This document discusses retinal detachment, which occurs when the retina separates from the underlying tissue. The most common type, rhegmatogenous retinal detachment, results from a tear or break in the retina that allows fluid to seep in. Symptoms include floaters, visual field defects, and flashes of light. Diagnosis involves examinations of the eye and ultrasound. Treatment depends on the type but generally aims to seal retinal breaks, relieve traction, and reattach the retina using procedures like cryotherapy, laser photocoagulation, pneumatic retinopexy using gas bubbles, or vitrectomy surgery to remove the vitreous gel.

1. By
Assistant Professor of Ophthalmology
Sohag University

2. • Retinal detachment refers
to separation of the inner
layers of the retina from the
underlying retinal pigment
epithelium (RPE, choroid).

3. Rhegmatogenous retinal
detachment
(the most common type)
• This results when a hole, tear, or
break in the neuronal layer allows
fluid from the vitreous to seep
between and separate sensory and
RPE layers.

4. • Vitreous becomes more
syneretic (liquefied) with
age.
• Posterior vitreous
detachment (PVD).
• Myopia, aphakia or
pseudophakia, familial
conditions, and
inflammation.

5. • These results from
adhesions between
the vitreous
gel/fibrovascular
proliferation and
the retina

6. • Contraction of vitreous or areas
of fibrovascular proliferation
• The severity of retinal
detachment is influenced by
the timing and degree of
shrinkage of the vitreous and
fibrovascular proliferations.
• It may occur in a number of
conditions, such as proliferative
diabetic retinopathy (PDR),
retinal vein occlusion, trauma,
sickling hemoglobinopathies,
and retinopathy of prematurity.

7. • This results from exudation
of fluid into the subretinal
space from retinal vessels
• (As in hypertension, central
retinal venous occlusion,
Posterior scleritis, Tumors,
Posterior uveitis, vasculitis,
or papilledema)

9. • Floaters
• Visual field defect
(developing over time;
may help localize
detachment)
.Photopsia (common
initially)

10. • Slow visual field defect
• Manifestations of the cause

11. Slit-lamp
biomicroscopy
Indirect
ophthalmoscopy
Ultrasound B scan
(USG-B scan)

12. General Principles
• Find all the retinal breaks in
Rhegmatogenous Retinal
Detachment
• Seal all the retinal breaks in
Rhegmatogenous Retinal
Detachment

13. • Relieve present (and
future) vitreoretinal
traction: In tractional
retinal detachment
• En bloc excision of
membranes,
segmentation, or
delamination
techniques

14. Cryopexy and Laser Photocoagulation
• Cryotherapy (freezing) or laser photocoagulation are
occasionally used alone to wall off a small area of retinal
detachment so that the detachment does not spread.

15. • A gas bubble (SF6 or C3F8 gas) is injected into the eye after which laser or
freezing treatment is applied to the retinal hole.

16. • Silicone bands (bands, tyres)
to the sclera .
• The bands push the wall of
the eye inward against the
retinal hole, closing the break
and reducing the effect of
vitreous traction thereby
allowing the retina to re-
attach with
external Cryotherapy.

17. • It involves the removal
of the vitreous gel and
is usually combined
with filling the eye
with either a gas
bubble(SF6 or C3F8 )
or silicone oil