Retinal Detachment

DESCRIPTION

• A vision threatening condition where the retina is separated (lifts away) from the underlying retinal pigment epithelium (RPE).
• Three types: rhegmatogenous retinal detachment (RRD), exudative (a.k.a. serous), and traction retinal detachment (TRD)
• Each type has a different mechanism where fluid accumulates under the retina, allowing separation from back of the eye.
• System(s) affected: nervous

EPIDEMIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

• RRD: most common type; full-thickness retinal break allows fluid to enter the subretinal space, separating retina from RPE; tension from posterior vitreous detachment (PVD) causes most retinal tears; with aging, vitreous gel liquefies, separating vitreous from retina.
• Exudative (serous) detachment: when fluid accumulates under retina due to breakdown in blood-retinal-barrier; can occur in any disorder that affects retinal or choroidal vasculature, like uveitis, malignant hypertension or preeclampsia, tumors, or medications (2)
• TRD: separation of retina from underlying RPE due to vitreoretinal membranes that occur most frequently with neovascularization of retina, as occurs in proliferative diabetic retinopathy, retinopathy of prematurity, sickle-cell retinopathy; penetrating trauma is another cause that can put traction on retina through same mechanism (3).

RISK FACTORS

• RRD:
  • Increasing age: average onset 55 years old but can occur in 20s in significant nearsightedness due to early liquefaction of the vitreous gel
  • Personal/family history of retinal detachment
  • Myopia (>6 diopters is considered high myopia)
  • Aphakia (not having a lens in the eye) or pseudophakia (having an intraocular lens implant)
• PVD
  • Lattice degeneration: areas of retinal thinning found in 7–8% of the general population (1); associated with atrophic retinal holes; <1% of lattice will convert to retinal detachment.
  • History ocular trauma (most often blunt trauma)
• TRD and exudative retinal detachment
  • Presence/history underlying conditions (see above) which could lead to retinal detachment

GENERAL PREVENTION

Pediatric Considerations
Retinopathy of prematurity can lead to TRDs—such patients requires frequent exams and prompt treatment to prevent permanent vision loss.

COMMONLY ASSOCIATED CONDITIONS

• Lattice degeneration
• High myopia
• Hypertension; diabetes

Pregnancy Considerations
Preeclampsia/eclampsia may be associated with exudative retinal detachment. No intervention is indicated, provided hypertension is controlled. Prognosis is usually good.