prepared by: liyana ashaari nur adila kamaruddin nur liyana omar
TRANSCRIPT
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Prepared by:Liyana AshaariNur Adila KamaruddinNur Liyana Omar
RETINAL DETACHMENT
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RETINA• innermost of three layers that make up the eyeball’s wall. The
layer outside the retina is the choroid
Anatomically, retina divided into:
1- CENTRAL RETINA : (macula lutea =5-7.5mm) The center of macula is an avascular depression called “fovea centralis”
Function: (mainly cones) responsible for visual acuity, color vision and form sense
2- PERIPHERAL RETINA : end at ora serrata Function: (mainly rods) responsible for night vision and peripheral
field
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Layer of retina1. Inner limiting membrane - Müller cell footplates
2. Nerve fiber layer
3. Ganglion cell layer - Layer that contains nuclei of ganglion cells and gives rise to optic
nerve fibers.
4. Inner plexiform layer
5. Inner nuclear layer contains bipolar cells
6. Outer plexiform layer - In the macular region, this is known as the Fiber layer of Henle.
7. Outer nuclear layer
8. External limiting membrane - Layer that separates the inner segment portions of the
photoreceptors from their cell nucleaus.
9. Photoreceptor layer - Rods / Cones
10. Retinal pigment epithelium
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Histology of the retina
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RETINAL DETACHMENT
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RETINAL DETACHMENT
DEFINITION: it`s a condition in which the retina is separate into 2 layer
1- retina pigment epithelium2- sensory retinaby subretinal fluid
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What detaches the retina
1. Retina break2. Traction on break3. Moving fluid (shaking )
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Types of retinal detachment
• TRACTIONAL RDRHEGMATOGENOUS
RD
EXUDATIVE RD
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Rhegmatogenous retinal
detachment
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RHEGMATOGENOUS RD
• DEFINITION :Formation of retinal tear , which allow the liquefied vitreous to enter between the retinal layers causing
retinal detachment formation
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RISK FACTORS
Blunt trauma
Chorio- retinal degeneration
( high myopia)
Family history Chorio-retinitis
Aphakia
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incidence
• patient : > 40 years• Sex : more male
• Refraction : > myopia • Bilateral in >10 % of cases
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Clinical pictures
• Symptoms
Flashes of light ( photopsia ) Due to mechanical traction of rods & cones by vitreous
traction
Floaters ( musca volitans ) Due to vitreous degenaration
Field defect ( black curtain ) Due to death of photoreceptor
Failure of vision ( HM or PL vision ) Due to foveal detachment
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Signs
1. Pupil : Relative Afferent Pupillary Defect when the detachment is extensive
2. IOP : 3. Ant. chamber : mild inflammatory cells4. Post. Segment :
(i) Retinal breaks: as full thickness defect in sensory retina. Look red in color due to color contrast between the sensory retina and underlying choroid
(ii) Detached retina : greyish in color, has corrugated appearance and undulates with eye movement. The retina surface is convex and subretinal fluid extends to ora serrata rapidly
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management• To find all retinal break by (i) Preoperative exam(ii) Intraoperative exam
• To close all retinal break(i) Scleral buckle(ii) intra-vitreal gas bubble
• To create firm chorio retinal adhesion(i) cryotherapy(ii) Diathermy(iii) Laser photocoagulation.
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Vitrectomy• Is indicated in case of rhegmatogenous retinal
detachment associated with giant tear, post retinal tear or proliferative vitreoretinopathy
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Rhematogenous retinal detachment
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Rhematogenous retinal detachment
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EXUDATIVE RETINAL
DETACHMENT
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EXUDATIVE retinal detachment
• DEFINITION: Extravasation of fluid from the retina or choroid into the subretinal space
• TREATMENT: - Inflamatory (choroiditis & post scleritis) give
cortisone- Malignant enucleation
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Exudative retinal detachment
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TRACTIONAL RETINAL
DETACHMENT
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Tractional retinal detachment
• DEFINITION: The retina is pulled from it`s position by contracting fibrous or fibro-vascular membranes
• TREATMENT: vitrectomy
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Tractional retinal detachment
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Differential diagnosis
RHEGMATOGENOUSRD
EXUDATIVERD
TRACTIONALRD
RETINAL BREAK
-PRESENT -NO -NO
SURFACE & HEIGHT
-CONVEX -CONVEX -CONCAVE
RETINAL MOBILITY
-UNDULATING BULLAE OR FOLDS
-SHIFTING ELEVATED BULLAE
-TAUT RETINA
EXTENT OF RD
-EXTENDS TO ORA SERRATA EARLY
-MAY EXTEND TO ORA
-DOES NOT EXTEND TO ORA
SRF -CLEAR, NO SHIFT -TURBID,SHIFT -CLEAR, NO SHIFT
IOP -LOW -VARIABLE -USUALLY NORMAL
CAUSES -RETINAL BREAK -UVEITIS,SUBRETINAL NEOVASCULAR, TUMOR
-PDR,RETINOPATHY OF PREMATURITY
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THANK YOU