From the Guidelines
Tractional retinal detachment is a serious eye condition most commonly caused by proliferative diabetic retinopathy, where abnormal blood vessels grow on the retina and form scar tissue that contracts and pulls the retina away from its normal position. This condition is characterized by the growth of scar tissue (fibrovascular membranes) on the retina's surface, which contracts and pulls the retina away from the back of the eye. The most common cause of tractional retinal detachment is proliferative diabetic retinopathy, a complication of diabetes where abnormal blood vessels grow on the retina in response to poor blood circulation, as described in the diabetic retinopathy preferred practice pattern 1.
Key Characteristics of Tractional Retinal Detachment
- Scar tissue grows on the retina's surface and contracts
- Retina is pulled away from its normal position against the back of the eye
- Most common cause is proliferative diabetic retinopathy
- Other causes include retinopathy of prematurity, sickle cell disease, and penetrating eye injuries
Symptoms and Treatment
Symptoms of tractional retinal detachment may include floaters, flashes of light, or a shadow or curtain across the visual field. Treatment typically involves vitrectomy surgery to remove the vitreous gel and scar tissue, followed by laser treatment and gas or silicone oil to reattach the retina, as part of the management of diabetic retinopathy 1. Early detection through regular eye examinations is crucial, especially for diabetic patients, as untreated tractional retinal detachment can lead to permanent vision loss.
Importance of Early Detection
Regular eye examinations are essential for early detection of tractional retinal detachment, particularly in diabetic patients, to prevent permanent vision loss. The condition differs from rhegmatogenous retinal detachment, which is caused by tears or holes in the retina. According to the diabetic retinopathy preferred practice pattern 1, prompt treatment can significantly improve outcomes and reduce the risk of vision loss.
From the Research
Definition of Tractional Retinal Detachment
- Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina 2.
- It is a severe complication in diabetic retinopathy, where the decision for surgical intervention has to consider the spontaneous course of the disease, intraoperative and postoperative complications, and the expected functional results 3.
Most Common Cause of Tractional Retinal Detachment
- Tractional retinal detachments (TRD) are most commonly associated with proliferative diabetic retinopathy (PDR) 4, 5.
- PDR is a major cause of vision loss in diabetic patients, and TRD is a common indication for PDR-related vitreoretinal surgery 5.
- The use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in eyes with PDR can also lead to tractional retinal detachment, known as anti-VEGF crunch syndrome 6.