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RETINAL DETACHMENT
Mohammed Al-KhaldiMPH
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 1
RD related Epidemiological facts
• The incidence of RD in otherwise normal eyes is around 5 new cases in 100,000 persons per year.
• RD is more frequent in middle-aged or elderly, with rates of around 20 in 100,000 per year, and the lifetime risk in normal individuals is about 1 in 300.
• RD is more common in people with severe myopia (above 5–6 diopters), in whom the retina is more thinly stretched. In such patients, lifetime risk rises to 1 in 20.
• About two-thirds of cases of RD occur in myopics. Myopic retinal detachment patients tend to be younger than non-myopic ones.
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 2
Contd,
RD related Epidemiological facts• RD is more frequent after surgery for cataracts. The estimated
long-term prevalence of RD after cataract surgery is in the range of 5 to 16 per 1000 cataract operations, but is much higher in patients who are highly myopic, with a prevalence of up to 7% being reported in one study.
• A study found that the probability of experiencing retinal detachment within 10 years of cataract surgery may be about 5 times higher than in the absence of treatment.
• Although RD usually occurs in just one eye, there is a 15% chance of it developing in the other eye, and this risk increases to 25–30% in patients who have had a retinal detachment and cataracts extracted from both eyes.
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 3
RETINA• light-sensitive layer
of tissue • sends visual
messages through the optic nerve
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 4
• pulled away from the underlying choroid
• small areas of the retina torn =>
retinal tears or retinal breaks
• retinal cells deprived of oxygen
• if not promptly treated => permanent vision loss
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 5
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 6
SYMPTOMS• floaters - bits of debris in field of vision that
look like spots, hairs or strings
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 7
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 8
SYMPTOMS• floaters• light flashes• shadow or curtain over a
portion of visual field • blur in vision
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 9
Can occur as a result of:
• trauma • advanced diabetes • an inflammatory disorder, such as
sarcoidosis• shrinkage of the jelly-like vitreous that fills
the inside of the eye
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 10
• vitreous liquid leaks through retinal tear and accumulates underneath retina
• retina can peel away from underlying layer of blood vessels
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 11
Factors that may increase risk of retinal detachment
• aging - more common in people older than 40 • previous retinal detachment in one eye • family history of retinal detachment • extreme nearsightedness • previous eye surgery• previous severe eye injury or trauma
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 12
TREATMENTSRetinal tears:• laser surgery (photocoagulation)• freezing (cryopexy)Retinal detachment:• pneumatic retinopexy• scleral buckling• vitrectomy
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 13
PHOTOCOAGULATION
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 14
CRYOPEXY
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 15
PNEUMATIC RETINOPEXY
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 16
PNEUMATIC RETINOPEXY
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 17
SCLERAL BUCKLING
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 18
VITRECTOMY
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 19
When a surgeon injects a bubble of expandable gas into the vitreous cavity it is called:
• scleral buckling• vitrectomy• pneumatic retinopexy• photocoagulation• cryopexy
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 20
Important hint related to the results of surgery
85 % of the cases dealt with successfully in a single operation with 15 % of the remaining cases need to be two or more. After treatment, patients regain their vision therapists gradually over a period of a few weeks, despite the fact that visual acuity may not be as good as it was before the detachment, especially if the spot included in the detachment.
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 21
Retinal detachment can occur as a result of;•Obesity•Trauma•Nearsightedness
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 22
When a surgeon uses intense cold to freeze the retina around the retinal tear it is called;
• Scleral buckling• Vitrectomy• Pneumatic retinopexy• Photocoagulation• Cryopexy
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 23
04/13/23 Retinal Detachment, Mohammed Al-Khali, 2014, St John Eye Hospital. 24