This document discusses different types of retinal detachment. Rhegmatogenous retinal detachment is the most common type and occurs when there is a break or tear in the retina that allows fluid from the vitreous to enter the subretinal space. Tractional retinal detachment occurs when the retina is pulled away from the retinal pigment epithelium due to contraction of fibrous tissue in the vitreous. Exudative retinal detachment occurs when fluid accumulates beneath the retinal pigment epithelium due to inflammation or vascular issues. The document outlines causes, symptoms, examinations, and treatments for each type of retinal detachment.

1. RETINAL
DETACHMENT
Niraj Phoju

2. RETINA
• light-sensitive layer of tissue
• sends visual messages through
the optic nerve

4. Retinal Detachment is the separation of the
neurosensory retina from the pigmented epithelium.
• Even normally potential space between the layers
• Thus, a misnomer------”Retinal Separation”

8. Types of Retinal
Detachment:Rhegmatogenous RD
(1O
Retinal Detachment)
Tractional Retinal Detachment
Exudative Retinal Detachment
Combined tractional-rhegmatogenous

10. Rhegmat ogenous
Ret i nal
Det achment
Rhegma :
Break

11. Ret i nal
Det achment
(Commonest variant)
occurs 20
to a full-thickness defect in the sensory retina,
which permits fluid derived from synchytic (liquefied)
vitreous to gain access to the subretinal space.
i.e. associated with retinal breaks (tear or hole) through
which sub-retinal fluid seeps into and separates the
sensory retina from the pigment epithelium
Etiology still not clear

12. Predisposing Factors:
Age: common in 40-60 yrs, however age is no bar
Sex: M>F
Myopia:
Aphakia and pseudophakia:
Retinal degenerations:
Trauma:
Senile posterior vitreous detachment:

13. Pathogenesis:
Senile acute PVD Predisposing Retinal Degenerations Aphakia
Retinal Breaks
Trauma
Degenerated vitreous fluid
seeps through the break and collects as Sub-retinal fluid (SRF)
between the sensory and pigment epithelium
Rhegmatogenous Retinal Detachment
Lincoff’s Rule

14. Prodromal Symptoms:
Floaters (d/t rapid vitreous degeneration)
Photopsia (d/t irritation of retina by vitreous movement)
Symptoms of detached retina:
Localised relative loss in visual field (black curtain)
Sudden appeareance of dark clouds in front of eye
Sudden painless loss of vision
(when detachment is large and central)
C/F:

15. Symptoms of detached retina:
External examination: normal eye
IOP: slightly lower or normal
Marcus Gunn Pupil: in extensive RD
Plane mirror examination: greyish reflex in the quadrant of
detached retina
Ophthalmoscopy: freshly detached retina retinal vessels appears
dark tortuous cords that moves with the
detached retina
Retinal breaks: commonest in upper temporal quadrant
Shaffer sign: vitreous pigment in anterior vitreous
Old retinal detachments
Electroretinography: sub-normal of absent
USG: confirmation of diagnosis

18. Proliferative vitreoretinopathy
Complicated cataract
Uveitis
Phithisis bulbi
Complications:

19. Principle:
Sealing retinal breaks
Reducing vitreous traction to retina
Flattening the retina by drainage of SRF
External or internal tamponade
Treatment:

20. Sealing retinal breaks
Detection
Accurate localization
Sealing (by aseptic chorioretinitis)
 Photocoagulation
 Cryocoagulation (prefered)

21. Drainage of SRF
• By fine needle insertion through sclera and choroid into sub-
retinal space
• Allows immediate apposition between the sensory and
pigmentary retina

22. Maintainence of
chorioretinal apposition
At least for couple of weeks
Many techniques:
 Scleral buckling (external tamponade)
 Pneumatic retinopexy
 Pars plana viterectomy
 Endolaser photocoagulation
 Internal tamponade

23. Pneumatic Retinopexy

25. Internal Tamponade
(Perfluorocarbon)
PPV

27. By preventing retinal break possibility
 Eg.: laser photocoagulation when lattice degenerations is diagnosed
By preventing high risk factors
 Eg.: myopia, aphakia…
Regular eye checkup
Prophylaxix:

28. Exudat i ve or Sol i d Ret i nal Det achment

29. Sol i d Ret i nal
Det achment
(aka Serous RD)Occurs due to retina being mechanically pushed
away by a neoplasm or accumulation of fluid
beneath the retinal pigment epithelium
caused neither by a break nor traction; the SRF is derived
from fluid in the vessels of the NSR or choroid, or both.
Usually associated with inflammatory or vascular lesion

30. Natural Response of the RPE

31. Etiology:

32. C/F:
• NO photopsia, retinal breaks, folds or undulations
• visual field defect may develop suddenly and progress rapidly
• Retina: smooth and convex
may show pigmentary disturbances
• Disturbed pattern of retinal vessels
• Detached retina is very mobile and demonstrate Shifting Fluid
(gravity)
• Transillumination test:
» Transparent or solid

33. Shifting Fluid:

34. Investigations:
• Complete ocular and systemic examination
• B-scan USG
• FFA:
• shows source of fluid
• CT/MRI
• Esp. useful in case of tumor

35. Treatment:
• Spontaneous regression after the absorption of the fluid
• Treatment of the cause:
• Enucleation
• Esp. if due to malignancy

37. Tr act i onal Ret i nal Det achment

38. • The NSR is pulled away from the RPE by contracting
vitreoretinal membranes in the absence of a retinal break.
• Here retina being mechanically pulled away from its bed by the
contraction of the fibrous tissue in the vitrous (vitreo-retinal
traction band)
Tr act i onal Ret i nal Det achment

39. Etiology:
• Post-traumatic (penetration trauma)
» Contraction of the scar tissue
• Proliferative diabetic retinopathy
• Post hemorrhagic retinitis proliferans
• ROP
• Retinal dysplasia
• Proliferative retinopathy of Eale’s disease
• Toxocariasis

41. C/F:
NO photopsia and floaters
Retinal breaks are usually absent
No shifting of fluid
Detached retina : Concave
Presence of vitreoretinal traction bands
Retinal mobility is severly reduced

42. Treatment:
Surgery
• Usually difficult
• PPV (to cut the traction bands)
• Then internal tamponade (long acting gas or silicon oil)
Usually bad prognosis

43. Thank You