"Understanding Retinal Detachment: Symptoms, Causes, and Treatment Options"

Retinal Detachment

Hello friends in this blog we are going to discuss retinal detachment with it classification rhegmatogenous retinal detachment, tractional retinal detachment and exudative and solid retinal detachment. 

Def: It is the separation of neurosensory retina from its Retinal Pigment Epithelium

These Two layer loosely attached to each other with potential space between them called "Sub Retinal Space". Fluid in sub retinal space called "Sub Retinal Fluid".

Classification of Retinal Degeneration

According to Underlaying Causes and Mechanism Retinal Degeneration is Classified into three types:

1. Rhegmatogenous or Primary Retinal Detachment
2. Tractional retinal Detachment
3. Exudative Retinal Detachment

Rhegmatogenous Retinal Detachment or Primary Retinal Detachment

• Usually Associated with Retinal Break. (Hole and Tear)
• Through Sub Retinal Fluid Seeps.
• Separate sensory retina from its Pigmentary Epithelium.

Risk factor for RRD

1. There is no age Bar but condition is most common in 40-60 years of age.
2. More in males than female (M: F=3:2)
3. High myopia, In myopia retinal thinning due stretching the retina.
4. Aphakia is More common than phakic.
5. Retinal Degeneration: A). Lattice Degeneration and B). Snail track degeneration.
6. Trauma is also Risk factors.
7. Senile Posterior Vitreous detachment (PVD)

The Retinal Breaks is responsible for RRD are causes plays important role dynamic vitreoretinal traction and degeneration peripheral retina. vitreoretinal traction is induced by Rapid eye movements in presence of PVD, Vitreous syneresis, Aphakia and myopia. Once The Retinal Breaks form liquified vitreous may seeps and accumulate and lead to separate neurosensory retina from RPE. 

Vitreous Syneresis: means this is natural process due to aging in Condensation and liquefaction of vitreous gel. this process can weakening vitreoretinal adhesion and lead condition of PVD.

Symptoms of RRD

Prodromal symptoms: prior to onset f disease or early symptoms.

1. Dark Spots (Floater) due to Rapid Vitreous Degeneration.
2. Photopsia: Sensation of Flashes of light. Retinal Irritation due to  Vitreous Movement.

Symptoms of detached retina.

1. Localised relative loss in field of vision, Pts notice in early stage gradually progresses and total loss done when macula detached.
2. sudden painless vision occurs, Detached is large and central.

Sign of RRD

1. External Examination, Usually Normal
2. Intraocular Pressure, Slightly Lower or may Normal
3. Marcus Gunn pupil, RAPD present with extensive RD (vision threatening emergency).
4. Plane Mirror examination shows altered red reflex in pupillary area. detached retina appears gray.
5. Ophthalmoscopy examination: RD best examine by Indirect Ophthalmoscopy using scleral indentation. detached Retina give grayish reflex instead of normal pink. raise anteriorly convex configuration move with eye movement. In total detachment retina became funnel shape attach only at Optic disc and Orra Serrate. Retinal Breaks associated with RRD is difficult to find look Reddish in color and vary in shape. this may be Round, horseshoe shaped, slit like or anterior dialysis. most frequently found in peripheral retina. 
6. Visual field Charting: reveals scotomas corresponding to detached retina.

Complications occur in long standing cases of RRD

• Proliferative vitreoretinopathy (PVR),
• Complicated cataract,
• uveitis,
• phthisis bulbi.

Exudative or Solid Retinal Detachment

• It occurs due to retina is pushed away by neoplasm or accumulation of fluid beneath the retina due to inflammatory or vascular lesions.
• This is secondary Retinal Detachment in which fluid accumulate beneath retina without retinal breaks.
• This detachment leads secondary cause like neoplasms means tumor and vascular lesion means: (Coats' disease, central serous chorioretinopathy)

• Exudative RD is, when fluid leaks into the space under the retinal layers without a tear or break in the retina itself. The fluid buildup pushes the retina away from the underlying tissue. and separation of neurosensory retina from its RPE.

• Solid RD is, detachment caused by a solid mass (e.g., a tumor like choroidal melanoma.

Common Causes Can be:

• Systemic Disease: these include, Toxemia of Pregnancy, Renal Hypertension, Blood Dyscrasias and Polyarteritis Nodosa.
• Ocular Inflammations such as, Harada disease, sympathetic ophthalmia, Posterior Scleritis and Orbital cellulitis.
• Ocular vascular Disease: Central Serous Retinopathy and Exudative retinopathy of coats.
• Neoplasm: Malignant Melanoma of Choroid and Retinoblastoma
• Hypotony: Sudden Hypotony due to perforation of globe and any Intraocular Operation.

Clinical features

• Absence of Photopsia, Hole/Tear, Fold and undulation.
• Exudative detachment is smooth and convex at summit of tumor.
• sometimes patterns of vessels also disturbed due to neovascularization on tumor summit.
• Shifting Fluid is characterized by changing position detached area with gravity is hallmark of Exudative retinal Detachment. movement of fluid with head movement into exudative RD.
• On Transillumination test: Simple detachment appears Transparent, while solid detachment is opaque.

Treatment for Exudative or solid RD

• Exudative RD due to Exudate or Hemorrhage may absorption of fluid.
• presence of intraocular tumor usually requires enucleation.

Tractional retinal detachment (TRD)

Tractional retinal detachment (TRD) occurs when scar tissue or abnormal membranes (typically from conditions like diabetic retinopathy or proliferative vitreoretinopathy) pull on the retina, causing it to detach from the underlying tissue. Unlike rhegmatogenous detachment, it’s not caused by a tear or hole but by mechanical traction. here also separation of neurosensory retina from its retinal pigment epithelium. in previous blog we have discus exudative and solid detachment.

TRD associated with following conditions:

• Post Traumatic retraction of scar tissue (penetrating injury)
• PDR
• Post hemorrhagic retinitis proliferons.
• Retinopathy of prematurity
• plastic cyclitis
• sickle cell Retinopathy

Clinical features:

• TRD is characterized present of vitreoretinal band with lesion of causative disease.
• Retinal Break are usually absent, and configuration of detached retina is concave. 
• highest elevated retina occurs at site of vitreoretinal traction.
• Retinal mobility and Shifting fluid are absent.

Treatment

• Treatment is difficult and requires pars plana vitrectomy to cut Vitreoretinal tractional bands.
• prognosis is not so good in these cases.