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Gibelalde A, Pinar-Sueiro S, Ibarrondo O, Ruiz Miguel M, Martínez Soroa I, Mendicute J. Characteristics of pseudophakic retinal detachment and risk factors of recurrence. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00092-6. [PMID: 38823449 DOI: 10.1016/j.oftale.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/21/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes. METHODS This was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain). RESULTS The mean age of the patients at the time of phacoemulsification was 63.06 ± 10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5-26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ± 4.17 years, which was reduced by half in the event of surgical complications (2.24 ± 2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21). CONCLUSIONS PRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.
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Affiliation(s)
- A Gibelalde
- Departamento de Oftalmología, Hospital Universitario de Donostia, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - S Pinar-Sueiro
- Departamento de Oftalmología, Hospital Universitario de Donostia, Donostia-San Sebastián, Gipuzkoa, Spain
| | - O Ibarrondo
- Unidad de Investigación AP-OSI, Alto Deba Integrated Health Care Organization, Arrasate-Mondragón, Mondragon, Spain
| | - M Ruiz Miguel
- Departamento de Oftalmología, Hospital Universitario de Donostia, Donostia-San Sebastián, Gipuzkoa, Spain
| | - I Martínez Soroa
- Departamento de Oftalmología, Hospital Universitario de Donostia, Donostia-San Sebastián, Gipuzkoa, Spain
| | - J Mendicute
- Departamento de Oftalmología, Hospital Universitario de Donostia, Donostia-San Sebastián, Gipuzkoa, Spain
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Babel A, Xu K, Chin EK, Almeida D. Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning. JOURNAL OF VITREORETINAL DISEASES 2024; 8:253-256. [PMID: 38770069 PMCID: PMC11102711 DOI: 10.1177/24741264241237022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To evaluate the anatomic and visual outcomes of primary vitrectomy for rhegmatogenous retinal detachment (RRD) repair using no amount of postoperative prone positioning to clarify the role of face-down posturing for RRD reattachment. Methods: This retrospective consecutive interventional case series comprised patients who had primary vitrectomy for RRD repair. The surgical outcomes, single-surgery anatomic success rate, and postoperative best-corrected visual acuity (BCVA) were assessed. The primary objective was to evaluate the anatomic and visual outcomes of vitrectomy RRD reattachment using no postoperative prone positioning. Results: This study comprised 116 eyes of 116 patients. Single-surgery anatomic success was achieved in 112 (96.5%) of 116 eyes. The single-surgery anatomic success rate was 100% in phakic patients (n = 56) and 93% in pseudophakic patients (n = 60), with both groups having an improvement in the mean BCVA. Conclusions: Primary vitrectomy with no postoperative prone positioning is a successful surgical intervention for RRD repair. The anatomic closure rate in this study is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and a significant improvement in BCVA, primarily using 14% perfluoropropane for gas tamponade.
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Affiliation(s)
- Adrian Babel
- Boonshoft School of Medicine, Dayton, OH, USA
- Erie Retinal Surgery & Erie Retina Research, Erie, PA, USA
| | - Kunyong Xu
- Retina Consultants of Georgia, Augusta, GA, USA
| | - Eric K. Chin
- Retina Consultants of Southern California, Redlands, CA, USA
- Loma Linda Eye Institute, Veterans Affair Hospital, Loma Linda, CA, USA
| | - David Almeida
- Erie Retinal Surgery & Erie Retina Research, Erie, PA, USA
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Quiroz-Reyes MA, Babar ZUD, Hussain R, Loh ZC, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review. Int J Retina Vitreous 2024; 10:35. [PMID: 38654369 PMCID: PMC11036595 DOI: 10.1186/s40942-024-00552-6] [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: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico.
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, HD1 3DH, Queensgate, Huddersfield, UK
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Zhe Chi Loh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico
- Institute of Ophthalmology, National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization, National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, 11000, Lomas de Chapultepec, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution, Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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El Baha S, Ghandour M, Ahmed ISH. Evaluation of the (Baha) technique of scleral indentation using a self-retained scleral indenter during vitrectomy surgery: a randomized trial. Int Ophthalmol 2024; 44:92. [PMID: 38367129 PMCID: PMC10874340 DOI: 10.1007/s10792-024-03028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/11/2024] [Indexed: 02/19/2024]
Abstract
AIMS The current study compared a novel technique of scleral indentation using the self-retaining Leyla retractor to the conventional scleral self-indentation with the chandelier light. METHODS Patients with rhegmatogenous retinal detachment were randomized on a 1:1 basis to either have the (Baha) indentation using a tip of a thimble scleral indenter welded to the support for the Leyla retractor system or to have the conventional scleral indentation while using a 25-gauge chandelier light. A video was recorded for the surgery of all the cases and reviewed by another consultant masked to the type of indentation. The indentation duration (i.e., the time in seconds between the first appearance of a hump due to scleral indentation in the recorded video until its final disappearance) was measured for every case. RESULTS The current study included 60 eyes of 60 adults with a mean age of 59.6 ± 9.8 years. Thirty-nine of the eyes were phakic and 21 were pseudophakic. The mean indentation time was 618 ± 87 and 696 ± 72 s in (Baha) indentation and conventional indentation groups, respectively. The difference was not statistically significant (p = 38). There was a positive correlation between the vertical palpebral fissure height and the indentation duration for both (Baha) indentation (r = 0.58) and conventional indentation groups (r = 0.42). Readjustment of the chandelier endo-illumination was required in 19 cases (63.3%) in the conventional indentation group. Iatrogenic breaks or accidental crystalline lens touch did not occur in any case. CONCLUSION The (Baha) technique is effective and safe, especially in patients with a larger palpebral fissure.
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Affiliation(s)
- Samir El Baha
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moutaz Ghandour
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Islam S H Ahmed
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Faculty of Medicine, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt.
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Confalonieri F, Barone G, Ferraro V, Ambrosini G, Gaeta A, Petrovski BÉ, Lumi X, Petrovski G, Di Maria A. Early versus Late Pars Plana Vitrectomy in Vitreous Hemorrhage: A Systematic Review. J Clin Med 2023; 12:6652. [PMID: 37892789 PMCID: PMC10607253 DOI: 10.3390/jcm12206652] [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: 08/17/2023] [Revised: 10/14/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Vitreous hemorrhage (VH) is a common vitreoretinal condition causing impairment of vision due to various etiologies. No consensus exists on the best timing for performing pars plana vitrectomy (PPV) in fundus-obscuring VH. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, we conducted a systematic review of the timing of PPV in VH. We assessed the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for all the included publications, in accordance with the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: A total of 1731 articles were identified. Following the removal of duplicates and screening of abstracts, 1203 articles remained. Subsequently, a comprehensive full-text review of 30 articles was conducted. Ultimately, 18 articles met the predefined inclusion criteria. Conclusions: Despite the small number of studies on the timing of treatment for VH, the advantage of early over late PPV seems to be a reasonable approach in selected cases, and it might be considered modern standard care.
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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Giacomo Ambrosini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 16132 Genova, Italy;
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
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Li C, Zhang B, Tan X, Jia Y, Guo L, Wang C, Xing Y, Li Q, Tian X. A pilot clinical study of complex rhegmatogenous retinal detachment treatment via foldable capsular buckle scleral buckling. BMC Ophthalmol 2023; 23:196. [PMID: 37142972 PMCID: PMC10158219 DOI: 10.1186/s12886-023-02913-5] [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: 11/30/2022] [Accepted: 04/08/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling. METHODS This prospective clinical study enrolled five patients with complex rhegmatogenous retinal detachment treated with foldable capsular buckle scleral buckling at the 988th Hospital of People's Liberation Army Joint Logistic Force, China. During the 24-week follow-up period, the patients underwent measurements of their best-corrected visual acuity, slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Additionally, B-ultrasound and fundus photography of the patients' retinal reattachments helped evaluate the treatment's post-surgery efficacy. We determined the safety of foldable capsular buckle scleral buckling based on infection, eye pain, diplopia, elevated intraocular pressure, and other postoperative severe complications. RESULTS All five patients' complex rhegmatogenous retinal detachments were successfully treated and evaluated via B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in four patients 24 weeks after surgery, while the remaining patients developed diplopia after surgery. No other complications were observed. CONCLUSION This pilot study preliminarily determined that foldable capsular buckle scleral buckling is feasible for efficient and safe treatment of complex rhegmatogenous retinal detachment. These results support this surgery as a potential and novel alternative to current extraocular procedures for treating complex rhegmatogenous retinal detachment. TRIAL REGISTRATION The prospective observational clinical study protocol was approved by the Institutional Review Board and Ethics Committee and registered at the clinical research center in the 988th Hospital of People's Liberation Army Joint Logistic Force, China (9,882,019,000).
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Affiliation(s)
- Cheng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Baike Zhang
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Xiao Tan
- Shenzhen Aier Eye Hospital Affiliated to Jinan University, Shenzhen, 518000, China
| | - Yong Jia
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Lisha Guo
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Chunlei Wang
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Yaofan Xing
- Xinxiang Medical University, Xinxiang, 453000, China
| | - Qiaoyun Li
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China
| | - Xuemin Tian
- The 988th Hospital of People's Liberation Army Joint Logistic Force, Zhengzhou, 450000, China.
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Gibelalde A, Pinar-Sueiro S, Ibarrondo O, Martínez-Soroa I, Mendicute J, Ruiz Miguel M. Are all primary retinal detachments the same? Anatomic and functional differences between phakic and pseudophakic patients. Int J Retina Vitreous 2023; 9:17. [PMID: 36967392 PMCID: PMC10040123 DOI: 10.1186/s40942-023-00455-y] [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: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Given differences in the pathogenic mechanisms underlying primary retinal detachment (RD) as a function of the status of the lens, the objective was to explore differences between pseudophakic and phakic patients with primary RD. METHODS A retrospective study including 821 patients who underwent surgery for RD [491 cases of phakic and 330 of pseudophakic RD (pRD and psRD, respectively)] in our hospital between 2012 and 2020. RESULTS The mean age was 58.24 ± 12.76 years in the pRD group and 66.87 ± 11.18 years in the psRD group (p = 0.001). There were more men in both groups (70% and 64.23% of pseudophakic and phakic patients, respectively; p = 0.07). The most common location for the RD was superior in both groups (43.94% and 51.93% of pseudophakic and phakic patients, respectively), rates of inferior and total RD were somewhat higher in the psRD group (31.82% and 13.33% in pseudophakic vs 25.25% and 11.0% in phakic patients, p = 0.001). In pseudophakic and phakic patients respectively, macular involvement in 69.09% and 62.73% of cases (p = 0.067). Proliferative vitreoretinopathy was significantly more common in the psRD group (7.88% vs 3.6% in phakic patients, p = 0.01).The rate of final anatomic reattachment differed markedly between groups, with a higher rate in phakic (94.03%) than pseudophakic (87.27%) patients (p = 0.001). CONCLUSIONS The specific pathogenic mechanism involved in psRD seems to be responsible for worse evolution characteristics which are associated with poorer final anatomic and functional outcomes in pseudophakic patients.
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Affiliation(s)
- Ane Gibelalde
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain.
| | - Sergio Pinar-Sueiro
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Oliver Ibarrondo
- AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain
| | - Itziar Martínez-Soroa
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Javier Mendicute
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
| | - Miguel Ruiz Miguel
- Department of Ophthalmology, Donostia University Hospital, Paseo del Dr Beguiristain sn. San Sebastian, 20014, Donostia San-Sebastian, Gipuzkoa, Spain
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Sonmez K, Hekimsoy HK. Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy. Int J Ophthalmol 2022; 15:1279-1289. [PMID: 36017034 DOI: 10.18240/ijo.2022.08.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.
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Affiliation(s)
- Kenan Sonmez
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara 06240, Turkey
| | - Hilal Kilinc Hekimsoy
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara 06240, Turkey
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D’Aloisio R, Gironi M, Verdina T, Vivarelli C, Leonelli R, Mariotti C, Kaleci S, Toto L, Mastropasqua R. Early Structural and Vascular Changes after Within-24 Hours Vitrectomy for Recent Onset Rhegmatogenous Retinal Detachment Treatment: A Pilot Study Comparing Bisected Macula and Not Bisected Macula. J Clin Med 2022; 11:jcm11123498. [PMID: 35743566 PMCID: PMC9225027 DOI: 10.3390/jcm11123498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/03/2022] [Accepted: 06/11/2022] [Indexed: 01/27/2023] Open
Abstract
Background: In this study we aimed at investigating macular perfusion/anatomical changes in eyes with early onset rhegmatogenous retinal detachment (RRD) after prompt surgery within 24 hours, comparing a bisected macula and not bisected macula RRD. Methods: In this prospective observational study, 14 eyes of 14 patients who underwent within-24 hours vitreoretinal surgery for early onset RRD were enrolled. Patients were further divided into two subgroups: the not bisected macula group (NBM group) and the bisected macula group (BM group). At baseline and 3-month follow up, macular architecture and vessel analysis were assessed using optical coherence tomography angiography (OCTA) imaging. In detail, quantitative and qualitative analyses of the macular area were performed to quantify topographical retinal perfusion changes after surgery, calculating the foveal avascular zone (FAZ), vessel density (VD) and vessel length density (VLD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Most cases (43%) were superotemporal RRD. Primary retinal reattachment was obtained in all cases, without recurrences within 3-month follow up. After surgery, a significant FAZ enlargement was observed at both the SCP and DCP level (p < 0.001; p < 0.05), with a significant effect of time noted between the two time points in the NBM and BM subanalysis (F = 3.68; p < 0.017). An excellent functional outcome was maintained for the whole follow-up. On the other hand, after surgery, perfusion parameters did not change significantly apart from the vessel density of the inferior macular sector at the DCP level (p = 0.03). Conclusions: Our findings suggest that the macular perfusion of eyes with RRD is still preserved if the surgery is performed really promptly, thus highlighting the great importance of a correct timing for surgery. OCTA analysis allows for a better understanding of the pathophysiological mechanisms underneath early vascular microarchitecture modifications of the posterior pole in retinal detachment, differentiating the two types of RRD not completely involving the fovea (BM and NBM).
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Affiliation(s)
- Rossella D’Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University Gabriele D’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (L.T.); (R.M.)
- Correspondence:
| | - Matteo Gironi
- Ophthalmology Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41122 Modena, Italy; (M.G.); (T.V.); (C.V.); (R.L.)
| | - Tommaso Verdina
- Ophthalmology Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41122 Modena, Italy; (M.G.); (T.V.); (C.V.); (R.L.)
| | - Chiara Vivarelli
- Ophthalmology Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41122 Modena, Italy; (M.G.); (T.V.); (C.V.); (R.L.)
| | - Riccardo Leonelli
- Ophthalmology Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41122 Modena, Italy; (M.G.); (T.V.); (C.V.); (R.L.)
| | - Cesare Mariotti
- Eye Clinic, AOU Ospedali Riuniti Ancona-Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41122 Modena, Italy;
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University Gabriele D’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (L.T.); (R.M.)
| | - Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University Gabriele D’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (L.T.); (R.M.)
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Valentín‐Bravo FJ, García‐Onrubia L, Andrés‐Iglesias C, Valentín‐Bravo E, Martín‐Vallejo J, Pastor JC, Usategui‐Martín R, Pastor‐Idoate S. Complications associated with the use of silicone oil in vitreoretinal surgery: A systemic review and meta-analysis. Acta Ophthalmol 2022; 100:e864-e880. [PMID: 34846097 DOI: 10.1111/aos.15055] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
Silicone oil (SO) still represents the main choice for long-term intraocular tamponade in complicated vitreoretinal surgery. This review compared the complications associated with the use of SO and other vitreous substitutes after pars plana vitrectomy in patients with different underlying diseases. Meta-analysis was conducted in accordance with PRISMA guidelines. We retrieved randomized clinical trials (RCTs), retrospective case-control and cohort studies evaluating the risk of using SO, published between 1994 and 2020, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. Primary outcome was the rate of complications such as intraocular hypertension, retinal re-detachment, unexpected vision loss or hypotony. Secondary outcome was to compare the rate of adverse events of different SO viscosities, especially emulsification. Forty-three articles were included. There were significant differences in intraocular hypertension (p = 0.0002, OR = 1.66; 95% CI = 1.27-2.18) and the rate of retinal re-detachment (p < 0.0009, OR = 0.65; 95% CI = 0.50-0.64) between SO and other agents, including placebo. However, there were no differences in other complication rates. Silicone oil (SO)-emulsification rate was non-significantly higher in low than high SO viscosity, and results from other complications were comparable in both groups. The high quality of most of the studies included in this study is noteworthy, which provides some certainty to the conclusions. Among them is the high variability of the SO residence time. The fact that ocular hypertension and not hypotension is related to SO use. A clear relationship is not found for the so-called unexplained vision loss, which affects a significant percentage of eyes. Re-detachment cases are less if SO is used and that surprisingly there does not seem to be a relationship in the percentage of emulsification between the low- and high-viscosity silicones. All these data warrant more standardized prospective studies.
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Affiliation(s)
- Fco. Javier Valentín‐Bravo
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
| | - Luis García‐Onrubia
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
| | | | | | - Javier Martín‐Vallejo
- Department of Statistics. Medical School University of Salamanca. Salamanca Biomedical Research Institute (IBSAL) Salamanca Spain
| | - José Carlos Pastor
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
| | - Ricardo Usategui‐Martín
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
| | - Salvador Pastor‐Idoate
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
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11
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Zubricky RD, Platt SM. Comparison of Face-down Positioning Durations Following Silicone Oil Tamponade. Ophthalmic Surg Lasers Imaging Retina 2022; 53:285-292. [PMID: 35575742 DOI: 10.3928/23258160-20220415-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze the rate and timing of retinal redetachments and other complications following pars plana vitrectomy for retinal detachment repair with silicone oil tamponade and the effect of face-down positioning duration on these endpoints. MATERIALS AND METHODS A retrospective study was performed on patients with retinal detachment repair via pars plana vitrectomy with silicone oil tamponade between 2015 and 2020. Surgery was performed by 10 physicians associated with a private retina practice in Cleveland, Ohio. Duration of postoperative face-down positioning was noted and patients were grouped by short (≤6 days) or long (≥7 days) durations. Outcome variables were retinal re-detachment, epiretinal membrane formation, cataract formation, and other complications. Timing and frequency of outcomes were noted and statistical analysis was performed. RESULTS The study was composed of 227 eyes. The mean age of patients was 62.09±13.65 years with 143 (63.00%) male and 84 (37.00%) female. Of the initial detachments, 63 (27.88%) were macula-on and 163 (72.12%) were macula-off. Overall, 128 (56.39%) patients were given instructions for face-down positioning for 6 days or less and 99 (43.61%) patients for 7 days or more. Retinal redetachment was seen in 42.19% of patients with face-down positioning ≤6 days and 29.29% of patients with face-down positioning ≥7 days (P = .045). No significant difference was found in epiretinal membrane formation or cataract formation (P >.05). CONCLUSION There was a lower rate of redetachment in patients who kept a face-down position for ≥7 days compared with ≤6 days. Further study to determine causality between duration of postoperative face-down positioning and retinal redetachment is recommended. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:285-292.].
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12
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Elghawy O, Duong R, Nigussie A, Bogaard JD, Patrie J, Shildkrot Y. Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study. BMC Ophthalmol 2022; 22:136. [PMID: 35337296 PMCID: PMC8957134 DOI: 10.1186/s12886-022-02364-4] [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: 10/14/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rhegmatogenous retinal detachment (RRD) is a common, potentially blinding ocular pathology that is considered a surgical emergency. Macular involvement has been identified as a major negative prognostic indicator for visual recovery after RRD correction. It is not currently clear whether early intervention improves visual outcomes, and in practice, there are potential disadvantages to performing early surgery for fovea-involving RRD. Such disadvantages include inadequate assessment of coexisting comorbidities, increased rate of complications related to poorly trained staff or tired surgeons, and anesthetic risk. Methods A single-center, retrospective, cohort study of patients who underwent repair of macula-involving rhegmatogenous retinal detachment at the University of Virginia was performed. Variables collected included patient demographics, ocular history, clinical characteristics, and post-operative complications. Patients were excluded if they had a history of congenital or acquired pathology with an effect on visual function, bilateral or repeat rhegmatogenous detachment, age less than 18 years, follow up duration less than 6 months, or if they were repaired using scleral buckle, pneumatic retinopexy, 25- or 27-gauge pars plana vitrectomy, or any combination of these techniques. A multivariate regression model was used to compare overall outcomes such as post-operative visual acuity, intra-ocular pressure, retina attachment status, and complications among patients of differing timing of surgical repair. These analyses were adjusted for clinical factors known or considered to be associated with worse prognosis in rhegmatogenous retinal detachment. Results A total of 104 patients undergoing 23-gauge vitrectomy for repair of macula involving rhegmatogenous retinal detachments were included in this study with mean follow up period 17.9 ± 14.1 months. Early surgical repair (< 48 h) was pursued in 26 patients, moderately delayed surgical repair (3–7 days), was performed in 29 patients and late surgical repair (> 7 days) in 49 patients. Our analysis showed no difference in post-operative visual acuity between patients with detachments undergoing early versus moderately delayed repair of RRD. However, mean visual acuity differed between patients undergoing early versus late repair at 3, 6, and 12 months. No significant difference was observed in post-operative complications between the three surgical timepoints including cataract formation, development of glaucoma and re-detachment rate. Use of 360 laser was found to be protective against re-detachment overall (OR 6.70 95% CI 1.93–23.2). Conclusions These findings indicate that a moderate delay of 3–7 days from symptom onset for repair of macula-involving retinal detachment may be a safe approach as there are no differences in terms of visual acuity or post-operative complications compared to early repair within 48 h. Delaying surgery for > 7 days however is not recommended due to the loss of recovery of visual acuity observed in this study. Use of 360 laser may prevent risk of re-detachment after primary repair. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02364-4.
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Affiliation(s)
- Omar Elghawy
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan Duong
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Amen Nigussie
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joseph D Bogaard
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, UVA, Charlottesville, VA, USA
| | - Yevgeniy Shildkrot
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA.
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13
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Seyyar SA, Saygılı O, Tıskaoğlu NS. Intraocular pressure outcomes after 23-G vitreoretinal surgery with two different transconjunctival sutureless sclerotomy techniques: vertical versus tunnel entry. Int Ophthalmol 2022; 42:1763-1769. [DOI: 10.1007/s10792-021-02172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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14
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Kumar V, Naik A, Kumawat D, Sundar D, Chawla R, Chandra P, Kumar A. Multimodal imaging of eyes with metamorphopsia after vitrectomy for rhegmatogenous retinal detachment. Indian J Ophthalmol 2021; 69:2757-2765. [PMID: 34571630 PMCID: PMC8597520 DOI: 10.4103/ijo.ijo_3658_20] [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] [Indexed: 12/04/2022] Open
Abstract
Purpose: To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI). Methods: In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI). Results: Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM. Conclusion: POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.
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Affiliation(s)
- Vinod Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Naik
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dheepak Sundar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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15
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Kim MS, Woo SJ, Park KH. PHACOVITRECTOMY VERSUS LENS-SPARING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT REPAIR ACCORDING TO THE SURGICAL EXPERIENCE. Retina 2021; 41:1597-1604. [PMID: 33394996 DOI: 10.1097/iae.0000000000003090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience. METHODS We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared. RESULTS Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively). CONCLUSION Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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16
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Lumi X, Bergant G, Lumi A, Mahnic M. Outcomes of vitrectomy for retinal detachment in a patient with Ehlers-Danlos syndrome type IV: a case report. J Med Case Rep 2021; 15:249. [PMID: 34011391 PMCID: PMC8135155 DOI: 10.1186/s13256-021-02855-w] [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: 04/09/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders characterized by fragile blood vessels and an increased tendency for bleeding and scarring. Here, we report the outcome of a pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment in a patient with EDS type IV (vascular type). CASE PRESENTATION A 40-year-old Slovenian man with high myopia, unilateral bullous retinal detachment, and vitreous hemorrhage was referred for surgery. The patient had a history of colon perforation, muscle and arterial rupture in both lower limbs, and recurrent shoulder joint luxations. Genetic testing revealed a pathogenic mutation in the COL3A1 gene. The patient underwent a 25-gauge three-port pars plana vitrectomy. The tendency for bleeding during surgery was prevented by endodiathermy applied to the edges of the retinal breaks. Endolaser photocoagulation was performed under air. The surgical procedure was completed with the injection of gas tamponade, followed by the patient remaining for a few days in a face-down position. Mild postoperative vitreous hemorrhage was resorbed in first week after the surgery. Postoperative extensive pigment dispersion on the posterior lens face persisted for several weeks. After the gas tamponade had resorbed, the retina was flat and remained attached during the follow-up period. Eight months after the surgery, visual acuity continued to improve from a preoperative 6/38 to 6/6.6 (Snellen chart) at the last checkup. CONCLUSION A small-gauge pars plana vitrectomy with gas tamponade and laser photocoagulation under air may successfully achieve reattachment of the retina in patients with high myopia with EDS type IV and restore visual acuity.
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Affiliation(s)
- Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva ulica 46, 1000, Ljubljana, Slovenia.
| | - Gaber Bergant
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Anila Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva ulica 46, 1000, Ljubljana, Slovenia
| | - Mina Mahnic
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva ulica 46, 1000, Ljubljana, Slovenia
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17
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Deiss M, Kaya C, Pfister IB, Garweg JG. Impact of Vitreal Tamponade on Functional Outcomes in Vitrectomy with ILM Peeling in Primary Macula-Involving Retinal Detachment: A Retrospective Analysis. Clin Ophthalmol 2020; 14:4493-4500. [PMID: 33380783 PMCID: PMC7769588 DOI: 10.2147/opth.s287107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling and failed SF6 gas tamponade requiring silicone oil (SO) in a second procedure with primary SO tamponade in fovea-involving retinal detachment (FiRD). METHODS Retrospective analysis of 82 eyes with retinal detachment and mild, but without advanced proliferative retinopathy (PVR ≥C2) requiring vitrectomy for FiRD. Group 1 comprised 23 eyes that underwent SF6 tamponade resulting in re-detachment requiring revision surgery with secondary SO tamponade. Based on the intraoperative findings, group 2 patients had primarily received SO as vitreal tamponade (n=59). Patients receiving a scleral buckle surgery or with advanced PVR as well as patients with underlying vascular diseases and uveitis were excluded. RESULTS Preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 13.5 ± 19.1 in group 1 and 14.0 ± 18.3 in group 2 (p=0.44). Twelve months after first surgery for FiRD, visual acuity was 49.8 ± 19.8 in group 1 and 51.7 ± 18.7 letters in group 2 (p=0.63). Re-detachment after SO removal requiring revision surgery developed in 17.4 (n=4) and 15.3% (n=9) cases. CONCLUSION Our findings suggest that if retinal traction is completely relieved at the end of surgery, vitrectomy with ILM peeling and SF6 may, if successful, improve the functional outcomes in instances with visual potential, ie, a foveal detachment of short duration despite the presence of a mild to moderate PVR, but with the inherent increased risk of re-detachment requiring further intervention and the use of a SO tamponade. Hence, secondary SO installation during re-vitrectomy after failed primary reattachment surgery results in similar functional outcomes as primary oil filling.
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Affiliation(s)
| | - Cagdas Kaya
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Justus G Garweg
- University of Bern, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Zaletel Benda P, Vratanar B, Petrovski G, Gavrić AU, Matović K, Gornik A, Vergot K, Lumi A, Lumi X. Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment. J Clin Med 2020; 9:jcm9103251. [PMID: 33053642 PMCID: PMC7601405 DOI: 10.3390/jcm9103251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. A swept source OCT was used to obtain images at the postoperative visit at least 6 months after PPV. Hierarchical linear regression model was used to evaluate the influence of preoperative factors related to patient, ocular clinical and postoperative OCT macular findings on functional outcomes of PPV for RRD. Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p < 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
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Affiliation(s)
- Polona Zaletel Benda
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Bor Vratanar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway;
| | - Ana Uršula Gavrić
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katja Matović
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Ana Gornik
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katarina Vergot
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Anila Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
- Correspondence: ; Tel.: +38-615-221-900
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19
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Begaj T, Marmalidou A, Papakostas TD, Diaz JD, Kim LA, Wu DM, Miller JB. Outcomes of primary rhegmatogenous retinal detachment repair with extensive scleral-depressed vitreous removal and dynamic examination. PLoS One 2020; 15:e0239138. [PMID: 32970724 PMCID: PMC7514044 DOI: 10.1371/journal.pone.0239138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: “extensive” removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that “extensive” removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.
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Affiliation(s)
- Tedi Begaj
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anna Marmalidou
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thanos D. Papakostas
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Retina Service, Cornell University Medical School, New York, New York, United States of America
| | - J. Daniel Diaz
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Leo A. Kim
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David M. Wu
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John B. Miller
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Abstract
Retinal diseases, such as age-related macular degeneration and diabetic retinopathy, are the leading causes of blindness worldwide. The mainstay of treatment for these blinding diseases remains to be surgery, and the available pharmaceutical therapies on the market are limited, partially owing to various biological barriers in hindering the delivery of therapeutics to the retina. The nanoparticulate drug delivery system confers the capability for delivering therapeutics to the specific ocular targets and, hence, potentially revolutionizes the current treatment landscape of retinal diseases. While the research to date indicates the enormous therapeutics potentials of the nanoparticulate delivery systems, the successful translation of these systems from the bench to bedside is challenging and requires a combined understanding of retinal pathology, physiology of the eye, and particle and formulation designs of nanoparticles. To this end, the review begins with an overview of the most prevalent retinal diseases and related pharmacotherapy. Highlights of the current challenges encountered in ocular drug delivery for each administration route are provided, followed by critical appraisal of various nanoparticulate drug delivery systems for the retinal diseases, including their formulation designs, therapeutic merits, limitations, and future direction. It is believed that a greater understanding of the nano-biointeraction in eyes will lead to the development of more sophisticated drug delivery systems for retinal diseases.
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Affiliation(s)
- Qingqing Li
- Faculty of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710049, China
| | - Jingwen Weng
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Si Nga Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Yip Thomas Lee
- Aptorum Group Limited, Unit 232, 12 Science Park West Avenue, Hong Kong Science Park, Shatin New Town, Hong Kong
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Balogh A, Milibák T, Szabó V, Nagy ZZ, Resch MD. Position of macula lutea and presence of proliferative vitreoretinopathy affect vitreous cytokine expression in rhegmatogenous retinal detachment. PLoS One 2020; 15:e0234525. [PMID: 32542038 PMCID: PMC7295219 DOI: 10.1371/journal.pone.0234525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
Our purpose was to evaluate the concentrations of vitreous cytokines in patients with rhegmatogenous retinal detachment (RRD). We hypothesized that patients with macula on RRD have lower levels of cytokines compared to patients with macula off RRD and proliferative vitreoretinopathy (PVR). Vitreous fluids were collected during 23G pars plana vitrectomy from 58 eyes of 58 patients. Indication for vitrectomy included macula off and macula on RRD, PVR, and idiopathic epiretinal membrane (ERM). A multiplex chemiluminescent immunoassay was performed to measure the concentrations of 48 cytokines, chemokines, and growth factors. Levels of HGF, IL-6, IL-8, IL-16, IFN-gamma, MCP-1, and MIF were significantly higher in all groups of retinal detachment compared to ERM. Levels of CTACK, eotaxin, G-CSF, IP-10, MIG, SCF, SCGF-beta, SDF-1alpha were significantly higher in PVR compared to macula on RRD and ERM. Levels of IL-1ra, IL-5, IL-9, M-CSF, MIP-1alpha, and TRIAL were significantly higher in PVR compared to macula on RRD. Our results indicate that the position of macula lutea and the presence of PVR significantly influence vitreous cytokine expression. The detected proteins may serve as biomarkers to estimate the possibility of PVR formation and may help to invent personalized therapeutic strategies to slow down or prevent PVR.
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Affiliation(s)
- Anikó Balogh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Tibor Milibák
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Viktória Szabó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Miklós D. Resch
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- * E-mail:
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Reply. Retina 2020; 40:e6-e7. [PMID: 31972813 DOI: 10.1097/iae.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vail D, Pershing S, Reeves MG, Afshar AR. The Relative Impact of Patient, Physician, and Geographic Factors on Variation in Primary Rhegmatogenous Retinal Detachment Management. Ophthalmology 2020; 127:97-106. [DOI: 10.1016/j.ophtha.2019.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022] Open
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Garweg JG, Zandi S, Pfister I, Rieben R, Skowronska M, Tappeiner C. Cytokine profiles of phakic and pseudophakic eyes with primary retinal detachment. Acta Ophthalmol 2019; 97:e580-e588. [PMID: 30561135 PMCID: PMC6590374 DOI: 10.1111/aos.13998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/16/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the cytokine profiles of phakic (p) and pseudophakic (ps) eyes with primary rhegmatogenous retinal detachment (RD) to eyes with macular holes (MH) and to identify differences in the specific cytokine profiles. METHODS Aqueous humour (AH) and vitreous fluid (VF) were obtained from patients with primary RD without proliferative vitreoretinopathy undergoing vitrectomy. AH and VF of patients with macular holes (MH) served as controls. Forty-three different cytokines were quantified using multiplex cytokine analysis. Intergroup and intragroup comparisons were performed. To control for multiple comparisons, Holm's correction was applied. RESULTS VF and AH samples of 71 eyes with RD (pRD N = 38; psRD N = 33) and 26 eyes with MH were included. Cytokine levels in psRD and pRD were similar (none with >10-fold difference). The levels of 39 of 43 cytokines in the VF were significantly higher in eyes with RD than in those with MH (>10-fold: CXLC5, CCL26, CCL1, IL-6, CXCL11, CCL7, CCL13, MIG/CXCL9, CCL19 and TGF-β1). In the AH, 23 of 43 cytokines were significantly higher compared to MH (>10-fold: CXCL5, IL-4, IL-6, IL-8/CXCL8 and CCL7). CONCLUSION A complex, but nonspecific cytokine environmental response seems to initiate immunological and profibrotic processes following RD. Relevant differences in the cytokine profiles of eyes with pRD and psRD were not identified, whereas cytokine differences between AH and VF in RD could be explained by upregulation in the vitreous, a higher turn around in the anterior chamber, or differences in inflammatory cascades in both compartments.
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Affiliation(s)
- Justus G. Garweg
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases Berner Augenklinik am Lindenhofspital Bern Switzerland
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Souska Zandi
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases Berner Augenklinik am Lindenhofspital Bern Switzerland
| | - Isabel Pfister
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases Berner Augenklinik am Lindenhofspital Bern Switzerland
| | - Robert Rieben
- Department for BioMedical Research University of Bern Bern Switzerland
| | - Magdalena Skowronska
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases Berner Augenklinik am Lindenhofspital Bern Switzerland
- Department for BioMedical Research University of Bern Bern Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
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Ghazza A, Bakhsh M, Hajji I, Moutaouaki A. [Treatment of retinal detachment of the pseudophak: vitrectomy without episcleral indentation versus ab externo surgery]. Pan Afr Med J 2019; 32:44. [PMID: 31143349 PMCID: PMC6522180 DOI: 10.11604/pamj.2019.32.44.15489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Several factors predispose to the occurrence of rhegmatogenous retinal detachment, including cataract surgery, myopia, and degenerative lesions of the peripheral retina as well as eye trauma. This study aims to compare the anatomical and functional outcome of the two surgical techniques (AB interno vs AB externo) in our Hospital. We conducted a descriptive, retrospective study in the Department of Ophthalmology at the University Hospital Mohamed VI in Marrakech, over a period of 3 years, ranging from January 2013 to December 2015. During the study period we compared two groups of people: the first group undergoing surgery by an external approach (cryoapplication of the dehiscences with episcleral indentation) while the second undergoing surgery by endo-ocular approach. Group A or AB externo group included 26 eyes (26 patients) while Group B or vitrectomy with internal tamponade group included 22 eyes (22 patients). In the AB externo group, the average age was 54.92 years against 51.64 years in the AB interno group, with a slight predominance of males in both groups. After the first surgery, retinal reapplication was obtained in both groups with no significant difference, (about 80.76% in Group A versus 81.82% of the second group). In both groups failure was caused advanced vitreoretinal proliferation (4 cases), de novo breaks (3 cases) and breaks which had not been detected on first examinations (2 cases). All these cases underwent reoperation by AB interno approach: patients of group A underwent complete vitrectomy with revision of the indentation +/- internal limiting membrane peeling with internal gas tamponade while patients of group B underwent complementary vitrectomy with dissection of proliferative vitreoretinopathy (PVR) and an internal tamponade with silicone oil. After a mean follow-up period of 12 months, there was no significant difference in visual acuity between the 2 groups, with more than one third of the patients who had regained visual acuity between 1/10 and 5/10 (about 34,61% in AB externo group and 36,36% in AB interno group). Given the technological advances in vitrectomy, the current trend is the endo-ocular surgery however ab-externo surgery is mainly used in the treatment of retinal detachment with visible breaks which can be easily treated with indentation without advanced vitreoretineal proliferation (PVR A-B).
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Affiliation(s)
- Ahmed Ghazza
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
| | - Maha Bakhsh
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
| | - Ibtissam Hajji
- Service d'Ophtalmologie, CHU Mohamed VI, Marrakech, Maroc
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Choice of Primary Rhegmatogenous Retinal Detachment Repair Method in US Commercially Insured and Medicare Advantage Patients, 2003-2016. Am J Ophthalmol 2018; 196:82-90. [PMID: 30144442 DOI: 10.1016/j.ajo.2018.08.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate trends for rhegmatogenous retinal detachment (RRD) repair and the influence of patient characteristics on repair type in a large US population including children and adults, between 2003 and 2016. DESIGN Retrospective cohort study. METHODS Setting: Administrative claims for beneficiaries in a large nationwide managed-care network, including Medicare Advantage, employer-sponsored, and commercial insurance. POPULATION Beneficiaries undergoing RRD primary repair procedures. MAIN OUTCOME MEASURE RRD repair procedure type. RESULTS We identified 31 995 beneficiaries with RRD over the study period, mean age 59.8 years. Ocular comorbidities, including pseudophakia (16.9%), vitreous hemorrhage (14.6%), myopia (2.9%), and lattice degeneration (11.0%), were more common among RRD than non-RRD patients. Pars plana vitrectomy (PPV) was consistently the most common repair procedure, increasing over time. Scleral buckle utilization declined and utilization of other procedures remained relatively constant. After adjustment for age, demographics, and geographic region, PPV was more likely among patients with pseudophakia (OR = 1.81, P < .001) and vitreous hemorrhage (OR = 1.38, P < .001). Lattice degeneration (OR = 1.42, P < .001) and younger age were associated with higher odds of scleral buckle. Pneumatic retinopexy was more likely among patients with better systemic health and less likely among patients with ocular comorbidities including vitreous hemorrhage or lattice degeneration. CONCLUSIONS PPV is increasingly the most common RRD repair procedure across a broadly representative US population. However, other techniques are still preferred for some patients and, in aggregate, choice of repair procedure seems influenced by patient characteristics in a manner consistent with recommendations in the literature.
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Vidne O, Blum Meirovitch S, Rabina G, Abd Eelkader A, Prat D, Barequet D, Moisseiev J, Moisseiev E. Perfluorocarbon Liquid Vs. Subretinal Fluid Drainage during Vitrectomy for the Primary Repair of Rhegmatogenous Retinal Detachment: A Comparative Study. Curr Eye Res 2018; 43:1389-1394. [PMID: 29912572 DOI: 10.1080/02713683.2018.1490436] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare the anatomical and functional results achieved with subretinal fluid drainage (SRFD) and perfluorocarbon liquid (PFCL) use in patients with rhegmatogenous retinal detachment (RRD) treated by primary pars plana vitrectomy (PPV). METHODS The study included 162 eyes of 162 patients who underwent PPV for RRD, either with PFCL (n = 108) or SRFD (n = 54). The two groups were matched in 2:1 ratio for age, gender, and lens status. Groups were compared for rates of retinal reattachment, visual improvement, and the occurrence of recurrent RRD and any other postoperative complications. RESULTS Both groups had a single surgery success rate of 90.7%, and 100% of retinas were reattached by the end of follow-up. Both groups had similar final VA (0.30 ± 0.39 logMAR in the SRFD group and 0.35 ± 0.44 in the PFCL group; p = 0.48) and degrees of visual improvement (0.64 ± 0.75 logMAR in the SRFD group and 0.59 ± 0.89 in the PFC group; p = 0.71). Complication rates were also similar between groups. The rate of additional interventions was higher (although not statistically significant) in the PFCL group than the SRFD group, due to cases of PFCL retention (4.6% vs. 1.8%, respectively). CONCLUSIONS Both PFCL and SRFD achieved excellent results in terms of retinal reattachment and visual improvement, and have comparable safety profiles. A slightly higher rate of additional surgeries was found in the PFCL group. These findings indicate that PFCL are not necessary in routine PPV for RRD, as they do not improve the results achieved with SRFD and may be less cost-effective due to their higher price and potential for a higher rate of additional surgeries.
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Affiliation(s)
- Orit Vidne
- a Department of Ophthalmology , Sheba Medical Center , Ramat Gan , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | | | - Gilad Rabina
- c Department of Ophthalmology , Tel Aviv Medical Center , Tel Aviv , Israel
| | - Amir Abd Eelkader
- a Department of Ophthalmology , Sheba Medical Center , Ramat Gan , Israel
| | - Daphna Prat
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Dana Barequet
- c Department of Ophthalmology , Tel Aviv Medical Center , Tel Aviv , Israel
| | - Joseph Moisseiev
- a Department of Ophthalmology , Sheba Medical Center , Ramat Gan , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Elad Moisseiev
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department of Ophthalmology , Tel Aviv Medical Center , Tel Aviv , Israel
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SCLERAL SELF-INDENTATION DURING CHANDELIER-ASSISTED PERIPHERAL VITRECTOMY UNDER AIR FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Retrospective Cohort Study. Retina 2017; 39:358-363. [PMID: 29117070 DOI: 10.1097/iae.0000000000001955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate incidence of iatrogenic retinal breaks in eyes for whom self-indentation during chandelier-assisted peripheral vitrectomy under air, for primary retinal detachment, had been performed compared with eyes for whom a nonindentation chandelier-assisted peripheral vitrectomy under air had been performed. METHODS Retrospective cohort study. One hundred and thirty eyes with primary rhegmatogenous retinal detachment were identified. All the patients had undergone a chandelier-assisted peripheral vitrectomy under air. Scleral self-indentation had been used in 68 eyes (study group; indentation), whereas nonindentation had been used in 62 eyes (comparison; nonindentation). Outcome variables included the following: trimming-induced retinal breaks, retinal redetachment rate, final logMAR best-corrected visual acuity, and intraoperative complications. RESULTS The number of eyes with trimming-induced retinal break was statistically less in indentation group than in nonindentation group (0/68 and 3/62 eyes, 0% and 4.8%, respectively) (P = 0.04). Redetachment was observed in one eye (indentation) (1/68) and in three eyes (nonindentation) (3/62) (P = 0.267). There was no statistically significant difference in logMAR best-corrected visual acuity between both groups (P = 0.229). Chandelier repositioning was needed in 22 eyes (indentation) compared with 46 eyes (nonindentation) (P < 0.001). CONCLUSION Self-indentation, during chandelier-assisted peripheral vitrectomy under air, enables complete trimming of the vitreous base without causing iatrogenic retinal breaks, with a higher retinal reattachment rate, and with less need for chandelier repositioning than with nonindentation approach. By contrast with previous reports, we consider scleral self-indentation as an advantage for chandelier air vitrectomy.
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Abstract
PURPOSE To assess the decentration and angle of tilt of the intraocular lens (IOL) according to the intravitreal tamponade types used in combined phacoemulsification and vitreoretinal surgery. METHODS This prospective and randomized clinical study involved 73 eyes of 69 patients who underwent combined vitreoretinal surgery. Eyes with intravitreal tamponades formed the study group and eyes without intravitreal tamponades formed the control group. The study group was further divided into silicone oil and gas tamponade subgroups. Cross-sectional IOL images were captured using a Pentacam HR (Oculus, Germany) and tilt and decentration were calculated with Adobe Photoshop software (Adobe, San Jose, CA). RESULTS The mean angle of tilt and decentration at the vertical meridian were significantly higher in both tamponade groups than in the control group (P < 0.05 for all). No significant difference was observed among the groups regarding IOL position parameters at the horizontal meridian (P > 0.05). When comparing the silicone oil and gas tamponade subgroups, no significant differences were noted on the position of IOL at both meridians (P > 0.05 for all). CONCLUSION Intravitreal tamponades have an important effect on the position of IOL in combined vitreoretinal surgery. Silicone oil and gas tamponades may induce postoperative tilt and decentration of one-piece acrylic IOLs.
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Skondra D, Westerfeld C, Vavvas DG. Modified Controlled Encircling Scleral Buckle for Retinal Detachment. ACTA ACUST UNITED AC 2017; 1:314-316. [PMID: 29119143 DOI: 10.1177/2474126417725218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During encircling scleral buckle placement, the ends of the element are tightened to achieve a shortened radius of the eye. The determining factor of the final buckle height is subjective using usually a combination of the buckle height visualized with the degree of scleral indentation and can be difficult to be taught early on to trainees. Here, we describe a case series in which a modified controlled encircling scleral buckle technique that simplifies and standardizes the achievement of reproducible buckle height of about a 1 mm is objective and easy to be taught. This novel encircling scleral buckling technique successfully achieves a good postoperative scleral buckle height in a reproducible and standardized fashion using objective measurements and it is easier to be taught to trainees.
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Affiliation(s)
- Dimitra Skondra
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Infirmary, Harvard Medical School, Boston, MA, USA
| | - Corey Westerfeld
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Infirmary, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Infirmary, Harvard Medical School, Boston, MA, USA
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