1
|
Cakir B, Peacker BL, Zeng R, Tracy JH, Feng Y, Miller JB. Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated With Epiretinal Membrane Formation. Ophthalmic Surg Lasers Imaging Retina 2024; 55:326-333. [PMID: 38531000 DOI: 10.3928/23258160-20240131-02] [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: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. PATIENTS AND METHODS A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. RESULTS Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. CONCLUSIONS Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:326-333.].
Collapse
|
2
|
Antaki F, Doucet C, Milad D, Giguère CÉ, Ozell B, Hammamji K. Democratizing Vitreoretinal Surgery Training With a Portable and Affordable Virtual Reality Simulator in the Metaverse. Transl Vis Sci Technol 2024; 13:5. [PMID: 38564199 PMCID: PMC10996990 DOI: 10.1167/tvst.13.4.5] [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: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose The purpose of this study was to develop and validate RetinaVR, an affordable, portable, and fully immersive virtual reality (VR) simulator for vitreoretinal surgery training. Methods We built RetinaVR as a standalone app on the Meta Quest 2 VR headset. It simulates core vitrectomy, peripheral shaving, membrane peeling, and endolaser application. In a validation study (n = 20 novices and experts), we measured: efficiency, safety, and module-specific performance. We first explored unadjusted performance differences through an effect size analysis. Then, a linear mixed-effects model was used to isolate the impact of age, sex, expertise, and experimental run on performance. Results Experts were significantly safer in membrane peeling but not when controlling for other factors. Experts were significantly better in core vitrectomy, even when controlling for other factors (P = 0.014). Heatmap analysis of endolaser applications showed more consistent retinopexy among experts. Age had no impact on performance, but male subjects were faster in peripheral shaving (P = 0.036) and membrane peeling (P = 0.004). A learning curve was demonstrated with improving efficiency at each experimental run for all modules. Repetition also led to improved safety during membrane peeling (P = 0.003), and better task-specific performance during core vitrectomy (P = 0.038), peripheral shaving (P = 0.011), and endolaser application (P = 0.043). User experience was favorable to excellent in all spheres. Conclusions RetinaVR demonstrates potential as an affordable, portable training tool for vitreoretinal surgery. Its construct validity is established, showing varying performance in a way that correlates with experimental runs, age, sex, and level of expertise. Translational Relevance Fully immersive VR technology could revolutionize surgical training, making it more accessible, especially in developing nations.
Collapse
Affiliation(s)
- Fares Antaki
- The CHUM School of Artificial Intelligence in Healthcare, Montreal, Quebec, Canada
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Cedryk Doucet
- Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montreal, Canada
| | - Daniel Milad
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Benoît Ozell
- Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montreal, Canada
| | - Karim Hammamji
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Cristescu IE, Ivanova T, Moussa G, Ziaei H, Ferrara M, Lippera M, El-Faouri M, Patton N, Jasani KM, Dhawahir-Scala F, Jalil A. The impact of 360-laser barricade on outcomes of vitrectomy for pseudophakic retinal detachment; The Manchester Pseudophakic Retinal Detachment Study. Eye (Lond) 2023; 37:3221-3227. [PMID: 36949246 PMCID: PMC10564870 DOI: 10.1038/s41433-023-02495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE To investigate the anatomical and functional outcomes and specifically, the effect of 360-degree barrier-laser, in pars plana vitrectomy (PPV) for primary pseudophakic rhegmatogenous retinal detachment (PRD). METHODS We conducted a single-centre retrospective, continuous and comparative study on eyes that had undergone PPV with focal-retinopexy (laser or cryotherapy) versus 360-laser for PRD repair between 2011-2020 at a single tertiary vitreoretinal centre in the UK. Primary outcomes were single surgery anatomical success (SSAS) rate and final postoperative visual acuity (VA). Multivariable regression covariates for primary re-detachment included age, gender, onset-of-detachment, pre-operative VA, ocular co-morbidities, macula-status, majority inferior (vs superior) PRD, number-of-tears and PRD extent (in clock-hours), 360-laser barricade, and perfluorocarbon liquid (PFCL) use. For VA gain, primary re-detachment was added as a covariate. RESULTS We included 467 eyes with a mean follow-up of 388 (161) days. The SSAS was 444/467 (95.1%) overall, and 351/370 (94.9%) and 93/97 (95.9%) in focal-retinopexy and 360-laser groups, respectively (p = 0.798). Compared to the focal-retinopexy group, the 360-laser group had significantly worse post-operative VA but similar logMAR gain (p = 0.812). A multivariable binary logistic regression found that only PFCL use was linked with increased primary re-detachment (OR:5.32 [p = 0.048]) and 360-laser did not contribute to increased SSAS. A multivariable linear regression analysis showed that poor logMAR gain was significantly associated with better pre-operative logMAR, ocular co-morbidities, greater PRD extent, use of 360-laser and primary re-detachment. However, when excluding macula-off RD (n = 211), 360-laser was no longer significant (p = 0.088). CONCLUSIONS Prophylactic 360-laser does not seem to impact on SSAS and functional outcomes following PPV for primary PRD.
Collapse
Affiliation(s)
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Hadi Ziaei
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Myrta Lippera
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Muhannd El-Faouri
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
- The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Kirti M Jasani
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Assad Jalil
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK.
| |
Collapse
|
4
|
Antaki F, Javidi E, Giguère CÉ, Hammamji K. Correspondence. Retina 2023; 43:e53-e55. [PMID: 37490754 DOI: 10.1097/iae.0000000000003853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Université de Montréal, Montréal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université́ de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eileen Javidi
- Department of Ophthalmology, Université de Montréal, Montréal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université́ de Montréal (CHUM), Montréal, Quebec, Canada
| | - Charles-Édouard Giguère
- Biostatistics, Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
| | - Karim Hammamji
- Department of Ophthalmology, Université de Montréal, Montréal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université́ de Montréal (CHUM), Montréal, Quebec, Canada
| |
Collapse
|
5
|
Starr MR, Ryan EH, Yonekawa Y. Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18. Curr Opin Ophthalmol 2023; 34:211-217. [PMID: 36866845 DOI: 10.1097/icu.0000000000000942] [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: 03/04/2023]
Abstract
PURPOSE OF REVIEW To highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group. RECENT FINDINGS The PRO database was a large dataset made up of patients with primary rhegmatogenous retinal detachments (RRD) who had surgical repair during 2015. The database was constituted of nearly 3000 eyes from 6 centers across the United States and included 61 vitreoretinal surgeons. Nearly 250 metrics were collected for each patient, creating one of the richest datasets of patients with primary rhegmatogenous detachments and their outcomes. The importance of scleral buckling was demonstrated, particularly for phakic eyes, elderly patients, and those with inferior breaks. 360° laser may result in poorer outcomes. Cystoid macular edema was common, and risk factors were identified. We also found risk factors for vision loss in eyes presenting with good vision. A PRO Score was devised, to predict outcomes based on presenting clinical characteristics. We also identified characteristics of surgeons with the highest single surgery success rates. Overall, there were no major outcome differences between viewing systems, gauges, buckles sutured vs. scleral tunnels, drainage method, and techniques to address proliferative vitreoretinopathy. All incisional techniques were found to be very cost-effective treatment modalities. SUMMARY Numerous studies resulted from the PRO database that significantly added to the literature regarding the repair of primary RRDs in the current era of vitreoretinal surgery.
Collapse
Affiliation(s)
| | - Edwin H Ryan
- Retina Consultants of Minnesota, Minneapolis, Minnesota
| | - Yoshihiro Yonekawa
- The Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Cai LZ, Lin J, Starr MR, Obeid A, Ryan EH, Ryan C, Forbes NJ, Arias D, Ammar MJ, Patel LG, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair. Br J Ophthalmol 2023; 107:555-559. [PMID: 34815237 DOI: 10.1136/bjophthalmol-2021-320440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system. METHODS Analysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200). RESULTS A total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher. CONCLUSIONS Independent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.
Collapse
Affiliation(s)
- Louis Z Cai
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey Lin
- Biostatistics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Matthew R Starr
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony Obeid
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Claire Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Nora J Forbes
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diego Arias
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Ammar
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Dean Eliott
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Omesh P Gupta
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Mathai M, Godwin KS, Albarracin J, Levinson J, Broderick K, Melamud A. 360 DEGREE ENDOLASER VERSUS FOCAL ENDOLASER IN PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2022; 42:2046-2050. [PMID: 35982506 DOI: 10.1097/iae.0000000000003599] [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: 11/26/2022]
Abstract
PURPOSE To determine the efficacy of the 360-degree endolaser (360EL) versus focal laser during primary vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair. METHODS A single-site retrospective chart review was performed on 241 patients who underwent PPV for primary RRD. Patients were assigned to two groups, PPV with 360EL (n = 183) and PPV without 360EL (n = 59). Only cases where surgeons performed 360EL on all RRDs or surgeons who never perform 360EL on RRDs were included. RESULTS The single surgery anatomical success rate in the 360EL group was 90.2% compared with 86.5% with focal laser ( P = 0.619). Epiretinal membrane formation in 360EL group at 1 year was 44.4% versus 37% with focal laser ( P = 0.429). Cystoid macular edema formation within 1 year of surgery was 25.8% in 360EL group versus 11.9% with focal laser ( P = 0.04). CONCLUSION The use of 360EL in PPV for RRD repair does not improve single-surgery anatomical success in routine RRDs when compared with PPV with focal laser.
Collapse
Affiliation(s)
- Mariam Mathai
- The Retina Group of Washington, Chevy Chase, Maryland
| | - Kristen S Godwin
- Medstar Georgetown Hospital, Department of Ophthalmology, Washington, District of Columbia; and
| | - Julio Albarracin
- Medstar Georgetown Hospital, Department of Ophthalmology, Washington, District of Columbia; and
| | | | - Kevin Broderick
- Walter Reed National Military Medical Center, Department of Ophthalmology, Bethesda, Maryland
| | | |
Collapse
|
9
|
Gopal AD, Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE, Yonekawa Y. Predictors of Vision Loss after Surgery for Macula-Sparing Rhegmatogenous Retinal Detachment. Curr Eye Res 2022; 47:1209-1217. [PMID: 35608082 DOI: 10.1080/02713683.2022.2081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine factors associated with loss of good vision (defined as Snellen visual acuity [VA] < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment (RRD) with initial VA ≥20/40. MATERIALS AND METHODS Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40. RESULTS Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 [20/28]) compared to eyes that preserved good vision (mean 0.11 ± 0.10 [20/26]) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 [95% CI 1.44-14.51]; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 [95% CI 2.10-24.90]; p = 0.0017) or PPV/SB (multivariate OR 10.74 [95% CI 3.20-36.11]; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 [95% CI 1.47-50.66]; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 [95% CI 5.39-38.21]; p <0.0001) were more likely to lose good vision. CONCLUSION Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.
Collapse
Affiliation(s)
- Anand D Gopal
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | |
Collapse
|
10
|
Peck TJ, Starr MR, Yonekawa Y, Khan MA, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Outcomes of Primary Rhegmatogenous Retinal Detachment Repair in Eyes With Preoperative Grade B or C Proliferative Vitreoretinopathy. JOURNAL OF VITREORETINAL DISEASES 2022; 6:194-200. [PMID: 37008548 PMCID: PMC9976120 DOI: 10.1177/24741264211046770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: This work evaluates the anatomic and functional outcomes of primary rhegmatogenous retinal detachments (RRDs) with preoperative grade B and C proliferative vitreoretinopathy (PVR) vs eyes without PVR. Methods: As a multi-institutional, interventional, retrospective study of all patients undergoing primary RRD surgical procedures from January 1, 2015, through December 31, 2015, this study evaluated the visual acuity (VA) outcomes and single-surgery anatomic success rates (SSAS) of patients with primary grade B and C PVR at the time of RRD repair. Results: A total of 2486 eyes underwent primary RD surgery during the study period, of which 153 eyes (6.2%) had documented preoperative PVR grade B or C. Eyes without PVR had better SSAS compared with eyes with grade B or C PVR (87% vs 83% vs 75%, respectively, P < .0001). Eyes without PVR also had better final mean (SD) logMAR VA (0.35 [0.47]; 20/45 Snellen equivalent) than eyes with PVR of grade B (0.50 [0.56]; 20/63 Snellen equivalent) or grade C ( P < .0001). In only eyes with preoperative PVR, there were no significant differences in final VA or SSAS on multivariate analysis based on surgical approach or use of retinectomy or membrane peeling alone in the intraoperative management of PVR. Conclusions: Eyes with primary preoperative grade B and C PVR appear to have significantly worse VA outcomes and lower surgical success rates. Surgical approach and management of PVR membranes did not appear to affect VA or success rates, indicating that preoperative PVR severity may dictate these outcomes.
Collapse
Affiliation(s)
- Travis J. Peck
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Matthew R. Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - M. Ali Khan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luv G. Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carl D. Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omesh P. Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
11
|
Peters MC, Murray-Douglass A, Park J, Cheng SSH, Sharma AK, Sharma A, Vandeleur KW, Lee LR, Moloney TP. 360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes. Int J Retina Vitreous 2022; 8:28. [PMID: 35387685 PMCID: PMC8985359 DOI: 10.1186/s40942-022-00377-1] [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: 02/10/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine patient and surgical factors associated with the use of 360-degree laser retinopexy during primary pars plana vitrectomy (PPV) ± scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS Patients who underwent PPV ± SB for repair of non-complex RRD at a single centre were included in this retrospective study. The primary outcome was single surgery anatomical success (SSAS). Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. Multiple logistic regression and multivariate regression was used. RESULTS The study included 192 cases, of which 130 received 360-degree laser. Worse preoperative logMAR visual acuity (P = 0.009), male sex (P = 0.060), higher PVR grades, supplemental SB (P = 0.0468) and silicone oil/C3F8 tamponade (P < 0.0001) were associated with 360-degree laser use. No significant associations between 360-degree laser and SSAS (P = 0.079), final logMAR visual acuity (P = 0.0623), ERM development (P = 0.8208), postoperative CMO (P = 0.5946), tonic pupil (P > 0.9999) or corneal epithelial defects (P = N/A) were found. CONCLUSIONS 360-degree laser retinopexy during primary PPV ± SB for RRD was associated with more complex cases and more extensive operations. Even when accounting for this, there was no difference in surgical outcomes or complication rates.
Collapse
Affiliation(s)
- Matthew C Peters
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Alexander Murray-Douglass
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Joseph Park
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Sean S H Cheng
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Anil K Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Kevin W Vandeleur
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Lawrence R Lee
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Thomas P Moloney
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia.
| |
Collapse
|
12
|
Russell JF. Whitish Outer Retinal Spots in Retinal Detachment: Longitudinal Follow-up, Multimodal Imaging, and Clinical Utility. Ophthalmol Retina 2022; 6:469-477. [PMID: 35114413 DOI: 10.1016/j.oret.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize the poorly understood phenomenon of whitish outer retinal spots that occasionally appear in retinal detachment (RD) DESIGN: Retrospective, consecutive case series SUBJECTS: Patients with RDs that had ophthalmoscopically-visible whitish outer retinal spots METHODS: All RDs with whitish outer retinal spots identified by one examiner over a 4-year interval were identified, and records were retrospectively reviewed. MAIN OUTCOME MEASURES Clinical and surgical observations, photography, and OCT RESULTS: Whitish outer retinal spots were visualized in 51 occurrences of RD: 45 in rhegmatogenous RDs (RRDs), 5 in tractional RDs (TRDs), and 1 in exudative RD (ERD). In RRDs the spots usually formed an arcuate band located between the causative retinal break and attached retina. However, 6 RRDs had spots located between a peripheral gutter of subretinal fluid (SRF) and attached retina. In 11 eyes, the spots were observed to appear over time and/or propagate to areas of detached retina more distal to the break. The spots corresponded to hyperreflective foci in the ellipsoid/interdigitation layers on OCT. The spots were isofluorescent on fluorescein angiography. The average duration of symptoms prior to surgical repair was 27.7 days. In 7 of 23 eyes surgically repaired by the author, the distribution of the spots assisted in localizing an occult retinal break. The spots sometimes appeared or persisted in areas of residual SRF but invariably resolved after retinal reattachment. CONCLUSIONS Whitish outer retinal spots can occur in all types of RD, not just RRDs. Observation of the spots can help to date an RD as subacute and should prompt surgery. Because the spots occur in distributions that reflect the path of spread of subretinal fluid, their position can be used to localize causative retinal breaks.
Collapse
Affiliation(s)
- Jonathan F Russell
- Institute for Vision Research and Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
| |
Collapse
|
13
|
Starr MR, Hsu J, Yonekawa Y, Mittra RA, Ryan C, Forbes NJ, Ammar M, Patel LG, Obeid A, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Ryan EH. Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates. Acta Ophthalmol 2021; 99:e1501-e1508. [PMID: 33720540 DOI: 10.1111/aos.14821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 02/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS To identify differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates (SSSR) for repair of rhegmatogenous retinal detachments (RRDs). METHODS This study is a sub-analysis of subjects who underwent RRD repair in the Primary Retinal Detachment Outcomes (PRO) study, a multi-institutional, retrospective comparative interventional study. The PRO study examined consecutive primary RRD surgeries from January 1, 2015 through December 31, 2015. The primary outcome was variations in surgical approach to different types of RRDs with secondary analyses of pre and intraoperative metrics for surgeons with SSSR > 90% compared to those <80% who performed at least 40 operations during the study period. RESULTS A total of 689 surgeries were included in the analysis. The mean SSSR was 94% for the higher tier and 75% for the lower tier (p < 0.0001). Surgeons with >90% SSSR were more likely to have graduated fellowship more recently (p = 0.0025), use less perfluorocarbon liquid (p < 0.0001), perform less 360 degree laser retinopexy (p < 0.0001), and perform a higher percentage of primary buckles and combined PPV/SB (p < 0.0001). For pseudophakic eyes there was no difference between PPV and PPV/SB use (p = 0.6211). CONCLUSION Surgeons with high SSSR typically performed SB as well as combination PPV/SB for more RRDs. Similar numbers of PPV and PPV/SB were performed for pseudophakic eyes, suggesting that the difference in SSSR between the two groups may be related to a combination of preoperative and intraoperative decisions as well as differences in technique.
Collapse
Affiliation(s)
- Matthew R. Starr
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Jason Hsu
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | | | | - Michael Ammar
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Luv G. Patel
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Anthony Obeid
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Antonio Capone
- Associated Retinal Consultants Oakland University William Beaumont School of Medicine Royal Oak MI USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | - Omesh P. Gupta
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Carl D. Regillo
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | |
Collapse
|
14
|
Soekamto C, Chu ER, Johnson DA, Sohn JH, Bahadorani S. Protective Role of 360° Laser Retinopexy in Patients with Rhegmatogenous Retinal Detachment: a Systematic Review and Meta-analysis. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:215-222. [PMID: 34120420 PMCID: PMC8200595 DOI: 10.3341/kjo.2021.0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. METHODS The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. RESULTS Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. CONCLUSIONS Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.
Collapse
Affiliation(s)
- Christa Soekamto
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Edward R Chu
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Daniel A Johnson
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Jeong-Hyeon Sohn
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Sepehr Bahadorani
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| |
Collapse
|
15
|
Starr MR, Cai L, Obeid A, Ryan EH, Eliott D, Ryan C, Forbes NJ, Ammar M, Patel LG, Capone A, Emerson GG, Joseph DP, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. Risk Factors for Presence of Cystoid Macular Edema following Rhegmatogenous Retinal Detachment Surgery. Curr Eye Res 2021; 46:1867-1875. [PMID: 33979556 DOI: 10.1080/02713683.2021.1929330] [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: 10/21/2022]
Abstract
Purpose: Cystoid macular edema (CME) following cataract surgery is a well-known entity. Less is known regarding the risk factors of developing CME following repair of rhegmatogenous retinal detachments (RRD).Methods: This was a multi-institutional study of primary RRD surgeries from 1/1/2015 through 12/31/2015. The primary outcome was the development of postoperative CME following RRD surgery. Post-operative optical coherence tomography imaging and 3 months of follow-up following RRD repair were required.Results: There were 1,466 eyes that met the inclusion criteria, and 140 (9.6%) developed postoperative CME following primary RRD repair. On multivariate analysis, the statistically significant metrics were older patient age (OR 1.03 per year, 95% CI 1.01 to 1.05), pre-operative proliferative vitreoretinopathy (PVR, OR 1.74, 95% 1.03 to 2.95), and cataract surgery following RRD repair (OR 2.18, 95% CI 1.47 to 3.25). Single surgery success was protective against CME (OR 0.20 (95% CI 0.14-0.30). Seventy-six (9.0%) of the phakic eyes and 60 (9.9%) of the pseudophakic eyes developed post-operative CME. Multivariate analysis showed that cataract surgery following RRD repair (p < .0001) for phakic eyes and older age (p = .0075) for pseudophakic eyes were risk factors. In eyes that underwent successful retinal reattachment with one surgery, post-operative cataract surgery (p = .0005) and pre-operative PVR (p = .0011) were risk factors for CME in this subgroup.Conclusion: CME occurred in nearly 10% of the eyes following RRD repair. The biggest risk factors were recurrent RRD, preexisting PVR, older age, and cataract surgery following RRD repair.
Collapse
Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Louis Cai
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
16
|
Starr MR, Yonekawa Y, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Comparison of Visual and Anatomic Outcomes Following RRD Surgery Using 23-Gauge Versus 25-Gauge Vitrectomy: PRO Study Report No. 12. Ophthalmic Surg Lasers Imaging Retina 2021; 52:70-76. [PMID: 33626167 DOI: 10.3928/23258160-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Most surgeons now utilize small-gauge (23- or 25-gauge) pars plana vitrectomy (PPV) with or without scleral buckling for repair of rhegmatogenous retinal detachments (RRD), in addition to primary scleral buckle (SB), but comparative data between the two gauges are limited. PATIENTS AND METHODS This study is an analysis of primary RRD repairs comparing 23- versus 25-gauge vitrectomy for PPV or combination PPV/SB from January 1, 2015, through December 31, 2015, across multiple institutions. The primary outcome was single-surgery success and secondary outcomes included postoperative complications. RESULTS There were 1,932 eyes that met inclusion criteria. There was no statistically significant difference in single-surgery success (82.9% vs. 83.8%; P = 0.6329). There were similar rates of postoperative hypotony, endophthalmitis, vitreous hemorrhage, and choroidal detachment. The findings were similar when analyzing only eyes that underwent primary PPV without SB. CONCLUSION Both 23- and 25-gauge vitrectomy systems have similar anatomic and visual outcomes in the primary repair of RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:70-76.].
Collapse
|
17
|
Outcomes of Vitrectomy Combined with Scleral Buckling for Eyes with Early Recurrence of Simple Rhegmatogenous Retinal Detachment Previously Treated by Pars Plana Vitrectomy. J Ophthalmol 2020; 2020:6637143. [PMID: 33489337 PMCID: PMC7803136 DOI: 10.1155/2020/6637143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the outcomes of pars plana vitrectomy (PPV) combined with scleral buckling (SB) in treating eyes with an early recurrent rhegmatogenous retinal detachment (rRRD). Methods This was a retrospective, interventional case series of 21 eyes with an early rRRD treated by PPV combined with SB. The significance of the associations between the variants before the surgeries and the final best-corrected visual acuity (BCVA) was determined. Results The average age of the patients was 61.0 ± 9.6 years. A retinal reattachment was observed in 20 of 21 eyes (95.2%) after a single reoperation. The BCVA was 0.91 ± 0.90 logMAR units before the initial surgery and 0.94 ± 0.94 logMAR units before the reoperations, and it improved significantly to 0.49 ± 0.50 logMAR units after the reoperation (P = 0.016, P = 0.002, respectively). The preoperative BCVA was significantly correlated with the final BCVA (P = 0.043, r = 0.445 before the primary surgery; P < 0.001, r = 0.885 before reoperation). Conclusions The reattachment of an early recurrent retinal detachment by PPV with SB is effective.
Collapse
|
18
|
Antaki F, Dirani A, Bachour K, Giguère CÉ, Hammamji K. Comment on: Localized versus 360° intraoperative laser retinopexy in cases of rhegmatogenous retinal detachment with mild-to-moderate grade proliferative vitreoretinopathy. Eye (Lond) 2020; 35:3174-3175. [PMID: 33188290 DOI: 10.1038/s41433-020-01279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 0C1, Canada
| | - Ali Dirani
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Kenan Bachour
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charles-Édouard Giguère
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Karim Hammamji
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 0C1, Canada.
| |
Collapse
|
19
|
Abstract
Purpose of Review In this article, the current use and limitations of existing retinal tamponades are discussed. Potential novel developments that address those limitations are subsequently highlighted, along with areas of future improvements. Recent Findings While retinal tamponades have existed for decades and improved the treatment of retinal detachments, many problems still exist with their use, including inadequate tamponade of the inferior retina, toxicity from retained heavy liquids, glaucoma, and keratopathy, among others. New advancements in the components of heavy liquids and vitreous substitutes aim to mitigate those issues. Summary Existing retinal tamponades, including perflurocarbon heavy liquids, fluorinated gases, and silicone oil, have specific limitations that cause potentially avoidable morbidity. New developments, such as heavy silicone oil, novel vitreous gels, and future avenues of approach, such as potentially reabsorbing heavy liquids may help increase our ability to treat retinal detachments with fewer complications.
Collapse
Affiliation(s)
- Avnish Deobhakta
- Department of Ophthalmology New York Eye and Ear Infirmary of Mount Sinai Icahn School of Medicine at Mount Sinai, New York, USA
| | - Richard Rosen
- Department of Ophthalmology New York Eye and Ear Infirmary of Mount Sinai Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|