Etiology and Symptoms

Definition

Fluid collects in the potential space between the retina and the retinal pigment epithelium that remains attached to Bruch's membrane.

Symptoms and signs

The patient initially experiences flashing lights and vitreous floaters. The collection of subretinal fluid causes retinal separation, resulting in a field loss corresponding to the area of detachment.

High risk group

1. High myopia
2. Aphakia
3. Trauma
4. Diabetes
5. Malignant hypertension

Types of retinal detachment

1. Rhegmatogenous retinal detachment (RRD): in 90-97% of RRDs a definite retinal break can be found. The detached retinal usually has a corrugated appearance, especially in recent retinal detachments and undulates with eye movements.
2. Tractional retinal detachment (TRD): vitreous membranes caused by penetrating injuries or by proliferative retinopathies such as diabetic retinopathy can pull the neurosensory retina away from the RPE, causing a tractional retinal detachment.
3. Exudative retinal detachment (ERD): exudative detachment occurs when either retinal blood vessels or the RPE is damaged, allowing fluid to pass into the subretinal space. Neoplasia and inflammatory diseases are the leading causes of large exudative detachment.

Treatment and Postoperative Care

Scleral buckling 

All retinal breaks are localized and a chorioretinal adhesion is initiated around the break with diathermy, laser, or the cryoprobe.

Pneumatic retinopexy

Used in selected retinal detachments caused by breaks in the superior two thirds of the fundus, is a procedure in which a gas bubble is injected into the vitreous cavity to tamponade the retinal breaks until the retina is rettached.

Vitrectomy

Pars plana vitrectomy with vitreous membrane cutting and pealing appears to be the only way of treating these detachments.

Prognosis

The status of the macula, whether it was detached and for how long, is the primary presurgery determinant of postoperative visual acuity. If the macula was detached, degeneration of photoreceptors may prevent good postoperative visual acuity. The overall rate of anatomic reattachment with current techniques is 90%. The prognosis is better for reattachment in patients whose detachments are caused by dialyses or small holes or who have detachments associated with