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Cristescu IE, Ivanova T, Moussa G, Ziaei H, Ferrara M, Lippera M, El-Faouri M, Patton N, Jasani KM, Dhawahir-Scala F, Jalil A. The impact of 360-laser barricade on outcomes of vitrectomy for pseudophakic retinal detachment; The Manchester Pseudophakic Retinal Detachment Study. Eye (Lond) 2023; 37:3221-3227. [PMID: 36949246 PMCID: PMC10564870 DOI: 10.1038/s41433-023-02495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE To investigate the anatomical and functional outcomes and specifically, the effect of 360-degree barrier-laser, in pars plana vitrectomy (PPV) for primary pseudophakic rhegmatogenous retinal detachment (PRD). METHODS We conducted a single-centre retrospective, continuous and comparative study on eyes that had undergone PPV with focal-retinopexy (laser or cryotherapy) versus 360-laser for PRD repair between 2011-2020 at a single tertiary vitreoretinal centre in the UK. Primary outcomes were single surgery anatomical success (SSAS) rate and final postoperative visual acuity (VA). Multivariable regression covariates for primary re-detachment included age, gender, onset-of-detachment, pre-operative VA, ocular co-morbidities, macula-status, majority inferior (vs superior) PRD, number-of-tears and PRD extent (in clock-hours), 360-laser barricade, and perfluorocarbon liquid (PFCL) use. For VA gain, primary re-detachment was added as a covariate. RESULTS We included 467 eyes with a mean follow-up of 388 (161) days. The SSAS was 444/467 (95.1%) overall, and 351/370 (94.9%) and 93/97 (95.9%) in focal-retinopexy and 360-laser groups, respectively (p = 0.798). Compared to the focal-retinopexy group, the 360-laser group had significantly worse post-operative VA but similar logMAR gain (p = 0.812). A multivariable binary logistic regression found that only PFCL use was linked with increased primary re-detachment (OR:5.32 [p = 0.048]) and 360-laser did not contribute to increased SSAS. A multivariable linear regression analysis showed that poor logMAR gain was significantly associated with better pre-operative logMAR, ocular co-morbidities, greater PRD extent, use of 360-laser and primary re-detachment. However, when excluding macula-off RD (n = 211), 360-laser was no longer significant (p = 0.088). CONCLUSIONS Prophylactic 360-laser does not seem to impact on SSAS and functional outcomes following PPV for primary PRD.
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Affiliation(s)
| | - Tsveta Ivanova
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - George Moussa
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Hadi Ziaei
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Myrta Lippera
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Muhannd El-Faouri
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
- The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Kirti M Jasani
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | | | - Assad Jalil
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK.
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Zheng Y, Schindler P, Druchkiv V, Schulz J, Spitzer SM, Skevas C. Comparison of treatment outcomes of 360° intraoperative laser retinopexy and focal laser retinopexy with pars plans vitrectomy in patients with primary rhegmatogenous retinal detachment. BMC Ophthalmol 2023; 23:73. [PMID: 36809995 PMCID: PMC9942399 DOI: 10.1186/s12886-023-02812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND This study was to compare the outcomes of 360° intra-operative laser retinopexy (ILR) and focal laser retinopexy in treating patients with pars plans vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). To identify other potential risk factors for retinal re-detachment after primary PPV. METHODS This was a retrospective cohort study. Three hundred and forty-four consecutive cases of primary rhegmatogenous retinal detachment treated with PPV were included between July 2013 and July 2018. Clinical characteristics and surgical outcomes were compared between focal laser retinopexy and additional 360° intra-operative laser retinopexy groups. Both univariate and multiple variable analysis were used to identify potential risk factors for retinal re-detachment. RESULTS Median follow-up was 6.2 months (Q1, Q3:2.0, 17.2). As estimated with survival analysis, the 360º ILR group had the incidence of 9.74% and focal laser 19.54% at 6 months postoperatively. At 12 months postoperatively the difference was 10.78% vs. 25.21%. The difference in survival rates was significant (p = 0.0021). In multivariate Cox regression, the risk factors for retinal re-detachment were without additional 360° ILR, diabetes and macula off before the primary surgery (relatively OR = 0.456, 95%-CI [0.245-0.848], p < 0.05; OR = 2.301, 95% CI [1.130-4.687], p < 0.05; OR = 2.243, 95% CI [1.212-4.149], p < 0.05). CONCLUSION Additional 360° ILR group had a significantly lower rate of retinal re-detachment when compared with focal laser retinopexy group. Our study also elucidated that diabetes and macular off before the primary surgery might also be the potential risk factors for higher rate of retinal re-detachment outcome. TRIAL REGISTRATION This was a retrospective cohort study.
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Affiliation(s)
- Ying Zheng
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, 200080, Shanghai, China.
| | - Philip Schindler
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Clínica Baviera, Valencia, Spain
| | - Jan Schulz
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Martin Spitzer
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Skevas
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mathai M, Godwin KS, Albarracin J, Levinson J, Broderick K, Melamud A. 360 DEGREE ENDOLASER VERSUS FOCAL ENDOLASER IN PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2022; 42:2046-2050. [PMID: 35982506 DOI: 10.1097/iae.0000000000003599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the efficacy of the 360-degree endolaser (360EL) versus focal laser during primary vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair. METHODS A single-site retrospective chart review was performed on 241 patients who underwent PPV for primary RRD. Patients were assigned to two groups, PPV with 360EL (n = 183) and PPV without 360EL (n = 59). Only cases where surgeons performed 360EL on all RRDs or surgeons who never perform 360EL on RRDs were included. RESULTS The single surgery anatomical success rate in the 360EL group was 90.2% compared with 86.5% with focal laser ( P = 0.619). Epiretinal membrane formation in 360EL group at 1 year was 44.4% versus 37% with focal laser ( P = 0.429). Cystoid macular edema formation within 1 year of surgery was 25.8% in 360EL group versus 11.9% with focal laser ( P = 0.04). CONCLUSION The use of 360EL in PPV for RRD repair does not improve single-surgery anatomical success in routine RRDs when compared with PPV with focal laser.
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Affiliation(s)
- Mariam Mathai
- The Retina Group of Washington, Chevy Chase, Maryland
| | - Kristen S Godwin
- Medstar Georgetown Hospital, Department of Ophthalmology, Washington, District of Columbia; and
| | - Julio Albarracin
- Medstar Georgetown Hospital, Department of Ophthalmology, Washington, District of Columbia; and
| | | | - Kevin Broderick
- Walter Reed National Military Medical Center, Department of Ophthalmology, Bethesda, Maryland
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Peters MC, Murray-Douglass A, Park J, Cheng SSH, Sharma AK, Sharma A, Vandeleur KW, Lee LR, Moloney TP. 360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes. Int J Retina Vitreous 2022; 8:28. [PMID: 35387685 PMCID: PMC8985359 DOI: 10.1186/s40942-022-00377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine patient and surgical factors associated with the use of 360-degree laser retinopexy during primary pars plana vitrectomy (PPV) ± scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS Patients who underwent PPV ± SB for repair of non-complex RRD at a single centre were included in this retrospective study. The primary outcome was single surgery anatomical success (SSAS). Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. Multiple logistic regression and multivariate regression was used. RESULTS The study included 192 cases, of which 130 received 360-degree laser. Worse preoperative logMAR visual acuity (P = 0.009), male sex (P = 0.060), higher PVR grades, supplemental SB (P = 0.0468) and silicone oil/C3F8 tamponade (P < 0.0001) were associated with 360-degree laser use. No significant associations between 360-degree laser and SSAS (P = 0.079), final logMAR visual acuity (P = 0.0623), ERM development (P = 0.8208), postoperative CMO (P = 0.5946), tonic pupil (P > 0.9999) or corneal epithelial defects (P = N/A) were found. CONCLUSIONS 360-degree laser retinopexy during primary PPV ± SB for RRD was associated with more complex cases and more extensive operations. Even when accounting for this, there was no difference in surgical outcomes or complication rates.
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Affiliation(s)
- Matthew C Peters
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Alexander Murray-Douglass
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Joseph Park
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Sean S H Cheng
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Anil K Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Kevin W Vandeleur
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Lawrence R Lee
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Thomas P Moloney
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia.
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Wang JC, Ryan EH, Ryan C, Kakulavarapu S, Mardis PJ, Rodriguez M, Stefater JA, Forbes NJ, Gupta O, Capone A, Emerson GG, Joseph DP, Eliott D, Yonekawa Y. FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4). Retina 2021; 40:2070-2076. [PMID: 31876884 DOI: 10.1097/iae.0000000000002728] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. RESULTS Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). CONCLUSION Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.
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Affiliation(s)
- Jay C Wang
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota
| | - Srividya Kakulavarapu
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | | | - James A Stefater
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | - Omesh Gupta
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Yoshihiro Yonekawa
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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6
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Soekamto C, Chu ER, Johnson DA, Sohn JH, Bahadorani S. Protective Role of 360° Laser Retinopexy in Patients with Rhegmatogenous Retinal Detachment: a Systematic Review and Meta-analysis. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:215-222. [PMID: 34120420 PMCID: PMC8200595 DOI: 10.3341/kjo.2021.0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. METHODS The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. RESULTS Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. CONCLUSIONS Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.
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Affiliation(s)
- Christa Soekamto
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Edward R Chu
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Daniel A Johnson
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Jeong-Hyeon Sohn
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Sepehr Bahadorani
- Department of Ophthalmology, University of Texas Health at San Antonio, San Antonio, TX, USA
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7
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Linton EF, Kim SJ, Patel SN. Effect of prophylactic laser during small-gauge vitrectomy for epiretinal membranes. Eur J Ophthalmol 2021; 32:514-519. [PMID: 33596685 DOI: 10.1177/1120672121992948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the rate of post-operative retinal detachment after elective pars plana vitrectomy for epiretinal membrane, and to test for the mitigating effect of prophylactic endolaser. METHODS We identified 459 eyes of 411 patients undergoing vitrectomy for epiretinal membrane at Vanderbilt University Medical Center between January 2010 and May 2017. Patients who underwent concurrent endolaser without any identified retinal break were included in the exposure cohort. Patients who underwent no prophylactic retinopexy or ablation were included in the unexposed cohort. Exposure data, demographic data, and outcome data were tabulated for comparison. RESULTS The final analysis included 343 eyes of 343 patients. Approximately 7% of eyes undergoing ERM surgery were found to have a full-thickness retinal break which was not seen preoperatively. The overall rate of postoperative RD was 2.04%. Postoperative retinal detachment occurred in 0 of the 34 eyes exposed to prophylactic laser, and in 7 of the 309 control eyes. Odds ratio was found to be 0.60 (p = 0.598 (95%CI 0.0327-10.7), p = 0.72), indicated the results were not statistically significant. DISCUSSION Looking at patients undergoing routine vitrectomy surgery for epiretinal membrane, no retinal detachments occurred in the group receiving prophylactic treatment, though this association did not reach statistical significance. With modern surgical techniques, post-operative retinal detachment remains relatively rare after vitrectomy for ERM though a thorough intraoperative exam is critical to identify occult retinal breaks.
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Affiliation(s)
- Edward F Linton
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen J Kim
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shriji N Patel
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Localized versus 360° intraoperative laser retinopexy in cases of rhegmatogenous retinal detachment with mild-to-moderate grade proliferative vitreoretinopathy. Eye (Lond) 2020; 35:786-790. [PMID: 32398848 DOI: 10.1038/s41433-020-0950-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare the efficacy of intraoperative localized and 360° laser retinopexy in cases of rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy and air tamponade. SUBJECTS/METHODS In this interventional, prospective, randomized, comparative study, 93 consecutive cases of RRD were enroled. After randomization 48 eyes received circumferential, while 45 underwent localized intraoperative laser retinopexy. Number and position of the retinal breaks, presence of proliferative vitreoretinopathy and/or lattice degeneration were recorded. Anatomical and visual outcome of the two groups were compared at 6 months postoperatively. RESULTS Baseline characteristics did not significantly differ between groups. The single-operation reattachment rate was 86.66% in localized group and 89.58% in 360° group. The difference was not significant. (P = 0.46, χ2 test). At 6 months postoperatively, visual acuity (logMAR) was 0.06 ± 0.05 in localized group and 0.05 ± 0.03 in 360° group. The difference was not statistically significant (P = 0.673, t-test). CONCLUSIONS Localized laser resulted to be as effective as 360° laser application; this may lead some advantages in term of lower invasiveness, reduction risk of complications and time saving.
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9
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Al-Saeed TA. Modeling retinal detachment associated with hemorrhage by Monte Carlo simulation. APPLIED OPTICS 2020; 59:3614-3618. [PMID: 32400485 DOI: 10.1364/ao.385247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
In this work we study fundus reflection in the case of retinal detachment. Vitreous humor builds up beneath the retina through a break in the retina or when there is traction on the retina. Further, we assume that this detachment is associated with hemorrhage in regions both above and below the retina. To investigate hemorrhage, we assume erythrocytes to be spheres of different radii. Then we apply Mie scattering theory to these spheres and calculate the scattering coefficient, the absorption coefficient, and the anisotropy factor. Using these parameters, we apply Monte Carlo simulation to calculate reflection. In order to model fundus reflection under retinal detachment, we define three types of reflection: reflection from the vitreous body, retinal reflection where photons are reflected from the retinal vitreous interface once, and retinal reflection where photons are reflected many times from the retinal vitreous interface.
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10
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Ohana O, Rutenberg R, Moisseiev E, Davidovich Z, Lowenstein A, Schwartz S, Barak A. Prophylactic Circumferential Laser Retinopexy in Macular Hole and Epiretinal Membrane Surgeries. Open Ophthalmol J 2020. [DOI: 10.2174/1874364102014010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The role of PCLR in vitrectomy surgeries for macular diseases is controversial. Several studies report a reduction in post-operative RD rates, while other studies do not show such reduction. reducing complications stemming from intra- and post- operative retinal tears, especially at sclerotomy sites, are suggested as reasons for PCLR use.
Objective:
To investigate the effect of PCLR on the rate of post-operative RD in patients undergoing pars plana vitrectomy for either Macular Hole (MH) or epiretinal membrane (ERM).
Methods:
This retrospective study included 179 eyes of 170 patients who underwent vitrectomy for either MH or ERM between 2006-2012. Recorded parameters included demographic information, diagnosis, lens status, use and type of tamponade, whether PCLR was performed, follow-up period, the occurrence of RD, the cause and time of RD. Outcome and complication rates were compared between patients who received PCLR (PCLR group) and those who did not (Control group).
Results:
The study included 179 eyes of 170 patients. 126 eyes had PCLR while 53 eyes did not. Pre-operative demographics data, best-corrected visual acuity, lens status and indication for macular surgery were similar between the two groups. Post-operative RD was diagnosed in one eye (1.8%) in the control group and 5 eyes (3.9%) in the PCLR group (Kaplan-Meier survival analysis, log-rank p = 0.28).
Conclusion:
PCLR was not correlated with a decrease in RD in MH and ERM surgeries in our cohort. Intra-operative and post-operative examination for small retinal breaks is essential in all surgeries. PCLR might be unnecessary in small gauge vitrectomies.
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Tarakcioglu HN, Tulu B, Ozkaya A. Subtotal vitrectomy in idiopathic macular hole surgery. Saudi J Ophthalmol 2020; 33:369-373. [PMID: 31920447 PMCID: PMC6950970 DOI: 10.1016/j.sjopt.2019.11.001] [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] [Received: 03/02/2019] [Revised: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess the outcomes of subtotal vitrectomy in idiopathic macular hole (IMH). Methods The patients with idiopathic IMH who had undergone vitreoretinal surgery and followed up for at least 12 months post-operatively were included. First the posterior hyaloid was detached, then cortical vitreous was removed incompletely by leaving anterior vitreous intact. Internal limiting membrane was peeled with the aid of brilliant blue. A non-expanding volume of perfluoropropane was used as a tamponade and face-down positioning for 5 days was suggested to the patients. The main outcome measure was the closure rate of IMH. Results Forty-three eyes were included. The mean follow-up time was 15.0 ± 3.8 months after surgery. Single surgery anatomical success was 86.0%. The mean BCVA at baseline, month 1, 3, 6, 12 and at the last follow-up was 0.99 ± 0.33 LogMAR (0,5–1.80), 1.04 ± 0.33 LogMAR (0.5–1.8), 0.94 ± 0.46 LogMAR (0.3–3.0), 0.84 ± 0.33 LogMAR (0.3–1.5), 0.82 ± 0.35 (0.2–1.5), and 0.70 ± 0.34 (0.1–1.5) (p > 0.05, for all). The mean visual acuity increased by 2.9 lines at the last follow-up visit and 51.2% of the patients gained ≥ 3 lines of vision. Conclusion The results of this study indicated limited core vitrectomy as a safe and effective surgical technique in the treatment of IMH, resulting in acceptable functional and anatomical outcomes without significant intra- and post-operative complications.
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Affiliation(s)
| | - Beril Tulu
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Ozkaya
- Memorial Sisli Hospital, Istanbul, Turkey.,Istanbul Aydin University Medical School, Istanbul, Turkey
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12
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Park SH, Yang SC, Lee JJ, Kwon H, Park SW, Lee JE. Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2019; 13:2127-2133. [PMID: 31802842 PMCID: PMC6827521 DOI: 10.2147/opth.s223415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base in vitrectomy for rhegmatogenous retinal detachment (RRD). Patients and methods This was a retrospective study of patients who underwent vitrectomy for RRD without proliferative vitreoretinopathy. Barrier laser was applied as 3-4 rows surrounding the break at the end of fluid-air exchange. For the FBL, 3-4 rows of laser burn were additionally made about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base. The primary outcome was single surgery success rate (SSSR) between two groups: FBL and conventional barrier laser (CBL) groups. Results Overall, 118 eyes were included; 50 eyes in the FBL group and 68 eyes in the CBL group. SSSR was 100% (50/50) in the FBL group and 91.2% (62/68) in the CBL group with a significant difference (p=0.038). Four eyes of the recurrent cases in the CBL group were related to reopening of the break. All eyes achieved reattachment, and no differences were found in postoperative visual acuity at 6 months. Conclusion FBL on the vitreous base was efficacious in improving the anatomical success rate of vitrectomy.
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Affiliation(s)
- Sun Ho Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Cheol Yang
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae Jung Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hanjo Kwon
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Pars plana vitrectomy with or without intraoperative 360° peripheral endolaser for rhegmatogenous retinal detachment treatment. Int Ophthalmol 2018; 39:1687-1694. [PMID: 29987705 DOI: 10.1007/s10792-018-0986-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to investigate whether intraoperative 360° prophylactic endolaser photocoagulation is necessary for the treatment of uncomplicated retinal detachment. METHODS This prospective, randomized, comparative and interventional study includes 50 consecutive patients with primary rhegmatogenous retinal detachment (RRD) who were treated by pars plana vitrectomy. The patients were divided into two groups: in Group A endolaser applied to all existing breaks as well as a 360° laser retinopexy, while Group B received endolaser only to the retinal breaks. Primary anatomical success rate, a final best-corrected visual acuity (BCVA) and postoperative complications were analyzed and compared between the groups at 1 and 3 months. RESULTS After the primary procedure, the retina was reattached in 96% (24 of 25) of patients in Group A and in 88% (22 of 25) of patients in Group B at 1 and 3 months. The mean final BCVA (logarithm of the minimum angle of resolution) improved from 1.26 to 0.52 in Group A with 17 cases (68%) macula-off and 1.19 to 0.77 in Group B with 18 cases (72%) macula-off at preoperative and final follow-up visit. Epiretinal membranes were seen in four cases in Group A and four cases in Group B at 3 months. No statistically significant difference in the anatomical, functional and complication outcomes between the two groups was recorded. CONCLUSIONS Pars plana vitrectomy without the 360° peripheral endolaser can provide successful anatomic outcomes and functional improvement in uncomplicated primary RRDs.
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Teh SW, Mok PL, Abd Rashid M, Bastion MLC, Ibrahim N, Higuchi A, Murugan K, Mariappan R, Subbiah SK. Recent Updates on Treatment of Ocular Microbial Infections by Stem Cell Therapy: A Review. Int J Mol Sci 2018; 19:ijms19020558. [PMID: 29438279 PMCID: PMC5855780 DOI: 10.3390/ijms19020558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/03/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
Ocular microbial infection has emerged as a major public health crisis during the past two decades. A variety of causative agents can cause ocular microbial infections; which are characterized by persistent and destructive inflammation of the ocular tissue; progressive visual disturbance; and may result in loss of visual function in patients if early and effective treatments are not received. The conventional therapeutic approaches to treat vision impairment and blindness resulting from microbial infections involve antimicrobial therapy to eliminate the offending pathogens or in severe cases; by surgical methods and retinal prosthesis replacing of the infected area. In cases where there is concurrent inflammation, once infection is controlled, anti-inflammatory agents are indicated to reduce ocular damage from inflammation which ensues. Despite advances in medical research; progress in the control of ocular microbial infections remains slow. The varying level of ocular tissue recovery in individuals and the incomplete visual functional restoration indicate the chief limitations of current strategies. The development of a more extensive therapy is needed to help in healing to regain vision in patients. Stem cells are multipotent stromal cells that can give rise to a vast variety of cell types following proper differentiation protocol. Stem cell therapy shows promise in reducing inflammation and repairing tissue damage on the eye caused by microbial infections by its ability to modulate immune response and promote tissue regeneration. This article reviews a selected list of common infectious agents affecting the eye; which include fungi; viruses; parasites and bacteria with the aim of discussing the current antimicrobial treatments and the associated therapeutic challenges. We also provide recent updates of the advances in stem cells studies on sepsis therapy as a suggestion of optimum treatment regime for ocular microbial infections.
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Affiliation(s)
- Seoh Wei Teh
- Department of Biomedical Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Pooi Ling Mok
- Department of Biomedical Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Genetics and Regenerative Medicine Research Centre, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Aljouf University, 72442 Sakaka, Aljouf Province, Saudi Arabia.
| | - Munirah Abd Rashid
- Department of Ophthalmology, Faculty of Medicine, UKM Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Faculty of Medicine, UKM Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Normala Ibrahim
- Department of Psychiatry, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Akon Higuchi
- Department of Chemical and Materials Engineering, National Central University, No. 300, Jhongda RD., Jhongli, 32001 Taoyuan, Taiwan.
| | - Kadarkarai Murugan
- Department of Zoology, Thiruvalluvar University, Serkkadu, 632 115 Vellore, India.
| | - Rajan Mariappan
- Biomaterials in Medicinal Chemistry Laboratory, Department of Natural Products Chemistry, School of Chemistry, Madurai Kamaraj University, Madurai, 625 021 Tamil Nadu, India.
| | - Suresh Kumar Subbiah
- Genetics and Regenerative Medicine Research Centre, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
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Ajlan R, Isenberg J, Cordahi G, Duval R, Olivier S, Rezende F. Primary rhegmatogenous retinal detachment with inferior retinal breaks postoperative prone positioning results: 1 day versus 7 days. Int J Retina Vitreous 2017; 3:47. [PMID: 29214057 PMCID: PMC5713118 DOI: 10.1186/s40942-017-0100-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/15/2017] [Indexed: 11/11/2022] Open
Abstract
Background To compare the primary anatomical outcome of pars plana vitrectomy, 360° peripheral endolaser, and 15% octafluoropropane C3F8 gas tamponade in patients with uncomplicated rhegmatogenous detachment and inferior retinal breaks, after 24-h postoperative prone positioning to similar patients with 1 week postoperative prone positioning. Methods Records of 5500 patients who underwent pars plana vitrectomy between 2008 and 2015 were retrieved. Collected data included age, gender, number of retinal quadrants with retinal breaks, number of retinal breaks, macula status on presentation (attached or detached), phakic status (phakic, pseudophakic, or aphakic), and primary anatomical outcome (at 1 and 3 months post-operative). Results 270 patients met the study inclusion criteria (78 females, and 192 males). In the 24-h positioning arm (183 patients), the overall anatomical success rate was 96.2% at 1 month and 83.6% at 3 months. In the 1-week positioning group (87 patients), the overall anatomical success rate was 93% at 1 month and 79% at 3 months. Both positioning groups did not show statistical difference in outcome at 1 month (p-value = 0.7) or at 3 months (p-value = 0.39). Logistic regression analysis found that the number of retinal breaks correlates with the postoperative anatomical success at 3 months (odd ratio 0.8, p-value = 0.016). Conclusion This short term retrospective study demonstrated that patients with uncomplicated rhegmatogenous retinal detachment due to inferior retinal breaks, who underwent pars plana vitrectomy, 360° endolaser, 15% C3F8 gas, and limited (24-h) prone positioning did not show statistical difference in the anatomical outcome (at 1, and 3 months) when compared with 1 week postoperative positioning. Larger prospective studies are warranted to further elucidate positioning role.
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Affiliation(s)
- Radwan Ajlan
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Jordan Isenberg
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Ghassan Cordahi
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Renaud Duval
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Sébastien Olivier
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
| | - Flavio Rezende
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montreal, QC H1T 2M4 Canada
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Chan DFF, Herrera-Arroyo M, Santiago DE, Castillo TR, Fajardo-Gomez MFQ. Panuveitis-like reaction following encircling laser retinopexy/cerclage in a 21-year-old male. J Ophthalmic Inflamm Infect 2017; 7:21. [PMID: 29038978 PMCID: PMC5643585 DOI: 10.1186/s12348-017-0139-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Severe vision-impairing ocular inflammation is rarely reported following extensive laser. Previous cases have involved retinal photocoagulation for diabetic retinopathy resolving over days. This report documents a rare instance of this where encircling retinopexy/cerclage was done as fellow eye retinal detachment prophylaxis in a patient with no overt comorbidities. Results A panuveitis-like reaction with severe, near-total visual impairment was documented 1 day following single-sitting encircling laser retinopexy/cerclage done as fellow eye prophylaxis for a 21-year-old male presenting with total retinal detachment in the other eye. Pre-laser findings were unremarkable, other than an equatorial ring of fine vitreous condensations. Pre-laser vision of 20/20 uncorrected decreased to hand motion, light perception on all quadrants, accompanied by severe anterior segment inflammation with hypopyon, retrolental membranes, vitreous cells, and choroidal effusion/suspicious exudative retinal detachment on B-scan ultrasound and ultrasound biomicroscopy. Combination of oral, topical, and depot steroids resulted in restoration of vision by 1 month post-laser, but with persistent anterior segment inflammation and retrolental membranes at month 2 post-laser. Conclusions The atypically inordinate degree of post-laser inflammation and multiple sequelae following encircling retinopexy/cerclage as retinal detachment prophylaxis, in this case, demonstrate the potency and risks of retinal photocoagulation. The value of pre-laser assessment for potential risk factors, caution and mindfulness in conducting the intervention, and, the value of prudent and thorough follow-up are exhibited in this case.
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Affiliation(s)
- David Francis Fullon Chan
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines.
| | - Milagros Herrera-Arroyo
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Darby E Santiago
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Teresita R Castillo
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Ma Florentina Q Fajardo-Gomez
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
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PROPHYLACTIC PREOPERATIVE LASER RETINOPEXY DOES NOT REDUCE THE OCCURRENCE OF RHEGMATOGENOUS RETINAL COMPLICATIONS IN MACULAR SURGERY. Retina 2017; 38:1707-1712. [PMID: 28737533 DOI: 10.1097/iae.0000000000001780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Knowledge on the utility of prophylactic 360° laser retinopexy before pars plana vitrectomy in the absence of peripheral retinal pathology is limited. This study compares the occurrence of rhegmatogenous events in the setting of small-gauge pars plana vitrectomy with and without prophylactic preoperative laser. METHODS Our multicenter, retrospective case-control analysis reviewed patients who underwent epiretinal membrane removal or macular hole repair through 23- or 25-gauge pars plana vitrectomy: 205 controls who did not receive prophylactic laser and 176 cases who received preoperative prophylactic laser retinopexy anterior to the equator. Main outcome measures were the rate and characteristics of postoperative retinal tears and detachments. Patients with previous pars plana vitrectomy or significant retinal disease were excluded. RESULTS Of those patients with prophylactic laser and those without, there was no significant difference in the number of retinal breaks (1.7% vs. 0.49%, respectively; P = 0.339) or retinal detachments (0% vs. 0.49%, respectively; P = 1.00). Of the lasered group, there was one sclerotomy-related retinal break and two non-sclerotomy-related retinal breaks. Of the nonlasered group, there was one non-sclerotomy-related retinal break and one sclerotomy-related retinal detachment. CONCLUSION Preoperative prophylactic peripheral laser retinopexy does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events.
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Pars plana vitrectomy with 360° versus localized laser retinopexy in the management of retinal detachment with undetected breaks intraoperatively: a retrospective, comparative, interventional study. Lasers Med Sci 2017; 32:583-589. [DOI: 10.1007/s10103-017-2152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
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Navigated Pattern Laser System versus Single-Spot Laser System for Postoperative 360-Degree Laser Retinopexy. J Ophthalmol 2016; 2016:9871976. [PMID: 28070417 PMCID: PMC5192347 DOI: 10.1155/2016/9871976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/20/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose. To compare three 360°-laser retinopexy (LRP) approaches (using navigated pattern laser system, single-spot slit-lamp (SL) laser delivery, and single-spot indirect ophthalmoscope (IO) laser delivery) in regard to procedure duration, procedural pain score, technical difficulties, and the ability to achieve surgical goals. Material and Methods. Eighty-six rhegmatogenous retinal detachment patients (86 eyes) were included in this prospective randomized study. The mean procedural time, procedural pain score (using 4-point Verbal Rating Scale), number of laser burns, and achievement of the surgical goals were compared between three groups (pattern LRP (Navilas® laser system), 36 patients; SL-LRP, 28 patients; and IO-LRP, 22 patients). Results. In the pattern LRP group, the amount of time needed for LRP and pain level were statistically significantly lower, whereas the number of applied laser burns was higher compared to those in the SL-LRP group and in the IO-LRP group. In the pattern LRP, SL-LRP, and IO-LRP groups, surgical goals were fully achieved in 28 (77.8%), 17 (60.7%), and 13 patients (59.1%), respectively (p > 0.05). Conclusion. The navigated pattern approach allows improving the treatment time and pain in postoperative 360° LRP. Moreover, 360° pattern LRP is at least as effective in achieving the surgical goal as the conventional (slit-lamp or indirect ophthalmoscope) approaches with a single-spot laser.
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Kessner R, Barak A. Pseudophakic rhegmatogenous retinal detachment: combined pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone. Graefes Arch Clin Exp Ophthalmol 2016; 254:2183-2189. [PMID: 27245856 DOI: 10.1007/s00417-016-3381-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare the outcomes of combined vitrectomy + scleral buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD). METHODS Cases included 65 eyes of 63 patients with primary non-complex pseudophakic RRD. The first group underwent combined vitrectomy + SB between January 2010 and August 2012, and the second group was treated with vitrectomy alone between September 2012 and October 2013. The medical records of the patients were reviewed for preoperative examinations, follow-up examinations (including final visual acuity [VA]), appearance of redetachment and complications. The main outcomes were recurrent retinal detachment, complications, and VA improvement. RESULTS The rate of single-surgery anatomic success was non-significantly lower in the combined vitrectomy + SB group compared with the vitrectomy alone group - 75.8 % versus 84.4 % respectively (P = 0.683). Complications were significantly more frequent in the former compared to the latter (P = 0.014). The final VAs were 0.580 (logMAR) and 0.486, respectively (P = 0.258). VA improvement of ≥3 lines was achieved in 48.5 % and in 50 % of the eyes respectively (P = 0.769). CONCLUSIONS There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.
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Affiliation(s)
- Rivka Kessner
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adiel Barak
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tosi GM, Esposti P, Romeo N, Marigliani D, Cevenini G, Massimo P, Nuti E, Esposti G, Ripandelli G. The Incidence of Rhegmatogenous Retinal Complications in Macular Surgery After Prophylactic Preoperative Laser Retinopexy: A Retrospective Study. Medicine (Baltimore) 2016; 95:e3283. [PMID: 27057893 PMCID: PMC4998809 DOI: 10.1097/md.0000000000003283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to evaluate the clinical characteristics of intraoperative retinal breaks (RBs) and postoperative retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) for macular disorders, who were treated preoperatively with prophylactic peripheral laser retinopexy.This observational cohort study comprised of 254 patients who underwent macular surgery and were preoperatively subjected to prophylactic laser retinopexy anterior to the equator. The main outcome measures were the incidence and characteristics of intraoperative RBs and postoperative RRD.Intraoperative RBs occurred in 14 patients (5.5%). Ten patients presented a sclerotomy-related RB (3.9%) and 4 patients a nonsclerotomy-related RB (1.6%). Two patients showed postoperative RRD (0.7%). Neither of the 2 patients with postoperative RRD was macula-off at presentation: one of them was successfully operated on with scleral buckling and the other was managed by observation alone. A significantly increased risk for the intraoperative development of sclerotomy-related RB was found in 20-gauge PPV compared with 23/25-gauge PPV.Preoperative prophylactic peripheral laser retinopexy does not guarantee the prevention of intraopertaive RBs or postoperative RRD. However, it might prevent the involvement of the macula when RRD occurs postoperatively.
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Affiliation(s)
- Gian Marco Tosi
- From the Ophthalmology Section of the Department of Medicine, Surgery and Neuroscience (GMT, PE, NR, DM, PM, EN, GE), University of Siena, Siena; Department of Medical Biotechnologies (GC), University of Siena, Siena; and G.B. Bietti Foundation (GR), IRCCS Rome, Italy
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Auchère Lavayssiere C, Lux AL, Degoumois A, Stchepinsky Launay M, Denion E. [Neurotrophic keratitis after vitrectomy and circumferential endophotocoagulation for retinal detachment]. J Fr Ophtalmol 2015; 39:195-201. [PMID: 26679387 DOI: 10.1016/j.jfo.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Circumferential (360°) endophotocoagulation is frequently implemented during vitrectomies for retinal detachment. This photocoagulation may result in neurotrophic keratitis by damaging the ciliary nerves in the suprachoroidal space on their way to the pupil. We report a series of 4 cases of neurotrophic keratitis following a circumferential endophotocoagulation. PATIENTS AND METHODS A retrospective observational case series of 4 non-diabetic patients having presented with a neurotrophic keratitis following a retinal detachment treated with vitrectomy and circumferential endophotocoagulation (532 nm) at Caen University Hospital. We report the various forms of corneal lesions and the diagnostic criteria allowing for the diagnosis of neurotrophic keratitis. DISCUSSION Neurotrophic keratitis is caused by lesions occurring at various levels of corneal innervation. Endophotocoagulation may cause a neurotrophic keratitis by damaging the short and long ciliary nerves on their way to the pupil in the suprachoroidal space. The sequelae of this condition can limit visual recovery. Hence, it is probably advisable to screen for corneal anesthesia or severe hypesthesia following a retinal detachment treated with vitrectomy and circumferential endophotocoagulation and to implement prophylactic treatment (intensive lubricant therapy; preservative-free eye drops) if needed. CONCLUSION The risk of neurotrophic keratitis should be weighed against the dose of laser retinopexy necessary and sufficient to obtain a sustained retinal reattachment. If circumferential endophotocoagulation is implemented, it is probably sensible to monitor corneal sensitivity and to adapt postoperative treatment if necessary.
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Affiliation(s)
- C Auchère Lavayssiere
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - A-L Lux
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - A Degoumois
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - M Stchepinsky Launay
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - E Denion
- Service ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.
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Zhou C, Qiu Q. 360° versus localized demarcation laser photocoagulation for macular-sparing retinal detachment in silicone oil-filled eyes with undetected breaks: A retrospective, comparative, interventional study. Lasers Surg Med 2015; 47:792-7. [PMID: 26437883 DOI: 10.1002/lsm.22430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Chuandi Zhou
- Department of Ophthalmology; Ninth People's Hospital of Shanghai; Shanghai Jiaotong University; Shanghai China
| | - Qinghua Qiu
- Department of Ophthalmology; First People's Hospital of Shanghai; Shanghai Jiaotong University; Shanghai China
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Bouheraoua N, Hrarat L, Parsa CF, Akesbi J, Sandali O, Goemaere I, Hamiche T, Laroche L, Borderie V. Decreased Corneal Sensation and Subbasal Nerve Density, and Thinned Corneal Epithelium as a Result of 360-Degree Laser Retinopexy. Ophthalmology 2015; 122:2095-102. [PMID: 26189186 DOI: 10.1016/j.ophtha.2015.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the effects of 360-degree laser retinopexy on human corneal subbasal nerve plexus and to investigate correlations among corneal subbasal nerve plexus density, corneal epithelial thickness, and corneal sensitivity. DESIGN Prospective, observational, nonrandomized study. PARTICIPANTS A total of 15 eyes of 15 patients who underwent pars plana vitrectomy (PPV) with 360-degree laser retinopexy for retinal detachment (RD) and 15 eyes of 15 patients who underwent PPV for macular hole (MH) without laser treatment. METHODS Corneal sensation, corneal epithelial thickness, and corneal subbasal nerve plexus density were assessed before surgery and 6 months after surgery via in vivo confocal microscopy, anterior segment optical coherence tomography (AS-OCT), and Cochet-Bonnet esthesiometry (Luneau Ophthalmologie, Paris, France). MAIN OUTCOME MEASURES Corneal subbasal nerve plexus density, corneal epithelium thickness, and central corneal sensitivity. RESULTS Compared with baselines values, the mean subbasal nerve density (P < 0.001), mean corneal epithelium thickness (P = 0.006), and mean corneal sensitivity (P < 0.001) in the RD group were significantly decreased 6 months after surgery by 74.3%, 4.7%, and 56.6%, respectively. Conversely, in the MH group there were no significant differences in the mean subbasal nerve density (P = 0.34), mean corneal epithelial thickness (P = 0.19), and mean corneal sensitivity (P = 0.42) between preoperative and 6-month postoperative values (0.7%, 0.4%, and 0.8%, respectively). The postoperative decrease in corneal subbasal nerve density after laser retinopexy was associated with a decrease in corneal epithelium thickness (r(2) = 0.42; P = 0.006) and a decrease in corneal sensitivity (r(2) = 0.48; P = 0.004). The postoperative decrease in corneal sensitivity poorly correlated with the decrease in corneal epithelial thickness (r(2) = 0.24; P = 0.045). Postoperative corneal nerve density decreased as total laser energy increased (r(2) = 0.51; P = 0.002). CONCLUSIONS Subbasal corneal nerve plexus density decreases after 360-degree laser retinopexy and is accompanied by epithelium thinning and decreased corneal sensation. Surgeons should eschew heavy confluent retinal laser treatment, and corneal sensitivity should be assessed postoperatively to determine whether significant anesthesia has occurred. In such instances, prophylactic measures may be warranted against the development of neurotrophic ulcers.
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Affiliation(s)
- Nacim Bouheraoua
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France; INSERM UMR S 968, Institut de la Vision, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Paris, France.
| | - Linda Hrarat
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Cameron F Parsa
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Jad Akesbi
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Otman Sandali
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Isabelle Goemaere
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Taous Hamiche
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France
| | - Laurent Laroche
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France; INSERM UMR S 968, Institut de la Vision, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Paris, France
| | - Vincent Borderie
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France; INSERM UMR S 968, Institut de la Vision, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Paris, France
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