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Baumann C, Kaye SB, Steel DH. Reversing the paradigm on the urgency of acute retinal detachments defined by their foveal status: when off may be more urgent than on. BMJ Open Ophthalmol 2024; 9:e001668. [PMID: 38683951 PMCID: PMC11033651 DOI: 10.1136/bmjophth-2024-001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Carmen Baumann
- Department of Ophthalmology, Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephen B Kaye
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, UK
| | - David H Steel
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Sunderland Eye Infirmary, Sunderland, Tyne and Wear, UK
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Sharma A, Wu L, Bloom S, Stanga P, Agrawal R, Downes RA, Rachitskaya AV, Ghalibafan S, Cai LZ, Yannuzzi NA, Shanmugam PM, Wakabayashi T, Avci R, Rezaei KA. RWC Update: Unstapling the Retina From a Firecracker Injury; Macula-On Retinal Detachment: When To Operate?; Choroidal Coloboma. Ophthalmic Surg Lasers Imaging Retina 2024; 55:125-128. [PMID: 38466966 DOI: 10.3928/23258160-20240212-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
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Alberti M, Ilsby C, Christensen UC, Kiilgaard JF, la Cour M. Preoperative Positioning and Progression of Fovea-on Retinal Detachments. Ophthalmol Retina 2024; 8:137-147. [PMID: 37659721 DOI: 10.1016/j.oret.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To study the relationship between positioning and rhegmatogenous retinal detachment (RRD) progression before surgery in patients with a fovea-on RRD. DESIGN Prospective, single-cohort study. SUBJECTS Patients with fovea-on RRD admitted to hospital for bedrest before surgical treatment were recruited. METHODS Primary outcome was the shortest distance from the foveal center to the retinal detachment border on OCT. Secondary outcomes were measured with a head-mounted positioning sensor and included measures of head movement (linear acceleration and angular velocity) as well as measures of positioning regimen compliance. MAIN OUTCOME MEASURES Distance from the fovea to the retinal detachment border. RESULTS Overall, 50 patients with fovea-on positioned before RRD repair. One patient (1/50, 2%) progressed from fovea-on to fovea-off. Of the positioning measures, angular velocity demonstrated the strongest correlation with RRD border movement, whereas measures of positioning compliance showed nonsignificant correlation. After defining 3 movement groups: stable, intermediate, and mobile RRDs, we found that a doubling of head movement (angular velocity) correlated with a median RRD border progression of -6 μm/h, -75 μm/h, and -219 μm/h in the 3 groups, respectively. CONCLUSIONS Rhegmatogenous retinal detachment border movement is correlated to angular velocity of the head, whereas compliance with our current positioning regimen does not have a significant impact on RRD border movement. Not all RRDs progress rapidly toward the fovea, but those that do seem to be highly influenced by head movement. For limiting RRD progression, a reduced movement positioning regimen may be superior to our current gravity-based approach. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mark Alberti
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
| | - Christian Ilsby
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
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Haq Z, Mittra RA, Parke DW, Yonekawa Y, Hsu J, Gupta O, Williams GA, Shah GK, Ryan EH. IMPACT OF FOVEAL STATUS AND TIMING OF SURGERY ON VISUAL OUTCOME IN RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:88-94. [PMID: 37603408 DOI: 10.1097/iae.0000000000003913] [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: 08/23/2023]
Abstract
PURPOSE To investigate the impact of surgical timing on visual acuity outcomes in retinal detachments based on the preoperative foveal status. METHODS A retrospective multicenter cohort study was conducted. Cases were stratified into fovea-on, fovea-split, and fovea-off groups. Days to surgery was defined as the time between the preoperative examination and surgery. The main outcome measure was the final postoperative visual acuity. RESULTS 1,675 cases were studied. More than 80% of fovea-on/fovea-split and fovea-off cases had surgery within 1 and 3 days, respectively. The mean final postoperative visual acuity did not differ significantly between the fovea-on and fovea-split groups (Snellen equivalent [SE] 20/33 ± 20/49 and 20/32 ± 20/39, P = 1.000) and did not change significantly based on days to surgery in either group. The mean final postoperative visual acuity was lowest in the fovea-off group (Snellen equivalent = 20/56 ± 20/76, P < 0.001) and was significantly lower in cases where surgery was performed after two or more days when compared with cases performed within 1 day (Snellen equivalent 20/74 ± 20/89 vs. 20/46 ± 20/63, P < 0.001). CONCLUSION Fovea-on and fovea-split retinal detachments demonstrated comparable visual outcomes. Fovea-off RDs demonstrated worse visual outcomes, which declined further when surgery was delayed by two or more days.
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Affiliation(s)
- Zeeshan Haq
- Retina Consultants of Minnesota, Edina, Minnesota
| | | | | | - Yoshihiro Yonekawa
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - Omesh Gupta
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - George A Williams
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | | | - Edwin H Ryan
- Retina Consultants of Minnesota, Edina, Minnesota
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Barequet D, Shemesh R, Zvi D, Cohen R, Trivizki O, Schwartz S, Barak A, Loewenstein A, Rabina G. Functional and anatomical outcomes of fovea on, fovea off and fovea-splitting rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2023; 261:3187-3192. [PMID: 37477738 DOI: 10.1007/s00417-023-06169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To compare the anatomical and functional outcomes of fovea-on, fovea-off, and fovea-split rhegmatogenous retinal detachment (RRD). METHODS Retrospective case series of consecutive patients diagnosed with RRD and treated with only pars plana vitrectomy (PPV). Preoperative and postoperative optical coherence tomography (OCT) and functional outcomes were obtained prior to and 6 months after surgery. RRD extending to the edge of the fovea on OCT was termed fovea-split RRD. RESULTS A total of 152 eyes were included, out of which 89 eyes presented with a fovea-off, 36 with a fovea-on, and 27 with a fovea-split RRD. The mean visual acuity (VA) preoperatively was 1.32 ± 0.58 logMAR (20/400 equivalent on Snellen chart), 0.19 ± 0.20 (20/30), and 0.71 ± 0.56 (20/100) for the fovea-off, fovea-on, and fovea-split groups, respectively (p < 0.001). The mean VA at 6 months of follow-up significantly improved for the fovea-split and fovea-off groups to 0.54 ± 0.79 (20/70) (p < 0.001) and 0.45 ± 0.29 (20/50) (p = 0.01), respectively, and remained stable for the fovea-on group 0.24 ± 0.20 (20/30) (p = 0.25). Differences in alterations of the outer retinal layers (p < 0.001) and in the in-segment/outer-segment ratio (p < 0.001) were found between the groups. CONCLUSION Eyes with fovea-split RRD had both a preoperative and a final postoperative VA between those of fovea-on and fovea-off eyes and different anatomical changes on OCT. This new entity warrants different patient expectations for postoperative outcomes.
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Affiliation(s)
- Dana Barequet
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rachel Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Dana Zvi
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Cohen
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Trivizki
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shulamit Schwartz
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adiel Barak
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Rabina
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Johannigmann-Malek N, Kaye SB, Badawood S, Maier M, Baumann C. INFLUENCE OF PREOPERATIVE POSTURING ON SUBFOVEAL FLUID HEIGHT IN MACULA-OFF RETINAL DETACHMENTS. Retina 2023; 43:1738-1744. [PMID: 37320856 DOI: 10.1097/iae.0000000000003864] [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: 06/17/2023]
Abstract
PURPOSE To evaluate the effect of preoperative posturing on subfoveal fluid height (SFFH) in macula-off retinal detachment. METHODS A prospective study including patients with macula-off retinal detachment with SFFH measurable on optical coherence tomography (OCT) and duration of loss of central vision (LCV) ≤ 7 days. Linear OCT volume scans were performed at baseline, after 1 minute, 1 hour, 4 hours, and on the next morning. For the first hour, all patients remained in an upright position. Patients were then either instructed to posture until the surgery according to the location of the primary retinal break (posturing group) or were not given any instructions (control group). RESULTS Twenty-four patients were included in the posturing group and 11 patients in the control group. There was no significant change in SFFH between baseline, 1 minute, 1 hour, and 4 hours. The mean SFFH in the control group increased by 243 µ m from 624 (±268) µ m at baseline to 867 (±303) µ m the next morning ( P < 0.01) but decreased in the posturing group by 150 µ m from 728 (±416) to 578 (±445) µ m ( P = 0.03). There was a significant association of the SFFH the next morning with posturing ( P < 0.01) and SFFH at baseline ( P < 0.01), but not with location of primary break ( P = 0.20). The change in SFFH from baseline to the next morning was significantly associated with posturing and primary break location ( P < 0.01), but not with SFFH at baseline ( P = 0.21). CONCLUSION Preoperative posturing is an effective measure to prevent progression of macular detachment in macula-off retinal detachment.
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Affiliation(s)
- Navid Johannigmann-Malek
- Department of Ophthalmology, Technical University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany; and
| | - Stephen B Kaye
- University of Liverpool, William Henry Duncan Building, Texas, United Kingdom
| | - Shadi Badawood
- Department of Ophthalmology, Technical University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany; and
| | - Mathias Maier
- Department of Ophthalmology, Technical University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany; and
| | - Carmen Baumann
- Department of Ophthalmology, Technical University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany; and
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Effect of Changes in Surgical Strategies for the Treatment of Primary Rhegmatogenous Retinal Detachment on Functional and Anatomical Outcomes: A Retrospective Analysis of 812 Cases from the Years 2004 to 2012. J Clin Med 2023; 12:jcm12062278. [PMID: 36983279 PMCID: PMC10057392 DOI: 10.3390/jcm12062278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime, nighttime) for the treatment of primary rhegmatogenous retinal detachment (RRD) changed continuously in the years 2004 to 2012. This study aims to evaluate changes in surgical strategies over time including their impact on functional and anatomical outcomes. Methods: Retrospective evaluation of patients operated on primary RRD between the years 2004 and 2012. Baseline demographic data, month 3 best-corrected visual acuity (BCVA), surgical method, single success surgery, surgical timing, and intraoperative complications were analyzed. Results: Overall, 812 eyes of 812 patients with a mean (±SD) age of 58.1 ± 13.3 years were included. A total of 413 (51%) patients presented with macula-on and 359 (44%) with macula-off RRD. Month 3 BCVA increased over time, both in macula-on or macula-off groups (p < 0.001). The rate of complete retinal reattachment 3 months postoperatively increased significantly from 65% in 2004 to 83% in 2012 in both groups. Scleral buckling surgeries decreased continuously from 95% to 16% with an appropriate increase in vitrectomies as well as a decrease in surgeries during nighttime (68% in 2004, 6% in 2012) with equal or better visual and functional outcomes. Conclusion: Our data showed that improving functional and single-success surgery outcomes in patients operated on for primary RRD. In the years 2004 to 2012, surgical techniques shifted from scleral buckling to primary vitrectomy and were increasingly scheduled during the daytime.
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Effects of the Implementation of an Emergency Surgical Pattern in Patients with Rhegmatogenous Retinal Detachment: A Retrospective Observational Study. J Ophthalmol 2022; 2022:4240225. [PMID: 36276920 PMCID: PMC9586816 DOI: 10.1155/2022/4240225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background To analyze the effects of the implementation of emergency surgical patterns in patients with rhegmatogenous retinal detachment (RRD) and provide evidence for promoting emergency surgical patterns for RRD. Methods We reviewed the electronic medical records of 346 patients (348 eyes) who underwent surgical repair of RRD at the Zhongshan Ophthalmic Center in Southern China. A total of 140 patients (140 eyes) in the routine inpatient surgery group were collected at the fundus disease department between January 2019 and December 2019, and 206 patients (208 eyes) in the emergency surgery group were collected at the ophthalmic emergency department between January 2021 and December 2021. Demographics, best-corrected visual acuity (BCVA) expressed as the logarithm of the minimum angle of resolution (logMAR), the status of the macula before surgery, time to presentation, treatment interval, and postoperative BCVA measured at least three months follow-up were compared. Results The preoperative BCVA (logMAR) of the emergency surgery group and the inpatient surgery group were 1.0 (0.4–1.7) and 1.4 (0.7–1.7), respectively, with significant differences between groups (P < 0.001). However, patients had a shorter time to presentation (7 days vs. 21 days, P < 0.001), shorter treatment interval (2 days vs. 12 days, P < 0.01), and significantly better postoperative BCVA (logMAR 0.5 vs. logMAR 1.0, P < 0.001) in the emergency surgery group than in the inpatient surgery group. There was no significant difference in primary anatomical success between the two groups (P=0.802). The median follow-up for the emergency surgery group and the inpatient surgery group were 6.08 months and 6.2 months, respectively, with no significant differences (P > 0.05). Conclusions Patients who underwent emergency surgical patterns of RRD had better visual outcomes after surgery than patients with routine inpatient surgery, which might be attributed to a shorter duration, shorter treatment interval, and the preoperative status of the macula in the emergency surgery pattern. Emergency surgical patterns for RRD should be considered to achieve better surgical outcomes in suitable patients.
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Gopal AD, Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE, Yonekawa Y. Predictors of Vision Loss after Surgery for Macula-Sparing Rhegmatogenous Retinal Detachment. Curr Eye Res 2022; 47:1209-1217. [PMID: 35608082 DOI: 10.1080/02713683.2022.2081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine factors associated with loss of good vision (defined as Snellen visual acuity [VA] < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment (RRD) with initial VA ≥20/40. MATERIALS AND METHODS Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40. RESULTS Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 [20/28]) compared to eyes that preserved good vision (mean 0.11 ± 0.10 [20/26]) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 [95% CI 1.44-14.51]; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 [95% CI 2.10-24.90]; p = 0.0017) or PPV/SB (multivariate OR 10.74 [95% CI 3.20-36.11]; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 [95% CI 1.47-50.66]; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 [95% CI 5.39-38.21]; p <0.0001) were more likely to lose good vision. CONCLUSION Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.
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Affiliation(s)
- Anand D Gopal
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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Raevis JJ, Oakey Z, Altaweel M, Nork TM, Gottlieb J, Ip M, Downie E, Lasarev M, Chang JS. Outcomes of Rhegmatogenous Retinal Detachment Repair When Comparing Surgeon Continuity in a Team-Based Practice. Ophthalmic Surg Lasers Imaging Retina 2021; 52:560-566. [PMID: 34661464 DOI: 10.3928/23258160-20210922-01] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To facilitate timely surgery and efficient use of operating room time, our practice uses a team-based approach so patients may undergo primary rhegmatogenous retinal detachment (RRD) surgery with a different surgeon instead of the diagnosing surgeon. PATIENTS AND METHODS This was a retrospective cohort study of 331 eyes that underwent RRD surgery. Patients were divided into two groups: RRD surgery performed by the diagnosing surgon, and RRD surgery performed by a different surgeon. RESULTS Of 331 eyes, 200 eyes (60.4%) were repaired by the diagnosing surgeon and 131 eyes (39.6%) were repaired by a different surgeon. Primary anatomic success (PAS) rates at 3 months postoperatively were equivalent between the two groups (87.0% and 87.8% in the diagnosing surgeon and different surgeon groups, respectively [P = .83]). There was no significant difference in preoperative (P = .08) or final (P = .28) visual acuity between the groups. Time between diagnosis and RRD repair was shorter in the different surgeon group (median of 1.5 days [IQR: 1.0-3.6] in the surgeon group versus 2.2 days [IQR: 0.8-5.7] in the diagnosing surgeon group) (P = .03). Logistic regression analysis gave no evidence to suggest that PAS rates depended on day of week, time of day surgery was performed, group, or the interaction between those factors (P = .93). CONCLUSIONS Visual and anatomic success in RRD repair are equivalent when surgery is performed by either the diagnosing surgeon or a surgical colleague because time to surgery is reduced. Neither time of day nor day of the week had any influence on the outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:560-566.].
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The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
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Urgency of retinal detachment repair: is it time to re-think our priorities? Eye (Lond) 2020; 35:1035-1036. [PMID: 32873942 DOI: 10.1038/s41433-020-01154-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022] Open
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Mané V, Chehaibou I, Lehmann M, Philippakis E, Rothschild PR, Bousquet E, Tadayoni R. Preoperative Optical Coherence Tomography Findings of Foveal-Splitting Rhegmatogenous Retinal Detachment. Ophthalmologica 2020; 244:127-132. [PMID: 32772030 DOI: 10.1159/000510726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess preoperative optical coherence tomography (OCT) findings of foveal-splitting retinal detachment (RD) and determine postoperative outcomes. METHODS Consecutive patients who underwent RD surgery over a 1-year period were included. Patients diagnosed with a detachment extending to the edge of the fovea on fundus examination (i.e., macula-On/Off) underwent macular OCT scanning. Visual acuity (VA) after 1 year of macula-On/Off, macula-On, and macula-Off eyes was compared. RESULTS A total of 85 eyes were included, 8 of which had a macula-On/Off RD. On preoperative OCT, all macula-On/Off RD eyes had foveal detachment extending beyond the foveal center over a median distance of 632 µm. Mean VA of the macula-On/Off eyes had improved from 20/160 to 20/40 at 1 year postoperatively (p = 0.035). The preoperative VA of macula-On/Off eyes was significantly better than macula-Off eyes (p = 0.032) and lower than macula-On eyes (p = 0.004). At 1 year, the VA of macula-On/Off eyes was no different from that of the macula-On eyes (p = 0.320), and tended to be better than that of the macula-Off eyes (p = 0.062). CONCLUSION Preoperative OCT revealed a shallow RD extending beyond the foveal center in eyes with clinical foveal-splitting RD. These eyes, termed macula-On/Off RD eyes, had a preoperative VA between macula-On and macula-Off eyes, while their final VA was close to those with macula-On RD.
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Affiliation(s)
- Valérie Mané
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France, .,Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France,
| | - Ismael Chehaibou
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Mathieu Lehmann
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Elise Philippakis
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Pierre-Raphaël Rothschild
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
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Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yannuzzi NA, Brown K, Callaway NF, Patel NA, Albini TA, Berrocal AM, Davis JL, Gregori NN, Fortun J, Haddock LJ, Lee WH, Schwartz SG, Sridhar J, Smiddy WE, Flynn HW, Townsend J. The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center. JOURNAL OF VITREORETINAL DISEASES 2020; 4:91-95. [PMID: 37008372 PMCID: PMC9976257 DOI: 10.1177/2474126419893816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. METHODS A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). RESULTS There were 202 eyes of 198 patients with an average of 22 months' follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more (P = .92). CONCLUSIONS Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.
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Affiliation(s)
- Nicolas A. Yannuzzi
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Karen Brown
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Natalia F. Callaway
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Nimesh A. Patel
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Thomas A. Albini
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Audina M. Berrocal
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Janet L. Davis
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Ninel N. Gregori
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jorge Fortun
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Luis J. Haddock
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Wen-Hsiang Lee
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Stephen G. Schwartz
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William E. Smiddy
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Justin Townsend
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
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Major JC, Hariprasad SM, Rusakevich AM. Developments in Fovea-Sparing RRD Repair: Reconsidering the Timing of Surgery. Ophthalmic Surg Lasers Imaging Retina 2019; 50:408-410. [PMID: 31344238 DOI: 10.3928/23258160-20190703-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Jong JH, Vigueras-Guillén JP, Wubbels RJ, Timman R, Vermeer KA, van Meurs JC. The Influence of Prolongation of Interruptions of Preoperative Posturing and Other Clinical Factors on the Progress of Macula-On Retinal Detachment. Ophthalmol Retina 2019; 3:938-946. [PMID: 31253473 DOI: 10.1016/j.oret.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate whether prolongation of interruptions of preoperative posturing by sitting upright influences retinal detachment (RD) progression. The secondary objective was to find clinical factors to identify patients with a high risk for RD progression. DESIGN Prospective cohort study. PARTICIPANTS One hundred ninety-eight patients divided among 3 cohorts of patients with macula-on RD were included. Inclusion criteria were volume OCT scans of sufficient quality and smallest distance from the fovea to the detachment border of at least 1.25 mm. In the second and third cohort, 50 patients with only superior temporal RD were included. METHODS Patients were admitted to the ward in anticipation of surgery. Preoperative bed rest and positioning were prescribed. The position of the RD border was determined based on OCT imaging performed at baseline, before and after the usual interruptions for meals or toilet visits. The duration of interruptions was prolonged with sitting upright for 20 minutes in cohort 2 and for 40 minutes in cohort 3. Various secondary outcome measures were defined, such as the baseline area of subretinal fluid (SRF) as measured on ultrasound images in the third cohort. MAIN OUTCOME MEASURES The RD border displacement was determined. The worst RD progression from baseline was given by the shortest distance to the fovea in any of the OCT scans during follow-up. The worst relative RD progression from baseline was defined as the worst RD progression from baseline as a percentage of the baseline distance between RD border and fovea. RESULTS The median duration of interruptions was 22, 41, and 58 minutes in cohorts 1, 2, and 3, respectively. The median RD border displacement during interruptions in patients with superior temporal RD was not significantly different among the cohorts (P = 0.28). The correlation coefficient between the SRF area at baseline and worst relative RD progression from baseline was 0.37 (95% confidence interval, 0.04-0.66; P = 0.009). CONCLUSIONS We did not find a significant increase in RD progression after prolongation of interruptions by sitting upright. Patients with a larger area of SRF on ultrasound showed more RD progression from baseline.
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Affiliation(s)
- Jan H de Jong
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands; Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
| | | | - René J Wubbels
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Reinier Timman
- Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jan C van Meurs
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands; Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Potic J, Bergin C, Giacuzzo C, Daruich A, Pournaras JA, Konstantinidis L, Wolfensberger TJ. Hemi-macular detachment: EnFace optical coherence tomography characteristics and clinical implications. Acta Ophthalmol 2019; 97:e129-e130. [PMID: 30187665 DOI: 10.1111/aos.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jelena Potic
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
- Clinic for Eye Diseases; Clinical Center of Serbia; Department of Ophthalmology; School of Medicine; University of Belgrade; Belgrade Serbia
| | - Ciara Bergin
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
| | - Clarice Giacuzzo
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
| | - Alejandra Daruich
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
| | - Jean-Antoine Pournaras
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
| | - Lazaros Konstantinidis
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
| | - Thomas J. Wolfensberger
- Jules-Gonin Eye Hospital; Fondation Asile des Aveugles; Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
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Lee IT, Lampen SI, Wong TP, Major JC, Wykoff CC. Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes. Graefes Arch Clin Exp Ophthalmol 2019; 257:883-889. [DOI: 10.1007/s00417-018-04236-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022] Open
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Uzel MM, Citirik M, İlhan Ç, Tekin K. The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value. Int Ophthalmol 2018; 39:2089-2095. [PMID: 30470984 DOI: 10.1007/s10792-018-1045-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
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Callizo J, Pfeiffer S, Lahme E, van Oterendorp C, Khattab M, Bemme S, Kulanga M, Hoerauf H, Feltgen N. Risk of progression in macula-on rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1559-1564. [PMID: 28551879 DOI: 10.1007/s00417-017-3696-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. METHODS Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. RESULTS A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8 ± 1.4 days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p = 0.0036) and without (p = 0.0014) macular involvement. CONCLUSIONS For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany.
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August University, Goettingen, Germany
| | - Eva Lahme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Christian van Oterendorp
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Mohammed Khattab
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Miroslav Kulanga
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
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Preoperative Posturing of Patients with Macula-On Retinal Detachment Reduces Progression Toward the Fovea. Ophthalmology 2017; 124:1510-1522. [PMID: 28499747 DOI: 10.1016/j.ophtha.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Traditionally, preoperative posturing consisting of bed rest and positioning is prescribed to patients with macula-on retinal detachment (RD) to prevent RD progression and detachment of the fovea. Execution of such advice can be cumbersome and expensive. This study aimed to investigate if preoperative posturing affects the progression of RD. DESIGN Prospective cohort study. PARTICIPANTS Ninety-eight patients with macula-on RD were included. Inclusion criteria were volume optical coherence tomography (OCT) scans could be obtained with sufficient quality; and the smallest distance from the fovea to the detachment border was 1.25 mm or more. METHODS Patients were admitted to the ward for bed rest in anticipation of surgery and were positioned on the side where the RD was mainly located. At baseline and before and after each interruption for meals or toilet visits, a 37°×45° OCT volume scan was performed using a wide-angle Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). The distance between the nearest point of the RD border and fovea was measured using a custom-built measuring tool. MAIN OUTCOME MEASURES The RD border displacement and the average RD border displacement velocity moving toward (negative) or away (positive) from the fovea were determined for intervals of posturing and interruptions. RESULTS The median duration of intervals of posturing was 3.0 hours (interquartile range [IQR], 1.8-14.0 hours; n = 202) and of interruptions 0.37 hours (IQR, 0.26-0.50 hours; n = 197). The median RD border displacement was 2 μm (IQR, -65 to +251 μm) during posturing and -61 μm (IQR, -140 to 0 μm) during interruptions, a statistically significant difference (P < 0.001, Mann-Whitney U test). The median RD border displacement velocity was +1 μm/hour (IQR, -21 to +49 μm/hour) during posturing and -149 μm/hour (IQR, -406 to +1 μm/hour) during interruptions, a statistically significant difference (P < 0.001). CONCLUSIONS By making use of usual interruptions of preoperative posturing we were able to show, in a prospective and ethically acceptable manner, that RD stabilizes during posturing and progresses during interruptions in patients with macula-on RD. Preoperative posturing is effective in reducing progression of RD.
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Kontos A, Williamson TH. Rate and risk factors for the conversion of fovea-on to fovea-off rhegmatogenous retinal detachment while awaiting surgery. Br J Ophthalmol 2016; 101:1011-1015. [PMID: 27913445 DOI: 10.1136/bjophthalmol-2016-309178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/20/2016] [Accepted: 11/14/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Progression of a fovea-on to a fovea-off rhegmatogenous retinal detachment (RRD) while awaiting surgery is rare. METHODS A retrospective review of patient records to identify patients in whom a fovea-on retinal detachment at presentation was found to be fovea off at surgery. RESULTS We identified 10 cases over 14 years which converted from fovea-on to fovea-off RRD while awaiting surgery. This represented 1.1% of RRDs that were fovea on at presentation (n=930). Nine out of 10 patients had superotemporal RRDs extending to at least the vascular arcade at presentation and all had superotemporal breaks within detached retina, which was significantly higher than the rate for other retinal detachments (100% vs 63%, p=0.02). There were 2.4 breaks per eye, similar to other retinal detachments. Six of the 10 patients converted to a fovea-off retinal detachment within a few hours and the rest by the following day. Visual outcomes were good, with eight patients maintaining their presenting visual acuity and two losing one Snellen line. CONCLUSIONS Offering same-day surgery to high-risk fovea-on RRDs may not significantly influence visual outcomes and would only prevent about half of the conversions to fovea off. Superotemporal retinal detachments extending to near the arcades are most at risk and might warrant posturing to limit spread of the detachment in the preoperative period.
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Affiliation(s)
- Andreas Kontos
- Department of Ophthalmology, St Thomas' Hospital, London, UK
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Mahmoudi S, Almony A. Macula-Sparing Rhegmatogenous Retinal Detachment: Is Emergent Surgery Necessary? J Ophthalmic Vis Res 2016; 11:100-7. [PMID: 27195093 PMCID: PMC4860974 DOI: 10.4103/2008-322x.180696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD) and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours). In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.
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Hajari JN. Optimizing the treatment of rhegmatogenous retinal detachment. Acta Ophthalmol 2016; 94 Thesis 1:1-12. [PMID: 26848100 DOI: 10.1111/aos.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surgical approaches for rhegmatogenous retinal detachment (RRD) have evolved rapidly in the past century. This has resulted in an increase in the anatomical success rate from zero per cent in the beginning of the 1900s to now almost 100 per cent. Rhegmatogenous retinal detachment is regarded as an acute eye disease that needs immediate treatment. With the increasing number of cataract surgeries and an increased elderly population, the numbers of RRD occurrences are increasing. The aim of this thesis is to create knowledge on how treatment and care of RRD patients can be optimized. In the first paper, data on the incidence of RRD in Denmark are presented based on data from a nation register the National Patient Registry (NPR). It was discovered that the incidence of RRD in Denmark is similar to previous reported numbers and that the incidence has been increasing due to increasing numbers of cataract surgeries and an increased elderly population. Using data from the NPR, we estimated that the risk of a RRD occurring on the fellow eye is 100 times larger than on the first eye and that middle aged men have the highest risk. Having an increase in the incidence of RRD we need to ensure that the patients are also treated in the most optimal way. To ensure this, an indicator is needed to monitor the quality at the different centres. This indicator presented in the second paper is based in the occurrence of redetachment. We define a detachment to be caused by poor surgery if the retina detaches within one year after initial surgery with pneumatic retinopexy, scleral buckling and VTX with gas, and one and a half years after surgery with VTX with oil. Also lack of oil removal within the first year is a failed operation. It is widely accepted that RRD is an acute disease but when should surgery be performed to attain the most optimal result? In the third paper, we evaluated the progression of posterior RRD with an optical coherence tomography to make an objective assessment of the movement. We found that the risk of a macula on RRD progressing to affect the fovea is small if the patient is postured appropriately. We found that the movement of the RRD is dynamic but the detachments will ultimately approach the fovea. Having an opportunity to postpone surgery without risking the outcome for the patient allows a more optimal surgery. The results of this thesis can be used by all health care systems to establish optimal conditions in the treatment of RRD.
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Affiliation(s)
- Javad Nouri Hajari
- Faculty of Health and Medical Sciences; University of Copenhagen; Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Glostrup Denmark
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Tolou C, Mahieu-Durringer L, Cassagne M, Hamid S, Billette de Villemeur R, Gualino V, Susini A, Pagot Mathis V, Gallini A, Soler V. [Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. J Fr Ophtalmol 2015; 39:90-7. [PMID: 26707754 DOI: 10.1016/j.jfo.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/29/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.
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Affiliation(s)
- C Tolou
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France.
| | - L Mahieu-Durringer
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - M Cassagne
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - S Hamid
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - R Billette de Villemeur
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Gualino
- Clinique Caves, 82000 Montauban, France
| | - A Susini
- Clinique de l'Union, 31240 Saint-Jean, France
| | - V Pagot Mathis
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - A Gallini
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Soler
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie Toulouse-Purpan, 31000 Toulouse, France
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Gorovoy IR, Porco TC, Bhisitkul RB, de Juan E, Schwartz DM, Stewart JM. Same-Day Versus Next-Day Repair of Fovea-Threatening Primary Rhegmatogenous Retinal Detachments. Semin Ophthalmol 2014; 31:219-25. [PMID: 25081305 DOI: 10.3109/08820538.2014.936619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the outcomes of same-day versus next-day repair of fovea-threatening rhegmatogenous retinal detachments (FT RRD). DESIGN Retrospective, multi-surgeon observational case series. METHODS Operative reports and medical records were reviewed to evaluate a number of visual and anatomic outcomes, including presenting features, intraoperative complications, and postoperative results in the repair of primary FT RRD undergoing same-day versus next-day repair with scleral buckling, pars plana vitrectomy, or both procedures. PARTICIPANTS A total of 96 consecutive patients (43 same-day, 45 next-day, and eight two days later) were compared. RESULTS There was no statistically significant difference in visual outcomes between same-day and next-day repair at postoperative months 3 and 6 and at last follow-up (month 3 mean BCVA 20/30 same day; 20/32 next day; p = 0.82). Preoperative vision was strongly correlated with postoperative acuity. Effect of differences in length or type of visual symptoms, location of RRD, gender, or lens status on postoperative month 3 best-corrected visual acuity (BCVA) was not statistically significant. Overall, 85% of patients had a BCVA of 20/40 or better at postoperative month 3. Reoperation rate and intraoperative complications were not statistically different between the two groups. Re-attachment was achieved in all but one patient in both groups. Time in the operating room was longer for same-day surgery (2.98 ± 0.46 hours) compared to next-day surgery (2.54 ± 0.38 hours) (p < 0.001), which was statistically significant even when factoring in the type of surgery performed. However, one case did progress to a macula-off detachment in a superior RRD with breaks found in lattice degeneration. CONCLUSION Next-day surgery provided equivalent visual outcomes. Emergent, same-day surgery has logistical and resource implications as it may be more expensive, may necessitate rescheduling of previously booked cases, and may limit preoperative examination by the surgeon and perioperative team.
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Affiliation(s)
- Ian R Gorovoy
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Travis C Porco
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Robert B Bhisitkul
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Eugene de Juan
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Daniel M Schwartz
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Jay M Stewart
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
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Kikushima W, Imai A, Hirano T, Iesato Y, Toriyama Y, Murata M, Murata T. Quick Referral and Urgent Surgery to Preempt Foveal Detachment in Retinal Detachment Repair. Asia Pac J Ophthalmol (Phila) 2014; 3:141-5. [PMID: 26107583 DOI: 10.1097/apo.0b013e3182a81240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to evaluate the consultation and referral pathway and benefit of urgent surgery within 24 hours of outpatient clinic presentation on increasing the ratio of eyes with fovea-on at surgery and visual outcomes in retinal detachment cases. DESIGN This is a retrospective, interventional case series. METHODS A total of 106 eyes underwent an operation for rhegmatogenous retinal detachment. Standard vitrectomy or explant scleral buckling was performed. The ratio of eyes with fovea-on at the time of operation, anatomical success rate, and postoperative best corrected visual acuity were measured. RESULTS Of the106 eyes, 46 (43.4%) already were fovea-off at initial eye clinic visit, and 9 eyes became fovea-off during referral. Consequently, 55 patients (51.9%) were fovea-off when presenting to our outpatient clinic. Retinal detachment was within 1 disc diameter of the fovea in 9 of 51 eyes with fovea-on at outpatient clinic presentation, but surgery within 24 hours spared 6 eyes from foveal involvement. The anatomical success rate of primary surgery was 98.8% (81/82 eyes) by vitrectomy and 83.3% (20/24 eyes) by scleral buckling. Postoperative best corrected visual acuity of the fovea-on group was significantly higher (mean [SD], -0.019 [0.22] logarithm of the minimal angle of resolution) than that of the fovea-off group (mean [SD], 0.32 [0.45] logarithm of the minimal angle of resolution; P = 0.002). CONCLUSIONS More than half (51.9%) of our cohort had already been fovea-off by outpatient presentation. Therefore, efforts to urge patients to visit operating facilities promptly seem to be as important as the urgent surgeries themselves.
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Affiliation(s)
- Wataru Kikushima
- From the *Department of Ophthalmology, Shinshu University School of Medicine; and †Department of Ophthalmology, National Hospital Organization, Matsumoto Medical Center, Matsumoto, Nagano, Japan
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Ehrlich R, Niederer RL, Ahmad N, Polkinghorne P. Timing of acute macula-on rhegmatogenous retinal detachment repair. Retina 2013; 33:105-10. [PMID: 22990323 DOI: 10.1097/iae.0b013e318263ceca] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if same-day or next available surgery changed the outcome of patients presenting with acute macula-on rhegmatogenous retinal detachments. METHODS A retrospective review of patients presenting with acute macula-on rhegmatogenous retinal detachments treated with small-gauge vitrectomy was performed. Data collection included subjects' demographics, duration of symptoms, location and extent of the retinal detachment, and timing of surgery. The primary outcome was anatomical and functional success rate for patients having same-day surgery compared with those for whom surgery was delayed. RESULTS One hundred and fourteen patients were included in this study. Sixty-two patients operated on day of presentation, 46 patients operated the day after presentation, and in 6 patients, surgery was delayed from 2 to 5 days. Time to surgery in hours ranged between 1 and 120 hours (mean 14.5 ± 15.05 hours). Retinal reattachment was achieved in 95.6% of patients, with 80% requiring only one procedure. Mean initial visual acuity was logarithm of the minimum angle of resolution 0.42 (SD 0.6), and mean final visual acuity was logarithm of the minimum angle of resolution 0.39 (SD 0.67) (P = 0.53). Time to surgery was not found to effect final anatomical outcome (P = 0.56). No statistically significant association was observed between change in visual acuity and time to surgery (P = 0.99). CONCLUSION Modest delay in timing of surgery for macula-on rhegmatogenous retinal detachment did not adversely impact on patients' outcome.
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Affiliation(s)
- Rita Ehrlich
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Reply. Retina 2011. [DOI: 10.1097/iae.0b013e31822650d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wykoff CC, Smiddy WE, Mathen T, Schwartz SG, Flynn HW, Shi W. Fovea-sparing retinal detachments: time to surgery and visual outcomes. Am J Ophthalmol 2010; 150:205-210.e2. [PMID: 20541738 DOI: 10.1016/j.ajo.2010.03.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/01/2010] [Accepted: 03/06/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the effect of the duration from initial evaluation to repair on outcomes for fovea-sparing rhegmatogenous retinal detachment (RRD). DESIGN Retrospective, single-surgeon, consecutive case series. METHODS Medical records were reviewed for preoperative and intraoperative factors possibly associated with visual and anatomic outcomes for all patients undergoing scleral buckling procedure (SBP) for fovea-sparing, primary RRD between 1989 and 2004. RESULTS Fifty-five percent of 199 patients had symptoms for < or = 7 days, 83% had best-corrected visual acuity (BCVA) > or = 20/40, and 33% had a RRD that had extended to within the macular arcade vessels. Eighty-five percent were operated within 3 days, including 56% within 24 hours. One case progressed to fovea-off status before surgery 4 days after initial evaluation (0.5%). The single-operation success rate was 88% and final anatomic success was 99.5% (1 patient refused reoperation). Eighty-six percent were examined postoperatively for at least 2 months; 73% had > or = 20/40 vision. The strongest predictor of postoperative BCVA was initial BCVA (r = 0.47; P < .001). There was no statistically significant difference in postoperative BCVA or single-operation success rate at any point within 3 days of initial examination. No statistically significant correlation was found between postoperative BCVA and duration of symptoms, RRD location, direction of the closest approach of the RRD to the fovea, or need for reoperation. CONCLUSIONS Progression to fovea-off status was rare in this series when a selectively urgent, but not strictly emergent, surgical approach was employed for fovea-sparing RRD.
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Richtlinie zur Dringlichkeit der operativen Intervention bei rhegmatogener Ablatio retinae. SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ho SF, Fitt A, Frimpong-Ansah K, Benson MT. Reply to Scott and Kirkby. Eye (Lond) 2007. [DOI: 10.1038/sj.eye.6702811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Scott R, Kirkby G. Treatment of macula-on retinal detachments. Eye (Lond) 2007; 21:1008; author reply 1008-9. [PMID: 17417617 DOI: 10.1038/sj.eye.6702810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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