- Jorge G Arroyo, MD, MPH
Jorge G Arroyo, MD, MPH
- Associate Professor of Ophthalmology
- Retina Service, Beth Israel Deaconess Medical Center
The retina is a multilayer of exquisitely organized neurons that line the back of the eye (picture 1 and picture 2). It is designed to convert photons into neural impulses that travel along the visual pathways to the visual cortex. The retinal photoreceptors are some of the most metabolically active cells in the body. They line the outer portion of the neurosensory retina and their outer segments are in contact with the retinal pigment epithelia and underlying choroid. The choroidal circulation has the highest blood flow rate per cubic centimeter of tissue in the human body and provides a critical supply of oxygen to the outer third of the neurosensory retina and, in particular, to the retinal photoreceptors.
Retinal detachment occurs when the multilayer neurosensory retina separates from the underlying retinal pigment epithelium and choroid. This separation can occur passively due to accumulation of fluid between these two layers, or it may occur actively due to vitreous traction on the retina, such as with diabetic traction retinal detachment.
Separation between the neurosensory retina and the underlying choroidal circulation results in ischemia and rapid and progressive photoreceptor degeneration . The amount of photoreceptor degeneration and loss of vision can be minimized by rapid diagnosis and treatment [2-4]. Without treatment, most symptomatic retinal detachments progress to involve the entire retina and lead to loss of vision.
Understanding the basic pathophysiology involved in the process of retinal tear formation and retinal detachment and understanding the symptoms and signs of the early stages of this process are important in identifying high-risk patients, preventing the development of retinal detachments, and preventing loss of vision.
Retinal detachments can be rhegmatogenous (caused by a break in the retina; rhegma is Greek for tear) or nonrhegmatogenous (caused by leakage or exudation from beneath the retina [exudative RD] or vitreous traction pulling on the retina [traction RD]). On occasion the retina appears to be detached but is actually not; this is termed pseudo retinal detachment.
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- Rhegmatogenous retinal detachment
- - Posterior vitreous detachment
- - Traumatic retinal detachment
- Nonrhegmatogenous retinal detachment
- - Traction retinal detachment
- - Exudative retinal detachment
- Lattice degeneration
- Pseudo retinal detachment
- EPIDEMIOLOGY/RISK FACTORS
- CLINICAL PRESENTATION
- Differential diagnosis
- Posterior vitreous detachment management
- Retinal hole or tear
- Rhegmatogenous retinal detachment
- - Pneumatic retinopexy
- - Scleral buckle
- - Vitrectomy
- Other causes of retinal detachments
- Photoreceptor neuroprotection
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Course, definitions, and pathophysiology
- Risk factors and clinical presentation
- Diagnosis and management