RETINOBLASTOMA ASSOCIATED WITH TOTAL EXUDATIVE RETINAL DETACHMENT: Treatment and Outcomes

PURPOSE

To study the clinical presentation, treatment, and outcomes of eyes presenting with retinoblastoma and total retinal detachment.

METHODS

A retrospective study of 50 eyes in 43 patients.

RESULTS

The mean age at presentation was 15 months (median, 9 months). Retinoblastoma-associated total retinal detachment was unilateral (n = 36; 84%) or bilateral (n = 7; 16%). The mean tumor basal diameter was 17 mm (median, 18 mm), and the mean tumor thickness was 13 mm (median, 12 mm). Associated features included subretinal seeds (n = 26; 52%), vitreous seeds (n = 13; 26%), and subretinal exudation (n = 4; 8%). Based on eighth edition of American Joint Committee on Cancer classification, the tumors were classified as cT2a (n = 19; 38%), cT2b (n = 28; 56%), or cT3c (n = 3; 6%). Primary treatment included intravenous (n = 48; 96%) or intraarterial chemotherapy (n = 2; 4%). Over a mean follow-up period of 30 months (median, 29 months; range, 7-62 months), retinal detachment resolved in 41 eyes (82%), tumor recurrence was noted in 39 eyes (78%), globe salvage was achieved in 35 eyes (70%), and one patient (2%) died due to metastasis.

CONCLUSION

Relatively high tumor recurrence rate is noted in retinoblastoma presenting with total retinal detachment. With appropriate treatment, 70% of the globes can be salvaged.

GIANT RETINAL TEAR DETACHMENT: Clinical Presentation and Treatment Outcomes in 396 Patients

PURPOSE

To study etiology, clinical presentation, anatomical, and functional outcomes of patients with giant retinal tear detachment at a tertiary eye institute.

METHODS

Retrospective, consecutive case series of 396 patients (396 eyes) who underwent surgery were reviewed. Factors affecting the final anatomical and functional success were determined.

RESULTS

Mean age was 37 years (range; 1-79 years), and 86% (n = 339) of the subjects were men. Trauma (21%) and high myopia (11%) were predisposing risk factors. Two hundred and seventy-seven eyes (70%) had giant retinal tear configuration of >180° and <270°, associated with partial retinal detachment in 282 (71%) eyes and macular detachment in 262 (66%) eyes. Primary surgery included pars plana vitrectomy (n = 240, 61%), pars plana vitrectomy with encirclage band (n = 152, 38%), or scleral buckle (n = 4, 1%). The mean follow-up duration was 15 months (median, 8.4 months; range, 3-83 months). Anatomical success after initial surgery was 64% (255 eyes), which improved to 78% (308 eyes) after undergoing a second vitreoretinal procedure for recurrent retinal detachment (53 eyes). Median visual acuity improved from 20/1,500 preoperatively to 20/400 at final follow-up ( P = 0.01), and 15% of eyes achieved postoperative visual acuity of 20/60 or better. Factors associated with poor anatomical success included age <16 years ( P = 0.005) and presenting visual acuity 20/400 or less ( P = 0.001).

CONCLUSION

Trauma and myopia constituted the major risk factors for giant retinal tear detachment in our series. Surgery for giant retinal tear detachment managed with pars plana vitrectomy with or without encirclage band and silicone oil tamponade had good anatomical and favorable visual outcomes at last follow-up.

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

PURPOSE OF REVIEW

To highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group.

RECENT FINDINGS

The PRO database was a large dataset made up of patients with primary rhegmatogenous retinal detachments (RRD) who had surgical repair during 2015. The database was constituted of nearly 3000 eyes from 6 centers across the United States and included 61 vitreoretinal surgeons. Nearly 250 metrics were collected for each patient, creating one of the richest datasets of patients with primary rhegmatogenous detachments and their outcomes. The importance of scleral buckling was demonstrated, particularly for phakic eyes, elderly patients, and those with inferior breaks. 360° laser may result in poorer outcomes. Cystoid macular edema was common, and risk factors were identified. We also found risk factors for vision loss in eyes presenting with good vision. A PRO Score was devised, to predict outcomes based on presenting clinical characteristics. We also identified characteristics of surgeons with the highest single surgery success rates. Overall, there were no major outcome differences between viewing systems, gauges, buckles sutured vs. scleral tunnels, drainage method, and techniques to address proliferative vitreoretinopathy. All incisional techniques were found to be very cost-effective treatment modalities.

SUMMARY

Numerous studies resulted from the PRO database that significantly added to the literature regarding the repair of primary RRDs in the current era of vitreoretinal surgery.

PREDISPOSING CHARACTERISTICS OF OPTICAL COHERENCE TOMOGRAPHY FOR PATIENTS WITH PERSISTENT SUBRETINAL FLUID AFTER SUCCESSFUL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENT

PURPOSE

To investigate the predisposing clinical parameters and characteristics of fundus imaging of patients with persistent subretinal fluid (PSF) after successful repair of rhegmatogenous retinal detachment.

METHODS

A retrospective study recruiting 57 patients was conducted. All patients underwent pars plana vitrectomy with silicone oil tamponade. Patients were divided into two groups: patients presenting PSF by the time of silicone oil removal as PSF group and patients presenting no PSF by the time of silicone oil removal as control group. All patients were followed up for 3 months or longer after primary surgery. Ophthalmic examinations, including fundus photography and optical coherence tomography, were performed.

RESULTS

There were significant differences between the two groups in average age, durations of preoperative symptoms, and type of retinal breaks ( P < 0.05). These clinical parameters showed statistical correlations with PSF ( P < 0.05). The proportions of patients presenting distinctive boundaries of the detached retina on fundus photograph and patients showing a hyperreflective line underlying the detached retina on optical coherence tomography in the PSF group were both significantly higher than the control group ( P < 0.05). The macular detachment heights on optical coherence tomography in the PSF group were significantly lower than the control group ( P < 0.05). These imaging characteristics also showed strong correlations with PSF ( P < 0.05).

CONCLUSION

This study suggests that patients with PSF have younger age, longer symptom duration, and higher incidence of retinal holes. The distinctive detachment boundary on fundus photograph, lower macular detachment height, and hyperreflective line underlying the detached retina on optical coherence tomography may be the predisposing characteristics of PSF.

THE STATE OF PEDIATRIC RETINAL DETACHMENT SURGERY IN THE UNITED STATES: A Nationwide Aggregated Health Record Analysis

PURPOSE

In this study, the authors aimed to identify the demographics of retinal detachment in children in the United States and to report the treatment modalities chosen by vitreoretinal surgeons and associated outcomes.

METHODS

This was a multicenter cohort analysis of the Vestrum Health LLC Database (Naperville, IL). Children (1-17 years) with rhegmatogenous retinal detachment, as identified by ICD10 and CPT codes, between January 2015 and August 2021 were enrolled. Demographic, comorbidity, visual acuity, and treatment modality data were analyzed.

RESULTS

A total of 168,152 RRDs were identified, of which 2,200 (1.3%) were aged 1 to 17 years. The mean age was 12.7 years, and 821 (37%) were women. The prevalence of rhegmatogenous retinal detachment increased with age ( P = 0.009). Associated comorbidities included myopia (17.3%), ocular trauma (7.5%), and history of prematurity (5.7%). Laser retinopexy alone was used as the initial treatment modality in 19%, primary vitrectomy in 23%, primary scleral buckle in 25%, and vitrectomy with scleral buckle in 33%. The single surgery success rate for all procedures was 73.3%. Of the incisional surgical modalities, primary scleral buckling had the best single surgery success rate (79.0%) compared with vitrectomy alone (64.5%) and vitrectomy with scleral buckle (67.2%) ( P < 0.001 and P = 0.004, respectively). Younger age resulted in worse SSSR overall (coefficient = 0.151, R 2 = 0.746, P = 0.027).

CONCLUSION

Rhegmatogenous retinal detachments in children increased with age. Myopia, trauma, and history of retinopathy of prematurity were common risk factors. Treatment techniques varied, but primary scleral buckling had the best anatomical and visual outcomes.

Long-term follow-up of acute retinal necrosis with retinal detachment secondary to herpes simplex virus type 2 with a successful visual outcome

A man in his early 20s presented with acute loss of vision in his only eye, the left eye (OS), and was on oral steroids. He had lost vision in his right eye during his childhood and the cause was unknown. There was no history of trauma. Best-corrected visual acuity (BCVA) in OS was 20/100 and in the right eye was hand movements. OS showed non-granulomatous keratic precipitates on the cornea, anterior chamber flare 1+ and cell 1+, early cataract, vitreous haze and cells 2+ with nasal retinal detachment and superior full thickness retinitis. He underwent pars plana vitrectomy with intravitreal ganciclovir and barrage laser away from the necrotic retina. PCR for herpes simplex virus 2 was positive from the aqueous and vitreous sample. He was started on oral valacyclovir 1 g three times a day and continued on tapering dose of oral steroids. BCVA in OS at 6-month follow-up was 20/25.

The Efficacy and Safety of Air Tamponade in the Repair of Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis

BACKGROUND

Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy (PPV) combined air tamponade has many advantages compared with PPV combined gas tamponade. However, there are controversial outcomes in RRD cases involving the lower quadrants.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of PPV combined air tamponade in patients with RRD compared with PPV combined gas tamponade and whether it could be a safe alternative to PPV combined gas tamponade.

METHODS

The PubMed, Embase, and Cochrane Library databases published until September 2022 were comprehensively searched for studies that compared PPV combined with air tamponade and gas tamponade in patients with RRD. The rate of primary treatment success, best-corrected visual acuity (BCVA), and postoperative complications were extracted from the final eligible studies. Study quality was assessed using the Jadad scale and Newcastle-Ottawa scale (NOS). The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals. The systematic review and meta-analysis were prospectively registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/; registration number CRD42022353479).

RESULTS

A total of 8 studies with 668 eyes in the air tamponade group and 944 in the gas tamponade group were included. There was no significant difference in the rate of primary treatment success between the air tamponade group and the gas tamponade group (RR = 1.00, p = 0.79). In addition, the subgroup analysis suggested that whether retinal breaks were located above or below, there was no significant difference in either rate of primary treatment success (RR = 0.99, p = 0.89; RR = 1.02, p = 0.45). There was no significant difference in mean BCVA 3 months after surgery (MD = -0.02, p = 0.50). For postoperative complications, mean postoperative intraocular pressure was lower in the air tamponade group at 1 day (MD = -4.24, p < 0.001), and there was no significant difference between the two groups at 7 days (MD = -0.45, p = 0.71), 1 month (MD = -0.69, p = 0.33), and 3 months (MD = 0.69, p = 0.35) after surgery. The rate of epiretinal membrane development was lower in the air tamponade group (RR = 0.48, p = 0.04).

CONCLUSIONS

For patients with uncomplicated RRD, PPV combined air tamponade is a feasible and safe alternative to PPV combined gas tamponade, regardless of the position of retinal breaks, with a similar primary treatment success rate, postoperative BCVA, and fewer postoperative complications.

Risk Factors for Epiretinal Membrane After Rhegmatogenous Retinal Detachment Repair: Quantitative Ultra Widefield Imaging Analysis

BACKGROUND AND OBJECTIVE

To utilize quantitative ultra widefield retinal imaging to investigate the risk factors associated with the incidence and severity of postoperative epiretinal membrane (ERM) in patients who underwent primary rhegmatogenous retinal detachment (RRD) repair.

PATIENTS AND METHODS

This retrospective study included patients who underwent pars plana vitrectomy (PPV) with scleral buckle (SB) for RRD, without a prior history of ERM, and who underwent ultra widefield imaging postoperatively between June 2020 and February 2022. The size and location (distance from the macula) of the drainage retinotomy and the area of peripheral pathology, including retinal breaks and laser scars, were quantitatively measured with cloud-based software. The severity of postoperative ERM formation at 6 months was graded from grade 1 to 4. We investigated the risk factors that were significantly associated with the incidence and severity of postoperative ERM at 6 months.

RESULTS

We included 80 eyes (80 patients) in this study. Postoperative ERM developed in 37 eyes (46%) at 6 months. The severity of ERM was grade 1 in 24 eyes (65%), grade 2 in 6 eyes (16%), grade 3 in 4 eyes (11%), and grade 4 in 3 eyes (8%). Postoperative ERM was not associated with the presence or the location of drainage retinotomy (P = 0.836 and 0.820, respectively). However, it was significantly associated with larger surface area of drainage retinotomy (P = 0.039). In addition, postoperative ERM was significantly associated with a larger area of peripheral pathology (P = 0.012), a larger extent of RRD (P = 0.013), vitreous hemorrhage (P = 0.026), redetachment within 6 months (P = 0.022), use of silicone oil as a tamponade (P = 0.047), and number of surgeries within 6 months (P = 0.027). These factors, in addition to 360° endolaser, were also significantly associated with the severity of postoperative ERM. In multivariable linear regression analysis, the only variable that remained statistically significant was the size of the drainage retinotomy (P = 0.023).

CONCLUSION

The pathogenesis of postoperative ERM is multifactorial. Large drainage retinotomies may increase the risk of ERM formation. [Ophthalmic Surg Lasers Imaging Retina 2023;54:206-216.].

Novel classification system for management of rhegmatogenous retinal detachment with minimally invasive detachment surgery: a network meta-analysis of randomized trials focused on patient-centred outcomes

OBJECTIVE

To describe a novel classification system for primary rhegmatogenous retinal detachment (RRD) based on level 1 evidence assessing the functional outcomes of repair techniques with the goal of using a minimally invasive detachment surgery.

METHODS

A systematic review and network meta-analysis of randomized, controlled trials comparing pneumatic retinopexy (PnR), scleral buckle (SB), or pars plana vitrectomy (PPV) for RRD was conducted. Primary outcomes were best-corrected visual acuity (BCVA), metamorphopsia, and operative complications. A meta-analysis was performed with a random effects maximum likelihood model, with outcomes of standardized mean difference (SMD) or risk ratio (RR) and 95% confidence interval. Inclusion and exclusion criteria were assessed to inform a classification system.

RESULTS

Fourteen trials were included. RRDs were classified from categories 1-3 based on configuration (simple to complex). There was no significant difference in final BCVA between PnR and PPV (categories 1 and 2; SMD = -0.10, 95% CI -0.24 to 0.04), nor was a final BVCA difference found between SB and PPV (SMD = 0.01, 95% CI -0.05 to 0.08), combined SB + PPV and PPV (SMD = 0.02, 95% CI -0.08 to 0.12), or combined SB + PPV and SB (SMD = 0.01, 95% CI -0.11 to 0.12). SB had an elevated risk of choroidal detachment (RR = 5.17, 95% CI 1.68-15.97), hypotony (RR = 12.26, 95% CI 1.63-92.04), and strabismus or diplopia (RR = 5.86, 95% CI 1.04-32.91) compared with PPV but a lower risk of iatrogenic breaks (RR = 0.08, 95% CI 0.02-0.43). Vertical metamorphopsia scores were superior for PnR over PPV at 12 months (Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial, p = 0.026).

CONCLUSION

This novel classification system may be useful for future trials assessing morphologic categories of RRD in a systematic manner. Minimally invasive detachment surgery may allow for trials to focus on maximizing functional outcomes while minimizing morbidity.

Impact of COVID-19 lockdown on surgical procedures for retinal detachment in France: a national database study

BACKGROUND/AIMS

The COVID-19 crisis and the decisions made regarding population lockdown may have changed patient care. We aimed to investigate the incidence rate of rhegmatogenous retinal detachment (RRD) cases during the COVID-19 lockdown period.

METHODS

In this nationwide database study, we identified hospital and clinic admissions of French residents for a first episode of RRD in France from 2017 to the lockdown period in 2020. The monthly hospital incidence rates of RRD procedures per 100 000 inhabitants before, during and after lockdown were computed for the whole country. Finally, we assessed the influence of viral incidence on the RRD incidence rate, comparing two regions with highly contrasting viral penetration.

RESULTS

From January to July, the average monthly national hospital incidence rate of RRD decreased from a mean of 2.59/100 000 inhabitants during 2017-2019 to 1.57/100 000 inhabitants in 2020. Compared with 2019, during the 8-week lockdown period in 2020, a 41.6% decrease in the number of RRD procedures was observed (p<0.001) with the weekly incidence of RRD decreasing from 0.63/100 000 inhabitants in 2019 to 0.36/100 000 inhabitants. During the 4-month post-lockdown period, no increased activity related to postponed procedures was observed. No difference was found in the rate of RRD surgery when comparing two regions with highly contrasting viral incidence.

CONCLUSION

Containment may have been responsible for a decrease in the number of surgical procedures for RRD, without any compensating post-lockdown activity in France. These results might help increase awareness of the management of RRD emergencies.

The effect of age on phenotype of primary rhegmatogenous retinal detachment

BACKGROUND

To evaluate the influence of age on the clinical characteristics of primary rhegmatogenous retinal detachments (RRD).

METHODS

We conducted a retrospective review of a prospectively collected dataset. Data regarding adult patients (aged 16-100 years) who had undergone primary RRD repair, were extracted from two online databases. Baseline demographics, preoperative clinical characteristics and surgical management details were collected. Age-based groups (16-30, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80) were compared using univariate analysis, with multivariate testing for interaction of age with sex, laterality and pseudophakia.

RESULTS

In total, 8,133 eyes were analysed, of which the majority (59%) were in the 50-69 age-range peaking at 60, with a male predominance (64%). Myopia was significantly more frequent in patients aged <50 years. The presence of posterior vitreous detachment increased up to 50 years, then remained >95%. Foveal involvement, grade C proliferative vitreoretinopathy, total RD and greater RD extent were more common and progressively increased after 60 years, with worsening visual acuity. Isolated superior RRDs became more prevalent with age reaching a plateau in the age-range 50-69, before reducing again; conversely, isolated inferior RRDs were commoner in those <30, with a minimum in the 70-79 age-range. The incidence of fellow-eye RRD decreased linearly with age.

CONCLUSIONS

Age appeared a key variable in RRD phenotype influencing a wide range of RRD characteristics. The higher incidence of myopia, PVD absent and bilateral RRD in patients <40 years and the significant phenotypical differences in the under 40 and over 50 age-groups highlight that there are several discrete forms of RRD.

Subretinal silicone oil: OCT imaging findings and surgical management of a rare and unusual iatrogenic complication of retinal detachment surgery

A man in his 50s underwent vitrectomy surgery for a macular off retinal detachment which was complicated by intraoperative hypotony and suprachoroidal haemorrhage, resulting in the use of silicone oil tamponade. Postoperatively, several retained cysts of fluid were seen underneath the retina, one of which was large and close to the macular. Imaging was used to determine that this was likely retained silicone oil. Given the potential of migration to the macular and retinal toxicity, the decision was made to remove the larger oil bubbles under the retina. We explain how the oil may have got under the retina in this unusual case, how we dealt with it and discuss other cases of different substances under the retina and their appearance on ocular imaging.

Analysis of Posterior Vitreous Detachment and Development of Complications Using a Large Database of Retina Specialists

PURPOSE

To examine the incidence of complications after posterior vitreous detachment (PVD) through an extended follow-up period and to identify patient-specific factors associated with a greater incidence of complication.

DESIGN

Multicenter, retrospective observational study.

PARTICIPANTS

Eyes with acute PVDs between 2015 and 2019 were identified through the Vestrum Health database.

METHODS

Complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute PVD at presentation and throughout the 6-month follow-up period.

MAIN OUTCOME MEASURES

Rate of complications throughout the 6 month follow-up period after PVD and odds of complications by patient-specific factors.

RESULTS

A total of 9635 eyes were included. The rate of any complication was 25.0%, isolated vitreous hemorrhage was 13.1%, retinal breaks without detachment was 16.0%, and retinal detachment was 4.2%. The majority of each complication was noted at presentation; however, 8.0% of isolated vitreous hemorrhages, 19.2% of retinal breaks without detachment, and 25.8% of retinal detachments were first noted within the 6-month follow-up period. Men experienced a significantly higher rate of any complication than women (30.0% versus 21.7%, P < 0.001), as well as retinal breaks and retinal detachments at both presentation and within 6-month follow-up. Patients with pseudophakia experienced significantly higher rates of delayed retinal detachment than phakic eyes (odds ratio, 1.85 [1.13, 3.04], P = 0.01). Among eyes with lattice/peripheral retinal degeneration, 44.2% experienced any complication throughout the clinical course. The presence of a retinal break in the fellow eye and retinal detachment in the fellow eye was associated with a significantly increased rate of any complication at any time point (retinal break: P < 0.0001; retinal detachment: P = 0.02), as well as each individual complication within the 6 month follow-up period. Among eyes with vitreous hemorrhage at presentation, 42.0% had a concurrent or delayed retinal break and 10.5% had concurrent or delayed retinal detachments.

CONCLUSIONS

A clinically significant proportion of PVD-related complications are detected late, warranting extended follow-up, especially in higher-risk groups such as men, pseudophakic eyes, eyes with lattice/peripheral retinal degeneration, and eyes with a history of retinal breaks or detachment in the fellow eye.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

PSEUDOPANUVEITIS AS A HARBINGER FOR SYSTEMIC LEUKEMIA RECURRENCE

PURPOSE

To describe a patient with a history of pre-B-cell acute lymphoblastic leukemia in remission, who developed recurrent alternating intraocular leukemia manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances, this constellation of ocular findings preceded systemic leukemia recurrence.

METHOD

Case report.

RESULTS

A 29-year-old man with a history of pre-B-cell acute lymphoblastic leukemia, in remission after a hematopoietic stem cell transplant, presented with pseudohypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudohypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution.

CONCLUSION

The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudopanuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.

Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting

OBJECTIVE

To investigate practice patterns and clinical outcomes in the repair of uncomplicated rhegmatogenous retinal detachments (RRD) in a real-world setting over a 10-year period.

METHODS

We compared preferences for scleral buckling (SB), pars plana vitrectomy (PPV), PPV/SB, or pneumatic retinopexy (PR) over time, and examined the 1-year single surgery anatomic success (SSAS) and best-corrected visual acuity (BCVA) at a tertiary academic institution from 2008-2018.

RESULTS

Eight hundred eight eyes had RRD repair between 2008-2011 (n = 240), 2012-2014 (n = 271), and 2015-2017 (n = 297). Compared to 2008-2011, PPV was preferred over SB in 2012-2014 (OR: 2.93; 95% CI: 1.86-4.63) and 2015-2017 (OR: 5.94; 95% CI: 3.76-9.38), and over PPV/SB in 2012-2014 (OR: 2.74; 95% CI: 1.65-4.56) and 2015-2017 (OR: 3.16; 95% CI: 31.96-5.12). PR was uncommonly utilized (<10%). Younger surgeons (graduating 2010-2017) favored PPV over SB when compared to older surgeons [graduating 1984-2000 (OR: 1.77; 95% CI: 1.18-2.65) and 2001-2009 (OR 1.73; 95% CI: 1.14-2.65)], but similarly selected PPV vs. PPV/SB as their older counterparts (p > 0.05). Compared to PPV, SSAS was higher with SB (OR: 1.53; 95% CI: 1.03-2.26) and PPV/SB (OR: 2.55; 95% CI: 1.56-4.17). One-year BCVA was markedly improved compared to baseline only for eyes that achieved SSAS (p < 0.001).

CONCLUSIONS

Over the past 10 years, PPV has become the favored approach to repair uncomplicated RRD and this appears to be driven by younger surgeons' preferences. Given the superior long-term SSAS in SB and PPV/SB as compared to PPV, SB and PPV/SB should be more frequently considered when determining the appropriate repair strategy for uncomplicated RRD.

Simultaneous Occurrence of Buckle Infection and Migration: A Case Report

Background: When scleral buckling is performed using a #240 encircling band anterior to the equator for rhegmatogenous retinal detachment, buckle migration may occur anteriorly, eroding the rectus muscle. There are few cases of buckle migration occurring simultaneously with buckle infection. Notably, most previous reports included inadequate data on the pathophysiology of buckle migration and did not include the Hess test and perioperative images. Case presentation: A 36-year-old man with a history of atopic dermatitis underwent scleral buckling for rhegmatogenous retinal detachment of the left eye with #287 and #240 encircling bands at Kagoshima University Hospital. Four years later, he developed discharge, redness, and diplopia of the left eye. He was then referred to our hospital because buckle infection was suspected. The buckle was partially visible on the lower nasal side. Optical coherence tomography of the anterior chamber revealed the buckle to be on the nasal side and overlying the medial rectus muscle. Buckle migration and infection in the left eye was diagnosed, and early buckle removal was recommended. Two weeks later, on the day before surgery, conjunctival melting progressed in the nasal and inferior areas, and the buckle was exposed to a greater extent. In the surgical video at the initial surgery, the silicone band was confirmed to pass under the four rectus muscles, specifically the inferior and medial rectus muscles. At the beginning of the second surgery, we confirmed that the buckles were over the inferior and medial rectus muscles. As far as could be observed after buckle removal, the inferior and medial rectus muscles were not present at the normal location. Postoperatively, ocular pain and discharge quickly resolved. The subjective symptoms of diplopia also improved, and the postoperative Hess chart showed an improved ocular movement in the upward and lateral directions. Conclusions: Buckle migration is a rare postoperative complication of scleral buckling; however, patients at risk of buckle migration, such as those with encircling scleral buckle anterior to the eyeball, should be monitored with caution. If a buckle infection develops, buckle migration may occur within a short period, and early buckle removal should be considered.

Steroid Drugs as an Adjunct for Reducing the Incidence of Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Surgery: A Meta-Analysis of Randomized Controlled Studies

INTRODUCTION

The efficacy and influence of steroids for reducing the incidence of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) surgery remain controversial. Systematic review and meta-analysis were conducted to explore the effect of steroids versus placebo on risk of PVR.

METHODS

We searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs), assessing the effect of steroid drugs as an adjunct for reducing the incidence of PVR after RRD surgery. This meta-analysis was performed using the random-effect model. Data were extracted by two reviewers independently; the quality of RCTs was assessed by the Cochrane risk-of-bias tool. We calculated risk ratio (RR) and the 95% confidence intervals (CIs) of all outcomes and plotted on forest plots. I2 accessed using the χ2 test was applied to quantify the degree of heterogeneity.

RESULTS

Four RCTs involving 478 patients (478 eyes) are included in the meta-analysis. There was no significant difference in the incidence of PVR recurrence between steroid groups and control groups (RR: 0.87, 95% CI: 0.70-1.08, p = 0.19). However, the incidence of recurrent PVR was lower in the steroid group (RR: 0.67, 95% CI: 0.46-0.99, p = 0.04) than in the control group when only PVR grades A and B were taken into consideration. Besides, steroids could significantly reduce the incidence of macular edema after surgery (RR: 0.64, 95% CI: 0.47-0.88, p = 0.007). The steroid group and control group had comparable outcomes of retinal reattachment rate and reoperation rate after primary surgery. Additionally, there was no significant difference of the incidence of epiretinal membrane, and the incidence of surgery required by epiretinal membrane.

CONCLUSION

This meta-analysis reveals that RRD surgery combined with steroid drugs administration could significantly reduce the recurrence in PVR grade A and B subgroup, as well as the incidence of macular edema after surgery.

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis

Importance

Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD.

Objective

To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD).

Data Sources

MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened.

Study Selection

Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months.

Data Extraction and Synthesis

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model.

Main Outcomes and Measures

Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated.

Results

Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes.

Conclusions and Relevance

Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.

Retinal Detachment Prophylaxis for Patients With Stickler Syndrome: A Survey of Pediatric Retinal Specialist Treatment Preferences

BACKGROUND AND OBJECTIVE

Stickler syndrome is the most common inherited cause of pediatric rhegmatogenous retinal detachment. The purpose of this study was to survey pediatric retinal surgeon preferences for prophylactic treatment of Stickler syndrome patients.

STUDY DESIGN

A voluntary, anonymous 27-question survey was developed by RedCap and distributed to the Association of Pediatric Retinal Surgeons. The survey was distributed on March 17, 2021. Results were tabulated on April 12, 2021 in Microsoft Excel. All surveys returned were included.

RESULTS

Thirty-four (76% response rate) respondents completed the survey. Twenty-six (76%) reported primarily using prophylactic laser retinopexy, four (12%) preferred use of cryotherapy, and 12% reported using prophylactic scleral buckle.

CONCLUSIONS

The majority of the United States. and international pediatric retinal surgeons use laser retinopexy as the primary method of prophylactic treatment. These results may serve as a benchmark for retinal surgeons less familiar with prophylactic treatment approaches. [Ophthalmic Surg Lasers Imaging Retina 2023;54:102-107.].

Air versus Perfluoropropane Gas in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A 3-Year Retrospective Study

INTRODUCTION

This study aimed to compare anatomical outcomes of air and perfluoropropane gas (C3F8) tamponade in pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD).

METHODS

In this retrospective study, data were gathered from 578 patients (578 eyes) with RRD. The follow-up records of all 578 patients that underwent primary vitrectomy for RRD with air or C3F8 were examined and analyzed. Surgical outcomes of the two groups were compared.

RESULTS

A total of 342 eyes were treated with air and 236 with C3F8. The mean follow-up period was 37.65 ± 2.33 months. Baseline and preoperative clinical characteristics were similar between groups, but the period to intraocular bubble disappearance (p < 0.0001), intraocular pressure on the first postoperative day (p < 0.0001), number of cases with intraocular pressure >21 mm Hg within 3 days post-surgery (p < 0.0001), and the number with intraocular pressure >21 mm Hg during follow-up (p = 0.0002) differed significantly between groups. Primary reattachment rates for air and C3F8 groups were 95.03% and 95.34%, respectively. Clinical characteristics were similar in those with and without successful reattachment, and the frequency of new or unclosed breaks was similar between the two groups. There was no significant difference in two groups according to the presence or absence of inferior retinal breaks and inferior detached quadrants. Univariate and multivariate logistic regression identified no risk factor for surgical failure.

CONCLUSIONS

Air showed equivalent effects to C3F8, with a shorter period to intraocular bubble disappearance, less risk of postoperative intraocular hypertension, and less expense.

Association of Treatment Type and Loss to Follow-up With Tractional Retinal Detachment in Proliferative Diabetic Retinopathy

Importance

The association of proliferative diabetic retinopathy (PDR) interventions of panretinal photocoagulation (PRP) and intravitreal injections (IVIs) with tractional retinal detachment (TRD) is unclear.

Objectives

To determine whether different treatment types or a 6-month or longer period of loss to follow-up (LTFU) is associated with TRD.

Design, Setting, and Participants

This nested case-control study included data from January 1, 2000, to June 30, 2021, of patients with PDR. Those who progressed to TRD were matched to non-TRD controls up to a 5:1 ratio. Exclusion criteria included 2 or fewer years in the plan, history of nondiabetic retinopathy, vitreous hemorrhage, previous RD, or any other surgically indicated diagnosis. Patient data were obtained from a deidentified commercial and Medicare Advantage medical claims database. Statistical analysis was performed from January to May 2022.

Exposures

Primary exposures of interest were prior treatment (PRP, IVI, both) and any period of 6 months or longer in which the patient received no eye care.

Main Outcomes and Measures

Odds ratios (ORs) of IVI only compared with PRP and 6-month or longer LTFU on development of TRD.

Results

After application of inclusion and exclusion criteria, a total of 214 patients (mean [SD] age, 55.6 [12.4] years; 115 female [53.7%]) with PDR and TRD were matched to 978 controls (mean [SD] age, 65.6 [11.3] years; 507 female [51.8%]) with only PDR. Among patients with TRD, 69 (32.2%) were treated with laser only, 17 (7.9%) were treated with injection only, 39 (18.2%) were treated with both, and 89 (41.6%) had no prior treatment. Among patients in the PDR-only group, 207 (21.2%) received laser only, 83 (8.5%) received injection only, 57 (5.8%) received both, and 631 (64.5%) received no treatment. After adjusted analysis, no difference in odds of TRD for patients who received injection only compared with patients who received laser only was found (adjusted OR [aOR], 0.56; 95% CI, 0.27-1.14). Patients who received both treatments had higher odds of TRD compared with those who received laser only (aOR, 2.33; 95% CI, 1.21-4.48), and patients who had no treatment had lower odds of TRD (aOR, 0.46; 95% CI, 0.29-0.71; P < .001 for treatment category). Similarly, no difference was seen in the odds of TRD between those with LTFU for 6 months or longer and those without LTFU (aOR, 0.72; 95% CI, 0.49-1.07; P = .11).

Conclusions and Relevance

Results of this case-control analysis suggest that there is no increased risk of TRD associated with IVI-only treatment or with 6-month or longer periods of LTFU, which supports the findings of other investigations. Nonetheless, LTFU rates continue to remain high in patients with PDR, which can contribute to substantial vision loss regardless of treatment regimen.

Late Vitreoretinal Complications of Regressed Retinopathy of Prematurity: Retinal Break, Vitreous Hemorrhage, and Retinal Detachment

PURPOSE

To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment.

DESIGN

International, multicenter, noncomparative retrospective case series.

PARTICIPANTS

We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP.

METHODS

Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared.

MAIN OUTCOME MEASURES

Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP.

RESULTS

A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P = 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement.

CONCLUSIONS

Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.

MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE

PURPOSE

Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease.

METHODS

Observational case report.

RESULTS

An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes.

CONCLUSION

Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.

Postoperative positioning regimens in adults who undergo retinal detachment repair: A systematic review

Little is known about the comparative benefit of different positioning regimens in rhegmatogenous retinal detachment (RRD) repair. We compared outcomes of different postoperative posturing regimens following pars plana vitrectomy (PPV). MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 2000 to February 2022 for original studies that compared at least 2 postoperative posturing regimens in adults who underwent PPV for RRD. Seven comparative studies and 703 eyes were included. There were no differences in final visual acuity between posturing regimens. Single-procedure reattachment rates were higher with alternative positioning compared to prone positioning in patients with inferior breaks. Prone and alternative positioning were associated with similar risks of complications. In contrast, prone posturing had a higher risk of neck pain and intraocular pressure elevation than support-the-break, which had a greater risk of retinal displacement, retinal folds, and binocular diplopia. Immediate prone positioning was superior to delayed prone for the risk of retinal displacement. The present review shows that prone positioning was associated with a lower reattachment rate than alternative positioning. There were trade-offs in complications between prone and support-the-break positioning. Retinal displacement could be mitigated when prone positioning is maintained immediately after surgery.

MACULAR HOLE-RELATED RETINAL DETACHMENT COMPLICATING AUTOSOMAL RECESSIVE BESTROPHINOPATHY: CLINICAL FEATURES, MULTIMODAL IMAGING, AND SURGICAL OUTCOME

PURPOSE

To report a case of full-thickness macular-hole related retinal detachment in a patient with autosomal recessive bestrophinopathy.

METHODS

A 3-year-old boy presented for squint assessment. In the examination, there were typical features of autosomal recessive bestrophinopathy in the left eye and a macular hole-related retinal detachment in his right eye. Color fundus photography, autofluorescence, fundus fluorescence angiography, and spectral-domain optical coherence tomography were recorded.

RESULTS

Optical coherence tomography of the right eye showed a full-thickness macular hole retinal detachment. The retina showed retinoschisis affecting the inner and outer nuclear layer at the fovea and parafoveal region. Also, hyperreflective dots were seen at the hole and on the inner retinal surface. The left eye showed subretinal fluid with stalactite-like extensions into the subretinal space, and hyperreflective material seen above the retinal pigment epithelium. Fundus autofluorescence showed hyperautofluorescence at the fovea of the right eye and punctate hyperautofluorescent spots in the mid-periphery of the left eye. After pars plana vitrectomy and temporal internal limiting membrane flap, the hole was closed and all the schitic cavities collapsed at the sixth-week follow-up visit.

CONCLUSION

A full-thickness macular hole-related retinal detachment can develop in autosomal recessive bestrophinopathy in the pediatric age group. Pars plana vitrectomy with temporal internal limiting membrane flap may be helpful for successful surgical repair.

[Horseshoe retinal tear: factors that determine the risk of developing rhegmatogenous retinal detachment]

Horseshoe (flap) retinal tears are the leading cause of rhegmatogenous retinal detachment (RRD). Identification of the most significant predictors of RRD in patients with a horseshoe tear will enable the development of an optimal treatment strategy.

PURPOSE

This study aimed to determine the main risk factors for RRD development based on the analysis of the condition of vitreoretinal interface in the area of horseshoe tears, both isolated and those that resulted in retinal detachment.

MATERIAL AND METHODS

A total of 88 patients with horseshoe retinal tears (43 patients with RRD due to the horseshoe tear and 45 with isolated horseshoe tears) were included in the study. All patients underwent wide-field multispectral laser scanning and optical coherence tomography to determine the shape of the horseshoe tear and the extent of vitreoretinal adhesion (VRA). Cluster analysis was used to differentiate horseshoe tears by shape. Spearman's correlation analysis was used to identify the relationship between the shape of the horseshoe tear and localization of VRA.

RESULTS

Spearman's correlation analysis revealed a strong negative correlation between the length-to-width ratio of the horseshoe tear and the extent of VRA. Cluster analysis helped determine four shapes of horseshoe tears, each corresponding to a certain localization of VRA. Analysis of RRD risk, depending on the characteristics of the horseshoe tear, showed that the most significant risk factor for the development of RRD is the presence of a horseshoe tear with width greater than its length, which is characterized by a larger VRA area.

CONCLUSION

The study established that the larger the horseshoe tear width and the smaller its length, the larger the VRA area and, consequently, the higher the risk of RRD development. Horseshoe retinal tears with a length-to-width ratio of less than 1/1 are the most dangerous in terms of RRD risk, which is important to consider when selecting the treatment tactics.

Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease

Objectives

To evaluate the frequency and treatment response of eyes with bacillary layer detachment (BLD) in acute Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT).

Materials and Methods

We retrospectively reviewed the medical records of 58 eyes of acute VKH patients with at least 6 months of follow-up between January 2009 and March 2021. SD-OCT, color fundus photographs, and fluorescein angiography images were analyzed in all patients.

Results

The study included 58 eyes of 29 patients. BLD was detected in 33 of the 58 eyes (56.9%) at baseline. Mean serous retinal detachment (SRD) height was 918.50±336.64 μm in the BLD group and 215.33±167.83 μm in the group without BLD (p<0.05). A positive correlation was found between SRD height and the presence of BLD (r=0.783, p<0.05). BLD was significantly more common in patients with a baseline SRD height greater than 500 μm (p<0.05). As subfoveal central choroidal thickness (CCT) could not be measured by enhanced depth imaging-OCT at baseline due to extreme choroidal thickness in all eyes, the earliest post-treatment CCT measurements were analyzed. At the completion of pulse steroid therapy, mean CCT was 425±82.87 μm in the BLD group and 385.58±82.87 μm in the group without BLD (p=0.04). The mean time to BLD resolution was 12.88±6.5 days (range: 2-26).

Conclusion

BLD is a common tomographic finding in eyes with acute VKH disease and can be differentiated from the associated SRD through careful SD-OCT analysis. Though it is mostly observed in patients with more serious disease, the presence of BLD has no negative effect on long-term visual function.

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

OBJECTIVE

To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery.

METHODS

Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes).

RESULTS

Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69).

CONCLUSIONS

This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration

OBJECTIVE

Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size.

METHODS

Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered.

RESULTS

The study included 14 eyes of 14 patients: mean age 77 ± 7 years, 11 (79%) females. 25 ± 13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64 ± 14-69 ± 11 letters after anti-VEGF therapy (p > 0.05). Mean baseline PED height was 817 ± 269 µm, being 639 ± 268 µm after Ozurdex and 370 ± 260 µm after anti-VEGF injections (p = 0.035 and p = 0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported.

CONCLUSIONS

Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.

Giant Retinal Tears: Long-Term Outcomes of Fellow Eyes

BACKGROUND AND OBJECTIVE

Determine clinical characteristics and long-term outcomes of fellow eyes for patients with prior repair of rhegmatogenous retinal detachments due to a giant retinal tear (GRT).

STUDY DESIGN

Retrospective case series of patients who underwent vitreoretinal surgery between January 2005 and August 2017 for GRT at the Bascom Palmer Eye Institute with a minimum of one year of follow-up information. Patients with a traumatic or post-vitrectomy GRT were excluded.

MAIN OUTCOME MEASURES

Visual acuity and rate of retinal events in fellow eyes.

RESULTS

The study group included 51 patients; 40 others were excluded due to having less than one year of follow-up (n = 27), a history of inciting trauma (n = 11), or a GRT occurring post-vitrectomy (n = 2). The mean age was 49.9 years (range 14 to 81) and mean follow-up duration was 6.9 years (range 1 to 16). During the follow-up interval, prophylactic laser retinopexy was performed in 5 fellow eyes for retinal breaks (9.8%) and in one fellow eye with a progressing retinoschisis cavity (2.0%). One patient had a previous history of a retinal break in the fellow eye. Vitreoretinal surgery was performed in 6 (11.8%) fellow eyes for rhegmatogenous retinal detachments, of which one was caused by a GRT. Three patients (5.9%) already had a retinal detachment repair in the fellow eye prior to presentation and one patient presented with bilateral giant retinal tear associated retinal detachments (GRT-RDs) at the initial visit. Overall, there was a retinal event in 33.3% of fellow eyes. Myopia was the most commonly documented associated factor (31%), followed by lattice degeneration (22%), and known or suspected inherited vitreoretinopathy (4%).

CONCLUSIONS

Retinal tears and/or detachments were encountered relatively frequently in the fellow eye of patients with a history of GRT-RD during follow-up, but the rate of GRTs in the fellow eye (4%) was below what has been generally reported in the literature. Regular dilated fundus exams are warranted for patients with a history of GRT. [Ophthalmic Surg Lasers Imaging Retina 2022;53:619-625.].

Iatrogenic Paracentral Visual Field Defect After Pars Plana Vitrectomy for Macula-On Retinal Detachment Repair

Perfluorocarbon liquid (PFCL) is an important adjunct in pars plana vitrectomy (PPV) for complex retinal detachment (RD). Complete removal of PFCL is critical to prevent retinal inflammation and cellular toxicity, but removal is not risk-free. We report a case of a new postoperative onset paracentral visual field defect after PPV with PFCL use for treatment of a macula-on RD. We present pre- and postoperative imaging that suggests a likely perioperative iatrogenic cause. [Ophthalmic Surg Lasers Imaging Retina 2022;53:644-646.].

Surgical Outcomes of Acute Retinal Necrosis-Related Retinal Detachment in Polymerase Chain Reaction-Positive Patients: A Single-Center Experience

PURPOSE

To evaluate the clinical features, operative techniques, and surgical outcomes of patients who underwent surgery for acute retinal necrosis (ARN)-related retinal detachment (RD).

DESIGN

Retrospective, longitudinal, consecutive case series.

PARTICIPANTS

Patients with polymerase chain reaction-positive ARN presenting from 2011 to 2021 who underwent vitreoretinal surgery for ARN-related RD at our institution.

METHODS

Univariate, multivariate, and survival analyses were used to determine predictors of anatomic and functional outcomes.

MAIN OUTCOME MEASURES

Single-surgery anatomic success rate, recurrent RD, and visual acuity (VA) at 1 year.

RESULTS

Thirty-four eyes of 34 patients (32.4% women, mean age, 45.1 ± 20.4 years) were included for analysis with a median follow-up of 2.5 years (interquartile range [IQR], 0.8-5.5 years). Presenting VA was 1.1 ± 0.8 logarithm of the minimum angle of resolution (LogMAR) (Snellen ∼20/250). The median time from presentation to RD surgery was 1.7 months (IQR, 0.8-4.1 months), and the mean preoperative VA was 1.6 ± 0.8 LogMAR (Snellen ∼20/800). Small-gauge pars plana vitrectomy (PPV) with or without a scleral buckle (SB) was performed for all eyes with an overall single-surgery success rate of 63.6%, with no statistically significant differences in visual/anatomic outcomes between PPV and PPV/SB cases. Silicone oil was used for tamponade in 33 (97.1%) cases and was removed in 10 (30.3%) with good anatomic and final functional outcomes (Snellen ∼20/80). Independent predictors of recurrent RD included the female sex (hazard ratio, 8.38; 95% confidence interval, 2.03-34.68; P < 0.01) and zone 1 retinitis involvement at presentation (hazard ratio, 10.95; 95% confidence interval, 2.12-56.48; P < 0.01). The mean VA at 1 year (VA_1year) and at the final follow-up both had a Snellen equivalent of 20/640 (P > 0.05 for both compared with preoperative VA, respectively). Eyes that achieved single-surgery success had VA_1year of 20/200 versus hand movements in those with single-surgery failure (P < 0.01). On multivariate linear regression, younger age (P = 0.04) and better presenting VA (P < 0.01) were both associated with better VA_1year.

CONCLUSIONS

Moderate single-surgery anatomic success can be achieved with modern vitreoretinal surgical techniques for ARN-related RD, although visual outcomes remain poor. Further studies investigating interventions for increasing single-surgery success rates, for the inflammatory complications of ARN, and for preventing ARN-related RD are needed.

Main Principles of Vitrectomy Using Intraocular Tamponades - A Basic Course in Surgery

This article is intended to clearly present the basic principles for the use of intraocular tamponades in vitreous/retinal surgery in the event of retinal detachment and other pathologies using additional video footage. It examines the various gases, silicone oils and perfluorocarbon liquids with their indications, administration and in particular intraoperative handling including pitfalls and complications. Characteristic animations show the principles of use in surgery in a comprehensible way. The two lead authors dedicate this article to their teacher Prof. Dr. V.-P. Gabel, who in the early 1990s successfully established the first vitrectomy courses for ophthalmologists at Regensburg University Eye Clinic each year. Many colleagues who still work in retinal surgery today first started learning about this segment on these courses. The other coauthors participated under his supervision in annual vitrectomy wet labs run by the German Academy of Ophthalmology.

Treatment of recurrent high myopic macular hole associated with retinal detachment using a human amniotic membrane

PURPOSE

To determine the efficacy of using a human amniotic membrane to close macular hole retinal detachment in highly myopic eyes.

STUDY DESIGN

Prospective, consecutive, nonrandomized interventional study.

METHODS

We included 19 high myopic eyes from 19 patients affected by macular hole retinal detachment who had already undergone vitrectomy with internal limiting membrane peeling. The patients underwent vitrectomy with amniotic membrane transplant.

RESULTS

Primary success was achieved after 3 months in 89.5% (17 of 19 eyes) and final macular hole closure was obtained in 94.7% (18 of 19 eyes) of the patients. The final retinal reattachment rate was 100%. The final 12-month mean BCVA improved from 20/2000 (2 logMAR) to 20/250 (1.1 logMAR). OCT-angiography revealed a high correlation between the superficial and deep capillary plexus and the final BCVA.

CONCLUSION

Human amniotic membrane patches can effectively repair macular hole retinal detachment in high myopic eyes in terms of anatomic results and BCVA recovery.

RE-INVENTING CYANOACRYLATE RETINOPEXY IN THE 21ST CENTURY: LITERATURE REVIEW AND CASE SERIES

PURPOSE

We report use of cyanoacrylate (N-butyl-Cyanoacrylate) in previously failed retinal reattachment surgeries for chorio-retinal colobomas. We report the surgical technique, its challenges, and long-term outcomes in three patients who underwent the surgery.

METHODS

A chart review of patients with chorio-retinal colobomas and retinal detachment repair with cyanoacrylate at a tertiary eye care center in Nepal. Cyanoacrylate was used to seal colobomatous retinal breaks in eyes which had undergone multiple retinal surgeries with failed outcome.

RESULTS

Three eyes that were operated using cyanoacrylate were included. All three patients had attached retina and none of the patients required a long-term tamponading agent. None of the patients underwent head positioning following the surgery. All of the patients had a visual acuity gain of 3/60 or more at the end of 8 months. No adverse or inflammatory reactions were noted.

CONCLUSION

We demonstrate that cyanoacrylate is safe and less resource-demanding without a requirement of second surgery to remove a tamponading agent. It could be helpful in eyes with persistent retinal detachment in colobomatous eyes. Because we were able to achieve favorable outcomes without head positioning, we believe it may also be helpful in patients who are not suitable for positioning because of bodily or bony deformities and in retinal detachment with other coexisting trauma.

Characteristics of Bilateral Retinal Detachment

INTRODUCTION

Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD.

METHODS

The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed.

RESULTS

A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break.

CONCLUSION

Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.

Hospital-Based Study of Risk Factors Associated with Development of Myopic Macular Neovascularization in Highly Myopic Eyes

INTRODUCTION

Myopic macular neovascularization (MNV) is the most common cause of a reduction of central vision in eyes with pathologic myopia, and it can progress to macular atrophy in the long term. The aim of this study was to determine the risk factors associated with the development of MNVs.

METHODS

There were 17,198 follow-up records from 5,409 eyes of 2,784 highly myopic patients that were reviewed. The general information and ophthalmic information in the records were studied. The significance of the correlations of factors associated with the development and predicting the development of myopic MNV were determined.

RESULTS

Being a woman (odds ratio [OR] = 0.727, p < 0.001), having a longer axial length (OR = 0.948, p < 0.001), having a poorer baseline best-correct visual acuity (BCVA, OR = 2.098, p < 0.001), having severe myopic maculopathy (overall: p < 0.001), prior myopic MNV in the fellow eye (OR = 4.105, p < 0.001), presence of patchy atrophy (overall p < 0.001), lacquer cracks (OR = 1.718, p < 0.001), prior foveal retinal detachment (RD, OR = 3.269, p < 0.001), prior macular hole (MH, OR = 0.641, p < 0.001), prior macular retinoschisis (OR = 1.533, p < 0.001), and prior macular edema (OR = 1.508, p < 0.001) were significantly correlated with the development of myopic MNV. Eyes with MNV and patchy atrophy would require an intensive follow-up examination for myopic patients as the fellow eye would have a risk of >70% for the development of myopic MNV in 3 years and nearly 80% in 5 years.

CONCLUSIONS

Clinicians need to pay special attention to eyes with severe grades of myopic maculopathy, prior myopic MNV in the fellow eye, presence of patchy atrophy, and prior foveal retinal detachment to determine the onset of myopic MNV.

A Case of Rhegmatogenous Retinal Detachment With an Unpredictable Macular Tear Treated With Autologous Retinal Graft

A 40-year-old male presented with decreased vision following trauma from a stone. The view of the posterior segment was precluded due to cortex material. Ocular ultrasonography detected total retinal detachment. During 25-G pars plana vitrectomy, a large macular tear was observed. Because this finding was not expected, autologous retinal graft was the only possible surgical option to close this macular tear. A retinal graft was taken from the periphery and spread over the macula. At the postoperative period, the retinal graft was in place and integrated with the tear. An autologous retinal graft may be an effective surgical option in the presence of macular tear. [Ophthalmic Surg Lasers Imaging Retina 2022;53:575-578.].

Surgical interventions for bilateral congenital cataract in children aged two years and under

BACKGROUND

Congenital cataracts are lens opacities in one or both eyes of babies or children present at birth. These may cause a reduction in vision severe enough to require surgery. Cataracts are proportionally the most treatable cause of visual loss in childhood, and are a particular problem in low-income countries, where early intervention may not be possible. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia (vision is obstructed by cataract from birth which prevents normal development of the visual system), posterior capsule opacification and uncertainty about the final trajectory of ocular growth parameters can affect results of treatment. Two options currently considered for children under 2 years of age with bilateral congenital cataracts are: (i) intraocular lens (IOL) implantation; or (ii) leaving a child with primary aphakia (no lens in the eye), necessitating the need for contact lenses or aphakic glasses. Other important considerations regarding surgery include the prevention of visual axis opacification (VAO), glaucoma and the route used to perform lensectomy.

OBJECTIVES

To assess the effectiveness of infant cataract surgery or lensectomy to no surgery for bilateral congenital cataracts in children aged 2 years and under.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 1); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 25 January 2022.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) that compared infant cataract surgery or lensectomy to no surgery, in children with bilateral congenital cataracts aged 2 years and younger. This update (of a review published in 2001 and updated in 2006) does not include children over 2 years of age because they have a wider variety of aetiologies, and are therefore managed differently, and have contrasting outcomes.

DATA COLLECTION AND ANALYSIS

We used standard methods expected by Cochrane. Two review authors extracted data independently. We assessed the risk of bias of included studies using RoB 1 and assessed the certainty of the evidence using GRADE.

MAIN RESULTS

We identified three RCTs that met our inclusion criteria with each trial comparing a different aspect of surgical intervention for this condition. The trials included a total of 79 participants under 2 years of age, were conducted in India and follow-up ranged from 1 to 5 years. Study participants and outcome assessors were not masked in these trials. One study (60 children) compared primary IOL implantation with primary aphakia. The results from this study suggest that there may be little or no difference in visual acuity at 5 years comparing children with pseudophakia (mean logMAR 0.50) and aphakia (mean logMAR 0.59) (mean difference (MD) -0.09 logMAR, 95% confidence intervals (CIs) -0.24 to 0.06; 54 participants; very low-certainty evidence), but the evidence is very uncertain. The evidence is very uncertain as to the effect of IOL implantation compared with aphakia on visual axis opacification (VAO) (risk ratio (RR) 1.29, 95% CI 0.23 to 7.13; 54 participants; very low-certainty evidence). The trial investigators did not report on the cases of amblyopia. There was little evidence of a difference betwen the two groups in cases of glaucoma at 5 years follow-up (RR 0.86, 95% CI 0.24 to 3.10; 54 participants; very low-certainty evidence). Cases of retinal detachment and reoperation rates were not reported. The impact of IOL implantation on adverse effects is very uncertain because of the sparse data available: of the children who were pseudophakic, 1/29  needed a trabeculectomy and 8/29 developed posterior synechiae. In comparison, no trabeculectomies were needed in the aphakic group and 2/25 children had posterior synechiae (54 participants; very low-certainty evidence).  The second study (14 eyes of 7 children under 2 years of age) compared posterior optic capture of IOL without vitrectomy versus endocapsular implantations with anterior vitrectomy (commonly called 'in-the-bag surgery'). The authors did not report on visual acuity, amblyopia, glaucoma and reoperation rate. They had no cases of VAO in either group. The evidence is very uncertain as to the effect of in-the-bag implantation in children aged under 1 year. There was a higher incidence of inflammatory sequelae: 4/7 in-the-bag implantation eyes and 1/7 in optic capture eyes (P = 0.04, 7 participants; very low-certainty evidence). We graded the certainty of evidence as low or very low for imprecision in all outcomes because their statistical analysis reported that a sample size of 13 was needed in each group to achieve a power of 80%, whereas their subset of children under the age of 1 year had only 7 eyes in each group. The third study (24 eyes of 12 children) compared a transcorneal versus pars plana route using a 25-gauge transconjunctival sutureless vitrectomy system. The evidence is very uncertain as to the effect of the route chosen on the incidence of VAO, with no cases reported at 1 year follow-up in either group. The investigators did not report on visual acuity, amblyopia, glaucoma, retinal detachment and reoperation rate. The pars plana route had the adverse effects of posterior capsule rupture in 2/12 eyes, and 1/12 eyes needing sutures. Conversely, 1/12 eyes operated on by the transcorneal route needed sutures. We graded the outcomes with very low-certainty because of the small sample size and the absence of a priori sample size calculation.

AUTHORS' CONCLUSIONS

There is no high level evidence for the effectiveness of one type of surgery for bilateral congenital cataracts over another, or whether surgery itself is better than primary aphakia. Further RCTs are required to inform modern practice about concerns, including the timing of surgery, age at which surgery should be undertaken, age for implantation of an IOL and development of complications, such as reoperations, glaucoma and retinal detachment. Standardising the methods used to measure visual function, along with objective monitoring of compliance with the use of aphakic glasses/contact lenses would greatly improve the quality of study data and enable more reliable interpretation of outcomes.

Computational Modeling of Ophthalmic Procedures: Computational Modeling of Ophthalmic Procedures

PURPOSE

To explore how finite-element calculations can continue to contribute to diverse problems in ophthalmology and vision science, we describe our recent work on modeling the force on the peripheral retina in intravitreal injections and how that force increases with shorter, smaller gauge needles. We also present a calculation that determines the location and stress on a retinal pigment epithelial detachment during an intravitreal injection, the possibility that stress induced by the injection can lead to a tear of the retinal pigment epithelium.

BACKGROUND

Advanced computational models can provide a critical insight into the underlying physics in many surgical procedures, which may not be intuitive.

METHODS

The simulations were implemented using COMSOL Multiphysics. We compared the monkey retinal adhesive force of 18 Pa with the results of this study to quantify the maximum retinal stress that occurs during intravitreal injections.

CONCLUSIONS

Currently used 30-gauge needles produce stress on the retina during intravitreal injections that is only slightly below the limit that can create retinal tears. As retina specialists attempt to use smaller needles, the risk of complications may increase. In addition, we find that during an intravitreal injection, the stress on the retina in a pigment epithelial detachment occurs at the edge of the detachment (found clinically), and the stress is sufficient to tear the retina. These findings may guide physicians in future clinical research. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

POSTERIOR TRACTIONAL MEMBRANES FOLLOWING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR RETINOPATHY OF PREMATURITY

PURPOSE

To report two cases of tractional membrane formation following treatment with anti-vascular endothelial growth factor therapy in infants with Stage-3 retinopathy of prematurity.

METHODS

Retrospective review of electronic medical record for historical information, clinical examination documentation, and imaging from fundus photography, retinal ultrasonography, and fluorescein angiography.

RESULTS

Two patients with Stage-3 retinopathy of prematurity, previously treated with laser therapy and intravitreal bevacizumab, were referred to our institution for tractional membranes. The first case is of a male infant with Zone-II disease that progressed to Stage 4A with evidence of inferotemporal tractional retinal detachment only in the left eye. The second case is of a male infant with stable Zone-I disease with an epiretinal membrane in the left eye.Pars plicata vitrectomy and membranectomy were required for both cases because of the concern for subsequent tractional retinal detachment.

CONCLUSION

Formation of tractional retinal membranes has been associated with anti-vascular endothelial growth factor therapy. These cases describe the formation of posterior tractional membranes after anti-vascular endothelial growth factor therapy. This potential ocular outcome should be considered when determining treatment plans for retinopathy of prematurity.

Risk Factors for Failure of Final Anatomic Surgical Reattachment in Retinal Detachments From Combat Ocular Trauma

BACKGROUND AND OBJECTIVE

The goal of this study was to determine the anatomic outcome of traumatic retinal detachment (RD) from combat ocular trauma.

MATERIALS AND METHODS

Retrospective study of patients sustaining a traumatic RD in Operation Iraqi Freedom and Operation Enduring Freedom who were evacuated to Walter Reed Army Medical Center from 2001 to 2011. The Fisher exact test, Wilcoxon rank sum test, and Agresti and Coull methods were used for analyses.

RESULTS

There were 143 eyes of 134 patients in which a traumatic RD developed, of a total of 890 eyes of 652 patients in the Walter Reed Ocular Trauma Database. Based on our results, predictors for failure to reattach the retina include maculaoff status (P = .0002), open-globe injury (P = .03), proliferative vitreoretinopathy postoperatively (P = .002), and presence of hyphema (P = .02). Intraocular foreign body and time to initial retinal surgery did not increase risk for failure. Thirty-four percent (34%) of eyes failed to be reattached.

CONCLUSIONS

Traumatic RD due to injury sustained in a combat zone resulted in poor prognosis, with 82.09% of eyes with RD having a best-corrected visual acuity worse than 20/200. The anatomic success of RD repair was shown to be 65.71%, likely owing to the severity of the injuries, concomitant systemic injuries, and delayed surgical intervention. [Ophthalmic Surg Lasers Imaging Retina 2022;53:493-501.].

Spontaneous resolution of subretinal fluid postvitreoretinal surgery for tractional retinal detachment in proliferative diabetic retinopathy

A man in his 60s with proliferative diabetic retinopathy presented with vision loss in both eyes in the past 1 month. On presentation, the best corrected visual acuity was 20/60 and 20/125 for the right and left eyes, respectively. On examination, he had total tractional retinal detachment (TRD) in the left eye and macula threatening TRD in the right eye. In both eyes, the patient had pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Though the left eye's postoperative recovery was uneventful, the subretinal fluid (SRF) in the right eye macula persisted. There was no open retinal break noted in the postoperative period, and no surgical intervention was done for the persistent SRF. The fluid was eventually absorbed over 4 months, with the recovery of vision to 20/40.

FOLDABLE CAPSULAR VITREOUS BODY IMPLANTATION FOR COMPLICATED RETINAL DETACHMENT CAUSED BY SEVERE OCULAR TRAUMA

PURPOSE

To explore the effectiveness, safety and psychological impact of foldable capsular vitreous body (FCVB) implantation for complicated retinal detachment caused by severe ocular trauma.

METHODS

This was a prospective, single-arm, surgical interventional case series study. A standard 3-port 23-gauge pars plana vitrectomy was performed, and the FCVB was implanted into the vitreous cavity. Observed indicators, including the best-corrected visual acuity, intraocular pressure (IOP), retinal reattachment, complications, and patient satisfaction, were analyzed to evaluate the study.

RESULTS

A total of 28 cases (eyes) were enrolled, with a mean follow-up of 16.93 ± 9.67 months and an average age of 51.11 ± 10.14 years, including 22 men (78.57%). The FCVB was successfully implanted, and the retina was reattached in all cases. The postoperative best-corrected visual acuity improved in 7 cases, and remained unchanged in 21 cases ( P > 0.05). The average IOP was 7.01 ± 2.43 mmHg before surgery and 8.54 ± 2.93 mmHg after surgery ( P < 0.05). Complications such as FCVB displacement, endophthalmitis, secondary glaucoma, silicone oil emulsification, and escape did not occur during the follow-up period. Patients with FCVB implantation are highly satisfied. Most patients feel hope, positive, and optimistic about life.

CONCLUSION

Foldable capsular vitreous body implantation for complicated retinal detachment caused by severe ocular trauma is effective and safe, and it allows patients to face life positively and optimistically.