This patient presented with a new retinal tear causing retinal detachment in an eye with previously lasered operculated hole.
Learning Points:
The normal neurosensory retina remains attached to the RPE due to numerous physiologic mechanisms including the the inner (retinal vascular endothelium) and outer (tight junctions at the apex of the RPE cells) blood retinal barriers, hyperosmotic choroid passively drawing fluid into the subretinal space, RPE pump, interphotoreceptor matrix, and friction between the RPE microvilli and the photoreceptor outer segments.
Rhegmatogenous retinal detachment (RRD) occurs when liquid vitreous, entering the subretinal space through a retinal break, overwhelms these forces favoring retinal detachment.
Repairing RRD involves finding and closing all breaks, essentially denying the liquid vitreous access to the subretinal space. The break(s) can be closed internally with a gas bubble with pneumatic retinopexy or vitrectomy surgery, or externally by sewing a piece of silicone material to the eye wall (scleral buckle). This indents, or buckles, the sclera up against the retinal break.
