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Alberti M, Ilsby C, Christensen UC, Kiilgaard JF, la Cour M. Preoperative Positioning and Progression of Fovea-on Retinal Detachments. Ophthalmol Retina 2024; 8:137-147. [PMID: 37659721 DOI: 10.1016/j.oret.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To study the relationship between positioning and rhegmatogenous retinal detachment (RRD) progression before surgery in patients with a fovea-on RRD. DESIGN Prospective, single-cohort study. SUBJECTS Patients with fovea-on RRD admitted to hospital for bedrest before surgical treatment were recruited. METHODS Primary outcome was the shortest distance from the foveal center to the retinal detachment border on OCT. Secondary outcomes were measured with a head-mounted positioning sensor and included measures of head movement (linear acceleration and angular velocity) as well as measures of positioning regimen compliance. MAIN OUTCOME MEASURES Distance from the fovea to the retinal detachment border. RESULTS Overall, 50 patients with fovea-on positioned before RRD repair. One patient (1/50, 2%) progressed from fovea-on to fovea-off. Of the positioning measures, angular velocity demonstrated the strongest correlation with RRD border movement, whereas measures of positioning compliance showed nonsignificant correlation. After defining 3 movement groups: stable, intermediate, and mobile RRDs, we found that a doubling of head movement (angular velocity) correlated with a median RRD border progression of -6 μm/h, -75 μm/h, and -219 μm/h in the 3 groups, respectively. CONCLUSIONS Rhegmatogenous retinal detachment border movement is correlated to angular velocity of the head, whereas compliance with our current positioning regimen does not have a significant impact on RRD border movement. Not all RRDs progress rapidly toward the fovea, but those that do seem to be highly influenced by head movement. For limiting RRD progression, a reduced movement positioning regimen may be superior to our current gravity-based approach. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mark Alberti
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
| | - Christian Ilsby
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
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Nagamoto T, Kubono H, Kawamura M, Suzuki K. A custom-made vitreoretinal surgical simulator using a silicone mold. BMC Ophthalmol 2023; 23:311. [PMID: 37434127 DOI: 10.1186/s12886-023-03070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE We constructed a custom-made vitreoretinal surgical simulator using a silicone mold and described its practicality. METHODS We obtained spherical silicone molds, mannequins, and spray material from an internet-based vendor and combined them with expired surgical instruments to complete the simulator. Vitreoretinal experts confirmed the practicality of the simulator after simulated vitrectomy, and the results of the questionnaires were confirmed by nonvitreoretinal experts. RESULTS Vitreoretinal experts observed that the simulated eyeball and the actual eyeball were similar in size and rigidity and that the intraocular practice swing seemed to be useful for the prevention of complications. The semitransparency and open-sky structure of the silicone material ensured visibility. The simulated membrane, which was spray glue, provided an excellent peeling sensation. In the results of the nonvitreoretinal experts' questionnaires, the average scores of all items were generally high, which supported the claims of the simulator's usefulness. CONCLUSION This report describes the simplicity and cost-effectiveness of our custom-made simulator and its contribution in creating an ideal training environment that does not necessitate travel to special facilities that offer a large number of pig eyes and vitreous surgical machines. The simple shape seems to allow many possibilities, and further verification at multiple facilities is necessary.
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Affiliation(s)
- Takashi Nagamoto
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Hirohisa Kubono
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
| | - Mari Kawamura
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
| | - Kotaro Suzuki
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
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Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Dated October 2020. Ophthalmologe 2021; 118:132-134. [PMID: 34232367 DOI: 10.1007/s00347-021-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
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Radeck V, Helbig H, Barth T, Gamulescu MA, Prahs P, Maerker D. [Retinal detachment surgery: trends over 15 years]. Ophthalmologe 2021; 119:64-70. [PMID: 34137944 DOI: 10.1007/s00347-021-01430-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15 years. METHOD Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed. RESULTS The number of retinal detachment surgeries over the past 15 years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed a slight trend towards improved results over the past 15 years. CONCLUSION The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. A slight trend towards better anatomical success rates could be observed.
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Affiliation(s)
- Viola Radeck
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland.
| | - Horst Helbig
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Teresa Barth
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Maria-Andreea Gamulescu
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Philipp Prahs
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - David Maerker
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
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Stellungnahme von DOG, RG und BVA zur zeitlichen Planung der Versorgung einer rhegmatogenen Amotio retinae. Klin Monbl Augenheilkd 2021; 238:314-316. [PMID: 33784791 DOI: 10.1055/a-1364-4747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
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[Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Situation October 2020]. Ophthalmologe 2021; 118:235-238. [PMID: 33459809 DOI: 10.1007/s00347-020-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
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Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Décollement de rétine rhegmatogène chez l’adulte jeune : caractéristiques cliniques et résultats chirurgicaux. J Fr Ophtalmol 2020; 43:404-410. [DOI: 10.1016/j.jfo.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
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Malosse L, Rousseau H, Baumann C, Angioi K, Leroy B, Sennlaub F, Berrod JP, Conart JB. Prevalence and risk factors for outer retinal layer damage after macula-off retinal detachment. Br J Ophthalmol 2019; 104:660-665. [PMID: 31462417 DOI: 10.1136/bjophthalmol-2019-314236] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/22/2019] [Accepted: 08/12/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine its associated preoperative risk factors. METHODS 253 eyes successfully operated for macula-off RRD were included in the study. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) of the photoreceptors was assessed at 1 month and 6 months using spectral-domain optical coherence tomography. Risk factors were analysed using univariate and multivariate logistic regression. The correlation between ORL integrity and visual outcomes was also evaluated. RESULTS CIZ, EZ and ELM defects were found in, respectively, 198 (93.4%) eyes, 100 (47.2%) eyes, 64 (30.2%) eyes at 1 month and in 160 (63.2%) eyes, 44 (17.4%) eyes and 18 (7.1%) eyes at 6 months. In multivariate analysis, duration of macular detachment was the only factor associated with ORL damage at 6 months (p=0.007). Best-corrected visual acuity significantly improved from 0.5±0.3 at 1 month to 0.3±0.3 logarithm of minimal angle of resolution at 6 months (p<0.001) and was strongly correlated with the number of affected bands (p<0.001). CONCLUSION Prevalence of outer retinal band defects substantially decreased through the study period, confirming the ability of photoreceptors to recover over time. However, shorter interval to surgery and better visual outcomes were significantly associated with fewer defects within the ORL at 6 months. These findings suggest that earlier surgery may limit RRD-associated photoreceptor degeneration and improve the patient's visual prognosis.
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Affiliation(s)
- Laure Malosse
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Hélène Rousseau
- ESPRI-BioBase Unit, Platform of PARC, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- ESPRI-BioBase Unit, Platform of PARC, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Karine Angioi
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Bertrand Leroy
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
| | - Florian Sennlaub
- Institut de la Vision, 17 rue Moreau, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Jean-Paul Berrod
- Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France
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Long-term Clinical Results of Vitrectomy and Scleral Buckling in Treatment of Rhegmatogenous Retinal Detachment. ScientificWorldJournal 2019; 2019:5416806. [PMID: 30956624 PMCID: PMC6431356 DOI: 10.1155/2019/5416806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD). Methods 155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic. Results Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively. Conclusion Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.
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Shields RA, Ludwig CA, Powers MA, Tijerina JD, Schachar IH, Moshfeghi DM. Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy. Eur J Ophthalmol 2018; 30:81-87. [PMID: 30426767 DOI: 10.1177/1120672118811980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. METHODS Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. RESULTS A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). DISCUSSION Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.
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Affiliation(s)
- Ryan A Shields
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew A Powers
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jonathan D Tijerina
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ira H Schachar
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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The Evolution of Pars Plana Vitrectomy to 27-G Microincision Vitrectomy Surgery. Int Ophthalmol Clin 2018; 56:97-111. [PMID: 27575761 DOI: 10.1097/iio.0000000000000131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loukovaara S, Sahanne S, Takala A, Haukka J. Statin use and vitreoretinal surgery: Findings from a Finnish population-based cohort study. Acta Ophthalmol 2018; 96:442-451. [PMID: 29338115 DOI: 10.1111/aos.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy. METHODS Our historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008-2014, covering 6.5 years. Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication. The primary end-point event was revitrectomy during a postoperative follow-up period of 1 year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole. RESULTS Rhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18-0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53-0.97), but not in absolute scale (incidence rate difference -0.58, 95% CI -4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups. CONCLUSION Use of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery; Department of Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Sari Sahanne
- Department of Anesthesiology and Intensive Care Medicine; Helsinki University Hospital; Helsinki Finland
| | - Annika Takala
- Department of Anesthesiology and Intensive Care Medicine; Helsinki University Hospital; Helsinki Finland
| | - Jari Haukka
- Department of Public Health; University of Helsinki; Helsinki Finland
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Schaub F, Hoerster R, Schiller P, Felsch M, Kraus D, Zarrouk M, Kirchhof B, Fauser S. Prophylactic intravitreal 5-fluorouracil and heparin to prevent proliferative vitreoretinopathy in high-risk patients with retinal detachment: study protocol for a randomized controlled trial. Trials 2018; 19:384. [PMID: 30012187 PMCID: PMC6048849 DOI: 10.1186/s13063-018-2761-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proliferative vitreoretinopathy (PVR) is the major cause for postoperative failure after vitreo-retinal surgery for primary rhegmatogenous retinal detachment (RRD). Adjunct pharmaceutical therapy was found to be ineffective once PVR is established. Preliminary data suggest that prevention of PVR yields better functional outcome. So far, there is no standard therapy to prevent PVR. METHODS/DESIGN This is a randomized, double-blind, controlled, multicenter, interventional trial with one interim analysis. High-risk patients for PVR with primary RRD will be allocated equally to the following treatment arms: (a) verum: intraoperative adjuvant application of 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) via intraocular infusion during routine pars plana vitrectomy (PPV) and (b) placebo: routinely used intraocular infusion with balanced salt solution during routine PPV. PVR risk is assessed by non-invasive aqueous flare measurement by using laser flare photometry. The primary endpoint of the trial is the occurrence of PVR grade CP (C: full-thickness retinal folds or subretinal strands in clock hours; P: located posterior to equator) 1 or higher within 12 weeks after treatment. Secondary endpoints include PVR grade CA (A: located anterior to equator), best corrected visual acuity, number and extent of surgical procedures to achieve retinal re-attachment, and occurrence of drug-related adverse events within 12 weeks. It is assumed, on the basis of previously published results, that the incidence of PVR grade CP 1 is 35% in the control group and that a reduction by one third would be clinically relevant. Given the sequential design and adjustment for a dropout rate of 5%, a total sample size of 560 patients (280 per group) was calculated to ensure a power of 80% for the confirmatory analysis. DISCUSSION The present trial uses intraoperative intravitreal 5-FU and LMWH as a prophylactic therapy in high-risk patients with primary RRD, aiming to reduce the incidence of PVR in the group that receives the trial drug. Using laser flare photometry to identify high-risk patients for PVR, this trial will test the effectiveness of a simple treatment to prevent PVR. TRIAL REGISTRATION EudraCT no.: 2015-004731-12, registered October 21, 2015; ClinicalTrials.gov Identifier: NCT02834559 , registered July 12, 2016. Protocol version: Version 02. Date: September 18, 2016.
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Affiliation(s)
- Friederike Schaub
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Robert Hoerster
- MVZ Augenärztliches Diagnostik- und Therapiecentrum Mönchengladbach/Erkelenz GmbH, Ostpromenade 41, 41812, Erkelenz, Germany
| | - Petra Schiller
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Bachemer Str. 86, 50931, Cologne, Germany
| | - Moritz Felsch
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Bachemer Str. 86, 50931, Cologne, Germany
| | - Daria Kraus
- Clinical Trials Center Cologne (CTCC), Gleueler Str. 269D, 50935, Cologne, Germany
| | - Marouan Zarrouk
- Clinical Trials Center Cologne (CTCC), Gleueler Str. 269D, 50935, Cologne, Germany
| | - Bernd Kirchhof
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Sascha Fauser
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.,F. Hoffmann-La Roche AG, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Callizo J, Pfeiffer S, Lahme E, van Oterendorp C, Khattab M, Bemme S, Kulanga M, Hoerauf H, Feltgen N. Risk of progression in macula-on rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1559-1564. [PMID: 28551879 DOI: 10.1007/s00417-017-3696-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. METHODS Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. RESULTS A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8 ± 1.4 days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p = 0.0036) and without (p = 0.0014) macular involvement. CONCLUSIONS For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany.
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August University, Goettingen, Germany
| | - Eva Lahme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Christian van Oterendorp
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Mohammed Khattab
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Miroslav Kulanga
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
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Mahmoudi S, Almony A. Macula-Sparing Rhegmatogenous Retinal Detachment: Is Emergent Surgery Necessary? J Ophthalmic Vis Res 2016; 11:100-7. [PMID: 27195093 PMCID: PMC4860974 DOI: 10.4103/2008-322x.180696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD) and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours). In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.
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Hajari JN. Optimizing the treatment of rhegmatogenous retinal detachment. Acta Ophthalmol 2016; 94 Thesis 1:1-12. [PMID: 26848100 DOI: 10.1111/aos.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surgical approaches for rhegmatogenous retinal detachment (RRD) have evolved rapidly in the past century. This has resulted in an increase in the anatomical success rate from zero per cent in the beginning of the 1900s to now almost 100 per cent. Rhegmatogenous retinal detachment is regarded as an acute eye disease that needs immediate treatment. With the increasing number of cataract surgeries and an increased elderly population, the numbers of RRD occurrences are increasing. The aim of this thesis is to create knowledge on how treatment and care of RRD patients can be optimized. In the first paper, data on the incidence of RRD in Denmark are presented based on data from a nation register the National Patient Registry (NPR). It was discovered that the incidence of RRD in Denmark is similar to previous reported numbers and that the incidence has been increasing due to increasing numbers of cataract surgeries and an increased elderly population. Using data from the NPR, we estimated that the risk of a RRD occurring on the fellow eye is 100 times larger than on the first eye and that middle aged men have the highest risk. Having an increase in the incidence of RRD we need to ensure that the patients are also treated in the most optimal way. To ensure this, an indicator is needed to monitor the quality at the different centres. This indicator presented in the second paper is based in the occurrence of redetachment. We define a detachment to be caused by poor surgery if the retina detaches within one year after initial surgery with pneumatic retinopexy, scleral buckling and VTX with gas, and one and a half years after surgery with VTX with oil. Also lack of oil removal within the first year is a failed operation. It is widely accepted that RRD is an acute disease but when should surgery be performed to attain the most optimal result? In the third paper, we evaluated the progression of posterior RRD with an optical coherence tomography to make an objective assessment of the movement. We found that the risk of a macula on RRD progressing to affect the fovea is small if the patient is postured appropriately. We found that the movement of the RRD is dynamic but the detachments will ultimately approach the fovea. Having an opportunity to postpone surgery without risking the outcome for the patient allows a more optimal surgery. The results of this thesis can be used by all health care systems to establish optimal conditions in the treatment of RRD.
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Affiliation(s)
- Javad Nouri Hajari
- Faculty of Health and Medical Sciences; University of Copenhagen; Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Glostrup Denmark
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Frings A, Markau N, Katz T, Stemplewitz B, Skevas C, Druchkiv V, Wagenfeld L. Visual recovery after retinal detachment with macula-off: is surgery within the first 72 h better than after? Br J Ophthalmol 2016; 100:1466-1469. [DOI: 10.1136/bjophthalmol-2015-308153] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 11/03/2022]
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Tolou C, Mahieu-Durringer L, Cassagne M, Hamid S, Billette de Villemeur R, Gualino V, Susini A, Pagot Mathis V, Gallini A, Soler V. [Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. J Fr Ophtalmol 2015; 39:90-7. [PMID: 26707754 DOI: 10.1016/j.jfo.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/29/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.
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Affiliation(s)
- C Tolou
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France.
| | - L Mahieu-Durringer
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - M Cassagne
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - S Hamid
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - R Billette de Villemeur
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Gualino
- Clinique Caves, 82000 Montauban, France
| | - A Susini
- Clinique de l'Union, 31240 Saint-Jean, France
| | - V Pagot Mathis
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - A Gallini
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Soler
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie Toulouse-Purpan, 31000 Toulouse, France
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Hajari JN, Christensen U, Kiilgaard JF, Bek T, la Cour M. Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management: a register study. Acta Ophthalmol 2015; 93:505-11. [PMID: 26031191 DOI: 10.1111/aos.12756] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 04/06/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). METHODS The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. RESULTS A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. CONCLUSIONS The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity.
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Affiliation(s)
- Javad N. Hajari
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Ulrik Christensen
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Jens F. Kiilgaard
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Toke Bek
- Department of Ophthalmology; Aarhus University Hospital; Aarhus Denmark
| | - Morten la Cour
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
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Matlach J, Pflüger B, Hain J, Göbel W. Inner and outer central retinal findings after surgery for rhegmatogenous retinal detachment using different spectral-domain optical coherence tomography devices. Graefes Arch Clin Exp Ophthalmol 2014; 253:369-80. [PMID: 25030236 DOI: 10.1007/s00417-014-2713-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of the study was to analyse macular changes after rhegmatogenous retinal detachment (RRD) repair using spectral-domain optical coherence tomography (SD-OCT). METHODS Forty eyes with macula-on and 27 eyes with macula-off RRD underwent scleral buckling or vitrectomy and were postoperatively imaged using 2 SD-OCT devices (Cirrus® HD-OCT, RTVue-100®). Measurement of total and inner macular thickness consisting of ganglion cell layer + inner plexiform layer (GCL-IPL) using Cirrus or retinal nerve fibre layer + ganglion cell layer + inner plexiform layer (RNFL-GCL-IPL) using RTVue was performed. Results of inner macular thickness were compared with image results of 40 healthy controls. Qualitative analysis of inner and outer retinal layers was additionally assessed. RESULTS Measurement of overall retinal thickness within the 9 ETDRS sectors was highly correlated between both OCTs (Pearson's r, range 0.88-0.99; p < 0.001). Correlation of RNFL-GCL-IPL complex between OCTs was excellent in both surgery groups (Pearson's r, range 0.73-0.88; p < 0.001) and normal controls (Pearson's r, range 0.79-0.90; p < 0.001). The RNFL-GCL-IPL complex was thicker in both surgery groups compared to normal controls using Cirrus. Outer retinal findings of macula-off patients were seen in four eyes (14.8 %). Visual acuity (VA) significantly improved in both groups independent of preoperative VA or duration of symptoms. CONCLUSION Agreement between both OCTs was excellent for overall and inner retinal thickness, although RTVue measured a thicker RNFL-GCL-IPL complex. Thinning of inner retinal layers as a potential cause of poor VA was rarely detected, possibly due to tractional changes at the vitreomacular interface. VA improved even in patients with macula-involving RRD.
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Affiliation(s)
- Juliane Matlach
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany,
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