Rhegmatogenous Retinal Detachment

introduction

What is Rhegmatogenous Retinal Detachment?

Rhegmatogenous retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium characterized by the presence of a retinal break in concert with vitreoretinal traction that allows accumulation of liquefied vitreous under the retina.

Symptoms of Rhegmatogenous Retinal Detachment

  • Very brief flashes of light (photopsia) in the extreme peripheral (outside of center) part of vision
  • A sudden dramatic increase in the number of floaters
  • A ring of floaters or hairs just to the temporal side of the central vision
  • A dense shadow that starts in the peripheral vision and slowly progresses towards the central vision
  • The impression that a veil or curtain was drawn over the field of vision
  • Straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved
  • Central visual loss

Causes of Rhegmatogenous Retinal Detachment

Risk factors include the following:

  • Myopia
  • Previous cataract surgery
  • Ocular trauma
  • Lattice retinal degeneration
  • A family history of retinal detachment

prevention

Rhegmatogenous Retinal Detachment Prevention

  • Avoid direct and indirect injury to the eyes
  • Regular eye check up

Types of Rhegmatogenous Retinal Detachment

Fresh Retinal Detachment

Long standing retinal detachment characterised by proliferative vitreo retinopathy changes

  • Grade A- diffuse vitreous haze and tobacco dust
  • Grade B-wrinkling of inner retinal surface & decreased mobility of vitreous gel
  • Grade C- rigid full thickness retinal folds with heavy vitreous condensation and strands

Rhegmatogenous Retinal Detachment Diagnosis

  • Ophthalmoscopy preferably with indirect ophthalmoscope
  • Fundus photography
  • Ultrasound B scan

Rhegmatogenous Retinal Detachment Treatment

  • Retinal laser photocoagulation and cryopexy
  • Scleral buckle surgery
  • Pneumatic retinopexy
  • Vitrectomy surgery

Rhegmatogenous detachment is treated with one or more methods, depending on the cause and location of the lesion. These methods involve sealing the retinal breaks by laser or cryotherapy. In scleral buckling, a piece of silicone is placed on the sclera, which indents the sclera and pushes the retina inward, thereby relieving vitreous traction on the retina. During this procedure, fluid may be drained from the subretinal space. The other modalities of treatment include pneumatic retinopexy (which means attachment of retina using gas) and vitrectomy. Laser photocoagulation using green Argon, red Krypton or Diode laser or cryopexy ( scarring the retinal tear by freezing) can help in treating retinal breaks. Surgical treatment is successful in most of the cases of rhegmatogenous retinal detachments.

Rhegmatogenous detachments due to vitreoretinal traction may be treated by vitrectomy. Vitrectomy is an increasingly used treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble (SF6 or C3F8 gas) or silicone oil. Vitrectomy is followed by filling of the vitreous cavity with gas (SF6. C3F8 gas) or silicone oil (PDMS). The disadvantage of silicone oil is that it causes a myopic shift and it needs to be removed by 6 months whereas when using gas, it warrants proper patient positioning after surgery and gas gets absorbed in a few weeks and there is no myopic shift.

 

Written by: Dr. Rakesh Seenappa – Consultant Ophthalmologist, Rajajinagar

FAQ

Can retinal detachment cause total blindness?

Yes, even a slight blockage of the vision caused by partial retinal detachment can result in blindness if not treated right away.

No. There is no medicine, eye drop, vitamin, herb, or diet that is beneficial to patients with retinal detachment.

Detachment is more likely to occur if the other eye has the condition (such as lattice degeneration) associated with retinal detachment in the first eye. If only one eye suffers a serious injury or requires eye surgery then, of course, the chance of detachment in the other eye is not increased by the event.

The outlook depends on the severity of the condition and how quickly you get expert medical care. Some people will recover completely, especially if the macula isn’t damaged. The macula is the part of the eye responsible for clear vision and is located near the center of the retina. However, some people may not regain full vision. This can occur if the macula is damaged and treatment isn’t sought quickly enough.

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