What is a Rhegmatogenous Retinal Detachment?
A rhegmatogenous retinal detachment (RRD) is the most common retina emergency with an incidence of 1 in 10,000 individuals per year. RRD occurs when a retinal tear or hole allows fluid to accumulate below the retinal surface, causing the retina to separate from the underlying layers. A retinal detachment is a separation of the neurosensory retina from the retinal pigment epithelium and can lead to vision loss.
Key Takeaways
- Rhegmatogenous retinal detachments are a serious ocular emergency.
- A sudden onset of floaters, flashes of light, or a curtain may indicate a rhegmatogenous detachment.
- Scleral buckles, vitrectomy, and pneumatic retinopexy are treatments for rhegmatogenous detachments.
Understanding Rhegmatogenous Retinal Detachments
Rhegmatogenous retinal detachments (RRD) are caused by the passage and collection of fluid into the retina through a hole or tear. The fluid builds up and causes the retina to pull away from underlying tissues resulting in the loss of the blood supply. RRD can result in a deterioration of one’s peripheral vision and central vision when it involves the macula. Rapid reattachment is required to prevent the eye from further photoreceptor damage and visual loss.
Tractional and exudative are the other two types of retinal detachments. Tractional detachments occur when scar tissue, typically from diabetic retinopathy, grows on the retinal surface causing the retina to pull away from the back of the eye. In an exudative detachment, there are no holes or tears, but fluid accumulates beneath the eye. An exudative detachment may be caused by age-related macular degeneration (ARMD), injury, tumors, or inflammatory disorders.
Risk Factors for Rhegmatogenous Retinal Detachments
Myopia (near-sightedness) and prior cataract surgery are the main risk factors for an RRD. Those in the sixth and seventh decades of life are most affected. It affects men more than women, and white people more than black people. Patients with a history of trauma, eye surgery, eye injury or previous retinal detachment are at an increased risk. Other eye diseases or disorders, including retinoschisis, uveitis and lattice degeneration (retinal thinning) may put a patient at risk.
Rhegmatogenous Retinal Detachment Symptoms
The symptoms of rhegmatogenous retinal detachment include:
- The sudden appearance of many floaters
- Flashes of light
- Blurred vision
- Gradually reduced side (peripheral) vision
- A curtain-like shadow over the field of vision
Diagnosing Rhegmatogenous Retinal Detachments
A rhegmatogenous retinal detachment is diagnosed by an eye doctor during a dilated eye exam.
Rhegmatogenous Retinal Detachment Treatment
The treatment for a rhegmatogenous retinal detachment (RRD) consists of a scleral buckle, removal of the vitreous body (vitrectomy), or a combination of both. Scleral buckle (SB) is the use of a silicone band placed around the eye to reduce traction on the retina caused by the vitreous humor that fills the eye. Pars plana vitrectomy (PPV) eliminates traction on the retina by removing the vitreous, and a pneumatic retinopexy (PR) is used to reattach the retina by holding it back into place with an expanding gas bubble. However, no consensus has been reached on which approach is ideal.
Success rates for RRD repair are in the range of 85% to 90%; however, vitrectomy results in cataracts in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so vision can be preserved. ’Macula-on’ detachments where the fovea is still attached have a better prognosis. ‘Macula-off’ retinal detachments have a worse prognosis even with successful reattachment of the retina.
