20. Vitreo/retinal Detachment
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20. Vitreo/retinal Detachment
What is a degenerative retinoschsis and what causes it?
split of retina at the OPL found in the peripheral retina due to coalescing of cystoid spaces
creating outer and inner holes
will produce VF defects
found mostly in periphery
1st appears in infero-temporal quadrant
slowly progressive with age
What are the types of degenerative retinoschisis and where is it found?
bulbous visible vs non visible flat
bullous Degen retino cf RD?
How does liquefaction of the vitreous occur and how can it lead to a PVD?
pockets of liquid appear within central vit and coalesce
weakensing of VR adhesion
liquid vit dissects gel away from ILM of the retina-> PVD
How is a retinal horseshoe tear formed?
incomplete PVD- traction of the retina
vitreous pulls away from sensory retina but remains attached to one end of the tear while the base is at the retina
What are sx of RB?
What are signs of RB?
how is RD associated with PVD?
RRD-> acute PVD
TRD-> incomplete PVD
serous/exudative NOT REALTED TO PVD
risk of RD with retinoschisis?
low as hard for liquefying vitreous to get through the lesion
What are some acute PVD sx?
Signs of acute PVD?
DDX for photopsia VR traction?
PVD, optic neuritis, migraine, hypotension, TIA
DDX for floaters?
PVD, PDR, uveitis
DDX for VF loss- peripheral detachment?
OPtic neuropathy CVA BRVO BRAO
Sx of RD?
VF loss- black curtain
: grey/opaque, balloning tears
Risk factors for RD?
aging, cataract surgury, focal retinal atrophy, myopia, trauma
What is the most common type of RD?
most common form of RD
How does an RRD occur?
fluid from vitreous cavity passes through retina defect into subretinal space and separates neural retina from RPE
retinal break + vitreous liquefication + traction
What can predispose a retinal break?
snail track degen
peripheral cystoid degeneration
How urgent is a RD?
if macula on detachment
if not on
: few days
Most common site of tear?
What is a tractional retinal detachment caused by?
fibrotic/fibrovascular membranes in vit (assoc with inflam exudates + vit haem) creating a retinal traction
PVR, ROP, trauma, cataract, post uveitis
What are some features of TRD?
concave and no breaks
retinal mobility is reduced
VF defect slow prog
What is dynamic traction?
What is a static traction?
indep of eye movement
TDR and PVR
What is Proliferative Vitreoretinopathy?
wound healing process
prolif of avascular retinal membranes assoc with RRD
contraction of membranes-> macula pucker-> new RB/RD and ocular hypotony
What is a combined RTRD?
combination of retinal break+traction
2ndy to traction
Therapeutic retinal detachment
OAG miotics cause intense miosis leading to retinal stretching in high myopic eyes -> RT
What is a serous/exudative/2ndy RD?
elevation of neural retina due to accumulation of subretinal fluid in ABSENCE of a retinal break or sig preretinal traction
What are some key features of a serous/exudative RD?
subretinal fluid shifts with head position
lack of RRD/TRD
2ndy to local ocular/systemic etiology
How can subretinal fluid accummulate?
increase in fluid flow in subret space
: leaky vessels in tumour
: choroidal inflam
outer BRB breakdown + impairment of RPE pump
Signs of serous RD?
convex smooth elevation
mobile deep and shifting fluid
: subret pigment
fluid escapes from vessels into body tissue/space
transudative fluid from choriocap
thickening of choroid/choroid detachment
uveal effusion (-)inflammation, surgery, hypot
abnormal scleral collagen
vortex vein compression
RD prophylactic tx?
: gas bubble, seal break/reattach retina
: scar-fusion of RPE and retina
Pars plana vitrectomy?
remove vitreal opacities/vitreous
: decrease of other RB
release VR traction
above midline progress to RD faster than below