Retinal Detachment PDF

Accumulation of subretinal fluid Separation of the neurosensory retina from the RPE Retinal Detachment Different types of RD...

Accumulation of subretinal fluid Separation of the neurosensory retina from the RPE Retinal Detachment Different types of RD Rhegmatogenous Tractional Exudative or serous Yang, 2024 -separation of neurosensory retina from RPE due to accumulation of sub retinal fluid 100  Symptoms Sudden appearance of many floaters Retinal Flashes of light in one or both eyes Detachment Blurred vision Gradually reduced peripheral vision Curtain-like shadow over the visual field Can be asymptomatic Yang, 2024 101  Risk factors Aging Men > women Retinal Extreme myopia Detachment RD in the fellow eye FOHx of RD Previous intraocular surgery Pre-existing retinal diseases or disorders, inflammatory conditions Severe ocular injury Yang, 2024 -common around age 40 -can occur in axial myopes 102  Types of detachment Retinal Rhegmatogenous Detachment Non-rhegmatogenous Tractional Exudative/serous Yang, 2024 -rhegmatogenous à precursors are retinal breaks or PVD and are more common than non-rhegmatogenous 103  Rhegmatogenous RD Yang, 2024 -vitreous flowing behind the retina is what causes a detachment between RPE and neurosensory 104  Rhegmatogenous RD Shafer’s sign (tobacco dust) Yang, 2024 -pigments floating in the vitreous 105  Rhegmatogenous RD Yang, 2024 -operculated hole resulting in large area of retinal detachment 106  Rhegmatogenous RD Yang, 2024 -peripheral horseshoe tear responsible for the tear 107  Rhegmatogenous RD Yang, 2024 108  Tractional RD Yang, 2024 -non-rhematogenous RD -occurs when the retina is pulled off of the retina RPE by tractional forces in the absence of retinal tears or breaks -such tractional forces can be tangential as in retinal scar tissue causing the retinal surface to contract and the retina to wrinkle and separate from the RPE 109  Proliferative diabetic retinopathy Sickle cell retinopathy Retinopathy of prematurity Familial exudative vitreoretinopathy Tractional RD Proliferative vitreoretinopathy Other vascular, inflammatory, infectious conditions Penetrating injury Yang, 2024 -proliferative vitreoretinopathy results from rhegmatogenous RD but can cause secondary traction -review lecture notes from OD2 110  Subretinal fluid accumulation in the absence of retinal breaks or traction Source of fluid from vessels of retina, choroid or both Exudative / Serous RD Serous or hemorrhagic Variety of etiologies Yang, 2024 -accumulation of fluid in the sub-retinal space -fluid can be serous or blood 111  Exudative / Serous RD Idiopathic Inflammatory Infectious Neoplastic Vascular Coats disease VKH syndrome Syphilis Choroidal melanoma HTN Central serous Posterior scleritis Toxoplasmosis Choroidal metastasis ARMD chorioretinopathy Wegener’s CMV retinitis Choroidal hemangioma DM granulomatosis APMPPE Tuberculosis Retinoblastoma Leukemia Retinal capillary Behcet’s disease Lyme disease hemangioma Rheumatoid arthritis Intraocular lymphoma Yang, 2024 -some of these conditions can manifest with rhegmatogenous as well as serous 112  Features of long-standing RD Retinal Pigmented demarcation line Subretinal fibrosis Detachment Intraretinal cyst Neovascularization: peripheral retina, rubeosis iridis High IOP Yang, 2024 113  Retinal Detachment Yang, 2024 -chronic retinal detachment that has a demarcation line in the inferior hemisphere -this is an RPE hyperplasia bc it occurs as a response to something 114  Retinal Detachment Yang, 2024 -can see a cyst developing within the detached retina -multiple cysts in the other pic 115  Retinal Detachment Yang, 2024 -when considering the urgency of the treatment the integrity of the macula is impt -macula is still intact and when the macula is still on, it requires more urgent care 116  Retinal Detachment Yang, 2024 -macula is already off -once macula is off it is less likely the vision will return to its pre-state so surgical intervention is not as urgent as someone who does have their macula intact 117  Management Laser retinopexy Retinal Cryopexy Detachment Scleral buckle Pneumatic retinopexy Pars plana vitrectomy Yang, 2024 118  Outcome Retinal High anatomical surgical success rate Detachment Visual outcome not always predictable Better visual outcome if RD is repaired before macula detaches Yang, 2024 119  Retinoschisis vs. Retinal Detachment Retinoschisis Retinal detachment Separation within neurosensory retina Separation of neurosensory retina from RPE Absolute scotoma à absence of light perception Relative scotoma à residual light sensitivity Transparent retina Opaque retina Dome shaped Undulating Remains taut Moves, changes shape with indentation Maintains smooth surface during indentation Yang, 2024 -someone who has a RD is more likely to have symptoms than someone with a retinoschisis 120  Retinoschisis vs. Retinal Detachment Yang, 2024 -left pic à retinoschisis -right pic à RD 121  Retinoschisis vs. Retinal Detachment Yang, 2024 122  Retinoschisis vs. Retinal Detachment Yang, 2024 -dome shaped is retinoschisis -other two pics are RD 123  Predisposition to RD Lesions predisposing to RD Lesions not predisposing to RD Lattice/snail track degeneration Microystoid degeneration Cystic vitreoretinal tuft White without pressure Retinoschisis Reticular degeneration Atrophic hole Pavingstone degeneration Operculated hole RPE hypertrophy Horseshoe tear RPE hyperplasia Giant tear Retinal dialysis Yang, 2024 -summary of lesions that cause retina detachment and ones that don’t -micro cystoid degeneration can cause a retinoschisis which can cause a retinal detachment but doesn’t cause it directly 124  Smooth, bullous, orange-brown elevation of the retina and choroid Virtual suprachoroidal space becoming real as fluid accumulates Choroidal Can extend 360 degrees in a lobular configuration Detachment Two forms Serous Hemorrhagic Yang, 2024 125  Choroidal effusion Serous Causes Choroidal Hypotony during or after intraocular surgery Detachment Elevated uveal venous pressure Malignant hypertension Inflammation Neoplastic conditions Abnormal sclera Yang, 2024 -choroidal detachment is the same as choroidal effusion 126  Serous Choroidal Detachment Hydrodynamic Inflammatory Neoplastic Abnormal sclera Hypotony High uveal venous pressure Malignant HTN After laser or cryotherapy Lymphoid Uveal effusion syndrome Ciliary body dysfunction Arteriovenous fistula After trauma or surgery Leukemic Nanophthalmos Cyclodialysis Prominent episcleral vessels Drug reaction Melanocytic Glaucoma filtration Sturge-Weber syndrome Orbital cellulitis Malignant melanoma Penetrating injury Valsalva maneuver Orbital pseudotumor Metastatic carcinoma Vortex vein compression by Rhegmatogenous RD Scleritis scleral buckle Wound leak Uveitis Yang, 2024 -serous choroidal detachment was thought to be due to hypotony or low IOP but later cases were found where it occurred in normal or high IOP 127  Drug reaction Dorzolamide Serous Oral CAI Choroidal Tamsulosin Choroidal effusion Detachment Topiramate Angle-closure glaucoma Myopic shift Sulfonamides Tetracycline Diuretics Selective serotonin reuptake inhibitors Yang, 2024 -can occur due to sulfa medications -Topamax à anti epileptic drug -when pt discontinues the medication it usually resolves the choroidal effusion 128  Serous Choroidal Detachment Yang, 2024 129  “Kissing Choroidals” Yang, 2024 130  Idiopathic spontaneous serous detachment of the choroid, ciliary body, retina Significant choroidal elevation, subretinal fluid, secondary RPE damage Rare Uveal Effusion Middle-aged men Syndrome Bilateral up to 65% Normal IOP Painless vision loss (or mild discomfort) Yang, 2024 131  Pathophysiology Impaired scleral permeability Choroidal venous congestion, fluid accumulation Uveal Effusion Association with high hyperopia, nanophthalmos Syndrome Concurrent non-rhegmatogenous RD Diagnosis of exclusion Yang, 2024 132  Blood accumulation in suprachoroidal space due to rupture of choroidal vessels Hemorrhagic Choroidal Abrupt onset Detachment Severe pain High IOP Yang, 2024 133  Causes Hemorrhagic Choroidal During or after eye surgery Detachment Ocular trauma Spontaneous (rare) Yang, 2024 134  Hemorrhagic Choroidal Detachment Yang, 2024 -can see the area filled with blood 135  Choroidal and Retinal Detachments Yang, 2024 -choroidal and RD can occur concurrently 136  Management Conservative management Manage underlying etiologies Choroidal Medications: steroids, cycloplegics Surgical drainage if: Detachment Flat anterior chamber Decreased vision Long lasting effusion Appositional choroidals Suprachoroidal hemorrhage Yang, 2024 -result spontaneously -can use topical or oral steroid -cyclo is used if anterior chamber is shallow to deepen it 137