Rhegmatogenous Retinal Detachment

Updated: Feb 24, 2017
  • Author: Lihteh Wu, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Overview

Background

Retinal detachment occurs when subretinal fluid accumulates in the potential space between the neurosensory retina and the underlying retinal pigment epithelium (RPE). Depending on the mechanism of subretinal fluid accumulation, retinal detachments traditionally have been classified into rhegmatogenous, tractional, and exudative.

The term rhegmatogenous is derived from the Greek word rhegma, which means a discontinuity or a break. A rhegmatogenous retinal detachment (RRD) occurs when a tear in the retina leads to fluid accumulation with a separation of the neurosensory retina from the underlying RPE; this is the most common type of retinal detachment.

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Pathophysiology

Vitreoretinal traction is responsible for the occurrence of most RRD. As the vitreous becomes more syneretic (liquefied) with age, a posterior vitreous detachment (PVD) occurs. In most eyes, the vitreous gel separates from the retina without any sequelae. However, in certain eyes, strong vitreoretinal adhesions are present and the occurrence of a PVD can lead to a retinal tear formation; then, fluid from the liquefied vitreous can seep under the tear, leading to a retinal detachment.

A number of conditions exist that predispose to a PVD by prematurely accelerating the liquefaction of the vitreous gel. Myopia, aphakia or pseudophakia, familial conditions, and inflammation are among the common causes. In other cases, retinal necrosis with a retinal break formation occurs; then, fluid from the vitreous cavity can flow through the breaks and detach the retina without there being overt vitreoretinal traction present. This commonly occurs in acute retinal necrosis syndrome and in cytomegalovirus (CMV) retinitis in AIDS patients.

A given amount of vitreoretinal traction will cause retinal tears if the retina is thinner, as in lattice degeneration of the retina.

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Epidemiology

Frequency

United States

According to population-based studies in Iowa by Haimann et al and in Minnesota by Wilkes et al, the annual incidence of RRD is 12 cases per 100,000. [1, 2]

International

Scandinavian studies by Laatikainen et al and Tornquist et al reveal an annual incidence of RRD of 7-10 cases per 100,000. [3, 4]

A Japanese study by Sasaki et al reported an annual incidence of RRD of 10.4 cases per 100,000. [5]

A study from Singapore by Wong et al reported annual incidences of RRD of 11.6 cases per 100,000 in the Chinese population, 7 cases per 100,000 in the Malay population, and 3.9 cases per 100,000 in the Indian population. [6]

A study from Beijing, China, estimated the annual incidence of RRD to be 7.98 cases per 100,000.

The annual incidence of RRD in the Netherlands during 2009 was reported to be 18.2 cases per 100,000 people. The peak incidence of 52.5 cases per 100,000 people was found in persons aged 55-59 years. [7]

In Denmark, the annual incidence of RRD from 2000-2011 was 13.7 per 100,000 people. [8]

Mortality/Morbidity

Visual results depend on the preoperative macular status. Most series report an anatomical success rate of 90-95%. Of the eyes that are successfully reattached, about 50% obtain a final visual acuity of 20/50 or better. In eyes where the macula was attached prior to surgery, as many as 10% have some vision loss despite successful surgery. In most cases, this decrease in vision is caused by cystoid macular edema, epiretinal membrane formation, and macular pucker.

Sex

RRD appears to be more common in males than in females.

Age

Most RRDs occur in persons aged 40-70 years. It is at this time that the syneretic vitreous undergoes separation from the retina.

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Prognosis

A large 2014 study from Europe identified clinical variables associated with surgical failure in RRD. These variables included choroidal detachment, hypotony, grade C1 PVR, 4 detached quadrants, and giant retinal breaks. [9]

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