Retinal detachment
Updates to Article Attributes
Retinal detachment is a detachment of the retina proper from the underlying pigmented choroid, and occurs in some settings:
- tractional: inflammatory or post-traumatic fibrous bands in the vitreous; also seen in sickle cell disease
- exudative: fluid accumulating in the subretinal space secondary to hypertension, central retinal venous occlusion, vasculitis, papilledema or tumour (choroidal melanoma)
- post operative: vitreous fluid accumulates in the subretinal space via a hole in the retina (rhegmatogenous RD)
- rhegmatogenous RD: (from rhegma meaning a fissure or fracture) can also be seen in ocular trauma
Pathology
Aetiology
Most common causes of retinal detachment are:
- myopia
- surgical aphakia (cataract removal) and pseudophakia (lens implant)
- trauma, e.g. bungee jumping
Radiographic features
Imaging is usually not required unless a specific underlying cause, such as a metastasis is considered.
Ultrasound
A high frequency, small footprint probe, performed through the closed eyelid provides good detail:
- typically appears on ultrasound as a bright, continuous, smooth and somewhat folded membrane within the vitreous, which is reflective and freely moving on real-time imaging
- movements become less pronounced in long-standing detachments
- when total or extensive, the detached retina has a typical triangular shape with insertion into the optic disc and ora serrata
CT/MRI
The axial imaging has the advantage of imaging the remainder of the orbit as well as the ability to use contrast. The images may show:
- folded membranes with subretinal space fluid (which is usually hyperdense on CT)
- the detachment is limited anteriorly by the ora serrata (compared to the choroidal detachment that is not limited and extends beyond it - see figure 2)
- posteriorly the detachment converges on the optic disc (compared to the choroidal detachment that diverges at the disc - see figure 2)
Differential diagnosis
Treatment and prognosis
Treatment is varied and beyond the scope of this article, but in general, terms requires reattachment of the retina using intraocular gas, lasers, cryotherapy or surgery. Most post treatment CT scan may sometimes show a scleral band that is sometimes used as part of treatment (scleral buckle surgery) 1.
-<strong>exudative:</strong> fluid accumulating in the subretinal space secondary to hypertension, central retinal venous occlusion, vasculitis, papilledema or tumour</li>- +<strong>exudative:</strong> fluid accumulating in the subretinal space secondary to hypertension, central retinal venous occlusion, vasculitis, papilledema or tumour (choroidal melanoma)</li>
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