INTRODUCTION TO RETINAL DETACHMENT (RD) 1. Definitions and classifications Retinal breaks Retinal detachment 2. Anatomy Anatomical landmarks Variants of ora serrata Vitreous base 3. Examination techniques Indirect ophthalmology Scleral indentation Fundus drawing Slitlamp biomicroscopy

Definition and classification Break - full-thickness defect in sensory retina Hole - caused by chronic retinal atrophy Tear - caused by dynamic vitreoretinal traction Morphology of tears a. Complete U-tear b. Linear c. Incomplete L-shaped d. Operculated e. Dialysis

Retinal detachment (RD) Separation of sensory retina from RPE by subretinal fluid (SRF) Rhegmatogenous - caused by a retinal break Non-rhegmatogenous - tractional or exudative

Normal anatomical landmarks Short ciliary arteries Nasal ora serrata Temporal ora serrata Vortex ampullae Short ciliary nerves Macula Long ciliary artery Long ciliary nerve Microcystoid degeneration Vortex vein Short ciliary nerves

Normal variants of ora serrata b c a. Meridional fold Small radial fold in line with a dentate process Occasionally small hole at base b. Enclosed oral bay May be mistaken for retinal hole c. Granular tissue Multiple, tiny, white opacities May be mistaken for small opercula

Anatomy of vitreous base Pars Plicata Pars Plana Vitreous base 3-4 mm wide zone straddling ora serrata Strong adhesion of cortical vitreous Anterior limit of posterior vitreous detachment

Indirect ophthalmology Condensing lenses Technique The higher the power, the less the magnification, the shorter the working distance but the greater the field of view Keep lens parallel to patient’s iris plane Avoid tendency to move towards patient Ask the patient to move eyes and head into optimal positions for examination

Scleral indentation Retinal breaks in detached retina without indentation Enhanced visualization of breaks with indentation

Fundus drawing Technique Colour code Place chart upside down Breaks Detached retina Vitreous opacity Thinning Exudate Lattice Retinal pigment Place chart upside down Draw what you see

Slitlamp biomicroscopy Goldmann triple-mirror lens View of peripheral fundus Image is upside down Equatorial mirror (largest and oblong) - from 30 to equator Peripheral mirror (square) - from equator to ora serrata Gonioscopic (smallest)

Primary retinal break It is responsible for RD and determines configuration of SRF Quadratic distribution of breaks in eyes with RD Configuration of SRF in relation to primary break