Ophtalmological Pathology and Medical and Surgical Management in Eye Disease: Retinal Detachment

There are three types of retinal detachment: rhegmatogenous, tractional and exudative. Rhegmatogenous retinal detachment (RRD) is caused by one or multiple retinal tears through which the liquid from the vitreous cavity passes, separating the neurosensitive retina from the retinal pigmented epithelium. The risk factors for RRD are: old age, previous cataract surgery, myopia, positive familial history, peripheral degenerative retinal lesions, RRD in the fellow eye and ocular trauma. The symptoms of RRD are specific, their onset respecting the chronology of pathogenetic events: perception of floaters corresponds to vitreous degeneration and detachment; repetitive and fixed photopsia signals the occurrence of a retinal tear; progressive amputation of the visual field evolves in parallel with the detachment of the retina; visual acuity decreases when the macular retina detaches. The treatment of RRD is surgical and urgent, especially if the macula is on. Two major categories of interventions are used: ab externo (scleral indentation) and ab interno (pars plana vitrectomy). RRD has a good prognosis if it is operated on in time. Tractional retinal detachment (TRD) is caused by tractions exerted by membranes in the vitreous or on the surface of the retina in the context of proliferative retinopathies, of which the most common one is diabetic retinopathy. The decision to operate depends on systemic and ocular factors and the visual prognosis should be discussed with the patient. In exudative retinal detachment, the functioning of the outer blood-retina barrier is disrupted, with the accummulation of fluid under the neurosensitive retina. Treatment addresses the cause.