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Review
. 2008 May 31;336(7655):1235-40.
doi: 10.1136/bmj.39581.525532.47.

Management of retinal detachment: a guide for non-ophthalmologists

Hyong Kwon Kang  1 , A J Luff
Affiliations
Review

Management of retinal detachment: a guide for non-ophthalmologists

Hyong Kwon Kang et al. BMJ. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 The retina lines the internal surface of the posterior two thirds of the globe. It is thickest around the optic nerve and ends at the ora serrata, 5-7 mm behind the limbus. The macula lies temporal to the optic nerve, bordered by the vascular arcades; the fovea is a depression at its centre that provides fine visual acuity. The outermost layer of the retina contains photoreceptors (rods and cones), loosely attached to the retinal pigment epithelium; they depend on the retinal pigment epithelium and choroid for support. The vitreous completely fills the vitreous cavity and is firmly attached to the retina near the ora serrata, over the optic nerve and macula, along the blood vessels, and around degenerative retinal lesions
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Fig 2 Rhegmatogenous retinal detachment. Hyaluronic acid in the vitreous holds water and keeps insoluble collagen fibrils dispersed in the gel matrix. A—with aging, changes to hyaluronic acid cause pockets of liquefied vitreous, leaving the collagen fibrils to condense into larger fibre bundles, which appear as chronic floaters. B—pockets of liquid vitreous coalesce to form larger spaces. Defects in the vitreous cortex let liquid into the plane between the vitreous cortex and retina, initiating posterior vitreous detachment. C—the collapsing vitreous exerts mechanical traction on the retina and optic nerve, which may be perceived as flashing lights; condensation of the vitreous around the optic nerve may appear as a crescent shaped floater (Weiss ring). Vitreous traction may lead to avulsion of blood vessels or formation of retinal breaks. D—fluid enters the subretinal space through the retinal break and retinal detachment develops
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Fig 3 Management of retinal detachment
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Fig 4 Funduscopic appearance of rhegmatogenous retinal detachment. The patient noticed blurred vision in her left eye three days earlier. A sector of retina is attached superiorly; shallow retinal detachment over the macula and nasally appears pale and featureless owing to the masking of the choroidal pattern. The fovea appears dark against the pallor of detached macula, and the bullous retinal detachment inferiorly appears pale, opaque, and wrinkled. The detachment was caused by a single superotemporal retinal tear
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Fig 5 Surgery for retinal detachment. A—in scleral buckle surgery, the retinal break is treated with cryotherapy or laser therapy, and an explant (usually a silicone band or strip) is sutured on the outer surface of the sclera to indent the wall of the globe. This interrupts the flow of fluid through the break, allowing it to close. Subretinal fluid is drained through a small sclerotomy or left to be absorbed into the choroid. B—the vitrectomy approach involves removing the vitreous through sclerotomies made in the pars plana. Subretinal fluid is drained internally, and laser therapy or cryotherapy is applied around the flattened retinal break. The vitreous cavity is filled with a tamponade (usually gas but occasionally silicone oil) to hold the retina in place while scarring develops around the break. In some cases, pneumatic retinopexy may be less invasive: a bubble of gas is injected into the vitreous cavity, and the patient’s head is positioned to place the bubble on the retinal break; once the retina is flattened, the break can be treated with laser therapy or cryotherapy
See this image and copyright information in PMC

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