Retinal detachment a brief presentation.pptx

Retinal detachment a brief presentation.pptx

• 1.
  Retinal Detachment DR. SHEHLADARESHANI PROFESSOR SMBBMCL, LYARI, KARACHI
• 2.
   Is atransparentlight-transforming laminated structure comprising photoreceptors, interneurons and ganglion cells overlying the retinal pigment epithelium.  Superficial retinal vessels form four major arcades over the surface of retina.  Within the suprachoroidal space are the long ciliary nerves and arteries which can be seen peripherallyat 3 and 9 o’ clock position Retina
• 3.
   Normal attachmentsare strongest at the ◦ Disc, the fovea and especially the ora serrata/vitreous base which remains adherent even when posterior vitreous detachment is otherwise complete.  Abnormal attachments ◦ Area of lattice degeneration, white without pressure, pigment clumps and condensation around vessels Vitreoretinal Adhesions
• 4.
   RD isa relatively common sight-threatening condition with an incidence of around 1/10,000/year.  Neurosensory retina is separated from retinal pjgment epithelium is termed as RD. Retinal Detachment
• 5.
   Rhegmatogenous (Rhegma-break) ◦ Occurs secondarily to a full thickness defect in the sensory retina which allow fluid derived from synchytic vitreous to gain access to the subretinal space.  Tractional ◦ In which the NSRis pulled away from the RPE by contracting vitreoretinal membranes in the absence of a retinal break  Exudative ◦ Is caused neither by break nor traction; the SRFis derived fromfluid in the vessels of the NSR or choroid or both  Combined tractional-rhegmatogenous ◦ Is the result of a combination of a retinal break and retinal traction Types of RD
• 6.
   It isa force exerted on the retina by structures originating in the vitreous, and may be dynamic or static  Dynamic ◦ Is induced by eye movements and exerts a cetripetal force towards the vitreous cavity. It plays an important role in the pathogenesis of retinal tear and rhegmatogenous RD  Static ◦ Is independent of ocular movements. It play a key role in the pathogenesis of tractional RD and proliferative vitreoretinopathy Vitreoretinal Traction
• 7.
   PVD isa separation of the cortical vitreous from the internal limiting membrane.  It can be classified as ◦ Onset  Acute PVD is by far the most common. It develops suddenly and usually becomes complete soon after onset. Chronic PVD occurs gradually and may take weeks or months to become complete ◦ Extent  Complete  PVD in which the entire vitreous cortex detaches up to the posterior margin of the vitreous base  Incomplete  PVD in which residual vitreoretinal attachements remain posterior to the vitreous base Posterior Vitreous Detachment
• 8.
   Is afull thickness defect in the sensory retina  It can be classified according to ◦ Pathogenesis ◦ Morphology ◦ Location Retinal Break
• 9.
   Tears ◦ Causedby dynamic vitreoretinal traction and have a predilection for the superior fundus  Holes ◦ Caused by chronic atrophy of the sensory retina and may be round or oval. They have predilection for the temporal fundus Pathogenesis
• 10.
   U-Tears ◦ (Horseshoe,flap or arrowhead) consist of a flap, the apex of which is pulled anteriorly by the vitreous, the base remaining attached to the retina  Incomplete U-Tears ◦ Which may be linear, L-shaped or J-shaped are often paravascular  Operculated Tears ◦ In which the flap is completely torn away from the retina by detached vitreous gel  Dialyses ◦ Are circumferential tear along the ora serrata with vitreous gel attached to the posterior margins  Giant Tears ◦ Involve 90 or more of the circumference of the globe Morphology
• 11.
   Oral ◦ Theyare located with in the vitreous base  Post-oral ◦ They are located between the posterior border of the vitreous base and equator  Equatorial ◦ At or near the equator  Post-equatorial ◦ Behind the equator  Macular ◦ Are at the fovea Location
• 14.
   Is usuallyan ophthalmic emergency  Untreated it usually progresses to blindness even pthysis  With appropriate treatment it may have an excellent outcome  Is the commonest form of RD  It occurs when break is allow to liquefaction vitreous to enter with in sub retinal space and lift the NSR from RPE Rhegmatogenous RD
• 15.
   Flashes (usuallytemporal and more noticeable in dim conditions)  Floaters  Curtain like field defect  Dec. VA  Retinal break upper temporal quadrant is the commonest location  RD unilateral corrugated convex dome shaped of retina and loss of RPE/choroidal clarity  Chronic signs, retinal thinning, demarcation line from 3months, intra retinal cyst from 1 year may also have RAPD if extensive RD, relative field defect, dec. IOP Clinical Features
• 16.
  Work up Toreach Diagnosis Visual Symptoms Asymptomatic, flashes, floaters, curtain field defect, decreased VA POH Refractive error, Surgery, Laser treatment, trauma PMH Connective tissue syndromes, diabetes, FH Retinal problems/detachment, connective tissue syndrome SH Driver, other occupation VA Best-corrected/pin-hole Cornea Clarity (for surgery) AC Cells/flare Pupil RAPD for extensive detachment Lens Cataract Tonometry IOP may be low, normal or high Vitreous Hemorrhage, pigment (tobacco dusting) Fundus RD; Location, extent, age (atrophy, intraretinal cyst, pigment demarcation line, PVR, Retinal break, associated degeneration
• 17.
   Consider USif unable to adequately visualize(dense cataract, hemorrhage)  B-Scan US Highly reflective irregular convex membrane Work-up to reach diagnosis
• 18.
  Ocular General Trauma (blunt/penetrating, Surgery RefractiveMyopia Lenticular Aphakia, Pseudophakia, posterior capsulotomy Retinal Lattice degeneration, Retinoschisis, Retinal necrosis Other eye H/O RD especially Giant retinal tear Systemic Stickler’s syndrome, Marfan’s syndrome Ehlers-Danlos Risk Factors for RRD according to other ocular and systemic features
• 19.
   Retinal thinning Demarcation lines (high water marks)  Intra retinal cysts  Proliferative vitreoretinopathy Features of Chronic RRD
• 20.
   The mainaim of surgery is to successfully repair the detachment with minimal trauma and attendant risk  To seal the hole and close the retinal breaks Principles of Retinal Surgery
• 21.
   Is asurgical procedure in which material sutured on to the sclera (explant) creates an inward indentation(Buckle).  Its purposes are to close retinal breaks by apposing the RPE the sensory retina and reduce dynamic vitreoretinal traction at site s of local vitreoretinal adhesions Principles of Scleral Buckkling