Retinal detachment. Retinoblastoma
Retinal detachment = Displacement of the neurosensory retina from the retinal pigment epithelium
Retinal detachment (Amotio retinae) refers to the detachment of the inner layer of the retina (neurosensory part) from its base, the retinal pigment epithelium. This leads to a loss of function in the lifted portion and to corresponding visual field defects. The most common cause of retinal detachments are cracks or holes in the retina, which can be caused by a glass body lift, for example. To prevent retinal detachment, circular laser coagulation in the immediate vicinity of the retinal defect should be performed when retinal tears or holes are diagnosed. Retinal detachment is an ophthalmological emergency and usually needs to be surgically treated promptly to prevent further detachment of the retina and restore sensory function as much as possible. The prognosis for vision depends mainly on the extent of the amotio (poor in macular involvement) and the length of time until the retina is restored.
Etiology:
Forms of retinal detachment
- Rhegmatogen (due to cracks): most common form, e.g. in the context of an acute, posterior vitreous detachment or traumatic
- Tractional
- Symptoms :
- Photopsia and floaters are absent, visual field defects progress slowly
- Signs:
- Detached retina is concave and breaks are absent, retinal mobility is severely reduced, shifting fluid is absent
- Exudative (due to fluid)
- Caused by a tumor
- Special forms: Falciform (in persistent hyperplastic primary vitreous)
Pathoyphsiology:
- Detachment of the retina by submerging the retina with fluid
- Functional loss of the retina due to impaired metabolic processes
Symptoms of rhegmatogenous retinal detachment:
- Visual field defects
- Flashes of light (photopsias)
- Black spots in the vitreous body due to intravitreal bleeding
- Distorted vision
- Floaters
Signs:
- The detached retina has a convex configuration
- Slightly opaque and corrugated appearance
- Undulates freely with eye movements
- Retinal breaks
- RAPD
- ↓ IOP
Risk factors of rhegmatogenous form:
- Myopia
- Vitreous detachment
- Traumata (Bulbus Contusion)
- Condition after retinal detachment of the other eye
- Family stress
- Condition after cataract surgery
Diagnosis: Ophthalmoscopy
Therapy:
If there are retinal holes or tears and very little local retinal detachment:
- Circular (argon) laser coagulation in the immediate vicinity of the retinal defect
For more extensive retinal detachment:
- Surgical procedure
- Denting procedures
- Cryotherapy
- Replacement of the vitreous
Retinoblastoma:
- The most common primary intraocular tumor in childhood
- Occurring in about 1:20 000 live births - 3% of all childhood cancers