Retinal Detachment

Question 1

What is retinal detachment?

Answer 1

Retinal detachment (RD) is typically a progressive condition in which the neuroretina separates (detaches) from the retinal pigment epithelium.

Sub-retinal fluid accumulates, and the retina temporarily loses its function. In case of a rhegmatogenous RD, the separation is due to a retinal discontinuity (break, tear).

In the tractional form, RD is caused by proliferative membranes, whether present on the retinal surface or, less commonly, underneath it (sub-retinal strands). No retinal break is present, although it may subsequently develop (combined rhegmatogenous/tractional RD)

Question 2

What are the risk factors for retinal detachment?

Answer 2

• posterior vitreous detachment
• increasing age
• myopia (exceeding -8D)
• prev cataract surgery
• trauma
• intraocular tumour

Question 3

What is posterior vitreous detachment?

Answer 3

The development of rhegmatogenous RD is a consequence of vitreoretinal traction (such as a posterior vitreous detachment) leading to the development of one or more breaks in the retina.

Detachment of the posterior vitreous is considered a major factor in the pathogenesis of rhegmatogenous RD.

Normally it is benign and very common

Question 4

What are the symptoms of posterior vitreous detachment causing retinal detachment?

Answer 4

• floaters (vitreous condensations)
• flashes (retinal stimulation from traction)
• small % → retinal tear (no additional symptoms)
• if untreated, retinal tear can allow fluid from vitreous space behind retina so it peels off (RD)
• black curtain/loss of vision progressing across visual field over hours-days (ie. not like TIA)
• eye will go blind if untreated

Question 5

How is retinal detachment investigated?

Answer 5

• visual impairment + field loss (O/E)
• RAPD
• visible detachment on fundoscopy

Question 6

How is retinal detachment treated?

Answer 6

Treatment w/ retinal surgery - vitrectomy / cryotherapy / gas