Retinal Detachment
Rhegmatogenous retinal detachments (RRDs) are particularly common in myopic eyes, and the pathogenesis as well as theoretical prevention of RRD is intimately related to changes in the myopic vitreous gel. Separation of the cortical vitreous surface from t
- PDF / 481,535 Bytes
- 10 Pages / 595.28 x 790.87 pts Page_size
- 2 Downloads / 211 Views
Retinal Detachment C.P. Wilkinson
18.1
Introduction
The relationship between rhegmatogenous retinal detachment (RRD) and myopia has been recognized since soon after the introduction of the ophthalmoscope [1]. More than half of retinal detachments appear to occur in eyes with some degree of myopia [2], and the risk of retinal detachment is three to eight times greater in myopic eyes than in emmetropic and hyperopic cases [2, 3]. The relationship between risk of detachment and amount of myopia is linear, with 1–3 diopters (D) of myopia being associated with four times increased risk, and greater than 3 D having a tenfold increased risk [2]. The relative risk appears to be higher in relatively youthful eyes than in patients over age 65 [2, 4], presumably due to an increased frequency of prior posterior vitreous detachment (PVD) in the older patients. Retinal detachments remain an important cause of reduced vision, and their prevention has long been considered a worthy goal. However, efforts to accomplish this task have not been particularly successful except in eyes with acute symptomatic horseshoe tears [5]. And to date, there are no Level I evidence-based guidelines regarding the prevention of retinal detachment [6]. Since RRDs always require the presence of retinal breaks and some degree of vitreous liquefaction and usually feature persistent vitreoretinal traction in the region of retinal breaks, changes in the vitreous gel are of critical importance in the pathogenesis of this form of retinal detachment. Still, most efforts to prevent retinal
detachment have involved treatment of visible peripheral retinal lesions, including degenerative lesions such as lattice degeneration and retinal breaks of various types [5–7]. An additional strategy has involved the creation of a 360° peripheral zone of chorioretinal adhesive burns anterior to the equator. This will be described in more detail later, but to date it has not been demonstrated to be of proven value [7], and an effective means of preventing RRD remains an elusive goal. The purpose of this review is to discuss the relatively unique vitreoretinal features of significantly myopic eyes that predispose them to RRD, to examine the results of specific efforts to prevent this problem, and to present a brief review of surgical reattachment methods. Vitreous changes and peripheral vitreoretinal degenerative lesions associated with myopia will be initially emphasized.
18.2
The Myopic Eye: Features Predisposing to Retinal Detachment
Vitreous gel changes and peripheral vitreoretinal degenerative disorders associated with anomalous vitreoretinal adhesions are responsible for most RRDs, and these factors are particularly common in myopic eyes.
18.2.1 Alterations in the Myopic Vitreous Gel C.P. Wilkinson, MD Department of Ophthalmology, Greater Baltimore Medical Center, Baltimore, MD, USA Department of Ophthalmology, Johns Hopkins University, 6569 N. Charles St., # 505, Baltimore, MD 21204, USA e-mail: [email protected]
The usual sequence of vitreous changes that lead
Data Loading...
