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   Table of Contents      
ARTICLES
Year : 1986  |  Volume : 34  |  Issue : 1  |  Page : 29-32

Traumatic retinal detachment


A M U Institute of Ophthalmology, Aligarh, India

Correspondence Address:
Manoj Shukla
A M U Institute of Ophthalmology, Aligarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 3443496

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How to cite this article:
Shukla M, Ahuja O P, Jamal N. Traumatic retinal detachment. Indian J Ophthalmol 1986;34:29-32

How to cite this URL:
Shukla M, Ahuja O P, Jamal N. Traumatic retinal detachment. Indian J Ophthalmol [serial online] 1986 [cited 2020 Mar 29];34:29-32. Available from: http://www.ijo.in/text.asp?1986/34/1/29/26348

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Table 1

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Table 1

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The role of trauma in the causation of reti­nal detachment has been recognised for long. Leber[1] 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 Top


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 Top


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 Top


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[3] 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[4]. 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[5].

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 Top


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 Top

1.
Lever, 1916, Graife-Saemisch hb.d.ges Augen­heilk, 15th ed. Leipzig 5:693.  Back to cited text no. 1
    
2.
Schepens, C L. and Marden, D., 1966, Amer. J. Ophthalmol. 61:213.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
4.
Ahuja, O.P., Shukla, M, Chandra, D. and Gopal, V., 1986, Proc. XXXXIV All India ophthal­mological Conf. Kanpur (In Press).  Back to cited text no. 4
    
5.
Shukla, M., Ahuja, O.P. and Bajaj, R.P., 1980, Proc. All Ind. Ophthalmol. Soc. 38:212.  Back to cited text no. 5
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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