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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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Hu JY, Ti SE, Chee SP. Risk factors affecting visual outcomes following dropped nucleus after cataract surgery. Eye (Lond) 2024; 38:253-258. [PMID: 37542173 PMCID: PMC10810779 DOI: 10.1038/s41433-023-02668-9] [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: 02/09/2023] [Revised: 06/03/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND/ AIMS To describe the visual outcomes in eyes with dropped nucleus during phacoemulsification surgery. SETTING Singapore National Eye Centre (SNEC). DESIGN Retrospective chart review of prospectively reported cases of dropped nucleus. METHODS The clinical charts of all cases of dropped nucleus (Jan 2001 to Dec 2016) were retrospectively reviewed for patient demographics, surgeon type, stage of surgery, timing of pars plana vitrectomy (PPV), and complications. Visual success was defined as best corrected visual acuity (BCVA) ≥ 20/40 at last review. Final risk factors affecting visual success were identified using multivariate logistic regression analysis. RESULTS Incidence of dropped nucleus following cataract surgery was 0.17% (n = 292). Duration of follow-up was 25.5 months (mean), 18.5 months (median). There was a statistically significant difference in dropped nucleus rate between Residents (0.3%) and Faculty (0.14%) (x2 = 38.2, P < 0.001), but ensuing major complications rates were similar. PPV was performed in 251 eyes (87.2%). At final examination, 202 cases (85.2%) achieved BCVA 20/40 or better, after excluding patients with co-existing ocular pathology. Timing of vitrectomy (delayed vs same-day) did not influence the final visual success (x2 = 0.969, p = 0.51). Risk factors for poor visual outcomes included age >70 years, absence of intraocular lens (IOL) implant, and presence of major complications. CONCLUSION Overall incidence of dropped nucleus in SNEC was 0.17%, with BCVA of 20/40 or better in 85.2% cases. Visual prognosis was influenced by patient's age, presence of IOL implant or additional major complications.
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Affiliation(s)
- Jeremy Youwei Hu
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, 11 Mandalay Rd, Singapore, 308232, Singapore
| | - Seng-Ei Ti
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Soon-Phaik Chee
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore.
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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Gonzalez-Lopez JJ, Arruza Santos ME, Leon Garcia J. Pars plana vitrectomy in patients aged 85 years and older: a single-centre, retrospective cohort study. Int Ophthalmol 2023; 43:4887-4896. [PMID: 37851142 PMCID: PMC10724084 DOI: 10.1007/s10792-023-02891-z] [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: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To describe the epidemiology, indications and surgical results of pars plana vitrectomy (PPV) in patients over 85 years of age. METHODS A retrospective cohort study was performed including all consecutive patients aged 85 years or older who underwent PPV between September 2018 and March 2022 in a single hospital in Madrid, Spain. Data on diagnosis, comorbidities, surgical indication, surgical details, surgical complications and surgical outcomes were collected from medical records. RESULTS A total of 124 eyes of 119 patients (56 males, 47.1%) underwent PPV. Median age was 87 years (range 85-96). The most common surgical indications were complications of cataract surgery in 34 patients (28.6%), macular epiretinal membrane in 32 (26.9%), and rhegmatogenous retinal detachment (RRD) in 12 (10.1%). Mean preoperative best corrected visual acuity (BCVA) was 13.33 ± 42.34 ETDRS letters and improved to 40.05 ± 41.04 letters at 3 months (p < 0.001). BCVA had improved in 68.82% of patients at 3 months. Patients with chronic kidney disease (CKD; p < 0.001), RRD (p = 0.003), ocular trauma (p = 0.001) and age-related macular degeneration (AMD; p = 0.002) showed worse BCVA at 3 months from surgery. Patients with better preoperative BCVA (p < 0.001), and those who underwent 25G PPV (p = 0.041) showed better visual outcomes. CONCLUSIONS PPV is an effective technique for improving visual acuity in patients aged 85 years and older with vitreoretinal diseases. Visual outcomes were better when patients had a better preoperative visual acuity and underwent 25G PPV. Patients with a previous diagnosis of AMD or CKD, and those undergoing surgery for ocular trauma or RRD had worse visual outcomes.
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Affiliation(s)
- Julio J Gonzalez-Lopez
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain.
- Surgery Department, Universidad de Alcala School of Medicine, Madrid, Spain.
| | - Maria E Arruza Santos
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain
| | - Jorge Leon Garcia
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 100, 28034, Madrid, Spain
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Shor R, Melo IM, Motekalem Y, Zajner C, Muni RH. Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment in Elderly Patients. Ophthalmol Retina 2023; 7:959-964. [PMID: 37459912 DOI: 10.1016/j.oret.2023.07.010] [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: 05/18/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE To assess clinical outcomes in elderly patients aged ≥ 75 years who underwent pneumatic retinopexy (PnR) for primary rhegmatogenous retinal detachment (RRD). DESIGN Retrospective cohort study. SUBJECTS Patients aged ≥ 75 years with primary RRD undergoing PnR. METHODS This study evaluates clinical outcomes among eligible patients who presented from October 1, 2010, to December 31, 2022, with a minimum of 3 months' follow-up. There were no limitations with respect to the number, size, or location of retinal breaks. Exclusion criteria included significant proliferative vitreoretinopathy or previous retinal detachment repair in the index eye, inability to maintain the postoperative posturing requirements or inability to carry out adequate examination of the peripheral retina because of media opacity. Lens status did not impact the decision to offer PnR. MAIN OUTCOME MEASURES Pneumatic retinopexy primary anatomic reattachment rate and postoperative best corrected visual acuity (BCVA) at 3 months. RESULTS Eighty patients with a mean age of 80.6 ± 4.6 years were included in this study; 35% (28/80) were phakic and 34% (27/80) presented with a fovea-on RRD. The mean number of breaks in the detached retina was 1.52 ± 1.13, and the mean number of quadrants of detached retina was 2.35 ± 0.93. The primary anatomic reattachment rate at 3 months after PnR was 78.8% (63/80), whereas the remaining 21.2% (17/80) failed PnR and underwent an operating room procedure. There was a statistically significant improvement in logarithm of the minimum angle of resolution (logMAR) BCVA from baseline to 3 months (1.29 ± 0.94 and 0.69 ± 0.67, respectively, P < 0.001). A subgroup analysis that only included patients aged > 80 years was also performed, with a total of 39 patients with a mean age of 84.4 ± 3.5 years. The primary anatomic reattachment rate with PnR in this subgroup was 74.4% (29/39), with a statistically significant improvement in BCVA from baseline to 3 months (1.4 ± 1.05 and 0.77 ± 0.70, respectively; P = 0.004). CONCLUSIONS Elderly patients treated with PnR for primary RRD had relatively comparable primary anatomic reattachment rates with other surgical techniques such as pars plana vitrectomy and scleral buckle. Pneumatic retinopexy is an effective, minimally invasive office-based procedure that may be desirable for some elderly patients. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Reut Shor
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yasmin Motekalem
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute, Toronto, Ontario, Canada.
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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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Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Aylward GW, Williamson TH. Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study. Eye (Lond) 2023; 37:1527-1537. [PMID: 37100934 PMCID: PMC10219959 DOI: 10.1038/s41433-023-02388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD). METHODS A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery. RESULTS There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C2F6 tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10-25%), and 10.1% are at high risk (>25%) of failure. CONCLUSIONS Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.
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Affiliation(s)
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - D A Laidlaw
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G W Aylward
- Moorfields Eye Hospital City Road, EC1V 2PD, London, UK
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Abumanhal M, Feldman I, Leibovitch I, Cnaan RB. Oculoplastic Surgeries in Patients Older than 90 Years of Age. Eur J Ophthalmol 2022; 32:2067-2071. [PMID: 35377245 DOI: 10.1177/11206721221086153] [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 report the epidemiology, indications and surgical outcomes of oculoplastic surgeries in older adults (≥ 90 years old). METHODS A retrospective study was conducted reviewing the medical charts of 114 patients aged 90 years old and older who underwent oculoplastic procedures from 2010 to 2020. Data retrieved from the medical records included: past medical and ocular history, indication for surgery, type of surgery, intra and post-operative complications, pathological analysis for removed tissues, and surgical outcome in the last follow-up. RESULTS One hundred and twenty eight surgeries were performed on 114 patients (male: female = 1:1). The mean age was 92.95 years old (± 3.12 SD). Six patients (5.2%) were older than 100 years old. The most common indication for surgery was lower lid malpositioning (32%). Mass/lesion excision was performed in 34 procedures (25%). Forty-three biopsies were analyzed and basal cell carcinoma was found to be the most common pathological diagnosis (32%). Hypertension was the most common associated systemic comorbidity (79 patients, 69%). 80% of the surgeries were performed under local anesthesia. Surgical revision was required in seven patients (5.2%). One patient had suffered from a minor stroke one day after the surgical pocedure. The same patient had orbital-skin fistulas after orbital exenteration. CONCLUSION In our experience, oculoplastic surgeries among the elderly population are safe without significant complications and can usually be performed under local anesthesia. Advanced age should not prevent surgery, especially if the procedure may improve vision and quality of life.
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Affiliation(s)
- Muhammad Abumanhal
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Feldman
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Igal Leibovitch
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Ran Ben Cnaan
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
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Elyashiv S, Fogel Levin M, Zloto O, Neimark E, Najjar R, Moisseiev J, Vidne-Hay O. Epidemiology of Pars Plana Vitrectomy in the Elderly: A Retrospective 10-Year Survey of 592 Cases. Clin Interv Aging 2021; 16:1007-1012. [PMID: 34103903 PMCID: PMC8179750 DOI: 10.2147/cia.s304683] [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: 01/31/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the epidemiology of the surgical indications of pars plana vitrectomy in patients aged 75 years or older. Patients and Methods The medical records of patients who underwent vitrectomy surgery in a single center between 2008 and 2018 were evaluated retrospectively for demographics, medical background, and surgical indications. Data on patients aged 75–85 were compared to those of patients older than 85 years and those recorded between 2008–2013 and 2014–2018. Results A total of 592 patients were included, of whom 55% were males. The mean±standard deviation age of the cohort at presentation was 80.4±4.60 years, and the mean visual acuity was 1.3±0.93 logMAR. The main indications for surgery were retinal detachment (n=117, 19.7%), epiretinal-membrane/vitreomacular traction (n=140, 23.6%), dropped intraocular lens/retained lens (n=89, 15%), macular hole (n=64, 11%), submacular hemorrhage (n=40, 6.7%), diagnostic vitrectomy (n=37, 6.2%), non-diabetic vitreous hemorrhage (n=30, 5.1%), and diabetic vitreous hemorrhage and other diabetic complications (n=33, 5.6%). Patients aged 85 years and older had higher rates of urgent surgeries (65%), such as for submacular hemorrhage and trauma (p=0.0000039 and p=0.001, respectively), and lower rates of non-urgent surgeries, such as for epiretinal membrane and macular hole (p=0.000032 and p=0.02, respectively), compared to patients aged 75–84 years. Additionally, the surgical rate for submacular hemorrhage decreased during 2008–2014 compared to 2014–2018 (p=0.000014). Conclusion Understanding the unique distribution of indications for vitrectomy among elderly patients is essential for appropriate management and treatment. Urgent cases represent 65% of the surgeries performed in the older population.
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Affiliation(s)
- Sivan Elyashiv
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Fogel Levin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Neimark
- Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Riham Najjar
- The Technion ─ Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Joseph Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Vidne-Hay
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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CHARACTERISTICS AND SURGICAL OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN OLDER ADULTS: A Multicenter Comparative Cohort Study. Retina 2021; 41:947-956. [PMID: 32858667 DOI: 10.1097/iae.0000000000002969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe characteristics and outcomes of primary rhegmatogenous retinal detachment in older adults (age ≥ 80). METHODS Consecutive patients with rhegmatogenous retinal detachment undergoing pars plana vitrectomy (PPV), scleral buckling (SB), or PPV/SB in the Primary Retinal Detachment Outcomes Study were evaluated. Outcome measures included single surgery anatomic success and visual acuity. RESULTS Of 2,144 patients included, 125 (6%) were 80 years or older. Compared with younger patients (age 40-79), older adults were more likely to be pseudophakic (P < 0.001), have macula-off detachments (P < 0.001), and have preoperative proliferative vitreoretinopathy (P = 0.02). In older adults, initial surgery was PPV in 73%, PPV/SB in 27%, and primary SB in 0%. Single surgery anatomic success was 78% in older adults compared with 84% in younger patients (P = 0.03). In older adults, single surgery anatomic success was 74% for PPV and 91% for PPV/SB (P = 0.03). The final mean logMAR was lower for older adults (0.79 [20/125] vs. 0.40 [20/40], [P < 0.001]). In older adults, the final mean logMAR for eyes that underwent PPV was 0.88 (20/160) compared with 0.50 (20/63) for PPV/SB (P = 0.03). CONCLUSION Octogenarians and nonagenarians presented with relatively complex pseudophakic rhegmatogenous retinal detachments. Single surgery anatomic success and visual outcomes were worse compared with younger patients, and PPV/SB had better outcomes compared with PPV alone.
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Chatziralli I, Chatzirallis A, Kazantzis D, Dimitriou E, Machairoudia G, Theodossiadis G, Parikakis E, Theodossiadis P. Predictive Factors for Long-Term Postoperative Visual Outcome in Patients with Macula-Off Rhegmatogenous Retinal Detachment Treated with Vitrectomy. Ophthalmologica 2021; 244:213-217. [PMID: 33465770 DOI: 10.1159/000514538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this prospective study was to evaluate potential predictive factors of long-term postoperative outcomes in patients with macula-off rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). METHODS Participants in this study were 86 patients diagnosed with macula-off RRD, who underwent PPV. Demographic characteristics and preoperative characteristics of RRD were recorded, while best corrected visual acuity (BCVA) was measured preoperatively and at specific postoperative time points (6 weeks and 6, 12, and 24 months). In addition, spectral domain-optical coherence tomography (SD-OCT) characteristics at postoperative week 6 were assessed as potential factors affecting the long-term postoperative visual outcome 24 months after PPV for RRD. RESULTS Increasing age, duration of RD of more than 1 week, presence of proliferative vitreoretinopathy, increasing central retinal thickness, ellipsoid zone disruption, and external limiting membrane disruption were significantly associated with a worse BVCA. BCVA was not associated with gender, lens status, the location of breaks, the gas tamponade agent used in PPV, the presence of subretinal fluid, and intraretinal fluid. CONCLUSIONS It is important to determine predictive factors for visual outcomes in order to inform patients about their prognosis and help in the decision-making process for patient management.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
| | | | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Yamashita K, Sakakura S, Ofuji Y, Sato M, Nagamoto T, Kubono H, Kawamura M, Suzuki K. Micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachments with posterior vitreous detachments in elderly patients: Preoperative characteristics and surgical outcomes. PLoS One 2021; 16:e0244614. [PMID: 33406140 PMCID: PMC7787454 DOI: 10.1371/journal.pone.0244614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/11/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose To assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group. Methods This retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications. Results Data were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients. Conclusions This study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.
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Affiliation(s)
- Kazuya Yamashita
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
- * E-mail:
| | - Saki Sakakura
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Yoshiko Ofuji
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Maho Sato
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | | | - Hirohisa Kubono
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Mari Kawamura
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Kotaro Suzuki
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
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