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Detachment
4th
Presented by
Medical student
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Points of
presentations
1.
1. Definition
Definition
2.
2. Risk
Risk Factors
Factors
3. Types of Retinal Detachment
3.1 Rhegmatogenous retinal detachment (RRD)
3.2 Tractional retinal detachment (TRD)
Points of Discussion
4.
4. Sings
Sings &
& Symtomps
Symtomps
5.
5. Prognosis
Prognosis
6.
6. Treatment
Treatment
Cryopexy
Cryopexy and
and laser
laser photocoagulation
photocoagulation
Scleral
Scleral buckle
buckle surgery
surgery
Pneumatic
Pneumatic retinopexy
retinopexy
Vitrectomy
Vitrectomy
Retinal Detachment
Definitions
A disorder of the eye in which the sensory
retina peels away from its underlying layer
of support tissue (retinal pigment
epithelium; RPE).
Initial detachment may be localized or
broad, but without rapid treatment the
entire retina may detach, leading to vision
loss and blindness.
It is a medical emergency.
Trauma
Metastatic cancer,
which spreads to the
eye (eye cancer)
Retinoblastoma
Severe Myopia
Smoking and Passive
smoking
Stickler syndrome
Von Hippel-Lindau
disease
Exudative, serous,
or secondary
retinal
Types
of Retinal
detachment
detachment
ERD occurs due to inflammation, injury or vascular
abnormalities that results in fluid accumulating
underneath the retina without the presence of a
hole, tear, or break.
In evaluation of retinal detachment it is critical to
exclude exudative detachment as surgery will make
the situation worse, not better.
Although rare, exudative detachment can be caused
by the growth of a tumor on the layers of tissue
beneath the retina, namely the choroid.
This cancer is called a choroidal melanoma.
Diagnosis
Diagnosis
Retinal detachment can be examined by fundus
photography or ophthalmoscopy.
Fundus photography generally needs a considerably larger
instrument than the ophthalmoscope, but has the
advantage of availing the image to be examined by a
specialist at another location and/or time, as well as
providing photo documentation for future reference.
Modern fundus photographs generally recreate
considerably larger areas of the fundus than what can be
seen at any one time with handheld ophthalmoscopes.
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Epidemology
The incidence of retinal detachment in
otherwise normal eyes is around 5 new
cases in 100,000 persons per year.
Detachment is more frequent in middleaged or elderly populations, with rates of
around 20 in 100,000 per year.The
lifetime risk in normal individuals is about
1 in 300.Asymptomatic retinal breaks are
present in about 6% of eyes in both
clinical and autopsy studies.
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Epidemology
Prognosis
Up until the early 20th century, the prognosis for RRD was very poor,
and no effective treatments were available.
Treatment
There are several methods of treating a
detached retina, each of which
depends on finding and closing the
breaks that have formed in the retina.
All three of the procedures follow the
same three general principles:
Find all retinal breaks
Seal all retinal breaks
Relieve present (and future)
vitreoretinal traction
Treatment
Cryopexy and laser
photocoagulation
Cryotherapy (freezing) or
laser photocoagulation are
occasionally used alone to
wall off a small area of
retinal detachment so that
the detachment does not
spread.
Treatment
Scleral buckle surgery
Scleral buckle surgery is an established treatment in
which the eye surgeon sews one or more silicone
bands (bands, tyres) to the sclera (the white outer
coat of the eyeball).
The bands push the wall of the eye inward against the
retinal hole, closing the break or reducing fluid flow
through it and reducing the effect of vitreous traction
thereby allowing the retina to re-attach.
Cryotherapy (freezing) is applied around Pneumatic
retinopexy
Treatment
Treatment
An advantage of using gas in this
operation is that there is no myopic
shift after the operation and gas is
absorbed within a few weeks. Silicon
oil (PDMS), if filled needs to be
removed after a period of 28
months depending on surgeon's
preference.
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