Retinal detachment (RD) is defined as a condition in which the inner part of the neural retina (sensory retina) from the photoreceptor layer separates from the retinal pigment epithelium (RPE) layer, with subretinal fluid accumulating between them. Embryologically, the neural retina differentiates from the inner layer of the neuroectoderm, while the RPE differentiates from the outer layer, so their attachment is inherently weak, making detachment prone to occur due to various causes.10,20)
When retinal detachment occurs, photoreceptor cells are separated from the oxygen and nutrient supply from the RPE and choroid. Degeneration and shedding of photoreceptor outer segments begin early after onset, and if prolonged, progress to irreversible photoreceptor damage. This time dependency is the basis for the “urgency” of retinal detachment. In particular, when the macula (fovea) detaches, central vision rapidly and severely declines, and visual recovery after surgery tends to be incomplete.
Based on the mechanism of onset, it is broadly classified into the following three types (some consider traumatic as a separate fourth type).
| Disease type | English name | Main abbreviations | Tear | Traction | Exudative |
|---|---|---|---|---|---|
| Rhegmatogenous | Rhegmatogenous RD | RRD | ◎ | △ (secondary) | — |
| Tractional | Tractional RD | TRD | — | ◎ | — |
| Exudative | Exudative RD | ERD | — | — | ◎ |
| Traumatic | Traumatic RD | — | △/◎ | △ | △ |
Definition and Epidemiology
The name rhegmatogenous retinal detachment (RRD) derives from the Greek word “rhegma,” meaning “rent” or “tear.” The annual incidence varies by region but is generally around 10–15 per 100,000 population. A history of retinal detachment in the fellow eye or a family history are risk factors for developing the condition. 7)
Age of onset shows a bimodal distribution:
Age, Sex, and Racial Differences
PVD occurs with aging and tends to occur earlier after myopia or cataract surgery. The risk of rhegmatogenous retinal detachment increases with older age, male sex, myopia, post-cataract surgery, trauma, history of rhegmatogenous retinal detachment in the fellow eye, and lattice degeneration, with incidence varying by region and race. 7)
Relationship between axial length and myopia
As axial length increases, degeneration of the retina and vitreous progresses, and the risk of rhegmatogenous retinal detachment rises stepwise. Compared to emmetropic eyes with axial length less than 24 mm, eyes with axial length of 26 mm or more (equivalent to high myopia) have a 2- to 3-fold higher incidence of peripheral retinal lattice degeneration and atrophic holes. In Japan, the proportion of rhegmatogenous retinal detachment due to macular holes in highly myopic eyes (over -6 diopters) is about 5% of all rhegmatogenous retinal detachments, which is higher than the 0.5-2.0% in Europe and the United States.
Necessary conditions for onset
The following two conditions are absolutely necessary for the development of rhegmatogenous retinal detachment:
Myopia is an important risk factor for rhegmatogenous retinal detachment, and it has been reported that the risk of developing the condition increases approximately 10-fold in myopia exceeding -3 diopters. In highly myopic eyes, posterior vitreous detachment (PVD) tends to occur early, and vitreous liquefaction and retinal traction progress rapidly. Lattice degeneration is also a representative peripheral retinal degeneration involved in the development of rhegmatogenous retinal detachment. 7, 9)
Main risk factors
Intrinsic ocular risk factors
Iatrogenic and external risks
Tractional retinal detachment occurs when incomplete posterior vitreous detachment leads to strong vitreous traction on the retina. It can be broadly classified into two types: fibrovascular membranes containing neovascularization from intraocular proliferative cells and vitreoretinal traction.
| Type | Representative diseases | Characteristics of traction |
|---|---|---|
| Fibrovascular membrane type | Proliferative diabetic retinopathy (PDR), retinal vein occlusion, retinopathy of prematurity (ROP) | Epiretinal membrane with neovascularization and fibroblasts |
| Simple vitreous traction type | Vitreomacular traction syndrome, penetrating ocular trauma | Pure traction without neovascularization |
Morphological features
Tractional retinal detachment is immobile and has a concave shape. Tent-shaped detachment occurs at the epicenter of neovascularization or along retinal vessels. If adhesion is extensive, it becomes a “tabletop type” (Mount Fuji type). If the detachment is dome-shaped and mobile, suspect combined tractional-rhegmatogenous retinal detachment.
Exudative retinal detachment is a non-rhegmatogenous retinal detachment caused by accumulation of exudative fluid under the retina due to functional disorders of retinal vessels, RPE, choroid, etc. Breakdown of the blood-retinal barrier (BRB) is the final common pathway, and causes are diverse.
Typical clinical features
Main causative diseases
| Etiological classification | Representative diseases |
|---|---|
| Inflammatory/immune | Vogt-Koyanagi-Harada disease (VKH), posterior scleritis, sympathetic ophthalmia, uveitis |
| Vascular | Central serous chorioretinopathy (CSC), Coats disease, exudative AMD, diabetic macular edema |
| Neoplastic | Choroidal malignant melanoma, metastatic choroidal tumor, retinoblastoma |
| Drug-induced | MEK inhibitors (e.g., binimetinib) 4), immune checkpoint inhibitors (including VKH-like syndrome caused by anti-PD-1/PD-L1 antibodies) 12) |
| Systemic diseases | Pregnancy-induced hypertension / preeclampsia (may cause bilateral exudative retinal detachment) 6) / malignant hypertension |
| Others | Idiopathic choroidal detachment / uveal effusion |
Traumatic retinal detachment is caused by blunt or perforating ocular trauma. In blunt trauma, retinal detachment occurs in 12% immediately after injury, 30% within 1 month, 50% within 8 months, and 80% within 24 months, according to reports, requiring long-term follow-up. A special type is retinal dialysis caused by trauma.
It varies greatly by type. Rhegmatogenous and tractional retinal detachments generally do not heal spontaneously. If left untreated, they progressively enlarge and eventually lead to blindness. On the other hand, exudative retinal detachment may resolve spontaneously with treatment of the underlying cause (e.g., VKH or drug-induced). However, if the cause is neoplastic, tumor treatment takes priority. If floaters, photopsia, or visual field defects appear, it is important to see an ophthalmologist promptly without waiting for spontaneous healing.
Prodromal symptoms (especially rhegmatogenous retinal detachment)
| Symptom | Mechanism | Note |
|---|---|---|
| Floaters (sudden increase or worsening) | Vitreous hemorrhage or pigment cell floatation (Shafer’s sign) | Sudden increase in floaters suggests retinal tear formation |
| Photopsia | Vitreous traction on the retina | Worsened in dark, with eye closure, or with eye movement |
| Curtain-like visual field defect | Decreased sensitivity corresponding to the detached area | Easily mistaken for glaucoma or ptosis |
| Decreased vision and metamorphopsia | Macular detachment and edema | Indicator of macular detachment |
Correspondence between symptoms and disease type
Rhegmatogenous retinal detachment
Tractional Retinal Detachment
Exudative retinal detachment
Changes in intraocular pressure
| Item to Confirm | Purpose |
|---|---|
| Onset and course of symptoms | Differentiate acute (rhegmatogenous) vs chronic (tractional/exudative) |
| Presence and changes of photopsia and floaters | Estimate timing of PVD and retinal break formation |
| Presence and degree of myopia | Assessment of rhegmatogenous retinal detachment risk |
| History of ocular surgery or trauma | Iatrogenic or traumatic risk |
| Systemic diseases (diabetes, hypertension, autoimmune diseases) | Search for causes of tractional or exudative retinal detachment |
| History of retinal detachment in the fellow eye or family | Identification of hereditary diseases or high-risk groups |
| Pregnancy and medication history | Search for causes of exudative retinal detachment |
Peripheral fundus examination using indirect ophthalmoscopy (binocular indirect ophthalmoscope) and scleral depression is the core of diagnosis.
OCT is an essential examination for confirming the diagnosis of retinal detachment, differentiating its types, planning surgery, and following up postoperatively.
| Purpose of examination | Information obtained |
|---|---|
| Confirmation of presence and extent of macular detachment | Prediction of visual prognosis and determination of surgical indication |
| Differential diagnosis of disease type | Rhegmatogenous vs exudative (characteristics and morphology of SRF) |
| Evaluation of tractional retinal detachment | Location of proliferative membrane and retinal traction pattern |
| Postoperative monitoring | Follow-up of retinal reattachment and macular recovery |
Structures to observe on OCT and their significance
When reading OCT for preoperative and postoperative evaluation of retinal detachment, pay attention to the following structures. Postoperative ellipsoid zone (EZ) recovery depends on the duration and extent of detachment, and the recovery of EZ length serves as an indicator of postoperative visual acuity. 3,15)
| Structure | Meaning of findings |
|---|---|
| Ellipsoid zone (EZ) | Hyperreflective band at the inner/outer segment junction of photoreceptors. Longer detachment duration leads to more indistinctness/defects → indicator of postoperative visual prognosis |
| External limiting membrane (ELM) | Hyperreflective band inner to EZ. More protected than EZ; recovery of ELM precedes that of EZ |
| Subretinal hyperreflective material (SHRM) | PRE cells and inflammatory debris under the detached retina. If it remains after surgery, it can impede EZ recovery. |
| Characteristics of subretinal fluid (SRF) | In rhegmatogenous detachment, SRF is hypoechoic and homogeneous; in exudative detachment, it may appear dome-shaped with punctate hyperreflectivity. |
Key points for differential diagnosis using OCT
This is an essential examination when the fundus is not visible (vitreous hemorrhage, cataract, corneal opacity). The probe is applied to the cornea or sclera, and longitudinal, transverse, and axial sections are systematically imaged.
Basic imaging technique
| Finding | Significance |
|---|---|
| Confirmation of total retinal detachment | Attachment to posterior wall at optic disc → determines ERG and surgical indication |
| Evaluation of tractional retinal detachment | Location, density, and extent of proliferative membrane |
| Confirmation of funnel-shaped closed retinal detachment (PVR D-3) | Assessment of poor prognosis |
| Detection of choroidal detachment | Complication of rhegmatogenous retinal detachment and cause of hypotony |
| Exclusion of intraocular tumors | Differential diagnosis of tumorous causes of exudative retinal detachment |
Ultra-widefield laser fundus cameras (OptosSS, Clarijs, etc.) capture 80–200° of the peripheral retina (near the ora serrata) in a single shot.
Useful for investigating the cause of exudative retinal detachment.
Fundus examination (indirect ophthalmoscopy) is excellent for assessing the location and shape of tears, but OCT can quantitatively evaluate the presence, extent, and type of macular detachment. When the fundus is not visible due to vitreous hemorrhage, B-mode ultrasound becomes indispensable. Particularly in tractional retinal detachment, preoperative mapping of proliferative membranes with ultrasound is important for surgical planning.
| Disease Type | Treatment Principle | Urgency |
|---|---|---|
| Rhegmatogenous Retinal Detachment | Surgical closure of retinal break and retinal reattachment | High (surgery before macular detachment) |
| Tractional retinal detachment | Traction removal via vitrectomy | Moderate to high (urgent if progression or combined tear) |
| Exudative retinal detachment | Treatment of underlying disease (collaboration with internal medicine/oncology) | Depends on the disease |
| Traumatic retinal detachment | Surgery according to injury type | Open wound is emergency |
There are three surgical approaches for treating rhegmatogenous retinal detachment.
Scleral buckling (SB)
Cryopexy and scleral buckle (silicone material) are applied externally to create an indentation at the tear site and reattach the retina.
Indications: Young patients, no posterior vitreous detachment, simple peripheral tears Advantages: Preserves the lens, maintains eye shape close to natural state Disadvantages: Not suitable for complex cases or proliferative changes
Pars Plana Vitrectomy (PPV)
The vitreous is removed, fluid-gas exchange is performed to flatten and reattach the retina, and laser photocoagulation closes the tear.
Indications: Middle-aged and elderly patients, PVD, complex tears, vitreous hemorrhage, PVR Advantages: Can manage complex pathology, direct visualization Disadvantages: Accelerates cataract progression, requires postoperative positioning
Pneumatic Retinopexy (PR)
Inject expanding gas into the eye to close the tear and reattach the retina. Can be performed as an outpatient procedure.
Indications: Single tear confined to the upper half Advantages: No hospitalization required, minimally invasive Disadvantages: Limited applicable cases, slightly lower success rate than other procedures
Guidelines for surgical selection
Postoperative management and precautions for gas tamponade
After intravitreal gas tamponade, postural restriction (usually prone or head tilt) is required for several days to 2 weeks to keep the gas pressing against the retinal break. After the gas is absorbed, the intraocular cavity is refilled with fluid.
| Gas type | Intraocular retention time | Expansion ratio | Approximate postural restriction period |
|---|---|---|---|
| Air | 5–7 days | No expansion | 3–5 days |
| 20% SF₆ | 10–14 days | Approximately 2 times | 5–10 days |
| 14% C₃F₈ | 6–8 weeks | Approximately 4 times | 10–14 days |
Contraindications during the period when gas remains
Periods of high risk for postoperative redetachment
Redetachment is often detected from the early postoperative period to several months, with PVR and new or missed retinal breaks being the main causes. Instruct patients to seek immediate medical attention if symptoms (increased floaters, reappearance of visual field defects) occur, and continue regular postoperative follow-up. 19, 22)
PVR is a serious complication of rhegmatogenous retinal detachment and the major cause of failure to achieve retinal reattachment. As a result of an excessive wound healing process of the detached retina, proliferative membranes composed of RPE cells, glial cells, fibroblast-like cells, and macrophages form on the retina, under the retina, and within the vitreous. Membrane contraction fixes the detached retina.
Retina Society Classification (old classification, 1983)
| Grade | Findings |
|---|---|
| A | Vitreous opacity (pigment clumps, pigment granules in the vitreous, pigment clumps on the retina) |
| B | Retinal surface wrinkling, tortuous retinal vessels, elevated edges of retinal breaks, reduced vitreous mobility |
| C-1 to C-3 | Full-thickness retinal folds (1 to 3 quadrants) |
| D-1 to D-3 | Fixed folds involving 4 quadrants (wide funnel/narrow funnel/closed funnel) |
In 1991, Machemer et al. proposed a new classification. The new classification considers anterior PVR and subretinal lesions, describing the extent of lesions using clock hours. 11) Rhegmatogenous retinal detachment with PVR often requires vitrectomy combined with removal of proliferative membranes, long-acting gas or silicone oil tamponade, and may require multiple surgeries. 7, 19)
In recent years, more facilities have chosen PPV as the initial treatment, leading to an increase in cases of anterior PVR. PVR developing after vitrectomy progresses rapidly and requires early reoperation.
The principle of treating tractional retinal detachment is to remove traction via vitrectomy. Proliferative membranes are managed using membrane peeling and vitreous scissors, with thorough endophotocoagulation and peripheral vitreous shaving. If a combined break is present, fluid-gas exchange is added following the approach for rhegmatogenous retinal detachment.
Preoperative anti-VEGF drug administration may be used in tractional retinal detachment surgery associated with proliferative diabetic retinopathy to regress neovascularization and reduce intraoperative bleeding. However, because contraction of fibrovascular membranes may worsen traction, careful judgment of surgical timing and indications is required. 5)
Treatment of exudative retinal detachment is primarily based on treating the underlying cause, and direct surgical reattachment of the retina is rarely performed. Inflammatory, vascular, and neoplastic causes should be identified, and appropriate medical and ophthalmic treatments selected accordingly. 21)
| Cause | Main Treatment |
|---|---|
| Vogt-Koyanagi-Harada disease | Systemic corticosteroids are the mainstay; for recurrent or persistent cases, immunosuppressive agents may be considered (VKH is a representative inflammatory cause of exudative retinal detachment). 2, 21) |
| CSC | Observation, laser photocoagulation, photodynamic therapy (PDT), anti-VEGF |
| Malignant hypertension, preeclampsia | Antihypertensive therapy, obstetric management (delivery) |
| Coats disease | Laser photocoagulation, cryotherapy, anti-VEGF, vitrectomy |
| Choroidal tumor | Oncologic treatment according to tumor type (radiation, resection, etc.) |
| Drug-induced | Discontinue causative drug (MEK inhibitors resolve within days after discontinuation) |
| Uveal effusion | Scleral decompression (vortex vein decompression) |
When differentiating the type of retinal detachment based on fundus findings, evaluate from the following three perspectives.
① Presence and shape of tears or holes
| Type of tear | Characteristics | Suggested type |
|---|---|---|
| Flap tear (horseshoe) | Vitreous traction leaves a flap; tear edges elevated | Rhegmatogenous retinal detachment (after PVD); rapid progression |
| Atrophic hole | Round full-thickness defect within lattice degeneration; edges flat | Rhegmatogenous retinal detachment (juvenile); slow progression |
| Giant tear | ≥1 quadrant (90°); edge may roll over | Rhegmatogenous retinal detachment (high myopia); difficult to treat |
| Dialysis | Along the ora serrata; more common in the inferotemporal quadrant | Traumatic retinal detachment; young males |
| No tear | — | Tractional retinal detachment / Exudative retinal detachment |
② Presence and morphology of proliferative membrane
③ Characteristics and mobility of subretinal fluid
| Characteristics | Suggested disease type |
|---|---|
| Clear, mobile (shifting fluid) | Exudative retinal detachment |
| Clear, no mobility | Rhegmatogenous retinal detachment |
| Cloudy, yellowish-white | Neoplastic/inflammatory exudative retinal detachment; old chronic retinal detachment |
| Fluid shifts with position change | Exudative retinal detachment (e.g., VKH, CSC) |
Rhegmatogenous retinal detachment is the most common type of retinal detachment and is one of the representative ophthalmic emergencies. The main subtypes include:
Flap tear (horseshoe tear) type: The retina is torn due to PVD. It accounts for about 30% of rhegmatogenous retinal detachments in phakic eyes, and causes rapid progression and high bullous detachment.
Atrophic hole type: A round hole due to atrophy within lattice degeneration. Common in young people and myopic eyes, presenting with low-lying localized detachment and slow progression.
Giant tear type: A tear of 90 degrees (1 quadrant) or more. Predisposed in high myopia with lattice degeneration. The tear edge rolls, and vitrectomy using liquid perfluorocarbon (PFC), which is heavier than water, is used for reattachment.
Macular hole type: More common in women with high myopia, accounting for about 5% of rhegmatogenous retinal detachments in Japan (higher than 0.5–2.0% in Western countries). Vitrectomy including internal limiting membrane (ILM) peeling is the standard procedure.
For details → Rhegmatogenous Retinal Detachment article
Proliferative diabetic retinopathy is the most common cause. Contraction of fibrovascular membranes containing new blood vessels leads to tent-shaped retinal detachment. Initially localized to the periphery, it causes rapid vision loss when it extends to the macula.
For details → Tractional Retinal Detachment article
Non-rhegmatogenous, non-tractional subretinal fluid accumulation. Shifting fluid with positional change is characteristic. In VKH, multiple bilateral dome-shaped detachments occur in the acute phase, and spontaneous resolution can be expected with appropriate immunosuppressive therapy. For neoplastic causes, tumor evaluation and treatment take priority.
For details → Exudative Retinal Detachment article
Blunt trauma (ocular contusion) can lead to retinal detachment within weeks to months after injury, so long-term follow-up is essential.
Retinal Dialysis: A full-thickness tear along the ora serrata, often occurring after trauma in young males. It is commonly located in the inferotemporal quadrant and is often asymptomatic due to slow progression.
Choroidal Rupture and Retinal Concussion (Berlin Edema): Posterior pole edema and hemorrhage immediately after blunt trauma. Photoreceptor damage may be permanent.
Related article → Retinal Tears, Holes, and Lattice Degeneration
Retinal detachment in children is rare compared to adults, but requires special consideration due to different underlying diseases.
Types of Underlying Diseases
| Disease | Characteristics | Type of detachment |
|---|---|---|
| Retinopathy of prematurity (ROP) Stage 4/5 | Traction by proliferative membrane; may extend to the posterior surface of the lens | Primarily tractional retinal detachment |
| Familial exudative vitreoretinopathy (FEVR) | Hereditary (FZD4, LRP5, etc.); peripheral avascular area → tear/traction | Mixed rhegmatogenous retinal detachment and tractional retinal detachment |
| Stickler syndrome | Type II collagen gene mutation; vitreous degeneration/lattice degeneration; perivascular degeneration | Rhegmatogenous retinal detachment; multiple tears |
| Norrie disease | X-linked recessive; limited to males; vitreous hemorrhage, ocular atrophy | Tractional retinal detachment |
| Bloch-Sulzberger syndrome (incontinentia pigmenti) | Only females (lethal in males); avascular area → neovascularization → traction | Tractional retinal detachment |
| Congenital retinoschisis | X-linked recessive; macular schisis and peripheral schisis; progresses to retinal detachment in 1–2% | Rhegmatogenous retinal detachment, schisis type |
Treatment peculiarities
Proliferative Vitreoretinopathy (PVR): The most severe postoperative complication of rhegmatogenous retinal detachment. Fixed folds form, causing the retina to become stiff and fixed. It occurs in 5–10% of cases postoperatively and often requires reoperation.
Retinoschisis: The retina splits at the inner or outer plexiform layer. Unlike retinal detachment, there is no separation from the RPE. It is differentiated by OCT, fluorescein angiography, and ERG.
For details → Retinoschisis article
Association with glaucoma: In rhegmatogenous retinal detachment, Schwartz syndrome (secondary open-angle glaucoma due to outer segment debris) may occur; in retinal detachment with choroidal detachment, hypotony is observed. Exudative retinal detachment may be complicated by secondary glaucoma from the underlying cause.
Anatomical prognosis: With appropriate surgery, anatomical reattachment of the retina is achieved in over 95% of cases. The primary success rate is approximately 90% or higher, and the final reattachment rate including multiple surgeries reaches about 98%.
Functional prognosis (visual acuity)
| Macular involvement | Visual acuity prognosis |
|---|---|
| Macula-on | Maintenance of vision close to preoperative visual acuity can be expected |
| Macula-off | Postoperative visual acuity is 0.5 or less in about half of cases, and visual field defects and metamorphopsia often remain |
Frequency of postoperative complications
| Complication | Incidence/Timing | Management |
|---|---|---|
| PVR (proliferative vitreoretinopathy) | 5–10% postoperatively; develops within 2–8 weeks19) | Repeat vitrectomy, silicone oil |
| Epiretinal membrane (ERM) | Can occur after PPV (frequency generally around 10% to 10-something% depending on reports) 16) | If vision or metamorphopsia worsens, perform detachment surgery |
| Cystoid macular edema (CME) | 10–20% in macular-off type; several months postoperatively | Anti-VEGF, steroid eye drops, NSAIDs |
| Cataract progression | Nuclear cataract progresses 2–3 years after PPV | Cataract surgery (often 1–2 years after PPV) |
| Recurrent detachment (rhegmatogenous) | 5–10% after initial surgery; most within 6 months | Reoperation (additional buckling or repeat PPV) |
Recurrence and long-term management
Control of the underlying disease directly affects visual prognosis. In diabetic tractional retinal detachment, blood glucose management and panretinal photocoagulation are fundamental. Surgical success rates are lower than for rhegmatogenous retinal detachment, with high risks of progression to PVR and reoperation.
Improvement can be expected with treatment of the underlying disease, but if RPE atrophy or organic damage to photoreceptors occurs, visual recovery becomes incomplete. In VKH, early treatment of the first episode yields a good prognosis, but recurrent cases may develop chronic changes such as sunset glow fundus and Dalen-Fuchs nodules. In neoplastic exudative retinal detachment, tumor control determines the prognosis.
It depends on the surgical procedure and the presence of complications. With scleral buckling, hospitalization is about 1–2 weeks, and postural restrictions are almost unnecessary. With vitrectomy, postoperative gas tamponade requires postural restrictions (prone or lateral position) for several days to 2 weeks. While gas remains, avoid low-pressure environments such as air travel or mountain climbing. Visual recovery may take several months after retinal reattachment, especially in cases with macular detachment, requiring follow-up for 6 months to 1 year.
強度近視（−6ジオプトリ超・眼軸長26mm以上）は網膜剥離の主要リスク因子であり、年1回以上の散瞳眼底検査が推奨される。特に新たな飛蚊症・光視症の出現後は1〜2週間以内に精査する。格子状変性が検出された場合はリスクに応じて予防的レーザー光凝固を検討する。白内障手術後や僚眼の網膜剥離既往がある場合はさらに頻繁な受診が必要で、症状出現時は当日受診が理想。
PVRとは、網膜剥離の術後に眼内の創傷治癒反応が過剰になり、網膜色素上皮やグリア細胞・線維芽細胞が増殖して網膜の表面や下面に膜を形成した状態である。膜が収縮すると固定皺襞（star fold）が形成され、網膜の可動性が著しく低下して再剥離をきたす。術後5〜10%に発症し、初期の硬化したGrade A〜Bなら強膜バックリング術が奏効することもあるが、重症例（Grade C〜D）では硝子体再手術による増殖膜除去と長期タンポナーデが必要で、複数回の手術を要することも多い。
Retinal detachment in children is less common than in adults, but it is important that the underlying diseases differ. Hereditary diseases such as retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR), Stickler syndrome, and Norrie disease are common, requiring different management from simple rhegmatogenous detachment. Pediatric eyes have high scleral elasticity, and scleral buckling surgery is often more effective than in adults. In ROP, tractional detachment is predominant, and surgery at Stage 4A is the best indication. The silicone band used for buckling must be removed within 6 months because it can cause constriction as the eye grows.
