![]() There are different types of retinal detachments. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately. A retinal detachment is a medical emergency. Symptoms include a sudden or gradual increase in the number of floaters and/or light flashes in the eye or the appearance of a curtain over the field of vision (that is loss of vision in the peripheral field of vision). A retinal tear, hole (or break) can lead to a retinal detachment. If not promptly treated, retinal detachment can cause permanent vision loss. ![]() When the retina detaches, it is lifted or pulled away from its normal position. Prognosis is particularly poor if there is macular involvement and in cases of metastatic and paraneoplastic disease.The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. Acute, self-limited causes of ERD have a favorable prognosis whereas chronic, irreversible causes have a poor prognosis. Prognosis for ERD is highly variable and heavily dependent on etiology. Interventionalįocal laser photocoagulation, cryotherapy, low-dose plaque radiotherapy, photodynamic therapy (PDT) and pars plana vitrectomy (PPV). OtherĮplerenone (mineralocorticoid receptor antagonist) for CSC. Intravitreal bevacizumab (IVB) can be helpful for subretinal fluid exudation due to its anti-angiogenic and anti-permeability properties. Tumor necrosis factor (TNF) alpha inhibitors (etanercept, infliximab, adalimumab), interferon alpha-2, interferon-beta, specific cell inhibitors (rituximab, daclizumab) and receptors antagonists (anakinra, efalizumab). Alternatives to steroids include cyclosporine A, azathioprine, methotrexate, mycophenolate mofetil and infliximab. Intravitreal triamcinolone has also been used. VKH syndrome), common treatment is high dose IV steroids followed by oral steroid taper. Treatment focuses on the underlying pathology causing the fluid buildup.įor ERD caused by non-infectious uveitis (e.g. Unlike rhegmatogenous and tractional detachment which are treated surgically, ERD is generally treated medically. ĭiagnostic vitrectomy is crucial for infectious and neoplastic causes of ERD. Blood tests, X-rays, CT scan, and Magnetic Resonance Imaging can identify systemic correlates that reveal the etiology. Exudative detachment looks smooth compared to a jagged, rhegmatogenous detachment.įluorescein angiography, Indocyanine green angiography (ICGA), Optical Coherence Tomography and echography aid in diagnosis. The fluid shifts with gravity and can change location according to patient position. ERD can appear as shifting fluid beneath the retina. Slit-lamp examination, dilated fundoscopy, and indirect ophthalmoscopy with scleral depression should all be performed. Some patients report a progressive, fluctuating loss of peripheral vision. Diagnosisĭiagnosis of ERD begins with a detailed history and ophthalmic exam.ĮRD may develop from localized ocular disease or as a manifestation of wide-spread systemic disease and thus a thorough ocular and medial history is required. The inner blood-retina barrier (iBRB) is composed of tight junctions in between cells of the retinal endothelium whereas the outer blood-retina barrier (oBRB) is composed of tight junctions between cells of the RPE. The BRB has an inner and outer component. However, pathologies that disrupt the integrity of the blood-retina barrier (BRB) can cause leakage of fluid that enlarges the subretinal space and separates the sensory retina from the RPE resulting in retinal detachment. The subretinal space, a remnant of the embryonic optic vesicle, is practically nonexistent in a healthy eye. Acute Paraneoplastic Polymorphous Vitelliform Maculopathy (AEPPVM).Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP).Idiopathic Macular Telangiectasia (IMT).Hemolytic Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP).Coats' Disease (Retinal Telangiectasis).Familial Exudative Vitreoretinopathy (FEVR).Retinal Astrocytic Hamartoma (Tuberous Sclerosis).Amelanotic choroidal melanoma with serous retinal detachment
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