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PATHOGENESIS AND SIGNS OF RETINAL DETACHMENT (RD). 1. Rhegmatogenous RD. Fresh Longstanding Proliferative vitreoretinopathy (PVR). 2. Diabetic tractional RD. 3. Exudative RD. 4. Differential diagnosis RD. Pathogenesis of rhegmatogenous RD.

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Presentation Transcript
slide1

PATHOGENESIS AND SIGNS OF

RETINAL DETACHMENT (RD)

1. Rhegmatogenous RD

  • Fresh
  • Longstanding
  • Proliferative vitreoretinopathy (PVR)

2. Diabetic tractional RD

3. Exudative RD

4. Differential diagnosis RD

slide2

Pathogenesis of rhegmatogenous RD

  • Two components for retinal break formation
  • Acute posterior vitreous detachment (PVD)
  • Predisposing peripheral retinal degeneration

Possible sequelae of acute PVD

Retinal tear formation and

haemorrhage (10-15%)

Avulsion of retinal vessel and

haemorrhage (uncommon)

Uncomplicated PVD (85%)

slide4

Fresh rhegmatogenous RD - signs

  • Annual incidence - 1:10,000 of population
  • Eventually bilateral in 10%
  • Loss of choroidal pattern
  • Retinal breaks
  • Convex, deep mobile elevation
  • extending to ora serrata
  • Slightly opaque with dark blood vessels
slide5

Longstanding rhegmatogenous RD - signs

  • Frequently inferior with small holes
  • Very thin retina
  • Secondary intraretinal cysts
  • Demarcation lines (high-water marks)
slide6

Proliferative vitreoretinopathy

Grade A (minimal)

Grade B (moderate)

Grade C (severe)

  • Vitreous haze and
  • tobacco dust
  • Retinal wrinkling and
  • stiffness
  • Rolled edges of tears
  • Rigid retinal folds
  • Vitreous condensations
  • and strands
slide7

Pathogenesis of diabetic tractional RD (1)

Antero-posterior

traction

RD

Preretinal

haemorrhage

slide8

Pathogenesis of diabetic tractional RD (2)

A-P traction

Bridging traction

Preretinal

haemorrhage

slide9

Signs of diabetic tractional RD

  • Slow progression and variable fibrosis
  • Does not extend to ora serrata
  • Concave, shallow immobile elevation
  • Highest at sites of vitreoretinal traction
slide10

Pathogenesis and Causes of Exudative RD

  • Damage to RPE by subretinal disease
  • Passage of fluid derived from choroid into subretinal space

1. Choroidal tumours

  • Primary
  • Metastatic

2. Intraocular inflammation

  • Harada disease
  • Posterior scleritis

3. Systemic

  • Toxaemia of pregnancy
  • Hypoproteinaemia

4. Iatrogenic

  • RD surgery
  • Excessive retinal photocoagulation

5. Miscellaneous

  • Choroidal neovascularization
  • Uveal effusion syndrome
slide11

Signs of exudative RD

  • Convex, smooth elevation
  • May be very mobile and deep with
  • shifting fluid
  • Subretinal pigment (leopard spots)
  • after flattening
slide12

Differential diagnosis of RD

Degenerative retinoschisis

Choroidal detachment

Uveal effusion syndrome

  • Frequently bilateral
  • Smooth, thin and immobile
  • Occasionally breaks in one
  • or both layers
  • Associated with hypotony
  • Unilateral, brown, smooth,
  • solid and immobile
  • Ora serrata may be visible
  • Idiopathic
  • Rare, unilateral
  • Combined choroidal and
  • exudative detachments