A multivariate analysis of factors affecting the management outcome in rhegmatogenous retinal detachment.

Retinal detachment is a condition in which fluid from the vitreous cavity passes through a full thickness retinal defect into the sub retinal space to cause separation of the neural retina from the underlying Retinal pigment epithelium. The term detachment of the retina is a misnomer. In the first place the retina as a whole is not involved, but a cleavage occurs between the two primitive retinal layers, the pigmentary epithelium remaining in position attached to the membrane of Bruch, while the inner neural layer becomes separated from it due to the opening of the potential space of the primary optic vesicle. The condition of the RD is not a pathological entity but an anatomical accident. In the spontaneous variety, the detachment itself is essential catastrophe and the casual lesion may be so slight as to escape notice even after the most careful search. In the secondary variety, the RD is an incident epiphenomenon in a clinical picture dominated by a neoplasm, inflammation or other pathological features of obvious importance - Sir Stewart Duke Elder. Over centuries the concepts and our approach towards retinal detachment has constantly changed a lot. An effort to trace it takes us through a journey into the evolution of modern ophthalmology itself. This study recommends the recognition of risk factors, proper patient education, periodic detailed examination and early detection as valuable tools to tackle rhegmatogenous retinal detachment and the importance of screening patients with known risk factors. So much is stressed upon the early diagnosis of glaucoma and diabetic retinopathy. But this study clearly emphasizes the importance of duration of retinal detachment in successful treatment outcome. So increased awareness about the symptoms of this condition like flashes and floaters should be provided to the general public. All patients who come for refraction should undergo a proper indirect ophthalmoscope examination under full dilatation with special reference to myopes. In modern cataract surgery refined techniques and instrumentation if meticulously used could greatly prevent the occurrence of posterior capsule rent. This can go a long way in preventing retinal detachment as a delayed complication in such cases. All patients who undergo cataract surgery especially those who undergo surgery in mobile eye camps in rural areas who will not be able to come to regular follow up should be made aware of the symptoms of retinal detachment at the time of final glass prescription. The benefit of YAG capsulotomy especially in the early post operative period in any case of posterior capsular opacification should be weighed against the risk it induces in the occurrence of retinal breaks. And if it has to be done it should be preferably done after six months post operative. Any patient with ocular trauma should undergo detailed indirect ophthalmoscope examination and should be educated about the symptoms of retinal detachment and report immediately if such symptoms occur