Retinal Detachment

A rhegmatogenous retinal detachment occurs when a full-thickness retinal tear or hole allows liquefied vitreous to pass underneath the neurosensory retina. The retina then lifts away from the retinal pigment epithelium, which normally supports the photoreceptors. Separation disrupts the retina’s blood supply and metabolic support, so untreated detachment can progress toward permanent visual loss. Posterior vitreous detachment is a common precipitant: as the vitreous gel pulls away from the retina, it may create a tear. Ocular trauma, high myopia, and lattice degeneration also weaken the retina or increase traction on it. The detachment may begin peripherally and enlarge toward the macula, the area responsible for detailed central vision. The macula’s status changes the prognosis. A macula-on detachment has not yet involved the central retina and therefore demands particularly rapid repair. A macula-off detachment has already affected central vision and generally carries a poorer visual outcome, but it remains an urgent surgical problem.