retinal anatomy

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Dr. Miratashi 1R.D. Retinal Anatomy

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Retinal Anatomy. Posterior Vitreous Detachment (PVD). Vit: collagen+ hyaluronic acid (mucopolysaccharide) Loss of gel contractile force defect in posterior vit. Face liquid escape posteriorly exam: Biomicroscopic, B-scan ultrasonography, OCT Autopsy study: - PowerPoint PPT Presentation

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Page 1: Retinal Anatomy

Dr. Miratashi 1R.D.

Retinal Anatomy

Page 2: Retinal Anatomy

Dr. Miratashi 2R.D.

Posterior Vitreous Detachment(PVD)

Vit: collagen+ hyaluronic acid (mucopolysaccharide)

Loss of gel contractile force defect in posterior vit. Face liquid escape posteriorly

exam: Biomicroscopic, B-scan ultrasonography, OCT

Autopsy study: <10% under age of 50years but 63%over age of 70

Page 3: Retinal Anatomy

Dr. Miratashi 3R.D.

P.V.D.

Patient’s age Aphakia Inflammatory disease Trauma Myopia

Page 4: Retinal Anatomy

Dr. Miratashi 4R.D.

Symptoms of PVD

Flashing lights Floaters Acute PVD have 15% netinal tear PVD with vit. Hemorrhage 50%-70% have

retinal tears PVD without vit. Hemorrhage 10%-12% have

retinal tears

Page 5: Retinal Anatomy

Dr. Miratashi 5R.D.

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Dr. Miratashi 6R.D.

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Dr. Miratashi 7R.D.

Page 8: Retinal Anatomy

Dr. Miratashi 8R.D.

PVD and Cataract Surgery

66% - 100% PVD ICCE 84% ECCE with open capsule 76% ECCE intact capsule 40%

Page 9: Retinal Anatomy

Dr. Miratashi 9R.D.

Retinal Breaks

Full-thickness defect in the neurosensory retina

Provide access for liquid to enter potential space between sensory retina & RPE Flap or horseshoe tear Giant retinal tear 90 or more Operculated hole Dialysis (ora serrata) Atrophic retinal hole (no traction not R.D) Macular hole

Page 10: Retinal Anatomy

Dr. Miratashi 10R.D.

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Dr. Miratashi 11R.D.

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Dr. Miratashi 12R.D.

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Dr. Miratashi 13R.D.

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Dr. Miratashi 14R.D.

Trauma In Eyes

12% are found immediately 30% are found within 1 month 50% are found within 8 months 80% are found within 24 months

Page 15: Retinal Anatomy

Dr. Miratashi 15R.D.

Page 16: Retinal Anatomy

Dr. Miratashi 16R.D.

Lattice Degeneration

6%-10% of general population Is bilateral in1/3-1/2 of affected patients More in myopic eyes Familial predilection Small number of lattice develop R.D.

But 20%-30% of R.D. have lattice

Page 17: Retinal Anatomy

Dr. Miratashi 17R.D.

Histopathology of Lattice

Discontinuity of I.L.M. Liquified vitreous Atrophy of inner layers of retina Condensation and adherence of vitreous at

the margin

Page 18: Retinal Anatomy

Dr. Miratashi 18R.D.

Page 19: Retinal Anatomy

Dr. Miratashi 19R.D.

Page 20: Retinal Anatomy

Dr. Miratashi 20R.D.

Aphakia and Psuedophakia

1%-3% have risk of R.D. compare to phakic Should be warned of potential symptoms

Page 21: Retinal Anatomy

Dr. Miratashi 21R.D.

Page 22: Retinal Anatomy

Dr. Miratashi 22R.D.

Fellow eye in patient with R.D.

10% of phakic 20%-36% of aphakic will develop R.D. in second eye

An other risk factor is present prophylactic treatment

Page 23: Retinal Anatomy

Dr. Miratashi 23R.D.

Indication for Treat of retinal tears and holes in symptomatic

patientsHorseshoe tears

Dialysis

Operculated tear

Atrophic hole

Lattice degeneration without horseshoe tears

Almost always

Almost always

Sometimes

Rarely

Rarely

Page 24: Retinal Anatomy

Dr. Miratashi 24R.D.

Page 25: Retinal Anatomy

Dr. Miratashi 25R.D.

Sub Clinical R.D.

Asymptomatic R.D. Fluid extends more than 1DD from the break

but not more than 2DD posterior to the equator

30%will progress to R.D. so treat is recommended

Page 26: Retinal Anatomy

Dr. Miratashi 26R.D.

Retinal Detachment

Rhegmatogenous, most common, rhegma means break

Tractional less common Exudative or secondary

Page 27: Retinal Anatomy

Dr. Miratashi 27R.D.

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Dr. Miratashi 28R.D.

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Dr. Miratashi 29R.D.

Symptom and Sign of R.D.

Photopsia or floater vision Visual field defect IOP Shafer’s sign (tobacco dust) in vitreous or

anterior segment Corrugated appearance In long standing R.D. P.V.D., fixed folds

Page 30: Retinal Anatomy

Dr. Miratashi 30R.D.

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Dr. Miratashi 31R.D.

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Dr. Miratashi 32R.D.

Management of R.R.D.

1. Find all breaks

2. Create a chorioretinal irritation around each break Laser Cryo Diathermy

3. Bring the retinal and choroid into contact to close the break

Scleral buckle, pneumatic retinopexy for superior break Vitrectomy in selected cases

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Dr. Miratashi 33R.D.

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Dr. Miratashi 34R.D.

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Dr. Miratashi 35R.D.

Anatomic Reattachment

Overall rate is 90% Aphakia and psuedophokia less prognosis Giant tear, PVR, uveitis, choroidal

detachment Posterior break has worst prognosis

Page 36: Retinal Anatomy

Dr. Miratashi 36R.D.

P.V.R.

Cause of failure to repair RPE., glial, other cells an inner and outer

retinal surface forming membrane Contraction fixed fold, new break, reopen

old break A, B, C, anterior, posterior

Page 37: Retinal Anatomy

Dr. Miratashi 37R.D.

Page 38: Retinal Anatomy

Dr. Miratashi 38R.D.

Page 39: Retinal Anatomy

Dr. Miratashi 39R.D.

Post Operative Vision

The status of macula 1week macula detach. 75% obtain 20/70 or

better 1-8 weeks 50% same vision Even with on macula preoperatively post

operation may develop macular edema or pucker

Intra operative complication may also limit visual recovery