Proliferative Retinal Detachment Clinical Presentation

Updated: Sep 26, 2017
  • Author: Steve Charles, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Presentation

History

History findings include the following:

  • Visual loss in the part of the visual field corresponding to the initial area of retinal detachment (chief complaint)

  • Field loss - Shadows, loss of portions of the visual field

  • Light flashes

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Physical

Retinal examination using binocular indirect ophthalmoscopy reveals the following:

  • Retinal detachment

  • Combination of star folds, fixed folds, subretinal proliferation, and vitreous contraction [16] - In some patients, the vitreous contraction component predominates, whereas in other patients, the periretinal proliferation is more apparent. Subretinal proliferation can be annular (napkin ring), placoid, or dendritic (bands, strands). Hypocellular vitreous contraction can involve circumferential fibers, radial pre-equatorial fibers, and contracted anterior and posterior vitreous cortex. [2, 3]

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Causes

Retinal breaks directly or indirectly cause most cases of proliferative vitreoretinopathy. Direct causation is a result of the loss of contact inhibition of retinal glial cells and RPE cells. Proliferative vitreoretinopathy may also result from cryopexy, diathermy, and laser retinopexy, especially if excessive. Repeated retinal surgery increases the risk for development or worsening of proliferative vitreoretinopathy.

Gas and silicone may contribute to proliferative vitreoretinopathy by sequestrating RPE, inflammatory, and glial cells; fibronectin; various cytokines; and fibrin at the retinal surface.

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