Retinal detachment is the separation between the neurosensorial layers of the retina and the retinal pigment epithelium. Rhegmatogenous retinal detachment is the most common type of retinal detachment.
It is caused by a retinal break, allowing access of a liquefied vitreous gel to the potential subretinal space. Symptoms are variable. Rhegmatogenous retinal detachment is usually preceded by posterior vitreous detachment causing photopsia and floating opacities.Post-detachment symptoms include blurred vision, metamorphopsia, visual field defects and/or loss of central vision.
Predisposing factors for this disease include high myopia, aphakia, pseudophakia, family background and inflammation.
Slit lamp examination usually reveals pigment cells suspended in the vitreous cavity (Schaffer sign), being colloquially know as “tobacco dust”. Vitreous hemorrhage can occur as result of a vascular rupture at the tear site. Usually intraocular pressure is lower in the affected eye. The recently detached retina usually has a convex, smooth and mobile appearance. As time passes, if no treatment is established, an inflammatory reaction, known as proliferative vitreoretinopathy (PVR) takes place, causing fibrosis, membrane formation and contraction. Progressively, the retina assumes a folded, convoluted, taut and immobile configuration. PVR adversely affects the prognosis.
Treatment for rhegmatogenous retinal detachment is surgical. Pars plana vitrectomy is the most commonly performed procedure. All retinal breaks are found, vitreoretinal traction is released, the retina and retinal pigment epithelium are brought into apposition, breaks are sealed with either Laser or cryoprobe and finally intraocular tamponade with either gas or silicone oil is performed. The main factor that determines outcome is the status of the macular region when surgery is performed.
If the macula is still attached by the time of surgery, the outcome is significantly superior. Also a longer interval between symptoms and surgery adversely affects the outcome.
