A patient with constant fixed or slowly progressive visual field loss should be suspected of having a detachment until proven otherwise.
Patients who present with symptoms of new onset significant photopsias and/or persistent new floaters should be suspected of having a retinal tear, which could lead to a retinal detachment. Patients undergoing cataract surgery should be counseled about the importance of reporting symptoms of retinal tears and detachments. Protective eyewear is recommended for individuals with high myopia that participate in contact sports.
#Layers of retina serial#
Patients with known risk factors for retinal detachment should have serial dilated fundus examinations with scleral depression, often yearly. Serous retinal detachments may also be the presenting sign in patients with aggressive metastatic cancer, such as testicular cancer. Serous detachments are caused by a number of inflammatory, or exudative retinal disease processes such as Sarcoidosis or choroidal neoplasms. This mechanism is known as a serous or exudative retinal detachment. The third mechanism for retinal detachment is due to accumulation of subretinal fluid due to inflammatory mediators or exudation of fluid from a mass lesion. Tractional retinal detachments can also be due to proliferative vitreoretinopathy after trauma or surgery. Tractional retinal detachments can be seen in proliferative retinopathy due to diabetic disease, sickle cell and other disease processes leading to neovascularization of the retina. This is called a tractional retinal detachment. These membranes can pull on the neurosensory retina causing a physical separation between the neurosensory retina and retinal pigment epithelium. A second mechanism involves proliferative membranes on the surface of the retina or vitreous. Rhegmatogenous retinal detachments are often due to retinal tears associated with posterior vitreous detachment or trauma.Īlthough this monograph focuses on rhegmatogenous retinal detachment, it is pertinent to note the other major causes of retinal detachment. This is known as a rhegmatogenous retinal detachment. One mechanism involves occurrence of a break in the retina allowing vitreous to directly enter the subretinal space. Retinal detachment occurs when subretinal fluid accumulates between the neurosensory retina and the retinal pigment epithelium. With retinal detachment, these mechanisms are overwhelmed leading to separation of the neurosensory (inner layers) retina from the retinal pigment epithelial layer. These mechanisms include active transport of subretinal fluid across RPE, metabolic activity of RPE, and interdigitation of the photoreceptor outer segments and the RPE microvilli. Normally, the retinal pigment epithelium (RPE) is able to maintain adhesion with the overlying neurosensory retina through a variety of mechanisms. Other peripheral lesions having slight increased risk of retinal detachment include ora bays, meridional folds and complexes, and cystic retinal tufts. Lattice degeneration is considered the most important peripheral retinal degeneration process that predisposes to a rhegmatogenous retinal detachment. Risk Factors for Rhegmatogenous Retinal Detachment
In the last 50 years techniques in scleral buckling, pneumatic retinopexy and vitrectomy have made the repair of retinal detachments significantly more manageable with better visual outcomes. In 1945 after the development of the binocular indirect ophthalmoscope by Charles Schepens, MD, techniques for retinal detachment repair improved. In subsequent years, Jules Gonin, MD, pioneered the first repair of retinal detachments in Lausanne, Switzerland. Before the 1920’s, this was a permanently blinding condition. Retinal detachment is a sight threatening condition with an incidence of approximately 1 in 10000. 1.2 Risk Factors for Rhegmatogenous Retinal Detachment.
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