Retinal Detachment

 

A retinal detachment is when the neurosensory retina detaches from the retinal pigment epithelium (RPE).

The three different types of retinal detachment:

Rhegmatogenous – most common, caused by a retinal tear or break allowing subretinal fluid to separate the neurosensory retina from the RPE.  

Tractional- traction on the neurosensory retina from fibrovascular proliferation, commonly seen in proliferative diabetic retinopathy.

Exudative- subretinal fluid accumulation between the neurosensory retina and RPE, secondary to retinal and choroidal conditions including inflammatory disorders or injury. There are no retinal tears or breaks.

 

Figure 1: Macula-off rhegmatogenous retinal detachment.  The detached neurosensory is irregular with intraretinal edema that corresponded to the corrugated appearance on clinical examination.  The patient also has drusen. 

 

 Figure 2: Macula-off rhegmatogenous retinal detachment.  The detached neurosensory is irregular with intraretinal edema that corresponded to the corrugated appearance on clinical examination. 

 

Tractional retinal detachment (TRD) is the second most common type of retinal detachment after rhegmatogenous retinal detachment. TRD may occur in proliferative diabetic retinopathy, sickling hemoglobinopathies, vein occlusions if neovascularization develops, retinopathy of prematurity and other conditions with extensive ischemia and retinal neovascularization.

 

Figure 3: Tractional retinal detachment secondary to proliferative diabetic retinopathy.  The retinal detachment is threatening fixation.  The BCVA was 20/30.  The patient had already previously received scatter pan-retinal photocoagulation (PRP) as seen on the photograph.

 

Figure 4: Tractional retinal detachment secondary to proliferative diabetic retinopathy.  The retinal detachment is macula-on and detached superior to the macula.  The tractional fibrovascular bands can be seen on the retinal photograph bridging the superior and inferior arcades with attachment to the optic nerve.

Figure 5: Tractional retinal detachment secondary to proliferative diabetic retinopathy.  

 

 Figure 6: Retinal detachment inferior to the optic nerve.