Retinal Anatomy
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Transcript of Retinal Anatomy
Dr. Miratashi 1R.D.
Retinal Anatomy
Dr. Miratashi 2R.D.
Posterior Vitreous Detachment(PVD)
Vit: collagen+ hyaluronic acid (mucopolysaccharide)
Loss of gel contractile force defect in posterior vit. Face liquid escape posteriorly
exam: Biomicroscopic, B-scan ultrasonography, OCT
Autopsy study: <10% under age of 50years but 63%over age of 70
Dr. Miratashi 3R.D.
P.V.D.
Patient’s age Aphakia Inflammatory disease Trauma Myopia
Dr. Miratashi 4R.D.
Symptoms of PVD
Flashing lights Floaters Acute PVD have 15% netinal tear PVD with vit. Hemorrhage 50%-70% have
retinal tears PVD without vit. Hemorrhage 10%-12% have
retinal tears
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Dr. Miratashi 6R.D.
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Dr. Miratashi 8R.D.
PVD and Cataract Surgery
66% - 100% PVD ICCE 84% ECCE with open capsule 76% ECCE intact capsule 40%
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Retinal Breaks
Full-thickness defect in the neurosensory retina
Provide access for liquid to enter potential space between sensory retina & RPE Flap or horseshoe tear Giant retinal tear 90 or more Operculated hole Dialysis (ora serrata) Atrophic retinal hole (no traction not R.D) Macular hole
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Dr. Miratashi 11R.D.
Dr. Miratashi 12R.D.
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Dr. Miratashi 14R.D.
Trauma In Eyes
12% are found immediately 30% are found within 1 month 50% are found within 8 months 80% are found within 24 months
Dr. Miratashi 15R.D.
Dr. Miratashi 16R.D.
Lattice Degeneration
6%-10% of general population Is bilateral in1/3-1/2 of affected patients More in myopic eyes Familial predilection Small number of lattice develop R.D.
But 20%-30% of R.D. have lattice
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Histopathology of Lattice
Discontinuity of I.L.M. Liquified vitreous Atrophy of inner layers of retina Condensation and adherence of vitreous at
the margin
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Dr. Miratashi 20R.D.
Aphakia and Psuedophakia
1%-3% have risk of R.D. compare to phakic Should be warned of potential symptoms
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Dr. Miratashi 22R.D.
Fellow eye in patient with R.D.
10% of phakic 20%-36% of aphakic will develop R.D. in second eye
An other risk factor is present prophylactic treatment
Dr. Miratashi 23R.D.
Indication for Treat of retinal tears and holes in symptomatic
patientsHorseshoe tears
Dialysis
Operculated tear
Atrophic hole
Lattice degeneration without horseshoe tears
Almost always
Almost always
Sometimes
Rarely
Rarely
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Dr. Miratashi 25R.D.
Sub Clinical R.D.
Asymptomatic R.D. Fluid extends more than 1DD from the break
but not more than 2DD posterior to the equator
30%will progress to R.D. so treat is recommended
Dr. Miratashi 26R.D.
Retinal Detachment
Rhegmatogenous, most common, rhegma means break
Tractional less common Exudative or secondary
Dr. Miratashi 27R.D.
Dr. Miratashi 28R.D.
Dr. Miratashi 29R.D.
Symptom and Sign of R.D.
Photopsia or floater vision Visual field defect IOP Shafer’s sign (tobacco dust) in vitreous or
anterior segment Corrugated appearance In long standing R.D. P.V.D., fixed folds
Dr. Miratashi 30R.D.
Dr. Miratashi 31R.D.
Dr. Miratashi 32R.D.
Management of R.R.D.
1. Find all breaks
2. Create a chorioretinal irritation around each break Laser Cryo Diathermy
3. Bring the retinal and choroid into contact to close the break
Scleral buckle, pneumatic retinopexy for superior break Vitrectomy in selected cases
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Dr. Miratashi 35R.D.
Anatomic Reattachment
Overall rate is 90% Aphakia and psuedophokia less prognosis Giant tear, PVR, uveitis, choroidal
detachment Posterior break has worst prognosis
Dr. Miratashi 36R.D.
P.V.R.
Cause of failure to repair RPE., glial, other cells an inner and outer
retinal surface forming membrane Contraction fixed fold, new break, reopen
old break A, B, C, anterior, posterior
Dr. Miratashi 37R.D.
Dr. Miratashi 38R.D.
Dr. Miratashi 39R.D.
Post Operative Vision
The status of macula 1week macula detach. 75% obtain 20/70 or
better 1-8 weeks 50% same vision Even with on macula preoperatively post
operation may develop macular edema or pucker
Intra operative complication may also limit visual recovery