Mohd Alhalki

West Middlesex University Hospital, London

Introduction

Retinal detachment is an ophthalmic emergency that occurs when the neurosensory retina is separated from the underlying retinal pigment epithelium (RPE) that can lead to irreversible loss of vision if left untreated. This article presents an overview of the causes, clinical presentation, diagnostic approaches, and management of retinal detachment.

Types of Retinal Detachment

Rhegmatogenous Retinal Detachment (RRD):

RRD occurs due to a retinal tear, allowing vitreous fluid to accumulate under the retina leading to its separation. This is usually caused by trauma or posterior vitreous detachment (PVD).

Tractional Retinal Detachment (TRD):

TRD are commonly seen in proliferative diabetic retinopathy resulting in formation of fibrovascular membranes, which can lead to mechanical traction on the retina causing detachment.

Exudative Retinal Detachment:

Occurs due to accumulation of fluid under the retina without a retinal tear which is commonly seen in wet age-related macular degeneration, central serous chorioretinopathy, and uveitis. This typically does not need surgical intervention and can be managed medically.

Clinical Presentation

Patients with retinal detachment often present with sudden onset of floaters, flashes of lights and visual field defects described as a “curtain”.

The visual acuity typically remains near normal or only slightly reduced in macula-on RD and the prognosis is generally better.

However, in macula-off RD the visual acuity is significantly reduced, with central vision being severely affected and the prognosis is usually worse.

Diagnosis

The diagnosis of retinal detachment can be made through a comprehensive diagnostic approach which include:

• Fundoscopic examination: for identifying retinal breaks

• B-Scan Ultrasonography

• Optical Coherence Tomography (OCT).

• Wide-field imaging (WFI) such as Optos ultra-widefield retinal imaging.

Management

The management of retinal detachment usually involves both non-surgical and surgical

Interventions such as:

• Argon laser therapy (photocoagulation) or cryotherapy which creates a scar adhesion between the retina and retinal pigment epithelium, sealing the break and preventing fluid access into the subretinal space.

• Pneumatic Retinopexy: involves injection of an intraocular gas bubble that floats upward and presses against the retinal tear, helping to flatten the detached retina against the RPE to seal retinal breaks.

• Scleral Buckling: which involves an external band to indent the eye wall and relieve retinal traction.

• Pars Plana Vitrectomy (PPV): This procedure involves removing the vitreous gel accompanied by the injection of intraocular gas or silicone oil tamponade .

Prognosis

The prognosis of retinal detachment depends on the time-sensitive recognition and early treatment and whether the macula is involved. Macula-on detachments have better visual outcomes than macula-off detachments .

Conclusion

Retinal detachment is a sight-threatening emergency requiring early recognition and management to prevent irreversible vision loss. Understanding the various types, aetiologies, clinical presentations, and treatment options is essential for effective management and improved visual outcomes.

References

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