ABSTRACT
The inner and outer layers of the embryological optic cup give rise to the adult neuroretina and retinal pigment epithelium (RPE), respectively, and separation of the two structures is termed retinal detachment. Apart from those retinal detachments that occur because of the accumulation of exudate beneath the neuroretina (exudative retinal detachment), as in choroidal tumors and inflammation, retinal detachments are thought to arise as a result of alterations in normal vitreoretinal relations. Our concept of these changes owes much to Gonin, whose work revolutionized the study and management of retinal detachment (29). Key to an understanding of retinal detachment is an appreciation of age-related change in the vitreous (see Chapter 29). The vitreous is a collagen-containing aqueous gel, the gel constituents of which tend to separate as part of the normal aging process (6), to produce a collagen-containing formed vitreous and a fluid vitreous. This syneretic process may be accelerated by a variety of conditions, including myopia and aphakia, and tends to lead to separation of the vitreous cortex from the retinal surface (posterior vitreous detachment [PVD]).
