RETINAL DETACHMENT
RETINA light-sensitive tissue layer sends visual messages through the optic nerve Retina have 2 layers Sensory retina – rods and cones are present Retinal pigment epithelium (RPE)
Retinal detachment is the separation of the retinal layers (sensory layer from RPE) due to a break or tear over the retinal layers Four types Rhegmatogenous Traction Combined form of rhegmatogenous and traction Exudative
Rhegmatogenous detachment – Most common one A hole or tear develops in the sensory retina allowing some of the liquid (vitreous) to seep through the sensory retina and detach it from the RPE
Traction – a pulling force is responsible Traction can be occur due to any scars or bands of fibrous material providing traction to the retina Vitreous hemorrhage, retinopathy can cause traction effect Exudative – due to production of serous fluid under the retina. (uveitis, degenerative disorders)
Pathophysiology Due to etiological factors (a torn or break in retina) Vitreous fluid or serous fluid leaks in between the layers of retina or behind the retinal layers Detachment of retinal layer Retina can peel away from the underlying layer of blood vessels Lack of oxygenation in tissues of retina Vision disturbances
SYMPTOMS Floaters Cobwebs Bright light flashes shadow or curtain over a portion of visual field blur in vision No complain of pain
floaters - bits of debris in field of vision that look like spots, hairs or strings
Etiology Trauma Advanced diabetes shrinkage of the jelly-like vitreous that fills the inside of the eye Myopia Degenerative disorders Inflammation and infections Scarring and fibrous material due to retinopathy and hemorrhages Ocular tumors
Factors that may increase risk of retinal detachment: aging - more common in people older than 40 previous retinal detachment in one eye family history of retinal detachment extreme nearsightedness previous eye surgery previous severe eye injury or trauma
Diagnostic findings Visual acuity Ophthalmoscopy Slit lamp microscopy Unltrasound
Surgical management Retinal tears: laser surgery (photocoagulation) – with the help of laser rays the tears are being joined or sutured. freezing (cryopexy) – cryoprob will freeze and join the retinal tears Retinal detachment: pneumatic retinopexy scleral buckling vitrectomy
PHOTOCOAGULATION
CRYOPEXY
Scleral buckling Compression of sclera to indent the scleral wall from the outside of the eye and bring the two retinal layers in contact with each other High success rate It uses silicone sponge, rubber, or semi-hard plastic for buckling It will provide a traction on the retina and allow the retinal tear to settle against the wall of the eyes
SCLERAL BUCKLING
Vitrectomy It is the surgical removal of the vitreous gel from the eye. It can also remove blood in the vitreous gel Three incisions are made One incision allows the introduction of light source Other incision for vitrectomy instrument The third incision for the instrument to refill the vitreous substitute (silicone oil) Duration is 2 to 3 hours
VITRECTOMY
This procedure can be used to remove foreign bodies, vitreous opacities such as blood Traction on the retina can be relieved
Pneumatic retinopexy Least invasive A gas bubble, silicone oil, or perflurocarbon may be injected into the vitreous cavity to help push the sensory retina up against the RPE Patient must be in prone position to hold the injected bubble in postition
PNEUMATIC RETINOPEXY
Care Complications – bleeding under retina, cataracts, recurrence or infection Home care – short recovery , can resume normal activity after two weeks, traveling should be avoided for a month, avoid increase altitudes Pain and eye protection – eye drops and eye patch may be necessary to keep the eye moist, no soap should enter into eye during bathing, if air bubble is injected- prone position should be provided for one to two weeks
Exercise – close concentration and TV watching should be avoided, heavy lifting over 20 pounds and strenuous activities should be avoided, Driving should be avoided Follow up should be done accordingly.