Retinal detachment

Definition

Décollement de rétine

This is an emergency eye on (usually operated in the days of diagnosis). It is relatively rare (an ophthalmologist in private practice sees one or two per year)

This is a split in the layers of the fundus. It is thus actually a duplication "intraretinal" more than a real separation "retinal". Importantly, the greater the separation lasts, the more the photoreceptors will degenerate, therefore the more likely consequences will be large where the emergency diagnosis on.

They know some contributing factors:

  • age + +: over the age progresses, the separations are common. In fact three age groups: child (rare but does exist, think of the battered child syndrome) in adults, often short-sighted, the elderly, often operated for cataract.
  • Family history of detachment: Often the fact that myopia is family
  • congenital cysts of the retina: retinoschisis (rare) may progress to retinal detachment 1 in 100
  • ocular trauma: E n case of contusion, it is a direct trauma, violent, and ultimately the risk is low. Disinsertion is pathognomonic of contusions.En cases of perforation (with or without foreign body), the risk is very important against (about 20%). Perforation of the globe are exposed to immediate risk of separation but also late (several years or even decades later). Forensic interest in the case of certificate (accident, assault and battery)
  • aphakia or pseudophakia + + +: all cataract surgery (with or without artificial lens) is a risk of detachment (about 3% within 10 years after). This risk is further increased (multiplied by 2) after YAG laser. This risk is even higher if the subject combines risk factors: myopia especially prior.
  • Myopia + + +: all myopia are at risk (even small so-called simple (<-3.00 diopters). However, the higher the myopia, the greater the risk increases. In the end, given that there are in the population myopia more small than large, it's the little myopia that make the most of retinal detachment! Myopes are predisposed because their glass is pathological (more liquid, so they are more posterior vitreous detachment) and younger ( ^ 40 years to 60 years rather than in the emmetropic) and they have lesions of fragility of the peripheral retina that promote dehiscence. It is therefore necessary to perform an examination of the three glass mirrors looking at any short-sighted especially high myopia, in the research device damage fragility of the retina.

It should also of course also look dehiscence of the retina (holes and tears). If there is damage to fragile and / or dehiscence, then carried out a preventive treatment with laser photocoagulation with argon around the lesions of fragility or dehiscences still flat, before the onset of retinal detachment.

Retinal detachment without dehiscence (1% of cases): Retinal detachment also called "secondary":

tumors of the choroid underlying

  • melanoma (better prognosis than the skin)
  • metastasis of breast cancer especially in women

Retinal detachment in these tumors, there was no dehiscence, the retinal detachment is more fixed (less mobile because the retina is stretched by the underlying tumor), we can see the tumor in the retina GLASS MIRROR 3 (the Melanoma is brown-black, the meta rather red). The diagnosis is made by two exams: the retinal angiography and especially eye-dimensional ultrasound (echogenic mass hyper, at the expense of the choroid, beneath the detached retina).

diabetic retinopathy very advanced (end-stage disease)

The retina is retracted by abnormal blood vessels occurring at the stage of ischemic proliferative retinopathy. Prognosis of said tractional retinal detachment appalling. Same operation (with vitrectomy required to release the traction), a re-application only once on 2 and poor functional outcome anyway. The best thing would have been prevented by photocoagulation of all territories of the argon laser retinal ischemia.

The evolution of retinal detachment will inexorably towards total separation (and the permanent loss of vision) if the subject is not made, the more quickly it is an upper detachment. It is logical that the separations are less diagnostic generally later, as the blackout is over and not annoying in real life, and these separations lower evolve more slowly because of gravity.

Treatment:

1. Preventive + + +: CAPITAL

It preventive photocoagulation argon laser retinal damage fragile (palisade and frost) or retinal dehiscence (that is to say, tears (photo) or holes or disinsertions) occurs before the separation of RETINA.

The laser "burning" the retina and choroid creates a scar adhesion between the retina and underlying choroid. It is done under local anesthesia with anesthetic drops through the GLASS MIRROR 3. It surrounds the lesions in three contiguous rows of spots (duration from 10 to 20 minutes, no pain)

This treatment involved:

  • either as a result of screening directed by the fundus 3 glass mirrors in any regular myopic (once every 2 or 3 years), aphakic or pseudophakic (once a year) or after severe ocular trauma (Fundus immediately if possible, otherwise after a few weeks)
  • be subject to a consultant for symptoms (myodésopsies, phosphenes) that can be a dehiscence still flat

2. Healing

= Emergency surgery is surgery on eye (retinal detachment, especially if higher macula not yet detached) with 3 stages

Pre-operative phase:

  • fairly strict bed rest in a position opposed to the detached retina (eg feet in the air at higher retinal detachment)
  • well we identify all dehiscences during this period of rest (often multiple and microscopic)

Surgery with two goals:

  • create a scar adhesion between retina and choroid at the level of dehiscences by cyroapplication (photo): on "frozen" with a cryoprobe (liquid nitrogen) the responsible dehiscences of retinal detachment (same effect as the adhesive Laser)
  • to the retina flat (bring it in contact with the choroid so that two sheets can join).
  • cause the sclera to the retina: it is the episcleral indentation (for synthetic materials like silicone sponge in the photo).
  • cause the retina to the sclera: injection into the eye of a gas bubble growing (photo).

The healing is done so in about 3 weeks. Rest during this time off with physical activity a few weeks.