Tractional Retinal Detachment

introduction

What is Tractional Retinal Detachment?

Tractional Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium caused by progressive contraction of fibrovascular membranes over large areas of vitreoretinal adhesions.

Symptoms of Tractional Retinal Detachment

  • Gradual diminution of vision
  • Visual field defect which usually progresses slowly
  • Straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved
  • Central visual loss if macula is detached
  • Sudden drop in vision if associated with vitreous haemorrhage

Causes of Tractional Retinal Detachment

  • Proliferative retinopathy due to diabetes
  • Penetrating posterior segment trauma
  • Vaso-occlusive lesions leading to fibrovascular proliferation
  • Other causes such as retinopathy of prematurity, familial exudative vitreo retinopathy, idiopathic vasculitis

prevention

Prevention

  • Controlling the systemic parameters such as blood glucose levels and blood pressure
  • Regular eye check up
  • Avoiding any trauma to the eyes

Types of Tractional Retinal Detachment

It can be classified based on type of vitreoretinal traction

  • Tangential- caused by the contraction of epiretinal fibrovascular membranes
  • Anteroposterior- due to the contraction of fibrovascular membranes extending from the posterior retina, usually in association with the major arcades, to the vitreous base anteriorly
  • Bridging(trampoline)- due to contraction of fibrovascular membranes stretching from one part of retina to another or between vascular arcades

Diagnosis

  • Ophthalmoscopy (direct and indirect ophthalmoscope)
  • Fundus photography and Fundus Fluorescein Angiography
  • Optical Coherence Tomography (OCT)
  • Ultrasound B scan

 Treatment

  • Retinal laser photocoagulation
  • Vitrectomy surgery
  • Intravitreal anti vegf injections (bevacizumab, ranibizumab, aflibercept)

Sometimes a tractional retinal detachment can be stopped before it affects the central vision. A small area of retinal detachment far from the center of the vision can sometimes be watched if it stops growing due to retinal laser or anit vegf injection treatment and improvement in blood sugars control. Other times, a tractional retinal detachment affects the central vision significantly enough to require surgical repair. The surgery performed is called a vitrectomy, or removal of the jelly in the back of the eye that the abnormal vessels are growing into. Vitrectomy is also combined with careful microscopic dissection of the fibrous scars left by the abnormal blood vessels from the surface of the retina. Laser is often performed simultaneously to reduce the risk of the vessels recurring or to treat stretch holes in the retina. To help keep the retina reattached, the eye is sometimes filled with a synthetic gas or silicone oil at the end of the repair. Oftentimes, the decision to use one of those materials as a vitreous substitute is made during the surgery.

 

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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