Retinal Detachment
 

Note: The majority of the cases has treated retinal detachment possibly with proliferative vitreoretinopathy (PVR). Otherwise, the patient may be an in-patient awaiting surgery (the wearing of hospital pyjama may provide the clue). Another favorite case is long-standing retinal detachment usually with watermark. In treated retinal detachment, there is/are area(s) of chorioretinal atrophy with indentation from cryotherapy and explant. Examine the conjunctiva and comment if the explant is secured. Look for wrinkling of the retinal surface, vessel tortusosity and retinal folds suggesting the development of PVR. Examine the opposite eye for lattice degeneration and cryo/photocoagulation scars. Note presence of other predisposing factors: aphakia high myopia Marfan's syndrome Sticker's syndrome In chronic retinal detachment, the margin of the retina contains water marks with hyperp-igmentation. The surface may contain fibrous tissue. Look for retinodialysis which is a common cause of chronic inferior retinal detachment.

Questions:
1. List the risk factors for retinal detachment

Answer

pre-exisitng retinal conditions:

lattice degenertion
snail track degeneration
white without pressure
diffuse chorioretinal atrophy

patients at risk:

myopia
aphakia
blunt ocular trauma with retinodialysis or retinal tear
patients with retinal detachment in the fellow eye

inherited conditions:

Stickler's syndrome, Janner's syndrome, Marfan, Ehler-Danlos syndrome

acquired infection:

cytomegalovirus retinitis
acute retinal necrosis

 

2. What is lattice retinal degeneration?

Answer
A peripheral reitnal degneration which can p;redisopose to retinal break foramtion and rhegmatogenous retinal detachment. It consists of pigmented lesion with white lines which is made up of hyalinzed retinal blood vessels.
Holes may be seen in this degeneration but the main cause of retinal detachment is caused by the development of retinal tear at the edge (especially posteriorly) of the lattice degeneration.
It is commonly seen in the upper temporal quadrant. It is seen in about 5 to 10% of the normal population but is seen in 40% of patients with rhegmatous retinal detachment. It is commoner in patients with myopia.
Treatment is controversial as the majority does not develop complications. However, in patients with tear, retinal detachment in the fellow eye, high myopia or a strong family history of retinal detachment. Prophylactic treatment with cryotherapy or photocoagulation is recommended.
 

3. What is proliferative vitreoretinopathy and how is it classified?

Answer
It is the development of cellular membranes on the surface of the retina and the vitreous cavity. It is seen in long-standing retinal detachment and also in eyes treated surgically for retinal detachment. It is thought to be caused by the transformation of retinal pigment epithelium cells and in surgically treated retinal detachment it is associated with excessive cryotherpy, retinal incarceration, haemorrhage and giant retinal tears.
PVR is classified into four main groups:
Grade A = vitreous haze and pigment clumps; no membranes seen
Grade B = wrinkling of the reitnal surface, a rolled edge to the break, vessel torutosity and retinal stiffness, no membranes are seen clinically
Grade C = fixed, full-thickness retinal folds and visible membranes, and is subdived into C1, C2 and C3, the number represents the number of invovled quadrants.
Grade D = fixed, full-thickness retinal folds in all four quadrants. D1 = an open wide funnel D2 = a narrow funnel with a visible disc D3 =  closed funnel without visibility fo the disc.

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Lattice degeneration

Enlarged view of lattic degeneration showing hyalined retinal blood vessels return to the top

 

Proliferative vitreoretinopathy return to the top

Watermarks in chronic retinal detachment return to the top