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Mansour AM, López-Guajardo L, Belotto S, Lima LH, Charbaji AR, Schwartz SG, Wu L, Smiddy WE, Ascaso J, Jürgens I, Foster RE, Elnahry AG, Sinawat S, Pinilla I, Pérez-Salvador García E, Suarez Leoz M, Olivier Pascual N, Zago Ribeiro L, Arroyo Castillo R, Navea A, Kadayifcilar S, Ellabban AA, Rey A, Mansour HA, Tripathy K, Kozak I, Uwaydat SH, Valero MS, Cobo-Soriano R, Díaz-Barreda MD, Monje Fernández L, González Del Valle F, López Liroz I, Vazquez Cruchaga E, Fonollosa A, Esteban Floria O, Relimpio Lopez MI, Shah G, Wingelaar MJ, Ravani R, Donate-López J, Rubio Velázquez E, Parodi M. Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment. Eur J Ophthalmol 2024; 34:1217-1227. [PMID: 37901895 DOI: 10.1177/11206721231210693] [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] [Indexed: 10/31/2023]
Abstract
PURPOSE To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
- Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | | | | | - Luiz H Lima
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Abdul Razzak Charbaji
- Department of Applied Statistics & Research Methods, Lebanese American University, Beirut, Lebanon
| | | | - Lihteh Wu
- Asociados de Macula Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - William E Smiddy
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Javier Ascaso
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | | | - Ayman G Elnahry
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Isabel Pinilla
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Marta Suarez Leoz
- Department of Ophthalmology, Hospital Universitario de Burgos, Burgos, Spain
| | - Nuria Olivier Pascual
- Department of Ophthalmology, Complejo Hospitalario Universitario de Ferrol, Galicia, Spain
| | - Lucas Zago Ribeiro
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Rosa Arroyo Castillo
- Department of Ophthalmology, Complejo Hospitalario Universitario de Ferrol, Galicia, Spain
| | | | - Sibel Kadayifcilar
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Abdallah A Ellabban
- Department of Ophthalmology, Suez Canal University, Ismaïlia, Egypt
- Department of Ophthalmology, Hull University Teaching Hospitals, Hull, UK
| | - Amanda Rey
- Institut Català de Retina, Barcelona, Spain
| | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Koushik Tripathy
- Department of Ophthalmology, ASG Eye Hospital, Kolkata, West Bengal, India
| | | | - Sami H Uwaydat
- Jones Eye Institute, University of Arkansas Medical School, Little Rock, Arkansas, USA
| | | | - Rosario Cobo-Soriano
- Department of Ophthalmology, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - María Dolores Díaz-Barreda
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Laura Monje Fernández
- Department of Ophthalmology, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Olivia Esteban Floria
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain
| | | | | | | | - Raghav Ravani
- Department of Ophthalmology, ASG Eye Hospital, Kolkata, West Bengal, India
| | | | | | - Maurizio Parodi
- Department of Ophthalmology, University Vita-Salute Milan, Milan, Italy
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Cheng FH, Lin HH, Zhu YC, Chen WJ, Wu CX, Wu YY, Zhang ZD, Pan QT. PERSISTENT SUBRETINAL FLUID AFTER VITRECTOMY FOR MACULAR HOLE-ASSOCIATED RETINAL DETACHMENT. Retina 2024; 44:782-790. [PMID: 38237083 DOI: 10.1097/iae.0000000000004050] [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: 04/24/2024]
Abstract
PURPOSE To evaluate the incidence, associated factors, and outcome of persistent subretinal fluid (SRF) after vitrectomy for macular hole-associated retinal detachment (MHRD). METHODS A total of 158 eyes from 156 patients with MHRD who achieved macular hole closure after primary vitrectomy were included in the analysis; persistent SRF was defined as the presence of SRF for more than 1 month after first surgery. Preoperative and postoperative parameters were analyzed for their relationship with SRF development. RESULTS Persistent SRF was observed in 19 eyes (12.0% of 158) postoperatively. Seven eyes (36.8% of 19) with persistent SRF eventually displayed complete absorption during follow-up. Univariate analysis revealed that eyes with persistent SRF were statistically associated with internal limiting membrane inverted flap, duration of symptoms, tamponade (perfluoropropane/silicone oil: 14/5 vs. 35/104, P < 0.001), and MHRD subtype (Type 1/Type 2/Type 3: 15/4/0 vs. 60/40/39, P = 0.003). In multivariate analysis, only internal limiting membrane inverted flap (odds ratio, 15.778, 95% confidence interval, 3.170-78.523; P = 0.001) was positively associated with persistent SRF. There were no significant differences in best-corrected visual acuity improvement ( P = 0.425) between the SRF involved foveal and without involved foveal groups and no significant differences between the SRF complete absorption and incomplete absorption groups. CONCLUSION Absorption of persistent SRF may be more difficult in MHRD eyes than in ordinary rhegmatogenous retinal detachment eyes. The internal limiting membrane inverted flap in MHRD was associated with a greater likelihood of persistent SRF. The location and incomplete absorption of persistent SRF did not seem to be associated with the final visual outcome.
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Affiliation(s)
- Feng-Hui Cheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Baumann C, Kaye SB, Steel DH. Reversing the paradigm on the urgency of acute retinal detachments defined by their foveal status: when off may be more urgent than on. BMJ Open Ophthalmol 2024; 9:e001668. [PMID: 38683951 PMCID: PMC11033651 DOI: 10.1136/bmjophth-2024-001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Carmen Baumann
- Department of Ophthalmology, Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephen B Kaye
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, UK
| | - David H Steel
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Sunderland Eye Infirmary, Sunderland, Tyne and Wear, UK
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Do JR, Park DH, Shin JP, Kang YK. Effect of external subretinal fluid drainage on persistent subretinal fluid after scleral buckle surgery in macula-involving rhegmatogenous retinal detachment. Sci Rep 2023; 13:22176. [PMID: 38093092 PMCID: PMC10719269 DOI: 10.1038/s41598-023-49719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to analyze the duration and causes of persistent subretinal fluid (PSF) after scleral buckle (SB) surgery in patients with macula-involving rhegmatogenous retinal detachment (RRD). Sixty-one eyes of 61 patients with macula-involving RRD who underwent SB surgery between 2016 and 2022 were reviewed retrospectively. PSF was confirmed on optical coherence tomography. The PSF duration after surgery and the analysis of relevant ocular and systemic factors were conducted according to the PSF duration. The mean duration of PSF was 5.9 ± 4.6 months in all eyes and 8.1 ± 5.0 months in eyes not treated with external subretinal fluid (SRF) drainage, which was significantly longer than 4.5 ± 3.7 months in those subjected to external SRF drainage. The mean best-corrected visual acuity improved significantly 3 months after surgery. There were significant visual improvements in the external SRF drainage group compared to the non-drainage group during all follow-up periods. Longstanding shallow RRD was significantly associated with longer PSF duration after SB surgery. External SRF drainage during SB surgery can effectively reduce SRF, shorten the duration of PSF, and accelerate visual improvement.
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Affiliation(s)
- Jae Rok Do
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Nune Eye Hospital, Daegu, Korea
| | - Yong Koo Kang
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea.
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Zhao T, Gu P, Sun C, Zhang M, Duan P. PREDISPOSING CHARACTERISTICS OF OPTICAL COHERENCE TOMOGRAPHY FOR PATIENTS WITH PERSISTENT SUBRETINAL FLUID AFTER SUCCESSFUL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2023; 43:793-801. [PMID: 36728019 DOI: 10.1097/iae.0000000000003739] [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: 02/03/2023]
Abstract
PURPOSE To investigate the predisposing clinical parameters and characteristics of fundus imaging of patients with persistent subretinal fluid (PSF) after successful repair of rhegmatogenous retinal detachment. METHODS A retrospective study recruiting 57 patients was conducted. All patients underwent pars plana vitrectomy with silicone oil tamponade. Patients were divided into two groups: patients presenting PSF by the time of silicone oil removal as PSF group and patients presenting no PSF by the time of silicone oil removal as control group. All patients were followed up for 3 months or longer after primary surgery. Ophthalmic examinations, including fundus photography and optical coherence tomography, were performed. RESULTS There were significant differences between the two groups in average age, durations of preoperative symptoms, and type of retinal breaks ( P < 0.05). These clinical parameters showed statistical correlations with PSF ( P < 0.05). The proportions of patients presenting distinctive boundaries of the detached retina on fundus photograph and patients showing a hyperreflective line underlying the detached retina on optical coherence tomography in the PSF group were both significantly higher than the control group ( P < 0.05). The macular detachment heights on optical coherence tomography in the PSF group were significantly lower than the control group ( P < 0.05). These imaging characteristics also showed strong correlations with PSF ( P < 0.05). CONCLUSION This study suggests that patients with PSF have younger age, longer symptom duration, and higher incidence of retinal holes. The distinctive detachment boundary on fundus photograph, lower macular detachment height, and hyperreflective line underlying the detached retina on optical coherence tomography may be the predisposing characteristics of PSF.
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Affiliation(s)
- Tongtao Zhao
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration and Restoration of Chongqing, Chongqing, China
| | - Peng Gu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration and Restoration of Chongqing, Chongqing, China
| | - Cheng Sun
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration and Restoration of Chongqing, Chongqing, China
| | - Minfang Zhang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration and Restoration of Chongqing, Chongqing, China
| | - Ping Duan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration and Restoration of Chongqing, Chongqing, China
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Prognostic Features of Preoperative OCT in Retinal Detachments: A Systematic Review and Meta-analysis. Ophthalmol Retina 2022; 7:383-397. [PMID: 36435422 DOI: 10.1016/j.oret.2022.11.011] [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: 04/11/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
TOPIC To evaluate the prognostic association between preoperative features seen on OCT imaging and postoperative visual acuity (VA) outcomes in rhegmatogenous retinal detachments (RRDs). CLINICAL RELEVANCE Currently, there is limited literature on the prognostic value of preoperative RRD OCT features. METHODS A literature search was conducted on Ovid MEDLINE, Ovid Embase, and Cochrane CENTRAL from inception to September 15, 2022. A meta-analysis was performed using a random-effects model. Quality of studies and evidence were assessed using the Joanna Briggs Institute tools and the Grading of Recommendations, Assessment, Development and Evaluation framework, respectively. RESULTS A total of 1671 eyes of 1670 patients from 29 observational studies were included. Of these, 89% of eyes had a macula-off RRD at presentation. The mean average duration of detachment was 15 ± 10 days. Most eyes (62%) underwent pars plana vitrectomy. Six preoperative OCT features were analyzed: height of retinal detachment (HRD) at the fovea, central macular thickness (CMT), disruption of the ellipsoid zone (EZ) and/or external limiting membrane (ELM), intraretinal cystic cavities (ICCs), outer retinal corrugations (ORCs), and macular detachment. A greater HRD was weakly associated with postoperative VA (Pearson correlation r = 0.35; 95% confidence interval [CI], 0.20-0.48; P < 0.01), and there was no change in this association throughout the postoperative follow-up period. The CMT was not associated with postoperative VA. Eyes with disruption of the EZ and/or ELM had a postoperative VA worse by 0.35 logarithm of the minimum angle of resolution (logMAR) (95% CI, 0.15-0.54; P < 0.01) or 3 Snellen lines. Eyes with ICCs had a postoperative VA worse by 0.14 logMAR (95% CI, 0.01-0.26; P < 0.01) or 2 Snellen lines. Eyes with ORCs did not have a significantly different postoperative VA than eyes without ORCs. Eyes with macular detachment had a postoperative VA worse by 0.15 logMAR (95% CI, -0.31 to 0.00; P = 0.02) or 2 Snellen lines. Overall, the quality of studies ranged from moderate to good (73%-100%). All associations had a low quality of evidence, with CMT being of very low quality. CONCLUSION Despite the low quality of evidence, a greater HRD, disruption of the EZ and/or ELM, presence of ICCs, and macular detachment were associated with a poor postoperative VA. We propose a standardized nomenclature for consistency and accuracy in reporting preoperative RRD OCT features for future studies.
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Aggarwal D, Rani PK. Spontaneous resolution of subretinal fluid postvitreoretinal surgery for tractional retinal detachment in proliferative diabetic retinopathy. BMJ Case Rep 2022; 15:e249745. [PMID: 36007977 PMCID: PMC9422852 DOI: 10.1136/bcr-2022-249745] [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] [Indexed: 11/04/2022] Open
Abstract
A man in his 60s with proliferative diabetic retinopathy presented with vision loss in both eyes in the past 1 month. On presentation, the best corrected visual acuity was 20/60 and 20/125 for the right and left eyes, respectively. On examination, he had total tractional retinal detachment (TRD) in the left eye and macula threatening TRD in the right eye. In both eyes, the patient had pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Though the left eye's postoperative recovery was uneventful, the subretinal fluid (SRF) in the right eye macula persisted. There was no open retinal break noted in the postoperative period, and no surgical intervention was done for the persistent SRF. The fluid was eventually absorbed over 4 months, with the recovery of vision to 20/40.
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Affiliation(s)
- David Aggarwal
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Padmaja Kumari Rani
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telengana, India
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Yee C, Xu DN, Berger RF, Traustason KE, Flaxel C. Visual Outcomes in Macula-Involving Retinal Detachments Based on Time to Surgical Repair. Ophthalmic Surg Lasers Imaging Retina 2022; 53:439-444. [PMID: 35951717 DOI: 10.3928/23258160-20220723-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To examine the relationship between duration of macular detachment and postoperative visual acuity in macula-involving rhegmatogenous retinal detachments. PATIENTS AND METHODS Retrospective review of patients who underwent surgical repair of macula-involving rhegmatogenous retinal detachments was conducted with Institutional Review Board approval. Primary outcome measure was postoperative best-corrected visual acuity (BCVA) as dependent on duration of macular detachment. RESULTS In eyes with duration of macular detachment less than or equal to 7 days, postoperative BCVA increased by 0.017 logarithm of the minimum angle of resolution (logMAR) units (P = .001), and the odds of achieving logMAR 0 decreased by a factor of 0.43 (95% CI, 0.21 to 0.87; P = .02) with each additional day of detachment. Eyes repaired within 3 days of macular detachment were more likely to have postoperative BCVA of logMAR 0 than eyes repaired 4 to 7 days after macular detachment (odds ratio, 2.32; 95% CI, 1.15 to 4.70; P = .02). CONCLUSION Increased duration of macular detachment is associated with progressive decline in postoperative visual acuity. [Ophthalmic Surg Lasers Imaging Retina 2022;53:439-444.].
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Fouad YA, Habib AM, Sanders RN, Sallam AB. Persistent Subretinal Fluid Following Successful Rhegmatogenous Retinal Detachment Surgery. Semin Ophthalmol 2022; 37:724-729. [PMID: 35666630 DOI: 10.1080/08820538.2022.2085516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide an updated, critical summary of the literature on the topic of persistent subretinal fluid (PSF) following successful rhegmatogenous retinal detachment surgery. METHODS Narrative literature review. RESULTS PSF remains an insufficiently studied topic. Incidence rates vary significantly between reports, but pars plana vitrectomy seems associated with lower rates than buckle surgery. Multiple etiologies and risk factors have been proposed, none being conclusive. PSF gradually resolves in most cases which may be a lengthy process, often with no effect on potential final visual acuity. There is concern that some cases with PSF may sustain photoreceptor damage, retinal displacement, or retinal fold formation. There is no current evidence to support any treatment modality over observation in uncomplicated cases of PSF. CONCLUSION Future large, well-controlled, prospective trials could help elucidate incidence rate, etiological factors, and sequelae of PSF, as well as the value of different interventions in its prevention and management.
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Affiliation(s)
- Yousef A Fouad
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.,Vitreoretinal Service, Al Mashreq Eye Center, Cairo, Egypt
| | - Ahmed M Habib
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.,Vitreoretinal Service, Al Mashreq Eye Center, Cairo, Egypt
| | - Riley N Sanders
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Kang YK, Shin JP. Clinical Analysis of Persistent Subretinal Fluid after Pars Plana Vitrectomy in Macula with Diabetic Tractional Retinal Detachment. J Clin Med 2021; 10:jcm10245929. [PMID: 34945225 PMCID: PMC8709087 DOI: 10.3390/jcm10245929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We analyzed the duration of persistent subretinal fluid (PSF) and the contributing factors of PSF after pars plana vitrectomy in patients who had a macula with diabetic tractional retinal detachment (TRD). (2) Methods: Forty eyes of 40 patients who had pars plana vitrectomy due to a macula with diabetic TRD, between 2014 and 2020, were retrospectively reviewed. The duration of PSF, as well as relevant ocular and systemic factors, was analyzed. (3) Results: The mean duration of PSF was 4.4 ± 4.7 months. The prevalence of PSF was 75.0% at 1 month, 50.0% at 3 months, 30.0% at 6 months and 10.0% at 12 months after surgery. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR) were significantly associated with the duration of PSF in the univariate analysis. In the multivariate analysis, only eGFR was significantly associated with the duration of PSF (β = -0.089, p = 0.030). (4) Conclusion: PSF may persist for more than 12 months in a macula with diabetic TRD after vitrectomy. Moreover, patients with impaired kidney function tended to have a delayed subretinal fluid absorption. Therefore, careful investigation of preoperative systemic conditions, especially kidney function, should be considered before TRD surgery in diabetic patients.
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ROLE OF OPTICAL COHERENCE TOMOGRAPHY FOR PREDICTING POSTOPERATIVE VISUAL OUTCOMES AFTER REPAIR OF MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2021; 41:2017-2025. [PMID: 33734189 DOI: 10.1097/iae.0000000000003162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify any prognostic associations between preoperative optical coherence tomography findings and postoperative visual outcomes in patients with macula-off rhegmatogenous retinal detachment. METHODS A retrospective, single-center study of patients diagnosed with macula-off rhegmatogenous retinal detachment whom underwent surgical reattachment from 2012 to 2017. Optical coherence tomography images were analyzed by two retina surgeons. Outcome measures included "good" final vision (best-corrected visual acuity of 20/40 or better), "poor" final vision (best-corrected visual acuity of 20/200 or worse), and change in vision (worsened, improved, and improved ≥15 letters) at most recent follow-up. P values were calculated using t tests, analysis of variance, Wilcoxon rank-sum, or Kruskall-Wallis test. RESULTS A total of 49 eyes were included. There was a significant difference in the mean preoperative central retinal thickness between patients who had good final vision and patients who did not (96 μm vs. 161 μm, P = 0.048). In addition, a worse preoperative best-corrected visual acuity and greater subretinal fluid height were associated with vision improvement (P < 0.001). Those with persistent ellipsoid zone disruption postoperatively were less likely to have good final vision (odds ratio = 0.217, 95% confidence interval: 0.057-0.828). CONCLUSION A lower mean preoperative central retinal thickness is associated with good visual prognosis. Eyes with ellipsoid zone disruption postoperatively were less likely to have good final vision. Future studies should include a larger cohort of patients and more optical coherence tomography variables to address the inconsistencies in the current literature.
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Angermann R, Mosböck S, Palme C, Ulmer H, Rauchegger T, Nowosielski Y, Bechrakis NE, Zehetner C. Impact of submacular fluid volume on visual outcome in macula-off rhegmatogenous retinal detachment using automated optical coherence tomography volumetric quantification. Clin Exp Ophthalmol 2021; 49:439-447. [PMID: 33864341 PMCID: PMC8360107 DOI: 10.1111/ceo.13929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023]
Abstract
Background We investigated effects of submacular fluid volume (SMFV) on visual outcomes following surgery for macula‐off primary rhegmatogenous retinal detachment (RRD) using automated fluid volumetric quantification with optical coherence tomography (OCT). Methods We analysed 127 eyes that were surgically treated for macula‐off RRDs. We obtained preoperative images following the spectral domain (SD)‐OCT dense volume protocol, applied automated retinal segmentation and used an automated algorithm to quantify each eye's SMFV. We used multivariate models to identify various risk factors for impaired visual outcome. Results Linear regression showed that preoperative SMFV (ß = 0.013; P = .005) was significantly associated with a reduced visual outcome 12 months after the treatment of macula‐off RRDs. SMFV was negatively correlated with 12‐month postoperative (r = .311; P = .001) visual acuity (VA). The group with low preoperative SMFV (≤9.0 mm3) showed an increasing VA up to 12 months postoperatively (P < .001), while the VA did not increase in the group with high SMFV (>9.0 mm3) beyond 3 months of follow‐up. Patients with a high SMFV were 8.0 times more likely to have worse visual outcomes after 12 months of follow‐up (P = .018). Conclusions SMFV was negatively correlated with visual outcomes after the surgical treatment of macula‐off RRDs. Patients with SMFV <9.0 mm3 12 months after surgery had an 8.0 times greater chance for better visual recovery than patients with high preoperative SMFV. Our findings highlight the efficacy of automated SMFV quantification in predicting surgical outcomes in patients with RRDs, which could be useful in future clinical practice and the development of research models.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria.,Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Mosböck
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Palme
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Teresa Rauchegger
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Claus Zehetner
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
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13
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Mimouni M, Jaouni T, Ben-Yair M, Almus S, Derman L, Ehrenberg S, Almeida D, Barak Y, Zayit-Soudry S, Averbukh E. PERSISTENT LOCULATED SUBRETINAL FLUID AFTER RHEGMATOGENOUS RETINAL DETACHMENT SURGERY. Retina 2021; 40:1153-1159. [PMID: 31241497 DOI: 10.1097/iae.0000000000002565] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To identify factors associated with persistent subretinal fluid (SRF) after small-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment. METHODS This retrospective study included patients from 2 tertiary centers who underwent pars plana vitrectomy for repair of rhegmatogenous retinal detachment between 2013 and 2016. Preoperative and intraoperative parameters were examined for association with development of SRF. RESULTS Overall, 153 eyes of 153 patients, mean age of 55.2 ± 17.9 years were included. Persistent SRF occurred in 15.0% (n = 23) and was associated with high myopia (65.22 vs. 26.15%, P < 0.001), macula-involving retinal detachment (91.30 vs. 66.15%, P = 0.02), phakic lens status (86.96 vs. 66.15%, P = 0.04), and younger age (47.8 ± 18.7 vs. 56.5 ± 17.5, P = 0.04) while drainage retinotomy was protective (13.04 vs. 34.11%, P = 0.04). In multivariate analysis, high myopia (P = 0.009) and macula-involving retinal detachment (P = 0.004) were associated with SRF, while drainage retinotomy was protective (P = 0.03). Persistent SRF was associated with outer retinal band irregularity (30.4 vs. 9.3%, P = 0.005). There were no significant differences in terms of change in best-corrected visual acuity from presentation (P = 0.70), or final best-corrected visual acuity (P = 0.54). CONCLUSION Eyes with preoperative high myopia and macular involvement, and those in which a drainage retinotomy was not performed, were more likely to develop persistent SRF.
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Affiliation(s)
- Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Tareq Jaouni
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mor Ben-Yair
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Shiran Almus
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Laura Derman
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Scott Ehrenberg
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Diego Almeida
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoreh Barak
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel; and
| | - Edward Averbukh
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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14
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Tang F, Xu F, Su N, Liu L, Jiang L, Tang N, Zhao X, Cui L, Zeng S, Lai Z, Li M, Zhong H. Impact of air injection on subretinal fluid following successful scleral buckling surgery for macular-involving retinal detachment. Sci Rep 2021; 11:9102. [PMID: 33907280 PMCID: PMC8079402 DOI: 10.1038/s41598-021-88670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
Air injection is an accessory technique during scleral buckling (SB). Subclinical subretinal fluid (SRF) may presence and persistent after SB. The impact of air injection on SRF is unclear. In the study, we retrospectively enrolled 51 patients with macular-involving RD who had undergone successful SB. They were categorized into Group A (SB without air injection) and Group B (SB with air injection). First, we found that although group B seem to be severer than group A before surgery, Kaplan–Meier graph showed that SRF absorbed more rapidly in group B after surgery, and the incidence of SRF in group B was much lower during the whole follow-up period. Moreover, the cases with superior breaks had the lowest incidence. Second, during the follow-up period, there was no significant difference about postoperative complication between two groups. Lastly, risk factors for persistent SRF were investigated with binary logistic regression, and no risk factor was found. In conclusion, air injection during the SB might accelerate SRF absorption and reduce the incidence of persistent SRF, especially for the longstanding macular-off RD with superior breaks.
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Affiliation(s)
- Fen Tang
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Fan Xu
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Ning Su
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lingjuan Liu
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Li Jiang
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ningning Tang
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xin Zhao
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ling Cui
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Siming Zeng
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhaoguang Lai
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Min Li
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Haibin Zhong
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
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15
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Long K, Meng Y, Chen J, Luo J. Multifactor analysis of delayed absorption of subretinal fluid after scleral buckling surgery. BMC Ophthalmol 2021; 21:86. [PMID: 33588767 PMCID: PMC7885473 DOI: 10.1186/s12886-021-01853-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal detachment (RRD). We also examined related factors that may affect the delayed absorption of SRF. Methods This retrospective study included patients who underwent successful SB surgery for the treatment of macula-off RRD and in which the retina was reattached after the surgery. The patients were categorized according to gender, duration, age, the number, and location of retinal breaks. Subfoveal choroidal thickness (SFCT), height of subretinal fluid (SRFH), and the choriocapillaris flow density (CCFD) within 3 × 3 mm macular fovea were included. Delayed absorption was determined by the SRF that remained unabsorbed for 3 months after the procedure. The endpoint was determined when the SRF could no longer be observed. Results A total of 62 patients (63 eyes) were enrolled. In 35 eyes (56.45%) SRF was completely absorbed and in 28 (43.55%) eyes delayed absorption of SRF in macular areas was observed at 3 months after surgery. A young age (< 35 years), inferior retinal breaks were associated with good outcomes by applying multivariable analysis on the rate of SRF absorption after SB instead of gender, the number of breaks, and duration (p < 0.05). CCFD was significantly different between the SRF group and the non-SRF group after SB (0.66 ± 0.04% vs 0.63 ± 0.05%, P < 0.05). SRFH showed a moderate positive correlation with SFCT (rs = 0.462, p = 0.000), however, using binary logistic regression analysis it was determined that SFCT was not related to the absorption of the SRF. Conclusions The absorption of SRF after SB may be correlated with choriocapillaris flow density. Age and location of breaks are significant factors affecting the absorption of SRF. The duration of disease is an uncertain factor due to several subjective reasons.
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Affiliation(s)
- Kejun Long
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Yongan Meng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Jing Chen
- Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China.
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16
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Morescalchi F, Russo A, Gandolfo F, Carnazza M, Bahja H, Costagliola C, Semeraro F. Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment. Acta Ophthalmol 2021; 99:e109-e116. [PMID: 32573121 DOI: 10.1111/aos.14528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). METHODS This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. RESULTS The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. CONCLUSION Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.
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Affiliation(s)
- Francesco Morescalchi
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Andrea Russo
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Federico Gandolfo
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Mario Carnazza
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Hassan Bahja
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Ciro Costagliola
- Eye Clinic Department of Health Sciences University of Molise Campobasso Italy
| | - Francesco Semeraro
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
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17
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Ng H, Vermeer KA, van Meurs JC, La Heij EC. Visual Acuity Inadequately Reflects Vision-Related Quality of Life in Patients After Macula-Off Retinal Detachment Surgery. Invest Ophthalmol Vis Sci 2021; 61:34. [PMID: 32805003 PMCID: PMC7441472 DOI: 10.1167/iovs.61.10.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the impact of postoperative visual function on the vision-related quality of life (VRQoL) in patients after anatomically successful surgery for macula-off rhegmatogenous retinal detachment (RRD) and to propose a classification to grade the extent of macular detachment using preoperative optical coherence tomography (OCT) scans. Methods This prospective study evaluated 48 patients. At 12 months after surgery, visual function assessments were as follows: metamorphopsia (M-CHARTS), aniseikonia (New Aniseikonia Test), best corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS]), low contrast BCVA (10% ETDRS), color vision (Hardy Rand Rittler), and stereopsis (Titmus Fly). VRQoL was assessed by the National Eye Institute Visual Functioning Questionnaire-25 (NEIVFQ-25). Associations between visual function parameters and NEIVFQ-25 scores were evaluated. Preoperative OCT-scans were classified into six stages according to the extent of macular detachment based on an ETDRS-grid: incomplete perifoveal detachment (1), incomplete parafoveal detachment (2), incomplete foveal detachment (3), complete foveal detachment (4), complete parafoveal detachment (5), and complete perifoveal detachment (6). Results General vision and driving were the lowest scoring categories. General vision had the strongest correlation with low contrast BCVA (r = −0.41, P = 0.002), while driving had the strongest correlation with stereopsis (r = −0.39, P = 0.008). All macular detachments were graded stage 3 or beyond. Patients with stage 3 macular detachments had the highest visual function values compared to the other stages. The highest percentage of patients with metamorphopsia, aniseikonia and BCVA>0.1 logMAR was found in stages 5 and 6. Conclusions Macula-off RRD particularly affects general vision and driving. The extent of macular detachment is a potential predictor for visual function and can be graded using the proposed classification.
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Affiliation(s)
- Heijan Ng
- Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
| | | | - Jan C van Meurs
- The Rotterdam Eye Hospital, Vitreoretinal Surgery, Rotterdam, the Netherlands
| | - Ellen C La Heij
- The Rotterdam Eye Hospital, Vitreoretinal Surgery, Rotterdam, the Netherlands
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18
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Fu Y, Chen S, Gu ZH, Zhang YL, Li LY, Yang N. Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment. Int J Ophthalmol 2020; 13:1621-1628. [PMID: 33078114 DOI: 10.18240/ijo.2020.10.17] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/18/2020] [Indexed: 01/01/2023] Open
Abstract
AIM To provide a detailed description of the natural history of persistent subretinal fluid (SRF) after successful repair of rhegmatogenous retinal detachment (RRD) and its association with visual outcome. METHODS This was a prospective long-term follow-up for eyes undergoing scleral buckling (SB) surgery for macula-off RRD. Examinations were carried out preoperatively and postoperatively at 1, 3, 6, 9 and 12mo, until persistent SRF had completely resolved. One month postoperatively, optical coherence tomography (OCT) was used to classify SRF into three patterns: bleb-like loculated (BL), shallow-diffused (SD), and multiple blebs (MB). Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance. Patients were divided into two groups depending on the presence or absence of persistent SRF. RESULTS A total of 59 patients (59 eyes) were included. There were no statistical differences between two groups at baseline, except for the proportion of patients with high myopia and a younger age. One month after surgery, OCT detected persistent SRF in 49 eyes (83.1%). The 3 morphological patterns of SRF were observed in 27 eyes (55.1%) with BL, 13 eyes (26.5%) with SD, and 9 eyes (18.4%) with MB. The mean time for complete absorption differed significantly across the three SRF patterns (F=8.097, P=0.001), which was 8.8±6.1, 20.1±12.1, and 16.7±10.2mo in BL, SD, and MB, respectively. In 9 of the 13 eyes with SD, the pattern transformed into MB type. In cases involving MB, the size and number of blebs decreased gradually until they had been completely absorbed. Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone (49.0% vs 10%, P=0.034). The final best-corrected visual acuity of two groups was 0.37±0.11 (with SRF) vs 0.34±0.12 (without SRF) logMAR (P=0.499), respectively. CONCLUSION High preoperative myopia and younger age are associated with persistent SRF. BL is the most commonly observed pattern with the shortest duration and gradually disappeared. Most cases involving SD SRF transform into MB type during resolution. The size and number of the MBs decrease gradually until they were completely absorbed. The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.
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Affiliation(s)
- Yan Fu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300000, China.,Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Song Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300000, China.,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300000, China
| | - Zhao-Hui Gu
- Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Yue-Ling Zhang
- Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Li-Ying Li
- Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Na Yang
- Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
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19
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Persistent subretinal fluid following diabetic tractional retinal detachment repair: risk factors, natural history, and management outcomes. Int Ophthalmol 2020; 41:453-464. [PMID: 33037551 DOI: 10.1007/s10792-020-01595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the natural history, anatomical and functional outcomes of persistent subretinal fluid (SRF) after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD) and combined traction-rhegmatogenous retinal detachment (TRRD). METHODS Retrospective interventional case series of 43 patients (46 eyes) with persistent SRF following PPV for diabetic TRD or combined TRRD from January 2010 to December 2017 at single tertiary institution. Primary outcomes included best corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS Thirty-one eyes (67.4%) had macula-off TRD, 5 (10.9%) had fovea-threatening TRD and 10 (21.7%) had combined TRRD. The mean (± SD) duration of decreased vision was 48.0 ± 58.2 weeks. The mean follow-up duration was 21 ± 13.2 months. Residual macular SRF was detected by optical coherence tomography in all eyes at 3 months and in 10 eyes (23.8%) at 12 months after surgery. Only 3 eyes (6.5%) had persistent SRF at final follow up. The mean time to resolution was 10.6 ± 4.1 months [range 6.0-23.0]. Thirteen eyes received additional intervention to address SRF. The mean CFT gradually improved until final follow-up (P-value < 0.001). The mean BCVA improved from 1.62 ± 0.88 LogMAR at presentation to 1.05 ± 0.76 LogMAR at final follow up. No statistically significant difference in final BCVA was found between eyes that had intervention and eyes that were observed (P value = 0.762). CONCLUSION Persistent SRF after diabetic vitrectomy resolves slowly over time with gradual improvement in visual acuity. Additional drainage of persistent SRF may not be necessary.
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20
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Mané V, Chehaibou I, Lehmann M, Philippakis E, Rothschild PR, Bousquet E, Tadayoni R. Preoperative Optical Coherence Tomography Findings of Foveal-Splitting Rhegmatogenous Retinal Detachment. Ophthalmologica 2020; 244:127-132. [PMID: 32772030 DOI: 10.1159/000510726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess preoperative optical coherence tomography (OCT) findings of foveal-splitting retinal detachment (RD) and determine postoperative outcomes. METHODS Consecutive patients who underwent RD surgery over a 1-year period were included. Patients diagnosed with a detachment extending to the edge of the fovea on fundus examination (i.e., macula-On/Off) underwent macular OCT scanning. Visual acuity (VA) after 1 year of macula-On/Off, macula-On, and macula-Off eyes was compared. RESULTS A total of 85 eyes were included, 8 of which had a macula-On/Off RD. On preoperative OCT, all macula-On/Off RD eyes had foveal detachment extending beyond the foveal center over a median distance of 632 µm. Mean VA of the macula-On/Off eyes had improved from 20/160 to 20/40 at 1 year postoperatively (p = 0.035). The preoperative VA of macula-On/Off eyes was significantly better than macula-Off eyes (p = 0.032) and lower than macula-On eyes (p = 0.004). At 1 year, the VA of macula-On/Off eyes was no different from that of the macula-On eyes (p = 0.320), and tended to be better than that of the macula-Off eyes (p = 0.062). CONCLUSION Preoperative OCT revealed a shallow RD extending beyond the foveal center in eyes with clinical foveal-splitting RD. These eyes, termed macula-On/Off RD eyes, had a preoperative VA between macula-On and macula-Off eyes, while their final VA was close to those with macula-On RD.
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Affiliation(s)
- Valérie Mané
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France, .,Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France,
| | - Ismael Chehaibou
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Mathieu Lehmann
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Elise Philippakis
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Pierre-Raphaël Rothschild
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle de Paris, AP-HP, Université Paris Descartes, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
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21
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Coppola M, Marchese A, Cicinelli MV, Rabiolo A, Giuffrè C, Gomarasca S, Querques G, Bandello F. Macular optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment. Eur J Ophthalmol 2020; 30:805-816. [DOI: 10.1177/1120672120911334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The primary aim of this study was to summarize and illustrate the main structural cross-sectional optical coherence tomography findings encountered after vitreoretinal surgery for rhegmatogenous retinal detachment. This was a non-systematic review of literature on structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment. Adequate illustrations of the main findings described were found after a retrospective analysis of imaging and charts of patients operated at the department where this study was performed. The main structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment included persistent subretinal fluid, subretinal blebs, retinal folds, subretinal perfluorocarbon liquids, macular alterations related to silicone oil, epiretinal membranes, proliferative vitreoretinopathy, cystoid macular edema, macular holes, and recurrent retinal detachment. In conclusion, optical coherence tomography was a useful tool after vitreoretinal surgery for rhegmatogenous retinal detachment. Some optical coherence tomography findings may not be evident on fundus examination, and optical coherence tomography can reveal essential details for the clinical management and the visual prognosis. Other findings, despite being visible on funduscopic examination, may be better assessed with the aid of optical coherence tomography. All these elements contribute to support the importance of tomographic assessment in the follow-up of eyes treated for vitreoretinal conditions.
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Affiliation(s)
- Michele Coppola
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Giuffrè
- Department of Ophthalmology, San Gerardo Hospital, Monza, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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22
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Effect of Timing on Visual Outcomes in Fovea-Involving Retinal Detachments Verified by SD-OCT. J Ophthalmol 2020; 2020:2307935. [PMID: 32148936 PMCID: PMC7057004 DOI: 10.1155/2020/2307935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the impact of surgical delay after the objectivation of the foveal status by spectral-domain optical coherence tomography (SD-OCT) on visual outcomes in patients with rhegmatogenous retinal detachment (RRD) with foveal involvement. Methods A retrospective dataset analysis of 508 eyes of 504 consecutive patients with primary RRD was performed. The primary outcome measure was the best-corrected visual acuity as a function of time between the assessment of the foveal status with SD-OCT upon initial examination at the department and RRD repair. Results In total, 188 eyes (37.0%) had a complete foveal detachment and 31 (6.1%) eyes had a bisected fovea by the retinal detachment. A hundred eyes with total foveal detachment received surgery within 24 h and 65 eyes between 24 h and 72 h. Visual outcomes for eyes with detached fovea were significantly better when treated within 24 h (0.47 ± 0.39) compared with those treated between 24 h and 72 h (0.84 ± 0.66; p=0.01) after objectivation of the foveal status with SD-OCT. Pars plana vitrectomy was performed in 174 (92.6%) eyes and scleral buckling surgery in 14 (7.4%) eyes with complete foveal involvement of RRD. Conclusions Our findings suggest improved visual outcomes for patients receiving surgery within 24 h after a definitive diagnosis of fovea-involving RRD compared to surgical interventions that were further delayed.
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Choroidal Thickness Is Associated with Delayed Subretinal Fluid Absorption after Rhegmatogenous Retinal Detachment Surgery. ACTA ACUST UNITED AC 2019; 3:947-955. [DOI: 10.1016/j.oret.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
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Kobayashi M, Iwase T, Yamamoto K, Ra E, Hirata N, Terasaki H. Influence of submacular fluid on recovery of retinal function and structure after successful rhegmatogenous retinal reattachment. PLoS One 2019; 14:e0218216. [PMID: 31269030 PMCID: PMC6608944 DOI: 10.1371/journal.pone.0218216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the influence of residual submacular fluid (SMF) on the recovery of function and structure of the retina after successful rhegmatogenous retinal detachment (RRD) reattachment. Methods We reviewed the medical records of all patients who had undergone successful RRD repair by scleral buckling (SB) surgery or by pars plana vitrectomy (PPV) from March 2011 to August 2014. Spectral-domain optical coherence tomographic images of the macular regions were used at 1, 2, 3, 6, 9, and 12 months following the surgery. The best-corrected visual acuities (BCVA) were evaluated at the same times. Results The eyes with a macula-off RRD that were treated by SB surgery had a significant higher incidence of residual SMF (52%) than those treated by PPV (6.8%; P <0.001). Nevertheless, the postoperative BCVA was significantly improved in the eyes that had undergone SB surgery (P = 0.007). The postoperative BCVAs were not significantly different between the groups in which the SMF was absorbed (12 eyes) and not absorbed (13 eyes) within 1 month after the SB surgery. The photoreceptor outer segment length and the presence of a foveal bulge were not significantly different between these two groups at 12 months. Multiple regression analyses showed that the presence of a foveal bulge (β = 0.531, P = 0.001) and the duration of the retinal detachment before surgery (β = 0.465, P = 0.002) but not the duration of the SMF were independent factors significantly correlated with the final BCVA. Conclusions These results suggest that the postoperative residual SMF does not significantly disrupt the functional and structural recovery of eyes with macula-off RRD treated by SB surgery.
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Affiliation(s)
- Misato Kobayashi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | - Kentaro Yamamoto
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eimei Ra
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norifumi Hirata
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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An optical coherence tomography study of residual subfoveal fluid after successful pars plana vitrectomy in patients with diabetic tractional macular detachment. Eye (Lond) 2018; 32:1472-1477. [PMID: 29795128 DOI: 10.1038/s41433-018-0111-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/20/2018] [Accepted: 03/25/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To analyze the prevalence of residual subfoveal fluid (RSF) after pars plana vitrectomy in patients with proliferative diabetic retinopathy complicated by tractional detachment of the macula and the effect of RSF on the postoperative visual outcome. METHODS This study was a prospective observational case study of the optical coherence tomography (OCT) records of 23 patients (24 eyes) with macula-off diabetic tractional retinal detachment (TRD) who underwent successful 23-gauge pars plana vitrectomy between July 2012 and December 2015. RESULTS The prevalence of RSF on OCT examination was 100% at 1 and 2 months, 91.7% at 3 months, 70.8% at 6 months, 25.0% at 9 months and 4.2% at 12 months after surgery (p < 0.001). Internal drainage of subretinal fluid (SRF) during primary surgery was performed in 13 (54.2%) eyes. The significant risk factor that was predictive of long-standing RSF was non-drainage of SRF (p = 0.04). CONCLUSION Persistent RSF is a common OCT finding after clinically successful vitrectomy surgery for the treatment of macula-off diabetic tractional retinal detachment. Internal drainage of SRF with active aspiration can be attempted if intraoperative breaks are found or if faster recovery is required. To date, observation seems to be the best option.
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Haghighi A, Do J, Ameri H. Eplerenone as a novel treatment for persistent subretinal fluid following retinal detachment surgery. Am J Ophthalmol Case Rep 2018; 10:261-263. [PMID: 29780947 PMCID: PMC5956724 DOI: 10.1016/j.ajoc.2018.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 10/31/2022] Open
Abstract
Purpose To describe the clinical course of a patient with persistent subretinal fluid (SRF) after primary scleral buckle surgery for a rhegmatogenous retinal detachment (RRD) repair who was subsequently treated with oral eplerenone for resolution of SRF. Observations A 34 year-old-male presented with a large bullous macula-involving RRD of unknown duration and underwent primary scleral buckle and retinotomy for drainage of subretinal fluid (SRF). His post-operative course was characterized by persistent macular SRF for 1.5 years with poor vision largely unchanged from his pre-operative presentation. Patient declined additional surgical treatment and opted for conservative management. Given such persistent SRF, the patient was trialed on a course of oral eplerenone 50 mg po bid. After only one month on this therapy, a marked decline in SRF was noted with near complete resolution after two months. Conclusions and Importance To our knowledge, this is the first report of its kind to show the effectivity of oral eplerenone treatment in the reduction of SRF following retinal detachment surgery.
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Affiliation(s)
- Arezu Haghighi
- USC Roski Eye Institute, University of Southern California, 1450 San Pablo Street, Los Angeles, CA, USA
| | - Jiun Do
- USC Roski Eye Institute, University of Southern California, 1450 San Pablo Street, Los Angeles, CA, USA.,University of San Diego Shiley Eye Institute, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Hossein Ameri
- USC Roski Eye Institute, University of Southern California, 1450 San Pablo Street, Los Angeles, CA, USA
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Wong R, Orabona GD, Simonelli F, Howard C. Novel technique for removal of persistent subretinal fluid following nondrain retinal detachment surgery. Taiwan J Ophthalmol 2017; 6:199-200. [PMID: 29018742 PMCID: PMC5525623 DOI: 10.1016/j.tjo.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/18/2016] [Accepted: 06/23/2016] [Indexed: 12/02/2022] Open
Abstract
This manuscript describes a case of successful reattachment of a macular-off retinal detachment following optical coherence tomography-guided internal drainage of retained subretinal fluid following a nondrain method. To date, there has not been any documented treatment option for this common phenomenon. This novel technique describes a method to remove such fluid and successfully appose the retina to the retinal pigment epithelial layer.
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Affiliation(s)
- Roger Wong
- St. Thomas' Hospital, Ophthalmology Department, London, UK.,Kings College London, New Hunt's House, Guy's Campus, London, UK
| | | | | | - Catherine Howard
- Kings College London, New Hunt's House, Guy's Campus, London, UK
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Simonett JM, Grewal DS, Fawzi AA, Lyon AT, Gill MK. Fundus Autofluorescence Patterns of Submacular Fluid Resolution Following Repair of Macula-Involving Rhegmatogenous Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina 2017; 47:1020-1029. [PMID: 27842197 DOI: 10.3928/23258160-20161031-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Submacular fluid (SMF) can persist for months to years following rhegmatogenous retinal detachment (RD) repair. The authors' objective was to describe fundus autofluorescence (FAF) and optical coherence tomography (OCT) findings associated with the absorption of persistent submacular fluid (SMF) following RD repair. PATIENTS AND METHODS Retrospective review of clinical data and FAF and OCT imaging from sequential postoperative visits in a cohort of patients with persistent SMF following RD repair. RESULTS In 11 of 13 eyes with persistent SMF, patches of decreased FAF signal corresponded to SMF on OCT. In eight eyes, there was a hypo- to hyperautofluorescence transition at the time of SMF resolution. These areas of increased FAF signal correlated with inner segment/outer segment (IS/OS) junction loss on OCT. CONCLUSION FAF imaging can be informative when following SMF after RD repair; a hypo- to hyper-FAF signal transition correlates with SMF resolution and photoreceptor loss. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1020-1029.].
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Persistent subfoveolar fluid following retinal detachment surgery: an SD-OCT guided study on the incidence, aetiological associations, and natural history. Eye (Lond) 2016; 30:481-7. [PMID: 26742870 DOI: 10.1038/eye.2015.270] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/28/2015] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To investigate the incidence and natural history of persistent subfoveolar fluid (PSF) following surgery for macular off rhegmatogenous retinal detachment and the effect of PSF on photoreceptor structure and final visual acuity. METHODS Retrospective study of 61 cases with post-operative optical coherence tomography (OCT) performed within 12 weeks of surgery. Based on aetiology, cases were categorized into tractional retinal tears (TRT) group or atrophic round holes and dialyses (RHD) group to investigate the incidence and duration of PSF. A Kaplan-Meier graph was plotted to compare survival time of subfoveolar fluid for both groups. Following secondary reclassification of cases into those with and without PSF, the effect of PSF on final visual acuity and photoreceptor structure was investigated with Mann-Whitney U-test used for comparison. Spearman's correlation testing was used to probe associations between time to recorded resolution of PSF with final visual acuity and photoreceptor structure. RESULTS Incidence of PSF was greater in the RHD group and persisted for longer compared with TRT group. No detectable adverse effect of PSF on final visual acuity was seen however an individual case of severe photoreceptor atrophy was observed. No significant correlation was found between the time to recorded resolution of PSF and the final visual acuity or to photoreceptor grading scores. CONCLUSIONS A difference in incidence of PSF was detected between the aetiological groups. PSF was ubiquitous and slow to resolve in the RHD group. Most cases of PSF resolve without adverse sequelae; however, progressive photoreceptor atrophy and sub-optimal visual outcome may result in a minority.
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SERIAL "EN FACE" OPTICAL COHERENCE TOMOGRAPHY IMAGING OF SLOWLY RESORBING SUBRETINAL FLUID AFTER PNEUMATIC RETINOPEXY. Retin Cases Brief Rep 2015; 10:286-8. [PMID: 26630242 DOI: 10.1097/icb.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the use and utility of serial "en face" C-scan optical coherence tomography in following the postoperative subretinal fluid status in a patient after pneumatic retinopexy treatment of a rhegmatogenous retinal detachment. METHOD Case study. RESULTS Serial "en face" optical coherence tomography imaging enhanced postoperative follow-up of persistent subretinal fluid, demonstrating its spontaneous disappearance over time. CONCLUSION Previous studies showed that subretinal fluid persists in a large proportion of patients after rhegmatogenous retinal detachment repair (especially in those with a chronic component). "En face" optical coherence tomography imaging is a valuable tool for demonstrating postoperative fluid status and aids in the ability of the practitioner to evaluate for spontaneous disappearance of fluid with time.
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Di Lauro S, Castrejón M, Fernández I, Rojas J, Coco RM, Sanabria MR, Rodríguez de la Rua E, Pastor JC. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. J Ophthalmol 2015; 2015:821864. [PMID: 26640704 PMCID: PMC4660023 DOI: 10.1155/2015/821864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/18/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.
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Affiliation(s)
- Salvatore Di Lauro
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Melissa Castrejón
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Itziar Fernández
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Ciber-BBN, 47011 Valladolid, Spain
| | - Jimena Rojas
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Rosa M. Coco
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - María R. Sanabria
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | | | - J. Carlos Pastor
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Gharbiya M, Malagola R, Mariotti C, Parisi F, De Vico U, Ganino C, Grandinetti F. Spectral-domain optical coherence tomography analysis of persistent subretinal fluid after scleral buckling surgery for macula-off retinal detachment. Eye (Lond) 2015; 29:1186-93. [PMID: 26139048 DOI: 10.1038/eye.2015.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/14/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the predictive value of markers for persistent subretinal fluid (SRF) absorption and the influence of subfoveal fluid on visual outcome after scleral buckle (SB) surgery for rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS This was a retrospective, observational study. We reviewed the medical records of 64 eyes of 64 patients who underwent SB surgery for macula-off RRD. Patients underwent clinical examination and spectral-domain optical coherence tomography before surgery, at 1 month and every 3 months postoperatively. The height and width of SRF bleb(s) were measured over time. RESULTS Persistent SRF at 1 month was observed in 40 eyes (62.5%). SRF blebs were first detected 1.7 ± 2.2 months postoperatively. In 29 cases that could be fully followed up, SRF blebs were completely absorbed 7.8 ± 4.4 months postoperatively. Resolution of fluid was associated with an improvement of VA (P = 0.003). Serial measurements of SRF bleb size showed that bleb width decreased significantly at all time points during the 12-month follow-up period (P < 0.05), while significant bleb height decrease occurred from postoperative sixth month only (P < 0.05). There was no correlation between VA outcomes and subfoveal bleb height or width (P > 0.05). The cut-off value of the bleb width-to-height ratio level for predicting bleb absorption at 6 months was 7, with 89% sensitivity and 83% specificity. CONCLUSIONS Visual improvement may occur with late resolution of residual subfoveal fluid. A bleb width-to-height ratio >7 indicates a higher risk of SRF to persist beyond 6 months after surgery.
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Affiliation(s)
- M Gharbiya
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
| | - R Malagola
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
| | - C Mariotti
- Department of Ophthalmology, Polytechnic University of Marche, Ancona, Italy
| | - F Parisi
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
| | - U De Vico
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
| | - C Ganino
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
| | - F Grandinetti
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
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van de Put MAJ, Vehof J, Hooymans JMM, Los LI. Postoperative metamorphopsia in macula-off rhegmatogenous retinal detachment: associations with visual function, vision related quality of life, and optical coherence tomography findings. PLoS One 2015; 10:e0120543. [PMID: 25853573 PMCID: PMC4390319 DOI: 10.1371/journal.pone.0120543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate postoperative metamorphopsia in macula-off rhegmatogenous retinal detachment (RRD) and its association with visual function, vision related quality of life, and optical coherence tomography (OCT) findings. Methods 45 patients with primary macula-off RRD were included. At 12 months postoperatively, data on metamorphopsia using sine amsler charts (SAC), best corrected visual acuity (BCVA), letter contrast sensitivity, color vision (saturated and desaturated color confusion indexes), critical print size, reading acuity, the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), and OCT, were obtained. Results Metamorphopsia was present in 39 patients (88.6%), with most of them (n = 35, 77.8%) showing only mild metamorphopsia (SAC score = 1). Patients with metamorphopsia had significantly worse postoperative BCVA (p = 0.02), critical print size (p<0.0005), and reading acuity (p = 0.001) compared to patients without metamorphopsia. Other visual function outcomes and NEI-VFQ-25 overall composite score were all also somewhat lower in patients with metamorphopsia, but this did not reach statistical significance. No association with OCT findings was present. Conclusion The prevalence of postoperative metamorphopsia in macula-off RRD patients is high, however, the degree of metamorphopsia is relatively low. When metamorphopsia is present, visual functions seem to be compromised, while vision related quality of life is only mildly affected.
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Affiliation(s)
- Mathijs A. J. van de Put
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Jelle Vehof
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Twin Research & Genetic Epidemiology, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Johanna. M. M. Hooymans
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Leonoor I. Los
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
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Kumar GN, Rao PK, Apte RS. Microstructural Retinal Findings by Spectral-Domain Optical Coherence Tomography After Vitrectomy Repair of Rhegmatogenous Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina 2015; 46:493-8. [DOI: 10.3928/23258160-20150422-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/19/2015] [Indexed: 11/20/2022]
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Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature. Retina 2015; 34:1917-25. [PMID: 25121930 DOI: 10.1097/iae.0000000000000296] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To systematically review the influence of the lag time between macula-off retinal detachment and surgical intervention on postoperative visual acuity as main outcome measure. METHODS Systematic review and meta-analysis of articles published from 1995 to October 2013 of patients with macula-off retinal detachment and treated with scleral buckling or pars plana vitrectomy. Eligible data were pooled in a meta-analysis, analyzing the odds ratio between different durations of ≤ 3, ≤ 4, ≤ 7, and ≤ 10 days, comparing a final visual acuity of ≤ 0.4 logMAR with >0.4 logMAR, using a random-effects model. Last, the number needed to treat was calculated. RESULTS Fourteen articles were eligible, of which 9 studies contained data that were suitable for meta-analysis. Patients who were operated with scleral buckling (n = 602) within 3 days since macular detachment had a statistically significant better chance of reaching a final visual acuity of 0.4 logMAR or better compared with a longer duration of macular detachment, with an odds ratio for ≤ 3 days versus 4 days to 7 days of 2.86 (95% confidence interval, 1.37-5.99) and an odds ratio for ≤ 3 days versus >3 days of 3.09 (95% confidence interval, 1.56-6.12), and with a number needed to treat of 4. For pars plana vitrectomy, the limited amount of data precluded a meta-analysis with substantial results. CONCLUSION This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome.
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LONGITUDINAL OPTICAL DENSITY ANALYSIS OF SUBRETINAL FLUID AFTER SURGICAL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2015; 35:149-56. [DOI: 10.1097/iae.0000000000000267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matlach J, Pflüger B, Hain J, Göbel W. Inner and outer central retinal findings after surgery for rhegmatogenous retinal detachment using different spectral-domain optical coherence tomography devices. Graefes Arch Clin Exp Ophthalmol 2014; 253:369-80. [PMID: 25030236 DOI: 10.1007/s00417-014-2713-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of the study was to analyse macular changes after rhegmatogenous retinal detachment (RRD) repair using spectral-domain optical coherence tomography (SD-OCT). METHODS Forty eyes with macula-on and 27 eyes with macula-off RRD underwent scleral buckling or vitrectomy and were postoperatively imaged using 2 SD-OCT devices (Cirrus® HD-OCT, RTVue-100®). Measurement of total and inner macular thickness consisting of ganglion cell layer + inner plexiform layer (GCL-IPL) using Cirrus or retinal nerve fibre layer + ganglion cell layer + inner plexiform layer (RNFL-GCL-IPL) using RTVue was performed. Results of inner macular thickness were compared with image results of 40 healthy controls. Qualitative analysis of inner and outer retinal layers was additionally assessed. RESULTS Measurement of overall retinal thickness within the 9 ETDRS sectors was highly correlated between both OCTs (Pearson's r, range 0.88-0.99; p < 0.001). Correlation of RNFL-GCL-IPL complex between OCTs was excellent in both surgery groups (Pearson's r, range 0.73-0.88; p < 0.001) and normal controls (Pearson's r, range 0.79-0.90; p < 0.001). The RNFL-GCL-IPL complex was thicker in both surgery groups compared to normal controls using Cirrus. Outer retinal findings of macula-off patients were seen in four eyes (14.8 %). Visual acuity (VA) significantly improved in both groups independent of preoperative VA or duration of symptoms. CONCLUSION Agreement between both OCTs was excellent for overall and inner retinal thickness, although RTVue measured a thicker RNFL-GCL-IPL complex. Thinning of inner retinal layers as a potential cause of poor VA was rarely detected, possibly due to tractional changes at the vitreomacular interface. VA improved even in patients with macula-involving RRD.
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Affiliation(s)
- Juliane Matlach
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany,
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Van Calster J, Verstraeten S, Van Ginderdeuren R, Vandewalle E, Stalmans I, Stalmans P. A safety evaluation of the intravitreal use of a beta-2 agonist in rabbit eyes. Acta Ophthalmol 2014; 92:e249-50. [PMID: 24033931 DOI: 10.1111/aos.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sofie Verstraeten
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | | | - Evelien Vandewalle
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Peter Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
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Sridhar J, Flynn HW. Spectral-domain optical coherence tomography imaging of macula-off rhegmatogenous retinal detachment. Clin Ophthalmol 2014; 8:561-6. [PMID: 24672221 PMCID: PMC3964164 DOI: 10.2147/opth.s58219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The timing of repair and the utility of spectral-domain optical coherence tomography (SD-OCT) for macula-off retinal detachment remains a controversial issue. Four patients who presented with macula-off retinal detachment underwent repair at various time points after symptom onset. Postoperative SD-OCT of the macula demonstrated correlation with final visual acuity.
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Affiliation(s)
- Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
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Five-year follow-up of macular morphologic changes after rhegmatogenous retinal detachment repair: Fourier domain OCT findings. Retina 2014; 33:2049-58. [PMID: 23591534 DOI: 10.1097/iae.0b013e3182891e81] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate serially long-term macular morphologic changes after successful macula-involving rhegmatogenous retinal detachment repair and correlate changes with macular function. METHODS Repeat Fourier domain optical coherence tomography (FD OCT) imaging and microperimetry (MP-1) testing of 8 of the initial cohort of 17 eyes studied 5 years earlier. RESULTS The mean follow-up after rhegmatogenous retinal detachment repair was 3.4 months (range, 1-8.5 months) for the first FD OCT and 5 years (range, 3.75-5.75 years) for the follow-up FD OCT. The final postoperative best-corrected visual acuity mean was 20/201 (range, 20/20 to counting fingers). Six eyes with final best-corrected visual acuity >20/40 had an intact external limiting membrane and progressive resolution of photoreceptor inner segment-outer segment junction disruption and/or subretinal fluid on serial FD OCT, which correlated with improvement in macular function on MP-1. Two eyes with poor or worsening best-corrected visual acuity on follow-up had persistent or worsening inner segment-outer segment disruption on serial FD OCT. External limiting membrane was intact in one eye and persistently disrupted in the other. CONCLUSION Macular function may progressively improve or worsen long-term after successful rhegmatogenous retinal detachment repair. Progressive resolution of subretinal fluid and/or inner segment-outer segment disruption on FD OCT correlated with improvement in macular function, whereas worsening or persistent inner segment-outer segment disruption correlates with worsening or persistently poor visual outcome.
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Veckeneer M, Derycke L, Lindstedt EW, van Meurs J, Cornelissen M, Bracke M, Van Aken E. Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review. Graefes Arch Clin Exp Ophthalmol 2012; 250:795-802. [PMID: 22234351 DOI: 10.1007/s00417-011-1870-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/19/2011] [Accepted: 11/15/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Persistent subretinal fluid after rhegmatogenous retinal detachment (RRD) surgery is responsible for delayed recovery, and may affect the final visual outcome. Cause, consequences, and treatment remain elusive. DESIGN Literature review and case series. METHODS We reviewed the pathophysiological principles and therapeutic options from the literature, and we report the results from a subretinal fluid cytology study. Nine eyes from nine patients with macula-involving RRD underwent surgical repair. The cellular content of subretinal fluid (SRF) was studied by electron microscopy and anti-rhodopsin immunostaining. All eyes were assessed postoperatively with optical coherence tomography for the detection of persistent submacular fluid (PSF) (Ethics Committee Ghent University Hospital, registration number B6702006169). RESULTS Certain patient characteristics as well as surgical methods were implicated. PSF appears to occur more frequently in patients with longstanding detachments treated with buckling surgery. Several therapeutic options have been suggested but safety and efficacy remain unclear. We found PSF in three eyes on postoperative OCT scans, which corresponded to the three cell-rich subretinal samples. CONCLUSIONS PSF after successful RRD repair seems to be related to fluid composition. We hypothesize, in the absence of an effective treatment, that a modified surgical drainage, including a washout of the subretinal space, could evacuate the subretinal fluid more completely, and may prevent this complication.
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Affiliation(s)
- M Veckeneer
- Rotterdam Eye Hospital, Vitreoretinal Surgery, Schiedamse vest 180, 3000LM Rotterdam, the Netherlands
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Jacobson SG, Cideciyan AV, Ratnakaram R, Heon E, Schwartz SB, Roman AJ, Peden MC, Aleman TS, Boye SL, Sumaroka A, Conlon TJ, Calcedo R, Pang JJ, Erger KE, Olivares MB, Mullins CL, Swider M, Kaushal S, Feuer WJ, Iannaccone A, Fishman GA, Stone EM, Byrne BJ, Hauswirth WW. Gene therapy for leber congenital amaurosis caused by RPE65 mutations: safety and efficacy in 15 children and adults followed up to 3 years. ACTA ACUST UNITED AC 2011; 130:9-24. [PMID: 21911650 DOI: 10.1001/archophthalmol.2011.298] [Citation(s) in RCA: 472] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the safety and efficacy of subretinal gene therapy in the RPE65 form of Leber congenital amaurosis using recombinant adeno-associated virus 2 (rAAV2) carrying the RPE65 gene. DESIGN Open-label, dose-escalation phase I study of 15 patients (range, 11-30 years of age) evaluated after subretinal injection of the rAAV2- RPE65 vector into the worse-functioning eye. Five cohorts represented 4 dose levels and 2 different injection strategies. MAIN OUTCOME MEASURES Primary outcomes were systemic and ocular safety. Secondary outcomes assayed visual function with dark-adapted full-field sensitivity testing and visual acuity with Early Treatment Diabetic Retinopathy Study charts. Further assays included immune responses to the vector, static visual fields, pupillometry, mobility performance, and optical coherence tomography. RESULTS No systemic toxicity was detected; ocular adverse events were related to surgery. Visual function improved in all patients to different degrees; improvements were localized to treated areas. Cone and rod sensitivities increased significantly in the study eyes but not in the control eyes. Minor acuity improvements were recorded in many study and control eyes. Major acuity improvements occurred in study eyes with the lowest entry acuities and parafoveal fixation loci treated with subretinal injections. Other patients with better foveal structure lost retinal thickness and acuity after subfoveal injections. CONCLUSIONS Gene therapy for Leber congenital amaurosis caused by RPE65 mutations is sufficiently safe and substantially efficacious in the extrafoveal retina. There is no benefit and some risk in treating the fovea. No evidence of age-dependent effects was found. Our results point to specific treatment strategies for subsequent phases. APPLICATION TO CLINICAL PRACTICE Gene therapy for inherited retinal disease has the potential to become a future part of clinical practice. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00481546.
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Affiliation(s)
- Samuel G Jacobson
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
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