1. VR Disorders Retinal Detachment (RD)
Ayesha S Abdullah

2. Learning outcomes
By the end of this lecture the students would be able to;
Define retinal detachment, describe its epidemiology, identify symptoms and signs of retinal detachment and outline the principles of treatment

3. Review?
Cotton wool spot is most suggestive of which of the following ?
Changes in viscosity of the blood
Hypersensitivity reaction
Ischemia
Leakage from retinal vessels
Neovascularization

7. DEVELOPMENT OF THE EYE

8. Definitions What is Retinal Detachment?
Separation of the neurosensory retina from the retinal pigment epithelium

9. RNC Definitions-Types Rhegmatogenous RD (RRD)
Non- rhegmatogenous RD (NRD)
Exudative RD
Tractional RD
Combined Tractional Rhegmatogenous
RNC

10. Definitions-Types RRD: RD secondary to a retinal break
NRD: RD without a retinal break
Exudative RD: RD where the detachment is secondary to fluid that leaks from the vessels of the retina/ choroid
Tractional RD: RD due to retinal fibrosis and traction

11. Epidemiology 1 in 10,000/ year Bilateral in about 10%
An ophthalmic emergency

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

14. Forces of attachment & Detachment
Forces across retina
Forces of attachment & Detachment
Hydrostatic pressure
RPE Pump
Osmotic gradient
Interphotoreceptor Matrix (IPM)
Traction
Liquefaction of vitreous
Gravity
The interphotoreceptor matrix (IPM) is a highly organized structure with interconnected domains surrounding cone and rod photoreceptor cells and extends throughout the subretinal space. Based on known roles of the extracellular matrix in other tissues, the IPM is thought to have several prominent functions including serving as a receptor for growth factors, regulating retinoid transport, participating in cytoskeletal organization in surrounding cells, and regulation of oxygen and nutrient transport. In addition, a number of studies suggest that the IPM also may play a significant role in the etiology of retinal degenerative disorders.

16. RRD
RD secondary to a break in the retina

18. 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

19. 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

20. Field loss

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

22. Clinical examination –signs
Direct Ophthalmoscopy

23. Indirect Ophthalmoscopy

25. Normal fundus

26. Retinal detachment with tear

27. RD

28. NRD
Exudative RD

29. Exudative RD

30. Tractional RD

31. Tractional RD

32. Principles of management
Identify & Seal the break
Drain the SRF (subretinal fluid)-if required
Apply temponade
External temponade/ scleral buckling
Internal temponade
IDeA

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

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

40. Clinical examination –signs
Direct Ophthalmoscopy

41. Indirect Ophthalmoscopy

42. HW
3 commonest causes of exudative RD