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Wang M, Zhu J, Keyal K, Liao X, Chen L, Li H, Wang F. Evaluation of the Effect of Scleral Buckling on Anterior Segment and Refractive Changes Using Anterior Segment Optical Coherence Tomography. Semin Ophthalmol 2024; 39:74-82. [PMID: 37309176 DOI: 10.1080/08820538.2023.2223271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the changes of anterior segment and refractive parameters after scleral buckling (SB) surgery for uncomplicated rhegmatogenous retinal detachment (RRD) using anterior segment optical coherence tomography (AS-OCT). METHODS Thirty-six RRD eyes were consecutively enrolled. Analysis concerned the central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), iris-trabecular contact (ITC), angel opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA),trabecular iris angle (TIA) and refractive parameters, including average keratometry (AvgK), cylindrical power (CYL), regular astigmatism, asymmetry and high order irregularity (HOI) at baseline and 1 day, 1 month, 2 months, 6 months and 12 months postoperatively. AS-OCT was performed at RRD diagnosis and day 1, week 1, month 1 and month 6 after SB to evaluate the scleral buckling. RESULTS A statistically significant postoperative CCT increase, ACD and ACV decrease were observed at 1 day and 1 month postoperatively. ITC analysis showed that the angle of the entire circumference narrowed at 1 month postoperatively. There was a significant decrease in all the angle parameters (AOD500/750, ARA500/750, TISA500/750, and ARA500/750) at 1 day and 1 month after SB surgery. However, all of the above parameters returned to the preoperative level at 12 months. Refractive parameters including AvgK, regular astigmatism, CYL, asymmetry, and HOI of anterior corneal surface and total corneal increased on the 1 day and 1 month after SB surgery and persisted even after 12 months follow-up. However, there was no significant difference in refractive parameters of posterior corneal surface during follow-up. CONCLUSION The changes in the structure of anterior segments after SB surgery were almost returned to the preoperative levels at 12 months postoperatively. However, SB surgery has a long-term effect on refractive parameters throughout a 12-month follow-up.
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Affiliation(s)
- Minli Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Juming Zhu
- Department of Ophthalmology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School; The First people's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Khusbu Keyal
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xin Liao
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Lei Chen
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
- Shanghai Bright Eye Hospital, Shanghai, China
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Milner DC, Le C, Marin AI, Smith JM, Manoharan N. Outcomes of chronic macula-off retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2023; 261:709-714. [PMID: 36289075 PMCID: PMC9607701 DOI: 10.1007/s00417-022-05876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There have been disparate outcomes in the few studies that have looked at anatomic success and visual acuity (VA) in chronic retinal rhegmatogenous detachment (RRD) repair. Chronic retinal detachments (RD) without a posterior vitreous detachment (PVD) occur in young myopes often secondary to an atrophic hole. These patients are often asymptomatic, and studies report good surgical anatomic results. However, chronic RD with a PVD is symptomatic but presents late due to patient compliance. This paper aims to evaluate this lesser-studied chronic macula-off RD with PVD. METHODS After obtaining Institutional Review Board (IRB) approval, patients who had undergone surgical intervention for all diagnosis codes of RD were identified in the Denver Health Medical Center database. Medical records were reviewed, and patients found to have open-globe injuries, tractional RD due to proliferative diabetic retinopathy, macula-on detachments, and RD due to previous ocular surgery were excluded. Similarly, patients without PVD were also excluded. A total of 37 patients with PVD-type chronic macula-off RD were thus identified and preoperative characteristics, surgical intervention, and complications were analyzed. RESULTS The average patient age was 53.8 years. The length of RRD duration ranged from 30 to 365 days (mean 136.7 days). Twenty-six (70.3% patients had proliferative vitreoretinopathy (PVR) grade C or greater. Initial anatomic success-defined as re-attachment after one surgery-was 54.1%. The final attachment was 94.6%. Fifteen of 37 (40.5%) of the patients had issues with drop adherence, positioning, or missing post-operative appointments. CONCLUSION Chronic macula-off RD with a PVD should be identified as it is associated with much lower rates of initial re-attachment. Socioeconomic factors likely are the driving factor for patients with PVD-type chronic macula-off RD to present late, struggle with positioning, and have difficulty with follow-up and drop compliance. These extended periods without treatment then lead to high rates of PVR and poor initial anatomic success. However, repair of PVD-type chronic macula-off RD should still be pursued as final anatomic success is high.
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Affiliation(s)
- Dallin C Milner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Christopher Le
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA
| | - Alejandro I Marin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jesse M Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA. .,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA. .,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
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Carlsson J, Fricke O, Dahlberg A, Crafoord S. Retinal surgery quality indicators for uncomplicated primary rhegmatogenous retinal detachment without a national registry. Acta Ophthalmol 2022; 100:e1589-e1594. [PMID: 35347861 PMCID: PMC9790464 DOI: 10.1111/aos.15138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/23/2022] [Accepted: 03/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres. METHODS In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re-detachment and/or serious postoperative complication would be reported back. RESULTS The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis. CONCLUSION Our hypothesis that data in the surgical department's medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals.
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Affiliation(s)
| | - Otto Fricke
- Department of OphthalmologyLinköping UniversityLinköpingSweden
| | - Anton Dahlberg
- Department of OphthalmologyÖrebro University HospitalÖrebroSweden
| | - Sven Crafoord
- Faculty of Medicine and Health, Department of OphthalmologyÖrebro UniversityÖrebroSweden
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Dhoot AS, Popovic MM, Nichani PAH, Eshtiaghi A, Mihalache A, Sayal AP, Yu H, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy versus Scleral Buckle: A Comprehensive Meta-Analysis of 15,947 Eyes. Surv Ophthalmol 2021; 67:932-949. [PMID: 34896191 DOI: 10.1016/j.survophthal.2021.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P=0.005). SB had a better final BCVA compared to PPV in observational studies (P=0.007) but not in RCTs (P=0.21). SB had a lower incidence of post-operative cataract formation (P<0.00001) and iatrogenic breaks (P<0.00001), but a higher incidence of choroidal hemorrhage (P=0.007), choroidal detachment (P=0.004), and residual subretinal fluid (RSRF) (P<0.00001). Primary (86.5% vs. 84.8%; P=0.13) and final (96.7% vs. 97.7%; P=0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P=0.02) but not in observational studies (P=0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.
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Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Yu
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Charles C Wykoff
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, 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.
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Reeves MGR, Afshar AR, Pershing S. Need for Retinal Detachment Reoperation Based on Primary Repair Method Among Commercially Insured Patients, 2003-2016. Am J Ophthalmol 2021; 229:71-81. [PMID: 33895151 PMCID: PMC10728497 DOI: 10.1016/j.ajo.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine associations between primary repair, patient characteristics, and rhegmatogenous retinal detachment (RRD) reoperation. DESIGN Retrospective cohort study. METHODS We used administrative claims to identify enrollees with incident RRD treatment by laser barricade, pneumatic retinopexy (PR), pars plana vitrectomy (PPV), or scleral buckle (SB) between 2003 and 2016. Analysis excluded patients with less than 3 years of continuous enrollment, previous RRD diagnosis, or repair. We determined reoperation frequency (PPV, PR, or SB) within 90 days postrepair and used multivariable logistic regression to identify associations between reoperation and patient and primary repair characteristics. RESULTS Of 16,190 patients with documented primary RRD repair, 2,918 (18.0%) required reoperation within 90 days. Reoperation was significantly associated with male sex (odds ratio [OR] 1.24, P < .001), pseudophakia (OR 1.25, P < .001), vitreous hemorrhage (OR 1.22, P = .001), and worse systemic health (OR 1.19-1.25, P < .05, for Charlson Comorbidity Index ≥3). Pseudophakia had higher reoperation odds after all primary procedures except PPV. In addition, 28.7% of primary PR cases required reoperation, vs 19.1% of SB and 17.9% of PPV repairs. Adjusting for other patient characteristics, PR had highest odds of reoperation (OR 1.90, P < .001, vs primary PPV). Primary laser barricade had lowest odds of reoperation (OR 0.49, P < .001). PPV was the most frequent reoperation procedure. CONCLUSIONS Nearly 1 in 5 patients require reoperation within 90 days after primary RRD repair. Cases requiring only primary laser barricade had lowest reoperation odds, likely representing less severe RRDs. Primary PR had highest reoperation odds; PPV and SB were similar to each other. These findings are important for patient education and surgical decision-making.
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Affiliation(s)
- Mary-Grace R Reeves
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, (M.G.R.R., S.P.), Palo Alto
| | - Armin R Afshar
- Department of Ophthalmology, Wayne and Gladys Valley Center for Vision, University of California, (A.R.A.), San Francisco
| | - Suzann Pershing
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, (M.G.R.R., S.P.), Palo Alto; Veterans Affairs Palo Alto Health Care System, (S.P.), Palo Alto, California, USA.
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Thylefors J, Zetterberg M, Jakobsson G. Anatomical outcome of retinal detachment surgery comparing different surgical approach. Acta Ophthalmol 2021; 99:e908-e913. [PMID: 33258226 DOI: 10.1111/aos.14678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013. METHOD All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal. RESULTS In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re-detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach. CONCLUSIONS There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.
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Affiliation(s)
- Joakim Thylefors
- Department of Ophthalmology Skåne University Hospital Lund Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
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Management of uncomplicated primary retinal rhegmatogenous detachment. Int Ophthalmol 2021; 41:1709-1716. [PMID: 33511514 DOI: 10.1007/s10792-021-01729-w] [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: 05/07/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN This was a retrospective, nonrandomized consecutive case series study. PARTICIPANTS Six hundred and eighty-three eyes with primary uncomplicated RRD between 2013 and 2017 were included in this study. METHOD Patients were treated by one of the following methods: pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV with SB (PPV + SB). The success rate was divided into an anatomical and functional one, the anatomical success rate was retinal reattachment, and the functional success rate was defined as a statistically significant improvement in BCVA patients within a 6-month follow-up period. RESULTS This study involved 683 eyes; of these, 79 eyes underwent PPV, combined PPV/SB was performed on 180 eyes, and 424 eyes underwent SB. The anatomical success rates were 83.5% for PPV and 80% for combined SB/PPV. The anatomical success rate for the SB group was 75.5%. There were no significant differences between these groups in terms of anatomical success rates (0.191) or functional success rates (p = 0.534). There was no significant difference between the PPV alone and PPV + SB in terms of the likelihood of anatomic success (p-value: 0.503) or functional success (p-value: 0.839). Preoperative worse BCVA and presence of PVR were associated with poor prognosis (p-value: 0.024, 0.013, respectively). CONCLUSION In the setting of appropriate instruments for microincision pars plana deep vitrectomy, it seems the surgical outcomes of scleral buckling and PPV are not different in patients with primary uncomplicated RRD. The supplementary band has not additional benefits in patients who underwent PPV with this type of RRD.
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Jia LY, Sun YX, Zhang YP, Ma K. Risk Factors of Recurrent Retinal Detachment Following Surgical Treatment for Rhegmatogenous Retinal Detachment: A Retrospective Study. Risk Manag Healthc Policy 2020; 13:3165-3171. [PMID: 33408538 PMCID: PMC7779298 DOI: 10.2147/rmhp.s288777] [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: 10/29/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To identify potential risk factors for recurrent retinal detachment after surgical treatment for rhegmatogenous retinal detachment with choroidal detachment (RRD-CD) in a Chinese population. Methods A total of 1212 patients with RRD-CD admitted to Beijing Tongren Hospital from 2004 to 2018 were reviewed retrospectively. The rate of recurrent retinal detachment was calculated, and risk factors were analyzed by logistic regression analysis. Results The average age of the patients was 48.51 years, 760 patients (62.7%) were male, and 630 patients (52.0%) had right eye disease. The recurrence rate in the same eye was 21.3%. The incidence of recurrence retinal detachment was higher in patients who were male, middle age, and with poor preoperative vision, longer axial length, and scleral buckling. Recurrence usually occurred 3 months after surgery. Conclusion Male, middle age, longer axial length, and scleral buckling could be risk factors for recurrent retinal detachment following surgical treatment in patients with RRD-CD.
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Affiliation(s)
- Li-Yun Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan-Xia Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kai Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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Sharma RK, Akkawi MT, Shehadeh MM, Aghbar AA, Qaddumi J. Anatomical and Visual Outcomes of Scleral Buckling Surgery in Rhegmatogenous Retinal Detachment. Middle East Afr J Ophthalmol 2020; 27:100-104. [PMID: 32874042 PMCID: PMC7442081 DOI: 10.4103/meajo.meajo_94_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 01/18/2019] [Accepted: 06/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE: The aim of this study is to evaluate the short anatomical and visual outcomes of scleral buckling surgery in relation to the pattern of presentation of rhegmatogenous retinal detachment (RRD) in the presence of different situations and risk factors. METHODS: A total of 206 eyes of 203 patients who underwent scleral buckling surgery for RRD were evaluated in this retrospective study. Information retrieved included patient demographics, duration of symptoms, and presenting vision, lens status, site of a retinal break, extent of retinal detachment, the involvement of the fellow eye, macular involvement, presence of lattice degeneration, and associated refractive errors. Postoperative retinal reattachment, postoperative visual acuity, the need for further surgical intervention, intraoperative, and postoperative complications were also evaluated. Proportions and percentages were used to analyze data. RESULTS: Primary anatomical reattachment was seen in 172 eyes (83.5%) after the complete resolution of the tamponade used. The mean best-corrected visual acuity improved from 2.81 logarithms of the minimum angle of resolution (LogMar) preoperatively to 1.21 LogMar postoperatively, the most important factors that appeared statistically significantly affecting the anatomic and visual outcome were the duration of macular detachment (P = 0.036), the status of the lens; phakic eyes gave better visual outcome than aphakic and pseudophakic eyes (P < 0.05). CONCLUSION: Scleral buckling procedure showed high structural and visual success rates, improvement of visual acuity was found to correlate well with the shorter duration of macular detachment and pseudophakic eyes. We believe that scleral buckling, when done appropriately in the appropriate cases, gives the maximum visual outcome with the least cost and need for consecutive procedures.
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Affiliation(s)
- Raj K Sharma
- Retina Unit of R.M Sahai Eye Hospital and Research Center, Jaipur, Rajasthan, India
| | - Mohammad T Akkawi
- Retina Unit of R.M Sahai Eye Hospital and Research Center, Jaipur, Rajasthan, India.,Department of Ophthalmology, Faculty of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Mohammad M Shehadeh
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.,Department of Ophthalmology, Faculty of Medicine, Vardinoyannion Eye Institute of Crete, University of Crete, Heraklion, Crete, Greece
| | - Ammar A Aghbar
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Jamal Qaddumi
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
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10
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Shu I, Ishikawa H, Nishikawa H, Morikawa S, Okamoto F, Sakamoto T, Sugimoto M, Kondo M, Iwasaki M, Kinoshita T, Toibana T, Mitamura Y, Takamura Y, Motohashi R, Shimura M, Sakurai Y, Takeuchi M, Gomi F. Scleral buckling versus vitrectomy for young japanese patients with rhegmatogenous retinal detachment in the era of microincision surgery: real-world evidence from a multicentre study in Japan. Acta Ophthalmol 2019; 97:e736-e741. [PMID: 30741467 DOI: 10.1111/aos.14050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/12/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate real-world evidence for young Japanese patients with rhegmatogenous retinal detachment (RRD) by retrospectively examining surgical procedures and clinical outcomes in the Japan Clinical Retina Study group. METHODS This was a multicentre retrospective study of the medical records of 562 young patients (384 males and 178 females; mean age: 33.0 ± 11.8 years) who had been diagnosed with RRD and who underwent surgical procedures in participating centres during the period between April 2013 and August 2016. RESULTS The selected surgeries were scleral buckling (SB) for 295 eyes (49.7%) and pars plana vitrectomy (PPV) for 262 eyes (44.1%). Between the two surgical procedures, there was no significant difference in the primary anatomical reattachment rate (PARR, SB = 92.2%, PPV = 93.9%); improvements in vision were noted in both groups. The incidences of proliferative vitreoretinopathy and cataract formation within 1 year of PPV were 2.3% (p = 0.0047) and 6.5% (p = 0.0005), whereas they were 0% and 1.0% in the SB group, respectively. CONCLUSION Scleral buckling (SB) and PPV were chosen with almost equal frequency for young patients with RRD. Clinical outcomes for SB and PPV exhibited a similar PARR. The incidence of cataract formation after PPV may constitute an important limitation of the procedure.
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Affiliation(s)
- Ingen Shu
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| | - Hiroto Ishikawa
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| | - Hiroki Nishikawa
- Center for Clinical Research and Education Hyogo College of Medicine Nishinomiya Japan
| | - Shohei Morikawa
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Fumiki Okamoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Taiji Sakamoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Masahiko Sugimoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Mie University Tsu Japan
| | - Mineo Kondo
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Mie University Tsu Japan
| | - Masanori Iwasaki
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Sapporo City General Hospital Sapporo Japan
| | - Takamasa Kinoshita
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Sapporo City General Hospital Sapporo Japan
| | - Toshi Toibana
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokushima University Tokushima Japan
| | - Yoshinori Mitamura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokushima University Tokushima Japan
| | - Yoshihiro Takamura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Fukui University Yoshida Japan
| | - Ryosuke Motohashi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokyo Medical University Hachioji Medical Center Hachioji Japan
| | - Masahiko Shimura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokyo Medical University Hachioji Medical Center Hachioji Japan
| | - Yutaka Sakurai
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology National Defense Medical College Tokorozawa Japan
| | - Masaru Takeuchi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology National Defense Medical College Tokorozawa Japan
| | - Fumi Gomi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
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11
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Rijal RK, Mourya D. The feasibility and efficacy of intraoperative laser retinopexy in scleral buckling surgery. Oman J Ophthalmol 2019; 12:84-87. [PMID: 31198292 PMCID: PMC6561036 DOI: 10.4103/ojo.ojo_255_2017] [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: 11/04/2022] Open
Abstract
BACKGROUND This study was performed to assess the feasibility and efficacy of intraoperative laser retinopexy in scleral buckling (SB) surgery. MATERIALS AND METHODS This was a retrospective, noncomparative, and interventional study. Records of 25 patients who had undergone intraoperative laser retinopexy during SB were retrospectively analyzed. RESULTS All patients were phakic and macula was off in all cases. Adequate intraoperative laser retinopexy was achieved in 22 (88%) patients, and 3 (12%) patients required additional postoperative laser. Retina was attached in all patients at 6-month follow-up. CONCLUSION Intraoperative laser retinopexy can give comparable results to cryoretinopexy with lesser postoperative complications in SB surgery. Although further comparative studies are needed, this study establishes the feasibility of intraoperative laser retinopexy in SB which has never been described before in the literature as per our knowledge.
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Affiliation(s)
| | - Deepesh Mourya
- Department of Vitreo Retinal Services, Akhand Jyoti Eye Hospital, Patna, Bihar, India
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12
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Loukovaara S, Haukka J. Repair of primary RRD - comparing pars plana vitrectomy procedure with combined phacovitrectomy with standard foldable intraocular lens implantation. Clin Ophthalmol 2018; 12:1449-1457. [PMID: 30147297 PMCID: PMC6101008 DOI: 10.2147/opth.s171451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Pars plana vitrectomy (PPV) combined with phacoemulsification and primary intraocular lens implantation can be performed for the repair of primary rhegmatogenous retinal detachment (RRD; PHACOVIT group). The safety and efficacy of this combined ophthalmic procedure on RRD surgery outcomes remain unclear compared with more conventional PPV technique alone (VITRET group). We explored the need for reoperation after primary surgical procedure in these two groups. Methods Retrospective, longitudinal, register-based cohort of RRD patients was operated in University Eye Clinic, Helsinki, Finland, during 2008–2014. The main outcome measure was reoperation rate during a postoperative follow-up period of 1 year due to retinal re-detachment, vitreous rehemorrhage, postoperative endophthalmitis, secondary pucker, macular hole or other reasons. Results We analyzed 1,690 consecutive RRD cases, out of which 1,564 patients were treated in the PPV VITRET group and 126 patients in the PHACOVIT-operated group. Risk for reoperation was 2.67 times higher in the PHACOVIT group compared to the PPV VITRET group (95% CI 1.85–3.85). Conclusion The reoperation rate was higher in RRD eyes operated with combined cataract surgery plus PPV, suggesting that RRD eyes should not primarily undergo combined PHACOVIT surgery.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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13
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Loukovaara S, Sahanne S, Takala A, Haukka J. Statin use and vitreoretinal surgery: Findings from a Finnish population-based cohort study. Acta Ophthalmol 2018; 96:442-451. [PMID: 29338115 DOI: 10.1111/aos.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy. METHODS Our historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008-2014, covering 6.5 years. Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication. The primary end-point event was revitrectomy during a postoperative follow-up period of 1 year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole. RESULTS Rhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18-0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53-0.97), but not in absolute scale (incidence rate difference -0.58, 95% CI -4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups. CONCLUSION Use of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery; Department of Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Sari Sahanne
- Department of Anesthesiology and Intensive Care Medicine; Helsinki University Hospital; Helsinki Finland
| | - Annika Takala
- Department of Anesthesiology and Intensive Care Medicine; Helsinki University Hospital; Helsinki Finland
| | - Jari Haukka
- Department of Public Health; University of Helsinki; Helsinki Finland
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14
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Santos FM, Gaspar LM, Ciordia S, Rocha AS, Castro E Sousa JP, Paradela A, Passarinha LA, Tomaz CT. iTRAQ Quantitative Proteomic Analysis of Vitreous from Patients with Retinal Detachment. Int J Mol Sci 2018; 19:ijms19041157. [PMID: 29641463 PMCID: PMC5979392 DOI: 10.3390/ijms19041157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 12/15/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition characterized by a physical separation between neurosensory retina and retinal pigment epithelium. Quantitative proteomics can help to understand the changes that occur at the cellular level during RRD, providing additional information about the molecular mechanisms underlying its pathogenesis. In the present study, iTRAQ labeling was combined with two-dimensional LC-ESI-MS/MS to find expression changes in the proteome of vitreous from patients with RRD when compared to control samples. A total of 150 proteins were found differentially expressed in the vitreous of patients with RRD, including 96 overexpressed and 54 underexpressed. Several overexpressed proteins, several such as glycolytic enzymes (fructose-bisphosphate aldolase A, gamma-enolase, and phosphoglycerate kinase 1), glucose transporters (GLUT-1), growth factors (metalloproteinase inhibitor 1), and serine protease inhibitors (plasminogen activator inhibitor 1) are regulated by HIF-1, which suggests that HIF-1 signaling pathway can be triggered in response to RRD. Also, the accumulation of photoreceptor proteins, including phosducin, rhodopsin, and s-arrestin, and vimentin in vitreous may indicate that photoreceptor degeneration occurs in RRD. Also, the accumulation of photoreceptor proteins, including phosducin, rhodopsin, and s-arrestin, and vimentin in vitreous may indicate that photoreceptor degeneration occurs in RRD. Nevertheless, the differentially expressed proteins found in this study suggest that different mechanisms are activated after RRD to promote the survival of retinal cells through complex cellular responses.
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Affiliation(s)
- Fátima Milhano Santos
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Chemistry Department, Faculty of Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal.
- Laboratory of Pharmacology and Toxicology-UBIMedical, University of Beira Interior, 6200-284 Covilhã, Portugal.
| | - Leonor Mesquita Gaspar
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Chemistry Department, Faculty of Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal.
| | - Sergio Ciordia
- Unidad de Proteomica, Centro Nacional de Biotecnología, CSIC, Calle Darwin 3, Campus de Cantoblanco, 28049 Madrid, Spain.
| | - Ana Sílvia Rocha
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Chemistry Department, Faculty of Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal.
| | - João Paulo Castro E Sousa
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Hospital Center Leiria-Pombal, 3100-462 Pombal, Portugal.
| | - Alberto Paradela
- Unidad de Proteomica, Centro Nacional de Biotecnología, CSIC, Calle Darwin 3, Campus de Cantoblanco, 28049 Madrid, Spain.
| | - Luís António Passarinha
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Laboratory of Pharmacology and Toxicology-UBIMedical, University of Beira Interior, 6200-284 Covilhã, Portugal.
| | - Cândida Teixeira Tomaz
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal.
- Chemistry Department, Faculty of Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal.
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