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Introduction to Eye Disease - Year 2 > Retinal Detachment > Flashcards

Retinal Detachment Flashcards

1
Q

What is a Retinal Detachment?

A

A separation of the neurosensory retina from the underlying RPE by sub-retinal fluid.

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2
Q

How can we classify Retinal Detachment?

A

By whether its Rhegmatogenous, tractional or exudative.

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3
Q

What does it mean to have a Rhegmatogenous retinal detachment?

A

Full thickness retinal break allows liquefied vitreous to collect under retina

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4
Q

What does it mean to have a tractional retinal detachment?

A

Vitreoretinal membranes pull on retina

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5
Q

What does it mean to have an exudative retinal detachment?

A

Fluid from choriocapillaris passes through damaged RPE and lifts retina

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6
Q

What is the prevalence of Retinal detachment?

A
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7
Q

What abbreviation is retinal detachment often given?

A

RD

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8
Q

What are the risk factors for Rhegmatogenous Retinal detachment?

A

The three main ones are:

  • Age
  • Myopia (>-6D)
  • Lattice degeneration

However other significant risk factors include:

  • Cataract surgery
  • Previous retinal detachment
  • Retinal tears, breaks and holes
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9
Q
A
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10
Q

What are causes of a Rhegmatogenous Retinal Detachment?

A
  • Vitreo retinal adhesion (Posterior Vitreous Detachment PVD)
  • Retinal degeneration
  • Retinal tears/breaks
  • Atrophic holes
  • Trauma
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11
Q

Define pathogenesis

A

The manner of development of a disease

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12
Q

What is lattice degeneration?

A
  • Area of atrophic retina with varying degree of RPE atrophy
  • It Runs circumferentially between ora serrata and the equator

[It may present with atrophic holes]

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13
Q

What is the pathogenesis of lattice degeneration?

A

It is unknown

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14
Q

What is the prevalence of lattice degeneration in population?

What is the prevalence of lattice degeneration in Retinal detachment cases?

A

It present in 6-10% of the general population

and in 50-60% of eyes with RD

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15
Q

What is the managment if you spot lattice degeneration in a px?

A
  • Dilated fundus examination to check for tears or RD
  • Annual dilated optometry review
  • Previously, lattice used to be treated •Nowadays, isolated lattice seldom treated
  • Give patient retinal detachment warning information
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16
Q

Are retinal tears common?

A

No

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17
Q

True or False- All retinal tears eventually lead to retinal detachment

A

False- Given prevalence of RD is much lower suggests that not all retinal breaks result in RD

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18
Q

If a px has a retinal detachment, what risk factors increase the likelyhood of the retinal tear leading to retinal detachment?

A
  • Residual vitreoretinal traction due to incomplete PVD
  • High myopia
  • Large break
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19
Q

What are the two types of retinal tears?

A

An Operculated retinal tear

A Horseshoe tear

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20
Q

What is an operculated retinal tear?

A

•A hole that forms in the outer part of the retina

21
Q

Following what, do operculated retinal tears form?

A

Often occur following PVD due to significant traction

22
Q

What type of retinal detachment may an operculated retinal tear lead to?

A

A Rhegmatogenous retinal detachment

23
Q

What does a horseshoe retinal tear look like?

A
  • U-shaped, incomplete break
  • Where the Apex points to posterior pole
24
Q

What type of retinal detachment may a horseshoe retinal tear lead to?

A

50% of horseshoe retinal tears lead to Rhegmatogenous retinal detachments

25
Q

What does the abbreviation RRD stand for?

A

Rhegmatogenous Retinal Detachment

26
Q

How may a horseshoe retinal tear form?

A

May be a result of vitreoretinal traction

27
Q

What are atrophic holes?

A

Chronic atrophy of sensory retina

28
Q

True or False- Atrophic holes are more dangerous than retinal tears

A

False- Retinal tears are more dangerous than atrophic holes as they can lead to Retinal detachment

29
Q

Are atrophic holes associated with vitreous traction?

A

No (unlike retinal tears)

30
Q

What are symptoms of retinal detachment?

A

Any combination of:

  • Photopsia
  • Traction on retina
  • Floaters (sudden onset)–Due to Associated PVD?
  • Visual field loss–Due to Detachment of neurosensory retina
  • Reduced visual acuity if macula involved
  • Curtain/veil over vision
  • Occasionally asymptomatic—Retinal holes in young myopic patients
31
Q

What clinical examinations would you do on a px you suspect to have retinal detachment and what my you expect to find?

A
32
Q

What are the clinical signs of a Retinal detachment?

A
33
Q

How can we roughly find out whether a retinal detachment is new or old?

A

As time progresses pigment deposits increase.

34
Q

What does it mean to have a macula on retinal detachment or a macula off retinal detachment?

A

It literally means whether the retinal detachment has progressed to the macula or not. I.e. in the top photo that would be macula on retinal detachment as the retinal detachment has not progressed to the macula yet.

The bottom photo would be macula off retinal detachment as the retinal detachment has surpassed the macula.

35
Q

True or False- If left untreated a macula on retinal detachment will always become a macula off retinal detachment

A

True - Rarely do they not progress from macula on to macula off

36
Q

If a px has macula on retinal detachment, how quickly does the px need to be dealt with?

A

Within 24 hours in hope of saving central vision

37
Q

If a px has macula off retinal detachment how quickly does the px need to be dealt with in order to save vision?

A

Within a week as vision has already been affected so not much we can do to save it!

38
Q

What are some causes of tractional retinal detachment?

A

Many causes e.g.

  • Proliferative diabetic retinopathy
  • Sickle cell retinopathy
  • Retinopathy of prematurity
  • Penetrating posterior segment trauma
39
Q

What are some causes of Exudative retinal detachment?

A
  • Choroidal tumours
  • Exopytic retinoblastoma
  • Posterior scleritis
  • Subretinal neovascularisation
  • Severe hypertension
40
Q

True or False- Tractional retinal detachment may be caused by a break in the retina (i.e. a retinal tear)

A

FALSE- it is caused by traction of the vitreous NOT a retinal tear

41
Q

True or False- Tractional retinal detachment is a chronic condition

A

True - it is caused by traction of the vitreous overtime that pulls the retina away

42
Q

What actions do you take if you suspect a retinal tear or detachment?

A

Take a detailed history and symptoms to identify any risk factors.

Examine the anterior vitreous looking for clinical signs such as Schaff’s sign

Do a dilated fundus examination

Give advice to the px including a pamphlet on flshes and floaters.

Refer same day (emergency) if you encounter the following:

•RD:

  • px describes sudden onset of “too many to count“ floaters”
  • Cloud, curtain or veil over the vision
  • Pigment in anterior vitreous
  • Vitreous or pre-retinal haemorrhage
  • Symptomatic retinal break/tear, lattice degeneration
43
Q

What is the management for retinal tears?

A
  • Refer to HES
  • Most flap tears (i.e. horseshoe tears) undergo retinopexy:
  • Laser retinopexy – where a laser is used to seal edges of the tear so it can’t worsen
  • Cryotherapy
  • Written information RD warning is given to px
  • Treatment is Reviewed every…
  • 2 weeks
  • 6 weeks for epiretinal membrane tear
  • as well as anually
44
Q

What is the management for retinal detachment?

A

SURGERY - where the aim is to appose the retina and RPE (i.e. to seal the break)

[RPE pumps retina flat]

45
Q

What are the three different surgeries you can have to treat retinal detachment?

A
  1. Pneumatic retinopexy
  2. Cryobuckle
  3. Vitrectomy
46
Q

What does Pneumatic retinopexy involve and what is it’s sucess rate?

A

It involves injecting a gas bubble into the vitreous - this gas bubble seals the tear and reataches the retina.

Success is 70%

47
Q

What does Cryobuckle surgery involve and what is it’s sucess rate?

A
  • Placing an external ‘buckle’ (i.e. a band) to indent sclera
  • This Pushes the RPE into apposition (sealing/connecting) with the retina
  • Usually no gas tamponade (i.e. usually you don’t need a gas bubble but in extreme cases you may use the buckle and a gas bubble to push the retina back onto the RPE)
  • Success 80-90%
48
Q

What does virectomy surgery involve and what is its success rate?

A
  • Surgical process where small incisions are made
  • Some, or all of vitreous is removed
  • central vitreous gel and posterior hyaloid face
  • This is replaced with saline

Introduction to Eye Disease - Year 2 (40 decks)

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