This document discusses retinal breaks and retinal detachment. Some key points:
- Retinal breaks can cause retinal detachment and occur in about 6% of the population, with retinal detachment occurring in around 0.07% of people in their lifetime.
- Common causes of retinal breaks include trauma, vitreous traction, and increasing age. Symptoms may include floaters, photopsias, and vitreous hemorrhage.
- Examination involves slit lamp biomicroscopy and sometimes B-scan ultrasound or vitrectomy. Certain lesions like retinal dialysis, horseshoe tears, and operculated tears often warrant treatment to prevent retinal detachment, while smaller lesions may not require intervention
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Retinal breaks
1.
2. Retinal breaks- any full- thickness
defect in the neurosensory retina
Can cause RD
6% of population have break
1/10,000-15,000 per year- RD
0.07% chance of developing RD in a
lifetime
3.
4. Directretinal perforation, contusion,
vitreous traction
Coup
Contrecoup
Usually multiple
Inferotemporal and superonasal quadrants
Most common- dialyses + avulsion of
vitreous base= ocular contusion
Others: horseshoe-shaped tears,
operculated holes
5.
6. Young patients- higher incidence of eye
injury
Rarely develop acute rhegmatogenous RD
Vitreous acts as tamponade
12%- immediately
30%- 1 month
50%- 8 months
80%- 24 mos
7. Vitreous base- 2 mm anterior and 4 mm
posterior to the ora serrata
Optic disc, macula, along major vessels,
margins of lattice degeneration, sites of
chorioretinal scars
8.
9.
10. Increasing age- 63% in > 70 y/o
axial length
Aphakia – 66-100%
ICCE- 84%
Inflammatory disease ECCE w/ open capsule- 76%
Trauma ECCE w/ intact capsule- 40%
myopia
12. IO w/ scleral depression
Slit lamp biomocroscopy w/ 3- mirror
lens
Hemorrhage or pigment?
Reexamine in 3- 4 weeks
patching, bed rest, head elevation for
45⁰
B- scan
vitrectomy
13. 6-10% of general population
1/3-1/2- bilateral
Myopia, familial predilection
1. Atrophy of the inner layers
2. Overlying pocket of liquefied vitreous,
3. condensation and adherence of vitreous at
the margin of lesion
Progressesto RD- tractional tear or
atrophic hole
14. Areas of elevated glial hyperplasia
Noncystic retinal tufts
Cystic retinal tufts may predispose
Zonular traction tufts to RD
15. folds of redundant retina
Superonasally
Associated w/ dentate processes
Tears occur at the most posterior limit
of the folds
16. Oval islands ofpars plana epithelium
located immediately posterior to the ora
Almost/completely circumscribed by the
peripheral retina
Tears can occur at or near the
posterrior margins of enclosed ora bays
17. Paving-stone or Cobblestone
•22% over 20 y/o Degeneration
•Proliferation of RPE cells
••Atrophy approximatelyretina > 20 RD,
RPE areas of inflammation100% trauma,y/o retinal
Old hyperplasia
•Present in of the outer and of
•Enlargement of RPE cells
•3.Atrophy of the
Temporal
RPE hypertrophy RPE and outer retinal layers
tear
•Congenital or acquired
•4.Attenuation or absence lossthe
•1. TYPICAL may cause field of
Aging and but Cystoid Degeneration
Benign,
Peripheral the outer plexiform layer
• • •Cysts degenerative change
in
Appears as black
choriocapillaries spherical melanin granules,
•Large cells and large,
•2. RETICULAR
5.Adhesions b/n the remaining neuroepithelial
•very•dark, well demarcated
Nerve fiber layer
•BENIGN amd bruch’s membrane
layers
•Posterior to typical cystoid
•Inferior quadrant,full-retinalto the equator
•May develop into anterior break
•NEVER the site of PRIMARY retinal break
18. Reduce the risk of RD
Risk outweigh the benefit
May not eliminate the risk of new tears
or detachment
GOAL: create a chorioretinal scar around
the break
Acute symptomatic break are more
dangerous than the old ones
19. Acute symptomatic flap tear
Acute operculated holes
+ persistent vitreous traction
Large hole
Superior location
Vit hem
Atrophic holes
+ traction
20. Flap tears
Emmetropic, phakic eyes
Lattice degeneration
Myopia
Subclinical detachment
Aphakia w/ detachment in the other eye
Operculated holes
Atrophic holes
21. Treat the entire lesion
Posterior and lateral margins
6-10% of eyes
•High myopia
20-30% of eyes w RD
•RD in the fellow eye
1%- RD in untreated lattice degeneration
•flap tears
•aphakia
23. Asymptomatic retinal detachment
Detachment in w/c subretinal fluid
extends more than 1 DD from the break
but not more than 2DD posterior to the
equator.
Traction on the break
24. TYPE OF LESION TREATMENT
Horseshoe tears Almost always
Dialysis Almost always
Operculated tear sometimes
Atrophic hole Rarely
Lattice degeneration w/o horseshoe Rarely
tears
Zorab et.al., American academy of Ophthalmology Section 12 p. 290 2008-2009
25. Type of lesion phakic Highly myopic Fellow eye Aphakic or
pseudophakic
Retinal Almost always Almost always Almost always Almost always
dialysis
Horseshoe sometimes sometimes sometimes sometimes
tears
Operculated no rarely rarely rarely
tears
Atrophic holes rarely rarely rarely rarely
Lattice deg’n no no sometimes rarely
w/ or w/o
holes
Zorab et.al., American academy of Ophthalmology Section 12 p. 291, 2008-2009