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Davidović S, Babović S, Miljković A, Pavin S, Bolesnikov-Tošić A, Barišić S. Updates on Treatment Modalities for Primary Rhegmatogenous Retinal Detachment Repair. Diagnostics (Basel) 2024; 14:1493. [PMID: 39061630 PMCID: PMC11276041 DOI: 10.3390/diagnostics14141493] [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: 06/11/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Rhegmatogenous retinal detachment, a severe eye condition, presents anatomic separation of the neurosensory retina from its outermost layer-the retinal pigment epithelium. Early recognition of this relatively common finding and proper referral of patients to the retinal surgery department is essential in order to minimize its consequent possible severe reduction in vision. Several major surgical methods for the repair of primary rhegmatogenous retinal detachment have been in use over the last several decades, and they all aim to find and close the break in the retina that has caused the detachment. Surgery can be performed as pneumatic retinopexy, pars plana vitrectomy, and/or episcleral surgery (buckling). General surgical trends for reattaching the retina include moving from extraocular to intraocular surgery and from bigger gauge to smaller gauge via minimal invasive vitrectomy surgery (MIVS), with implementing shorter-lasting intraocular tamponades. Surgical options for rhegmatogenous retinal detachment treatment nowadays emphasize gaining retinal reattachment, preferably with one surgery and with minimum damage to the eye. The procedure should not bring secondary eye conditions and complications with severe impairment of visual acuity, and it should be performed on as much as a smaller budget, with possibly peribulbar anesthesia, enabling the patient the quickest possible recovery. It should be adjusted to the patient's condition, not to the surgeon's skills or preferences.
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Affiliation(s)
- Sofija Davidović
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Siniša Babović
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Aleksandar Miljković
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Svetlana Pavin
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Ana Bolesnikov-Tošić
- University Clinic for Anesthesiology, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
| | - Sava Barišić
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
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Pan Q, Gao Z, Chen X, Yang Z, Huang S, Hu X, Zheng J, Zhang Z. Outcomes of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. Acta Ophthalmol 2022; 100:e1024-e1030. [PMID: 34403213 DOI: 10.1111/aos.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical outcomes and evaluate the efficacy of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS One hundred and fifty-one eyes of 146 consecutive patients with proliferative diabetic retinopathy (PDR), vitreous haemorrhage originating from retinal vein occlusion (VH-RVO), epiretinal membrane (EM), macular hole (MH) or retinal detachment (RD) who underwent vitreoretinal surgery using the bubble ultra-wide field viewing system were included. METHODS A standard phacoemulsification was performed on each patient. Core humour and mid-peripheral vitreous humour were removed using a planoconcave lens. A suitably sized bubble was infused to attach to the posterior capsule or the anterior chamber depending on the integrity of the posterior capsule. The planoconcave lens and the air bubble formed the wide-angle viewing system, through which peripheral vitrectomy was performed. MAIN OUTCOME MEASURES Range of applications, field of view, model validation and complications were recorded. RESULTS The new ultra-wide field viewing system was successfully applied in all eyes, including 34 with PDR, 28 VH-RVO, 28 EM, 25 MH and 36 RD. Peripheral vitrectomy, local or panretinal laser photocoagulation, and removal of the peripheral proliferative membrane were successfully performed while viewing through this system. Maximum peripheral retinal area observable during the procedure was positively correlated with pupil diameter. Model analysis results showed that when the pupil diameter was 6 mm, the maximum field of view was approximately 128.1- 148.0 degrees with this system. Of 142 eyes, the main intraoperative complication was iatrogenic retinal breaks (IRBs) in 8 eyes (5.3%) and posterior capsule injury by vitreous cutter during bubble removal in 6 eyes (4.2%). The postsurgery mean best-corrected visual acuity (BCVA) (0.48 ± 0.39 logMAR) was significantly improved compared with the preoperative mean BCVA (1.60 ± 1.08 logMAR, p < 0.001). No incidents of postoperative choroidal detachment, secondary glaucoma or endophthalmitis were recorded. CONCLUSIONS For patients with lens excision or absence, vitreoretinal surgery can be successfully performed using the novel viewing system described here. The system is a safe, convenient and economical ultra-wide field viewing system with a wide range of applications.
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Affiliation(s)
- Qin‐tuo Pan
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zhi‐qiang Gao
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐hao Chen
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zheng‐wei Yang
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science Eye Institute and School of Optometry Tianjin Medical University Eye Hospital Tianjin China
| | - Sheng‐hai Huang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Xu‐ting Hu
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Jing‐wei Zheng
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
| | - Zong‐duan Zhang
- Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University Wenzhou China
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Xu D, Belin PJ, Staropoli PC, Yannuzzi NA, Vangipuram G, Chiang A, Shah GK, Townsend JH, Ryan EH, Klufas MA. Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis. Ophthalmol Retina 2021; 5:797-804. [PMID: 33197679 DOI: 10.1016/j.oret.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included. METHODS Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES Single-operation anatomic success between the initial-eye and subsequent-eye RRD. RESULTS Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
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Affiliation(s)
- David Xu
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | | | - Patrick C Staropoli
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Nicolas A Yannuzzi
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Allen Chiang
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | - Justin H Townsend
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Michael A Klufas
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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Radeck V, Helbig H, Barth T, Gamulescu MA, Prahs P, Maerker D. [Retinal detachment surgery: trends over 15 years]. Ophthalmologe 2021; 119:64-70. [PMID: 34137944 DOI: 10.1007/s00347-021-01430-4] [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: 03/14/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15 years. METHOD Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed. RESULTS The number of retinal detachment surgeries over the past 15 years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed a slight trend towards improved results over the past 15 years. CONCLUSION The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. A slight trend towards better anatomical success rates could be observed.
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Affiliation(s)
- Viola Radeck
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland.
| | - Horst Helbig
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Teresa Barth
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Maria-Andreea Gamulescu
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Philipp Prahs
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - David Maerker
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
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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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