Rhegmatogenous retinal detachment--an ophthalmologic emergency

Abstract

Background: Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result.

Method: Selective review of the literature.

Results: Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved.

Conclusion: Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.

Figure 1

Schematic diagram of an eye. The anatomical structures are marked by color and/or an arrow. a) Normal eye with intact vitreous body. b) Eye with rhegmatogenous retinal detachment. Vitreous traction causes a tear in the retina through which fluid enters the subretinal space, resulting in detachment

Figure 2a

Macroscopic view of an eyeball opened at both sides. C, Cornea; V vitreous body; E, equator; *, lens (loss of translucency due to fixation process); arrows: margin of anteriorly displaced vitreous (source: Prof. Peter Meyer, Kantonsspital Basel, Switzerland)

Figure 2b

Macroscopic view of an eye with vitreous traction on the retina that has not produced a retinal hole. White arrow: vitreous traction strand; black arrow: point of adhesion of vitreous to retina; *, retinal vessel (source: Prof. Peter Meyer, Kantonsspital Basel, Switzerland).

Figure 3

Sketch of fundus in detachment with a superotemporal U-shaped hole. The arrows indicate the margin of detachment. Blue, area of detachment; red, attached retina; E, equator, Ora, ora serrata; M, macula; P, papilla; *, U-shaped hole exposing the choroid membrane under the retina

Figure 4

Retinal detachment with two U-shaped holes. H, Retinal hole; F, covering flap; *, bridging artery stabilizing the flap at its apex; arrows, hole margins

Figure 5

Sponge under double hole. Owing to cryocoagulation the edge of the hole is whiter than the rest of the retina. From this perspective the sponge, sutured externally onto the sclera, can be seen indirectly as a concavity of the retina

Figure 6

Vitrectomy in retinal detachment.