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

• Incidence increases with age.
• Predominant sex: male > female (3:2)
• Per year: 1/10,000 in patients who have not had cataract surgery
• 1–3% develop a retinal detachment (RD) after cataract surgery.

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. Vitreoschisis (lamellar separation of the posterior vitreous cortex) commonly precedes a complete PVD. 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
  • Miscellaneous (central serous retinopathy, uveal effusion syndrome, malignant hypertension, drugs—ipilimumab, topiramate)
• Traction detachment
  • Proliferative diabetic retinopathy
  • Cicatricial retinopathy of prematurity
  • Proliferative sickle-cell retinopathy
  • Proliferative vitreoretinopathy (PVR)
  • Pars planitis
• Penetrating trauma

Genetics
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 RD is 2.7%.
• PVD
• RD in fellow eye
• Lattice degeneration: a vitreoretinal abnormality found in 6–10% of the general population
• Glaucoma: 4–7% of patients with RD have chronic open-angle glaucoma.
• The risk of RD after intravitreal injection for age-related macular degeneration or retinal vein occlusion is low with a rate of approximately 1 in 7,500 injections (1)[B].

General Prevention

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

Commonly Associated Conditions

• Lattice degeneration
• High myopia
• Glaucoma

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