Retinal disorders involve damage or abnormalities of the retina. The most common type of retinal detachment is rhegmatogenous detachment, which occurs when a tear or hole develops in the sensory retina, allowing fluid to leak through and detach the retina from the retinal pigment epithelium. Traction retinal detachment is caused by scar tissue pulling on the retina. Surgical techniques to repair retinal detachments include scleral buckling and transconjunctival sutureless vitrectomy. Postoperative nursing care focuses on educating patients about signs of complications and providing supportive care during their recovery.

1. RETINAL DISORDERS
Elective
‫اعداد‬‫الطالب‬:
‫حسوني‬ ‫سالم‬ ‫صادق‬
Master student in
Babylon university
College of nursing

2. RETINAL DISORDERS
the retina is composed of multiple microscopic
layers, the two innermost layers, the sensory
retina and the
retinal pigment epithelium (RPE), are the most
relevant to
common retinal disorders.
the photoreceptor cells, are found in the sensory
layer of the retina. Beneath the sensory layer
lies the RPE, the pigmented layer.

3. Retinal Detachment
Retinal detachment refers to the separation of
retina pigment epithelium(RPE) from the sensory layer.
The four types of retinal detachment
1.Rhegmatogenous
2.traction
3.a combination of rhegmatogenous and traction
4.and exudative
.

5. Rhegmatogenous detachment
is the most common form. In this condition,
a hole or tear develops in the sensory retina,
allowing
some of the liquid vitreous to seep through the
sensory
retina and detach it from the RPE

6. People at risk for this type of detachment include
those with high myopia or aphakia after cataract
surgery.
Trauma may also
play a role in rhegmatogenous retinal detachment.
between 5% and 10% of all rhegmatogenous retinal
detachments
are associated with proliferative retinopathy, a
retinopathy associated with diabetic
neovascularization

7. Tension, or a pulling force, is responsible for traction retinal
detachment.
An ophthalmologist must ascertain all of
the areas of retinal break and identify and release the scars
or bands of fibrous material providing traction on the
retina.
Generally, patients with this condition have developed
fibrous scar tissue from conditions such as diabetic
retinopathy, vitreous hemorrhage, or the retinopathy of
prematurity.
The hemorrhages and fibrous proliferation associated
with these conditions exert a pulling force on the
delicate retina.

8. Clinical Manifestations
Patients may report the sensation of a
shade or curtain coming
across the vision of one eye, cobwebs,
bright flashing
lights, or the sudden onset of a great
number of floaters. Patients
do not complain of pain.

9. Patients can have both rhegmatogenous and
traction
retinal detachment.
Exudative retinal detachments are the result
of the production of a serous fluid under the
retina from
the choroid. Conditions such as uveitis and
macular degeneration
may cause the production of this serous fluid.

10. Assessment and Diagnostic Findings
After visual acuity is determined, the patient must have a
dilated fundus examination using an indirect ophthalmoscope
as well as slit-lamp biomicroscopy. Stereo fundus photography
and fluorescein angiography are commonly used
during the evaluation.
Increasingly, optical coherence tomography and ultrasound
are used for the complete retinal assessment, especially
if the view is obscured by a dense cataract or vitreal
hemorrhage.

11. Surgical Management
In rhegmatogenous detachment, an attempt is made to surgically
reattach the sensory retina to the RPE. In traction
detachment, the source of traction must be removed and
the sensory retina reattached. New surgical techniques as
well as advances in instrumentation have led to an increased
rate of success of surgical reattachment and better
visual outcomes. The most commonly used surgical
interventions
are the scleral buckle
A recently developed procedure
is the 25-gauge transconjunctival sutureless vitrectomy.

12. Scleral Buckle
The retinal surgeon compresses the sclera (often with a
scleral buckle or a silicone band; to indent the
scleral wall from the outside of the eye and bring the two
retinal layers in contact with each other. This type of surgery
has a high success rate in the hands of experienced retinal
surgeons. It causes less damage to the lens of the eye in
phakic patients, and there is a low risk of endophthalmitis.
However, there is an increased incidence of diplopia and
other complications, such as induced myopia and increased
postoperative pain.

14. Transconjunctival Sutureless Vitrectomy
The 25-gauge transconjunctival sutureless vitrectomy is a
significant advancement in vitreoretinal surgery. Replacement
of the larger 20-gauge approach with the less invasive
25-gauge technique allows for self-sealing transconjunctival
. As a result, postoperative inflammation
is decreased, thus promoting rapid wound healing
and patient recovery. The 25-gauge microcannula maintains
the alignment between the entry site of the conjunctiva
and the sclera (Chen, 2007)

15. Complications
such as hypotony and endophthalmitis
may be related to the unsutured sclerotomy.
However, clinical
experience has shown that this sutureless system is
both
safe and effective with decreased surgical times,
reduced
postoperative inflammation, and more rapid recovery
(Chen, 2007).

17. Nursing Management
For the most part, nursing interventions consist
of educating
the patient and providing supportive care..
Patients and family members should be made
aware
of these special needs beforehand so that the
patient can be
made as comfortable as possible .

18. Teaching About Complications
In many cases, Postoperative complications may include
increased
IOP, endophthalmitis, development of other retinal
detachments, development of cataracts, and loss of turgor
of the eye. Patients must be taught the signs and
symptoms of complications, particularly of increasing IOP
and postoperative infection. Patients should be provided
with telephone numbers of members of the ophthalmic
team and encouraged to call immediately if discomfort escalates.