Rhegmatogenous Retinal Detachment
Rhegmatogenous retinal detachment (RRD) occurs in 3% of patients with uveitis. Panuveitis and infectious uveitis are the entities most frequently associated with RRD, although pars planitis and posterior uveitis can also be associated with rhegmatogenous or tractional retinal detachments. Uveitis is often still active in eyes that present with RRD. Up to 30% of patients with uveitis and RRD may have proliferative vitreoretinopathy (PVR) at presentation; this percentage is significantly higher than in primary RRD in patients without uveitis. Repair is often complicated by preexisting PVR, vitreous membranes, and poor visualization. Repair of retinal detachment in uveitis is challenging and may require the full armamentarium of surgical strategies employed in complex retinal detachment repair. Additionally, it is essential to control inflammation aggressively in the perioperative period.
Acute retinal necrosis and cytomegalovirus retinitis frequently lead to retinal detachments that are difficult to repair because of multiple, often occult, posterior retinal breaks. The benefit of prophylactic laser treatment applied as soon as adequate visualization can be achieved is controversial. Pars plana vitrectomy and endolaser treatment with internal silicone oil tamponade are most often required to repair these detachments.
Kerkhoff FT, Lamberts QJ, van den Biesen PR, Rothova A. Rhegmatogenous retinal detachment and uveitis. Ophthalmology. 2003;110(2):427–431.
Nussenblatt RB, Whitcup SM. Uveitis: Fundamentals and Clinical Practice. 4th ed. Philadelphia, PA: Mosby; 2010.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.