14.1 Features
A retinal dialysis is defined histologically and clinically as a separation between the neurosensory retina and the nonpigmented pars plana epithelium at the ora serrata (▶ Fig. 14.1). While idiopathic and familial causes of retinal dialysis have been reported, the most common etiology is ocular trauma. Young adult men comprise the majority of retinal dialysis patients, and the most common location for a dialysis to occur is the inferotemporal quadrant of the retina.
Fig. 14.1 Ultra-widefield photograph of a chronic retinal detachment secondary to a retinal dialysis with subretinal fluid extending posteriorly (arrowhead) and retinal microcyst (arrows).
The natural history of untreated retinal dialyses is evolution to a retinal detachment, which can occur coinciding with or years after the initial injury that caused the retinal dialysis. There is often an interval of several months or even years between an initial eye injury/retinal dialysis and the onset of a symptomatic retinal detachment. This is likely because retinal dialyses tend to occur in younger patients with a formed vitreous, which helps guard against the occurrence of a coexistent retinal detachment. However, as the vitreous liquefies with age and gains entrance to the subretinal space, patients may progress to a symptomatic retinal detachment.
14.1.1 Common Symptoms
Patients with a retinal dialysis who lack other ocular pathology may be totally asymptomatic; if the dialysis is associated with a retinal detachment or avulsion of the vitreous base, the patient may complain of floaters or a blind spot in their vision (▶ Fig. 14.2). Patients may have symptoms, such as decreased vision, unrelated to the dialysis but are due instead to coincident ocular pathology secondary to the trauma (e.g., commotio retinae, traumatic optic neuropathy, macular hole, vitreous hemorrhage, and hyphema).
Fig. 14.2 Ultra-widefield fundus photograph of a traumatic retinal dialysis with avulsion of the vitreous base. The free edge of retina can be seen nasally (arrow), and the avulsed vitreous base is represented by the dark, rope-like structure in the superior portion of the photograph (arrowheads).
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