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Retinal detachment

Nature Reviews Disease Primers volume 10, Article number: 18 (2024) Cite this article

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Abstract

Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.

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Fig. 1: Schematic of various types of RD.
Fig. 2: Rhegmatogenous retinal detachment and tractional retinal detachment.
Fig. 3: Paediatric retinal detachment.
Fig. 4: Overarching principles that influence management decisions for retinal detachment.
Fig. 5: Giant retinal tear.
Fig. 6: Scleral buckling.
Fig. 7: Rhegmatogenous retinal detachment in a highly myopic eye.

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Authors and Affiliations

  1. Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA

    Jonathan B. Lin

  2. Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India

    Raja Narayanan

  3. Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France

    Elise Philippakis

  4. Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA

    Yoshihiro Yonekawa

  5. John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Rajendra S. Apte

  6. Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Rajendra S. Apte

  7. Department of Developmental, Regenerative, and Stem Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Rajendra S. Apte

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  1. Jonathan B. Lin
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  2. Raja Narayanan
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  3. Elise Philippakis
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  4. Yoshihiro Yonekawa
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Contributions

Introduction (R.S.A. and J.B.L.); Epidemiology (R.S.A. and J.B.L.); Mechanisms/pathophysiology (R.S.A., J.B.L., R.N., E.P. and Y.Y.); Diagnosis, screening and prevention (R.S.A. and J.B.L.); Management (R.S.A., J.B.L., R.N., E.P. and Y.Y.); Quality of life (R.S.A. and J.B.L.); Outlook (R.S.A. and J.B.L.); overview of the Primer (R.S.A. and J.B.L.).

Corresponding author

Correspondence to Rajendra S. Apte.

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Competing interests

R.N. consultant: Alcon. Y.Y. consultant: Alcon, EyePoint, Pykus, Versant Health; research funding: Kodiak, Genentech, Regeneron. R.S.A. founder and scientific advisory board: Metro Biotech, Mobius Scientific; equity: EdenRoc Sciences; scientific advisory board: Roche, Delavie Sciences, New Amsterdam Pharma. J.B.L. and E.P. declare no competing interests.

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Nature Reviews Disease Primers thanks S. Loukovaara, T. Sakamoto, A. Wolf and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Lin, J.B., Narayanan, R., Philippakis, E. et al. Retinal detachment. Nat Rev Dis Primers 10, 18 (2024). https://doi.org/10.1038/s41572-024-00501-5

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