Retinal Detachment: Diagnosis, Assessment, and Management

Pathophysiology and Classification

Types of Retinal Detachment

1. Rhegmatogenous Retinal Detachment (RRD)

- Most common form (90% of cases)

- Characterized by retinal breaks allowing vitreous fluid ingress

- Primary mechanisms:

* Posterior vitreous detachment (PVD)

* Lattice degeneration

* High myopia-associated changes

2. Tractional Retinal Detachment (TRD)

- Common in diabetic retinopathy

- Fibrovascular proliferation creating mechanical traction

- No retinal breaks initially present

3. Exudative/Serous Retinal Detachment

- Secondary to inflammatory or vascular disorders

- Fluid accumulation without retinal breaks

- Common in conditions like Coats' disease or choroidal tumors

Diagnostic Imaging and Assessment

Essential Imaging Modalities

1. Wide-field Fundus Imaging

- Critical for documenting extent and characteristics

- Special attention to peripheral retina

- Documentation of macular status

2. OCT

- Crucial for:

* Macular involvement evaluation

* Subretinal fluid quantification

* Post-operative monitoring

- Key features to assess:

* Height of detachment

* Presence of outer retinal corrugations

* Status of photoreceptor layers

3. B-scan Ultrasonography ( Echography B )

- Essential when fundus view is obscured

- Helps differentiate RD types

- Evaluates associated pathologies (PVD, tumors)

Clinical Presentation and Assessment

Key Symptoms to Document

- Photopsia

- Visual field defects

- Shadow or curtain in vision

- Recent onset floaters

- Changes in visual acuity

Essential Clinical Tests

1. Visual Acuity Assessment

- Document best-corrected VA

- Consider pattern of vision loss

2. Visual Field Testing

- Document field defects corresponding to detachment

- Assess peripheral vision integrity

3. Slit Lamp Biomicroscopy

- Anterior segment examination

- Assessment of vitreous status

- Shaffer's sign evaluation

Pre-operative Assessment

1. Documentation Requirements

- Detailed retinal drawing

- Location and characteristics of breaks

- Extent of detachment

- Proliferative vitreoretinopathy (PVR) grading

2. Risk Factor Assessment

- Previous ocular surgery

- Family history

- Systemic conditions

- Fellow eye status

Post-operative Monitoring

Essential Follow-up Elements

1. Early Post-op (1-7 days)

- IOP monitoring

- Position compliance

- Break sealing assessment

- Early complications detection

2. Intermediate (1-4 weeks)

- Visual recovery documentation

- OCT monitoring of macular recovery

- PVR development surveillance

3. Long-term (2-6 months)

- Final visual outcome assessment

- Fellow eye monitoring

- Patient education for future symptoms

Special Considerations

1. High-Risk Patients

- High myopes (>-6.00D)

- Post-cataract surgery

- Fellow eye RD history

- Family history of RD

2. Documentation Pearls

- Standard retinal drawings

- Sequential OCT documentation

- Progression photography

- Visual field changes

Conclusion

As orthoptists, our role in the management of retinal detachment is crucial for both initial detection and follow-up care. Understanding the nuances of different RD types, mastering imaging techniques, and maintaining detailed documentation are essential skills for optimal patient outcomes.

Remember that early detection and prompt referral remain key factors in preserving vision in RD cases. Continuous monitoring and thorough documentation of both pre- and post-operative findings are essential for successful management.

Note : This document serves educational purposes exclusively and does not constitute medical advice or treatment guidelines