Retinal

Detachment
by
The Awesome Three
Participant of Credential & Privileging for Fundus Camera Handling and Fundus Photo
Grading, Eye Clinic Sarawak General Hospital.
Retinal Detachment (RD)

▪ Separation of the Neurosensory Retina from the Retinal Pigment

Epithelium (RPE)
▪ 3 types of Retinal Detachment
A. Rhegmatogenous RD
B. Tractional RD
C. Exudative RD
Rhegmatogenous Retinal
Detachment (RRD)
Definition
▪ A break / tear (Rhegma) in retina, allowing fluid to accumulate under the retina.
▪ Resulting in the separation of retina from underlying Retinal Pigment Epithelium
(RPE).
▪ Causing vision loss if untreated.
Rhegmatogenous Retinal
Detachment (RRD)
Related Anatomy of Eyes
▪ Retina : Light-Sensitive tissue responsible for converting light into electrical signals
sent to the brain
▪ Retinal Pigment Epithelium (RPE) : Layer beneath the retina that nourish and
maintain the retina
▪ Vitreous Body : a gel-like substance in the eye that helps maintain it’s shape
Rhegmatogenous Retinal
Detachment (RRD)
Causes of RRD
▪ Retinal tears / holes – vitreous gel pulls the retina away
▪ Posterior Vitreous Detachment (PVD) – vitreous gel shrinks and separates from the
retina
▪ Trauma / Injury – direct trauma cause retinal tear and subsequent detachment
▪ Severe Myopia – High myopic eye have thinner retina and prone to tear
▪ Previous eye surgery – procedure like cataract surgery increase risk of RRD
Rhegmatogenous Retinal
Detachment (RRD)
Risk Factor
▪ Age
▪ Severe Myopia
▪ Previous RD
▪ Family Hx
▪ Trauma / Injury
▪ Prior cataract / other eye surgery
Rhegmatogenous Retinal
Detachment (RRD)
Sx of RRD
▪ Sudden appearance of Floaters
▪ Photopsia
▪ Shadow / curtain effect
▪ BOV
▪ Sudden vision loss
Rhegmatogenous Retinal
Detachment (RRD)
Diagnosis
▪ Ophthalmoscopic Exam
▪ B-scan Ocular Ultrasound
▪ Optical Coherence Tomography (OCT)
Rhegmatogenous Retinal
Detachment (RRD)
Pathophysiology
▪ A hole forms in the retina usually due to vitreous traction
▪ Vitreous fluid (often liquefied vitreous fluid) leaks through the tear and accumulate
between the sensory retina and Retinal Pigment Epithelium (RPE)
▪ This cause disruption of oxygen and nutrients supply to the retina
Rhegmatogenous Retinal
Detachment (RRD)
Treatment
▪ Laser Photocoagulation – Retinal tear is sealed with laser preventing further fluid
leaking under the retina
▪ Cryopexy – Freezing technique applied to the outer surface of the eye to seal the
retina
▪ Scleral Bucking – a band is placed / buckled around the eye tangling the eyeball
inward to relieve the traction
▪ Vitrectomy – Vitreous gel is replaced with a gas bubble or silicone oil to press the
retina back in it’s place
▪ Pneumatic Retinopexy – gas bubble is injected in the eye to push the retina follow
by laser or cryotherapy to close the tear
Rhegmatogenous Retinal
Detachment (RRD)
Prognosis
▪ Early detection is crucial in preserving vision
▪ Success rate of 85-90% in reattaching retina if treated in time
▪ Vision recovery may be incomplete especially when macula is involve or if the
detachment is long-standing
Tractional Retinal
Detachment (TRD)
Definiton
▪ Fibrous / Scar tissue grows on retina’s surface, exerting
a pulling force (traction) that lift the retina form it’s normal
position
▪ Unlike Rhegmatogenous RD, TRD occur without retinal
tear
Tractional Retinal
Detachment (TRD)
Related Anatomy of Eyes
▪ Retina : Light-Sensitive tissue responsible for converting light into electrical signals
sent to the brain
▪ Retinal Pigment Epithelium : Layer beneath the retina that nourish and maintain the
retina
▪ Vitreous Body : a gel-like substance in the eye that helps maintain it’s shape
Tractional Retinal
Detachment (TRD)
Causes of TRD
▪ Proliferative Diabetic Retinopathy (PDR) – Diabetes can lead to abnormal blood
vessel growth and formation of fibrous scar tissue that pulls the retina
▪ Vitreoretinal Interface Disorder – Such condition is tractional-induced, incuding the
epiretinal membrane
▪ Retinal Vein Occlusion – blockage of retinal vein cause abnormal blood vessel
growth and formation of scar tissue
▪ Sickle Cell Retinopathy – This lead to ischemia (reduced blood flow) and
neovascularization or traction may occur
▪ Ocular Trauma – scarring from injury may pull the retina
Tractional Retinal
Detachment (TRD)
Risk factor
▪ Diabetes Mellitus – uncontrolled DM may cause Proliferative Diabetes Mellitus
▪ Vitreous Hemorrhage – blood in the vitreous can promote scar tissue formation.
▪ Retinal Ischemia (Lack of Oxygen) – poor retinal blood supply lead to
neovascularization
▪ Previous retinal surgery / trauma
▪ Sickle cell disease and other hemoglobinopathies
Tractional Retinal
Detachment (TRD)
Sx of TRD
▪ Gradual / sudden vision loss
▪ Distorted vision (Metamorphasia)
▪ Floaters appear
▪ Shadow / Curtain effect
▪ Decreased peripheral vision
▪ Symptom progress slower than in RRD
Tractional Retinal
Detachment (TRD)
▪ Pathophysiology
▪ Scar tissue or fibrovascular proliferation on the retinal surface exerts tractional forces
▪ The pulling forces causes retina to elevate or detach from Retinal Pigment Epithelium
(RPE)
Tractional Retinal
Detachment (TRD)
Diagnosis
▪ Ophthalmoscopic Exam
▪ B-Scan Ocular Ultrasound
▪ Optical Coherence Tomography (OCT)
Tractional Retinal
Detachment (TRD)
Treatment
▪ Vitrectomy – Vitreous gel is replaced with a gas bubble or silicone oil to press the
retina back in it’s place
▪ Laser Photocoagulation – Retinal tear is sealed with laser preventing further fluid
leaking under the retina
▪ Anti-VEGF – block vascular endothelial growth factor to prevent / reduce abnormal
blood vessel growth especially in diabetic retinopathy
▪ Scleral Bucking – a band is placed / buckled around the eye tangling the eyeball
inward to relieve the traction
Tractional Retinal
Detachment (TRD)
▪ Prognosis
▪ Vision recovery – depend on the extent of the detachment, macula’s involvement and
the duration of the detachment
▪ Long-term outcome – early treatment improves outcomes but it’s often guarded,
particularly if significant scarring has developed or the macula is affected
▪ Recurrence – it can re-occur if new scar tissue forms
Exudative Retinal
Detachment (ERD)
▪ Definition
▪ Also known as Serous Retinal Detachment
▪ Occur when fluid accumulates beneath the retina
without retinal tears or break
▪ Primarily caused by inflammation, vascular leakage
or underlying systemic conditions rather than
mechanical forces
Exudative Retinal
Detachment (ERD)
Related Anatomy of Eyes
▪ Retina : Light-Sensitive tissue responsible for converting light into electrical signals
sent to the brain
▪ Retinal Pigment Epithelium : Layer beneath the retina that nourish and maintain the
retina
▪ Choroid : Vascular layer beneath RPE
Exudative Retinal
Detachment (ERD)
Causes of ERD
▪ Inflammatory conditions –
▪ Vogt-Koyanagi-Harada Disease (VKH) : an autoimmune condition causing inflammation in
the eye
▪ Posterior Uveitis : Inflammation of the Uvea (middle layer of the eye consist of choroid,
ciliary body and iris)
▪ Scleritis : Severe inflammation if the sclera
Exudative Retinal
Detachment (ERD)
Causes of ERD

▪ Vascular Conditions –

▪ Central Serous Chorioretinopathy (CSCR) : Leakage of fluid from choroid under retina

▪ Hypertensive Retinopathy : High BP cause leakage from damaged retinal blood vessels

▪ Pre-Eclampsia / Eclampsia : Pregnancy induced hypertension that lead to fluid

accumulation beneath the retina

Exudative Retinal
Detachment (ERD)
Causes of ERD

▪ Tumors –

▪ Choroidal Melanoma : A malignant tumor in the choroid that leak fluid

▪ Retinal Hemangioma : A benign vascular tumor causing fluid leakage

▪ Systemic Conditions –

▪ Kidney Disease : Can result in fluid overload and vascular abnormalities

▪ Autoimmune Diseases : Condition like lupus or sarcoidosis may lead to inflammation and fluid
buildup
Exudative Retinal
Detachment (ERD)
Risk Factors

▪ Chronic systemic inflammation (e.g., autoimmune diseases like lupus, Vogt-Koyanagi-

Harada Disease (VKH) )

▪ Hypertension and cardiovascular disorders

▪ Pregnancy-related hypertensive conditions (pre-eclampsia/eclampsia)

▪ Tumors (e.g.,choroidal melanoma)

▪ Renal disease or conditions leading to fluid retention

Exudative Retinal
Detachment (ERD)
Sx of Exudative Retinal Detachment

▪ Painless vision loss – usually gradual but may occur quickly in severe cases

▪ Blurred or distorted vision (metamorphasia) – object may appear wavy or misshapen

▪ Blind spots (scotomas) – Loss of vision in certain areas

▪ Central or peripheral vision loss – Depending on the location and extent of

detachment
Exudative Retinal
Detachment (ERD)
Pathophysiology

▪ Fluid leaks from abnormal blood vessels or inflamed tissues beneath the retina

▪ This accumulates in the subretinal space between the sensory retina and the retina

pigment epithelium (RPE)

▪ Unlike RRD, ERD occurs without retinal tear or hole and the detachment is caused by

fluid buildup rather than vitreoretinal traction

Exudative Retinal
Detachment (ERD)
Diagnosis
▪ Ophthalmoscopy – direct visual via ophthalmoscope
▪ Optical Coherence Tomography (OCT)
▪ Fluorescein Angiography – Dye test to identify abnormal leakage from blood vessels
or choroidal abnormalities
▪ B-Scan Ocular Ultrasound
 Exudative Retinal
Detachment (ERD)
Treatment Options
▪ Treating underlying cause
▪ Corticosteroids or other anti-inflammatory drugs for inflammation (e.g., uveitis, VKH)

▪ Anti-VEGF Therapy : Blocks vascular endothelial growth factor to reduce abnormal blood vessel

growth and leakage, especially in conditions like CSCR or choroidal neovascularization

▪ Immunosuppressive therapy : For autoimmune conditions causing the detachment

▪ Observation : in cases like CSCR, where spontaneous resolution may occur without intervention

▪ Surgical treatment: If there is a related tumor (e.g., choroidal melanoma) or in severe cases

where medical treatment alone is insufficient

Exudative Retinal
Detachment (ERD)
▪ Prognosis
▪ Good prognosis if treated early and the underlying cause is managed
▪ Vision recovery depends on the extent and duration of the detachment and whether
the macula is involved
▪ Chronic conditions or delays in treatment can lead to permanent vision loss or
recurrent of detachment
Thank You