Retinal detachment

The entity retinal detachment (RD) was recognized early in 18th century by Saint-Yves who described the gross pathologic examination of detached retina. The first clinical description was provided by Beer in 1817, while Coccius was first to detect breaks in detached retina ophthalmoscopically (1851). Theories to explain the etiology of RD were proposed by Von Graefe, Girard-Teulon, Iwanoff, de Wecker at the end of the 19th century.

Retinal detachment (RD) occurs when the neurosensory retina separates from the underlying retinal pigment epithelium (RPE) and fluid accumulates within this potential space.

There are three categories of RD termed rhegmatogenous, exudative and tractional. Rhegmatogenous retinal detachment (RRD) is caused by a break in the retina (including round holes and tears), through which vitreous fluid passes from the vitreous cavity into the subretinal space, thus separating the sensory retina from the RPE. Exudative retinal detachment (ERD), also known as serous RD, occurs when subretinal fluid accumulates without a retinal break. This type of RD is often associated with choroidal tumors and posterior inflammatory diseases. The excessive accumulation of subretinal serous fluid in ERD may shift with changes in body position. Tractional retinal detachment (TRD) occurs when vitreoretinal adhesions or membranes mechanically pull the retina away from the RPE, without a retinal break (Fig. 1). This condition is most commonly associated with proliferative diabetic retinopathy, sickle cell disease, advanced retinopathy of prematurity. Vitreoretinal traction increases with age and frequently causes posterior vitreous detachments (detected in approximately two thirds of persons older than 70 years). Posterior vitreous detachments occur earlier in life in highly myopic eyes. In TRD, retinal breaks may develop secondarily. Combined retinal detachments with features of ERD and TRD may be associated with proliferative diabetic retinopathy or proliferative vitreoretinopathy and trauma.

RDD is also called “primary” detachment. Primary RD refers to i) rhegmatogenous detachment that occurs in a previously uninvolved phakic eye (an eye in which the crystalline lens is present) with no complicating factors such as underlying diabetic retinopathy or penetrating trauma or ii) detachment that occurs after cataract surgery. ERD and TRD are referred to as “secondary” or “non-rhegmatogenous” detachments.
The term “recurrent RD” is used to describe repeated occurrence of the primary detachment, occurrence of new or missed retinal breaks, or overgrowth of the retina by membranes and scar tissue.