Cataract progression after primary pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachments in young adults

BACKGROUND

Scleral buckling is typically implemented to repair rhegmatogenous retinal detachments (RRD) in young patients. Therefore, there is limited data on post-pars plana vitrectomy (PPV) cataract formation in this cohort. We report the rates and risk factors of cataract progression after PPV for RRD repair in young eyes.

METHODS

Retrospective single-center cohort study. Medical records of patients between the ages of 15 to 45 undergoing PPV for uncomplicated RRD between 2014 and 2020 were reviewed.

RESULTS

Twenty-eight eyes from 26 patients met inclusion criteria. Cataracts developed in 20/28 (71%) eyes after PPV. After PPV, nuclear sclerotic cataract (NSC) rates were higher in patients above 35 (65%) compared to below 35 years (18%) (p = 0.024). Cataracts developed more frequently after macula-off RRDs (88%) compared to macula-on RRDs (50%) (p = 0.044) with NSC more common in macula-off detachments (p = 0.020). At postoperative month 2, all eyes with C3F8 gas developed cataracts compared to 59% of eyes with no gas (p = 0.040).

CONCLUSIONS

Cataract formation was common and frequent after PPV. After PPV, young eyes and macula-on detachments developed cataracts less frequently than older eyes and macula-off detachments. If appropriate, a shorter acting gas tamponade should be considered in young eyes to minimize cataract formation.

CHRONIC PEDIATRIC RETINAL DETACHMENT WITH MULTIPLE MACROCYSTS

PURPOSE

To describe a case of chronic pediatric retinal detachment with multiple macrocysts, its surgical management, and a review of the literature.

METHODS

Case report with fundus photography and optical coherence tomography.

RESULTS

We describe a case of an asymptomatic, 11-year-old boy with a chronic rhegmatogenous retinal detachment with multiple peripheral macrocysts. The patient had counting fingers visual acuity on presentation. The detachment was successfully surgically repaired with scleral buckling, subretinal fluid drainage, cryotherapy, and a SF6 tamponade. At the 12-month follow-up, the retina remained attached with improvement of visual acuity to 20/100 with resolution of the cysts. Optical coherence tomography revealed loss of macular ellipsoid zone. Genetic testing revealed a heterozygous dominant COL11A1 mutation.

CONCLUSION

To the authors' knowledge, this is the first reported case of chronic retinal detachment presenting with multiple peripheral macrocysts in a pediatric patient with Stickler syndrome. More research is needed into the cause and significance of retinal macrocysts, particularly in the pediatric population.

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

BACKGROUND

Scleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes.

METHODS

Retrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal-Wallis tests for numeric covariates between age groups.

RESULTS

Eyes were stratified by age: 15-24 (group 1, n = 10), 25-34 (group 2, n = 14), and 35-45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p < 0.001).

CONCLUSION

While the final reattachment rates were excellent in all groups, the higher rates of proliferative vitreoretinopathy and lower single surgery success rate in younger patients may suggest that primary pars plana vitrectomy may not be the optimal repair method in these age groups.

Late-Onset Retinal Findings and Complications in Untreated Retinopathy of Prematurity

PURPOSE

To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy.

DESIGN

Retrospective, nonconsecutive, noncomparative, multicenter case series.

PARTICIPANTS

Three hundred sixty-three eyes of 186 patients.

METHODS

Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings.

MAIN OUTCOME MEASURES

Rate of RDs and factors conferring a higher risk of RDs.

RESULTS

The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009).

CONCLUSIONS

Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.

Neurocysticercosis

Cysticercosis is a helmenthic infection involving pigs and man. Most cases of cysticercosis occur in developing countries. The disease is very rare in Islamic countries, as moslems are supposed to abstain from eating pork meat. In the last 10 years, reports of cysticercosis among moslems were published. Imigrants from endemic countries, who work as housemaids and food handlers played a role in transmitting the disease. Man becomes a definitive host if he ingests insufficiently cooked pork meat, which contains viable Iarvae of Taenia Solium or cysticerci. Neurocysticercosis denotes presence of a Taenia Solium larva cysts (Cysticercus cellulosae) in the brain parenchyma, meninges, or ventricular spaces. Neuroimaging by computerized tomography and magnetic resonance imaging are the best procedures to diagnose neurocysticercosis. Serological tests (EITB) or ELISA) are not sensitive as more than 50% of patients with neurocysticercosis have negative serology. Alpendazole and praziquentel are the most effective antihelmenthic drugs. Prevention of the disease and its complications as epilepsy is the management corner stone. A single dose of praziquentel for every emigrant from endemic areas will eradicate the adult tapeworm and reduce the incidence of neurocysticercosis. Physicians in moslem countries should be aware about the disease not only among immigrants but among moslems. We reviewed the available information about the disease epidemiologically, clinically, radiologically, laboratory tests, and methods of prevention.

Valproate associated acute pancreatitis

There is a definitive association between valproate therapy and acute pancreatitis. More than 50 cases have been reported. Most of the reported cases were mild yet there were a few more cases with higher morbidity and mortality. The risk is higher in patients under 20 years of age, during the first year of therapy, on the patient having encephalopathy or chronic renal failure and on patients with anti-epileptic drug polytherapy. The treatment of pancreatitis is supportive, laparotomy should be avoided. Re-challenge is hazardous and should be avoided.