Treatment of retinal detachment

Abstract

This chapter serves primarily as a guide to the causative pathology and the secondary disturbances that are encountered when an enucleated eye is submitted with a clinical history of "Retinal detachment - treatment unsuccessful." Retinal detachment may be "Rhegmatogenous" which occurs when fluid passes from the vitreous cavity through a hole in the retina into the "subretinal space." The "hole" or "tear" is most commonly secondary to degenerative disease in the retina and vitreous. By contrast, "exudative" detachment refers to accumulation of fluid under the neural retina in situations in which there is abnormally excessive permeability in the retinal vessels or in the choroidal vessels. This process is encountered in inflammation or neoplasia and in retinal or choroidal vasculopathy with loss of endothelial cell integrity, and in this event the subretinal space is filled with a more viscous proteinaceous exudate. "Tractional" detachment occurs when there is condensation or organization of the vitreous, by trauma or neovascularization. In the treatment of retinal detachment there are basically two lines of approach to sealing off a hole in the retina after subretinal fluid has been drained either by indenting the sclera and choroid so that the retinal hole is sealed or by replacing the vitreous with a bubble of silicone oil, or inert gas. The pathological effects at these attempts at treatment are commonly seen in globes enucleated for retinal detachment.