Fig. 6.13 A retinal cyst has formed in the macular area in this patient with chronic RRD

Fig. 6.14 Subretinal bands in a chronic RRD, these are commoner in vitreous-attached RRD, e.g. retinal dialysis or round hole (young myope) RRD

Fig. 6.15 The fovea was in place in this chronic RRD with subretinal bands. The retinal hole appeared to be plugged with vitreous perhaps preventioning further fluid vitreous entry through the break and further spread of the RRD (see Fig. 6.16)

Fig. 6.16 See previous figure

6.1.3Natural History

•Most retinal detachments if untreated will progress to totality or near totality. The visual loss is profound, and potential recovery of vision by surgery reduces as the weeks go by.

•The accumulation of SRF in the periphery seems to be important for the development of loss of vision as patients

with RRD lose more vision in comparison to CSR for the same foveal.

•Initially, the retina is thickened and less transparent than normal.

•If the retina remains detached for many months, it becomes progressively atrophic.

•The longer the retina remains detached, the higher the risk of a scarring response, proliferative vitreoretinopathy (see PVR, Chap. 8).

Fig. 6.17 If a RRD spontaneously reattaches, retinal pigment epithelial changes may occur

Fig. 6.18 Tiny white flecks can be seen in the fovea in patients with chronic retinal detachment. These are signs of oxalosis, a secondary complication from the chronicity of the retinal detachment

Fig. 6.19 A tiny speck of oxalate can be seen on the foveal surface on OCT (greyscale image)

Fig. 6.20 Some long-standing RRDs, e.g. from retinal dialysis, will show white spots on the outer retina. These fade after reattachment of the retina (see Fig. 6.21)