Retinal Detachment

A new shower of floaters, change in photopsias, vitreous hemorrhage, or a peripheral visual-field defect warrants prompt assessment for vitreoretinal traction, retinal tear, and retinal detachment. High myopia, trauma, and prior retinal detachment in either eye increase concern.ScienceDirect+1ScienceDirectPosterior Vitreous Detachment - an overviewScienceDirectVitreous Floaters - an overview

Pigment granules in the anterior vitreous (Shafer sign, or tobacco dust) are strongly associated with retinal break in the appropriate symptomatic setting. Relative afferent pupillary defect, reduced visual acuity, mild anterior uveitis, and lower intraocular pressure than the fellow eye may occur in rhegmatogenous retinal detachment but are nonspecific.ScienceDirect+1ScienceDirectPosterior Vitreous Detachment - an overviewScienceDirectPhotopsia - an overview | ScienceDirect Topics

Do not reassure solely on the basis of longstanding floaters. The clinically important change is an abrupt increase in floaters or a change in photopsia pattern, particularly temporal flashes, which may indicate significant vitreoretinal traction.ScienceDirectScienceDirectVitreous Floaters - an overview

Retinal detachment may be rhegmatogenous, tractional, or exudative. Rhegmatogenous detachment occurs when a retinal break permits vitreous fluid to enter the subretinal space. Tractional detachment results from proliferative tissue on the retinal or vitreous surface pulling the neurosensory retina away from the retinal pigment epithelium. Exudative detachment results from subretinal fluid accumulation associated with inflammatory, vascular, or mass lesions.NatureNatureOcular conditions and injuries, detection and management in spaceflight | npj Microgravity

The key immediate ophthalmic distinction in rhegmatogenous disease is whether the macula remains attached. Macula-on status is associated with better postoperative visual prognosis; one cited study found best-corrected visual acuity of 20/40 or better in 83% of patients whose macula remained attached.PubMedPubMedRetinal Detachment - StatPearls - NCBI Bookshelf

Direct visualization with dilated examination remains central. When media opacity or other constraints prevent adequate posterior-segment examination, ocular ultrasound can demonstrate retinal detachment and other pathology, including lens dislocation, intraocular foreign body, choroidal detachment, and globe disruption; it is also used for posterior chamber and orbital pathology in point-of-care settings.Nature+2NatureOcular conditions and injuries, detection and management in spaceflight | npj MicrogravityScienceDirectExaminer Position in Ocular Point-of-Care Ultrasoundpubs rsnaOcular trauma: evaluation with US. | Radiology

For rhegmatogenous retinal detachment, macula-on status, shorter duration of macular detachment, and lower height of macular detachment are associated with better visual prognosis.PubMedPubMedRetinal Detachment - StatPearls - NCBI Bookshelf Visual recovery is generally less favorable after macular involvement. In one cited synthesis, approximately 50% of patients with macula-off detachment achieved 6/15 or better after surgery performed within the first week.PubMedPubMedRetinal Detachment - StatPearls - NCBI Bookshelf

The available evidence summarized in the supplied literature indicates that macula-off detachment repair should occur within the first week and need not invariably be performed within the first 24 hours; however, cases operated within 72 hours may have visual outcomes only marginally worse than macula-on detachments in some reports.PubMedPubMedRetinal Detachment - StatPearls - NCBI Bookshelf These observations should not delay urgent retinal specialist assessment, because detachment extent, progression, break configuration, and local surgical capability alter prioritization.

After repair, recurrent detachment is clinically consequential because it often requires additional surgery and is associated with poorer visual outcomes. Reported recurrence rates vary substantially across studies, from 5% to 37.3%, reflecting heterogeneous populations and operative contexts.PubMedPubMedIncidence and risk factors for recurrence after surgical treatment of rhegmatogenous retinal detachment: a retrospective cohort study

The principal surgical options for rhegmatogenous retinal detachment are pneumatic retinopexy, scleral buckling, and pars plana vitrectomy; combined procedures are used selectively.Nature+2NatureRetinal detachment | Nature Reviews Disease PrimersPubMedScleral Buckling - StatPearls - NCBI BookshelfPubMedPneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis Choice depends on break location and number, detachment configuration, lens status, proliferative vitreoretinopathy, and surgeon clinical judgment and experience.NatureNatureRetinal detachment | Nature Reviews Disease Primers

Pneumatic retinopexy is an option in selected cases. A systematic review and meta-analysis found that pars plana vitrectomy was associated with greater odds of retinal displacement than pneumatic retinopexy, whereas cataract formation and cataract surgery were more frequent after vitrectomy and new retinal tears were more frequent after pneumatic retinopexy.PubMedPubMedPneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis These comparative data support individualized selection rather than a universal preference.

Scleral buckling remains useful in selected situations despite declining procedural frequency relative to vitrectomy.PubMedPubMedScleral Buckling - StatPearls - NCBI Bookshelf Relevant complications include refractive change, diplopia, buckle extrusion or infection, transscleral erosion, cystoid macular edema, epiretinal membrane, and proliferative vitreoretinopathy changes.PubMed+1PubMedScleral Buckling - StatPearls - NCBI BookshelfPubMedScleral Buckling: A Review of Clinical Aspects and Current Concepts

For suspected retinal detachment, document onset and progression of flashes, floaters, field loss, trauma, prior ocular surgery, myopia, prior detachment, visual acuity, pupil findings, and whether central vision appears affected. These data help the receiving ophthalmologist assess probable mechanism, macular status, and urgency.ScienceDirect+2ScienceDirectPhotopsia - an overview | ScienceDirect TopicsScienceDirectVitreous Floaters - an overviewPubMedRetinal Detachment - StatPearls - NCBI Bookshelf

If posterior-segment visualization is limited, ocular ultrasound may support the diagnosis of detachment or identify alternative pathology. It should be interpreted in context and should not substitute for specialist evaluation when symptoms or examination suggest a retinal break or detachment.Nature+2NatureOcular conditions and injuries, detection and management in spaceflight | npj MicrogravityScienceDirectExaminer Position in Ocular Point-of-Care Ultrasoundpubs rsnaOcular trauma: evaluation with US. | Radiology