1. Retinal Anatomy
Dr. Miratashi

2. 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

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

4. 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

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

9. 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

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14. 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

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16. 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

17. Histopathology of Lattice
Discontinuity of I.L.M.
Liquified vitreous
Atrophy of inner layers of retina
Condensation and adherence of vitreous at the margin
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20. Aphakia and Psuedophakia
1%-3% have risk of R.D. compare to phakic
Should be warned of potential symptoms
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22. 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

23. 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
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25. 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

26. Retinal Detachment Rhegmatogenous, most common, rhegma means break
Tractional less common
Exudative or secondary
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29. 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
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32. 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
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35. Anatomic Reattachment
Overall rate is 90%
Aphakia and psuedophokia less prognosis
Giant tear, PVR, uveitis, choroidal detachment
Posterior break has worst prognosis
Dr. Miratashi

36. 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
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39. 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