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Momenaei B, Wakabayashi T, Kazan AS, Oh GJ, Kozarsky S, Vander JF, Gupta OP, Yonekawa Y, Hsu J. Incidence and Outcomes of Recurrent Retinal Detachment after Cataract Surgery in Eyes with Prior Retinal Detachment Repair. Ophthalmol Retina 2024; 8:447-455. [PMID: 37989465 DOI: 10.1016/j.oret.2023.11.005] [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: 10/07/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To investigate the incidence and outcomes of recurrent retinal detachment (RD) after cataract extraction (CE). DESIGN Retrospective case series. SUBJECTS Phakic eyes with RD that were successfully repaired with pneumatic retinopexy (PR), scleral buckle (SB), pars plana vitrectomy (PPV), or combined PPV/SB and subsequently underwent cataract surgery. METHODS A retrospective review of phakic eyes that underwent successful RD repair followed by subsequent cataract surgery between April 2012 and January 2023 was performed. Patients with multiple RD surgeries before CE and those with silicone oil tamponade before cataract surgery were excluded. Eyes that redetached were matched 1:2 with eyes that did not redetach after cataract surgery. MAIN OUTCOME MEASURES Incidence of redetachment after cataract surgery as well as visual and anatomic outcomes at 6 months after first redetachment and at the final visit. RESULTS Of 4833 phakic eyes at the time of initial RD, 1893 patients (39.2%) underwent cataract surgery. After applying exclusion criteria, 763 patients were included. The mean (standard deviation) duration of follow-up was 48.4 (29.1) months. The overall incidence of retinal redetachment after cataract surgery was 2.5% (19/763 eyes). The rate of redetachment based on the type of initial RD repair was 9.1% (1/11), 5.3% (2/38), 2.8% (9/317), and 1.8% (7/397) for PR, SB, PPV, and combined PPV/SB, respectively (P = 0.24). The median (interquartile range [IQR]; range) duration between the cataract surgery and first redetachment was 301 (104-1222; 8-2760) days. Single surgery anatomic success for the RD repair after cataract surgery was achieved in 17 eyes (89.5%) at 3 months and 14 eyes (73.7%) at 6 months and at the final visit. Final anatomic success rate for reattachment was 100% (19/19). The median (IQR) logarithm of the minimal angle of resolution visual acuity (VA) at the final visit was 1.00 (0.18-2.00, Snellen equivalent, 20/200) with significant worsening compared with vision after cataract surgery (0.18 [0.10-0.48], 20/30) (P = 0.001). CONCLUSION Recurrent RD was not uncommon in patients with a prior history of RD repair after CE. Reoperation resulted in relatively favorable anatomic success but there were declines in VA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Bita Momenaei
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Taku Wakabayashi
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Adina S Kazan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Glenn J Oh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott Kozarsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James F Vander
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omesh P Gupta
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Gietzelt C, Hoerster R, Schiller P, Hermann S, Kraus D, Holz FG, Guthoff R, Agostini H, Spitzer MS, Wiedemann P, Lommatzsch A, Boden KT, Bartz-Schmidt U, Bemme S, Tamm S, Maier M, Roider J, Kirchhof B, Fauser S, Schaub F. LASER FLARE PHOTOMETRY IN PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: An Evaluation of 2,487 Cases. Retina 2024; 44:764-773. [PMID: 38181515 DOI: 10.1097/iae.0000000000004026] [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: 01/07/2024]
Abstract
PURPOSE Exploratory analysis associated with the prospective, multicenter, randomized PRIVENT trial. To characterize the associations between laser flare photometry and anatomical and epidemiological features of rhegmatogenous retinal detachment (RRD). METHODS The authors measured laser flare values of all 3,048 prescreened patients excluding those with comorbidities. A mixed regression analysis evaluated the strength of the influencing factors like age, sex, lens status, and presence and extent of RRD on laser flare. RESULTS Rhegmatogenous retinal detachment was more frequent in men (65.8%) than in women (34.2%, P < 0.001) and in right (52%) than in left eyes (48%, P = 0.045). Phakic RRD affected less quadrants and was less likely to be associated with macula-off status than pseudophakic RRD (48.4% vs. 58.0% macula off, 23% vs. 31% ≥3 quadrants, P < 0.001). Laser flare of affected eyes was significantly higher compared with fellow eyes (12.6 ± 15.2 vs. 8.3 ± 7.4 pc/ms, P < 0.001). The factors age, sex, lens status, presence of RRD, and the number of quadrants affected were independent influencing factors on laser flare. R 2 was 0.145 for phakic and 0.094 for pseudophakic eyes. CONCLUSION The results indicate that there may be more factors affecting laser flare than previously assumed. This might limit flare as predictive value for PVR and retinal redetachment.
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Affiliation(s)
- Caroline Gietzelt
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert Hoerster
- MVZ Augenärztliches Diagnostik- und Therapiecentrum (ADTC) Mönchengladbach/Erkelenz GmbH, Erkelenz, Germany
| | - Petra Schiller
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Saskia Hermann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daria Kraus
- Clinical Trials Center Cologne (CTCC), Cologne, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Rainer Guthoff
- Department of Ophthalmology, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Faculty, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wiedemann
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
| | | | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | | | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Svenja Tamm
- Department of Ophthalmology, University of Regensburg, Regensburg, Germany
| | - Mathias Maier
- Department of Ophthalmology, Technical University Munich (TUM), Munich, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, Kiel, Germany
| | - Bernd Kirchhof
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Friederike Schaub
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Ophthalmology, University Medical Center Rostock, Rostock, Germany
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Fung TH, Yim TW, Lois N, Wright DM, Liu SH, Williamson T. Face-down positioning or posturing after pars plana vitrectomy for macula-involving rhegmatogenous retinal detachments. Cochrane Database Syst Rev 2024; 3:CD015514. [PMID: 38488250 PMCID: PMC10941635 DOI: 10.1002/14651858.cd015514.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND A macula-involving rhegmatogenous retinal detachment (RRD) is one of the most common ophthalmic surgical emergencies and causes significant visual morbidity. Pars plana vitrectomy (PPV) with gas tamponade is often performed to repair primary macula-involving RRDs with a high rate of anatomical retinal reattachment. It has been advocated by some ophthalmologists that face-down positioning after PPV and gas tamponade helps reduce postoperative retinal displacement. Retinal displacement can cause metamorphopsia and binocular diplopia. OBJECTIVES The primary objective of this review is to determine whether face-down positioning reduces the risk of retinal displacement following PPV and gas tamponade for primary macula-involving RRDs. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 11), MEDLINE (January 1946 to 28 November 2022), Embase.com (January 1947 to 28 November 2022), PubMed (1948 to 28 November 2022), Latin American and Caribbean Health Sciences Literature database (1982 to 28 November 2022), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We did not use any date or language restrictions in the electronic search. We last searched the electronic databases on 28 November 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in which face-down positioning was compared with no positioning or another form of positioning following PPV and gas tamponade for primary macula-involving RRDs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE approach. MAIN RESULTS We identified three RCTs (369 eyes of 368 participants) that met the eligibility criteria. Two RCTs provided data on postoperative retinal displacement, one reported on postoperative distortion and quality of life outcomes, two on postoperative best-corrected visual acuity (BCVA) in logMAR, and two on postoperative ocular adverse events such as outer retinal folds. Study characteristics and risk of bias All the trials involved predominantly male participants (range: 68% to 72%). Only one trial provided race and ethnicity information, was registered on a trial registry, and reported funding sources. Using the RoB 2 tool, we assessed the risk of bias for proportion of eyes with retinal displacement, mean change in visual acuity, objective distortion scores, quality of life assessments, and ocular adverse events, with most domains judged to be at low risk of bias. Findings Immediate face-down positioning may result in a lower proportion of participants with postoperative retinal displacement compared with support-the-break positioning at six months (risk ratio [RR] 0.73, 95% confidence interval [CI] 0.54 to 0.99; 1 RCT; 239 eyes of 239 participants; very low certainty evidence). One study found no evidence of a difference in BCVA at three months when comparing postoperative face-up with face-down positioning with or without perfluorocarbon liquid (mean difference [MD] -0.03, 95% CI -0.09 to 0.02; I2 = 0; 56 eyes of 56 participants; very low certainty evidence). Immediate face-down positioning appears to have little to no effect on postoperative distortion scores at week 26 (MD 1.80, 95% CI -1.92 to 5.52; 1 RCT; 219 eyes of 219 participants; very low certainty evidence) and postoperative quality of life assessment scores at week 26 (MD -1.80, 95% CI -5.52 to 1.92; 1 RCT; 217 eyes of 217 participants; very low certainty evidence). Adverse events One study that enrolled 262 participants with macula-involving RRDs suggested that immediate face-down positioning after PPV and gas tamponade may reduce the ocular adverse event of postoperative outer retinal folds at six months (RR 0.39, 95% CI 0.17 to 0.90; 1 RCT; 262 eyes of 262 participants; very low certainty evidence) and binocular diplopia (RR 0.20, 95% CI 0.04 to 0.90; 1 RCT; 262 eyes of 262 participants; very low certainty evidence) compared with support-the-break positioning. Immediate face-down positioning may increase the ocular adverse event of elevated intraocular pressure compared with support-the-break positioning (RR 1.74, 95% CI 1.11 to 2.73; 1 RCT; 262 eyes of 262 participants; very low certainty evidence). Another study found no evidence of a difference in postoperative outer retinal folds when comparing face-down versus face-up positioning at one and three months (RR 1.00, 95% CI 0.50 to 2.02; RR 1.00, 95% CI 0.28 to 3.61; 1 RCT; 56 eyes of 56 participants; very low certainty evidence). No studies reported non-ocular adverse events. AUTHORS' CONCLUSIONS Very low certainty evidence suggests that immediate face-down positioning after PPV and gas tamponade may result in a reduction in postoperative retinal displacement, outer retinal folds, and binocular diplopia, but may increase the chance of postoperative raised intraocular pressure compared with support-the-break positioning at six months. We identified two ongoing trials that compare face-down positioning with face-up positioning following PPV and gas tamponade in participants with primary macula-involving RRDs, whose results may provide relevant evidence for our stated objectives. Future trials should be rigorously designed, and investigators should analyze outcome data appropriately and report adequate information to provide evidence of high certainty. Quality of life and patient preferences should be examined in addition to clinical and adverse event outcomes.
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Affiliation(s)
| | - Tsz Wing Yim
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - David M Wright
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Su-Hsun Liu
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Jung KI, Lee J, Shin DY, Park CK. Long-Term Intraocular Pressure Fluctuation and Epiretinal Membrane in Patients with Glaucoma or Glaucoma Suspect. J Clin Med 2024; 13:1138. [PMID: 38398451 PMCID: PMC10889118 DOI: 10.3390/jcm13041138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Background: A relationship between glaucoma and epiretinal membrane (ERM) has been suggested previously. We investigated the association between intraocular pressure (IOP) fluctuation and idiopathic ERM in patients with glaucoma or glaucoma suspect. Methods: Among patients with glaucoma or glaucoma suspect, data from 43 patients with ERM and 41 patients without ERM were reviewed and analyzed in this retrospective study. The long-term fluctuation of IOP was defined based on the standard deviation of IOP across all visits. Results: Patients with ERM were older and had a higher SD of IOP and a higher proportion of having a history of cataract surgery and greater macular thickness (p = 0.018, 0.049, 0.013, and <0.001, respectively). In multiple logistic regression analysis, the high-IOP-fluctuation group was associated with the presence of ERM (p = 0.047). Among patients with ERM, eyes with stage-3 or -4 ERM had worse visual field defects based on mean deviation than those with stage-1 or -2 ERM (p = 0.025). Conclusions: Long-term IOP fluctuation was associated with idiopathic ERM in patients with glaucoma or glaucoma suspect. Idiopathic ERM could serve as a biomarker for long-term IOP fluctuation in glaucoma patients, particularly in clinics where measuring long-term IOP fluctuation during the first visit is not feasible due to its time-consuming nature.
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Affiliation(s)
- Kyoung In Jung
- College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.I.J.); (J.L.); (D.Y.S.)
- Department of Ophthalmology, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
| | - Jiyun Lee
- College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.I.J.); (J.L.); (D.Y.S.)
- Department of Ophthalmology, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
| | - Da Young Shin
- College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.I.J.); (J.L.); (D.Y.S.)
- Department of Ophthalmology, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
| | - Chan Kee Park
- College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (K.I.J.); (J.L.); (D.Y.S.)
- Department of Ophthalmology, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
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Curran CD, Adams OE, Vagaggini T, Sodhi GS, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. PROPHYLACTIC TREATMENT OF LATTICE DEGENERATION IN FELLOW EYES AFTER REPAIR OF UNCOMPLICATED PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:63-70. [PMID: 37536462 DOI: 10.1097/iae.0000000000003908] [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: 08/05/2023]
Abstract
PURPOSE To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye. METHODS This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia. RESULTS Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts. CONCLUSION PTx of asymptomatic fellow eye LD reduced RT/RRD risk.
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Affiliation(s)
- Christian D Curran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Olufemi E Adams
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | | | - Mikayla J Baker
- University of Minnesota Medical School, Minneapolis, Minnesota; and
| | - Ananth Sastry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - David Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
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Morano MJ, Khan MA, Zhang Q, Halfpenny CP, Wisner DM, Sharpe J, Li A, Tomaiuolo M, Haller JA, Hyman L, Ho AC. Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis. OPHTHALMOLOGY SCIENCE 2023; 3:100314. [PMID: 37274012 PMCID: PMC10239011 DOI: 10.1016/j.xops.2023.100314] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023]
Abstract
Objective To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Design Retrospective cohort study. Participants Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017. Methods Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Main Outcome Measures Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Results Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99-3.32; P < 0.001 and 1.79; 95% CI, 1.70-1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74-9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52-2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82-11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06-2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4-1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15-1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14-1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39-46.49; P < 0.001). Conclusion In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - M. Ali Khan
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Colleen P. Halfpenny
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Douglas M. Wisner
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Sharpe
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alexander Li
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Maurizio Tomaiuolo
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Julia A. Haller
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen C. Ho
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - IRIS Registry Analytic Center Consortium
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
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Skevas C, Thiwa D, Bartz-Schmidt KU, Katz T, Spitzer M, Dimopoulos S. Pupillotonia after endolaser retinopexy during vitrectomy for retinal detachment: a prospective cohort study comparing circumferential and focal retinopexy. Br J Ophthalmol 2023; 107:1900-1906. [PMID: 36288913 DOI: 10.1136/bjo-2022-321640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine differences in postoperative pupil diameter in eyes that undergo pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with endolaser retinopexy (ELR), comparing 360° vs focal ELR. METHODS Patients with uncomplicated RRD who underwent PPV were prospectively analysed regarding the postoperative pupil diameter difference (PDD) between the affected eye and the partner eye. Group 1 underwent 360° ELR and group 2 received focal ELR. Postoperative vision and complications, including redetachment rate, macular oedema and epiretinal membrane formation, were also compared. RESULTS A total of 72 patients, 42 in group 1 and 30 in group 2, were analysed. PDD, as observed at 6 weeks, was significantly greater than the preoperative values in both groups 1 and 2. It increased by a mean of 1±1.11 mm in group 1 and by 0.5±0.78 in group 2. This initial increase in PDD receded over time, but remained statistically significant in both groups, even at 6 months. The top 20% of patients with the largest PDD change comprised 13 out of 15 eyes from group 1, which was a statistically significant overrepresentation (p=0.0435). CONCLUSIONS Moderate pupillotonia was induced post-ELR in vitrectomy and correlated to the extent of ELR. The pupillotonia effect of ELR was significantly less marked in pseudophakic eyes.
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Affiliation(s)
- Christos Skevas
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - David Thiwa
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Karl-Ulrich Bartz-Schmidt
- Department of Ophthalmology, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Toam Katz
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Martin Spitzer
- University Medical Center, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - Spyridon Dimopoulos
- Department of Ophthalmology, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
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Pujol J, Lamglait B, Vanore M, Rousseau C, Vergneau-Grosset C. A Post-Operative Follow-Up of an Endangered Saltwater Fish Lensectomy for Cataract Management in a Public Aquarium: A Case Series. Vet Sci 2023; 10:611. [PMID: 37888563 PMCID: PMC10611108 DOI: 10.3390/vetsci10100611] [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: 07/20/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Mature cataracts can be a life-threatening condition in fish as it may result in anorexia. Lens extraction has been previously described in fish, but the long-term outcome of this procedure has not been evaluated. Eleven captive-bred adult fish housed in a public aquarium presented with unilateral (n = 3/11) or bilateral (n = 8/11) mature cataracts. All cases belonged to three endangered fish populations: striped bass (Morone saxatilis) originating from the Saint Lawrence River and Atlantic and spotted wolffish (Anarhichas lupus and Anarhichas minor). Pre-operatively, fish presented with anorexia, dark discoloration, abnormal position in the water column, skin abrasions, and/or decreased body condition scores. A lensectomy was performed in eleven fish, including a bilateral procedure in four fish, corresponding to fifteen eyes. Follow-up examinations were performed one to two weeks and one year post surgery. The main complication was self-resolving: corneal edema was present in 67% of eyes, persistent after a week in 47% of eyes, and resolved thereafter. Post-operatively, 73% of fish resumed feeding and regained a good body condition score. Persistent visual impairment post-surgery associated with anorexia required euthanasia in three out of eleven cases. The median time of death was 336 days post surgery (range: 27-1439 days) and three cases were still alive 1334 to 1425 days after the lensectomy. This was considered a favorable outcome for these older individuals with concurrent diseases.
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Affiliation(s)
- Julie Pujol
- Département de Sciences Cliniques, Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada; (J.P.); (M.V.)
| | - Benjamin Lamglait
- Centre Québécois sur la Santé des Animaux Sauvages, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada;
| | - Maria Vanore
- Département de Sciences Cliniques, Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada; (J.P.); (M.V.)
| | | | - Claire Vergneau-Grosset
- Département de Sciences Cliniques, Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada; (J.P.); (M.V.)
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9
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Cristescu IE, Ivanova T, Moussa G, Ziaei H, Ferrara M, Lippera M, El-Faouri M, Patton N, Jasani KM, Dhawahir-Scala F, Jalil A. The impact of 360-laser barricade on outcomes of vitrectomy for pseudophakic retinal detachment; The Manchester Pseudophakic Retinal Detachment Study. Eye (Lond) 2023; 37:3221-3227. [PMID: 36949246 PMCID: PMC10564870 DOI: 10.1038/s41433-023-02495-y] [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: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE To investigate the anatomical and functional outcomes and specifically, the effect of 360-degree barrier-laser, in pars plana vitrectomy (PPV) for primary pseudophakic rhegmatogenous retinal detachment (PRD). METHODS We conducted a single-centre retrospective, continuous and comparative study on eyes that had undergone PPV with focal-retinopexy (laser or cryotherapy) versus 360-laser for PRD repair between 2011-2020 at a single tertiary vitreoretinal centre in the UK. Primary outcomes were single surgery anatomical success (SSAS) rate and final postoperative visual acuity (VA). Multivariable regression covariates for primary re-detachment included age, gender, onset-of-detachment, pre-operative VA, ocular co-morbidities, macula-status, majority inferior (vs superior) PRD, number-of-tears and PRD extent (in clock-hours), 360-laser barricade, and perfluorocarbon liquid (PFCL) use. For VA gain, primary re-detachment was added as a covariate. RESULTS We included 467 eyes with a mean follow-up of 388 (161) days. The SSAS was 444/467 (95.1%) overall, and 351/370 (94.9%) and 93/97 (95.9%) in focal-retinopexy and 360-laser groups, respectively (p = 0.798). Compared to the focal-retinopexy group, the 360-laser group had significantly worse post-operative VA but similar logMAR gain (p = 0.812). A multivariable binary logistic regression found that only PFCL use was linked with increased primary re-detachment (OR:5.32 [p = 0.048]) and 360-laser did not contribute to increased SSAS. A multivariable linear regression analysis showed that poor logMAR gain was significantly associated with better pre-operative logMAR, ocular co-morbidities, greater PRD extent, use of 360-laser and primary re-detachment. However, when excluding macula-off RD (n = 211), 360-laser was no longer significant (p = 0.088). CONCLUSIONS Prophylactic 360-laser does not seem to impact on SSAS and functional outcomes following PPV for primary PRD.
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Affiliation(s)
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Hadi Ziaei
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Myrta Lippera
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Muhannd El-Faouri
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
- The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Kirti M Jasani
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Assad Jalil
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK.
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10
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Thylefors J, Jakobsson G, Zetterberg M, Sheikh R. Visual Acuity Prior to Cataract Surgery and Risk of Retinal Detachment - A Population-Based Study. Clin Ophthalmol 2023; 17:1975-1980. [PMID: 37465271 PMCID: PMC10350414 DOI: 10.2147/opth.s410585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/19/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose To analyze preoperative visual acuity before cataract surgery regarding the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery. Methods The preoperative visual acuity in an observational cohort study of patients undergoing cataract surgery in Skåne, southern Sweden, during 2015-2017 was analyzed with data retrieved from the Swedish National Cataract Register. This was then cross-referenced with patients undergoing surgery for retinal detachment at the Skåne University Hospital in Lund from 2015 to 2020. The main outcome was the risk-benefit ratio of measuring preoperative visual acuity before cataract surgery and the risk of RRD. Results The mean visual acuity in the whole study group (N=58,624), expressed as LogMAR, was 0.40 ± 0.32 (SD). In the group with RRD (n=298), the mean visual acuity was 0.44 ± 0.36 (p=0.07). In the subgroups of RRD, those aged <60 years 0.49 ± 0.44 (p=0.07), aged <60 years and axial length (AL) >25 mm 0.42 ± 0.38 (p=0.68), and in those aged <60 years, AL >25 mm and male sex 0.44 ± 0.39 (p=0.53). However, there is considerable variations in visual acuity of the various groups and in the high-risk group with RRD aged <60 years with AL>25 mm, 15% had a visual acuity of 0.8 or better in the operated eye. Conclusion There must be strong indications for performing cataract surgery in those with a high risk of retinal detachment, and the patient must be given adequate information on the risk of retinal detachment.
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Affiliation(s)
- Joakim Thylefors
- Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Västra Götaland, Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Västra Götaland, Sweden
| | - Rafi Sheikh
- Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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11
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Choi S, Goduni L, Wald KJ. Clinical Outcomes of Symptomatic Horseshoe Tears After Laser Retinopexy. JOURNAL OF VITREORETINAL DISEASES 2023; 7:290-292. [PMID: 37927320 PMCID: PMC10621698 DOI: 10.1177/24741264231171822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To determine the clinical course of patients treated for acute symptomatic horseshoe retinal tears (HSTs). Methods: A retrospective chart review was performed of patients presenting between January 2014 and December 2021 with acute onset of floaters and/or flashes who were found to have horseshoe retinal tear HRT(s) without retinal detachment (RD). Patients were included if they had at least 3 months of follow-up. Exclusion criteria were a rhegmatogenous RD (RRD) at initial presentation, asymptomatic HST(s), operculated hole, atrophic hole, retinal dialysis, history of trauma, or previous retinal surgery. Charts were reviewed for subsequent new HST(s), progression to RRD, and development of epiretinal membrane (ERM). Characteristics, including age, sex, eye laterality, phakic status, high myopia, lattice degeneration, and vitreous hemorrhage (VH) at initial presentation, were also noted. The main outcome measures were the percentage and timing of subsequent new HST(s), progression to RRD, and development of ERM. Results: The study included 216 eyes (199 patients). The mean age was 60.4 years. Of the eyes, 27.3% had lattice degeneration and 6.5% high myopia. At presentation, 25.9% of eyes had a VH. Twenty-seven eyes (12.5%) experienced new tear(s); 63.0% occurred between 1 month and 3 months. Progression to RRD occurred in 15 eyes (6.9%); 53.3% occurred within 3 months. On multivariate logistic regression, VH was a significant risk factor (odds ratio, 6.48; P = .002) for progression to new HST(s) or RRD. Conclusions: Eyes treated for acute symptomatic HSTs require ongoing follow-up. Although new retinal tears and progression to RRD tends to occur within 3 months, these events can occur later.
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Affiliation(s)
- Stephanie Choi
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | | | - Kenneth J. Wald
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
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12
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Muni RH, Minaker SA, Mason RH, Popovic MM, Kertes PJ, Hillier RJ. Novel classification system for management of rhegmatogenous retinal detachment with minimally invasive detachment surgery: a network meta-analysis of randomized trials focused on patient-centred outcomes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:97-112. [PMID: 34798054 DOI: 10.1016/j.jcjo.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/25/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a novel classification system for primary rhegmatogenous retinal detachment (RRD) based on level 1 evidence assessing the functional outcomes of repair techniques with the goal of using a minimally invasive detachment surgery. METHODS A systematic review and network meta-analysis of randomized, controlled trials comparing pneumatic retinopexy (PnR), scleral buckle (SB), or pars plana vitrectomy (PPV) for RRD was conducted. Primary outcomes were best-corrected visual acuity (BCVA), metamorphopsia, and operative complications. A meta-analysis was performed with a random effects maximum likelihood model, with outcomes of standardized mean difference (SMD) or risk ratio (RR) and 95% confidence interval. Inclusion and exclusion criteria were assessed to inform a classification system. RESULTS Fourteen trials were included. RRDs were classified from categories 1-3 based on configuration (simple to complex). There was no significant difference in final BCVA between PnR and PPV (categories 1 and 2; SMD = -0.10, 95% CI -0.24 to 0.04), nor was a final BVCA difference found between SB and PPV (SMD = 0.01, 95% CI -0.05 to 0.08), combined SB + PPV and PPV (SMD = 0.02, 95% CI -0.08 to 0.12), or combined SB + PPV and SB (SMD = 0.01, 95% CI -0.11 to 0.12). SB had an elevated risk of choroidal detachment (RR = 5.17, 95% CI 1.68-15.97), hypotony (RR = 12.26, 95% CI 1.63-92.04), and strabismus or diplopia (RR = 5.86, 95% CI 1.04-32.91) compared with PPV but a lower risk of iatrogenic breaks (RR = 0.08, 95% CI 0.02-0.43). Vertical metamorphopsia scores were superior for PnR over PPV at 12 months (Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial, p = 0.026). CONCLUSION This novel classification system may be useful for future trials assessing morphologic categories of RRD in a systematic manner. Minimally invasive detachment surgery may allow for trials to focus on maximizing functional outcomes while minimizing morbidity.
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Affiliation(s)
- Rajeev H Muni
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON.
| | - Samuel A Minaker
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Ryan H Mason
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Marko M Popovic
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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13
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Srinivasan S. Pseudophakic retinal detachment: a ticking time bomb. J Cataract Refract Surg 2023; 49:225-226. [PMID: 36867469 DOI: 10.1097/j.jcrs.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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14
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Frederick GA, Bonilla-Escobar FJ, Acosta A, Candelo PC, Castro A. Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:663-669. [PMID: 36097149 DOI: 10.1016/j.oftale.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.
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Affiliation(s)
- G A Frederick
- Retina y Vítreo, Clínica de Oftalmología de Cali, Cali, Colombia.
| | - F J Bonilla-Escobar
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO, Servicio de Oftalmología, Universidad del Valleorg, Cali, Colombia; Grupo de investigación en Visión y Salud Ocular, VISOC, Servicio de Oftalmología, Universidad del Valle, Cali, Colombia; Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - A Acosta
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - P C Candelo
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - A Castro
- Retina y Vítreo, Clínica de Oftalmología de Cali, Cali, Colombia
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15
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Fung T, Lois N, Wright DM, Liu SH, Williamson T. Face‐down positioning or posturing after vitrectomy for macula‐involving rhegmatogenous retinal detachments. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9713859 DOI: 10.1002/14651858.cd015514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective of this review is to determine whether face‐down positioning reduces the risk of retinal displacement following pars plana vitrectomy (PPV) and gas tamponade for macula‐involving rhegmatogenous retinal detachment (RRD).
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Affiliation(s)
| | | | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental MedicineQueen's UniversityBelfastUK
| | - David M Wright
- Wellcome-Wolfson Institute for Experimental MedicineQueen's UniversityBelfastUK
| | - Su-Hsun Liu
- Department of OphthalmologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA,Department of EpidemiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
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16
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Thylefors J, Jakobsson G, Zetterberg M, Sheikh R. Retinal detachment after cataract surgery: a population-based study. Acta Ophthalmol 2022; 100:e1595-e1599. [PMID: 35338568 PMCID: PMC9790371 DOI: 10.1111/aos.15142] [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: 10/28/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To analyse the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery, and to identify possible risk factors. METHOD Observational cohort study of patients undergoing cataract surgery in Region Skåne, southern Sweden, during 2015-2017 were retrieved from the Swedish National Cataract Register. These were then cross-referenced with cases of retinal detachment surgery performed at the Skåne University Hospital in Lund from 2015 to 2020. The main outcome was RRD after cataract surgery. The influence of sex, age, axial length of the eye, rupture of the posterior capsule, patient comorbidity and other cataract complications were analysed. RESULTS Among the 58 624 cases of cataract surgery, a total of 298 RRDs (0.51%) were identified up to the end of 2020. The mean time from cataract surgery to RRD was 667 days. The mean age was 65.3 years, compared to 74 years in the control group. A strong correlation was found between RDD and age: <60 years, incidence = 0.50%; 60-75 years, incidence = 0.14%; and >75 years, incidence = 0.04%. The correlation with axial length was also very strong: mean value 23.73 mm in those without RRD, and 25.13 mm in those with RRD (p < 0.001). Sex was also strongly correlated to RDD; 68.8% of cases of RRD being men. Among men younger than 60 years of age, with an axial length ≥25 mm, 9.46% exhibited RRD within the follow-up period (mean 4.7 years). Rupture of the posterior capsule was found in 2.01% of RRD patients compared to 0.74% in the control group. Diabetes, glaucoma or pseudoexfoliation had no impact on the prevalence of RRD. CONCLUSIONS The three main risk factors for RRD following cataract surgery were found to be sex, age and axial length. The highest incidence of RRD (9.46%) were identified among men younger than 60 years of age and an axial length ≥25 mm.
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Affiliation(s)
- Joakim Thylefors
- Department of Clinical Sciences LundOphthalmologySkåne University HospitalLund UniversityLundSweden
| | - Gunnar Jakobsson
- Department of OphthalmologySahlgrenska University HospitalMölndalSweden
| | | | - Rafi Sheikh
- Department of Clinical Sciences LundOphthalmologySkåne University HospitalLund UniversityLundSweden
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Mishra SK, Kumar P, Rana V, Seth S, Kumar A. Novel technique of pupillary dilation during retinal detachment surgery in an eye with iris claw lens. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Massote JA, Oliveira VDMM, Cronemberger S. Glaucoma drainage devices. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Shahid A, Iqbal K, Iqbal SM, Ghaffar Z, Tariq M, Jehanzeb Tahir M, Rahman FU, Raheem U, Butt JB, Abbas K. Risk Factors Associated With Rhegmatogenous Retinal Detachment. Cureus 2022; 14:e23201. [PMID: 35444874 PMCID: PMC9010810 DOI: 10.7759/cureus.23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
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20
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Freissinger S, Vounotrypidis E, Stetzer E, Bayer I, Shajari M, Kreutzer T, Keidel L, Kern C, Priglinger S, Wolf A. Visual outcome after rhegmatogenous retinal detachment repair surgery in patients with multifocal vs monofocal intraocular lenses. J Cataract Refract Surg 2021; 47:1561-1567. [PMID: 33974368 DOI: 10.1097/j.jcrs.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate functional outcome after retinal detachment (RD) repair surgery in eyes with a multifocal intraocular lens (mIOL). SETTING Ludwig-Maximilians-University, Munich, Germany. DESIGN Single-center case control study. METHODS 52 pseudophakic eyes with successful anatomical outcome after surgical RD repair were included. Retrospectively, 21 mIOL eyes were compared with a matched group of 21 monofocal eyes over 6 weeks. Prospectively, corrected distance visual acuity (CDVA) was evaluated over 12 months in these eyes. Furthermore, uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), defocus curves, and patient-reported outcomes were evaluated at 1 year in 24 mIOL eyes. RESULTS 52 eyes of 48 patients comprised the study. The mean CDVA (logMAR) improved significantly from 1.35 ± 1.38 to 0.29 ± 0.37 at 6 weeks and remained stable at 12 months postoperatively in monofocal eyes (P = .001) and from 1.16 ± 1.2 to 0.37 ± 0.29 (6 weeks) and 0.20 ± 0.36 (12 months) in mIOL eyes (P = .001). Univariate factorial analysis of variance showed no statistically significant differences in CDVA at 6 weeks or 12 months postoperatively for IOL type or for preoperative macular status (P > .05). In the prospective cohort of 24 mIOL eyes, a mean CDVA of 0.13 ± 0.33 logMAR, UDVA of 0.21 ± 0.34 logMAR, UIVA of 0.17 ± 0.28 logMAR, and UNVA of 0.23 ± 0.32 logMAR was achieved. Macular status did not affect final outcome significantly (P > .05). Most patients stated they usually did not need spectacles; no patient wanted mIOL replacement. CONCLUSIONS 1 year after successful anatomical repair after 23-gauge vitrectomy with gas tamponade, functionality of mIOL was restored, and CDVA was comparable with that of patients with monofocal IOL.
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Affiliation(s)
- Sigrid Freissinger
- From the Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany (Freissinger, Vounotrypidis, Bayer, Shajari, Kreutzer, Keidel, Kern, Priglinger, Wolf); University Eye Hospital Ulm, Ulm, Germany (Vounotrypidis, Stetzer, Wolf)
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Effect of Nd: YAG laser capsulotomy on the risk of retinal detachment after cataract surgery: A systematic review and meta-analysis. J Cataract Refract Surg 2021; 48:238-244. [PMID: 34538778 DOI: 10.1097/j.jcrs.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT We aimed to evaluate the impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on the incidence of pseudophakic retinal detachment (RD). The PubMed and Embase databases were searched for meta-analysis. Subgroup analyses were conducted according to study location, number of cases, mean follow-up time, and cataract procedure. The final analysis included 11 studies with 309 cases of RD in 65,117 eyes undergoing cataract surgery. Among them, 8,232 eyes underwent Nd:YAG capsulotomy. Our analysis demonstrated an increased risk of RD with Nd:YAG laser capsulotomy (RR=1.57; 95%CI, 1.17-2.12; P=0.003; HR=1.64; 95%CI, 1.03-2.62; P=0.04). Subgroup analysis suggested somewhat stronger associations in Asian (RR=4.54; 95%CI, 2.20-9.38; P<0.0001) than in non-Asian populations (America, P=0.12; Europe and others, P=0.21), and with extracapsular cataract extraction (RR=2.97; 95%CI, 1.83-4.83; P<0.0001) than with phacoemulsification (P=0.95). To conclude, Nd:YAG laser capsulotomy may be associated with an increased risk of pseudophakic RD.
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Ferrara M, Mehta A, Qureshi H, Avery P, Yorston D, Laidlaw DA, Williamson TH, Steel DH, Casswell A, Morris AH, Jalil A, Babar AR, Goldsmith C, Steel D, Sanchez-Chicharro D, Hughes E, Herbert E, Jenkins H, Khan IJ, Ellis JD, Smith J, Balaggan KS, Cornish KS, Wakeley L, Costen M, Tarafdar S, Charles SJ, Winder S, Cochrane T, Ivanova T, Papastavrou VT, Tanner V, Yorston D, Laidlaw DA, Williamson T. Phenotype and Outcomes of Phakic Versus Pseudophakic Primary Rhegmatogenous Retinal Detachments: Cataract or Cataract Surgery Related? Am J Ophthalmol 2021; 222:318-327. [PMID: 32987002 DOI: 10.1016/j.ajo.2020.09.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare phakic and pseudophakic primary rhegmatogenous retinal detachments (RD) and, within phakic RD, eyes with and without cataract. DESIGN Retrospective comparative clinical study. METHODS Setting: Online database of prospectively collected data. StudyPopulation: Patients aged ≥50 years who had undergone RD repair. PROCEDURE Data included baseline demographic and clinical features, surgical details, and anatomical and functional outcomes. Univariate analysis was performed to compare pseudophakic with phakic RD, and phakic RD with and without cataract. Age and sex dependency of variables was analyzed and the association of preoperative variables with final visual acuity was assessed using multivariate analysis. MainOutcomeMeasures: Preoperative features, intraoperative management, postoperative outcomes, association of preoperative features with postoperative outcomes. RESULTS Of 4,231 eyes, 1,212 were pseudophakic and 3,019 phakic, among which 310 had cataract. Pseudophakic RD showed significant differences compared with phakic RD, including older age, higher prevalence of male sex, foveal detachment, grade C proliferative vitreoretinopathy (PVR), inferior retinal breaks, inferior retinal involvement, and greater RD extent. Despite the more advanced features of pseudophakic RD, pseudophakia was a positive factor for visual outcome. Contralateral RD was more frequent in pseudophakic than phakic RD eyes (P < .0001). Within phakic RD, phakic RD with cataract exhibited several similarities with pseudophakic RD, including greater age, more frequent foveal detachment, PVR, and greater RD extent. CONCLUSIONS The presenting features differed significantly between pseudophakic and phakic RD, with greater occurrence of inferior retinal breaks and inferior retinal involvement in particular. Phakic RD with cataract shared several features in common with pseudophakic RD.
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Go JA, Gupta A, Khandelwal SS. Five Pearls for Long Eyes. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Maqsood S, Elalfy M, Abdou Hannon A, Hegazy SM, Elborgy ES. Functional and Structural Outcomes at the Foveal Avascular Zone with Optical Coherence Tomography Following Macula off Retinal Detachment Repair. Clin Ophthalmol 2020; 14:3261-3270. [PMID: 33116377 PMCID: PMC7568611 DOI: 10.2147/opth.s271944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Visual recovery following macula involving rhegmatogenous retinal detachment remains poorly understood. The aim of this work is to correlate the functional and the anatomical changes in retinal vasculature in the foveal avascular zone using optical coherence tomography angiography (OCTA) after successful retinal reattachment repair and correlate this data with retinal thickness and post-operative visual recovery. Methods A prospective, comparative observational study of 28 eyes of 14 patients with 14 eyes undergoing macula off retinal detachment repair with pars plana vitrectomy, endo-laser and silicone oil-based tamponade compared with 14 fellow healthy eyes at 1, 6 and 12 weeks post-operative period. The study was conducted at the Research Institute of Ophthalmology, Giza, Egypt between February 2018 and August 2018. Results The foveal avascular zone (FAZ) area in the patients group was not significantly different compared to the control group and was found to be negatively correlated with the central retinal thickness in both the study and control group. The superficial capillary plexus (SCP) area at the FAZ was significantly larger than the deep capillary plexus (DCP) area at the FAZ in both the study and control group over the follow-up period. The DCP area at the FAZ was significantly larger at the 3rd follow-up than the 1st follow-up. The SCP FAZ area was significantly larger than the DCP FAZ area in both the study and control group over the follow-up period. BCVA was found to be negatively correlated to the retinal thickness of the temporal 3 mm paracentral quadrant with no correlation with central foveal thickness (CFT) and the FAZ area. Conclusion Optical coherence tomography (OCT) and OCTA are valuable noninvasive imaging tools to monitor and predict the structural changes at the foveal avascular zone during the recovery phase after successful retinal reattachment involving macula.
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Affiliation(s)
| | - Mohamed Elalfy
- Queen Victoria Hospital, East Grinstead, UK.,Research Institute of Ophthalmology, Giza, Egypt.,Maidstone and Tunbridge Wells Hospitals, Tunbridge Wells, UK
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25
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Demographic and Clinical Characteristics of Patients with Pseudophakic Retinal Detachment and Their Effects on the Success of Surgery. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.768979] [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] Open
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26
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Incidence of rhegmatogenous retinal detachment after bag-in-the-lens IOL implantation: extended follow-up in a larger cohort of patients. J Cataract Refract Surg 2020; 46:820-826. [PMID: 32541406 DOI: 10.1097/j.jcrs.0000000000000164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique. SETTING Department of Ophthalmology, Antwerp University Hospital, Belgium. DESIGN Prospective cohort study. METHODS All consecutive BIL IOL surgeries performed between January 2001 and December 2010 were included, with the exclusion of combined procedures and IOL exchanges. The incidence of RRD was reported first in the total cohort, then in a subgroup of patients with 1 year to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors, except gender. Risk factors associated with RRD were examined using multiple Cox regression analysis with a random intercept. RESULTS Rhegmatogenous RD was diagnosed in 36 eyes (1.06%) of 3385 BIL cases, with a mean follow-up of 48.28 ± 40.05 months (range 0 to 195 months). The 2-year cumulative RRD incidence rate was 0.66% (17 cases in 1024 eyes; 0.00% in patients without risk factors). The 5-year cumulative RRD incidence rate was 1.17% (26 cases in 931 eyes; 0.15% without risk factors). Five risk factors were confirmed: male sex, age less than 60 years at the time of surgery, axial length 25.0 mm or greater, a history of contralateral RD, and intraoperative surgical complications. CONCLUSIONS The incidence of RRD after BIL IOL implantation is comparable with that of lens-in-the-bag (LIB) implantation. This larger study provided a longer follow-up and suggested that RRD incidence is even lower than that previously reported. This study also confirmed intraoperative surgical complications as an additional risk factor for RRD development, as already described with LIB implantation.
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Topical Ascorbic Acid Ameliorates Oxidative Stress-Induced Corneal Endothelial Damage via Suppression of Apoptosis and Autophagic Flux Blockage. Cells 2020; 9:cells9040943. [PMID: 32290365 PMCID: PMC7227019 DOI: 10.3390/cells9040943] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
Compromised pumping function of the corneal endothelium, due to loss of endothelial cells, results in corneal edema and subsequent visual problems. Clinically and experimentally, oxidative stress may cause corneal endothelial decompensation after phacoemulsification. Additionally, in vitro and animal studies have demonstrated the protective effects of intraoperative infusion of ascorbic acid (AA). Here, we established a paraquat-induced cell damage model, in which paraquat induced reactive oxygen species (ROS) production and apoptosis in the B4G12 and ARPE-19 cell lines. We demonstrate that oxidative stress triggered autophagic flux blockage in corneal endothelial cells and that addition of AA ameliorated such oxidative damage. We also demonstrate the downregulation of Akt phosphorylation in response to oxidative stress. Pretreatment with ascorbic acid reduced the downregulation of Akt phosphorylation, while inhibition of the PI3K/Akt pathway attenuated the protective effects of AA. Further, we establish an in vivo rabbit model of corneal endothelial damage, in which an intracameral infusion of paraquat caused corneal opacity. Administration of AA via topical application increased its concentration in the corneal stroma and reduced oxidative stress in the corneal endothelium, thereby promoting corneal clarity. Our findings indicate a perioperative strategy of topical AA administration to prevent oxidative stress-induced damage, particularly for those with vulnerable corneal endothelia.
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28
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Qureshi MH, Steel DHW. Retinal detachment following cataract phacoemulsification-a review of the literature. Eye (Lond) 2020; 34:616-631. [PMID: 31576027 PMCID: PMC7093479 DOI: 10.1038/s41433-019-0575-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 11/09/2022] Open
Abstract
A link between cataract surgery and rhegmatogenous retinal detachment (RRD) has long been considered. Indeed, pseudophakic retinal detachment (PPRD) forms a substantial and increasing proportion of RRD. We reviewed the literature to answer the following questions: what is the incidence of PPRD in eyes following phacoemulsification cataract surgery and how does its risk change over time following surgery? We also sought to assess how the risk is modified by intraoperative factors (operative complications, surgeon grade, subsequent laser capsulotomy), intrinsic eye-related factors (laterality, myopia, previous RRD, previous trauma, previous PVD) and patient factors (sex, age, ethnicity, affluence, systemic comorbidities). Secondarily we asked how the incidence of PPRD after phacoemulsification compares with the RRD incidence in the general population and how identified risk factors contribute to the pathophysiology of PPRD. A search of the Medline and Ovid databases was conducted for relevant publications from 1990 onwards using defined search terms with pre planned inclusion and exclusion criteria. The 10-year PPRD incidence after phacoemulsification was identified as being between 0.36 and 2.9%. This decreases over time to 0.1-0.2% annually but remains above the general population. The PPRD risk is further elevated by (in order of decreasing effect) intraoperative vitreous loss, increasing axial length, younger age, male sex and trainee operating surgeons. The PPRD risk after phacoemulsification is approximately ten times the general population's RRD risk. This risk is modified by the interplay of a hierarchy of risk factors, of which intraoperative vitreous loss, myopia, age and sex have the biggest effect.
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Affiliation(s)
- M Hamza Qureshi
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, UK
| | - David H W Steel
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK.
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29
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Lankry P, Loewenstein A, Moisseiev E. Outcomes following Laser Retinopexy for Retinal Tears: A Comparative Study between Trainees and Specialists. Ophthalmologica 2020; 243:355-359. [DOI: 10.1159/000507483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
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30
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Ng TK, Chen W, Chen Q, Zheng Y, Xu Y, Chen W, Zhang G, Chen J, Pang CP, Chen H. COL2A1 protective variant reduces sporadic rhegmatogenous retinal detachment severity. Exp Eye Res 2020; 191:107907. [PMID: 31899252 DOI: 10.1016/j.exer.2019.107907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/05/2019] [Accepted: 12/30/2019] [Indexed: 02/05/2023]
Abstract
Rhegmatogenous retinal detachment (RRD) is the most common type of RD, the separation of neurosensory retina from the underlying retinal pigment epithelium. The RRD patients can be benefited from appropriate treatment if detected early, especially for the people predicted at high risk. In this study, we aimed to investigate the genetic association and clinical correlation of collagen type II alpha 1 (COL2A1) variants with sporadic RRD in a southern Chinese population. Totally 156 RRD patients and 254 control subjects were recruited, and 12 COL2A1 tag single nucleotide polymorphisms were genotyped by the TaqMan assay. The RRD patients had poorer visual acuity (P < 0.001) and lower intraocular pressure (IOP; P < 0.001) in their surgical eyes compared to the fellow eyes. The COL2A1 rs1793958 variant was significantly associated with RRD in the genotypic (P = 0.024), allelic (P = 0.011, odds ratio (OR) = 0.669), recessive (P = 0.011, OR = 0.384) and homozygous models (P = 0.007, OR = 0.348). RRD patients carrying the rs1793958 G allele had smaller retinal detachment area (P = 0.041) and smaller IOP differences (P = 0.046) between the surgical and fellow eyes compared to those carrying the wildtype AA genotype. In summary, this study revealed that the COL2A1 rs1793958 variant is associated with reduced risk of sporadic RRD, and patients carrying rs1793958 G allele have lower RRD severity.
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Affiliation(s)
- Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Shantou University Medical College, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Wanghao Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Qianwen Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yuqian Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yanxuan Xu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Guihua Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jianhuan Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Chi Pui Pang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Haoyu Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China.
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31
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Han JV, Patel DV, Liu K, Kim BZ, Sherwin T, McGhee CNJ. Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications. Clin Exp Ophthalmol 2019; 48:311-318. [PMID: 31804765 DOI: 10.1111/ceo.13696] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/01/2022]
Abstract
IMPORTANCE Reduction of intraoperative complications in phacoemulsification cataract surgery. BACKGROUND To assess practicability of a risk stratification system, the New Zealand Cataract Risk Stratification (NZCRS) system, in a major teaching hospital service, without investigator oversight, to ascertain whether benefits identified in research studies are maintained in busy clinical practice. DESIGN Prospective cohort study in a major public teaching hospital. PARTICIPANTS Five hundred cases of phacoemulsification cataract surgery. METHODS NZCRS system inserted into 621 consecutive preoperative cataract patient files. Recommendation to allocate higher-risk cases to experienced surgeons. MAIN OUTCOME MEASURES NZCRS system uptake and adherence, appropriate identification of high risk cases and intraoperative complication rates. RESULTS NZCRS scores calculated in 500 of 621 (80.5%) cases and 98 (19.6%) scored as "high risk." Cataract surgery (N = 500) performed by: 12 Registrars (20%), 4 Fellows (7.2%), 26 Consultants (72.8%). Risk scores adhered to in 99%. Overall intraoperative complications (3.0%) included iris prolapse 1.6% and posterior capsule tear 0.8%. No statistical difference in complication rates identified between surgeon grades. Mean best-corrected visual acuity was 6/10 (20/32). Postoperatively, cystoid macular oedema occurred in 3.2%. Rescoring by an experienced investigator noted a greater number of "high risk scores" (31.6% vs 19.6%) related to differences in subjective scoring of anterior chamber depth and cataract density. CONCLUSIONS AND RELEVANCE Practical uptake of cataract risk stratification was promising in this study with NZCRS calculated in 80.5% with 99% adherence to scoring recommendations. Compared to baseline studies, in the day-to-day clinical setting, a continued, decreasing trend in frequency and severity of intraoperative complications was noted. Subjective variability of risk scoring may be further improved by better, objective, standardization.
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Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Kevin Liu
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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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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33
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Moustafa GA, Borkar DS, Borboli-Gerogiannis S, Greenstein SH, Lorch AC, Vasan RA, Kloek CE. Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one. PLoS One 2019; 14:e0221243. [PMID: 31536500 PMCID: PMC6752806 DOI: 10.1371/journal.pone.0221243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose There is limited evidence to inform the optimal follow-up schedule after cataract surgery. This study aims to determine whether a standardized question set can predict unexpected management changes (UMCs) at the postoperative week one (POW1) timepoint. Setting Massachusetts Eye and Ear, Harvard Medical School. Design Prospective cohort study. Methods Two-hundred-and-fifty-four consecutive phacoemulsification cases having attended an examination between postoperative days 5–14. A set of 7 ‘Yes’ or ‘No’ questions were administered to all participants by a technician at the POW1 visit. Patient answers along with perioperative patient information were recorded and analyzed. Outcomes were the incidence of UMCs at POW1. Results The incidence of UMCs was zero in uneventful cataract cases with unremarkable history and normal postoperative day one exam if no positive answers were given with the question set demonstrating 100% sensitivity (p<0.0001). A test version with 5 questions was equally sensitive in detecting UMCs at POW1 after cataract surgery. Conclusion In routine cataract cases with no positive answers to the current set of clinical questions, a POW1 visit is unlikely to result in a management change. This result offers the opportunity for eye care providers to risk-stratify patients who have had cataract surgery and individualize follow-up.
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Affiliation(s)
- Giannis A. Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Durga S. Borkar
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States of America
| | - Sheila Borboli-Gerogiannis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott H. Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan A. Vasan
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carolyn E. Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
- * E-mail:
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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.
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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
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Núñez MX, Henriquez MA, Escaf LJ, Ventura BV, Srur M, Newball L, Espaillat A, Centurion VA. Consensus on the management of astigmatism in cataract surgery. Clin Ophthalmol 2019; 13:311-324. [PMID: 30809088 PMCID: PMC6376888 DOI: 10.2147/opth.s178277] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.
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Affiliation(s)
- Maria X Núñez
- Unit of Cornea, Cataract and Refractive Surgery, Grupo de Investigacion Vision Sana, Clinica de Oftalmología de Cali, Universidad Javeriana, Cali, Colombia,
| | - Maria A Henriquez
- Department of Cataract, Department of Research, Oftalmosalud Instituto de Ojos, Lima, Peru
| | - Luis J Escaf
- Clinica Oftalmologica del Caribe (Cofca), Universidad Javeriana, Barranquilla, Colombia
| | - Bruna V Ventura
- Department of Cataract, Altino Ventura Foundation, HOPE Eye Hospital, Recife, Brazil
| | - Miguel Srur
- Centro de la Visión, Filial Clínica Las Condes, Universidad de Los Andes, Santiago de Chile, Chile
| | | | - Arnaldo Espaillat
- Cataract and refractive surgery service, Espaillat Cabral Institute, Santo Domingo, Dominican Republic
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36
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Cho SC, Park SJ, Byun SJ, Woo SJ, Park KH. Five-year nationwide incidence of macular hole requiring surgery in Korea. Br J Ophthalmol 2019; 103:1619-1623. [DOI: 10.1136/bjophthalmol-2018-313237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/18/2018] [Accepted: 12/26/2018] [Indexed: 11/03/2022]
Abstract
Background/aimsTo estimate the incidence and demographics of macular hole (MH) requiring surgery in Korea.MethodsPatients who underwent surgery for MH in Korea from 2011 to 2015 with the diagnostic code for MH and the surgical code for vitrectomy were retrospectively identified using the Korean national health claims database. The average incidence rate of MH during the 5-year study period was estimated by applying the direct method of standardisation using the 2015 census data as a reference population.ResultsA total of 7301 patients with MH requiring surgery were identified. The average incidence of MH requiring surgery was 3.14 (95 % CI, 3.07 to 3.21) per 100 000 person-years . The incidence in women (4.29 per 100 000 person-years; 95% CI, 4.17 to 4.40) was significantly higher than that in men (2.00 per 100 000 person-years; 95% CI, 1.92 to 2.07; p<0.001). The incidence rate of MH increased exponentially with increasing age between the ages of 35 years and 69 years and was highest among patients aged 65–69 years. The female-to-male ratio for the incidence of MH was 2.15:1.ConclusionsThis study represents the largest nationwide population-based investigation of the incidence of MH, using a database that covers the entire population of South Korea. MH is the disease of elderly peaked 70 years old and more common in women.
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Elzarrug H, Miller KM, Fei Y, Daifalla AEM. Risk Factors for Postoperative Retinal Detachment Following Cataract Surgery. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojoph.2019.93015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Han JV, Patel DV, Wallace HB, Kim BZ, Sherwin T, McGhee CN. Auckland Cataract Study III: Refining Preoperative Assessment With Cataract Risk Stratification to Reduce Intraoperative Complications. Am J Ophthalmol 2019; 197:114-120. [PMID: 30278159 DOI: 10.1016/j.ajo.2018.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess intraoperative complications of phacoemulsification surgery in public teaching hospital settings using modified preoperative risk stratification systems. DESIGN Prospective cohort study. METHODS Preoperative risk stratification of 500 consecutive cataract cases using the New Zealand Cataract Risk Stratification (NZCRS) scoring system. Recommended allocation of higher-risk phacoemulsification procedures to experienced surgeons in public teaching hospital setting. MAIN OUTCOME MEASURE Intraoperative complications relative to adherence to stratification recommendations. RESULTS NZCRS classified 192 cases (38%) as high-risk, recommended for fellows or consultants (attendings). Primary surgeons were residents (n = 142, 28%), fellows (n = 88, 18%), and consultants (n = 270, 54%). Overall rate (N = 500) of any intraoperative complication was 5.0%. Where NZCRS scoring recommendations were observed (n = 448) the intraoperative complication rate was 4.5% but in "nonadherence" cases (n = 52 residents operating on higher-risk cases) this nearly doubled (9.6%). Postoperative complications occurred in 5.2%, primarily cystoid macular edema (3.7%). Postoperatively, mean unaided visual acuity was 6/12 (20/40) and best-corrected visual acuity improved from 6/20 (20/63) preoperatively to 6/10 (20/32) postoperatively (P < .05). CONCLUSIONS The NZCRS system aids identification of higher-risk cataract cases and appropriate case-to-surgeon allocation and may increase surgeon awareness of risk factors. Compared to 2 previous studies under similar conditions in the same institution, the NZCRS system was associated with a 40% reduction in intraoperative complications (8.4% to 5%). The rate of posterior capsular tear was 0.6% (P = .035) compared to 2.6% in baseline phase and 1.4% in a prior risk stratification phase. Risk stratification seems to reduce intraoperative phacoemulsification complications in public teaching hospital settings.
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Andrews H, Soni A, Green M, Ely A, Quillen D. Parent attitudes toward resident involvement in their child's strabismus surgery. J AAPOS 2018; 22:262-265.e3. [PMID: 30026137 DOI: 10.1016/j.jaapos.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore patterns in parents' understanding and preferences related to ophthalmology resident participation in their child's strabismus surgery. METHODS Over a 4-week period, a survey was distributed at a suburban, academic eye center to English-speaking parents of children with strabismus who have not previously undergone, or were not being scheduled for, strabismus surgery. RESULTS All of the 64 eligible parents participated in the survey. For a resident to assist or perform the surgery, 80% and 97% of parents, respectively, indicated it was important or extremely important to be asked permission beforehand; 69% indicated the attending surgeon should ask permission for the resident to perform the surgery, whereas only 11% believed a standard written consent was sufficient. Of the 64 respondents, 77% indicated that they would agree to a resident assisting with their child's operation; 36% would agree to a resident performing the surgery. CONCLUSIONS Nearly all parents in our study indicated that they would want to be informed of resident involvement by the attending surgeon. The vast majority would consent to having an ophthalmology resident assist in their child's strabismus surgery, and more than one-third would consent to having the resident perform their child's strabismus surgery. Obtaining informed consent prior to resident involvement increases transparency and highlights the importance of ophthalmology residency education.
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Affiliation(s)
- Hans Andrews
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Ajay Soni
- Penn State Eye Center, Hershey, Pennsylvania.
| | - Michael Green
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Amanda Ely
- Penn State Eye Center, Hershey, Pennsylvania
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Transscleral Suture-Fixated Versus Intrascleral Haptic-Fixated Intraocular Lens: A Comparative Study. Eye Contact Lens 2018; 43:389-393. [PMID: 27243351 DOI: 10.1097/icl.0000000000000287] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the clinical outcomes between sutured transscleral-fixated and intrascleral haptic-fixated posterior chamber intraocular lens (IOL). SETTING Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. DESIGN A comparative case series. METHODS Forty eyes of 40 patients were included; 20 in each group. Patients in group 1 underwent sutured transscleral-fixated IOL and those in group 2 underwent intrascleral haptic-fixated IOL augmented by fibrin glue. Parameters evaluated were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), IOL tilt on ultrasound biomicroscopy (UBM), and pseudophakodonesis on slitlamp and UBM. RESULTS The most common cause of aphakia was complicated cataract surgery (50%). The mean preoperative UCVA in logarithm of minimum angle of resolution (logMAR) was 1.59±0.24 and 1.63±0.26 in group 1 and 2, respectively (P=0.45). There was significant improvement in UCVA in both groups (P=0.001) at 6 months (group 1: 0.33±0.17; group 2: 0.22±0.10); the improvement being greater in group 2 (P<0.05). Mean percentage endothelial cell loss and IOP change were comparable. Mean CMT (μm) was 250.95±23.98 and 225.85±21.13 in group 1 and 2, respectively (P=0.009). Pseudophakodonesis was more in group 1 as assessed on slitlamp (P=0.037) and as assessed on UBM (P=0.046). Macular edema was the most common complication seen more in group 1. CONCLUSIONS Intrascleral haptic-fixated IOL provides more stable fixation, better visual outcome, and lesser complication in comparison with sutured transscleral-fixated IOL.
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Forsell S, Mönestam E. Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery. Ophthalmol Retina 2018; 2:4-9. [PMID: 31047301 DOI: 10.1016/j.oret.2017.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques. DESIGN Population-based, retrospective cohort study. PARTICIPANTS All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n = 537). METHODS International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed. MAIN OUTCOME MEASURES Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA). RESULTS Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P = 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P = 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery. CONCLUSIONS In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.
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Affiliation(s)
- Sara Forsell
- Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Eva Mönestam
- Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Abstract
Objective To investigate the incidence and risk factors for retinal detachment (RD) after cataract surgery or refractive lens exchange (RLE) in patients aged below 61 years. Methods Retrospective medical chart review of 7,886 patients (13,925 eyes) who underwent cataract surgery or RLE. Patients aged below 61 years were selected. Age, gender, axial length, follow-up times, and the occurrence of RD were recorded. Additional characteristics documented for RD cases were: history of RD, preexisting retinal findings, laser capsulotomy, status of macula at RD, date and details of RD. Results From a total of 421 patients (677 eyes) aged below 61 years 24 cases of RD were identified, resulting in an overall cumulative incidence per eyes of 3.55%. The mean follow-up time was 45 ± 32.8 months. Ninety-two % of all RDs occurred within 3.6 years from surgery. Axial length had a significant effect on the risk of RD after cataract/ RLE surgery (HR = 1.42, P = 0.0001, 95% CI 1.19–1.69). The highest incidence of RD occurred in the subgroup of 25 to 28.9 mm axial length (10.2%). With an increase in age of ten years, the hazard of postoperative RD was not significantly increased by a factor of 1.50 (P = 0.286, 95% CI 0.71–3.15). The highest incidence of RD occurred in patients aged 50–54 years (5.39%). Compared to females, males had an almost twofold not significant risk of postoperative RD (HR = 1.96, P = 0.123, 95% CI 0.83–4.63). None of the RD cases had a history of RD. Conclusions Axial length is a significant risk factor for pseudophakic RD. The need for cataract surgery or RLE should be carefully considered in patients with axial lengths between 25 and 29 mm, aged 50–54 years, in males, and in case of preexisting retinal findings.
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CHANGES IN THE POSTERIOR VITREOUS AFTER CATARACT SURGERY ASSESSED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retin Cases Brief Rep 2017; 13:227-231. [PMID: 28277441 DOI: 10.1097/icb.0000000000000563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess changes in the posterior vitreous caused directly by phacoemulsification with implantation of an intraocular lens, using the enhanced vitreous swept-source optical coherence tomography system (Topcon, Tokyo, Japan). METHODS Consecutive patients with cataract without posterior vitreous detachment were enrolled. Swept-source optical coherence tomography examinations were performed 1 day before and several days after surgery, using enhanced vitreous visualization. We compared preoperative and postoperative posterior vitreous status and measured the distance between the internal limiting membrane and the posterior vitreous membrane at 26 locations at the posterior pole. RESULTS Images of 33 eyes (21 patients) could be analyzed. The perifoveal posterior vitreous detachment was not extended in any eyes, and the internal limiting membrane to posterior vitreous membrane distance before and after surgery did not differ at any location measured (P = 0.071-1.000). The posterior precortical vitreous pocket was dilated in three eyes. Age, gender, axial length, preoperative visual activity, nuclear sclerosis, duration of surgery, and duration between surgery and swept-source optical coherence tomography did not differ between the dilated vitreous pocket group (n = 3) and the unchanged group (n = 30). CONCLUSION The height of the posterior vitreous membrane remained unchanged after surgery, although the posterior precortical vitreous pocket was dilated in three patients. Cataract surgery procedures seem to have little influence on the posterior vitreous membrane.
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Cankurtaran V, Citirik M, Simsek M, Tekin K, Teke MY. Anatomical and functional outcomes of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Bosn J Basic Med Sci 2017; 17:74-80. [PMID: 28135566 DOI: 10.17305/bjbms.2017.1560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/30/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022] Open
Abstract
Retinal detachment is the separation of the sensory retina from the retinal pigment epithelium by subretinal fluid. There are several types of retinal re-attachment surgery, including scleral buckling (SB), pneumatic retinopexy, and vitrectomy (with or without SB). The objective of this study was to compare anatomical and visual outcomes between patients with pseudophakic rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) with silicone oil (SO) or perfluoropropane (C3F8) gas tamponade and pseudophakic RRD patients who underwent SB surgery. We evaluated retrospectively 101 pseudophakic RRD patients from a single center. The patients were classified into three groups according to the surgical procedure performed: PPV + Silicone - patients who underwent PPV with SO tamponade; PPV + Gas - patients who underwent PPV with perfluoropropane gas tamponade; and SB group - patients who underwent SB surgery. The groups were compared with regard to primary and final anatomical and visual outcomes. The number of patients in PPV + Silicone, PPV + Gas, and SB group was 39 (38.6%), 32 (31.7%), and 30 (29.7%), respectively. The mean follow-up period in PPV + Silicone, PPV + Gas, and SB group was 33.95 ± 23.58, 32.62 ± 10.95, and 33.76 ± 16.62 months, respectively. No significant difference was observed between the groups neither with regard to primary and final anatomical and visual success rates nor in relation to the recurrence rate of retinal detachment. According to our anatomical and visual outcome results, either of the three methods (i.e., PPV + Silicone, PPV + Gas, or SB) can be used in the treatment of pseudophakic retinal detachment.
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Affiliation(s)
- Veysel Cankurtaran
- Department of Retina, SB Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.
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Ling J, Noori J, Safi F, Eller AW. Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment in Pseudophakia. Semin Ophthalmol 2016; 33:198-201. [PMID: 27599596 DOI: 10.1080/08820538.2016.1190849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify the characteristics predictive of unfavorable outcomes for pneumatic retinopexy (PR) in the repair of pseudophakic rhegmatogenous retinal detachments (RD). METHODS A retrospective chart review was performed at a single institution to identify patients who underwent PR in pseudophakic eyes. Pre- and postoperative data were reviewed and analyzed to evaluate predictive factors of failure. RESULTS Forty-four patients met the study criteria. PR was successful in 23 (52.3%) patients. The failed cases underwent scleral buckles, vitrectomies, or both. A retinal tear located outside the superior four clock hours was a significant predictor of PR failure. At six months post-intervention, the failure and success groups were statistically similar for vision and rate of reattachment. CONCLUSIONS Modified criteria for PR in pseudophakia may include cases with retinal breaks within the superior four clock hours. If further surgery is required, the final vision and anatomic reattachment are not disadvantaged by the initial PR procedure.
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Affiliation(s)
- Jennifer Ling
- a Retina Service, UPMC Eye Center, Department of Ophthalmology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Jila Noori
- a Retina Service, UPMC Eye Center, Department of Ophthalmology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Farhad Safi
- a Retina Service, UPMC Eye Center, Department of Ophthalmology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Andrew W Eller
- a Retina Service, UPMC Eye Center, Department of Ophthalmology , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Patterns of pseudophakic retinal detachment in a referral tertiary care center and the need for improving cataract surgical training. Eur J Ophthalmol 2016; 26:361-3. [PMID: 26833227 DOI: 10.5301/ejo.5000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the risk factors associated with development of rhegmatogenous retinal detachment (RRD) in patients undergoing different types of cataract surgery. METHODS Records of 200 patients presenting with pseudophakic retinal detachment (PRD) between January 2012 and July 2013 at a tertiary care center were reviewed. Duration and type of cataract surgery (phacoemulsification, extracapsular cataract extraction [ECCE], and small-incision cataract surgery [SICS]) and history of YAG capsulotomy with risk factors were recorded. Presence or absence of these risk factors was analyzed and their association with type of cataract surgery was evaluated. RESULTS Of these 200 patients, 137 were male and 63 were female. The mean age of the patients was 55.19 ± 12.60 years and mean duration of cataract surgery to diagnosis of RRD was 8.64 ± 5.15 months. Most patients underwent phacoemulsification (45%), followed by ECCE (31.5%) and SICS (23.5%). Most of the patients with PRD had complicated cataract surgery with intraocular lens (IOL) in sulcus in 63%, anterior chamber IOL in 3%, and aphakia in 0.5%. There was no difference among the 3 types of surgery performed in mean presenting visual acuity, duration between cataract surgery and YAG capsulotomy, or number of posterior chamber IOLs. Incidence of posterior capsular rent (p = 0.02) and presence of vitreous in anterior chamber (p = 0.01) were significantly higher for patients with retinal detachment (RD) who underwent SICS. CONCLUSIONS Many risk factors are associated with RD development after cataract surgery. More stringent efforts at improving the quality of cataract surgical training are likely to help in reducing the risk of PRD.
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Tassignon MJ, Van den Heurck JJI, Boven KBM, Van Looveren J, Wouters K, Bali E, Ní Dhubhghaill S, Mathysen DGP. Incidence of rhegmatogenous retinal detachment after bag-in-the-lens intraocular lens implantation. J Cataract Refract Surg 2015; 41:2430-7. [PMID: 26703493 DOI: 10.1016/j.jcrs.2015.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/13/2015] [Accepted: 05/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after phacoemulsification and bag-in-the-lens intraocular lens (IOL) implantation. SETTING Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. DESIGN Prospective cohort study. METHODS All consecutive bag-in-the-lens IOL implantations performed between January 2001 and December 2007 were included, with the exception of combined procedures and IOL exchanges. The retinal detachment (RD) incidence was studied in the total cohort, in a subgroup of patients with 1 to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors except gender. RESULTS RD after bag-in-the-lens IOL implantation in 1323 eyes with an average follow-up of 44.75 months (range 0 to 152 months) was found in 19 eyes (1.44%). The 1-year RD incidence was 0.49% (5 RD cases in 1024 eyes) (0.00% in patients without risk factors). The 2-year cumulative RD incidence was 0.84% (9 RD cases in 931 eyes; 0.15% without risk factors). Four clinically significant risk factors were confirmed: male gender, young age at time of surgery (<60 years), axial myopia (axial length ≥25 mm), and history of contralateral RD in the total cohort. CONCLUSION The RRD incidence following bag-in-the-lens IOL implantation was comparable to that seen after lens-in-the-bag (LIB) implantation. The wide variation in study design in the literature precludes direct comparison, so there is a need for standardization in evaluating RRD incidence after cataract surgery. Future prospective studies should consider patients with and without risk factors (except gender) separately. FINANCIAL DISCLOSURE Prof. dr. M.J. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794; PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany.
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Affiliation(s)
- Marie-José Tassignon
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Jonas J I Van den Heurck
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Kim B M Boven
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Jan Van Looveren
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Kristien Wouters
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Ernesto Bali
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Sorcha Ní Dhubhghaill
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium
| | - Danny G P Mathysen
- From the Department of Ophthalmology (Tassignon, Van den Heurck, Boven, Van Looveren, Dhubhghaill, Mathysen) Antwerp University Hospital, Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences (Tassignon, Van den Heurck, Boven, Jan Van Looveren, Wouters, Mathysen), University of Antwerp, Wilrijk, Antwerp, Belgium; Department of Scientific Coordination-Biostatistics (Wouters), Antwerp University Hospital, Edegem, Antwerp, Belgium; Department of Ophthalmology (Bali), Clinique du Parc Léopold, Brussels, Belgium.
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Prophylactic Circumferential Retinal Cryopexy to Prevent Pseudophakic Retinal Detachment after Posterior Capsule Rupture during Phacoemulsification. J Ophthalmol 2015; 2015:807389. [PMID: 26697214 PMCID: PMC4677226 DOI: 10.1155/2015/807389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/16/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate whether prophylactic circumferential retinal cryopexy (CRC) can prevent pseudophakic retinal detachment (PRD) development after posterior capsule rupture (PCR) during phacoemulsification. Methods. Retrospective patient chart analysis of eyes experiencing a PCR during phacoemulsification. Comparison of PRD development between eyes receiving CRC (cryo+ group) or not (cryo- group). Results. Overall 106 patients were analyzed, thereof 61 (58%) in the cryo+ and 45 (42%) in the cryo- group. In both clusters a total of 10 PRDs (9.4%) occurred, thereof 3 (30%) in the cryo+ as well as 7 (70%) in the cryo- group (p = 0.087), 79.8 ± 81.58 weeks after PCR. Relative/absolute risk reduction in CRC-treated eyes was calculated to be 68%/11%. Prophylactic CRC reduced PRD development 0.3-fold. Number needed to treat was estimated to be 9.4. Conclusion. Prophylactic CRC might be a useful treatment option in eyes with PCR to hamper PRD development in the further course. Further research is indicated to evaluate this beneficial effect between eyes with and without a rupture of the anterior vitreous cortex and accompanying vitreous loss in an expanding number of eyes.
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Jan S, Hussain Z, Khan U, Khan MT, Karim S. Retinal Detachment Due to Retinal Dialysis: Surgical Outcome After Scleral Buckling. Asia Pac J Ophthalmol (Phila) 2015; 4:259-62. [PMID: 26431208 DOI: 10.1097/apo.0000000000000084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to determine the efficacy and safety of scleral buckling surgery in retinal detachment due to retinal dialysis. DESIGN This study was a prospective, interventional case series. METHODS A total of 48 eyes of 48 consecutive patients were included after obtaining informed written consent. Besides taking a thorough history, all eyes were examined by a retinal surgeon. The macula status, site, and extent of retinal dialysis and rhegmatogenous retinal detachment (RRD) were particularly noted. Proliferative vitreoretinopathy grading was done. Buckling was performed by a single surgeon. At every follow-up, visual acuity, intraocular pressure, retina status, and buckle position were noted. Any complication found was recorded. Follow-up was done for at least 6 months. SPSS version 16 was used for data analysis. RESULTS We included 48 cases of RRD due to retinal dialysis. The mean ± SD age of the patients was 26.85 ± 15.1 years. The macula was detached in 85.4% of the cases, and proliferative vitreoretinopathy grade C was found in 25% of the cases. A surgical reattachment rate of 95.8% was attained after a single primary buckling procedure. Final Snellen best-corrected visual acuity of 6/18 or better was attained in 12.5% of the cases. However, 62.5% of the cases had best-corrected visual acuity in the range of 6/24 to 6/60. Subretinal hemorrhage occurred in 8.3% of cases intraoperatively after subretinal fluid drainage. CONCLUSIONS We conclude that scleral buckling has a definite role in the management of RRD due to retinal dialysis.
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Affiliation(s)
- Sanaullah Jan
- From the Department of Ophthalmology, Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
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