1. RETINAL DETACHMENT
Demir Başar (Professor) DB09

2. ANATOMICAL CONSIDERATIONS

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

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

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

7. TWO MAIN LAYERS
Pigment epithelium
Neural retina

8. 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 ?

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

10. 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

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

12. VITREUS DEGENERATION

14. Muscoe volitantes
Light
Shadow
Syneresis

15. flo2.JPG

16. Syneresis
Posterior hyaloid
water
Vitreus gel

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

18. 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

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

20. Vitreous traction
Vitreoretinal adhesion

21. LATTICE DEGENERATION

23. Retinal tractional tear

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

25. Pigment epithelium
Neural retina
Water
Tear

26. 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)

27. 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)

28. 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

29. DIAGNOSTIC TOOL
OPHTHALMOSCOPY

31. TREATMENT
SURGERY
1-EXTRASCLERAL
2-TRANSVITREAL