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Burton TC, Haimann MH, 2006;113:2026-2032). This treatment is over 95 percent effective in preventing progression of a retinal tear to retinal detachment17(Figures 4a and 4b). Orbit. This procedure indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Trempe CL. AskMayoExpert. Street DA, 8. Mayo Clinic facts about coronavirus disease 2019 (COVID-19), OurCOVID-19 patientand visitor guidelines, plus trusted health information, Mayo Clinic Health System patient vaccination updates, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, FREE book offer Mayo Clinic Health Letter, Time running out - 40% off Online Mayo Clinic Diet ends soon. Park DW, 1994;101:150313. Brown CK. Campochiaro PA. (B) With aging and other factors, the gel shrinks, exerts a centripetal traction force on the retina (arrows), and eventually separates from the retina, a condition known as posterior vitreous detachment; a fluid-filled space enlarges between the retracting gel and the retinal surface. Prevention is important in the treatment of retinal detachment. Park DW, Sarrafizadeh R, For example, a small detachment in the inferior retina results in a small superior visual field defect, while a large temporal detachment causes extensive nasal field loss. Mayo Clinic is a not-for-profit organization. David DJ. Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. The direct (hand-held) ophthalmoscope is useful to detect an altered red reflex sometimes associated with retinal detachment. Immediate, unlimited access to all AFP content. Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Benson WE. Br J Plast Surg. Accessed Sept. 12, 2018. Irvine AR, Trempe CL. Sipperley JO, Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. Cleary PE, Fixed field defects of variable size occur in patients with retinal vascular occlusion; these patients often have hypertension or other atherogenic diseases, lack acute flashes, floaters, or other risk factors for retinal detachment, and may exhibit flame hemorrhage or arteriolar plaques by ophthalmoscopy. American Academy of Ophthalmology. Podgor MJ, Marden D. Ultrastructure of traction retinal detachment in rhesus monkey eyes after a posterior penetrating ocular injury. Arch Ophthalmol. Deformation of the globe under high-speed impact: its relation to contusion injuries. What will determine whether I should plan for a follow-up visit? Ruby AJ, The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments. Dugel PU, Visual loss from a transient ischemic attack may be unilateral, but is episodic, not persistent or progressive as in cases of retinal detachment, and may be accompanied by other neurologic symptoms. A single copy of these materials may be reprinted for noncommercial personal use only. National outcomes of cataract extraction. Make a donation. Retinal detachment is relatively uncommon, affecting only one in 10,000 people per year, or approximately one in 300 patients in the course of a life-time.1 Retinal detachment often is repaired with little or no vision loss; therefore, it is a much less significant cause of irreversible blindness than other retinal diseases, such as diabetic retinopathy and macular degeneration.2 Retinal detachment should be considered in the differential diagnosis of vision loss, however, because it is more prevalent in defined subpopulations and may require urgent surgical repair. 1998;17:416. 24. When the retina tears, blood and retinal pigment epithelium cells may enter the vitreous cavity and are perceived as floaters (Figure 2c). et al. Shrinkage and detachment of the vitreous are accelerated, and increase the risk of development to retinal tears. Choose a single article, issue, or full-access subscription. If silicone oil was used, it may be surgically removed months later. A patient may present with one or more of these types. Cleary PE, / Journals Retinal detachment can also develop from holes in the peripheral retina which develop in areas of retinal thinning. 1994;101:1005. Hilton GF. (A) The vitreous gel evenly fills the vitreous cavity and is adherent to the retinal surface. Cataract Patient Outcomes Research Team. Schedule your appointment now for safe in-person care. / afp If I need surgery, how long will recovery take? Creating a comfortable environment for people with low vision. There exists a Have any of your family members ever had a retinal detachment? Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. Medical Malpractice Defense Verdict in a Case of Retinal Detachment . Retinal detachment. 1996;80:68993. Flynn HW Jr, If the central macula has not yet detached when the repair is achieved, visual acuity equal to preretinal detachment levels can be expected. B-mode ocular ultrasound. Retinal detachment occurs in approximately 1 percent of patients in the weeks to years following cataract surgery.8, Inflammation (sarcoid uveitis), severe acute hypertension, neoplastic tumors. 9. Smiddy WE, Hilton GF. Retinal detachment. Address correspondence to Ray F. Gariano, M.D., Ph.D., Stanford University School of Medicine, Department of Ophthalmology, 300 Pasteur Dr., A157, Stanford, CA 94305 (e-mail: The authors indicate that they do not have any conflicts of interest. Early intervention facilitates prevention of retinal detachment after formation of retinal breaks and improves visual outcomes of retinal detachment surgery. Hyaluronic acid content in the developing and aging human liquid and gel vitreous. 25. The retina, the layer of tissue in the back of the eye, pulls away from tissues supporting it. 1987;1pt 2:25462. Marin MI, Pediatric retinal detachment accounts for up to 5.9% of all rhegmatogenous retinal detachments (RRD). An alternative means to relieve vitreoretinal traction is to remove the vitreous humor. It occurs when the retina develops a hole or tear and the vitreous seeps between the retina and choroid. Flynn HW Jr, Have you had any symptoms in your other eye? Jacobsen J, Seventeen eyes with retinal detachment secondary to retinal breaks in the colobomatous area were managed by vitrectomy procedures. et al. Early treatment can help prevent permanent vision loss. Andersen TF, Draining and replacing the fluid in the eye. Michels RM. Accessed Sept. 12, 2018. Arroyo JG. Surgical management Laser photocoagulation: It seal retinal break by creating an inflammatory reaction to causes a choriretinal adeshion or scar. Silicone Study Report 2. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. However, if the central macula is detached at the time of repair, final visual recovery may vary from none to nearly complete, depending on the duration and degree of elevation of macular detachment and the patient's age. Olsen KR, Sudden changes, including eye floaters and flashes and darkening side vision, are signs this may be happening. Lean JS, 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Facts about retinal detachment. This site complies with the HONcode standard for trustworthy health information: verify here. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Therefore, surgical repair is indicated more urgently in patients with preserved central acuity, less urgently in patients whose macula detached in the previous hours to days, and routinely in those whose macula has been detached for several days or weeks. Retinal detachment: diagnosis and management. Trott JA, Tejero TR, 11. An updated classification of retinal detachment with proliferative vitreoretinopathy. At the moment of impact, rapid compression and decompression of the globe may generate sufficient vitreoretinal traction to produce retinal tears.11 Alternatively, retinal detachment may occur weeks, months, or even years after trauma because vitreous contraction is accelerated by inflammatory and blood-borne mediators that access the vitreous cavity at the time of injury.12 Despite these concerns, retinal detachment rarely follows head and periocular trauma,13,14 and fundus examination is warranted only if visual symptoms or external or radiographic evidence of ocular injury are present. The symptoms of retinal detachment often come on quickly. Byer NE. Ophthalmology. Exudative (or serous) retinal detachment results from the accumulation of serous and/or hemorrhagic fluid in the subretinal space because of hydrostatic factors (e.g., severe acute hypertension), or inflammation (e.g., sarcoid uveitis), or neoplastic effusions. American Society of Retina Specialists. 2002;109:14652. Floaters caused by acute posterior vitreous detachment, especially in the presence of a retinal tear, occur more abruptly and dramatically than do the floaters that people experience for much of their lifetime. Ophthalmology. et al. Softing Hataye AL (expert opinion). *Atrophic retinal lesions are designated by descriptive terms such as lattice degeneration. Guo H, Ophthalmology. Do they require any special preparation? 1969;8:290301. Am J Ophthalmol. Schepens CL, It is quick and is usually done under topical anesthesia. Classification and Management of Retinal Detachment, Caused by previous retinal detachment, surgery, trauma, or proliferative retinopathy, Atrophic retinal lesions are designated by descriptive terms such as lattice degeneration, Differential Diagnoses of Retinal Detachment, PVD = posterior vitreous detachment; PDR = proliferative diabetic retinopathy; CVA = cerebrovascular accident; BRVO = branch retinal vein occlusion; BRAO = branch retinal artery occlusion, Guidelines for Referral to an Ophthalmologist. Khawly JA, Retinal detachment may be treated with a variety of surgical techniques, which aim to close any retinal tears or holes, reduce vitreous traction, and reattach the retina to provide permanent adhesion between the retina and retinal pigment epithelium. We review the literature related to the management of this disease. Haimann MH, Aaberg TM, Gass JD, Silicone Study Report 2. Sources of funding: none reported, The authors thank Steven A. 12. The authors thank Steven A. Synchysis senilis and posterior vitreous detachment. Wheeler NC. Pathogenesis of rhegmatogenous retinal detachment. Schien O, In the left eye, there was a posterior vitreous detachment with vitreous hemorrhage. Associated injuries in facial fractures: review of 839 patients. Retinal detachment is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of sub-retinal fluid and loss of retinal function. 10. Gottlieb MS, (D) As liquid vitreous passes through the break (curved arrow), it dissects the retina from the underlying retinal pigment epithelium, resulting in retinal detachment. Lam LK, *Caused by previous retinal detachment, surgery, trauma, or proliferative retinopathy. Associated injuries in facial fractures: review of 839 patients. Lim LH, This content is owned by the AAFP. In North America, most retinal detachment surgeries are performed by retinal specialists. The doctor may use an instrument with a bright light and special lenses to examine the back of your eye, including the retina. American Foundation for the Blind. Retinal detachment: diagnosis and management. In this procedure, called pneumatic retinopexy (RET-ih-no-pek-see), the surgeon injects a bubble of air or gas into the center part of the eye (the vitreous cavity). Cox MS. In cases where severe photophobia, periorbital edema, or opacity (e.g., cataract, intraocular blood) preclude ophthalmoscopy, ophthalmic ultrasonography is superior to magnetic resonance imaging and computed tomography for revealing occult retinal detachment (Figure 3). Within one week, sooner if the floaters worsen. Invest Ophthalmol Vis Sci. Foos RY, You may need to hold your head in a certain position for up to several days to keep the bubble in the proper position. Injecting air or gas into your eye. Freeman HM, Hartz AJ, Garretson BR, Hainsworth DP, During vitrectomy, the vitreous is removed from the eye and is replaced Your doctor also uses cryopexy during the procedure to repair the retinal break. Campochiaro PA. Wang Q, Retinal detachment. As persons age, this macromolecular network begins to liquefy and collapse, the vitreous shrinks, and vitreo-retinal traction develops.3 Eventually, the vitreous partly separates from the retinal surface, which is known as posterior vitreous detachment (Figure 2b). Cause. Myopia, or nearsightedness, is another leading risk factor for retinal detachment.9 In most patients with moderate or severe myopia, the axial (anteroposterior) length of the eye is greater, resulting in an egg-shaped globe. Byer NE. Bernth-Petersen P, Machemer R, The cumulative probability of RD is estimated at 0.27% during the first year after cataract surgery, and it continues to rise over time in a nearly linear manner to 1.79% at 20 years (Ophthalmology. Williams DF, A careful history helps to distinguish retinal detachment from other conditions with similar symptoms (Table 3). Williams DF, Wang Q, Green, M.D., for helpful comments regarding the manuscript. 22. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. An intravitreal sustained-release triamcinolone and 5-fluorouracil codrug in the treatment of experimental proliferative vitreoretinopathy. St. Louis: Mosby; 1990:9523.

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