This 77YO male presented with 20/400 vision from a chronic macula-off rhegmatogenous retinal detachment (RRD).
Demarcation lines are common in these cases (not present here). The billowing, corrugated convex appearance of the inferior retina is typical of RRD. The retina is mobile without proliferative vitreoretinopathy.
Learning Points:
The normal neurosensory retina remains attached to the RPE due to numerous physiologic mechanisms, including 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.
