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Kazan AS, Mahmoudzadeh R, Salabati M, Sharpe J, Fineman MS, Hsu J, Yonekawa Y, Spirn MJ. Indications and Outcomes of Laser Retinopexy in Eyes With High-Risk Lattice Degeneration. JOURNAL OF VITREORETINAL DISEASES 2024; 8:381-387. [PMID: 39148566 PMCID: PMC11323511 DOI: 10.1177/24741264241248253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Purpose: To examine the characteristics of eyes with high-risk lattice degeneration treated with laser retinopexy and determine the indications, safety, and outcomes of the treatment. Methods: This interventional single-surgeon consecutive retrospective study was conducted at Wills Eye Hospital between 2014 and 2021. The series included eyes with lattice degeneration with high-risk lesions. Documented characteristics and outcomes of these eyes and fellow eyes were documented. Results: The study comprised 167 eyes of 143 patients (53.3% women; mean age [±SD], 50 ± 17 years). Complications after laser treatment included new posterior vitreous detachment (PVD) (n = 21), epiretinal membrane (ERM) (n = 13), retinal detachment (RD) (n = 5), and additional laser required (n = 22). Eyes that developed ERMs were more likely to develop PVDs (odds ratio, 5.39; 95% CI, 1.57-18.47). Patents who developed ERMs were older (mean, 60 ± 7 years vs 49 ± 17 years; P = .016), as were those developing PVDs (mean, 59 ± 8 years vs 48 ± 17; P = .005). No eye with a new ERM required surgery (n = 13). Four eyes with a new RD required laser retinopexy alone; 1 eye was treated surgically. No eye had an RD at the most recent evaluation. Conclusions: Despite high-risk lesions in areas of lattice degeneration, few eyes developed RDs after prophylactic laser retinopexy. Older patients may have a higher risk for ERM or PVD after laser treatment. Eyes with post-laser PVD were more likely to develop an ERM.
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Affiliation(s)
- Adina S. Kazan
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Raziyeh Mahmoudzadeh
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - James Sharpe
- Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Mitchell S. Fineman
- 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
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc J. Spirn
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
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Liu J, Zhang Q, Zhao P. AN EIGHT-YEAR RETROSPECTIVE STUDY OF THE ETIOLOGIES, CLINICAL CHARACTERISTICS, AND VISUAL OUTCOMES OF PEDIATRIC LAMELLAR MACULAR HOLE. Retina 2023; 43:2010-2018. [PMID: 37870909 DOI: 10.1097/iae.0000000000003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE To explore the etiologies, characteristics, and prognosis of lamellar macular hole (LMH) in pediatric patients. METHODS A consecutive series of 59 patients (62 eyes) aged <16 years with MHs (lamellar and full-thickness) treated from 2013 to 2021 in a tertiary center was reviewed. Data collected included demographic and clinical characteristics, management, and outcomes of patients presenting with LMH. RESULTS Twelve eyes (19.4%) of 11 children had LMH. Seven patients were male, with an average age of 6.9 years. The primary pathologies included X-linked retinoschisis in six eyes (50%); familial exudative vitreoretinopathy in two (16.7%); and ocular toxocariasis, Coats disease, persistent hyperplastic primary vitreous, and idiopathic LMH with associated lenticonus in one eye (8.3%) each. Four eyes (36.4%) showed tractional appearance and seven (63.6%) degenerative. All degenerative LMH showed ellipsoidal zone defect, significantly higher than that in the tractional group (25%, 1/4) ( P = 0.024). Five eyes achieved closed LMH and limited visual gain, four underwent surgery, and one closed spontaneously. CONCLUSION X-linked retinoschisis was the most frequent primary cause in pediatric LMH. Two types of LMH can be classified: tractional and degenerative. The latter showed a higher rate of ellipsoidal zone defect. Vision improved after LMH closed, regardless of surgery or spontaneous closure.
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Affiliation(s)
- Jingjing Liu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Johari M, Khani S, Amini A, Bolkheir A. Effect of peripheral laser photocoagulation retinopexy on macular morphology and optic nerve fiber layer thickness; a prospective case series. BMC Ophthalmol 2022; 22:453. [PMID: 36434550 PMCID: PMC9700918 DOI: 10.1186/s12886-022-02681-8] [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: 04/24/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral laser photocoagulation retinopexy. METHODS Patients with retinal breaks, retinal holes, retinal dialysis, and lattice degenerations who required peripheral laser photocoagulation retinopexy were recruited in this prospective case series investigation. We performed preoperative and postoperative evaluations, including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) measurement, funduscopic examination, and macular and ONH optical coherence tomography (OCT). RESULTS Thirty-three eyes of the twenty-three patients enrolled in this study, 14 of which were female. The mean age of the sample was 45.12 ± 9.12 years. The mean refractive error was - 2.45 ± 1.12 Diopters (D). The most prevalent reason for peripheral laser photocoagulation retinopexy was retinal thinning with symptomatic lattice degeneration (90%), followed by retinal hole and break (7%) and retinal dialysis (3%). Between preoperative and postoperative (6-month) evaluation, there was no statistically significant difference in BCVA (P = 0.82), IOP (P = 0.54), central foveal thickness in macular OCT (P = 0.39), or global retinal nerve fiber layer (RNFL) thickness (P = 0.51). There was no association between changes in central foveal thickness and global RNFL thickness and total laser spot numbers (r = - 0.17 P = 0.21, r = 0.06 P = 0.60, respectively). None of patients developed cystoid macular edema (CME) or macular epiretinal membrane (ERM) . CONCLUSION We found that OCT parameters were not significantly affected by laser retinopexy in patients with high-risk peripheral retinal lesions, also none of our patients had developed ERM, vitromacular traction or CME at 6 months follow up periods.
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Affiliation(s)
- Mohammadkarim Johari
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salman Khani
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdulrahim Amini
- grid.412237.10000 0004 0385 452XHormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Alireza Bolkheir
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Moussa G, Samia-Aly E, Ch’ng SW, Lett KS, Mitra A, Tyagi AK, Sharma A, Andreatta W. Primary retinopexy in preventing retinal detachment in a tertiary eye hospital: a study of 1157 eyes. Eye (Lond) 2022; 36:1080-1085. [PMID: 34035492 PMCID: PMC9046430 DOI: 10.1038/s41433-021-01581-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Retinopexy is the most common vitreo-retinal procedure performed in the eye emergency department and significantly reduces the risk of a rhegmatogenous retinal detachment (RRD). There are various indications for retinopexy, with the most common being horseshoe-tears (HST). Multiple treatment techniques exist, ranging from slit-lamp laser-retinopexy, indirect laser-retinopexy or cryopexy. We report on our primary retinopexy 6-month RRD rate, repeat retinopexy rate and compare outcomes of different indications and treatment modalities. METHODS Retrospective consecutive case series of 1157 patients attending Birmingham and Midlands Eye Centre, UK between January 2017 and 2020. RESULTS The RRD rate at 6 months was 3.9%, with 19.1% requiring subsequent retinopexies. Multivariate Cox survival regression analysis showed that significant risk factors for RRD following primary retinopexy included male gender (p = 0.012), high myopia (≤ - 6.00D, p = 0.004), HST (compared to round holes, p = 0.026) and primary cryopexy (compared to slit-lamp laser, p = 0.014). HST was the most common indication for retinopexy (812 [70.2%]) in which 118 (14.5%) had multiple tears. Slit-lamp laser was used in 883 (76.3%) of cases. The rate for subsequent epiretinal membrane peel surgery was 3 (0.3%) and was higher in eyes that required multiple retinopexy procedures (p = 0.035). CONCLUSION With our large cohort of patients over three years, we provide additional evidence on the RRD and subsequent retinopexy rate after primary retinopexy. Further retinopexy is a common occurrence, particularly in high-risk retinal tears such as HST. Strict monitoring and prompt follow-up after retinopexy is important to prevent progression to RRD and should be of priority in the clinicians post-retinopexy management plan, particularly in those with associated risk factors.
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Affiliation(s)
- George Moussa
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emma Samia-Aly
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Soon Wai Ch’ng
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Kim Son Lett
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Arijit Mitra
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ajai K. Tyagi
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ash Sharma
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Walter Andreatta
- grid.412919.6Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK ,grid.452288.10000 0001 0697 1703Kantonsspital Winterthur, Winterthur, Switzerland
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Lee SJ, Oh JH. Incidence and Risk Factors of Epiretinal Membrane Following Acute Posterior Vitreous Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schuster AK, Kluck A, Korb CA, Stoffelns B, Nickels S, Schulz A, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Peto T, Pfeiffer N. Characteristics and pathologies of the vitreo-macular interface-results from the Gutenberg Health Study. Acta Ophthalmol 2020; 98:e273-e281. [PMID: 31680456 DOI: 10.1111/aos.14285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to determine the prevalence of characteristics and pathologies of the vitreo-macular interface within the general population. METHODS The Gutenberg Health Study is a population-based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo-macular interface were graded on volume scans including visibility of an epiretinal membrane, full-thickness macular hole, lamellar hole and pseudohole. Overall and age-specific prevalences including 95% confidence intervals [95%-CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression. RESULTS A total of 1890 people aged 40-80 years were included in the study. Of these, 4.7% (95%-CI: 3.8%-5.8%) had an epiretinal membrane in at least one eye, 0.1% a full-thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure. CONCLUSIONS Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy.
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Affiliation(s)
| | - Anne‐Kristin Kluck
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Christina A. Korb
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Bernhard Stoffelns
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Stefan Nickels
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Thomas Münzel
- Center for Cardiology I University Medical Center Mainz Mainz Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- DZHK (German Center for Cardiovascular Research), partner site Rhine‐Main Mainz Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy University Medical Center Mainz Mainz Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine University Medical Center Mainz Mainz Germany
| | - Tunde Peto
- Centre for Public Health Queen's University Belfast Northern Ireland UK
| | - Norbert Pfeiffer
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
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Ajlan R, Shaath D, Gilbert M. Cryotherapy and Pneumatic Retinopexy in Schisis-Related Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2019; 50:791-794. [DOI: 10.3928/23258160-20191119-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P146-P181. [PMID: 31757500 DOI: 10.1016/j.ophtha.2019.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Adeniran JF, Duff SM, Mimouni M, Lambert N, Ramasubramanian A. Treatment of Coats' disease: an analysis of pooled results. Int J Ophthalmol 2019; 12:668-674. [PMID: 31024824 DOI: 10.18240/ijo.2019.04.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/18/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To elucidate the association of treatment modality to vitreoretinal fibrosis and traction retinal detachment (TRD) in Coats' disease. METHODS A PubMed search for Coats' disease with included studies describing eyes with clinical features and treatment course of Coats' disease. Binary logistic regression with fibrosis at presentation and treatment type as independent variables was performed to determine predictors of TRD historically (since 1921) and in the anti-vascular endothelial growth factor (VEGF) era (since 2007). Odds ratios (OR) with 95% confidence intervals (CI) reported. RESULTS Of 175 articles described 1183 eyes. Vitreoretinal fibrosis increased from presentation (5.4%) to follow-up (15.5%) and TRD increased from 0.44% to 3.9% at follow up. Laser was protective against vitreoretinal fibrosis (OR 0.6, 95%CI 0.4-0.9) but TRD was borderline (OR 0.6, 95%CI 0.3-1.1). Cryotherapy showed a higher association with TRD (OR 1.9, 95%CI 1.0-3.7) than with vitreoretinal fibrosis (OR 0.8, 95%CI 0.5-1.2). Similarly, intravitreal anti-VEGF alone was not associated with fibrosis (OR 1.1, 95%CI 0.6-1.8) nor TRD (OR 1.1, 95%CI 0.5-2.6) but the combination of laser and anti-VEGF therapy was protective [Fibrosis: 0.1 (0.03, 0.35); TRD: 0.05 (0.01, 0.23)] compared to anti-VEGF plus cryotherapy (P<0.001). Disease stage ≤2B or ≥3A was not associated with TRD. CONCLUSION Vitreoretinal fibrosis and TRD increase after treatment in Coats' disease. The combination of anti-VEGF agents and cryotherapy may lead to higher risk for TRD. Presence of pre-treatment fibrosis is the highest risk factor for post-treatment worsening of vitreoretinal fibrosis and TRD.
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Affiliation(s)
- Janelle Fassbender Adeniran
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Sarah M Duff
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | | | | | - Aparna Ramasubramanian
- Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Abstract
PURPOSE To report rates and timing of retreatments, new break formation, and vitreoretinal surgical intervention after initial treatment of retinal breaks, and to identify factors associated with increased rates of additional vitreoretinal interventions. METHODS Retrospective, consecutive case series of all patients who were diagnosed with a retinal break and underwent laser retinopexy for prophylaxis of retinal detachment at the Bascom Palmer Eye Institute, Miami, FL, from 2013 through 2016 were reviewed. The main outcome measure was if additional laser treatment or vitreoretinal surgical procedure was performed after the initial laser retinopexy. RESULTS Additional laser retinopexy was performed in 75 (18.7%) of 401 study eyes over 113 sessions: 58 (51.3%) sessions to retreat the original tear and 55 (48.7%) to treat a new tear. Vitreoretinal surgery for retinal detachment after the initial laser retinopexy was performed in 23 (5.7%) eyes. Risk factors associated with vitreoretinal surgery after initial laser treatment included superotemporal location (OR = 3.62; p = 0.008), vitreous hemorrhage (OR = 2.62; p = 0.017), and multiple breaks (OR = 2.60; p = 0.014). CONCLUSIONS Additional treatment is often performed after the initial treatment of a retinal break. Although progression to retinal detachment is not common, regular follow-up examinations are recommended.
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11
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Quezada C, Pieramici DJ, Matsui R, Rabena M, Graue F. Demarcation laser photocoagulation induced retinal necrosis and rupture resulting in large retinal tear formation. Photodiagnosis Photodyn Ther 2015; 12:314-6. [PMID: 25770055 DOI: 10.1016/j.pdpdt.2015.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
Retinal tears after laser photocoagulation are a rare complication that occurs after intense laser. It is talked about among retina specialist occurring particularly at the end of a surgical case while applying endophotocoagulation; to the best our knowledge, there are no reports in the literature of a large retinal tear induced after attempted in-office demarcation laser photocoagulation (DLP) that simulated a giant retinal tear. DLP has been employed in the management of selected cases of macula sparring rhegmatogenous retinal detachment (RRD). Even though extension of the retinal detachment through the "laser barrier" is considered a failure of treatment, few complications have been described with the use of this less invasive retinal detachment repair technique. We describe a case of a high myopic woman who initially was treated with demarcation laser photocoagulation for an asymptomatic retinal detachment associated with a single horseshoe tear and a full thickness large retinal tear was created where the laser was placed. Intense laser photocoagulation resulted in abrupt laser induced retinal necrosis and rupture creating this large retinal break. Proper laser technique should reduce the risks associated with this procedure.
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Affiliation(s)
- Carlos Quezada
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States; Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico.
| | - Dante J Pieramici
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States
| | - Rodrigo Matsui
- Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico
| | - Melvin Rabena
- California Retina Consultants and Research Foundation, Santa Barbara, CA, United States
| | - Federico Graue
- Instituto de Oftalmología "Fundación Conde de Valenciana", Mexico City, Mexico
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12
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Abouammoh MA, Belliveau MJ, Almeida DRP, Gale JS, Sharma S. Ranibizumab for idiopathic epiretinal membranes: A retrospective case series. Saudi J Ophthalmol 2013; 27:79-82. [PMID: 24227966 DOI: 10.1016/j.sjopt.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/28/2012] [Accepted: 01/01/2013] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study the effect of intravitreal ranibizumab on idiopathic epiretinal membranes (ERMs). METHODS A retrospective cohort study on a consecutive series of ranibizumab intravitreal injections for epiretinal membranes was performed. Four cases were identified by reviewing a claims database linked to electronic medical records. All patients received a total of three 0.05 mg/0.05 ml ranibizumab intravitreal injections at a monthly interval. The primary outcome measure was the final best-corrected visual acuity (BCVA) at the end of the injection series, and the final central macular thickness (CMT). RESULTS All four patients completed 3 months follow-up after the last ranibizumab injection. The mean baseline CMT was 509 microns (SD = 111). A trend was noticed for reduction in CMT (Δ = 41 microns) P = 0.08. Three patients improved by one line in their BCVA. The remaining patient maintained the same BCVA. No complications were noted. CONCLUSION In this study, intravitreal injection of ranibizumab marginally reduced retinal thickness in four patients with minimal improvement in visual acuity. No safety concerns were noticed. Further basic science and clinical studies may be warranted to assess the role of vascular endothelial growth factor and the effect of ranibizumab on idiopathic epiretinal membranes.
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Affiliation(s)
- Marwan A Abouammoh
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Department of Ophthalmology, Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada
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14
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Levin M, Naseri A, Stewart JM. Resident-Performed Prophylactic Retinopexy and the Risk of Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2009; 40:120-6. [DOI: 10.3928/15428877-20090301-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chan CK, Lin SG, Nuthi ASD, Salib DM. Pneumatic retinopexy for the repair of retinal detachments: a comprehensive review (1986-2007). Surv Ophthalmol 2008; 53:443-78. [PMID: 18929759 DOI: 10.1016/j.survophthal.2008.06.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pneumatic retinopexy has become an important surgical technique in the modern era of retinal surgical management for retinal detachments. It is primarily indicated for uncomplicated retinal detachments with retinal breaks involving the superior 8 clock hours of the fundus, although more complex retinal detachments may be successfully managed with this technique on a selected basis. Qualified candidates must be willing to maintain a specific head posture for five or more days for optimal outcome with pneumatic retinopexy. Basic surgical steps of pneumatic retinopexy include retinopexy of retinal breaks with cryotherapy or laser, intraocular gas injection before or after retinopexy, and maintenance of proper head posture by the patient for the required time period after surgery. Phakic eyes fared better than nonphakic eyes for pneumatic retinopexy, with the single-operation successes of 71-84% for the former and 41-67% for the latter. Despite lower single-operation successes with pneumatic retinopexy in comparison to sclera buckling, the multicenter pneumatic retinopexy trial and other published reports have shown that the final anatomical and visual outcomes are not disadvantaged by the initial pneumatic retinopexy. An extensive discussion of complications associated with pneumatic retinopexy is presented. In addition, a key feature of this review is a comprehensive update in the outcome of pneumatic retinopexy in published reports from 1986 to the present in chronological order not available in the current literature. This comprehensive summary shows updated average surgical outcomes for the 4,138 eyes in the 21-year period to be similar to previous reports: single-operation successes (74.4%), final operation successes (96.1%), new retinal breaks (11.7%), and proliferative vitreoretinopathy (5.2%).
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Affiliation(s)
- Clement K Chan
- Southern California Desert Retina Consultants, Palm Springs, California, USA
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Wallentén KG, Malmsjö M, Andréasson S, Wackenfors A, Johansson K, Ghosh F. Retinal function and PKC alpha expression after focal laser photocoagulation. Graefes Arch Clin Exp Ophthalmol 2007; 245:1815-24. [PMID: 17639452 DOI: 10.1007/s00417-007-0646-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 06/18/2007] [Accepted: 06/23/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To examine the effects of focal laser photocoagulation on general and local retinal function and to relate electrophysiological findings with changes in protein kinase C (PKC) alpha expression. METHODS Twelve rabbits were treated with 70 spots of laser photocoagulation in the central cone-rich retina. The operated eyes were investigated with electroretinography (full-field ERG and multifocal electroretinography, mfERG) preoperatively and at 1, 3, and 5 weeks after surgery. The expression of PKC alpha was examined at all three time points using immunohistochemistry, and PKC alpha mRNA levels were quantified using real-time polymerase chain reaction (PCR). Immunohistochemistry for glial fibrillary acidic protein (GFAP) and hematoxylin and eosin staining was employed to monitor the extent and dynamics of the morphological response. RESULTS The full-field ERG revealed a significant increase in b-wave amplitudes derived from the isolated rod response (blue light) at all three time points after surgery (p < 0.05). Supernormal b-wave amplitudes were also found for the combined rod-cone response at 3 weeks (white light), and for the isolated cone response (light-adapted 30-Hz flicker) at 5 weeks after treatment. In the mfERG, amplitudes derived from the central retina did not change postoperatively, while the implicit time was significantly increased at all time points. Immunohistochemistry for PKC alpha revealed a reduced expression of the enzyme in rod bipolar cells 1 and 3 weeks after laser treatment compared with untreated controls. Five weeks postoperatively, no PKC alpha labeling in rod bipolar cells was found in any part of the retina. Real-time PCR 1 and 3 weeks after treatment displayed a decreased level of PKC alpha mRNA compared to the controls. Immunolabeled tissue sections from laser-treated eyes displayed GFAP expression in Müller cells in the treated as well as untreated retina 1 week postoperatively. At 3 and 5 weeks, GFAP labeling was less pronounced and was concentrated around the laser-treated spots. CONCLUSIONS Focal laser treatment in the rabbit eye induces local and wide-spread alterations in both rod- and cone-mediated retinal function in the form of supernormal b-wave amplitudes in the full-field ERG and increased latency in the mfERG. The electrophysiological abnormalities are accompanied by a progressive down-regulation of the PKC alpha isoenzyme in rod bipolar cells, reaching far beyond the treated area. PKC alpha is down-regulated directly by impaired protein synthesis, and also possibly indirectly by protein consumption related to GFAP up-regulation. The results indicate that focal laser photocoagulation interferes with PKC-alpha-mediated inhibitory regulation of inner retinal signal transmission.
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Prevention of Retinal Detachment. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vitrektomie und Membrane Peeling epiretinaler Gliosen nach konservativer Amotiochirurgie. SPEKTRUM DER AUGENHEILKUNDE 2001. [DOI: 10.1007/bf03162890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mittra RA, Mieler WF. Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol 1999; 44:215-25. [PMID: 10588440 DOI: 10.1016/s0039-6257(99)00104-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are numerous unresolved issues and controversies regarding the management of open-globe injuries involving the posterior segment. These areas include, but are not limited to, the following issues. Although vitrectomy has been shown to improve visual outcomes and allow retention of the eye in many cases, the extent of visual improvement is often limited because of the nature of the injury. Timing of vitrectomy surgery has been and will continue to be debated by proponents of early versus delayed intervention. The multiple features of acute ocular injury make it very difficult to interpret retrospective data regarding the most appropriate timing for surgical intervention. The use of prophylactic cryotherapy, in the setting of a scleral laceration with possible retinal damage, is not as controversial at present, as there is now sufficient data indicating that cryotherapy may actually exacerbate intraocular proliferation and worsen the situation. The role and benefit of a prophylactic scleral buckle is very widely contested, and it is not known if it truly decreases the risk of subsequent retinal detachment. Another area of debate centers on the use of antibiotics. When there is a known clinical infection, intravitreal antibiotics are the mainstays of therapy. However, in the absence of clinical infection, the use of prophylactic antibiotics and their routes of administration are quite controversial. Although there are significant data regarding the use of antibiotics in the postoperative setting, this information cannot be extrapolated into the setting of open-globe injuries, as organisms and virulence factors differ. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved, although vitrectomy is used in most cases to repair concurrent damage from the injury itself. Finally, the placement of intraocular lenses in the acute trauma setting is controversial, as the risk of complications is quite high. Prospective, controlled clinical studies have not been done. This article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.
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Affiliation(s)
- R A Mittra
- Retina Associates of Cleveland, Ohio, USA
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Baumal CR, Shields CL, Shields JA, Tasman WS. Surgical repair of rhegmatogenous retinal detachment after treatment for retinoblastoma. Ophthalmology 1998; 105:2134-9. [PMID: 9818618 DOI: 10.1016/s0161-6420(98)91139-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the causes of rhegmatogenous retinal detachment in children with retinoblastoma and to assess the surgical approach and results of retinal reattachment surgery. DESIGN The study design was a retrospective review of all children in whom a rhegmatogenous retinal detachment developed after treatment for retinoblastoma over a 20-year period. PARTICIPANTS Nine children, 5 to 33 months of age, participated. MAIN OUTCOME MEASURES Assessment of the treatment methods for retinoblastoma, apparent cause of the rhegmatogenous retinal detachment, interval from the most recent retinoblastoma treatment until repair of the rhegmatogenous retinal detachment, method of surgical repair, and long-term anatomic and visual results were measured. RESULTS Rhegmatogenous retinal detachment was diagnosed in nine eyes of nine children with treated retinoblastoma. Prior treatment of retinoblastoma included cryotherapy (n = 5), laser photocoagulation (n = 1), external beam radiation therapy (n = 7), and systemic chemotherapy (n = 4). An atrophic retinal hole was present at the most recent site of cryotherapy in three eyes and of laser photocoagulation in one eye. Extreme retinal thinning with a possible retinal break was noted in two eyes at a cryotherapy site. A dialysis was noted in one eye, and a retinal break could not be detected in two eyes. Treatment of retinoblastoma tumors was performed between 1 week and 15 years before retinal reattachment surgery. The retinal detachment was repaired externally with a scleral buckling procedure in seven eyes, with subretinal fluid drainage in five eyes, and without drainage in two eyes. Cytologic evaluation of subretinal fluid was performed in three eyes and showed no tumor cells. The retinal detachment was repaired by pars plana vitrectomy in one eye, and the vitrectomy specimen showed no tumor cells. In one child, the retinal detachment was not repaired. The retina remained attached after surgery in five eyes with follow-up ranging from 5 to 115 months. In three eyes, retinal redetachment associated with recurrent viable intraocular retinoblastoma was noted after surgery, necessitating enucleation. In no case was orbital or metastatic retinoblastoma detected at follow-up. CONCLUSIONS Rhegmatogenous retinal detachment in children with treated retinoblastoma generally originates from an atrophic retinal hole at the site of prior cryotherapy or laser photocoagulation. If there appears to be complete regression of the intraocular tumor after treatment, surgical repair of the rhegmatogenous retinal detachment may be approached cautiously.
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Affiliation(s)
- C R Baumal
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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