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Retinal Detachment

Retinal Detachment. Abdulkrim Alkharashi , MD. RD History:. Causes of primary RD:-. Theory of distension. Theory of hypotony. Theory of exudation. Theory of retinal breaks. RD History: cont. Beer – 1817 first to detect RD clinically.

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Retinal Detachment

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  1. Retinal Detachment AbdulkrimAlkharashi , MD

  2. RD History: • Causes of primary RD:- • Theory of distension. • Theory of hypotony. • Theory of exudation. • Theory of retinal breaks.

  3. RD History: cont. • Beer – 1817 first to detect RD clinically. • Von Helmholtz – 1851 invented the ophthalmoscope. • Coccius – 1853 first to find retinal breaks (r.b.). • De Wecker – 1870 first suggested that r.b. were the causes of  RD.

  4. RD History: cont. • Leber – 1882 found r.b. in 70% of RD, vit. deg. and collapse  traction  r.b.  RD. Changed to pre-retinal memb.  r.b. (in PVR). • Jules Gonin – 1919 Father of RD surgery. Performed the first RD operation to close r.b. – Ignipuncture of Thermocautery.

  5. RD: • Rhegmatogenous – Greek thegma = rent • Tractional • Exudative

  6. RD Epidemiology: • Incidence 1: 10,000 / year. • In aphakics: 1– 3%. • In the second eye (-): 5%. • In the second eye (+): 10%. • 99% of untreated symptomatic RD  blindness. • 5 – 15% of population with retinal break(s)  7% of these develop new break(s).

  7. Rhegma. RD: • Pre-requisite:- • Some degree of vitreous liquifaction. • Retinal break: - tear - hole - dialysis • Eye movements (Edie’s currents) • PVD, V-R traction

  8. PVD_______________________________ • Due to loss of hyaluronic acid  collapse of vit. collagen with liquefaction. • Rare before 30 yrs. • Increases with age (63% in > 70 yrs.) • Most PVDs are asymptomatic. 2nd eye in 1 yr. • 15% of acute PVD have a retinal tear (pathologic). • Increases significantly after cataract extraction: pathologic vs. physiologic PVD.

  9. RD • PVD • 13-19% of PVD have vit. Hem. • PVD + hem.  70% with tears. • PVD + no hem.  2-4% with tears.

  10. RD F/U: • Acute PVD:- • Examine periphery. • + vit. Hem. - rest, patching  examine. • U/S.

  11. RD Risk Factors: Lattice and other peripheral deg.: • Present in 8% of the population. In SA – 9.1% • As a cause of RD in 20-30%. • In RDs with L.D.:- 30-45%  Atrophic holes. 55-70%  A tear at edge of L.D.

  12. RD Risk Factors: cont. High myopia: • > 6 D. • 60 yr. myope risk of RD is 2.4% whereas normal risk 0.06%

  13. RD Risk Factors: cont. Cataract surgery: • Increases PVD: Does it convert physiological PVD to a pathological one? • 1.3% RD in aphakes. • ICCE > ECCE. • Risk of RD increased with:- - P.C. otomy: 1.3%. - Vit. loss. • 50% of RDs in 1st year.

  14. RD Risk Factors: cont. Glaucoma: • In general population – 1% COAG. • In RD patients – 4-7% COAG. • > in pigment dispersion synd. ? myopia. • Miotics & RD.

  15. RD Risk Factors: cont. RD in fellow eye or F/H of RD. Trauma.

  16. RD Symptoms: • PVD – flaches & floaters. • Painless loss of peripheral VF. • Painless loss of central vision.

  17. RD Examination: • VA. • IOP. • SLE – blood, pigment (Shafer’s sign) in the vitreous. • Careful binocular indirect ophthalmoscopy with scleral indentation. • C.L. exam.

  18. RD Types of Breaks: • Fresh (acute) tear either:- Symptomatic tear. Tear with retinal hem. at the edge. A new tear in that location. • Flap (horseshoe) tear. • An operculated hole. • Atrophic holes.

  19. RD DDX: • Exudative RD:- • Neoplasms. • Inflammations – VKH, ICSC, post. Scleritis. • Cong. Anomalies – optic pit, morning glory, choroidalcoloboma, nanophthalmos, uveal effusion syndrome

  20. RD DDX: cont. • Traction RD. • Retinoschisis – senile, juvenile. • Choroidal detachment.

  21. RD Treatment: • Prophylactic Rx:- • Olny selected breaks require Rx. • A symptomatic tear – caused by PVD or vit. Traction in the eye of a pt. C/O photopsias +/- floaters.

  22. Indications for Prophylactic Treatment of Retinal Tears and Holes in Symptomatic Patients: Flap tears Frequently (always) Operculated holes Sometimes Atrophic holes No Macular holes Rarely Lesion Treatment _____________________________________

  23. RD Treatment: • Prophylactic Rx to breaks:- • Cryotherapy. • Photocoagulation. • Surround it ant. & post. • Macular pucker. • Tears at margins of Rx scar.

  24. RD Treatment: cont. • Principles of Surgery:- • Emergency. • Localization of break(s). • Creation of C-R adhestion around the break(s). • Closure of break(s). • Relief of V-R traction.

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