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INTRODUCTION TO RETINAL DETACHMENT (RD)

INTRODUCTION TO RETINAL DETACHMENT (RD). 1. Definitions and classifications. Retinal breaks Retinal detachment. 2. Anatomy. Anatomical landmarks Variants of ora serrata Vitreous base. 3. Examination techniques. Indirect ophthalmology Scleral indentation

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INTRODUCTION TO RETINAL DETACHMENT (RD)

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  1. INTRODUCTION TO RETINAL DETACHMENT (RD) 1. Definitions and classifications • Retinal breaks • Retinal detachment 2. Anatomy • Anatomical landmarks • Variants of ora serrata • Vitreous base 3. Examination techniques • Indirect ophthalmology • Scleral indentation • Fundus drawing • Slitlamp biomicroscopy

  2. Definition and classification • Break - full-thickness defect in sensory retina • Hole - caused by chronic retinal atrophy • Tear - caused by dynamic vitreoretinal traction Morphology of tears a. Complete U-tear b. Linear c. Incomplete L-shaped d. Operculated e. Dialysis

  3. Retinal detachment (RD) Separation of sensory retina from RPE by subretinal fluid (SRF) Rhegmatogenous - caused by a retinal break Non-rhegmatogenous - tractional or exudative

  4. Normal anatomical landmarks Short ciliary arteries Temporal ora serrata Nasal ora serrata Short ciliary nerves Vortex ampullae Macula Long ciliary artery Long ciliary nerve Microcystoid degeneration Vortex vein Short ciliary nerves

  5. Normal variants of ora serrata a. Meridional fold a b c • Small radial fold in line with • a dentate process • Occasionally small hole at base b. Enclosed oral bay • May be mistaken for retinal • hole c. Granular tissue • Multiple, tiny, white opacities • May be mistaken for small • opercula

  6. Anatomy of vitreous base Pars Plicata Pars Plana Vitreous base • 3-4 mm wide zone straddling ora serrata • Strong adhesion of cortical vitreous • Anterior limit of posterior vitreous detachment

  7. Indirect ophthalmology Condensing lenses Technique • Keep lens parallel to patient’s iris plane • Avoid tendency to move towards patient • Ask the patient to move eyes and head • into optimal positions for examination • The higher the power, the less the • magnification, the shorter the working • distance but the greater the field of view

  8. Scleral indentation Retinal breaks in detached retina without indentation Enhanced visualization of breaks with indentation

  9. Fundus drawing Technique Colour code Breaks Detached retina Vitreous opacity Thinning Exudate Lattice Retinal pigment • Place chart upside down • Draw what you see

  10. Slitlamp biomicroscopy Goldmann triple-mirror lens View of peripheral fundus • Image is upside down • Equatorial mirror (largest and • oblong) - from 30 to equator • Peripheral mirror (square) - • from equator to ora serrata • Gonioscopic (smallest)

  11. Primary retinal break It is responsible for RD and determines configuration of SRF Quadratic distribution of breaks in eyes with RD Configuration of SRF in relation to primary break

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