Management of rhegmatogenous retinal detachment in a full. Although retinal detachments are common, there is still some controversy on the optimal treatment options for different types and presentations of retinal detachment. One hundred thirtyfour consecutive eyes with rhegmatogenous retinal detachment involving the macula were evaluated with reference to the effectiveness of systemic steroids in preventing choroidal detachment. Changes in iris perfusion following scleral buckle surgery for rhegmatogenous retinal detachment. Management of cytomegalovirusrelated rhegmatogenous retinal detachments.
An acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of sub retinal fluid and loss of retinal function. The three most important reattachment procedures are scleral buckling, pars plana vitrectomy. Retinal detachment often is a preventable cause of vision loss. Primary rhegmatogenous retinal detachment is caused by one or more retinal breaks, usually with concomitant vitreous traction. A tractional retinal detachment occurs when pre retinal fibrovascular or fibrotic membrane pulls the retina anteriorly causing detachment.
Paper ii reoperation for rhegmatogenous retinal detachment as quality indicator for disease management. Evaluation and management of suspected retinal detachment. Rhegmatogenous retinal detachments rrd with inferior breaks are usually treated by scleral buckling sb or pars plana vitrectomy ppv or a combination of both methods. A nationwide study on the incidence of rhegmatogenous retinal detachment in denmark, with emphasis on the risk of the fellow eye. Pdf advances in the treatment of rhegmatogenous retinal. Clinical findings and management of rhegmatogenous retinal. Although rhegmatogenous retinal detachment rrd surgery achieves success rates of 80% or over, improvement in success rates has been minimal in. High myopia extreme nearsightedness advanced age family history of retinal tears or retinal detachment previous retinal detachment previous eye surgery such as cataract surgery. It is to determine the configuration of the detachment as shallow, flat or bullous 51. New treatment modalities could be explored in a detach.
As technology and repair techniques continued to evolve, a myriad of therapeutic options are now available for the management of retinal detachments. These included repeated pr, scleral buckling, vitrectomy with gas or silicone oil, and vitrectomy with scleral buckling. Anytime subretinal fluid accumulates in the space between the neurosensory retina and the underlying retinal pigment epithelium rpe, a retinal detachment occurs. Retinal detachment the detachment produces a bright continuous, folded appearance with insertion into the disc and ora serrata. Management of primary rhegmatogenous retinal detachment. Rhegmatogenous retinal detachment a rhegmatogenous retinal detachment occurs due to a break in the retina called a retinal tear that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. Recognition of symptoms and awareness of the risk factors for retinal detachment may help in making speedy referrals and saving vision. Management of rhegmatogenous retinal detachment with.
He underwent lensectomy, 23g pars planar vitrectomy, air fluid exchange, endolaser and silicone oil injection which successfully reattached the retina. Retinal detachments can be rhegmatogenous caused by a break in the retina. Management of rhegmatogenous retinal detachment without detectable breaks. Rhegmatogenous retinal detachment is the most common type. Hyaluronic acid in the vitreous holds water and keeps insoluble collagen fibrils dispersed in the gel matrix. Loss of retinal tension and permanent decrease in retinal. Management of the macula in rhegmatogenous retinal. The development of rhegmatogenous rd is a consequence of vitreoretinal traction such as a posterior vitreous detachment leading to the development of one or more breaks in the retina. The aim of the study was to evaluate the anatomical success of surgical management of primary rhegmatogenous retinal detachment rrd and to compare the anatomical outcomes from different. Awith aging, changes to hyaluronic acid cause pockets of liquefied vitreous, leaving the collagen. Management of a rhegmatogenous retinal detachment in a low. G w aylward, a laidlaw, n patton, d steel, t williamson, d yorston.
Rhegmatogenous retinal detachment can lead to profound loss of vision. How to proceed rrds with superior breaks that threaten. Retinal detachment a self directed learning package for medical students. Usually, these breaks are caused by vitreous traction on the retina and allow the accumulation of fluid in the subretinal space. Retinal breaks are divided into three types holes, tears and dialyses. This month, the authors continue with a discussion of rrd management. Evaluation and management of sus pected retinal detachment. A case is presented herein of rhegmatogenous retinal detachment occurring during pregnancy.
Fluid can then pass from the vitreous cavity through these retinal breaks into the subretinal space, which extends the detachment once the amount of incoming. Intraoperative fundus photograph of a 62yearold woman who had a rhegmatogenous retinal detachment with a coexisting macular hole of 1month. Changes in iris perfusion following scleral buckle surgery. Management of a rhegmatogenous retinal detachment in a. Horizontal time domain oct left to right, 10mm scan of the left eye captures the macular hole in the detached retina but not the underlying retinal pigment epithelium. Retinal detachment occurs when subretinal fluid accumulates in the potential space between the neurosensory retina and the underlying retinal pigment epithelium rpe. Optimizing the treatment of rhegmatogenous retinal. Detachment is more likely with advancing age because molecular breakdown and shrinkage of the. With it, you get a hole, tear, or break in the retina.
Cmvrelated rhegmatogenous retinal detachment in aids occurs in 10% to. The distinguishing characteristic is the presence or absence of a fullthickness retinal break rhegma. Reattachment can be achieved with a single pneumatic retinopexy procedure in 80% of cases and with. The royal college of ophthalmologists retinal detachment data set 2011prof158. However, applying a sb during ppv may produce a risk of choroidal haemorrhage. Some of the challenges arising from this uncommon clinical scenario are discussed. Surgical management of unilateral rhegmatogenous retinal. To describe the management of a rhegmatogenous retinal detachment rrd in a pregnant patient. We discuss the case of a 49yearold soldier with a maculaon rhegmatogenous retinal detachment in sierra leone. Management, part 2 retina ophthalmic pearls l ast month, ophthalmic pearls discussed risk factors, features, and examination of rhegmatogenous retinal detachments rrd. Management of rhegmatogenous retinal detachment with macula detached steroids, choroidal detachment, and acuity james valone, jr. Combined or sequential surgery for management of rhegmatogenous retinal detachment with macular holes. Introduction learning outcomes epidemiology anatomy of the eye anatomy of the retina pathogenesis rhegmatogenous tractional exudative quiz symptoms signs and investigations treatment external internal prognosis quiz references. Surgical techniques for repairing rrd have advanced considerably since the days of jules gonin in the early 20th century, however.
Pdf management of rhegmatogenous retinal detachment. Purpose permanent loss of visual function after rhegmatogenous retinal detachment can occur despite successful surgical reattachment in humans. Management of cytomegalovirusrelated rhegmatogenous. The case highlights the challenge of accessing visually preserving ophthalmic specialist care in subsaharan africa ssa for vitreoretinal vr disease. The groups were compared for rates of retinal reattachment, visual improvement, and the occurrence of recurrent rhegmatogenous retinal detachment and any. In general, the sooner a rhegmatogenous retinal detachment is repaired the better. The authors would like to present an unusual case of unilateral retinal detachment, phacodonesis, dense cataract and ocular coloboma in a 7yearold indian muslim boy with noonan syndrome. In general, management includes sealing all retinal breaks and relieving all vitreous traction. To compare the outcomes of vitrectomy with or without internal limiting membrane peeling for rhegmatogenous retinal detachment and coexisting macular hole. A 30yearold, 26week pregnant female presented with cu. Intraoperative fundus photograph of a 62yearold woman who had a rhegmatogenous retinal detachment with a coexisting macular hole of 1month duration. Some of the common etiologies for tractional retinal detachment include diabetes, connective tissue disease, sickle cells and trauma.
Rrd is frequently encountered by ophthalmologists of all. Pdf management of rhegmatogenous retinal detachment with. Thirtyone consecutive patients 31 eyes with maculaoff retinal detachment, peripheral breaks and a coexisting macular hole were prospectively enrolled over a 3year period. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling. May be primary rhegmatogenous retinal detachment, secondary to traction, or exudative in nature. Although exudative retinal detachments have been well documented to occur during pregnancy, reports of rhegmatogenous retinal detachments occurring during pregnancy are rare. Rhegmatogenous retinal detachment rrd is defined as the separation of the neurosensory retina from the retinal pigment epithelium rpe layer due to the presence of retinal breaks.
430 1317 887 733 147 762 828 1023 500 975 840 772 1459 1141 493 219 876 1553 1495 293 722 1461 232 573 1283 1179 96 153 139 1367 256 1356 164 299 257 1442 413 183 1073 762 242 191 1457 682