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Exudative (or serous) retinal detachment (ERD) occurs when fluid accumulates in the subretinal space between the sensory retina and the retinal pigmented epithelium (RPE) resulting in retinal detachment. Causes for fluid accumulation include inflammatory, infectious, and neoplastic diseases of the choroid or retina.[1][2]




Detachment image



The subretinal space, a remnant of the embryonic optic vesicle, is practically nonexistent in a healthy eye. However, pathologies that disrupt the integrity of the blood-retina barrier (BRB) can cause leakage of fluid that enlarges the subretinal space and separates the sensory retina from the RPE resulting in retinal detachment.[1]


Slit-lamp examination, dilated fundoscopy, and indirect ophthalmoscopy with scleral depression should all be performed. ERD can appear as shifting fluid beneath the retina. The fluid shifts with gravity and can change location according to patient position.[4] Exudative detachment looks smooth compared to a jagged, rhegmatogenous detachment.


There is no clear consensus for management of atrophic retinal holes; therefore, many practitioners elect to monitor.3-5 However, a full-thickness retinal hole can allow transmission of fluid from the vitreous cavity to the subretinal space and may result in subretinal fluid accumulation and a rhegmatogenous retinal detachment (RRD).5


Often, atrophic round holes lead to slow-growing chronic detachments (Figure 5).6 RRDs located in the inferior or temporal retinal quadrants, or both, are often found in completely asymptomatic patients not aware of superior or nasal field loss.5


Vitreous tufts are congenital vitreoretinal developmental anomalies. These have cystic and non-cystic variations (Figure 7).2 The separation of this abnormally adhered vitreous clump during a broad or localized posterior vitreous detachment (PVD) can result in round operculated holes (Figure 8). Others can result in irregular-shaped operculated retinal holes (Figure 9). These holes can cause chronic or acute RRDs (Figures 9 and 10). 9,10


No consensus exists on treating symptomatic and asymptomatic operculated holes. Prophylactic laser is usually recommended for symptomatic cases. Treatment of asymptomatic holes may reduce the risk of retinal detachment with minimal to no risk to the patient (Figure 11).4,5


Fig. 13. Following PVD symptoms this patient (A) developed a superotemporal RRD caused by a small HSRT (blue arrow), while another patient (B) has developed an inferior macula off RRD from HSRT (blue arrow). These patients required surgical intervention. The RRD in (C) is caused by more than one retinal tear, not an uncommon finding. Click image to enlarge.


Giant retinal breaks are full-thickness tears that extend at least three clock hours (Figure 15). Retinal detachments caused by giant breaks may require different surgical modalities compared to other RRDs. For instance, perfluorocarbon (PFO) may be used to unfold a retinal detachment intraoperatively.11,12


Retinal dialysis is a break in which the anterior portion is adjacent to the ora serrata (Figure 16A). The majority of these cases are associated with ocular trauma, and most are diagnosed in young patients without posterior vitreous detachment. Managing retinal dialysis can be challenging as well.


Retinal detachment may be prevented by treating the extent of the dialysis with laser retinopexy. If retinal detachment is present, treatment needs to be tailored to the individual patient. Options include: vitrectomy with gas or oil, scleral buckling with or without vitrectomy, and laser retinopexy may still be used if the detachment is limited (Figure 16B). Making the appropriate surgical decision leads to good outcomes in the vast majority of patients.13-15


Images using the v2 or later image format have a content-addressable identifiercalled a digest. As long as the input used to generate the image is unchanged,the digest value is predictable and referenceable.


This command is optional because the person who created the IMAGE mayhave already provided a default COMMAND using the Dockerfile CMDinstruction. As the operator (the person running a container from theimage), you can override that CMD instruction just by specifying a newCOMMAND.


The ENTRYPOINT of an image is similar to a COMMAND because itspecifies what executable to run when the container starts, but it is(purposely) more difficult to override. The ENTRYPOINT gives acontainer its default nature or behavior, so that when you set anENTRYPOINT you can run the container as if it were that binary,complete with default options, and you can pass in more options via theCOMMAND. But, sometimes an operator may want to run something elseinside the container, so you can override the default ENTRYPOINT atruntime by using a string to specify the new ENTRYPOINT. Here is anexample of how to run a shell in a container that has been set up toautomatically run something else (like /usr/bin/redis-server):


The port number inside the container (where the service listens) doesnot need to match the port number exposed on the outside of thecontainer (where clients connect). For example, inside the container anHTTP service is listening on port 80 (and so the image developerspecifies EXPOSE 80 in the Dockerfile). At runtime, the port might bebound to 42800 on the host. To find the mapping between the host portsand the exposed ports, use docker port.


root (id = 0) is the default user within a container. The image developer cancreate additional users. Those users are accessible by name. When passing a numericID, the user does not have to exist in the container.


71-year-old man presented with 2 weeks of blurred vision and curtain-like vision loss obscuring the inferior portion of his left visual field. Visual acuity was 20/50+2. Fundoscopy (see image) demonstrated a large horseshoe break at 12:30 at the equator, with a slightly rolled edge and a bridging vessel. There was subretinal fluid from 10:00 clockwise to 3:00, extending posteriorly to just involve the center of the fovea. This macula-involving rhegmatogenous retinal detachment was repaired surgically. Three months later, his vision improved to 20/20.


This is a patient who presented with an inferior visual field defect and multiple flashes and floaters. These images demonstrate an excellent example of a large, superior horseshoe tear with a bullous retinal detachment.


Detachment 925 is an Air Force ROTC program that covers the campuses of UW-Madison, UW-Whitewater, Edgewood, Madison Area Technical College and Maranatha Baptist University. Proud of high standards of professionalism and a well developed cadet run corps, Detachment 925 is one of the more distinguished detachments in the nation.


Retinal detachment is a detachment of the neurosensory retina from the underlying pigmented choroid. Apposition of the retinal pigmented epithelium to the overlying retina is essential for normal retinal function.


Rhegmatogenous retinal detachment is most common in the 6th and 7th decade of life but can occur at any age and has a slight male predilection 5. The annual incidence is variable. Observational studies with sample sizes >300 showed a median annual incidence of 1 in 10,000 6.


Retinal detachments are classified as rhegmatogenous, meaning caused by a tear (rhegma) in the retina, or non-rhegmatogenous. The interplay between vitreoretinal traction and predisposing retinal lesions is associated with retinal detachment.


Improved prognosis and surgical outcomes are seen with macula-on retinal detachments where the fovea is still attached 5. Macula-off, or central retinal detachments have worse initial visual acuity and prognosis. Overall prognosis is good with approximately 95% of patients having an anatomically successful repair 5.


Alexander E Salmon, Benjamin S Sajdak, Thomas B Connor, Alfredo Dubra, Joseph Carroll; High resolution imaging of retinal detachment in the cone-dominant ground squirrel. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1154.


Methods : Baseline optical coherence tomography (OCT), scanning light ophthalmoscopy (SLO), and adaptive optics SLO (AOSLO) images were acquired before saline was infused into the subretinal space of thirteen-lined ground squirrels (13-LGS; n=3). The detached region was then imaged at several time points over 6 months. Cone inner segments were identified using the non-confocal split-detection or dark-field AOSLO image. Cone density, Voronoi cell area regularity (VCAR), and confocal reflectance intensity (normalized by detector gain) was measured at 14 days post-detachment at the edge of the bleb and compared to isoeccentric regions at baseline.


Results : Cone photoreceptors were visible inside much of the re-attached area in split-detector and dark-field images. Hyperreflective lesions and diffuse, graded opacities were common at the photoreceptor layer within the detached region which obscured cone visualization. Changes in confocal reflectance intensity and cone density values were variable (Table). The mosaic exhibited a significant reduction in VCAR after detachment (p = 0.0071, paired t-test, n = 3). In other regions, cone death gave rise to visibility of the underlying RPE cells (Figure). On OCT, disruption of the laminar appearance of the outer retinal layers occurred in the detached areas and hyper-reflectivity was evident in the inner retina.


View OriginalDownload SlideView OriginalDownload Slide View OriginalDownload Slide(A) SLO image of the detached region (t: 180d). Confocal (B) split-detector (C), and dark-field (D) images from the outlined area in (A). (B-D) RPE cells are visible (left) adjacent to surviving cones. Images have been contrast adjusted for display purposes. Scale bars: 750µm (A) and 50µm (B-D).


"Floaters" and flashes are a common sight for many people. Floater is a catchall term for the specks, threads, or cobweb-like images that occasionally drift across the line of vision. Flashes are sparks or strands of light that flicker across the visual field. Both are usually harmless. But they can be a warning sign of trouble in the eye, especially when they suddenly appear or become more plentiful. 041b061a72


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