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Retinal detachment
is separation of the neural retinal layer from the underlying retinal
pigment epithelium layer. Symptoms are decreased peripheral or central
vision, often described in the acute phase as a curtain coming down.
Associated symptoms are painless vision disturbances, including
flashing lights and numerous floaters. Diagnosis is by indirect
funduscopy; ultrasonography may determine the extent of the lesion.
Immediate treatment to reattach the retina is imperative if central
vision is threatened. Treatment includes systemic corticosteroids;
sealing the retinal holes by laser, diathermy, or cryotherapy; scleral
buckling; transconjunctival cryopexy; photocoagulation; pneumatic
retinopexy; intravitreal surgery; and enucleation, depending on
the cause and location of the lesion. Most reversible damage occurs early,
so once the macula is detached and vision decreases, treatment is
less urgent.
Rhegmatogenous detachment implies the presence of a retinal tear. It occurs more frequently in myopia, after cataract surgery, or after ocular trauma.
Nonrhegmatogenous detachment (detachment without a tear) can be produced by vitreoretinal traction (eg, as occurs in proliferative retinopathy of diabetes or sickle cell disease) or by transudation of fluid into the subretinal space (eg, severe uveitis, especially in Vogt-Koyanagi-Harada syndrome, or primary or metastatic choroidal tumors).
Symptoms,
Signs, and Diagnosis
Retinal detachment is painless. Early symptoms may include dark or irregular vitreous floaters, flashes of light, and blurred vision. As detachment progresses, the patient notices a curtain or veil in the field of vision. If the macula is involved, central visual acuity fails drastically. Direct funduscopy may show retinal irregularities and a bullous retinal elevation with darkened blood vessels.
Retinal detachment is suggested by symptoms and findings on funduscopy. Indirect funduscopy with scleral depression is done to detect peripheral tears and detachment.
If vitreous hemorrhage from a retinal tear obscures the retina, retinal detachment should be suspected and B-scan ultrasonography performed.
Treatment
Although often localized, retinal detachments due to retinal tears can expand to involve the entire retina if not treated promptly. Any patient with
a suspected or established retinal detachment should be seen urgently by
an ophthalmologist.
Rhegmatogenous detachment is treated by sealing the retinal holes by laser, diathermy, or cryotherapy. The eye may be treated by scleral buckling, during which fluid may be drained from the subretinal space. Anterior retinal tears without detachment can be sealed by transconjunctival cryopexy; posterior tears can be sealed by photocoagulation. More than 90% of rhegmatogenous detachments can be reattached surgically. If tears occur in the superior 2⁄3 of the eye, simple detachments can be treated by pneumatic retinopexy (an office procedure).
Nonrhegmatogenous detachments due to vitreoretinal traction may be treated by surgical vitrectomy; transudative detachments due to uveitis may respond to systemic corticosteroids. Primary choroidal tumors (malignant melanomas) may require enucleation, although radiation therapy and local resection are used occasionally; choroidal hemangiomas may respond to localized photocoagulation. Metastatic choroidal tumors, most often from breast, lung, or GI tract, may respond well to radiation therapy.
Last full review/revision November 2005
Content last modified November 2005
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