Surgical Outcomes of Rhegmatogenous Retinal Detachment and Fellow Eye Involvement in Adolescent and Young Adult Patients

PURPOSE

To investigate the associations, fellow eye retinal tear or detachment, and surgical outcomes of rhegmatogenous retinal detachments (RRDs) in young adults.

DESIGN

Retrospective consecutive case series.

SUBJECTS

Patients aged ≤ 30 years who underwent surgical repair for RRD between 2014 and 2021 at a single practice. The mean age was 23.85 years (range, 12-30 years).

METHODS

Data collected included demographics, preoperative clinical features of the RRD, visual acuity (VA), type of surgery performed, anatomic outcomes, OCT findings, fellow eye retinal tear or detachment, and postoperative complications.

MAIN OUTCOME MEASURES

Postoperative VA and single-surgery anatomic success rate.

RESULTS

One hundred one patients (109 eyes) were included. Sixty-seven patients (74 eyes) and 17 patients (19 eyes) were followed for ≥ 1 year and 5 years, respectively. The most common associations were myopia (66 eyes, 60.6%), trauma (8 eyes, 7.3%), and prior ocular surgery (7 eyes, 6.4%). Median preoperative Snellen VA was 20/70. The macula was attached in 31 eyes. Scleral buckle (SB) alone was performed in 75 eyes, pars plana vitrectomy (PPV) + SB was performed in 27 eyes, PPV alone was performed in 6 eyes, and cryotherapy with pneumatic retinopexy was performed in 1 patient. Single-surgery anatomical success was 88.7% for SB, 89.7% for PPV + SB, and 75% for PPV. The median final postoperative Snellen VA was 20/50. Twelve patients presented with bilateral RRDs, and sequential surgery was performed in 8 patients, followed by 4 patients who underwent surgery with fellow eye laser barricade. Fourteen patients (13.9%) developed a retinal tear or detachment in the fellow eye, with a mean interval of 8 months from presentation. Of the 17 patients who were followed for ≥ 5 years, 3 patients (17.6%) developed a fellow eye retinal tear or detachment. After initial anatomical success, 6 eyes (5.5%) developed proliferative vitreoretinopathy.

CONCLUSIONS

The most common association of RRD in this study was myopia. Scleral buckle alone was the most common surgical intervention. However, outcomes were generally favorable with SB-only and PPV + SB. Surgeons and patients should be aware of the risk of bilateral retinal detachment and the risk of fellow eye retinal tear and detachment. These patients require long-term surveillance in both eyes.

FINANCIAL DISCLOSURE(S)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Laser Marking of the Meridian of Retinal Breaks at the Ora: A Novel Technique for Pneumatic Retinopexy

BACKGROUND AND OBJECTIVE

Localization of retinal breaks in rhegmatogenous retinal detachment (RRD) after pneumatic retinopexy (PR) can be challenging once the retina is reattached. Laser can be applied to the pigmented and always-attached ora serrata in the meridian of the retinal breaks prior to pneumatic retinopexy, resulting in subsequent rapid localization of the breaks even in the presence of a gas bubble or media opacity.

PATIENTS AND METHODS

Ten cases of indirect laser photocoagulation marking at the ora prior to intraocular gas injection in PR for RRD. Subsequent laser retinopexy was completed 48 hours after utilizing the landmarks at the ora to localize the reattached retinal breaks.

RESULTS

In all 10 cases, laser photocoagulation marking was easily applied to the ora in the meridian of the retinal breaks prior to gas injection with no complications. The retinal breaks were subsequently identified 48 hours after gas injection.

CONCLUSION

Laser marking of the ora prior to pneumatic retinopexy is a rapid and effective way to localize the re-attached retina breaks. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:570-572.].

Can general surgeons evaluate visceral slide with transabdominal ultrasound to predict safe sites for primary laparoscopic port placement? A prospective study of sonographically naïve operators at a tertiary center

BACKGROUND

Port placement injuries are a potentially devastating complication of laparoscopic surgery. Ultrasound assessment for visceral slide has the ability to preoperatively determine adhesion-free areas. The utility of this technique has not been studied when performed by surgeons.

METHODS

Surgeons without expertise in ultrasound were taught the visceral slide technique. Patients with a history of abdominal surgery were then assessed for adhesion-free areas on the abdominal wall. Ultrasound assessments were validated against intraoperative visualization.

RESULTS

Nine surgeons using the visceral slide technique assessed 145 patients for the presence of adhesions immediately before surgery. Surgeon who performed ultrasound demonstrated a sensitivity of 69.6%, specificity of 98.7%, and positive predictive value of 99.5% for detection of areas free from critical adhesions. The median time to perform the examination was 2 minutes.

CONCLUSION

The visceral slide technique was easily learned, was rapid to perform, and reliably identified adhesion-free areas of the abdominal wall.