Retinal detachment

Slide 1: 

RETINAL DETACHMENT KIRAN RANDHAWA ARMY COLLEGE OF NURSING

Retinal detachment: 

Retinal detachment

RETINAL DETACHMENT: 

RETINAL DETACHMENT DEFINITION –The sepration of retinal pigment layer from sensory layer. Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue.

RPE: 

RPE

Types: 

Types 1.Rhegmatogenous retinal detachment – A rhegmatogenous retinal detachment occurs due to a break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. It is most common form &m risk – myopia or aphakia after cataract surgery

Slide 6: 

2.Exudative, serous, or secondary retinal detachment – An exudative retinal detachment occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break. In evaluation of retinal detachment it is critical to exclude exudative detahment as surgery will make the situation worse not better. Macular degeneration may cause production of serous fluid

contt: 

contt

Types: 

Types 3.Tractional retinal detachment – A tractional retinal detachment occurs when fibrous or fibrovascular tissue, caused by an injury, inflammation or neovascularization , pulls the sensory retina from the retinal pigment epithelium.pulling force or tension is responsible for traction. 4.BOTH Rhegmatogenous & traction RD

Clinical manifestation: 

Clinical manifestation flashes of light ( photopsia ) – very brief in the extreme peripheral (outside of center) part of vision a sudden dramatic increase in the number of floaters a ring of floaters & no pain associated with RD the impression that a curtain was drawn over the field of vision straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsle grid test) central visual loss

ETIOLOGY: 

ETIOLOGY A minority of retinal detachments result from trauma, including blunt blows to the orbit, penetrating trauma. A retrospective Indian study of more than 500 cases of rhegmatogenous detachments found that 11% were due to trauma, and that gradual onset was the norm, with over 50% presenting more than one month after the inciting injury PREDISPOSING FOCTOR – Aging Cataract extraction Degeneration of retina Trauma Severe myopia Family history

Prevalence: 

Prevalence The risk of retinal detachment in otherwise normal eyes is around 5 in 100,000 per year. Detachment is more frequent in the middle-aged or elderly population with rates of around 20 in 100,000 per YEAR Retinal detachment is more common in those with severe myopia , as their eyes are longer and the retina is stretched thin. The lifetime risk increases to 1 in 20. Retinal detachment can occur more frequently after surgery for cataracts. The estimated of risk of retinal detachment after cataract surgery

Surgical procedure: 

Surgical procedure Scleral buckling surgery is probably the most commonly required procedure for repair of retinal detachment. In this procedure, a soft silicone band is placed around the eye to bring two retinal layers in contact with each other. The buckle is much like a belt around one's waist. It is kept in place with tiny sutures to the sclera of the eye. In many cases, the vitreo-retinal surgeon drains the fluid under the retina at the site of the retinal detachment, and then seals the hole (or holes) with laser or cryotherapy .

Scleral buckling: 

Scleral buckling

Viterectomy: 

Viterectomy In some cases, a vitrectomy is also necessary for repair of a retinal detachment. In this procedure, the vitreous humor is removed from the eye with an instrument known as a vitrector . safely remove the vitreous while replacing it with saline. Laser photocoagulation or cryotherapy are still typically used if a retinal hole or tear is present, and in some cases, a special fluid known as Perfluoron may be used to help push the retina back into position. A scleral buckling procedure may also be combined with the vitrectomy for certain types of retinal detachment. In traction retinal detachment it is performed in which 1- 4 mm incision made .incision allow introduction of light source & for instrument.

viterectomy: 

viterectomy

Laser photocoagulation: 

Laser photocoagulation Out patient procedure with local anesthesia . Laser is used to burn the edges of the tear & stop progression. Laser can seal retina against choroid. Cryopexy – use of nitrous oxide to freeze the tissue behind the retinal tear stimulating scar formation that will seal edges of tear. Out patient procedure under local anaesthesia .

Cont..: 

Cont.. Pneumatic Retinopexy Pneumatic retinopexy is a procedure in which a gas bubble is placed inside the vitreous cavity, either before or after, the retinal hole is treated with laser or cryotherapy (freezing) to help seal the hole permanently. The gas bubble, which must be positioned over the hole, prevents fluid from entering the hole while the retina heals. Ophthalmologists sometimes use the phrase, "put the bubble on the trouble" to describe this aspect of the procedure to patients. Since the positioning of the bubble is dependent on positioning of the patient, pneumatic retinopexy is usually only appropriate for retinal detachments (with holes) in the superior (top) part of the eye

Nursing management: 

Nursing management Educating the patient & providing supportive care helping the patient to cope up with fears & reality of loss of vision & adapt to changes in vision. Promoting comfort- If gas tamponade is used to flatten the retina the patient may have to be specially positioned to make the gas bubble float into the best position . Patient must lie face down or side for days . Teaching about complication – in many cases viteroretinal procedure are performed on an out patient basis , follow up care next day examination & closely monitor . Increase IOP , endopthalmitis , retinal detachment , development of cataract , post operative infection.

CONT..: 

CONT.. Observe eye patch for any drainage Blood in RD surgery is minimal. Serous drainage is seen post operatively Activity restriction may be necessary . IV acetozolomide may be used to reduce increased IOP which is monitored closely during 1 st 24 hrs encourage client to resume regular diet & fluid as tolerated. Post operative eye medication include an antibiotics , steroids combination eye drop to prevent infection & decrease inflammation . Eye patch & eye shield removed next morning. Cycloplegic agents are prescribed to dilate pupil & relax ciliary muscle & decrease discomfort

Cont..: 

Cont.. Warm or cold compress may be applied for comfort several times a day . Insructions – instruct to clean eye with warm tap water using a clean wash cloth Warm compress may be continued at home Eyeshield or glasses to be worn during day Avoid vigrous activities & heavy lifting during immediate post operative period. If air or gas bubble avoid air travelling