slide1
Download
Skip this Video
Download Presentation
Retinal Detachment

Loading in 2 Seconds...

play fullscreen
1 / 71

Retinal Detachment - PowerPoint PPT Presentation


  • 118 Views
  • Uploaded on

Retinal Detachment. Abdulkrim Alkharashi , MD. RD History:. Causes of primary RD:-. Theory of distension. Theory of hypotony. Theory of exudation. Theory of retinal breaks. RD History: cont. Beer – 1817 first to detect RD clinically.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Retinal Detachment' - natala


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
retinal detachment

Retinal Detachment

AbdulkrimAlkharashi , MD

rd history
RD History:
  • Causes of primary RD:-
  • Theory of distension.
  • Theory of hypotony.
  • Theory of exudation.
  • Theory of retinal breaks.
rd history cont
RD History: cont.
  • Beer – 1817 first to detect RD clinically.
  • Von Helmholtz – 1851 invented the ophthalmoscope.
  • Coccius – 1853 first to find retinal breaks (r.b.).
  • De Wecker – 1870 first suggested that r.b. were the causes of  RD.
rd history cont1
RD History: cont.
  • Leber – 1882 found r.b. in 70% of RD, vit. deg. and collapse  traction  r.b.  RD. Changed to pre-retinal memb.  r.b. (in PVR).
  • Jules Gonin – 1919 Father of RD surgery. Performed the first RD operation to close r.b. – Ignipuncture of Thermocautery.
slide8
RD:
  • Rhegmatogenous – Greek thegma = rent
  • Tractional
  • Exudative
rd epidemiology
RD Epidemiology:
  • Incidence 1: 10,000 / year.
  • In aphakics: 1– 3%.
  • In the second eye (-): 5%.
  • In the second eye (+): 10%.
  • 99% of untreated symptomatic RD  blindness.
  • 5 – 15% of population with retinal break(s)  7% of these develop new break(s).
rhegma rd
Rhegma. RD:
  • Pre-requisite:-
  • Some degree of vitreous liquifaction.
  • Retinal break: - tear

- hole

- dialysis

  • Eye movements (Edie’s currents)
  • PVD, V-R traction
slide11
PVD_______________________________
  • Due to loss of hyaluronic acid  collapse of vit. collagen with liquefaction.
  • Rare before 30 yrs.
  • Increases with age (63% in > 70 yrs.)
  • Most PVDs are asymptomatic. 2nd eye in 1 yr.
  • 15% of acute PVD have a retinal tear (pathologic).
  • Increases significantly after cataract extraction: pathologic vs. physiologic PVD.
slide12
RD
  • PVD
  • 13-19% of PVD have vit. Hem.
  • PVD + hem.  70% with tears.
  • PVD + no hem.  2-4% with tears.
rd f u
RD F/U:
  • Acute PVD:-
  • Examine periphery.
  • + vit. Hem.

- rest, patching  examine.

  • U/S.
rd risk factors
RD Risk Factors:

Lattice and other peripheral deg.:

  • Present in 8% of the population. In SA – 9.1%
  • As a cause of RD in 20-30%.
  • In RDs with L.D.:-

30-45%  Atrophic holes.

55-70%  A tear at edge of L.D.

rd risk factors cont
RD Risk Factors: cont.

High myopia:

  • > 6 D.
  • 60 yr. myope risk of RD is 2.4% whereas normal risk 0.06%
rd risk factors cont1
RD Risk Factors: cont.

Cataract surgery:

  • Increases PVD: Does it convert physiological PVD to a pathological one?
  • 1.3% RD in aphakes.
  • ICCE > ECCE.
  • Risk of RD increased with:-

- P.C. otomy: 1.3%.

- Vit. loss.

  • 50% of RDs in 1st year.
rd risk factors cont2
RD Risk Factors: cont.

Glaucoma:

  • In general population – 1% COAG.
  • In RD patients – 4-7% COAG.
  • > in pigment dispersion synd.

? myopia.

  • Miotics & RD.
rd risk factors cont3
RD Risk Factors: cont.

RD in fellow eye or F/H of RD.

Trauma.

rd symptoms
RD Symptoms:
  • PVD – flaches & floaters.
  • Painless loss of peripheral VF.
  • Painless loss of central vision.
rd examination
RD Examination:
  • VA.
  • IOP.
  • SLE – blood, pigment (Shafer’s sign) in the vitreous.
  • Careful binocular indirect ophthalmoscopy with scleral indentation.
  • C.L. exam.
rd types of breaks
RD Types of Breaks:
  • Fresh (acute) tear either:-

Symptomatic tear.

Tear with retinal hem. at the edge.

A new tear in that location.

  • Flap (horseshoe) tear.
  • An operculated hole.
  • Atrophic holes.
rd ddx
RD DDX:
  • Exudative RD:-
  • Neoplasms.
  • Inflammations – VKH, ICSC, post. Scleritis.
  • Cong. Anomalies – optic pit, morning glory, choroidalcoloboma, nanophthalmos, uveal effusion syndrome
rd ddx cont
RD DDX: cont.
  • Traction RD.
  • Retinoschisis – senile, juvenile.
  • Choroidal detachment.
rd treatment
RD Treatment:
  • Prophylactic Rx:-
  • Olny selected breaks require Rx.
  • A symptomatic tear – caused by PVD or vit. Traction in the eye of a pt. C/O photopsias +/- floaters.
indications for prophylactic treatment of retinal tears and holes in symptomatic patients
Indications for Prophylactic Treatment of Retinal Tears and Holes in Symptomatic Patients:

Flap tears Frequently (always)

Operculated holes Sometimes

Atrophic holes No

Macular holes Rarely

Lesion Treatment

_____________________________________

rd treatment1
RD Treatment:
  • Prophylactic Rx to breaks:-
  • Cryotherapy.
  • Photocoagulation.
  • Surround it ant. & post.
  • Macular pucker.
  • Tears at margins of Rx scar.
rd treatment cont
RD Treatment: cont.
  • Principles of Surgery:-
  • Emergency.
  • Localization of break(s).
  • Creation of C-R adhestion around the break(s).
  • Closure of break(s).
  • Relief of V-R traction.
rd treatment cont1
RD Treatment: cont.
  • LA/GA

Surgical techniques:-

  • Scleral buckle.
  • Orbital balloon.
  • Pneumatic retinopexy.
  • Primary vitrectomy + GFX, Long-term tamponade.
rd prognosis va
RD prognosis & VA:
  • 90-95% - Anatomic success.
  • Overall 40-50%  20/50 or >

25%  20/60 – 20/100

25%  20/200 or <

rd prognosis va cont
RD prognosis & VA: cont.
  • If macula off < 1 wk – 75%  20/70 or >.
  • If macula off 1-8 wk – 50%  20/70 pr >.
  • If macula on 90%  Preop. VA  pucker, CME, recurrent RD.
rd prognosis
RD Prognosis:

Excellent prognosis (nearly 100%):

  • Detachments due to dialysis or to small or round holes.
  • Detachments with demarcation lines.
  • Detachments with minimal subretinal fluid.
rd prognosis cont
RD Prognosis: cont.

Slightly poorer prognosis (95%):

  • Aphakic detachments.
  • Total detachments.
  • Detachments with associated detachment of the nonpigmented epithelium of the pars plana.
  • Detachments caused by flap tears.
rd prognosis cont1
RD Prognosis: cont.

Poor prognosis (50 to 70%):

  • Detachments with associated choroidal detachment
  • Detachments with breaks larger than 180.
  • Detachments with PVR.
  • Detachments in patients with stickler’s syndrome.
  • Detachments caused by acute retinal necrosis.
ad