Due to tumors: enucleation (see “Therapy” in retinoblastoma).Due to sub-retinal fluid accumulation: spontaneous reabsorption of fluid no treatment is required.Tractional retinal detachment: Vitrectomy followed by internal tamponade and laser photocoagulation/cryoretinopexy.Retinal detachment is an emergency condition that warrants prompt surgical intervention! Second-line: vitrectomy followed by subretinal fluid drainage, internal tamponade, and laser photocoagulation/cryoretinopexy.Pneumatic retinopexy (internal tamponade).In the case of extensive retinal detachment: prompt surgical treatment.For retinal holes/retinal tears with little or no retinal detachment (prophylaxis against retinal detachment): laser photocoagulation or cryoretinopexy in the direct vicinity of the retinal defect.Preliminary stages of retinal detachment should be diagnosed early and, if necessary, promptly treated (e.g., via laser)! References: Differential diagnoses The unaffected eye should always be examined, as in ∼ 15% of cases of rhegmatogenous retinal detachment, there is a bilateral tear.
Electroretinography: decreased or absent impulse in the region of the retinal detachment.Perimetry: to assess visual field defects.Ocular ultrasound: if the retina cannot be viewed during fundoscopy (e.g., in the case of vitreous hemorrhage or an advanced cataract).The detachment appears opaque upon transillumination.Subretinal lipid accumulation ( exudate) and hemorrhage.The detachment appears round/ convex with hyperpigmentation and/or retinal vessels at the summit of the retinal detachment.Retinal connective tissue membranes and/or connective tissue proliferation in the papilla region.The detached retina appears tented and is relatively immobile.Non- rhegmatogenous retinal detachment: No retinal tear is observed.Old retinal detachments: retinal thinning, subretinal demarcation line ( high-water mark), secondary intraretinal cysts.Blood-vessel orientation in the detached portion of the retina differs from that in the normal retina.The detached retina floats freely in the vitreous body, and moves with eye movements.A retinal tear may potentially be visible (e.g., horseshoe, linear, or round retinal tears).Opthalmoscopic findings: A freshly detached retina has a grey color instead of the normal pink color and may appear crinkled.Indirect retinoscopy is useful to visualize the peripheral retina. References: Pathophysiologyīoth direct and indirect ophthalmoscopy should be performed after dilating the pupil. Sudden decrease in intra-ocular pressure due to perforating injuries or intraocular surgery.Scar tissue following penetrating injury.Peripheral retinal breaks, commonly due to:.Previous intraocular surgery (e.g., cataract surgery).Subretinal fluid accumulation without retinal tears.Formation of vitreoretinal bands → traction on the vitreoretinal band during eye movements or as a result of sudden decrease in intraocular pressure → retinal detachment.Retinal tears → retinal fluid, which is formed by vitreous degeneration, seeps into the subretinal space → retinal detachment.Visual prognosis depends particularly on the extent of retinal detachment (poor with macular involvement) and how much time passes before the retina is reattached. Extensive retinal detachment is an ophthalmic emergency and usually requires prompt surgery to prevent further detachment and restore sensory function. To prevent retinal detachment, laser photocoagulation in the direct vicinity of the retinal defect should be performed after diagnosis of retinal tears or holes. The diagnosis is confirmed by ophthalmoscopy. Loss of vision may be severe if the retinal detachment is extensive and/or the macula is affected. Small detachments typically present with photopsia, floaters, and/or visual field defects. Non-rhegmatogenous retinal detachment is most often the result of vitreoretinal bands (e.g., proliferative diabetic retinopathy), subretinal/intraretinal tumors (e.g., choroidal melanoma), or a number of systemic and ocular causes that result in subretinal fluid accumulation. Less commonly, retinal detachment occurs without any retinal tears ( non-rhegmatogenous retinal detachment). The most frequent causes of retinal detachment are tears or holes in the retina ( rhegmatogenous retinal detachment), risk factors for which include myopia, previous intraocular surgery, trauma, and/or posterior vitreous detachment. Retinal detachment refers to the detachment of the inner layer of the retina (neurosensory retina) from the retinal pigment epithelium.
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