Rhegmatogenous retinal detachments

Rhegmatogenous retinal detachment (RD) is defined by fluid accumulation in the subretinal space through retinal tear, inducing separation of the neurosensory retina from the retinal pigmentary epithelium (Fig. 1). 

Primary (idiopathic, rhegmatogeneous) retinal detachment is induced by a retinal tear, followed by penetration of vitreous fluid between the sensoric retina and the pigment epithelium. 

Miotics may cause peripheral retinal tears with subsequent rhegmatogenous retinal detachment. Periodic dilation for peripheral retinal examination can identify these patients. 

Postoperative patients who are found to have symptomatic tears or frank retinal detachment should be referred immediately to a vitreoretinal surgeon for treatment. Repair of a rhegmatogenous retinal detachment involves locating retinal breaks, draining subretinal fluid, and sealing the breaks with cryotherapy, endolaser, or diathermy in conjunction with application of a scleral buckle or sponge or pneumatic retinopexy. 

The most common symptoms reported by patients are changes in color vision and impaired vision. These symptoms can take many forms and include the visual phenomena listed in Box 35-4. A common symptom is snowy vision (objects appear to be covered with frost or snow), and this observation is intensified in brightly illuminated environments. There is also evidence that digoxin may contribute to rhegmatogenous retinal detachment by decreasing the normal adhesion of the retina to the RPE. 

Rhegmatogenous retinal detachment and bitemporal hemianopsia have both been seen in association with chloroquine retinopathy. Bilateral edema of the optic nerve occurred in a woman who took chloroquine 200 mg/day for 2.5 months. Diplopia and impaired accommodation (characterized by difficulty in changing focus quickly from near to far vision and vice versa) also affect a minority of patients (SEDA-13, 806). 

A 29-year-old man with a high degree of myopia developed a rhegmatogenous retinal detachment due to a giant retinal tear following blunt trauma (18). After... 

Anand R, Tasman WS. Non-rhegmatogenous retinal detachment. In Glaser BM, ed. Retina. St. Louis Mosby, 1994 2463-2488. 

The repair of rhegmatogenous retinal detachments. American Academy of Ophthalmology. Ophthalmology 1990 97 1562-1572. 

Hagimura N, Iida T, Suto K, Kishi S. Persistent foveal retinal detachment after successful rhegmatogenous retinal detachment surgery. Am J Ophthalmol 2002 133 516-520. 

Figure 1 Migrating and proliferating cells in the subretinal space, on the retinal surface and undersurface, and in the vitreous cavity following rhegmatogenous retinal detachment.

Drugs have been placed in the intraocular infusate during vitrectomy surgery to repair rhegmatogenous retinal detachment with PVR. This method can produce local delivery of a relatively high drug dose, avoid systemic complications, and minimize additional surgical risk. 

Bonnet M, Fleury J, Guenoun S, Yaniali A, Dumas C, Hajjar C. Cryopexy in primary rhegmatogenous retinal detachment a risk factor for postoperative proliferative vitreoretinopathy Graefes Arch Clin Exp Ophthalmol 1996 234 739-743. 

Heimann H, Bornfeld N, Friedrichs W, et al. Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment [comment]. Graefes Arch Clin Exp Ophthalmol 1996 234 561-568. 

Meredith TA, Aaberg TM, Reeser FH. Rhegmatogenous retinal detachment complicating cytomegalovirus retinitis. Am J Ophthalmol 1979 87 793. 

Freeman WR, Henderly DE, Wan WL, et al. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol 1987 103 527. 

Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis. Am J Ophthalmol 1993 116 713-720. 

Baumal CR, Reichel E. Management of cytomegalovirus-related rhegmatogenous retinal detachment. Ophthalmic Surg Lasers 1998 29 916-925. 

The glycosaminoglycans in the subretinal fluid of rhegmatogenous retinal detachment were characterized (52). The results revealed that hyaluronan alone (HA type) was present in 50% of the eyes. A combination of chondroitin sulfate (chSA) and hyaluronan (chSA type) was present in 15% of the eyes. A combination of dermatan sulfate (DS) and hyaluronan (DS type) was present in 35% of the eyes. Retinal detachment with a demarcation line resulted in subretinal strand formation in the DS-type eyes, while no such formation was seen in the chSA type. Vitreous haze was observed in one eye of the DS type. All eyes with grade C proliferative vitreoretinopathy were the DS type. The eyes with reoperated surgeries were the DS type. The presence of DS may indicate an advanced condition of retinal detachment. 

Subretinal fluid from patients with rhegmatogenous retinal detachment showed hyaluronan in 70% of the eyes examined (54). Other samples showed no hyaluronan but hyaluronidase activity. The hyaluronidase activity in the subretinal fluid increased with the duration of the retinal detachment. 

On the other hand, the maximum tolerated dose of enoxaparin, a low-molecular-weight heparin, during vitrectomy for rhegmatogenous retinal detachment with proliferative vitreoretinopathy and severe diabetic retinopathy was determined (103). The study was able to achieve the 6.0 lU/ml maximum dose in the infusion fluid, and enoxaparin dose escalation did not result in a dose-dependent increase in acute side effects. 

To examine the occurrence of secondary rhegmatogenous retinal detachment after intravitreal bevacizumab injection in patients with Bales disease, clinical records of 14 eyes from 14 patients with Bales disease were reviewed in a retrospective, comparative case series [103 ]. Four patients were recorded as developing secondary rhegmatogenous retinal detachment with retinal breaks localised to the base of fractional retinal bands within 1 week of bevacizumab injection. 

Kumar A, Sehra SV, Thirumalesh MB, Gogia V. Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment secondary to Eales disease. Graefes Arch Clin Exp Ophthalmol 2012 250(5) 685-90. 

Silicone oils have been used as vitreous fluid substitute to treat difficult cases of retinal detachment, such as those complicated with proliferative vitreoretinotherapy, giant retinal tears, and penetrating ocular trauma. The incidence and cause of several visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (SSD) was investigated. 

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