Retinal detachment

Retinal detachment (RD) is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium. Most cases present as rhegmatogenous RD, secondary to traction that causes a retinal break promoting the accumulation of subretinal fluid in the subretinal space. Nonrhegmatogenous forms of RD (i.e., not associated with a retinal break) include tractional, exudative, and hemorrhagic.

Diagnosis relies on indirect ophthalmoscopy or slit-lamp exam, with B-scan ultrasonography used for cases with media opacity.

Refer patients with RD early for specialist intervention by an appropriately trained ophthalmologist. Treatment depends on the type of detachment and underlying etiology. If treated promptly, prognosis is generally good. Left untreated, rhegmatogenous RD typically results in blindness.

Surgical treatment aims to prevent fluid accessing the subretinal space through the break and to eliminate any traction that caused the break. Choice of surgery will depend on patient-specific factors, such as the number, location, and size of retinal breaks, plus the surgeon’s preference and the presence of any proliferative vitreoretinopathy (PVR).

Recurrence or treatment failure (defined as lack of retinal reattachment or retinal redetachment) may occur due to a missed retinal break, postoperative development, or PVR.

RD is typically a progressive condition in which the neuroretina detaches from the retinal pigment epithelium. Subretinal fluid accumulates between the neuroretina and the retinal pigment epithelium, causing temporary loss of retinal function.

In rhegmatogenous RD, the separation results from a retinal discontinuity (break, tear).

Tractional RD arises when proliferative membranes on (or less commonly underneath) the retinal surface (subretinal strands) pull on the neuroretina, causing separation of the neuroretina from the retinal pigment epithelium. Tractional RD usually occurs without a retinal break, although one may develop to cause a combined rhegmatogenous/tractional RD. Similarly, rhegmatogenous RD may develop a secondary tractional element.

Exudative RD develops due to the subretinal accumulation of fluid, other than that originating in the vitreous cavity. Leaking retinal blood vessels or discontinuities in the retinal pigment epithelium are the usual cause; hemorrhagic RD is mostly observed after trauma.

Retinoschisis does not qualify as a true RD because layers of the neuroretina split and fluid enters the space created. Full thickness RD can rarely complicate retinoschisis.