Retinal Detachment

Retinal Detachment is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Separation of the sensory retina from the underlying retinal pigment epithelium
  • Rhegmatogenous retinal detachment (RRD): most common type; occurs when the fluid vitreous gains access to the subretinal space through a break in the retina (Greek rhegma, “rent”)
  • Exudative or serous detachment: occurs in the absence of a retinal break, usually in association with inflammation or a tumor
  • Traction detachment: Vitreoretinal adhesions mechanically pull the retina from the retinal pigment epithelium. The most common cause is proliferative diabetic retinopathy.
  • System(s) affected: nervous

Epidemiology

Incidence
  • Predominant age: Incidence increases with age.
  • Predominant sex: male > female (3:2)
  • Per year: 1/10,000 in patients who have not had cataract surgery

Prevalence
After cataract surgery, 1–3% of patients will develop a retinal detachment.

Etiology and Pathophysiology

  • Traction from a posterior vitreous detachment (PVD) causes most retinal tears. With aging, vitreous gel liquefies, leading to separation of the vitreous from the retina. The vitreous gel remains attached at the vitreous base, in the retinal periphery, resulting in vitreous traction that produces tears in the retinal periphery. There is an ~15% chance of developing a retinal tear from a PVD.
  • PVD associated with vitreous hemorrhage has a high incidence of retinal tears.
  • Exudative detachment
    • Tumors
    • Inflammatory diseases (Vogt-Koyanagi-Harada disease, posterior scleritis)
    • Miscellaneous (central serous retinopathy, uveal effusion syndrome, malignant hypertension, drugs—ipilimumab)
  • Traction detachment
    • Proliferative diabetic retinopathy
    • Cicatricial retinopathy of prematurity
    • Proliferative sickle-cell retinopathy
  • Penetrating trauma

Genetics
  • Most cases are sporadic.
  • There is an increased risk of RRD if a sibling has been affected by this condition. The risk increases with higher levels of myopia in the family history.

Risk Factors

  • Myopia (>5 diopters)
  • Aphakia or pseudophakia
    • In patients undergoing small-incision coaxial phacoemulsification with high myopia (axial length ≥26 mm), the incidence of retinal detachment is 2.7%.
  • PVD and associated conditions (e.g., aphakia, inflammatory disease, and trauma)
  • Trauma
  • Retinal detachment in fellow eye
  • Lattice degeneration: a vitreoretinal abnormality found in 6–10% of the general population
  • Glaucoma: 4–7% of patients with retinal detachment have chronic open-angle glaucoma.
  • Vitreoretinal tufts: Peripheral retinal tufts are caused by focal areas of vitreous traction.
  • Meridional folds: Redundant retina usually is found in the supranasal quadrant.

General Prevention

Patients at risk for retinal detachment should have regular ophthalmologic exams.

Geriatric Considerations
  • PVD
  • Cataract surgery

Pediatric Considerations
Usually associated with underlying vitreoretinal disorders and/or retinopathy of prematurity

Commonly Associated Conditions

  • Lattice degeneration
  • High myopia
  • Cataract surgery
  • Glaucoma
  • History of retinal detachment in the fellow eye
  • Trauma

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

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Citation

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TY - ELEC T1 - Retinal Detachment ID - 116525 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116525/all/Retinal_Detachment PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -