RETINAL DETACHMENT /

ABLATIO RETINA
Rr
 Retinal Detachment

The accumulation of SRF accumulates in the potential space

between the neurosensory layer and the RPE of the retina.
The separation usually results from a tear
CARA PEMERIKSAAN RETINA
INDIRECT OPHTHALMOSCOPY
PEMERIKSAAN DENGAN LENSA
KONTAK
Pathogenetic mechanisms of
RD

RHEGMATOGENOUS RD RRD
TRACTION RD TRD
COMBINED TRACTION-

RHEGMATOGENOUS RD TRRD

EXUDATIVE/SEROUS RD SRD
 PATHOGENESIS OF
Retinal Detachment
 Mechanisms of normal attachment
of NSR to RPE
Forces of adhesion
• MECHANICAL
• Outside the SRS
• Fluid pressures
• Intraocular
• Choroidal oncotic
• Vitreous
• Inside the SRS
• IPM (interphotoreceptor matrix)
• RPE microvilli-photoreceptors
interdigitations
• METABOLIC
• Oxygenation
• Effect of drugs on RPE fluid transport
activity
RHEGMATOGENOUS RD

• Liquefied vitreous/ syneresis

• Culminates in PVD
(posterior vitreous detachment)
• Tractional forces
• Retinal break

Syneresis  partial PVD  tractional forces on

attached vitreous with eye movements  retinal
break  fluid vitreous into SRS  RD
Pathogenesis of diabetic tractional RD (1)
Antero-posterior
traction RD

Preretinal
haemorrhage
Pathogenesis and Causes of Exudative RD
• Damage to RPE by subretinal disease
• Passage of fluid derived from choroid into subretinal space

1. Choroidal tumours
• Primary
• Metastatic

2. Intraocular inflammation
• Harada disease
• Posterior scleritis

3. Systemic
• Toxaemia of pregnancy
• Hypoproteinaemia

4. Iatrogenic
• RD surgery
• Excessive retinal photocoagulation

5. Miscellaneous
• Choroidal neovascularization
• Uveal effusion syndrome
Basic principle approach to
PRIMARY RETINAL DETACHMENT:
Principles of Retinal Reattachment
 Bring the retina tear into contact with
underlying RPE/the eyewall to close the tear
• Subretinal fluid drainage
• Scleral buckle
• Intraocular gas injection
 Create a chorioretinal adhesion around all
retinal breaks to seal the breaks
• Diathermy
• Cryotherapy
• Photocoagulation
 Release all important vitreoretinal traction
• Scleral buckle
• Vitrectomy
Basic Surgical Approaches :

• Pneumatic Retinopexy
• Scleral Buckling
• Vitrectomy
• Combination procedures
Scleral Buckling declining in popularity, but
still , it remains a valuable procedure in many
instances

• effective technique for the repair of RRD

• Prefer for younger patients
Despite major advances in vitreoretinal surgical techniques
over the past 30 years, relief of vitreoretinal traction remains
the most critical and perhaps the most difficult step in the
surgical management of such diseases.