eMedicine Specialties > Ophthalmology > Retina

Retinal Detachment, Rhegmatogenous: Follow-up

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Aug 2, 2007

Follow-up

Further Inpatient Care

  • Currently, most vitreoretinal surgery is performed as an outpatient procedure.

Further Outpatient Care

  • Depending on the presence or absence of an intraocular gas bubble, the patient will be instructed to maintain a certain head position.

Inpatient & Outpatient Medications

  • Following surgery, most surgeons elect to place the patient on a topical antibiotic for prophylaxis for 7-10 days, a cycloplegic agent (eg, atropine 1%) for about 1 month, and a topical steroid (eg, prednisolone acetate 1%) also for about 1 month. The intraocular pressure is monitored during the postoperative period and treated as necessary.

Deterrence/Prevention

  • The principal cause of a RRD is the formation of a retinal break following a PVD.
    • To prevent a RRD from occurring, one could try to find a way to prevent vitreous syneresis or PVD. So far, no such prevention method is available.
    • Another strategy would be to relieve vitreoretinal traction. Currently, the only known way to do this is through surgery (ie, scleral buckle, vitrectomy). However, the risks of these procedures do not justify their use in the prevention of a RRD.
    • The third strategy is to create chorioretinal adhesions around retinal breaks and other visible predisposing lesions. One must take into account whether other risk factors are present (eg, myopia, fellow eye RRD, family history, previous cataract surgery) and whether the patient is symptomatic. On one hand, asymptomatic patients with visible lesions (eg, lattice) probably have a very low risk of retinal detachment. These patients can be observed without treatment. On the other hand, myopic, pseudophakic patients with a RRD in the fellow eye with visible lesions should be strongly considered for prophylactic treatment.
  • Whether laser treatment is in fact beneficial in preventing a RRD in fellow eyes is not known. However, the adverse effects are minimal and the potential benefits are great. One must caution the patient that despite prophylactic treatment, a retinal tear may still occur. On the other hand, Wilkinson concluded that no conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration.21

Complications

  • PVR is the most common reason for surgical failure.
  • Rubeosis iridis

Prognosis

  • Retinal reattachment surgery has improved over the past few decades. Currently, as many as 95% of patients can have an anatomical success. Visual prognosis depends on whether the macula is attached at the time of surgery. Once the macula is detached, the photoreceptors start to degenerate, impairing the visual recovery. It is believed that only 50% of patients reach a visual acuity of 20/50 or better.

Patient Education

  • Warn patients who experience a retinal detachment of the potential risk to the fellow eye. In phakic eyes, the risk is estimated to be 10-15%. In aphakic or pseudophakic eyes, the risk increases to 25-40%.
  • Instruct patients to seek attention immediately if they start experiencing floaters and/or photopsias.

Miscellaneous

Medicolegal Pitfalls

  • Since most general ophthalmologists do not repair retinal detachments on their own, it is imperative that the patient is referred to a vitreoretinal specialist immediately.
  • When discussing possible cataract surgery or YAG capsulotomy, the risk of retinal detachment must be revealed to the patient.
 


More on Retinal Detachment, Rhegmatogenous

Overview: Retinal Detachment, Rhegmatogenous
Differential Diagnoses & Workup: Retinal Detachment, Rhegmatogenous
Treatment & Medication: Retinal Detachment, Rhegmatogenous
Follow-up: Retinal Detachment, Rhegmatogenous
Multimedia: Retinal Detachment, Rhegmatogenous
References
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Further Reading

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Keywords

rhegmatogenous retinal detachment, RRD, subretinal fluid accumulation, retinal tear, neurosensory retina, retinal pigment epithelium, RPE, vitreoretinal traction, posterior vitreous detachment, PVD, vitreoretinal adhesions

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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