RETINAL DETACHMENT REGMATOGENIC: A REVIEW OF THERAPEUTIC OPTIONS

Abstract

This study provides a comprehensive analysis of rhegmatogenous retinal detachment (RRD), an ophthalmological condition of significant severity that can lead to permanent visual loss if not properly treated. RRD occurs when there is a tear in the retina, allowing vitreous fluid to seep under the neurosensory retina, separating it from the retinal pigment epithelium (RPE). This condition is considered an ophthalmic emergency and requires immediate treatment to prevent the progression of the detachment and irreversible vision loss. The therapeutic approach to RRD is complex and must be adapted to the specific characteristics of the detachment, including its severity, the location of the tears, and the patient’s clinical condition. Various treatment methods are available, each with its own indications, contraindications, and potential complications. Laser retinopexy is one of the techniques used to treat RRD. This method is indicated for early or localized detachments, where the tear is detected early and the detachment area is not extensive. The technique uses laser energy to create a scar around the tear, promoting the adhesion of the retina to the RPE and preventing the progression of the detachment. However, laser retinopexy is not suitable for all cases, especially in extensive detachments, multiple or large tears, where other more comprehensive interventions are necessary. Complications associated with this technique are relatively rare but may include incomplete retinal adhesion and the development of new tears. Another approach is pneumatic retinopexy, which is effective for detachments with localized tears and when the detachment is recent, generally not exceeding 8 hours. This method combines cryotherapy or laser to promote retinal adhesion with the injection of a gas (such as sulfur hexafluoride, perfluoropropane, or perfluoropropane) into the vitreous to tamponade the tear. The success of the technique heavily depends on the correct positioning of the patient’s head, which must be maintained to ensure that the gas presses against the tear. Contraindications for pneumatic retinopexy include advanced glaucoma and air travel, due to the risk of gas expansion. Possible complications are failure to close all tears, migration of the gas to the subretinal space, increased intraocular pressure, and cataract. Scleral buckling is a surgical approach recommended especially for young and phakic patients with retinal tears anterior to the equator. The technique involves placing a silicone band around the eye to create a scleral indentation that relieves vitreous traction and promotes the adhesion of the retina to the RPE. Transscleral cryotherapy is often performed around the tear, and the external indentation provided by the buckle supports the tear. The surgical procedure includes performing a 360-degree conjunctival peritomy to expose the sclera, positioning the extraocular muscles, locating the tear with indirect binocular ophthalmoscopy, and applying cryotherapy. After the buckle is placed, the area is washed with antibiotics, and the conjunctiva is closed with subconjunctival injections of antibiotics and steroids for infection prevention. Contraindications for scleral buckling include detachments with complex posterior locations and advanced PVR. Complications associated with this technique may include scleral perforation, trauma to extraocular muscles, suprachoroidal hemorrhage, ocular hypotonia, and buckle migration or extrusion. Finally, pars plana vitrectomy (PPV) is indicated for more complex cases of RRD, such as multiple tears in different meridians, giant tears, and recurrent PVR. This procedure involves removing the vitreous and applying gas or silicone oil to tamponade the tear. The success of vitrectomy heavily relies on postoperative positioning to allow the gas or oil to float and press against the tear adequately. Contraindications include patients with a high risk of postoperative complications and those with a history of severe complications from previous vitrectomies. Potential complications include iatrogenic tear, iatrogenic cataract, glaucoma, endophthalmitis, and sympathetic ophthalmia, a rare but serious condition that can affect the contralateral eye due to an inflammatory and immune reaction. Treatment choice should be based on the individual clinical context of the patient and the timing of the intervention, which is crucial for treatment success. Studies indicate that surgery performed within 3 days for macula-off detachment results in better visual prognosis, with little difference when surgery is performed after 10 days or one month. Thus, timely and appropriate intervention is fundamental. In summary, the treatment of rhegmatogenous retinal detachment is challenging and requires thorough evaluation and an approach tailored to the individual clinical context of the patient. Understanding the indications, contraindications, and complications of each technique is essential to optimize outcomes and promote the best possible visual prognosis.