VR Disorders Retinal Detachment (RD) Ayesha S Abdullah 06.02.2015

DEVELOPMENT OF THE EYE

What is RD? Separation of the neurosensory retina from the retinal pigment epithelium

Non- rhegmatogenous RD TYPES Rhegmatogenous RD Non- rhegmatogenous RD Exudative RD Tractional RD Combined Tractional Rhegmatogenous

Epidemiology 1 in 10,000/ year Bilateral in about 10% Risk factors? An ophthalmic emergency

RRD Some Anatomical Considerations Vitreo-retinal adhesions disc, ora, blood vessels & at fovea Potential subretinal space

RRD RD secondary to a break in the retina

Causes & risk factors PVD Lattice degeneration, 8% in general population, 40% in eyes with RD Myopia Post- Cataract surgery (pseudophakia) Trauma PVD In 15% of cases with Posterior vitreous detachment (PVD) a tear develops in the retina Lattice degeneration 60% of tears develop in peripheral retina with retinal degenerations like Lattice degeneration Myopia 40% of the RD occur in myopic eyes; the higher the error the greater the risk Post- Cataract surgery (pseudophakia) especially in eyes with retinal degeneration and myopia can develop retinal tears and RRD

Clinical presentation –symptoms Flashes of light Floaters Visual loss Visual field loss Usually an acute event History of predisposing factors, myopia, cataract surgery, trauma etc

Field loss

Clinical examination –signs Significantly reduced Visual acuity Anterior segment examination Pupils, (RAPD) Posterior segment examination Vitreous- tobacco dust Retinal signs IOP ( may be low)

Clinical examination –signs Direct Ophthalmoscopy

Indirect Ophthalmoscopy

Normal fundus

Retinal detachment with tear

RD

RD with giant tear

Tractional RD

Principles of management External temponade/ scleral buckling Seal the break Create a buckle Drain the SRF (subretinal fluid)-if required Internal temponade

Prophylaxis of RRD Photocoagulation of the risky lesions with laser So patients with risk factors should be referred to an ophthalmologist

Announcements HW 5 risk factors for RD Three common causes of exudative retinal detachment Last date for submission 20th Feb 2015 msqheartline@hotmail.com Test in topics covered in 4th year after VR finishes