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ABLATIO RETINA
Rr
Retinal Detachment
RHEGMATOGENOUS RD RRD
TRACTION RD TRD
COMBINED TRACTION-
RHEGMATOGENOUS RD TRRD
EXUDATIVE/SEROUS RD SRD
PATHOGENESIS OF
Retinal Detachment
Mechanisms of normal attachment
of NSR to RPE
Forces of adhesion
• MECHANICAL
• Outside the SRS
• Fluid pressures
• Intraocular
• Choroidal oncotic
• Vitreous
• Inside the SRS
• IPM (interphotoreceptor matrix)
• RPE microvilli-photoreceptors
interdigitations
• METABOLIC
• Oxygenation
• Effect of drugs on RPE fluid transport
activity
RHEGMATOGENOUS RD
Preretinal
haemorrhage
Pathogenesis and Causes of Exudative RD
• Damage to RPE by subretinal disease
• Passage of fluid derived from choroid into subretinal space
1. Choroidal tumours
• Primary
• Metastatic
2. Intraocular inflammation
• Harada disease
• Posterior scleritis
3. Systemic
• Toxaemia of pregnancy
• Hypoproteinaemia
4. Iatrogenic
• RD surgery
• Excessive retinal photocoagulation
5. Miscellaneous
• Choroidal neovascularization
• Uveal effusion syndrome
Basic principle approach to
PRIMARY RETINAL DETACHMENT:
Principles of Retinal Reattachment
Bring the retina tear into contact with
underlying RPE/the eyewall to close the tear
• Subretinal fluid drainage
• Scleral buckle
• Intraocular gas injection
Create a chorioretinal adhesion around all
retinal breaks to seal the breaks
• Diathermy
• Cryotherapy
• Photocoagulation
Release all important vitreoretinal traction
• Scleral buckle
• Vitrectomy
Basic Surgical Approaches :
• Pneumatic Retinopexy
• Scleral Buckling
• Vitrectomy
• Combination procedures
Scleral Buckling declining in popularity, but
still , it remains a valuable procedure in many
instances