RD or retinal tear in periphery - Relative afferent pupillary defect
If significant RD - Reduced IOP
- Visual field
- Slit-lamp
Anterior chamber - Dilated fundus and vitreous examination with high-powered fundus viewing lens
what causes a reduced IOP with a retinal detachment
RD causes inflammation in the anterior chamber, which affects the ciliary epithelium and hence the production of aqueous
what 2 things can cause the visual acuity to decrease in an RD
- Subretinal fluid spreading towards macula
- Macula off
list 3 things you will look for in the vitreous when investigating an RD
- Posterior vitreous detachment
Weiss ring
Vitreous syneresis - Vitreous haemorrhage
- Shafer’s sign
what is Shafer’s sign
pigment epithelium in the anterior vitreous - Berger’s space
list the 4 things you will look for on the fundus with indirect fundus examination when investigating an RD
- Lattice degeneration - Atrophic retina with varying degree of RPE atrophy
- Holes - Chronic atrophy of sensory retina
- Tears
- Detachment
what is the hospital management of lattice degeneration
- Dilated, indented examination both eyes
- Isolated lattice seldom treated now
- Usually discharged
- Retinal detachment warning (RDW)
- Annual dilated optometry review
what are retinal tears the result of and name 3 types of retinal tears
Result of vitreoretinal traction
- Horse shoe tear - ripped retina
- Operculated tear - area of retina that’s torn off and floating in vitreous
- Dialysis - retina hanging down from gravity
list how you must manage a retinal break/tear which is, symptomatic, any fluid and asymptomatic/lower risk
Refer all retinal breaks
- Symptomatic: emergency
- Any fluid: emergency
- Lower risk/asymptomatic: urgent
what is the hospital management of a retinal break and name the 2 types of this.
what are the 3 steps of the review period following treatment
Most flap tears undergo retinopexy
- Laser retinopexy: burning retina onto sclera
- Cryotherapy: freezing probe
(Written information retinal detachment warning)
Review
- 2 weeks
- 6 weeks for epiretinal membrane
- Discharge for annual dilated optometry review
what is what referral speed/optometric management for macula on and for macula off RD
Retina needs to be reattached within:
24 hours if macula on
1 week of macula off
what can occur the longer that the retina is off and what is the disadvantage of this
Proliferative vitreoretinopathy’
where the RPE and glial cells proliferate and produce cells that form a membrane over the retina.
Disadvantage = this stops light getting to the retina and it contracts and pulls the retina off
list 3 types of surgeries used to treat an RD
- Pneumatic retinopexy
- Cryobuckle
- Vitrectomy
list the steps of a Pneumatic retinopexy used to treat an RD
- Cryo or laser break
- Inject intravitreal expansile gas (C3F8) into vitreous chamber
- Floatation force tamponades the retina onto the RPE
- Position patient for 1 -2 weeks 23/24 hours a day head forwards so gas bubble pushes retina onto RPE
Success 70%
list the steps of how a Cryobuckle surgery is carried out to treat an RD
- Locate breaks with 20D indirect ophthalmoscope
- Cryo or laser break
- Place external explant to indent sclera - squeeze the eye with a buckle
- Pushes RPE into apposition with retina
- Usually no gas tamponade
Success 80-90%
