1/12/2024 0 Comments Tractional retinal detachmentFlashes may be associated with successful vitreous separation without retinal tears or detachment or may have non-ocular etiologies such as transient ischemic attack and acephalgic migraine. Floaters, a common problem across all age groups, are usually benign. There are many causes for this: patients do not notice flashes if they are asleep, recognition of unilateral vision loss is often delayed and RDs are usually first noticed only when they begin to affect central vision. Most patients presenting with an RD report recent positive visual phenomenon despite the detachment’s onset possibly being weeks to months prior to the presentation of symptoms. This is particularly common when RRDs occur in inferior and temporal locations because the superior and nasal fields of view are less sensitive. A non-central RD can be asymptomatic, as patients may not be as sensitive to slowly progressive peripheral vision loss. These usually present as inferior or temporal chronic detachments originating from atrophic holes (Figure 3). Click image to enlarge.Īsymptomatic RDs are usually detected during primary eye care visits. This patient with preexisting lattice (green arrow), developed a retinal break (blue arrows) during PVD (yellow arrow), resulting in an inferior retinal detachment (red arrows). 3,22 Approximately 30% of phakic patients with RRD have pre-existing lattice degeneration, whereas all patients with lattice degeneration have less than 1% chance of developing RRD. 16-21 Peripheral retinal disease and degeneration can be a predisposing risk factor for RRD, especially lattice degeneration (Figure 2). 5-15 This increases to 1% following cataract surgery and up to a four-fold increase with Nd:YAG capsulotomy. The incidence of RD in the general population is between 0.01% and 0.018%. Previous intraocular surgery, especially for cataract, is a risk factor. Risk factors other than age include: family history, particularly in certain genetic conditions, high axial myopia, history of RRD in the fellow eye, trauma, certain conditions such as uveitis and retinopathy of prematurity (ROP). Once a retinal detachment develops, surgical intervention becomes necessary. Most tears, if caught early, can be treated with a laser in a clinical setting even with the presence of a small amount of subretinal fluid. Some tears may exist chronically for years, while others create detachments in a matter of hours. Progression time from tear to detachment is unpredictable, and varies from hours to days or even months. 1-4 Vitreous degeneration as a process of aging is well understood and is best described as the progressive detachment of the vitreous cortex from the retinal surface, which rarely creates retinal tears. Retinal defects are commonly described as tears or holes, and the most common way to acquire one is through the development of a posterior vitreous detachment (PVD). Click image to enlarge.Īll non-exudative and non-tractional RDs originate from a retinal defect. Optical coherence tomography showing (A) separation of neurosensory retina (yellow arrow) from the RPE (blue arrow) (B) percolated retinal break (red arrow). Here are the principles of RRD, including pathophysiology, symptomatology, clinical findings and surgical management.įig. At times, these presenting examination findings can be misleading, resulting in misdiagnosis and mismanagement of the patient. The preliminary or “triage” diagnosis is made based on the presenting history-such as sudden onset flashes, floaters, vision loss or a combination-as well as clinical and ancillary examination. Even giant tears may sit idly without progressing to a detachment for an extended period of time. The intervening time between the development of a retinal defect and retinal detachment is highly variable and often unpredictable. Rhegmatogenous retinal detachment (RRD) is the separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) by fluid traversing from the vitreous cavity into the subretinal space via a retinal defect (Figure 1). R etinal detachment (RD)-a serious condition that requires urgent attention-is commonly encountered in vitreoretinal subspecialty practices.
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