RETINAL DETACHMENT Demir Baar Professor DB 07 ANATOMICAL

RETINAL DETACHMENT Demir Başar (Professor) DB 07

ANATOMICAL CONSIDERATIONS

NEURONS Photoreceptors Rods &Cones Nuclei Plexiform Bipolars Nuclei Plexiform Ganglion cells Nerve fibers

Rods and Cones External limiting External nuclear External plexiform Internal nuclear Internal plexiform Ganglion cells Nerve fibers Internal limiting

Pigment Epithelium Rods and Cones External limiting External nuclear External plexiform Internal nuclear Internal plexiform Ganglion cells Nerve fibers Internal limiting

TWO MAIN LAYERS Pigment epithelium Neural retina

There are no tissue adhesives between pigment epithelium and neural retina (i. e. fibronectins) WHAT then , KEEPS THE RETINA IN PLACE ?

Equator Patellary fossa IOP Light Optic nerve Hyaloid membrane Equator Lens Vitreus Gel

VARIOUS FORCES PLAY PART. . . Sclera Choroid Epithelial pump (suction power) Pigment epithelium Retina Neural retina Vitreus IOP and WATER STREAM from vitreus to choroid push the neural retina towards the pigment epithelium

WHY DETACHMENT OCCURS? PREDISPOSING FACTORS 1 -VITREUS DEGENERATİON 2 -PERIPHERAL RETINAL DEGENERATION 3 -VITREO-RETINAL ADHESIONS (fibrosis)

VITREUS DEGENERATION

Muscoe volitantes Light Syneresis Shadow

n flo 2. JPG

Syneresis Posterior hyaloid water Vitreus gel

Newtons first law of motion (Law of Inertia) Objects tend to keep on doing what they are doing. An object at rest tend to stay at rest , and an object in motion tend to stay in motion with the same speed and in the same direction

Vitreus collapse and vitreus shock (Photopsia) Posterior hyaloid rupture (Newtons 1 rst law of motion) Drained lagoon Vitreous gel collapsed Water moves behind Detached post. hyaloid

Vitreous traction Vitreoretinal adhesion

LATTICE DEGENERATION

Retinal tractional tear

Pigment epithelium Neural retina Water Tear

VITREUS DEGENERATION + PERIPHERAL RETINAL DEGENERATION + FIBROTIC TRACTION RETINAL TEAR RETINAL DETACHMENT

SIGNS and SYMPTOMS SUBJECTIVE I- Before the onset of retinal detachment (NOT CONSTANT) 1 -Entopsia A-muscoe volitantes (flying objects) B-photopsia (seeing lights that do not exist) II-After the retina is really detached 2 -loss of part of the visual field 3 -deterioration of visual acuity(when macula is involved)

OBJECTIVE 1 -Grey and elevated area(s) in ophthalmoscopy against red fundus reflex 2 -One or more retinal tear(s) in various shapes and locations 3 -Blurred vitreus in some cases, showing the existence of intravitreal hemorhage (due to retinal rupture)

DIAGNOSTIC TOOL OPHTHALMOSCOPY

TREATMENT SURGERY 1 -SCLERAL 2 -TRANSVITRERAL