1. 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

2. 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

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

4. 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

5. Normal variants of ora serratab 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

6. 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

7. 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

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

9. 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

10. 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)

11. 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