Retinal Detachment (R.D.) is a separation of the sensory retina from the retinal pigment epithelium(R.P.E) by sub retinal fluid(S.R.F)

There are two main types.

1. Rhegmatogenous or Primary R.D.
2. Nonrhegmatous or Secondary R.D.

Secondary R.D sub divided in to two types:

• Tractional R.D.
•  Exudative(Serous) R.D

Rhegmatogenous RD

• Rhegmatogenous R.D is a condition in which fluid from vitreous cavity passes through a full thickness retinal defect in to the sub retinal space to cause separation of the neural retina from the underlying R.P.E
• It affects about 1:10,000 of the population each year

Etiology

• Neural retinal break
• Vitreous liquefaction and detachment
• Vitreoretinal traction
• Intra ocular fluid currents associated with   movement of liquid vitreous and sub retinal  fluid
• History of trauma
• History of previous ocular disease
• History of systemic diseases

Ophthalmic Features

• Age: Common age group is 40-70 years
• Sex: 60 % case comprises by males
• Hereditary: although a no.of pedigree shows familial detachments, most cases are sporadi
• Common complains -
• Flashes of lights(Photopsia)
• Floaters- may be
• Solitary ring shaped opacity(Weiss Ring)
• Cobwebs
• Sudden shower of minute red colored or dark spots
• Localized relative loss in field of vision
• sudden painless loss of vision
• Blurring of distant vision
• Pupil – RAPD
• Fundus Examination – Loss of normal fundal glow
• Retinal breaks:
• Present in about 70% of
• The eyes with tobacco dust.
• appears as red discontinuities in the retinal surface
• Upper temporal quadrant is the commonest site for retinal break

           
Shape of R.D in relation to primary break

Retinal signs depends on duration of R.D.

1. Fresh R.D
• Detached retina has a convex configuration,slightly opaque and corrugated appearance, undulates freely with eye movements
2. Long standing retinal detachment
• Retinal thinning secondary to atrophy, secondary intraretinal cysts if more than 1 year,  sub retinal  demarcation lines, present after 3 months.

Treatment

1. Cryotherapy
2. Scleral Buckling
3. Pneumatic Retinopexy
4. Vitrectomy

1. Cryo therapy
• Cryotherapy (freezing) or laser photocoagulation  are occasionally used alone to wall off a small area of retinal detachment so that the detachment does not spread.
2. Scleral Buckle surgery
• Scleral buckle surgery is an established treatment in which the eye surgeon sews one or more silicone bands (bands, tyres) to the sclera (the white outer coat of the eyeball). The bands push the wall of the eye inward against the retinal hole, closing the break or reducing fluid flow through it and reducing the effect of vitreous traction thereby allowing the retina to re-attach. Cryotherapy (freezing) is applied around retinal breaks prior to placing the buckle. Often subretinal fluid is drained as part of the buckling procedure. The buckle remains in situ. The most common side effect of a scleral operation is myopic shift.
3. Pneumatic retinopexy
• This operation is generally performed in the doctor's office under local anesthesia. It is another method of repairing a retinal detachment in which a gas bubble (SF6 or C3F8 gas) is injected into the eye after which laser or freezing treatment is applied to the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole. Patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole. The surface tension of the air/water interface seals the hole in the retina, and allows the retinal pigment epithelium to pump the subretinal space dry and suck the retina back into place. This strict positioning requirement makes the treatment of the retinal holes and detachments that occurs in the lower part of the eyeball impractical. This procedure is usually combined with cryopexy or laser photocoagulation.
4. Vitrectomy
   • Vitrectomy is an increasingly used treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble (SF6 or C3F8 gas) or silicon oil. An advantage of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks. Silicon oil (PDMS), if filled needs to be removed after a period of 2–8 months depending on surgeon's preference. Silicon oil is more commonly used in cases associated with proliferative vitreo-retinopathy (PVR). A disadvantage is that a vitrectomy always leads to more rapid progression of a cataract in the operated eye. In many places vitrectomy is the most commonly performed operation for the treatment of retinal detachment.