What Is Rhegmatogenous Retinal Detachment?

Retinal detachment is the separation of the neuroepithelial layer from the pigment epithelium of the retina. There is a latent gap between the two layers. The fluid retained in the gap after separation is called subretinal fluid. The detached part of the retina cannot sense the light stimulus, resulting in incomplete or missing images from the eye.

Basic Information

nickname

Retinal detachment, retinal detachment, retinal detachment

English name

retina detachment

English alias

detached retina

Visiting department

Ophthalmology

Multiple groups

Adults over 30

Common locations

eye

Common causes

High myopia, retinal degeneration and ocular trauma

Common symptoms

Impaired vision

Contagious

no

Causes of retinal detachment

There are many reasons for retinal detachment. Pore-induced retinal detachment is more common in middle-aged or elderly people, and myopia is most common. Both eyes may develop successively. The causes of the disease include lattice-like and cystic degeneration in the periphery of the retina, vitreous liquefaction and retinal adhesion. These factors are related to age, genetics, trauma and other factors. Traction retinal detachment is more common in proliferative diabetic retinopathy, eye trauma, long-term vitreous hemorrhage, retinal venous inflammation, and multiple retinal detachment and condensation after multiple eye surgery. Exudative retinal detachment is more common in intraocular retinal choroid tumors such as retinal hemangiomas, retinoblastoma, choroid melanoma, and metastatic cancer; inflammations such as uveitis, VKH, choroiditis, and scleritis; pigment epithelial lesions such as bullous Retinopathy, uve membrane leakage syndrome; retinal vascular diseases such as von-Hippel and coats disease; systemic diseases such as pregnancy hypertension, hypertensive retinopathy, and some hematological diseases.

Retinal detachment classification

There are many retinal classification methods. According to the pathogenesis, it can be divided into porogen, traction and exudative retinal detachment. According to the scope of retinal detachment, it is divided into two types: partial and complete. According to its etiology, it is divided into two types: primary and secondary.

Primary retinal detachment

Primary retinal detachment is also called hole-derived retinal detachment. Liquid in the vitreous cavity enters the retina through the retinal pores, causing the separation of neuroepithelium and pigment epithelium. Such patients often have retinal degeneration, atrophy, thinning, or high myopia, vitreous liquefaction, detachment, concentration, and adhesion to the retina due to factors such as high myopia and advanced age.

2. Secondary retinal detachment

The cause of secondary retinal detachment is relatively clear. It is caused by other eye diseases or some systemic diseases, such as exudative retinitis, acute diffuse choroiditis, and pregnancy-induced hypertension retinopathy. A large amount of exudate accumulates in the retina. Down, causing retinal detachment. After ocular trauma or retinal vein inflammation, vitreous hemorrhage, mechanized and proliferated vitreous cords are pulled to pull the retina down. There are also choroidal tumors or subretinal parasites that can lift the retina and cause retinal detachment. Systemic diseases such as diabetic vitreoretinopathy, detachment due to vitreous proliferation pulling the retina.

There are also some special eye diseases caused by retinal detachment, such as congenital choroidal defect, Marfan syndrome, etc., are related to congenital hypoplasia of the fundus.

Retinal detachment clinical manifestations

When the retina is partially detached, a fixed cloud-like shadow appears in the visual field on the opposite side of the detachment. When macular detachment occurs, central vision drops sharply. There are usually aura symptoms before detachment, and flashes occur during eye movements. Due to the opacity of the vitreous body, there are often dark shadows in the field of vision. If the retina is completely detached, the vision is reduced to light or completely lost. Before vision loss, the vision is often deformed, and there is a feeling of tremor during the movement of the eyeball. As the intraocular fluid passes through the pigment epithelium into the choroid, the intraocular pressure is low. The wider and longer the separation, the lower the intraocular pressure. Occasionally there are cases of high intraocular pressure. Small white spots are visible behind the detached retina. When the retina is reset, the subretinal fluid is absorbed and the intraocular pressure can be restored.

Retinal detachment test

With adequate mydriasis, indirect ophthalmoscope combined with scleral depression or slit lamp and contact lens can be used to check the appearance of the omentum. Fundus examination showed that the retina in the detached area lost normal red reflections and turned gray or cyan. Minor tremor. Dark red blood vessels crawl on the surface. The bulging retina looks like hills. The bulge and wide range can cover the optic disc. And there are folds. Flat disengagement. It is often easy to miss a diagnosis without detailed inspection. When the macula is detached. The center of the macula is concave with a red dot. In stark contrast to a nearby gray-white detached retina.

The key to differentiating foramen retinal detachment from secondary retinal detachment is to examine the fundus in detail to find retinal holes that may exist or be covered up. Difficult patients need to find the holes multiple times. The holes are mostly located near the equator, the most common is supratemporal, followed by subtemporal. The nasal side is the least common. A hole in the jagged edge. Mostly below or below the temporal. The hole is often located at the highest point of the retinal detachment or at the periphery of the detachment. The holes can be round, oval, horseshoe-shaped or irregular, with or without cover, and the anterior petals are mostly adhered and pulled by the vitreous. Fissures can also occur in the macula and are one of the types of retinal detachment.

Differential diagnosis of retinal detachment

Retinoschisis

The location of the retinal schizophrenia is located at the lower peripheral fundus. It is a hemispherical ridge, formed by the fusion of cystic degeneration. The inner wall is thin and transparent, and the pigmentation can be near the outer wall edge. Retinoschisis is an absolute dark spot with no activity and no subretinal fluid. If the inner and outer walls are ruptured, it becomes a true hiatus and a hiatal retinal detachment occurs.

2. Solid retinal detachment

Those with high vitreous body are more likely to be misdiagnosed. It can be identified by ultrasound or CT or MRI scans.

3. Vesicular retinal detachment

The disengagement surface is smooth, without wave-like wrinkles, and the fluid under the neuroepithelial layer is clear. It can flow quickly with the change of body position and has no cracks.

4. Grape membrane leakage

That is choroidal leakage, often accompanied by retinal detachment, hemispherical bulge, easy to move with changes in body position, no holes. B-ultrasound showed a spherical bulge of the vitreous cavity, and its liquid dark area.

5. Central serous choroidal retinopathy (referred to as "medium plasma")

"Medium Plasma" itself is also a shallow detachment of the neuroepithelial layer in or near the macula, and is a self-limiting disease that can resolve on its own. Unlike primary retinal detachment, retinal detachment involves macular deformities and micro-vision, which is the same as the "medium pulp" symptom. The surrounding area should be dilated.

Retinal detachment treatment

According to the type and mechanism of retinal detachment, different treatment methods are adopted, and surgery is the main method.

Mainly for the prevention of rhegmatogenous retinal detachment. High-risk factors include high myopia, eye trauma, aging, and other fundus diseases. Check and treat in time, and treat the peripheral retinal lattice-like degeneration, cystic deformation and traction, and those who find the hole should be treated with laser in time. Vitrectomy can be performed early for severe severe proliferative retinopathy.