## Anatomical Sites of Retinal Breaks in RRD **Key Point:** The location of retinal breaks in rhegmatogenous detachment is determined by the distribution of vitreous adhesions and traction forces. The vitreous base is the zone of strongest vitreoretinal adhesion. ### Vitreous Base Anatomy and Traction The vitreous base is a 3–4 mm wide band of strong adhesion between the vitreous cortex and the retina, spanning from the equator to approximately 2 mm anterior to the equator. This is the site of maximum traction during PVD. **High-Yield:** Retinal breaks occur most commonly in the **peripheral retina near or at the vitreous base** because: 1. Vitreous traction is greatest at the vitreous base during PVD 2. The retina is thinner peripherally, more susceptible to tearing 3. Vitreous base adhesions create focal stress concentration 4. In postoperative eyes, vitreous disturbance during surgery increases traction forces ### Distribution of Retinal Breaks by Site | Location | Frequency | Mechanism | |---|---|---| | Vitreous base/peripheral retina | 60–70% | Maximum vitreous traction | | Equatorial region | 15–20% | Secondary traction | | Macula | <5% | Rare; usually in advanced detachment | | Optic disc margin | <2% | Very rare | **Clinical Pearl:** In postoperative RD (especially after cataract surgery), vitreous manipulation during surgery accelerates PVD, increasing the likelihood of peripheral breaks. The superior temporal quadrant is most commonly affected because gravity and postural factors favor superior detachment. **Mnemonic:** **VB-RB** — **V**itreous **B**ase = **R**etinal **B**reak site. The strongest adhesion zone is where traction is strongest. [cite:Yanoff & Duker Ophthalmology 5e Ch 6.14]
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