Rhegmatogenous Retinal Detachment

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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.

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.

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]

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.

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

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

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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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: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering; Novartis.

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.

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.

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.

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

Disclosure: Nothing to disclose.

Rhegmatogenous Retinal Detachment

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