Introduction:

Retinal detachment (RD) is a separation of the neurosensory retina from the underlying retinal pigment epithelium. There are three different forms of RDs:

Some eyes may present with a combination of these three. Tractional and exudative detachments are dealt in greater detail in the chapters associated with their underlying pathologies. Rhegmatogenous RD are more common in men, particularly those between 40 and 70 years of age. Risk factors for rhegmatogenous RD include prior cataract surgery, myopia, trauma, peripheral lattice degeneration, a family history of rhegmatogenous RDs, retinal tears and other intraocular surgery. Tractional RDs occur most commonly in the setting of fibrous membranes in the vitreous, secondary to diseases like proliferative diabetic retinopathy, retinopathy of prematurity, sickle cell retinopathy, trauma or proliferative vitreoretinopathy. Exudative RDs occur secondary to neoplastic or inflammatory processes, central serous chorioretinopathy, or uveal effusion syndrome

Clinical features:

Patients with rhegmatogenous RD present with painless unilateral decrease in vision or visual field with flashes and floaters. Most eyes have a posterior vitreous detachment. Examination reveals elevation of the retina, with a corrugated appearance and generally clear subretinal fluid that does not shift with position. The pathognomonic sign of a rhegmatogenous RD is the presence of one or more retinal tears or full thickness holes (Fig. 24.1.1).

Exudative RDs are serous, with a smooth surface and with shifting subretinal fluid. Other signs may be seen depending on the etiology.

Tractional RDs show preretinal proliferation with traction on the retinal surface and elevated, taut retina.

OCT Features:

OCT of RD shows elevation of the neurosensory retina from the underlying RPE (Figs 24.1.2 and 24.1.3). No splitting of retinal layers is seen except in the setting of combined retinoschisis-rhegmatogenous RD. Occasionally, RDs especially chronic RDs may be associated with cystic changes within the retina. The subretinal fluid in rhegmatogenous RDs is usually clear and hyporeflective.

Tractional RDs show hyper-reflective bands that attach to the inner retina and cause retinal elevation.

Serous RDs may occasionally be associated with turbid subretinal fluid that is hyper-reflective.

Ancillary Testing:

The diagnosis of rhegmatogenous RDs is made on clinical examination. Tractional and serous RDs may need additional testing based on the underlying pathophysiology. B-scan ultrasonography is critical in the setting of cloudy media.

Management:

Rhegmatogenous RD usually require surgical intervention, with pneumatic retinopexy, vitrectomy surgery or scleral buckling surgery, or a combination of both. Laser demarcation is an option in peripheral rhegmatogenous RD.

The management of tractional and serous RDs depends on their underlying etiology and the location of the detachment in relation to the macula.