 Retinal  breaks- any full- thickness  defect in the neurosensory retina Can cause RD 6% of population have break 1/10...
 Directretinal perforation, contusion, vitreous traction    Coup    Contrecoup Usually multiple Inferotemporal and su...
 Young   patients- higher incidence of eye  injury Rarely develop acute rhegmatogenous RD Vitreous acts as tamponade 1...
 Vitreous base- 2 mm anterior and 4 mm  posterior to the ora serrata Optic disc, macula, along major vessels,  margins o...
Increasing age- 63% in > 70 y/o     axial lengthAphakia – 66-100%                                ICCE- 84%Inflammatory dis...
 Photopsias Multiple floaters Curtain or cloud Vitreous hemorrhage    Retinal tear present in        15% w/ acute PV...
  IO w/ scleral depression Slit lamp biomocroscopy w/ 3- mirror  lens Hemorrhage or pigment? Reexamine in 3- 4 weeks ...
 6-10%  of general population 1/3-1/2- bilateral Myopia, familial predilection  1.   Atrophy of the inner layers  2.   ...
 Areas  of elevated glial hyperplasia Noncystic retinal tufts Cystic retinal tufts      may predispose Zonular tractio...
  folds of redundant retina Superonasally Associated w/ dentate processes Tears occur at the most posterior limit  of ...
 Oval islands ofpars plana epithelium  located immediately posterior to the ora Almost/completely circumscribed by the  ...
 Paving-stone or Cobblestone   •22% over 20 y/o                 Degeneration  •Proliferation of RPE cells  ••Atrophy appr...
 Reduce  the risk of RD Risk outweigh the benefit May not eliminate the risk of new tears  or detachment GOAL: create ...
 Acute symptomatic flap tear Acute operculated holes    + persistent vitreous traction    Large hole    Superior loca...
 Flap   tears    Emmetropic, phakic eyes    Lattice degeneration    Myopia    Subclinical detachment    Aphakia w/ d...
 Treat the entire lesion Posterior and lateral margins 6-10% of eyes     •High myopia 20-30% of eyes w RD     •RD in t...
 1-3  % incidence of RD Asymptomatic breaks – prophylaxis? Flap tears Subclinical detachments
 Asymptomatic  retinal detachment Detachment in w/c subretinal fluid  extends more than 1 DD from the break  but not mor...
TYPE OF LESION                                      TREATMENTHorseshoe tears                          Almost alwaysDialysi...
Type of lesion        phakic     Highly myopic                  Fellow eye                 Aphakic or                     ...
http://one.aao.org/CE/Practice Guidelines
Retinal breaks
Retinal breaks
Retinal breaks
Retinal breaks
Retinal breaks
Retinal breaks
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Retinal breaks

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Retinal breaks

  1. 1.  Retinal breaks- any full- thickness defect in the neurosensory retina Can cause RD 6% of population have break 1/10,000-15,000 per year- RD 0.07% chance of developing RD in a lifetime
  2. 2.  Directretinal perforation, contusion, vitreous traction  Coup  Contrecoup Usually multiple Inferotemporal and superonasal quadrants Most common- dialyses + avulsion of vitreous base= ocular contusion Others: horseshoe-shaped tears, operculated holes
  3. 3.  Young patients- higher incidence of eye injury Rarely develop acute rhegmatogenous RD Vitreous acts as tamponade 12%- immediately 30%- 1 month 50%- 8 months 80%- 24 mos
  4. 4.  Vitreous base- 2 mm anterior and 4 mm posterior to the ora serrata Optic disc, macula, along major vessels, margins of lattice degeneration, sites of chorioretinal scars
  5. 5. Increasing age- 63% in > 70 y/o axial lengthAphakia – 66-100% ICCE- 84%Inflammatory disease ECCE w/ open capsule- 76%Trauma ECCE w/ intact capsule- 40%myopia
  6. 6.  Photopsias Multiple floaters Curtain or cloud Vitreous hemorrhage  Retinal tear present in  15% w/ acute PVD  50-70% w/ acute PVD + vitreous hge
  7. 7.  IO w/ scleral depression Slit lamp biomocroscopy w/ 3- mirror lens Hemorrhage or pigment? Reexamine in 3- 4 weeks patching, bed rest, head elevation for 45⁰ B- scan vitrectomy
  8. 8.  6-10% of general population 1/3-1/2- bilateral Myopia, familial predilection 1. Atrophy of the inner layers 2. Overlying pocket of liquefied vitreous, 3. condensation and adherence of vitreous at the margin of lesion Progressesto RD- tractional tear or atrophic hole
  9. 9.  Areas of elevated glial hyperplasia Noncystic retinal tufts Cystic retinal tufts may predispose Zonular traction tufts to RD
  10. 10.  folds of redundant retina Superonasally Associated w/ dentate processes Tears occur at the most posterior limit of the folds
  11. 11.  Oval islands ofpars plana epithelium located immediately posterior to the ora Almost/completely circumscribed by the peripheral retina Tears can occur at or near the posterrior margins of enclosed ora bays
  12. 12.  Paving-stone or Cobblestone •22% over 20 y/o Degeneration •Proliferation of RPE cells ••Atrophy approximatelyretina > 20 RD, RPE areas of inflammation100% trauma,y/o retinal Old hyperplasia •Present in of the outer and of•Enlargement of RPE cells •3.Atrophy of the Temporal RPE hypertrophy RPE and outer retinal layers tear•Congenital or acquired •4.Attenuation or absence lossthe •1. TYPICAL may cause field ofAging and but Cystoid Degeneration Benign, Peripheral the outer plexiform layer• • •Cysts degenerative change in Appears as black choriocapillaries spherical melanin granules,•Large cells and large, •2. RETICULAR 5.Adhesions b/n the remaining neuroepithelial•very•dark, well demarcated Nerve fiber layer•BENIGN amd bruch’s membrane layers •Posterior to typical cystoid •Inferior quadrant,full-retinalto the equator •May develop into anterior break •NEVER the site of PRIMARY retinal break
  13. 13.  Reduce the risk of RD Risk outweigh the benefit May not eliminate the risk of new tears or detachment GOAL: create a chorioretinal scar around the break Acute symptomatic break are more dangerous than the old ones
  14. 14.  Acute symptomatic flap tear Acute operculated holes  + persistent vitreous traction  Large hole  Superior location  Vit hem Atrophic holes  + traction
  15. 15.  Flap tears  Emmetropic, phakic eyes  Lattice degeneration  Myopia  Subclinical detachment  Aphakia w/ detachment in the other eye Operculated holes Atrophic holes
  16. 16.  Treat the entire lesion Posterior and lateral margins 6-10% of eyes •High myopia 20-30% of eyes w RD •RD in the fellow eye 1%- RD in untreated lattice degeneration •flap tears •aphakia
  17. 17.  1-3 % incidence of RD Asymptomatic breaks – prophylaxis? Flap tears Subclinical detachments
  18. 18.  Asymptomatic retinal detachment Detachment in w/c subretinal fluid extends more than 1 DD from the break but not more than 2DD posterior to the equator. Traction on the break
  19. 19. TYPE OF LESION TREATMENTHorseshoe tears Almost alwaysDialysis Almost alwaysOperculated tear sometimesAtrophic hole RarelyLattice degeneration w/o horseshoe Rarelytears Zorab et.al., American academy of Ophthalmology Section 12 p. 290 2008-2009
  20. 20. Type of lesion phakic Highly myopic Fellow eye Aphakic or pseudophakicRetinal Almost always Almost always Almost always Almost alwaysdialysisHorseshoe sometimes sometimes sometimes sometimestearsOperculated no rarely rarely rarelytearsAtrophic holes rarely rarely rarely rarelyLattice deg’n no no sometimes rarelyw/ or w/oholes Zorab et.al., American academy of Ophthalmology Section 12 p. 291, 2008-2009
  21. 21. http://one.aao.org/CE/Practice Guidelines

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