Retinal Anatomy Dr. Miratashi

Posterior Vitreous Detachment (PVD) Vit: collagen+ hyaluronic acid (mucopolysaccharide) Loss of gel contractile force defect in posterior vit. Face liquid escape posteriorly exam: Biomicroscopic, B-scan ultrasonography, OCT Autopsy study: <10% under age of 50years but 63%over age of 70 Dr. Miratashi

P.V.D. Patient’s age Aphakia Inflammatory disease Trauma Myopia Dr. Miratashi

Symptoms of PVD Flashing lights Floaters Acute PVD have 15% netinal tear PVD with vit. Hemorrhage 50%-70% have retinal tears PVD without vit. Hemorrhage 10%-12% have retinal tears Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

PVD and Cataract Surgery ICCE 84% ECCE with open capsule 76% ECCE intact capsule 40% Dr. Miratashi

Retinal Breaks Full-thickness defect in the neurosensory retina Provide access for liquid to enter potential space between sensory retina & RPE Flap or horseshoe tear Giant retinal tear 90 or more Operculated hole Dialysis (ora serrata) Atrophic retinal hole (no traction not R.D) Macular hole Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Trauma In Eyes 12% are found immediately 30% are found within 1 month 50% are found within 8 months 80% are found within 24 months Dr. Miratashi

Dr. Miratashi

Lattice Degeneration 6%-10% of general population Is bilateral in1/3-1/2 of affected patients More in myopic eyes Familial predilection Small number of lattice develop R.D. But 20%-30% of R.D. have lattice Dr. Miratashi

Histopathology of Lattice Discontinuity of I.L.M. Liquified vitreous Atrophy of inner layers of retina Condensation and adherence of vitreous at the margin Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Aphakia and Psuedophakia 1%-3% have risk of R.D. compare to phakic Should be warned of potential symptoms Dr. Miratashi

Dr. Miratashi

Fellow eye in patient with R.D. 10% of phakic 20%-36% of aphakic will develop R.D. in second eye An other risk factor is present prophylactic treatment Dr. Miratashi

Indication for Treat of retinal tears and holes in symptomatic patients Horseshoe tears Dialysis Operculated tear Atrophic hole Lattice degeneration without horseshoe tears Almost always Sometimes Rarely Dr. Miratashi

Dr. Miratashi

Sub Clinical R.D. Asymptomatic R.D. Fluid extends more than 1DD from the break but not more than 2DD posterior to the equator 30%will progress to R.D. so treat is recommended Dr. Miratashi

Retinal Detachment Rhegmatogenous, most common, rhegma means break Tractional less common Exudative or secondary Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Symptom and Sign of R.D. Photopsia or floater vision Visual field defect IOP Shafer’s sign (tobacco dust) in vitreous or anterior segment Corrugated appearance In long standing R.D. P.V.D., fixed folds Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Management of R.R.D. Find all breaks Create a chorioretinal irritation around each break Laser Cryo Diathermy Bring the retinal and choroid into contact to close the break Scleral buckle, pneumatic retinopexy for superior break Vitrectomy in selected cases Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Anatomic Reattachment Overall rate is 90% Aphakia and psuedophokia less prognosis Giant tear, PVR, uveitis, choroidal detachment Posterior break has worst prognosis Dr. Miratashi

P.V.R. Cause of failure to repair RPE., glial, other cells an inner and outer retinal surface forming membrane Contraction fixed fold, new break, reopen old break A, B, C, anterior, posterior Dr. Miratashi

Dr. Miratashi

Dr. Miratashi

Post Operative Vision The status of macula 1week macula detach. 75% obtain 20/70 or better 1-8 weeks 50% same vision Even with on macula preoperatively post operation may develop macular edema or pucker Intra operative complication may also limit visual recovery Dr. Miratashi