Highlights & Basics
- Retinal detachment (RD) is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium. Most cases present as rhegmatogenous RD, secondary to traction that causes a retinal break promoting the accumulation of subretinal fluid in the subretinal space. Nonrhegmatogenous forms of RD (i.e., not associated with a retinal break) include tractional, exudative, and hemorrhagic.
- Diagnosis relies on indirect ophthalmoscopy or slit-lamp exam, with B-scan ultrasonography used for cases with media opacity.
- Refer patients with RD early for specialist intervention by an appropriately trained ophthalmologist. Treatment depends on the type of detachment and underlying etiology. If treated promptly, prognosis is generally good. Left untreated, rhegmatogenous RD typically results in blindness.
- Surgical treatment aims to prevent fluid accessing the subretinal space through the break and to eliminate any traction that caused the break. Choice of surgery will depend on patient-specific factors, such as the number, location, and size of retinal breaks, plus the surgeon's preference and the presence of any proliferative vitreoretinopathy (PVR).
- Recurrence or treatment failure (defined as lack of retinal reattachment or retinal redetachment) may occur due to a missed retinal break, postoperative development, or PVR.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Retinal detachment approaching the macula, showing typical, full-thickness folds
Tractional retinal detachment in a patient with diabetes
Uveitis-related serous retinal detachment
Diagram of rhegmatogenous retinal detachment. Traction of vitreous gel on the retina creates a retinal break, allowing liquified vitreous to penetrate into the subretinal space where it induces retinal detachment
Rhegmatogenous retinal detachment. Hyaluronic acid in the vitreous holds water and keeps insoluble collagen fibrils dispersed in the gel matrix. A--with aging, changes to hyaluronic acid cause pockets of liquefied vitreous, leaving the collagen fibrils to condense into larger fiber bundles, which appear as chronic floaters. B--pockets of liquid vitreous coalesce to form larger spaces. Defects in the vitreous cortex let liquid into the plane between the vitreous cortex and retina, initiating posterior vitreous detachment. C--the collapsing vitreous exerts mechanical traction on the retina and optic nerve, which may be perceived as flashing lights; condensation of the vitreous around the optic nerve may appear as a crescent shaped floater (Weiss ring). Vitreous traction may lead to avulsion of blood vessels or formation of retinal breaks. D--fluid enters the subretinal space through the retinal break and retinal detachment develops
Summary of "Lincoff Rules" to aid the identification and position of a retinal break in rhegmatogenous retinal detachment
Images show the early stage of proliferative vitreoretinopathy (PVR) development. The whitish lines represent retinal folds that develop due to the formation of scar tissue on the retinal surface; at this stage, the scar tissue itself is not visible yet. The arrows point to the typical "starfold" appearance (this is where the scar tissue, if surgery is performed, is most easily grabbed)
Severe inferior proliferative vitreoretinopathy (PVR) is shown in an eye filled with silicone oil following rupture injury and vitrectomy. PVR can develop even after complete vitrectomy, but often the surgeon will not fully detach the posterior hyaloid face, increasing the risk of PVR
Scleral buckle technique. (A) Identify retinal break. (B) Expose sclera, sling rectus muscles (white arrowheads), mark break position (on sclera) then apply cryotherapy. (C) Various available buckles, including segments and encircling bands. (D) Scleral indentation apposing the break
Pars plana vitretomy. Three ports--an infusion line, a light source and a vitrector
Subretinal fluid pocket temporal to fovea (A, red arrow). (B) Attached retina after pneumatic retinopexy
Proliferative vitreoretinopathy (PVR) is shown after rupture injury and vitrectomy. The scar tissue is subretinal, with the white membrane (arrow) clearly seen underneath the retinal blood vessels
Vitrectomy with retinectomy for proliferative vitreoretinopathy (PVR)-related retinal detachment (RD). A. Immediatedly after 360-degree retinectomy during vitrectomy. The blurry white line indicates the fresh laser spots at the edge of the retinotomy. B. Several weeks later, the laser spots have healed with a clearly visible pigmentary reaction; there is no PVR or RD. The whitish lines (arrow) are artifacts due to silicone oil that has not been removed
Citations
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