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Davidović S, Babović S, Miljković A, Pavin S, Bolesnikov-Tošić A, Barišić S. Updates on Treatment Modalities for Primary Rhegmatogenous Retinal Detachment Repair. Diagnostics (Basel) 2024; 14:1493. [PMID: 39061630 DOI: 10.3390/diagnostics14141493] [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: 06/11/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Rhegmatogenous retinal detachment, a severe eye condition, presents anatomic separation of the neurosensory retina from its outermost layer-the retinal pigment epithelium. Early recognition of this relatively common finding and proper referral of patients to the retinal surgery department is essential in order to minimize its consequent possible severe reduction in vision. Several major surgical methods for the repair of primary rhegmatogenous retinal detachment have been in use over the last several decades, and they all aim to find and close the break in the retina that has caused the detachment. Surgery can be performed as pneumatic retinopexy, pars plana vitrectomy, and/or episcleral surgery (buckling). General surgical trends for reattaching the retina include moving from extraocular to intraocular surgery and from bigger gauge to smaller gauge via minimal invasive vitrectomy surgery (MIVS), with implementing shorter-lasting intraocular tamponades. Surgical options for rhegmatogenous retinal detachment treatment nowadays emphasize gaining retinal reattachment, preferably with one surgery and with minimum damage to the eye. The procedure should not bring secondary eye conditions and complications with severe impairment of visual acuity, and it should be performed on as much as a smaller budget, with possibly peribulbar anesthesia, enabling the patient the quickest possible recovery. It should be adjusted to the patient's condition, not to the surgeon's skills or preferences.
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Affiliation(s)
- Sofija Davidović
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Siniša Babović
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Aleksandar Miljković
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Svetlana Pavin
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Ana Bolesnikov-Tošić
- University Clinic for Anesthesiology, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Sava Barišić
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
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Muqit MMK, Macri C, Chan WO, Elnaggar M, Casswell EJ, Ng J, Yang E, Katta M, Anguita R. CLINICAL FEATURES AND SURGICAL OUTCOMES OF SCLERAL BUCKLE SURGERY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: Moorfields Buckle Study. Retina 2024; 44:1134-1141. [PMID: 38437825 DOI: 10.1097/iae.0000000000004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE Long-term study to evaluate the clinical and surgical outcomes of scleral buckle (SB) surgery for primary rhegmatogenous retinal detachment (RRD) at a large tertiary eye center. METHODS Noncomparative, retrospective case series of 589 eyes of 569 patients with primary RRD who underwent SB surgery between 2004 and 2022 with a median follow-up of 6 months. The main outcome measures were best-corrected visual acuity, surgical outcomes, complications, and classification of RRD. RESULTS At baseline, 447/589 (76.1%) round hole RRD, and 133/589 (22.7%) retinal dialysis RRD. Overall primary SB success rate was 83.7% for all retinal detachment subtypes, with round hole retinal detachment 84.8% and dialysis RRD 81.2%. Overall, the baseline best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) and the final best-corrected visual acuity was 0.26 logMAR ( P < 0.0001). In macula-off RRD, the best-corrected visual acuity significantly improved from 0.79 to 0.48 logMAR ( P < 0.0001). In patients with macula-on RRD, it improved from 0.19 to 0.12 logMAR ( P = 0.014). Binary logistic regression showed registrar surgeon grade (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.01-0.55), and partial or complete posterior vitreous detachment (OR 0.21, 95% CI 0.10-0.49) was associated with reduced odds of primary success. Higher surgical failure was associated with low pre-fellowship SB surgeon experience ( P = 0.024). CONCLUSION Favorable visual and functional outcomes have been reported in a large series of SB for primary retinal detachment, mainly for patients with round hole RRD and retinal dialysis RRD.
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Affiliation(s)
- Mahiul M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Carmelo Macri
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Weng Onn Chan
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Mohamed Elnaggar
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Edward J Casswell
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom ; and
| | - James Ng
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Yang
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mohamed Katta
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Rodrigo Anguita
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
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Peter S. Clinical trial to test the safety of the EVA Nexus surgical platform. Int J Retina Vitreous 2024; 10:45. [PMID: 38915097 PMCID: PMC11197291 DOI: 10.1186/s40942-024-00563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety. METHODS In total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system. RESULTS The average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports. CONCLUSIONS The EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery. TRIAL REGISTRATION NUMBER CLINICALTRIALS.GOV: : NCT05229094 Data 22/5/2021.
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Affiliation(s)
- Stalmans Peter
- Department Ophthalmology UZLeuven, Herestraat 49, Leuven, 3000, Belgium.
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Huang RS, Mihalache A, Lau THA, Popovic MM, Kertes PJ, Muni RH. Pars Plana Vitrectomy With Silicone Oil or Gas Tamponade for Uncomplicated Retinal Detachment: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2024; 266:144-155. [PMID: 38815844 DOI: 10.1016/j.ajo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To compare the efficacy and safety of pars plana vitrectomy (PPV) with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to September 2023 for comparative studies evaluating the efficacy and safety of PPV with either silicone oil or gas tamponade in the setting of uncomplicated RRD. Our primary outcome was best-corrected visual acuity at the last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. We performed a meta-analysis using a random-effects model. RESULTS Nine observational studies reporting on 491 RRD eyes were included. The mean best-corrected visual acuity at the last study observation was significantly better in the gas tamponade group than in the silicone oil group (weighted mean difference [WMD] = 0.17 logMAR, 95% confidence interval [CI] = [0.06, 0.27], P = .002). Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups (P = .89). The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD =-3.70 µm, 95% CI = [-5.87, -1.53, P = .0008), as was the inner plexiform layer (WMD = -2.45, 95% CI = [-4.50, -0.40], P = .02) and outer nuclear layer (WMD = -11.74 µm, 95% CI = [-18.39, -5.10], P = .0005). CONCLUSIONS PPV with gas tamponade was associated with better functional outcomes compared to PPV with silicone oil, although both tamponades yielded comparable primary reattachment rates. The absence of randomized trials and the potential for selection bias underscore the importance of further investigation in diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto (RSH, AM), Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto (RSH, AM), Toronto, Ontario, Canada
| | - Tsz Hin Alexander Lau
- Department of Ophthalmology and Visual Sciences, McGill University (THAL), Montreal, Quebec, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre (PJK), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto (MMP, PJK, RHM), Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto (RHM), Toronto, Ontario, Canada.
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Thylefors J, Sheikh R, Jakobsson G. The effect of axial length on pseudophakic retinal detachment. Acta Ophthalmol 2024. [PMID: 38587993 DOI: 10.1111/aos.16691] [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: 12/17/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The purpose of the study was to analyse the surgical management and outcome regarding axial length in the population affected by pseudophakic retinal detachment (PRD) 2015-2020. METHOD The patients included were from an observational cohort study of patients undergoing cataract surgery in the region of Skåne during 2015-2017. Data were retrieved from the Swedish National Cataract Register and cross-referenced with cases of PRD in the same region from 2015 to 2020. The surgical method used and findings at follow-up were recorded. The patients were stratified according to axial length (AL) to <25 mm, 25 ≤ n < 26.5 mm and ≥26.5 mm. The main outcome was primary success with one surgery apart from silicone oil removal. The secondary outcome was postoperative visual acuity. RESULTS In the whole study group of 58 624 cases, complete follow-up data were available for 288 eyes. The median follow-up time was 324 days, and primary operation was successful in 82.9% of these cases. The median visual acuity was 0.31 (LogMAR). In the stratification those with AL < 25 mm had a primary success of 75.8%, AL 25 ≤ n < 26.5 mm of 87.9% and ≥26.5 mm of 95.8%. CONCLUSIONS The primary anatomical success was 82.9% in the whole group of PRD but with stratification they had an increasing number of primary success with longer AL.
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Affiliation(s)
- Joakim Thylefors
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
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Fung TH, Yim TW, Lois N, Wright DM, Liu SH, Williamson T. Face-down positioning or posturing after pars plana vitrectomy for macula-involving rhegmatogenous retinal detachments. Cochrane Database Syst Rev 2024; 3:CD015514. [PMID: 38488250 PMCID: PMC10941635 DOI: 10.1002/14651858.cd015514.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND A macula-involving rhegmatogenous retinal detachment (RRD) is one of the most common ophthalmic surgical emergencies and causes significant visual morbidity. Pars plana vitrectomy (PPV) with gas tamponade is often performed to repair primary macula-involving RRDs with a high rate of anatomical retinal reattachment. It has been advocated by some ophthalmologists that face-down positioning after PPV and gas tamponade helps reduce postoperative retinal displacement. Retinal displacement can cause metamorphopsia and binocular diplopia. OBJECTIVES The primary objective of this review is to determine whether face-down positioning reduces the risk of retinal displacement following PPV and gas tamponade for primary macula-involving RRDs. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 11), MEDLINE (January 1946 to 28 November 2022), Embase.com (January 1947 to 28 November 2022), PubMed (1948 to 28 November 2022), Latin American and Caribbean Health Sciences Literature database (1982 to 28 November 2022), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We did not use any date or language restrictions in the electronic search. We last searched the electronic databases on 28 November 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in which face-down positioning was compared with no positioning or another form of positioning following PPV and gas tamponade for primary macula-involving RRDs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE approach. MAIN RESULTS We identified three RCTs (369 eyes of 368 participants) that met the eligibility criteria. Two RCTs provided data on postoperative retinal displacement, one reported on postoperative distortion and quality of life outcomes, two on postoperative best-corrected visual acuity (BCVA) in logMAR, and two on postoperative ocular adverse events such as outer retinal folds. Study characteristics and risk of bias All the trials involved predominantly male participants (range: 68% to 72%). Only one trial provided race and ethnicity information, was registered on a trial registry, and reported funding sources. Using the RoB 2 tool, we assessed the risk of bias for proportion of eyes with retinal displacement, mean change in visual acuity, objective distortion scores, quality of life assessments, and ocular adverse events, with most domains judged to be at low risk of bias. Findings Immediate face-down positioning may result in a lower proportion of participants with postoperative retinal displacement compared with support-the-break positioning at six months (risk ratio [RR] 0.73, 95% confidence interval [CI] 0.54 to 0.99; 1 RCT; 239 eyes of 239 participants; very low certainty evidence). One study found no evidence of a difference in BCVA at three months when comparing postoperative face-up with face-down positioning with or without perfluorocarbon liquid (mean difference [MD] -0.03, 95% CI -0.09 to 0.02; I2 = 0; 56 eyes of 56 participants; very low certainty evidence). Immediate face-down positioning appears to have little to no effect on postoperative distortion scores at week 26 (MD 1.80, 95% CI -1.92 to 5.52; 1 RCT; 219 eyes of 219 participants; very low certainty evidence) and postoperative quality of life assessment scores at week 26 (MD -1.80, 95% CI -5.52 to 1.92; 1 RCT; 217 eyes of 217 participants; very low certainty evidence). Adverse events One study that enrolled 262 participants with macula-involving RRDs suggested that immediate face-down positioning after PPV and gas tamponade may reduce the ocular adverse event of postoperative outer retinal folds at six months (RR 0.39, 95% CI 0.17 to 0.90; 1 RCT; 262 eyes of 262 participants; very low certainty evidence) and binocular diplopia (RR 0.20, 95% CI 0.04 to 0.90; 1 RCT; 262 eyes of 262 participants; very low certainty evidence) compared with support-the-break positioning. Immediate face-down positioning may increase the ocular adverse event of elevated intraocular pressure compared with support-the-break positioning (RR 1.74, 95% CI 1.11 to 2.73; 1 RCT; 262 eyes of 262 participants; very low certainty evidence). Another study found no evidence of a difference in postoperative outer retinal folds when comparing face-down versus face-up positioning at one and three months (RR 1.00, 95% CI 0.50 to 2.02; RR 1.00, 95% CI 0.28 to 3.61; 1 RCT; 56 eyes of 56 participants; very low certainty evidence). No studies reported non-ocular adverse events. AUTHORS' CONCLUSIONS Very low certainty evidence suggests that immediate face-down positioning after PPV and gas tamponade may result in a reduction in postoperative retinal displacement, outer retinal folds, and binocular diplopia, but may increase the chance of postoperative raised intraocular pressure compared with support-the-break positioning at six months. We identified two ongoing trials that compare face-down positioning with face-up positioning following PPV and gas tamponade in participants with primary macula-involving RRDs, whose results may provide relevant evidence for our stated objectives. Future trials should be rigorously designed, and investigators should analyze outcome data appropriately and report adequate information to provide evidence of high certainty. Quality of life and patient preferences should be examined in addition to clinical and adverse event outcomes.
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Affiliation(s)
| | - Tsz Wing Yim
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - David M Wright
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Su-Hsun Liu
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Bomdica PR, MacCumber MW, Abdel-Hadi S, Parker M, Minaker S. Surgical Outcomes of Rhegmatogenous Retinal Detachment and Fellow Eye Involvement in Adolescent and Young Adult Patients. Ophthalmol Retina 2024; 8:148-154. [PMID: 37716430 DOI: 10.1016/j.oret.2023.09.011] [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: 06/05/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To investigate the associations, fellow eye retinal tear or detachment, and surgical outcomes of rhegmatogenous retinal detachments (RRDs) in young adults. DESIGN Retrospective consecutive case series. SUBJECTS Patients aged ≤ 30 years who underwent surgical repair for RRD between 2014 and 2021 at a single practice. The mean age was 23.85 years (range, 12-30 years). METHODS Data collected included demographics, preoperative clinical features of the RRD, visual acuity (VA), type of surgery performed, anatomic outcomes, OCT findings, fellow eye retinal tear or detachment, and postoperative complications. MAIN OUTCOME MEASURES Postoperative VA and single-surgery anatomic success rate. RESULTS One hundred one patients (109 eyes) were included. Sixty-seven patients (74 eyes) and 17 patients (19 eyes) were followed for ≥ 1 year and 5 years, respectively. The most common associations were myopia (66 eyes, 60.6%), trauma (8 eyes, 7.3%), and prior ocular surgery (7 eyes, 6.4%). Median preoperative Snellen VA was 20/70. The macula was attached in 31 eyes. Scleral buckle (SB) alone was performed in 75 eyes, pars plana vitrectomy (PPV) + SB was performed in 27 eyes, PPV alone was performed in 6 eyes, and cryotherapy with pneumatic retinopexy was performed in 1 patient. Single-surgery anatomical success was 88.7% for SB, 89.7% for PPV + SB, and 75% for PPV. The median final postoperative Snellen VA was 20/50. Twelve patients presented with bilateral RRDs, and sequential surgery was performed in 8 patients, followed by 4 patients who underwent surgery with fellow eye laser barricade. Fourteen patients (13.9%) developed a retinal tear or detachment in the fellow eye, with a mean interval of 8 months from presentation. Of the 17 patients who were followed for ≥ 5 years, 3 patients (17.6%) developed a fellow eye retinal tear or detachment. After initial anatomical success, 6 eyes (5.5%) developed proliferative vitreoretinopathy. CONCLUSIONS The most common association of RRD in this study was myopia. Scleral buckle alone was the most common surgical intervention. However, outcomes were generally favorable with SB-only and PPV + SB. Surgeons and patients should be aware of the risk of bilateral retinal detachment and the risk of fellow eye retinal tear and detachment. These patients require long-term surveillance in both eyes. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Prithvi R Bomdica
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Mathew W MacCumber
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois; Illinois Retina Associates, Chicago, Illinois
| | - Sarah Abdel-Hadi
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Makena Parker
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Samuel Minaker
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois; Illinois Retina Associates, Chicago, Illinois.
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Teh BL, Toh S, Williamson TH, Obara B, Guillemaut JY, Steel DH. Reducing the use of fluorinated gases in vitreoretinal surgery. Eye (Lond) 2024; 38:229-232. [PMID: 37419956 PMCID: PMC10810807 DOI: 10.1038/s41433-023-02639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
| | - Steven Toh
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tom H Williamson
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
- King's College Medical School, London, UK
| | - Boguslaw Obara
- School of Computing and Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jean-Yves Guillemaut
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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9
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Anguita R, Makuloluwa A, Sim SY, Flores-Sanchez B, Roth J, Charteris DG. LATE RECURRENCE OF RETINAL DETACHMENT: Incidence, Clinical Features, and Surgical Outcomes. Retina 2024; 44:83-87. [PMID: 37671784 DOI: 10.1097/iae.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To describe and evaluate demographics, clinical features, prognostic factors, rate of success of surgery, incidence, and visual outcomes in patients with a late recurrence of rhegmatogenous retinal detachment over a 10-year period at a large tertiary referral eye center. METHODS A retrospective, observational case series of patients with late recurrence of retinal detachment, defined as redetachment after at least six months of total reattachment in non-proliferative vitreoretinopathy (PVR) rhegmatogenous retinal detachment, after pars plana vitrectomy (PPV) surgery with gas tamponade. RESULTS Thirty-nine patients had a late recurrence of rhegmatogenous retinal detachment of 16,396 rhegmatogenous retinal detachment operations. The mean of time between the first retinal detachment (RD) surgery and redetachment was 122.7 (SD 115) weeks. On presentation with late recurrence, 72% of eyes were pseudophakic and 64% were macula-off. In 28 eyes, small breaks were found. Thirty-eight percent had established PVR (PVR-C in 80%). Ninety-five percent underwent PPV. Gas was used in 61%. The initial secondary success rate was 64%. Initial best-corrected visual acuity was 1.32 logarithm of the minimum angle of resolution (logMAR) (6/120) and final was 0.8 logMAR (6/38; P value 0.002). CONCLUSION Late recurrence of retinal detachment is rare. It is characterized by small retinal breaks that may be difficult to visualize. Although cases can be treated with favorable anatomical results, visual outcomes are often less good and the success rate is lower.
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Affiliation(s)
- Rodrigo Anguita
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Achini Makuloluwa
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Sing Yue Sim
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Blanca Flores-Sanchez
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Janice Roth
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - David G Charteris
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
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10
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Anguita R, Ferro Desideri L, Zinkernagel M. Altitude and gas expansion in repaired rhegmatogenous retinal detachment. Eye (Lond) 2023; 37:3861-3862. [PMID: 37264119 PMCID: PMC10697935 DOI: 10.1038/s41433-023-02598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Rodrigo Anguita
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland.
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom.
| | - Lorenzo Ferro Desideri
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Martin Zinkernagel
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
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Felfeli T, Teja B, Miranda RN, Simbulan F, Sridhar J, Sander B, Naimark DM. Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model. Am J Ophthalmol 2023; 255:141-154. [PMID: 37327958 DOI: 10.1016/j.ajo.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime. DESIGN Model-based cost-utility analysis. METHODS A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY. RESULTS Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV. CONCLUSIONS This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.
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Affiliation(s)
- Tina Felfeli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F.), Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada.
| | - Bijan Teja
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto (B.T.), Ontario, Canada
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; The Hospital for Sick Children Research Institute, University of Toronto (F.S.), Ontario, Canada
| | - Jayanth Sridhar
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine (J.S.), Florida, USA
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - David M Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre (D.N.), Ontario, Canada
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12
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Mariacher S, Khalil H, Bolz M. Enhancing Scleral Buckling Surgery Using an Illuminated Scleral Depressor. Retina 2023; 43:2027-2029. [PMID: 37870910 DOI: 10.1097/iae.0000000000003274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a technique for scleral buckling surgery under the operating microscope with wide-field viewing. METHODS The identification and reliable marking of retinal breaks is one of the key steps for successful surgery in scleral buckling. For sufficient visualization of retinal breaks, some kind of indentation and illumination is necessary. In this technique, one instrument (Visible Periphery illuminated scleral indentor; Oertli Instrumente AG, Switzerland) combines scleral depression, illumination, and color marking (using a surgical marking pen) of the corresponding sclera above the retinal break. RESULTS The illuminated scleral depressor enables the surgeon to safely and precisely mark the retinal break while stabilizing and rotating the eye with the other hand. This technique simplifies scleral buckling surgery by improving the handling and visualization of marking retinal breaks at the corresponding scleral. Neither intraoperative indirect ophthalmoscopy nor sclerotomies for chandelier light systems or any intraocular instrument are necessary. CONCLUSION The illuminated scleral depressor facilitates scleral buckling surgery in a convenient way for easy and precise scleral marking of the retinal breaks even in challenging situations and positions of retinal breaks under the operating microscope with wide-field viewing. Indirect ophthalmology or other illumination sources are no longer needed.
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Affiliation(s)
- Siegfried Mariacher
- Department for Ophthalmology and Optometry, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
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13
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Fricke TR, Sankaridurg P, Naduvilath T, Resnikoff S, Tahhan N, He M, Frick KD. Establishing a method to estimate the effect of antimyopia management options on lifetime cost of myopia. Br J Ophthalmol 2023; 107:1043-1050. [PMID: 35264328 PMCID: PMC10359589 DOI: 10.1136/bjophthalmol-2021-320318] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using exemplars in Australia and China. METHODS We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% annual discounting, where discounting adjusts future costs to 2020 value. RESULTS Low-dose atropine, antimyopia spectacles, antimyopia multifocal soft contact lenses and orthokeratology met our AMM inclusion criteria. Lifetime cost for TMM with 3% discounting was US$7437 (CI US$4953 to US$10 740) in Australia and US$8006 (CI US$3026 to US$13 707) in China. The lowest lifetime cost options with 3% discounting were antimyopia spectacles (US$7280, CI US$5246 to US$9888) in Australia and low-dose atropine (US$4453, CI US$2136 to US$9115) in China. CONCLUSIONS Financial investment in AMM during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Our methodology can be applied to estimate cost in comparable scenarios.
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Affiliation(s)
- Tim R Fricke
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Nina Tahhan
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Mingguang He
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Kevin D Frick
- Johns Hopkins Carey Business School, Baltimore, Maryland, USA
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14
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Aykut A, Sevik MO, Kubat B, Dericioğlu V, Şahin Ö. A Useful Method for the Practice of Pneumatic Retinopexy: Slit-Lamp Laser Photocoagulation through the Gas Bubble. J Pers Med 2023; 13:jpm13050741. [PMID: 37240912 DOI: 10.3390/jpm13050741] [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: 02/27/2023] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to demonstrate the laser retinopexy method through the gas bubble under a slit-lamp biomicroscope using a wide-field contact lens to treat rhegmatogenous retinal detachment (RRD) with pneumatic retinopexy (PR) and report its anatomical and functional results. This single-center, retrospective case series included RRD patients treated with PR using sulfur hexafluoride (SF6). The demographics, preoperative factors, and anatomical and functional outcomes were collected from the patient files. The single-procedure success rate of PR at postoperative 6th months was 70.8% (17/24 eyes), and the final success rate after secondary surgeries was 100%. The BCVA was better in the successful PR eyes at postoperative 3rd (p = 0.011) and 6th month (p = 0.016) than in failed eyes. No single preoperative factor was associated with PR success. The single-procedure success rate of PR using the laser retinopexy method through the gas bubble with a wide-field contact lens system seems comparable to the PR literature.
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Affiliation(s)
- Aslan Aykut
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Betül Kubat
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Volkan Dericioğlu
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul 34854, Turkey
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15
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Caporossi T, Scampoli A, Tatti F, Mangoni L, Carlà MM, Pintor ES, Frongia F, Iovino C, Bernardinelli P, Peiretti E. Two-Port “Dry Vitrectomy” as a New Surgical Technique for Rhegmatogenous Retinal Detachment: Focus on Macula-on Results. Diagnostics (Basel) 2023; 13:diagnostics13071301. [PMID: 37046519 PMCID: PMC10093090 DOI: 10.3390/diagnostics13071301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
We evaluated a new surgical technique for treating primary rhegmatogenous retinal detachment (RRD), consisting of localized vitrectomy near the retinal break associated with drainage of subretinal fluid without infusion. Twelve eyes of twelve patients with primary RRDs with macula-on superior, temporal, and/or nasal quadrants’ RRD with retinal breaks between 8 and 4 o’clock, pseudophakic or phakic eyes, were enrolled. All eyes underwent a two-port 25-gauge vitrectomy with localized removal of the vitreous surrounding the retinal break(s), followed by a 20% SF6 injection and cryopexy. The difference between pre-operative (T0) and post-operative mean BCVA at 6 months follow-up (T6) was not statistically significant (0.16 logMAR vs. 0.21 logMAR; p = 0.055). Primary anatomic success at 6 months was achieved by 86% of patients. No other complications, except for two retinal re-detachments linked to an incorrect head position of the patients, were recorded. Although further studies are necessary to evaluate the treatment’s efficacy, we believe our technique could be considered a valid alternative for managing primary RRD.
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Affiliation(s)
- Tomaso Caporossi
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alessandra Scampoli
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Filippo Tatti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Lorenzo Mangoni
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Matteo Mario Carlà
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Emanuele Siotto Pintor
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Francesca Frongia
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Claudio Iovino
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Patrizio Bernardinelli
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Peiretti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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16
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Chizzolini M, Martini F, Melis R, Montericcio A, Raimondi R, Allegrini D, Romano MR. Pneumatic retinopexy versus scleral buckling for the management of primary rhegmatogenous retinal detachment. Eur J Ophthalmol 2023; 33:498-505. [PMID: 35469453 DOI: 10.1177/11206721221095041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE To compare pneumatic retinopexy (PnR) and scleral buckling (SB) for repair of primary rhegmatogenous retinal detachment. MATERIALS AND METHODS Single-centre retrospective analysis of patients undergoing PnR and SB. Inclusion criteria comprehend phakic patients with a single retinal break or a group of breaks in detached retina in the same quadrant above the 8- and 4-o'clock meridians. A total of 184 patients were included, respectively 106 underwent PnR and 78 SB. Follow-up time was 6 months. RESULTS Final visual outcome did not differ significantly between the two procedures (P = 0.12). Single-procedure reattachment rate was significantly higher in SB (94%) than in PnR (68%) (P < 0001). Anatomical success rate was not influenced by macular involving. Reattachment rate in repeated PnR was 95% and in these patients visual outcome did not statistically differ compared to those reattached with first attempt (P = 0.196). Total reattachment rate including repeated procedures was 87% in PnR group and 94% in SB group, the difference was not significant (P = 0.06). CONCLUSION SB has a higher single reattachment rate than PnR. However, final visual outcomes of both procedures are comparable. In selected cases, PnR can be repeated with a high successful rate.
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Affiliation(s)
- Marzio Chizzolini
- Department of Ophthalmology, 196013Camposampiero Hospital, Padua, Italy
| | | | - Riccardo Melis
- Department of Ophthalmology, 196013Camposampiero Hospital, Padua, Italy
| | | | - Raffaele Raimondi
- Department of Biomedical Sciences, 437807Humanitas University, Milan, Italy
| | - Davide Allegrini
- Department of Biomedical Sciences, 437807Humanitas University, Milan, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, 437807Humanitas University, Milan, Italy.,Department of Ophthalmology, Humanitas Gavazzeni - Castelli, Bergamo, Italy
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17
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Fung T, Lois N, Wright DM, Liu SH, Williamson T. Face‐down positioning or posturing after vitrectomy for macula‐involving rhegmatogenous retinal detachments. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9713859 DOI: 10.1002/14651858.cd015514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective of this review is to determine whether face‐down positioning reduces the risk of retinal displacement following pars plana vitrectomy (PPV) and gas tamponade for macula‐involving rhegmatogenous retinal detachment (RRD).
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Affiliation(s)
| | | | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental MedicineQueen's UniversityBelfastUK
| | - David M Wright
- Wellcome-Wolfson Institute for Experimental MedicineQueen's UniversityBelfastUK
| | - Su-Hsun Liu
- Department of OphthalmologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA,Department of EpidemiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
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18
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Besozzi G, Montericcio A, Costa MC, Nitti G, Parolini B, Giancipoli E, Greggio A, Tozzi L, Gius I, Frisina R. Microscope-assisted pneumatic retinopexy for the management of primary rhegmatogenous retinal detachment. Eur J Ophthalmol 2022; 33:11206721221142636. [PMID: 36437613 DOI: 10.1177/11206721221142636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Outcomes of pneumatic retinopexy (PnR) using surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted pneumatic retinopexy) for primary rhegmatogenous retinal detachment (RRD). METHODS Retrospective study. 43 consecutive eyes with RRD undergoing microscope-assisted PnR surgery (MAPR) were analysed. Inclusion criteria comprehend phakic eyes with single retinal break or a group of breaks in detached retina in the same quadrant above 8- and 4-o'clock meridians. Follow-up was at least 6 months. RESULTS Of the 43 eyes, a total of 25 (58%) presented preoperatively a single retinal break, 15 (35%) had two retinal breaks in the same quadrant and 3 (7%) presented three or more retinal breaks in the same quadrant. Other retinal breaks not observed preoperatively were discovered intraoperatively in 12 eyes (28%). In 9 (21%) the missed retinal breaks were in the same quadrant as the main diagnosed break(s), while 3 (7%) had missed retinal breaks in a different one. These 3 eyes as no longer adhering to the PnR indication criteria switched intraoperatively to other surgical procedures and were excluded in the reattachment rate results. The total primary reattachment rate with MAPR was achieved in 37 eyes (92.5%). No significant BCVA changes were observed postoperatively. CONCLUSION MAPR is an effective and safe surgical option, it allows to work with both hands free and provides an adequate visualization of the retina during the procedure minimizing the risk of missed retinal breaks potentially leading to surgical failure.
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Affiliation(s)
- Gianluca Besozzi
- Department of Ophthalmology, 34408Vito Fazzi Hospital, Lecce, Italy
| | | | | | - Giuseppe Nitti
- Department of Ophthalmology, 34408Vito Fazzi Hospital, Lecce, Italy
| | | | | | - Angelo Greggio
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Luigi Tozzi
- Department of Ophthalmology, Belluno Hospital, Belluno, Italy
| | - Irene Gius
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Rino Frisina
- Department of Ophthalmology, University of Padova, Padova, Italy
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Cobbs L, Wakabayashi T, Yonekawa Y. Surgical management of recurrent rhegmatogenous retinal detachment. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2152004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lucy Cobbs
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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20
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Muni RH, Lee WW, Bansal A, Ramachandran A, Hillier RJ. A paradigm shift in retinal detachment repair: The concept of integrity. Prog Retin Eye Res 2022; 91:101079. [DOI: 10.1016/j.preteyeres.2022.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
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21
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Hsu CR, Yang CM. Peripheral Circumferential Retinal Detachment after Pars Plana Vitrectomy: Complications and Management. J Clin Med 2022; 11:jcm11164856. [PMID: 36013094 PMCID: PMC9410417 DOI: 10.3390/jcm11164856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to evaluate treatment outcomes and complications of peripheral circumferential retinal detachment (PCD) after successful vitrectomy. Methods: Eyes diagnosed with PCD after pars plana vitrectomy (PPV) were retrospectively reviewed. The patient demographic data, complications, management, and treatment outcomes were collected and analyzed. Results: The mean follow-up duration was 18.0 ± 11.9 months. BCVA ranged from light perception to 0.1 (median: counting fingers at 40 cm). Major complications included rubeosis iridis (seven eyes), vitreous hemorrhage (five eyes), hyphema (five eyes), corneal decompensation (three eyes), hypotony (two eyes), and neovascular glaucoma (two eyes). All eyes underwent peripheral retinectomy to remove the detached retina and release traction. Complete retinal reattachment was achieved in all eyes. The final BCVA ranged from hand motion to 0.1 (median: counting fingers at 30 cm). Conclusion: PCD may be associated with delayed-onset complications, causing severe loss of vision. Proper management, including peripheral retinectomy, may preserve visual function.
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Affiliation(s)
- Cherng-Ru Hsu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 65181); Fax: +886-2-23934420
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22
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Lan C, Chen YH, Chen YJ, Lee JJ, Kuo HK, Wu PC. Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia. Front Public Health 2022; 10:895024. [PMID: 36033821 PMCID: PMC9403186 DOI: 10.3389/fpubh.2022.895024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area. Methods This retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained. Results A total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > -3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was -8.66 ± 0.92 (range: -3.00--12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important. Conclusion In the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.
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Affiliation(s)
- Chieh Lan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Jen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,*Correspondence: Pei-Chang Wu
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Markatia Z, Hudson J, Leung EH, Sajjad A, Gibbons A. The Postvitrectomy Cataract. Int Ophthalmol Clin 2022; 62:79-91. [PMID: 35752887 PMCID: PMC10187786 DOI: 10.1097/iio.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
To review the recent literature regarding risk factors for cataract formation after vitrectomy, the challenges and management strategies for anterior segment surgeons when facing post-vitrectomy cataract surgery, and the visual outcomes of patients undergoing post-vitrectomy cataract surgery. Cataract surgery after vitrectomy can be safely performed to significantly improve the visual outcome in most post-vitrectomy patients, although final visual acuity is primarily limited by the patient’s underlying vitreoretinal pathology.
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Affiliation(s)
- Zahra Markatia
- Bascom Palmer Eye Institute / University of Miami, Miami, FL
| | - Julia Hudson
- Bascom Palmer Eye Institute / University of Miami, Miami, FL
| | - Ella H. Leung
- Baylor College of Medicine, Houston, TX
- Georgia Retina, Atlanta, Georgia
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Alexander P, Snead MP. Prevention of Blindness in Stickler Syndrome. Genes (Basel) 2022; 13:genes13071150. [PMID: 35885933 PMCID: PMC9318672 DOI: 10.3390/genes13071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
Stickler syndromes are inherited conditions caused by abnormalities of structural proteins in the eye, inner ear and cartilage. The risk of retinal detachment, particularly due to the development of giant retinal tears, is high. Stickler syndrome is the most common cause of childhood retinal detachment. Although retinal detachment surgery in the general population has a high success rate, outcomes from surgical repair in Stickler syndrome patients are notoriously poor, providing a strong argument for prophylactic intervention. Variable case selection, absence of molecular genetic sub-typing and inconsistent treatment strategies have all contributed to the historic uncertainty regarding the safety and efficacy of prophylactic treatment. This paper reviews the major published clinical studies that have evaluated different methods and strategies for prophylaxis. Based on the current body of literature, there is extremely strong evidence from cohort comparison studies demonstrating the efficacy and safety of prophylactic retinopexy to reduce, but not eliminate, the risk of retinal detachment in Stickler syndrome patients. It is vital that this body of evidence is provided to Stickler syndrome patients, to enable them to make their own fully informed choice about whether to receive prophylaxis for themselves and particularly on behalf of their affected children, to reduce the risk of retinal detachment.
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Affiliation(s)
- Philip Alexander
- NHS England Stickler Syndrome Highly Specialised Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
- Vitreoretinal Service, Addenbrooke’s Hospital, Hills Road, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-(0)-1223-216106
| | - Martin P. Snead
- NHS England Stickler Syndrome Highly Specialised Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
- Vitreoretinal Service, Addenbrooke’s Hospital, Hills Road, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Cambridge CB2 0PY, UK
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Six-Year Outcomes of 25-Gauge Chandelier Illumination-Assisted Scleral Buckling. BIOMED RESEARCH INTERNATIONAL 2022; 2021:4628160. [PMID: 35402605 PMCID: PMC8986389 DOI: 10.1155/2021/4628160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022]
Abstract
Objectives To report the long-term results of scleral buckling using 25-gauge chandelier illumination. Methods The medical records of all patients presenting to Shanghai Tenth People's Hospital with simple rhegmatogenous retinal detachment (RRD) from June 2013 to Oct 2015 were retrospectively reviewed in this consecutive case series. All patients underwent preoperative and postoperative best corrected visual acuity (BCVA), B-ultrasound, fundus photography, and optical coherence tomography examination. Ultrasound biomicroscopy (UBM) was obtained postoperatively. Results Ten patients (10 eyes) were included in the final analysis. Of 10 patients, the average age was 49.3 ± 18.9 years old, the average duration of RRD was 30.9 ± 53.3 days, and the mean follow-up period was 6.2 ± 0.9 years. There were nine eyes with myopia and four eyes with macular detachment. The primary anatomical success rate was 90%. Five eyes underwent 360-degree band with element surgery, and five eyes underwent element surgery alone. The average length of encircling band and element was 68.2 ± 1.3 mm and 10.5 ± 2.5 mm, respectively. There were no intraoperative or postoperative complications that occurred. The final BCVA was greater than or equal to 20/40 in nine eyes, of which four eyes achieved 20/20. UBM examination of the 25-gauge chandelier insertion site revealed no tissue proliferation. Conclusions For simple rhegmatogenous retinal detachment treatment, 25-gauge chandelier illumination-assisted scleral buckling is a kind of effective and safe method.
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Vitrectomy Combined with Cataract Surgery for Retinal Detachment Using a Three-Dimensional Viewing System. J Clin Med 2022; 11:jcm11071788. [PMID: 35407397 PMCID: PMC8999361 DOI: 10.3390/jcm11071788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). Methods: Medical reports of 82 patients were retrospectively reviewed: 26 patients were operated on with 3D and 56 patients were operated on with CM. The main outcome measures were visual acuity, duration of the surgery, and the rate of postoperative complications. Results: No statistically significant differences in pre- and postoperative visual acuity were found between both groups. There was significant improvement in the visual acuity in both groups. The best postoperative visual acuity was achieved with SF6 gas tamponade, followed by C3F8 gas and silicone oil in both groups. The duration of the surgery (60 min vs. 55 min) and the rate of postoperative complications (15% vs. 14%) were similar in both groups. Conclusions: The similar postoperative visual acuity and rate of complications detected using 3D and CM indicate that the 3D viewing system may be advantageous in the treatment of rhematogenous RD with PPV combined with cataract surgery, i.e., a complex procedure involving both anterior and posterior segment manipulations.
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Air versus sulfur hexafluoride gas tamponade in vitrectomy for uncomplicated retinal detachment with inferior breaks. Retina 2022; 42:1262-1267. [DOI: 10.1097/iae.0000000000003470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seyyar SA, Saygılı O, Tıskaoğlu NS. Intraocular pressure outcomes after 23-G vitreoretinal surgery with two different transconjunctival sutureless sclerotomy techniques: vertical versus tunnel entry. Int Ophthalmol 2022; 42:1763-1769. [DOI: 10.1007/s10792-021-02172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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Visual Outcome after Vitrectomy with Subretinal tPA Injection to Treat Submacular Hemorrhage Secondary to Age-Related Macular Degeneration or Macroaneurysm. J Ophthalmol 2022; 2021:3160963. [PMID: 35003789 PMCID: PMC8736698 DOI: 10.1155/2021/3160963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy, subretinal injection of tissue plasminogen activator using the EVA Surgical System, and pneumatic displacement with air to treat submacular hemorrhages. Methods Retrospective analysis of 93 eyes surgically treated for submacular hemorrhage caused by neovascular AMD or retinal macroaneurysms. Main Outcome Measures. Postoperative visual acuity and surgical complications. Results After surgery, visual acuity improved after 6 weeks but decreased again at the final postoperative visit at 8 months due to progression of the underlying disease. Complications consisted of 2 cases of retinal pigment epithelial tear, 7 vitreous hemorrhages, 4 hyphema, 6 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period. Conclusions This study suggests that a surgical approach with 23G vitrectomy, subretinal tPA injection, and pneumatic displacement using air may be an effective procedure for submacular hemorrhage displacement in patients with AMD and retinal macroaneurysms. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.
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Angermann R, Huber AL, Hofer M, Nowosielski Y, Egger S, Kralinger MT, Zehetner C. Efficiency benchmarks in the surgical management of primary rhegmatogenous retinal detachment: a monocentric register cohort study of operating room time metrics and influential factors. BMJ Open 2021; 11:e052513. [PMID: 34933861 PMCID: PMC8693097 DOI: 10.1136/bmjopen-2021-052513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the effect of clinical, methodological and logistic factors on operating room (OR) efficiency in the surgical management of primary rhegmatogenous retinal detachment (RRD). DESIGN Monocentric retrospective register cohort study. SETTING Single tertiary centre in the western region of Austria. PARTICIPANTS We audited patients diagnosed with primary RRD who were treated between January 2014 and August 2019. In total, 783 eyes of 776 consecutive patients were included in this study. Various risk factors affecting OR time efficiency and anatomical success after pars plana vitrectomy (PPV) procedures and scleral buckle (SB) surgery were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES OR efficiency was the primary outcome measure. Secondary outcome measures were the primary success rate after PPV procedures and SB surgery. RESULTS PPV was performed in 641 (81.9%) eyes and SB surgery in 142 (18.1%) eyes. Mean surgical times in PPV and SB under retrobulbar anaesthesia (RA) were 74.0 (±32.6) min and 62.1 (±24.6) min (p<0.001), respectively, while under general anaesthesia (GA), these values were 112.0 (±52.0) min and 76.0 (±22.5) min (p<0.001), respectively. A regression analysis revealed the following main risk factors for prolonged OR time for the surgical management of RRD with PPV (all p<0.001): presence of a giant tear (β=24.01; 32%), proliferative vitreoretinopathy (PVR)-C (β=16.43; 22%), surgery postponed for 72 hours after diagnosis (β=21.40; 29%), GA (β=23.64; 32%) or surgery performed by a trainee (β=17.35; 23%). PVR (p=0.022) in PPV cases, after-hours settings (p=0.006) and surgeon experience (p=0.030) in SB cases were independent risk factors for reduced success rates. CONCLUSIONS OR coordinators should consider various independent clinical (giant tear, PVR-C, advanced detachment), methodological (PPV vs SB) and logistic (GA vs RA, after-hours setting and surgeon experience) factors to improve the success rate and surgical management planning of RRD accurately while optimising OR resources and staff efficiency.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
- Department of Ophthalmology, Paracelsus Medical Private University, Salzburg, Austria
| | - Anna Lena Huber
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Markus Hofer
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Stefan Egger
- Department of Ophthalmology, Paracelsus Medical Private University, Salzburg, Austria
| | - Martina T Kralinger
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
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Safadi K, Chowers I, Khateb S. Outcomes of primary rhegmatogenous retinal detachment repair among young adult patients. Acta Ophthalmol 2021; 99:892-897. [PMID: 33538410 DOI: 10.1111/aos.14783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults. METHODS A retrospective, comparative case series study. Patients between the ages of 18 and 40 years who underwent surgical repair of primary RRD between the years 2006 and 2013 were included. Patients were divided into three groups according to the surgical technique used: scleral buckle (SB), pars plana vitrectomy (PPV) or combined surgery (SB-PPV). RESULTS Ninety eyes (90 patients) were included. The mean age (SD) was 31.5 ± 5.1 years (range 22-40). Sixty-seven patients underwent SB, 10 had PPV and 13 had SB-PPV. Anatomical success rates were similar between the three groups (87%, 90% and 85% for SB, PPV and SB-PPV groups, respectively; p-value = 0.9). Mean (SD) preoperative LogMAR visual acuity (VA) was 0.46 ± 0.6, 1.73 ± 1.1, 1.1 ± 1.1 for SB, PPV and SB-PPV groups, respectively (p < 0.0001). The VA improved at last follow-up to 0.23 ± 0.4, 0.7 ± 1.5 and 1.09 ± 1.08 in SB, PPV and SB-PPV groups, respectively (p < 0.0001). Macula-off was diagnosed in 19.4% of SB, 80% of PPV and 53.9% of SB-PPV groups (p < 0.0001). In the SB group one phakic patient (1.5%) needed cataract extraction, while following PPV, all phakic eyes (100%) underwent cataract extraction eventually (p-value < 0.0001). CONCLUSIONS The study emphasizes the efficacy of SB as a primary procedure for the repair of retinal detachment in young adults in terms of anatomical and functional success. Furthermore, preservation of the lens as a result of using SB rather than PPV when possible is of great importance in this age group.
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Affiliation(s)
- Khaled Safadi
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Itay Chowers
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Samer Khateb
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
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Huang NT, Kurochkin P, Petrela R, Rosenberg KI, Brown JS, Oellers P. Incidence, Management, and Surgical Outcomes of Macular Splitting Rhegmatogenous Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2021; 52:602-608. [PMID: 34766847 DOI: 10.3928/23258160-20211026-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Limited knowledge exists regarding macular splitting retinal detachment (RD). The purpose of this study is to investigate clinical features and outcomes of macular splitting RD. PATIENTS AND METHODS This was a retrospective case series performed at a single practice. Macular splitting RD was identified clinically and on optical coherence tomography (OCT). Primary outcomes were anatomical and functional success, and secondary outcomes were factors associated with postoperative visual acuity. RESULTS The overall number of patients with OCT-confirmed macular splitting RD was 16 of 664, which is an incidence rate of 2.4%. Preoperative and final logMAR were 0.33 and 0.13, respectively (P = .002). Presenting visual acuity (VA) (P = 0.015) and duration of symptoms (P = .007) were associated with final VA, whereas time to surgery was not significant (P = .581). CONCLUSION The incidence of macular splitting RD is higher than previously reported. Anatomical and functional outcomes were excellent in this study. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:602-608.].
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Huang CY, Mikowski M, Wu L. Pneumatic retinopexy: an update. Graefes Arch Clin Exp Ophthalmol 2021; 260:711-722. [PMID: 34636994 DOI: 10.1007/s00417-021-05448-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] [Received: 06/21/2021] [Revised: 08/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022] Open
Abstract
Pneumatic retinopexy (PR) is a minimally invasive, non-incisional procedure for repairing uncomplicated rhegmatogenous retinal detachment. It consists of an intravitreal gas injection followed by the maintenance of a postoperative head position and the use of laser or cryopexy to seal the retinal breaks. It was initially indicated for a single or a group of retinal breaks no larger than 1 clock hour involving the superior 8 clock hours in phakic eyes with no proliferative vitreoretinopathy. We aim to perform a narrative review on pneumatic retinopexy since the last major review of 2008, based on a Medline search up to June 20 2021 using multiple search words including pneumatic retinopexy, pneumoretinopexy, retinal detachment, and pars plana vitrectomy. Indications for PR have been expanded and include pseudophakic eyes, eyes with mild PVR, and even breaks in the inferior fundus. Depending on the case selection, PR has a single-operation success rate ranging from 45 to 80%. Despite the lower single operation success rate, the functional outcomes of those eyes repaired successfully by primary PR exceed those of scleral buckling (SB) and pars plana vitrectomy (PPV). Best corrected visual acuity, metamorphopsia scores, mental health scores, and vision-related functioning scores were all better in PR-treated eyes compared to PPV-treated eyes. PR should be strongly considered for eligible patients with a primary uncomplicated rhegmatogenous retinal detachments.
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Affiliation(s)
- Chyong-Yng Huang
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica
| | - Mia Mikowski
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica. .,Illinois Eye and Ear Infirmary, Department of Ophthalmology, School of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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Thylefors J, Zetterberg M, Jakobsson G. Anatomical outcome of retinal detachment surgery comparing different surgical approach. Acta Ophthalmol 2021; 99:e908-e913. [PMID: 33258226 DOI: 10.1111/aos.14678] [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: 04/28/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013. METHOD All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal. RESULTS In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re-detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach. CONCLUSIONS There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.
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Affiliation(s)
- Joakim Thylefors
- Department of Ophthalmology Skåne University Hospital Lund Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
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Moussa G, Mohite AA, Sachdev A, Hero M, Ch'ng SW, Andreatta W. Refractive Outcomes of Phacovitrectomy in Retinal Detachment Compared to Phacoemulsification Alone Using Swept-Source OCT Biometry. Ophthalmic Surg Lasers Imaging Retina 2021; 52:432-437. [PMID: 34410194 DOI: 10.3928/23258160-20210727-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the refractive outcomes in patients who underwent combined phacovitrectomy for retinal detachment compared to phacoemulsification and intraocular lens (IOL) implant utilizing newer swept-source optical-coherence-tomography (SS-OCT) biometry and determine the requirement of an adjustment factor for superior predicted refractive outcomes. PATIENTS AND METHODS Retrospective study of 95 eyes: 52 eyes that underwent phacovitrectomy and 43 eyes with phacoemulsification only that served as the control group. Mean refractive error (ME) and mean absolute error (MAE) were used to compare the groups. RESULTS No statistically significant postoperative refractive shift was found between phacoemulsification and phacovitrectomy eyes for (1) ME (0.05 D [± 0.51 diopters (D)] and (0.03 [± 0.73 D], respectively; P = .348), (2) MAE (0.41 D ± 0.29 D and 0.60 ± 0.44 D, respectively), or (3) MAE of the control compared to macula-on/off eyes (P = .160 and P = .078, respectively). CONCLUSION The authors do not recommend an adjustment factor for IOL selection when utilizing SS-OCT biometry, as it provided refractive outcomes superior to those found in previous studies utilizing a partial coherence interferometry system. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:432-437.].
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Rossi T, Querzoli G, Badas MG, Angius F, Telani S, Ripandelli G. Computational Fluid Dynamics of Intraocular Silicone Oil Tamponade. Transl Vis Sci Technol 2021; 10:22. [PMID: 34313726 PMCID: PMC8322710 DOI: 10.1167/tvst.10.8.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the behavior of silicone oil (SiO) at the steady equilibrium and during saccades and calculate SiO-retina contact, shear stress (SS), and shear rate (SR). Methods A 24 mm phakic eye mesh model underwent 50°/0.137s saccade. The vitreous chamber compartment was divided into superior and inferior 180° sectors: lens, pre-equator, postequator, and macula. SiO-retina contact was evaluated as a function of fill percentages between 80% and 90% for a standing patient, 45° upward gaze, and supine. SS and SR for 1000 mPa-s (SiO1000) and 5000 mPa-s (SiO5000) silicon oil were calculated. Results SiO fill between 80% to 90% allowed 55% to 78% retinal contact. The superior retina always kept better contact with SiO, regardless of the fill percentage (P < 0.01). SiO interface thoroughly contacted the macula only in standing position. SS followed a bimodal behavior and was always significantly higher for SiO5000 compared to SiO1000 (P < 0.01) throughout the saccade. The macula suffered the highest mean SS in standing position, while throughout the saccade the average SS was maximum at the SiO-aqueous interface. SR was significantly higher for SiO1000 compared to SiO5000 (P < 0.001). Conclusions SS on the retinal surface may instantaneously exceed reported retinal adhesiveness values especially at the SiO-aqueous interface and possibly favor redetachment. Despite 90% SiO fill the inferior retina remains extremely difficult to tamponade. Translational Relevance Accurate assessment of retina-tamponade interaction may explain recurrent inferior retinal redetachment, silicone oil emulsification, and help to develop better vitreous substitutes.
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Kim MS, Woo SJ, Park KH. PHACOVITRECTOMY VERSUS LENS-SPARING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT REPAIR ACCORDING TO THE SURGICAL EXPERIENCE. Retina 2021; 41:1597-1604. [PMID: 33394996 DOI: 10.1097/iae.0000000000003090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience. METHODS We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared. RESULTS Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively). CONCLUSION Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Moussa G, Sachdev A, Mohite AA, Hero M, Ch'ng SW, Andreatta W. ASSESSING REFRACTIVE OUTCOMES AND ACCURACY OF BIOMETRY IN PHACOVITRECTOMY AND SEQUENTIAL OPERATIONS IN PATIENTS WITH RETINAL DETACHMENT COMPARED WITH ROUTINE CATARACT SURGERY. Retina 2021; 41:1605-1611. [PMID: 33394963 DOI: 10.1097/iae.0000000000003092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare refractive outcomes and accuracy of modern optical biometry, swept-source optical coherence tomography, ultrasound biometry, and effect of the macula status in rhegmatogenous retinal detachment managed with either combined phacovitrectomy or sequential vitrectomy and cataract surgery compared with a control, phacoemulsification alone. METHODS Retrospective, comparative, consecutive study of 154 eyes; Group 1 underwent phacovitrectomy (n: 70), Group 2 underwent vitrectomy with subsequent cataract surgery (n: 41), and Group 3 underwent cataract surgery alone (n: 43). RESULTS No difference in the mean absolute error was found between Group 2 (0.41 ± 0.56) and Group 3 (0.41 ± 0.29); both were superior to Group 1 (0.74 ± 0.57). Between Group 1 and Group 2, no statistically significant difference in the mean absolute error was found between macula-on subgroups (P = 0.057), but this was statistically significant between macula-off subgroups (P = 0.009). Subgroup analysis by biometry showed that the difference in the mean absolute error between macula-off optical biometry Group 1 and Group 2 against our control, Group 3, were not significant (P = 0.078 and P = 0.119, respectively); the mean absolute error was significantly different when considering macula-off ultrasound biometry cases (P < 0.001 and P = 0.038, respectively). CONCLUSION All three groups had comparable refractive outcomes when using optical biometry. However, phacovitrectomy macula-off cases had inferior refractive outcomes when the ultrasound biometry had to be used. In macula-off rhegmatogenous retinal detachment, when optical biometry is not reliable, it is preferable to perform sequential surgery rather than phacovitrectomy.
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Affiliation(s)
- George Moussa
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; and
| | - Amun Sachdev
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- New Cross Hospital, the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Abhijit A Mohite
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- New Cross Hospital, the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Mark Hero
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Soon Wai Ch'ng
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; and
| | - Walter Andreatta
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Ophthalmology Department, Kantonsspital Winterthur, Winterthur, Switzerland
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Xu ZY, Azuara-Blanco A, Kadonosono K, Murray T, Natarajan S, Sii S, Smiddy W, Steel DH, Wolfensberger TJ, Lois N. New Classification for the Reporting of Complications in Retinal Detachment Surgical Trials. JAMA Ophthalmol 2021; 139:857-864. [PMID: 34165493 PMCID: PMC8227451 DOI: 10.1001/jamaophthalmol.2021.1078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/05/2021] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Quantifying severity of complications in rhegmatogenous retinal detachment (RRD) surgical trials is needed. A consensus classification system will help surgeons to more effectively compare harms of different surgical techniques. OBJECTIVE To develop a new consensus-based classification to quantify severity of complications of RRD surgery. DESIGN, SETTING, AND PARTICIPANTS A comprehensive list of complications was developed followed by a Delphi consensus survey of international vitreoretinal surgeons. The survey was conducted in 17 countries in mainland Europe, the United Kingdom, the United States, Asia, South Africa, and Australia. Seventy vitreoretinal surgeons were invited to take part in the Delphi survey; 45 agreed to participate. Participants were selected through boards/members lists of retinal societies. Data were analyzed between April 2019 and August 2019. MAIN OUTCOMES AND MEASURES Consensus-derived classification of complications of RRD surgery, according to their severity. RESULTS Forty-three of 45 vitreoretinal surgeons who agreed to participate in the Delphi survey completed round 1 (96%); all but 1 (98%) completed round 2. Consensus was reached for 96% of the 84 complications assessed. Examples of complications classified as least severe (graded 1) included subconjunctival hemorrhage and chemosis while those classified as most severe included endophthalmitis and sympathetic ophthalmia (graded 9) and phthisis (graded 10). CONCLUSIONS AND RELEVANCE We propose a new classification for quantifying severity of surgical complications based on an international consensus of vitreoretinal surgeons to quantify harm and improve the reporting of complications of RRD surgery.
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Affiliation(s)
- Zheng Yang Xu
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Timothy Murray
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Samantha Sii
- Department of Ophthalmology, Lincoln County Hospital, Lincoln, England
| | | | - David H. Steel
- Sunderland Eye Infirmary, and Institute of Genetic Medicine, University of Newcastle Upon Tyne, Newcastle Upon Tyne, England
| | | | - Noemi Lois
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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Increasing frequency of hospital admissions for retinal detachment and vitreo-retinal surgery in England 2000-2018. Eye (Lond) 2021; 36:1610-1614. [PMID: 34290443 PMCID: PMC8294214 DOI: 10.1038/s41433-021-01647-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To analyse the changes in reported frequency of retinal detachment admissions and vitreo-retinal surgery procedures performed between 2000 and 2018 in England. To obtain information useful to contribute towards the planning of service delivery. Methods Analysis of England’s Hospital Episode Statistics from the Health and Social Care Information Centre and population data from the United Kingdom’s Office for National Statistics. Results Episodes of ‘retinal detachments with breaks’ increased year on year from 3447 (7.0/100 M) in 2000 to 10,971 (19.7/100 M) in 2018 (p < 0.001), whereas records of ‘tractional retinal detachment’ increased from 290 (0.6/100 M) to 910 (1.6/100 M) in the same period (p < 0.0001). The number of reported pars plana vitrectomies irrespective of indication increased over fourfold from 5761 to 26,900 (p < 0.0001), while the number of scleral buckling records decreased by two thirds from 2897 to 780 (p < 0.0001). During the same period, the population of England increased from 49.2 to 55.6 million, proportionally at a slower rate than that for recorded hospital episodes. Conclusions The frequency of admissions to hospital for surgically treated retinal detachment seems to have been increasing significantly since 2000. This effect is more marked in cases of rhegmatogenous retinal detachment. This may be explained by increased incidence of disease (due to increased rates of cataract surgery, increasing longevity and increasing rates of myopia) as well as repeat surgery in cases of recurrent retinal detachment. Other factors which may play a role include improvements in patient access, increased public awareness and improved local coding and reporting practice.
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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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Xu ZY, Azuara-Blanco A, Kadonosono K, Murray T, Natarajan S, Sii S, Smiddy W, Steel DH, Wolfensberger TJ, Lois N. Reporting of Complications in Retinal Detachment Surgical Trials: A Systematic Review Using the CONSORT Extension for Harms. JAMA Ophthalmol 2021; 139:2781201. [PMID: 34137800 DOI: 10.1001/jamaophthalmol.2021.1836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Knowledge on the frequency and severity of complications in surgical trials for rhegmatogenous retinal detachment (RRD) is essential to determine whether surgical procedures are developed and compared adequately, taking into account not only efficacy but also harms. OBJECTIVE To review standards of reporting of complications in recent randomized clinical trials of RRD surgery. EVIDENCE REVIEW This systematic review included randomized clinical trials on RRD surgery published between January 2008 and January 2021 in Embase, MEDLINE, and Web of Science Core Collection databases. Titles, abstracts, and full-text articles retrieved were reviewed for eligibility by 2 independent authors. Eligible studies were evaluated against checklist items from the Consolidated Standards of Reporting Trials Extension for Harms criteria by 2 independent authors, and discrepancies were resolved by discussion with a third author. FINDINGS Fifty studies were included. The median number of checklist items fulfilled was 8 (range, 0-15), of a possible total of 18. Frequently reported items were discussions balanced with regard to efficacy and adverse events (42 studies [84%]) and inclusions of harm-associated timing of data collection (41 studies [82%]). The least frequently reported items were distinctions between expected and unexpected adverse events (1 study [2%]) and mentions of the use of a validated instrument to report adverse event severity (4 studies [8%]). Frequency of complications was commonly reported (29 studies [58%]) in contrast with complication severity (10 studies [20%]). CONCLUSIONS AND RELEVANCE This review suggests that severity of complications of RRD surgery has been infrequently quantified and reported in randomized clinical trials and potentially represents an important area of improvement in future RRD surgical trials.
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Affiliation(s)
- Zheng Yang Xu
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Japan
| | | | | | - Samantha Sii
- Department of Ophthalmology, Lincoln County Hospital, United Kingdom
| | | | - David H Steel
- Sunderland Eye Infirmary, University of Newcastle Upon Tyne, United Kingdom
- Institute of Genetic Medicine, University of Newcastle Upon Tyne, United Kingdom
| | | | - Noemi Lois
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University, Belfast, United Kingdom
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Kantor P, Matonti F, Varenne F, Sentis V, Pagot-Mathis V, Fournié P, Soler V. Use of the heads-up NGENUITY 3D Visualization System for vitreoretinal surgery: a retrospective evaluation of outcomes in a French tertiary center. Sci Rep 2021; 11:10031. [PMID: 33976247 PMCID: PMC8113355 DOI: 10.1038/s41598-021-88993-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
Heads-up three-dimensional (3D) surgical visualization systems allow ophthalmic surgeons to replace surgical microscope eyepieces with high-resolution stereoscopic cameras transmitting an image to a screen. We investigated the effectiveness and safety of the heads-up NGENUITY 3D Visualization System in a retrospective evaluation of 241 consecutive vitreoretinal surgeries performed by the same surgeon using conventional microscopy (CM group) over a 1-year period versus the NGENUITY System (3D group) over a consecutive 1-year period. We included for study vitreoretinal surgeries for treatment of retinal detachment (RD) (98 surgeries), macular hole (MH) (48 surgeries), or epiretinal membrane (ERM) (95 surgeries). A total of 138 and 103 eyes were divided into 3D and CM groups, respectively. We found no differences in 3-month postoperative rates of recurrence of RD (10% versus 18%, p = 0.42), MH closure (82% versus 88%, p = 0.69), or decrease in central macular thickness of ERMs (134 ± 188 µm versus 115 ± 105 µm, p = 0.57) between the 3D and CM groups, respectively. Surgery durations and visual prognosis were also similar between both groups. We consolidate that the NGENUITY System is comparable in terms of visual and anatomical outcomes, giving it perspectives for integration into future robotized intervention.
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Affiliation(s)
- Pierre Kantor
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France
| | - Frédéric Matonti
- Centre Monticelli Paradis, 433 bis rue Paradis, 13008, Marseille, France.,CNRS, Timone Neuroscience Institute, Aix-Marseille University, Marseille, France
| | - Fanny Varenne
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France
| | - Vanessa Sentis
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France
| | - Véronique Pagot-Mathis
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France
| | - Pierre Fournié
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France.,University of Toulouse III, Toulouse, France
| | - Vincent Soler
- Retina Unit, Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital (CHU Toulouse), Place Baylac, 31059, Toulouse Cedex, France. .,University of Toulouse III, Toulouse, France.
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Abstract
PURPOSE To evaluate the visual and anatomical outcomes of reoperations following failure of pneumatic retinopexy (PR) for rhegmatogenous retinal detachment repair and compare the different surgical techniques used in these cases. METHODS The study included 114 eyes of 114 patients who underwent PR for rhegmatogenous retinal detachment and required subsequent surgery for its repair. These included repeated PR, scleral buckling, vitrectomy with gas or silicone oil, and vitrectomy with scleral buckling. The groups were compared for rates of retinal reattachment, visual improvement, and the occurrence of recurrent rhegmatogenous retinal detachment and any other postoperative complications. RESULTS In 91 (79.8%) eyes, the retina was reattached with one additional procedure. The success rate was significantly lower in eyes treated by repeated PR than by other surgical techniques (33 vs. 76-90%; P < 0.001). Visual acuity after PR failure was not significantly different than that at presentation and had improved significantly after surgery for retinal reattachment (P < 0.001). CONCLUSION Pneumatic retinopexy failure was not associated with visual acuity loss, and the outcomes in 79.2% of cases that required only one additional surgery are comparable with those achieved with primary surgery. Poor outcomes were associated with eyes that required more than one additional surgery and that suffered complications.
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CHARACTERISTICS AND SURGICAL OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN OLDER ADULTS: A Multicenter Comparative Cohort Study. Retina 2021; 41:947-956. [PMID: 32858667 DOI: 10.1097/iae.0000000000002969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe characteristics and outcomes of primary rhegmatogenous retinal detachment in older adults (age ≥ 80). METHODS Consecutive patients with rhegmatogenous retinal detachment undergoing pars plana vitrectomy (PPV), scleral buckling (SB), or PPV/SB in the Primary Retinal Detachment Outcomes Study were evaluated. Outcome measures included single surgery anatomic success and visual acuity. RESULTS Of 2,144 patients included, 125 (6%) were 80 years or older. Compared with younger patients (age 40-79), older adults were more likely to be pseudophakic (P < 0.001), have macula-off detachments (P < 0.001), and have preoperative proliferative vitreoretinopathy (P = 0.02). In older adults, initial surgery was PPV in 73%, PPV/SB in 27%, and primary SB in 0%. Single surgery anatomic success was 78% in older adults compared with 84% in younger patients (P = 0.03). In older adults, single surgery anatomic success was 74% for PPV and 91% for PPV/SB (P = 0.03). The final mean logMAR was lower for older adults (0.79 [20/125] vs. 0.40 [20/40], [P < 0.001]). In older adults, the final mean logMAR for eyes that underwent PPV was 0.88 (20/160) compared with 0.50 (20/63) for PPV/SB (P = 0.03). CONCLUSION Octogenarians and nonagenarians presented with relatively complex pseudophakic rhegmatogenous retinal detachments. Single surgery anatomic success and visual outcomes were worse compared with younger patients, and PPV/SB had better outcomes compared with PPV alone.
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Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment. J Ophthalmol 2021; 2021:5588479. [PMID: 33996150 PMCID: PMC8081592 DOI: 10.1155/2021/5588479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022] Open
Abstract
Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.
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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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Bosch-Morell F, García-Gen E, Mérida S, Penadés M, Desco C, Navea A. Lipid Peroxidation in Subretinal Fluid: Some Light on the Prognosis Factors. Biomolecules 2021; 11:biom11040514. [PMID: 33808427 PMCID: PMC8065644 DOI: 10.3390/biom11040514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to identify a relation between the clinical characteristics and differences in lipid peroxidation in the subretinal fluid (SRF) of rhegmatogenous retinal detached patients by malondialdehyde (MDA) quantification. We collected 65 SRF samples from consecutive patients during scleral buckling surgery in rhegmatogenous retinal detachment (RRD) eyes. In addition to a complete ophthalmic evaluation, we studied the refractive status, evolution time, and the number of detached retinal quadrants to establish the extension of RRD. We studied the clinical aspects and oxidative stress and compared the characteristics among groups. We found that neither the evolution time of RRD nor the patients’ age correlated with the MDA concentration in the SRF. The MDA and the protein content of the SRF increased in the patients with high myopia and with more extended RRD. Our results suggest that oxidative imbalance was important in more extended retinal detachment (RD) and in myopic eyes and should be taken into account in the managing of these cases.
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Affiliation(s)
- Francisco Bosch-Morell
- Departamento Ciencias Biomédicas, Biomedical Research Institute, Universidad Cardenal Herrera-CEU, CEU Universities, Av. Seminario s/n, 46113 Valencia, Spain; (F.B.-M.); (E.G.-G.); (S.M.); (M.P.); (C.D.)
- Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, 28220 Madrid, Spain
| | - Enrique García-Gen
- Departamento Ciencias Biomédicas, Biomedical Research Institute, Universidad Cardenal Herrera-CEU, CEU Universities, Av. Seminario s/n, 46113 Valencia, Spain; (F.B.-M.); (E.G.-G.); (S.M.); (M.P.); (C.D.)
| | - Salvador Mérida
- Departamento Ciencias Biomédicas, Biomedical Research Institute, Universidad Cardenal Herrera-CEU, CEU Universities, Av. Seminario s/n, 46113 Valencia, Spain; (F.B.-M.); (E.G.-G.); (S.M.); (M.P.); (C.D.)
- Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, 28220 Madrid, Spain
| | - Mariola Penadés
- Departamento Ciencias Biomédicas, Biomedical Research Institute, Universidad Cardenal Herrera-CEU, CEU Universities, Av. Seminario s/n, 46113 Valencia, Spain; (F.B.-M.); (E.G.-G.); (S.M.); (M.P.); (C.D.)
- Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, 28220 Madrid, Spain
- FISABIO Oftalmología Médica, Retina Unit Pío Baroja 12, 46015 Valencia, Spain
| | - Carmen Desco
- Departamento Ciencias Biomédicas, Biomedical Research Institute, Universidad Cardenal Herrera-CEU, CEU Universities, Av. Seminario s/n, 46113 Valencia, Spain; (F.B.-M.); (E.G.-G.); (S.M.); (M.P.); (C.D.)
- Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, 28220 Madrid, Spain
- FISABIO Oftalmología Médica, Retina Unit Pío Baroja 12, 46015 Valencia, Spain
| | - Amparo Navea
- Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, 28220 Madrid, Spain
- Correspondence:
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Kurochkin P, Huang N, Petrela R, Rosenberg KI, Brown JS, Oellers P. Pars Plana Vitrectomy Outcomes for Rhegmatogenous Retinal Detachment Qualifying for Pneumatic Retinopexy. Clin Ophthalmol 2021; 15:1207-1214. [PMID: 33776417 PMCID: PMC7989046 DOI: 10.2147/opth.s302413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate real-world outcomes of pars plana vitrectomy (PPV) for eyes with primary rhegmatogenous retinal detachments (RRD) eligible for pneumatic retinopexy (PnR). Methods This was a single center retrospective case series looking at consecutive patients with primary RRDs. A database was created on all patients with a primary RRD from 2010 to 2018 based on billing code 67108. Eyes anatomically eligible for PnR were reviewed for preoperative, intraoperative and postoperative characteristics. The main outcome assessed was single surgery anatomical success (SSAS), final anatomical success (FAS), and postoperative LogMAR vision. Results A total of 720 eyes (age, 62.9 ± 9.1 years; 61.7% were male) met inclusion criteria for PnR and underwent PPV. SSAS was 94.0% and FAS was 99.9%. Preoperative and final LogMAR vision was 0.853 and 0.293 (P<0.001) in eyes with SSAS vs 0.714 and 0.648 (P=0.686) in eyes with primary failure. PVR was the most common etiology of primary surgical failure (n=21, 49%). Patients who failed primary repair had a mean of 1.12 additional surgeries with a median time of 45 days between surgeries. Conclusion A robust single surgery success rate with good visual outcomes was achieved across 8 years and multiple surgeons utilizing PPV to treat primary RRDs in eyes which anatomically qualified for pneumatic retinopexy in a real-world setting.
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