14.10.10-ret detach. int class (2)

8/11/2019 14.10.10-Ret Detach. Int Class (2)

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NORMAL FUNDUS


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Retinal layer


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EMBRIOLOGY OF THE EYE

SUBRETINAL SPACE


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Direct ophthalmoscopy


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RETINAL DETACHMENT

Separation of the sensory part of the retina from

the retinal pigment epithelium (RPE).

There is an accumulation of fluid in the space

between the neural retina and the RPE known as

Subretinal fluid.


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Pathogenesis

There is an embryological explanation for retinal detachment

in that the separating layers open up a potential space that

existed during the early development of the eye.The inner lining of the eye develops as two layers.

The outer of the two layers remains as a single layer of

pigmented cells, known as the pigment epithelium. The inner ofthe two layers becomes many cells thick and develops into the

sensory retina.


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CLASSIFICATION

Rhegmatogenous Retinal Detachment

Tractional Retinal Detachment

Exudative Retinal Detachment


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Rhegmatogenous

Retinal Detachment

This is the most common form of

retinal detachment, caused by the

recruitment of fluid from the vitreous

cavity to the subretinal spacevia a full-thickness discontinuity (a

retinal break) in the sensory retina.

Retinal degeneration of peripheral retina

(lattice degeneration in high myopia >>>.

Vitreous change ( posterior vitreous

detachment/PVD. Vitreous traction).

Trauma

Etiology


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PVD


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Tractional

Retinal Detachment

This form of retinal detachmentdevelops as a result of tractional

forces within the vitreous gel

pulling on the retina, causing

the retina to be tented up from

the RPE. No retinal breaks.

The retinal detachment can be pulled away by the contraction of fibrousbands in the vitreous, advanced proliferative diabetic retinopathy is the

common cause of tractional retinal detachment.

Etiology


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Flashes (Photopsiae)The patient usually says those flashes probably present all the

time but are only noticeable in the dark.

FloatersBlack spots floating in front of the vision are commonplace but

often called to our attention by anxious patients.

Shadowa black shadow is seen encroaching from the peripheral field. If the

detachment is above, the shadow encroaches from below and it

might seem to improve spontaneously with bedrest, being at first

better in the morning.

Visual loss occurs when the fovea is involved by the detachment, or

the visual axis is obstructedby a bullous detachment

Signs and Symptoms Retinal Detachment(esp. Rhegmatogeneous RD)


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Ophthalmoscopy :

- Grey retinal bullous seen inthe part of retinal

detachment. Retinalvasculatures were join thebullous retina. Inrhegmatogenous RD, retinal

break can be identified.


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Tractional ret. Detachment in PDR


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Large retinal tears


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MANAGEMENT

Rhegmatogenous retinal detachmentProphylaxis

Retinal tears without significant subretinal fluid

can be sealed by means of light coagulation. Apowerful light beam from a laser is directed at

the surrounds of the tear.

Retinal tears

Laser spots


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Retinal Surgery

Modern retinal reattachment surgery is carried out using either thecryobuckling or vitrectomy technique. Addition treatment are

unrarely performed with scleral buckling/vitrectomy are internal

drainage, endolaser photocoagulation, or gas/silicon intravitreal

injection.


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Cryobuckle

This involves the sewing of small inert pieces of material,

usually silicone rubber, onto the outside of the sclera in such away as to make a suitable indent at the site of the tear.

This is combined with cryopexy to the break.

It is often necessary to drain off

the subretinal fluid and inject air

or gas into the vitreous. In more

difficult cases, the eye can be

encircled with a silicone strap toprovide allround support to a

retina with extensive

degenerative changes.


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Scleralbuckling


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Retinal detachment surgery: retinal tear surrounded

by cryopexy and covered by indent


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Vitrectomy

The detached retina is reattached from within the vitreous

cavity.

Cannula infusion is inserted to the globe

for maintaining the intraocular pressure.

A light probe is used to illuminate the

operative field

Vitrectomy cutter is used to remove the

vitreous,

hence relieving the abnormal vitreous

adhesions that produced the retinal tear

in the first instance


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Injecting air or

gas into the

vitreous.


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Laser endophotocoagulationCutting fibrous membrane


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Serous Retinal

Detachment

Depend on the cause of the retinal

detachment.


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14.10.10-ret detach. int class (2)

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