1. RETINAL DETACHMENT

2. 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)

3. 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

4. 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

5. 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)

6. 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

7. SYMPTOMS
Floaters
Cobwebs
Bright light flashes
shadow or curtain over a portion of visual field
blur in vision
No complain of pain

8. floaters - bits of debris in field of vision that look like spots, hairs or strings

9. 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

10. 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

11. Diagnostic findings Visual acuity Ophthalmoscopy Slit lamp microscopy
Unltrasound

12. 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

13. PHOTOCOAGULATION

14. CRYOPEXY

15. 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

16. SCLERAL BUCKLING

17. 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

18. VITRECTOMY

19. This procedure can be used to remove foreign bodies, vitreous opacities such as blood
Traction on the retina can be relieved

20. 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

21. PNEUMATIC RETINOPEXY

22. 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

23. 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.