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Chahar A, Sen A, Shukla D, Talwar D. THE ROLE OF INTRAVITREAL METHOTREXATE AS AN ADJUNCT TO LOCAL OR SYSTEMIC CORTICOSTEROIDS IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT AND CHOROIDAL DETACHMENT: A Pilot Study. Retina 2024; 44:774-781. [PMID: 38194672 DOI: 10.1097/iae.0000000000004046] [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: 01/11/2024]
Abstract
PURPOSE To evaluate the role of repeated intravitreal methotrexate as an adjunct to pars plana vitrectomy in the management of rhegmatogenous retinal detachment with choroidal detachment. METHOD The authors compared anatomical and visual outcomes of rhegmatogenous retinal detachment with choroidal detachment eyes that underwent pars plana vitrectomy with (Group B) or without repeated intravitreal methotrexate (Group A). RESULTS The study included 25 eyes of 25 patients, 16 eyes in Group A and nine in Group B. Both groups had similar baseline characteristics. In Group A, successful retinal attachment was achieved in 50% as compared with 89% in Group B; however, the difference was not statistically significant ( P = 0.08). Also, Group B had a significantly greater change in visual acuity from baseline to the last follow-up visit (1.6 + 1.5 logMAR units) compared with Group A (1.18 + 1 logMAR units) ( P = 0.05). There were no significant safety concerns with the use of intravitreal methotrexate. CONCLUSION Repeated intravitreal methotrexate after vitrectomy for rhegmatogenous retinal detachment with choroidal detachment improves outcomes without posing major safety concerns. Nonetheless, further investigation is necessary to establish the optimal intravitreal methotrexate dosage and duration to prevent recurrence effectively.
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Affiliation(s)
- Annu Chahar
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Alok Sen
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Dhananjay Shukla
- Department of Retinal and Vitreous, Ratan Jyoti Eye Hospital, Gwalior, India ; and
| | - Dinesh Talwar
- Department of Retina and Vitreous, Indraprastha Apollo Hospital, New Delhi, India
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Li P, Li L, Wu J. The Effect of Steroid Intervention before Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment: A Meta-Analysis and Systematic Review. Curr Eye Res 2024:1-7. [PMID: 38679916 DOI: 10.1080/02713683.2024.2343333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/09/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This meta-analysis discusses the effectiveness of steroid intervention before vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment. METHODS We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies published until August 2023. We included studies involving: patients with rhegmatogenous retinal detachment associated with choroidal detachment with proliferative vitreoretinopathy; an experimental group that was not administered steroids and a control group that was administered steroids; and assessment of visual acuity, retinal reattachment rate, and complications. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis. RESULTS Two randomized controlled trials and four case-control studies involving 490 eyes were included in the meta-analysis. There were no significant differences in the primary and final retinal reattachment rates after surgery between the steroid and non-steroid groups (primary retinal reattachment rate: odds ratio = 1.01, 95% confidence interval = 0.63-1.63, p = .41; final retinal reattachment rate: odds ratio = 0.82, 95% confidence interval = 0.43-1.59, p = .33). There was no statistically significant difference in postoperative visual acuity improvement between the two groups (odds ratio = 1.19, confidence interval = 0.63-2.25, p = .69). In addition, subgroup analyses of different types of steroids showed that systemic and local administration of steroids had similar results for retinal reattachment rate and visual acuity improvement. CONCLUSION Patients with rhegmatogenous retinal detachment associated with choroidal detachment who did not receive preoperative steroids achieved the same effect as patients with rhegmatogenous retinal detachment associated with choroidal detachment who did receive preoperative steroids in terms of retinal reattachment rate and visual acuity. It is recommended that patients with rhegmatogenous retinal detachment associated with choroidal detachment undergo surgery as promptly as possible.
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Affiliation(s)
- Pingping Li
- AIER Eye Hospital of Wuhan University, Wuhan, China
| | - Lu Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianhua Wu
- AIER Eye Hospital of Wuhan University, Wuhan, China
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Dave VP, Chou HD, Kiri H, Ieng FC, Hwang YS, Wu WC, Chen KJ, Das AV, Pathengay A, Pappuru RR, Lai CC. PRESENTATIONS AND FACTORS AFFECTING OUTCOME OF RHEGMATOGENOUS RETINAL DETACHMENT WITH CHOROIDAL DETACHMENT: An Indo-Taiwanese Study. Retina 2024; 44:255-260. [PMID: 37903447 DOI: 10.1097/iae.0000000000003962] [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] [Received: 11/08/2022] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To report the clinical settings, management, and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment. METHODS Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan. RESULTS Overall 303 eyes were included. Mean age was 43.72 ± 20.64 years (median 46). Best-corrected presenting visual acuity was 1.79 ± 0.92 logMAR (median 2.10) (Snellen 20/1,233). Forty-four patients (17.91%) received preoperative steroids. Final visual acuity was 1.33 ± 0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%), whereas favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (odds ratio [OR] 2.76), absence of proliferative vitreoretinopathy worse than Grade A (OR 7.69), use of preoperative steroids (OR 4.50), and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of proliferative vitreoretinopathy worse than Grade A (OR 10.41), and use of preoperative steroids (OR 7.24). CONCLUSION Administration of preoperative steroids, use of an encircling band during surgery, and pseudophakic status of the eye were found to have better outcomes in rhegmatogenous retinal detachment with concurrent choroidal detachment.
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Affiliation(s)
- Vivek Pravin Dave
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hardik Kiri
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Fok Chak Ieng
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Anthony Vipin Das
- Department of EyeSmart EMR & AEye, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Service, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Rajeev Reddy Pappuru
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; and
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Xu Q, Zhou Y, Liu W, Du S, Yang X. Efficacy of Pneumatic Retinopexy Preceding Pars Plana Vitrectomy in Managing Combined Retinal and Choroidal Detachment: A Retrospective Study of 64 Patients. Med Sci Monit 2023; 29:e940746. [PMID: 37840473 PMCID: PMC10561988 DOI: 10.12659/msm.940746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Combined retinal and choroidal detachment (RD-CD) poses significant challenges in ophthalmic treatment, often requiring surgical intervention for optimal outcomes. The selection of the appropriate surgical procedure is crucial for ensuring visual restoration and overall eye health. This study delves into the therapeutic benefits and outcomes of two distinct surgical approaches for RD-CD: pneumatic retinopexy (PR) followed by pars plana vitrectomy (PPV) and PPV alone, in an attempt to guide optimal clinical decision-making. MATERIAL AND METHODS We retrospectively analyzed data from 64 consecutive patients diagnosed with RD-CD. They were categorized into two groups: Group A consisted of 34 patients (34 eyes) who underwent PR as an initial treatment and subsequently received PPV, while Group B, serving as a control, comprised 30 patients (30 eyes) treated solely with PPV. RESULTS The application of PR in Group A notably accelerated intraocular pressure (IOP) increase (P.
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Affiliation(s)
- Qiang Xu
- Department of Ophthalmology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, PR China
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, Jiangsu, PR China
- Department of Ophthalmology, Lianyungang Second People’s Hospital, Lianyungang, Jiangsu, PR China
| | - Ying Zhou
- Department of Ophthalmology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, PR China
| | - Wei Liu
- Department of Ophthalmology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, PR China
| | - Shu Du
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Xun Yang
- Department of Fundus Diseases and Ocular Trauma, LiXiang Eye Hospital of Soochow University, Suzhou, Jiangsu, PR China
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Tsui JC, Brucker AJ, Kim BJ, Kolomeyer AM. COMBINED RHEGMATOGENOUS RETINAL AND CHOROIDAL DETACHMENT: A Systematic Review. Retina 2023; 43:1226-1239. [PMID: 36893435 DOI: 10.1097/iae.0000000000003770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE To review the literature on eyes with concurrent rhegmatogenous retinal and choroidal detachment (RRD-CD). METHODS Several databases were searched for "rhegmatogenous retinal detachment" and "choroidal detachment" through October 2022. All English language primary literature was reviewed. RESULTS Studies demonstrated that eyes with RRD-CD were very uncommon and had diminished baseline visual acuity (VA) and intraocular pressure (IOP) compared with eyes with RRD only. Although no randomized trials have been performed, pars plana vitrectomy with or without scleral buckle (SB) have reported higher surgical success rates than SB alone. Reattachment rates were affected by age, IOP, adjuvant steroids, and grade of proliferative vitreoretinopathy. CONCLUSION Low IOP and poor initial VA are salient features of eyes with RRD-CD. Steroids can be useful adjuvants administered safely using several routes including periocular and intravitreal injection. PPV ± SB may result in best surgical outcomes.
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Affiliation(s)
- Jonathan C Tsui
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Sheth JU, Weng C, Singh R, Khatri M, Saurabh K, Chawla S, Rajendran A, Narayanan R. Vitreoretinal Society of India practice pattern survey 2020: Surgical retina. Indian J Ophthalmol 2021; 69:1442-1449. [PMID: 34011717 PMCID: PMC8302326 DOI: 10.4103/ijo.ijo_2877_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To present the outcomes of the Vitreo-retinal Society of India (VRSI) Practice Pattern Survey 2020 in surgical retina. Methods: An online survey of members of VRSI was conducted in April 2020 regarding their practice patterns on varied medical and surgical retina topics concerning imaging and management approach. The results were evaluated by two independent experts in this field and compared with the evidence and other practice patterns in the world. Results: A total of 107 VRSI members participated in the online survey. Responses were obtained on management of wide-ranging surgical retina topics such as diabetic retinopathy, retinal detachments, Macular Hole, and Epiretinal membranes. Participants were also surveyed regarding their attitudes and perceptions about microscopes with the heads-up display system. Each of the survey question responses were then compared to contemporary literature, including evidence-based guidelines, randomized controlled trials, real-world evidence, and analogous international surveys. Comprehensive analysis related to this has been put forward in the article. Conclusion: This survey represents the contemporary practice patterns among vitreoretinal specialists in India. The survey results are vital for fellow practitioners to understand the “standard of care” practice in surgical retina. This will guide them to devise the best possible individualized treatment strategy for most favorable clinical outcomes.
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Affiliation(s)
- Jay U Sheth
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
| | - Christina Weng
- Associate Professor, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manoj Khatri
- Department of Vitreoretina, Eydox Eye Hospital and Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Kumar Saurabh
- Department of Vitreo Retina, Kamalnayan Bajaj Sankara Nethralaya, Kolkata, West Bengal, India
| | - Shobhit Chawla
- Medical Director, Prakash Netra Kendr, Lucknow, Uttar Pradeshl Vitreoretinal Society of India, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Vitreoretinal Society of India; Retina-Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Vitreoretinal Society of India, Chennai, Tamil Nadu; Suven Clinical Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
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