Imaging Studies

Ultrasound

On certain occasions, the media may not be clear, impairing a thorough retinal examination with the binocular indirect ophthalmoscope. An ultrasound is a useful adjunct in these situations.

Ultra–high-frequency sounds travel to the back of the eye as the probe emits them. Once a structure is contacted by the sound waves, the sound wave is attenuated and reflected back to the probe. The pattern of these waves is specific for certain tissues. Thus, localization and tissue characterization is possible using this technique. Typically, an A scan and a B scan are obtained. For instance, retinal tissue usually shows a large spike in the A scan, reflecting an increased acoustic density of the tissue. The B scan shows a composite picture of the globe and its intraocular contents.

Sometimes, it may be difficult to differentiate a retinal detachment from a thickened, partially detached posterior hyaloid. In this case, A-scan and B-scan findings often overlap. Tissue mobility during scanning may help to differentiate the 2two. Usually, a RRD has a characteristic undulating motion after a sudden saccade, whereas a thickened posterior hyaloid moves in a brisker manner but with less excursion. Results from a B scan are shown below.

This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.

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Fluorescein angiography (FA)

Cystoid macular edema may complicate the postoperative course of an eye that has undergone retinal reattachment surgery. FA is a useful adjunct in helping to diagnose this condition.

Optical coherence tomography (OCT)

Occasionally, certain eyes appear to have complete retinal reattachment, but the visual acuity recovery appears to be incomplete or delayed. OCT helps to reveal subfoveal fluid in these eyes.^[15]Spectral domain (SD) OCT also is used to prospectively study the restoration of the foveal architecture following macular reattachment.^[16]

Electroretinogram (ERG)

When a patient presents with a dense vitreous hemorrhage or a cataract that precludes direct visualization of the retina, an ultrasound of the posterior pole is indicated. Sometimes, differentiating a RRD and a thickened posterior hyaloid that is partially detached using ultrasound is difficult. In these circumstances, an ERG is a useful adjunct in the evaluation of a patient suspected of having a RRD. If a good response from the ERG is obtained, the retina probably is attached. If the electric response from the retina is attenuated to a great degree, the retina probably is detached.

Histologic Findings

During separation of the neurosensory retina from the RPE, the choroidal blood flow to the outer retinal layers is lost. The RPE also loses its ability to modulate the health of the outer segments of the photoreceptors. Initially, the outer segments of the photoreceptors are lost. After successful retinal reattachment, the outer segments may regenerate. As the detachment becomes more chronic, atrophy of the entire photoreceptor layer, cystic degeneration, macrocyst formation, demarcation lines, and even rubeosis iridis may be seen.

Treatment & Management

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Media Gallery

Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
Clinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.
This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.

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Author

Lihteh Wu, MD Ophthalmologist, Costa Rica Vitreo and Retina Macular Associates

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, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Bayer; Quantel Medical, Roche<br/>Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical, Roche.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.