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RETINAL DETATCHMENT
BY DR NITISH
RETINAL DETATCHMENTSeparation of neurosensory retina from retinal pigment
epithelium
Caused by breakdown the forces that attatch the NSR to the RPE
TYPESRhegmatoenous RD
Tractional RD
Exudative RD
RHEGMATOGENOUS RDOccurs due to full thickness defect in neurosensory
retina which permit fluid from synchytic vitreous to enter into subretinal space
RISK FACTORSAge - MC in 40-60 yrs age
Sex - MC in males M:F -3:2
Myopia
Aphakia
Retinal degenerations – lattice degen , snail tract degen , retinoschisis
Trauma
Senile PVD
CLINICAL FEATURESSYMPTOMS-
Loss of vision
Floaters – weiss ring
- cobwebs
-sudden shower of minute dark
spots
Flashes
SIGNS
Marcus gunn pupil
IOP - lower
Tobacco dust - anterior vitreous
Mild irits
FUNDUS EXAMINATIONFresh tear –
-Grey reflex instead of normal pink reflex
-Convex configuration
- Thrown into folds which move with movement of eye
Long standing RD –
-Retinal thinning
-Intraretinal cyst- 1 year
-Subretinal demarkation line – 3 months
INVESTIGATIONSPERIMETRY – scotomas corresponding to
detatchment
ERG - subnormal or absent
B SCAN –in case of dense cataract
COMPLICATIONSProliferative vitreoretinopathy
Complicated cataract
Uveitis
Phthisis bulbi
TREATMENTMainly surgical
INDICATIONS OF URGENT SURGERY
Position of break
Size of break
State of vitreous gel
SURGICAL TECHNIQUESPneumatic Retinopexy
Scleral Buckling
Sub retinal fluid drainage
PROPHYLAXISLaser photocoagulation
Cryotherapy
TRACTIONAL RDNSR pulled away RPE by contracting vitreoretinal
traction bands in absence of retinal break
ETIOLOGYProliferative Diabetic Retinopathy
Retinopathy of Prematurity
Penetrating injuries
Sickle cell retinopathy
Eales disease
CLINICAL FEATURESVitreoretinal tractional bands
Configuration of detatched area is concave
TREATMENTPars Plana Vitrectomy
EXUDATIVE RDCaused neither by a break nor traction
Sub retinal fluid derived from fluid in vessels of NSR or choroid
ETIOLOGYChoroidal tumours - melanomas , haemangiomas ,
metastasis
Inflammation – VKH , posterior scleritis
CSR
Choroidal neovascularisation
Hypertensive choroidopathy
Idiopathic
CLINICAL FEATURESSYMPTOMS-
Floaters
Photopsia is absent
Visual field defect
SIGNS-
RD - convex configuration but smooth surface
Shifting fluid
Leapord spots
TREATMENTSpontaneous regression
Treat the cause
Intra ocular tumours - Enucleation
THANK YOU