Tractional Retinal Detachment
Vitreous membranes caused by penetrating injuries or by proliferative retinopathies such as diabetic retinopathy can pull the neurosensory retina away from the RPE, causing a tractional retinal detachment. The retina characteristically has smooth concave surfaces and contours and is immobile. The detachment can be central or peripheral and, in rare cases, can extend from the optic nerve head to the ora serrata. In most cases, the causative vitreous membrane can be seen biomicroscopically with a 3-mirror contact lens or a 60 D to 90 D indirect lens. If the traction can be released by vitrectomy, the detachment may resolve.
In some cases, traction may tear the retina and cause a combined tractional and rhegmatogenous retinal detachment. Clinically, the tractional retinal detachment loses its concave surface and assumes a convex shape more reminiscent of an RRD. However, the retinal mobility is often limited compared with that of an eye with RRD because of the tethering by proliferative tissue. In addition, corrugations characteristic of an RRD are present, and subretinal fluid, which is more extensive than in tractional retinal detachment, may extend from the optic nerve head to the ora. Treatment may require a combination of vitrectomy and a scleral buckling procedure to release the traction and seal the break.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.