Materiały źródłowe

• #1 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  Retinal detachments (RDs) constitute a severe ocular condition that can lead to permanent vision loss. When the neurosensory retina detaches from the retinal pigment epithelium and the choroid, it loses its oxygen and nutrient supply, leading to the death of the tissue. RDs can be classified into rhegmatogenous, exudative, and tractional varieties. Rhegmatogenous RDs are associated with retinal break(s) (rhegma). In tractional RD, there is traction over the retina, which causes detachment of the neurosensory retina from the retinal pigment epithelium. Both rhegmatogenous and tractional RDs usually need surgical correction. On the other hand, exudative RDs occur due to the exudation of fluid between the neurosensory retina and the retinal pigment epithelium due to various causes. Exudative RDs usually need medical therapy or laser.

• #2 Retinal detachment – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/retinal-detachment/

  Detachment of the neurosensory retina, which contains the photoreceptor layer, from the retinal pigment epithelium. […] Disturbed metabolism of the photoreceptor layer leads to loss of retinal function (i.e., vision impairment) […] Separation of the retina from the choroid for more than 12 hours leads to retinal ischemia and retinal degeneration.

• #3 Retinal detachment – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/retinal-detachment/

  Detachment of the neurosensory retina, which contains the photoreceptor layer, from the retinal pigment epithelium. […] Disturbed metabolism of the photoreceptor layer leads to loss of retinal function (i.e., vision impairment) […] Separation of the retina from the choroid for more than 12 hours leads to retinal ischemia and retinal degeneration.

• #4 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Retinal detachment, separation of the neurosensory retina from the underlying retinal pigment epithelium, is a sight threatening condition that is considered one of the few ocular emergencies. […] We briefly review major aspects of retinal detachment and discuss various important contributions in this field, focussing mainly on the pathogenesis of and predisposing factors to retinal detachment, and on the pathologic changes that occur following its development and following various surgical procedures currently used in its management. […] A retinal detachment occurs when the forces of adhesion between the NSR and the RPE are overwhelmed. This can occur by different mechanisms. Regardless of the mechanism, all types of retinal detachment have one characteristic in common, the accumulation of subretinal fluid.

• #5 Pathogenetic Mechanisms of Retinal Detachment | Clinical Gate

  https://clinicalgate.com/pathogenetic-mechanisms-of-retinal-detachment/

  Rhegmatogenous retinal detachments are those arising from one or more full-thickness retinal breaks. The term retinal break refers either to a retinal tear or to a retinal hole. […] The characteristics of a rhegmatogenous retinal detachment are: (1) the existence of abnormal mobility of partially liquefied vitreous gel; (2) tractional forces that can precipitate a retinal break; and (3) the presence of a retinal break that will allow the passage of liquefied vitreous into the subretinal space. […] In retinal detachment, the normal forces maintaining neurosensory retinal attachment to the RPE are overwhelmed by opposing forces causing retinal detachment. The forces maintaining retinal adhesion are discussed in detail elsewhere in the text and include the Na+/K+-ATPase metabolic pump of the RPE, the osmotic pressure of the choroid, and the weaker forces of the interphotoreceptor matrix. The opposing forces include hydraulic dissection caused by the intraocular fluid swirling through the retinal break held open by vitreoretinal traction.

• #6 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  Retinal detachments (RDs) constitute a severe ocular condition that can lead to permanent vision loss. When the neurosensory retina detaches from the retinal pigment epithelium and the choroid, it loses its oxygen and nutrient supply, leading to the death of the tissue. RDs can be classified into rhegmatogenous, exudative, and tractional varieties. Rhegmatogenous RDs are associated with retinal break(s) (rhegma). In tractional RD, there is traction over the retina, which causes detachment of the neurosensory retina from the retinal pigment epithelium. Both rhegmatogenous and tractional RDs usually need surgical correction. On the other hand, exudative RDs occur due to the exudation of fluid between the neurosensory retina and the retinal pigment epithelium due to various causes. Exudative RDs usually need medical therapy or laser.

• #7 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Rhegmatogenous retinal detachment (RRD) is characterized by the presence of a full thickness retinal break as the prefix rhegma, which means rent in Greek, implies. This break is held open by vitreoretinal traction that allows accumulation of liquefied vitreous under the retina separating it from the RPE. […] Traction retinal detachment (TRD) occurs when the retina is pulled off the RPE by tractional forces in the absence of retinal tears. […] Combined traction-rhegmatogenous retinal detachment (TRRD), as the name implies, is the result of a combination of a retinal break and retinal traction. […] Exudative, transudative or serous retinal detachment (SRD) is characterized by fluid accumulation in the subretinal space in the absence of retinal breaks or traction. […] Factors predisposing to TRD and SRD are the disease entities associated with them as discussed above. However, factors predisposing to RRD are less obvious, more difficult to diagnose and, when they exist, the indications for prophylactic treatment are sometimes controversial.

• #8 Pathogenetic Mechanisms of Retinal Detachment | Clinical Gate

  https://clinicalgate.com/pathogenetic-mechanisms-of-retinal-detachment/

  Rhegmatogenous retinal detachments are those arising from one or more full-thickness retinal breaks. The term retinal break refers either to a retinal tear or to a retinal hole. […] The characteristics of a rhegmatogenous retinal detachment are: (1) the existence of abnormal mobility of partially liquefied vitreous gel; (2) tractional forces that can precipitate a retinal break; and (3) the presence of a retinal break that will allow the passage of liquefied vitreous into the subretinal space. […] In retinal detachment, the normal forces maintaining neurosensory retinal attachment to the RPE are overwhelmed by opposing forces causing retinal detachment. The forces maintaining retinal adhesion are discussed in detail elsewhere in the text and include the Na+/K+-ATPase metabolic pump of the RPE, the osmotic pressure of the choroid, and the weaker forces of the interphotoreceptor matrix. The opposing forces include hydraulic dissection caused by the intraocular fluid swirling through the retinal break held open by vitreoretinal traction.

• #9 Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management | BMJ Open Ophthalmology

  https://bmjophth.bmj.com/content/5/1/e000474

  Until the early 1900s, RD was a blinding disorder with unclear pathogenesis; RD was initially thought to represent an exudative process, occurring from choroidal leakage and not caused by retinal breaks. […] The past 80 years of RRD treatment have, therefore, focused on surgical techniques to close or appose the retinal break(s) to the RPE. […] There are no anatomic junctions between the NSR and RPE, but weak mechanical forces are responsible for their adhesion. […] The two prerequisites for the development of RRD are (1) liquefaction of the vitreous; an RRD will not occur without first some degree of liquefaction of the formed vitreous gel that precedes posterior vitreous detachment (PVD), and supplies the low viscosity fluid that is able to flow through retinal breaks, and (2) a retinal break through which fluid gains access into the subretinal space. […] These can take a variety of forms including retinal tears, as well as round retinal holes, usually forming in the context of pre-existing lattice degeneration.

• #10 Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management | BMJ Open Ophthalmology

  https://bmjophth.bmj.com/content/5/1/e000474

  Until the early 1900s, RD was a blinding disorder with unclear pathogenesis; RD was initially thought to represent an exudative process, occurring from choroidal leakage and not caused by retinal breaks. […] The past 80 years of RRD treatment have, therefore, focused on surgical techniques to close or appose the retinal break(s) to the RPE. […] There are no anatomic junctions between the NSR and RPE, but weak mechanical forces are responsible for their adhesion. […] The two prerequisites for the development of RRD are (1) liquefaction of the vitreous; an RRD will not occur without first some degree of liquefaction of the formed vitreous gel that precedes posterior vitreous detachment (PVD), and supplies the low viscosity fluid that is able to flow through retinal breaks, and (2) a retinal break through which fluid gains access into the subretinal space. […] These can take a variety of forms including retinal tears, as well as round retinal holes, usually forming in the context of pre-existing lattice degeneration.

• #11 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  An RRD occurs when a tear, break, or hole presents in the retina. When a break occurs, this may allow vitreous to enter the space underneath the neurosensory retina, causing a detachment from the RPE. The fluid continues to enter underneath the retina so that it peels off from the RPE until the entire posterior retina is detached. For an RRD to occur, the following are needed: A full-thickness retinal break, Liquified vitreous, with or without, Traction over the break. […] TRDs do not include a break in the neurosensory retina. When proliferative membranes are in the vitreous or on the retinal surface, these membranes can pull on the neurosensory retina. When the force is strong enough, it can cause separation of the neurosensory retina from the underlying RPE. […] ERDs also do not involve a break in the neurosensory retina. In these detachments, subretinal fluid accumulates due to fluid exudation from a large lesion, such as a tumor or inflammatory lesion.

• #12 Retinal Detachment: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1224737-overview

  Traction from inflammatory or vascular fibrous membranes on the surface of the retina, which tether to the vitreous […] Exudation of material into the subretinal space from retinal vessels such as in hypertension, central retinal venous occlusion, vasculitis, or papilledema. […] Of the 3 types of retinal detachment, rhegmatogenous RD is the most common, deriving its name from rhegma, meaning rent or break. Vitreous fluid enters the break and separates the sensory retina from the underlying RPE, resulting in detachment. […] Exudative or serous detachments occur when subretinal fluid accumulates and causes detachment without any corresponding break in the retina. […] Tractional retinal detachment occurs as a result of adhesions between the vitreous gel/fibrovascular proliferation and the retina. Mechanical forces cause the separation of the retina from the RPE without a retinal break. Advanced adhesion may result in the eventual development of a tear or break.

• #13 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  An RRD occurs when a tear, break, or hole presents in the retina. When a break occurs, this may allow vitreous to enter the space underneath the neurosensory retina, causing a detachment from the RPE. The fluid continues to enter underneath the retina so that it peels off from the RPE until the entire posterior retina is detached. For an RRD to occur, the following are needed: A full-thickness retinal break, Liquified vitreous, with or without, Traction over the break. […] TRDs do not include a break in the neurosensory retina. When proliferative membranes are in the vitreous or on the retinal surface, these membranes can pull on the neurosensory retina. When the force is strong enough, it can cause separation of the neurosensory retina from the underlying RPE. […] ERDs also do not involve a break in the neurosensory retina. In these detachments, subretinal fluid accumulates due to fluid exudation from a large lesion, such as a tumor or inflammatory lesion.

• #14 Pathogenetic Mechanisms of Retinal Detachment | Clinical Gate

  https://clinicalgate.com/pathogenetic-mechanisms-of-retinal-detachment/

  Rhegmatogenous retinal detachments are those arising from one or more full-thickness retinal breaks. The term retinal break refers either to a retinal tear or to a retinal hole. […] The characteristics of a rhegmatogenous retinal detachment are: (1) the existence of abnormal mobility of partially liquefied vitreous gel; (2) tractional forces that can precipitate a retinal break; and (3) the presence of a retinal break that will allow the passage of liquefied vitreous into the subretinal space. […] In retinal detachment, the normal forces maintaining neurosensory retinal attachment to the RPE are overwhelmed by opposing forces causing retinal detachment. The forces maintaining retinal adhesion are discussed in detail elsewhere in the text and include the Na+/K+-ATPase metabolic pump of the RPE, the osmotic pressure of the choroid, and the weaker forces of the interphotoreceptor matrix. The opposing forces include hydraulic dissection caused by the intraocular fluid swirling through the retinal break held open by vitreoretinal traction.

• #15 Pathogenetic mechanism of Retinal Detachment | PPT

  https://www.slideshare.net/slideshow/pathogenetic-mechanism-of-retinal-detachment/251615958

  5) RHEGMATOGENOUS RD RD d/t one or more full thickness retinal breaks. Most breaks HSTs occurs at sites of strong VR adhesions MC irregular posterior margins of vitreous base during PVD. […] 8) LIQUEFACTION (SYNERESIS) OF VITREOUS With age, Fragmentation of collagen fibres, aggregation of proteoglycans around the fragments. […] 14) TRACTIONAL RD Occurs d/t VR forces which mechanically pull the retina away from RPE. Commonly seen in:- Diabetic retinopathy PVR Penetrating trauma RVO ROP Membranes have Fibroblasts, Glial and RPE cells show a contractile nature. […] 20) EXUDATIVE HEMORRHAGIC RD Collection of SRF secondary to diseases of Choroid, RPE or Retina. RPE pump mechanism- Active transport Creation of osmotic gradient, Hydrostatic forces. Exudative RD when above forces are disrupted. Either damage to RPE or Excess fluid production. […] 23) SUBRETINAL BLOOD MC cause trauma (contusion), POHS, Polypoidal choroidal neovascularization, Subretinal NV membranes Blood toxic to retina and RPE, Displacement of blood using gas bubble in nAMD dec toxicity to photoreceptors.

• #16 Evaluation and Management of Suspected Retinal Detachment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1691.html

  Retinal detachment results when physiologic and anatomic mechanisms of retinal attachment are overcome and the retina separates from the underlying retinal pigment epithelium. […] Retinal detachments are classified into three pathogenetic types. A patient may present with one or more of these types. […] The key pathogenetic steps of rhegmatogenous retinal detachment are illustrated in Figure 2. The vitreous humor is a hydrated gel whose structure is maintained by a collagenous and mucopolysaccharide matrix. As persons age, this macromolecular network begins to liquefy and collapse, the vitreous shrinks, and vitreo-retinal traction develops. […] Rhegmatogenous detachment occurs when liquid vitreous enters the subretinal space through a retinal break and creates a plane of dissection between the retina and retinal pigment epithelium. Over time, the area of detachment increases as more fluid passes through the retinal break.

• #17 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  Rhegmatogenous retinal detachments occur when liquefied vitreous fluid enters the subretinal space through a full-thickness retinal break. […] The mechanism of rhegmatogenous retinal detachments centers on the relationship between the vitreous and the retina. The key event that can predispose an eye to retinal tears and detachment is a posterior vitreous detachment (PVD). With aging, the vitreous becomes syneretic (liquefied) and may detach itself from the retina. This detachment begins posteriorly and progresses anteriorly toward the vitreous base, and it is here that retinal flap tears (horseshoe tears) are commonly located. A retinal flap tear can progress to a retinal detachment because of increased movement of syneretic vitreous fluid though the open break and into the subretinal space. The continued vitreous traction on the anterior flap of the tear facilitates the process.

• #18 Pathogenesis of rhegmatogenous retinal detachment: predisposing anatomy and cell biology – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21060268/

  The pathogenesis of rhegmatogenous retinal detachment is complex, and our knowledge of the exact mechanism of vitreoretinal attachment and detachment remains incomplete. […] The distribution and age-related changes in the structure of these molecules play an important role in the formation of a retinal break, which may compromise and disrupt the normal mechanisms of neurosensory retinal adhesion. […] Rhegmatogenous retinal detachment development is intimately related to changes in the fibrillar structure of the aging vitreous culminating in posterior vitreous detachment with regions of persistent and tangential vitreoretinal traction predisposing to retinal tear formation. A complex interplay of factors such as weakening of vitreoretinal adhesion, posterior migration of the vitreous base, and molecular changes at the vitreoretinal interface are important in predisposing to focal areas of vitreoretinal traction precipitating rhegmatogenous retinal detachment.

• #19 Retinal detachment – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinal-detachment/symptoms-causes/syc-20351344

  Retinal detachment is an emergency situation in which the thin layer of tissue at the back of the eye, called the retina, pulls away from its usual position. […] Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment to the eye. The most common cause of rhegmatogenous detachment is aging. As you age, gel-like material that fills the inside of your eye, called vitreous, may change in texture and shrink or become more liquid. […] As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a tear. Most of the time it doesn’t. But if a PVD causes a tear and the tear isn’t treated, the liquid vitreous can pass through the tear into the space behind the retina. This causes the retina to detach.

• #20 Retinal Detachment Surgery – Retina Doctors in New York

  https://www.vrmny.com/conditions/retinal-tears-and-detachments/

  Some diseases, such as diabetes, cause blood vessels and cells similar to those found in scar tissue to grow into the middle parts of the eye from the retina. […] Contraction of the scar tissue can pull the retina away from the back of the eye. […] Excessive pulling, especially if concentrated to a small area, can cause the retina to tear. Fluid from the vitreous cavity can come in through the hole and accumulate under the retina. […] A complicated net of blood vessels exists under the retina in a structure called the choroid. […] Problems can arise if the vessels in the choroid become excessively leaky. […] The sequence of events leading to a detachment are pulling by the vitreous to create a tear, fluid going under the retina to start the detachment process, and expansion of the detachment over time. […] If proliferative vitreoretinopathy occurs the only option in trying to repair the eye is more surgery. […] The second main reason to have another detachment is a repeat of what caused the detachment in the first place.

• #21 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  Rhegmatogenous retinal detachments occur when liquefied vitreous fluid enters the subretinal space through a full-thickness retinal break. […] The mechanism of rhegmatogenous retinal detachments centers on the relationship between the vitreous and the retina. The key event that can predispose an eye to retinal tears and detachment is a posterior vitreous detachment (PVD). With aging, the vitreous becomes syneretic (liquefied) and may detach itself from the retina. This detachment begins posteriorly and progresses anteriorly toward the vitreous base, and it is here that retinal flap tears (horseshoe tears) are commonly located. A retinal flap tear can progress to a retinal detachment because of increased movement of syneretic vitreous fluid though the open break and into the subretinal space. The continued vitreous traction on the anterior flap of the tear facilitates the process.

• #22 Pathogenetic Mechanisms of Retinal Detachment | Clinical Gate

  https://clinicalgate.com/pathogenetic-mechanisms-of-retinal-detachment/

  Rhegmatogenous retinal detachments are those arising from one or more full-thickness retinal breaks. The term retinal break refers either to a retinal tear or to a retinal hole. […] The characteristics of a rhegmatogenous retinal detachment are: (1) the existence of abnormal mobility of partially liquefied vitreous gel; (2) tractional forces that can precipitate a retinal break; and (3) the presence of a retinal break that will allow the passage of liquefied vitreous into the subretinal space. […] In retinal detachment, the normal forces maintaining neurosensory retinal attachment to the RPE are overwhelmed by opposing forces causing retinal detachment. The forces maintaining retinal adhesion are discussed in detail elsewhere in the text and include the Na+/K+-ATPase metabolic pump of the RPE, the osmotic pressure of the choroid, and the weaker forces of the interphotoreceptor matrix. The opposing forces include hydraulic dissection caused by the intraocular fluid swirling through the retinal break held open by vitreoretinal traction.

• #23 Pathogenetic mechanism of Retinal Detachment | PPT

  https://www.slideshare.net/slideshow/pathogenetic-mechanism-of-retinal-detachment/251615958

  5) RHEGMATOGENOUS RD RD d/t one or more full thickness retinal breaks. Most breaks HSTs occurs at sites of strong VR adhesions MC irregular posterior margins of vitreous base during PVD. […] 8) LIQUEFACTION (SYNERESIS) OF VITREOUS With age, Fragmentation of collagen fibres, aggregation of proteoglycans around the fragments. […] 14) TRACTIONAL RD Occurs d/t VR forces which mechanically pull the retina away from RPE. Commonly seen in:- Diabetic retinopathy PVR Penetrating trauma RVO ROP Membranes have Fibroblasts, Glial and RPE cells show a contractile nature. […] 20) EXUDATIVE HEMORRHAGIC RD Collection of SRF secondary to diseases of Choroid, RPE or Retina. RPE pump mechanism- Active transport Creation of osmotic gradient, Hydrostatic forces. Exudative RD when above forces are disrupted. Either damage to RPE or Excess fluid production. […] 23) SUBRETINAL BLOOD MC cause trauma (contusion), POHS, Polypoidal choroidal neovascularization, Subretinal NV membranes Blood toxic to retina and RPE, Displacement of blood using gas bubble in nAMD dec toxicity to photoreceptors.

• #24 Rhegmatogenous retinal detachment | PPT

  https://www.slideshare.net/slideshow/rhegmatogenous-retinal-detachment/29395048

  It is characterized by the presence of a retinal break held open by vitreoretinal traction. Rhegmatogenous (rhegma break), occurs secondarily to a full-thickness defect in the sensory retina, which permits fluid derived from synchytic (liquefied) vitreous to gain access to the subretinal space. […] Pathogenesis – Dynamic Vitreoretinal traction liquefaction of the vitreous gel hole in the posterior hyaloid membrane Fluid tru defect into retrohyaloid space vitreous gel collapses synchytic fluid in space Detachment of posterior vitreous from ILM Acute PVD […] Common predisposing factors are lattice degeneration and retinal tears caused by vitreous traction.

• #25 Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management | BMJ Open Ophthalmology

  https://bmjophth.bmj.com/content/5/1/e000474

  Until the early 1900s, RD was a blinding disorder with unclear pathogenesis; RD was initially thought to represent an exudative process, occurring from choroidal leakage and not caused by retinal breaks. […] The past 80 years of RRD treatment have, therefore, focused on surgical techniques to close or appose the retinal break(s) to the RPE. […] There are no anatomic junctions between the NSR and RPE, but weak mechanical forces are responsible for their adhesion. […] The two prerequisites for the development of RRD are (1) liquefaction of the vitreous; an RRD will not occur without first some degree of liquefaction of the formed vitreous gel that precedes posterior vitreous detachment (PVD), and supplies the low viscosity fluid that is able to flow through retinal breaks, and (2) a retinal break through which fluid gains access into the subretinal space. […] These can take a variety of forms including retinal tears, as well as round retinal holes, usually forming in the context of pre-existing lattice degeneration.

• #26 Retinal Detachment: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1224737-overview

  Traction from inflammatory or vascular fibrous membranes on the surface of the retina, which tether to the vitreous […] Exudation of material into the subretinal space from retinal vessels such as in hypertension, central retinal venous occlusion, vasculitis, or papilledema. […] Of the 3 types of retinal detachment, rhegmatogenous RD is the most common, deriving its name from rhegma, meaning rent or break. Vitreous fluid enters the break and separates the sensory retina from the underlying RPE, resulting in detachment. […] Exudative or serous detachments occur when subretinal fluid accumulates and causes detachment without any corresponding break in the retina. […] Tractional retinal detachment occurs as a result of adhesions between the vitreous gel/fibrovascular proliferation and the retina. Mechanical forces cause the separation of the retina from the RPE without a retinal break. Advanced adhesion may result in the eventual development of a tear or break.

• #27 Retinal detachment – Wikipedia

  https://en.wikipedia.org/wiki/Retinal_detachment

  Retinal detachment occurs when the retina separates from the layers underneath it. This impairs its function, potentially leading to vision loss. Retinal detachment often requires urgent medical intervention to prevent permanent vision loss. […] Rhegmatogenous retinal detachment is caused by a tear or break in the retina. This allows vitreous humor, the fluid that normally sits in the center of the eye, to build up behind the retina. As a result, the retina can eventually separate from the tissues underneath it. This is the most common type of retinal detachment. […] Tractional retinal detachment occurs when scar tissue on the retina exerts a pulling force, leading to detachment. This occurs in the absence of retinal tears or breaks and is most commonly associated with abnormal blood vessel growth due to proliferative diabetic retinopathy. […] Exudative retinal detachment occurs when fluid accumulates beneath the retina, causing it to detach. This occurs in the absence of retinal tears or breaks. Common causes include age-related macular degeneration, inflammatory diseases, ocular tumors, and injuries to the eye.

• #28 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  An RRD occurs when a tear, break, or hole presents in the retina. When a break occurs, this may allow vitreous to enter the space underneath the neurosensory retina, causing a detachment from the RPE. The fluid continues to enter underneath the retina so that it peels off from the RPE until the entire posterior retina is detached. For an RRD to occur, the following are needed: A full-thickness retinal break, Liquified vitreous, with or without, Traction over the break. […] TRDs do not include a break in the neurosensory retina. When proliferative membranes are in the vitreous or on the retinal surface, these membranes can pull on the neurosensory retina. When the force is strong enough, it can cause separation of the neurosensory retina from the underlying RPE. […] ERDs also do not involve a break in the neurosensory retina. In these detachments, subretinal fluid accumulates due to fluid exudation from a large lesion, such as a tumor or inflammatory lesion.

• #29 Pathogenetic mechanism of Retinal Detachment | PPT

  https://www.slideshare.net/slideshow/pathogenetic-mechanism-of-retinal-detachment/251615958

  5) RHEGMATOGENOUS RD RD d/t one or more full thickness retinal breaks. Most breaks HSTs occurs at sites of strong VR adhesions MC irregular posterior margins of vitreous base during PVD. […] 8) LIQUEFACTION (SYNERESIS) OF VITREOUS With age, Fragmentation of collagen fibres, aggregation of proteoglycans around the fragments. […] 14) TRACTIONAL RD Occurs d/t VR forces which mechanically pull the retina away from RPE. Commonly seen in:- Diabetic retinopathy PVR Penetrating trauma RVO ROP Membranes have Fibroblasts, Glial and RPE cells show a contractile nature. […] 20) EXUDATIVE HEMORRHAGIC RD Collection of SRF secondary to diseases of Choroid, RPE or Retina. RPE pump mechanism- Active transport Creation of osmotic gradient, Hydrostatic forces. Exudative RD when above forces are disrupted. Either damage to RPE or Excess fluid production. […] 23) SUBRETINAL BLOOD MC cause trauma (contusion), POHS, Polypoidal choroidal neovascularization, Subretinal NV membranes Blood toxic to retina and RPE, Displacement of blood using gas bubble in nAMD dec toxicity to photoreceptors.

• #30 The Different Types of Retinal Detachment – Fluorescene Media

  http://fluorescene.odcommunity.com/the-different-types-of-retinal-detachment/

  Retinal detachment is a serious condition that requires prompt diagnosis and treatment. […] This is the most common type of retinal detachment accounting for about 90% of cases. It occurs when a tear or hole forms in the retina, allowing for fluid to enter and detach the retina from the underlying tissue. […] A PVD can cause RRD by creating tears in the retina due to the traction exerted on it as the vitreous separates. […] This type of retinal detachment can occur in virtually any condition that involves pre-retinal neovascularization such as Proliferative Diabetic retinopathy (PDR) which is the most common cause of TRD, Retinopathy of prematurity, Vascular occlusions etc. […] This type of retinal detachment is less common and occurs when fluid leaks into the subretinal space, separating the retina from the underlying tissue. […] Mixed mechanism retinal detachment refers to a type of retinal detachment in which there are elements of both tractional and rhegmatogenous mechanisms involved.

• #31 Pathogenetic mechanism of Retinal Detachment | PPT

  https://www.slideshare.net/slideshow/pathogenetic-mechanism-of-retinal-detachment/251615958

  5) RHEGMATOGENOUS RD RD d/t one or more full thickness retinal breaks. Most breaks HSTs occurs at sites of strong VR adhesions MC irregular posterior margins of vitreous base during PVD. […] 8) LIQUEFACTION (SYNERESIS) OF VITREOUS With age, Fragmentation of collagen fibres, aggregation of proteoglycans around the fragments. […] 14) TRACTIONAL RD Occurs d/t VR forces which mechanically pull the retina away from RPE. Commonly seen in:- Diabetic retinopathy PVR Penetrating trauma RVO ROP Membranes have Fibroblasts, Glial and RPE cells show a contractile nature. […] 20) EXUDATIVE HEMORRHAGIC RD Collection of SRF secondary to diseases of Choroid, RPE or Retina. RPE pump mechanism- Active transport Creation of osmotic gradient, Hydrostatic forces. Exudative RD when above forces are disrupted. Either damage to RPE or Excess fluid production. […] 23) SUBRETINAL BLOOD MC cause trauma (contusion), POHS, Polypoidal choroidal neovascularization, Subretinal NV membranes Blood toxic to retina and RPE, Displacement of blood using gas bubble in nAMD dec toxicity to photoreceptors.

• #32 Personal Foul

  https://www.reviewofoptometry.com/article/personal-foul

  The etiology of TRD involves fibrotic scaffolding of the vitreous along proliferative vascular networks, which through vitreal shrinkage, induce strong anterior tractional forces.39,42-44 RPE cell proliferation and migration are believed to play a role in the pathogenesis.43 Findings suggest that the vitreous contributes modulators that stimulate RPE cells along with macrophages, fibroblasts and glial cells to interact with constituents of the extracellular matrix such as fibronectin, vitronectin, and factor XIII.43,44 These mechanisms induce the formation of membranes that capture the sensory retina and forcibly separate it from the underlying RPE.39,42-44 Unlike rhegmatogenous or exudative retinal detachments which tend to occur acutely, TRD often develop slowly. When positioned peripherally TRD may not be noticed by the patient until visual acuity is compromised by the underlying disease process.

• #33 Molecular pathogenesis of rhegmatogenous retinal detachment | Scientific Reports

  https://www.nature.com/articles/s41598-020-80005-w

  The activation of the MAPK cascade has been shown to be especially important in Mller glial cells formation during retina development and retinal detachment. […] Our data reveals that several important alterations are present in RRD vitreous also in protein level and highlight apoptotic and fibrotic components as potential therapeutic targets to prevent RRD process and conversion of RRD into the most severe form.

• #34 Types of Retinal Detachment, Their Causes, and Treatments

  https://www.healthline.com/health/eye-health/types-of-retinal-detachment

  There are three main types of retinal detachment, determined by the exact mechanism that caused the detachment. […] A rhegmatogenous retinal detachment occurs when you develop a break, small hole, or tear in your retina. Liquified vitreous fluid inside of your eye can then pass through this break and collect behind your retina. This causes your retina to come loose and detach. […] Tractional retinal detachment (TRD) also called retinal traction detachment (RTD) does not involve any breaks or tears in your retina. Instead, formation of dense fibrous strands of inflamed vitreous bind to the retina, causing membrane contraction and pulling that result in your retina detaching. […] When this happens to the retina, it leads to ischemia due to lack of oxygen. In response, the retina signals the growth of new, abnormal blood vessels that leak and bleed into the vitreous. This situation leads to inflammation and scar tissue membranes within the vitreous that can cause TRD.

• #35 Diabetic retinopathy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611

  Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily. […] Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye (vitreous). […] Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma. […] The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or severe vision loss.

• #36 Retinal Detachment: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1224737-overview

  Traction from inflammatory or vascular fibrous membranes on the surface of the retina, which tether to the vitreous […] Exudation of material into the subretinal space from retinal vessels such as in hypertension, central retinal venous occlusion, vasculitis, or papilledema. […] Of the 3 types of retinal detachment, rhegmatogenous RD is the most common, deriving its name from rhegma, meaning rent or break. Vitreous fluid enters the break and separates the sensory retina from the underlying RPE, resulting in detachment. […] Exudative or serous detachments occur when subretinal fluid accumulates and causes detachment without any corresponding break in the retina. […] Tractional retinal detachment occurs as a result of adhesions between the vitreous gel/fibrovascular proliferation and the retina. Mechanical forces cause the separation of the retina from the RPE without a retinal break. Advanced adhesion may result in the eventual development of a tear or break.

• #37 The Different Types of Retinal Detachment – Fluorescene Media

  http://fluorescene.odcommunity.com/the-different-types-of-retinal-detachment/

  Retinal detachment is a serious condition that requires prompt diagnosis and treatment. […] This is the most common type of retinal detachment accounting for about 90% of cases. It occurs when a tear or hole forms in the retina, allowing for fluid to enter and detach the retina from the underlying tissue. […] A PVD can cause RRD by creating tears in the retina due to the traction exerted on it as the vitreous separates. […] This type of retinal detachment can occur in virtually any condition that involves pre-retinal neovascularization such as Proliferative Diabetic retinopathy (PDR) which is the most common cause of TRD, Retinopathy of prematurity, Vascular occlusions etc. […] This type of retinal detachment is less common and occurs when fluid leaks into the subretinal space, separating the retina from the underlying tissue. […] Mixed mechanism retinal detachment refers to a type of retinal detachment in which there are elements of both tractional and rhegmatogenous mechanisms involved.

• #38 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  An RRD occurs when a tear, break, or hole presents in the retina. When a break occurs, this may allow vitreous to enter the space underneath the neurosensory retina, causing a detachment from the RPE. The fluid continues to enter underneath the retina so that it peels off from the RPE until the entire posterior retina is detached. For an RRD to occur, the following are needed: A full-thickness retinal break, Liquified vitreous, with or without, Traction over the break. […] TRDs do not include a break in the neurosensory retina. When proliferative membranes are in the vitreous or on the retinal surface, these membranes can pull on the neurosensory retina. When the force is strong enough, it can cause separation of the neurosensory retina from the underlying RPE. […] ERDs also do not involve a break in the neurosensory retina. In these detachments, subretinal fluid accumulates due to fluid exudation from a large lesion, such as a tumor or inflammatory lesion.

• #39 Retinal Detachment: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1224737-overview

  Traction from inflammatory or vascular fibrous membranes on the surface of the retina, which tether to the vitreous […] Exudation of material into the subretinal space from retinal vessels such as in hypertension, central retinal venous occlusion, vasculitis, or papilledema. […] Of the 3 types of retinal detachment, rhegmatogenous RD is the most common, deriving its name from rhegma, meaning rent or break. Vitreous fluid enters the break and separates the sensory retina from the underlying RPE, resulting in detachment. […] Exudative or serous detachments occur when subretinal fluid accumulates and causes detachment without any corresponding break in the retina. […] Tractional retinal detachment occurs as a result of adhesions between the vitreous gel/fibrovascular proliferation and the retina. Mechanical forces cause the separation of the retina from the RPE without a retinal break. Advanced adhesion may result in the eventual development of a tear or break.

• #40 Pathogenetic mechanism of Retinal Detachment | PPT

  https://www.slideshare.net/slideshow/pathogenetic-mechanism-of-retinal-detachment/251615958

  5) RHEGMATOGENOUS RD RD d/t one or more full thickness retinal breaks. Most breaks HSTs occurs at sites of strong VR adhesions MC irregular posterior margins of vitreous base during PVD. […] 8) LIQUEFACTION (SYNERESIS) OF VITREOUS With age, Fragmentation of collagen fibres, aggregation of proteoglycans around the fragments. […] 14) TRACTIONAL RD Occurs d/t VR forces which mechanically pull the retina away from RPE. Commonly seen in:- Diabetic retinopathy PVR Penetrating trauma RVO ROP Membranes have Fibroblasts, Glial and RPE cells show a contractile nature. […] 20) EXUDATIVE HEMORRHAGIC RD Collection of SRF secondary to diseases of Choroid, RPE or Retina. RPE pump mechanism- Active transport Creation of osmotic gradient, Hydrostatic forces. Exudative RD when above forces are disrupted. Either damage to RPE or Excess fluid production. […] 23) SUBRETINAL BLOOD MC cause trauma (contusion), POHS, Polypoidal choroidal neovascularization, Subretinal NV membranes Blood toxic to retina and RPE, Displacement of blood using gas bubble in nAMD dec toxicity to photoreceptors.

• #41

  https://link.springer.com/article/10.1007/BF02169203

  Recent experimental work has shown that, under normal conditions, most subretinal fluid is absorbed rapidly by active transport across the retinal pigment epithelium (RPE). […] However, in the presence of damage to the RPE blood-retinal barrier, subretinal fluid is rapidly cleared by passive forces. […] Thus, it is apparent that RPE defects do not by themselves cause serous retinal detachment. […] A hypothesis is presented that some serous detachments occur because normal metabolic transport systems of the RPE have been damaged, while the blood-retinal barrier remains intact to prevent passive drainage of the subretinal space. […] Under these conditions, a focal RPE leak can overload the system so that the serous fluid accumulates and persists. […] Some forms of serous detachment may thus be viewed as diffuse rather than focal ocular disorders in which the transport capability of the RPE has been damaged; such damage can result from systemic pathology such as adrenergic stress (e.g., central serous chorioretinopathy) or vascular disease (e.g., hypertension).

• #42

  https://link.springer.com/article/10.1007/BF02169203

  Recent experimental work has shown that, under normal conditions, most subretinal fluid is absorbed rapidly by active transport across the retinal pigment epithelium (RPE). […] However, in the presence of damage to the RPE blood-retinal barrier, subretinal fluid is rapidly cleared by passive forces. […] Thus, it is apparent that RPE defects do not by themselves cause serous retinal detachment. […] A hypothesis is presented that some serous detachments occur because normal metabolic transport systems of the RPE have been damaged, while the blood-retinal barrier remains intact to prevent passive drainage of the subretinal space. […] Under these conditions, a focal RPE leak can overload the system so that the serous fluid accumulates and persists. […] Some forms of serous detachment may thus be viewed as diffuse rather than focal ocular disorders in which the transport capability of the RPE has been damaged; such damage can result from systemic pathology such as adrenergic stress (e.g., central serous chorioretinopathy) or vascular disease (e.g., hypertension).

• #43 Exudative Retinal Detachment – EyeWiki

  https://eyewiki.org/Exudative_Retinal_Detachment

  Exudative (or serous) retinal detachment (ERD) occurs when fluid accumulates in the subretinal space between the sensory retina and the retinal pigmented epithelium (RPE) resulting in retinal detachment. Causes for fluid accumulation include inflammatory, infectious, and neoplastic diseases of the choroid or retina. […] The subretinal space, a remnant of the embryonic optic vesicle, is practically nonexistent in a healthy eye. However, pathologies that disrupt the integrity of the blood-retina barrier (BRB) can cause leakage of fluid that enlarges the subretinal space and separates the sensory retina from the RPE resulting in retinal detachment. […] The BRB has an inner and outer component. The inner blood-retina barrier (iBRB) is composed of tight junctions in between cells of the retinal endothelium whereas the outer blood-retina barrier (oBRB) is composed of tight junctions between cells of the RPE.

• #44 Exudative Retinal Detachment – EyeWiki

  https://eyewiki.org/Exudative_Retinal_Detachment

  Exudative (or serous) retinal detachment (ERD) occurs when fluid accumulates in the subretinal space between the sensory retina and the retinal pigmented epithelium (RPE) resulting in retinal detachment. Causes for fluid accumulation include inflammatory, infectious, and neoplastic diseases of the choroid or retina. […] The subretinal space, a remnant of the embryonic optic vesicle, is practically nonexistent in a healthy eye. However, pathologies that disrupt the integrity of the blood-retina barrier (BRB) can cause leakage of fluid that enlarges the subretinal space and separates the sensory retina from the RPE resulting in retinal detachment. […] The BRB has an inner and outer component. The inner blood-retina barrier (iBRB) is composed of tight junctions in between cells of the retinal endothelium whereas the outer blood-retina barrier (oBRB) is composed of tight junctions between cells of the RPE.

• #45 Retinal Detachment – EyeWiki

  https://eyewiki.org/Retinal_Detachment

  Retinal detachment occurs when subretinal fluid accumulates between the neurosensory retina and the retinal pigment epithelium. This process can occur in three ways. One mechanism involves occurrence of a break in the retina allowing liquified vitreous to directly enter the subretinal space. This is known as a rhegmatogenous retinal detachment. Rhegmatogenous retinal detachments are often due to retinal tears associated with posterior vitreous detachment or trauma. […] Although this monograph focuses on rhegmatogenous retinal detachment, it is pertinent to note the other major causes of retinal detachment. A second mechanism involves proliferative membranes on the surface of the retina or vitreous. These membranes can pull on the neurosensory retina causing a physical separation between the neurosensory retina and retinal pigment epithelium. This is called a tractional retinal detachment. Tractional retinal detachments can be seen in proliferative retinopathy due to diabetic disease, sickle cell and other disease processes leading to neovascularization of the retina. Tractional retinal detachments can also be due to proliferative vitreoretinopathy after trauma or surgery. The third mechanism for retinal detachment is due to accumulation of subretinal fluid due to inflammatory mediators or exudation of fluid from a mass lesion or insufficient RPE function. This mechanism is known as a serous or exudative retinal detachment. Serous detachments are caused by a number of inflammatory, or exudative retinal disease processes such as Sarcoidosis, medication toxicity, myeloma, or choroidal neoplasms. Serous retinal detachments may also be the presenting sign in patients with aggressive metastatic cancer, such as testicular cancer.

• #46 Types of Retinal Detachment, Their Causes, and Treatments

  https://www.healthline.com/health/eye-health/types-of-retinal-detachment

  The third type of retinal detachment is exudative retinal detachment. In this case, fluid leaking from the underlying choroidal layer collects beneath your retina and floats your retina from the back of your eye. […] If you have an exudative retinal detachment, your retina does not have any tears, holes, or breaks. Instead, the fluid builds up behind your retina by getting past your blood-retina barrier because of things like inflammation or infection. […] Rhegmatogenous retinal detachments are the most common type. The most common causes of retinal detachments are advanced age and eye injuries. […] Trauma that creates a tear in your retina can lead to rhegmatogenous retinal detachment. Trauma that does not tear your retina can still potentially cause leaking choroidal fluid to enter the space underneath your retina and lead to exudative retinal detachment. […] If your injury causes vitreous traction bands to pull on your retina, it could lead to TRD.

• #47 Molecular pathogenesis of rhegmatogenous retinal detachment | Scientific Reports

  https://www.nature.com/articles/s41598-020-80005-w

  Rhegmatogenous retinal detachment (RRD) is an ophthalmic emergency, which usually requires prompt surgery to prevent further detachment and restore sensory function. […] To address this gap in knowledge we performed the molecular level systems pathology analysis of the vitreous from 127 patients with RRD using state-of-the art quantitative mass spectrometry to identify the individual key proteins, as well as the biochemical pathways contributing to the development of the disease. […] Our data indicate that various mechanisms, including glycolysis, photoreceptor death, and Wnt and MAPK signaling, are activated during or after the RRD to promote retinal cell survival. […] In addition, platelet-mediated wound healing processes, cell adhesion molecules reorganization and apoptotic processes were detected during RRD progression or proliferative vitreoretinopathy formation.

• #48 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #49 Personal Foul

  https://www.reviewofoptometry.com/article/personal-foul

  Retinal breaks are the predisposing factor in patients with rhegmatogenous retinal detachment.1,22-27 These may occur spontaneously from preexisting conditions or as a result of ocular trauma.1-3 Some of the common entities associated with RRD include lattice degeneration, flap tears, atrophic holes, operculated retinal breaks and acquired retinoschisis with both inner and outer holes.1,3,4,41 As the retinal tissue loses its connection to the RPE, it becomes edematous and dysfunctional.22 The detached retina loses its oxygen supply and relies on anaerobic pathways to metabolize glucose.22 Long-duration retinal detachments feature increased lactic acid and dextrose concentrations.23 Phospholipids are also increased in the subretinal fluid, reflecting retinal organelle degradation.23 Eventually, photoreceptor death occurs within 48-72 hours unless surgical intervention is employed.23,40

• #50 Personal Foul

  https://www.reviewofoptometry.com/article/personal-foul

  Retinal breaks are the predisposing factor in patients with rhegmatogenous retinal detachment.1,22-27 These may occur spontaneously from preexisting conditions or as a result of ocular trauma.1-3 Some of the common entities associated with RRD include lattice degeneration, flap tears, atrophic holes, operculated retinal breaks and acquired retinoschisis with both inner and outer holes.1,3,4,41 As the retinal tissue loses its connection to the RPE, it becomes edematous and dysfunctional.22 The detached retina loses its oxygen supply and relies on anaerobic pathways to metabolize glucose.22 Long-duration retinal detachments feature increased lactic acid and dextrose concentrations.23 Phospholipids are also increased in the subretinal fluid, reflecting retinal organelle degradation.23 Eventually, photoreceptor death occurs within 48-72 hours unless surgical intervention is employed.23,40

• #51 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #52 Personal Foul

  https://www.reviewofoptometry.com/article/personal-foul

  Retinal breaks are the predisposing factor in patients with rhegmatogenous retinal detachment.1,22-27 These may occur spontaneously from preexisting conditions or as a result of ocular trauma.1-3 Some of the common entities associated with RRD include lattice degeneration, flap tears, atrophic holes, operculated retinal breaks and acquired retinoschisis with both inner and outer holes.1,3,4,41 As the retinal tissue loses its connection to the RPE, it becomes edematous and dysfunctional.22 The detached retina loses its oxygen supply and relies on anaerobic pathways to metabolize glucose.22 Long-duration retinal detachments feature increased lactic acid and dextrose concentrations.23 Phospholipids are also increased in the subretinal fluid, reflecting retinal organelle degradation.23 Eventually, photoreceptor death occurs within 48-72 hours unless surgical intervention is employed.23,40

• #53 Molecular pathogenesis of rhegmatogenous retinal detachment | Scientific Reports

  https://www.nature.com/articles/s41598-020-80005-w

  Rhegmatogenous retinal detachment (RRD) is an ophthalmic emergency, which usually requires prompt surgery to prevent further detachment and restore sensory function. […] To address this gap in knowledge we performed the molecular level systems pathology analysis of the vitreous from 127 patients with RRD using state-of-the art quantitative mass spectrometry to identify the individual key proteins, as well as the biochemical pathways contributing to the development of the disease. […] Our data indicate that various mechanisms, including glycolysis, photoreceptor death, and Wnt and MAPK signaling, are activated during or after the RRD to promote retinal cell survival. […] In addition, platelet-mediated wound healing processes, cell adhesion molecules reorganization and apoptotic processes were detected during RRD progression or proliferative vitreoretinopathy formation.

• #54 Molecular pathogenesis of rhegmatogenous retinal detachment | Scientific Reports

  https://www.nature.com/articles/s41598-020-80005-w

  Rhegmatogenous retinal detachment (RRD) is an ophthalmic emergency, which usually requires prompt surgery to prevent further detachment and restore sensory function. […] To address this gap in knowledge we performed the molecular level systems pathology analysis of the vitreous from 127 patients with RRD using state-of-the art quantitative mass spectrometry to identify the individual key proteins, as well as the biochemical pathways contributing to the development of the disease. […] Our data indicate that various mechanisms, including glycolysis, photoreceptor death, and Wnt and MAPK signaling, are activated during or after the RRD to promote retinal cell survival. […] In addition, platelet-mediated wound healing processes, cell adhesion molecules reorganization and apoptotic processes were detected during RRD progression or proliferative vitreoretinopathy formation.

• #55 Proliferative Vitreoretinopathy in Retinal Detachment: Perspectives on Building a Digital Twin Model Using Nintedanib

  https://www.mdpi.com/1422-0067/25/20/11074

  Proliferative vitreoretinopathy (PVR) remains a significant complication following retinal detachment (RD), leading to recurrent detachment in a considerable percentage of cases, even after successful surgical repair. […] PVR is characterized by the formation of epiretinal and subretinal fibrotic membranes, which apply tractional forces on the retina, often resulting in refractory or recurrent retinal detachment. […] The pathogenesis of PVR is complex, involving various molecular and cellular processes that lead to the formation of fibrotic membranes and retinal contraction. […] A key mechanism in the development of PVR is the EMT of retinal pigment epithelial (RPE) cells. During EMT, RPE cells transform into myofibroblasts that secrete extracellular matrix (ECM) proteins, contributing to the formation of fibrotic membranes.

• #56 Proliferative Vitreoretinopathy in Retinal Detachment: Perspectives on Building a Digital Twin Model Using Nintedanib

  https://www.mdpi.com/1422-0067/25/20/11074

  Proliferative vitreoretinopathy (PVR) remains a significant complication following retinal detachment (RD), leading to recurrent detachment in a considerable percentage of cases, even after successful surgical repair. […] PVR is characterized by the formation of epiretinal and subretinal fibrotic membranes, which apply tractional forces on the retina, often resulting in refractory or recurrent retinal detachment. […] The pathogenesis of PVR is complex, involving various molecular and cellular processes that lead to the formation of fibrotic membranes and retinal contraction. […] A key mechanism in the development of PVR is the EMT of retinal pigment epithelial (RPE) cells. During EMT, RPE cells transform into myofibroblasts that secrete extracellular matrix (ECM) proteins, contributing to the formation of fibrotic membranes.

• #57 Proliferative Vitreoretinopathy in Retinal Detachment: Perspectives on Building a Digital Twin Model Using Nintedanib

  https://www.mdpi.com/1422-0067/25/20/11074

  Proliferative vitreoretinopathy (PVR) remains a significant complication following retinal detachment (RD), leading to recurrent detachment in a considerable percentage of cases, even after successful surgical repair. […] PVR is characterized by the formation of epiretinal and subretinal fibrotic membranes, which apply tractional forces on the retina, often resulting in refractory or recurrent retinal detachment. […] The pathogenesis of PVR is complex, involving various molecular and cellular processes that lead to the formation of fibrotic membranes and retinal contraction. […] A key mechanism in the development of PVR is the EMT of retinal pigment epithelial (RPE) cells. During EMT, RPE cells transform into myofibroblasts that secrete extracellular matrix (ECM) proteins, contributing to the formation of fibrotic membranes.

• #58 Proliferative Vitreoretinopathy in Retinal Detachment: Perspectives on Building a Digital Twin Model Using Nintedanib

  https://www.mdpi.com/1422-0067/25/20/11074

  Several cytokines and growth factors are heavily implicated in this process, including transforming growth factor β (TGF-β), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and tumor necrosis factor-α (TNF-α). […] The progression of PVR typically begins with two main events: the breakdown of the blood–retinal barrier and hypoxia, which leads to photoreceptor death. […] In response to these events, RPE cells, along with glial cells, macrophages, and lymphocytes, are activated and undergo the EMT process, transforming into mesenchymal cells that produce fibrotic membranes. […] Nintedanib, a multi-target tyrosine kinase inhibitor, has been investigated for its potential application in ocular fibrosis. […] In vitro studies have shown that Nintedanib can inhibit the epithelial–mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells induced by TGF-β2, which may help reduce the formation of fibrotic membranes in conditions like proliferative vitreoretinopathy (PVR). […] By virtually testing these interventions, a Digital Twin could help predict their efficacy, optimize treatment strategies, and reduce the need for invasive in vivo testing.

• #59 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  In cases of chronic detachment, more prominent changes occur including cystic and macrocystic retinal degeneration, retinal thinning, RPE alterations, demarcation lines, large drusen, choroidal neovascularization at the ora serrata and iris neovascularization secondary to angiogenic factor elaboration by the ischemic detached retina.

• #60 Evaluation and Management of Suspected Retinal Detachment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1691.html

  The role of the vitreous in the pathogenesis of retinal breaks and detachments clarifies the risk factors for retinal detachment. […] Retinal detachment occurs in approximately 1 percent of patients in the weeks to years following cataract surgery. […] Myopia, or nearsightedness, is another leading risk factor for retinal detachment. […] Trauma precipitates retinal detachment for several reasons. At the moment of impact, rapid compression and decompression of the globe may generate sufficient vitreoretinal traction to produce retinal tears. […] Retinal detachment surgery fails in 5 to 10 percent of patients because of the growth of scar tissue on the retinal surface in the weeks following repair.

• #61 GUARD Against PVR: Methotrexate for Proliferative Vitreoretinopathy After Retinal Detachment Surgery – Retina Today

  https://retinatoday.com/articles/2020-apr/guard-against-pvr-methotrexate-for-proliferative-vitreoretinopathy-after-retinal-detachment-surgery

  PVR is a complex disease process that can occur after rhegmatogenous retinal detachment surgery in 5% to 10% of patients. PVR is initiated as a reparative process following a retinal break and retinal detachment. It is characterized by glial cell or retinal pigment epithelium cell migration with resulting proliferation of preretinal or subretinal membranes. Contraction of these membranes after surgical repair is the most common cause for failure of primary retinal detachment surgery. […] PVR has been shown to be associated with multiple cytokines, chemokines, and growth factors, as well as other extracellular matrix proteins. This complex pathophysiology hints at the difficulty of developing pharmaceutical treatments for PVR. […] The rationale for use of intravitreal methotrexate for treatment of PVR is based on its mechanism of action. Methotrexate suppresses inflammation and inhibits cellular replication, both of which are key in the pathogenesis of PVR. PVR typically manifests weeks to months after surgical repair, so the treatment is given repeatedly throughout the entire risk period rather than as a single injection at the time of surgery. […] The pathophysiology of PVR is complex, with multiple targets contributing to its development and progression.

• #62 Evaluation and Management of Suspected Retinal Detachment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1691.html

  The role of the vitreous in the pathogenesis of retinal breaks and detachments clarifies the risk factors for retinal detachment. […] Retinal detachment occurs in approximately 1 percent of patients in the weeks to years following cataract surgery. […] Myopia, or nearsightedness, is another leading risk factor for retinal detachment. […] Trauma precipitates retinal detachment for several reasons. At the moment of impact, rapid compression and decompression of the globe may generate sufficient vitreoretinal traction to produce retinal tears. […] Retinal detachment surgery fails in 5 to 10 percent of patients because of the growth of scar tissue on the retinal surface in the weeks following repair.

• #63 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #64 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #65 Evaluation and Management of Suspected Retinal Detachment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1691.html

  The role of the vitreous in the pathogenesis of retinal breaks and detachments clarifies the risk factors for retinal detachment. […] Retinal detachment occurs in approximately 1 percent of patients in the weeks to years following cataract surgery. […] Myopia, or nearsightedness, is another leading risk factor for retinal detachment. […] Trauma precipitates retinal detachment for several reasons. At the moment of impact, rapid compression and decompression of the globe may generate sufficient vitreoretinal traction to produce retinal tears. […] Retinal detachment surgery fails in 5 to 10 percent of patients because of the growth of scar tissue on the retinal surface in the weeks following repair.

• #66 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #67 Evaluation and Management of Suspected Retinal Detachment | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0401/p1691.html

  The role of the vitreous in the pathogenesis of retinal breaks and detachments clarifies the risk factors for retinal detachment. […] Retinal detachment occurs in approximately 1 percent of patients in the weeks to years following cataract surgery. […] Myopia, or nearsightedness, is another leading risk factor for retinal detachment. […] Trauma precipitates retinal detachment for several reasons. At the moment of impact, rapid compression and decompression of the globe may generate sufficient vitreoretinal traction to produce retinal tears. […] Retinal detachment surgery fails in 5 to 10 percent of patients because of the growth of scar tissue on the retinal surface in the weeks following repair.

• #68 Pathology and pathogenesis of retinal detachment | Eye

  https://www.nature.com/articles/6700197

  Myopia is a definite risk factor for retinal detachment and the risk increases with higher degrees of myopia. […] The crystalline lens and its posterior capsule constitute a stabilizing factor on the vitreous body. […] About 15% of all retinal detachments are traumatic and they are much more common in young individuals. […] The occurrence of retinal breaks following ocular contusion is not sufficient to induce retinal detachment because the vitreous in such young patients is intact and provides a tamponade or sealing effect on retinal breaks. […] When the retina separates from the RPE secondary to retinal detachment of any type, the outer retina becomes ischemic due to loss of its blood supply from the choroid. […] Apoptosis appears to play an important role in the time-dependent photoreceptor cell decay that occurs following retinal detachment.

• #69 Retinal Tear Treatment | Retinal Detachment Treatment | Bethesda MD

  https://www.center4retina.org/our-services/retinal-tear-detachment

  Retinal tear and retinal detachment are part of the same spectrum of disease requiring urgent, and frequently emergent, evaluation and treatment. […] Most of the time the vitreous will separate cleanly without complication, but the patient may notice flashes and/or floaters. […] If the retinal tear remains unrecognized and untreated, then fluid can rapidly accumulate through a defect (or multiple retinal defects). […] This mechanism, or cause, of retinal detachment can be seen especially in younger patients before the vitreous gel separates. […] The vitreous tends to be more stuck to the retina around patches of lattice degeneration making an individual more vulnerable to developing retinal tear or retinal detachment during or following recent vitreous separation. […] If performed in a timely fashion, treatment of a retinal tear can prevent progression to retinal detachment.

• #70 Pathogenesis of rhegmatogenous retinal detachment: predisposing anatomy and cell biology – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21060268/

  To understand the molecular events underlying rhegmatogenous retinal detachment so that new therapies can be developed, it is important to appreciate the structural organization of the vitreous, the biology underlying vitreous liquefaction and posterior vitreous detachment, and the mechanisms of vitreoretinal attachment and detachment.

• #71 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  In order to effectively treat a retinal detachment, all retinal breaks should be identified and treated to create chorioretinal adhesion, and causative vitreoretinal traction needs to be relieved. […] The principle is that the buoyancy and surface tension of the intraocular gas bubble, which is typically sulfur hexafluoride (SF6) or perfluoropropane (C3F8), applies upward pressure to the retina and closes the retinal break. […] Scleral buckle surgery, in conjunction with chorioretinal adhesion, is an effective technique for the repair of rhegmatogenous retinal detachments. This technique works by altering the geometry and fluid dynamics of the eye such that closure of retinal tears is achieved. […] Standard 20-ga. pars plana vitrectomy (PPV) involves removing the vitreous and relieving primary vitreoretinal traction.

• #72 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  In order to effectively treat a retinal detachment, all retinal breaks should be identified and treated to create chorioretinal adhesion, and causative vitreoretinal traction needs to be relieved. […] The principle is that the buoyancy and surface tension of the intraocular gas bubble, which is typically sulfur hexafluoride (SF6) or perfluoropropane (C3F8), applies upward pressure to the retina and closes the retinal break. […] Scleral buckle surgery, in conjunction with chorioretinal adhesion, is an effective technique for the repair of rhegmatogenous retinal detachments. This technique works by altering the geometry and fluid dynamics of the eye such that closure of retinal tears is achieved. […] Standard 20-ga. pars plana vitrectomy (PPV) involves removing the vitreous and relieving primary vitreoretinal traction.

• #73 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  In order to effectively treat a retinal detachment, all retinal breaks should be identified and treated to create chorioretinal adhesion, and causative vitreoretinal traction needs to be relieved. […] The principle is that the buoyancy and surface tension of the intraocular gas bubble, which is typically sulfur hexafluoride (SF6) or perfluoropropane (C3F8), applies upward pressure to the retina and closes the retinal break. […] Scleral buckle surgery, in conjunction with chorioretinal adhesion, is an effective technique for the repair of rhegmatogenous retinal detachments. This technique works by altering the geometry and fluid dynamics of the eye such that closure of retinal tears is achieved. […] Standard 20-ga. pars plana vitrectomy (PPV) involves removing the vitreous and relieving primary vitreoretinal traction.

• #74 Management of Primary Retinal Detachments

  https://www.reviewofophthalmology.com/article/management-of-primary-retinal-detachments

  In order to effectively treat a retinal detachment, all retinal breaks should be identified and treated to create chorioretinal adhesion, and causative vitreoretinal traction needs to be relieved. […] The principle is that the buoyancy and surface tension of the intraocular gas bubble, which is typically sulfur hexafluoride (SF6) or perfluoropropane (C3F8), applies upward pressure to the retina and closes the retinal break. […] Scleral buckle surgery, in conjunction with chorioretinal adhesion, is an effective technique for the repair of rhegmatogenous retinal detachments. This technique works by altering the geometry and fluid dynamics of the eye such that closure of retinal tears is achieved. […] Standard 20-ga. pars plana vitrectomy (PPV) involves removing the vitreous and relieving primary vitreoretinal traction.

• #75 Retinal Tear Treatment | Retinal Detachment Treatment | Bethesda MD

  https://www.center4retina.org/our-services/retinal-tear-detachment

  The application of either of these techniques creates a scar around the retinal defect preventing the extension of fluid which could lead to retinal detachment. […] More extensive retinal detachments will require surgical procedures such as scleral buckle or pars plana vitrectomy, which are performed in the operating room. […] Another increasingly used technique is pars plana vitrectomy, a surgical procedure which involves inserting specially designed small instruments into the eye to remove the vitreous gel which is pulling on the retina. […] Complex retinal detachments may require a combination of vitrectomy and scleral buckle. […] In some chronic cases, scar tissue membrane sheets grow along the retinal surface and must be removed by a technique called membranectomy or membrane peel for the retina to successfully reattach.

• #76 Retinal Tear Treatment | Retinal Detachment Treatment | Bethesda MD

  https://www.center4retina.org/our-services/retinal-tear-detachment

  The application of either of these techniques creates a scar around the retinal defect preventing the extension of fluid which could lead to retinal detachment. […] More extensive retinal detachments will require surgical procedures such as scleral buckle or pars plana vitrectomy, which are performed in the operating room. […] Another increasingly used technique is pars plana vitrectomy, a surgical procedure which involves inserting specially designed small instruments into the eye to remove the vitreous gel which is pulling on the retina. […] Complex retinal detachments may require a combination of vitrectomy and scleral buckle. […] In some chronic cases, scar tissue membrane sheets grow along the retinal surface and must be removed by a technique called membranectomy or membrane peel for the retina to successfully reattach.

• #77 Retinal Tear Treatment | Retinal Detachment Treatment | Bethesda MD

  https://www.center4retina.org/our-services/retinal-tear-detachment

  The application of either of these techniques creates a scar around the retinal defect preventing the extension of fluid which could lead to retinal detachment. […] More extensive retinal detachments will require surgical procedures such as scleral buckle or pars plana vitrectomy, which are performed in the operating room. […] Another increasingly used technique is pars plana vitrectomy, a surgical procedure which involves inserting specially designed small instruments into the eye to remove the vitreous gel which is pulling on the retina. […] Complex retinal detachments may require a combination of vitrectomy and scleral buckle. […] In some chronic cases, scar tissue membrane sheets grow along the retinal surface and must be removed by a technique called membranectomy or membrane peel for the retina to successfully reattach.

• #78 Retinal Detachment – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551502/

  Retinal detachments (RDs) constitute a severe ocular condition that can lead to permanent vision loss. When the neurosensory retina detaches from the retinal pigment epithelium and the choroid, it loses its oxygen and nutrient supply, leading to the death of the tissue. RDs can be classified into rhegmatogenous, exudative, and tractional varieties. Rhegmatogenous RDs are associated with retinal break(s) (rhegma). In tractional RD, there is traction over the retina, which causes detachment of the neurosensory retina from the retinal pigment epithelium. Both rhegmatogenous and tractional RDs usually need surgical correction. On the other hand, exudative RDs occur due to the exudation of fluid between the neurosensory retina and the retinal pigment epithelium due to various causes. Exudative RDs usually need medical therapy or laser.

• #79 Management of recurrent retinal detachment in silicone oil filled eyes: keys to diagnosis of pathogenesis and management – MedCrave online

  https://medcraveonline.com/AOVS/management-of-recurrent-retinal-detachment-in-silicone-oil-filled-eyes-keys-to-diagnosis-of-pathogenesis-and-management.html

  The use of vitrectomy techniques, augmented with silicone oil tamponade, signifies an important shift in the management of complicated retinal detachments. Recurrence of retinal detachment under silicone oil provides both a diagnostic challenge for the pathogenesis and for how to manage. Unfortunately, no study has clearly put guidelines for the diagnosis and management of these complicated cases. […] Several factors are involved in the pathogenesis of recurrence of retinal detachment under silicone oil, these include: […] The most common reason for redetachment in silicone oil-filled eyes is PVR, and it occurs in approximately 80% of the affected eyes. […] It is known that the tamponade force of silicone oil is less than that of air, and the oil does not have any negative effect on PVR.

• #80 Proliferative Vitreoretinopathy in Retinal Detachment: Perspectives on Building a Digital Twin Model Using Nintedanib

  https://www.mdpi.com/1422-0067/25/20/11074

  Several cytokines and growth factors are heavily implicated in this process, including transforming growth factor β (TGF-β), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and tumor necrosis factor-α (TNF-α). […] The progression of PVR typically begins with two main events: the breakdown of the blood–retinal barrier and hypoxia, which leads to photoreceptor death. […] In response to these events, RPE cells, along with glial cells, macrophages, and lymphocytes, are activated and undergo the EMT process, transforming into mesenchymal cells that produce fibrotic membranes. […] Nintedanib, a multi-target tyrosine kinase inhibitor, has been investigated for its potential application in ocular fibrosis. […] In vitro studies have shown that Nintedanib can inhibit the epithelial–mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells induced by TGF-β2, which may help reduce the formation of fibrotic membranes in conditions like proliferative vitreoretinopathy (PVR). […] By virtually testing these interventions, a Digital Twin could help predict their efficacy, optimize treatment strategies, and reduce the need for invasive in vivo testing.

• #81 Molecular pathogenesis of rhegmatogenous retinal detachment | Scientific Reports

  https://www.nature.com/articles/s41598-020-80005-w

  These findings improve the understanding of RRD pathogenesis, identify novel targets for treatment of this ophthalmic disease, and possibly affect the prognosis of eyes treated or operated upon due to RRD. […] In addition to structural changes in the retina, complex biomolecular mechanisms activated after RRD may also play an important role in its pathogenesis. […] It has been suggested that these molecules play a significant role in the injury-induced wound-healing process and apoptosis of retinal photoreceptors in RRD. […] The second most enriched pathway was glycolysis, a process of converting glucose into pyruvate and generating small amounts of ATP (energy) and NADH (reducing power). […] Our data showed that two of the classical cellular signaling pathways, Wnt signaling and MAPK cascade, were enriched in RRD.

Zobacz więcej