THE RETINA
Baghdad University
College of Medicine
Department of Surgery
Ophthalmology Division
Objectives
The students should be able to:
Describe applied anatomy of the retina.
Define, list the types and causes of retinal detachment, describe
clinical symptoms and signs and differentiate between different
types.
Outline the treatment of different types of retinal detachment.
State the pathogenesis, classification, complications and
treatment of diabetic retinopathy.
Define, state the clinical features, risk factors and treatment of
age related macular degeneration.
The retina
Anatomy:
Blood supply:
- The outer one third (1/3) of retina (including RPE,
photoreceptors and half of the outer nuclear layer)
- The inner 2/3 of retina
Blood-Retinal Barrier (BRB):
1-Outer BRB:
2-Inner BRB:
Applied anatomy:
1- The macula:
2- The fovea:
3- The foveola:
4- Umbo
Macula
1.5 mm 1 disc
Ø
3 mm
Fovea
FAZ 300-500μm
7°
4 mm
Applied anatomy:
1- The macula:
2- The fovea:
3- The foveola:
Retinal Detachment (RD)
Types of retinal detachment:
1- Rhegmatogenous RD: (Rhegma = break)
2- Non-rhegmatogenous RD:
a- Tractional RD:
b- Exudative (serous) RD:
1- Rhegmatogenous RD
Causes:
a- Idiopathic.
b- Myopia.
c- Trauma.
d- Intraocular surgery, e.g. cataract surgery.
e- Hereditary diseases of vitreous and retina, e.g. Stickler's
syndrome.
f- In association with Tractional RD.
1- Rhegmatogenous RD
Symptoms:
a- Photopsia (flashes of light): PVD
b- Floaters:
c- Peripheral visual field defect:
d- Decreased central visual acuity (drop
vision):
Posterior vitreous detachment
PVD
Rhegmatogenous RD
1- Rhegmatogenous RD
1- Rhegmatogenous RD
1- Rhegmatogenous RD
1- Rhegmatogenous RD
1- Rhegmatogenous RD
2- Non-rhegmatogenous RD:
a- Tractional RD:
Causes:
i- Proliferative diabetic neuropathy.
ii- Retinopathy of prematurity "ROP"
(retrolental fibropathy or fibroplasias):
iii- Sickle cell retinopathy.
iv- Penetrating trauma.
2- Non-rhegmatogenous RD:
a- Tractional RD:
2- Non-rhegmatogenous RD:
a- Tractional RD:
Symptoms of tractional RD:
i- Visual field defect:
ii- Decreased central visual acuity:
2- Non-rhegmatogenous RD:
a- Tractional RD:
Treatment: Vitrectomy
2- Non-rhegmatogenous RD:
b- Exudative RD:
Causes:
i- Choroidal tumours.
ii- Retinblastoma.
iii- Uveitis (posterior uveitis).
iv- Posterior scleritis.
v- Malignant hypertension.
vi- Eclampsia.
2- Non-rhegmatogenous RD:
b- Exudative RD:
Symptoms:
Photopsiae are absent. Why??
Floaters.
Visual field defect develops suddenly & progress rapidly.
Bilateral eye involvement is possible.
Treatment???
Diabetic Retinopathy
Pathogenesis:
either microvascular occlusion.
Or microvascular leakage.
Vascular endothelial
groth factor (VEGF)v
Diabetic Retinopathy
The consequences of leakage and increased
vascular permeability include the development of
intraretinal haemorrahges and oedema.
Diabetic Retinopathy
Clinically DR may be:
1- Background DR.
2- Pre-proliferative DR
3- Proliferative DR.
4- maculopathy, which associates (1), (2) or (3).
5- Advanced diabetic eye disease.
Diabetic Retinopathy
Diabetic Retinopathy
Age-Related Macular Degeneration
(AMD)
A common, chronic, progressive degenerative
disorder of the macula that affect peoples above
50.
dry AMD
wet AMD
Macula
1.5 mm 1 disc
Ø
3 mm
Risk factors
• Age
• Race -Caucasians.
• Family history
• Smoking
• Hypertension and other cardiovascular risk factors
• Obesity and high fat intake
• Sun exposure, female gender and blue iris colour are
suspected
Symptoms
Gradual and progressive painless loss of vision
Decreased reading ability
Positive scotoma
metamorphopsia
Sudden deterioration of vision
Amsler Grid
Dry AMD
Dry AMD
Treatment
Antioxidant vitamins and
minerals
Intravitreal antiVEGF
