DOI: 10.1148/rg.234025163
Retinal Detachment: Imaging of Surgical Treatments and Complications1
John I. Lane, MD,
Robert E. Watson, Jr, MD, PhD,
Robert J. Witte, MD and
Colin A. McCannel, MD
1 From the Departments of Radiology (J.I.L., R.E.W., R.J.W.) and Ophthalmology (C.A.M.), Mayo Clinic, 200 First St SW, Rochester, MN 55902. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received November 18, 2002; revision requested December 17 and received January 21, 2003; accepted January 23. Address correspondence to J.I.L. (e-mail: lane.john@mayo.edu).
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Figure 1a. Untreated rhegmatogenous retinal detachment. (a) Ophthalmoscopic photograph shows retinal detachment and associated subretinal fluid. Note the leading edge of the detachment (arrows). (b) Higher-magnification photograph shows a large retinal tear. Note the free edges of the tear (arrows), which are elevated by the accumulation of subretinal fluid. (c) Axial computed tomographic (CT) scan shows hemorrhagic subretinal fluid in another patient with retinal detachment (arrow). Note that the detachment spares the optic disk.
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Figure 1b. Untreated rhegmatogenous retinal detachment. (a) Ophthalmoscopic photograph shows retinal detachment and associated subretinal fluid. Note the leading edge of the detachment (arrows). (b) Higher-magnification photograph shows a large retinal tear. Note the free edges of the tear (arrows), which are elevated by the accumulation of subretinal fluid. (c) Axial computed tomographic (CT) scan shows hemorrhagic subretinal fluid in another patient with retinal detachment (arrow). Note that the detachment spares the optic disk.
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Figure 1c. Untreated rhegmatogenous retinal detachment. (a) Ophthalmoscopic photograph shows retinal detachment and associated subretinal fluid. Note the leading edge of the detachment (arrows). (b) Higher-magnification photograph shows a large retinal tear. Note the free edges of the tear (arrows), which are elevated by the accumulation of subretinal fluid. (c) Axial computed tomographic (CT) scan shows hemorrhagic subretinal fluid in another patient with retinal detachment (arrow). Note that the detachment spares the optic disk.
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Figure 2a. Natural history of untreated retinal detachment. (a) Drawing shows a retinal tear (straight arrow) with accumulation of subretinal fluid (curved arrow) beneath the detached sensory retina. (b) Drawing shows the globe affected by long-term detachment and proliferative vitreoretinopathy. Note the extensive retraction of the sensory retina from the underlying retinal pigment epithelium as a result of contraction of scar tissue. (c) Drawing shows phthisis bulbi. Note the shrunken globe with associated scleral thickening.
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Figure 2b. Natural history of untreated retinal detachment. (a) Drawing shows a retinal tear (straight arrow) with accumulation of subretinal fluid (curved arrow) beneath the detached sensory retina. (b) Drawing shows the globe affected by long-term detachment and proliferative vitreoretinopathy. Note the extensive retraction of the sensory retina from the underlying retinal pigment epithelium as a result of contraction of scar tissue. (c) Drawing shows phthisis bulbi. Note the shrunken globe with associated scleral thickening.
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Figure 2c. Natural history of untreated retinal detachment. (a) Drawing shows a retinal tear (straight arrow) with accumulation of subretinal fluid (curved arrow) beneath the detached sensory retina. (b) Drawing shows the globe affected by long-term detachment and proliferative vitreoretinopathy. Note the extensive retraction of the sensory retina from the underlying retinal pigment epithelium as a result of contraction of scar tissue. (c) Drawing shows phthisis bulbi. Note the shrunken globe with associated scleral thickening.
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Figure 3. Phthisis bulbi. Axial CT scan shows a shrunken left globe with a thickened, calcified sclera.
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Figure 4a. Surgical treatment of retinal detachment. (a) Intraoperative photograph obtained before placement of a scleral buckle shows use of a direct ophthalmoscope to position a cryoprobe (arrow) directly over a retinal tear, thus producing chorioretinal adhesions. (b) Intraoperative photograph obtained after application of a circumferential silicone band (arrow). Sutures around the extraocular muscles are used to control the position of the eye during the procedure.
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Figure 4b. Surgical treatment of retinal detachment. (a) Intraoperative photograph obtained before placement of a scleral buckle shows use of a direct ophthalmoscope to position a cryoprobe (arrow) directly over a retinal tear, thus producing chorioretinal adhesions. (b) Intraoperative photograph obtained after application of a circumferential silicone band (arrow). Sutures around the extraocular muscles are used to control the position of the eye during the procedure.
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Figure 5. Scleral buckling. Drawing shows a silicone sponge (straight arrow) and a silicone band (arrowhead). The circumferential silicone band compresses the underlying silicone sponge (which is in contact with the sclera), thus producing apposition of the underlying retinal pigment epithelium and the sensory layer of the retina (curved arrow).
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Figure 6a. Large retinal detachment extending from 6 to 10 o’clock in the right eye treated with an encircling silicone rubber band. Axial (a) and coronal (b) CT scans show a high-attenuation scleral band that encircles the right globe (arrows). Note the physiologic calcification at the anteromedial aspect of the left globe (arrowhead in a), which represents calcified scleral plaque at the attachment of the medial rectus muscle.
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Figure 6b. Large retinal detachment extending from 6 to 10 o’clock in the right eye treated with an encircling silicone rubber band. Axial (a) and coronal (b) CT scans show a high-attenuation scleral band that encircles the right globe (arrows). Note the physiologic calcification at the anteromedial aspect of the left globe (arrowhead in a), which represents calcified scleral plaque at the attachment of the medial rectus muscle.
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Figure 7. Large retinal detachment extending from 7 to 10 o’clock in the left eye treated with a circumferential silicone sponge and an encircling silicone rubber band. Axial CT scan shows a circumferential silicone sponge that is isoattenuating to air (arrows) deep to an encircling high-attenuation silicone band (arrowheads).
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Figure 8. Small retinal detachment extending from 3:00 to 3:30 in the left eye treated with a radial silicone sponge sutured to the sclera. Axial CT scan shows a radial silicone sponge that is isoattenuating to air (arrow). Note the absence of a high-attenuation silicone band, which was not used in this case.
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Figure 9a. Large retinal tear in the right eye treated with an encircling silicone sponge and intraocular gas tamponade with C3F8. Axial (a) and coronal (b) CT scans show a circumferential low-attenuation silicone sponge (arrows) and intravitreal gas.
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Figure 9b. Large retinal tear in the right eye treated with an encircling silicone sponge and intraocular gas tamponade with C3F8. Axial (a) and coronal (b) CT scans show a circumferential low-attenuation silicone sponge (arrows) and intravitreal gas.
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Figure 10. Large retinal detachment in the left eye treated with an encircling silicone rubber band. Axial T1-weighted MR image obtained with fat saturation shows contour deformities of the medial and lateral surfaces of the left globe (arrow) secondary to an encircling silicone band.
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Figure 11a. Tantalum clip used to secure the free edges of a silicone band. (a) Anteroposterior radiograph shows a metallic clip at the inferolateral aspect of the left orbit (arrow). (b) Drawing shows the surgical technique.
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Figure 11b. Tantalum clip used to secure the free edges of a silicone band. (a) Anteroposterior radiograph shows a metallic clip at the inferolateral aspect of the left orbit (arrow). (b) Drawing shows the surgical technique.
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Figure 12. Drawing shows use of intraocular air tamponade in conjunction with a scleral buckle for treatment of retinal detachment.
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Figure 13. Large retinal detachment in the left eye treated with an encircling silicone sponge and intraocular air tamponade. Axial CT scan shows the air attenuation of an encircling silicone sponge (arrows) as well as intravitreal air.
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Figure 14. Large retinal detachment in the right eye treated with a scleral buckle and intraocular air tamponade. Axial T1-weighted MR image shows intravitreal gas as complete loss of signal with an air-fluid level and a hypointense encircling silicone band (arrows).
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Figure 15. Drawing shows treatment of chronic retinal detachment and proliferative vitreoretinopathy with vitrectomy, scleral banding (arrows), and intraocular silicone oil tamponade.
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Figure 16. Chronic retinal detachment with proliferative vitreoretinopathy in the left eye treated with intraocular silicone oil tamponade and an encircling silicone sponge. Axial CT scan shows high-attenuation silicone oil in the anterior aspect of the posterior chamber and the air attenuation of an encircling sponge (arrows).
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Figure 17a. Large chronic retinal detachment and proliferative vitreoretinopathy in the left eye treated with vitrectomy, scleral banding, and intraocular silicone oil tamponade. (a) Axial T1-weighted MR image shows high-signal-intensity silicone oil in the vitreous cavity of the left globe and contour deformity from an encircling scleral band. (b) Axial T1-weighted MR image obtained with fat saturation shows a decrease in the signal intensity of the silicone oil. (c) Axial T2-weighted MR image shows chemical shift artifact at the interface between the silicone oil and vitreous fluid (arrow). (d) Axial T2-weighted MR image obtained with fat saturation shows low signal intensity of the silicone oil.
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Figure 17b. Large chronic retinal detachment and proliferative vitreoretinopathy in the left eye treated with vitrectomy, scleral banding, and intraocular silicone oil tamponade. (a) Axial T1-weighted MR image shows high-signal-intensity silicone oil in the vitreous cavity of the left globe and contour deformity from an encircling scleral band. (b) Axial T1-weighted MR image obtained with fat saturation shows a decrease in the signal intensity of the silicone oil. (c) Axial T2-weighted MR image shows chemical shift artifact at the interface between the silicone oil and vitreous fluid (arrow). (d) Axial T2-weighted MR image obtained with fat saturation shows low signal intensity of the silicone oil.
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Figure 17c. Large chronic retinal detachment and proliferative vitreoretinopathy in the left eye treated with vitrectomy, scleral banding, and intraocular silicone oil tamponade. (a) Axial T1-weighted MR image shows high-signal-intensity silicone oil in the vitreous cavity of the left globe and contour deformity from an encircling scleral band. (b) Axial T1-weighted MR image obtained with fat saturation shows a decrease in the signal intensity of the silicone oil. (c) Axial T2-weighted MR image shows chemical shift artifact at the interface between the silicone oil and vitreous fluid (arrow). (d) Axial T2-weighted MR image obtained with fat saturation shows low signal intensity of the silicone oil.
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Figure 17d. Large chronic retinal detachment and proliferative vitreoretinopathy in the left eye treated with vitrectomy, scleral banding, and intraocular silicone oil tamponade. (a) Axial T1-weighted MR image shows high-signal-intensity silicone oil in the vitreous cavity of the left globe and contour deformity from an encircling scleral band. (b) Axial T1-weighted MR image obtained with fat saturation shows a decrease in the signal intensity of the silicone oil. (c) Axial T2-weighted MR image shows chemical shift artifact at the interface between the silicone oil and vitreous fluid (arrow). (d) Axial T2-weighted MR image obtained with fat saturation shows low signal intensity of the silicone oil.
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Figure 18a. Complication of scleral buckling with hydrogel. (a) Intraoperative photograph shows an extruded, swollen hydrogel band encircling the right eye (arrows). (b) Photograph of the surgical specimen shows that the hydrolyzed buckle material has fragmented and expanded. (Reprinted, with permission, from reference 10.)
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Figure 18b. Complication of scleral buckling with hydrogel. (a) Intraoperative photograph shows an extruded, swollen hydrogel band encircling the right eye (arrows). (b) Photograph of the surgical specimen shows that the hydrolyzed buckle material has fragmented and expanded. (Reprinted, with permission, from reference 10.)
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Figure 19a. Complication of scleral buckling with hydrogel. Contrast material-enhanced axial (a) and coronal (b) CT scans show a circumferential soft-tissue mass surrounding the globe with a focal dystrophic calcification (arrow) and a peripherally enhancing rim. (Reprinted, with permission, from reference 10.)
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Figure 19b. Complication of scleral buckling with hydrogel. Contrast material-enhanced axial (a) and coronal (b) CT scans show a circumferential soft-tissue mass surrounding the globe with a focal dystrophic calcification (arrow) and a peripherally enhancing rim. (Reprinted, with permission, from reference 10.)
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Figure 20a. Complication of scleral buckling with hydrogel. (a) Axial T2-weighted MR image shows a markedly expanded buckle element, which is hyperintense with a low-signal-intensity rim (arrow). (b) Axial contrast-enhanced T1-weighted MR image shows that the buckle element is expanded and has rim enhancement (arrow). (Reprinted, with permission, from reference 10.)
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Figure 20b. Complication of scleral buckling with hydrogel. (a) Axial T2-weighted MR image shows a markedly expanded buckle element, which is hyperintense with a low-signal-intensity rim (arrow). (b) Axial contrast-enhanced T1-weighted MR image shows that the buckle element is expanded and has rim enhancement (arrow). (Reprinted, with permission, from reference 10.)
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Copyright © 2003 by the Radiological Society of North America.
