20. Vitreo/retinal Detachment

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sookylala
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240709
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20. Vitreo/retinal Detachment
Updated:
2013-11-13 08:02:15
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retinal detachment
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retinal detachment
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  1. 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
  2. Degenerative retinoschisis?
    • bilateral
    • 1st appears in infero-temporal quadrant
    • slowly progressive with age
    • asymptomatic
  3. What are the types of degenerative retinoschisis and where is it found?
    bulbous visible vs non visible flat
  4. bullous Degen retino cf RD?
    doesnt undulate/wobble
  5. 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
  6. 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
  7. What are sx of RB?
    • floaters
    • photopsia
    • blurry va
  8. What are signs of RB?
    • atrophic holes
    • operculated tears
    • linear tears
    • retinal dialysis
  9. how is RD associated with PVD?
    • RRD-> acute PVD
    • TRD-> incomplete PVD
    • serous/exudative NOT REALTED TO PVD
  10. risk of RD with retinoschisis?
    low as hard for liquefying vitreous to get through the lesion
  11. What are some acute PVD sx?
    • floaters
    • photopsia
    • blurry vision
    • metamorphopsia
  12. Signs of acute PVD?
    • weiss ring
    • disc haem
    • vit haem
    • shafers
  13. DDX for photopsia VR traction?
    PVD, optic neuritis, migraine, hypotension, TIA
  14. DDX for floaters?
    PVD, PDR, uveitis
  15. DDX for VF loss- peripheral detachment?
    OPtic neuropathy CVA BRVO BRAO
  16. Sx of RD?
    • photopsia
    • floaters
    • weiss
    • schaffers
    • VF loss- black curtain
    • decreased VA
    • RAPD
    • IOP changes
    • retinal appearance: grey/opaque, balloning tears
  17. Risk factors for RD?
    aging, cataract surgury, focal retinal atrophy, myopia, trauma
  18. What is the most common type of RD?
    RRD
  19. RRD facts?
    • most common form of RD
    • 40-80yo
  20. 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
  21. What can predispose a retinal break?
    • lattice degeneration
    • snail track degen
    • peripheral cystoid degeneration
    • retinoschisis
    • retinal tuft
  22. How urgent is a RD?
    • if macula on detachment: urgent
    • if not on: few days
  23. Most common site of tear?
    superotemporal>superonasal,inferiortemporal> inferonasal
  24. 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
  25. What are some features of TRD?
    • concave and no breaks
    • retinal mobility is reduced
    • photopsia+floaters absent
    • VF defect slow prog
  26. What is dynamic traction?
    • eye movements
    • RRD
  27. What is a static traction?
    • indep of eye movement
    • TDR and PVR
  28. 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
  29. What is a combined RTRD?
    • combination of retinal break+traction
    • 2ndy to traction
    • PVR
  30. Therapeutic retinal detachment
    • rare
    • OAG miotics cause intense miosis leading to retinal stretching in high myopic eyes -> RT
  31. 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
  32. 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
  33. How can subretinal fluid accummulate?
    • increase in fluid flow in subret space: leaky vessels in tumour
    • impaired outflows: choroidal inflam
    • outer BRB breakdown + impairment of RPE pump: CSCR
  34. Signs of serous RD?
    • convex smooth elevation
    • mobile deep and shifting fluid
    • leopard spots: subret pigment
  35. Uveal effusion?
    • fluid escapes from vessels into body tissue/space
    • transudative fluid from choriocap
    • thickening of choroid/choroid detachment
  36. UES?
    • uveal effusion (-)inflammation, surgery, hypot
    • idiopathic?
    • abnormal scleral collagen
    • vortex vein compression
  37. RD prophylactic tx?
    • laser photocoagulation
    • cryotherapy
    • laser/scleral indentation
  38. RD tx?
    • scleral buckling
    • pneumatic retinopexy: gas bubble, seal break/reattach retina
    • cryotherapy: scar-fusion of RPE and retina
  39. Pars plana vitrectomy?
    • remove vitreal opacities/vitreous: decrease of other RB
    • release VR traction
  40. Vitreous substitues?
    • inert
    • clear
    • viscoelastic
  41. RT position?
    above midline progress to RD faster than below

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