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Dimakopoulou I, Mylonas G, Iby J, Sedova A, Hollaus M, Sacu S, Georgopoulos M, Schmidt-Erfurth U. Vitrectomy versus scleral buckle for retinal detachment without posterior vitreous detachment. Sci Rep 2024; 14:17141. [PMID: 39060328 PMCID: PMC11282269 DOI: 10.1038/s41598-024-67318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
To compare the effectiveness and safety of scleral buckling and pars plana vitrectomy in treating retinal detachment without posterior vitreous detachment. A total of 88 eyes of 83 patients with retinal detachment without prior posterior vitreous detachment were investigated retrospectively. Group A comprised patients who underwent scleral buckling (n = 47) and Group B (n = 36) patients who were treated with pars plana vitrectomy. Anatomical success, postoperative visual acuity, and ocular adverse events were evaluated. The primary and final anatomical success rate showed a nonsignificant difference (p = 0.465 and p = 0.37 respectively). No significant difference was observed in the reoperation rate or development of epiretinal membrane between the groups (p = 0.254 and p = 0.254 respectively). However, scleral buckling resulted in significantly better visual acuity at the last follow-up (0.12 ± 0.23) compared to pars plana vitrectomy (0.37 ± 0.46, p = 0.001). The incidence of cataract progression was also significantly higher in the pars plana vitrectomy group (46%) compared to the scleral buckling group (10%, p < 0.001). Scleral buckling and pars plana vitrectomy show similar success rates in treating retinal detachment without vitreous detachment. However, due to less cataract progression and better visual acuity outcomes, scleral buckling is recommended for these cases. Determining vitreous status before surgery is crucial for optimal outcomes.
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Affiliation(s)
- Ioanna Dimakopoulou
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johannes Iby
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexandra Sedova
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marlene Hollaus
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Jung YH, Woo SJ, Joo K, Kim MS. ADDITIONAL PNEUMATIC RETINOPEXY IN PATIENTS WITH PERSISTENT RETINAL DETACHMENT AFTER SCLERAL BUCKLING. Retina 2024; 44:799-809. [PMID: 38261829 DOI: 10.1097/iae.0000000000004055] [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: 01/25/2024]
Abstract
PURPOSE To investigate the efficacy, safety, and indications for additional pneumatic retinopexy (PR) in patients with persistent retinal detachment after scleral buckling. METHODS This retrospective study included patients who underwent additional PR after scleral buckling for primary rhegmatogenous retinal detachment (n = 78). We defined "inadequate buckle" as retinal detachment persistence because of low buckle height despite accurate buckle placement and "buckle misplacement" as an uncovered tear because of incorrect buckle placement. RESULTS The anatomical success rate after additional PR was 52.6%. Development of proliferative vitreoretinopathy Grade B (hazard ratio, 5.73; P < 0.001) and inferior retinal tears (hazard ratio, 2.12; P = 0.040) were significant risk factors for anatomical failure. The most common cause of anatomical failure was proliferative vitreoretinopathy (19 of 37; 51.4%), and epiretinal membrane formation was a common complication after additional PR (22 of 78; 28.2%). The anatomical success rate with additional PR was significantly higher in the inadequate buckle group than in the misplacement group (8 of 9 [88.9%] vs. 1228 [42.9%]; P = 0.023). CONCLUSION Development of proliferative vitreoretinopathy Grade B and inferior retinal tears were significantly associated with anatomical failure after additional PR. Additional PR may benefit patients with superior retinal tears or low buckle height and those without proliferative vitreoretinopathy.
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Affiliation(s)
- Young Hoon Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Lin JB, Narayanan R, Philippakis E, Yonekawa Y, Apte RS. Retinal detachment. Nat Rev Dis Primers 2024; 10:18. [PMID: 38485969 DOI: 10.1038/s41572-024-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.
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Affiliation(s)
- Jonathan B Lin
- Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Elise Philippakis
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rajendra S Apte
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Developmental, Regenerative, and Stem Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Jung YH, Park KH, Woo SJ, Joo K, Kim MS. Scleral buckling with adjuvant pneumatic retinopexy versus scleral buckling alone for rhegmatogenous retinal detachment. Sci Rep 2024; 14:5249. [PMID: 38438557 PMCID: PMC10912704 DOI: 10.1038/s41598-024-55999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Abstract
To compare the efficacy of scleral buckling with adjuvant pneumatic retinopexy (SB with PR) and scleral buckling (SB) alone for primary rhegmatogenous retinal detachment (RRD). This retrospective and comparative study included patients who underwent SB with PR (n = 88) or SB alone (n = 161) for primary RRD. The primary anatomical success rate for SB with PR was 81.8%, whereas that for SB alone was 80.7% (P = 0.836). Among patients who achieved primary anatomical success, those in the SB with PR group showed postoperative epiretinal membrane (ERM) formation more frequently than those in the SB alone group (11 of 72 [15.3%] vs. 6 of 130 [4.6%]) (P = 0.009). The mean time to subretinal fluid absorption was not significantly different between the SB with PR and SB alone groups (11.2 ± 6.2 vs. 11.4 ± 5.8 months, P = 0.881). In the SB with PR group, retinal detachment involving ≥ three quadrants was a significant risk factor for surgical failure (hazard ratio, 3.04; P = 0.041). Adjuvant pneumatic retinopexy does not provide additional benefit in improving the surgical outcomes of SB for primary RRD repair.
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Affiliation(s)
- Young Hoon Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Zajner C, Leung B, Sheidow T, Malvankar-Mehta MS. Quality of Life after Pars Plana Vitrectomy, Scleral Buckle, or Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment: A Meta-Analysis. Curr Eye Res 2024; 49:295-302. [PMID: 37937863 DOI: 10.1080/02713683.2023.2280440] [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: 01/17/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Comparisons of the surgical and anatomic results of rhegmatogenous retinal detachment surgery have been investigated previously. A systematic evaluation of the available evidence comparing quality of life outcomes of either pars plana vitrectomy, scleral buckling, or pneumatic retinopexy has not been evaluated to date. This article analyzes whether pars plana vitrectomy, scleral buckling, or pneumatic retinopexy for the treatment of rhegmatogenous retinal detachment results in differing quality of life outcomes. METHODS In February of 2022, a comprehensive search of MEDLINE, EMBASE, CINHAL, and Cochrane Library was conducted for studies on patients treated surgically for rhegmatogenous retinal detachment and included follow-up measurements of quality of life outcomes. Meta-analysis was completed using STATA v. 14.0. The main outcomes of interest were the mean vision-related quality of life score (VRQOL) and SD of VRQOL of each type of surgical procedure. RESULTS In this systematic review of 13 distinct trials including follow-up of patient quality of life after rhegmatogenous retinal detachment surgery (n = 1063), a better correlation was found between higher quality of life outcomes with scleral buckling than with pars plana vitrectomy (SMD = 0.62, CI: [0.31, 0.93]). There was also no signficant difference in quality of life outcomes between pneumatic retinopexy and pars plana vitrectomy (SMD = 0.08, CI: [-0.07, 0.22]). CONCLUSIONS Scleral buckling results in better quality of life outcomes for patients when compared to pars plana vitrectomy. Pneumatic retinopexy did not show a difference in quality of life outcomes compared to pars plana vitrectomy.
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Affiliation(s)
- Chris Zajner
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Bernice Leung
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Tom Sheidow
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
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Felfeli T, Teja B, Miranda RN, Simbulan F, Sridhar J, Sander B, Naimark DM. Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model. Am J Ophthalmol 2023; 255:141-154. [PMID: 37327958 DOI: 10.1016/j.ajo.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime. DESIGN Model-based cost-utility analysis. METHODS A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY. RESULTS Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV. CONCLUSIONS This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.
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Affiliation(s)
- Tina Felfeli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F.), Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada.
| | - Bijan Teja
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto (B.T.), Ontario, Canada
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; The Hospital for Sick Children Research Institute, University of Toronto (F.S.), Ontario, Canada
| | - Jayanth Sridhar
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine (J.S.), Florida, USA
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - David M Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre (D.N.), Ontario, Canada
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Wu PY, Fung AT, Dave VP, Iu LPL, Sjahreza E, Chaikitmongkol V, Sivagurunathan PD, Ahn J, Misra DK, Wong CW, Chou HD. COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey. Clin Exp Ophthalmol 2023; 51:585-597. [PMID: 37170410 DOI: 10.1111/ceo.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic. METHODS An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022. RESULTS To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation. CONCLUSIONS SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.
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Affiliation(s)
- Po-Yi Wu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Vivek P Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Lawrence P L Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | | | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Premala D Sivagurunathan
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Malaysian Ministry of Health, Kota Bharu, Kelantan, Malaysia
| | - Jeeyun Ahn
- Department of Ophthalmology, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- College of Medicine, Seoul National University, Seoul, Korea
| | - Diva K Misra
- Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Li C, Zhang B, Tan X, Jia Y, Guo L, Wang C, Xing Y, Li Q, Tian X. A pilot clinical study of complex rhegmatogenous retinal detachment treatment via foldable capsular buckle scleral buckling. BMC Ophthalmol 2023; 23:196. [PMID: 37142972 PMCID: PMC10158219 DOI: 10.1186/s12886-023-02913-5] [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: 11/30/2022] [Accepted: 04/08/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling. METHODS This prospective clinical study enrolled five patients with complex rhegmatogenous retinal detachment treated with foldable capsular buckle scleral buckling at the 988th Hospital of People's Liberation Army Joint Logistic Force, China. During the 24-week follow-up period, the patients underwent measurements of their best-corrected visual acuity, slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Additionally, B-ultrasound and fundus photography of the patients' retinal reattachments helped evaluate the treatment's post-surgery efficacy. We determined the safety of foldable capsular buckle scleral buckling based on infection, eye pain, diplopia, elevated intraocular pressure, and other postoperative severe complications. RESULTS All five patients' complex rhegmatogenous retinal detachments were successfully treated and evaluated via B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in four patients 24 weeks after surgery, while the remaining patients developed diplopia after surgery. No other complications were observed. CONCLUSION This pilot study preliminarily determined that foldable capsular buckle scleral buckling is feasible for efficient and safe treatment of complex rhegmatogenous retinal detachment. These results support this surgery as a potential and novel alternative to current extraocular procedures for treating complex rhegmatogenous retinal detachment. TRIAL REGISTRATION The prospective observational clinical study protocol was approved by the Institutional Review Board and Ethics Committee and registered at the clinical research center in the 988th Hospital of People's Liberation Army Joint Logistic Force, China (9,882,019,000).
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Affiliation(s)
- Cheng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Baike Zhang
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Xiao Tan
- Shenzhen Aier Eye Hospital Affiliated to Jinan University, Shenzhen, 518000, China
| | - Yong Jia
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Lisha Guo
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Chunlei Wang
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Yaofan Xing
- Xinxiang Medical University, Xinxiang, 453000, China
| | - Qiaoyun Li
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Xuemin Tian
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China.
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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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Warren A, Wang DW, Lim JI. Rhegmatogenous retinal detachment surgery: A review. Clin Exp Ophthalmol 2023; 51:271-279. [PMID: 36640144 DOI: 10.1111/ceo.14205] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management.
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Affiliation(s)
- Alexis Warren
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Daniel W Wang
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Jennifer I Lim
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
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11
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Cobbs L, Wakabayashi T, Yonekawa Y. Surgical management of recurrent rhegmatogenous retinal detachment. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2152004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lucy Cobbs
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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12
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Baldwin G, Sokol JT, Ludwig CA, Miller JB. A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization. Clin Ophthalmol 2022; 16:3079-3088. [PMID: 36160731 PMCID: PMC9507285 DOI: 10.2147/opth.s378179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP). Methods A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16). Results The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0–0.20) in the ID group and 0.08 (0.02–0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94–123) minutes in the ID group and 100 (90–111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100–135) minutes vs 93 (85–111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group. Conclusion Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.
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Affiliation(s)
- Grace Baldwin
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jared T Sokol
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Cassie A Ludwig
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Correspondence: John B Miller, Retina Service, Mass Eye and Ear, Harvard Medical School, Principal Investigator, Harvard Retinal Imaging Lab, 243 Charles St, Boston, MA, 02114, USA, Tel +1 (617) 573-3750, Fax +1 (617) 573-3698, Email
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13
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Shi J, Wu K, Wen H, Wei J, Zong Y, Yu J, Zhu H, Jiang C. Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. BMC Ophthalmol 2022; 22:257. [PMID: 35676663 PMCID: PMC9175333 DOI: 10.1186/s12886-022-02433-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background We aimed to explore the changes in the axial length and related factors after vitrectomy for rhegmatogenous retinal detachment (RRD). Methods This study retrospectively evaluated patients who underwent vitrectomy with silicone oil (SO) tamponade for RRD and subsequent silicone oil removal at our clinic. Using a Zeiss IOLMaster 700, axial length was measured before vitrectomy for RRD and SO removal. The change in axial length (ΔAL) was calculated, and multivariate binary logistic regression analysis was performed to investigate the potential correlation between ΔAL and clinical factors, such as preoperative hypotony, extreme myopia, age, macular involvement, choroidal detachment, operation duration, and operation history. Results In total, 213 eyes from 213 patients were included. The mean axial length changed significantly pre- and post-vitrectomy (25.98 ± 2.87 mm and 26.25 ± 3.07 mm, respectively, P < 0.001); the mean ΔAL was 0.37 ± 0.62 mm. Multivariate binary logistic regression analysis showed that preoperative hypotony and extreme myopia were significantly correlated with the ΔAL (P = 0.001 and P = 0.001, respectively). A higher proportion of hypotonic eyes had ΔAL ≥ 0.3 mm (33/76 in hypotony eyes and 32/137 in others; P = 0.003). A higher proportion of extremely myopic eyes also had a ΔAL ≥ 0.3 mm (23/46 in extremely myopic eyes and 42/167 in others; P = 0.002). Conclusion For patients with RRD and cataracts, as axial length changed significantly after vitrectomy in those with hypotony or extreme myopia, secondary lOL implantation should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02433-8.
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Affiliation(s)
- Jiemei Shi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Huiming Wen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Jiaojiao Wei
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Haohao Zhu
- Department of Ophthalmology, People's Hospital of Shanghai No. 5, Shanghai, 200240, People's Republic of China.
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China.
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14
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Staropoli PC, Brown K, Townsend JH. Return to the Operating Room After Repair of Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2022; 16:1391-1399. [PMID: 35535125 PMCID: PMC9078860 DOI: 10.2147/opth.s360313] [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: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the rate of all-cause returns to the operating room (OR) after surgery for rhegmatogenous retinal detachment (RRD). Patients and Methods This was a retrospective consecutive case series; 1278 eyes underwent RRD repair from 1/1/2014 to 12/31/2016 at a tertiary care center. A total of 507 eyes returned to the OR. Surgical indication, procedure, number of reoperations, and final vision were recorded. Results At least one secondary procedure was performed in 24.9% at 6 months, 34.7% at 1 year, and 39.7% as of last follow-up. The most common indications for reoperation were cataract (43.9%) and recurrent RRD (12.8%). Cornea, glaucoma, and oculoplastic issues were rare (each <1.1%). There was no association between final visual outcome and number of reoperations (p > 0.05). SB/PPV had the highest rate of return to OR (p < 0.001) but lowest rate of recurrent RRD (p = 0.007). Conclusion To our knowledge, there are no other large studies that examine all-cause returns to the OR after primary RRD repair. This study provides important risk-benefit and prognostic information to patients undergoing RRD repair.
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Affiliation(s)
- Patrick C Staropoli
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karen Brown
- Ophthalmology Department, University of Texas Southwestern, Dallas, TX, USA
| | - Justin H Townsend
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Justin H Townsend, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Miami, FL, 33136, USA, Tel +1 352 2624220, Fax +1 305 326 6114, Email
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15
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Scleral Buckling: A Review of Clinical Aspects and Current Concepts. J Clin Med 2022; 11:jcm11020314. [PMID: 35054009 PMCID: PMC8778378 DOI: 10.3390/jcm11020314] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 01/27/2023] Open
Abstract
Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.
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16
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Shishkin MM, Kocheva EA, Fayzrakhmanov RR, Sukhanova AV. [Episcleral circular buckling in surgical treatment of recurrent rhegmatogenous retinal detachment after vitrectomy]. Vestn Oftalmol 2022; 138:65-69. [PMID: 36573949 DOI: 10.17116/oftalma202213806165] [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: 12/29/2022]
Abstract
Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high. PURPOSE Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery. RESULTS Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil. CONCLUSIONS Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.
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Affiliation(s)
- M M Shishkin
- N.I. Pirogov National Medical and Surgical Center, Moscow, Russia
| | - E A Kocheva
- N.I. Pirogov National Medical and Surgical Center, Moscow, Russia
| | | | - A V Sukhanova
- N.I. Pirogov National Medical and Surgical Center, Moscow, Russia
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17
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Dhoot AS, Popovic MM, Nichani PAH, Eshtiaghi A, Mihalache A, Sayal AP, Yu H, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy versus Scleral Buckle: A Comprehensive Meta-Analysis of 15,947 Eyes. Surv Ophthalmol 2021; 67:932-949. [PMID: 34896191 DOI: 10.1016/j.survophthal.2021.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P=0.005). SB had a better final BCVA compared to PPV in observational studies (P=0.007) but not in RCTs (P=0.21). SB had a lower incidence of post-operative cataract formation (P<0.00001) and iatrogenic breaks (P<0.00001), but a higher incidence of choroidal hemorrhage (P=0.007), choroidal detachment (P=0.004), and residual subretinal fluid (RSRF) (P<0.00001). Primary (86.5% vs. 84.8%; P=0.13) and final (96.7% vs. 97.7%; P=0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P=0.02) but not in observational studies (P=0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.
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Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Yu
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Charles C Wykoff
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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18
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Ness S, Subramanian ML, Chen X, Siegel NH. Diagnosis and Management of Degenerative Retinoschisis and Related Complications. Surv Ophthalmol 2021; 67:892-907. [PMID: 34896193 DOI: 10.1016/j.survophthal.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
Degenerative retinoschisis is a common condition characterized by elevation of the inner layers of the peripheral retina. While uncomplicated retinoschisis (i.e. with no associated retinal layer breaks) is almost invariably a benign process, retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) is fairly common. Historically, schisis-detachment has been treated with a variety of interventions ranging from retinopexy to intraocular surgery. Based on published descriptions of the natural history of the disease, these interventions are likely unnecessary in many cases and may place the patient's vision at unnecessary risk. Progressive symptomatic schisis-related retinal detachment, on the other hand, is a vision threatening condition that requires intervention. While clinical examination remains the mainstay of diagnosis, recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring. When evaluating patients with peripheral retinal elevation, it is important for ophthalmologists to make an accurate diagnosis and understand the risk-benefit ratio associated with intervention. Thus, we summarize the current literature on the natural history, clinical and imaging diagnosis, and surgical management of degenerative retinoschisis and its related complications.
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Affiliation(s)
- Steven Ness
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Manju L Subramanian
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Xuejing Chen
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Nicole H Siegel
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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19
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Safadi K, Chowers I, Khateb S. Outcomes of primary rhegmatogenous retinal detachment repair among young adult patients. Acta Ophthalmol 2021; 99:892-897. [PMID: 33538410 DOI: 10.1111/aos.14783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults. METHODS A retrospective, comparative case series study. Patients between the ages of 18 and 40 years who underwent surgical repair of primary RRD between the years 2006 and 2013 were included. Patients were divided into three groups according to the surgical technique used: scleral buckle (SB), pars plana vitrectomy (PPV) or combined surgery (SB-PPV). RESULTS Ninety eyes (90 patients) were included. The mean age (SD) was 31.5 ± 5.1 years (range 22-40). Sixty-seven patients underwent SB, 10 had PPV and 13 had SB-PPV. Anatomical success rates were similar between the three groups (87%, 90% and 85% for SB, PPV and SB-PPV groups, respectively; p-value = 0.9). Mean (SD) preoperative LogMAR visual acuity (VA) was 0.46 ± 0.6, 1.73 ± 1.1, 1.1 ± 1.1 for SB, PPV and SB-PPV groups, respectively (p < 0.0001). The VA improved at last follow-up to 0.23 ± 0.4, 0.7 ± 1.5 and 1.09 ± 1.08 in SB, PPV and SB-PPV groups, respectively (p < 0.0001). Macula-off was diagnosed in 19.4% of SB, 80% of PPV and 53.9% of SB-PPV groups (p < 0.0001). In the SB group one phakic patient (1.5%) needed cataract extraction, while following PPV, all phakic eyes (100%) underwent cataract extraction eventually (p-value < 0.0001). CONCLUSIONS The study emphasizes the efficacy of SB as a primary procedure for the repair of retinal detachment in young adults in terms of anatomical and functional success. Furthermore, preservation of the lens as a result of using SB rather than PPV when possible is of great importance in this age group.
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Affiliation(s)
- Khaled Safadi
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Itay Chowers
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Samer Khateb
- Department of Ophthalmology Hadassah‐Hebrew University Medical Center Jerusalem Israel
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20
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Baudin F, Deschasse C, Gabrielle P, Berrod JP, Le Mer Y, Arndt C, Tadayoni R, Delyfer MN, Weber M, Gaucher D, Saleh M, Chiquet C, Creuzot‐Garcher C. Functional and anatomical outcomes after successful repair of macula-off retinal detachment: a 12-month follow-up of the DOREFA study. Acta Ophthalmol 2021; 99:e1190-e1197. [PMID: 33576133 DOI: 10.1111/aos.14777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/11/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula-off rhegmatogenous retinal detachment (RD). METHODS Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral-domain optical coherence tomography (SD-OCT) macular images at 1, 3, 6 and 12 months after surgery. RESULTS Over the follow-up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD-OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001). CONCLUSION Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD-OCT lesions after macula-off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery.
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Affiliation(s)
- Florian Baudin
- Department of Ophthalmology University Hospital Dijon France
- EA 7460 Pathophysiology and Epidemiology of Cerebro‐Cardiovascular Diseases (PEC2) University Hospital Dijon France
| | | | | | - Jean P. Berrod
- Department of Ophthalmology University Hospital Nancy France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation A. de Rothschild Paris France
| | - Carl Arndt
- Department of Ophthalmology University Hospital Reims France
| | - Ramin Tadayoni
- Department of Ophthalmology Lariboisière Hospital Paris France
| | | | - Michel Weber
- Department of Ophthalmology University Hospital Nantes France
| | - David Gaucher
- Department of Ophthalmology University Hospital Strasbourg France
- Bacteriology institute, UR‐7290 Strasbourg University Strasbourg France
| | - Maher Saleh
- Department of Ophthalmology University Hospital Besançon France
| | | | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research group GSGA UMR 1324 INRA 6265 CNRS Dijon France
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Abstract
Retinal detachments are a potentially sight-threatening ophthalmic emergency that may result in significant, irreversible vision loss. The risk of developing retinal detachment increases with advancing age, myopia and trauma. Pre-existing retinal degenerations can precipitate a pre-detachment symptomatic period of photopsia or floaters, allowing clinicians to intervene early and prevent detachments. Novel imaging techniques, such as spectral-domain optical coherence tomography, and well-established topographic modalities, such as B scan, can help to elucidate the type of detachment and any underlying causes, and help with surgical management. The overarching goal of treatment is to identify and seal all retinal holes, relieve vitreoretinal traction and prevent further recurrence. Prompt prophylactic retinopexy of retinal holes and tears is crucial in preventing retinal detachment, the main treatments of which are pars plana vitrectomy, tamponading agents and silicone scleral buckle.
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Affiliation(s)
- Ahmed Ibrar
- Ophthalmology Department, Great Western Hospital, Swindon, UK
| | - Maghsoudlou Panayiotis
- Ophthalmology Department, Great Western Hospital, Swindon, UK.,Department of Stem Cells and Regenerative Medicine, University College London, London, UK
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22
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A PILOT CLINICAL STUDY OF TREATING RHEGMATOGENOUS RETINAL DETACHMENT BY SILICONE RUBBER BALLOON SCLERAL BUCKLING. Retina 2021; 40:1918-1928. [PMID: 31725525 PMCID: PMC7505152 DOI: 10.1097/iae.0000000000002685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy and primary safety of treating rhegmatogenous retinal detachment (RRD) using foldable capsular vitreous body scleral buckling. METHODS Five patients with simple RRD were treated with foldable capsular vitreous body scleral buckling. B-ultrasound and fundus photography examining of retina reattachment were used to evaluate the postsurgery efficacy. The safety of the treatment was evaluated based on the occurrence of infection, eye pain, diplopia, elevated intraocular pressure, and other serious postoperative complications after surgery. The observation time after the operation was at least 12 weeks. RESULTS The simple RRD of all five patients was successfully reattached before being evaluating by B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in two patients who were macularly affected. One patient had temporary diplopia and eye movement limitation after surgery. No other complications were recorded. CONCLUSION This pilot study determined that foldable capsular vitreous body scleral buckling can be efficacious and safe for simple RRD. The results indicate that this surgery may be a novel alternative to the current extraocular procedures for simple RRD.
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Kim MS, Woo SJ, Park KH. PHACOVITRECTOMY VERSUS LENS-SPARING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT REPAIR ACCORDING TO THE SURGICAL EXPERIENCE. Retina 2021; 41:1597-1604. [PMID: 33394996 DOI: 10.1097/iae.0000000000003090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience. METHODS We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared. RESULTS Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively). CONCLUSION Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Popovic MM, Muni RH, Nichani P, Kertes PJ. Pars plana vitrectomy, scleral buckle, and pneumatic retinopexy for the management of rhegmatogenous retinal detachment: a meta-analysis. Surv Ophthalmol 2021; 67:184-196. [PMID: 34043984 DOI: 10.1016/j.survophthal.2021.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate. In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Prem Nichani
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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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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Moinuddin O, Abuzaitoun RO, Hwang MW, Sathrasala SK, Chen XD, Stein JD, Johnson MW, Zacks DN, Wubben TJ, Besirli CG. Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy. BMJ Open Ophthalmol 2021; 6:e000651. [PMID: 33718613 PMCID: PMC7908907 DOI: 10.1136/bmjophth-2020-000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD). METHODS AND ANALYSIS Data from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research. RESULTS PPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of the PPV, PPV/SB and SB groups. CONCLUSIONS In this large, single institution, retrospective case series, we report surgical outcomes for patients with primary non-complex RRD managed with PPV, SB or PPV/SB in the modern era of small-gauge vitrectomy. We demonstrate that primary PPV without adjunct SB provides excellent anatomic and visual outcomes irrespective of lens status, macular involvement or pathology location.
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Affiliation(s)
- Omar Moinuddin
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebhi O Abuzaitoun
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Min W Hwang
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjana K Sathrasala
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Xing D Chen
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Stein
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark W Johnson
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David N Zacks
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Thomas J Wubben
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cagri G Besirli
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Nair AA, Liebenthal R, Sood S, Hom GL, Ohlhausen ME, Conti TF, Valentim CCS, Ishikawa H, Wollstein G, Schuman JS, Singh RP, Modi YS. Determining the Location of the Fovea Centralis Via En-Face SLO and Cross-Sectional OCT Imaging in Patients Without Retinal Pathology. Transl Vis Sci Technol 2021; 10:25. [PMID: 34003910 PMCID: PMC7900853 DOI: 10.1167/tvst.10.2.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/03/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose was to establish the position of the fovea centralis to the optic nerve via en-face, near-infrared spectral domain optical coherence tomography (NIR-OCT) in healthy patients. This may shed light on physiological variability and be used for studying subtle cases of foveal ectopia in macular pathology and after retinal detachment. Methods SD-OCT data of 890 healthy eyes were retrospectively analyzed. Exclusion criteria included axial myopia causing tilting of the optic disc, peripapillary atrophy >1/3 the width of the disc, macular images excluding greater than half of the optic disc, and patients unable to maintain vertical head positioning. Two independent reviewers measured the horizontal and vertical distance from the fovea to the optic disc center and optic disc diameter via cross-sectional and en-face scanning laser ophthalmoloscopy OCT imaging. Results 890 eyes were included in the study. The right and left eyes differed in the horizontal distance from the fovea to the disc center (4359 vs. 4248 µm, P < 0.001) and vertical distance from the fovea to the disc center (464 µm vs. 647, P < 0.001). This corresponded to a smaller angle between the right and left eyes (6.07° vs. 8.67°, P < 0.001). Older age was associated with a larger horizontal (P = 0.008) and vertical distance (0.025). These differences persisted after correcting for axial length in the 487 patients with axial-length data. Conclusions This study compares the position of the fovea centralis among individuals without macular pathology on a micron level basis. The significant variability between right and left eyes indicates that contralateral eye evaluation cannot be reliably used. Rather, true foveal ectopia requires assessments of preoperative and postoperative NIR-OCT scans. This finding is relevant to retinal detachment cases and evaluation of subtle foveal ectopia. Translational Relevance This finding is relevant to retinal detachment cases and evaluation of subtle foveal ectopia.
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Affiliation(s)
- Archana A. Nair
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rebecca Liebenthal
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Shefali Sood
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Grant L. Hom
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Thais F. Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carolina C. S. Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasha S. Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
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Wilde C, Awad M, Orr G, Kumudhan D, Saker S, Zaman A. Incidence of Clinically Significant Aniseikonia Following Encircling Scleral Buckle Surgery: An Evaluation of Refractive and Axial Length Changes Requiring Intervention. Vision (Basel) 2021; 5:vision5010007. [PMID: 33546116 PMCID: PMC7931070 DOI: 10.3390/vision5010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61; 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.
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Rao P, Kaiser R, Lum F, Atchison E, Parke DW, Williams GA. Reoperation Rates of Patients Undergoing Primary Noncomplex Retinal Detachment Surgery in a Cohort of the IRIS Registry. Am J Ophthalmol 2021; 222:69-75. [PMID: 32898502 DOI: 10.1016/j.ajo.2020.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To present the reoperation rates of patients who underwent a primary noncomplex RD repair in a cohort of the American Academy of Ophthalmology IRIS Registry. DESIGN Retrospective, nonrandomized comparative clinical study. METHODS This was a retrospective, nonrandomized cohort study of patients who underwent a primary noncomplex RD repair with either a scleral buckle (SB) or vitrectomy with or without scleral buckle (PPV±SB) between 2013 and 2016. The primary outcome was the odds of reoperation within 12 months. RESULTS Of 24,068 patients, 2,937 patients (12.2%) underwent an SB and 21,131 patients (87.8%) a PPV ± SB. The overall reoperation rate was 12.2% for SB and 11.6% for PPV ± SB. After multivariate adjustment for age and initial RD diagnosis, the PPV ± SB group exhibited a lower odds of reoperation within 12 months compared with SB only (OR 0.84, 95% CI 0.75-0.96, P = .007). However, there was an age interaction. Patients ≤50 years old with PPV ± SB exhibited a higher odds of reoperation (OR 1.46, 95% CI 1.14-1.88, P = .003) compared to SB only. Patients >50 years with PPV ± SB had a lower odds of reoperation (OR 0.73, 95% CI 0.63-0.84, P < .0001). CONCLUSION The odds of reoperation of PPV ± SB compared with SB only varies depending on the patient's age. Further subset analyses are required to determine if there are clinically relevant differences with respect to RD configuration or other RD repair types (PPV only vs PPV with SB).
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Affiliation(s)
- Prethy Rao
- Emory Eye Center, Atlanta, Georgia, USA.
| | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| | | | - David W Parke
- American Academy of Ophthalmology, San Francisco, California, USA
| | - George A Williams
- American Academy of Ophthalmology, San Francisco, California, USA; Associated Retinal Consultants, Royal Oak, Michigan, USA
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Rani PK, Narayanan R, Deshpande RS, Balakrishnan D, Ali MH. Scleral Buckling Versus Sutureless Parsplana Vitrectomy in the Management of Primary Rhegmatogenous Retinal Detachment. Cureus 2020; 12:e11579. [PMID: 33364103 PMCID: PMC7749805 DOI: 10.7759/cureus.11579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of the article is to compare scleral buckle (SB) and primary sutureless pars plana vitrectomy (PPV) without SB in rhegmatogenous retinal detachment (RRD) repair. Methods A retrospective study of rhegmatogenous RD surgeries performed between eyes with proliferative vitreoretinopathy (PVR) up to grade B and a minimum of two months postoperative follow-up were included. The primary outcome measure was an improvement in the final best-corrected visual acuity (BCVA) and secondary outcome measures were a final anatomical success, number of resurgeries, and cataract progression. Results A total of 37 eyes in the SB group and 30 eyes in the sutureless PPV group were included. The mean follow-up was 7.5 ± 5 months and 9 ± 4 months in the SB and PPV group, respectively. The improvement in the final BCVA from baseline was four lines in the SB group and five lines in the PPV group (p=0.87). The final anatomical success was 97% in SB and 93% in the PPV group. The number of re-surgeries for attachment of retina were higher in the PPV group, (SB: 8/37 vs PPV: 8/30 p=0.03).The number of resurgeries (16/37 vs. 33/30; p=<0.05), cataract progression (3/37 vs. 10/30; p=0.01), and the mean number of hospital visits (6 vs. 9; p=0.001) were significantly higher in the sutureless PPV group. Conclusions Visual acuity improvement and anatomical success rates were similar between SB and sutureless PPV in RRD repair. The number of operations, cataract progression, and the mean number of hospital visits were higher in the sutureless PPV group.
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Velieva IA, Surnina ZV. [Indications for retinal laser coagulation in the treatment of retinoschisis and rhegmatogenous retinal detachment]. Vestn Oftalmol 2020; 136:50-56. [PMID: 33084279 DOI: 10.17116/oftalma202013606150] [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: 11/18/2022]
Abstract
PURPOSE To determine the indications and assess the effectiveness of laser coagulation of the retina (RLC) after different types of surgeries for retinal detachment (RD), except vitrectomy. MATERIAL AND METHODS The study included 160 patients (165 eyes) with various types of retinal detachment and retinoschisis who remained under observation for 11 years. RESULTS In case of retinal tear with a slight local RD (less than one quadrant), we recommend the use of RLC as monotherapy. Such patients are indicated to undergo regular examinations (1 month, 3 months, 6 months, 1 year). Due to risk of tractional defects of the retina in the lower quadrants during the introduction of gas-air mixture into the vitreous cavity, in the presence of retinal pathology it is recommended to perform RLC before the pneumatic retinopexy stage. In large retinal tears, despite their upper localization, pneumatic retinopexy is not indicated due to the possibility of gas spilling over the edges of the tear under the retina, leading to an increase in the initial size of the tear and spread of RD. We noted the effectiveness of RLC monotherapy for retinal detachment of various localization. After sealing the sclera, retinal laser coagulation on the shaft along the seal is necessary to limit the tear along the edge, since over time the seal may shift causing a relapse of RD. CONCLUSION The study has confirmed the effectiveness of laser coagulation of the retina as an independent method for the treatment of retinoschisis and retinal tears with local detachment.
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Affiliation(s)
- I A Velieva
- Research Institute of Eye Diseases, Moscow, Russia
| | - Z V Surnina
- Research Institute of Eye Diseases, Moscow, Russia
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Kasyanov AA, Vinogradova EY. [Distinctive features of phacoemulsification in previously vitrectomized eyes]. Vestn Oftalmol 2020; 136:301-307. [PMID: 33063981 DOI: 10.17116/oftalma2020136052301] [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: 11/18/2022]
Abstract
The review presents the main pathogenetic mechanisms of cataract development in an avitic eye as well as anatomical and functional changes of the eye in the state of avitria. The authors have also analyzed distinctive behavior of such eyes during phacoemulsification and surgical techniques used to answer specific avitreal phenomena.
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Affiliation(s)
- A A Kasyanov
- Research Institute of Eye Diseases, Moscow, Russia
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33
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Six-months primary success rate for retinal detachment between vitrectomy and scleral buckling. Retina 2020; 41:1164-1173. [DOI: 10.1097/iae.0000000000002994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sultan ZN, Agorogiannis EI, Iannetta D, Steel D, Sandinha T. Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management. BMJ Open Ophthalmol 2020; 5:e000474. [PMID: 33083551 PMCID: PMC7549457 DOI: 10.1136/bmjophth-2020-000474] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/04/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) is a common condition with an increasing incidence, related to the ageing demographics of many populations and the rising global prevalence of myopia, both well known risk factors. Previously untreatable, RRD now achieves primary surgical success rates of over 80%-90% with complex cases also amenable to treatment. The optimal management for RRD attracts much debate with the main options of pneumatic retinopexy, scleral buckling and vitrectomy all having their proponents based on surgeon experience and preference, case mix and equipment availability. The aim of this review is to provide an overview for the non-retina specialist that will aid and inform their understanding and discussions with patients. We review the incidence and pathogenesis of RRD, present a systematic approach to diagnosis and treatment with special consideration to managing the fellow eye and summarise surgical success and visual recovery following different surgical options.
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Affiliation(s)
- Ziyaad Nabil Sultan
- Ophthalmology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | | | - Danilo Iannetta
- Ophthalmology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.,UOSD Glaucoma, Arcispedale S Maria Nuova, Reggio Emilia, Emilia-Romagna, Italy
| | - David Steel
- Ophthalmology, Sunderland Eye Infirmary, Sunderland, Sunderland, UK
| | - Teresa Sandinha
- St Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Liverpool, UK
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Frisina R, Gius I, Frascogna G, Pizzolon T, Greggio A, Tozzi L, Midena E. A possible strategic role of air during pars plana vitrectomy for macula-involving rhegmatogenous retinal detachment. Int Ophthalmol 2020; 41:421-431. [PMID: 32951112 DOI: 10.1007/s10792-020-01591-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/04/2020] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the advantages and safety of vitrectomy under air for treating macula-involving rhegmatogenous retinal detachment (RRD). METHODS Consecutive patients with macula-involving RRD who underwent vitrectomy under air were recruited. Demographic and clinical data were: age, gender, eye, lens status, best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR), axial length, intraocular pressure (IOP). RRD parameters were: RRD extent, retinal breaks number. Surgical data were: cataract surgery, tamponade used. Postoperative parameters were: BCVA, IOP at first, third, sixth month, recurrent RD, incidence of retinal folds, subretinal fluid (SRF) persistence, macular displacement. RESULTS Seventy-one eyes (71 patients) were recruited. Cataract surgery was performed in 32 of 45 phakic patients. The tamponade used was: sulfur hexafluoride 18% (41), silicon oil (SO) (26), high-density SO (4). BCVA improved significantly from baseline (1.2 ± 0.4 logMAR) to the last control (0.8 ± 0.7 logMAR) (P = 0.03285). Recurrent RD incidence was 14.1%. Postoperative complications were: retinal folds (2), SRF persistence (3), macular displacement (2). CONCLUSION Vitrectomy under air is a safe alternative technique for treating macula-involving RRD. Vitrectomy under air allows surgeon to remove accurately the vitreous from the peripheral retina and facilitates the removal of SRF reducing the complications related to its postoperative persistence.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy.
| | - Irene Gius
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Giuseppe Frascogna
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Tobia Pizzolon
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Angelo Greggio
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, via Giustiniani n. 2, 35128, Padua, Italy
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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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Mafi M, Mirghorbani M, Ghahvehchian H, Mohammadi SS, Riazi-Esfahani H, Khalili Pour E, Mahmoudi A, Khojasteh H, Modjtahedi BS. Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy. Ophthalmol Ther 2020; 9:641-651. [PMID: 32666396 PMCID: PMC7406596 DOI: 10.1007/s40123-020-00279-1] [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: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Scleral buckling (SB) tends to be more challenging and time-consuming for compared to the pars plana vitrectomy for repairing rhegmatogenous retinal detachments (RRDs). This study characterizes a novel and simplified technique for SB. Methods In this single-masked randomized interventional study, patients with RRDs who were eligible for SB were randomly assigned to either the standard (S) or modified (M) technique of SB. In the modified approach, neither intraoperative break localization nor cryopexy or subretinal fluid drainage was done. A large tire (276/279) was placed where preoperative retinal breaks had been localized with a 240 encircling band placed for support of the remaining retina. Patients were followed for 12 months and the primary outcomes were differences between the surgical groups in operative time, anatomical success, visual acuity, and complication rate. Results Thirty-six eyes were included in the study (18 in each arm). There were no differences in baseline patient demographics or characteristics including gender, age, lens and macular status, preoperative vision, and symptom duration. The mean length of surgery was 72.2 ± 13.2 and 56.2 ± 9.5 min in groups S and M, respectively (P = 0.001). Complete retinal reattachment at the end of month 12 after single surgery was 80.6% overall; 77.8% (14/18) in group S and 83.3% (15/18) in group M (P > 0.999). After 12 months, both groups achieved similar final best-corrected visual acuity (BCVA): 0.26 ± 0.23 and 0.23 ± 0.17 logMAR in groups S and M, respectively (P = 0.231). Controlling for preoperative BCVA on ANCOVA testing, there were no significant differences in visual improvement between the two groups [F (1,26) = 0.02, P = 0.966 (95% CI) − 0.128 to 0.123)]. Scleral perforation (2:1), vitreous hemorrhage (3:2), and transient rise of intraocular pressure (3:4) all occurred at a low and similar rate between the two groups (S:M). Conclusion Modified SB technique was non-inferior compared to the standard approach for anatomical and visual outcomes. Shortening surgical time while maintaining low complication rates makes this an appropriate approach to SB, especially for vitreoretinal surgery trainees. Electronic supplementary material The online version of this article (10.1007/s40123-020-00279-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mostafa Mafi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mahmoudi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.,Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA.,Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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Radice P, Carini E, Seidenari P, Govetto A. Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment. Eur J Ophthalmol 2020; 31:1993-2002. [PMID: 32613861 DOI: 10.1177/1120672120940209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). METHODS Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. RESULTS Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes (p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. CONCLUSION A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.
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Affiliation(s)
- Paolo Radice
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Elisa Carini
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Patrizio Seidenari
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
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IMPACT OF INNER LIMITING MEMBRANE PEELING ON VISUAL RECOVERY AFTER VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT INVOLVING THE FOVEA. Retina 2020; 39:853-859. [PMID: 29394235 DOI: 10.1097/iae.0000000000002046] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the impact of inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment on best-corrected visual acuity (VA). METHODS Retrospective analysis of 89 eyes with primary macula-involving retinal detachment, which was undergoing vitrectomy, endolaser, retinotomy, endodrainage, and SF6 tamponade. Membrane-blue-assisted membrane peeling had been performed in 61 of the eyes (Group 1) but not in the other 28 (Group 2), which served as controls. RESULTS Age, lens status, and incidence of proliferative vitreoretinopathy 26.2% versus 39.3%; P = 0.23 in the 2 groups were comparable. The preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 25.7 ± 27.9 in Group 1 and 28.8 ± 29.9 in Group 2 (P = 0.47). After surgery, these rose from 62.3 ± 30.5 (Group 1) and 34.2 ± 35.8 (Group 2) after 1 week (P = 0.090), through 83.1 ± 8.0 and 57.2 ± 32.4 at 1 month (P = 0.0005), to 92.1 ± 4.5 and 74.4 ± 23.1 Early Treatment Diabetic Retinopathy Study letters after 6 months (P = 0.0005). More than 6-month incidences of proliferative vitreoretinopathy (13.1% vs. 28.6%; P = 0.13) were similar, whereas the redetachment rate (9.8% vs. 32.1%; P = 0.014), the incidence of secondary epiretinal membranes (1.6% vs. 35.7%; P = 0.0005), and the revitrectomy rate were lower in group 1 (9.8% vs. 53.6%; P = 0.0005). CONCLUSION Inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment may substantially contribute to the visual recovery, reducing the incidence of secondary epiretinal membrane formation.
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Schwartz SG, Flynn HW, Wang X, Kuriyan AE, Abariga SA, Lee WH. Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy. Cochrane Database Syst Rev 2020; 5:CD006126. [PMID: 32408387 PMCID: PMC7388158 DOI: 10.1002/14651858.cd006126.pub4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery), but occasionally may be associated with primary RD. Either way, for both circumstances a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. OBJECTIVES The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for RD complicated by PVR. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (the Cochrane Library 2019, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2019), Embase (January 1980 to January 2019), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2019), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 January 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) on participants undergoing surgery for RD associated with PVR that compared various tamponade agents. DATA COLLECTION AND ANALYSIS Two review authors screened the search results independently. We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified four RCTs (601 participants) that provided data for the primary and secondary outcomes. Three RCTs provided data on visual acuity, two reported on macular attachment, one on retinal reattachment and another two on adverse events such as RD, worsening visual acuity and intraocular pressure. Study Characteristics Participants' characteristics varied across studies and across intervention groups, with an age range between 21 to 89 years, and were predominantly men. The Silicone Study was conducted in the USA and consisted of two RCTs: (silicone oil versus sulfur hexafluoride (SF6) gas tamponades; 151 participants) and (silicone oil versus perfluropropane (C3F8) gas tamponades; 271 participants). The third RCT compared heavy silicone oil (a mixture of perfluorohexyloctane (F6H8) and silicone oil) with standard silicone oil (either 1000 centistokes or 5000 centistokes; 94 participants). The fourth RCT compared 1000 centistokes with 5000 centistokes silicone oil in 85 participants. We assessed most RCTs at low or unclear risk of bias for most 'Risk of bias' domains. Findings Although SF6 gas was reported to be associated with worse anatomic and visual outcomes than was silicone oil at one year (quantitative data not reported), at two years, silicone oil compared to SF6 gas showed no evidence of a difference in visual acuity (33% versus 51%; risk ratio (RR) 1.57; 95% confidence interval (CI) 0.93 to 2.66; 1 RCT, 87 participants; low-certainty evidence). At one year, another RCT comparing silicone oil and C3F8 gas found no evidence of a difference in visual acuity between the two groups (41% versus 39%; RR 0.97; 95% CI 0.73 to 1.31; 1 RCT, 264 participants; low-certainty evidence). In a third RCT, participants treated with standard silicone oil compared to those receiving heavy silicone oil also showed no evidence of a difference in the change in visual acuity at one year, measured on logMAR scale ( mean difference -0.03 logMAR; 95% CI -0.35 to 0.29; 1 RCT; 93 participants; low-certainty evidence). The fourth RCT with 5000-centistoke and 1000-centistoke comparisons did not report data on visual acuity. For macular attachment, participants treated with silicone oil may probably experience more favorable outcomes than did participants who received SF6 at both one year (quantitative data not reported) and two years (58% versus 79%; RR 1.37; 95% CI 1.01 to 1.86; 1 RCT; 87 participants; low-certainty evidence). In another RCT, silicone oil compared to C3F8 at one year found no evidence of difference in macular attachment (RR 1.00; 95% CI 0.86 to 1.15; 1 RCT, 264 participants; low-certainty evidence). One RCT that compared 5000 centistokes to 1000 centistoke reported that retinal reattachment was successful in 67 participants (78.8%) with first surgery and 79 participants (92.9%) with the second surgery, and no evidence of between-group difference (1 RCT; 85 participants; low-certainty evidence). The fourth RCT that compared standard silicone oil with heavy silicone oil did not report on macular attachment. Adverse events In one RCT (86 participants), those receiving standard 1000 centistoke silicone oil compared with those of the 5000 centistoke silicone oil showed no evidence of a difference in intraocular pressure elevation at 18 months (24% versus 22%; RR 0.90; 95% CI 0.41 to 1.94; low-certainty evidence), visually significant cataract (49% versus 64%; RR 1.30; 95% CI 0.89 to 1.89; low-certainty evidence), and incidence of retina detachment after the removal of silicone oil (RR 0.36 95% CI 0.08 to 1.67; low-certainty evidence). Another RCT that compared standard silicone oil with heavy silicone oil suggests no difference in retinal detachment at one year (25% versus 22%; RR 0.89; 95% CI 0.54 to 1.48; 1 RCT; 186 participants; low-certainty evidence). Retinal detachment was not reported in the RCTs that compared silicone oil versus SF6 and silicone oil versus to C3F8. AUTHORS' CONCLUSIONS There do not appear to be any major differences in outcomes between C3F8 and silicone oil. Silicone oil may be better than SF6 for macular attachment and other short-term outcomes. The choice of a tamponade agent should be individualized for each patient. The use of either C3F8 or standard silicone oil appears reasonable for most patients with RD associated with PVR. Heavy silicone oil, which is not available for routine clinical use in the USA, may not demonstrate evidence of superiority over standard silicone oil.
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Affiliation(s)
- Stephen G Schwartz
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ajay E Kuriyan
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Samuel A Abariga
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Wen-Hsiang Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Joseph DP, Ryan EH, Ryan CM, Forbes NJK, Wagley S, Yonekawa Y, Mittra RA, Parke DW, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study: Pseudophakic Retinal Detachment Outcomes: Primary Retinal Detachment Outcomes Study Report Number 3. Ophthalmology 2020; 127:1507-1514. [PMID: 32437865 DOI: 10.1016/j.ophtha.2020.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE This study evaluates outcomes of comparable pseudophakic rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). DESIGN Multicenter, retrospective, interventional cohort study. PARTICIPANTS Data were gathered from patients from multiple retina practices in the United States with RRD in 2015. METHODS A large detailed database was generated. Pseudophakic patients with RRD managed with PPV or PPV-SB were analyzed for anatomic and visual outcomes. Eyes with proliferative vitreoretinopathy, giant retinal tears, previous invasive glaucoma surgery, and ≤90 days of follow-up were excluded from outcomes analysis. Single surgery anatomic success (SSAS) was defined as retinal attachment without ongoing tamponade and with no other RRD surgery within 90 days. MAIN OUTCOME MEASURES Single surgery anatomic success and final Snellen visual acuity (VA). RESULTS A total of 1158 of 2620 eyes (44%) with primary RRD were pseudophakic. A total of 1018 eyes had greater than 90 days of follow-up. Eyes with proliferative vitreoretinopathy, previous glaucoma surgery, and giant retinal tears were excluded, leaving 893 pseudophakic eyes eligible for outcome analysis. A total of 461 (52%) were right eyes. A total of 606 patients (67%) were male, with a mean age of 65±11 years. Pars plana vitrectomy and PPV-SB as the first procedure were performed on 684 eyes (77%) and 209 eyes (23%), respectively. The mean follow-up was 388±161 days, and overall SSAS was achieved in 770 eyes (86%). Single surgery anatomic success was 84% (577/684) for PPV and 92% (193/209) for PPV-SB. The difference in SSAS between types of treatment was significant (P = 0.009). In eyes with macula-on RRD, SSAS was 88% in eyes treated with PPV and 100% in eyes treated with PPV-SB (P = 0.0088). In eyes with macula-off RRD, SSAS was 81% in eyes treated with PPV and 89% in eyes treated with PPV-SB (P = 0.029). Single surgery anatomic success was greater for PPV-SB than PPV for inferior (96% vs. 82%) and superior (90% vs. 82%) detachments. Mean final VA was similar for PPV (20/47) and PPV-SB (20/46; P = 0.805). CONCLUSIONS In pseudophakic RRDs, SSAS was better in patients treated with PPV-SB compared with PPV alone, whereas visual outcomes were similar for both groups.
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Affiliation(s)
| | - Edwin H Ryan
- VitreoRetinal Surgery PA, Minneapolis, Minnesota
| | | | | | | | - Yoshihiro Yonekawa
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Boston, Massachusetts
| | - Omesh P Gupta
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
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Vail D, Pershing S, Reeves MG, Afshar AR. The Relative Impact of Patient, Physician, and Geographic Factors on Variation in Primary Rhegmatogenous Retinal Detachment Management. Ophthalmology 2020; 127:97-106. [DOI: 10.1016/j.ophtha.2019.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022] Open
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Wang A, Snead MP. Scleral buckling-a brief historical overview and current indications. Graefes Arch Clin Exp Ophthalmol 2019; 258:467-478. [PMID: 31828426 DOI: 10.1007/s00417-019-04562-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/17/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.
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Affiliation(s)
- Aijing Wang
- Vitreoretinal Service, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Martin P Snead
- Vitreoretinal Service, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Carpineto P, Agnifili L, Senatore A, Agbeanda A, Lappa A, Borrelli E, Di Martino G, Oddone F, Mastropasqua R. Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study. Acta Ophthalmol 2019; 97:e1069-e1076. [PMID: 31125179 DOI: 10.1111/aos.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). METHODS Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. RESULTS Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall-, AQ- and UQ-MISHA further increased (p < 0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p < 0.05). Rhegmatogenous retinal detachment- diagnosis (RRD-D), 1- and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p < 0.05). CONCLUSION Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.
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Affiliation(s)
- Paolo Carpineto
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Luca Agnifili
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Alfonso Senatore
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Aharrh‐Gnama Agbeanda
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Andrea Lappa
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Enrico Borrelli
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Giuseppe Di Martino
- School of Hygiene Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
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Results of pars plana vitrectomy for primary rhegmatogenous retinal detachment with PVR grades A and B in high-myopic eyes. Int Ophthalmol 2019; 39:2797-2805. [PMID: 31129751 DOI: 10.1007/s10792-019-01126-4] [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: 11/11/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the results of pars plana vitrectomy (PPV) without adjuvant buckling procedures for the primary rhegmatogenous retinal detachment (RRD) with PVR grades A and B in high-myopic eyes. METHODS A retrospective review included 291 eyes treated for primary RRD from 2008 to 2016. The single surgery success rate (SSSR), the total number of surgeries, outcomes and complications were analysed between group of 67 eyes with high axial myopia (group A) and group of 224 eyes without high myopia (group B). RESULTS The mean follow-up was 30.6 ± 22.8 months. The SSSR in group A was 82.1% and in group B was 86.2% (p > 0.05). The final reattachment rate and number of required surgeries were in group A 96.3% (3.1 surgeries) and in group B 96.0% (2.8 surgeries). The initial BCVA improved in group A from 1.58 to 0.58 LogMAR at year 3; and in group B from 1.21 to 0.34 LogMAR. In match-pair analysis of macula-off RRD, no significant difference of the CRT between groups A and B was observed within 3 years of follow-up. CONCLUSION The anatomical success of primary PPV for RRD did not differ between high-myopic and non-high-myopic eyes in PVR grades A and B. However, functional results of high-myopic eyes are worse compared to eyes without high axial myopia.
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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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Liao L, Zhu XH. Advances in the treatment of rhegmatogenous retinal detachment. Int J Ophthalmol 2019; 12:660-667. [PMID: 31024823 PMCID: PMC6469565 DOI: 10.18240/ijo.2019.04.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/08/2018] [Indexed: 12/15/2022] Open
Abstract
The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.
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Affiliation(s)
- Li Liao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Hua Zhu
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Znaor L, Medic A, Binder S, Vucinovic A, Marin Lovric J, Puljak L. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev 2019; 3:CD009562. [PMID: 30848830 PMCID: PMC6407688 DOI: 10.1002/14651858.cd009562.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let fluid pass from the vitreous cavity to the subretinal space. Pars plana vitrectomy (PPV), scleral buckling surgery and pneumatic retinopexy are three accepted management strategies whose efficacy remains controversial. Pneumatic retinopexy is considered in a separate Cochrane Review. OBJECTIVES The primary objective of this review was to assess the efficacy of PPV versus scleral buckling for the treatment of simple RRD (primary RRD of any extension with up to two clock hours large break(s) regardless of their anterior/posterior localisation) in people with (phakia) or without (aphakia) a natural lens in the eye, or with an artificial lens (pseudophakia). A secondary objective was to assess any data on economic and quality-of-life measures. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 5 December 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing PPV versus scleral buckling surgery with at least three months of follow-up. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Two review authors independently extracted the data and study characteristics from the studies identified as eligible after initial screening. We considered the following outcomes: primary retinal reattachment, postoperative visual acuity, final anatomical success, recurrence of retinal detachment, number of interventions needed to achieve final anatomical success, quality of life and adverse effects. We assessed the certainty of evidence using GRADE. MAIN RESULTS This review included 10 RCTs (1307 eyes of 1307 participants) from Europe, India, Iran, Japan and Mexico, which compared PPV and scleral buckling for RRD repair. Two of these 10 studies compared PPV combined with scleral buckling with scleral buckling alone (54 participants). All studies were high or unclear risk of bias on at least one domain. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.There was little or no difference in the proportion of participants who achieved retinal reattachment at least 3 months after the operation in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16; 9 RCTs, 1261 participants, low-certainty evidence). Approximately 67 in every 100 people treated with scleral buckling had retinal reattachment by 3 to 12 months. Treatment with PPV may result in 4 more people with retinal reattachment in every 100 people treated (95% confidence interval (CI) 2 fewer to 11 more).There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10, 6 RCTs, 1138 participants, low-certainty evidence).There was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR 1.01, 95% CI 0.99 to 1.04, 9 RCTs, 1235 participants, low-certainty evidence). There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.Retinal redetachment was reported in fewer participants in the PPV group compared to the scleral buckling group (RR 0.75 (95% CI 0.59 to 0.96, 9 RCTs, 1320 participants, low-certainty evidence). Approximately 28 in every 100 people treated with scleral buckling had retinal detachment by 3 to 36 months. Treatment with PPV may result in seven fewer people with retinal detachment in every 100 people treated (95% CI 1 to 11 fewer).Participants treated with PPV on average needed fewer interventions to achieve final anatomical success but the difference was small and data were skewed (MD -0.20, 95% CI -0.34 to -0.06, 2 RCTs, 682 participants, very low-certainty evidence).Very low-certainty evidence on quality of life suggested that more people in the PPV group were "satisfied with vision" compared with the scleral buckling group (RR 6.22, 95% CI 0.88 to 44.09, 1 RCT, 32 participants).All included studies reported adverse effects, however, it was not always clear whether they were reported as number of participants or number of adverse effects. Cataract development or progression was more prevalent in the PPV group (RR 1.71, 95% CI 1.45 to 2.01), choroidal detachment was more prevalent in the scleral buckling group (RR 0.19, 95% CI 0.06 to 0.65) and new/iatrogenic breaks were observed only in the PPV group (RR 8.21, 95% CI 1.91 to 35.21). Estimates of the relative frequency of other adverse effects, including postoperative proliferative vitreoretinopathy, postoperative increase in intraocular pressure, development of cystoid macular oedema, macular pucker and strabismus were imprecise. Evidence for adverse effects was low-certainty evidence. AUTHORS' CONCLUSIONS Low- or very low-certainty evidence indicates that there may be little or no difference between PPV and scleral buckling in terms of primary success rate, visual acuity gain and final anatomical success in treating primary RRD. Low-certainty evidence suggests that there may be less retinal redetachment in the PPV group. Some adverse events appeared to be more common in the PPV group, such as cataract progression and new iatrogenic breaks, whereas others were more commonly seen in the scleral buckling group such as choroidal detachment.
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Affiliation(s)
- Ljubo Znaor
- University Hospital Centre SplitDepartment of OphthalmologySpinciceva 1SplitCroatia21000
- University of Split School of MedicineDepartment of OphthalmologySplitCroatia
| | - Aleksej Medic
- University Hospital Centre SplitDepartment of OphthalmologySpinciceva 1SplitCroatia21000
| | - Susanne Binder
- Sigmund Freud PrivatuniversitätDepartment of OphthalmologyViennaAustria
| | - Ana Vucinovic
- University Hospital Centre SplitDepartment of OphthalmologySpinciceva 1SplitCroatia21000
| | - Josipa Marin Lovric
- University Hospital Centre SplitDepartment of OphthalmologySpinciceva 1SplitCroatia21000
| | - Livia Puljak
- Catholic University of CroatiaCenter for Evidence‐Based Medicine and Health CareIlica 242ZagrebCroatia10000
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Long-term Clinical Results of Vitrectomy and Scleral Buckling in Treatment of Rhegmatogenous Retinal Detachment. ScientificWorldJournal 2019; 2019:5416806. [PMID: 30956624 PMCID: PMC6431356 DOI: 10.1155/2019/5416806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD). Methods 155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic. Results Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively. Conclusion Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.
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Nagpal M, Chaudhary P, Wachasundar S, Eltayib A, Raihan A. Management of recurrent rhegmatogenous retinal detachment. Indian J Ophthalmol 2019; 66:1763-1771. [PMID: 30451176 PMCID: PMC6256876 DOI: 10.4103/ijo.ijo_1212_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) repair is one of the most common vitreoretinal surgeries a surgeon performs. In an ideal scenario, RRD can be repaired with a single surgical intervention; however, despite excellent skill, flawless technique, and the introduction of high-end technology, up to 10% of cases require additional interventions to ultimately repair recurrent detachments. It is thus important to study the outcomes of multiple interventions to understand whether performing repeat vitrectomy on patients with a history of failed surgeries is worthwhile. Thus, recurrent retinal detachment (re-RD) remains a significant challenge for vitreoretinal surgeons as well as the patients considering the economic and the emotional burden of undergoing multiple interventions. The advent of microincision vitrectomy system, perfluorocarbon liquids, and effective intraocular tamponades has opened new doors for managing re-RDs. In this article, we have reviewed and summarized the various causes and approaches for management for optimal anatomical and functional outcomes.
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Affiliation(s)
- Manish Nagpal
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Pranita Chaudhary
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Shachi Wachasundar
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Ahmed Eltayib
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
| | - Aparajita Raihan
- Department of Retina and Vitreous, Retina Foundation, Ahmedabad, Gujarat, India
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