Ophthalmology Book

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Retinal Detachment

Aka: Retinal Detachment, Detached Retina
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  1. Epidemiology
    1. Incidence (U.S.): one in 10,000 per year
    2. Lifetime risk: 1 in 300 patients
  2. Pathophysiology
    1. Retina detaches from underlying epithelium
    2. Types and associated causes
      1. Exudative or serous Retinal Detachment
        1. Sarcoid Uveitis
        2. Severe Hypertension
        3. Neoplasm
      2. Tractional Retinal Detachment
        1. Fibrosis due to trauma or retinopathy
      3. Rhegmatogenous Retinal Detachment (most common)
        1. Posterior Vitreous Detachment (confers 10-15% risk)
        2. Common age >60 years
  3. Risk Factors
    1. Most common risks
      1. Myopia (Near-sightedness, due to egg-shaped globe)
      2. Eye Trauma
      3. Coagulopathy
      4. Older age (especially age > 60 years)
      5. Prior Cataract surgery (decreases vitreous): 1% risk
    2. Other risk factors
      1. Diabetic Retinopathy
      2. Retinopathy of Prematurity
      3. Congenital Cataracts
      4. Congenital Glaucoma
      5. Retinal Detachment Family History
  4. Symptoms
    1. Acute, painless Vision Loss
      1. Develops peripherally and progresses centrally
      2. Develops over a course of hours or longer
    2. Shadow or curtain sensation falls over affected eye
    3. Unilateral Photopsia (Light Flashes seen)
    4. Metamorphopsia (wavy distortion of vision)
    5. Unilateral increase in n umber of Floaters
  5. Signs
    1. Ophthalmoscope may not show lesion
  6. Differential Diagnosis
    1. See Floaters (Entopsias)
    2. See Flashing Lights (Photopsias)
    3. See Acute Vision Loss
  7. Imaging
    1. Ophthalmic Ultrasonography
      1. Indicated if Ophthalmoscopy is non-diagnostic
  8. Management
    1. Immediate ophthalmology referral
    2. Procedures
      1. Scleral buckling
      2. Posterior vitrectomy
      3. Pneumatic retinopexy
  9. Prognosis (with surgical repair)
    1. Good prognosis unless central macula involvement
  10. Complications
    1. Proliferative vitreoretinopathy
      1. Fibrosis forms within weeks of repair
  11. Prevention
    1. Sports Eye Protection
    2. Posterior Vitreous Detachment
      1. May require laser "tacking" of Retina
      2. Aggressively follow patients with new onset
      3. Higher risk if increase in Floaters present
  12. References
    1. Banker (2001) Ophthalmol Clin North Am 14(4):695-704
    2. Gariano (2004) Am Fam Physician 69:1691-8

Retinal Detachment (C0035305)

Definition (NCI) An eye emergency condition which may lead to blindness if left untreated. It is characterized by the separation of the inner retina layers from the underlying pigment epithelium. Causes include trauma, advanced diabetes mellitus, high myopia, and choroid tumors. Symptoms include sudden appearance of floaters, sudden light flushes, and blurred vision.
Definition (NCI) A disorder characterized by the separation of the inner retina layers from the underlying pigment epithelium.
Definition (MSH) Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12).
Definition (CSP) separation of the inner layers of the retina from the pigment epithelium.
Concepts Disease or Syndrome (T047)
MSH D012163
ICD9 361.9
ICD10 H33.2
SnomedCT 42059000, 155103005, 193347002
English RETINA DETACHMENT, Detachment, Retinal, Detachments, Retinal, Retinal Detachments, Unspecified retinal detachment, RETINA, DETACHMENT, DETACHMENT RETINAL, RETINA, SEPARATION, RETINAL DETACHMENT, retina detachment, Retinal detachment, NOS, Retinal detachment NOS, Retina Detachment, Sensory retinal detachment, RETINA, CONGENITAL NONATTACHMENT OF, Retinal Detachment, retinal detachment, retinal detachment (physical finding), detached retina, retinal detachment (diagnosis), Detachment retinal, Retinal detachment NOS (disorder), RETINA, DETACHED, DETACHED RETINA, Retinal Detachment [Disease/Finding], retinal detachments, Detachment;retinal, retina detached, Retinal detachment, RD - Retinal detachment, Detached retina, Retinal detachment (disorder), detachment; retina, retina; detachment, Amotio retinae
German NETZHAUTABLOESUNG, Abloesung der Netzhaut, abgeloeste Netzhaut, unspezifische Netzhautabloesung, Amotio retinae, Netzhautabloesung, Ablatio retinae, Netzhautablösung
Italian Distacco retinico, Distacco di retina, Distacco retinico non specificato, Distacco della retina
Dutch amotio retinae, niet-gespecificeerde retinaloslating, losgelaten retina, loslating retina, Netvlies loslating, loslating; retina, retina; loslating, retinaloslating, Ablatio retinae, Netvliesloslating
French Rétine décollée, Décollement de la rétine (amotio retinae), Décollement rétinien non précisé, DECOLLEMENT DE LA RETINE, Decollement de la retine, Décollement de la rétine, Décollement rétinien
Portuguese Amotio retinae (descolamento da retina), Descolamento da retina NE, Retina descolada, DESCOLAMENTO DA RETINA, Descolamento de Retina, Descolamento da retina, Descolamento do Epitélio Pigmentar da Retina, Descolamento Retiniano
Spanish Desprendimiento retiniano, Desprendimiento de retina no especificado, Amotio retinae, Retinal detachment, RETINA, DESPRENDIMIENTO, desprendimiento de retina (trastorno), desprendimiento de retina, SAI (trastorno), desprendimiento de retina, SAI, desprendimiento de retina, desprendimiento retiniano, Desprendimiento de retina, Desprendimiento de Retina
Japanese 網膜剥離, 詳細不明の網膜剥離, ﾓｳﾏｸﾊｸﾘ, ｼｮｳｻｲﾌﾒｲﾉﾓｳﾏｸﾊｸﾘ
Swedish Näthinneavlossning, NATHINNEAVLOSNING
Czech retina - odchlípení, Odchlípená sítnice, Amotio retinae, Odchlípení sítnice, Blíže neurčené retinální odchlípení
Finnish Verkkokalvon irtauma, VERKKOKALVON IRTOAMINEN
Russian SETCHATKI OTSLOIKA, PIGMENTNOGO EPITELIIA SETCHATKI OTSLOIKA, ПИГМЕНТНОГО ЭПИТЕЛИЯ СЕТЧАТКИ ОТСЛОЙКА, СЕТЧАТКИ ОТСЛОЙКА
Norwegian NETTHINNEAVLOSNING
Danish Nethindelosning
Hungarian retinalevalas, Retina leválás, Levált retina, Nem meghatározott retinaleválás, Retinaleválás, Ideghártya-leválás
Croatian RETINALNA ABLACIJA
Basque ERRETINAREN DESPRENDIMENTUA
Hebrew hafradat rishtit
Polish Odwarstwienie siatkówki
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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