Retinal tears

Retinal breaks are deep defects of the sensory retina. Retinal breaks are distinguished by: pathogenesis, morphology, localization.

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Pathogenesis of retinal tears

Retinal tears are a consequence of vitreoretinal tractions and occur in the upper half of the retina (most often on the temporal side, less often on the nasal side). Retinal holes occur as a result of chronic retinal atrophy and are round or oval. They are mainly located on the temporal side (most often at the top, less often at the bottom); compared to retinal tears, they are less dangerous.

Morphology of retinal tears

Retinal tears come in several configurations.

• U-shaped retinal tears (sagittal tears). These tears have a valve with an apex that is pulled up by the vitreous body and a base attached to the retina itself. Such tears consist of two parallel stripes that join at the apex, directed toward the posterior segment of the eyeball. Incomplete U-shaped tears can be linear or L-shaped.
• Retinal tears with a “lid,” in which the valve is completely torn off, a consequence of vitreous detachment.
• Tears are referred to as peripheral breaks along the "serrated" line with vitreous attachment to the posterior edge of the retinal tear.
• Giant retinal tears cover 90 or more of the periphery of the retina. They are represented by various forms of U-shaped tears with the attachment of the vitreous body to the anterior edge of the tear. Giant retinal tears are most often localized directly behind the "dentate" line and less often - in the equatorial region.

Localization of retinal tears

• The "jag" line is a retinal tear at the base of the vitreous body.
• Behind the "dentate" line is a retinal rupture between the posterior border of the base of the vitreous body and the equator.
• Equatorial - a retinal tear at the equator.
• Behind the equator - a retinal tear posterior to the equator.
• Macula is a retinal tear in the form of a hole in the macular area.

Retinal tears and detachments are red and have different shapes. There are perforated, valve, capped, and atypical tears. Tears can be single or multiple, central and paracentral, equatorial and paraoral (located near the dentate line). The type, location, and size of the tear largely determine the topography and rate of spread of retinal detachment. When tears are located in the upper half of the fundus, detachment usually progresses much faster than with lower tears and detachments. Tears are most often localized in the upper outer quadrant of the fundus. Having detected one retinal tear, the doctor must continue the search, sequentially examining the central and paracentral, and then the equatorial and paraoral parts of the fundus along the meridians, since the detection and blockade of all retinal tears determines both the choice of the optimal intervention method and its effectiveness. It is also necessary to identify vitreoretinal adhesions.

Treatment of retinal detachment

When performing the operation at a modern technical level, it is possible to achieve retinal adhesion in 92-97% of patients. In the early postoperative period, local and general anti-inflammatory therapy with non-steroidal and steroid drugs, systemic enzyme therapy in the presence of hemorrhages is indicated. Subsequently, it is advisable to conduct repeated courses of treatment, including drugs that normalize hemodynamics and microcirculation of the eye. Patients operated on for retinal detachment should be under the dispensary supervision of an ophthalmologist and avoid physical overloads.