RETINAL DETACHMENT

/ ABLATIO RETINA

Rr

Retinal Detachment

accumulation of SRF accumulates in the potential s

ween the neurosensory layer and the RPE of the reti
separation usually results from a tear

CARA PEMERIKSAAN
RETINA

INDIRECT
OPHTHALMOSCOPY

PEMERIKSAAN DENGAN
LENSA KONTAK

Pathogenetic mechanisms of RD
RHEGMATOGENOUS RD
TRACTION RD

RRD

TRD

COMBINED TRACTIONRHEGMATOGENOUS RD
EXUDATIVE/SEROUS RD

TRRD
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 R

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:

Find and Close the Break

Gonin Rules (1920)

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.