Retinal detachment

Retinal detachment (RD) is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium, sub-retinal fluid accumulates, and retinal function is lost.

Presents as primary rhegmatogenous RD, secondary to traction, or exudative in nature.

In rhegmatogenous RD, retinal discontinuity promotes detachment.

Diagnosis usually relies on indirect ophthalmoscopy or slit-lamp examination, with B-scan ultrasonography reserved for cases with media opacity.

Left untreated, rhegmatogenous RD typically results in blindness.

Surgical treatment aims to prevent fluid accessing the sub-retinal space through the break and to eliminate the traction that caused the break.

If treated promptly, prognosis is generally good. Failure occurs in cases with scarring due to proliferative vitreoretinopathy (PVR).

RD is typically a progressive condition in which the neuroretina detaches from the retinal pigment epithelium. Sub-retinal fluid accumulates, causing temporary loss of retinal function.

In rhegmatogenous RD, the separation results from a retinal discontinuity (break, tear).[1]Robertson DM, Norton EW. Long-term follow-up of treated retinal breaks. Am J Ophthalmol. 1973;75:395-404. http://www.ncbi.nlm.nih.gov/pubmed/4697192?tool=bestpractice.com

Tractional RD occurs due to proliferative membranes on, or less commonly underneath, the retinal surface (sub-retinal strands). This usually occurs without a retinal break, although one may develop to cause a combined rhegmatogenous/tractional RD. Similarly, rhegmatogenous RD may develop a secondary tractional element.

Exudative RD develops due to the sub-retinal accumulation of fluid, other than that originating in the vitreous cavity. Leaking retinal blood vessels or discontinuities in the retinal pigment epithelium are the usual cause, with haemorrhagic RD mostly observed after trauma.

Retinoschisis does not qualify as a true RD because layers of the neuroretina split and fluid enters the space created. Full thickness RD can rarely complicate retinoschisis.