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Full thickness defects of neurosensory retina Retinal Breaks Causes (Holes/Tears) Atrophy of the inner retinal layers...

Full thickness defects of neurosensory retina Retinal Breaks Causes (Holes/Tears) Atrophy of the inner retinal layers Vitreoretinal traction Trauma Yang, 2024 -more serious conditions 72  Atrophic holes Retinal Breaks Operculated holes (Holes/Tears) Horseshoe tears Different configurations Giant tears Dialyses Yang, 2024 -can occur due to any of these conditions 73  Full thickness atrophic breaks Not associated with vitreoretinal traction Atrophic ~5% in general population Retinal Holes More often found in younger myopic eyes Often associated with lattice degeneration Mostly asymptomatic incidental finding Yang, 2024 -due to chronic atrophy or degeneration of neurosensory retina 74  Atrophic Retinal Holes Yang, 2024 -can look like a dot hemorrhage but is actually atrophic hole 75  Atrophic Retinal Holes Yang, 2024 -commonly found in lattice degeneration and snail tracks -presence of holes may increase the risk progressing towards retinal detachment 76  Atrophic Retinal Holes Yang, 2024 -atrophic holes appreciated with scleral indentation 77  Atrophic Retinal Holes Yang, 2024 -can appreciate multiple holes -one of the holes on the OCT is actually a full thickness hole where the entire neurosensory is gone 78  Atrophic Retinal Holes Yang, 2024 79  Complications Atrophic Small risk of RD Retinal Holes Possible symptoms of flashes, floaters, loss of visual field Yang, 2024 -vitreous fluid can go underneath the hole and can result in retinal detachment 80  Management Atrophic No mandatory treatment May consider prophylactic laser retinopexy if: Retinal Holes Visual symptoms High myopia Vitreoretinal disease RD in fellow eye FHx of RD Planned intraocular surgery Yang, 2024 81  Significant vitreous traction A complete avulsion of a small piece of retina Operculated A plug of sensory retina overlying a round retinal break Holes Whitish, disc-shaped, mobile/floating operculum Operculum can shrink over time Located between the ora and the equator Yang, 2024 -opposed to atrophic holes there are operculated holes where there is significant vitreoretinal detachment -pt will be more symptomatic compared to someone who has atrophic hole 82  Operculated Holes Yang, 2024 83  Mostly asymptomatic Risk of RD Operculated Low risk of rhegmatogenous RD Holes May consider treatment If symptomatic If incomplete operculated hole Yang, 2024 84  Incomplete vitreous traction Horseshoe A flap of retina towards the vitreous cavity Tear Most often found near the posterior margin of the vitreous base or at the edge of lattice Yang, 2024 -results in a linear flap of sensory retina 85  Horseshoe Tear Yang, 2024 -has a horseshoe shape hence the name 86  Horseshoe Tear Yang, 2024 -this also shows a singular isolated paving stone or cobblestone 87  Risk of RD Horseshoe 35-50% of symptomatic horseshoe tears develop RD Tear Asymptomatic tears are less likely to develop RD Prophylactic treatment can reduce the risk of RD to ~5% Yang, 2024 88  Large Retinal Tear Yang, 2024 -large linear tear with minimal retinal detachment à left pic -large, flat tear with significant amount of detachment 89  Full thickness retinal break in presence of PVD 3 or more clock hours of retina involved Giant Located near ora Retinal Tear ~1.5% of rhegmatogenous RD Male > female ~13% bilateral Yang, 2024 90  Giant Retinal Tear Causes Idiopathic Trauma Hereditary vitreoretinopathies High myopia Iatrogenic during intraocular surgeries Yang, 2024 -most of giant retinal tears are idiopathic 91  Giant Retinal Tear Yang, 2024 -posterior vitreous is detached but the vitreous gel is still adherent to the anterior flap 92  Giant Retinal Tear Yang, 2024 93  Retinal Dialysis A tear at the ora serrata / vitreous base No PVD Concentric with the ora Less than 90 degrees involved Blurry vision, VF loss, photopsia, floaters Male > female Yang, 2024 -retinal dialysis is a retinal tear in the retina whose anterior edge is at the ora seratta and the posterior edge is still attached the the vitreous -most common symptoms are VF loss or blurry vision 94  Retinal Dialysis Causes Blunt trauma Spontaneous Complications ~8-15% of RD Yang, 2024 95  Retinal Dialysis Yang, 2024 -traumatic retinal dialysis with vitreous hemorrhage 96  Post-traumatic Congenital More common Less common Inf/temp retina Inf/temp retina Retinal Dialysis Sup/nasal retina Unilateral Bilateral Young patients Slow progression to RD Spontaneous Asymptomatic Slow progression to RD Yang, 2024 -most commonly found in the inferior temporal retina bc it’s the weakest part of the retina but some studies show that it occurs more in the superior nasal location as well -retinal dialysis is a slow progression in RD esp if its in the inferior fundus 97  Giant Retinal Tear Retinal dialysis Management Emergent surgery Surgery highly successful Poorer visual prognosis Better visual prognosis Yang, 2024 -retinal detachment can occur more rapidly in a giant retinal tear as the flap falls over into the vitreous space and does need immediate surgery -someone who has retinal dialysis surgery is not urgent 98  Factors to consider Symptoms To Treat or Age Not to Treat Systemic status Retinal Break Refractive errors Break location, age, type, size Status of fellow eye Aphakic, PC IOL, or need cataract surgery FOHx Yang, 2024 99