Referat

RETINAL DETACHMENT
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Dewi Fortuna Mahrifany. S

Perceptor: dr. Rahmat Syuhada, Sp.M

 WHAT IS THE RETINA?

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 The RETINA is a thin layer
of light-sensitive nerve tissue
that lines the back of the eye
(or vitreous) cavity. When
light enters the eye, it passes
through the iris to the retina
where images are focused
and converted to electrical
impulses that are carried by
the optic nerve to the brain
resulting in sight.
 
The retina is bounded by
the choroid with retinal
pigment epithelial cells
and consists of layers:
 WHAT IS RETINAL DETACHMENT ?

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 Retinal detachment (RD) involves the neurosensory
layer of the retina separating off from the underlying
retinal pigment epithelium (RPE).
 THE TYPES OF RETINAL DETACHMENT

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. Rhegmatogenous retinal detachment

. Tractional retinal detachment

. Exudative retinal detachments

 Rhegmatogenous retinal detachment

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 Most common type of Retinal Detachment.
 Caused by a tear or hole or break in the
neurosensory retina, allowing fluid from the vitreous
to pass into the subretinal space.
 Tears may be caused by posterior vitreous
detachment (PVD), degeneratif retinal changes,
trauma or iatrogenicaly.
 Incidence increases with advancing age, and more
likely to occur spontaneously in high myopes, or
after ocular surgery / trauma.
Rhegmatogenous retinal detachment

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 Tractional retinal detachment

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 Caused by traction (due to vitreal, epiretinal or
subretinal membrane) pulling the neurosensory
retina away from the underlying Retinal Pigment
Epithelium (RPE).
 Found in condition such as diabetic retinophaty,
sickle cell diseases, and ocular trauma.
Tractional retinal detachment

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 Exudative retinal detachments

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 Caused by damage to the RPE resulting in fluid
accumulation in the subretinal place.
 Main causes are intaocular tumours, posterior
uveitis, central serous retinophaty.
Exudative retinal detachments

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
 Symptoms 4F
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 Flashing light (Photopsia) – caused by traction on the
retina and usually seen in the periphery.
 Floaters – caused by condensations in the vitreous
humor causing shadows to be cast onto retina. These
are described by patients as spots or strands moving
with eye movements. They can also occor due to
small bleeds into the vitreous humour during a
retinal tear. As floaters are common in myopic
patients, it is a sudden onset or an increased number
which are important.
 Symptoms 4F

 Visual Field defect – often manifesting as a dark
shadow or curtain coming across the eye from the
periphery.
 Falling acuity – loss of central vision or visual
blurring occurs when the detachment directly
involves the fovea, or if the usual light pathway is
obscured by a detachment elsewhere.
 Risk Factor
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 Lattice degeneration (thinning in the peripheral
retina, or the area outside of the central retina.)
 High myopia (extreme near-sightedness)
 Advanced age
 Family history of retinal tears or retinal detachment
 Previous retinal detachment
 Previous eye surgery such as cataract surgery
 Trauma
 Treatment
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Scleral buckle—In this surgery, a silicone band is
placed outside the eye wall to push the wall of the
eye closer to the retinal tear in order to close the tear.
The tear is treated with a freezing treatment to
induce controlled scarring around the tear and
permanently seal it. The fluid under the retina is
sometimes removed at the time of surgery.
Scleral buckle
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 Treatment
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Vitrectomy—In this surgery, three small incisions
are made in the white part of the eye and fine
instruments are manipulated using an operating
microscope to remove the vitreous gel that fills the
eye and drain the fluid from under the retina. The
surgeon may then use a laser or cryopexy to seal the
retinal tears or holes. The eye is then filled with a gas
bubble to hold the retina in place while it heals.
Vitrectomy
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 Treatment
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 Pneumatic retinopexy—In this office-based
procedure, a gas bubble is injected into the eye and
the patient maintains a specific head posture to
position the gas bubble over the retinal tear. The tear
itself is sealed either with a freezing treatment at the
time of the procedure, or with laser after the retina is
re-attached.
Pneumatic retinopexy
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 Treatment
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 Laser surgery—In certain cases, a retinal detachment
can be walled off with laser to prevent the retinal
detachment from spreading. This is generally
appropriate for small detachments.
Laser surgery
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THANK YOU
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