Retinal detachment 175

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D: Separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE) and choroid.

A: Proliferative diabetic retinopathy, sickle-cell disease, advanced retinopathy of prematurity and penetrating trauma give rise to tractional and or rhegmato-genous retinal detachment. Tumour growth and inflammation give rise to exudative or serous detachments.

A/R: Associated with myopia, aphakia, pseudophakia, i.e. cataract removal with lens implant, trauma (including previous ocular surgery), congenital malformations, metabolic disorders, vascular disease, vitreous disease or degeneration. ^^

E: Retinal detachment usually occurs in persons aged 40-70 years.

H: Initial symptoms include the sensation of a flashing light (photopsia) accompanied by a shower of floaters. A wavy distortion of objects (metamorphop-sia) may occur if the retina is involved.

Over time, the patient may notice a shadow in the peripheral visual field, which, if ignored, may rapidly involve the entire visual field.

E: Examine closely the visual acuity, visual field, pupil reaction and fundus. Indirect ophthalmoscopy is required.

P: Separation of the sensory retina from the underlying RPE occurs by the following three basic mechanisms: a break in the retina (i.e. rhegmatogen-ous); traction from fibrous membranes on the surface of the retina; or exudation of material into the subretinal space.

_I: Imaging techniques, such as orbital films, CT scans, or MRI, are not necessary to diagnose retinal detachment, but they may be necessary to detect intraocular foreign bodies and tumours. If the retina cannot be visualised because of corneal changes or cataracts, USG is necessary.

M: Surgical: The repair technique is dependent on the type, location and size of the detachment. In scleral buckling a silicone band indents the eye to approximate the retina and RPE. Intraocular repair with vitrectomy may be necessary in complicated tractional and exudative detachments.

Other nonsurgical procedures: The use of intraocular gas to tamponade the detachment, laser therapy and cryotherapy.

_C Loss of vision and blindness.

_P: Ultimate outcome depends upon the time, type of retinal detachment and whether the macula is involved. Prognosis is related inversely to the degree of macular involvement and the length of time the retina has been off. 15% of people with retinal detachments in one eye develop detachment in the other eye.

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