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Anguita R, Makuloluwa A, Sim SY, Flores-Sanchez B, Roth J, Charteris DG. LATE RECURRENCE OF RETINAL DETACHMENT: Incidence, Clinical Features, and Surgical Outcomes. Retina 2024; 44:83-87. [PMID: 37671784 DOI: 10.1097/iae.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To describe and evaluate demographics, clinical features, prognostic factors, rate of success of surgery, incidence, and visual outcomes in patients with a late recurrence of rhegmatogenous retinal detachment over a 10-year period at a large tertiary referral eye center. METHODS A retrospective, observational case series of patients with late recurrence of retinal detachment, defined as redetachment after at least six months of total reattachment in non-proliferative vitreoretinopathy (PVR) rhegmatogenous retinal detachment, after pars plana vitrectomy (PPV) surgery with gas tamponade. RESULTS Thirty-nine patients had a late recurrence of rhegmatogenous retinal detachment of 16,396 rhegmatogenous retinal detachment operations. The mean of time between the first retinal detachment (RD) surgery and redetachment was 122.7 (SD 115) weeks. On presentation with late recurrence, 72% of eyes were pseudophakic and 64% were macula-off. In 28 eyes, small breaks were found. Thirty-eight percent had established PVR (PVR-C in 80%). Ninety-five percent underwent PPV. Gas was used in 61%. The initial secondary success rate was 64%. Initial best-corrected visual acuity was 1.32 logarithm of the minimum angle of resolution (logMAR) (6/120) and final was 0.8 logMAR (6/38; P value 0.002). CONCLUSION Late recurrence of retinal detachment is rare. It is characterized by small retinal breaks that may be difficult to visualize. Although cases can be treated with favorable anatomical results, visual outcomes are often less good and the success rate is lower.
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Affiliation(s)
- Rodrigo Anguita
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Achini Makuloluwa
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Sing Yue Sim
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Blanca Flores-Sanchez
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Janice Roth
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - David G Charteris
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
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Christensen CA, Thompson IA, Nielsen JS. Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge. JOURNAL OF VITREORETINAL DISEASES 2024; 8:45-50. [PMID: 38223781 PMCID: PMC10786086 DOI: 10.1177/24741264231209587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To evaluate the effectiveness of and to compare vitrectomy performed with 25-gauge or 27-gauge instrumentation for macular surgery by assessing the surgical duration, wound closure, and complication rate using a systematic approach to wound closure. Methods: In this retrospective chart review, 125 25-gauge and 125 27-gauge consecutive small-gauge vitrectomy surgeries for epiretinal membrane, macular hole, vitreomacular adhesion, or a combination were analyzed during and immediately after surgery. Wound closure was performed using a systematic protocol. Results: Baseline characteristics were not statistically different between the 2 groups. The surgical duration was similar with 25-gauge vitrectomy and 27-gauge vitrectomy (P = .07). Although spontaneous wound closure was common in both groups, it was more common in the 27-gauge group (P = .22). Intraoperative and postoperative complications were uncommon in both groups. Conclusions: Findings show that 27-gauge vitrectomy is a safe, effective alternative to the more commonly used 25-gauge vitrectomy for macular surgery. Less manipulation was required to achieve wound closure with 27-gauge vitrectomy using a standardized wound-closure protocol. Smaller 27-gauge vitrectomy did not increase surgical time or complications over 25-gauge vitrectomy for macular surgery.
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Affiliation(s)
- Cory A. Christensen
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Jared S. Nielsen
- Vitreoretinal Diseases and Surgery, Wolfe Eye Clinic, West Des Moines, IA, USA
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Li D, Zhou N, Gao R, Duan J, Shang Q. Preoperative estimation of retinal hole location using ultra-wide-field imaging. Ann Med 2023; 55:2258790. [PMID: 37725940 PMCID: PMC10512843 DOI: 10.1080/07853890.2023.2258790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND/OBJECTIVE Accurate localization of retinal holes is essential for successful scleral buckling (SB) surgery. We aimed to verify the feasibility of using ultra-wide-field (UWF) imaging for preoperative estimation of retinal hole location. PATIENTS AND METHODS We observed 21 eyes from 21 patients with rhegmatogenous retinal detachment (RRD) who underwent successful SB. They were treated at the Department of Ophthalmology of the Second Hospital of Hebei Medical University between November 2020 and November 2021. UWF fundus photography using an Optos device was performed at different steering positions 1 day before, 1 day after, and 1 month after SB. Using the preoperative fundus images, we measured the transverse diameter of the optic disc (D1) and the distance from the centre of the retinal holes to the ora serrata (D2). The accurate transverse diameter of the optic disc (Dd) was measured preoperatively using optical coherence tomography. The same surgeon measured the scleral chord lengths intraoperatively from the limbus to the located retinal hole marked on the sclera using an ophthalmic calliper. Statistical software was used to analyze the consistency of scleral chord length between the retinal hole and the limbus, which was estimated by preoperative UWF imaging and was measured using an ophthalmic calliper intraoperatively. RESULTS There was no statistically significant difference in the scleral chord length between the retinal holes and the limbus, which was estimated by preoperative UWF fundus photography and was measured by the calliper during surgery. CONCLUSION It is feasible to locate retinal holes using UWF fundus photography before SB, which is helpful for quick localization, thereby reducing the learning curve of SB surgery.
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Affiliation(s)
- Donghui Li
- Ophthalmology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nalei Zhou
- Ophthalmology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Gao
- Ophthalmology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jialiang Duan
- Ophthalmology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingli Shang
- Ophthalmology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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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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Chandelier-Assisted versus Standard Scleral Buckling for Primary Rhegmatogenous Retinal Detachment: A Randomized Clinical Study. Retina 2022; 42:1745-1755. [PMID: 35507948 DOI: 10.1097/iae.0000000000003519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare anatomical outcomes, functional outcomes, and rate of complications of standard (SSB) versus chandelier-assisted scleral buckling (CSB) in phakic eyes with rhegmatogenous retinal detachment (RRD). Methods: Patients were randomly assigned to either SSB or CSB. Surgical success/failure rate, corrected distance visual acuity (CDVA), surgical operating time, rate of intraoperative and postoperative complications including epiretinal membranes (ERM) by spectral-domain optical coherence tomography (SD-OCT) were compared between groups. Results: A total of 50 eyes of 49 patients were included. At 6 months, there was no statistically significant difference between groups in primary success, or final anatomical success (P > 0.9); mean CDVA at any visit (P values >0.05); or mean surgical time: 120.3±39.05 and 102.48±43.76 minutes for the SSB and CSB, respectively (P = 0.1). The CSB had a higher rate of postoperative complications (34.8%) compared to the SSB (3.8%) (P < 0.05). On SD-OCT, CSB had a statistically significant higher rate of ERMs compared to SSB (44% versus 18% (P < 0.05)) and showed vitreous entrapment in the chandelier sclerotomy site on the UBM. Conclusion: CSB do not offer encouraging advantages over SSB. On the contrary, we detected a higher rate of complications with CSB especially ERMs development.
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Tosi GM, Malandrini A, Bacci T, Posarelli M, Oddone C, Virgili G. Vitreous incarceration in sutured vs non-sutured sclerotomies after 25-gauge macular surgery. Eye (Lond) 2020; 35:2246-2253. [PMID: 33110248 DOI: 10.1038/s41433-020-01234-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To study the patterns of vitreous incarceration in sutured vs non-sutured sclerotomies in patients subjected to 25-gauge macular surgery. METHODS A prospective study of 135 eyes affected by epiretinal membrane or macular hole. Vitreal disposition was evaluated via ultrasound biomicroscopy (UBM) at the sclerotomy sites between 30 and 40 days after surgery, once the tamponade had completely disappeared. RESULTS In total, 349 sclerotomies (86.2%) of 99 patients were non-sutured while 56 sclerotomies (13.8%) of 36 patients were sutured at the end of the surgical procedure. Among the 36 patients with sutured sclerotomies, 15 out of 36 (41.6%) had at least two sclerotomies sutured. All the sclerotomy sites were evaluated (405 sclerotomies). Sclerotomy suture was significantly associated with a less aggressive pattern of vitreal incarceration (OR: 0.16, 95% CI: 0.07-0.35, p < 0.001). Compared to preoperative values, day 1 post operative IOP was not significantly different in patients with sutured sclerotomies, while patients with non-sutured sclerotomies had a significantly lower day 1 post operative IOP. CONCLUSIONS In 25-gauge macular surgery, UBM evaluation documented a higher rate of postoperative vitreous incarceration in the non-sutured sclerotomies, confirming the previously postulated role of the residual vitreous, left at the end of the surgery, in closing the sclerotomy site.
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Affiliation(s)
- Gian Marco Tosi
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | | | - Tommaso Bacci
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Matteo Posarelli
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Chiara Oddone
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Garweg JG, Ouassi D, Pfister IB. Hybrid 23/27 Gauge Vitrectomy - Combining the Charm of 27G with the Efficacy of 23G. Clin Ophthalmol 2020; 14:299-305. [PMID: 32099314 PMCID: PMC6999778 DOI: 10.2147/opth.s233884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes. Methods This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra- and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma. Results Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy. Conclusion In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, Bern, Switzerland
| | - Dean Ouassi
- Medical Faculty, University of Strasbourg, Strasbourg, France
| | - Isabel B Pfister
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
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SCLERAL BUCKLING FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT USING A NONCONTACT WIDE-ANGLE VIEWING SYSTEM WITH A CANNULA-BASED 27-G CHANDELIER ENDOILLUMINATOR. Retina 2019; 39 Suppl 1:S144-S150. [DOI: 10.1097/iae.0000000000001891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kopecky A, Nemcansky J. Changes in the anterior segment of the eye following uncomplicated pars plana vitrectomy. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:207-211. [PMID: 30994110 DOI: 10.5507/bp.2019.014] [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: 10/14/2018] [Accepted: 04/03/2019] [Indexed: 11/23/2022] Open
Abstract
Pars plana vitrectomy is currently the most common technique used in retinal surgery. Although primarily involving the posterior segment of the eye it also affects the anterior segment. As this is a less published topic, the aim of this paper was to review the literature on changes in the anterior segment after uncomplicated pars plana vitrectomy using data based literature search. The conclusions are that even in otherwise ophthalmologically healthy patients, complications may occur in the anterior segment. Surgeons need to pay utmost attention in glaucoma patients and in those with endothelial insufficiency who are at highest risk of complications. He/she must also correctly plan a potential cataract surgery if not already done earlier. From the literature, most of the changes in the anterior segment after uncomplicated PPV are found to be temporary.
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Affiliation(s)
- Adam Kopecky
- Clinic of Ophthalmology, University Hospital Ostrava, Czech Republic.,First Faculty of Medicine, Charles University Prague, Czech Republic
| | - Jan Nemcansky
- Clinic of Ophthalmology, University Hospital Ostrava, Czech Republic
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