retinaldetachment-231220054928-55e589a5 (1).pptx

Retinal Detachment classified in four major groups those are Rhegmatogenous retinal detachment tractional retinal detachment exudative retinal detachment and combine form of tractional and Rhegmatogenous

1. RETINAL DETACHMENT P r e p a r e d b y : D r . E h s a n H a s h e m i

2. RETINA light-sensitive tissue layer sends visual messages through the optic nerve Retina have 2 layers Sensory retina – rods and cones are present Retinal pigment epithelium (RPE)

3. Retinal detachmen t is the separation of the retinal layers (sensory layer from RPE) due to r e t i n a l b r e a k o r t e a r o r S R F accumulati o n i n S R S Four types Rhegmatogenous Traction Combined form of rhegmatogenous and traction Exudative

4. Rhegmatogenous detachment – Most common one A hole or tear develops in the sensory retina allowing some of the liquid (vitreous) to seep through the sensory retina and detach it from the RPE

5. Tractional RD The NSR is pulled away from the RPE by contracting vitreoretinal membranes in the absence of a retinal bre a k The main causes of tractional RD are proliferative retinopathy secondary to diabetes , retinopathy of prematurity and penetrating posterior segment trauma

6. Combined tractional–rhegmatogenous RD results when a retinal break is caused by traction from an adjacent area of fibrovascular proliferation.

7. E x u d a t i v e R D Exudative (serous, secondary) RD. SRF is derived from vessels of the NSR and/or choroid. Exudative RD is characterized by the accumulation of SRF in the absence of retinal breaks or traction.

8. Pathophysiology Due to etiological factors (a torn or break in retina) Vitreous fluid or serous fluid leaks in between the layers of retina or behind the retinal layers Detachment of retinal layer Retina can peel away from the underlying layer of blood vessels Lack of oxygenation in tissues of retina Vision disturbances

9. SYMPTOMS Floaters Cobwebs Bright light flashes shadow or curtain over a portion of visual field blur in vision No complain of pain

10. Etiology Trauma Advanced diabetes s hrinkage of the jelly-like vitreous that fills the inside of the eye Myopia Degenerative disorders Inflammation and infections Scarring and fibrous material due to retinopathy and hemorrhages Ocular tumors

11. Factors that may increase risk of retinal detachment: aging - more common in people older than 40 previous retinal detachment in one eye family history of retinal detachment extreme nearsightedness previous eye surgery previous severe eye injury or trauma

12. Diagnostic findings Visual acuity Ophthalmoscopy Slit lamp microscopy Unltrasound

13. Surgical management Retinal tears: laser surgery (photocoagulation) – with the help of laser rays the tears are being joined or sutured. freezing (cryopexy) – cryoprob will freeze and join the retinal tears Retinal detachment: pneumatic retinopexy scleral buckling vitrectomy

14. PHOTOCOAGULATION

15. CRYOPEXY

16. Pneumatic retinopexy Least invasive A gas bubble, silicone oil, or perflurocarbon may be injected into the vitreous cavity to help push the sensory retina up against the RPE Patient must be in prone position to hold the injected bubble in postition

17. PNEUMATIC RETINOPEXY

18. Scleral buckling Compression of sclera to indent the scleral wall from the outside of the eye and bring the two retinal layers in contact with each other High success rate It uses silicone sponge, rubber, or semi-hard plastic for buckling It will provide a traction on the retina and allow the retinal tear to settle against the wall of the eyes

19. SCLERAL BUCKLING

20. Vitrectomy It is the surgical removal of the vitreous gel from the eye. It can also remove blood in the vitreous gel Three incisions are made One incision allows the introduction of light source Other incision for vitrectomy instrument The third incision for the instrument to refill the vitreous substitute (silicone oil) Duration is 2 to 3 hours

21. This procedure can be used to remove foreign bodies, vitreous opacities such as blood Traction on the retina can be relieved

22. VITRECTOMY

23. Goals of P P V : To separate the posterior hyaloid from the retinal surface. To remove the epiretinal tissue in order to release the central and/or peripheral retinal traction. To close retinal breaks if present.

24. Tamponading agents : Expanding gases Silicone oils Heavy liquids

25. i n d i c a t i o n o f P P V i n Rhegmatogenous retinal detachment When retinal breaks cannot be visualized When retinal breaks are unlikely to be closed by scleral b u c k l i n g

26. I n d i c a t i o n o f P P V i n Tractional retinal detachment : Indications in diabetic RD : Tractional RD threatening or involving the macula Combined tractional–rhegmatogenous RD should be treated urgently, even if the macula is not involved, because SRF is likely to spread quickly.

27. Indications in penetrating t r a u ma : Prevention of tractional RD Late tractional RD

28. S u r g i c a l T e c h n i q ue s : Delamination involves the horizontal cutting Segmentation involves the vertical cutting En-bloc dissection . The key step is to separate posterior h y a l o i d f r o m r e t i n a

29. Care Complications – bleeding under retina, cataracts, recurrence or infection Home care – short recovery , can resume normal activity after two weeks, traveling should be avoided for a month, avoid increase altitudes Pain and eye protection – eye drops and eye patch may be necessary to keep the eye moist, no soap should enter into eye during bathing, if air bubble is injected- prone position should be provided for one to two weeks

30. Exercise – close concentration and TV watching should be avoided, heavy lifting over 20 pounds and strenuous activities should be avoided, Driving should be avoided Follow up should be done accordingly.

31. T h a n k s f o r y o u r A t t e n t i o n a n d T i m e