Tractional Retinal Detachment
Retinal traction detachment (RTD) is the separation of the neurosensory retina from the underlying retinal pigment epithelium due to the traction resulting from membranes in the vitreous or over the retinal surface.
Tractional Retinal Detachment:
What is Tractional Retinal Detachment?
Tractional Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium caused by progressive contraction of fibrovascular membranes over large areas of vitreoretinal adhesions.
Symptoms of Tractional Retinal Detachment:
Gradual diminution of vision
Visual field defect which usually progresses slowly
Straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved
Central visual loss if macula is detached
Sudden drop in vision if associated with vitreous haemorrhage
Causes of Tractional Retinal Detachment
Proliferative retinopathy due to diabetes
Penetrating posterior segment trauma
Vaso-occlusive lesions leading to fibrovascular proliferation
Other causes such as retinopathy of prematurity, familial exudative vitreo retinopathy, idiopathic vasculitis
Prevention
Controlling the systemic parameters such as blood glucose levels and blood pressure
Regular eye check up
Avoiding any trauma to the eyes
Types of Tractional Retinal Detachment
It can be classified based on type of vitreoretinal traction
Tangential- caused by the contraction of epiretinal fibrovascular membranes
Anteroposterior- due to the contraction of fibrovascular membranes extending from the posterior retina, usually in association with the major arcades, to the vitreous base anteriorly
Bridging(trampoline)- due to contraction of fibrovascular membranes stretching from one part of retina to another or between vascular arcades
Treatment
- Retinal laser photocoagulation
- Vitrectomy surgery
- Intravitreal anti vegf injections (bevacizumab, ranibizumab, aflibercept)
Occasionally, central vision loss from tractional retinal detachment can be prevented. Some cases of retinal detachment outside the central field of vision may be monitored if they cease growing after therapy with a retinal laser or anti-VEGF injection and better blood sugar control. Occasionally, a tractional retinal detachment causes such damage to the patient’s central vision that it must be surgically repaired. Surgery to remove the vitreous gel from the back of the eye into which the aberrant blood vessels have grown is called a vitrectomy. Fibrous scars formed by aberrant blood vessels on the retina’s surface are removed alongside the vitrectomy using a microscope. In order to lessen the likelihood of further artery growth or to cure stretch holes in the retina, laser treatment is frequently used simultaneously. Once the retina is successfully reattached, the eye is occasionally filled with a synthetic gas or silicone oil to assist it stay in place. During surgery, surgeons will often decide which of these substances will be used in place of vitreous.