RETINAL DETACHMENT Demir Başar (Professor) DB09

ANATOMICAL CONSIDERATIONS

Photoreceptors Bipolars Ganglion cells NEURONS Rods &Cones Nuclei Plexiform Ganglion cells Nerve fibers

Rods and Cones External limiting External nuclear External plexiform Internal nuclear Internal plexiform Ganglion cells Nerve fibers Internal limiting

Pigment Epithelium Rods and Cones External limiting External nuclear External plexiform Internal nuclear Internal plexiform Ganglion cells Nerve fibers Internal limiting

TWO MAIN LAYERS Pigment epithelium Neural retina

KEEPS THE RETINA IN PLACE ? There are no tissue adhesives between pigment epithelium and neural retina (i.e. fibronectins) WHAT then , KEEPS THE RETINA IN PLACE ?

Equator Patellary fossa IOP Light Optic nerve Hyaloid membrane Equator Lens Vitreus Gel

VARIOUS FORCES PLAY PART... Sclera Choroid Tissue adhesivity Epithelial pump (suction power) Pigment Epithelium Neural Retina Retina Vitreus IOP and WATER STREAM from vitreus to choroid push the neural retina towards the pigment epithelium

WHY DETACHMENT OCCURS? PREDISPOSING FACTORS 1-VITREUS DEGENERATİON 2-PERIPHERAL RETINAL DEGENERATION 3-VITREO-RETINAL ADHESIONS (fibrosis)

VITREUS DEGENERATION

Muscoe volitantes Light Shadow Syneresis

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Syneresis Posterior hyaloid water Vitreus gel

Vitreus collapse and vitreus shock (Photopsia) Posterior hyaloid rupture Drained lagoon Water moves behind Vitreous gel collapsed Detached post.hyaloid

Objects tend to keep on doing what they are doing. Newtons first law of motion (Law of Inertia) Objects tend to keep on doing what they are doing. An object at rest tend to stay at rest , and an object in motion tend to stay in motion with the same speed and in the same direction

MECHANİSM OF PHOTOPSİA Posterior hyaloid rupture (Newtons 1rst law of motion) Drained lagoon Water moves behind Vitreous gel collapsed Detached post.hyaloid

Vitreous traction Vitreoretinal adhesion

LATTICE DEGENERATION

Retinal tractional tear

PERIPHERAL RETINAL DEGENERATION VITREUS DEGENERATION + PERIPHERAL RETINAL DEGENERATION FIBROTIC TRACTION RETINAL TEAR RETINAL DETACHMENT

Pigment epithelium Neural retina Water Tear

SIGNS and SYMPTOMS SUBJECTIVE I- Before the onset of retinal detachment (NOT CONSTANT) 1-Entopsia A-muscoe volitantes (flying objects) B-photopsia (seeing lights that do not exist) II-After the retina is really detached 2-loss of part of the visual field 3-deterioration of visual acuity(when macula is involved)

OBJECTIVE 1-Grey and elevated area(s) in ophthalmoscopy against red fundus reflex 2-One or more retinal tear(s) in various shapes and locations 3-Blurred vitreus in some cases, showing the existence of intravitreal hemorhage (due to retinal rupture)

Mostly Horsshoe Superior Temporally A-Shape of tears Horsshoe,Arrowhead,Fishmouth,Round İrregular,disinsertions Mostly Horsshoe B-Location of tears They can be anywhere but mostly Superior Temporally e

DIAGNOSTIC TOOL OPHTHALMOSCOPY

TREATMENT SURGERY 1-EXTRASCLERAL 2-TRANSVITREAL