Retinal Detachment/Ablatio Retina

Refers to the detachment of the inner layer of the retina from the retinal pigment epithelium

Aetiology

Rhegmatogenous

• Tears or holes in the retina leading to detachment - most common cause

• Requires acute posterior vitreous detachment and predisposing peripheral retinal degeneration

• Posterior vitreous detachment

• Pathological myopia > 6.0 D

• Previous intraocular surgery

• Trauma

Non-rhegmatogenous

• Detachment without any retinal tears

1. Formation of vitreoretinal bands (most commonly due to proliferative diabetic retinopathy)

2. Pressure on the band during eye movement or as a result of sudden decrease in intraocular pressure

3. Retinal detachment

• Subretinal fluid accumulation without retinal tears

• Choroidal tumours - primary or metastatic

• Intraocular inflammation - Harada disease, posterior scleritis

• Systemic - toxaemia of pregnancy, hypoproteinaemia

• Iatrogenic - RD surgery, excessive retinal photocoagulation

• Miscellaneous - choroidal neovascularisation, uveal effusion sydrome

Clinical presentation

Symptoms

• Painless, progressive visual field loss

• Patients may describe a curtain/shadow descending or ascending on field of vision
• Shadow corresponds to area of detached retina

• If detachment affects macula, central vision will be lost

• Sudden onset of floaters/flashes can preceed visual loss - indicates posterior vitreal detachment

Signs

• May have RAPD

Investigations

Fundoscopy

• Retinal tear may be visible

• Detatched retina takes a convex shape

• Deep mobile elevation extending to ora serrata (junction between retina and ciliary body)

• Slightly opaque with dark blood vessels

• Loss of choroidal pattern

• Detatched retina takes a convex shape

• Smooth elevation

• May be very mobile deep with shifting fluid

• Subretinal pigment (leopard spots) after flattening

• No retinal tear visible

Management

• Various surgical options which aim to reattach the retina and reduce any traction or pressure that may cause it to detach again