Khawly JA, Draining and replacing the fluid in the eye. Retinal detachment is the separation of the the retina from the choroid (the middle vascular coat of the eye between the retina and sclera). Correction of tractional retinal detachment requires disengaging scar tissue from the retinal surface. As a consequence, centripetal vitreoretinal traction increases and posterior vitreous detachment may occur at a younger age than in persons without myopia.4 Also, in myopic eyes, the retina is thinner and more prone to tear or hole formation at the time of posterior vitreous detachment. The third and most common type is rhegmatogenous retinal detachment. Cataract Patient Outcomes Research Team. (Bottom) Detached retina (white arrowhead) caused by traction on the retinal surface by intravitreal fibrosis (white arrow) in a patient with diabetic retinopathy. Accessed Sept. 12, 2018. Do you have your symptoms all the time, or do they come and go? American Academy of Ophthalmology. Bernth-Petersen P, Ultrastructure of traction retinal detachment in rhesus monkey eyes after a posterior penetrating ocular injury. Guo H, A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. Javitt JC, When the macula detaches, central acuity is lost. Ashton P, Even in patients with severe field loss caused by cerebral disease, the macula is spared and central vision persists. https://www.asrs.org/patients/retinal-diseases/6/retinal-detachment. As persons age, this macromolecular network begins to liquefy and collapse, the vitreous shrinks, and vitreo-retinal traction develops.3 Eventually, the vitreous partly separates from the retinal surface, which is known as posterior vitreous detachment (Figure 2b). Hilton GF. Have you had any symptoms in your other eye? Street DA, Am J Epidemiol. If you have symptoms of a detached retina, it’s important to go to your eye doctor or the emergency room right away. The retina, the layer of tissue in the back of the eye, pulls away from tissues supporting it. Photoreceptor cells in the outermost retina adhere to the retinal pigment epithelium, which appears as a darkly pigmented cellular monolayer above the vascular choroid. Similar floaters occur with other causes of intraocular bleeding, such as proliferative diabetic retinopathy, trauma, and ocular inflammation (uveitis). Sebag J. Dr. Kim completed an internship in pediatrics at the National Naval Medical Center, Bethesda, Md. Any type of retinal detachment is a medical emergency. There are three types of retinal detachments: exudative, tractional, and rhegmatogenous. Trempe CL. Retinal detachment occurs when the multilayer neurosensory retina separates from the underlying retinal pigment epithelium and choroid. Freeman HM, After surgery your vision may take several months to improve. The bubble eventually will reabsorb on its own. How can I best manage them together? Sudden changes, including eye floaters and flashes and darkening side vision, are signs this may be happening. Tejero TR, RRDs with superior breaks that threaten the macula require urgent vitreoretinal intervention. Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. et al. Evaluation and Management of Suspected Retinal Detachment. 22. Javitt JC, 9. American Society of Retina Specialists. In patients with optic nerve disorders, visual field loss is typically central or paracentral, pupillary reactions are diminished in the affected eye, and optic nerve head edema may be evident. Smiddy WE, Michels RM. If the central macula has not yet detached when the repair is achieved, visual acuity equal to preretinal detachment levels can be expected. Williams GA. Retinal detachment may cause you to lose vision. In about 7% of cases both eyes are affected. Philadelphia: Lippincott, 1988:4. In patients with tractional retinal detachment, vision outcomes are often poor. The bubble applies gentle pressure, helping a detached section of the retina to reattach to the eyeball. Your doctor also uses cryopexy during the procedure to repair the retinal break. Trauma precipitates retinal detachment for several reasons. If the retinal detachment progresses into the macula, or central part of the retina, the impact on vision can become more severe. Nicholson DH, 1998;17:41–6. However, because its view is narrow, a normal examination with the direct ophthalmoscope cannot exclude a diagnosis of retinal detachment. Softing Hataye AL (expert opinion). / afp Ruby AJ, Preoperative planning includes … et al. Chen SN, What tests do I need? Schepens CL, Retinal detachment: diagnosis and management. Retinal detachment may be treated with a variety of surgical techniques, which aim to close any retinal tears or holes, reduce vitreous traction, and reattach the retina to provide permanent adhesion between the retina and retinal pigment epithelium. Hassan TS, Fluid that had collected under the retina is absorbed by itself, and the retina can then adhere to the wall of your eye. Ageing of the vitreous. For example, a small detachment in the inferior retina results in a small superior visual field defect, while a large temporal detachment causes extensive nasal field loss. Retinal detachment can also develop from holes in the peripheral retina which develop in areas of retinal thinning. Ederer F. Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. To see the full article, log in or purchase access. Norregaard JC, Leske MC, Retinal detachment results when physiologic and anatomic mechanisms of retinal attachment are overcome and the retina separates from the underlying retinal pigment epithelium (Figure 1, lower right). Machemer R, 1989;96:1396–401. Yang CS, 14. If your retina has detached, you'll need surgery to repair it, preferably within days of a diagnosis. Garretson BR, Marin MI, Therefore, surgical repair is indicated more urgently in patients with preserved central acuity, less urgently in patients whose macula detached in the previous hours to days, and routinely in those whose macula has been detached for several days or weeks21,22 (Table 4).Within months, photoreceptors in a detached retina suffer severe and irreversible damage caused by the separation from the underlying choroidal vascular supply (Figure 1, lower right), and repair yields less visual improvement. Ashton P, The retina is a neurosensory tissue that lines the interior posterior two thirds of the eye (Figure 1, left). Ocular injuries in midfacial fractures. Hyaluronic acid content in the developing and aging human liquid and gel vitreous. Address correspondence to Ray F. Gariano, M.D., Ph.D., Stanford University School of Medicine, Department of Ophthalmology, 300 Pasteur Dr., A157, Stanford, CA 94305 (e-mail:Ray.Gariano@hhs.co.santa-clara.ca.us). 1996;80:689–93. (D) As liquid vitreous passes through the break (curved arrow), it dissects the retina from the underlying retinal pigment epithelium, resulting in retinal detachment. Moore MH, Further characterization of certain unilateral nontraumatic cases. To evaluate functional and anatomical results of pars plana vitrectomy (PPV) in the retinal detachment (RD) followed by severe eye trauma. Michels RM. Thus, patients with extramacular detachment require more urgent management, even though they may present with excellent central visual acuity. Synchysis senilis and posterior vitreous detachment. Focal areas of peripheral retinal thinning and vitreoretinal adhesion occur less often in those without myopia, and are associated with retinal detachment.10. Associated injuries in facial fractures: review of 839 patients.
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