Retinal breaks- any full- thickness defect in the neurosensory retina
Can cause RD 6% of population have break 1/10,000-15,000 per year- RD 0.07% chance of developing RD in a
lifetime
Direct retinal perforation, contusion, vitreous tractionCoupContrecoup
Usually multiple Inferotemporal and superonasal
quadrants Most common- dialyses + avulsion
of vitreous base= ocular contusion Others: horseshoe-shaped tears,
operculated holes
Young patients- higher incidence of eye injury
Rarely develop acute rhegmatogenous RD
Vitreous acts as tamponade 12%- immediately 30%- 1 month 50%- 8 months 80%- 24 mos
Vitreous base- 2 mm anterior and 4 mm posterior to the ora serrata
Optic disc, macula, along major vessels, margins of lattice degeneration, sites of chorioretinal scars
Increasing age- 63% in > 70 y/o axial lengthAphakia – 66-100% Inflammatory diseaseTraumamyopia
ICCE- 84%ECCE w/ open capsule-
76%ECCE w/ intact capsule-
40%
Photopsias Multiple floaters Curtain or cloud Vitreous hemorrhage
Retinal tear present in 15% w/ acute PVD 50-70% w/ acute PVD + vitreous hge
IO w/ scleral depression Slit lamp biomocroscopy w/ 3-
mirror lens Hemorrhage or pigment? Reexamine in 3- 4 weeks patching, bed rest, head elevation
for 45⁰ B- scan vitrectomy
6-10% of general population 1/3-1/2- bilateral Myopia, familial predilection
1. Atrophy of the inner layers2. Overlying pocket of liquefied
vitreous, 3. condensation and adherence of
vitreous at the margin of lesion Progresses to RD- tractional tear or
atrophic hole
Areas of elevated glial hyperplasia Noncystic retinal tufts Cystic retinal tufts may
predispose Zonular traction tufts to RD
folds of redundant retina Superonasally Associated w/ dentate processes Tears occur at the most posterior
limit of the folds
Oval islands ofpars plana epithelium located immediately posterior to the ora
Almost/completely circumscribed by the peripheral retina
Tears can occur at or near the posterrior margins of enclosed ora bays
Paving-stone or Cobblestone Degeneration
RPE hyperplasia RPE hypertrophy Peripheral Cystoid Degeneration
•22% over 20 y/o•Atrophy of the outer retina1.Atrophy of the RPE and outer retinal layers2.Attenuation or absence of the choriocapillaries3.Adhesions b/n the remaining neuroepithelial layers amd bruch’s membrane•Inferior quadrant, anterior to the equator•NEVER the site of PRIMARY retinal break
•Proliferation of RPE cells•Old areas of inflammation and trauma, RD, retinal tear •Benign, but may cause field loss•Appears as black
•Enlargement of RPE cells•Congenital or acquired•Aging and degenerative change•Large cells and large, spherical melanin granules, •very dark, well demarcated•BENIGN
•Present in approximately 100% of > 20 y/o•Temporal•1. TYPICAL•Cysts in the outer plexiform layer
•2. RETICULAR•Nerve fiber layer•Posterior to typical cystoid•May develop into full-retinal break
Reduce the risk of RD Risk outweigh the benefit May not eliminate the risk of new
tears or detachment GOAL: create a chorioretinal scar
around the break Acute symptomatic break are more
dangerous than the old ones
Acute symptomatic flap tear Acute operculated holes
+ persistent vitreous tractionLarge holeSuperior locationVit hem
Atrophic holes+ traction
Flap tearsEmmetropic, phakic eyesLattice degenerationMyopiaSubclinical detachmentAphakia w/ detachment in the other
eye Operculated holes Atrophic holes
Treat the entire lesion Posterior and lateral margins 6-10% of eyes 20-30% of eyes w RD 1%- RD in untreated lattice
degeneration
•High myopia •RD in the fellow eye•flap tears•aphakia
1-3 % incidence of RD Asymptomatic breaks –
prophylaxis? Flap tears Subclinical detachments
Asymptomatic retinal detachment Detachment in w/c subretinal fluid
extends more than 1 DD from the break but not more than 2DD posterior to the equator.
Traction on the break
TYPE OF LESION TREATMENT
Horseshoe tears Almost always
Dialysis Almost always
Operculated tear sometimes
Atrophic hole Rarely
Lattice degeneration w/o horseshoe tears
Rarely
Zorab et.al., American academy of Ophthalmology Section 12 p. 290 2008-2009
Type of lesion
phakic Highly myopic
Fellow eye Aphakic or pseudopha
kic
Retinal dialysis
Almost always
Almost always
Almost always
Almost always
Horseshoe tears
sometimes sometimes sometimes sometimes
Operculated tears
no rarely rarely rarely
Atrophic holes
rarely rarely rarely rarely
Lattice deg’n w/ or w/o holes
no no sometimes rarely
Zorab et.al., American academy of Ophthalmology Section 12 p. 291, 2008-2009
http://one.aao.org/CE/Practice Guidelines