Retinal Detachment

Question 1

What is the retina?

Answer 1

The retina is a light sensitive tissue lining the back of the eye

Question 2

Gross anatomy of the retina?

Answer 2

1. Optic disc (optic nerve head)
   - white circular layer where the main vessels supplying the retina radiate, it connects the optic nerve to the retina
   - Lacks photoreceptors so is referred to as the blind spot
2. Macula
   – yellow, contains the fovea, the area with the highest conc
   - Of photoreceptors responsible for sharp central vision and color perception.
3. Ora Serrata
   - junction between the choroid and pars plana.

Question 3

Microscopic structures of the retina?

Answer 3

1. Neurosensory retina
   - (1-9) light sensitive layer of the retina composed of Photoreceptors (rods and cones)
   - convert light into electrical signals, bipolar cells
   - transmit signals from the photoreceptors to ganglion cells, ganglion cells
   - send visual information to the optic nerve and brain.
2. Retinal pigment epithelium
   - a layer of pigmented cells that nourishes and supports the neurosensory retina.
   - It helps to regenerate rhodopsin, absorbs excess light and removes waste products.

Question 4

Definition of retinal detachment?

Answer 4

• Detachment of the inner layer of the retina (neurosensory retina) from the retinal pigment epithelium.
• It is an ophthalmic emergency

Question 5

Epidemiology of retinal detachment?

Answer 5

• Men are 1.5 times more likely to develop retinal detachment than women
• The lifetime risk of developing retinal detachment is estimated to be around 3% by age 85.

Question 6

Types of retinal detachment?

Answer 6

1. Rhegmatogenous retinal detachment
2. Non-rhegmatogenous retinal detachment
   - Tractional retinal detachment
   - Exudative retinal detachment

Question 7

Rhegmatogenous retinal detachment?

Answer 7

• Most common type
• Occurs when a tear or break in the retina allows fluid from the vitreous gel to seep under the retina causing it to detach

Question 8

Tractional retinal detachment?

Answer 8

• Caused by fibrovascular tissue pulling on the retina leading to separation from the underlying tissue
• Often associated with:
  1. diabetic retinopathy
  2. retinopathy of prematurity
  3. other conditions that cause fibrovascular proliferation
  4. sickle cell

Question 9

Exudative retinal detachment?

Answer 9

Caused by fluid leaking from the blood vessels under the retina often due to conditions like age related macular degeneration.

Question 10

Risk factors for rhegmatogenous retinal detachment?

Answer 10

1. pathological myopia
2. trauma
3. > 50 years age
4. family hx of retinal detachment 5

Question 11

Risk factors for tractional retinal detachment?

Answer 11

1. diabetic retinopathy
2. sickle cell retinopathy
3. retinopathy of prematurity

Question 12

Risk factors of exudative retinal detachment?

Answer 12

1. uveitis
2. central serous chorioretinopathy

Question 13

Clinical features of retinal detachment?

Answer 13

1. Sudden, painless loss of vision: typically described as a curtain shadow descending or ascending across the field
2. Flashes of light (photopsia): sudden brief flashes of light often in the peripheral vision
3. Floaters: small spots or cobwebs floating in the visual field

Question 14

Ddx for retinal detachment?

Answer 14

1. Vitreous hemorrhage
2. Posterior vitreous detachment
3. Retinoschisis
4. Uveitis
5. Choroidal tumors

Question 15

Examination of retinal detachment?

Answer 15

1. Microscopy
2. Slit lamp examination
3. Indirect ophthalmoscopy with scleral depression

Question 16

Investigations of retinal detachment?

Answer 16

Imaging
1. B-scan
2. Optical coherence tomography

Question 17

Management of rhegmatogenous retinal detachment?

Answer 17

1. laser retinopexy
2. cyroretinopexy - in the direct vicinity of the retinal defect
3. pneumatic retinoplexy
4. scleral buckling
5. pars plana vitrectomy

Question 18

Management of tractional retinal detachment?

Answer 18

vitrectomy with or without scleral buckling

Question 19

Management of exudative retinal detachment?

Answer 19

treatment of underlying cause

Question 20

Prognosis of retinal detachment?

Answer 20

• The prognosis for retinal detachment is generally good with prompt treatment with about 9 out of 10 detachments successfully attached.
• The extent of vision recovery depends on factors like duration of the detachment and whether the macula was involved.

Question 21

Prognosis of rhegmatogenous retinal detachment?

Answer 21

• Rhegmatogenous retinal detachment – the smaller the area of detachment the better the prognosis
• The prognosis is good if surgery is performed at an early stage and there is no macular involvement

Question 22

Prognosis of non-rhegmatogenous retinal detachment?

Answer 22

significantly poor prognosis

Question 23

Complications from retinal detachment?

Answer 23

1. toxic uveitis
2. proliferative vitreoretinopathy

Question 24

Complications from treatment of retinal detachment?

Answer 24

1. cataract formation
2. glaucoma
3. hemorrhage into vitreous cavity