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Rhegmatogenous Retinal Detachment (RRD)

Rhegmatogenous Retinal Detachment (RRD)

Introduction

Retinal detachment is a serious problem that usually affects middle-aged or older people. In normal eyes, it occurs at a rate of approximately 5 per 100 000 people per year in the USA. If it isn’t treated immediately, it will lead to vision problems or even vision loss. While there are three major types of retinal detachment, the focus of this article is mainly on Rhegmatogenous retinal detachment, which refers to detachment due to round holes, tears, or breaks in the retina and is an important cause of visual symptoms and visual loss.

Are there other types of retinal detachments than rhegmatogenous?

There are three different types of retinal detachment:

Rhegmatogenous:

A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina.

These types of retinal detachments are the most common.

2- Tractional:

In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

3- Exudative:

Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

How does rhegmatogenous retinal detachment occur?

Rhegmatogenous RD presents as an accumulation of subretinal fluid with one or more retinal breaks. The development of rhegmatogenous detachment typically involves the convergence of three fact ors: posterior vitreous detachment, one or more full thickness breaks in the retina, and the passage of fluid from the vitreous cavity through the retinal breaks into the potential subretinal space. Vitreous currents from eye movements force fluid through these retinal breaks and progressively extend the retinal detachment.

Risk factors that might increase my chances of this happening

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:

  • Are extremely nearsighted
  • Have had a retinal detachment in the other eye
  • Have a family history of retinal detachment
  • Have had cataract surgery (RD occurs at a rate of 5 – 16 per 1000 cases following cataract surgery, and this comprises approximately 30 – 40% of all reported RD)
  • Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
  • Have had an eye injury

The most common worldwide causes associated with retinal detachment are myopia, cataract removal, and trauma. Approximately 40 – 50% of all patients with RD have myopia.

RD related to myopia tends to occur in patients aged 25 – 45 years, while nonmyopia RD tends to occur in older individuals. Patients with high myopia (> 6 D), which is more common in males than females, have a 5% lifetime risk of RD.

How will I know if rhegmatogenous Retinal Detachment is happening?

You may notice that spots or flashes of light have suddenly appeared in your vision. This can mean the vitreous is separating and possibly tearing the retina. Your vision may seem wavy or watery, or you may have a shadow in your side (peripheral) vision. As the retina detaches further, central vision gets blurry. This can lead to serious vision loss unless it is fixed. Sometimes retinal detachment happens suddenly, leading to blindness in one eye. You may also quickly lose sight, if your retina is torn and bleeding into the vitreous.

A detached retina is painless and cannot be seen from the outside of the eye. If you notice symptoms, you should see an ophthalmologist right away. Patients with new symptoms of lashing lights or floaters or with loss of central or side vision should

How does it get repaired? What different methods are available?

If the retina is detached, you will need surgery to fix it. In over 90% of cases, retinal detachment can be fixed successfully. Occasionally, more than one operation is needed. Sometimes the ophthalmologist has to drain fluid so the retina can settle onto the back wall of the eye. A silicone band or pressure pad (called a “scleral buckle”) may be put on the outside of the eye to push the back wall of the eye against the retina. Then cryopexy, a laser, or an electric current applied through a needle (called “diathermy”) will be used to seal the tear.

In more complicated cases, a procedure called a “vitrectomy” is done. This involves cutting the vitreous away from the retina and taking it out of the eye. If the retina is shrunken and puckered from scar tissue, it may be necessary to temporarily fill the space with air, gas or silicone oil to push the retina against the back wall of the eye. If gas is used, clear fluid eventually seeps into the vitreous cavity to fill it again. Silicone oil is usually removed from the eye if the retina remains attached.

What are my chances of being either completely blind in that eye or having perfect vision?

The primary aim of the surgery is to re-attach the retina. The vision regained primarily depends upon the 'strength' of retina, which in turn depends upon many factors, especially the duration of detachment. The earlier the surgery is done, the better are the visual results. The vision regained may not be the same as that before the detachment occurred. But in case no surgery is done, the vision is likely to deteriorate further leading to blindness, shrinking and disfiguration of eyeball.

Hence it is important to do the surgery as soon as possible. About 40% of people who have their detachment successfully repaired have excellent vision within 6 months of surgery. The results are not usually as good when the retina has been detached for a long time or when there is a fibrous growth on the surface of the retina. The other 60% of people have various levels of reading and distance vision. If scar tissue develops, the retina cannot always be reattached. In this case, the eye will continue to lose sight and will eventually become blind.

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