Retinal detachment – classification

Description pigmentation A retinal detachment (RD) refers to the ● Pavingstone/cobblestone degeneration. condition where the neurosensory retina lifts off and separates from the underly- Signs that uncommonly lead to RD: ing retinal pigment epithelium (RPE). ● Lattice degeneration, but only if extensive Classification ● Snail track degeneration Possible causes of a RD include: ● Peripheral cystoid degeneration ● Rhegmatogenous: where a full-thick- ● Asymptomatic operculated tears, ness retinal break (tear or hole) allows pigmented breaks, atrophic holes liquid vitreous fluid between the sensory ● Post-inflammatory chorioretinal retina and the RPE, thereby causing scars the retina to lift off. Possible predis- ● Retinoschisis, commotio retinae. posing factors include lattice degen- eration, posterior vitreous detachment Signs with significant risk for RD, in (PVD), trauma, intraocular surgery, and conjunction with vitreo-retinal traction: myopia ● Asymptomatic flap or tears ● Tractional: where another retinal ● Symptomatic operculated tears or An inferior rhegmatogenous retinal detachment in an disease such as proliferative diabetic atrophic holes, or asymptomatic lesions asymptomatic 20-year-old student. The patient had retinopathy, or retinopathy of with other risk factors as listed below presented for a routine eye examination prematurity, leads to direct fibrotic or ● Symptomatic tears with persistent fibrovascular traction on the retina traction, horseshoe tears, giant tears Laser treatment without a break ● Retinal dialysis, post-traumatic tears. Indicated for symptomatic lesions. Two ● Exudative: due to the accumulation of Other risk factors: aphakia, pseudo- or three rows of laser photocoagulation exudative material, serous fluid, or blood phakia, high myopia, personal or family around tears or holes located posteriorly. beneath the retina, without a retinal history of retinal detachment, use of Also appropriate to prevent progression break or tear having occurred. miotics. of rhegmatogenous retinal detachment ● Therapeutic: miotic therapy, such as if asymptomatic and not threatening pilocarpine, used in glaucoma therapy PREVALENCE the macula. may precipitate RD. Rare (approximately 1 in 10,000) in the general population, although more Cryotherapy Symptoms common in specific risk groups as More useful for anterior lesions, cloudy A sudden or dramatic onset in: mentioned above. media, significant sub-retinal fluid. ● An increased number of floaters ● Increased flashes of light (photopsia) Significance Surgical treatment which does not diminish Acutely vision-threatening. Options include scleral buckle, ● Loss of peripheral or side vision pneumatic retinopexy, plars plana ● The appearance of a curtain or blind Differential diagnosis vitrectomy, drainage of sub-retinal fluid. coming down over vision Retinoschisis, central serous retinopathy, If there are underlying conditions, for ● Cloudy vision, cobwebs or shadow choroidal detachment. example in exudative retinal detach- observed. ment, then the underlying condition Management should be treated. If vitreoretinal traction Signs is present, surgery to relieve the traction The retina appears elevated and undulat- Urgent will be considered. ing or billowing with eye movements. A rhegmatogenous RD in which the While retinal blood vessels may be macula is not yet involved is an ocular The full series of these articles is available in the book visible, the underlying choroidal detail emergency needing treatment within Posterior Eye Disease and Glaucoma A-Z by Bruce AS, is obscured. When the RD is recent, the 24 hours. If the macula has already O’Day J, McKay D and Swann P. £39.99. For further retina may be relatively transparent, but detached, treatment is still urgent, 48- information click on the Bookstore at opticianonline.net with time the separated tissue becomes 96 hours. more opaque. If the detachment has been ● Adrian Bruce is a Chief Optometrist at the Victorian static for some months, the posterior Additional investigations College of Optometry and a Senior Fellow, Department border may be pigmented. A rhegmatog- B-scan ultrasound may be used to of Optometry and Vision Sciences, The University of enous RD is indicated by the presence of assess the mobility of the vitreous, the Melbourne. a retinal break, often a tear, more obvious presence of PVD and whether there ● Justin O’Day is an Associate Professor in the with scleral indentation. There may be is vitreous traction. Ocular coherence Department of Ophthalmology, The University of pigment cells in the vitreous (Shafer’s tomography may also be helpful in Melbourne and Head Of Neuro-Ophthalmology Clinic, sign), as well as reduced intraocular establishing the presence of vitreous Royal Victorian Eye and Ear Hospital. pressure and a relative afferent pupillary traction. Fluorescein angiography may ● Daniel McKay is a Medical Officer at the Royal defect (RAPD). Peripheral retinal lesions be helpful in evaluating exudative Victorian Eye & Ear Hospital. which are not considered a predisposing retinal detachment. Peripheral visual ● Peter Swann is Associate Professor in the School of condition for RD: field testing (30º-60°) may be required Optometry, Queensland University of Technology. ● Bear tracks or peripheral grouped to detect field loss. opticianonline.net 18.04.08 | Optician | 63