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A Journal on Ophthalmology
Minerva Oftalmologica 2009 June;51(2):79-92
Ratiglia R., Villani E.
Unità Operativa di Oculistica, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Mangiagalli e Regina Elena, Milano, Italia
Retinal detachment (RD) is a separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) with subretinal fluid accumulation. Based on his pathogenesis, RD can be classified as rhegmatogenous, tractional or exudative. Rhegmatogenous retinal detachment (RRD) is due to the presence of retinal breaks, allowing the transition of liquified vitreous into the subretinal space. Symptomatic RRD is treated by surgery: scleral buckling, pars plana vitrectomy and pneumatic retinopexy are the main approaches. Anatomical success has a very high rate, but there are no defined guidelines for the best approach. Transconjunctival sutureless vitrectomy is the most innovative technique in selected cases thanks to an earlier rheabilitation and better comfort for the patient. Tractional retinal detachment (TRD) occurs when retina is pulled off from RPE by tractional forces (preretinal membranes or vitreous band), without retinal tears. TRD is associated with proliferative retinal or vitreoretinal disease, as proliferative diabetic retinopathy. Treatment is represented by surgical removal of the traction through pars plana vitrectomy. Exudative or serous retinal detachment (SRD) is characterized by fluid accumulation in the subretinal space in absence of retinal breaks or tractions. This can occur in a variety of vascular, inflammatory or neoplastic diseases which damage RPE and thereby fluid leaks outside the retinal or choroidal vessels accumulating in the subretinal space. Treatment depends on the pathogenesis. Some resolves spontaneously, while others are treated by surgical (as in Coats disease) or medical approch (as in posterior scleritis).