Subtitle Detachment
Before an entity undertakes an annexation, consolidation, or detachment proceeding under this chapter, the entity shall coordinate with the Arkansas Geographic Information Systems Office for preparation of legal descriptions and digital mapping for the relevant annexation, consolidation, and detachment areas.
subtitle Detachment
While any detachment of the Navy or Marine Corps is on shore duty in cooperation with troops of the Army, the officer of the Army designated by the Secretary of the Army shall, upon the requisition of the officer of the Navy or Marine Corps in command of the detachment, issue rations and camp equipment, and furnish transportation, to that detachment.
Lattice degeneration is considered the most important peripheral retinal degeneration process that predisposes to a rhegmatogenous retinal detachment.[5] Other peripheral lesions having slight increased risk of retinal detachment include ora bays, meridional folds and complexes, and cystic retinal tufts.
Normally, the retinal pigment epithelium (RPE) is able to maintain adhesion with the overlying neurosensory retina through a variety of mechanisms. These mechanisms include active transport of subretinal fluid across RPE , metabolic activity of RPE, and interdigitation of the photoreceptor outer segments and the RPE microvilli. With retinal detachment, these mechanisms are overwhelmed leading to separation of the neurosensory (inner layers) retina from the retinal pigment epithelial layer.
Retinal detachment occurs when subretinal fluid accumulates between the neurosensory retina and the retinal pigment epithelium. This process can occur in three ways. One mechanism involves occurrence of a break in the retina allowing vitreous to directly enter the subretinal space. This is known as a rhegmatogenous retinal detachment. Rhegmatogenous retinal detachments are often due to retinal tears associated with posterior vitreous detachment or trauma.
Although this monograph focuses on rhegmatogenous retinal detachment, it is pertinent to note the other major causes of retinal detachment. A second mechanism involves proliferative membranes on the surface of the retina or vitreous. These membranes can pull on the neurosensory retina causing a physical separation between the neurosensory retina and retinal pigment epithelium. This is called a tractional retinal detachment. Tractional retinal detachments can be seen in proliferative retinopathy due to diabetic disease, sickle cell and other disease processes leading to neovascularization of the retina. Tractional retinal detachments can also be due to proliferative vitreoretinopathy after trauma or surgery. The third mechanism for retinal detachment is due to accumulation of subretinal fluid due to inflammatory mediators or exudation of fluid from a mass lesion. This mechanism is known as a serous or exudative retinal detachment. Serous detachments are caused by a number of inflammatory, or exudative retinal disease processes such as Sarcoidosis or choroidal neoplasms. Serous retinal detachments may also be the presenting sign in patients with aggressive metastatic cancer, such as testicular cancer.[6]
Patients with known risk factors for retinal detachment should have serial dilated fundus examinations with scleral depression, often yearly. Protective eyewear is recommended for individuals with high myopia that participate in contact sports. Patients undergoing cataract surgery should be counseled about the importance of reporting symptoms of retinal tears and detachments.
Patients who present with symptoms of new onset significant photopsias and/or persistent new floaters should be suspected of having a retinal tear, which could lead to a retinal detachment. A patient with constant fixed or slowly progressive visual field loss should be suspected of having a detachment until proven otherwise. Important information in the history includes onset of symptoms, presence and duration of decreased central visual acuity, prior trauma, prior surgery, hemorrhage, and a complete past medical history and review of systems.
Visual acuity, pupillary examination, visual field testing and intraocular pressure measurement are important parts of the pre-dilated ophthalmic examination to evaluate patients with symptoms of retinal detachment. Additional examination to include color vision in the visual field.
Slit lamp examination of the anterior segment should be completed prior to dilation. Examination of the anterior vitreous for pigment (Schaffer's sign) or vitreous hemorrhage is critical. A thorough fundus examination to include indirect ophthalmoscopy with scleral depression and visualization to the ora serrata should be completed. A detailed drawing describing the detachment with location of retinal pathology may be documented.
Rhegmatogenous retinal detachment has a characteristic appearance differentiating it from a tractional or serous detachment. A rhegmatogenous retinal detachment has a corrugated appearance and undulates with eye movements. Tractional detachments have smooth concave surfaces with minimal shifting with eye movements. Serous detachments show a smooth retinal surface and shifting fluid depending on patient positioning. In the vast majority of cases, a retinal break will be identified with proper examination, thus confirming a rhegmatogenous retinal detachment. Without visualization of a retinal break, the diagnosis of rhegmatogenous retinal detachment should be questioned, however there are cases where the retinal break is obscured by vitreous hemorrhage or other media opacities; occasionally the offending retinal breaks are too small to visualize.
Rhegmatogenous retinal detachment is a clinical diagnosis. Where available, it is sometimes appropriate to examine and document macula status with ocular coherence tomography and/or wide field fundus photography. Additionally, in cases of media opacities, B-scan ultrasound is indicated and may be a critical diagnostic tool.
Laboratory testing is typically only indicated in traction or exudative detachments. If a cause for the traction retinal detachment cannot be determined by history, further laboratory analysis may be required to determine if diabetes, sickle cell, carotid disease or another systemic or ocular process is the source for proliferative retinopathy. Since exudative detachments may be due to a systemic or ocular inflammatory process, laboratory investigation may be indicated. In these cases, fluorescein angiography may be indicated to further clarify exudative processes such as macular degeneration, central serous chorioretinopathy, and Vogt-Koyanagi-Harada syndrome or other uveitic processes. Ultrasound is a useful imaging modality to evaluate choroidal masses or posterior scleritis.
The differential diagnosis of retinal detachment includes retinoschisis and choroidal mass. Rhegmatogenous retinal detachment is most often confused with retinoschisis and serous retinal detachment. Retinoschsis can be distinguished from retinal detachment by appearance on ultrasound, uptake of photocoagulation with retinoschisis, and absolute scotoma with retinoschisis versus relative scotoma in retinal detachment. Choroidal masses can be distinguished from retinal detachment by observing the characteristics of imaging with ultrasound.
For rhegmatogenous detachments, all retinal breaks should be identified, treated and closed. Techniques for repair include pneumatic retinopexy, scleral buckle or vitrectomy, or combinations of these techniques.
In tractional detachments, tractional elements (usually epiretinal or subretinal membranes) must be relieved. This is typically accomplished with pars plana vitrectomy, but may be combined with scleral buckling as an adjunct.
Retinal Detachment is an eye disorder in which the retina (light receptive layer of tissue at the back of the eye) is pulled away from its normal position. In retinal detachment, the retina gets separated from the underlying choroid (layer of blood vessels that supplies oxygen and nutrients to the retina) and leaves the retinal cells deprived of oxygen. Certain risk factors, such as aging, severe near-sightedness, eye injury, cataract surgery, and family history, can increase the chances of retinal detachment. If not treated early, this condition can cause permanent vision loss.
Certain symptoms appear as warning signs and almost always appear before retinal detachment can occur or become more severe. The characteristic signs and symptoms that indicate the onset of retinal detachment include:
Rhegmatogenous retinal detachment (RRD): This is the most common type of retinal detachment and is associated with a hole or tear in the retina. Fluid from the vitreous humor (jelly-like center of the eye) seeps through the retinal hole and accumulates in the space between the retina and the underlying retinal pigment epithelium (RPE), thereby lifting the retina. RPE, located between the retina and the choroid layer, is a pigmented cell layer that nourishes the retinal cells.
Tractional retinal detachment (TRD): It is the second most common type of retinal detachment. TRD occurs due to the formation of scar tissue or growth of other abnormal tissue on the surface of the retina, separating the retina from the underlying RPE. TRD is commonly observed in people with uncontrolled diabetes, previous retinal surgery, or chronic inflammation.
Exudative retinal detachment: This type occurs when blood or fluid from the choroid leaks into the space between the retina and the underlying RPE, causing a detachment. This is an uncommon complication of conditions such as hypertension, eye tumors, and rare blood vessel disorders.
To diagnose retinal detachment, a comprehensive eye examination is performed; wherein the physical appearance of your eye, vision, eye pressure and your ability to see colors is tested. Your doctor instills eye drops to dilate your pupil in order to see your retina properly. An ultrasound may also be ordered in certain cases. 041b061a72