|Year : 1986 | Volume
| Issue : 1 | Page : 29-32
Traumatic retinal detachment
Manoj Shukla, OP Ahuja, Nasir Jamal
A M U Institute of Ophthalmology, Aligarh, India
A M U Institute of Ophthalmology, Aligarh
|How to cite this article:|
Shukla M, Ahuja O P, Jamal N. Traumatic retinal detachment. Indian J Ophthalmol 1986;34:29-32
The role of trauma in the causation of retinal detachment has been recognised for long. Leber in 1916 observed that ocular contusions played an important role in the etiology of retinal detachment in 16.18% of cases. All types of injuries i.e. ocular contusions, perforating ocular injuries and concussion injuries to head can cause retinal detachment. In the present communication various aspects of traumatic retinal detachments as seen in our series have been analysed and discussed.
| Materials and me thods|| |
The present investigation is a retrospective analysis of retina records of 500 consecutive patients of rhegmatogenous retinal detachment seen in our "Retina Service". Out of these, 55 patients had a history of having sustained a direct or indirect ocular trauma. The retina files of these patients were statistically analysed.
| Observations|| |
11 % (55 out of 500) of all cases of rhegmatogenous retinal detachment were found to be caused by trauma in one form or the other. Majority of cases (77.40%) were below the age of 30 years, maximum number of cases being in the age group of 11 to 20 years [Table - 1]. The average age for traumatic retinal detachment was found to be 27.45 years. An overwhelming proportion of cases (89%) were males. Out of 55 cases, reliable details of trauma were available in 51 cases. Direct hit to the eye causing nonperforating contusion injuries was the commonest type of injury in majority of the cases [Table - 2]. Onset of retinal detachment. In nearly 2/3rd of our cases, the occurrence of retinal detachment was delayed until about a month or more from the onset of trauma.
Eye affected: The left eye (61.80%) was affected more commonly than the right eye (38.20%). Although mild to moderate degree of myopia was seen in 15 (27.27%) out of 55 eyes, there was no statistically significant relationship between traumatic retinal detachment and type of refractive error. Majority of the eyes (53 out of 55) had a poor visual acuity on account of macular involvement. The visual acuity in these eyes ranged from hand movement to finger counting at one meter.
48 (87.27°%) eyes had a total retinal detachment. Out of the remaining 7 eyes with incomplete retinal detachment, macula was detached in 5. Thus macular involvement was seen in 53 (96.33%) out of 55 eyes. 55 retinal breaks were seen in 3h (69.09%) out of 55 eyes. In the remaining 17 eyes, retinal breaks were not detected primarily because of the poor visibility of the retina on account of vitreo-retinal fibrous changes and/or lenticular opacities. Multiple breaks were seen in 9 eyes. Flap tears were found to be the most common type of retinal break [Table - 3]. Equatorial retina in the infero-temporal quadrant was most frquently involved.
Peripheral retinal degeneration (P.R.D ) There was an evidence of P.R.D. in 7 (12.72 %)eyes. Lattice degeneration was seen in 5 eyes. Gross morphological changes in the vitreous were not observed in relation to peripheral retinal degenerations.
Proliferative vitreo-retinopathy (P.V.R.): Different grades of P.V.R. were seen in 19 (34.54%) eyes. Majority of these eyes were having retinal detachment for more than one year.
Surgical results : Surgery was undertaken in 27 eyes. The remaining eyes were not considered suitable for surgical intervention on account of factors like proliferative vitreoretinopathy, Giant retinal tears and poor visibility of the retina. All the eyes underwent an encircling procedure with drainage of subretinal fluid. Intravitreal air was used in 8 eyes as these were grossly hypotonic following fluid removal. Out of 27 eyes, anatomical and functional recovery was achieved in 21 and 16 eyes respectively. The retina did not settle in 6 eyes and this was on account of mild to moderate degree of preoperative P.V.R. The criteria for a successful anatomical reapposition of retina was a firm approximation of neurosensory retina to retinal pigment epithelium. The visual improvement after successful retinal surgery vas recorded 8-10 days following surgery and it largely depended on duration of retinal detachment. 13 out of 16 patients had a visual improvement varying from 1-3 snellen lines (6160-6/24). The remaining 3 eyes had a visual recovery of 4-5 snellen lines (6/186/12).
| Discussion|| |
Traumatic retinal detachment constitute a special group of retinal detachment on account of certain important clinical features. Young male individuals are more vulnerable to ocular trauma probably because of their physical outdoor activities. Small children constitute yet another important group of cases which is also prone for the occurrence of traumatic retinal detachment. The commonest type of trauma responsible for the occurrence of retinal detachment is in the form of blunt injuries to the eye which commonly include first blow injuries, sports injuries, automobile injuries and similar forms of blunt injuries related to different occupational hazards. The force of the injury is an important factor in determining the extent of vitreo-retinal damage and subsequent formation of retinal breaks. Certain "high risk eyes" like those having high myopia, aphakia or fellow eyes of retinal detachment cases are much more prone to develop retinal detachment following a traumatic injury to the eye than otherwise. Traumatic injuries to such eyes irrespective of the nature of trauma would require a most meticulous screening of the peripheral retina for the presence of retinal defects and retinal detachment. As there is often a latent period between the time of trauma and the development of vitreoretinal pathology, these eyes should be periodically observed even if no vitreo-retinal pathology is observed in the initial examination soon after trauma. Schepens has also emphasized a similar approach for better management of similar cases.
The retinal detachment following trauma is often total involving the macula and this is probably on account of a delay in the diagnosis of retinal detachment in most of the cases. Further, associated glial and fibrous proliferation in the form of proliferative vitreo-retinopathy (P.V.R) are more common and were seen in about 1/3rd of eyes in the present study. Most of these eyes had a retinal detachment of more than one year duration. This figure is significantly more when compared to an unselected group of 500 consecutive cases of retinal detachment. It is thus reasonable to believe that it is the duration of retinal detachment alongwith fibrous tissue changes in the vitreous which are responsible for the frequent occurrence of proliferative vitreo-retinopathy in traumatic retinal detachments. The type and distribution of retinal break in traumatic retinal detachment is more or less the same as in non-traumatic rhegmatogenous retinal detachment'. However, in the former there is a frequent failure in localisation of retinal breaks on account of poor visibility of retina due to associated lenticular opacities, uveitis and/or fibrous tissue changes in the vitreous.
On the basis of observations made in this study there appears no significant relationship between retinal degenerations and retinal detachment. However, a peripheral retinal degeneration with associated vitreous traction is likely to develop retinal break and retinal detachment following a direct or indirect trauma to the eye. In this connection eyes harbouring lattice degeneration of the retina should receive particular attention more so when lattice degeneration is responsible for about 25% of cases of rhegmatogenous retinal detachment.
The morphological and functional results after retinal surgery in traumatic retinal detachment are not spectacular probably on account of a longer duration of retinal detachment, frequent macular involvement and a common occurence of proliferative vitreo-retinopathy. It would thus be reasonable to understand that an early diagnosis of traumatic retinal detachment may have great bearing on the surgical results of these cases and in this connection the role of periodic painstaking indirect ophthalmoscopy with indentation can not be over-emphasized.
| Summary|| |
A retrospective analysis of the records of 500 cases of rhegmatogeno retinal detachment revealed that 55 (11 %) cases were caused on account of a direct or indirect trauma to the eye. The commonest type of retinal breaks were flap tears, being most commonly present in the lower temporal quadrant of equatorial retina. There was a time lag between the development of retinal detachment and trauma. Proliferative vitreo-retinopathy (P.V.R.) was seen in about one third eyes while macula was involved in nearly all the eyes affected with traumatic retinal detachment, Post-operative visual improvement depended largely upon the duration of retinal detachment irrespective of an anatomically successful operation.
| References|| |
|1.||Lever, 1916, Graife-Saemisch hb.d.ges Augenheilk, 15th ed. Leipzig 5:693. |
|2.||Schepens, C L. and Marden, D., 1966, Amer. J. Ophthalmol. 61:213. |
|3.||Schepens, C.L., 1969. Traumatic retinal detachments : Clinical and experimental study. In Retina and Retinal Surgery. C.V. Mosby Company St. Louis, pp. 302, 1969. |
|4.||Ahuja, O.P., Shukla, M, Chandra, D. and Gopal, V., 1986, Proc. XXXXIV All India ophthalmological Conf. Kanpur (In Press). |
|5.||Shukla, M., Ahuja, O.P. and Bajaj, R.P., 1980, Proc. All Ind. Ophthalmol. Soc. 38:212. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4]