1
|
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 PMCID: PMC11276041 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.
Collapse
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; (S.B.); (S.P.); (S.B.)
| | - Siniša Babović
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - 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; (S.B.); (S.P.); (S.B.)
| | - Svetlana Pavin
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - 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; (S.B.); (S.P.); (S.B.)
| |
Collapse
|
2
|
Yang BCL, Tsui MC, Yang CM, Fu YT, Hwang JF, Lai TT, Ho TC, Yang CH, Hsieh YT, Chen SN. Clinical characteristics and optical coherence tomography of concomitant macular hole and rhgematogenous retinal detachment. Sci Rep 2024; 14:12023. [PMID: 38797771 PMCID: PMC11128434 DOI: 10.1038/s41598-024-61899-2] [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: 06/21/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI - 0.661 to - 0.126), duration of RRD (p = 0.021, CI - 0.576 to - 0.048) and presence of PVR (p = 0.001, CI - 0.131 to - 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.
Collapse
Affiliation(s)
- Benjamin Chi-Lan Yang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 91, Hsueh Shih Road, Taichung, 404, Taiwan
| | - Mei-Chi Tsui
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Teng Fu
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
| | - Jiunn-Feng Hwang
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Ho Yang
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, 7, Chung Shan South Road, Taipei, Taiwan.
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 91, Hsueh Shih Road, Taichung, 404, Taiwan.
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan.
- Department of Ophthalmology, China Medical University, Taichung, Taiwan.
| |
Collapse
|
3
|
Chahar A, Sen A, Shukla D, Talwar D. THE ROLE OF INTRAVITREAL METHOTREXATE AS AN ADJUNCT TO LOCAL OR SYSTEMIC CORTICOSTEROIDS IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT AND CHOROIDAL DETACHMENT: A Pilot Study. Retina 2024; 44:774-781. [PMID: 38194672 DOI: 10.1097/iae.0000000000004046] [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: 01/11/2024]
Abstract
PURPOSE To evaluate the role of repeated intravitreal methotrexate as an adjunct to pars plana vitrectomy in the management of rhegmatogenous retinal detachment with choroidal detachment. METHOD The authors compared anatomical and visual outcomes of rhegmatogenous retinal detachment with choroidal detachment eyes that underwent pars plana vitrectomy with (Group B) or without repeated intravitreal methotrexate (Group A). RESULTS The study included 25 eyes of 25 patients, 16 eyes in Group A and nine in Group B. Both groups had similar baseline characteristics. In Group A, successful retinal attachment was achieved in 50% as compared with 89% in Group B; however, the difference was not statistically significant ( P = 0.08). Also, Group B had a significantly greater change in visual acuity from baseline to the last follow-up visit (1.6 + 1.5 logMAR units) compared with Group A (1.18 + 1 logMAR units) ( P = 0.05). There were no significant safety concerns with the use of intravitreal methotrexate. CONCLUSION Repeated intravitreal methotrexate after vitrectomy for rhegmatogenous retinal detachment with choroidal detachment improves outcomes without posing major safety concerns. Nonetheless, further investigation is necessary to establish the optimal intravitreal methotrexate dosage and duration to prevent recurrence effectively.
Collapse
Affiliation(s)
- Annu Chahar
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Alok Sen
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Dhananjay Shukla
- Department of Retinal and Vitreous, Ratan Jyoti Eye Hospital, Gwalior, India ; and
| | - Dinesh Talwar
- Department of Retina and Vitreous, Indraprastha Apollo Hospital, New Delhi, India
| |
Collapse
|
4
|
Catania F, Chapron T, Crincoli E, Miere A, Abdelmassih Y, Beaumont W, Chehaibou I, Metge F, Bruneau S, Bonnin S, Souied EH, Caputo G. Deep Learning for prediction of late recurrence of retinal detachment using preoperative and postoperative ultra-wide field imaging. Acta Ophthalmol 2024. [PMID: 38682863 DOI: 10.1111/aos.16693] [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: 01/20/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To elaborate a deep learning (DL) model for automatic prediction of late recurrence (LR) of rhegmatogenous retinal detachment (RRD) using pseudocolor and fundus autofluorescence (AF) ultra-wide field (UWF) images obtained preoperatively and postoperatively. MATERIALS AND METHODS We retrospectively included patients >18 years who underwent either scleral buckling (SB) or pars plana vitrectomy (PPV) for primary or recurrent RRD with a post-operative follow-up >2 years. Records of RRD recurrence between 6 weeks and 2 years after surgery served as a ground truth for the training of the deep learning (DL) models. Four separate DL models were trained to predict LR within the 2 postoperative years (binary outputs) using, respectively, UWF preoperative and postoperative pseudocolor images and UWF preoperative and postoperative AF images. RESULTS A total of 412 eyes were included in the study (332 eyes treated with PPV and 80 eyes with SB). The mean follow-up was 4.0 ± 2.1 years. The DL models based on preoperative and postoperative pseudocolor UWF imaging predicted recurrence with 85.6% (sensitivity 86.7%, specificity 85.4%) and 90.2% accuracy (sensitivity 87.0%, specificity 90.8%) in PPV-treated eyes, and 87.0% (sensitivity 86.7%, specificity 87.0%) and 91.1% (sensitivity 88.2%, specificity 91.9%) in SB-treated eyes, respectively. The DL models using preoperative and postoperative AF-UWF imaging predicted recurrence with 87.6% (sensitivity 84.0% and specificity 88.3%) and 91.0% (sensitivity 88.9%, specificity 91.5%) accuracy in PPV eyes, and 86.5% (sensitivity 87.5%; specificity 86.2%) and 90.6% (sensitivity 90.0%, specificity 90.7%) in SB eyes, respectively. Among the risk factors detected with visualisation methods, potential novel ones were extensive laser retinopexy and asymmetric staphyloma. CONCLUSIONS DL can accurately predict the LR of RRD based on UWF images (especially postoperative ones), which can help refine follow-up strategies. Saliency maps might provide further insight into the dynamics of RRD recurrence.
Collapse
Affiliation(s)
- Fiammetta Catania
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Thibaut Chapron
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
- Université Paris Cité, CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, Paris, France
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Catholic University "Sacro Cuore", Rome, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - William Beaumont
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Ismael Chehaibou
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Florence Metge
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Sebastien Bruneau
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Sophie Bonnin
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Georges Caputo
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| |
Collapse
|
5
|
Tan S, Wu S, Miao J, Han J, Jin W, Li D, Cui S, Wan X, Zhang L, Yao T, Zhang C, Wang C, Hu J. A Short-Time Real-World Study of Two Perfluoropropane Tamponade Methods in Pars Plana Vitrectomy for Retinal Detachment. Ophthalmic Res 2023; 66:1300-1307. [PMID: 37812921 PMCID: PMC10627491 DOI: 10.1159/000534208] [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: 03/25/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This real-world study evaluated the efficacy, safety, and operative parameters of two perfluoropropane (C3F8) tamponade methods combined with pars plana vitrectomy (PPV) for retinal detachment (RD). METHODS A retrospective study of 132 patients (132 eyes) with RD (pure C3F8 in 38 eyes, mixed C3F8 in 94 eyes). All eyes underwent PPV with C3F8 tamponade and were followed up for at least 3 months. Retinal reattachment rate, time of gas configuration and injection, C3F8 dosage, intraocular pressure (IOP), best corrected visual acuity, postoperative ocular inflammation, and patients' complaints were evaluated. RESULTS The single-surgery retinal reattachment rates of the pure C3F8 group and mixed C3F8 group were 97.4% and 96.8%, respectively, with no significant difference (p = 1.00). The final retinal reattachment rates of the two groups were 100% and 97.2%, respectively, with no significant difference (p = 1.00). The gas configuration time, gas injection time, and C3F8 dosage were significantly less in the pure C3F8 group (all p < 0.001). Time, but not group, was the influencing factor of postoperative IOP changes in the two groups (p < 0.001, p = 0.547, respectively). Compared with the baseline, the IOP estimates of the pure C3F8 group showed a significant increase immediately after surgery (p < 0.001), and the mixed C3F8 group showed a significant increase immediately and 1-2 days after surgery (all p < 0.05). There was no statistical difference in ocular inflammation (p = 0.339) and patients' complaints of discomfort (p = 0.175) between the two groups. CONCLUSION Both the two methods of C3F8 tamponade combined with PPV in RD patients showed good efficacy and safety, but the clinical operation of pure C3F8 tamponade was more convenient and eco-friendly.
Collapse
Affiliation(s)
- Shumei Tan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China,
| | - Sefei Wu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jinhong Miao
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Han
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Wei Jin
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Dan Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Shuang Cui
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xiaohui Wan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Li Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Ting Yao
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chun Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jinping Hu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| |
Collapse
|
6
|
Tsui JC, Brucker AJ, Kim BJ, Kolomeyer AM. COMBINED RHEGMATOGENOUS RETINAL AND CHOROIDAL DETACHMENT: A Systematic Review. Retina 2023; 43:1226-1239. [PMID: 36893435 DOI: 10.1097/iae.0000000000003770] [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: 03/11/2023]
Abstract
PURPOSE To review the literature on eyes with concurrent rhegmatogenous retinal and choroidal detachment (RRD-CD). METHODS Several databases were searched for "rhegmatogenous retinal detachment" and "choroidal detachment" through October 2022. All English language primary literature was reviewed. RESULTS Studies demonstrated that eyes with RRD-CD were very uncommon and had diminished baseline visual acuity (VA) and intraocular pressure (IOP) compared with eyes with RRD only. Although no randomized trials have been performed, pars plana vitrectomy with or without scleral buckle (SB) have reported higher surgical success rates than SB alone. Reattachment rates were affected by age, IOP, adjuvant steroids, and grade of proliferative vitreoretinopathy. CONCLUSION Low IOP and poor initial VA are salient features of eyes with RRD-CD. Steroids can be useful adjuvants administered safely using several routes including periocular and intravitreal injection. PPV ± SB may result in best surgical outcomes.
Collapse
Affiliation(s)
- Jonathan C Tsui
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | |
Collapse
|
7
|
Obata S, Sawada O, Kakinoki M, Matsumoto R, Saishin Y, Ohji M. Effects of internal limiting membrane peeling on anatomical and functional outcomes in macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy: Japan-Retinal Detachment Registry. Jpn J Ophthalmol 2023:10.1007/s10384-023-01000-y. [PMID: 37289298 DOI: 10.1007/s10384-023-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the effects of internal limiting membrane (ILM) peeling on retinal attachment after a single surgery, and on postoperative visual acuity (VA) at 6 months, in eyes with macula-off rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR). STUDY DESIGN Nationwide, multicenter retrospective cohort study. METHODS The Japan-RD Registry database was used for analysis of patients who had undergone vitrectomy for macula-off RRD complicated by PVR. Multivariate analysis was performed to detect prognostic factors for retinal attachment after a single surgery and for VA at 6 months postoperatively. Retinal attachment after a single surgery or VA at 6 months postoperatively was the objective variable; ILM peeling, preoperative VA, PVR grade, age, and intraocular pressure were explanatory variables. RESULTS Eighty-nine eyes met the inclusion criteria; ILM peeling was performed in 25 eyes (28%). Preoperative VA was significantly associated with retinal attachment, but ILM peeling did not (odds ratios = 2.1 and 1.3, respectively; p = 0.009 and 0.67, respectively). Poor preoperative VA and younger patient age were significantly associated with poor postoperative VA, but ILM peeling was not (β-values = 0.37, -0.008, and 0.15, respectively; p < 0.001, p = 0.02, and p = 0.15, respectively. CONCLUSIONS Preoperative VA was a risk factor associated with retinal attachment. Preoperative VA and patient age were risk factors associated with postoperative poor VA. In eyes with macula-off RRD complicated by PVR, ILM peeling did not have a clear beneficial effect on anatomical and functional outcomes, suggesting that it may be unnecessary for eyes with this condition.
Collapse
Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
| | - Riko Matsumoto
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
| |
Collapse
|
8
|
Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Aylward GW, Williamson TH. Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study. Eye (Lond) 2023; 37:1527-1537. [PMID: 37100934 PMCID: PMC10219959 DOI: 10.1038/s41433-023-02388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD). METHODS A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery. RESULTS There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C2F6 tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10-25%), and 10.1% are at high risk (>25%) of failure. CONCLUSIONS Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.
Collapse
Affiliation(s)
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - D A Laidlaw
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G W Aylward
- Moorfields Eye Hospital City Road, EC1V 2PD, London, UK
| | | |
Collapse
|
9
|
Cai LZ, Lin J, Starr MR, Obeid A, Ryan EH, Ryan C, Forbes NJ, Arias D, Ammar MJ, Patel LG, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair. Br J Ophthalmol 2023; 107:555-559. [PMID: 34815237 DOI: 10.1136/bjophthalmol-2021-320440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system. METHODS Analysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200). RESULTS A total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher. CONCLUSIONS Independent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.
Collapse
Affiliation(s)
- Louis Z Cai
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey Lin
- Biostatistics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Matthew R Starr
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony Obeid
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Claire Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Nora J Forbes
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diego Arias
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Ammar
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Dean Eliott
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Omesh P Gupta
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
10
|
Artificial intelligence using deep learning to predict the anatomical outcome of rhegmatogenous retinal detachment surgery: a pilot study. Graefes Arch Clin Exp Ophthalmol 2023; 261:715-721. [PMID: 36303063 DOI: 10.1007/s00417-022-05884-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To develop and evaluate an automated deep learning model to predict the anatomical outcome of rhegmatogenous retinal detachment (RRD) surgery. METHODS Six thousand six hundred and sixty-one digital images of RRD treated by vitrectomy and internal tamponade were collected from the British and Eire Association of Vitreoretinal Surgeons database. Each image was classified as a primary surgical success or a primary surgical failure. The synthetic minority over-sampling technique was used to address class imbalance. We adopted the state-of-the-art deep convolutional neural network architecture Inception v3 to train, validate, and test deep learning models to predict the anatomical outcome of RRD surgery. The area under the curve (AUC), sensitivity, and specificity for predicting the outcome of RRD surgery was calculated for the best predictive deep learning model. RESULTS The deep learning model was able to predict the anatomical outcome of RRD surgery with an AUC of 0.94, with a corresponding sensitivity of 73.3% and a specificity of 96%. CONCLUSION A deep learning model is capable of accurately predicting the anatomical outcome of RRD surgery. This fully automated model has potential application in surgical care of patients with RRD.
Collapse
|
11
|
Davidson M, Dowlut S, Zhang J, Naderi K, Sandinha T, Wood MK, Schneiders M, Saidkasimova S, Peart S, Chaudhuri R, Gunda M, Saeed M, Heussen F, Keller J, Tarafdar S, Chandra A. Heavy silicone oil tamponade: a multicentre experience. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001018. [PMID: 36710637 PMCID: PMC9743375 DOI: 10.1136/bmjophth-2022-001018] [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: 03/18/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications. METHODS AND ANALYSIS Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil. RESULTS 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0-2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes). CONCLUSION This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies.
Collapse
Affiliation(s)
- Max Davidson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | | | - Megan Kay Wood
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Schneiders
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | | | | | | | | | | | - Florian Heussen
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Johannes Keller
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | |
Collapse
|
12
|
Balas M, Abdelaal A, Popovic MM, Kertes PJ, Muni RH. Intravitreal Methotrexate for the Prevention and Treatment of Proliferative Vitreoretinopathy in Rhegmatogenous Retinal Detachment: A Systematic Review. Ophthalmic Surg Lasers Imaging Retina 2022; 53:561-568. [DOI: 10.3928/23258160-20220920-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Recurrent retinal detachment after pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. Int Ophthalmol 2022; 42:3813-3820. [PMID: 35802298 DOI: 10.1007/s10792-022-02401-7] [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: 10/11/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The recurrence of retinal detachment following rhegmatogenous retinal detachment (RRD) is a relatively common complication that can lead to reduced visual acuity and requires further surgery. The purpose of this study was to investigate the risk factors and visual outcomes of recurrent RRD following pars plana vitrectomy (PPV) with silicone oil tamponade for primary RRD. METHODS This was a retrospective follow-up study of 343 eyes that underwent initial PPV surgery with silicone oil tamponade for primary RRD. Patients were divided into a recurrence group and a reattachment group. The main outcome measures included causative factors, visual outcomes related to the recurrence of RRD, and the perioperative factors most affecting the recurrence of RRD. RESULTS After retinal reattachment, we observed RRD recurrence after PPV for primary RRD in 42 out of 343 eyes (12.2%) during the follow-up period. Most causes of recurrence (69%) occurred within 6 months of surgery. Multivariate logistic regression analysis showed that a PVR ≥ Grade C (odds ratio [OR]: 4.015; 95% confidence interval [CI] 1.721-9.367; P = 0.001) was a significant predictor for the development of recurrent RRD. Compared with the reattachment group, the recurrence group exhibited a significant decline in best-corrected visual acuity (BCVA) at the last follow-up visit (P = 0.000). Eyes with PVR prior to primary surgery, or at the diagnosis of re-detachment, showed a worse final BCVA. CONCLUSIONS Our analysis shows that the predominant risk factor for the recurrence of RRD is a PVR ≥ Grade C. PVR prior to primary surgery, or at the diagnosis of re-detachment, was also shown to limit the recovery of final visual acuity.
Collapse
|
15
|
Mundae R, Wagley S, Ryan EH, Parke DW, Mittra RA, Tang PH. COVID-19 vaccination hesitancy and its association with altered presentation of primary rhegmatogenous retinal detachment. Am J Ophthalmol 2022; 242:7-17. [PMID: 35609676 PMCID: PMC9122843 DOI: 10.1016/j.ajo.2022.05.013] [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] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Evaluate factors associated with coronavirus 2019 (COVID-19) vaccine hesitancy and clinical trends in primary rhegmatogenous retinal detachments (RRDs) during the first year of vaccine availability. DESIGN Single-center, clinical cohort study. METHODS Consecutive patients from December 14, 2020, to December 12, 2021, presenting vaccinated (Prior-), subsequently vaccinated (Later-), or remaining unvaccinated (Never-Vax). Primary outcome was proportion with macula-off (mac-off) RRD. Secondary outcomes included logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), primary proliferative vitreoretinopathy (PVR), proportion lost to follow-up, and distance traveled. RESULTS 1047 patients were divided into 391 Prior-, 252 Later-, and 404 Never-Vax cohorts. Significantly greater proportions of Later- and Never-Vax cohorts presented with mac-off RRDs (Prior-Vax = 44.5%; Later-Vax = 54%, P < .0001; Never-Vax = 57.9%, P < .0001) and primary PVR (Prior-Vax = 4.3%; Later-Vax = 13.6%, P < .0001; Never-Vax = 17.1%, P < .0001) compared to Prior-Vax cohort. Significantly greater proportion of Never-Vax cohort (7.7%, P < .0001) were lost to follow-up compared to Prior- (2.3%) and Later-Vax (2.2%) cohorts. Never-Vax cohort (median = 35 miles) traveled farther compared to Prior- (median = 22.3 miles; P < .0001) and Later-Vax cohorts (25.45 miles; P = .0038). Prior-Vax cohort had significantly better (P < .05) initial (median = 0.30 logMAR) and final (0.18 logMAR) BCVA compared to Later- (Initial: 0.54 logMAR; Final: 0.30 logMAR) and Never-Vax (Initial: 0.70 logMAR; Final: 0.40 logMAR) cohorts. CONCLUSIONS COVID-19 vaccine hesitancy is associated with worse clinical presentation and outcomes for primary RRD.
Collapse
Affiliation(s)
- Rusdeep Mundae
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Sushant Wagley
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Edwin H Ryan
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - D Wilkin Parke
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Robert A Mittra
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Peter H Tang
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA..
| |
Collapse
|
16
|
Peck TJ, Starr MR, Yonekawa Y, Khan MA, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Outcomes of Primary Rhegmatogenous Retinal Detachment Repair in Eyes With Preoperative Grade B or C Proliferative Vitreoretinopathy. JOURNAL OF VITREORETINAL DISEASES 2022; 6:194-200. [PMID: 37008548 PMCID: PMC9976120 DOI: 10.1177/24741264211046770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: This work evaluates the anatomic and functional outcomes of primary rhegmatogenous retinal detachments (RRDs) with preoperative grade B and C proliferative vitreoretinopathy (PVR) vs eyes without PVR. Methods: As a multi-institutional, interventional, retrospective study of all patients undergoing primary RRD surgical procedures from January 1, 2015, through December 31, 2015, this study evaluated the visual acuity (VA) outcomes and single-surgery anatomic success rates (SSAS) of patients with primary grade B and C PVR at the time of RRD repair. Results: A total of 2486 eyes underwent primary RD surgery during the study period, of which 153 eyes (6.2%) had documented preoperative PVR grade B or C. Eyes without PVR had better SSAS compared with eyes with grade B or C PVR (87% vs 83% vs 75%, respectively, P < .0001). Eyes without PVR also had better final mean (SD) logMAR VA (0.35 [0.47]; 20/45 Snellen equivalent) than eyes with PVR of grade B (0.50 [0.56]; 20/63 Snellen equivalent) or grade C ( P < .0001). In only eyes with preoperative PVR, there were no significant differences in final VA or SSAS on multivariate analysis based on surgical approach or use of retinectomy or membrane peeling alone in the intraoperative management of PVR. Conclusions: Eyes with primary preoperative grade B and C PVR appear to have significantly worse VA outcomes and lower surgical success rates. Surgical approach and management of PVR membranes did not appear to affect VA or success rates, indicating that preoperative PVR severity may dictate these outcomes.
Collapse
Affiliation(s)
- Travis J. Peck
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Matthew R. Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - M. Ali Khan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luv G. Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carl D. Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omesh P. Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
17
|
Mundae R, Velez A, Sodhi GS, Belin PJ, Kohler JM, Ryan EH, Tang PH. Trends in the Clinical Presentation of Primary Rhegmatogenous Retinal Detachments During the First Year of the COVID-19 Pandemic. Am J Ophthalmol 2022; 237:49-57. [PMID: 34801509 PMCID: PMC8603252 DOI: 10.1016/j.ajo.2021.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the effect of 1 full year of the coronavirus disease 2019 (COVID-19) pandemic on clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, retrospective observational cohort study. Methods Patients were divided into 2 cohorts: consecutive patients treated for primary RRD during the COVID-19 pandemic (March 9, 2020, to March 7, 2021; pandemic cohort) and patients treated during the corresponding time in previous year (March 11, 2019, to March 8, 2020; control cohort). Main outcome measures: Proportion of patients presenting with macula-involving (mac-off) or macula-sparring (mac-on) RRD. Results A total of 952 patients in the pandemic cohort and 872 patients in the control cohort were included. Demographic factors were similar. Compared with the control cohort, a significantly greater number of pandemic cohort patients presented with mac-off RRDs ([60.92%] pandemic, [48.17%] control, P = .0001) and primary proliferative vitreoretinopathy ([15.53%] pandemic, [6.9%] control, P = .0001). Pandemic cohort patients (10.81%) had significantly higher rates of lost to follow-up compared with the control cohort (4.43%; P = .0001). Patients new to our clinic demonstrated a significant increase in mac-off RRDs in the pandemic cohort (65.35%) compared with the control cohort (50.40%; P = .0001). Pandemic cohort patients showed worse median final best-corrected visual acuity (0.30 logarithm of the minimum angle of resolution) compared with the control cohort (0.18 logarithm of the minimum angle of resolution; P = .0001). Conclusions Patients with primary RRD during the first year of the COVID-19 pandemic were more likely to have mac-off disease, present with primary proliferative vitreoretinopathy, be lost to follow-up, and have worse final best-corrected visual acuity outcomes.
Collapse
|
18
|
Nakamura M, Nishi K, Nishitsuka K. Selection Criteria for Air Tamponade During Vitrectomy for Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2022; 16:981-986. [PMID: 35386614 PMCID: PMC8977474 DOI: 10.2147/opth.s359936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare air tamponade and sulfur hexafluoride (SF6) gas tamponade during vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). Methods We reviewed 294 eyes with RRD treated with 25-gauge vitrectomy by a single surgeon between June 2011 and April 2018 retrospectively. The exclusion criteria for the proposed air tamponade selection were more than 2 weeks since onset, giant retinal tears, history of complications following cataract surgery, high myopia, and proliferative vitreoretinopathy classified as grade C or higher. We examined the differences in the therapeutic effect between the air group and SF6 group at 6-month follow-up. Results A total of 294 eyes were included in the study, 156 eyes in the air group and 138 eyes in the SF6 group. No difference was observed in the primary anatomical success rates between the air group (99.4%; 155/156 eyes) and the SF6 group (96.5%; 135/138 eyes; P = 0.102). Postoperative intraocular gas half-life was shorter in the air group (3.97 ± 0.87 days) compared with the that in the SF6 group (8.67 ± 1.47 days; P = 0.0001). The incidence of postoperative ocular hypertension was lower in the air group (19.9%; 31/156 eyes) than in the SF6 group (62.3% 86 /138 eyes; P = 0.0001). Conclusion We compared the criteria for proper selection between air and SF6 gas tamponade during vitrectomy for the treatment of RRD. Air tamponade was able to reduce the period of prone position and the risk of ocular hypertension without reducing the therapeutic effect.
Collapse
Affiliation(s)
- Madoka Nakamura
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
- Correspondence: Koichi Nishitsuka, Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan, Tel +81 23-628-5374, Fax + 81 23-528-5377, Email
| |
Collapse
|
19
|
Vitrectomy for Complicated Retinal Detachment Without the Use of Perfluorocarbon Liquid: A Real-World Data and Retrospective Study. Ophthalmol Ther 2022; 11:857-868. [PMID: 35195877 PMCID: PMC8927548 DOI: 10.1007/s40123-022-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction This study aimed to evaluate the effectiveness of vitrectomy without using perfluorocarbon liquid (PFCL) for the treatment of complicated retinal detachment (RD). Methods The utilisation of PFCL was calculated in four hospitals in 2020 and in one hospital every year from 2012 to 2020. A case series of 320 RD eyes treated with vitrectomy without the use of perfluorocarbon liquid (VWTPL) was followed up for 1–26 months. The rate of retinal reattachment (RR) and postoperative visual acuity (VA, LogMAR) was evaluated. Furthermore, factors influencing RR and VA were analysed. Results The overall utilisation of PFCL was 43.87% (42.74%, 45.83%, 62.39% and 4.5%). The annual utilisation was 46.94%, 20.43%, 46.73%, 47.41%, 20%, 17.24%, 7.60%, 10.67% and 4.49% from 2012 to 2020. The VA of 320 eyes improved from 1.96 ± 1.07 preoperatively to 1.43 ± 0.92 (LogMAR, p < 0.001) 1 week post-operation. In the follow-up of 1–26 months (median: 9 months), the primary and final RR was 87.37% and 95.56%, respectively. Age, uveitis, recurrent RD, the number of detached retinal quadrants, aPVR and preoperative VA were considered as the factors influencing postoperative VA. Moreover, preoperative VA and preoperative intraocular pressure were the factors influencing RR. Conclusion The utilisation of PFCL varies amongst hospitals with a highest percentage of 62.39%. VWTPL is safe and effective, thereby saving costs and preventing complications related to PFCL. Trial Registration ChiCTR-ORC-17014225. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00479-x.
Collapse
|
20
|
Chen C, Chen P, Liu X, Li H. Combined 5-Fluorouracil and Low Molecular Weight Heparin for the Prevention of Postoperative Proliferative Vitreoretinopathy in Patients With Retinal Detachment: A Meta-Analysis. Front Med (Lausanne) 2021; 8:790460. [PMID: 34917641 PMCID: PMC8669826 DOI: 10.3389/fmed.2021.790460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postoperative proliferative vitreoretinopathy (PVR) remains a dilemma for retinal surgeons. We performed a literature search and meta-analyses to figure out whether combined 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) treatment were effective in improving the primary success of vitrectomy and preventing postoperative PVR occurrence in patients with retinal detachment (RD). Methods: Databases including PubMed, Embase, the Cochrane library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 2021. Comparative studies approaching the effects of combined 5-FU and LMWH on postoperative PVR were included. Quality assessment was performed using RoB 2 and ROBINS-I tool. Study data were pooled using Review manager 5.4.1. The main outcomes were: the primary success of vitrectomy at 6 months and the postoperative PVR occurrence. The additional outcomes were: number of patients who underwent vitreoretinal reoperations and the number of vitreoretinal reoperations due to postoperative PVR. Subgroup analyses and sensitivity analyses were also performed. Results: Six clinical trials with a total of 1,208 participants were included. We found that combined 5-FU and LMWH infusion did not improve the primary success of vitrectomy at 6 months (RR = 1.00, 95% CI = 0.95, 1.07, P = 0.89, I2 = 50%). Also, the conjunct therapy had no effect on reducing the number of patients who underwent vitreoretinal reoperations (RR = 1.00, 95% CI = 0.78, 1.28, P = 1.00, I2 = 42%). The overall effect of the treatment on preventing postoperative PVR was negative. However, in patients with PVR grade C (PVRC) before intervention, the 5-FU and LMWH treatment significantly reduced PVR occurrence. Visual acuity was not different between the treatment and control groups. Nevertheless, in one RCT, a significant reduction of VA was observed in the treatment group in macular-sparing patients with RD. No complications were attributed to the conjunct therapy. Conclusions: The combined 5-FU and LMWH treatment neither improved the primary success of vitrectomy at 6 months nor decreased number of patients who underwent vitreoretinal reoperations. Thus, the treatment should not be routinely used in vitrectomy for patients with RD. However, the treatment proved beneficial in reducing postoperative PVR in patients with PVRC before intervention. More high-quality clinical trials are needed to confirm the results. Systematic Review Registration:https://inplasy.com/inplasy-2021-8-0117/, identifier: INPLASY202180117.
Collapse
Affiliation(s)
- Chen Chen
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China.,Yunnan Clinical Medicine Center for Ocular Disease, Yunnan Eye Institute, Kunming, China.,Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmic Diseases, Yunnan Eye Institute, Kunming, China
| | - Peng Chen
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xia Liu
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Hua Li
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China.,Yunnan Clinical Medicine Center for Ocular Disease, Yunnan Eye Institute, Kunming, China.,Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmic Diseases, Yunnan Eye Institute, Kunming, China
| |
Collapse
|
21
|
Li J, Zhao M, She H. The impact of the COVID-19 Pandemic on rhegmatogenous retinal detachment treatment patterns. BMC Ophthalmol 2021; 21:372. [PMID: 34666710 PMCID: PMC8524212 DOI: 10.1186/s12886-021-02127-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/23/2021] [Indexed: 02/02/2023] Open
Abstract
Backgrounds To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 Pandemic. Methods A retrospective cohort of RRD patients was analyzed. Patients were divided into the COVID-19 pandemic group and pre-COVID-19 group according to their presentation. The presurgery characteristics, surgical procedures, and surgery outcomes were collected. The potential factors related to the choice of pars plana vitrectomy (PPV) or scleral buckling (SB) were analyzed using logistic regression. The differences in the procedure choice under specific conditions were compared. Surgery outcomes were compared between the two groups. Results In the COVID-19 pandemic group, less patients received SB (27.8, 41.3%, p = 0.02) while more patients received PPV (72.2, 58.6%, p = 0.02); in patients who received SB, fewer patients received subretinal fluid drainage (45.4,75.7%, p = 0.01); in patients who received PPV, fewer patients received phacovitrectomy (7.0, 21.0%, p = 0.02). The choice of PPV was related to older age (1.03, p = 0.005), the presence of RRD with choroidal detachment (RRD-CD) (2.92, p = 0.03), pseudophakia (5.0, p = 0.002), retinal breaks located posterior to the equator (4.87, p < 0.001), macular holes (9.76, p = 0.005), and a presurgery visual acuity (VA) less than 0.02 (0.44, p = 0.03). Fewer phakia patients with retinal breaks located posterior to the equator (1/28, 11/30, p = 0.01) and fewer patients with chronic RRD and subretinal strand (1/9, 9/16, p = 0.03) received SB in the COVID-19 pandemic group. There were more patients with improved VA (55.7, 40.2%, p = 0.03) in the COVID-19 pandemic group. The overall single-surgery retinal attachment rate was similar in the two groups (94.9, 94.5%, p = 0.99). Conclusions During the COVID-19 Pandemic, the main reason for the increased number of PPV in RRD treatment was that more complicated cases were presented. However, the surgeons were conservative in procedure choice in specific cases. The adjustments on RRD treatments lead to comparable surgery outcomes.
Collapse
Affiliation(s)
- Jipeng Li
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| | - Meng Zhao
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China.
| | - Haicheng She
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| |
Collapse
|
22
|
Grosinger AJ, Nicholson BP, Shah SM, Pulido JS, Barkmeier AJ, Iezzi R, Bakri SJ. Time to Unplanned Return to the Operating Room and Associated Risk Factors in Patients With Surgical Retinal Detachment Repair. Am J Ophthalmol 2021; 229:18-25. [PMID: 33626361 DOI: 10.1016/j.ajo.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the incidence of unplanned return to the operating room (ROR) at ≤45 days or ≥46 days after primary retinal detachment (RD) surgery and correlate ROR with preoperative risk factors and visual outcomes. DESIGN Retrospective cohort study. METHODS This was a retrospective review of patients with primary RD surgery to assess for unplanned ROR between January 1, 2012 and June 30, 2014, with follow-up of 90 days to 8 years (mean, 1.5 years). We assessed 268 patients receiving 270 primary rhegmatogenous RD surgeries between January 1, 2012 and June 30, 2014 in an academic tertiary referral center. RESULTS Of the 270 RD surgeries, 82 were complicated (history of proliferative vitreoretinopathy or trauma-related RDs at presentation) and 188 were uncomplicated (RD unrelated to trauma or proliferative vitreoretinopathy at presentation). The ROR rate for all surgeries was 12.2% (33/270) over the follow-up period, with 51.5% (17/33) having reoperations within 45 days. The complicated detachment group had a ROR rate of 14.6% (12/82) over the follow-up period, and 50% of those (6/12) had reoperations within 45 days. The uncomplicated detachment group had a ROR rate of 11.2% (21/188) over the follow-up period. Of those, 52.4% (11/21) had reoperations within 45 days. CONCLUSIONS Given that only 51.5% of all RORs occurred within 45 days, a 45-day ROR surgical quality metric that has been previously used may be of limited value for RD surgery. Factors such as age at presentation, number of retinal breaks, number of detached clock hours, use of silicone oil tamponade for pars plana vitrectomy, history of choroidal detachment, high myopia, ocular trauma, and open globe were associated with increasing risk of ROR. Implementing risk-adjusted metrics may provide a more accurate and useful quality improvement metric for evaluating quality of surgical care in vitreoretinal surgery. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
| | | | - Saumya M Shah
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose S Pulido
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Barkmeier
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymond Iezzi
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sophie J Bakri
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
23
|
Shorter Axial Length Is a Risk Factor for Proliferative Vitreoretinopathy Grade C in Eyes Unmodified by Surgical Invasion. J Clin Med 2021; 10:jcm10173944. [PMID: 34501393 PMCID: PMC8432245 DOI: 10.3390/jcm10173944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the risk factors for the development of proliferative vitreoretinopathy grade C (PVR-C), independent of prior surgical invasion. METHODS Patients who underwent surgery for rhegmatogenous retinal detachment were prospectively registered with the Japan-Retinal Detachment Registry, organized by the Japanese Retina and Vitreous Society, between February 2016 and March 2017. Data obtained from general ophthalmic examinations performed before and at 1, 3, and 6 months after surgery were analyzed. RESULTS We included 2013 eyes of 2013 patients (men, 1326 (65.9%); mean age, 55.2 ± 15.2 years) from amongst 3446 registered patients. Preoperative PVR-C was observed in 3.6% of patients. Propensity score matching revealed that a shorter axial length (AL) was a risk factor for preoperative PVR-C (OR (Odds Ratio), 0.81; 95% CI (Confidence Interval), 0.69 to 0.96; p = 0.015), which was a risk factor for surgical failure (OR, 4.22; 95% CI, 1.12 to 15.93; p = 0.034); the association was particularly significant for eyes with an AL < 25.0 mm (p = 0.016), while it was insignificant for eyes with an AL ≥ 25.0 mm. CONCLUSIONS A shorter AL was related to the development of PVR-C before surgical invasion. Our results will help elucidate the fundamental pathogenesis of PVR and caution clinicians to meticulously examine eyes with a shorter AL to detect retinal detachment before PVR development.
Collapse
|
24
|
The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services-Experiences from the Tongren eye center in Beijing. PLoS One 2021; 16:e0254751. [PMID: 34411135 PMCID: PMC8375993 DOI: 10.1371/journal.pone.0254751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose To investigate the impact on services for rhegmatogenous retinal detachment (RRD) patients during the COVID-19 (2019coronal virus disease) pandemic in one tertiary center in Beijing. Methods A retrospective cohort study. Two reviewed consecutive RRD patients cohorts of the same length were treated during two different periods: the COVID-19 pandemic and the pre-COVID-19 group. The characteristics of patients, surgery, anesthesia methods, length of hospital stay, and the latest follow-up were recorded and analyzed. Results There were 79 patients in the COVID-19 pandemic group with a 55.9% reduction (179). Compared to patients in the pre-COVID-19, patients in the COVID-19 pandemic had a longer presurgical waiting times (28days, 3days, p<0.001), a higher percentage of patients with presurgical poor (less than 0.02) visual acuity (55.7%, 32.4%, p = 0.009), and a higher percentage of patients with presurgical choroidal detachment (34.2%, 19.6%, p = 0.01). There was no significant difference in the severity of presurgical proliferative vitreoretinopathy between the two groups (p = 0.64). Surgeries on pathological myopia patients with macular hole retinal detachment were postponed in the COVID-19 pandemic. There was a lower percentage of scleral buckling (27.8%, 41.3%, p = 0.02) and a lower rate of subretinal fluid drainage (45.4%, 75.7%, p = 0.01) in the COVID-19 pandemic. There was no significant difference in either postoperative visual acuity (p = 0.73) or the rate of single-surgery retinal attachment (p = 1) between the two groups. Patients in the COVID-19 pandemic had a shorter length of hospital stay (3hours, 35 hours, p<0.001), and a lower percentage of patients received general anesthesia (48.1%, 83.2%, p<0.001). None was infected with COVID-19 disease during the pandemic. Conclusion The COVID-19 pandemic lockdown caused prolonged presurgical waiting times, shorter hospital stays, less general anesthesia, and a significant reduction of RRD surgeries. The RD were more complicated, the surgeons were more conservative on procedures and patients selection, while the surgery outcomes were comparable.
Collapse
|
25
|
Funatsu R, Terasaki H, Koriyama C, Yamashita T, Shiihara H, Sakamoto T. Silicone oil versus gas tamponade for primary rhegmatogenous retinal detachment treated successfully with a propensity score analysis: Japan Retinal Detachment Registry. Br J Ophthalmol 2021; 106:1044-1050. [PMID: 34373251 PMCID: PMC9340049 DOI: 10.1136/bjophthalmol-2021-319876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/25/2021] [Indexed: 12/29/2022]
Abstract
Background/aims To compare the effects of silicone oil tamponade (SOT) to that of gas tamponade (GT) on the best-corrected visual acuity (BCVA) after successful vitrectomy for retinal detachment (RD). Methods A retrospective, multicentre, nationwide study with RD who were registered in the Japan-RD Registry. All cases with RD treated with successful vitrectomy between February 2016 and March 2017 were studied. A propensity score matching was performed using the preoperative findings as covariates to adjust the relevant confounders. The primary outcome was the estimated mean difference of the postoperative BCVA in 6 months between eyes treated with SOT to those treated with GT. Results Of the 3446 cases registered, 2097 cases met the entry criteria. There were 2042 eyes that had GT and 55 eyes that had SOT. Primary success was defined as a reattached retina with no tamponade at 6 months. After propensity score matching, each group contained 40 cases. The preoperative BCVA was 0.966±0.738 logMAR units in the GT group and 1.270±0.945 logMAR units in the SOT group (p=0.177). Six months postoperatively, the BCVA in the GT group was significantly better at 0.309 logMAR units in the GT group than the 0.671 logMAR units in the SOT group (p=0.002). Conclusions Even after successful surgery for RD, eyes that experienced SOT had poorer BCVA than eyes treated with GOT. SOT should be considered cautiously. Precis Propensity score analysis of eyes with rhegmatogenous RD showed that postoperative vision was worse in eyes treated once with silicone oil than with gas even after completely successful surgery.
Collapse
Affiliation(s)
- Ryoh Funatsu
- Ophhtalmology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- Ophhtalmology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| | - Chihaya Koriyama
- Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| | - Toshifumi Yamashita
- Ophhtalmology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| | - Hideki Shiihara
- Ophhtalmology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Ophhtalmology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
26
|
Obata S, Kakinoki M, Sawada O, Saishin Y, Ichiyama Y, Ohji M. Effect of internal limiting membrane peeling on postoperative visual acuity in macula-off rhegmatogenous retinal detachment. PLoS One 2021; 16:e0255827. [PMID: 34352010 PMCID: PMC8341536 DOI: 10.1371/journal.pone.0255827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the effects of internal limiting membrane (ILM) peeling on visual acuity (VA) after rhegmatogenous retinal detachment (RRD) surgery. METHODS This retrospective analysis examined the medical records of patients with RRD who underwent vitrectomy at 26 institutions. To detect prognostic factors of VA at 6 months postoperatively (post-VA), multivariate linear regression was performed with post-VA as the objective variable; ILM peeling, sex, age, preoperative VA (pre-VA), intraocular pressure, axial length, duration of RRD, and cataract surgery served as explanatory variables. Recurrence of RRD and epiretinal membrane formation within 6 months postoperatively were compared between groups of patients with and without ILM peeling, among patients with macula-on and macula-off RRD. RESULTS The inclusion criteria were met by 523 eyes with a macula-on RRD and 364 eyes with a macula-off RRD. ILM peeling was performed in 85 eyes with a macula-on RRD and 57 eyes with a macula-off RRD. In eyes with a macula-on RRD, ILM peeling did not affect post-VA (p = 0.72). Vitrectomy without cataract surgery and poor pre-VA were significantly associated with poor post-VA (p = 0.01 and p < 0.001, respectively). In eyes with a macula-off RRD, ILM peeling, long duration of RRD, and poor pre-VA were significantly associated with poor post-VA (p = 0.037, p = 0.007, and p < 0.001, respectively). Recurrence of RRD and epiretinal membrane formation were similar between groups of patients with and without ILM peeling, among patients with macula-on and macula-off RRD. Retina sensitivity was not evaluated by microperimetry. CONCLUSION ILM peeling did not affect post-VA in eyes with a macula-on RRD, whereas post-VA was worse in eyes with ILM peeling than in eyes without peeling, among eyes with a macula-off RRD.
Collapse
Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Yusuke Ichiyama
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | | |
Collapse
|
27
|
Xu D, Belin PJ, Staropoli PC, Yannuzzi NA, Vangipuram G, Chiang A, Shah GK, Townsend JH, Ryan EH, Klufas MA. Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis. Ophthalmol Retina 2021; 5:797-804. [PMID: 33197679 DOI: 10.1016/j.oret.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included. METHODS Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES Single-operation anatomic success between the initial-eye and subsequent-eye RRD. RESULTS Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
Collapse
Affiliation(s)
- David Xu
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | | | - Patrick C Staropoli
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Nicolas A Yannuzzi
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Allen Chiang
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | - Justin H Townsend
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Michael A Klufas
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| |
Collapse
|
28
|
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: 5] [Impact Index Per Article: 1.7] [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.
Collapse
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
| |
Collapse
|
29
|
[Reasons and risk factors for recurrent retinal detachment after removal of silicon oil in various vitreoretinal diseases]. Ophthalmologe 2021; 119:170-175. [PMID: 34086072 DOI: 10.1007/s00347-021-01420-6] [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: 07/20/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pars plana vitrectomy (ppV) combined with silicone oil tamponade is a standard technique in the treatment of complicated retinal detachment. There are still recurrent cases of retinal detachment after silicone oil removal or redetachment with in situ oil tamponade. OBJECTIVE The aim was to identify possible risk factors for retinal redetachment and to use the knowledge for optimizing treatment. METHODS Analysis of data from patients who were treated with ppV and silicone oil tamponade in the University Department of Ophthalmology in Marburg during 2010-2015 and who had a retinal redetachment during this period. The results were divided into two groups, redetachment with oil in situ and redetachment after oil removal. RESULTS A total of 43 cases (15.6%) had a redetachment, which included 22/43 cases (50%) with a redetachment after oil removal and 21/43 cases (50%) with redetachment with oil in situ. The cause for the renewed detachment was given as proliferative vitreoretinopathy (PVR) in 90.6% (39/43) of the cases, new foramina in 20.9% (9/43) and persisting foramina in 25.5% (11/43). CONCLUSION Vitreoretinal scar formation (PVR reaction) was the main risk factor for renewed retinal detachment. Persisting foramina were also named as a frequent cause. Recurrent retinal detachment represents a significant challenge for vitreoretinal surgeons and for the patients considering the economic and emotional burden due to multiple interventions.
Collapse
|
30
|
Nishitsuka K, Nakamura M, Nishi K, Namba H, Kaneko Y, Yamashita H. Surgical Outcomes of Rhegmatogenous Retinal Detachment with Different Peripheral Vitreous-Shaving Procedures. Clin Ophthalmol 2021; 15:2197-2202. [PMID: 34113072 PMCID: PMC8183455 DOI: 10.2147/opth.s310789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/06/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose To compare the surgical outcomes of vitreous surgery for rhegmatogenous retinal detachment (RRD) after two different peripheral vitreous-shaving techniques are performed. Methods We reviewed 269 eyes with RRD that were treated with a 25-gauge vitrectomy by a single surgeon between June 2015 and May 2020. The exclusion criteria for the proposed air tamponade selection were as follows: more than two weeks since RRD onset, giant retinal tears, a history of complications following cataract surgery, high myopia, and proliferative vitreoretinopathy classified as grade C or higher. We examined the differences in the therapeutic effect between shaving under slit lamp microscope illumination (group A) and shaving under a wide-angle viewing system (group B). Results A total of 269 eyes were included in this study, with 146 eyes in group A and 123 eyes in group B. The primary anatomical success rates did not differ between group A (97.3%; 142/146 eyes) and group B (97.6%; 120/123 eyes; P = 0.102). However, the surgical time was significantly longer in group A (60.2 ± 17.1 min) than that in group B (46.9 ± 12.6 min) (P < 0.001). The multiple linear regression analysis revealed that surgical time was significantly correlated with using the wide-angle noncontact viewing system for vitreous shaving (adjusted R2 = 0.248; beta [standard partial regression coefficient] = −0.447, P < 0.001), the number of retinal breaks (beta = 0.182, P = 0.001), and the quadrant of retinal detachment (beta = 0.205, P < 0.001). Conclusion The surgical outcomes were similar regardless of the shaving procedure performed, and the surgical time was shortened by using the wide-angle noncontact viewing system for vitreous shaving.
Collapse
Affiliation(s)
- Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Madoka Nakamura
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyuki Namba
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yutaka Kaneko
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| |
Collapse
|
31
|
Franzolin E, Longo R, Casati S, Ceruti P, Marchini G. Influence of the COVID-19 Pandemic on Admissions for Retinal Detachment in a Tertiary Eye Emergency Department. Clin Ophthalmol 2021; 15:2127-2131. [PMID: 34054291 PMCID: PMC8149301 DOI: 10.2147/opth.s307407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the incidence and clinical characteristics of retinal detachments (RDs) diagnosed in a tertiary eye emergency department (EED) during the COVID-19 pandemic and in the corresponding period of the previous 4 years. Methods EED consultations performed from February 21, 2020 (first national case of COVID-19 infection) to May 3, 2020 (end of lockdown imposed by national Government) and for the same date range of 2016–2019 (pre-COVID-19 period), and with a confirmed diagnosis of RD were collected and reviewed. The following demographical and clinical features have been analyzed: age, gender, etiology of RD, macular involvement, best corrected visual acuity (BCVA), and duration of experienced symptoms. Results Eighty-two subjects (20.5±1.0 eyes/year) were diagnosed with RD in the pre-COVID-19 period, compared to 12 patients in the COVID-19 period (−41.5%). During the pandemic, patients complained symptoms for a median of 8.5 days (IQR, 1.7–15 days) before the EED consultation, while in the pre-COVID-19 period, they declared they had been symptomatic for 2 days (IQR, 1–4 days) (p=0.037); macula-off RD raised from 56% to 75% and no one reported trauma as a triggering event. Conclusion During the COVID-19 pandemic, the rate of RD diagnosed in our EED decreased significantly and patients waited longer before asking for an ophthalmologic examination. These findings are probably due to the fear of contracting the COVID-19 infection attending hospital environments. Even if emergency departments are often misused by people suffering non-urgent conditions, patients complaining of sudden visual loss, visual field defects, or phosphenes should always and promptly attend an EED visit to prevent a worse prognosis.
Collapse
Affiliation(s)
- Elia Franzolin
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosa Longo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Casati
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Piero Ceruti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
32
|
Zhao M, Li J, She H, Liu N. The risk factors of the progression of rhegmatogenous retinal detachment on patients with the fourteen-day quarantine in the early period of COVID-19 outbreak. BMC Ophthalmol 2021; 21:215. [PMID: 33990185 PMCID: PMC8121638 DOI: 10.1186/s12886-021-01985-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/07/2021] [Indexed: 01/14/2023] Open
Abstract
Backgrounds The COVID-19 Pandemic has a great impact on hospitals and patients. The 14-day quarantine caused surgery of rhegmatogenous retinal detachment (RRD) postponed. We aimed to explore the risk factors of RRD progression in a group of patients whose surgery was postponed during the top-level emergency response of COVID-19. Methods A retrospective case series. Medical records of all consecutive patients with a diagnosis of RRD who underwent a surgical treatment at Beijing Tongren Hospital’s retina service from February 16, 2020, to April 30, 2020 have been reviewed retrospectively. Medical history, symptoms, and clinical signs of progression of RRD were recorded. RRD progression was defined as the presence of either choroidal detachment or proliferative vitreoretinopathy (PVR) progression during the quarantine period. Risk factors were analyzed using the Cox proportional hazards model, survival analysis, and logistic regression. Results Seventy-nine eyes of 79 patients met the inclusion criteria and were included in the study. The median time from the patients’ presentation at the clinic to admission for surgery was 14 days (3–61 days). There were 70 cases (88.6%) who did not present to the hospital within 1 week of the onset of visual symptoms. There were 69 (87.3%) macular-off cases at the presentation and 27 (34.2%) cases combined with choroidal detachment. There were 49 (62.0%) cases with PVR B, 22 (27.8%) cases with PVR C, 4 (5.1%) cases with PVR D, and 4 (5.1%) cases with anterior PVR. After the 14-day quarantine, 21 (26.6%) cases showed RRD progression, and 9 cases showed RRD regression at the time of surgery. Neither the time of onset of the visual symptom (p = 0.46) nor the time between presentation and admission (p = 0.31) was significantly different between the patients with RRD progression and patients without RRD progression. The combination of choroidal detachment (3.07, 1.68-5.60, p<0.001) and retinal breaks located posterior to the equator (3.79, 1.21-11.80, p=0.02) were factors related to the progression of RRD. Conclusions In our study during the COVID-19 outbreak, the RRD progression risk factors included a combination of choroidal detachment and retinal breaks posterior to the equator. Ophthalmologists should schedule the surgeries for RRD patients with these signs as soon as possible.
Collapse
Affiliation(s)
- Meng Zhao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Jipeng Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Haicheng She
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Ningpu Liu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
33
|
Hocaoglu M, Karacorlu M, Giray Ersoz M, Sayman Muslubas I, Arf S. Retinotomy and retinectomy for anterior inferior proliferative vitreoretinopathy: Can visual outcome be improved? Eur J Ophthalmol 2021; 32:11206721211012848. [PMID: 33887980 DOI: 10.1177/11206721211012848] [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: 11/17/2022]
Abstract
PURPOSE To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR). METHODS Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated. RESULTS Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 (p < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA (p = 0.02), previous vitrectomy with gas tamponade (p = 0.007), and was negatively correlated with number of previous RD operations (p = 0.01), larger extent of RD (p = 0.02) and more extensive retinotomy/retinectomy (p = 0.04). CONCLUSIONS An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.
Collapse
Affiliation(s)
| | | | - M Giray Ersoz
- Biruni University School of Medicine, Istanbul, Turkey
| | | | - Serra Arf
- Istanbul Retina Institute, Istanbul, Turkey
| |
Collapse
|
34
|
Radeck V, Helbig H, Barth T, Gamulescu MA, Maerker D, Prahs P. The learning curve of retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2021; 259:2167-2173. [PMID: 33544177 PMCID: PMC8352825 DOI: 10.1007/s00417-021-05096-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.
Collapse
Affiliation(s)
- Viola Radeck
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany.
| | - Teresa Barth
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - David Maerker
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| |
Collapse
|
35
|
Kawano S, Imai T, Sakamoto T. Scleral buckling versus pars plana vitrectomy in simple phakic macula-on retinal detachment: a propensity score-matched, registry-based study. Br J Ophthalmol 2021; 106:857-862. [PMID: 33514527 DOI: 10.1136/bjophthalmol-2020-318451] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIMS To assess the anatomical and visual results of uncomplicated phakic macula-on retinal detachment (RD) in patients treated with pars plana vitrectomy (PPV) or scleral buckling (SB). METHODS A retrospective cohort of patients aged <65 years and diagnosed with uncomplicated phakic macula-on primary RD, who were registered in the Japan-Retinal Detachment Registry, was compiled between February 2016 and March 2017. We performed propensity score matching using preoperative findings and surgeon-related factors as covariates to account for relevant confounders. The primary outcome was anatomical failures at 6 months postoperatively, classified as follows: level 1, an inoperable state; level 2, anatomical recovery with silicone oil tamponade; and level 3, need for additional surgery to repair the detachments. The secondary outcome was change in best-corrected visual acuity (BCVA). RESULTS Of the 822 included patients, 552 underwent PPV and 270 underwent SB. After propensity score matching, 137 matched cases between the PPV and SB groups were analysed. The total proportion of surgical failures in the PPV group was higher than that in the SB group (risk difference, 0.10 (0.02 to 0.18), p=0.011, McNemar's test). Conversely, the change in BCVA was not significantly different between the two groups (logMAR units, -0.015 (-0.084 to 0.053), p=0.66, paired samples t-test). CONCLUSIONS Although the indications for PPV are becoming broader, PPV may not be the optimal approach for repairing all types of RD. Therefore, careful consideration is needed when selecting the right surgical technique for treating uncomplicated phakic macula-on RD cases.
Collapse
Affiliation(s)
- Sumihiro Kawano
- Ophthalmology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takumi Imai
- Medical Statistics, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan
| | | | | |
Collapse
|
36
|
Jia LY, Sun YX, Zhang YP, Ma K. Risk Factors of Recurrent Retinal Detachment Following Surgical Treatment for Rhegmatogenous Retinal Detachment: A Retrospective Study. Risk Manag Healthc Policy 2020; 13:3165-3171. [PMID: 33408538 PMCID: PMC7779298 DOI: 10.2147/rmhp.s288777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To identify potential risk factors for recurrent retinal detachment after surgical treatment for rhegmatogenous retinal detachment with choroidal detachment (RRD-CD) in a Chinese population. Methods A total of 1212 patients with RRD-CD admitted to Beijing Tongren Hospital from 2004 to 2018 were reviewed retrospectively. The rate of recurrent retinal detachment was calculated, and risk factors were analyzed by logistic regression analysis. Results The average age of the patients was 48.51 years, 760 patients (62.7%) were male, and 630 patients (52.0%) had right eye disease. The recurrence rate in the same eye was 21.3%. The incidence of recurrence retinal detachment was higher in patients who were male, middle age, and with poor preoperative vision, longer axial length, and scleral buckling. Recurrence usually occurred 3 months after surgery. Conclusion Male, middle age, longer axial length, and scleral buckling could be risk factors for recurrent retinal detachment following surgical treatment in patients with RRD-CD.
Collapse
Affiliation(s)
- Li-Yun Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan-Xia Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kai Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
37
|
Six-months primary success rate for retinal detachment between vitrectomy and scleral buckling. Retina 2020; 41:1164-1173. [DOI: 10.1097/iae.0000000000002994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Patel LG, Peck T, Starr MR, Ammar MJ, Khan MA, Yonekawa Y, Klufas MA, Regillo CD, Ho AC, Xu D. Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic: A Historical Cohort Study. Ophthalmology 2020; 128:686-692. [PMID: 33058938 PMCID: PMC7550253 DOI: 10.1016/j.ophtha.2020.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, consecutive case series with historical controls. Participants Consecutive patients seeking treatment for primary RRD in a 50-day period during the COVID-19 pandemic (March 9–April 27, 2020) and the corresponding 50-day period during the previous year (March 4–April 22, 2019) in the United States. Methods The cohorts were compared to assess demographic variables and clinical presentations. Multivariate logistic regression was used to identify factors predictive of presenting macular attachment status. Main Outcome Measures The primary outcome was the proportion of patients with macula-on RRD at presentation. Secondary outcomes included visual acuity (VA), duration of symptoms before presentation, proportion seeking treatment within 1 day of symptom onset, and presence of primary proliferative vitreoretinopathy (PVR). Results Eighty-two patients were included in the 2020 cohort compared with 111 patients in the 2019 primary control cohort. Demographic factors were similar between the groups. Significantly fewer patients demonstrated macula-on RRD in the 2020 cohort (20/82 patients [24.4%]) than in the 2019 cohort (55/111 patients [49.5%]; P = 0.001). Patients in the 2020 cohort showed worse median VA at presentation (1.00 logarithm of the minimum angle of resolution [logMAR; Snellen equivalent, 20/200] in 2020 vs. 0.48 logMAR [Snellen equivalent, 20/60] in 2019; P = 0.008), fewer patients sought treatment within 1 day of symptoms (16/80 patients [19.5%] in 2020 vs. 41/106 patients [36.9%] in 2019; P = 0.005), and a greater proportion demonstrated primary PVR (11/82 patients [13.4%] in 2020 vs. 5/111 patients [4.5%] in 2019; P = 0.03). In multivariate analysis, younger age (P = 0.03) and established patient status (P = 0.02) were independent predictors of macula-on status in the 2020 cohort. Conclusions Patients with primary RRD during the 2020 COVID-19 pandemic were less likely to have macula-on disease and more likely to delay seeking treatment and to show worse vision and PVR.
Collapse
Affiliation(s)
- Luv G Patel
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Travis Peck
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Matthew R Starr
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Michael J Ammar
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Michael A Klufas
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Carl D Regillo
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - David Xu
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| |
Collapse
|
39
|
Frisina R, Gius I, Frascogna G, Pizzolon T, Greggio A, Tozzi L, Midena E. A possible strategic role of air during pars plana vitrectomy for macula-involving rhegmatogenous retinal detachment. Int Ophthalmol 2020; 41:421-431. [PMID: 32951112 DOI: 10.1007/s10792-020-01591-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/04/2020] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the advantages and safety of vitrectomy under air for treating macula-involving rhegmatogenous retinal detachment (RRD). METHODS Consecutive patients with macula-involving RRD who underwent vitrectomy under air were recruited. Demographic and clinical data were: age, gender, eye, lens status, best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR), axial length, intraocular pressure (IOP). RRD parameters were: RRD extent, retinal breaks number. Surgical data were: cataract surgery, tamponade used. Postoperative parameters were: BCVA, IOP at first, third, sixth month, recurrent RD, incidence of retinal folds, subretinal fluid (SRF) persistence, macular displacement. RESULTS Seventy-one eyes (71 patients) were recruited. Cataract surgery was performed in 32 of 45 phakic patients. The tamponade used was: sulfur hexafluoride 18% (41), silicon oil (SO) (26), high-density SO (4). BCVA improved significantly from baseline (1.2 ± 0.4 logMAR) to the last control (0.8 ± 0.7 logMAR) (P = 0.03285). Recurrent RD incidence was 14.1%. Postoperative complications were: retinal folds (2), SRF persistence (3), macular displacement (2). CONCLUSION Vitrectomy under air is a safe alternative technique for treating macula-involving RRD. Vitrectomy under air allows surgeon to remove accurately the vitreous from the peripheral retina and facilitates the removal of SRF reducing the complications related to its postoperative persistence.
Collapse
Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy.
| | - Irene Gius
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Giuseppe Frascogna
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Tobia Pizzolon
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Angelo Greggio
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| |
Collapse
|
40
|
Babu N, Kohli P, Kumar K, Rajan RP, Baliga G, Sen S, Ramachandran NO, Bhavani S, Ramasamy K. Two-staged surgery as an alternative to buckle-vitrectomy for rhegmatogenous retinal detachment complicated by choroidal detachment. Int Ophthalmol 2020; 41:135-141. [PMID: 32860153 DOI: 10.1007/s10792-020-01560-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the outcome and safety profile of short-term perfluorocarbon liquids (PFCL) tamponade in comparison with buckle-vitrectomy in case of rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). METHODS Records of patients who underwent surgery for RRD/CD from January 2016 to July 2019 were reviewed retrospectively. The patients were allocated into two groups-group 1 patients underwent buckle-vitrectomy, while those in group 2 underwent a two-staged vitrectomy with short-term (5 days) PFCL tamponade. RESULTS The study included 33 eyes (33 patients) with mean age of 50.3 ± 17.2 years. Group 1 included 15 patients, while group 2 included 18. The pre-operative characteristics were similar in both the groups. The mean pre-operative intraocular pressure in group 1 and 2 was 9.1 ± 4.0 and 8.6 ± 5.2 mmHg, respectively (p = 0.755). Retinal re-attachment after single surgery was achieved in 10 (66.7%) and 14 eyes (77.8%), respectively. All the eyes achieved retinal re-attachment after repeat surgery in both the groups (1.40 vs 1.39 surgeries, p = 0.963). Post-surgery visual improvement was seen in 13 (86.7%) and 17 eyes (94.4%), respectively (p = 0.579). Final visual acuity of ≥ 6/60 was obtained in 7 (46.7%) and 9 eyes (50.0%), respectively (p > 0.999). None of the patients needed retinectomy during repeat surgery. None of the patients experienced exaggerated inflammation or intractable raised IOP spike which could not be controlled with medications. CONCLUSION Surgical outcomes were similar in both the groups. No clinically apparent toxicity was seen with post-operative short-term PFCL tamponade. Two-staged surgery is a good alternative to buckle-vitrectomy for eyes with RRD associated with CD.
Collapse
Affiliation(s)
- Naresh Babu
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
| | - Karthik Kumar
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Renu P Rajan
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Girish Baliga
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sagnik Sen
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - N O Ramachandran
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - S Bhavani
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| |
Collapse
|
41
|
Nishitsuka K, Kawasaki R, Yamakiri K, Baba T, Koto T, Yamashita H, Sakamoto T. Preoperative factors to select vitrectomy or scleral buckling for retinal detachment in microincision vitrectomy era. Graefes Arch Clin Exp Ophthalmol 2020; 258:1871-1880. [PMID: 32430633 DOI: 10.1007/s00417-020-04744-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the preoperative factors associated with selecting scleral buckling (SB) or pars plana vitrectomy (PPV) to treat rhegmatogenous retinal detachments (RRDs) in the era of microincision vitrectomy surgery. METHODS A nationwide, multicenter, observational study in the Japan Retinal Detachment Registry was done. From February 2016 to March 2017, 3446 cases were registered, and 3219 among them were analyzed. The factors related to the patient or surgeon were selected; the surgeon's factor included years of experience, number of cases registered, and current activity. The odds ratio (OR) for factors associated with SB or PPV was estimated by a mixed logistic regression model. RESULTS SB was selected in 24.2% (779/3219), PPV was in 71.5% (2238/3219), and PPV+SB was in 6.3% (202/3219). Multivariate analysis showed that age [< 70 years old, OR 4.27, 95% confidence interval (CI) 2.34-7.79, P < 0.001], visual acuity [1.0+ (OR 7.41, 95% CI 3.47-15.82, P < 0.001)], pseudo-phakia (OR 4.83, 95%CI 2.11-10.56, P < 0.001), retinal tear (OR 6.92, 95% CI 4.83-9.92, P < 0.001), breaks at/near the vitreous base (OR 8.07, 95% CI 3.50-18.62, P < 0.001), 90+° retinal tear (OR 108.24, 95% CI 7.44-1574.34, P < 0.001), and number of breaks 4+ (OR 3.15, 95% CI 1.95-5.09, P < 0.001), were significantly associated with selecting PPV over SB. The surgeons' activity defined as the number of cases experienced during the registry period was related to the selection of PPV (OR 3.83, 95% CI 2.11-6.93, P < 0.001). CONCLUSIONS The choice of PPV for the RRD was associated not only with patients' preoperative factors but also the surgeon's activity. Active surgeons selected PPV more than SB.
Collapse
Affiliation(s)
- Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ryo Kawasaki
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keita Yamakiri
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Koto
- Department of Ophthalmology, Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| |
Collapse
|
42
|
Baba T, Kawasaki R, Yamakiri K, Koto T, Nishitsuka K, Yamamoto S, Sakamoto T. Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV. Br J Ophthalmol 2020; 105:227-232. [DOI: 10.1136/bjophthalmol-2020-315945] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/03/2022]
Abstract
Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis was a prospective, nationwide, multicentre, observational study. Data from the Japanese Retina and Vitreous Society registry from 2016 to 2017 were used to determine the association between preoperative clinical factors, surgical procedures and postoperative BCVA at 6 months. Japanese individuals >40 years of age were included. Eyes with proliferative vitreoretinopathy were included. The primary outcome was the percentage of eyes that achieved 20/25 vision.ResultsOf the 3219 registered cases, 2192 met the inclusion criteria (344 SB, 1738 PPV, 110 PPV+SB). Cases with preoperative BCVA (≤0 logarithm of the minimum angle of resolution (logMAR) units) had good postoperative BCVA (OR=3.97, CI 2.87 to 5.51). Older age (>70 years), low intraocular pressure (<10 mm Hg), high myopia (<−5 dioptres), multiple retinal breaks (>4), giant retinal tear (>90°), wide retinal detachment (>3 quadrants) and macula-off detachment were associated with less probability of postoperative 20/25 vision (OR=0.39, 0.64, 0.62, 0.60, 0.12, 0.51 and 0.36, respectively). Postoperative BCVA was 0.03±0.23 and 0.10±0.32 logMAR units after SB and PPV, respectively. The percentage of cases that achieved 20/25 vision was not significantly different after PPV or SB if cases that had concurrent cataract surgery were excluded (p=0.251).ConclusionsBetter BCVA in patients with RRD who had undergone PPV was observed. However, if concurrent cataract surgery is not performed, BCVA will be comparable with either PPV or SB.
Collapse
|
43
|
Japan-Retinal Detachment Registry Report I: preoperative findings in eyes with primary retinal detachment. Jpn J Ophthalmol 2019; 64:1-12. [PMID: 31768687 DOI: 10.1007/s10384-019-00702-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To report the demographics and clinical characteristics of patients with a primary retinal detachment (RD). DESIGN Prospective cohort study by a registry design. PARTICIPANTS Patients with RD treated at vitreoretinal sub-specialty institutions in Japan from February 2016 to March 2017. METHODS Descriptive statistics for the primary RD, and multivariable ordered logistic regression and multiple linear regression analyses were performed. RESULTS 3178 eyes of 3178 cases were analyzed. The interval from onset to surgery was significantly shorter in patients in the 40-year age group than in other age groups except for the 50-year age group (P<0.05, Steel-Dwass test). The proportion of complex cases was significantly higher in the 10-year, 70-year, and 80+ year age groups than in the 40 and 50-year age groups (P<0.05, Steel-Dwass test). The size of RD was significantly associated with the male sex (odds ratio, 1.29; 95% confidence interval [CI], 1.07 to 1.56; P=0.0085) and the interval from onset to surgery (odds ratio, 1.03 95% CI, 1.01 to 1.04; P=0.0014). Low IOPs in eyes with RD were significantly associated with an older age (-0.24 mmHg/10 years, 95% CI, -0.32 to -0.16], P<0.0001) and larger RD area (-0.91 mmHg/quadrant, 95% CI, [-1.06 to -0.76], P <0.0001). CONCLUSION Profile and clinical characteristics of patients with a primary RD were not exactly the same as previous reports. A preoperative low IOP was associated with several ocular factors while the area of RD was associated not only with ocular but with social factors as well.
Collapse
|
44
|
Nossair AA, Ewais WA, Eissa SA. Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair. Int J Ophthalmol 2019; 12:627-633. [PMID: 31024818 DOI: 10.18240/ijo.2019.04.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate a modified technique for scleral buckling (SB) in pseudophakic retinal detachment (RD). METHODS A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing (WAV) contact lens. Segmental tire alone was used in 5 eyes (23.81%), and combined with encircling band in 7 eyes (33.33%). Radial sponge alone was used in 3 eyes (14.29%) and combined with encircling band in 6 eyes (28.57%). RESULTS Primary success rate was (90.48%). External drainage of subretinal fluid was performed in 8 eyes (38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes (19.05%) and localized subretinal hemorrhage at drainage site in one eye (4.76%). No case of intraocular lens (IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye (4.76%), elevated intraocular pressure in 2 eyes (9.52%), epiretinal membrane formation in one eye (4.76%) and proliferative vitreoretinopathy in 3 eyes (14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. CONCLUSION Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.
Collapse
Affiliation(s)
- Ashraf Ahmed Nossair
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.,Dar El Oyoun Hospital, Dokki, Giza 1261, Egypt
| | - Wael Ahmed Ewais
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.,Dar El Oyoun Hospital, Dokki, Giza 1261, Egypt
| | - Sherif Ahmed Eissa
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| |
Collapse
|
45
|
Wei Y, Zhou R, Wang X, Chen X, Chen H. The effect of single periocular injection of methylprednisolone and drainage of suprachoroidal fluid in the treatment of rhegmatogenous retinal detachment combined with choroidal detachment. Eye (Lond) 2019; 33:1387-1392. [PMID: 30940887 DOI: 10.1038/s41433-019-0420-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study we compared the anatomic and functional outcomes of two steroid treatments on rhegmatogenous retinal detachment (RRD) combined with choroidal detachment (CD), namely treatment with oral prednisolone (1 mg/kg daily) for 3-7 days before vitrectomy or a single periocular injection of methylprednisolone (40 mg) 1-3 days before vitrectomy. We also analyzed the outcomes of the eyes with subsided CD and the eyes with persistent CD that underwent drainage of suprachoroidal fluids during the vitrectomy. METHODS This was a prospective randomized study. Seventy five eyes with RRD combined with CD were divided into 2 groups based on the two different treatment regimens as above. The eyes in each group were further divided into 2 subgroups (A: CD subsided eyes; B: CD persistent eyes) according to the response of CD to the treatment of steroids. Retinal reattachment rates were measured at 6 months after the removal of silicone oil. RESULTS At 6 months after silicone oil removal, the retinal reattachment rate was similar (p = 0.666) in the oral prednisolone group (91.7%, 33/36) and the periocular injection group (94.9%, 37/39). Similar retinal reattachment rates (p = 0.364) were also found in the CD subsided eyes (97.1%, 34/35) and the CD persistent eyes (90.0%, 36/40). The retinal reattachment rate was comparable among the subgroups (p = 0.395; oral prednisolone A group: 95.2%, 20/21; oral prednisolone B group: 86.7%, 13/15; periocular injection A group: 100%, 14/14; periocular injection B group: 92.0%, 23/25). CONCLUSIONS For RRD combined with CD, eyes treated with a single periocular injection of methylprednisolone (40 mg, 1-3 days before pars plana vitrectomy) combined with the drainage of suprachoroidal fluids during the surgery had similar anatomic and functional outcomes compared to the eyes treated with oral prednisolone for 3-7 days before vitrectomy.
Collapse
Affiliation(s)
- Yong Wei
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China. .,Xiamen Eye Center Affiliated to Xiamen University, Xiamen, 361000, China.
| | - RongLe Zhou
- Shaanxi Ophthalmic Medical Center, Xi'an No.4 Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xiaobo Wang
- Xiamen Eye Center Affiliated to Xiamen University, Xiamen, 361000, China
| | - Xiuju Chen
- Xiamen Eye Center Affiliated to Xiamen University, Xiamen, 361000, China
| | - Hao Chen
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| |
Collapse
|
46
|
Nagpal M, Chaudhary P, Wachasundar S, Eltayib A, Raihan A. Management of recurrent rhegmatogenous retinal detachment. Indian J Ophthalmol 2019; 66:1763-1771. [PMID: 30451176 PMCID: PMC6256876 DOI: 10.4103/ijo.ijo_1212_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) repair is one of the most common vitreoretinal surgeries a surgeon performs. In an ideal scenario, RRD can be repaired with a single surgical intervention; however, despite excellent skill, flawless technique, and the introduction of high-end technology, up to 10% of cases require additional interventions to ultimately repair recurrent detachments. It is thus important to study the outcomes of multiple interventions to understand whether performing repeat vitrectomy on patients with a history of failed surgeries is worthwhile. Thus, recurrent retinal detachment (re-RD) remains a significant challenge for vitreoretinal surgeons as well as the patients considering the economic and the emotional burden of undergoing multiple interventions. The advent of microincision vitrectomy system, perfluorocarbon liquids, and effective intraocular tamponades has opened new doors for managing re-RDs. In this article, we have reviewed and summarized the various causes and approaches for management for optimal anatomical and functional outcomes.
Collapse
Affiliation(s)
- Manish Nagpal
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Pranita Chaudhary
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Shachi Wachasundar
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Ahmed Eltayib
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Aparajita Raihan
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| |
Collapse
|
47
|
Yu Y, Yue Y, Tong N, Zheng P, Liu W, An M. Anatomic Outcomes and Prognostic Factors of Vitrectomy in Patients with Primary Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment. Curr Eye Res 2018; 44:329-333. [PMID: 30362843 DOI: 10.1080/02713683.2018.1540705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was undertaken to assess the associations between the anatomic outcomes of patients who underwent vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) and their preoperative variables. METHODS A total of 175 patients with RRDCD who underwent vitrectomy in one eye were included in the analysis. The primary outcome measured was the retinal status after primary vitrectomy and at the end of follow-up. RESULTS The retinal reattachment rate was 72.57% after primary surgery, and the final total reattachment rate was 89.14% after follow-up. Binary logistic regression analysis identified that the retinal reattachment rate after primary vitrectomy was significantly associated with older age (odds ratio = 1.03, p = 0.02), mild proliferative vitreoretinopathy (PVR) (PVR grade C vs. PVR grades A-B: odds ratio = 0.31, p = 0.04; PVR grade D vs. PVR grades A-B: odds ratio = 0.03, p < 0.01), and intravitreal steroid treatment (odds ratio = 4.60, p = 0.02), and that the final retinal reattachment rate was independently associated with older age (odds ratio = 1.05; p = 0.01). CONCLUSIONS Vitrectomy is a good surgical option for RRDCD. Older age, mild preoperative PVR, and perioperative intravitreal triamcinolone acetonide injections increase the primary reattachment rates after one operation. Older age was the only independent prognostic factor for the final retinal reattachment in patients with RRDCD.
Collapse
Affiliation(s)
- Yajie Yu
- a Beijing Tongren Eye Center , Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory , Beijing , China
| | - Yankun Yue
- b Department of Ophthalmology , Beijing Fuxing Hospital, Capital Medical University , Beijing , China
| | - Nianting Tong
- c Department of Ophthalmology , Qingdao Municipal Hospital , Qingdao , China
| | - Pengfei Zheng
- a Beijing Tongren Eye Center , Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory , Beijing , China
| | - Wu Liu
- a Beijing Tongren Eye Center , Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory , Beijing , China
| | - Ming An
- c Department of Ophthalmology , Qingdao Municipal Hospital , Qingdao , China
| |
Collapse
|
48
|
Abraham JR, Srivastava SK, Reese JL, Ehlers JP. Intraoperative OCT Features and Postoperative Ellipsoid Mapping in Primary Macula-Involving Retinal Detachments from the PIONEER Study. Ophthalmol Retina 2018; 3:252-257. [PMID: 31014703 DOI: 10.1016/j.oret.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Intraoperative OCT (iOCT) has enabled visualization of subtle structural details during surgical interventions, including retinal detachment repair. The purpose of this study was to evaluate iOCT findings during retinal detachment repair and to assess their impact on anatomic and functional outcomes, including outer retinal integrity. DESIGN The PIONEER Intraoperative and Perioperative OCT Study is a prospective cohort, institutional review board-approved study. PARTICIPANTS Participants in the PIONEER undergoing surgical repair for primary macula-involving retinal detachment. METHODS This was a post hoc analysis of all eyes in the PIONEER undergoing surgical repair with primary macula-involving retinal detachments. Inclusion criteria included iOCT after perfluorocarbon liquid (PFO) placement, visualization of the foveal center on iOCT, and images of sufficient quality for quantitative assessment of submacular fluid volume. Exclusion criteria included recurrent retinal detachment, proliferative vitreoretinopathy, and a lack of postoperative OCT data after gas bubble resolution. Subretinal fluid volume on iOCT imaging was quantified. Qualitative review of iOCT images was performed for visualization of outer retinal bands, fluid, and retinal corrugations. Postoperative OCT images were analyzed using an ellipsoid zone (EZ) mapping platform to evaluate and quantify outer retinal metrics. Postoperative OCT images also were reviewed qualitatively for persistent subretinal fluid. Associations between various anatomic and functional outcomes were assessed. MAIN OUTCOME MEASURES Presence of intraoperative subretinal fluid under PFO tamponade, postoperative persistent subretinal fluid, postoperative visual acuity at 1 year, and EZ integrity at 1 year. RESULTS Fifteen eyes of 15 patients were analyzed. All 15 eyes (100%) showed subretinal fluid on iOCT. All eyes demonstrated spontaneous fluid resolution on follow-up OCT imaging. Increased intraoperative subretinal fluid volume under PFO tamponade trended toward significantly worse visual acuity outcome (P = 0.07). Postoperative quantitative EZ integrity at 12 months directly correlated with visual outcome (P = 0.01). CONCLUSIONS Intraoperative subretinal fluid persists under PFO tamponade with high frequency in eyes undergoing retinal detachment repair, but this fluid does not seem to be associated with persistent postoperative subretinal fluid. Postoperative EZ integrity is associated with visual acuity outcome, and intraoperative subretinal fluid volume under PFO tamponade also may be linked to visual outcomes.
Collapse
Affiliation(s)
- Joseph R Abraham
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie L Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
49
|
Jovanović Đ, Jovanović V, Karadžić J. Significance of clinical parameters and treatment methods for prognosis and postoperative outcome of rhegmatogenous retinal detachment. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
50
|
Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment. Eye (Lond) 2017; 32:602-607. [PMID: 29219956 DOI: 10.1038/eye.2017.262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/02/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo investigate the effect of preoperative steroid on anatomical and functional outcomes of vitrectomy in patients with rhegmatogenous retinal detachment with associated choroidal detachment (RRD-CD), a rare but particular type of RRD.Patients and methodsThis retrospective cohort study included RRD-CD patients at Siriraj Hospital during January 2005 to December 2014. Patients with preexisting uveitis or RRD with giant retinal tears were excluded. Preoperative, intraoperative, and postoperative data were reviewed and analyzed.ResultsA total of 76 patients (76 eyes) with RRD-CD were included: 37 patients without preoperative steroid (Group A) and 39 patients with preoperative steroid for a median of 7 days (Group B: 34 patients with oral prednisolone (0.5-1 mg/kg/day) and 5 patients with 20 or 40 mg of subtenon triamcinolone). The total retinal reattachment rate at 3 months after one operation was not different between the two groups (59 vs 51%) with adjustment for confounders. The proportion of patients with visual acuity (VA) improvement at 3 months was also not different (57 vs 54%). Survival analysis revealed that 96% of redetachment cases occurred within the first 3 months and redetachment rate was not different between the two groups for up to 3 years. However, Group B showed a significant regression (partial or complete) of CD prior to operation compared to Group A (82 vs 30%, P<0.001).ConclusionPreoperative steroid significantly improved CD before vitrectomy, but seemed not to improve the single-operation retinal reattachment rate or VA at 3 months when compared to no steroid treatment in RRD-CD patients.
Collapse
|