Akiyama, Kunihiko; Fujinami, Kaoru; Watanabe, Ken; Tsunoda, Kazushige; Noda, Toru
To determine the efficacy of internal limiting membrane (ILM) peeling during vitrectomy for rhegmatogenous retinal detachment (RRD) regarding post-vitrectomy epiretinal membrane (ERM) development and visual outcomes. Retrospective, interventional, comparative case series. Setting: Institutional. One hundred and two consecutive eyes with RRD treated with vitrectomy and followed for at least 6 months. ILM was peeled without using dye such as indocyanine green (ICG). Observational Procedures: Patients were divided into 2 groups based on postoperative ERM development: Group 1, 81 eyes without ERM formation; Group 2, 21 eyes with ERM development. Patients also were divided into 2 subgroups: those with and without ILM peeling (58 and 44 eyes, respectively). Statistical analyses were performed between the 2 groups with/without ERM formation and between the 2 subgroups with/without ILM peeling for 5 preoperative factors including foveal involvement of the RRD, 4 intraoperative factors including ILM peeling, baseline best-corrected visual acuity (BCVA), and final BCVA. An association of ILM peeling with ERM prevention and the influence of ILM peeling on visual outcomes. ILM peeling was significantly (P < .001) associated with ERM prevention. There was no significant difference in the final BCVA between subgroups with and without ILM peeling. ILM peeling without ICG staining during the initial vitrectomy for RRDs may prevent postoperative ERM formation with favorable visual outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
Ogata, Masafumi; Suzuki, Takahiro; Nakagawa, Yoshihiro; Hayakawa, Kenji; Kawai, Kenji
Treating Coat's disease with exudative retinal detachment remains a challenge, since vitreous surgery is frequently accompanied by serious complications such as secondary glaucoma. A 25-year-old woman with Coat's disease of the right eye had cystic exudative retinal detachment along the naso-inferior vessels at the peripheral retina, due to 5-o'clock telangiectasia. Right visual acuity was finger counting. This patient underwent vitrectomy simultaneously with cataract surgery, completed with silicone oil replacement, with thorough drainage of subretinal exudates through the artificial break. Although the complication of secondary glaucoma developed as a result of using silicone oil, approximately three years after the operation, this condition was ameliorated by removing the silicone oil. Thus, blindness was prevented in this patient. Long-term tamponade with silicone oil facilitates performing vitreous surgery in this patient suffering from Coat's disease associated from exudative retinal detachment.
Cavallerano, A A
Retinal detachment is a separation of the neurosensory retina from the retinal pigment epithelium. Most retinal detachments are rhegmatogenous, and identification of risk factors and predisposing lesions are important aspects of patient management. Retinal detachment is relatively rare, but can pose a significant threat to vision if there is macular involvement. Prompt diagnosis combined with patient education and appropriate intervention often can avert irrevocable visual impairment. This paper presents an overview of the categories of retinal detachment, discusses the pathogenesis of the various types of detachment, and provides recommendations for primary care of patients with predisposing factors and high-risk characteristics.
Introduction Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment, where a retinal "break" allows the ingress of fluid from the vitreous cavity to the subretinal space, resulting in retinal separation. It occurs in about 1 in 10,000 people a year. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent progression from retinal breaks or lattice degeneration to retinal detachment? What are the effects of different surgical interventions in people with rhegmatogenous retinal detachment? What are the effects of interventions to treat proliferative vitreoretinopathy occurring as a complication of retinal detachment or previous treatment for retinal detachment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: corticosteroids, cryotherapy, daunorubicin, fluorouracil plus low molecular weight heparin, laser photocoagulation, pneumatic retinopexy, scleral buckling, short-acting or long-acting gas tamponade, silicone oil tamponade, and vitrectomy. PMID:21406128
Introduction Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment, where a retinal "break" allows the ingress of fluid from the vitreous cavity to the subretinal space, resulting in retinal separation. It occurs in about 1 in 10,000 people a year. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent progression from retinal breaks or lattice degeneration to retinal detachment? What are the effects of different surgical interventions in people with rhegmatogenous retinal detachment? What are the effects of interventions to treat proliferative vitreoretinopathy occurring as a complication of retinal detachment or previous treatment for retinal detachment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 20 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: corticosteroids; cryotherapy; daunorubicin; fluorouracil plus low-molecular-weight heparin; laser photocoagulation; pneumatic retinopexy; scleral buckling; short-acting or long-acting gas tamponade; silicone oil tamponade; and vitrectomy. PMID:19450333
... immediately. Treatment How is retinal detachment treated? Small holes and tears are treated with laser surgery or ... laser surgery tiny burns are made around the hole to “weld” the retina back into place. Cryopexy ...
The retina is a layer of tissue in the back of your eye that senses light and sends images ... for reading, driving, and seeing fine detail. A retinal detachment lifts or pulls the retina from its ...
Introduction Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment, where a retinal 'break' allows the ingress of fluid from the vitreous cavity to the subretinal space, resulting in retinal separation. It occurs in about 1 in 10,000 people a year. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of different surgical interventions in people with rhegmatogenous retinal detachment? What are the effects of interventions to treat proliferative vitreoretinopathy occurring as a complication of retinal detachment or previous treatment for retinal detachment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: corticosteroids, daunorubicin, fluorouracil plus low molecular weight heparin, pneumatic retinopexy, scleral buckling, short-acting or long-acting gas tamponade, silicone oil tamponade, and vitrectomy. PMID:24807890
... of the retina responsible for sharp, detailed vision. Symptoms Symptoms of detached retina can include: Bright flashes of ... right away or within a short time after diagnosis. Some types of surgery can be done in ...
Scleral buckling; Vitrectomy; Pneumatic retinopexy; Laser retinopexy; Rhegmatogenous retinal detachment repair ... it meets the hole in the retina. Scleral buckling can be done using numbing medicine while you ...
... this page: //medlineplus.gov/ency/presentations/100132.htm Retinal detachment repair - series—Normal anatomy To use the ... to slide 6 out of 6 Overview The retina is the internal layer of the eye that ...
Galin, M A; Poole, T A; Obstbaum, S A
In a series of cataract patients excluding myopic individuals, under age 60 years, and cases in which vitreous loss occurred, retinal detachment was no less frequent after intracapsular cataract extraction and Sputnik iris supported lenses than in controls. Both groups were followed up for a minimum of two years. The detachments predominantly occurred from retinal breaks in areas of the retina that looked normal preoperatively.
Wubben, Thomas J; Besirli, Cagri G; Zacks, David N
Retinal detachment is an important cause of visual loss. Currently, surgical techniques, including vitrectomy, scleral buckle, and pneumatic retinopexy, are the only means to repair retinal detachment and restore vision. However, surgical failure rates may be as high as 20%, and visual outcomes continue to vary secondary to multiple processes, including postoperative cystoid macular edema, epiretinal membrane formation, macular folds, and, ultimately, photoreceptor death. Therefore, pharmacotherapies are being sought to aid the success rates of modern surgical techniques and reduce or slow the degeneration of photoreceptors during retinal detachment. This review discusses potential therapeutic avenues that aid in retinal reattachment, reduce the rate of retinal redetachment by limiting proliferative vitreoretinopathy, and protect against photoreceptor cell death.
AlAli, Alaa; Bushehri, Ahmad; Park, Jonathan C.; Krema, Hatem
Purpose: To report a case of multifocal serous retinal detachments associated with pimasertib. Methods: The authors report a 26-year-old patient who developed bilateral multifocal serous retinal detachments appearing 2 days after starting pimasertib (as part of a clinical trial investigating its use in low-grade metastatic ovarian cancer) and rapidly resolving 3 days after stopping it. Conclusion: The mechanism of MEK inhibitor induced visual toxicity remains unclear. The pathophysiology of multifocal serous retinal detachments as a complication of pimasertib is still poorly understood. PMID:26444523
García-Arumí, J; Martínez-Castillo, V; Boixadera, A; Blasco, H; Marticorena, J; Zapata, M Á; Macià, C; Badal, J; Distéfano, L; Rafart, J M; Berrocal, M; Zambrano, A; Ruíz-Moreno, J M; Figueroa, M S
This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.
Takkar, Brijesh; Azad, Shorya; Shashni, Adarsh; Pujari, Amar; Bhatia, Indrish; Azad, Rajvardhan
To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
Takkar, Brijesh; Azad, Shorya; Shashni, Adarsh; Pujari, Amar; Bhatia, Indrish; Azad, Rajvardhan
AIM To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). METHODS Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. RESULTS Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. CONCLUSION Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD. PMID:27990367
Chou, Tom; Siegel, Michael
We present a model of the mechanical and fluid forces associated with exudative retinal detachments where the retinal photoreceptor cells separate typically from the underlying retinal pigment epithelium (RPE). By computing the total fluid volume flow arising from transretinal, vascular, and retinal pigment epithelium (RPE) pump currents, we determine the conditions under which the subretinal fluid pressure exceeds the maximum yield stress holding the retina and RPE together, giving rise to an irreversible, extended retinal delamination. We also investigate localized, blister-like retinal detachments by balancing mechanical tension in the retina with both the retina-RPE adhesion energy and the hydraulic pressure jump across the retina. For detachments induced by traction forces, we find a critical radius beyond which the blister is unstable to growth. Growth of a detached blister can also be driven by inflamed tissue within which e.g., the hydraulic conductivities of the retina or choroid increase, the RPE pumps fail, or the adhesion properties change. We determine the parameter regimes in which the blister either becomes unstable to growth, remains stable and finite-sized, or shrinks, allowing possible healing. This work supported by the Army Research Office through grant 58386MA
Haritoglou, C; Wolf, A
The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.
Kelley, J S; Doxanas, M T
PURPOSE: To estimate the incidence of retinal detachment after cataract surgery with capsulorhexis. METHODS: A consecutive series of 2,150 cataract operations were followed for incidence of retinal detachment. A series of 1,000 patients from this group were analyzed for high risk factors: myopia, age, sex, operative complications and capsulotomy. RESULTS: With minimum one year follow up in 90% of patients the incidence of retinal detachment was 0.25% (5 cases). CONCLUSION: The true incidence of retinal detachment after cataract surgery remains elusive. There is probably a trend toward lower incidence compared to previous reports. PMID:8719688
The purpose of this study was to report two cases of rhegmatogenous retinal detachment noted immediately after roller coaster riding in an at-risk population. In separate incidents, a 35-year-old woman and a 45-year-old woman, both significantly myopic, presented with visual symptoms after riding roller coasters. Both patients were found to have acute rhegmatogenous retinal detachments associated with myopic degenerative changes. The pathology supported an acute, traumatic etiology for the detachments. Roller coaster riding should be considered an adjunct risk factor for retinal detachment in predisposed patients.
Müller, V C; Mihailovic, N; Clemens, C R; Alten, F; Eter, N
We present a case of a 57-year-old woman who reported bilateral visual impairment since 2 weeks. She had a medical history of congenital, cyanotic heart failure. Funduscopic examination revealed serous retinal detachment on the left side, central subneurosensory detachment on the right side, retinal vessel tortuosity and multiple retinal haemorrhages in the periphery. As blood analysis showed a distinct increase in haemoglobin and haematocrit, hyperviscosity syndrome was suspected to have caused bilateral serous retinal detachment. Isovolemic haemodilution was performed in close cooperation with the cardiology department with repeated phlebotomy, which resulted in a significant reduction of subretinal fluid and, concurrently, an increase in visual acuity.
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Ozkan, Seyhan Sonar; Citirik, Mehmet; Beyazyildiz, Emrullah; Beyazyildiz, Ozlem
The aim of this study is to assess clinical outcomes of 23-gauge vitrectomy and silicone oil (SO) tamponade combined with and without phacoemulsification (PE) in rhegmatogenous retinal detachment (RRD). The study included forty eyes of 40 patients that underwent 23-gauge vitrectomy and SO tamponade combined with and without PE. Twenty eyes of 20 cases, of whom underwent 23-gauge vitrectomy and SO tamponade combined with PE were allocated to the group 1. Likewise, 20 eyes of 20 cases that underwent 23-gauge vitrectomy and SO tamponade alone were allocated to the group 2. Best corrected visual acuity (BCVA) between two groups was compared. There was no significant difference in BCVA between the two groups during the 6 months (P = 0.3). Recurrent retinal detachments were observed in 2 cases (10%) in both groups. There was no statistically significant difference between two groups as a point of recurrent retinal detachments (P = 1). We have found higher rates of post-vitrectomy cataract progression (45%) in the eyes with RRD who underwent 23-gauge vitrectomy and SO tamponade. Combined vitrectomy and PE is safe and effective for the patients with RRD.
Mortada, Hassan A.
The purpose would be to describe and evaluate a novel technique of episcleral macular buckling in postvitrectomy recurrent macular hole retinal detachment in highly myopic eyes. A 7mm silicone sponge strengthened with a U-shaped 0.5mm orthodontics stainless steel wire fed along its length and hand-bent to produce L-shaped buckle of appropriate shape and length, is used. The episcleral macular buckling has performed on 15 highly myopic eyes (axial length > 30mm) with recurrent macular hole retinal detachment following silicone oil removal. Buckle localization has been performed by manipulating the long arm of the exoplant, under direct internal visualization, scleral marking and suturing. Successful retinal reattachment with improvement in visual acuity achieved in all 15 eyes. Closure of the macular holes was confirmed by Optical Coherence Tomography. The anatomical and functional outcomes of this new technique of macular buckling appears to provide an effective and feasible means of retinal reattachment and hole closure in postvitrectomy recurrent macular hole detachment in highly myopic eyes. PMID:24600635
Mortada, Hassan A
The purpose would be to describe and evaluate a novel technique of episcleral macular buckling in postvitrectomy recurrent macular hole retinal detachment in highly myopic eyes. A 7mm silicone sponge strengthened with a U-shaped 0.5mm orthodontics stainless steel wire fed along its length and hand-bent to produce L-shaped buckle of appropriate shape and length, is used. The episcleral macular buckling has performed on 15 highly myopic eyes (axial length > 30mm) with recurrent macular hole retinal detachment following silicone oil removal. Buckle localization has been performed by manipulating the long arm of the exoplant, under direct internal visualization, scleral marking and suturing. Successful retinal reattachment with improvement in visual acuity achieved in all 15 eyes. Closure of the macular holes was confirmed by Optical Coherence Tomography. The anatomical and functional outcomes of this new technique of macular buckling appears to provide an effective and feasible means of retinal reattachment and hole closure in postvitrectomy recurrent macular hole detachment in highly myopic eyes.
Levai, L; Gavriş, Monica; Gábor, Radó; Bagosi, P
To evaluate the efficiency of retinal pneumopexy in patients with rhegmatogenous retinal detachment. This clinical prospective study unrolled between november 2010-june 2012 in the Ophthalmology Department of the Military Hospital in Cluj-Napoca and Satu Mare Emergency Hospital included 20 patients (20 eyes) with rhegmatogenous retinal detachment. Patients were treated with retinal pneumopexy followed by laser photocoagulation. Anatomical and functional results were evaluated 1, 3, 6, 12 and 19 months after treatment. In 17 eyes out of 20, we achieved retinal reattachment and visual recovery. Three cases yelded no success, these being further treated with posterior vitrectomy. Retinal pneumopexy is a minimally invasive treatment method of rhegmatogenous retinal detachment with very good results in well selected cases.
Muşat, O; Cristescu, R; Coman, Corina; Asandi, R
This papers presents a case of a patient with retinal detachement, 3 days ago operated (posterior vitrectomy internal tamponament with silicon oil 1000) who develop increased ocular pressure following silicon oil output in the anterior chamber.
Muşat, O; Cristescu, R; Coman, Corina; Asandi, R
This papers presents a case of a patient with retinal detachment, 3 days ago operated (posterior vitrectomy, internal tamponament with silicon oil 1000) who developed increased ocular pressure following silicon oil output in the anterior chamber.
Stryjewski, Tomasz P.; Andreoli, Christopher M.; Eliott, Dean
Purpose To characterize the development of retinal detachment after open globe trauma. Design Case-control study Participants 892 patients comprising 893 open globe injuries, of which 255 were ultimately diagnosed with retinal detachment, with the remaining eyes serving as controls. Methods Retrospective chart review of open globe injuries presenting to the Massachusetts Eye and Ear Infirmary between 1999 and 2011. Kaplan-Meier analysis was used to estimate time to detachment and multivariable logistic regression was used to define clinical factors associated with retinal detachment after open globe injury. Main Outcome Measures Demographic and clinical characteristics at the time of presentation after open globe injury, date of retinal detachment diagnosis, and last date of follow-up. Results Primary repair of the open globe was typically undertaken within hours of presentation. 255 eyes were ultimately diagnosed with retinal detachment after open globe trauma, yielding an incidence of 29% (95% confidence interval: 26%-32%). For eyes that developed retinal detachment, 27% (69/255) detached within 24 hours of primary open globe repair, 47% (119/255) detached within one week, 72% (183/255) within one month. Multivariable regression analysis revealed presence of vitreous hemorrhage (odds ratio: 7.29, p<0.001), higher zone of injury (odds ratio: 2.51 per integer increase in zone number, odds ratio: 1.00-6.30, p<0.001), and poorer Logarithm of the Minimum Angle of Resolution visual acuity at the time of presentation after open globe injury (odds ratio: 2.41 per integer increase in Logarithm of the Minimum Angle of Resolution visual acuity, odds ratio: 1.00-81.30, p<0.001) to be associated with retinal detachment. A screening tool, named herein the Retinal Detachment after Open Globe Injury (RD-OGI) score, was created. Conclusions Retinal detachment is common after open globe trauma, though often not appearing until days to weeks after the initial traumatic event
Chou, Tom; Siegel, Michael
We present a model of the mechanical and fluid forces associated with exudative retinal detachments where the retinal photoreceptor cells separate, typically from the underlying retinal pigment epithelium (RPE). By computing the total fluid volume flow arising from transretinal, vascular and RPE pump currents, we determine the conditions under which the subretinal fluid pressure exceeds the maximum yield stress holding the retina and RPE together, giving rise to an irreversible, extended retinal delamination. We also investigate localized, blister-like retinal detachments by balancing mechanical tension in the retina with both the retina-RPE adhesion energy and the hydraulic pressure jump across the retina. For detachments induced by traction forces, we find a critical radius beyond which the blister is unstable to growth. Growth of a detached blister can also be driven by inflamed lesions in which the tissue has a higher choroidal hydraulic conductivity, has insufficient RPE pump activity, or has defective adhesion bonds. We determine the parameter regimes in which the blister either becomes unstable to growth, remains stable and finite-sized, or shrinks, allowing possible healing. The corresponding stable blister radius and shape are calculated. Our analysis provides a quantitative description of the physical mechanisms involved in exudative retinal detachments and can help guide the development of retinal reattachment protocols or preventative procedures.
Foster, William J
When a patient suffers a retinal detachment and surgery is delayed, it is known clinically that bilaterally patching the patient may allow the retina to partially reattach or "settle." Although this procedure has been performed since the 1860s, there is still debate as to how such a maneuver facilitates the reattachment of the retina. Finite element calculations using commercially available analysis software are used to elucidate the influence of reduction in eye movement caused by bilateral patching on the flow of subretinal fluid in a physical model of retinal detachment. It was found that by coupling fluid mechanics with structural mechanics, a physically consistent explanation of increased retinal detachment with eye movements can be found in the case of traction on the retinal hole. Large eye movements increase vitreous traction and detachment forces on the edge of the retinal hole, creating a subretinal vacuum and facilitating increased subretinal fluid. Alternative models, in which intraocular fluid flow is redirected into the subretinal space, are not consistent with these simulations. The results of these simulations explain the physical principles behind bilateral patching and provide insight that can be used clinically. In particular, as is known clinically, bilateral patching may facilitate a decrease in the height of a retinal detachment. The results described here provide a description of a physical mechanism underlying this technique. The findings of this study may aid in deciding whether to bilaterally patch patients and in counseling patients on pre- and postoperative care.
Maksymowicz, Małgorzata; Raczyńska, Krystyna; Maksymowicz, Jarosław
The study covered 79 patients after treatment of retinal detachment. Double vision, strabismus and disturbances of eyeballs motility were found. Up to 12 months after intervention, the deterioration of binocular vision was observed in 48.28 to 89.66% of patients, depending on the method used. The majority of disturbances were observed during the first 3 months with tendency to gradual subsidence during consecutive 9 months. A patient, after treatment of retinal detachment, can be qualified to return to work where stereopsis is needed under condition that ophthalmologic examination is done every three months during the first year after operation and than once a year.
Pikulski, Z; Nawrocki, J; Dziegielewski, K
The methods and results of surgery in 6 cases of retinal detachment with macular hole are presented. In all 6 cases pars plana vitrectomy was performed, in 4 with subsequent SF6 and in 2 with silicone oil tamponade. Retinal attachment was achieved in 4 eyes. Visual acuity 1/50-2/50 was found after surgery in 5 cases. The follow-up ranged from 6 to 9 months.
The basic aim of this study was to find the group of "critical" myopic refraction with the highest occurrence of retinal detachment. In the study, 180 myopic eyes were analyzed. Upon the targeted ophthalmological anamnesis, definition of the objective refraction, and indirect binocular ophthalmoscopy, we analyzed the distribution of retinal detachment and the area affected in relation to refraction. All the eyes were divided into groups according to the refraction height. Average age of our patients ranged from 48.43 to 51.60 years with SD from 13.88 to 18.45. We did not find a statistically significant difference for a certain age. The study covered 102 (56.6%) male and 78 (43.3%) female patients. The highest occurrence of retinal detachment was found in Refraction Group from 3.5 to 7.49 dsph, total 21 (11.6%). The retinal detachments usually affected 2/4 or 3/4 of the eye fundus surface respectively.
Cristescu, R; Muşat, O; Toma, Oana; Coma, Corina; Gabej, Ioana; Burcea, M
We present the case of a 43 year old patient diagnosed with rhegmatogenous retinal detachment and retinoschizis, a rare case of disease association. Surgery is recommended and we practice 23 gauge vitrectomy, laser retinopexy, criopexy in the periphery and internal heavy oil tamponade. Postoperatory evolution was favorable.
Gupta, Deepak; Ching, Jared; Tornambe, Paul E
The successful detection of retinal breaks is a critical step in rhegmatogenous retinal detachment (RRD) surgery in order to prevent persistent/recurrent RRDs. Not all retinal breaks causing retinal detachments are obvious. Retinal breaks may be obscured due to opacities that are either anterior-segment related, lens related or posterior-segment related. Rules to identify breaks based on sub-retinal fluid (SRF) configuration are more difficult to apply in pseudophakic, aphakic, encircled eyes, and eyes with repeat detachments and those with proliferative vitreoretinopathy (PVR). Exudative detachments exhibit characteristic features and must be ruled out. A thorough clinical examination pre-operatively is important even if a vitrectomy is planned. This paper reviews the incidence and causes of undetected breaks along with pre-operative/clinical issues that may hinder break detection. We review the literature with respect to investigative approaches and techniques that are available to the vitreo-retinal surgeon when primary breaks remains clinically undetected during the pre-operative examination. We broadly divide the surgical approaches into ones where the surgeon utilises techniques to actively pursue a search for breaks versus adopting a purely speculative approach. Advantages and disadvantages of various techniques are appraised. Intuitively one might argue that an encircling scleral buckle combined with vitrectomy would give higher single operation success than PPV alone because 'undetected' retinal breaks would be addressed by a 360° plombage. We could not confirm this concept. Newer techniques, such as PPV augmented with dye extrusion or endoscopic-assisted PPV show encouraging results. Technological advances such as intraoperative OCT will also help to broaden the VR surgeon's armamentarium. At this time there is no gold standard in terms of the recommended approach and this is reflected in the many options that are available for management in this
Lauritzen, Derek B; Avila, Marcos P; Buzney, Sheldon M; Weiter, John J
With refinement of vitrectomy techniques over the past 30 years, the treatment of rhegmatogenous retinal detachment (RRD) has transitioned from the almost exclusive use of extraocular techniques to the present time in which intraocular interventions are available and, in some practices, enjoy almost exclusive use for primary repair of RRD. Except for those situations in which a retinal detachment is associated with obvious immediate complications related to the cataract surgery, the considerations for the treatment of pseudophakic RRD are quite similar to those of phakic RRD. The current options are: use of an extraocular buckling device, vitrectomy-related procedures, intraocular gas injection with associated retinopexy, and combinations of these. Disagreement on the ideal intervention for pseudophakic retinal detachment is not uncommon and particularly so in those RRDs which lie somewhere in the spectrum between complex and simple. As is so often the case in the surgical treatment of disease, there may not be one ideal technique for a particular type of RRD; but knowledge of alternatives logically increases the likelihood of a successful result. The goal of this paper is to outline the clinical factors shown to be of importance in deciding which technique will have the greatest chance at not only achieving retinal re-attachment but also in optimizing long-term vision.
Lean, J S; Mahmood, M; Manna, R; Chignell, A H
In an unselected series of retinal detachments a 24-hour period of binocular occlusion and posture with a retinal hole dependent produces some resolution of subretinal fluid in 13% of cases. If only patients with acute, freely mobile detachments and retinal holes above the horizontal meridian were selected the proportion of detachments showing some resolution rose to 30%. In 8% of cases a paradoxical response occurred, the detachment increasing in depth or extending to involve an additional area of retina. PMID:7362818
Pikulski, Z; Nawrocki, J; Dziegielewski, K
The authors presented 6 cases of macular hole retinal detachment in which pars plana vitrectomy with endo-tamponade was performed; in 4 cases SF6 gas and in 2, with PVR silicone oil was used. Retina was completely attached in 4 eyes. Visual acuity 1/50 to 2/50 was achieved in 5 eyes. Follow-up ranged from 5 to 9 months.
Jarrett, W H
The author reports 16 cases of rhegmatogenous retinal detachment in which, for a variety of reasons, immediate reparative surgery was not carried out. To date, one-half of these cases have not been operated, and four have been followed for 6 years or longer. No case suffered visual loss because of the delay in surgery, nor has chronic inflammation, glaucoma, or rubeosis been a problem. The clinical characteristics of this group of cases is defined. PMID:2979020
Vukojević, Nenad; Sikić, Jakov; Curković, Tihomir; Juratovac, Zlatko; Katusić, Damir; Sarić, Borna; Jukić, Tomislav
Changes in the eye axial diameter were studied to assess the eye globe impact of conventional operation for retinal detachment. The study included 69 eyes in 69 patients operated on for rhegmatogenous retinal detachment. There were 46.4% of men and 53.6% of women, mean age 52.7 (+/- 15.21) years. Results of preoperative and postoperative ultrasonographic measurement of axial diameter are presented. The mean preoperative and postoperative eye axial diameter was 23.69 (+/- 1.84) mm and 24.43 (+/- 1.91) mm, respectively. Postoperative results showed the axial eye length to increase by a mean of 0.74 (+/- 0.44) mm, yielding a statistically significant difference from the preoperative measurement (p < 0.001). The mean myopia induced by this eyeball elongation was 1.77 D. The encircling band with and without segmental buckling used in surgical repair of retinal detachment creates circular and segmental indentation of the eyeball, thus increasing its axial length. The myopia induced by elongation of the eyeball results in considerable myopia, which requires appropriate correction in the early postoperative period to achieve favorable vision rehabilitation.
Stryjewski, Tomasz P; Andreoli, Christopher M; Eliott, Dean
To characterize the development of retinal detachment (RD) after open globe trauma. Case-control study. A total of 892 patients comprising 893 open globe injuries (OGIs), of whom 255 were ultimately diagnosed with RD, with the remaining eyes serving as controls. Retrospective chart review of patients with OGIs presenting to the Massachusetts Eye and Ear Infirmary between 1999 and 2011. Kaplan-Meier analysis was used to estimate the time to detachment, and multivariable logistic regression was used to define the clinical factors associated with RD after OGI. Demographic and clinical characteristics at the time of presentation after OGI, date of RD diagnosis, and last date of follow-up. Primary repair of the open globe was typically undertaken within hours of presentation. A total of 255 eyes were ultimately diagnosed with RD after open globe trauma, yielding an incidence of 29% (95% confidence interval, 26-32). For eyes that developed RD, 27% (69/255) detached within 24 hours of primary open globe repair, 47% (119/255) detached within 1 week, and 72% (183/255) detached within 1 month. Multivariable regression analysis revealed the presence of vitreous hemorrhage (odds ratio [OR], 7.29; P < 0.001), higher zone of injury (OR, 2.51 per integer increase in zone number; OR, 1.00-6.30; P < 0.001), and poorer logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of presentation after OGI (OR, 2.41 per integer increase in logMAR visual acuity; OR, 1.00-81.30; P < 0.001) to be associated with RD. A screening tool was created: the Retinal Detachment after Open Globe Injury score. Retinal detachment is common after open globe trauma, although often not appearing until days to weeks after the initial traumatic event. Several clinical variables at the time of initial presentation can predict the future risk of detachment. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
The aim of the paper was to present the efficacy and indications for application of conventional surgical treatment of retinal detachment by using external implants, that is,application of encircling band and buckle. This study comprised patients from the University Eye Clinic in Skopje. A total of 33 patients were diagnosed and surgically treated in the period between May 2010 and August 2011. Conventional surgery was applied in smaller number of patients whose changes of the vitreous body were manifested by detachment of posterior hyaloid membrane, syneresis, with appearance of a small number of pigment cells in the vitreous body and synchysis, and the very retina was with fresh detachment without folds or epiretinal changes (that is, PVR A grade). There were a larger number of patients with more distinct proliferative changes of the vitreous body and of the retina, grades PVR B to C1-C2, and who also underwent the same surgical approach. Routine ophthalmologic examinations were performed, including: determination of visual acuity by Snellen's optotypes, determination of eye pressure with Schiotz's tonometer, examination of anterior segment on biomicroscopy, indirect biomicroscopy of posterior eye segment (vitreous body and retina) and examination on biomicroscopy with Goldmann prism, B scan echography of the eyes before and after surgical treatment. Conventional treatment was used by external application of buckle or application of buckle and encircling band. In case of one break, radial buckle was applied and in case of multiple breaks in one quadrant limbus parallel buckle was applied. Besides buckle, encircling band was applied in patients with total or subtotal retinal detachment with already present distinct changes in the vitreous body (PVR B or C1-C2) and degenerative changes in the vitreous body. Breaks were closed with cryopexy. The results obtained have shown that male gender was predominant and that the disease was manifested in younger male adults
Ross, W H
With modern surgical techniques to repair retinal detachments, a greater than 90% primary anatomic success rate can be expected. Despite this high level of anatomic success, visual results remain compromised mainly because of permanent functional damage once the macula becomes detached. The most important predictor of visual recovery after retinal detachment surgery is preoperative visual acuity. Preoperative acuity appears to be directly related to the height of macular detachment. Shorter duration of detachment and younger age are also important in visual recovery. This paper will review the current literature that helps to improve our understanding of visual recovery after macula-off retinal detachments.
Berrocal, Maria H.; Chenworth, Megan L.; Acaba, Luis A.
Giant retinal tears (GRTs) are full-thickness circumferential tears of more than 90 degrees of the retina that are associated with vitreous detachment. They are related to ocular trauma, high myopia, aphakia, pseudophakia, genetic mutations involving collagen and young age. GRTs comprise 1.5% of all rhegmatogenous retinal detachments and the average age of incidence is 42 years. GRTs are more common in males, as 72% of all cases occur in males. The incidence of GRTs in the general population is estimated to be 0.05 per 100,000 individuals. Common techniques used in the management of GRTs include fluid-air exchange, pneumatic retinopexy, scleral buckling, primary vitrectomy with gas or silicone oil tamponade, and combined scleral buckle-vitrectomies. However, management of GRTs poses a great challenge to physicians due to the high risk of intra- and post-operative complications and the many technical difficulties involved. The advent of perfluorocarbon liquids (PFCL) and the use of micro-incisional surgery for the treatment of GRTs has provided new opportunities for the management of GTRs. Today, retinal reattachment can be achieved in 94-100% of cases. PMID:28299011
Hajari, Javad Nouri
Surgical approaches for rhegmatogenous retinal detachment (RRD) have evolved rapidly in the past century. This has resulted in an increase in the anatomical success rate from zero per cent in the beginning of the 1900s to now almost 100 per cent. Rhegmatogenous retinal detachment is regarded as an acute eye disease that needs immediate treatment. With the increasing number of cataract surgeries and an increased elderly population, the numbers of RRD occurrences are increasing. The aim of this thesis is to create knowledge on how treatment and care of RRD patients can be optimized. In the first paper, data on the incidence of RRD in Denmark are presented based on data from a nation register the National Patient Registry (NPR). It was discovered that the incidence of RRD in Denmark is similar to previous reported numbers and that the incidence has been increasing due to increasing numbers of cataract surgeries and an increased elderly population. Using data from the NPR, we estimated that the risk of a RRD occurring on the fellow eye is 100 times larger than on the first eye and that middle aged men have the highest risk. Having an increase in the incidence of RRD we need to ensure that the patients are also treated in the most optimal way. To ensure this, an indicator is needed to monitor the quality at the different centres. This indicator presented in the second paper is based in the occurrence of redetachment. We define a detachment to be caused by poor surgery if the retina detaches within one year after initial surgery with pneumatic retinopexy, scleral buckling and VTX with gas, and one and a half years after surgery with VTX with oil. Also lack of oil removal within the first year is a failed operation. It is widely accepted that RRD is an acute disease but when should surgery be performed to attain the most optimal result? In the third paper, we evaluated the progression of posterior RRD with an optical coherence tomography to make an objective assessment of
Enders, Philip; Schick, Tina; Schaub, Friederike; Kemper, Carolin; Fauser, Sascha
To evaluate functional and anatomical outcomes of patients with retinal redetachments (re-RD) after surgery for primary rhegmatogenous retinal detachment. Medical records of eyes with re-RD after rhegmatogenous retinal detachment surgery between 1999 and 2014 at the Department of Ophthalmology, University of Cologne, Germany, were retrospectively evaluated. Data included preoperative and postoperative clinical findings, best-corrected visual acuity, presence and grade of proliferative vitreoretinopathy, surgical procedures, and complication rates. Three hundred and twenty-eight eyes of 2,457 developed a re-RD (13.3%). Of these 328 eyes, 242 eyes (73.8%) had only one re-RD, whereas 86 eyes (26.2%) had 2 or more re-RDs. Visible presence of proliferative vitreoretinopathy during first redetachment surgery increased risk of re-RD with relative risk ratio of 1.46 (P = 0.05). Best-corrected visual acuity deteriorated with every additional re-RD (P < 0.001). Two hundred and thirty-seven eyes received oil endotamponde at least once. In 91 cases, oil endotamponade was left for long-term until last follow-up. Multiple re-RD (≥2 re-RDs) is an infrequent complication after rhegmatogenous retinal detachment surgery. After a first re-RD occurred, risk for multiple re-RD doubles compared with the risk of a first redetachment. Mean functional outcome is unfavorable, whereas predictability remains nevertheless poor because of the wide range of interindividual postoperative best-corrected visual acuity.
Ung, T; Comer, M B; Ang, A J S; Sheard, R; Lee, C; Poulson, A V; Newman, D K; Scott, J D; Richards, A J; Snead, M P
The majority of rhegmatogenous retinal detachments result from pathological posterior vitreous detachment (PVD) and secondary horseshoe or giant retinal tears. Retinal detachment without PVD is usually associated with either retinal dialysis or round retinal holes. This study characterises the features, surgical outcome, and incidence of bilateral involvement of detachment associated with round retinal holes. In all, 110 retinal detachments from 96 consecutive patients with retinal detachment secondary to round retinal holes were studied. Analysis of patient age, sex, refraction, preoperative visual acuity, presented symptoms, position and extent of detachment, number and distribution of holes present, posterior hyaloid membrane status, surgical management, outcome of surgery, and postoperative visual acuity were studied. The mean age for patients was 34 years with a marked female preponderance (64%) and myopia (83%). The posterior hyaloid membrane remained attached in 95 eyes (86%). In all, 45% patients had bilateral pathology, of which 33% had 'mirror image' distribution. Detachments were predominantly shallow (93%) and slow in progression (17%). A total of 100 detachments were repaired with cryotherapy and scleral buckling, eight with cryotherapy alone, and one with laser retinopexy. In all, 99% detachments were successfully reattached with a single procedure. The mean follow-up period was 2 years. There were no instances of redetachment. Round hole detachments are slowly evolving detachments with attached vitreous gel in young, predominantly female myopes. Examination of the fellow eye should be mandatory as there is a high incidence of bilateral pathology. Scleral buckling procedures remained highly effective in this selected group of patients.
Buzney, S.M.; Pruett, R.C.; Regan, C.D.; Walton, D.S.; Smith, T.R.
Three children (two girls and one boy) with bilateral retinoblastoma each developed a presumed rhegmatogenous retinal detachment in one eye. All three eyes had previously received radiation and cryotherapy. In each case the retinal detachment responded promptly to conventional surgical methods via scleral buckling in the area of treated retinoblastoma and presumed retinal break. All three eyes have retained useful vision for follow-up periods of 3.5 to 12 years.
Joondeph, Stephanie A.; Joondeph, Brian C.
The purpose of this paper is to describe a traumatic retinal detachment occurring as a result of CrossFit training using an elastic exercise band. The patient sustained an ocular injury from an elastic band during CrossFit training, resulting in a giant retinal dialysis and retinal detachment, which were successfully repaired. Trainers and athletes need to be aware of the potential for ocular injury from elastic exercise bands and take appropriate precautions. PMID:24106626
Joondeph, Stephanie A; Joondeph, Brian C
The purpose of this paper is to describe a traumatic retinal detachment occurring as a result of CrossFit training using an elastic exercise band. The patient sustained an ocular injury from an elastic band during CrossFit training, resulting in a giant retinal dialysis and retinal detachment, which were successfully repaired. Trainers and athletes need to be aware of the potential for ocular injury from elastic exercise bands and take appropriate precautions.
Adelman, Ron A; Parnes, Aaron J; Sipperley, Jack O; Ducournau, Didier
To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter, retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. Reported data included clinical manifestations, the method of repair, and the outcome. Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)). In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal
Burton, T C; Herron, B E; Ossoinig, K C
A-scan echography was an accurate method for detecting changes in the depth of the anterior chamber, lens thickness, and length of the vitreous cavity after retinal detachment surgery in 30 eyes. Approximately 60% of the eyes had significant alterations in axial lengths exceeding+/-0.36 mm in aphakic eyes and +/-0.54 mm in phakic eyes. However, the operation of scleral bucklingg with large segments of hard silicone rubber implants or explants supported by an encircling band failed to result in a significant predictable shift of axial change in phakic or aphakic eyes. A-scan echography showed significant shallowing of the anterior chamber, and scleral buckling significantly increases lens thickness for at least six weeks. This induced a minor myopic refractive change that may explain some of the difference in postoperative refracitons between phakic and aphakic eyes.
Sánchez-Vicente, J L; Rueda-Rueda, T; González-García, M L; López-Herrero, F; Sánchez-Vicente, P; Castilla-Lázpita, A
We present the case of an 81-year-old man with retinal detachment caused by intrusion of an Arruga suture. The encircling buckle was located in the sub-retinal space and caused retinal breaks with retinal detachment A pars plana vitrectomy was performed along with intraocular cutting of the Arruga suture with retinal re-attachment. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Vilaplana, F; Muiños, S J; Nadal, J; Elizalde, J; Mojal, S
A review was performed on all patients with Stickler syndrome that had been treated in our Centre since it was diagnosed, in order to evaluate the risk of suffering a retinal detachment (RD). A total of 14 patients, diagnosed by clinical criteria, were included. The following variables were evaluated: age, gender, ocular background, follow-up, initial and final visual acuity (VA), optical prescription, prophylactic treatment, surgery and techniques performed. The risk age to suffer a RD, as well as cataracts, was determined by using the Kaplan-Meier survival curve analysis. From a total of 5 men and 9 women, the median initial VA was 0.35, which was the same as the final VA. The median optical prescription was -9.5 D myopia. The median of follow-up was 7 years. Ocular background was 4 RD cases and 2 Lasik surgeries. The operations performed were 8 RD, 12 cataract, 2 glaucoma, 2 macular hole, and one endotropia. The median age of RD was 20 years and cataract 34 years. As regards surgical tecnique, 4 scleral buckle cases, and 4 scleral buckle+pars plana vitrectomy cases were formed. The prophylactic treatments performed were: one scleral buckle case, 4 endolaser photocoagulation, and one cryotherapy. Two of which presented with RD. In the series presented, retinal detachment in Stickler syndrome mainly occurs in the second decade of life, with cataracts mainly developing in the fourth decade. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Wang, J Z
93 eyes (93 patients) of complicated retinal detachment were treated with vitreo-retinal surgery. Among the series, 75 eyes were rhegmatogenous with PVR C3-D3 in 66 eyes (88.0%), while the remaining 18 eyes were traction induced. None of the cases had giant tears or complicating diabetes. On discharge from the hospital, the operation was effective in 62 cases (66.7%), in whom the retina was totally reattached or only a small amount of subretinal fluid remained. In a group of 40 eyes where the inert gas SF6 was used, the operation was effective in 30 cases (75.0%). 41 cases were followed up postoperatively for over 3 months, averaging 13.7 months, to find the operative results stable in 33 eyes (80.5%), with the visual acuity improved in 22 cases (66.7%), unchanged in 9 cases (27.3%), and decreased in 2 cases (6.0%). The operative procedures, the peeling of pre-retinal membrane, the effect of PVR severity on the operative results, and the promotion of operative efficacy by application of wide encircling buckle and inert gas tamponade were discussed.
Poole, T A; Sudarsky, R D
A temporary apposition of retina and choroid has been created during retinal detachment surgery by injection of sodium hyaluronate into the suprachoroidal space in 14 patients. The iatrogenic choroidal detachment lasts at least seven to ten days, allowing adequate time for retinopexy to permanently seal the retinal hole. Suprachoroidal implantation is compatible with and additive to conventional retinal detachment techniques, or it can be used alone as a primary treatment modality. Further clinical evaluation and development are necessary to establish indications and limitations for this technique.
Sternfeld, Amir; Axer-Siegel, Ruth; Stiebel-Kalish, Hadas; Weinberger, Dov; Ehrlich, Rita
Purpose To evaluate the outcomes and complications of patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV). Patients and methods We retrospectively studied a case series of 24 eyes of 21 patients at a single tertiary, university-affiliated medical center. A review was carried out on patients who underwent PPV for the management of TRD due to proliferative diabetic retinopathy from October 2011 to November 2013. Preoperative and final visual outcomes, intraoperative and postoperative complications, and medical background were evaluated. Results A 23 G instrumentation was used in 23 eyes (95.8%), and a 25 G instrumentation in one (4.2%). Mean postoperative follow-up time was 13.3 months (4–30 months). Visual acuity significantly improved from logarithm of the minimum angle of resolution (LogMAR) 1.48 to LogMAR 1.05 (P<0.05). Visual acuity improved by ≥3 lines in 75% of patients. Intraoperative complications included iatrogenic retinal breaks in seven eyes (22.9%) and vitreal hemorrhage in nine eyes (37.5%). In two eyes, one sclerotomy was enlarged to 20 G (8.3%). Postoperative complications included reoperation in five eyes (20.8%) due to persistent subretinal fluid (n=3), vitreous hemorrhage (n=1), and dislocated intraocular lens (n=1). Thirteen patients (54.2%) had postoperative vitreous hemorrhage that cleared spontaneously, five patients (20.8%) required antiglaucoma medications for increased intraocular pressure, seven patients (29.2%) developed an epiretinal membrane, and two patients (8.3%) developed a macular hole. Conclusion Patients with diabetic TRD can benefit from PPV surgery. Intraoperative and postoperative complications can be attributed to the complexity of this disease. PMID:26604667
Chen, Muh-Shy; Ho, Tzyy-Chang; Chang, Ching-Chung; Hou, Ping-Kang
We report extensive myelinated retinal nerve fibers in a 42-year-old patient with retinal detachment. Fundus examination revealed a horseshoe-shaped tear near the temporal edge. Pars plana vitrectomy was performed and firm vitreo-retinal adhesion was noticed in the area of extensive myelinated retinal nerve fibers. Following vitrectomy with silicone oil tamponade, the retina was reattached successfully. In conclusion, retinal detachment may develop in patients with extensive myelinated retinal nerve fibers. Vitrectomy may be performed to treat this condition.
Noble, K G; Levitzky, M J; Carr, R E
Multiple vitelliform cysts of the retina, a disorder of unknown cause in which there are multiple detachments of the retinal pigment epithelium at the posterior pole, occurred in five patients. In four patients all lesions were located outside the parafoveal area while one patient showed bilateral foveal elevations associated with more eccentric detachments. Several patients showed slow resolution of some of the detachments with mild disturbances of the pigment epithelium.
The paper reports on the threshold values for light perception of circumscript retinal areas for different adaptation levels in patients successfully operated for retinal detachment. The examinations were carried out by means of the Tübingen projection perimeter, using the method of static perimetry in a meridian containing an approximately equal area of healthy and of formerly detached retina. The main aim of this examination was to establish whether both retinal photoreceptor systems recover within the same time after the operation. There is various evidence that the restitutions of the rod and cone systems do not occur at the same time.
Pasternak, Björn; Svanström, Henrik; Melbye, Mads; Hviid, Anders
A recent study of ophthalmologic patients found a strong association between fluoroquinolone use and retinal detachment. Given the prevalent use of fluoroquinolones, this could, if confirmed in the general population, translate to many excess cases of retinal detachment that are potentially preventable. To investigate if oral fluoroquinolone use is associated with an increased risk of retinal detachment. A nationwide, register-based cohort study in Denmark from 1997 through 2011, using linked data on participant characteristics, filled prescriptions, and cases of retinal detachment with surgical treatment (scleral buckling, vitrectomy, or pneumatic retinopexy). The cohort included 748,792 episodes of fluoroquinolone use (660,572 [88%] ciprofloxacin) and 5,520,446 control episodes of nonuse. Poisson regression was used to estimate rate ratios (RRs) for incident retinal detachment, adjusting for a propensity score that included a total of 21 variables. The risk windows were classified as current use (days 1-10 from start of treatment), recent use (days 11-30), past use (days 31-60), and distant use (days 61-180). A total of 566 cases of retinal detachment occurred, of which 465 (82%) were rhegmatogenous detachments; 72 in fluoroquinolone users and 494 in control nonusers. The crude incidence rate was 25.3 cases per 100,000 person-years in current users, 18.9 in recent users, 26.8 in past users, and 24.8 in distant users compared with 19.0 in nonusers. Compared with nonuse, fluoroquinolone use was not associated with a significantly increased risk of retinal detachment: the adjusted RRs were 1.29 (95% CI, 0.53 to 3.13) for current use; 0.97 (95% CI, 0.46 to 2.05) for recent use; 1.37 (95% CI, 0.80 to 2.35) for past use; and 1.27 (95% CI, 0.93 to 1.75) for distant use. The absolute risk difference, estimated as the adjusted number of retinal detachment cases per 1,000,000 treatment episodes, was 1.5 (95% CI, -2.4 to 11.1) for current use. In this cohort study based on
Adelman, Ron A; Parnes, Aaron J; Ducournau, Didier
To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs. Reported data included specific clinical findings, the method of repair, and the outcome after intervention. Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate). Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10(-8)). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034). In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle
Ho, C L; Wei, L C
We report a case of morning glory syndrome with retinal detachment. A slit-like retinal break at the edge of the excavated disc anomaly provided a direct communication between the subretinal space and the vitreous cavity. Retinal reattachment and useful vision was achieved after a single procedure of vitrectomy and gas tamponade. We believe that identification of the retinal break, removal of epipapillary fibroglial tissue and its traction force, the avoidance of perfluorocarbon liquid and the appropriate use of long-acting gas as endotamponade, all contributed to the favorable outcome. This is more evidence supporting the rhegmatogenous theory of retinal detachment in morning glory syndrome. A literature review of the clinical presentations and treatments of similar cases is included.
Gu, Yong-Hao; Ke, Gen-Jie; Wang, Lin; Gu, Qi-Hong; Zhou, En-Liang; Pan, Hong-Biao; Wang, Shi-Ying
AIM To comprehensively analyze the risk factors of rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). METHODS A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B-scan ultrasonography, and ultrasound biomicroscope (UBM). Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS There were 52 eyes (19.62%) with CD. Pseudophakia was more commonly seen in RRDCD (21.15% vs 6.10%, P=0.002). Intraocular pressure (IOP) was lower (8.60±3.62 vs 12.96±3.55, P<0.001), best-corrected visual acuity was worse [3.00 (2.00 to 3.00) vs 1.92 (1.22 to 3.00), P=0.001], and refractive error was more myopic [-4 (-9 to -2) vs -2 (-6 to 0), P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment (P=0.007). In RRDCD, 34.62% of eyes presented with multiple holes (P=0.044) and 25.00% with macular holes (P=0.012), compared with 20.66% and 14.08% in RRD. High myopia (P=0.039), low IOP (P=0.017), and larger extent of retinal detachment (P<0.001) were significant and independent risk factors for developing CD. CONCLUSION For CD in RRD, related factors include BCVA, IOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low IOP are significant and independent risk factors. PMID:27500106
Cebulla, Colleen M.; Zelinka, Chris P.; Scott, Melissa A.; Lubow, Martin; Bingham, Amanda; Rasiah, Stephen; Mahmoud, Ashraf M.; Fischer, Andy J.
Background Development of retinal detachment models in small animals can be difficult and expensive. Here we create and characterize a novel, cone-rich retinal detachment (RD) model in the chick. Methodology/Principal Findings Retinal detachments were created in chicks between postnatal days 7 and 21 by subretinal injections of either saline (SA) or hyaluronic acid (HA). Injections were performed through a dilated pupil with observation via surgical microscope, using the fellow eye as a control. Immunohistochemical analyses were performed at days 1, 3, 7, 10 and 14 after retinal detachment to evaluate the cellular responses of photoreceptors, Müller glia, microglia and nonastrocytic inner retinal glia (NIRG). Cell proliferation was detected with bromodeoxyuridine (BrdU)-incorporation and by the expression of proliferating cell nuclear antigen (PCNA). Cell death was detected with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). As in mammalian models of RD, there is shortening of photoreceptor outer segments and mis-trafficking of photoreceptor opsins in areas of RD. Photoreceptor cell death was maximal 1 day after RD, but continued until 14 days after RD. Müller glia up-regulated glial fibriliary acidic protein (GFAP), proliferated, showed interkinetic nuclear migration, and migrated to the subretinal space in areas of detachment. Microglia became reactive; they up-regulated CD45, acquired amoeboid morphology, and migrated toward outer retina in areas of RD. Reactive NIRG cells accumulated in detached areas. Conclusions/Significance Subretinal injections of SA or HA in the chick eye successfully produced retinal detachments and cellular responses similar to those seen in standard mammalian models. Given the relatively large eye size, and considering the low cost, the chick model of RD offers advantages for high-throughput studies. PMID:22970190
Lee, Tsung-Han; Chen, Yi-Hao; Kuo, Hsi-Kung; Chen, Yung-Jen; Chen, Chih-Hsin; Lee, Jong-Jer; Wu, Pei-Chang
Basketball is a popular sport involving significant body contact, which may frequently result in ocular trauma. The aim of this study was to evaluate the characteristics and visual outcomes of retinal detachment associated with basketball-related injury. Retrospective, interventional case series. We reviewed the course of patients who sustained traumatic retinal detachment from basketball-related ocular trauma between 2003 and 2015. Thirteen patients were evaluated for basketball-related traumatic retinal detachment. Twelve (92%) were male and 1 (8%) female, with an average age of 18.2 years. The majority (9 of 13, 70%) of patients had moderate-to-high myopia, and none were using protective eyewear when they sustained the eye trauma. Rhegmatogenous retinal detachment was observed in all eyes. The preoperative mean visual acuity was 20/625 (range, hand motions to 20/20). Initial surgery using scleral buckling alone was performed in most (8 of 13, 62%) of the patients. Retinal reattachment was achieved in 10 (76%) eyes after the first operation and in 12 (92%) at the end of the intervention. The mean follow-up was 3.9 years (range, 4 months to 12 years). The visual acuity during last follow-up was 20/231 (range, light perception to 20/20). In the multivariable analysis, initial visual acuity was an independent factor affecting the final visual outcome (P = .006). Retinal detachment associated with basketball-related injury may cause severe visual loss. In the current study, all retinal detachments were of rhegmatogenous type and commonly occurred in young individuals with myopia. Initial visual acuity was associated with the prognosis. Risk awareness for early detection and intervention are important in these traumas. Copyright © 2017 Elsevier Inc. All rights reserved.
Ho, Vincent Y; Wehmeier, Jarrod M; Shah, Gaurav K
Retinoschisis and retinal detachments are primarily differentiated based on characteristic examination findings. In diagnostically challenging cases, noncontact wide-field infrared imaging can help diagnosis and visualize the extent/margins of retinoschisis, retinal detachment, or combined schisis detachments by comparing reflectivity patterns. This is a retrospective, observational, descriptive case series of 14 eyes of 14 nonconsecutive patients, ranging from 28 to 89 years old (mean 61), diagnosed with retinoschisis, retinal detachment, or schisis detachment from May 5, 2014 to March 4, 2015. Patients with secondary retinoschisis and/or retinal detachment from other causes were not included in the study. Heidelberg Wide-Field Module lens and Heidelberg Spectralis HRA+OCT machine (Heidelberg Engineering, Heidelberg, Germany) were used to obtain noncontact, wide-field infrared images on each study eye. Seven eyes with retinal detachments, four with retinoschises, and three with schisis detachments were imaged using this novel wide-field infrared technique. Retinoschisis appears light and translucent with prominent vasculature, retinal detachments appear dark and opaque, and combined retinoschisis/retinal detachment exhibit mixed reflectivity patterns. Wide-field infrared imaging provides a quick, noncontact, noninvasive method to accurately diagnose and to monitor for progression of retinoschisis, retinal detachment, or combined schisis detachments.
Nawrocki, J; Dziegielewski, K; Pikulski, Z
The authors presented their experiences concerning the treatment of 26 eyes (in 25 patients) with retinal detachment complicated by PVR in which pars plana vitrectomy and silicone oil tamponade were applied. The patients have been previously operated with traditional methods however without success. Positive results, it is retinal attachment completely or in the superior and central part of the fundus with residual detachment inferiorly were achieved in 19 eyes (73%). An useful visual acuity (> 1/50) was achieved in 12 eyes and in 7 (27%) it was better than 5/50. Our results confirmed that this method (pars plana vitrectomy with silicone oil tamponade) is a method of choice in complicated retinal detachment, in which traditional methods failed.
Roy, Avik Kumar; Padhy, Debananda
An 18-year-old male with 360 degree angle recession after blunt trauma in his right eye developed uncontrolled intraocular pressure (IOP) despite four antiglaucoma medications (AGM) with advancing disc damage. He underwent trabeculectomy with intraoperative mitomycin-c (MMC) application. There was an intraoperative vitreous prolapse which was managed accordingly. On post-surgery day 1, he had shallow choroidal detachment superiorly with non-recordable IOP. This was deteriorated 1 week postoperatively as choroidal detachment proceeded to serous retinal detachment. He was started with systemic steroid in addition to topical route. The serous effusions subsided within 2 weeks time. At the last follow up at 3 months, he was enjoying good visual acuity, deep anterior chamber, diffuse bleb, an IOP in low teens off any AGM and attached retina. This case highlights the rare occurrence of serous retinal detachment after surgical management of angle recession glaucoma.
Wilkinson, Charles P
Background Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven. Objectives The purpose of this review was to evaluate the effectiveness of interventions for asymptomatic retinal breaks and lattice degeneration. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 28 January 2012. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional
Hakenová, J; Rozsíval, P
The authors investigate in a retrospective study complications of cataract operations which were performed in their department during the last 2.5 years by vitreoretinal surgery. They divided the operations into three basic groups: retinal detachment, luxation of the lens into the vitreous body and endophthalmitis. The largest group was formed by pseudophakic detachments--0.29% of operated cataracts. Luxation of the lens into the vitreous body and endophthalmitis treated by vitrectomy accounted for 0.06% each of operated cataracts. In the first part of the paper the authors analyze peroperative complications of cataract surgery, risk factors enhancing the risk of retinal detachment and evaluate anatomical and functional results of operations of pseudophakic retinal detachments. Peroperative rupture of the posterior capsule before cataract surgery was found in 63.6% of pseudophakic detachments, anterior vitrectomy was performed in 40%, YAG capsulotomy preceded the development of detachments in 13.3% of patients. The retina was applied in 76.4% of the eyes. Functional improvement was recorded in 65.8%, deterioration in 15.6% and an unaltered function after surgery was recorded in 18.6% eyes.
Luna, Gabriel; Keeley, Patrick W.; Reese, Benjamin E.; Linberg, Kenneth A.; Lewis, Geoffrey P.; Fisher, Steven K.
Although retinal neurodegenerative conditions such as age-related macular degeneration, glaucoma, diabetic retinopathy, retinitis pigmentosa, and retinal detachment have different etiologies and pathological characteristics, they also have many responses in common at the cellular level, including neural and glial remodeling. Structural changes in Müller cells, the large radial glia of the retina in retinal disease and injury have been well described, that of the retinal astrocytes remains less so. Using modern imaging technology to describe the structural remodeling of retinal astrocytes after retinal detachment is the focus of this paper. We present both a review of critical literature as well as novel work focusing on the responses of astrocytes following rhegmatogenous and serous retinal detachment. The mouse presents a convenient model system in which to study astrocyte reactivity since the Müller cell response is muted in comparison to other species thereby allowing better visualization of the astrocytes. We also show data from rat, cat, squirrel, and human retina demonstrating similarities and differences across species. Our data from immunolabeling and dye-filling experiments demonstrate previously undescribed morphological characteristics of normal astrocytes and changes induced by detachment. Astrocytes not only upregulate GFAP, but structurally remodel, becoming increasingly irregular in appearance, and often penetrating deep into neural retina. Understanding these responses, their consequences, and what drives them may prove to be an important component in improving visual outcome in a variety of therapeutic situations. Our data further supports the concept that astrocytes are important players in the retina’s overall response to injury and disease. PMID:27060374
Luna, Gabriel; Keeley, Patrick W; Reese, Benjamin E; Linberg, Kenneth A; Lewis, Geoffrey P; Fisher, Steven K
Although retinal neurodegenerative conditions such as age-related macular degeneration, glaucoma, diabetic retinopathy, retinitis pigmentosa, and retinal detachment have different etiologies and pathological characteristics, they also have many responses in common at the cellular level, including neural and glial remodeling. Structural changes in Müller cells, the large radial glia of the retina in retinal disease and injury have been well described, that of the retinal astrocytes remains less so. Using modern imaging technology to describe the structural remodeling of retinal astrocytes after retinal detachment is the focus of this paper. We present both a review of critical literature as well as novel work focusing on the responses of astrocytes following rhegmatogenous and serous retinal detachment. The mouse presents a convenient model system in which to study astrocyte reactivity since the Mϋller cell response is muted in comparison to other species thereby allowing better visualization of the astrocytes. We also show data from rat, cat, squirrel, and human retina demonstrating similarities and differences across species. Our data from immunolabeling and dye-filling experiments demonstrate previously undescribed morphological characteristics of normal astrocytes and changes induced by detachment. Astrocytes not only upregulate GFAP, but structurally remodel, becoming increasingly irregular in appearance, and often penetrating deep into neural retina. Understanding these responses, their consequences, and what drives them may prove to be an important component in improving visual outcome in a variety of therapeutic situations. Our data further supports the concept that astrocytes are important players in the retina's overall response to injury and disease. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Yogo, Norihiro; Nichol, Aran Cunningham; Campbell, Thomas B; Erlandson, Kristine M
Retinal detachment and testicular lesions are 2 rare presentations of syphilis. We describe a man with bilateral retinal detachment from ocular syphilis and syphilitic orchitis as a manifestation of syphilis and HIV coinfection.
Williams, Katie M; Dogramaci, Mahmut; Williamson, Tom H
The authors aim to analyze the incidence, characteristics, surgical management, and outcome of patients presenting to St Thomas' Hospital with a rhegmatogenous retinal detachment secondary to atrophic round retinal holes. This is a retrospective collation of patients presenting to a single surgeon with a round hole-associated retinal detachment between 2001 and 2009. Specific collation of demographics, retinal detachment features, choice of management, complications, requirement for further surgery, and ultimate surgical success with final visual acuity is reported. Fifty-six patients with a retinal detachment secondary to a round hole were identified (4.49% incidence). The cohort had a median age of 28.9 years (range 14 to 39) and a female predominance (64%). The median spherical equivalent refractive error was -5.5 diopters (range -1 to -18). The commonest quadrant with retinal holes was the inferotemporal quadrant (40% of patients). Approximately half of our cohort were identified to have lattice degeneration at any site and in either eye. The majority of patients received an external nondrainage procedure (92%) with cryotherapy (88%) and an explant (94%). Three patients required further surgery to achieve retinal reattachment and 12% required surgery for a retinal detachment in the fellow eye. At final follow-up, 78% achieved a visual acuity of 0.18 logMAR (6/12 Snellen) or better and the median final visual acuity was 0.00 logMAR (6/6 Snellen). Retinal detachments secondary to round holes have consistent characteristic features (young, myopic, female, inferior detachment). Surgical management is increasingly advocated and most achieve primary surgical success with a good final visual acuity.
Ying, Michelle S; Fuller, Jeff; Young, Joshua; Marcus, Dennis M
We report a congenital neurosensory retinal detachment associated with an optic nerve coloboma with subsequent spontaneous reattachment. This represents the earliest reported case of such a clinical situation. An observation period is recommended for infants with this clinical course to allow for the opportunity of spontaneous reattachment.
Mason, John O; Somaiya, Mamta D; White, Milton F; Vail, Rachel S
Evaluation of surgical treatment of full-thickness macular holes secondary to diabetic tractional retinal detachments was conducted. A retrospective review of medical records, fluorescein angiograms, fundus photographs, optical coherence tomography images, and operative findings of six consecutive patients with full-thickness macular holes and diabetic tractional retinal detachments was completed. Each eye was treated with pars plana vitrectomy, tractional retinal detachment repair, membranectomy, indocyanine green-assisted internal limiting membrane peeling, and intraocular gas tamponade. Surgical intervention resulted in the closure of all full-thickness macular holes. Mean best-corrected visual acuity was 20/250 preoperatively and 20/100 postoperatively, with all patients having improvement after a mean follow-up of 10 months. Closure of tractional retinal detachments related to full-thickness macular holes can be achieved via pars plana vitrectomy, complete membranectomy, and intraocular gas. Vitrectomy with dissection of proliferative membranes helps to relieve the tractional forces responsible for full-thickness macular hole formation, enabling successful closure of the diabetic full-thickness macular holes and resulting in visual acuity improvement.
Menchini, U; Scialdone, A; Visconti, C; Brancato, R
Nine eyes of nine patients affected by retinal detachment with macular hole were treated with pneumoretinopexy and postoperative positioning. All the eyes were myopic (mean 13.3 d., sd 3.3), two were amblyopic and one was aphakic. The operative technique included eye softening and intravitreal SF6 gas injection only. Barrage laser photocoagulation was carried out after retinal reattachment. In seven eyes (77.8%) the retina reattached in a mean of three days and the visual acuity improved. No recurrences were observed after a mean of 11.6 months. No severe complications occurred. Vitreous flare was present in 44% and increase of floaters in 55% of the eyes. We believe that pneumoretinopexy can be employed as the first treatment in case of myopic retinal detachment with macular hole.
Kothari, Nikisha; Kuriyan, Ajay E; Flynn, Harry W
We report three patients with subretinal bands associated with retinal detachment in chronic retinal detachments who underwent successful retinal reattachment. Subretinal bands before and after surgery can be identified on clinical examination and spectral domain optical coherence tomography. Removal of subretinal bands is not mandatory to achieve retinal reattachment. PMID:27099457
Adelman, Ron A; Parnes, Aaron J; Michalewska, Zofia; Ducournau, Didier
To identify risk factors associated with failure of anatomic reattachment in primary rhegmatogenous retinal detachment repair. Nonrandomized, multicenter, collaborative study. Primary procedures for 7678 rhegmatogenous retinal detachments reported by 176 surgeons from 48 countries. We recorded specific preoperative clinical findings, repair method, and outcome after intervention. We performed univariate, bivariate, and multivariate analyses to identify variables associated with surgical failure. Final failure of retinal detachment repair (level 1), remaining silicone oil at study conclusion (level 2), and need for additional procedures to repair the detachment (level 3). We analyzed 7678 cases of rhegmatogenous retinal detachment repair. Presence of choroidal detachment or significant hypotony was associated with significantly higher level 1 failure rates when grade 0 or B proliferative vitreoretinopathy (PVR) was present and higher level 2 failure rates, regardless of PVR status (P<0.05). Excluding cases with choroidal detachment or hypotony, increasing PVR was associated with increasing level 1 failure rates. The difference between grade B and C-1 PVR was significant (P = 2 × 10(-6)). No difference was observed in level 1 failure rates when operated eyes were phakic versus pseudophakic. Level 1 failure was significantly higher when all 4 quadrants of retina (4.4%) were detached than when only 1 quadrant (0.8%) had subretinal fluid. With grade B or C-1 PVR, cases with large or giant tears had significantly higher level 1 failure rates. No association was observed between number of retinal breaks and failure rates. Multivariate analysis showed grade C-1 PVR, 4 detached quadrants, and presence of choroidal detachment or significant hypotony were independently linked with a greater level 1 failure rate; the presence of a smaller retinal break was associated with a lesser level 1 failure rate. Choroidal detachment, significant hypotony, grade C-1 PVR, 4 detached
Seelenfreund, M H; Freilich, D B
With the growth in popularity of tennis has come an increase in ocular injuries due to tennis balls. This report describes ten patients who sustained ocular confusion from high-speed tennis balls. Seven of the patients required either retinal surgery, laser photocoagulation, or both. Early detection of regional damage is essential, but of greater importance is prevention. For that reason, we advise use of some sort of ocular protection device for high-risk individuals.
[Posterior vitreous detachment with collapse, and peripheral retinal degeneration in the aetiology of idiopathic retinal detachment. A synapsis of clinical observations and anatomical studies (author's transl)].
The crucial aetiological factors of idiopathic retinal detachment are posterior vitreous detachment with collapse, and degenerative lesions in the fundus periphery. Posterior vitreous detachment does not imply diagnostic problems to the expert in this field. On the other hand, the peripheral retinal degenerations include wide range of lesions the clinical and pathoanatomical study of which has so far not resulted in a complete picture. The author of the present paper attempts to get closer to a clearly arranged classification and terminology of those peripheral retinal degenerations, which are of importance to the aetiology, prophylaxis and treatment of idiopathic retinal detachment.
AlAhmadi, Badr O.; Alsulaiman, Sulaiman M.; Arevalo, J. Fernando
Purpose. To determine the functional and anatomic outcomes of rhegmatogenous retinal detachment (RRD) surgery in patients with Down syndrome. Methods. A retrospective chart review was performed of patients with Down syndrome who had undergone surgery for RRD at King Khalid Eye Specialist Hospital between 1995 and 2014. Results. A total of 245 patients with Down syndrome were evaluated during the study period. Eighteen eyes of 15 patients (6.1%) with RRD were identified. Three out of 15 patients (20%) presented with bilateral retinal detachment. All eyes presented with macula off retinal detachment. The retina was successfully reattached in 16/18 (88.8%) eyes after a mean follow-up of 48 months. The final postoperative visual acuity ranged from light perception to 20/125 (median: hand motion) (11/18 eyes). Conclusions. The anatomic success rate of retinal reattachment surgery in patients with Down syndrome is comparable to the general population. Patients with Down syndrome should undergo regular ophthalmic examinations for early diagnosis. Despite late diagnosis and the presence of proliferative vitreoretinopathy (PVR) in some patients, favorable anatomical outcomes can be achieved. PMID:27123341
Hejsek, L; Ernest, J; Němec, P; Rejmont, L; Manethová, K; Stepanov, A; Rozsíval, P
Rhegmatogenous retinal detachment is a serious ocular pathology. Therapeutic options are surgical only. Surgery is in advanced stages technically and financially demanding. In this paper, we consider the results operated detachments, which were for their advancement, with respect to the technical possibilities of the present intraocular surgery, on the border of the surgical possibilities. The group consisted of 37 eyes of 37 patients who were followed prospectively and had in the affected eye very advanced (old) rhegmatogenous retinal detachment. As a method to confirtm any visual functions were used visual evoked potentials in flash monocular stimulation (F-VEP). All patients had a cerclage performed 12 mm from the limbus, 20G pars plana vitrectomy (PPV), in 2 was also performed cataract surgery (phacoemulsification with implantation of an artificial intraocular lens to the bag). Surgery was done in 23 of 37 patients (62 % of the whole group), with the remaining 14 eyes was not due to the severity of finding highly advanced retinal detachment. Attached retina at the end of the observation period had 14 eyes (61% of the patients, 38% of the whole group). In 5 eyes was due to local re-detachment in the periphery only stabilized finding (22% of operated eyes, 14% of all). The values of visual acuity in the subgroup of operated eyes were statistically significantly increased after surgery (Wilcoxon p = 0.036). The values of F-VEP were not statistically significantly different between operated and non-operated patients and was not found any statistically significant correlation between the vision (and even after surgery) and F-VEP in operated eyes. Anatomical success of surgical treatment of advanced retinal detachment is possible. But the correlation was not found in visual acuity and F-VEP or the severity of preoperative disturbed visual function, even in the improvement in the postoperative period. F-VEP is not a suitable marker for determining the
Taylor, B C; Winslow, R L
Flat anterior chambers were caused by varying mechanisms in 10 of 70 consecutive pseudophakic eyes operated on for retinal detachment. With iris or capsular implant fixation, three of 46 (7%) developed flat anterior chambers, and with anterior chamber lenses, the occurrence was seven of 24 (29%). Events initiating flat chambers included wound leak, pupillary block, and choroidal detachment. In eyes with flat anterior chambers, the retina could not be reattached in one case, extensive peripheral anterior synechia with persistent intraocular pressure elevation occurred in another case, and bullous keratopathy remained in two additional instances. Endothelial cell densities were obtained in eight eyes and were low on an age-related basis.
Andión-Fernández, M; Dorado-Fernández, T; Juárez-Casado, M A; Santamarina-Pernas, R
A 41-year-old woman with a bilateral loss of visual acuity and a history of IgA nephropathy. The ophthalmic examination revealed bilateral neurosensory detachments that resolved completely after four months of peritoneal dialysis. Bilateral serous retinal detachments are a rare manifestation of IgA nephropathy, in which the etiology is probably multifactorial and their resolution depends on the underlying disease. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Wilkinson, Charles P
Background Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these lesions frequently is recommended, in spite of the fact that the effectiveness of this therapy is unproven. Objectives The objective of this review was to assess the effectiveness and safety of techniques used to treat asymptomatic retinal breaks and lattice degeneration for the prevention of retinal detachment. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to February 2014), PubMed (January 1948 to February 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in
Hisatomi, Toshio; Tachibana, Takashi; Notomi, Shoji; Koyanagi, Yoshito; Murakami, Yusuke; Takeda, Atsunobu; Ikeda, Yasuhiro; Yoshida, Shigeo; Enaida, Hiroshi; Murata, Toshinori; Sakamoto, Taiji; Sonoda, Koh-Hei; Ishibashi, Tatsuro
To examine retinal changes after vitrectomy with internal limiting membrane (ILM) peeling, we used 3-dimensional optical coherence tomography (3D-OCT) in rhegmatogenous retinal detachment cases. The 68 eyes from 67 patients with rhegmatogenous retinal detachment were studied, including 35 detached macula cases (51%) and 33 attached macula cases. Internal limiting membrane peeling was performed with fine forceps after brilliant blue G staining. The 3D-OCT images were obtained with volume-rendering technologies from cross-sectional OCT images. The 3D-OCT detected 45 eyes (66%) with ILM peeling-dependent retinal changes, including dissociated optic nerve fiber layer appearance, dimple sign, temporal macular thinning, ILM peeling area thinning, or forceps-related retinal thinning. The ILM peeled area was detectable in only 9 eyes with 3D-OCT, whereas it was undetectable in other 59 eyes. The dissociated optic nerve fiber layer appearance was detected in 8 of the total cases (12%), and dimple signs were observed in 14 cases (21%). Forceps-related thinning was also noted in eight cases (24%) of attached macula cases and in four cases (11%) of detached macula cases. No postoperative macular pucker was noted in the observational period. The 3D-OCT clearly revealed spatial and time-dependent retinal changes after ILM peeling. The changes occurred in 2 months and remained thereafter.
Eliott, Dean; Hauch, Adam; Kim, Rubin W; Fawzi, Amani
A variety of airbag-associated ocular injuries have been reported in children sitting in the front passenger seat during automobile collisions. These injuries range from corneal abrasions to traumatic hyphema with secondary glaucoma and cataract. We report the case of a 5-year-old boy who experienced retinal dialysis and detachment associated with airbag deployment. The patient recovered 20/20 visual acuity after cryopexy and placement of a radial sponge.
Dong, Kai; Zhu, Zi-Cheng; Wang, Feng-Hua; Ke, Gen-Jie; Yu, Zhang; Xu, Xun
AIM To investigate whether photoreceptor necroptosis induced by z-VAD-FMK (pan caspase inhibitor) was involved the activation of autophagy and whether Necrostatin-1, a specific necroptosis inhibitor, could inhibit this induction of autophagy after experimental retinal detachment. METHODS Experimental retinal detachment models were created in Sprague-Dawley rats by subretinal injection of sodium hyaluronate and subretinal injections of z-VAD-FMK, vehicle or z-VAD-FMK plus Necrostatin-1. Three days after retinal detachment, morphologic changes were observed by transmission electron microscopy. In other animals, retinas were subjected to immunoprecipitation and Western Blotting, then probed with anti-RIP1, phosphoserine, LC-3II or caspase 8 antibody. RESULTS It was proved by immunoprecipitation and western blotting, that photoreceptor necroptosis was mediated by caspase-8 inhibition and receptor interacting protein kinase (RIP1) phosphorylation activation. Transmission electron microscope and western blotting results indicated that photoreceptor necroptosis was involved the LC-3II and autophagosomes induction. We also discovered Necrostatin-1 could inhibit RIP1 phosphorylation and LC-3II induction. CONCLUSION These data firstly indicate photoreceptor necroptosis is associated with the activation of autophagy. Necrostatin-1 protects photoreceptors from necroptosis and autophagy by down-regulation of RIP1 phosphorylation and LC-3II. PMID:25349786
Traumatic retinal detachments are a significant cause of morbidity. There are currently no evidence-based guidelines on the appropriate time to perform vitreoretinal surgery to repair a traumatic retinal detachment. Early intervention, within seven days of the inciting trauma, may decrease proliferative vitreoretinopathy and postoperative endophthalmitis. Later intervention may yield a reduced risk of inflammation and hemorrhage, particularly in cases of concomitant open globe injuries. This article reviews the literature on the management of retinal detachments associated with ocular trauma from the years 2006 to 2016. Particular focus was placed on the timing of surgery, concomitant open globe injury, anatomical success rates, visual acuity, and complication rates. In this review, anatomical success was not significantly related to timing of intervention when compared between early and delayed intervention in eyes with and without concomitant open globe injuries. Visual acuities postoperatively varied widely despite timing of intervention due to the large variation in mechanism and extent of ocular injuries. Proliferative vitreoretinopathy was a common complication. Preliminary data indicate that endophthalmitis rates may be lower when early vitreoretinal surgery is performed. There is insufficient data to conclude whether early or delayed surgery leads to improved outcomes, highlighting the need for further research in this domain. PMID:27999681
Rattner, Amir; Toulabi, Leila; Williams, John; Yu, Huimin; Nathans, Jeremy
The retinal pigment epithelium (RPE) plays an essential role in maintaining the health of the retina. The RPE is also the site of pathologic processes in a wide variety of retinal disorders including monogenic retinal dystrophies, age-related macular degeneration, and retinal detachment. Despite intense interest in the RPE, little is known about its molecular response to ocular damage or disease. We have conducted a comprehensive analysis of changes in transcript abundance (the “genomic response”) in the murine RPE following light damage. Several dozen transcripts, many related to cell-cell signaling, show significant increases in abundance in response to bright light; transcripts encoding visual cycle proteins show a decrease in abundance. Similar changes are induced by retinal detachment. Environmental and genetic perturbations that modulate the RPE response to bright light suggest that this response is controlled by the retina. In contrast to the response to bright light, the RPE response to retinal detachment over-rides these modulatory affects. PMID:18815272
Fischer, Andy J.; Zelinka, Christopher; Milani-Nejad, Nima
Reactive microglia and macrophages are prevalent in damaged retinas. Accordingly, we investigate how the activation or ablation of microglia/macrophages influences the survival of neurons in the chick retina in vivo. We applied intraocular injections of interleukin 6 (IL6) to stimulate the reactivity of microglia/macrophages and clodronate-liposomes to ablate microglia/macrophages. Activation of the microglia/macrophages with IL6 delays the death of retinal neurons from N-methyl-D-aspartate (NMDA) -induced excitotoxicity. In addition, activation of microglia/macrophages combined with colchicine-mediated retinal damage diminished the survival of ganglion cells. Application of IL6 after an excitotoxic insult greatly exacerbates the damage, and causes widespread retinal detachments and folds, accompanied by accumulation of microglia/macrophages in the subretinal space. Damage-induced retinal folds and detachments were significantly reduced by the ablation of microglia/macrophages. We conclude that microglial reactivity is detrimental to the survival of ganglion cells in colchicine-damaged retinas and detrimental to the survival of photoreceptors in retinal folds. In addition, we conclude that IL6-treatment transiently protects amacrine and bipolar cells against an excitotoxic insult. We propose that suppressing reactivity of microglia/macrophages may be an effective means to lessen the damage and vision loss resulting from damage, in particular during retinal detachment injuries. PMID:25231952
Rusu, Irene M; Zizva, Jessica; Myung, Jane S; Wald, Kenneth
The purpose of this paper is to report a series of macular holes that developed after demarcation laser photocoagulation for subclinical retinal detachments. This observational case series consists of three eyes from three patients seen between 2005 and 2012. Delayed idiopathic macular hole formation occurred following demarcation laser photocoagulation for subclinical retinal detachment. Demarcation laser photocoagulation of subclinical retinal detachments may predispose to macular hole formation.
Pitts, R E; Awan, K J; Yanoff, M
An unusual case of choroidal malignant melanoma with heterochromia iridis, massive subretinal hemorrhage and fibrosis, spontaneously resolving retinal detachment, and subretinal seeding is reported. Clinical and pathological findings are presented and discussed. The unusual aspects of the case are further considered by Drs. Andrew Ferry and Mark Tso.
Maia, Mauricio; Farah, Michel E; Aggio, Fabio B; Rodrigues, Eduardo B; de Souza, Eduardo C; Magalhães, Octaviano
Central retinal vein occlusion is a common vascular cause of blidness. In this paper, we first report focal haemorrhagic pigment epithelium detachment and chorioretinal anastomosis in the peripapillary area as an intraoperative complication of radial optic neurotomy (RON). A 65-year-old white man presented with ischaemic central vein occlusion OS. He underwent vitrectomy with RON, panretinal photocoagulation and intravitreal injection of triamcinolone acetonide. A circumscribed subretinal haemorrhage was noted intraoperatively at the nasal site of the RON. The haemorrhage size decreased at the seventh postoperative day when an optical coherence tomography scan disclosed a haemorrhagic pigment epithelium detachment. Fluorescein angiography and fundus photograph revealed a chorioretinal anastomosis formation nasal to the optic nerve confirmed by indocyanine green angiography. Best-correlated visual acuity improved from hand movements to 6/18 at the fourth week and it was stable until last examination. This case illustrates the role of chorioretinal anastomosis formation in the vision improvement following RON.
Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W
Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors.
Gibson, R A
Corneal sensitivity measurements were performed on both eyes of 57 patients after they were subjected to unilateral retinal detachment surgery, the unoperated eyes acting as controls. A marked decrease in corneal sensitivity was found in eyes that were treated with encircling bands, but no significant change of sensitivity could be detected in eyes in which localised radial or circumferential silicone sponge explants alone had been employed. It would appear that encirclement procedures lower the sensitivity of the cornea, and this may continue as a long-term effect. PMID:7295628
Velez, Gabriel; Roybal, C Nathaniel; Binkley, Elaine; Bassuk, Alexander G; Tsang, Stephen H; Mahajan, Vinit B
To report a case of elevated intraocular pressure with retinal detachment. Liquid chromatography and tandem mass spectrometry was performed on the patient aqueous biopsy. Protein levels were analyzed with 1-way analysis of variance (ANOVA) and unbiased clustering. High levels of rod outer segment proteins were not detected, suggesting that this was not a case of Schwartz-Matsuo syndrome. Instead, elevated levels of Hepcidin (HEPC) and Cystatin C (CYTC; candidate biomarkers for primary open angle glaucoma) were detected, suggesting a different, unknown etiology. Molecular diagnoses can differentiate between clinical diagnoses and point to common biomarkers or disease mechanisms.
Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W
Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors. PMID:27041988
Byon, Ik Soo; Kwon, Han Jo; Park, Gun Hyung; Park, Sung Who
Purpose To describe early macular hole (MH) development in rhegmatogenous retinal detachment (RRD) after scleral buckling (SB) based on optical coherence tomography (OCT) findings. Methods The medical records and spectral domain OCT images of patients in whom MH developed after RRD repair were evaluated retrospectively. Results A postoperative MH was detected in five eyes that underwent SB during a 6-year period. All had fovea-off RRD without MH at the time of surgery. OCT showed partial loss of the inner retina with a preserved photoreceptor layer in early postoperative days. On average, 7 days (range,5 to 8 days) after surgery, outer retinal tissues disappeared, resulting in the full-thickness MH. Conclusions Serial OCT findings revealed that partial-thickness lamellar holes progressed to full-thickness MHs, which were formed by the degeneration of the outer retina in eyes with preceding loss of the glial cone in the fovea. PMID:25276077
Comaratta, M R; Chang, S
Low viscosity perfluorocarbon liquids have unique physical properties making them ideal for the temporary tamponade, mechanical fixation, and manipulation of the retina. These substances are optically clear, have a specific gravity greater than that of water, and have interfacial tension properties similar to those of silicone oil. The temporary mechanical fixation of the retina by perfluorocarbon liquids facilitates the removal of epiretinal membranes and release of tractional forces. Intraoperative flattening of the retina under perfluorocarbon liquid eliminates the need for a posterior retinotomy. Perfluorocarbon liquids are being used intraoperatively for hydrokinetic manipulation of the retina during vitrectomy for complicated retinal detachments secondary to proliferative vitreoretinopathy, giant retinal tears, and trauma. Additional indications for the intraoperative utilization of perfluorocarbon liquids in vitreous surgery are discussed.
Hussain, Rehan M.; Abbey, Ashkan M.; Shah, Ankoor R.; Drenser, Kimberly A.; Trese, Michael T.; Capone, Antonio
Purpose: To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV). Methods: This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit. Results: Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%). Conclusion: RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes. PMID:28299000
Murakami, Yusuke; Notomi, Shoji; Hisatomi, Toshio; Nakazawa, Toru; Ishibashi, Tatsuro; Miller, Joan W.; Vavvas, Demetrios G.
Photoreceptor cell death is the ultimate cause of vision loss in various retinal disorders, including retinal detachment (RD). Photoreceptor cell death has been thought to occur mainly through apoptosis, which is the most characterized form of programmed cell death. The caspase family of cysteine proteases plays a central role for inducing apoptosis, and in experimental models of RD, dying photoreceptor cells exhibit caspase activation; however, there is a paradox that caspase inhibition alone does not provide a sufficient protection against photoreceptor cell loss, suggesting that other mechanisms of cell death are involved. Recent accumulating evidence demonstrates that non-apoptotic forms of cell death, such as autophagy and necrosis, are also regulated by specific molecular machinery, such as those mediated by autophagy-related proteins and receptor-interacting protein kinases, respectively. Here we summarize the current knowledge of cell death signaling and its roles in photoreceptor cell death after RD and other retinal degenerative diseases. A body of studies indicate that not only apoptotic but also autophagic and necrotic signaling are involved in photoreceptor cell death, and that combined targeting of these pathways may be an effective neuroprotective strategy for retinal diseases associated with photoreceptor cell loss. PMID:23994436
Dave, Vivek P; Jalali, Subhadra; Nayaka, Ashraya; Pappuru, Rajeev R; Pathengay, Avinash; Das, Taraprasad
To describe the clinical presentations and outcomes of rhegmatogenous retinal detachments (RRD) in eyes with retinitis pigmentosa. A retrospective review of all patients of retinitis pigmentosa with RRD from January 1990 to December 2013 at a tertiary eye care institute. Of total 28,622 patients of retinitis pigmentosa over a 23-year period, 17 eyes of 17 patients had RRD. Mean age at presentation was 34.53 ± 16.42 years (median 32 years). Median duration of decreased vision attributed to RRD was 6 months. Ten eyes (59%) had cataract and 3 eyes (18%) had history of cataract surgery. Thirteen eyes (76%) had inferior retinal detachment; 9 eyes (53%) had lattice with retinal holes; and 8 eyes (47%) had atrophic retinal holes. There were no horse-shoe tears, giant retinal tears, dialysis, and macular holes related RRD. Majority (82%) of retinal breaks were in the inferotemporal quadrant. Only 3 eyes (18%) had proliferative vitreoretinopathy at presentation. Twelve eyes at presentation had best-corrected visual acuity <20/200 and 6 eyes had only light perception. The macula was involved by the detachment in all cases. Mean preoperative visual acuity was 1.4 ± 0.88 logarithm of the minimum angle of resolution (median 1.3, range 3-0.1; 20/502). Surgery was not advised in 6 eyes (35% patients); 5 eyes (30%) underwent scleral buckling and 6 eyes (35%) underwent vitrectomy. Median follow-up was 5 months. Reattachment rate at last follow-up was 91% (15 eyes). Mean postoperative best-corrected visual acuity recorded was 1.06 ± 0.8 (median 1, range 3-0.1; 20/229) (P = 0.15). Eight eyes at last visit had best-corrected visual acuity <20/200. Of the 11 eyes operated, 4 improved in vision and 7 retained the preoperative vision. The incidence of RRD in retinitis pigmentosa is very low. Presentation, although delayed, is at a younger age. Horse-shoe tears and proliferative vitreoretinopathy are uncommon; cataract is a common coexisting pathology. Surgical reattachment rates
Roldán Pallarés, M; Ossama, I A; Contreras, E; Hernández, J; Ganado, T; Bravo, C
To determine if ocular blood flow (OBF) changes in retinal detachment (RD) are related with its characteristics (extension, macular involvement, PVR or duration). 60 patients with unilateral rhegmatogenous RD and 20
Sinha, M K; Chhablani, J; Shah, B S; Narayanan, R; Jalali, S
Purpose To report the outcomes and surgical difficulties during rhegmatogenous retinal detachment (RRD) repair in patients with albinism. Methods Retrospective analysis of 10 eyes of 9 patients with albinism that underwent RRD repair was performed. Collected data included demographic details, preoperative examination details, surgical procedure, surgical difficulties, anatomical, and visual outcomes. Outcome measures were retinal reattachment and visual acuity at the last follow-up. Results Mean preoperative best-corrected visual acuity (BCVA) was logMAR (Logarithm of the Minimum Angle of Resolution) 2.15 (range 0.9–3.0) with preoperative localization of causative break in six eyes. One eye had proliferative vitreoretinopathy grade C1 preoperatively. Four eyes underwent scleral buckling (SB) and six underwent 20G pars plana vitrectomy (PPV) with silicone oil injection. Intraoperative complication as iatrogenic retinal break occurred in four eyes. For retinopexy during vitrectomy, endolaser delivery was possible in three out of six eyes, whereas three eyes had cryopexy. The mean follow-up was 12 months in SB group (range 1–12; median 12 months) and 5.33 months (range 1–12; median 3 months) in PPV group. Among vitrectomized eye, two eyes had recurrence at 3 months with oil in situ. Rest of the eyes had attached retina at last follow-up. Mean BCVA at last follow-up was logMAR −1.46 (range 0.7–2.0) with mean improvement of −0.57 logMAR. Conclusions Identification of break, induction of posterior vitreous detachment, and endolaser delivery may be difficult during RRD repair in patients with albinism. The incidence of PVR appeared less in these eyes. Both SB and PPV were efficacious and appear to be good surgical techniques for use in this patient population. PMID:26611845
Sinha, M K; Chhablani, J; Shah, B S; Narayanan, R; Jalali, S
To report the outcomes and surgical difficulties during rhegmatogenous retinal detachment (RRD) repair in patients with albinism. Retrospective analysis of 10 eyes of 9 patients with albinism that underwent RRD repair was performed. Collected data included demographic details, preoperative examination details, surgical procedure, surgical difficulties, anatomical, and visual outcomes. Outcome measures were retinal reattachment and visual acuity at the last follow-up. Mean preoperative best-corrected visual acuity (BCVA) was logMAR (Logarithm of the Minimum Angle of Resolution) 2.15 (range 0.9-3.0) with preoperative localization of causative break in six eyes. One eye had proliferative vitreoretinopathy grade C1 preoperatively. Four eyes underwent scleral buckling (SB) and six underwent 20G pars plana vitrectomy (PPV) with silicone oil injection. Intraoperative complication as iatrogenic retinal break occurred in four eyes. For retinopexy during vitrectomy, endolaser delivery was possible in three out of six eyes, whereas three eyes had cryopexy. The mean follow-up was 12 months in SB group (range 1-12; median 12 months) and 5.33 months (range 1-12; median 3 months) in PPV group. Among vitrectomized eye, two eyes had recurrence at 3 months with oil in situ. Rest of the eyes had attached retina at last follow-up. Mean BCVA at last follow-up was logMAR -1.46 (range 0.7-2.0) with mean improvement of -0.57 logMAR. Identification of break, induction of posterior vitreous detachment, and endolaser delivery may be difficult during RRD repair in patients with albinism. The incidence of PVR appeared less in these eyes. Both SB and PPV were efficacious and appear to be good surgical techniques for use in this patient population.
Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Wang, Xue
Background Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery) but occasionally may be associated with primary RD. Either way, a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. Objectives The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 June 2013. Selection criteria We included randomized controlled trials (RCTs) of participants undergoing surgery for RD associated with PVR that compared various tamponade agents. Data collection and analysis Two review authors screened the search results independently. We used the standard methodological procedures expected by The Cochrane Collaboration. PMID:24532038
Faude, F; Francke, M; Makarov, F; Schuck, J; Gärtner, U; Reichelt, W; Wiedemann, P; Wolburg, H; Reichenbach, A
Retinal detachment remains one of the most frequent causes of visual impairment in humans, even after ophthalmoscopically successful retinal reattachment. This study was aimed at monitoring (ultra-) structural alterations of retinae of rabbits after experimental detachment. A surgical procedure was used to produce local retinal detachments in rabbit eyes similar to the typical lesions in human patients. At various periods after detachment, the detached retinal area as well as neighbouring attached regions were studied by light and electron microscopy. In addition to the well-known degeneration of photoreceptor cells in the detached retina, the following progressive alterations were observed, (i) in both the detached and the attached regions, an incomplete but severe loss of ganglion cell axons occurs; (ii) there is considerable ganglion cell death, particularly in the detached area; (iii) even in the attached retina distant from the detachment, small adherent groups of photoreceptor cells degenerate; (iv) these photoreceptor cells degenerate in an atypical sequence, with severely destructed somata and inner segments but well-maintained outer segments; and (v) the severe loss of retinal neurons is not accompanied by any significant loss of Müller (glial) cells. It is noteworthy that the described progressive (and probably irreparable) retinal destructions occur also in the attached retina, and may account for visual impairment in strikingly large areas of the visual field, even after retinal reattachment.
Ghasemi Falavarjani, K; Alemzadeh, S A; Modarres, M; Parvaresh, M M; Hashemi, M; Naseripour, M; Nazari Khanamiri, H; Askari, S
Purpose To evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation. Methods In this retrospective study, a chart review of all patients with RRD associated with subretinal proliferation who were primarily treated with scleral buckling procedure, from April 2007 to April 2014, was undertaken. Main outcome measures were anatomical retinal reattachment and visual acuity. Results Forty-four eyes of 43 patients including 24 males and 19 females with a mean age of 26.5±13.1 years were evaluated. Immediately after the surgery, retina was reattached in all eyes. However, five eyes (11.3%) needed additional surgery for retinal redetachment. Single surgery anatomical success rate was 88.7%. Four eyes (9.1%), needed pars plana vitrectomy for the treatment of redetachment associated with proliferative vitreoretinopathy and scleral buckle revision surgery was successfully performed in the other eye. Best corrected visual acuity improved from 1.5±0.9 logMAR before surgery to 1.1±0.7 logMAR after surgery (P<0.001). An improvement in BCVA of >2 lines was found in 23 eyes (52.2%) and worsening of best corrected visual acuity of >2 lines was observed in 2 eyes (4.5%). Conclusions Scleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation. PMID:25613841
Ono, Kozue; Kinoshita, Hirofumi; Uematsu, Masafumi; Tsuiki, Eiko; Fujikawa, Azusa; Kitaoka, Takashi
Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%. PMID:27478632
Mohamed, Yasser Helmy; Ono, Kozue; Kinoshita, Hirofumi; Uematsu, Masafumi; Tsuiki, Eiko; Fujikawa, Azusa; Kitaoka, Takashi
Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2-6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.
Gui, Jun-Min; Jia, Li; Liu, Lei; Liu, Jian-Di
AIM To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). METHODS A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP) were recorded and analyzed. RESULTS Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye. CONCLUSION Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony. PMID:23826529
Padhi, Tapas Ranjan; Kesarwani, Siddharth; Jalali, Subhadra
A 34-year-old man presented with reduction and distortion of vision in both the eyes. The best-corrected vision was 20/20 parts, N6 in either eye. The external and slit lamp examination of both the eyes was unremarkable. The fundus examination showed multiple intraretinal crystalline deposits at the posterior pole, extending up to midperiphery, tortuous retinal blood vessels with S-shaped deflections, and absent foveal reflex in both the eyes. There were no corneal crystals, and the color vision was defective in both the eyes. Fundus autofluorescence and fundus fluorescein angiogram (FFA) were suggestive of geographic areas of retinal pigment epithelium (RPE) and choriocapillary (CC) loss. OCT revealed subfoveal neurosensory detachment. Flash ERG and EOG were normal except for a slight decrease in amplitude and delay in latency of pattern ERG waveforms. The Humphrey's visual field showed paracentral scotoma with reduction in the amplitude of waveforms from the corresponding area in the multifocal ERG in both the eyes. Systemic evaluation for crystalline retinopathy was unremarkable. He was diagnosed to be a case of Bietti crystalline retinopathy (local/regional variant). The subfoveal neurosensory detachment could represent early RPE dysfunction caused by these crystals and could account for the mild visual disturbance in both the eyes. Retinal vascular tortuosity and neurosensory detachment seen in this case is the first time to be reported in literature.
Kapoor, Kapil G.; Hodge, David O.; St Sauver, Jennifer L.; Barkmeier, Andrew J.
Objective To examine whether oral fluoroquinolone antibiotics are associated with an increase in subsequent rhegmatogenous retinal detachment and symptomatic retinal breaks in a large, population-based cohort. Design Population-based cohort study Participants and Controls Adult residents of Olmsted County, Minnesota who were prescribed oral fluoroquinolone medications from 1/01/03 – 6/30/11. Comparison cohorts consisted of patients prescribed oral macrolide and β-lactam antibiotics during the study period. Methods Procedure codes were used to identify retinal detachment repair and prophylaxis procedures occurring within 1 year of prescription dates. Travel clinic, pro re nata, and self-treatment prescriptions were excluded. Patients with tractional retinal detachment, previous retinal detachment repair, endophthalmitis, and necrotizing retinitis were excluded, as were those with intraocular surgery or severe head/eye trauma ≤ 90 days prior to the procedure. Main Outcome Measures Rates of retinal detachment repair and prophylaxis procedures within 7, 30, 90, and 365 days of the first prescription were calculated and compared between antibiotic prescription cohorts using Chi-square tests. Retinal detachment repair rates were also compared to the expected Olmsted County, Minnesota rates using the one-sample log rank test. Results Oral fluoroquinolones were prescribed for 38,046 patients (macrolide n=48,074, β-lactam n=69,079) during the study period. Retinal detachment repair procedures were performed within 365 days of the first prescription in 0.03% (95% confidence interval [CI] 0.01–0.06%) of the fluoroquinolone, 0.02% (95% CI 0.01–0.03%) of the macrolide, and 0.03% (95% CI 0.02–0.05%) of the β-lactam cohorts (p>0.05). Retinal detachment prophylaxis procedures for symptomatic retinal breaks were performed within 365 days of the first prescription in 0.01% (95% CI 0.00–0.03%) of the fluoroquinolone, 0.02% (95% CI 0.01–0.04%) of the macrolide, and 0
Ricker, Lukas J A G; Dieri, Raed Al; Beckers, Gerold J M; Pels, Elisabeth; Liem, Albert T A; Hendrikse, Fred; Kijlstra, Aize; Hemker, H Coenraad; La Heij, Ellen C
An increased mRNA expression of genes related to blood coagulation has been demonstrated in an experimental retinal detachment model but has not yet been confirmed in human clinical specimens. Tissue factor (TF), the initiating factor of blood coagulation, may be a determinant of the extent of tissue injury after rhegmatogenous retinal detachment (RRD). This study was conducted to determine whether subretinal fluid and vitreous fluid collected from patients with RRD have a procoagulant effect. Calibrated thrombin generation (CAT) was used to investigate the thrombogenic properties of 28 subretinal fluids collected during scleral buckling surgery for RRD. Further, the thrombogenic properties of vitreous fluids from RRD (n = 12), macular pucker (n = 5), macular hole (n = 6), and proliferative diabetic retinopathy (n = 5) were compared with the properties of eye bank eyes (n = 11), which served as control specimens. The procoagulant activity of TF was determined with Western blot analysis. The addition of subretinal fluid from all RRD patients (28/28, 100%) induced thrombin generation in normal and severely factor (F)XII-deficient plasma. Contrary to the subretinal fluid, the addition of vitreous fluids from various ocular disorders evoked very little thrombin generation in normal and severely FXII-deficient plasma (4/12, 33% RRD; 1/5, 20% macular pucker; 0/6, 0% macular hole; 0/5, 0% proliferative diabetic retinopathy; and 2/11, 18% eye bank eyes). The procoagulant activity in subretinal fluid was almost completely neutralized by antibodies against human TF. The presence of TF in subretinal fluid was confirmed by Western blot. Subretinal fluid of patients with RRD induces high procoagulant activity, determined by measuring the level of tissue factor.
Tumahai, Perle; Saas, Philippe; Ricouard, Fanny; Biichlé, Sabéha; Puyraveau, Marc; Laheurte, Caroline; Delbosc, Bernard; Saleh, Maher
Microparticles (MPs) are membrane-derived vesicles measuring less than 1 μm in diameter. They are shed from nearly every activated or preapoptotic cell and may exhibit biologic activities in inflammation or apoptosis settings. The main purpose of this study was to determine whether MP shedding was higher in the vitreous of patients with retinal detachment (RD). This was a prospective, comparative study. Levels of vitreous MPs (including phosphatidylserine [PS]-expressing MPs, photoreceptor cell-derived MPs, and photoreceptor cell-derived MPs expressing PS) and soluble proinflammatory factors (i.e., monocyte chemoattractant protein-1, intercellular adhesion molecule-1, and IL-6) were analyzed by flow cytometry. Samples were obtained from 49 eyes undergoing RD surgery and 41 control eyes. Vitreous levels of all the MPs studied were significantly increased in the RD group. Vitreous MP levels were correlated with levels of at least one proinflammatory factor depending on MP subsets. Concerning clinical parameters, vitreous PS-expressing MP and PS-expressing photoreceptor cell-derived MP levels were higher depending on the duration of RD at surgery, the detached retina surface, and the macula status and were found more sensitive than proinflammatory factors only for the duration of RD at surgery. Vitreous concentrations of MPs (mainly derived from photoreceptor cells) are higher after rhegmatogenous RD and found to be correlated with soluble proinflammatory factors.
Mahmoudi, Sasan; Almony, Arghavan
The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD) and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours). In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame. PMID:27195093
Chen, San-Ni; Hwang, Jiunn-Feng; Wu, Wen-Chuan
This is an observational study of fluorescein angiography (FA) in consecutive patients with rhegmatogenous retinal detachment (RRD) in Changhua Christian Hospital to investigate the peripheral retinal vascular patterns in those patients. All patients had their age, sex, axial length (AXL), and refraction status (RF) recorded. According to the findings in FA of the peripheral retina, the eyes were divided into 4 groups: in group 1, there was a ramified pattern of peripheral retinal vasculature with gradual tapering; in group 2, there was an abrupt ending of peripheral vasculature with peripheral non-perfusion; in group 3, there was a curving route of peripheral vasculature forming vascular arcades or anastomosis; and in group 4, the same as in group 3, but with one or more wedge-shaped avascular notches. Comparisons of age, sex, AXL, and RF, association of breaks with lattice degeneration and retinal non-perfusion, surgical procedures utilized, and mean numbers of operations were made among the four groups. Of the 73 eyes studied, there were 13 eyes (17.8%) in group 1, 3 eyes (4.1%) in group 2, 40 eyes (54.8%) in group 3 and 17 eyes (23.3%) in group 4. Significant differences in age, AXL and RF, and association of retinal breaks to non-perfusion were noted among the four groups. Patients in group 1 had older ages, while younger ages were noted in groups 3 and 4. Eyes in group 1 had the shortest average AXL and were least myopic in contrast to the eyes in groups 3 and 4. Association of retinal breaks and retinal non-perfusion was significantly higher in groups 2, 3 and 4 than in group 1. In conclusion, peripheral vascular anomalies are common in cases with RRD. Patients with peripheral non-perfusion tend to be younger, with longer axial length and have the breaks associated with retinal non-perfusion. PMID:26909812
Rani, Padmaja Kumari; Ambiya, Vikas; Senthil, Sirisha; Jalali, Subhadra
We present a case of bilateral choroidal and exudative retinal detachment with hypotony in a patient with septicaemia. Our patient after initial hospitalisation was treated by the local ophthalmologist as a case of sterile pan uveitis with systemic and topical steroids that did not have any effect. Our patient responded well to timely surgical intervention of choroidal drainage and vitrectomy with silicone oil tamponade followed by steroids and antibiotics. Cataract progression in both eyes occurred due to hypotony, inflammation, use of steroids and the vitreous surgery. It was successfully managed with timely surgical removal of cataract and intraocular lens implantation in both eyes facilitating early visual rehabilitation. Topical medications included frequent topical steroids and antibiotics as per our published protocols. 2016 BMJ Publishing Group Ltd.
Okamoto, Fumiki; Sugiura, Yoshimi; Okamoto, Yoshifumi; Hiraoka, Takahiro; Oshika, Tetsuro
Purpose:To quantify aniseikonia after successful surgical repair of rhegmatogenous retinal detachment (RD), and to investigate the relationship between the severity of postoperative aniseikonia and retinal microstructures as well as clinical parameters. Methods:The study included 106 eyes of 106 patients, without any history of ocular disease/surgery and less than 2 diopters of anisometropia, who had undergone successful retinal reattachment surgery. Aniseikonia was measured with New Aniseikonia Test and foveal microstructure was assessed with the spectral-domain optical coherence tomography at 6 months postoperatively. Results:Twenty-eight of 106 patients (26%) had micropsia, 17 patients (16%) had macropsia, and 61 patients (58%) had no aniseikonia. The mean absolute value of aniseikonia was 2.3 ± 2.9% (range; -12.5% - +12.0%). Of 57 eyes with macula-on RD, 3 had micropsia and 12 had macropsia. Of 49 eyes with macula-off RD, 25 had micropsia and 5 had macropsia. Eyes with micropsia mostly exhibited persistent or transient cystoid macular edema, subretinal fluid, hyperreflective or disruption of IS/OS line, while most of the eyes with macropsia presented epiretinal membrane. Stepwise multiple regression analysis revealed that postoperative best-corrected visual acuity and the area of RD were significantly relevant to the mean absolute value of aniseikonia. Conclusions:These results suggested that about half of patients with successful repair of RD had aniseikonia. Eyes with macula-off RD tended to show micropsia, while those with macula-on RD mostly presented macropsia. Micropsia and macropsia were primarily caused by respective specific abnormal structures at the foveal region.
Wassmer, Sarah; Leonard, Brian C; Coupland, Stuart G; Baker, Adam; Hamilton, John; Torlone, Renée; Zacks, David N; Tsilfidis, Catherine
We present an optimized surgical technique for feline retinal detachment which allows for natural re-attachment, reduces retinal scarring and vitreal bands, and allows central placement of the detachment in close proximity to the optic nerve. This enables imaging via Optical Coherence Tomography (OCT) and multifocal electroretinography (mfERG) analysis. Ideal detachment conditions involve a lensectomy followed by a three-port pars plana vitrectomy. A 16-20 % retinal detachment is induced by injecting 8 % C3F8 gas into the subretinal space in the central retina with a 42G cannula. The retinal detachment resolves approximately 6 weeks post-surgery. Imaging is enhanced by using a 7.5 and 20 diopter lens for OCT and mfERG fundus imaging, respectively, to compensate for the removed lens.
Villalba-Pinto, Luis; Hernández-Ortega, M. Ángeles; de los Mozos, F. Javier Lavid; Pascual-Camps, Isabel; Dolz-Marco, Rosa; Arevalo, J. Fernando; Gallego-Pinazo, Roberto
Introduction Systemic high blood pressure is related to a variety of retinal manifestations. We present an atypical case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment. Case Report A 26-year-old male with a genitourinary malformation and secondary grade IV chronic kidney failure as well as high blood pressure complained of acute vision loss. Dilated fundus examination evidenced a bilateral serous retinal detachment with macular involvement. The patient was unresponsive to oral antihypertensive therapy and dialysis treatment. The serous retinal detachment progressively decreased after the restoration of dialysis and antihypertensive therapy. The final visual acuity was 0.50 in both eyes. Discussion In cases of serous macular detachment, it is mandatory to rule out different systemic and ocular diseases. The presence of uncontrolled high blood pressure may produce aggressive bilateral retinal changes, thus hypertension must be under early and strict control in order to improve the visual outcomes. PMID:25120474
Schatz, Patrik; Aldayel, Ahmed; Taskintuna, Ibrahim; Abdelkader, Ehab; Mura, Marco
Proliferative diabetic retinopathy is a major cause of visual impairment in working-age adults worldwide. Panretinal photocoagulation is a cornerstone in its management; however, it may include a range of side effects and complications, one of these being serous retinal detachment. To the best of our knowledge, this is the first report of the use of intravitreal injection of bevacizumab for serous retinal detachment after panretinal photocoagulation. A 24-year-old Saudi man with poorly controlled type 1 diabetes presented with bilateral progressive proliferative retinopathy in spite of several sessions of panretinal photocoagulation. After one additional such session, he developed bilateral serous retinal detachment and vision loss, which was managed with a single bilateral intravitreal bevacizumab injection. The serous retinal detachment subsided with partial recovery of vision. Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy is a rare complication nowadays. In this case, it seems that excessive photocoagulation exceeded the energy-absorbing capacity of the retinal pigment epithelium, leading to a disruption of the blood-retinal barrier. A single injection of bilateral intravitreal bevacizumab was sufficient to control the serous retinal detachment. This effect may have been due to a reduction of vascular leakage resulting from the mechanism of action of this drug. No complications were noted from the injection. Caution should be exerted when attempting bilateral panretinal photocoagulation.
Kanan, Yogita; Brobst, Daniel; Han, Zongchao; Naash, Muna I.; Al-Ubaidi, Muayyad R.
Retinal detachment is the physical separation of the retina from the retinal pigment epithelium. It occurs during aging, trauma, or during a variety of retinal disorders such as age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity, or as a complication following cataract surgery. This report investigates the role of fibulin 2, an extracellular component, in retinal detachment. A major mechanism for detachment resolution is enhancement of cellular adhesion between the retina and the retinal pigment epithelium and prevention of its cellular migration. This report shows that fibulin 2 is mainly present in the retinal pigment epithelium, Bruch membrane, choriocapillary, and to a lesser degree in the retina. In vitro studies revealed the presence of two isoforms for fibulin 2. The small isoform is located inside the cell, and the large isoform is present inside and outside the cells. Furthermore, fibulin 2 is post-translationally modified by tyrosine sulfation, and the sulfated isoform is present outside the cell, whereas the unsulfated pool is internally located. Interestingly, sulfated fibulin 2 significantly reduced the rate of cellular growth and migration. Finally, levels of fibulin 2 dramatically increased in the retinal pigment epithelium following retinal detachment, suggesting a direct role for fibulin 2 in the re-attachment of the retina to the retinal pigment epithelium. Understanding the role of fibulin 2 in enhancing retinal attachment is likely to help improve the current therapies or allow the development of new strategies for the treatment of this sight-threatening condition. PMID:24692557
Mantopoulos, Dimosthenis; Murakami, Yusuke; Comander, Jason; Thanos, Aristomenis; Roh, Miin; Miller, Joan W.; Vavvas, Demetrios G.
Background Detachment of photoreceptors from the underlying retinal pigment epithelium is seen in various retinal disorders such as retinal detachment and age-related macular degeneration and leads to loss of photoreceptors and vision. Pharmacologic inhibition of photoreceptor cell death may prevent this outcome. This study tests whether systemic administration of tauroursodeoxycholic acid (TUDCA) can protect photoreceptors from cell death after experimental retinal detachment in rodents. Methodology/Principal Findings Retinal detachment was created in rats by subretinal injection of hyaluronic acid. The animals were treated daily with vehicle or TUDCA (500 mg/kg). TUNEL staining was used to evaluate cell death. Photoreceptor loss was evaluated by measuring the relative thickness of the outer nuclear layer (ONL). Macrophage recruitment, oxidative stress, cytokine levels, and caspase levels were also quantified. Three days after detachment, TUDCA decreased the number of TUNEL-positive cells compared to vehicle (651±68/mm2 vs. 1314±68/mm2, P = 0.001) and prevented the reduction of ONL thickness ratio (0.84±0.03 vs. 0.65±0.03, P = 0.002). Similar results were obtained after 5 days of retinal detachment. Macrophage recruitment and expression levels of TNF-a and MCP-1 after retinal detachment were not affected by TUDCA treatment, whereas increases in activity of caspases 3 and 9 as well as carbonyl-protein adducts were almost completely inhibited by TUDCA treatment. Conclusions/Significance Systemic administration of TUDCA preserved photoreceptors after retinal detachment, and was associated with decreased oxidative stress and caspase activity. TUDCA may be used as a novel therapeutic agent for preventing vision loss in diseases that are characterized by photoreceptor detachment. PMID:21961034
Burcea, M; Muşat, O; Gheorghe, Andreea; Mahdi, Labib; Colta, Diana; Cernat, Corina; Mansour, Agajani
We present the case of a 54 year old patient diagnosed with rhegmatogenous retinal detachment and perforating keratoplasty. Surgery is recommended and we performed posterior vitrectomy, endolaser, and internal heavy oil tamponade. The post-operative course was favorable.
Mozaffarieh, Maneli; Sacu, Stefan; Benesch, Thomas; Wedrich, Andreas
In this study, the researchers examined anxious and depressive symptoms of patients with rhegmatogenous retinal detachment (RRD) prior to and up to year after retinal detachment surgery. One hundred and thirteen (113) patients with RRD took part in this prospective longitudinal study. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Visual acuity (VA) results and HADS scores of all participants were recorded prior to and 3, 6 and 12 months after retinal detachment surgery. Pearson correlation analysis showed a significant association between the patients' VA and HADS psychological scores both prior to and three months after surgery, regardless of the type of surgery performed. Psychological distress is a significant problem associated with retinal detachments that requires more attention.
Raguideau, Fanny; Lemaitre, Magali; Dray-Spira, Rosemary; Zureik, Mahmoud
Several studies have focused on the current use of oral fluoroquinolones and the risk for retinal detachment (RD), but the existence of this association is under debate. Given the widespread fluoroquinolone use, investigation of this association is essential. To assess the association between oral fluoroquinolone use and the risk for RD, including the rhegmatogenous and exudative types. This case-crossover study included 27,540 adults with RD from French health care databases from July 1, 2010, through December 31, 2013. Patients with a history of RD or retinal break, endophthalmitis, intravitreal injection, choroidal retinal vitreal biopsy, and human immunodeficiency virus infection or those hospitalized within 6 months of RD were excluded. The risk period of primary interest was current use, defined as exposure to fluoroquinolones within 10 days immediately before RD surgery, according to previous findings. Oral fluoroquinolone use was assumed to start on the day the prescription was dispensed. Exposure to fluoroquinolones during the risk period (1-10 days) compared with the control period (61-180 days). The association was also assessed regarding use in the recent (11-30 days) and past (31-60 days) intermediate risk period, type of fluoroquinolone, and type of RD. Of the 27,540 eligible patients (57% men; mean [SD] age, 61.5 [13.6] years), 663 patients with RD were exposed to fluoroquinolones during the observation period, corresponding to 80 cases exposed during the 10-day risk period (≤10 days before RD) and 583 cases exposed during the control period (61-180 days). We found a significant increased risk for RD during the 10-day period after the dispensing of oral fluoroquinolones, with an adjusted odds ratio of 1.46 (95% CI, 1.15-1.87). The risk was significantly increased for rhegmatogenous and exudative RD, with adjusted odds ratios of 1.41 (95% CI, 1.04-1.92) and 2.57 (95% CI, 1.46-4.53), respectively. Recent and past use of fluoroquinolones were not
Alves, Carlos; Penedones, Ana; Mendes, Diogo; Batel Marques, Francisco
Several pharmacoepidemiologic studies have been carried out evaluating the risk of retinal detachment associated with systemic fluoroquinolones. This meta-analysis aims to investigate such association, in the light of the best scientific evidence available. A literature search was conducted to identify relevant studies evaluating the risk for retinal detachment associated with systemic fluoroquinolones. A meta-analysis was performed to pool rate ratios (RRs). Meta-regressions were conducted aiming to evaluate the influence of time interval between fluoroquinolones use and retinal detachment diagnosis or treatment risk estimates. Ten observational studies from seven publications were included. Overall, fluoroquinolones were not associated with an increased risk for retinal detachment [RR 1.47 (95% CI 0.95-2.27): p = 0.09; I(2) = 92.8%]. When the analysis was stratified according to different study designs, the result was statistically significant for retrospective cohort studies [RR 1.87 (95% CI 1.36-2.58); p < 0.001; I(2) = 0.0%] and for past users of fluoroquinolones, based on data from case-control studies [RR 1.07 (95% CI 1.01-1.12); p = 0.01; I(2) = 0.0%]. According to meta-regressions, the risk for retinal detachment did not vary due to different time intervals between fluoroquinolones prescription and retinal detachment occurrence. No statistically significant results were identified among studies evaluating only rhegmatogenous retinal detachments, as well as among studies that evaluated patients not requiring a prior ophthalmologist visit to be included. In light of the current available evidence, systemic fluoroquinolones do not seem to be associated with retinal detachment. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Ahn, Jae Kyoun
Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis. Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups. Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p < 0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%, p = 0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors. Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB. PMID:27688907
Morris, Robert E; Shere, Jeffrey L; Witherspoon, C Douglas; Segal, Zachary K; Tehranchi, Linda; Kuhn, Ferenc; Sapp, Mathew
To assess the safety and efficacy of peripheral 360-degree laser retinopexy as prophylaxis against rhegmatogenous retinal detachment (RRD) in eyes having pars plana vitrectomy (PPV) for the removal of retained cataract fragments. Private practice, Callahan Eye Foundation Hospital, University of Alabama at Birmingham, and Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA. This retrospective analysis comprised a consecutive series of patients who had PPV with 360-degree laser retinopexy for retained cataract fragment removal between January 1, 1995, and December 31, 2000. All laser treatments were applied with indirect ophthalmoscope delivery. In 78 eyes of 78 patients, the mean interval between cataract surgery and PPV with 360-degree laser retinopexy prophylaxis was 14 days. One (1.3%) of 78 eyes had postoperative RRD during a mean follow-up of 6 years. No laser-related complications occurred. The incidence of RRD after PPV with 360-degree laser retinopexy prophylaxis was 1.3%, a significant reduction from the average 8.2% RRD rate in the literature (P = .024). Although future prospective trials are indicated, the results suggest that 360-degree laser retinopexy prophylaxis could significantly reduce the incidence of this visually disabling complication.
Leshno, Ari; Barak, Adiel; Loewenstein, Anat; Weinberg, Amit; Neudorfer, Meira
To investigate the changes over time in optical density (OD) characteristics of subretinal fluid (SRF) in rhegmatogenous retinal detachment (RRD) and their clinical relevance. The study included patients with first-onset RRD and no history of intraocular illness who underwent optical coherence tomography (OCT) and whose OCT scans showed sufficient SRF for sampling (08/2013-09/2014). The highest quality B-scan (as graded by the OCT image acquisition software) containing SRF was analyzed. Optical density measurements were obtained using ImageJ. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. Time from onset of RRD was determined by first signs of visual loss as described in the patient's anamnesis. Patients were divided into three groups by RRD duration: acute (≤1 week), subacute (between 1 week and 1 month), and chronic (>1 month). Thirty-five eyes (34 patients) met the inclusion criteria. The ODR measurement was significantly associated with RRD duration. The ODR had a significant (P < 0.0001) association with the 3-month postoperative visual acuity (VA). Vitreous OD did not differ significantly between the three groups. The increase over time in the ODR of the SRF in RRD might reflect a change in SRF composition and state of the retina. This, together with a significant association between preoperative ODR values and postoperative VA suggest its potential as a biological prognostic marker.
Vingolo, Enzo M.; Fragiotta, Serena; Domanico, Daniela; Limoli, Paolo G.; Nebbioso, Marcella; Spadea, Leopoldo
Purpose. To evaluate possible speeding up recovery time after retinal detachment (RD) surgery using biofeedback strategy. Methods. A total of 52 eyes were selected. After surgery, patients were divided into two groups: group A, including patients submitted to biofeedback with MP-1 strategy; group B, patients who received common care strategy. Biofeedback strategy was started 15 days after the suspension of cycloplegic eye drops in buckling procedure or after silicone oil removal in the vitrectomized eyes. Controls were scheduled at baseline and 6, 12, and 18 weeks. Results. At baseline, there was no significant difference in BCVA between groups (P = 0.4230). At the end of biofeedback treatment (WK 6) BCVA of group A was significantly better (P < 0.001) than group B and BCVA was still better in group A than group B at WK 12 (P = 0.028) and at WK 18 (P = 0.041). Conclusions. Visual recovery after RD surgery is still unclear, and it does not depend on entity of the RD. Our data demonstrate that in biofeedback group there was a significant recovery in visual performances that still remains evident after 3 months from the baseline. PMID:26998353
Reed, David C; Juhn, Alexander T; Rayess, Nadim; Hsu, Jason; Chiang, Allen
To report outcomes of retinal detachment (RD) repair following posterior open globe injury. This retrospective, consecutive case series examined patients who underwent RD repair following Zone II and/or III open globe injury repair between January 1, 2007 and October 31, 2013. Patients with <3 months of follow-up since their last vitreoretinal surgery, and those who underwent pars plana vitrectomy (e.g., for intraocular foreign body) during their initial open globe injury repair were excluded. Of 30 patients who met inclusion criteria, reattachment of the retina was achieved in 25 (83%) during the first vitreoretinal surgical procedure and 5 (17%) were deemed inoperable intraoperatively. Ten patients (30%) developed recurrent RD, and 8 underwent additional surgery. At last follow-up, reattachment was observed in 4 of these 8. The overall rate of final reattachment was 63% (19 patients). The mean number of surgeries for RD was 1.5 (range, 1-3). Fifteen patients (50%) achieved final visual acuity of counting fingers or better. Mean follow-up from the last vitreoretinal surgery was 23 months (range, 3-52). Although RD following posterior open globe injury confers a grave prognosis, successful anatomic reattachment of the retina was achieved in the majority of patients in this series, with half achieving ambulatory vision.
Spielberg, Leigh H; Heckenlively, John R; Leys, Anita M
Background/purpose Light-chain deposition disease (LCDD) is a rare condition characterised by deposition of monoclonal immunoglobulin light chains (LCs) in tissues, resulting in varying degrees of organ dysfunction. This study reports the characteristic clinical ocular findings seen in advanced LCDD upon development of ocular fundus changes. This is the first report to describe this entity in vivo in a series of patients. Methods A case series of ocular fundus changes in three patients with kidney biopsy-proven LCDD. All patients underwent best corrected visual acuity (BCVA) exam, perimetry, colour fundus photography and fluorescein angiography; two patients underwent indocyanine green angiography, optical coherence tomography, ultrasound and electroretinography; and one patient underwent fundus autofluorescence. Results Three patients, 53–60 years old at initial presentation, were studied. All three presented with night blindness, poor dark adaptation, metamorphopsia and visual loss. Examination revealed serous and serohaemorrhagic detachments, multiple retinal pigment epithelial (RPE) tears, diffuse RPE degeneration and progressive fibrotic changes. Neither choroidal neovascularisation nor other vascular abnormalities were present. Final best corrected visual acuity (BCVA) ranged from 20/40 to 20/300. Conclusions Progressive LC deposition in the fundus seems to damage RPE pump function with flow disturbance between choroid and retina. This pathogenesis can explain the evolution to RPE detachments and subsequent rips and progressive retinal malfunction. PMID:23385633
Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Wang, Xue
Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery) but occasionally may be associated with primary RD. Either way, a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 June 2013. We included randomized controlled trials (RCTs) of participants undergoing surgery for RD associated with PVR that compared various tamponade agents. Two review authors screened the search results independently. We used the standard methodological procedures expected by The Cochrane Collaboration. The review included 516 participants from three RCTs. One study was conducted in the USA and consisted of two trials: the first trial randomized 151 adults to receive either silicone oil or sulfur hexafluoride (SF6) gas tamponades; and the second trial randomized 271 adults to receive either
Posterior vitreous detachment (PVD) is the consequence of changes in the macromolecular structure of gel vitreous that result in liquefaction, concurrent with alterations in the extracellular matrix at the vitro-retinal interface that allow the posterior vitreous cortex to detach from the internal limiting lamina of the retina. Gel liquefaction that exceeds the degree of vitro-retinal dehiscence results in anomalous PVD (APVD). APVD varies in its clinical manifestations depending upon where in the fundus vitreo-retinal adhesion is strongest. At the periphery, APVD results in retinal tears and detachments. In the macula, APVD causes vitreo-macular traction syndrome, results in vitreoeschisis with macular pucker or macular holes, or contributes to some cases of diabetic macular edema. At the optic disc and retina, APVD causes vitreo-papillary traction and promotes retinal and optic disc neovascularization. Unifying the spectrum of vitreo-retinal diseases into the conceptual frame-work of APVD underscores that to more effectively treat, and ultimately prevent, these disorders it is necessary to replicate the two components of an innocuous PVD, i.e., gel liquefaction and vitreo-retinal dehiscence. Pharmacologic vitreolysis is designed to mitigate against APVD by chemically breaking down vitreous macromolecules and weakening vitro-retinal adhesion to safely detach the posterior vitreous cortex. This would not only facilitate surgery, but if performed early in the natural history of disease, it should prevent progressive disease.
Fincham, Gregory S; Pasea, Laura; Carroll, Christopher; McNinch, Annie M; Poulson, Arabella V; Richards, Allan J; Scott, John D; Snead, Martin P
The Stickler syndromes are the most common causes of inherited and childhood retinal detachment; however, no consensus exists regarding the effectiveness of prophylactic intervention. We evaluate the long-term safety and efficacy of the Cambridge prophylactic cryotherapy protocol, a standardized retinal prophylactic treatment developed to prevent retinal detachment arising from giant retinal tears in type 1 Stickler syndrome. Retrospective comparative case series. Four hundred eighty seven patients with type 1 Stickler syndrome. Time to retinal detachment was compared between patients who received bilateral prophylaxis and untreated controls, with and without individual patient matching. Patients receiving unilateral prophylaxis (after fellow eye retinal detachment) were similarly compared with an appropriate control subgroup. Individual patient matching ensured equal age and follow-up between groups and that an appropriate control (who had not suffered a retinal detachment before the age at which their individually matched treatment patient underwent prophylactic treatment) was selected. Matching was blinded to outcome events. Individual patient matching protocols purposely weighted bias against the effectiveness of treatment. All treatment side effects are reported. Time to retinal detachment and side effects occurring after prophylactic treatment. The bilateral control group (n = 194) had a 7.4-fold increased risk of retinal detachment compared to the bilateral prophylaxis group (n = 229) (hazard ratio [HR], 7.40; 95% confidence interval [CI], 4.53-12.08; P<0.001); the matched bilateral control group (n = 165) had a 5.0-fold increased risk compared to the matched bilateral prophylaxis group (n = 165) (HR, 4.97; 95% CI, 2.82-8.78; P<0.001). The unilateral control group (n = 104) had a 10.3-fold increased risk of retinal detachment compared to the unilateral prophylaxis group (n = 64) (HR, 10.29; 95% CI, 4.96-21.36; P<0.001); the matched unilateral control group
Terasaki, Hiroko; Hirose, Tatsuo
To study the characteristics of late-onset retinal detachments in patients with regressed retinopathy of prematurity (ROP) and the condition of their fellow eyes. We carried out a retrospective review of 29 patients (38 eyes) who had been treated at two institutions, one in the US and the other in Japan, between 1986 and 1997. The age at the time of treatment ranged from 6 to 51 years (mean=23.1). Five of the 38 eyes with tractional detachment were treated with either open-sky vitrectomy, closed vitrectomy, or scleral buckling; 27 of the 38 eyes with rhegmatogenous retinal detachment underwent scleral buckling or closed vitrectomy or both. The remaining 6 of the 38 eyes had subclinical rhegmatogenous detachment and were treated with photocoagulation or cryopexy, or followed without treatment. The most characteristic retinal breaks were multiple holes with a prevalence of equator and posterior types. Overall, anatomical reattachment was accomplished in 27/32 eyes (84%) that underwent surgery. Two thirds of the patients who underwent vitrectomy either initially or at a later time had poor postoperative visual acuity. More than half of the fellow eyes had retinal detachment and others had various characteristic fundus changes of regressed ROP. Long-term, probably life-long follow-up of high-risk patients is necessary so that diagnosis and treatment can be instituted at an early stage of retinal detachment.
Todorich, Bozho; Thanos, Aristomenis; Yonekawa, Yoshihiro; Capone, Antonio
Norrie disease is a rare, but devastating cause of pediatric retinal detachment, universally portending a poor visual prognosis. This paper describes successful surgical management of an infant with total retinal detachment associated with Norrie disease mutation. The infant was a full-term white male who presented with bilateral total funnel retinal detachments (RDs). He underwent genetic testing, which demonstrated single-point mutation 133 G>A transition in exon 2 of the NDP gene. The retinal detachment was managed with translimbal iridectomy, lensectomy, capsulectomy, and vitrectomy. Careful dissection of the retrolental membranes resulted in opening of the funnel. Single-stage surgery in this child's eye achieved re-attachment of the posterior pole with progressive reabsorption of subretinal fluid and cholesterol without the need for external drainage. Fluorescein angiography, performed at 2 months postoperatively, demonstrated perfusion of major vascular arcades, but with significant abnormalities and aneurysmal changes of higher-order vessels, suggestive of retinal and vascular dysplasia. The child has maintained brisk light perception vision. Early surgical intervention with careful dissection of tractional tissues can potentially result in good anatomic outcomes in some patients with Norrie disease-associated retinal detachment. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:260-262.]. Copyright 2017, SLACK Incorporated.
Kita, Mihori; Fujii, Yukiko; Kawagoe, Naoaki; Hama, Sachiyo
A young patient who showed rhegmatogenous retinal detachment with preoperatively undetected retinal break was successfully treated by scleral buckling using a noncontact wide-angle viewing system. PMID:23569352
Foster, William Joseph; Dowla, Nadia; Joshi, Saurabh Y; Nikolaou, Michael
Scleral buckling is a common surgical technique used to treat retinal detachments that involves suturing a radial or circumferential silicone element on the sclera. Although this procedure has been performed since the 1960s, and there is a reasonable experimental model of retinal detachment, there is still debate as to how this surgery facilitates the re-attachment of the retina. Finite element calculations using the COMSOL Multiphysics system are utilized to explain the influence of the scleral buckle on the flow of sub-retinal fluid in a physical model of retinal detachment. We found that, by coupling fluid mechanics with structural mechanics, laminar fluid flow and the Bernoulli effect are necessary for a physically consistent explanation of retinal reattachment. Improved fluid outflow and retinal reattachment are found with low fluid viscosity and rapid eye movements. A simulation of saccadic eye movements was more effective in removing sub-retinal fluid than slower, reading speed, eye movements in removing subretinal fluid. The results of our simulations allow us to explain the physical principles behind scleral buckling surgery and provide insight that can be utilized clinically. In particular, we find that rapid eye movements facilitate more rapid retinal reattachment. This is contradictory to the conventional wisdom of attempting to minimize eye movements.
Erdogan, Gurkan; Unlu, Cihan; Karasu, Bugra; Kardes, Esra; Ergin, Ahmet
To evaluate the efficacy and safety of peripheral vitrectomy under air infusion in comparison with fluid infusion in patients undergoing 23-gauge pars plana vitrectomy for primary rhegmatogenous retinal detachment. A total of 80 eyes of 80 patients with primary rhegmatogenous retinal detachment were enrolled into the study. Forty cases underwent peripheral vitrectomy under air infusion (air group), and a control group of equal number underwent peripheral vitrectomy under fluid infusion (fluid group). Peripheral iatrogenic retinal breaks during peripheral vitrectomy, postoperative visual acuities, and retinal redetachment rates were compared. The number of eyes with peripheral iatrogenic retinal breaks in air group during peripheral vitrectomy was statistically comparable with that in fluid group (1/40 and 4/40, 2.5% and 10%, respectively; P = 0.16). Scleral depression was necessitated in 7 of 40 cases (17.5%) during the operation in the air group. There were no statistically significant differences between the groups in means of postoperative visual acuity and retinal redetachment (P = 0.18 and P = 1.0, respectively). Peripheral vitrectomy under air infusion for primary rhegmatogenous retinal detachment revealed comparable results with fluid infusion in terms of intraoperative and postoperative complications and surgical outcomes.
Kang, Ji Eun; Kim, Hyun Jin; Boo, Hee Don; Kim, Ha Kyoung
Purpose To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. Methods A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. Results The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. Conclusions Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary. PMID:16892652
Rishi, Karandeep; Venkatesh, Pradeep; Garg, Satpal P
Retinal detachment after ocular perforation related to local anesthesia is a common complication, which is usually associated with a poor prognosis despite complex vitreoretinal surgical procedures. We report a case of 62-year-old male with cataract surgery done 4 weeks back with nasal retinal detachment with a posterior break. Pneumatic retinopexy was performed and laser barrage of the breaks was done the next day when the retina got attached. A vision of 20/30 was achieved at the end of 2 months. To the best of our knowledge, this is a first case report in literature where pneumatic retinopexy was used to manage a retinal detachment caused by block-related perforation.
Nawrocki, J; Wesołek, A; Pikulski, Z; Suprunowicz, I
The authors present results of the treatment of retinal detachment with giant tear in 12 eyes in 11 patients. The encirclement of the eyeball, vitrectomy and endo-tamponade with gas in 3 cases and silicone oil in 9 were applied. In 4 cases, perfluorocarbon liquid was used to unroll the retina. After 6-15 months follow-up retina was completely attached in 8 eyes (66%); in 3 eyes (25%) residual detachment was observed in the inferior part of the fundus and in 1 eye retina remained detached. In 8 eyes, visual acuity was above 5/50, in 3 above 1/50. The type of endo-tamponade and the role of perfluorocarbon liquid in this kind of retinal detachment are discussed.
Read, Sarah P; Aziz, Hassan A; Kuriyan, Ajay; Kothari, Nikisha; Davis, Janet L; Smiddy, William E; Flynn, Harry W; Murray, Timothy G; Berrocal, Audina
Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center. A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution. A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P < 0.0001). Anatomical success was strongly correlated with visual acuity outcome (P < 0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P < 0.05). The rates of obtaining a final best-corrected visual acuity > 20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P < 0.01) or traumatic RD (28%, P < 0.05). Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.
Gupta, D; Ong, J; Burton, R L
Background/aims Finding all retinal breaks is a critical step in rhegmatogenous retinal detachment (RRD) surgery in order to prevent persistent/recurrent retinal detachment (RD). We describe a technique of trans-scleral dye injection into the subretinal fluid under the detached retina in the context of recurrent/persistent RD in vitrectomized eyes, in order to determine the location of clinically unidentified (occult) retinal breaks causing RD. Methods Retrospective consecutive single-surgeon case-series analysis of patients presenting with a repeat RRD after having been treated with pars plana vitrectomy (PPV) as the method of primary RRD repair. Trans-scleral injection of subretinal vision blue (TSVB) was used to help identify retinal breaks during repeat vitrectomy. Outcome measures: successful detection of a break; location of breaks; persistent retinal attachment; final visual acuity (VA); complications. Results There were 395 cases of RRD during the 3-year period reviewed. TSVB was used for eight instances in seven eyes. All eight instances were repeat RRD. TSVB facilitated occult break detection in 7/8 instances of use. Breaks were at or adjacent to the previous cryo site in three instances. Persistent retinal attachment was achieved in 5/7 cases. Final VA increased in 5/7 cases. There was no evidence of complications as a result of TSVB injection. Conclusions TSVB coupled with indentation to vent a plume of dye through an occult break during vitreous surgery is a relatively simple technique that may facilitate the identification of occult retinal breaks and help achieve anatomical success and functional success. PMID:21637304
Townes-Anderson, Ellen; Wang, Jianfeng; Halász, Éva; Sugino, Ilene; Pitler, Amy; Whitehead, Ian; Zarbin, Marco
Retinal detachment disrupts the rod-bipolar synapse in the outer plexiform layer by retraction of rod axons. We showed that breakage is due to RhoA activation whereas inhibition of Rho kinase (ROCK), using Y27632, reduces synaptic damage. We test whether the ROCK inhibitor fasudil, used for other clinical applications, can prevent synaptic injury after detachment. Detachments were made in pigs by subretinal injection of balanced salt solution (BSS) or fasudil (1, 10 mM). In some animals, fasudil was injected intravitreally after BSS-induced detachment. After 2 to 4 hours, retinae were fixed for immunocytochemistry and confocal microscopy. Axon retraction was quantified by imaging synaptic vesicle label in the outer nuclear layer. Apoptosis was analyzed using propidium iodide staining. For biochemical analysis by Western blotting, retinal explants, detached from retinal pigmented epithelium, were cultured for 2 hours. Subretinal injection of fasudil (10 mM) reduced retraction of rod spherules by 51.3% compared to control detachments (n = 3 pigs, P = 0.002). Intravitreal injection of 10 mM fasudil, a more clinically feasible route of administration, also reduced retraction (28.7%, n = 5, P < 0.05). Controls had no photoreceptor degeneration at 2 hours, but by 4 hours apoptosis was evident. Fasudil 10 mM reduced pyknotic nuclei by 55.7% (n = 4, P < 0.001). Phosphorylation of cofilin and myosin light chain, downstream effectors of ROCK, was decreased with 30 μM fasudil (n = 8-10 explants, P < 0.05). Inhibition of ROCK signaling with fasudil reduced photoreceptor degeneration and preserved the rod-bipolar synapse after retinal detachment. These results support the possibility, previously tested with Y27632, that ROCK inhibition may attenuate synaptic damage in iatrogenic detachments.
Isernhagen, R D; Wilkinson, C P
Postoperative visual acuities were evaluated in a series of 100 pseudophakic eyes in which rhegmatogenous retinal detachments involved the macula and in which reattachment surgery was successful. Preoperative visual acuity and duration of macular detachment were directly and indirectly related to visual outcome, respectively. Eyes in which extracapsular surgery had been followed by posterior chamber lens implantation had significantly better postoperative visual acuities than cases in which older iris-fixation IOLs were placed following intracapsular procedures. PMID:2979019
Kowalski, M; Nawrocki, J; Dziegielewski, K; Pikulski, Z; Bogorodzki, B; Bielecka-Kowalska, A
This paper presents early and later stage of the treatment of 93 eyes (89 patients) with retinal detachment in the course of PVR. All patients were treated in our department between February 1992 and February 1994. Standard port pars plana vitrectomy was performed in all cases related earlier with sclear buckling procedure without success. One week, 6, 12, 24 months after surgery good anatomical results were achieved respectively in: 82%, 80%, 78%. One week, 6, 12, 24 months after surgery good functional results were achieved respectively in: 74%, 67%, 58%. Vitrectomy with silicone oil tamponade is method of choice in the treatment of retinal detachment in the course of PVR.
Carroll, B F; Peyman, G A; Mehta, N J; Millsap, C M; Greve, M D; Dunlap, W A; Lee, K J; Ma, P E
A total of 140 consecutive patients underwent repair of retinal detachment associated with grade C2 to D3 proliferative vitreoretinopathy with perfluoroperhydrophenanthrene (Vitreon) as an intraoperative hydrokinetic tool. In seven patients the Vitreon was left in the eye for extended tamponade. Intraoperative reattachment was obtained in 98% of patients. At the final follow-up examination (mean 7 months) 84% of retinas remained attached, and 92% of patients had stable or improved visual acuity. Vitreon was found to be safe and effective in the repair of complicated retinal detachments. No complications were directly related to Vitreon when used intraoperatively or when left in the eye for extended tamponade.
Jordan, Michael A; Montezuma, Sandra R
The purpose of this study was to report the association of septo-optic dysplasia, persistent fetal vasculature, retinal detachment, and gastroschisis in a preterm neonate. This is a case report. A female preterm neonate was found to have septo-optic dysplasia, with optic nerve hypoplasia, tripartite splitting of the vessels at the optic nerve, an ectopic pituitary gland, and absence of the septum pellucidum associated with persistent fetal vasculature, a retinal detachment, and gastroschisis. Septo-optic dysplasia may also be associated with other ophthalmic findings and other developmental malformations as the authors report in this case. Follow-up should consist of a multidisciplinary approach with radiologic and endocrinology consultation.
Wu, Zhifeng; Ding, Nannan; Yu, Mengxi; Wang, Ke; Luo, Shasha; Zou, Wenjun; Zhou, Ying; Yan, Biao; Jiang, Qin
Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is a complicated and serious type of rhegmatogenous retinal detachment (RRD). In this study, we identified differentially expressed proteins in the vitreous humors of RRDCD and RRD using isobaric tags for relative and absolute quantitation (iTRAQ) combined with nano-liquid chromatography-electrospray ion trap-mass spectrometry-mass spectrometry (nano-LC-ESI-MS/MS) and bioinformatic analysis. Our result shows that 103 differentially expressed proteins, including 54 up-regulated and 49 down-regulated proteins were identified in RRDCD. Gene ontology (GO) analysis suggested that most of the differentially expressed proteins were extracellular．The Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis suggested that proteins related to complement and coagulation cascades were significantly enriched. iTRAQ-based proteomic profiling reveals that complement and coagulation cascades and inflammation may play important roles in the pathogenesis of RRDCD. This study may provide novel insights into the pathogenesis of RRDCD and offer potential opportunities for the diagnosis and treatment of RRDCD. PMID:27941623
Kataoka, K; Matsumoto, H; Kaneko, H; Notomi, S; Takeuchi, K; Sweigard, J H; Atik, A; Murakami, Y; Connor, K M; Terasaki, H; Miller, J W; Vavvas, D G
Detachment of photoreceptors from the retinal pigment epithelium is seen in various retinal disorders, resulting in photoreceptor death and subsequent vision loss. Cell death results in the release of endogenous molecules that activate molecular platforms containing caspase-1, termed inflammasomes. Inflammasome activation in retinal diseases has been reported in some cases to be protective and in others to be detrimental, causing neuronal cell death. Moreover, the cellular source of inflammasomes in retinal disorders is not clear. Here, we demonstrate that patients with photoreceptor injury by retinal detachment (RD) have increased levels of cleaved IL-1β, an end product of inflammasome activation. In an animal model of RD, photoreceptor cell death led to activation of endogenous inflammasomes, and this activation was diminished by Rip3 deletion. The major source of Il1b expression was found to be infiltrating macrophages in the subretinal space, rather than dying photoreceptors. Inflammasome inhibition attenuated photoreceptor death after RD. Our data implicate the infiltrating macrophages as a source of damaging inflammasomes after photoreceptor detachment in a RIP3-dependent manner and suggest a novel therapeutic target for treatment of retinal diseases. PMID:25906154
Ueda, Tomoko; Gomi, Fumi; Suzuki, Mihoko; Sakaguchi, Hirokazu; Sawa, Miki; Kamei, Motohiro; Nishida, Kohji
To report the usefulness of indocyanine green angiography (ICGA) to depict the retinal vascular anomalies associated with distant branch retinal vein occlusion resulting in serous retinal detachment at the macula. This was a retrospective, case series of 6 patients (6 eyes) with serous retinal detachments. Fluorescein angiography and ICGA showed that those 6 eyes had a distant branch retinal vein occlusion. The characteristics in ophthalmic examinations such as fundus appearance, fluorescein angiography, ICGA, optical coherence tomography, and clinical courses were evaluated. In addition to serous retinal detachments, five eyes exhibited hard exudates around the macula. Fluorescein angiography and ICGA clearly showed the vessel occlusion; however, no apparent abnormalities appeared in the macular area in any of the eyes. In four eyes, early-phase ICGA depicted the retinal vascular anomalies within the area of venous occlusion and those were seen as hyperfluorescent patches on late-phase ICGA. In two eyes, punctate hyperfluorescent spots were seen in the area of venous occlusion on late-phase ICGA. Optical coherence tomography depicted a serous retinal detachment at the macula and retinal swelling in the outer nuclear layer from the macula to the hyperfluorescent abnormalities on ICGA. The macular serous retinal detachments were resolved within 3 months after laser photocoagulation was applied to the hyperfluorescent areas on ICGA. Leakage from subsequent vascular anomalies after branch retinal vein occlusion can cause submacular fluid. Indocyanine green angiography is useful for detecting the causative vascular regions of the fluid.
Witmer, M T; Cho, M; Favarone, G; Paul Chan, R V; D'Amico, D J; Kiss, S
Purpose Rhegmatogenous retinal detachment (RRD) affects the function of the retina before and after surgical repair. We investigated ultra-wide-field autofluorescence (UAF) abnormalities in patients with acute RRD to improve our understanding of the functional changes in the retina before and after surgery. Methods In this retrospective study, we present the UAF imaging findings of 16 patients with acute, non-traumatic RRD. Imaging was obtained with the Optos 200 Tx (Optos) in 14 eyes preoperatively and in 12 eyes postoperatively. Twelve eyes had RRDs that involved the macula (group A), whereas four eyes had macula-sparing RRDs (group B). Results All patients (100%) with bullous retinal detachments demonstrated hypofluorescence over the area of retinal detachment. A hyperfluorescent leading edge (HLE) to the retinal detachment was observed preoperatively in 100% of eyes in group A and 75% of eyes in group B. Preoperative UAF through the fovea of group A eyes was normal (30%), hypofluorescent (50%) or hyperfluorescent (20%). In all patients with a HLE preoperatively, the HLE resolved by the 1-month postoperative visit. A residual line of demarcation remained in 8 of the 12 eyes (67%). In group A eyes, postoperative granular autofluorescent changes were present in four of the nine (44%) eyes, and were associated with worse preoperative (P=0.04) and postoperative (P=0.09) visual acuity. Conclusion UAF imaging reveals abnormalities in RRDs that allow excellent demarcation of the extent of the retinal detachment and assist in preoperative characterization of the detachment and postoperative counselling. PMID:22722489
Keser, Vafa; Khan, Ayesha; Siddiqui, Sorath; Lopez, Irma; Ren, Huanan; Qamar, Raheel; Nadaf, Javad; Majewski, Jacek; Chen, Rui; Koenekoop, Robert K.
Purpose To evaluate consanguineous pedigrees from Pakistan with a clinical diagnosis of nonsyndromic congenital retinal nonattachment (NCRNA) and identify genes responsible for the disease as currently only one NCRNA gene is known (atonal basic helix-loop-helix transcription factor 7: ATOH7). Methods We implemented a three-step genotyping platform: single nucleotide polymorphism genotyping to identify loss of heterozygosity regions in patients, Retinal Information Network panel screening for mutations in currently known retinal genes. Negative patients were then subjected to whole exome sequencing. Results We evaluated 21 consanguineous NCRNA pedigrees and identified the causal mutations in known retinal genes in 13 out of our 21 families. We found mutations in ATOH7 in three families. Surprisingly, we then found mutations in familial exudative vitreoretinopathy (FEVR) genes; low-density lipoprotein receptor-related protein 5 mutations (six families), tetraspanin 12 mutations (two families), and NDP mutations (two families). Thus, 62% of the patients were successfully genotyped in our study with seven novel and six previously reported mutations in known retinal genes. Conclusions Although the clinical diagnosis of all children was NCRNA with severe congenital fibrotic retinal detachments, the molecular diagnosis determined that the disease process was in fact a very severe form of FEVR in 10 families. Because severe congenital retinal detachment has not been previously associated with all the FEVR genes, we have thus expanded the phenotypic spectrum of FEVR, a highly variable retinal detachment phenotype that has clinical overlap with NCRNA. We identified seven novel mutations. We also established for the first time genetic overlap between the Iranian and Pakistani populations. We identified eight NCRNA families that do not harbor mutations in any known retinal genes, suggesting novel causal genes in these families. PMID:28192794
Oluleye, TS; Ibrahim, OA; Olusanya, BA
Background Scleral buckle surgery is not a commonly performed surgical procedure in Sub-Saharan Africa due to a paucity of trained vitreo retinal surgeons. The aim of the study was to review sclera buckle procedures with a view to evaluating the anatomical and visual outcomes. Methods Case records of patients that had scleral buckle surgery at the Retina Unit of the University College Hospital, Ibadan, Nigeria, between 2007 and 2010 were reviewed. Information retrieved included patients’ demographics, duration of symptoms, and presenting vision. Other information included site of retinal break, extent of retinal detachment, involvement of the fellow eye, and macular involvement. Postoperative retina reattachment and postoperative visual acuity were also recorded. Proportions and percentages were used to analyze data. Results Forty five eyes of 42 patients were studied with a male to female ratio of 1.6:1. The mean age was 47.7 years (±17.6 years). The median duration before presentation was 3 months (range: 5 days – 156 months). Subtotal retinal detachment was found in 35 eyes (77.8%) while total retinal detachment occurred in ten eyes (22.2%). Thirty four eyes (75.6%) had “macular off ” detachments. At 6 weeks, there was an improvement in visual acuity in 23 eyes (51.1%), while visual acuity remained the same in nine eyes (20%) and was worse in 13 eyes (28.9%). Anatomical attachment was seen in 43 eyes (95.6%) on the operation table, in 40 eyes (90.9%) at first day postoperatively and in 32 eyes (86.5%) at 6 weeks after surgery. Conclusion Outcome of sclera buckle surgery for rhegmatogenous retinal detachment may be improved in developing countries of Sub Sahara Africa if adequate awareness is created to educate the populace on early presentation. PMID:23754869
Gundorova, R A; Poliakova, L Ia; Malaev, A A
The paper presents a clinical analysis of surgical treatment of 378 patients (426 operations) with posttraumatic retinal detachment. A broadened variant of a classification of traumatic retinal detachment signs in associated pathology of the retina and vitreous body is proposed. Recommendations are worked out concerning the approach of surgical treatment of traumatic detachment with determination of indications and the sequence of vitrectomy and scleroplastic operations. It is advisable to assess the effectiveness of surgical intervention in this pathology in more delayed terms.
Mastropasqua, L.; Carpineto, P.; Ciancaglini, M.; Falconio, G.; Gallenga, P.
BACKGROUND/AIMS—Fellow eye prophylaxis for retinal detachment (RD) is still a controversial issue since opinions are not unanimous regarding the kind of lesions to be treated or the method of treatment. This prospective clinical study aimed to follow the course of vitreoretinal conditions in 150 high risk fellow eyes. METHODS—150 consecutive patients with unilateral rhegmatogenous RD were included in this study. Inclusion criteria were good explorability of fellow eye retinal periphery and one of the following conditions in the fellow eye—aphakia, pseudophakia with capsulotomy, high myopia (>−6D), contralateral eye to a giant retinal tear. Prophylactic treatment (photocoagulation or scleral buckling) was performed in the presence of retinal tears and lattice degenerations. The state of the vitreous body was determined at the beginning of the study and at the end, when RD occurred. RESULTS—Follow up ranged from 36 to 132 months. 95 fellow eyes were subjected to laser treatment; five eyes underwent prophylactic surgical treatment. Initially, in the treated group posterior vitreous detachment (PVD) was present in 100 eyes (100% of cases), but as a complete PVD only in 42 of them (42%). 10 eyes in the treated group developed RD during the follow up period. In five of these cases the partial PVD had progressed and a retinal tear in a previously healthy area was the cause of the retinal detachment. In the other five eyes RD apparently developed from previously treated lesions. Progression of PVD was evident in four out of these five eyes. The untreated eyes had no visible degenerative lesions. During follow up eight eyes developed RD. These eyes had no PVD at the beginning of the study, but showed a partial PVD at the time of the diagnosis of RD. CONCLUSION—Fellow eyes with pre-existing retinal tears and PVDs can go on to retinal detachment in spite of laser prophylactic treatment. When PVD is not detectable or a partial PVD is present, the
Schatz, H; McDonald, H R
Six eyes with optic nerve pit and associated sensory retinal detachment of the macula were treated using a management plan that utilized a combination of techniques including laser photocoagulation, pars plana vitrectomy, and intraocular air/fluid exchange. In each treated eye the retina was eventually flattened. This paper discusses this plan of management and series of treatment modalities.
Misiuk-Hojło, Marta; Grzech, Adam; Słownski, Krzysztof
Both exotamponade and endotamponade have application in retinal detachment surgery in order to reattache the retina. Exotamponades include silicone buckles and bands. Endotamponades include substances replacing the vitreous: gases and liquids. In this paper physical characteristics of the most frequently used as endotamponade polymeric liquid substances are presented. Advantages and disadvantages of each of them are listed.
Wong, Roger; De Luca, Marco; Shunmugam, Manoharan; Williamson, Tom; Laidlaw, Alistair; Vaccaro, Valeria
AIM To evaluate the functional outcome after removal of silicone oil (ROSO) in patients undergoing retinectomy for complex retinal detachment. METHODS We performed a retrospective case note review of patients who underwent ROSO after retinectomy for complex retinal detachment. Patients with less than 6mo follow up and recurrent retinal detachment following ROSO were excluded. RESULTS Thirty-six patients were included. The mean best corrected visual acuity (BCVA) pre-ROSO was 1.13 logMAR (SD 0.5). The mean BCVA 3mo following ROSO was 1.16 logMAR (SD 0.53), 6mo following ROSO 1.13 (SD 0.63), and 12mo following ROSO 1.18 (SD 0.69). At 12mo after ROSO, the BCVA improved in 38.9% of patients, remained unchanged in 25%, and deteriorated in 36.1%, although there was no statistical significant difference in BCVA after ROSO at 3, 6 and 12mo (P=0.93). The size of retinectomy ranged from 15° to 270° (SD 53) and did not influence the visual outcome (P=0.11). CONCLUSION There was no statistically significanT difference in BCVA between pre- and post- ROSO following retinectomy for complex retinal detachment. There was no statistical difference in visual outcome related to the size of the retinectomy. PMID:26949619
Ren, Qiushi; Simon, Gabriel; Parel, Jean-Marie A.; Takesue, Yoshiko; Shen, Jin-Hui; Smiddy, William E.
Scleral indentation was induced in cadaver eyes by shrinkage of scleral collagen fibers using a pulsed solid state Ho:YAG (2.1 micrometers ) laser with fiber optic delivery. Applying Ho:YAG laser radiation permits control of the amount of laser induced buckling effect by selecting laser treatment parameters such as beam spot, radiant exposure, and number of pulses. With treatment using 11.3 +/- 1.2 J/cm2 laser radiant exposure and 5 pulses, laser induced scleral shrinkage affected only the external two-thirds of scleral tissue. No thermal damage or disruption was observed in subjacent retinal pigment epithelium, chorioid, or retina. Coupling of two appropriately selected lasers may allow laser induced scleral buckling and transscleral retinal photocoagulation using the same laser probe for retinal reattachment surgery.
Campos-Pavón, J; Sambricio, J; Redondo-García, I
The case is presented of a 56 year-old patient diagnosed with rhegmatogenous retinal detachment and on treatment with hydroxychloroquine (HCQ). A Spectral Domain-Optical Coherence Tomography (SD-OCT) was performed that showed changes in the outer retina in the eye with macular detachment, as well as the «flying saucer» sign in the other eye. After a complete retinopexy the «flying saucer» sign was still present. SD-OCT could be used as a test in order to reveal HCQ toxicity in the event of retinal detachment. In this case, this technique shows abnormalities such as a hyper-reflective line in the outer retina layers. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Brodowska, Katarzyna; Stryjewski, Tomasz P; Papavasileiou, Evangelia; Chee, Yewlin E; Eliott, Dean
The Retinal Detachment after Open Globe Injury (RD-OGI) Score is a clinical prediction model that was developed at the Massachusetts Eye and Ear Infirmary to predict the risk of retinal detachment (RD) after open globe injury (OGI). This study sought to validate the RD-OGI Score in an independent cohort of patients. Retrospective cohort study. The predictive value of the RD-OGI Score was evaluated by comparing the original RD-OGI Scores of 893 eyes with OGI that presented between 1999 and 2011 (the derivation cohort) with 184 eyes with OGI that presented from January 1, 2012, to January 31, 2014 (the validation cohort). Three risk classes (low, moderate, and high) were created and logistic regression was undertaken to evaluate the optimal predictive value of the RD-OGI Score. A Kaplan-Meier survival analysis evaluated survival experience between the risk classes. Time to RD. At 1 year after OGI, 255 eyes (29%) in the derivation cohort and 66 eyes (36%) in the validation cohort were diagnosed with an RD. At 1 year, the low risk class (RD-OGI Scores 0-2) had a 3% detachment rate in the derivation cohort and a 0% detachment rate in the validation cohort, the moderate risk class (RD-OGI Scores 2.5-4.5) had a 29% detachment rate in the derivation cohort and a 35% detachment rate in the validation cohort, and the high risk class (RD-OGI scores 5-7.5) had a 73% detachment rate in the derivation cohort and an 86% detachment rate in the validation cohort. Regression modeling revealed the RD-OGI to be highly discriminative, especially 30 days after injury, with an area under the receiver operating characteristic curve of 0.939 in the validation cohort. Survival experience was significantly different depending upon the risk class (P < 0.0001, log-rank chi-square). The RD-OGI Score can reliably predict the future risk of developing an RD based on clinical variables that are present at the time of the initial evaluation after OGI. Copyright © 2017 American Academy of
Coakes, R L; Ramsay, J H; Tarbuck, D T
The value of long-term follow-up of patients after retinal detachment surgery depends on the number of further detachments prevented. This in turn depends on the frequency with which predisposing lesions are found and treated and also the risk of leaving them untreated. In a retrospective study of 128 patients who had attended the Retina Clinic at Moorfields, High Holborn, for at least 10 years, the frequency with which asymptomatic retinal breaks were detected was less than two per hundred patients per year of follow-up. The risk of such lesions progressing to detachment if left untreated is estimated to be no more than 12 per cent and on this basis it is likely that no more than four or five detachments were prevented in our series. During the same period 66 new or re-detachments occurred, in spite of regular examination and treatment of predisposing lesions found, and it is concluded that long-term follow-up is of doubtful value in the prevention of further detachments.
Cankurtaran, Veysel; Citirik, Mehmet; Simsek, Mert; Tekin, Kemal; Teke, Mehmet Yasin
Retinal detachment is the separation of the sensory retina from the retinal pigment epithelium by subretinal fluid. There are several types of retinal re-attachment surgery, including scleral buckling (SB), pneumatic retinopexy, and vitrectomy (with or without SB). The objective of this study was to compare anatomical and visual outcomes between patients with pseudophakic rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) with silicone oil (SO) or perfluoropropane (C3F8) gas tamponade and pseudophakic RRD patients who underwent SB surgery. We evaluated retrospectively 101 pseudophakic RRD patients from a single center. The patients were classified into three groups according to the surgical procedure performed: PPV + Silicone - patients who underwent PPV with SO tamponade; PPV + Gas - patients who underwent PPV with perfluoropropane gas tamponade; and SB group - patients who underwent SB surgery. The groups were compared with regard to primary and final anatomical and visual outcomes. The number of patients in PPV + Silicone, PPV + Gas, and SB group was 39 (38.6%), 32 (31.7%), and 30 (29.7%), respectively. The mean follow-up period in PPV + Silicone, PPV + Gas, and SB group was 33.95 ± 23.58, 32.62 ± 10.95, and 33.76 ± 16.62 months, respectively. No significant difference was observed between the groups neither with regard to primary and final anatomical and visual success rates nor in relation to the recurrence rate of retinal detachment. According to our anatomical and visual outcome results, either of the three methods (i.e., PPV + Silicone, PPV + Gas, or SB) can be used in the treatment of pseudophakic retinal detachment.
Cankurtaran, Veysel; Citirik, Mehmet; Simsek, Mert; Tekin, Kemal; Teke, Mehmet Yasin
Retinal detachment is the separation of the sensory retina from the retinal pigment epithelium by subretinal fluid. There are several types of retinal re-attachment surgery, including scleral buckling (SB), pneumatic retinopexy, and vitrectomy (with or without SB). The objective of this study was to compare anatomical and visual outcomes between patients with pseudophakic rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) with silicone oil (SO) or perfluoropropane (C3F8) gas tamponade and pseudophakic RRD patients who underwent SB surgery. We evaluated retrospectively 101 pseudophakic RRD patients from a single center. The patients were classified into three groups according to the surgical procedure performed: PPV + Silicone - patients who underwent PPV with SO tamponade; PPV + Gas - patients who underwent PPV with perfluoropropane gas tamponade; and SB group - patients who underwent SB surgery. The groups were compared with regard to primary and final anatomical and visual outcomes. The number of patients in PPV + Silicone, PPV + Gas, and SB group was 39 (38.6%), 32 (31.7%), and 30 (29.7%), respectively. The mean follow-up period in PPV + Silicone, PPV + Gas, and SB group was 33.95 ± 23.58, 32.62 ± 10.95, and 33.76 ± 16.62 months, respectively. No significant difference was observed between the groups neither with regard to primary and final anatomical and visual success rates nor in relation to the recurrence rate of retinal detachment. According to our anatomical and visual outcome results, either of the three methods (i.e. PPV + Silicone, PPV + Gas, or SB) can be used in the treatment of pseudophakic retinal detachment. PMID:28135566
Yokoyama, Toshiyuki; Kanbayashi, Koki; Yamaguchi, Tamaki
Purpose To assess the treatment of pediatric patients with rhegmatogenous retinal detachment (RRD) by scleral buckling with chandelier illumination. Methods Three eyes were treated in three patients, healthy boys aged 7 years, 12 years, and 11 years, with RRD, macular involvement, and small retinal holes, of which two were preoperatively undetectable. Conventional scleral buckling with cryoretinopexy was performed under the contact lens for vitreous surgery or noncontact wide-angle viewing system using 27-gauge twin chandelier illumination. Results The only known predisposing factor for retinal detachment was myopia stronger than 3 D with lattice retinal degeneration in two of the three patients. Retinal reattachment was achieved in all cases without intra- or postoperative complications. However, visual recovery was limited in one of the three patients. Conclusion Scleral buckling with chandelier illumination is effective for pediatric RRD, especially if the retinal hole is difficult to detect preoperatively. However, visual recovery was sometimes limited because of macular involvement due to late diagnosis, which is one of the characteristic features of pediatric RRD. PMID:25657577
Cabric, Emir; Salihefendic, Nizama; Zildzic, Muharem; Licanin, Zoran; Smajlovic, Fahrudin
Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.
Zlotcavitch, Leonid; Flynn, Harry W; Avery, Robert L; Rachitskaya, Aleksandra
We report a patient with progression to a macula-off tractional retinal detachment in a fellow eye after a contralateral intraoperative intravitreal bevacizumab injection. A 32-year-old diabetic man noted decreased vision in his left eye 1 week following 25 gauge pars plana vitrectomy, gas tamponade, and intraoperative injection of bevacizumab in his right eye. Left eye visual acuity decreased from 20/80 to 20/200, and macula-off tractional retinal detachment was seen on clinical exam and imaging. Progression of tractional retinal detachment associated with proliferative diabetic retinopathy in a fellow eye after a contralateral intraoperative intravitreal bevacizumab injection may occur.
Rashaed, Saba Al
The purpose of this paper is to report an unusual case of accumulation of residual subretinal fluid after surgery for acute rhegmatogenous retinal detachment, sparing the fovea. A 28-year-old male presented with a four-day history of acute visual loss in his right eye secondary to bulbous rhegmatogenous retinal detachment, sparing the fovea. The patient underwent an uneventful pars plana vitrectomy and scleral buckling procedure. At four weeks postoperatively (after complete gas resorption), the visual acuity was 20/40. However, the patient complained of blurred vision. A dilated fundus examination showed a fat retina and the presence of multiple yellowish subretinal deposits resembling vitelliform lesions in the macula. Some lesions were encroaching on the fovea, and were connected via a tract to a previous horseshoe tear with evidence of a thin layer of subretinal fluid. The patient symptoms persisted for one year postoperatively. However, the retina remained fat with evidence of retinal pigment epithelium mottling and faint scars corresponding to previous lesions. Persistent subretinal fluid with thick subretinal precipitate can occur even after successful surgery for acute retinal detachment sparing the fovea and cause visual dysfunction.
Pars plana vitrectomy combined with an endotamponade is the most important concept in retinal detachment surgery. Numerous advances in techniques and tamponade materials have been made, but the general problems of retinal detachment surgery are still unsolved: The primary success rate is not adequate, and there is no adequate strategy to address proliferative vitreoretinopathy, multiple retinal breaks or persistent hypotony. The story of tamponades is full of myths and misunderstandings. A critical review shows that tamponades have only a minor role in the history of retinal detachment surgery. One might assume that the value of tamponades is overestimated. This may be because the underlying concept is limited: All available tamponades are hydrophobic, so they act by buoyant force and surface tension. This narrow focus on the hydraulic function allows only one tamponade vector and makes complete filling of the vitreous body space impossible. The hydrophobic character of the materials has fundamental disadvantages that tend to increase the risk of new breaks or PVR formation. Thus, a critical revaluation of the value of current tamponades is necessary. One solution might be to develop hydrogels as vitreous body substitute. Such a hydrophilic vitreous body substitute fits the natural and complex function of a juvenile, healthy vitreous much better than gas or silicone oil. Georg Thieme Verlag KG Stuttgart · New York.
Sato, Tatsuhiko; Wakabayashi, Taku; Shiraki, Nobuhiko; Sakaguchi, Hirokazu
To investigate retinal thickness in the central and parafoveal subfields, including segmented analysis of the inner and outer retinal layers, after vitrectomy for macula-off rhegmatogenous retinal detachment (RRD) repair. Twenty-four eyes of 24 patients who underwent primary vitrectomy for macula-off RRD repair were enrolled in this study. Spectral-domain optical coherence tomography examination and best-corrected visual acuity (BCVA) measurements were performed at 1, 3, and 6 months after vitrectomy. At 1, 3, and 6 months after vitrectomy, retinal thickness in the temporal parafoveal subfield was more significantly (P = 0.004, 0.001, and 0.003, respectively) correlated with BCVA than the central subfield (P = 0.014, 0.001, and 0.022, respectively). Segmented analysis showed significant correlations between the retinal thickness of both the outer layer (P = 0.018, 0.030, and 0.018, respectively) and the inner layer (P = 0.003, 0.002, and 0.001, respectively) in the temporal parafoveal subfield and BCVA at every time point after vitrectomy. These results suggest that retinal thickness in the temporal parafoveal subfield may most closely reflect postoperative BCVA after macula-off RRD repair.
Wang, H Z; Chen, M T; Chang, C H; Tsai, M C; Wu, W C; Chung, C B
As myopia plays an important role in the pathogenesis of retinal detachment, alterations of refractive components after scleral buckling procedures for retinal detachment may be an important factor for retinal redetachment. To find out the refractive change following retinal detachment surgery, we prospectively followed up the alterations of corneal curvature, and axial components (axial length, anterior chamber depth, lens thickness, and vitreous length) of 44 eyes of rhegmatogenous retinal detachment before and after operations. The procedures consisted of encircling scleral buckling (12 eyes) and segmental scleral buckling (32 eyes). All patients were followed for 6 months postoperatively. The corneal curvatures were measured with a keratometer, the axial length and axial components were measured with an A-scan ultrasonography. The methods and materials used in operation were recorded in detail to correlate with the refractive changes. The corneal curvature showed a trend to flatten early after operation (the 1st week), and gradually reversed to steepening. But, the difference was statistically significant only at the K2 (vertical meridian) in the 1st postoperative week and the K1 (horizontal meridian) in the 4th postoperative week. Lengthening of eyeballs were noted in the encircling group (12 eyes), but only the elongation in the 1st postoperative week was statistically significant. While in segmental buckling group, the axial length of the eyeballs was transiently shortened. The shortening was significant in the 2nd, 4th, and 6th week after operation. The reduction of eyeball's axial length was related to the shortening of vitreous length and shallowing of anterior chamber.(ABSTRACT TRUNCATED AT 250 WORDS)
VELEZ-MONTOYA, Raul; JACOBO-OCEGUERA, Paola; FLORES-PRECIADO, Javier; DALMA-WEISZHAUSZ, Jose; GUERRERO-NARANJO, Jose; SALCEDO-VILLANUEVA, Guillermo; GARCIA-AGUIRRE, Gerardo; FROMOW-GUERRA, Jans; MORALES-CANTON, Virgilio
We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery. PMID:28289689
Poulsen, Christina Doefler; Peto, Tunde; Grauslund, Jakob; Green, Anders
To examine the incidence of retinal detachments and to evaluate patient profiles and surgical characteristics. Retrospective review of patients operated for primary retinal detachment (RD) and redetachment between 2010 and 2012 at the Department of Ophthalmology, Odense University Hospital, Denmark. We included all RD such as rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD) and exudative retinal detachment (ERD). In total, 779 RD surgeries were performed: 83.7% (n = 652) primary operations and 16.3% (n = 127) reoperation. For primary operation, pars plana vitrectomy (PPV), scleral buckling and combined operations were performed in 95.1% (n = 620), 4.6% (n = 30) and 0.3% (n = 2) respectively. Over time there was less use of silicone oil and greater use of gas tamponade (p = <0.001), less simultaneous cataract operations (p = <0.001), less use of cryotherapy (p = 0.045) and more use of peeling procedures (p = <0.001) in primary operations. The annual incidence of surgery for primary RD was 22.0 [95% confidence interval (CI) 20.4-23.8] per 100 000 inhabitants aged >15 years. Retinal detachment (RD) was more common in males than females (1.8:1), and mean age at presentation was 61.8 years (standard deviations ± 12.3). The annual incidence for RRD and TRD operation was 20.72 (95% CI 19.11-22.43) and 1.25 (95% CI 0.9-1.7) per 100 000 inhabitants >15 years. This study presents the first overall incidence for RD in Denmark. The highest incidence of RRD was among males aged 60 to 79 years, whereas TRD was among females at same age. Pars plana vitrectomy (PPV) was the preferred surgical technique, and during 2012 all RD patients were treated with PPV, independent of lens status and age. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Perfluorodecalin is a clear colourless fluid with high specific gravity. It is immiscible with gas, blood, water, or any other fluid used in vitrectomy. The low viscosity permits easy injection and removal with microsurgical equipment. The high weight displaces subretinal fluid anteriorly through retinal breaks back into the vitreous space. Posterior retinotomies can be avoided. A large bubble of perfluorodecalin in the vitreous cavity stabilizes the retina mechanically during dissection and peeling of epiretinal membranes. Before the procedure is ended the fluid must be completely removed from the eye and replaced by BSS, air, gas, or silicon oil. We present the surgical technique and preliminary results.
Jalali, Subhadra; Rani, Alka; Rawal, Hema
To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG- assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE. PMID:18711276
Reddy, Devasis N; Yonekawa, Yoshihiro; Thomas, Benjamin J; Nudleman, Eric D; Williams, George A
Purpose The aim of the study was to present the long-term anatomical and visual outcomes of retinal detachment repair in patients with Stickler syndrome. Patients and methods This study is a retrospective, interventional, consecutive case series of patients with Stickler syndrome undergoing retinal reattachment surgery from 2009 to 2014 at the Associated Retinal Consultants, William Beaumont Hospital. Results Sixteen eyes from 13 patients were identified. Patients underwent a mean of 3.1 surgical interventions (range: 1–13) with a mean postoperative follow-up of 94 months (range: 5–313 months). Twelve eyes (75%) developed proliferative vitreoretinopathy. Retinal reattachment was achieved in 100% of eyes, with ten eyes (63%) requiring silicone oil tamponade at final follow-up. Mean preoperative visual acuity (VA) was 20/914, which improved to 20/796 at final follow-up (P=0.81). There was a significant correlation between presenting and final VA (P<0.001), and patients with poorer presenting VA were more likely to require silicone oil tamponade at final follow-up (P=0.04). Conclusion Repair of retinal detachment in patients with Stickler syndrome often requires multiple surgeries, and visual outcomes are variable. Presenting VA is significantly predictive of long-term VA outcomes. PMID:27574392
Voltairas, P. A.; Fotiadis, D. I.; Massalas, C. V.
It has been argued that silicone ferrofluid internal tamponade (SFIT) can provide (360°) tamponade of the retina in retinal detachment surgery. Provided that the produced SFIT is biocompatible, exact knowledge is needed of its elastic stability in the magnetic field produced by the semi-solid magnetic silicon band (MSB) used as a scleral buckle. We propose a quantitative, phenomenological model to estimate the critical magnetic field produced by the MSB that 'closes' retinal tears and results in the reattachment of the retina. The magnetic 'deformation' of SFIT is modeled in accordance with the deformation of a ferrofluid droplet in an external magnetic field.
Goel, Neha; Bhambhwani, Vishaal; Jain, Pooja; Ghosh, Basudeb
To describe an unusual retinal manifestation of dengue fever in an endemic region. A 35 year old male presenting with acute onset decreased vision in his right eye, was found to have a massive retinal pigment epithelial detachment (PED) extending up to the vascular arcades. He had been diagnosed with acute hypokalemic quadriparesis in dengue fever in the preceding week, which had resolved following treatment. The patient was managed conservatively. At three months follow up, there was spontaneous flattening of the PEDs with improvement in visual acuity. Dengue fever complicated by acute hypokalemic quadriparesis can be associated with PED, which can be large. The condition resolves spontaneously and bears a good prognosis.
Zhong, Liu-xue-ying; Liu, Wen; Huang, Su-Ying; Zhang, Shao-chong
Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ≤ C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness. PMID:24790997
Zhong, Liu-xue-ying; Du, Yi; Liu, Wen; Huang, Su-Ying; Zhang, Shao-chong
Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ≤ C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness.
Heriot, Wilson J
To develop an animal model to test the hypothesis that immediate adhesion of the retina to the choroid (retinopexy) can be created by elimination of the water separating the retina from the retinal pigment epithelium (RPE) prior to photocoagulation. The retina and RPE are hydrophobic lipoprotein structures separated intraoperatively by a thin layer of fluid despite surgical drainage. If the RPE and retina are contacting, heating should create a unified local coagulum and achieve instantaneous fusing of the retina and RPE, thus sealing the subretinal space around the retinal tear. The surgical technique and histological findings in a rabbit model of rhegmatogenous retinal detachment (RRD) are reported here. Nine Dutch-belted, pigmented rabbits underwent vitrectomy with lensectomy, creation of localised retinal detachment by subretinal injection of balanced salt solution (BSS), enlargement of the hole and fluid-gas exchange to "re-attach" the retina. Dehydration of the retina surrounding the hole was achieved by an airstream from a flute needle. A laser (810 nm) was applied in long pulses to achieve a mild retinal reaction around the hole in the dehydrated adjacent retina. The BSS irrigation was resumed. Eyes were then enucleated and the treated retina examined histologically. The dehydrated and lasered retinal tear margin demonstrated fusion of the retina with the RPE/choroid. The non-dehydrated adjacent areas showed thermal tissue changes in the retina, RPE/choroid and adjacent sclera but remained separated by persistent subretinal fluid and no fusion or unified coagulum developed. Immediate laser-induced thermal fusion of the retina with the RPE at the margin of a retinal tear can be achieved by removing the subretinal fluid prior to photocoagulation. The integrated coagulum seals the tear margin preventing further fluid entering the subretinal space, thus correcting the cause of RRD. This method may facilitate RRD repair without buckling or internal tamponade.
Tsunekawa, Taichi; Hwang, Shiang-Jyi; Oishi, Akio; Nagasaka, Yosuke; Iwase, Takeshi; Nonobe, Norie; Ueno, Shinji; Ito, Yasuki; Yasuda, Shunsuke; Shimizu, Hideyuki; Suzumura, Ayana; Kataoka, Keiko; Terasaki, Hiroko
Purpose. We had earlier reported positive hsa-miR-148a-3p expression in eyes with rhegmatogenous retinal detachment (RRD) and its involvement in the epithelial-mesenchymal transition of retinal pigment epithelium in vitro. Here we investigated the association of hsa-miR-148a-3p expression levels in the vitreous fluid of patients with RRD with severity of RRD. Methods. The hsa-miR-148a-3p expression levels in the vitreous fluid, range (degree) of retinal detachment (RD), and pixels of retinal break were measured in 27 eyes with RRD. The association of hsa-miR-148a-3p expression levels with other factors was evaluated by multiple regression analysis. Results. The hsa-miR-148a-3p expression levels, time from onset of RRD to vitrectomy, range of RD, and pixels of retinal breaks were 23.68 ± 43.00, 12.07 ± 15.36 days, 155.85 ± 86.67 degrees, and 37000 ± 67100 pixels, respectively. Five eyes with RRD had vitreous hemorrhage preoperatively. The hsa-miR-148a-3p expression levels were significantly associated with pixels of retinal breaks (β = 0.699) and the time from onset of RRD to vitrectomy (β = 0.358) but not with the range of RD or presence of vitreous hemorrhage. Conclusion. The hsa-miR-148a-3p expression levels in the vitreous fluid were significantly associated with the size of retinal break and disease duration. PMID:28261609
Ranjan, Ratnesh; Kushwaha, Rajnath; Gupta, Ramesh Chandra; Khan, Perwez
To describe an unusual case of methanol-induced optic neuritis with bilateral multifocal extrafoveal serous retinal pigment epithelial (RPE) detachment. Single case report. A 40-year-old male presented with acute bilateral loss of vision and history of consumption of adulterated alcohol. On examination, his vision was perception of light in the right eye and finger counting at 1-ft distance in the left eye. Pupillary reactions were sluggish. The optic discs were normal. An elevated lesion with subretinal serous fluid was present over macula adjacent to superior major vessel arcade in the right eye, which was confirmed as a large extrafoveal RPE detachment on fluorescein angiography. There were two more small RPE detachments in the right eye as well as in the left eye. All RPE detachments were extrafoveal in location. The patient was managed medically with intravenous methylprednisolone (1 g) in 500 ml of ringer lactate for three consecutive days. After three doses, visual acuity of both eyes was recorded as 20/20. We herein report an unusual case of bilateral multifocal extrafoveal serous RPE detachment in a patient of methanol-induced optic neuritis. RPE detachments may be due to the toxic effect of methanol metabolites.
Temkar, Shreyas; Takkar, Brijesh; Azad, Shorya Vardhan; Venkatesh, Pradeep
Endoilluminator-assisted scleral buckling combines the advantages of scleral buckling for its external approach and pars plana vitrectomy for its better visual visualization in the management of retinal detachment (RD). It has recently been proven to be safe and efficacious in simple cases. This report discusses successful management of a complex case of RD in a patient with the single functioning eye, where vitrectomy was expected to have a complicated course.
Temkar, Shreyas; Takkar, Brijesh; Azad, Shorya Vardhan; Venkatesh, Pradeep
Endoilluminator-assisted scleral buckling combines the advantages of scleral buckling for its external approach and pars plana vitrectomy for its better visual visualization in the management of retinal detachment (RD). It has recently been proven to be safe and efficacious in simple cases. This report discusses successful management of a complex case of RD in a patient with the single functioning eye, where vitrectomy was expected to have a complicated course. PMID:27958210
Azar, Georges; Wolff, Benjamin; Cornut, Pierre-Loïc; Mauget-Faÿsse, Martine
To report a case of serous retinal detachment after Pattern Scan Laser (PASCAL) treatment in a diabetic woman. A 34-year-old diabetic woman presented with florid diabetic retinopathy after a miscarriage during the 20(th) week of pregnancy. Her Best Corrected Visual Acuity (BCVA) was 20/40 right eye (OD) and 20/30 left eye (OS). Fundus exam showed multiple microaneurysms, large blot hemorrhages and venous dilation both eyes (OU). Fundus fluorescein angiography (FFA) revealed large areas of capillary nonperfusion and panretinal neovascularisation in all quadrants OU. Macular Spectral-Domain Optical Coherence Tomography scan (SD-OCT) did not show any foveal thickening. Panretinal photocoagulation (PRP) was immediately performed OU during the same day. Two days after PASCAL treatment, her BCVA decreased to 20/80 OU and worsened to Count Fingers (CF) during the following days. Fundus exam revealed an extensive serous retinal detachment confirmed on SD-OCT. 2 sub-conjunctival injections of 0.1 ml Betamethasone were done OU. One month later, BCVA improved to 20/30 and SD-OCT confirmed regression of retinal detachment. PASCAL is considered to be a safe treatment, but one has to be aware of its potential side effects. It has to be used with caution in pregnant women.
Wong, John X; Wong, Elizabeth P; Teoh, Stephen C
This study reports the surgical outcomes of acquired immunodeficiency syndrome (AIDS) patients with Cytomegalovirus retinitis (CMVR) -related retinal detachments(RD) in an Asian population. Review of CMVR characteristics, surgical outcomes and complications in 19 eyes with CMVR-related RD that underwent surgery from January 2000 to June 2011. CMVR was inactive in 73.7% of the eyes at time of surgery. Anatomical success was achieved in 14 eyes. Seven eyes (36.8%) had improvement of two or more lines in visual acuity (VA) and 8 eyes (42.1%) maintained VA. Thirteen eyes presented with worse than 6/120 vision, with 30.8% of them achieving ambulatory vision or better. Five eyes had re-detachments. Median durations from CMVR and immune recovery uveitis (IRU) diagnoses to RD were 2.7 and 1.0 months respectively. Surgery for CMVR-related RD is associated with good anatomical outcomes with most eyes maintaining or having improved vision. CMVR lesion size of <50% retinal area is associated with better outcomes. Eyes with CMVR and IRU require close monitoring for RD.
Ooshiro, Tomohiro; Iijima, Hiroyuki
To investigate whether postoperative light sensitivity recovers completely to the level prior to the development of rhegmatogenous retinal detachment (RRD) after successful surgery. We retrospectively studied 44 eyes of 44 patients with RRD who were successfully operated and who underwent Humphrey central 30-2 perimetry postoperatively. The averaged total deviation in Humphrey perimetry in the reattached retina was compared with that of the horizontal or vertical counterpart in the preoperatively non-detached retina. The averaged total deviation in the reattached retina was significantly lower than in its counterpart (p < 0.0001). The averaged residual loss of light sensitivity did not correlate with postoperative visual acuity (p = 0.8047) or with its change (p = 0.1242). Light sensitivity in the detached retina in eyes with RRD does not completely recover after successful surgery. © 2017 The Author(s) Published by S. Karger AG, Basel.
Foos, R Y; Simons, K B; Wheeler, N C
Because rhegmatogenous retinal detachments are thought to be much less common in blacks than in whites, we compared the incidence of various lesions known to cause or predispose to this condition (synchysis senilis, posterior vitreous detachment, breaks, tears, and holes of the peripheral fundus, and lattice degeneration of the retina) in a series of postmortem eyes on the basis of race. Our statistical analysis also included trauma, myopia, and chorioretinitis. The series included 322 black subjects and 2,012 white subjects. The subjects ranged in age from 20 to 93 years at the time of death. Although the initial data showed a racial difference in the incidence of synchysis senilis of grade 3 (50% destruction) or higher and posterior vitreous detachment (P = .033 and P = .021, respectively), we found no difference when the data were age-corrected.
El-Sanhouri, A A; Foster, R E; Petersen, M R; Hutchins, R K; Miller, D M; Evans, T M; Trichopoulos, N; Riemann, C D
Aims or Purpose To determine the rate of retinal tears (RTs) after posterior vitreous detachment (PVD) and vitreous hemorrhage (VH) in patients on systemic anticoagulants. Methods In all, 260 eyes of 260 patients with an acute PVD and VH were followed for evidence of an RT or detachment. Patients were divided into those taking systemic anticoagulants and those not taking anticoagulants. Results A total of 137 patients (53%) were taking anticoagulants, 123 (47%) were not. Overall, 72% of patients not taking any anticoagulant had evidence of an RT, whereas 46% of patients taking an anticoagulant had an RT (P-value 0.0002). Also, 37% of patients not taking an anticoagulant had a retinal detachment (RD), whereas 23% of patients taking any anticoagulant had an RD (P-value 0.01). Conclusions In patients with an acute PVD and VH using anticoagulants, RTs and RDs were common. Anticoagulation status may be an important contributing factor in predicting the incidence of an RT or detachment. PMID:21587275
Alshahrani, Saeed T; Ghazi, Nicola G; Al-Rashaed, Saba
Purpose To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD) in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy. Patients and methods Chart review of 70 eyes (62 patients). Incidence of RRD, postoperative visual acuity, and risk factors were evaluated. Results Twenty-two patients (35%) had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8%) of patients had successful surgery (including second surgery). Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027). Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001); preoperative cataract (P=0.023); and proliferative vitreoretinopathy (P<0.001). RRD developed in 16/44 eyes despite laser prophylaxis. Conclusion Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade. PMID:26730175
Francke, Mike; Faude, Frank; Pannicke, Thomas; Uckermann, Ortrud; Weick, Michael; Wolburg, Hartwig; Wiedemann, Peter; Reichenbach, Andreas; Uhlmann, Susann; Bringmann, Andreas
In human subjects with peripheral retinal detachments, visual deficits are not restricted to the detached retina but are also present in the non-detached tissue. Based upon studies on a rabbit model of rhegmatogenous retinal detachment, we propose a glial cell-mediated mechanism of spread of retinal degeneration into non-detached retinal areas which may also have importance for the understanding of alterations in the human retina. Both detached and attached portions of the rabbit retina display photoreceptor cell degeneration and cystic degeneration of the innermost layers. An inverse mode of photoreceptor cell degeneration in the attached tissue suggests a disturbed support of the photoreceptor cells by Müller cells which show various indications of gliosis (increased expression of intermediate filaments, cell hypertrophy, decreased plasma membrane K(+) conductance, increased Ca(2+) responsiveness to purinergic stimulation) in both detached and attached tissues. We propose that gliotic alterations of Müller cells contribute to the degeneration of the attached retina, via disturbance of glial homeostasis mechanisms. A down-regulation of the K(+) conductance of Müller cells may prevent effective retinal K(+) and water clearance, and may favor photoreceptor cell degeneration and edema development.
Eftekhari, Kian; Ghodasra, Devon H.; Haynes, Kevin; Chen, Jinbo; Kempen, John H.; VanderBeek, Brian L.
Purpose To determine if oral fluoroquinolone exposure is associated with an increased hazard for having a retinal tear or detachment. Methods A retrospective cohort study was performed using individuals who met inclusion criteria from The Health Improvement Network (THIN) database. Cohorts were created for individuals who had a prescription written for either an oral fluoroquinolone or an oral β-lactam antibiotic (comparison group). Subjects were excluded if they had a previous diagnosis of a retinal tear or detachment (hereafter retinal break, or RB) or a procedure code to treat an RB, were in the practice for less than 365 days, had a previous prescription for either antibiotic within 365 days of the index date, or had intraocular surgery or a diagnosis of endophthalmitis within 90 days prior to the antibiotic prescription. Covariates of interest were age, gender, diabetes and year of index. The primary outcome measure of interest was the hazard ratio of undergoing a procedure to treat a RB within 7, 30, 90 or 365 days after exposure to an oral fluoroquinolone prescription versus an oral β-lactam prescription. Results After exclusions, 6,604,423 prescriptions (290,393 fluoroquinolone; 6,314,030 β-lactam) from 3,413,498 patients (247,073 fluoroquinolone; 3,303,641 β-lactam) and, 2,685 RB procedures were eligible for analysis (661 retinal tears, 2,024 retinal detachments). For fluoroquinolones, zero, one, five, and 23 retinal breaks occurred at the 7-, 30-, 90-, and 365-day time points, respectively. For β-lactam prescriptions, 7, 28, 87, 373 retinal breaks occurred at the 7-, 30-, 90-, and 365-day time points, respectively. Due to zero events occurring in the fluoroquinolone cohort during the 7-day observation period an unadjusted or an adjusted hazard ratio (and subsequent p-value or confidence intervals) were unable to be calculated. Univariate and multivariate analysis demonstrated that fluoroquinolones were not significantly associated with RB in the 30
Dong, Feng; Yu, Chenying; Ding, Haiyuan; Shen, Liping; Lou, Dinghua
Abstract This study aims to investigate intravitreal injection of Ranibizumab on the surgical outcome for diabetic patients who had tractional retinal detachment but did not receive any preoperative retinal photocoagulation. Ninety-seven patients (97 eyes) who had diabetic retinopathy with tractional retinal detachment were enrolled to receive 23-G pars plana vitrectomy (PPV). They were assigned to an experimental group (Group I, n = 47 eyes) and a control group (Group II, n = 50 eyes). The patients in Group I were given 1 injection of intravitreal Ranibizumab (Lucentis 0.5 mg/0.05 mL) 1 week before surgery, whereas those in Group II went down to surgery directly. Follow-ups were performed for 6 months to 3 years (16 ± 6 months), and indicators observed included postoperative best-corrected visual acuity, complications, and retinal thickness in the macula measured by optical coherence tomography. In Group I, BCVA improved from logMAR 1.92 ± 0.49 to logMAR 0.81 ± 0.39 following surgery, whereas in Group II, BCVA improved from logMAR 1.91 ± 0.49 to logMAR 0.85 ± 0.41. There was significant postoperative gain in vision, but there was no significant difference between the 2 groups at postoperative follow-up visits. The mean duration of vitrectomy in Group I and Group II was (40 ± 7) minutes and (53 ± 9) minutes, respectively, with significant difference. Iatrogenic breaks were noted in 5 eyes (11%) in the experimental group and 17 eyes (34%) in the control group; the difference was significant. The retinal thickness in the macula measured by OCT was (256 ± 44) μm and (299 ± 84) μm in Group I and Group II respectively with significant difference. Besides, there were significantly more eyes in Group II that required silicone oil tamponade and postoperative retinal photocoagulation. 23-G PPV combined with intravitreal tamponade and panretinal photocoagulation still remains an effective regimen for the
Goldenberg, David T.; Giblin, Frank J.; Cheng, Mei; Chintala, Shravan K.; Trese, Michael T.; Drenser, Kimberly A.; Ruby, Alan J.
Purpose Intravitreal bevacizumab (Avastin) is frequently used for the treatment of age-related macular degeneration. Previous studies have demonstrated full thickness retinal penetration. Intravitreal recombinant microplasmin (MP) has been shown to successfully induce a posterior vitreous detachment (PVD) and vitreous liquefaction in animals. It has been suggested that a PVD may alter the retinal penetration of molecules in the vitreous cavity. The aim of this study was to compare bevacizumab (BV) retinal penetration in rabbit eyes with and without a MP-induced PVD. Methods Twelve adult rabbits were injected with 0.1 ml (0.4 mg) of MP into the vitreous cavity of one eye. One week later, the rabbits were injected with 0.05 ml (1.25 mg) of BV into both eyes. Both eyes of three rabbits each were harvested at 6, 12, 24, and 72 hours after the BV injection. Frozen retinal cross sections were prepared, and BV retinal penetration was evaluated with immunohistochemistry using a fluorescence-labeled antibody against BV. Two eyes from one rabbit were not injected with either agent and used as controls to compare the background autofluorescence. Peripapillary retinal sections were recorded with a digital camera, and intra-retinal BV fluorescence-labeled antibody was measured by qualitative photographic interpretation. Two additional rabbits received an intravitreal injection of 0.1 ml of MP in one eye. One week later, both eyes from each rabbit were enucleated and frozen retinal sections were prepared and analyzed with light microscopy to evaluate for histologic damage. Results Full thickness BV retinal penetration was observed throughout the retina in both eyes of each rabbit. All of the MP-injected eyes exhibited increased antibody labeling in retinas evaluated 6, 12, and 24 hours after BV injection when compared with the contralateral non-MP-injected eyes. By three days after BV injection, all eyes demonstrated decreased antibody labeling compared to earlier time periods
Irvine, A R; Crawford, J B; Sullivan, J H
A child with nonrhegmatogenous retinal detachment associated with morning glory disc underwent first a vitrectomy and then, some months later, an optic nerve sheath fenestration. The latter procedure led to retinal reattachment. It also produced a biopsy specimen that confirmed the perineural herniation of poorly differentiated retinal tissue in this condition, similar to that in congenital pit of the optic nerve. It demonstrated continuity of the vitreous cavity with the perineural space, both histologically and by the fact that gas injected through the pars plana into the vitreous cavity bubbled out the window in the optic nerve sheath. The authors suggest that morning glory disc and optic pit share similar anatomic features, differing more in degree than in kind, and that the porous nature of the poorly differentiated tissue herniated around the optic nerve into the subarachnoid space in these conditions makes several sources of subretinal fluid possible.
Cohen, Eyal; Zerach, Amir; Mimouni, Michael; Barak, Adiel
Background Pneumatic retinopexy (PR) remains a popular technique for the treatment of rhegmatogenous retinal detachment (RRD). Objective To evaluate the single operation and final success rate of PR for primary treatment of RRD and to determine factors associated with anatomical and visual outcomes. Methods This retrospective case review study analyzed the data of patients who underwent PR for primary treatment of RRD. Patients with a follow-up period of <2 months were excluded. Single operation success was defined as successful retinal reattachment following a single PR throughout 2 months of follow-up. Results Eighty-four eyes met the inclusion criteria. Single operation success was achieved in 50 eyes (59.5%), while 82 obtained anatomical success at the final follow-up visit (97.6%). An average of 0.702±1.095 additional retinal detachment operations was necessary to achieve final anatomical success in the entire cohort (n=84) and 1.4±1.3 in the single operation failure group (n=34). Both groups (single operation success vs failure) did not differ significantly in any of the preoperative variables. Multivariate analysis of pseudophakic patients (n=22) revealed that 52.65% of the variation in single operation outcome was explained by the number of clock-hours detached (partial R2=43.76%, P=0.001). The final best-corrected visual acuity was significantly better in the single operation success group (logarithm of minimum angle [logMAR] 0.229±0.249 vs logMAR 0.747±0.567, P<0.001). Conclusion Careful patient selection is warranted before performing PR in RRD, particularly in pseudophakic patients with large detachments. Ultimately 60% of the cases will attach after the procedure with the rest requiring on average 1.4 additional procedures to achieve final anatomical success. PMID:26586932
Fajnkuchen, Franck; Cohen, Salomon Y; Thay, Nathalie; Ayrault, Sandrine; Delahaye-Mazza, Corinne; Grenet, Typhaine; Nghiem-Buffet, Sylvia; Quentel, Gabriel; Giocanti-Auregan, Audrey
To describe bridge arch-shaped serous retinal detachment (SRD) in exudative age-related macular degeneration and evaluate its functional outcomes. In this monocentric, retrospective, noncomparative case series, patients were included. Patients with exudative age-related macular degeneration and bridge arch-shaped SRD treated with ranibizumab were included. Anatomical patterns of SRD and functional outcomes were assessed. Twenty-two eyes with bridge arch-shaped SRD of 22 patients with age-related macular degeneration were included. Serous retinal detachments were characterized by a steep angle at the junction between the retinal pigment epithelium and the sensory retina (mean, 53.45 ± 12.5°), and characterized by the presence of adhesion areas between the sensory retina and a fibrous complex developed from the choroidal neovascularization. In 15 eyes, the choroidal neovascularization was classic choroidal neovascularization and a fibrotic evolution was observed. Serous retinal detachments were compartmentalized in 14 eyes, leading to a multipocket structure. Visual acuity decreased from 49.9 ± 19.2 letters (20/100) to 40.3 ± 18.6 letters (20/160), corresponding to a mean change of -9.6 ± 19.4 letters. This was the first study to describe the specific morphologic features of bridge arch-shaped SRD, a previously undescribed type of SRD complicating exudative age-related macular degeneration. Patients with bridge arch-shaped SRD responded to intravitreal injections of ranibizumab, but their visual prognosis was unfavorable, compared with the literature. The presence of bridge arch-shaped SRD seemed to be a marker for the fibrotic evolution of the choroidal neovascularization.
Tareen, Saifullah; Tahir, Muhammad Ali; Cheema, Alyscia Miriam
Objective: To investigate the outcome of rhegmatogenous retinal detachment repair at Vitreoretinal unit of Jinnah Post Graduate Medical Centre Karachi in year 2014. Methods: One hundred and three eyes of one hundred and three patients, who underwent three ports parsplana vitrectomy + band + silicone oil, three ports pars plana vitrectomy + silicone oil, three ports pars plana vitrectomy + C3F8 for rhegmatogenous retinal detachment (RRD) repair, at Jinnah Post Graduate Medical Centre, were included in this observational prospective study. Parsplana vitrectomy was done using 23G vitrectomy system. Duration of study was one year. Removal of silicone oil (ROSO) was done on the basis of completely flat retina at least for eight weeks or because of complications due to silicone oil. Patients were followed up post operatively on day one and after one week and then at four weekly interval till the end of the study. Results: Anatomical success was achieved in 91 eyes (88.3%). However in 12 eyes (11.7%) retina redetached after removal of silicone oil. Functional success achievement of visual acuity of 3/60 or better was achieved in 85 (82.5%) of eyes post operatively after removal of silicone oil or absorption of gas C3F8 as the case may be. Conclusion: Re-detachment is common after removal of silicone oil and incidence of re-detachment is related to the degree of preoperative PVR and location of breaks. Re-detachment occurs more commonly if the breaks are inferiorly located as compared to the superior ones. PMID:27022354
Shelby, Shameka J; Angadi, Pavan S; Zheng, Qiong-Duon; Yao, Jingyu; Jia, Lin; Zacks, David N
Photoreceptor (PR) cells receive oxygen and nutritional support from the underlying retinal pigment epithelium (RPE). Retinal detachment results in PR hypoxia and their time-dependent death. Detachment also activates autophagy within the PR, which serves to reduce the rate of PR apoptosis. In this study, we test the hypothesis that autophagy activation in the PR results, at least in part, from the detachment-induced activation of hypoxia-inducible factors (HIF). Retina-RPE separation was created in Brown-Norway rats and C57BL/6J mice by injection of 1% hyaluronic acid into the subretinal space. Retinas were harvested and assayed for HIF protein levels. Cultured 661W photoreceptor cells were subjected to hypoxic conditions and assayed for induction of HIF and autophagy. The requirement of HIF-1α and HIF-2α in regulating photoreceptor autophagy was tested using siRNA in vitro and in vivo. We observed increased levels of HIF-1α and HIF-2α within 1 day post-detachment, as well as increased levels of BNIP3, a downstream target of HIF-1α that contributes to autophagy activation. Exposing 661W cells to hypoxia resulted in increased HIF-1α and HIF-2α levels and increase in conversion of LC3-I to LC3-II. Silencing of HIF-1α, but not HIF-2α, reduced the hypoxia-induced increase in LC3-II formation and increased cell death in 661W cells. Silencing of HIF-1α in rat retinas prevented the detachment-induced increase in BNIP3 and LC3-II, resulting in increased PR cell death. Our data support the hypothesis that HIF-1α, but not HIF-2α, serves as an early response signal to induce autophagy and reduce photoreceptor cell death.
Lin, Zhong; Sun, Jin Tao; Moonasar, Nived; Zhou, Ye Hui
Purpose. To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD). Methods. Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position. Results. 403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%. Conclusion. Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended. PMID:28409022
Lin, Zhong; Sun, Jin Tao; Wu, Rong Han; Moonasar, Nived; Zhou, Ye Hui
Purpose. To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD). Methods. Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position. Results. 403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%. Conclusion. Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended.
Chui, Celine S L; Man, Kenneth K C; Cheng, Ching-Lan; Chan, Esther W; Lau, Wallis C Y; Cheng, Vincent C C; Wong, David S H; Yang Kao, Yea-Huei; Wong, Ian C K
A study reported a significant association between oral fluoroquinolones and the development of retinal detachment among current users of oral fluoroquinolones (Etminan M, Forooghian F, Brophy JM et al. JAMA 2012; 307: 1414-9). However, other published studies have discordant results. This study aimed to investigate this association and to estimate the absolute risk of developing retinal detachment in patients exposed to oral fluoroquinolones. A self-controlled case series study was conducted with data retrieved from the Hong Kong Clinical Data Analysis and Reporting System database and the Taiwan National Health Insurance Research Database. Hong Kong and Taiwanese patients who had prescriptions for oral fluoroquinolones and a procedure for retinal detachment between 2001 and 2012 and between 2000 and 2010, respectively, were defined as cases and included in the analysis. A total of 9 events were found during the fluoroquinolone-exposed period and 1407 events were found during the non-exposed period. The adjusted incidence rate ratio in the combined model was 1.26 (0.65-2.47). The crude absolute risk of experiencing retinal detachment whilst on oral fluoroquinolones was ∼1.3 per 200 000 prescriptions. Our study does not support the association between the use of fluoroquinolones and the development of retinal detachment and our findings are strikingly similar to that of the study conducted in Denmark. Doubt is cast on the association between the use of fluoroquinolones and the development of retinal detachment. Therefore, the use of fluoroquinolones should not be precluded based on the current evidence on the risk of retinal detachment. The impact of different ethnicities on the response to fluoroquinolones should also be investigated. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: email@example.com.
MALAGOLA, R.; PANNARALE, L.; TORTORELLA, P.; ARRICO, L.
Background and objective The purpose of the study is to compare the drainage of subretinal fluid (SRF) in a scleral pocket (SP) with incision parallel to the limbus to drainage through a simple radial scleral thinning (ST), during scleral buckling surgery for rhegmatogenous retinal detachment (RRD). Patients and methods Retrospective cohort study of one hundred sixty-nine consecutive buckling surgery for RRD, where a drainage puncture was performed through SP in eighty-five cases and through previous radial ST in eighty-four cases. Results PT shows significant lower complication rate. The incidence of retinal incarceration or formation of a retinal hole at the first drainage site is lower in PT group (p=0.0285). During surgery choroidal detachment have been observed in a higher percentage of cases in the SP group (p=0.0379). At the end of the surgery a certain amount of SRF behind the buckling was significant in ST group (p=0.0026). Conclusion The SP drainage technique appears to be a useful, effective and safe method to drain SRF. PMID:26188754
Rabinowitz, Ronen; Velez, Federico G.; Pineles, Stacy L.
Purpose To determine factors associated with surgical success in patients undergoing strabismus surgery after retinal detachment repair with scleral buckle. Methods The medical records of consecutive patients who underwent strabismus surgery after repair of retinal detachment with scleral buckle were retrospectively reviewed. A successful “motor” outcome was defined as horizontal deviation <10Δ and vertical deviation <4Δ in the primary position; successful “sensory” outcome was no diplopia in the primary position. Various factors such as removing the scleral buckle at the time of strabismus surgery, the macula structural status, size of the preoperative deviation, presence of restriction to passive movement, and whether the eye with the scleral buckle was the operated eye were compared among groups based on motor success. Results A total of 25 patients were included. The overall motor success rate was 72% after 1.8 ± 0.9 operations, with 62% of patients diplopia free in the primary position. Horizontal deviation <10Δ (P = 0.005) and minimal restriction on forced duction test were associated with motor success after the first surgery (P = 0.05). Partial or entire scleral buckle removal (n = 15) and fellow-eye surgery were not significantly correlated with motor success in our cohort. There were no retinal redetachments after scleral buckle removal. Conclusions A small preoperative horizontal deviation, and minimally restricted ocular rotations were associated with better results. Removing the scleral buckle did not improve results. PMID:24215808
Tosi, Gian Marco; Baiocchi, Stefano; Balestrazzi, Angelo; Martone, Gianluca; Marigliani, Davide; Neri, Giovanni; Caporossi, Tomaso
To evaluate the occurrence of late-onset corneal haze (LOCH) after vitrectomy for rhegmatogenous retinal detachment (RRD) in photorefractive keratectomy (PRK)-treated eyes. This observational cohort study comprised 13 eyes of 13 patients who underwent vitrectomy for RRD and who had been subjected to PRK years earlier. The occurrence of LOCH was evaluated together with all the preoperative, intraoperative, and postoperative factors that could affect final corneal status. LOCH developed in 2 eyes. Both patients had undergone PRK for high myopia--one 3 years and the other 9 years prior to RRD. Both patients presented with RRD due to giant retinal tear and were subjected to scleral buckle, 20-gauge vitrectomy, and silicone oil tamponade. Three months after vitrectomy and 1 month after silicone oil removal they both developed LOCH. During vitreoretinal surgery neither of the 2 patients needed mechanical epithelial debridement. Intraoperative epithelial debridement was performed in 2 of the other patients of the series, who had undergone previous PRK for high myopia and had clear corneas at presentation; in 1 of them this manoeuvre hampered intraoperative visualization. Follow-up after retinal detachment surgery ranged from 6 to 156 months (mean, 37.5 months). Subepithelial corneal scarring may be reactivated many years after PRK. In our series this happened after vitrectomy.
Tosi, Gian Marco; Baiocchi, Stefano; Balestrazzi, Angelo; Martone, Gianluca; Marigliani, Davide; Neri, Giovanni; Caporossi, Tomaso
Abstract To evaluate the occurrence of late-onset corneal haze (LOCH) after vitrectomy for rhegmatogenous retinal detachment (RRD) in photorefractive keratectomy (PRK)-treated eyes. This observational cohort study comprised 13 eyes of 13 patients who underwent vitrectomy for RRD and who had been subjected to PRK years earlier. The occurrence of LOCH was evaluated together with all the preoperative, intraoperative, and postoperative factors that could affect final corneal status. LOCH developed in 2 eyes. Both patients had undergone PRK for high myopia—one 3 years and the other 9 years prior to RRD. Both patients presented with RRD due to giant retinal tear and were subjected to scleral buckle, 20-gauge vitrectomy, and silicone oil tamponade. Three months after vitrectomy and 1 month after silicone oil removal they both developed LOCH. During vitreoretinal surgery neither of the 2 patients needed mechanical epithelial debridement. Intraoperative epithelial debridement was performed in 2 of the other patients of the series, who had undergone previous PRK for high myopia and had clear corneas at presentation; in 1 of them this manoeuvre hampered intraoperative visualization. Follow-up after retinal detachment surgery ranged from 6 to 156 months (mean, 37.5 months). Subepithelial corneal scarring may be reactivated many years after PRK. In our series this happened after vitrectomy. PMID:26683931
Kashani, Amir H; Cheung, Albert Y; Robinson, Joshua; Williams, George A
To investigate optical coherence tomography-derived reflectivity and optical density (OD) characteristics of persistent subretinal fluid (SRF) in eyes after surgical repair of macula-off rhegmatogenous retinal detachment. Retrospective case series of nine eyes with macula-off rhegmatogenous retinal detachment that underwent surgical repair with either scleral buckling or vitrectomy with or without scleral buckling. Major inclusion criteria included 1) availability of high-quality optical coherence tomography scans at 2 or more time points, and 2) sufficient SRF for optical coherence tomography sampling without including tissue edges. Demographic, clinical, and optical coherence tomography imaging data were collected on all eyes. Optical density and SRF height measurements were obtained using a manual image segmentation method with ImageJ. Optical density measurements were standardized by conversion to optical density ratios to facilitate comparison between different visits and eyes. Correlations were assessed for significance through both univariate and multivariate regression analyses. Optical density ratio measurements increased with time after surgery, and this was statistically significant (P = 0.001, R = 0.331). Subretinal fluid height measurements decreased in all eyes. There was a significant correlation between optical density ratios and log of SRF height (P ≤ 0.001, R = 0.485). In multivariate analysis, neither optical density ratios nor SRF height was a statistically significant predictor of visual acuity. Changes in optical density ratios of the residual SRF after retinal detachment repair may be representative of changes in the SRF composition over time. This is in agreement with previous biochemical studies and may serve as a noninvasive method of assessing SRF content in vivo.
Velez-Montoya, Raul; Guerrero-Naranjo, Jose Luis; Garcia-Aguirre, Gerardo; Morales-Cantón, Virgilio; Fromow-Guerra, Jans; Quiroz-Mercado, Hugo
Background Perfluorocarbon liquid (PCL)-perfused vitrectomy has been shown in previous studies to be feasible, safe, and to have advantages in managing complicated cases of tractional retinal detachment. The present study had the objectives of describing the anatomical results and measuring surgical time and PCL consumption when combining PCL-perfused techniques with modern vitrectomy equipment. Methods A prospective, interventional consecutive case series was investigated. We enrolled patients with diabetic tractional retinal detachment, complicated by proliferative vitreoretinopathy and poor vision. A 23 gauge PCL-perfused vitrectomy was done with three-dimensional settings. During the procedure, we assessed the degree of surgical bleeding, visualization quality, and difficulty of membrane dissections. Visual acuity, intraocular pressure, and anatomical success were assessed at one and 3 months of follow-up. Results Twelve patients were enrolled in this study. There were no statistical significant changes in intraocular pressure and visual acuity throughout the follow-up period. Surgery was performed in a hemorrhage-free environment in almost all cases, with good visualization and low technical difficulty. The mean complete surgical time was 94.92 ± 25.03 minutes. The mean effective vitrectomy time was 22.50 ± 19.04 minutes and the mean PCL consumption was 25.08 ± 9.76 mL, with a speed of 1.11 mL/minute. Anatomical success was 67% at 3 months. Conclusion Although the technique proved to have some advantages in managing complicated cases of diabetic tractional retinal detachment, there was a high consumption of PCL. A redesign of the entire system is needed in order to decrease the amount of PCL needed for the technique. PMID:22267907
Thanos, Aristomenis; Todorich, Bozho; Yonekawa, Yoshihiro; Papakostas, Thanos D; Khundkar, Tahsin; Eliott, Dean; Dass, Ashvani B; Williams, George A; Capone, Antonio; Faia, Lisa J; Wolfe, Jeremy D; Hassan, Tarek S; Ruby, Alan J
To investigate the efficacy of the intravitreal dexamethasone implant as the treatment for recalcitrant macular edema after successful rhegmatogenous retinal detachment repair. A retrospective review of the medical records was performed on 17 consecutive patients (17 eyes) with recalcitrant macular edema associated with rhegmatogenous retinal detachment repair who were treated with a single or multiple injections of an intravitreal dexamethasone 0.7-mg implant (Ozurdex; Allergan Inc) at two centers. Main outcomes of the study were change in logarithm of the minimum angle of resolution visual acuity, measurement of central foveal thickness, and macular cube volume as measured by spectral domain optical coherence tomography and frequency of complications. The mean age was 67 years (range, 51-78 years). All 17 patients received previous topical therapy and 12 of them had previous administration of intravitreal triamcinolone with persistence of macular edema. Baseline mean best-corrected visual acuity was 20/100 (logarithm of the minimum angle of resolution 0.75; range, 0.18-1.3 ±0.37) in the affected eyes. There was a statistically significant improvement in best-corrected visual acuity at 1 month (P < 0.001) and 3 months (P = 0.01). Mean baseline central foveal thickness was 505 μm, and mean macular cube volume was 10.62 mm. There was a statistically significant decrease in central foveal thickness and macular cube volume at 1 month (505-290 μm, P = 0.013 and 10.62-9.13 mm, P < 0.0001) and 3 months (P = 0.01). All patients developed recurrence of macular edema at 3 months, which required retreatment. The average number of implants was 4 (range, 1-14). No adverse effects such as retinal detachment or endophthalmitis occurred. Two patients experienced an increase in intraocular pressure that was controlled with topical therapy. Macular edema that occurs in eyes after successful repair of rhegmatogenous retinal detachment can be chronic and recalcitrant, and may be
Hernández-Da Mota, Sergio Eustolio; Béjar-Cornejo, Jorge Francisco
During a pars plana vitrectomy, an unplanned retinotomy in the raphe was performed in a 55-year-old female patient with rhegmatogenous retinal detachment and proliferative vitreoretinopathy. Since diathermy and laser therapy were not available at that moment, it was decided to peel off a small graft of the internal limiting membrane adjacent to the retinotomy site which had been previously stained with Brilliant Blue G. The graft was displaced under perfluorocarbon fluids and placed inside the retinotomy. Three weeks after surgery, the apparent closure of the retinotomy was observed clinically. PMID:28101042
Tosi, Gian Marco; Baiocchi, Stefano; Caporossi, Tomaso
A 42-year-old man had uneventful bilateral nonsimultaneous photorefractive keratectomy (PRK) for severe myopia. Thirty-nine months after the procedure, the patient presented with a retinal detachment (RD) in the right eye. Cerclage, vitrectomy, endolaser, and intravitreal silicone oil tamponade were performed, and the RD was successfully repaired. Three months after vitrectomy and 42 months after PRK, the patient complained of visual impairment in the right eye and photophobia. On slitlamp examination, marked reticular scarring of the central anterior cornea was observed. The occurrence of late-onset corneal haze highlights the need for special attention to patients who have vitrectomy after PRK.
Rueda-Rueda, T; Sánchez-Vicente, J L; Llerena-Manzorro, L; Medina-Tapia, A; González-García, L; Alfaro-Juárez, A; Vital-Berral, C; López-Herrero, F; Muñoz-Morales, A; Ortega, L S; Herrador-Montiel, Á
The case is presented on a 54-year-old woman with a central serous chorioretinopathy, misdiagnosed as Vogt-Koyanagi-Harada disease, and treated with systemic corticosteroids. The patient presented with a bilateral bullous exudative retinal detachment. Discontinuation of corticosteroid therapy, surgical drainage of subretinal fluid, and photodynamic therapy, led to anatomical and functional improvement. The recognition of an atypical presentation of central serous chorioretinopathy may avoid complications of the inappropriate treatment with corticosteroids. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.
Aoyagi, Ranko; Hayashi, Takaaki; Tsuneoka, Hiroshi
Objective The purpose of this study was to report optical coherence tomography (OCT) and angiographic findings in a patient with pregnancy-induced hypertension (PIH). Case report A 39-year-old woman, who was diagnosed with PIH, reported blurred and distorted vision at 5 days after an emergency cesarean delivery. OCT revealed a large serous retinal detachment (SRD) that included areas in the macula, along with an increased choroidal thickness noted in both eyes. Indocyanine green angiograms indicated delayed filling of the choroidal circulation in the early phase but choroidal hyperpermeability in the mid-phase. The SRD was gradually resolving without any treatment except for antihypertensive drugs. At 40 days after the initial examination, OCT revealed both the disappearance of the SRD and marked improvement of the choroidal thickening. Conclusion Ophthalmologists need to be aware that PIH can cause choroidal ischemia, a breakdown of the outer blood–retinal barrier, and lead to the development of SRD. PMID:26635487
Asensio-Sánchez, V M; Collazos, J M; Cantón, M
To measure interleuquin-6 (IL-6) levels in the vitreous body of patients with retinal detachment (RD). Undiluted vitreous samples were obtained from 40 patients with no history of prior vitreous or intraocular surgery. Patients were divided into two groups: A (n=20) patients with RD and B (n=20) patients with pre-retinal macular membranes and macular holes. IL-6 was determined using radioimmunoassay. IL-6 vitreous concentration in group A was 122.4+-16pg/mL (range 91.5-620) and in group B was 46+/-23pg/mL (range 3-150) (p <.001). These results show that the concentration of IL-6 in the vitreous body was significantly higher in patients with RD than in the control group. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Hejsek, L; Dusová, J; Stepanov, A; Rozsíval, P
Rhegmatogenous retinal detachment is a serious condition that can significantly impair visual function, even after a successful surgery. One of the complications that can significantly impair visual acuity in the postoperative period is a development of the epimacular membrane (ERM). The aim of this work is to monitor the effect of peeling of the internal limiting membrane (ILM) in the macula at the anatomical and functional results in the postoperative period, especially with regard to the development of ERM. Prospective study of 21 eyes, which underwent peeling of ILM during pars plana vitrectomy for rhegmatogenous retinal detachment (on detached macula). The ILM peeling was done without using decalin during this procedure. We tested best corrected visual acuity (BCVA) and followed fundus biomicroscopic findings. Proliferative vitreoretinopathy (PVR) was evaluated according to the recommendations of the Retina Society Terminology Committee. To exclude the development of ERM in the macula optical coherence tomography (OCT) was performed at the end of the 18-month follow-up period. In total, the results of 21 eyes of 21 patients who underwent PPV for rhegmatogenous retinal detachment were evaluated. In all of them was during PPV performed ILM peeling on detached macula, these are followed prospectively. ILM peeling without using decalin was sufficient in all eyes. All eyes with ILM peeling did not develop ERM at the end of the follow-up period. ILM peeling during PPV for rhegmatogenous retinal detachment reduces the risk of developing secondary ERM.
Dave, Vivek Pravin; Pathengay, Avinash; Relhan, Nidhi; Sharma, Pranjali; Jalali, Subhadra; Pappuru, Rajeev Reddy; Tyagi, Mudit; Narayanan, Raja; Chhablani, Jay; Das, Taraprasad; Flynn, Harry W
The current study describes the treatment outcomes in patients with endophthalmitis and concurrent or delayed-onset retinal detachment managed with pars plana vitrectomy, intravitreal antibiotics, and silicone oil. In this noncomparative, retrospective case series, the medical records of patients diagnosed with endophthalmitis and retinal detachment from January 1991 through December 2014 at a tertiary eye care center in South India were reviewed. All patients received silicone oil for the management of retinal detachment either concurrently or during follow-up treatment. A total of 93 patients were included in the current study. Retinal detachment was diagnosed at presentation in 20 of 93 patients (21.5%) (concurrent group: Group 1) and during follow-up in the remaining 73 of 93 patients (78.5%) (delayed-onset group: Group 2). In Group 1, the initial treatment consisted of vitrectomy, intravitreal antibiotics, and silicone oil injection in 19 of 20 patients. In Group 2, patients did not receive silicone oil during initial treatment but underwent silicone oil injection during subsequent surgery for repair of retinal detachment. Rates of complete retinal reattachment and visual acuity of 20/400 or better were 73.7% and 30.0%, respectively, in Group 1 and 98.5% and 39.7%, respectively, in Group 2. The median visual acuity at last follow-up in 44 eyes undergoing silicone oil removal was 20/100 (logMAR 0.7), whereas in the remaining 49 eyes that did not undergo silicone oil removal, median visual acuity was 20/2000 (logMAR 2.0). In these patients with endophthalmitis with concurrent or delayed-onset retinal detachment, the use of silicone oil can be a useful adjunct. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:546-551.]. © 2017 Dave, Pathengay, Relhan, et al.
Farjo, Rafal; Peterson, Ward M.; Naash, Muna I.
Purpose Retinal detachment (RD) is associated with acute visual loss caused by anatomic displacement of the photoreceptors and with chronic visual loss/disturbance caused by retinal remodeling and photoreceptor cell death, which may occur even after successful reattachment. The P2Y2 receptor agonist INS37217 improves the rate of retinal reattachment in animal models of induced RD, and has been shown to also significantly enhance the rate of ERG recovery in a mouse model of RD. The identification of genes modulated by INS37217 may allow further drug discovery for treating RD and edema. Methods To identify genes involved in RD and subsequent reattachment, a retinal microarray screen was performed using a mouse model of RD in the presence or absence of INS37217. Results Ninety-two genes were identified as differentially expressed across three time points, most of which were upregulated in the presence of this agonist. Furthermore, it was shown that RD alters the expression of aquaporin-0 (AQP-0), and this modulation is prevented by treatment with INS37217. The presence of AQP-0 in retinal bipolar cells was also demonstrated, whereas it was previously thought to be specific to the lens. Mice lacking functional alleles of AQP-0 had a photo-transduction deficit as assessed by electroretinography; however, their photoreceptor structure was normal, indicative of a problem with signal transmission between neurons. Conclusions This study establishes the genes involved in RD and reattachment, and also demonstrates for the first time a physiologically significant role for AQP-0 in retinal function. PMID:18234993
Sarfare, Shanta; Dacquay, Yann; Askari, Syed; Nusinowitz, Steven; Hubschman, Jean-Pierre
Objective The aim of this study is to evaluate the retinal safety and toxicity of a novel synthetic biopolymer to be used as a patch to treat rhegmatogenous retinal detachment. Methods Thirty one adult wild type albino mice were divided in 2 groups. In Group A (n=9) 0.2 μl balanced salt solution (BSS) and in Group B (n=22), 0.2 μl biopolymer was injected in the subretinal space. Trans-scleral subretinal injection was performed in one eye and the fellow eye was used as control. In both groups, in vivo color fundus photography, electroretinogram (ERG), spectral domain optical coherence tomography (SD-OCT) were performed before injection and at days 7 and 14 post-intervention. Histological analysis was performed following euthanization at days 1, 7 and 21 post-injection. Results The biopolymer was visualized in the subretinal space in vivo by SD-OCT and post-life by histology up to 1 week after the injection. There were no significant differences in ERG parameters between the two groups at 1 and 2 weeks post-injection. Minimal inflammatory response and loss of photoreceptor cells was only observed in the immediate proximity of the site of scleral perforation, which was similar in both groups. Overall integrity of the outer, inner retina and retinal pigment epithelial (RPE) layers was unaffected by the presence of the biopolymer in the subretinal space. Conclusions Functional and histological evaluation suggests that the synthetic biopolymer is non-inflammatory and non-toxic to the eye. It may represent a safe therapeutic agent in the future, for the treatment of rhegmatogenous retinal detachment. PMID:26744635
Fleury, J; Bonnet, M
The perfluoropropane gas was used as an adjunct to vitreoretinal microsurgery in 60 eyes of 60 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy. 0.3 ml to 1.8 ml (average 0.9 ml) of pure perfluoropropane gas was used. The surgical procedure included vitrectomy and scleral buckling in all patients. The follow-up after complete gas absorption ranged from 6 months to 3 years in the successful eyes. Total retinal reattachment was achieved in 41 eyes (68.3%). The anatomical success rate was 88% (22/25 eyes) in grade C1-C2 PVR cases, 68.7% (11/15 eyes) in grade C3-D1 PVR cases, and 42% (8/19 eyes) in grade D2-D3 PVR cases. Visual acuity of 0.1 or better was achieved in 80% of eyes with grade C PVR and 61% of eyes with grade D PVR. Visual acuity of 0.4 or better was achieved in 26.9% of eyes with grade C PVR. Macular changes were revealed by fluorescein angiography in 53% of successful eyes. We recommend the use of C3F8 rather than SF6 in the management of rhegmatogenous retinal detachment complicated by PVR. In our experience the anatomical success rate achieved with C3F8 is approximately the same as that achieved with SF6. However permanent retinal reattachment was achieved with a single operation in 87.8% of successful eyes of the present series of patients managed with C3F8 as compared to only 12% of successful eyes of a previous series of patients managed with SF6. The anatomical results achieved with a single operation in the C3F8 series are probably related to the greater longevity of C3F8 as compared to that of SF6.(ABSTRACT TRUNCATED AT 250 WORDS)
Eftekhari, Kian; Ghodasra, Devon H; Haynes, Kevin; Chen, Jinbo; Kempen, John H; VanderBeek, Brian L
The aim of this study is to determine if oral fluoroquinolone exposure is associated with an increased hazard for having a retinal tear or detachment. A retrospective cohort study was performed using individuals who met inclusion criteria from The Health Improvement Network database. Cohorts were created for individuals who had a prescription written for either an oral fluoroquinolone or an oral β-lactam antibiotic (comparison group). Subjects were excluded if they had a previous diagnosis of a retinal tear or detachment (hereafter retinal break (RB)), or a procedure code to treat an RB, where in the practice for less than 365 days, had a previous prescription for either antibiotic within 365 days of the index date or had intraocular surgery or a diagnosis of endophthalmitis within 90 days prior to the antibiotic prescription. Covariates of interest were age, gender, diabetes, and year of index. The primary outcome measure of interest was the hazard ratio (HR) of undergoing a procedure to treat an RB within 7, 30, 90, or 365 days after exposure to an oral fluoroquinolone prescription versus an oral β-lactam prescription. After exclusions, 6,604,423 prescriptions (290,393 fluoroquinolone; 6,314,030 β-lactam) from 3,413,498 patients (247,073 fluoroquinolone; 3,303,641 β-lactam) and 2685 RB procedures were eligible for analysis (661 retinal tears and 2024 retinal detachments). For fluoroquinolones, 0, 1, 5, and 23 RBs occurred at the 7-, 30-, 90-, and 365-day time points, respectively. For β-lactam prescriptions, 7, 28, 87, and 373 RBs occurred at the 7-, 30-, 90-, and 365-day time points, respectively. Because of zero events occurring in the fluoroquinolone cohort during the 7-day observation period, an unadjusted or an adjusted HR (and subsequent p-value or confidence intervals) was unable to be calculated. Univariate and multivariate analyses demonstrated that fluoroquinolones were not significantly associated with RB in the 30-, 90-, or 365-day
Guixeres Esteve, María Carmen; Pardo Saiz, Augusto Octavio; Martínez-Costa, Lucía; González-Ocampo Dorta, Samuel; Sanz Solana, Pedro
The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided. PMID:28203198
Ho, Vincent Y; Shah, Vaishali G; Yates, David M; Shah, Gaurav K
GoPro and Google Glass technology have previously been used to record procedures in ophthalmology and other medical fields. In this manuscript, GoPro's latest HERO 4 Black edition camera (GoPro Inc, San Mateo, Calif.) will be used to record the placement of a scleral buckle during retinal detachment surgery. GoPro HERO 4 Black edition camera, which records 4K-quality video with a resolution of 3840 (pixels) x 2160 (lines), was mounted on a head strap to record placement of a scleral buckle for a retinal detachment. Excellent video quality was achieved with the 4K SuperView setting. Bluetooth connection with an Apple iPad (Apple Inc, Cupertino, Calif.) provided live streaming and use of the GoPro App. Zoom, horizontal/vertical alignment, exposure, and contrast adjustments were made with postproduction editing on GoPro Studio software. Video recording with the GoPro HERO 4 Black edition camera is an excellent way to document extraocular procedures to improve medical education, self-training, or medicolegal documentation. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Lin, Henry; Lema, Gareth M C; Yoganathan, Pradeepa
To identify prognostic indicators of postoperative visual acuity and retinal detachment (RD) in open globe injuries. Retrospective review of 50 adult open globe injuries between September 2011 and March 2014. Hierarchical multivariable regression was used to evaluate relationships among injury characteristics, postoperative visual acuity, and RD after age adjustment. Mean participant age was 46.2 years, and mean follow-up was 1.2 years. Blunt trauma accounted for 58% of injuries (29/50), and the wound extended posteriorly into sclera in 64% of cases (32/50). The retinal detachment occurred in 40% of patients (20/50), 95% of whom had developed vitreous hemorrhage (19/20). Multivariable regression revealed that preoperative visual acuity (P = 0.0010), posterior wound extension (P = 0.022), and RD (P = 0.0038) independently predicted postoperative visual acuity. No other injury characteristic was related to postoperative visual acuity after adjustment for preoperative visual acuity. Vitreous hemorrhage predicted RD (P < 0.001), and further consideration of preoperative visual acuity and other variables did not improve model fit. Moreover, among patients who underwent RD repair (n = 13), earlier vitrectomy after vitreous hemorrhage diagnosis (≤12 days) was associated with fewer macula-off RDs (P = 0.018) and better postoperative visual acuity (P = 0.0055). Preoperative visual acuity, posterior wound extension, and RD significantly influenced postoperative visual acuity after open globe injury. Vitreous hemorrhage predicted RD, and prompt intervention after detection may improve visual outcomes.
Eid, Ramzi; Guzman, David Sanchez-Migallon; Keller, Krista A; Wiggans, K Tomo; Murphy, Christopher J; LaDouceur, Elise E B; Keel, M Kevin; Reilly, Christopher M
A subadult male bald eagle ( Haliaeetus leucocephalus ) was presented for severe depression and weakness. Physical examination findings included depressed mentation, dehydration, sternal recumbency, poor body condition, and bilateral, whole-head, horizontal nystagmus. A heavy-metal panel was performed, and blood lead levels were 6.1 ppm. Treatment for lead poisoning was initiated, including subcutaneous fluids and parenteral calcium-disodium ethylenediaminetetraacetic acid, ceftiofur, and meloxicam. Ophthalmic examination findings included absent menace response, absent dazzle reflex, slow and incomplete direct pupillary light reflex, mild anterior uveitis, incipient cataracts, multifocal retinal tears, and retinal separation in both eyes. Because of poor prognosis for vision and release to the wild, the eagle was euthanatized. No lesions were observed on gross postmortem examination. Histologically, extensive myocardial necrosis and multisystemic arteriolar vasculopathy were identified. The eyes were examined after tissue processing, and the vasculopathy extended into the choriocapillaris and was associated with a secondary, bilateral, exudative, retinal detachment. This is the first report in avian species characterizing the histopathologic ocular lesions of lead poisoning.
Luna, Gabriel; Lewis, Geoffrey P.; Linberg, Kenneth A.; Chang, Bo; Hu, Quiri; Munson, Peter J.; Maminishkis, Arvydas; Miller, Sheldon S.; Fisher, Steven K.
Purpose The purpose of this study was to examine the rpea1 mouse whose retina spontaneously detaches from the underlying RPE as a potential model for studying the cellular effects of serous retinal detachment (SRD). Methods Optical coherence tomography (OCT) was performed immediately prior to euthanasia; retinal tissue was subsequently prepared for Western blotting, microarray analysis, immunocytochemistry, and light and electron microscopy (LM, EM). Results By postnatal day (P) 30, OCT, LM, and EM revealed the presence of small shallow detachments that increased in number and size over time. By P60 in regions of detachment, there was a dramatic loss of PNA binding around cones in the interphotoreceptor matrix and a concomitant increase in labeling of the outer nuclear layer and rod synaptic terminals. Retinal pigment epithelium wholemounts revealed a patchy loss in immunolabeling for both ezrin and aquaporin 1. Anti-ezrin labeling was lost from small regions of the RPE apical surface underlying detachments at P30. Labeling for tight-junction proteins provided a regular array of profiles outlining the periphery of RPE cells in wild-type tissue, however, this pattern was disrupted in the mutant as early as P30. Microarray analysis revealed a broad range of changes in genes involved in metabolism, signaling, cell polarity, and tight-junction organization. Conclusions These data indicate changes in this mutant mouse that may provide clues to the underlying mechanisms of SRD in humans. Importantly, these changes include the production of multiple spontaneous detachments without the presence of a retinal tear or significant degeneration of outer segments, changes in the expression of proteins involved in adhesion and fluid transport, and a disrupted organization of RPE tight junctions that may contribute to the formation of focal detachments. PMID:27603725
Morisawa, Hiroyuki; Makino, Shinji; Takahashi, Hironori; Sorita, Mari; Matsubara, Shigeki
Serous retinal detachment is sometimes caused by hypertensive disorders in pregnancy and its associated conditions, in which the predominant eye symptoms are blurred vision, distorted vision, and reduced visual acuity. To our best knowledge, this is the first report of a puerperal woman with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome in whom color vision abnormality was the first and predominant manifestation of serous retinal detachment. At 32 weeks of gestation, the 34-year-old Japanese woman underwent cesarean section due to HELLP syndrome. She complained of color vision abnormality on day 1 post-partum and ophthalmological examination revealed serous retinal detachment of both eyes. The visual acuity was preserved. With supportive therapy, her color vision abnormality gradually ameliorated and retinal detachment completely resolved on day 34 post-partum without any sequelae. Obstetricians should be aware that color vision abnormality can be the first and predominant symptom of HELLP-related serous retinal detachment.
Besirli, Cagri G; Chinskey, Nicholas D; Zheng, Qiong-Duan; Zacks, David N
Purpose. To test the effect of a small peptide inhibitor (Met12) of the Fas receptor on the activation of extrinsic and intrinsic apoptosis pathways after retinal detachment. Methods. Retinal-RPE separation was created in Brown Norway rats by subretinal injection of 1% hyaluronic acid. Met12, derived from the Fas-binding extracellular domain of the oncoprotein Met, was injected into the subretinal space at the time of separation. A mutant peptide and vehicle administered in a similar fashion acted as inactive controls. The extrinsic apoptotic pathway was induced in 661W cells using a Fas-activating antibody in the presence or absence of Met12. Caspase 3, caspase 8, and caspase 9 activities were measured with calorimetric and luminescent assays in retinal extracts and cell lysates. Terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) was performed in retinal sections 3 days after separation. Histology was performed in retinal sections 2 months after retinal detachment. Results. Met12 inhibited Fas-induced caspase 8 activation in 661W cells. Similarly, administration of Met12 into the subretinal space inhibited the activation of caspase 3, caspase 8, and caspase 9 after retinal detachment. This corresponded to a decreased level of TUNEL-positive staining of photoreceptors after retinal-RPE separation in animals that received Met12, but not inactive mutant, peptide treatment. After 2 months, the outer nuclear layer was significantly thicker, and the photoreceptor count was higher in animals treated with subretinal Met12. Conclusions. The small peptide Met12 may serve as a photoreceptor-protective agent in the setting of retinal-RPE separation.
Wang, Jianfeng; Zarbin, Marco; Sugino, Ilene; Whitehead, Ian; Townes-Anderson, Ellen
Purpose The RhoA pathway is activated after retinal injury. However, the time of onset and consequences of activation are unknown in vivo. Based on in vitro studies we focused on a period 2 hours after retinal detachment, in pig, an animal whose retina is holangiotic and contains cones. Methods Under anesthesia, retinal detachments were created by subretinal injection of a balanced salt solution. Two hours later, animals were sacrificed and enucleated for GTPase activity assays and quantitative Western blot and confocal microscopy analyses. Results RhoA activity with detachment was increased 1.5-fold compared to that in normal eyes or in eyes that had undergone vitrectomy only. Increased phosphorylation of myosin light chain, a RhoA effector, also occurred. By 2 hours, rod cells had retracted their terminals toward their cell bodies, disrupting the photoreceptor-to-bipolar synapse and producing significant numbers of spherules with SV2 immunolabel in the outer nuclear layer of the retina. In eyes with detachment, distant retina that remained attached also showed significant increases in RhoA activity and synaptic disjunction. Increases in RAC1 activity and glial fibrillary acidic protein (GFAP) were not specific for detachment, and sprouting of bipolar dendrites, reported for longer detachments, was not seen. The RhoA kinase inhibitor Y27632 significantly reduced axonal retraction by rod cells. Conclusions Activation of the RhoA pathway occurs quickly after injury and promotes synaptic damage that can be controlled by RhoA kinase inhibition. We suggest that retinal detachment joins the list of central nervous system injuries, such as stroke and spinal cord injury, that should be considered for rapid therapeutic intervention. PMID:27472075
Cho, Minhee; Witmer, Matthew T; Favarone, Guilleherme; Chan, RV Paul; D’Amico, Donald J; Kiss, Szilárd
Purpose Visual recovery after rhegmatogenous retinal detachment (RRD) repair depends upon various anatomical factors. We investigated spectral-domain optical coherence tomography (SD-OCT) abnormalities, pre- and postoperatively, in patients with nontraumatic RRD and correlated these findings with visual outcome. Methods The medical records of all patients presenting to Weill Cornell Medical College with nontraumatic macula-involving RRD from August 2010 to September 2011 were retrospectively reviewed in this single-center, consecutive case series. All patients underwent pre- and postoperative visual acuity (VA) testing, slit-lamp biomicroscopy, and dilated fundus examination. Spectral domain optical coherence tomography was obtained preoperatively in twelve patients and postoperatively in ten patients. Results Twelve patients (12 eyes) were included in the final analysis. Preoperative optical coherence tomography revealed that the inner segment/outer segment (IS/OS) junction was disrupted in 10/12 eyes (83%), the external limiting membrane (ELM) was disrupted in 9/12 (75%) eyes, cystoid macular edema (CME) was present in 10/12 (83%) eyes, an epiretinal membrane (ERM) was present in 2/12 eyes (17%) and outer retinal corrugation was present in 7/12 (58%) eyes. In postoperative imaging of 10 eyes, the IS/OS junction was disrupted in 4/10 (40%), the ELM was disrupted in 3/10 (30%) eyes, CME was present in 2/10 (20%), and an ERM in 1/10 (10%). All retinas were attached postoperatively. Outer retinal corrugation was the most predictive of worse preoperative (P = 0.0016) and 1-month postoperative visual acuity (P = 0.05). Conclusion Preoperative SD-OCT demonstrating outer retinal corrugation in macula involving RRD predicts poor visual acuity outcome in nontraumatic RRD. Such findings may have implications for the urgency for these eyes to undergo surgical repair. PMID:22275812
Fang, Wei; Li, Jiu-Ke; Jin, Xiao-Hong; Dai, Yuan-Min; Li, Yu-Min
AIM To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). METHODS Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. RESULTS Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, P<0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P=0.0250), better baseline BCVA (r=0.7291, P<0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR2)=0.5316, P<0.0001], shorter symptoms duration (PR2=0.0609, P=0.0101), longer follow up duration (PR2=0.0278, P=0.0477) and shorter operative duration (PR2=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0
Gharbiya, Magda; Grandinetti, Francesca; Scavella, Vittorio; Cecere, Michela; Esposito, Mariacristina; Segnalini, Alessandro; Gabrieli, Corrado Balacco
To correlate the postoperative visual outcome with the spectral-domain optical coherence tomography (SD-OCT) findings in the fovea after successful rhegmatogenous retinal detachment repair. Cross-sectional, observational study. Thirty-five patients with preoperative macula-on rhegmatogenous retinal detachment (12 eyes) and macula-off rhegmatogenous retinal detachment (23 eyes) who underwent scleral buckling surgery for primary rhegmatogenous retinal detachment were recruited. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity measurement, microperimetry, and SD-OCT examination were performed on the same day. Foveal center retinal thickness, central 1-mm subfield thickness, and outer nuclear layer thickness were measured using SD-OCT. The presence or absence of epiretinal membrane, intraretinal fluid, and subretinal fluid was assessed. The status of the external limiting membrane, inner/outer segment junction, and intermediate line was also evaluated and judged as disrupted or complete. The correlations between SD-OCT findings and either postoperative best-corrected visual acuity or retinal sensitivities for central 12° were analyzed. The outer nuclear layer thickness was the only significant SD-OCT retinal measurement strongly correlated with both postoperative best-corrected visual acuity (r = 0.61; P < 0.001) and retinal sensitivities for central 12° (r = 0.53; P = 0.001). Among the SD-OCT imaging findings, status of the external limiting membrane, inner/outer segment junction, and intermediate line and the presence of intraretinal fluid showed a significantly high correlation either with best-corrected visual acuity outcome (r = -0.60; P < 0.001, r = -0.63; P < 0.001, r = -0.66; P < 0.001, and r = -0.50; P = 0.002, respectively) or with postoperative retinal sensitivities (r = -0.59; P < 0.001, r = -0.61; P < 0.001, r = -0.66; P < 0.001, r = -0.50; P = 0.002, respectively). Multivariate analysis showed that the outer nuclear layer
Toygar, O; Riemann, C D
Purpose To investigate microanatomical relationships during surgical repair of macula involving retinal detachment with pars plana vitrectomy (PPV) and perfluoron (PFO) with a microscope-integrated intraoperative optical coherence tomography (iOCT) device. Patients and methods This consecutive case series included nine eyes of nine patients with macula involving retinal detachment operated by a single surgeon at the Cincinnati Eye Institute. All patients underwent PPV, PFO injection, endolaser, and air–fluid exchange. The macula was imaged with iOCT before PFO injection, after PFO injection, and after air–fluid exchange in all eyes. Results iOCT imaging was ergonomically easy to obtain in all eyes. iOCT clearly demonstrated submacular fluid (SMF) at the beginning of the surgery, macular flattening under PFO in all eyes, small residual SMF under PFO in six of nine eyes, and increased occult SMF following air–fluid exchange in all eyes. Conclusion Microscope-integrated iOCT is a versatile and powerful imaging modality that holds a great deal of promise in the future. Its confirmation of persistent occult SMF in this small series of macular involving retinal detachment repair with PFO, may inform surgical decision making, and demonstrates a pathophysiological rationale for initial face-down positioning after retinal detachment repair. PMID:26656086
Ricker, Lukas J A G; Dieudonné, Suzanne C; Kessels, Alfons G H; Rennel, Emma S; Berendschot, Tos T J M; Hendrikse, Fred; Kijlstra, Aize; La Heij, Ellen C
In proliferative vitreoretinopathy (PVR), a nonangiogenic eye disease that is characterized by the formation of mainly avascular membranes, vascular endothelial growth factor (VEGF) levels are found to be upregulated. Recently, it was discovered that VEGF is alternatively spliced to form the angiogenic (VEGF xxx) and antiangiogenic (VEGF xxx b) family of isoforms. Previous studies on expression of VEGF in PVR samples have not distinguished between the two families of isoforms. We measured total VEGF and VEGF xxx b levels in subretinal fluid of patients with PVR (n = 10) and in patients with uncomplicated rhegmatogenous retinal detachment (n = 27) using enzyme-linked immunosorbent assay. : We found total VEGF levels to be 2- to 3-fold elevated in the PVR group as compared with the rhegmatogenous retinal detachment group (P = 0.047). Antiangiogenic VEGF xxx b isoforms predominated (>60% of total VEGF) in the majority of rhegmatogenous retinal detachment and PVR samples investigated, although a wide variability of isoform ratios was observed within both groups. The absence of an increased ratio of VEGF xxx to VEGF xxx b in patients with PVR as compared with patients with uncomplicated rhegmatogenous retinal detachment may explain a lack of blood vessels in PVR membranes. Elevated VEGF levels indicate that this cytokine may play a role in the pathogenesis of PVR that is not related to angiogenesis.
Larsen, J S; Syrdalen, P
The pre- and postoperative results of ultrasonographic measurements on the axial ocular components in 10 phakic eyes with retinal detachment treated with encircling silicone rubber band are presented. A significant increase (P less than 0.001) in axial eye length from 0.62 to 1.24 mm (average: 0.98 mm) was found. The elongation of the eye was caused by a corresponding increase in the length of the vitreous cavity. No significant changes were found in the anterior segment of the eyes. These data demonstrate that the postoperative refractive change in a myopic direction, which an encircling procedure with moderate indentation often produces, is caused by an axial elongation of the eye.
Panikkar, Kartik; Manayath, George; Rajaraman, Revathi; Saravanan, Veerappan
An 18-year-old boy with an obsessive–compulsive disorder of eye rubbing presented with forme fruste keratoconus (KC) and posterior subcapsular cataracts. After evaluation, he underwent phacoemulsification in his left eye with intraocular lens implantation. The aggressive eye rubbing, however, aggravated the rapid progression to established KC, and further acute corneal hydrops within 3 months. Within the next 3 months, the eye rubbing precipitated rhegmatogenous retinal detachments (RDs) in both eyes. Furthermore, after undergoing a combined cataract and RD surgery with belt buckling and silicone oil endotamponade in his right eye, the repeated eye rubbing caused extrusion of the implanted silicone oil into the subconjunctival space and within the corneal stroma. This is the first report to our knowledge describing this unique complication associated with eye rubbing. It also highlights the need for increased vigilance and care that needs to be directed toward patients predisposed to such complications. PMID:27843234
Kawano, Hiroki; Ito, Takashi; Yamada, Shingo; Hashiguchi, Teruto; Maruyama, Ikuro; Hisatomi, Toshio; Nakamura, Makoto; Sakamoto, Taiji
Histones are DNA-binding proteins and are involved in chromatin remodeling and regulation of gene expression. Histones can be released after tissue injuries, and the extracellular histones cause cellular damage and organ dysfunction. Regardless of their clinical significance, the role and relevance of histones in ocular diseases are unknown. We studied the role of histones in eyes with retinal detachment (RD). Vitreous samples were collected during vitrectomy, and the concentration of histone H3 was measured by enzyme-linked immunosorbent assay. The location of the histones and related molecules was examined in a rat RD model. The release of histones and their effects on rat retinal progenitor cells R28 and ARPE-19 were evaluated in vitro. In addition, the protective role of the vitreous body against histones was tested. The intravitreal concentration of histones was higher in eyes with RD (mean, 30.9 ± 9.8 ng/ml) than in control eyes (below the limit of detection, P<0.05). In the rat RD model, histone H3 was observed on the outer side of the detached retina and was associated with photoreceptor death. Histone H3 was released from cultured R28 by oxidative stress. Histones at a concentration 10 μg/ml induced the production of interleukin-8 in ARPE-19 cells (2.5-fold increase, P<0.05) that was mediated through the ERK1/2- and p38 MAPK-dependent pathways and Toll-like receptor 4. Histones were toxic to cells at concentrations of ≥ 20 μg/ml. Vitreous body or hyaluronan decreased toxicity of histones by inhibiting diffusion of histones. These results indicate that histones are released from retinas with RD and may modulate the subretinal microenvironment by functioning as damage-associated molecular pattern molecules, thereby inducing proinflammatory cytokines or cell toxicity. In addition, the important role of the vitreous body and hyaluronan in protecting the retina from these toxic effects is suggested.
Tian, Jiao; Tang, Luo-Sheng; Guo, Xiao-Jian; Luo, Yong-Heng
AIM To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole. METHODS Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months. RESULTS Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08. CONCLUSION Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome. PMID:23638417
Matsumoto, H; Murakami, Y; Kataoka, K; Lin, H; Connor, K M; Miller, J W; Zhou, D; Avruch, J; Vavvas, D G
Photoreceptor cell death is the definitive cause of vision loss in retinal detachment (RD). Mammalian STE20-like kinase (MST) is a master regulator of both cell death and proliferation and a critical factor in development and tumorigenesis. However, to date the role of MST in neurodegeneration has not been fully explored. Utilizing MST1−/− and MST2−/− mice we identified MST2, but not MST1, as a regulator of photoreceptor cell death in a mouse model of RD. MST2−/− mice demonstrated significantly decreased photoreceptor cell death and outer nuclear layer (ONL) thinning after RD. Additionally, caspase-3 activation was attenuated in MST2−/− mice compared to control mice after RD. The transcription of p53 upregulated modulator of apoptosis (PUMA) and Fas was also reduced in MST2−/− mice post-RD. Retinas of MST2−/− mice displayed suppressed nuclear relocalization of phosphorylated YAP after RD. Consistent with the reduction of photoreceptor cell death, MST2−/− mice showed decreased levels of proinflammatory cytokines such as monocyte chemoattractant protein 1 and interleukin 6 as well as attenuated inflammatory CD11b cell infiltration during the early phase of RD. These results identify MST2, not MST1, as a critical regulator of caspase-mediated photoreceptor cell death in the detached retina and indicate its potential as a future neuroprotection target. PMID:24874741
Welinder, Lotte G; Robitaille, Johane M; Rupps, Rosemarie; Boerkoel, Cornelius F; Lyons, Christopher J
The birth of a bilaterally blind child is catastrophic for families and a challenging diagnostic and management problem for ophthalmologists. Early identification of the underlying cause and its genetic basis helps initiate possible treatment, delineate prognosis, and identify risks for future pregnancies. In some cases, an early diagnosis can also influence the treatment of other family members. We report two sisters with bilateral retinal detachment and retro-lental masses from birth with no detectable NDP or FZD4 mutations. They were born to parents without detectable retinal anomalies. At 1 year of age, the elder sister had low impact bone fractures, and further evaluation identified severe osteopenia and multiple spinal compression fractures. Molecular testing identified biallelic lipoprotein receptor-related protein 5 (LRP5) mutations (NM_002335.3:c. [889dupA]; [2827 + 1G > A]) confirming a diagnosis of osteoporosis-pseudoglioma (OPPG) syndrome. After this diagnosis, the father and mother were found to have low bone mass and the father started on therapy. We conclude that early detection of LRP5 mutations is important for initiation of treatment of reduced bone density in the patients and their carrier relatives.
Nowomiejska, Katarzyna; Choragiewicz, Tomasz; Borowicz, Dorota; Brzozowska, Agnieszka; Moneta-Wielgos, Joanna; Maciejewski, Ryszard; Jünemann, Anselm G; Rejdak, Robert
Purpose. To evaluate functional and anatomical results of pars plana vitrectomy (PPV) in the retinal detachment (RD) followed by severe eye trauma. Methods. Retrospective analysis of medical records of forty-one consecutive patients treated with 23-gauge PPV due to traumatic RD. Age, gender, timing of PPV, visual acuity, and presence of intraocular foreign body (IOFB) and proliferative vitreoretinopathy (PVR) were included in the analysis. Results. Mean age of patients was 47 years; the majority of patients were men (88%). Closed globe injury was present in 21 eyes and open globe injury in 20 eyes (IOFB in 13 eyes, penetration injury in 4 eyes, and eye rupture in 3 eyes). Mean follow-up period was 14 months; mean timing of PPV was 67 days. Twenty-seven (66%) eyes had a functional success; 32 eyes (78%) had anatomical success. As a tamponade silicone oil was used in 33 cases and SF6 gas in 8 cases. Conclusions. Severe eye injuries are potentially devastating for vision, but vitreoretinal surgery can improve anatomical and functional outcomes. Among analysed pre- and intra- and postoperative factors, absence of PVR, postoperative retinal attachment, and silicone oil as a tamponade were related to significantly improved visual acuity.
Roohipoor, Ramak; Mohammadi, Naseh; Ghassemi, Fariba; Karkhaneh, Reza; Rezaei, Mansour; Nili-Ahmadabadi, Mehdi; Ebrahimiadib, Nazanin
Purpose: To evaluate foveal microstructural changes and to determine its association with visual outcomes after reattachment of rhegmatogenous retinal detachments (RRDs) by scleral buckling (SB) or pars plana vitrectomy (PPV). Methods: Using spectral domain optical coherence tomography (SD-OCT), foveal microstructure in eyes with macula-off RRD were studied 1, 3, 6, 9, 12 and 15 months after PPV or SB and correlated with visual outcomes. Results: Forty-two eyes were included in the final analysis. Even with improved microstructural changes and normalization of retinal structures on OCT, final visual acuity was not correlated with microstructural changes in eyes undergoing PPV. In the SB group, final visual acuity was significantly correlated with an intact inner segment/outer segment (IS/OS) junction (P = 0.013). There was no significant correlation between final visual acuity and presence of subretinal fluid (SRF) in either group. Conclusion: After SB, eyes with an intact IS/OS junction had better final visual acuity. In the PPV group, there was no significant correlation between microstructural changes and visual acuity. The presence of SRF did not influence final visual acuity in both groups. PMID:26425321
Al-Hinai, Ahmed S.; Al-Abri, Mohamed S.
Aim: To study the outcome of repair of rhegmatogenous retinal detachment (RRD) in a tertiary center. Materials and Methods: Review of electronic medical records within a period of 29 months of consecutive patients who underwent surgical repair for RRD in Sultan Qaboos University Hospital (SQUH). Results: We included 33 consecutive patients (36 eyes). Males constituted 70% of them. The average age was 47 years. Seven eyes out of the 36 had macula-on RRD at presentation. The primary success rate with a single procedure was 86%. However, redetachment occurred in five eyes (14%). Visual acuity was either same as preoperative or better in 81% of the eyes. Giant retinal tear was found in three eyes (8%). The average follow-up period for all patients was 10.25 months (range: 3-25 months). Conclusion: Rhegmatogenous RD is not uncommon disorder. It occurs more frequently in males. However, it has a good prognosis if an intervention was performed in early stages. PMID:24379553
Borowicz, Dorota; Brzozowska, Agnieszka; Moneta-Wielgos, Joanna; Maciejewski, Ryszard; Jünemann, Anselm G.
Purpose. To evaluate functional and anatomical results of pars plana vitrectomy (PPV) in the retinal detachment (RD) followed by severe eye trauma. Methods. Retrospective analysis of medical records of forty-one consecutive patients treated with 23-gauge PPV due to traumatic RD. Age, gender, timing of PPV, visual acuity, and presence of intraocular foreign body (IOFB) and proliferative vitreoretinopathy (PVR) were included in the analysis. Results. Mean age of patients was 47 years; the majority of patients were men (88%). Closed globe injury was present in 21 eyes and open globe injury in 20 eyes (IOFB in 13 eyes, penetration injury in 4 eyes, and eye rupture in 3 eyes). Mean follow-up period was 14 months; mean timing of PPV was 67 days. Twenty-seven (66%) eyes had a functional success; 32 eyes (78%) had anatomical success. As a tamponade silicone oil was used in 33 cases and SF6 gas in 8 cases. Conclusions. Severe eye injuries are potentially devastating for vision, but vitreoretinal surgery can improve anatomical and functional outcomes. Among analysed pre- and intra- and postoperative factors, absence of PVR, postoperative retinal attachment, and silicone oil as a tamponade were related to significantly improved visual acuity. PMID:28163930
Chen, M T; Wu, H J
To report an unusual case of leukemia presenting as both bilateral exudative retinal detachment (ERD) and central diabetes insipidus (DI), we evaluate the clinical hematological records including bone marrow aspirations and CSF tapping, both osmolarity and electrolytes concentration of the serum and urine, brain MRI, fundus photographs and fluorescein angiographs in this 25-year-old female patient. Examinations of peripheral blood and bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia (AML-M0). Fluorescein angiography (FA) revealed bilateral ERD, dense choroidal leukemia cell infiltration with overlying retinal pigment epithelium (RPE) dysfunction and focal areas of choroidal infarction. Changes in both osmolarity and electrolytes concentration of the serum and urine from vasopressin test supported the diagnosis of central DI. Central DI and ERD may be presenting signs of acute leukemia and both may represent CNS involvement. In our case, dense choroidal leukemic cell infiltration results in devitalization of RPE and choroidal infarction. Leukemic disruption of hypothalamic pituitary area may lead to complete or partial deficiency of antidiuretic hormone (ADH). Rapid improvement in visual acuity and partial symptom relief of DI may ensue from appropriate chemotherapy and nasal DDAVP (1-desamino-8-D-arginine vasopressin) supply.
Arevalo, J Fernando; Serrano, Martin A; Arias, Juan D
AIM: To describe the en bloc perfluorodissection (EBPD) technique and to demonstrate the applicability of using preoperative intravitreal bevacizumab during small-gauge vitreoretinal surgery (23-gauge transconjunctival sutureless vitrectomy) in eyes with advanced proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD). METHODS: This is a prospective, interventional case series. Participants included 114 (eyes) with advanced proliferative diabetic retinopathy and TRD. EBPD was performed in 114 eyes (consecutive patients) during 23-gauge vitrectomy with the utilization of preoperative bevacizumab (1.25 mg/0.05 mL). Patients mean age was 45 years (range, 21-85 years). Surgical time had a mean of 55 min (Range, 25-85 min). Mean follow up of this group of patients was 24 mo (range, 12-32 mo). Main outcome measures included best-corrected visual acuity (BCVA), retinal reattachment, and complications. RESULTS: Anatomic success occurred in 100% (114/114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study (ETDRS) lines] was obtained in 69.2% (79/114), in 26 eyes (22.8%) BCVA remained stable, and in 8 eyes (7%) BCVA decreased (≥ 2 ETDRS lines). Final BCVA was 20/50 or better in 24% of eyes, between 20/60 and 20/400 in 46% of eyes, and worse than 20/400 in 30% of eyes. Complications included cataract in 32 (28%) eyes, iatrogenic retinal breaks in 9 (7.8%) eyes, vitreous hemorrhage requiring another procedure in 7 (6.1%) eyes, and phthisis bulbi in 1 (0.9%) eye. CONCLUSION: This study demonstrates the usefulness of using preoperative intravitreal bevacizumab and EBPD during small-gauge vitreoretinal surgery in eyes with TRD in PDR. PMID:25317250
Theelen, Thomas; Go, Sioe Lie; Tilanus, Maurits A D; Klevering, B Jeroen; Deutman, August F; Cremers, Frans P M; Hoyng, Carel B
To study the clinical appearance and surgical results of autosomal dominantly inherited rhegmatogenous retinal detachments (RRDs). After prospective examination of all but two family members, the medical records of 16 affected patients (21 eyes) of two families from the Netherlands with autosomal dominantly inherited RRD were retrospectively evaluated. Special attention was paid to the age at onset, the ocular morphology and the clinical appearance of the RRD. The type and number of the various surgical procedures were analyzed with respect to preoperative appearance of the RRD, postoperative results and final visual acuity. The mean age at onset of RRD of affected individuals in families A and B was 37 +/- 18 years and 19 +/- 10 years, respectively. The mean ocular axial length in the two families was 24.7 mm and 26.7 mm. The mean number of retinal defects preoperatively found was 2.2 in family A and 7.1 in family B. Round, atrophic retinal holes predominated. Two of 21 affected eyes showed significant preoperative proliferative vitreoretinopathy. Pars plana vitrectomy was the primary procedure in 4 cases; extra ocular buckling was the initial procedure in 15 cases. One eye received scleral folding with diathermy as primary surgery. Redetachment following surgery occurred in 5 of 10 cases in family A and 4 of 10 eyes in family B. Anatomical success could be achieved in 9 of 10 and 8 of 10 eyes in families A and B, respectively. In these families the prevalence of RRD is high. Most patients were affected at a relatively young age compared with non-genetically linked forms of RRD. Because of the low success rate of surgical intervention and, subsequently, the high number of operations necessary to achieve reattachment of the retina, the use of diagnostic genetic techniques to identify individuals at risk would be advisable. In these subjects measures to prevent RRD are an option, even when anatomical substrates of precursors of RRD are absent.
Zhu, Bijun; Sun, Qian; Xu, Xian; Miao, Yuyu; Zou, Haidong
Rhegmatenous retinal detachment (RRD) is one of the most serious complications after phacoemulsification combined with intraocular lens implantation surgery. It has been reported that vision-related quality of life (VRQoL), as well as visual acuity rapidly decreased when RRD developed. However, little is known of the VRQoL in those RRD patients after anatomical retinal re-attachment, especially whether or not the VRQoL is higher than that before cataract surgery. In this prospective case series study, we use the Chinese-version low vision quality of life questionnaire (CLVQOL) to assess the changes of VRQoL in age-related cataract patients who suffered from RRD after phacoemulsification with intraocular lens (phaco-IOL) implantation. All participants were asked to complete questionnaires in face- to-face interviews one day before and two weeks after cataract surgery, as well as one day before and three months after RRD surgery. A total of 10,127 consecutive age-related cataract patients were followed up to one year after phaco-IOL implantation; among these patients, 17 were diagnosed as RRD. The total CLVQOL scores and subscale scores except “Mobility” decreased significantly when RRD developed. After retinal surgery, only the score of “General vision and lighting” in the CLVQOL questionnaires improved when compared to the scores two weeks after cataract surgery, although the best corrected visual acuity of all patients significantly raised up. However, the mean CLVQOL scores and subscale scores were still considerably higher than the level prior to cataract surgery. Our study suggests that cataract patients at high risk of postoperative RRD should not deny the opportunity to undergo phaco-IOL implantation, even though potential VRQoL impairment induced by RRD exists. PMID:25764367
Zhu, Mingming; Huang, Jiannan; Zhu, Bijun; Sun, Qian; Xu, Xian; Miao, Yuyu; Zou, Haidong
Rhegmatenous retinal detachment (RRD) is one of the most serious complications after phacoemulsification combined with intraocular lens implantation surgery. It has been reported that vision-related quality of life (VRQoL), as well as visual acuity rapidly decreased when RRD developed. However, little is known of the VRQoL in those RRD patients after anatomical retinal re-attachment, especially whether or not the VRQoL is higher than that before cataract surgery. In this prospective case series study, we use the Chinese-version low vision quality of life questionnaire (CLVQOL) to assess the changes of VRQoL in age-related cataract patients who suffered from RRD after phacoemulsification with intraocular lens (phaco-IOL) implantation. All participants were asked to complete questionnaires in face- to-face interviews one day before and two weeks after cataract surgery, as well as one day before and three months after RRD surgery. A total of 10,127 consecutive age-related cataract patients were followed up to one year after phaco-IOL implantation; among these patients, 17 were diagnosed as RRD. The total CLVQOL scores and subscale scores except "Mobility" decreased significantly when RRD developed. After retinal surgery, only the score of "General vision and lighting" in the CLVQOL questionnaires improved when compared to the scores two weeks after cataract surgery, although the best corrected visual acuity of all patients significantly raised up. However, the mean CLVQOL scores and subscale scores were still considerably higher than the level prior to cataract surgery. Our study suggests that cataract patients at high risk of postoperative RRD should not deny the opportunity to undergo phaco-IOL implantation, even though potential VRQoL impairment induced by RRD exists.
Hirashima, Takafumi; Kita, Mihori; Yoshitake, Shin; Hirose, Miou; Oh, Hideyasu
This paper reports a young patient with a traumatic rhegmatogenous retinal detachment and massive vitreous gel incarceration into the subretinal space, who was successfully treated with 23-gauge transconjunctival vitrectomy. An 11-year-old boy was referred to the authors' clinic with traumatic retinal detachment in the right eye, 2 weeks after ocular contusion in a baseball accident. At the time of the injury, emergency fundus examination by his local doctor had revealed vitreous hemorrhage in the inferior quadrant of the right eye. Visual acuity was 1.5. He had continued to play baseball as usual for 2 weeks after the injury. At his first visit to the authors' clinic, fundus examination showed a highly bullous retinal detachment involving the inferior two quadrants, associated with multiple irregular retinal breaks. There was an oval hole in the inferior quadrant which was 10-disc diameter × 5-disc diameter in size and was surrounded by edematous and hemorrhagic retina. The macula remained attached. Absolute rest for 4 hours in the supine position with binocular occlusion did not diminish the height of the retinal detachment. A 23-gauge three-port pars plana vitrectomy combined with 360° circumferential buckling was performed under general anesthesia. The lens was retained. Incarceration of massive vitreous gel, including vitreous hemorrhage into the subretinal space through the largest break, was observed during vitrectomy. Reattachment of the retina was achieved by fluid-air exchange and internal tamponade using SF(6) gas. At follow-up at 9 months, the retina remained attached and visual acuity in the right eye was 1.2.
Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens F; Bek, Toke; la Cour, Morten
To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Yamamoto, Kentaro; Iwase, Takeshi; Terasaki, Hiroko
Purpose To determine the long-term changes in the intraocular pressure (IOP) following vitrectomy for rhegmatogenous retinal detachment (RRD), epiretinal membrane (ERM), and macular hole (MH), and to investigate the relationship between the retinal disease and the incidence of late-onset IOP elevation. Methods This was a retrospective, observational, comparative study. We reviewed the medical records of 54 eyes of 54 RRD patients, 117 eyes of 117 ERM patients, and 75 eyes of 75 MH patients who underwent 20-, 23- or 25-gauge vitrectomy. The IOPs before surgery and 1, 3, 6, and 12 months following vitrectomy, and also at the final visit (average, 23.95 months) were evaluated. We defined a significant increase in the IOP as an increase of ≥4 mmHg from the preoperative IOP, and this increase was taken to be a ‘death’ event for the Kaplan-Meier survival analyses. Results The mean follow-up period was not significantly different among the groups. The mean IOP at 3 (P = 0.001) and 12 (P = 0.011) months following the vitrectomy and at the final visit (P = 0.002) were significantly higher than that before the vitrectomy in the RRD group. The mean IOP in the RRD group was significant higher than that in the ERM group at 1 (P = 0.005), 3 (P = 0.009), and 12 (P = 0.013) months following vitrectomy, and at the final visit (P = 0.032). Kaplan-Meier survival analyses showed that the RRD group had a significantly higher risk of an IOP increase following vitrectomy than the other groups (P<0.001 by log-rank test). Multivariate logistic regression analyses showed that a preoperative diagnosis of RRD was the only risk factor that was significantly associated with a postoperative IOP elevation after excluding eyes with a low preoperative IOP (odds ratio, 3.208; P = 0.003). Conclusions A late-onset IOP elevation following vitrectomy was observed only in eyes that underwent RRD surgery. The elevation was probably caused by the specific characteristics and surgical procedures of
Roldán-Pallarés, M; Bravo-Llatas, C; Musa, A-S; Hernandez-Montero, J; Fernández-Durango, R
To find models that will explain the variability in postoperative visual acuity (VA) (logarithmic: logMAR) associated with unilateral primary rhegmatogenous retinal detachment (RD). This was a prospective clinical cohort study of 33 patients with proliferative vitreoretinopathy (PVR: PVR
Chiu, Hannah; Steele, Donna; McAlister, Chryssa; Lam, Wai-Ching
High-risk pathologies for rhegmatogenous retinal detachment (RRD) in otherwise healthy pregnant females are not contraindications for spontaneous vaginal delivery. However, 74% of European obstetrician-gynecologist (OBGYN) respondents in 2008 recommended operative delivery for females at risk for RRD. This discrepancy is likely due to an older study suggesting a causal relation between Valsalva-like manoeuvres and RRD. The purpose of this study is to determine current delivery recommendations for healthy pregnant females with high-risk pathologies for RRD among Canadian ophthalmologists and OBGYNs. Anonymous prospective cross-sectional survey sent via electronic link in 2013. χ(2) test of proportions was used to compare delivery recommendations between the 2 specialties. Multinomial logistic regression was used to identify predictors for recommendations. A total of 356 participants responded including 92 ophthalmologists and 27 trainees, and 185 OBGYNs and 52 trainees. For healthy pregnant females with previously treated retinal hole/tear or treated RRD, significantly more OBGYNs recommended cesarean section and significantly more ophthalmologists recommended spontaneous vaginal delivery. Length of practice and type of practice setting were significant predictors among obstetricians in their delivery recommendations. This study is the first to include obstetricians, ophthalmologists, and their trainees in a survey of the recommended mode of delivery for pregnant females with risk factors of RRD. Our results suggest that obstetricians concerned about potential RRD in pregnant patients may be unnecessarily recommending operative management. Educational sessions on the risk for RRD with spontaneous vaginal delivery may reconcile the current differences in recommendations between ophthalmologists and obstetricians. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Clemens, Christoph R; Bastian, Nina; Alten, Florian; Milojcic, Carolin; Heiduschka, Peter; Eter, Nicole
The aim of the study was to identify predictive factors for detection of impending retinal pigment epithelium (RPE) tears in patients under anti-VEGF therapy for treatment of retinal pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD) using near-infrared reflectance imaging (NIR), spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FLA). We retrospectively evaluated NIR, SD-OCT and FLA images, number of intravitreal injections as well as demographical data of 103 eyes of 98 patients with vascularized PED [48.5% fibrovascular PED (fPED), 51.5% serous vascularized PED (svPED)] secondary to AMD. Fifteen eyes with svPED of 103 included eyes (14.6%) developed an RPE tear under anti-VEGF therapy. Prior to RPE tear formation, we could identify radial hyperreflective lines spreading in a funnel-like pattern across the PED lesion in NIR images in 11 eyes correlating with folds in the RPE on corresponding SD-OCT scans (mean observation period: 115.4 ± 66.6 days; mean number of injections: 3.2 ± 1.5; mean PED height 828.2 ± 356.5 μm). In nine RPE tears (81.8%), the edge of the tear could be clearly localized on the opposite side of the PED lesion in relation to the origin of hyperreflective lines. None of the fPED patients showed the described signal. Patients under anti-VEGF therapy for treatment of svPED due to AMD frequently show radial hyperreflective lines in NIR images prior to RPE tear development that correspond to wrinkled changes in the RPE. Hyperreflective lines may serve as an indicator for an impending RPE tear in svPED patients. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Bedda, Ahmed M.; Lolah, Mohamed; Abd Al Shafy, Muhammad S.
Purpose. To report the anatomic and visual results of a new sutureless illuminated macular buckle designed for patients with macular hole retinal detachment related to high myopia (MMHRD). Design. Prospective nonrandomized comparative interventional trial. Methods. Twenty myopic eyes of 20 patients (mean age, 51.4 years; range, 35–65 years) presenting with MMHRD with a posterior staphyloma, in whom the new buckle was used, were evaluated. The buckle used was assembled from a 5 mm wide sponge and a 7 mm wide silicone tire; it was fixed utilizing the sterile topical adhesive Histoacryl Blue (B Braun, TS1050044FP) which polymerizes in seconds upon being exposed to water-containing substances. The primary outcomes measured included aided visual acuity (BCVA) and optical coherence tomography (OCT) findings. The mean follow-up period was 6 months. Results. Postoperatively, the MH closure was identified by OCT in 8 (40%) eyes. The mean BCVA increased from 0.11 to 0.21 (p < 0.005). The axial length of the eyes included decreased from 30.5 mm preoperatively to 29.8 mm (p = 0.002) postoperatively. Conclusion. Preparation of the new sutureless macular buckle is simple and easy. Illumination of the terminal part of the buckle ensures proper placement. Histoacryl Blue is effective in fixing the buckle in its place for at least 6 months with no reported intra- or postoperative complications. PMID:28409023
Chawla, H B
To produce a flat retina after an operation demands an unrestricted view of the retina during the operation, and to achieve such a view most retinal surgeons would unhesitatingly recommend the binocular indirect ophthalmoscope and scleral depression. Once the retina and all its breaks are clearly in view, the keynote of the ensuing surgery should be simplicity and safety. The former requires that the intended operation should be the least complicated available, and, should the surgical intention be frustrated, that each step should blend with the next in orderly progression, the surgeon exhausting the possibility of one step before moving on to the next and being able to recognise when the possibilities are exhausted. The latter requires experience in deciding which is in fact the least complicated operation. In general the cavity of the globe should not be entered unless the eye stands to lose more than it gains by remaining inviolate. Paracentesis, fluid release, and intravitreal air all have their place, and to avoid them gains us nothing if the retina remains detached. PMID:7115648
Pak, Kang Yeun; Lee, Seok Jae; Kwon, Han Jo; Lee, Ji Eun
Purpose To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). Conclusions In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358. PMID:28785481
Moon, Hoseok; Sohn, Hee Jin; Lee, Dea Yeong; Lee, Jong Yeon; Nam, Dong Heun
AIM To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment (RRD) repair. METHODS This was a retrospective, consecutive, non-comparative, interventional case series of 30 eyes of 30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications. RESULTS Primary reattachment was achieved in 27 eyes (90.0%). The reasons for redetachment (3 eyes, 10%) were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy, respectively. The logarithm of the minimum angle of resolution visual acuity (mean±SD) improved from 0.76±0.74 preoperatively to 0.21±0.37 6 months' postoperatively (P<0.0001). Postoperative hypotony was not detected, but 1 eye (3.3%) had increased intraocular pressure (30mmHg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes (10.0%). CONCLUSION Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation. PMID:25709921
The effect of a preoperative subconjuntival injection of dexamethasone on blood–retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial
Bali, Ernesto; Feron, Eric J.; Peperkamp, Ed; Veckeneer, Marc; Mulder, Paul G.
Background Blood–retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood–retinal barrier breakdown postoperatively. Methods Prospective, placebo-controlled, double blind clinical trial. In 34 patients with rhegmatogenous retinal detachment scheduled for conventional scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5 ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5–6 hours before surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and 6 weeks after randomisation between dexamethasone and placebo were analysed using mixed model ANOVA, while correcting for the preoperative flare measurement. Results Six patients did not complete the study, one because of recurrent detachment within 1 week, and five because they missed their postoperative laser flare visits. The use of dexamethasone resulted in a statistically significant decrease in laser flare measurements at the 1-week postoperative visit. Conclusion The use of a preoperative subconjunctival injection of dexamethasone decreased 1-week postoperative blood–retina barrier breakdown in patients undergoing conventional scleral buckling retinal detachment surgery. This steroid priming could be useful as a part of a peri-operative regime that would aim at decreasing the incidence of PVR. PMID:20182883
Shiraki, Nobuhiko; Wakabayashi, Taku; Sato, Tatsuhiko; Sakaguchi, Hirokazu; Nishida, Kohji
Our purpose was to report the initial clinical experience of intraoperative B-scan ultrasonography in combination with 25-gauge pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment. Six eyes of six consecutive patients with severe open globe injury underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy at Osaka University Hospital in Japan. The feasibility of intraoperative B-scan ultrasonography, best-corrected visual acuity (BCVA), retinal reattachment, and intraoperative and postoperative complications were evaluated. Five patients presented with a ruptured globe and one patient with double penetration. Preoperative best-corrected visual acuity was no light perception in four eyes and light perception in two eyes. All patients underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy within 12 h after open globe injury. Intraoperative B-scan ultrasonography was feasible in all cases and was useful for diagnosing choroidal hemorrhage (four eyes), massive subretinal hemorrhage (two eyes), and retinal detachment (five eyes). In addition, serial real-time B-scan imaging facilitated successful evacuation of the choroidal hemorrhage and massive subretinal hemorrhage by external drainage, resulting in opening of the vitreous space to allow subsequent pars plana vitrectomy without entry site-related complications. After surgery, all patients had successful retinal attachment, and there was no loss of light perception. Intraoperative B-scan ultrasonography is technically feasible and may potentially improve the safety and efficacy of severe open globe injury repair.
Li, Xiu-Juan; Yang, Xiao-Peng; Lyu, Xiao-Bei
AIM To compare the effects of scleral buckling using wide-angle viewing systems (WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment. METHODS The study was a retrospective analyses of the medical records of 94 eyes (94 patients) with rhegmatogenous retinal detachment. Among them, 47 eyes underwent scleral buckling using WAVS with endoilluminator (Group W), and 47 eyes underwent scleral buckling using indirect ophthalmoscope (Group I). Surgical durations, primary success rate, best-corrected visual acuities (BCVA), delayed subretinal fluid absorptions and surgical complications were compared between the two groups. RESULTS At baseline, there were no statistical differences between the two groups in patient's age (P=0.997), gender (P=0.853), symptom duration (P=0.216), BCVA (P=0.389), refractive error (P=0.167), intraocular pressure (P=0.595), the number of retinal breaks (P=0.832), the extent of retinal detachment (P=0.246), subretinal demarcation line (P=0.801), and macular detachment (P=0.811). The follow-up period was 12mo. The surgical durations in Group W (with or without encircling buckling) were significant shorter than those in Group I (P<0.001 respectively). The primary success rate was 94.27% in Group W, which was similar to that in Group I (92.38%, P = 0.931). The BCVA in Group W was better than that in Group I (P<0.001) at 1-month follow-up visit. However, there were no significant differences between the two groups at 3-month (P=0.221), 6-month (P=0.674), and 12-month (P=0.363) follow-up visits respectively. Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month (P=0.045) follow-up visit, but there were no significant differences between the two groups at 3-month (P=0.111), 6-month (P=1.000) and 12-month follow-up visits respectively. CONCLUSION Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment. PMID:27672597
Farioli, Andrea; Kriebel, David; Mattioli, Stefano; Kjellberg, Katarina; Hemmingsson, Tomas
To investigate the association between occupational lifting and the risk of rhegmatogenous retinal detachment (RRD) using data from a large population of men. We used data from a national cohort of 49 321 Swedish men conscripted for compulsory military service in 1969-1970. We collected information on surgically treated RRD from the National Patient Register and we followed up the cohort between 1991 and 2009 at ages 40-60 years. Exposure to occupational lifting was assessed by applying a job exposure matrix to occupational data from the 1990 census. Incidence rate ratios (IRRs) and 95% CIs were estimated through Poisson regression models adjusted by degree of myopia, income and education level. We observed 217 cases of RRD in 7 80 166 person-years. In univariate analyses we did not observe an association between occupational lifting and RRD. However, after adjustment for myopia and socioeconomic factors, we found an increased risk of RRD (IRR 2.38, 95% CI 1.15 to 4.93) for subjects in the highest category of exposure compared with those in the lowest one. The incidence rate of RRD among subjects lifting heavy loads at least twice per week, aged between 50 years and 59 years, and affected by severe myopia was as high as 7.9 cases per 1000 person-years, compared with an overall rate of 0.28. Our study supports the hypothesis that heavy occupational lifting is a risk factor for RRD. Information on myopia degree and socioeconomic status is necessary when studying the association between occupational lifting and RRD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Erie, Jay C.; Raecker, Matthew E.; Baratz, Keith H.; Schleck, Cathy D.; Robertson, Dennis M.
Purpose To estimate the long-term cumulative risk of retinal detachment (RD) after cataract extraction. Methods Using the resources of the Rochester Epidemiology Project, we retrospectively identified all residents of Olmsted County, Minnesota, who had cataract extraction from 1980 through 2004 (10,256 cataract extractions in 7,137 residents) and were diagnosed with RD. The observed probability of RD after cataract extraction was estimated using the Kaplan-Meier method. A cumulative probability ratio of RD after cataract extraction was determined by comparing the observed probability of RD with the expected probability of RD in residents without cataract extraction. Two controls chosen from the primary cataract surgery cohort were matched to each RD case by age, sex, and duration of follow-up. Logistic regression models assessed differences between cases and controls. Results Eighty-two cases of RD after cataract extraction were identified. The cumulative probability of RD after extracapsular cataract extraction (ECCE) and phacoemulsification was 0.27%, 0.71%, 1.23%, 1.58%, and 1.79% at 1, 5, 10, 15, and 20 years after surgery. There was no significant difference in the probability of RD after ECCE when compared to phacoemulsification (P =.13). The cumulative probability ratio of RD at 20 years after ECCE and phacoemulsification was four times (95% CI, 2.6–5.4) higher than would be expected in a similar group of residents not undergoing cataract extraction (P <.001). Males, younger age, myopia, and increased axial length were significantly associated with RD (P <.001). Conclusions The cumulative risk of RD after ECCE and phacoemulsification is increased for up to 20 years after surgery. PMID:17471337
Erie, Jay C; Raecker, Matthew E; Baratz, Keith H; Schleck, Cathy D; Robertson, Dennis M
To estimate the long-term cumulative risk of retinal detachment (RD) after cataract extraction. Using the resources of the Rochester Epidemiology Project, we retrospectively identified all residents of Olmsted County, Minnesota, who had cataract extraction from 1980 through 2004 (10,256 cataract extractions in 7,137 residents) and were diagnosed with RD. The observed probability of RD after cataract extraction was estimated using the Kaplan-Meier method. A cumulative probability ratio of RD after cataract extraction was determined by comparing the observed probability of RD with the expected probability of RD in residents without cataract extraction. Two controls chosen from the primary cataract surgery cohort were matched to each RD case by age, sex, and duration of follow-up. Logistic regression models assessed differences between cases and controls. Eighty-two cases of RD after cataract extraction were identified. The cumulative probability of RD after extracapsular cataract extraction (ECCE) and phacoemulsification was 0.27%, 0.71%, 1.23%, 1.58%, and 1.79% at 1, 5, 10, 15, and 20 years after surgery. There was no significant difference in the probability of RD after ECCE when compared to phacoemulsification (P =.13). The cumulative probability ratio of RD at 20 years after ECCE and phacoemulsification was four times (95% CI, 2.6-5.4) higher than would be expected in a similar group of residents not undergoing cataract extraction (P <.001). Males, younger age, myopia, and increased axial length were significantly associated with RD (P <.001). The cumulative risk of RD after ECCE and phacoemulsification is increased for up to 20 years after surgery.
Erie, Jay C; Raecker, Matthew A; Baratz, Keith H; Schleck, Cathy D; Burke, James P; Robertson, Dennis M
To estimate the long-term cumulative risk of retinal detachment (RD) after cataract extraction (CE). Retrospective cohort study and nested case-control study. All residents of Olmsted County, Minnesota who had CE from 1980 through 2004 (10 256 CEs in 7137 residents) and were diagnosed subsequently with RD in the same period. Two controls chosen from the primary cataract surgery cohort were matched to each RD case by age, gender, and duration of follow-up. Cases were identified through the Rochester Epidemiology Project databases. Records were reviewed to confirm case status and ascertain risk factor information. The observed probability of RD after CE was estimated using the Kaplan-Meier method. A cumulative probability ratio of RD after CE was determined by comparing the observed probability of RD and the expected probability of RD in residents without CE. Logistic regression models assessed differences between cases and controls. Probability of and risk factors associated with RD after CE. Eighty-two cases of RD were identified. The cumulative probability of RD increased in a nearly linear manner over the 25-year study period. At 1, 5, 10, 15, and 20 years after extracapsular CE (ECCE) and phacoemulsification, cumulative probabilities of RD were 0.27%, 0.71%, 1.23%, 1.58%, and 1.79%, respectively. There was no significant difference in the probability of RD after ECCE when compared with phacoemulsification (P = 0.13). The cumulative probability ratio of RD at 20 years after ECCE and phacoemulsification remained 4.0-fold (95% confidence interval, 2.6-5.4) higher than would be expected in a similar group of residents not undergoing CE (P<0.001). Male gender, younger age, myopia, increased axial length, and posterior capsular tear were associated significantly with RD (P<0.01). The cumulative risk of RD after ECCE and phacoemulsification is increased for up to 20 years after surgery.
Clemens, Christoph R; Alten, Florian; Heiduschka, Peter; Eter, Nicole
To evaluate a morphology score for drusenoid pigment epithelial detachment (dPED) regarding predictability of a decline in retinal function beyond best-corrected visual acuity. Thirteen eyes of 10 patients with dPED due to age-related macular degeneration (AMD) were included (age 72.8 ± 4.2 years). All underwent volume spectral domain optical coherence tomography, fluorescence angiography, and confocal scanning laser ophthalmoscopy infrared imaging as well as multifocal electroretinography and microperimetry. The dPED morphology score suggested consists of five parameters: hyperreflective spots in infrared, lesion diameter, lesion height, presence of vitelliform-like material in the subretinal space or subretinal fluid, and integrity of the ellipsoid zone in spectral domain optical coherence tomography. Subsequently, a score value between 0 and 1 according to the extent of morphologic changes was correlated to foveal multifocal electroretinography and microperimetry measurements. The mean best-corrected visual acuity was 20/40. The mean height and mean diameter of dPED were 312.2 ± 111 μm and 2,535 ± 805 μm. Two dPED showed no hyperreflective spots in confocal scanning laser ophthalmoscopy infrared images, three displayed a moderate stage of hyperreflective spots, and eight had severe hyperreflective spots. Two eyes showed subretinal fluid, and five patients showed vitelliform-like material in the subretinal space. Eight eyes revealed a severe disruption of the ellipsoid zone. Although no correlation was found between dPED morphology score and best-corrected visual acuity, eyes with a dPED morphology score >0.5 revealed distinctly decreased values in functional measurements compared with those with a score ≤0.5. The dPED morphology score aggregates all currently known morphologic changes in dPED and represents a valuable tool for clinical lesion evaluation. Furthermore, it allows for assessing an estimate of functional decline beyond best-corrected visual
Odrobina, Dominik; Gołębiewska, Joanna; Maroszyńska, Iwona
To access the potential effect of vitrectomy and silicone oil tamponade on the choroid. Eighteen patients (18 eyes) who had undergone pars plana vitrectomy with 1,000-cSt silicone oil tamponade for proliferative vitreoretinopathy retinal detachment were included in this retrospective study. All patients underwent ophthalmologic examinations before treatment and 1 week and 1, 3, and 6 months after vitrectomy with silicone oil tamponade. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (Spectralis; Heidelberg Engineering) in a horizontal and vertical section beneath the fovea. Choroidal thickness statistically significantly decreased till 3 months after pars plana vitrectomy with silicone oil tamponade: under the center of the fovea (P = 0.014) and in the temporal (P = 0.029), superior (P = 0.046), and inferior areas, determined at 1,500 μm from the center of the fovea (P = 0.030). After 6 months, the desired effect in the form of a decrease in the choroidal thickness was even more prominent, both under the center of the fovea (P < 0.001) and in the nasal (P < 0.001), temporal (P < 0.001), superior (P < 0.001), and inferior areas at 1,500 μm from the center of the fovea (P < 0.001). Choroidal thickness is reduced in eyes receiving silicone oil intraocular tamponade. Silicone oil tamponade may have an impact on the structure and proper functioning of the choroid. The measurements of the choroidal thickness by optical coherence tomography might be a very good tool to detect early changes in choroidal thickness and impact the decision when to remove silicone oil.
Solomon, Sharon D; Dong, Li Ming; Haller, Julia A; Gilson, Marta M; Hawkins, Barbara S; Bressler, Neil M
To identify risk factors associated with the development of rhegmatogenous retinal detachment (RRD) in patients enrolled in the Submacular Surgery Trials. One thousand fifteen patients with eligible subfoveal neovascular lesions in the study eye were assigned randomly to observation or to surgery. Eyes were examined at 3 months, 6 months, 12 months, and 24 months after enrollment to assess study outcomes and adverse events, including RRDs. Adverse events also were reported at other times as clinical personnel became aware of them. Potential risk factors for the development of RRD in study eyes were evaluated using recursive partitioning and logistic regression analysis. Among 506 eyes assigned to surgery, RRD developed in 44 (8.7%) compared with 4 (0.8%) of 509 eyes assigned to observation. Of the 44 eyes in which RRD developed, 27 had age-related macular degeneration (AMD) and large (>3.5 MPS disk areas) hemorrhagic subfoveal neovascular lesions at baseline and represented 16.1% of all eyes with such lesions assigned to surgery. Eyes with AMD and larger hemorrhagic lesions (>16 MPS disk areas) together with relatively poor visual acuity (best-corrected visual acuity < or =20/1280) had a higher risk of RRD (odds ratio = 6.2, 95% confidence interval: 2.2-16.7) compared with those with smaller lesions and better visual acuity at baseline. Poor visual acuity and very large, predominantly hemorrhagic subfoveal neovascular AMD lesion type were the greatest risk factors for RRD after submacular surgery. Submacular surgery should be undertaken in such eyes with full awareness of the risk of RRD during subsequent follow-up.
Kaluzny, Jakub J.; Sikorski, Bartosz L.; Czajkowski, Grzegorz; Burduk, Mateusz; Kaluzny, Bartlomiej J.; Stafiej, Joanna; Malukiewicz, Grazyna
Purpose. To evaluate the spatial distribution of photoreceptor inner and outer segment junction (IS/OS) reflectivity changes after successful vitrectomy for macula-off retinal detachment (PPV-mOFF) using spectral domain optical coherence tomography (SdOCT). Methods. Twenty eyes after successful PPV-mOFF were included in the study. During a mean follow-up period of 15.3 months, SdOCT was performed four times. To evaluate the IS/OS reflectivity a four-grade scale was used. Results. At the first follow-up visit the IS/OS had very similar reflectivity in entire length of the central scan with total average value of 1,05. At the second visit the most significant increase of the reflectivity was observed in temporal and nasal parafovea with average values of 2,17 and 2,22, respectively. The third region of increased reflectivity of an average value of 2,33 appeared during the third follow-up visit and was located in the foveola. At the last follow-up visit in entire central cross section the IS/OS reflectivity exceeded grade 2 reaching the highest average values in nasal and temporal parafovea and foveola. Conclusions. A gradual increase of the IS/OS reflectivity was observed in eyes after PPV-mOFF. The process is not random and starts independently in the peripheral and central part of the macula which may be attributed to the variable regenerative potential of cones and rods. PMID:26579234
Shrestha, Gentle Sunder; Rajbhandari, Shayuja; Dhungel, Shashwat; Sharma, Nutan; Poudel, Nimesh; Manandhar, Dhiraj N.
Retinal detachment is a rare, but well-known cause of visual impairment in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. With supportive care, patients usually improve, with complete recovery of vision. Bedside ultrasonography of the orbit can be helpful for early detection of retinal detachment in these patients. Here, we present a case of HELLP syndrome presenting with severe visual symptoms. Retinal detachment was detected with point-of-care ocular sonography, which was confirmed with ophthalmoscopic examination. The patient was reassured of the favorable prognosis. Early initiation of aggressive supportive care was followed by progressive improvement of vision, which correlated with sonographic evidence of resolution of detachment. Her vision recovered completely in 2 weeks. PMID:27688632
Covert, Douglas J; Henry, Christopher R; Bhatia, Sandeep K; Croskrey, Jason; Sanchez, Cecilia R; Han, Dennis P
To compare 20-gauge standard pars plana vitrectomy (PPV) with transconjunctival cannulated PPV in the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in a large series of patients undergoing PPV for macular pucker or macular hole. This study was conducted at an academic tertiary care vitreoretinal practice in Milwaukee, Wisconsin. Patients undergoing 3-port PPV with standard 20-gauge instrumentation were compared with patients undergoing 3-port PPV with transconjunctival cannulated systems, including 20 gauge, 23 gauge, and 25 gauge, from January 1, 2003, through December 31, 2009. The main outcome measures were rates of intraoperative retinal breaks and postoperative RRD. Four hundred twenty-six unique eyes met inclusion criteria. Fifty-four of 426 eyes (12.7%) were diagnosed as having new retinal tears intraoperatively as follows: 47 of 204 patients (23.0%) undergoing the standard 20-gauge procedure developed intraoperative retinal tears compared with 7 of 211 patients (3.3%) undergoing the transconjunctival cannulated procedure (risk ratio [RR], 0.12; 95% CI, 0.05-0.26; P < .001). Patients experiencing intraoperative retinal tears were not at increased risk of developing postoperative RRD (RR, 1.4; 95% CI, 0.39-5.0; P = .61). Although a trend was present, transconjunctival cannulated vitrectomy was not significantly protective against the development of postoperative RRD (RR, 0.60; 95% CI, 0.17-1.3; P = .14). Transconjunctival cannulated PPV, including 20-gauge, 23-gauge, and 25-gauge systems, is associated with significantly reduced rates of intraoperative retinal tear formation compared with standard 20-gauge PPV.
Hatef, Elham; Sena, Dayse F; Fallano, Katherine A; Crews, Jonathan; Do, Diana V
Rhegmatogenous retinal detachment (RRD) is a full-thickness break in the sensory retina, caused by vitreous traction on the retina. While pneumatic retinopexy, scleral buckle, and vitrectomy are the accepted surgical interventions for eyes with RRD, their relative effectiveness has remained controversial. The objectives of this review were to assess the effectiveness and safety of pneumatic retinopexy versus scleral buckle or pneumatic retinopexy versus a combination treatment of scleral buckle and vitrectomy for people with RRD. The secondary objectives were to summarize any data on economic measures and quality of life. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 January 2015. We included all randomized or quasi-randomized controlled trials comparing the effectiveness of pneumatic retinopexy versus scleral buckle (with or without vitrectomy) for eyes with RRD. After screening for eligibility, two review authors independently extracted study characteristics, methods, and outcomes. We followed systematic review standards as set forth by The Cochrane Collaboration. We included two randomized controlled trials (218 eyes of 216 participants) comparing the effectiveness of pneumatic retinopexy versus scleral buckle for eyes with RRD. We identified no studies
Hatef, Elham; Sena, Dayse F; Fallano, Katherine A; Crews, Jonathan; Do, Diana V
Background Rhegmatogenous retinal detachment (RRD) is a full-thickness break in the sensory retina, caused by vitreous traction on the retina. While pneumatic retinopexy, scleral buckle, and vitrectomy are the accepted surgical interventions for eyes with RRD, their relative effectiveness has remained controversial. Objectives The objectives of this review were to assess the effectiveness and safety of pneumatic retinopexy versus scleral buckle or pneumatic retinopexy versus a combination treatment of scleral buckle and vitrectomy for people with RRD. The secondary objectives were to summarize any data on economic measures and quality of life. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 January 2015. Selection criteria We included all randomized or quasi-randomized controlled trials comparing the effectiveness of pneumatic retinopexy versus scleral buckle (with or without vitrectomy) for eyes with RRD. Data collection and analysis After screening for eligibility, two review authors independently extracted study characteristics, methods, and outcomes. We followed systematic review standards as set forth by The Cochrane Collaboration. Main results We included two randomized controlled trials (218 eyes of 216 participants) comparing the effectiveness of
Chui, Celine S L; Wong, Ian C K; Wong, Lisa Y L; Chan, Esther W
Several observational studies have been published investigating the association between oral fluoroquinolone use and the development of retinal detachment; however, the findings are not concordant. This study is a meta-analysis of the existing literature and estimates the overall absolute risk of such an event. Electronic databases were searched for observational studies on the association between oral fluoroquinolone and retinal detachment up to August 2014. Studies that did not meet the criteria for meta-analysis were narratively reviewed. Cases of retinal detachment during current fluoroquinolone use were also extracted for absolute risk calculation. Seven observational studies were included. Three (case-control and self-controlled case series studies) were eligible for meta-analysis and four (cohort studies) were narratively reviewed. The rate ratio of the case-control studies was 1.82 (95% CI 0.67-4.93), I(2) =96% and the incidence rate ratio of the self-controlled case series was 1.03 (95% CI 0.84-1.27), I(2) =36%. Three of the four cohort studies found no significant association between oral fluoroquinolone use and the development of retinal detachment. The pooled absolute risk of retinal detachment whilst on current oral fluoroquinolone treatment is estimated to be 4.85 per 1000000 prescriptions (95% CI 0.78-8.91). The findings of this systematic review and meta-analysis do not support an association between oral fluoroquinolone use and the development of retinal detachment. Given the low absolute risk, such an event would be rare if there were an association. The current prescribing practice for fluoroquinolones should not be altered because of a previously suggested potential risk of retinal detachment. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Enders, Philip; Schick, Tina; Kemper, Carolin; Schaub, Friederike; Fauser, Sascha
To investigate the effect of symptom duration in pseudophakic primary rhegmatogenous retinal detachment (RRD) with or without macular involvement on functional and anatomical outcome during first-year follow-up. Retrospective review of cases with pars plana vitrectomy for retinal detachment repair. Symptom duration, functional outcome, and redetachment rates were analyzed. Symptom duration was grouped (1-3, 4-7, 8-14, 15-30, >30 days) and correlated to outcome in the first year of follow-up. 371 macula-off and 230 macula-on RRDs could be included. In macula-off RRDs, longer symptom duration was associated with higher redetachment rates (10-21%; p = 0.032). Patients presenting symptoms for less than 8 days showed significantly lower rates than those with a longer symptom duration (p = 0.046). In macula-on RRDs, symptom duration and outcome were not associated (p > 0.6). In macula-off RRD, early reattachment surgery is necessary to lower the risk for retinal redetachment. The aim in macula-on RRD is to prevent conversion to a macula-off situation. © 2017 S. Karger AG, Basel.
Ghoraba, Hamouda Hamdy; Zaky, Adel Galal; Ellakwa, Amin Faisal
Objective The aim of this study was to report and compare the anatomic and functional results of primary vitrectomy with and without 360° encircling scleral buckle (SB) for the treatment of rhegmatogenous retinal detachment (RRD) due to inferior retinal break(s). Background A variety of options, including SB, pars plana vitrectomy (PPV) with or without SB, and pneumatic retinopexy have been described as methods to repair RRDs. The use of additional SB with vitrectomy for RRD associated with inferior breaks has been a recent controversy after the introduction of transconjunctival cannula systems. Patients and methods A retrospective, interventional, comparative case study was performed. In this study, we reviewed 105 consecutive patients who underwent vitrectomy for primary RRD with inferior retinal break(s) at the vitreoretinal center, performed by a single surgeon. Ninety four patients (94 eyes) were followed up for at least 4 months after silicon oil removal (SOR), and were analyzed. They were divided into two groups: group I included 50 patients who underwent PPV alone + silicon oil (SO); and group II included 44 patients who underwent PPV with 360° SB + SO. The essential parameters were single-operation success rate (SOSR) before SOR, incidence of retinal redetachment after SOR, and final visual acuity. Results SOSR was obtained in 89 eyes (47 [94%] in group I and 42 [95.5%] in group II). From overall 59 phakic retinal detachments (RDs), SOSR was obtained in 56 eyes (30 in group I [93.8%] and 26 in group II [96.3%]) while from overall 35 aphakic or pseudophakic RDs, SOSR was obtained in 33 eyes (17 in group I [94.4%] and 16 in group II [94.1%]). Retinal redetachments after SOR occurred in three patients in group I and two patients in group II. Visual acuity improvement was greater in group I than in group II before SOR. Conclusion Both surgical procedures had similar reattachment rates. The addition of 360° SB to PPV + SO might not have additional benefits
Tabandeh, Homayoun; Dubovy, Sander; Green, W Richard
The ocular histopathologic features of a patient with bilateral multiple midperipheral areas of choroidal vascularization, large drusen, and detachments of the retinal pigment epithelium (RPE) are presented. The eyes were obtained at autopsy and fixed in 4% buffered formaldehyde. Serial sections through the macula area and inferior segments were prepared. Light as well as electron microscopy was performed. Microscopic examination disclosed numerous large drusen measuring up to 200 micro m in height and 280 micro m in diameter and areas of serous RPE detachments in the midperiphery of both eyes. Some of the large drusen had choroidal vascularization. Areas of sub-RPE neovascularization that measured up to 6.5 mm in diameter were present in the midperiphery of both eyes. The choroidal origin for neovascularization was evident in 10 areas. A 1-mm area of hemorrhagic detachment of the RPE contiguous with choroidal neovascularization (CNV) was present in the immediate postequatorial area temporally in the left eye. No drusen, basal deposit, or CNV was present in the macular area. Multifocal midperipheral RPE detachments and CNV can occur in the absence of significant age-related macular disease.
Rashed, O; Sheta, S
A total of 50 eyes with retinal detachment due to macular holes were treated in the period from July 1986 to December 1987. In all, 10 eyes underwent pneumatic retinopexy using plain room air. A total of 30 eyes were treated by pars plana vitrectomy, followed by fluid/air exchange, with no treatment of the macular break; in 9 of these the detachment recurred, reflattening of the retina by air tamponade followed by laser photo-coagulation. The other 10 eyes underwent pars plana vitrectomy followed by silicone oil tamponading because of proliferative vitreoretinopathy (PVR). This paper compares the functional results for each group. The parameters used included visual acuity, color vision and visual fields.
Wu, Menglin; Fan, Wen; Chen, Qiang; Du, Zhenlong; Li, Xiaoli; Yuan, Songtao; Park, Hyunjin
Assessment of serous retinal detachment plays an important role in the diagnosis of central serous chorioretinopathy (CSC). In this paper, we propose an automatic, three-dimensional segmentation method to detect both neurosensory retinal detachment (NRD) and pigment epithelial detachment (PED) in spectral domain optical coherence tomography (SD-OCT) images. The proposed method involves constructing a probability map from training samples using random forest classification. The probability map is constructed from a linear combination of structural texture, intensity, and layer thickness information. Then, a continuous max flow optimization algorithm is applied to the probability map to segment the retinal detachment-associated fluid regions. Experimental results from 37 retinal SD-OCT volumes from cases of CSC demonstrate the proposed method can achieve a true positive volume fraction (TPVF), false positive volume fraction (FPVF), positive predicative value (PPV), and dice similarity coefficient (DSC) of 92.1%, 0.53%, 94.7%, and 93.3%, respectively, for NRD segmentation and 92.5%, 0.14%, 80.9%, and 84.6%, respectively, for PED segmentation. The proposed method can be an automatic tool to evaluate serous retinal detachment and has the potential to improve the clinical evaluation of CSC.
Mefford, Olin T.; Woodward, Robert C.; Goff, Jonathan D.; Vadala, T. P.; St. Pierre, Tim G.; Dailey, James P.; Riffle, Judy S.
Biocompatible, hydrophobic ferrofluids comprised of magnetite nanoparticles dispersed in polydimethylsiloxane show promise as materials for the treatment of retinal detachment. This paper focuses on the motion of hydrophobic ferrofluid droplets traveling through viscous aqueous media, whereby the movement is induced by gradients in external fields generated by small permanent magnets. A numerical method was utilized to predict the force on a spherical droplet, and then the calculated force was used to estimate the time required for the droplet to reach the permanent magnet. The calculated forces and travel times were verified experimentally.
Palacz, Olgierd; Karczewicz, Danuta; Owczarska, Wieslawa; Sylwestrzak, Zofia
The first part of the paper presents the results of laser ¬Â¢hotocoaculation treatment involving: 141 patients with retinal detachment , 20 with holes in the macula, and 33 with holes at the eye fundus periphery. At estimating the results, the apposition of retina and the observation time have been taken into account. The second part contains the results of observation of 21 patients, in whom, in 26 eyes laser trabeculoplasty was performed. Normalization of intraocular pressure has been obtained in 76.9% of cases. The outflow coefficient after trabeculoplasty has increased in 57.6% of cases.
Saraf, Steven S; Cunningham, Matthew A; Kuriyan, Ajay E; Read, Sarah P; Rosenfeld, Philip J; Flynn, Harry W; Albini, Thomas A
A 77-year-old woman with exudative macular degeneration underwent bilateral intravitreal injections of "stem cells" at a clinic in Georgia. One month and 3 months after injection, she developed retinal detachments in the left and right eyes, respectively. Increased awareness within the medical community of such poor outcomes is critical so that clinics offering untested practices that have been shown to be potentially harmful to patients can be identified and brought under U.S. Food and Drug Administration oversight. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:772-775.]. © 2017 [Saraf, Cunningham, Kuriyan, et al.].
Kornberg, Daniel L; Klufas, Michael A; Yannuzzi, Nicolas A; Orlin, Anton; D'Amico, Donald J; Kiss, Szilárd
To evaluate the clinical utility of ultra-widefield imaging as an adjunctive tool in the diagnosis, management, and follow-up of eyes with non-traumatic rhegmatogenous retinal detachment. Retrospective chart review of patients with a rhegmatogenous retinal detachment who received ultra-widefield imaging with the Optos® Optomap® P200Tx. Comparisons were made between UWF imaging and indirect ophthalmoscopy for features of detachments, including extent of detachment, holes, retinopexy, and related pathology. Thirty-six eyes of 34 patients were included. Preoperatively, ultra-widefield imaging more precisely documented the extent of retinal detachments in the superior, inferior, and nasal quadrants in 13.9% of cases. Ultra-widefield imaging failed to detect retinal holes in the superior and inferior quadrants in 11.1% and 19.4% of cases, respectively. In postoperative imaging, UWF photos did not detect retinopexy which was ophthalmoscopy-visible both superiorly and inferiorly in 19.4% of cases. The mean differences in clock hours of the detachments as documented on the clinical exam compared to ultra-widefield imaging in the superior, inferior, temporal, and nasal quadrants were -0.18 ± 0.84, 0.41 ± 1.16, 0.08 ± 1.08, and -0.13 ± 2.25 hours, respectively. Ultra-widefield imaging is a useful adjunct for documentation of rhegmatogenous retinal detachments and their postoperative repair. However, detection of retinal holes, tears, and postoperative scarring is poor, especially in the inferior and superior periphery.
Iwase, Takeshi; Yamamoto, Kentaro; Yanagida, Kosei; Kobayashi, Misato; Ra, Eimei; Murotani, Kenta; Terasaki, Hiroko
The aim of this study was to compare changes in refraction following lens-sparing vitrectomy between patients with rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) and to investigate factors associated with the change in refraction.We reviewed medical records of 49 eyes of 49 patients with RRD (53.6 ± 7.8 years, mean ± standard deviation) and 24 eyes of 24 patients with ERM (50.9 ± 15.7 years) who underwent lens-sparing vitrectomy. Spherical equivalent refractive power was evaluated before and up to 18 months after surgery. The relationship between the change in refraction and several parameters was evaluated.A significant progressive myopic shift in refractive power was observed after vitrectomy in operated RRD and ERM eyes (P < 0.001, P = 0.016, respectively), with no significant difference in fellow eyes. The refraction values observed at ≥3 and ≥12 months following vitrectomy were significantly different as compared with those observed at baseline in the RRD group (P < 0.001) and the ERM group (P < 0.05), respectively. The change in refraction between the RRD and ERM groups was significant (P = 0.030). The multiple linear regression analysis showed that only age was significantly correlated with the change in refraction in RRD (P = 0.018) and ERM (P < 0.001) groups. The change in refraction was significantly and positively correlated with age in RRD (r = -0.461, P = 0.001) and ERM (r = -0.687, P < 0.001) groups. Following lens-sparing vitrectomy, cataract surgery was performed on 30 eyes after 0.89 ± 0.26 years in the RRD group and on 10 eyes after 1.11 ± 0.14 years in the ERM group; there was a significant difference in time to cataract surgery between the groups (P = 0.007). Kaplan-Meier survival analysis demonstrated that there was a significant difference in the rate of cataract surgeries between the RRD and ERM groups (P = 0.022).Following lens
Jackson, Timothy L; Donachie, Paul H J; Sallam, Ahmed; Sparrow, John M; Johnston, Robert L
To describe rhegmatogenous retinal detachment (RD) surgery. National Ophthalmology Database study. A total of 3403 eyes from 3321 patients undergoing primary RD surgery. Participating centers prospectively collected clinical data using a single electronic medical record system, with automatic extraction of anonymized data to a national database, from 2002 to 2010. Description of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing subsequent RD or cataract surgery. We undertook an exploratory analysis of change in visual acuity (VA) using the data available. Of 3403 operations, 2693 (79.1%) were pars plana vitrectomy (PPV), 413 (12.1%) were retinopexy with a scleral buckle (SB), and 297 (8.7%) were PPV with an SB (PPV-SB). For PPV and PPV-SB, 18.8% were with hexafluoroethane, 12.1% were with perfluoropropane, 43.1% were with sulfahexafluoride, 1.8% were with air, 17.9% were with silicone oil, and 10.7% were with cataract surgery. Within 1 year of vitrectomy, 52.1% of phakic eyes had undergone cataract surgery. For all RD operations combined (and excluding cataract surgery complications), 5.1% had 1 or more intraoperative complication, 13.0% underwent further RD surgery, and 8.3% had silicone oil in situ at last review. The RD reoperation rate was 13.3%, 12.3%, and 14.5% for PPV, SB, and PPV-SB, respectively. For 961 eyes with a baseline and final VA measurement, the median presenting logarithm of the minimum angle of resolution VA improved from 1.0 to 0.5 (20/200-20/63) after a median follow-up of 0.6 years. These results may help vitreoretinal surgeons to benchmark their intraoperative complication rate and reoperation rate and to compare their surgical techniques with their peers'. They suggest that the benefits of RD surgery greatly outweigh the risks. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Iwase, Takeshi; Yamamoto, Kentaro; Yanagida, Kosei; Kobayashi, Misato; Ra, Eimei; Murotani, Kenta; Terasaki, Hiroko
Abstract The aim of this study was to compare changes in refraction following lens-sparing vitrectomy between patients with rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) and to investigate factors associated with the change in refraction. We reviewed medical records of 49 eyes of 49 patients with RRD (53.6 ± 7.8 years, mean ± standard deviation) and 24 eyes of 24 patients with ERM (50.9 ± 15.7 years) who underwent lens-sparing vitrectomy. Spherical equivalent refractive power was evaluated before and up to 18 months after surgery. The relationship between the change in refraction and several parameters was evaluated. A significant progressive myopic shift in refractive power was observed after vitrectomy in operated RRD and ERM eyes (P < 0.001, P = 0.016, respectively), with no significant difference in fellow eyes. The refraction values observed at ≥3 and ≥12 months following vitrectomy were significantly different as compared with those observed at baseline in the RRD group (P < 0.001) and the ERM group (P < 0.05), respectively. The change in refraction between the RRD and ERM groups was significant (P = 0.030). The multiple linear regression analysis showed that only age was significantly correlated with the change in refraction in RRD (P = 0.018) and ERM (P < 0.001) groups. The change in refraction was significantly and positively correlated with age in RRD (r = −0.461, P = 0.001) and ERM (r = −0.687, P < 0.001) groups. Following lens-sparing vitrectomy, cataract surgery was performed on 30 eyes after 0.89 ± 0.26 years in the RRD group and on 10 eyes after 1.11 ± 0.14 years in the ERM group; there was a significant difference in time to cataract surgery between the groups (P = 0.007). Kaplan–Meier survival analysis demonstrated that there was a significant difference in the rate of cataract surgeries between the RRD and ERM groups (P = 0
Abouammoh, Marwan A; Alsulaiman, Sulaiman M; Gupta, Vishali S; Younis, Afnan; Chhablani, Jay; Hussein, Abdullah; Casella, Antonio M; Banker, Alay S; Arevalo, J Fernando
To study the outcomes of management of rhegmatogenous retinal detachment in eyes with chorioretinal colobomas. A retrospective review of 119 patients (119 eyes) with chorioretinal colobomas who underwent surgical repair for rhegmatogenous retinal detachment was performed. Data were collected on the site of the retinal break, type of surgery, anatomical success, and complications. The most common location of the primary retinal break was the intercalary membrane in 58.8% of eyes. The most common surgical intervention was vitrectomy with endolaser and silicone oil tamponade (77.3% of eyes). Final anatomical success was achieved in 87.4% of eyes. Anatomical success was significantly higher in eyes that received long-acting tamponade (P = 0.006). Cryotherapy was significantly associated with failure of primary vitrectomy (P = 0.028). Placement of an encircling band did not affect anatomical outcomes (P = 0.75). Most of the eyes (60%) with recurrent retinal detachment after primary vitrectomy had a primary break within the normal retina. The optimal option for managing retinal detachment in eyes with chorioretinal colobomas is pars plana vitrectomy with long-acting tamponade (silicone oil or octafluoropropane) and retinopexy to the edge of the coloboma and the primary breaks. Cryotherapy is associated with poor anatomical outcomes. An encircling band does not seem to affect the final anatomical outcome.
Ji, Xiaojie; Liu, Ye; Hurd, Ron; Wang, Jieping; Fitzmaurice, Bernie; Nishina, Patsy M.; Chang, Bo
Purpose Retinal detachments (RDs), a separation of the light-sensitive tissue of the retina from its supporting layers in the posterior eye, isolate retinal cells from their normal supply of nourishment and can lead to their deterioration and death. We identified a new, spontaneous murine model of exudative retinal detachment, nm3342 (new mutant 3342, also referred to as rpea1: retinal pigment epithelium atrophy 1), which we characterize herein. Methods The chromosomal position for the recessive nm3342 mutation was determined by DNA pooling, and the causative mutation was discovered by comparison of whole exome sequences of mutant and wild-type controls. The effects of the mutation were examined in longitudinal studies by clinical evaluation, electroretinography (ERG), light microscopy, and marker and Western blot analyses. Results New mutant 3342, nm3342, also referred to as rpea1, causes an early-onset, complete RD on the ABJ/LeJ strain background, and central exudative RD and late-onset RPE atrophy on the C57BL/6J background. The ERG responses were normal at 2 months of age but deteriorate as mice age, concomitant with progressive pan-retinal photoreceptor loss. Genetic analysis localized rpea1 to mouse chromosome 2. By high-throughput sequencing of a whole exome capture library of an rpea1/rpea1 mutant and subsequent sequence analysis, a splice donor site mutation in the Prkcq (protein kinase C, θ) gene, was identified, leading to a skipping of exon 6, frame shift and premature termination. Homozygotes with a Prkcq-targeted null allele (Prkcqtm1Litt) have similar retinal phenotypes as homozygous rpea1 mice. We determined that the PKCθ protein is abundant in the lateral surfaces of RPE cells and colocalizes with both tight and adherens junction proteins. Phalloidin-stained RPE whole mounts showed abnormal RPE cell morphology with aberrant actin ring formation. Conclusions The homozygous Prkcqrpea1 and the null Prkcqtm1Litt mutants are reliable novel mouse
Bjerrum, Søren Solborg
The main purpose of this thesis was to examine whether the Danish National Patient Registry (NPR) could be used to monitor and assess the quality of cataract surgery in Denmark by studying the risks of two serious postoperative complications following cataract surgery - retinal detachment (RD) and postoperative endophthalmitis (PE). The thesis consists of four retrospective studies. In the first study (paper I), we used data from the NPR in the calendar period 2000-2010 to investigate the risk of pseudophakic retinal detachment (PRD) using the fellow non-operated eyes of the patients as reference. The study showed that over a 10-year study period, the risk of PRD was increased by a factor of 4.2 irrespective of sex and age. The risk of PRD was highest in the first part of the postoperative period and then gradually decreased but remained statistically significantly higher than the risk of RD in non-operated fellow eyes up to 10 years after cataract surgery. The epidemiology of RD in the non-operated fellow eyes was different from the epidemiology of RD in the background population as young men had the highest risk of RD in the non-operated fellow eyes. This means that the absolute risk of PRD was highest for young men because they had a higher risk of RD before they underwent cataract surgery. In the second study (paper II), we used data from the NPR and reviewed patient charts to assess the risk of PE after cataract surgery performed in public eye departments and private hospitals/clinics in the study period 2002-2010. The overall risk of PE among the seven public eye departments was 0.36 per 1000 registered cataract operations, and the PE risk among the departments was homogeneous. The overall risk of PE among the 28 private hospitals/clinics was 0.73 per 1000 registered cataract operations, and the risk among the private hospitals/clinics was heterogeneous. Most private hospitals/clinics had a risk of PE that was lower than or similar to the risk of PE after
Sahanne, Sari; Tuuminen, Raimo; Haukka, Jari; Loukovaara, Sirpa
Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV). Methods This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively. Results Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures. Conclusion PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD. PMID:28331284
Lai, Wei-Yu; Wu, Tsung-Tien
Background Retinal detachment (RD) following ocular trauma often results in guarded visual prognosis and sometimes leads to loss of the eye. With the advent of microincisional vitrectomy surgery and the development of surgical techniques, the management of ocular trauma has been transformed. Case Presentation A 34-year-old man sustained an open globe injury from fragmented glass at work. He received primary repair and another follow-up surgery 9 days later, including vitrectomy, silicone oil tamponade, and lensectomy for RD and traumatic cataract at another medical center. However, his retina was totally detached and completely curled up in a roll with choroid on display when he was seen by us 1 month later. He was managed with vigilant and patient peeling and unfolding of the retina using a 23-gauge forceps and silicone oil tamponade, and achieved anatomical success and preservation of his eye at 6-month follow-up. Conclusions This report demonstrates that even in cases which appear to be hopeless at presentation, the surgeon's perseverance and surgical technique can salvage an eye that may otherwise be phthisical. It also encourages retinal surgeons to use microincisional vitrectomy to manage severe traumatic RD. PMID:28101038
Mikhail, Michael A; Mangioris, George; Casalino, Giuseepe; McGimpsey, Stuart; Sharkey, James; Best, Richard
Purpose To report the primary and final success, functional outcome and complication rates of patients with primary rhegmatogenous retinal detachment (RRD) who underwent retinal detachment surgery in a tertiary referral centre in Northern Ireland. Venue Vitreoretinal service, Royal Victoria Hospital, Belfast, Northern Ireland. Methods This is a retrospective case series of all patients who underwent primary RRD repair between 1st of January 2013 and 31st of December 2013. Charts were reviewed. Patients’ demographics, overall primary and final success, functional outcome, complication rates were identified and recorded. Subgroup analysis according to lens status and foveal attachment was also performed. Results A total of 212 cases of primary RRD were included. Mean age at time of surgery was 56.6 years (range 9-90 years); 175(82.5%) had pars plana vitrectomy (PPV), 27 (12.5%), scleral buckle (SB) repair and 10 (5%) pneumatic retinopexy (PR). Overall primary and final success rate were 86% and 95.6% respectively. Overall mean visual acuity improved from 1.1 to 0.4 LogMAR postoperatively after a mean follow-up of 9 months. There was no significant difference in the primary success rate in relation to the baseline lens status (χ2 = 3.4, P = 0.2) and to the baseline macular status (χ2 = 0.6, P = 0.7). Presence of proliferative vitreoretinopathy (PVR) negatively affected the primary success rate (χ2=7.2, P = 0.03). Poor prognostic factors for success were PVR at presentation, inferior breaks and increasing number of detached quadrants. Conclusions This study demonstrates a success rate comparable with other centres with a low rate of final failure. Despite sub-specialism and the great advances in VR surgery, the biology of RRD dictates a failure rate. New therapies may improve results in the future. PMID:28298707
Su, Jing; Liu, Xinquan; Zheng, Lijun; Cui, Hongping
we conducted our meta-analysis of published studies to assess existing evidence about the efficacy and safety of vitrectomy with ILM peeling vs. that of vitrectomy with no ILM peeling for Macular hole-induced retinal detachment. Databases, including Pubmed, Cochrane Library, Ovid, Web of Science, Wanfang and CNKI, were searched to identify studies comparing outcomes following vitrectomy with ILM peeling and that with no ILM peeling for macular hole-induced retinal detachment. The meta-analysis was performed by RevMan 5.1. Six comparative studies comprising 180 eyes were identified. It was indicated that the rate of retinal reattachment (Odds ratio (OR) = 3.03, 95 % Confidence interval (CI):1.35 to 6.78; P = 0.007) and macular hole closure (OR = 6.74, 95 % CI:3.26 to 13.93; P < 0.001) after initial surgery was higher and the rate of recurrent retinal detachment (OR = 0.08, 95 % CI:0.02 to 0.30; P = 0.0002) was lower in the group of vitrectomy with ILM peeling than that in the group of vitrectomy with no ILM peeling. However, the improved BCVA (Weighted mean difference (WMD) = 0.14, 95 % CI: -0.20 to 0.47; P = 0.42) and the rate of postoperative complications were similar between the two groups. Vitrectomy with internal limiting membrane peeling is an efficient and safe procedure for macular hole-induced retinal detachment.
Min, H Y; Chen, D; Chen, Y; Dong, F T
The aim of this study was to investigate the outcomes of one "8"-shaped scleral suture of minimal scleral buckling (MSB) surgery without sub-retinal drainage for rhegmatogenous retinal detachment (RRD) treatment. Thirty patients (30 eyes) with RRD were recruited. Thirty eyes with RRD were repaired by one "8"-shaped scleral suture of minimal buckling without subretinal drainage by one surgeon. The refined MSB procedure is described. Reattachment time and best-corrected visual acuity (BCVA) were observed. The age of the 30 patients ranged from 17 to 65 years (mean, 43.1 ± 8.6 years). The retinas of 19 eyes (63.3%) reattached within 12 h of the operations, and those of 11 eyes (67%) reattached within 72 h. The average time of follow-up was 10.4 ± 2.8 months. BCVAs were increased in 27 eyes (90%), whereas those of 3 eyes did not change. The mean preoperative BCVA was 0.738 ± 0.368 log minimal angle of resolution (MAR), and mean postoperative BCVA was 0.422 ± 0.278 logMAR, and the difference was statistically significant (P < 0.05). The sponge for buckling in only one eye exposed from the conjunctiva was taken out, and the retina remained attached. In conclusion, an "8"-shaped scleral suture of MSB without sub-retinal drainage is an efficient procedure to treat selected RRD cases.
Lam, Delphine; Semoun, Oudy; Blanco-Garavito, Rocio; Jung, Camille; Nguyen, Diem T; Souied, Eric H; Mimoun, Gerard
Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED. In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years. Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20
Theodossiadis, G P
For the treatment of retinal detachment arising from macular holes we do not apply cryotherapy, light-coagulation, or diathermy in the area of the macula. Our method involves merely the fixation of a silastic sponge of 14-17 mm length and 7.5 mm diameter at the posterior part of the eyeball corresponding to macula and along the meridian of 12-6 o'clock axis. The sponge is stretched and then fixed at both ends to the sclera away from the posterior pole. The stretching and fixation of the sponge creates the proper indentation which closes the macular hole. By avoiding energy application we obtain better visual acuity. The present paper describes the results we have had in the last 7 years exclusively using this technique.
Nam, Ki Yup; Kim, Jung Yeul
To investigate the difference in the occurrence of postoperative epiretinal membranes (ERMs) in vitrectomy for rhegmatogenous retinal detachment with and without peeling of the internal limiting membrane (ILM). The medical records of the 135 patients, who underwent vitrectomy for primary rhegmatogenous retinal detachment from November 2007 to August 2011, were analyzed retrospectively. Of the subjects, 70 patients underwent ILM peeling during the surgery and 65 did not. The best-corrected visual acuity, fundus photograph, and optical coherence tomography were collected 3, 6, and 12 months postoperatively. The relationship between ILM peeling and the preoperative findings of rhegmatogenous retinal detachment and development of a postoperative ERM was analyzed. No ERM occurred in the ILM peeling group, whereas an ERM occurred in 14 of 65 patients who underwent vitrectomy without ILM peeling (21.5%). This difference was significant (P < 0.001). The occurrence of a postoperative ERM was not significantly correlated with other preoperative factors. In the macular-on group, the overall mean best-corrected visual acuity was better in the ILM peeling group and was significantly higher 12 months postoperatively (P = 0.03). Internal limiting membrane peeling seems to prevent the occurrence of a postoperative ERM in patients with primary rhegmatogenous retinal detachment.
Alakeely, Adel G.; Alrashaed, Saba
Dome-shaped macula (DSM) was first described by Gaucher et al. as a convex protrusion of macula within a staphyloma in highly myopic eyes that cause visual impairment associated with serous foveal detachment (SFD). We describe a patient with persistent SFD in DSM documented by serial spectral domain optical coherence tomography for 7 years with stable vision. PMID:27994399
Chong, Deborah Y; Boehlke, Christopher S; Zheng, Qiong-Duan; Zhang, Linda; Han, Ying; Zacks, David N
To test the hypothesis that interleukin (IL)-6 prevents photoreceptor cell death during periods of retinal separation from the retinal pigment epithelium (RPE). Retinal-RPE separation was created in wild-type C57BL mice, IL-6(-/-) mice, and Brown Norway rats by subretinal injection of 1% hyaluronic acid. In some animals, anti-IL-6 neutralizing antibody (NAB) or exogenous IL-6 was administered into the subretinal space at the time of separation or at specified times afterward. Terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) was performed 3 days after separation to detect apoptotic photoreceptors. Photoreceptor cell counts were performed after 1 and 2 months. Loss of IL-6 function through genetic ablation (IL-6(-/-) mice) or injection of anti-IL-6 NAB resulted in significantly increased levels of TUNEL-positive staining 3 days after retinal-RPE separation. One month after separation, outer nuclear layer (ONL) cell counts were significantly lower in IL-6(-/-) mice or in animals injected with anti-IL-6 NAB than in controls. Gain of IL-6 function through the addition of exogenous IL-6 resulted in significantly increased ONL counts at 1 month but not at 2 months. Reinjection of IL-6 at 1 month led to continued preservation of ONL counts compared with controls. A window of opportunity for treatment was detected because delaying injection of exogenous IL-6 to 2 weeks after retinal-RPE separation still resulted in significantly greater ONL cell counts compared with controls. IL-6 may serve as a photoreceptor neuroprotectant in the setting of retinal-RPE separation.
Shankar, Vikas; Lim, Lik Thai; Ah-Kee, Elliott Yann; Hammer, Harold
Purpose: The primary aim of this study is to report the outcome of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling (SB) surgery. Methods: This is a retrospective noncomparative case series study of all patients who underwent RRD repair by primary SB between March 2008 and February 2009. Patient demographics, visual outcome, complications, and failure rates were identified and recorded. Results: A total of 65 patients underwent RRD repair by SB, with a mean age of 44.44 years. Results showed that the primary outcome (primary anatomical success following index surgery) was 90.77%, while the secondary outcome (anatomical success following repeat surgery) was 98.46%. Conclusion: The study showed a high-success rate of SB in phakic eyes both in terms of postoperative best-corrected visual acuity and complication rates. We recommend the continued use of this technique in selected cases of RRD. PMID:25378877
Barthelmes, Daniel; Chandra, Jay
Purpose To evaluate outcomes in patients with complex retinal detachments (RD) with proliferative vitreoretinopathy (PVR) requiring retinectomy using a staged approach utilizing perfluoro-n-octane (PFO) as a short-term postoperative intraocular tamponade. Methods Retrospective analysis. Patients who underwent 23G pars plana vitrectomy for the management of complicated RD where PFO was used as a primary temporary intraocular tamponade. Only eyes with PVR in rhegmatogenous RD or eyes with penetrating injuries or globe ruptures (ocular trauma) and subsequent RD with PVR were included. Analysis of 17 eyes of 17 consecutive patients with a minimum follow-up of 12 months during a period of 5 years. The primary outcome measure was the reattachment rate after at least 12 months of follow-up after the PFO removal. Secondary outcome measures were changes in visual acuity, complications due to PFO use, and necessity for further surgeries. Results Eight eyes with prior penetrating injuries or globe rupture and nine eyes with rhegmatogenous pathology were included. All eyes had PFO as temporary tamponade for 14 days (median), which was replaced by silicon oil. Sixteen eyes (94%) had complete and one eye partial reattachment. No redetachments occurred. All eyes retained or improved visual acuity. On average, only 2.5 procedures, including silicon oil removal, were performed. Two eyes had long-term intraocular pressure of 5 mmHg and no eye had intraocular pressure of ≥21 mmHg. No long-term inflammation was observed. Conclusion PFO seems to be beneficial in a staged approach to repair complex detachments when used as short-term tamponade. A median period of 14 days allowed for both sufficient retinal support plus a reduction in side effects seen in long-term endotamponades. PMID:25784785
Schnichels, Sven; Schneider, Nele; Hohenadl, Christine; Hurst, José; Schatz, Andreas; Januschowski, Kai; Spitzer, Martin S.
The efficacy of two novel artificial vitreous body substitutes (VBS) consisting of highly biocompatible thiolated cross-linked hyaluronic acid (HA)-based hydrogels in comparison to silicone oil in a model of retinal detachment was investigated. Pars plana vitrectomy (23G) was performed in the right eye of 24 pigmented rabbits. Retinal detachment of two quadrants was induced by creating a small retinotomy near the vascular arcade and injecting balanced salt solution (BSS) subretinally. The retina was reattached by injecting air, which was followed by increasing the infusion pressure, and the retinal tear was treated by endolaser photocoagulation. At the end of the procedure, the eye was filled either with 5000-cs silicone oil (after fluid air exchange) or the respective hydrogel (with two different viscosities). Follow-up examination included slit lamp examination, funduscopy, intraocular pressure measurements (IOP), optical coherence tomography (OCT) and electroretinogram (ERG) measurements. After a maximum follow-up of four weeks both eyes were removed, examined macroscopically, photographed, and prepared for histology. Of the eight rabbits that received silicone oil, seven (87.5%) developed a recurrent retinal detachment with pronounced proliferative vitreoretinopathy within the first two weeks after surgery. In contrast, in the hydrogel treated eyes, the retina stayed attached in the majority of the cases (73.3%). IOP and retinal morphology were normal as long as the retina remained re-attached. In conclusions, this model of retinal detachment, both thiolated crosslinked hyaluronate hydrogels showed superior efficacy when compared to silicone oil. These hydrogels have a promising potential as novel vitreous body substitutes. PMID:28248989
Ghoraba, Hammouda Hamdy; Elgouhary, Sameh Mohamed; Mansour, Hosam Osman
Purpose. To evaluate the efficacy of silicone oil (S.O) reinjection without macular buckling for treatment of recurrent myopic macular hole retinal detachment (MHRD) after silicone oil removal. Methods. A retrospective consecutive interventional study from medical reports on cases of myopic MHRD. Fifty-three eyes of 51 patients underwent silicone oil removal after successful repair of MHRD were reviewed. The main outcomes were the retinal status after silicone oil removal and management of recurrent cases. Results. The rate of recurrent RD (Re RD) after silicone oil removal was 11.3% (6 out of 53 eyes). One case refused any other interference. In the remaining 5 eyes, 4 eyes (80%) could be reattached by S.O re-injection and one eye (20%) developed Re RD after S.O re-injection. Range of followup after management of recurrence was 5–53 months (mean 18.7 months). Conclusions. This case series concluded that the risk factors for recurrent RD after silicone oil removal from cases of myopic MHRD were high myopia, open flat MH, and large posterior staphyloma. Revision of vitrectomy and S.O re-injection can reattach most of recurrent cases. PMID:24672706
Takahashi, Shizuka; Adachi, Kobu; Suzuki, Yukihiko; Maeno, Atsuko
Purpose. To characterize the profiles for inflammatory cytokines in the vitreous fluid from patients with rhegmatogenous retinal detachment (RRD) by comparing those of other vitreoretinal diseases and to analyze the correlation between intravitreal cytokines and clinical features. Materials and Methods. Vitreous fluid was obtained at the time of surgery from 28 RRD eyes. Vitreous fluid was similarly collected from patients with macular hole (MH), epiretinal membrane, proliferative diabetic retinopathy (PDR), and retinal vein occlusion as controls. Twenty-seven cytokines were measured. Intravitreal cytokine profiles in RRD were characterized by comparing these with those in other vitreoretinal diseases. We also analyzed the correlations between vitreous cytokines and clinical features. Results. There were statistical differences in the MCP-1, MIP-1β, and IP-10 between the RRD and MH, while the IL-6 and IL-8 exhibited levels that were between those for the PDR and MH. MIP-1β was significantly correlated to both the extent and duration of the RRD, while IL-8 was significantly correlated to the extent of the RRD. Conclusions. MCP-1, MIP-1β, and IP-10 may modify the pathologic features of RRD. The levels of these cytokines are related in part to the clinical features and the level of photoreceptor damage. PMID:28074184
Di Lauro, Salvatore; Castrejón, Melissa; Fernández, Itziar; Rojas, Jimena; Coco, Rosa M.; Sanabria, María R.; Rodríguez de la Rua, Enrique; Pastor, J. Carlos
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis. PMID:26640704
The author evaluates the importance of different vitreoretinal factors and the role of indirect injury in the pathogenesis of detachment of the retina/DR/and holds the following view as regards subjects inclined to pursue physical activity. Numerous and frequent vitreoretinal risk factors are a forecast of DR only in a small fraction of patients. Indirect injury is not recognized as a cause of DR. Risk factors incl. medium-grade and high-grade myopia are not an indication for restriction of physical activity nor for Caesarean section in pregnant women. Restriction of physical activity acts as a psychic trauma and does not prevent the development of DR.
Alexander, P; Prasad, R; Ang, A; Poulson, A V; Scott, J D; Snead, M P
For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.
Minarcik, John R; von Fricken, Manfred A
Background The purpose of this study was to describe and evaluate a surgical approach, known as internal limiting membrane (ILM) peeling, as an adjunct to repair of recurrent retinal detachment due to proliferative vitreoretinopathy (PVR). Methods This was a retrospective case series. All eyes underwent repair of recurrent PVR-related rhegmatogenous retinal detachment incorporating macular indocyanine green-assisted ILM peeling. Patients with primary detachments, diabetes, staphyloma, or macular holes were excluded. The main outcome measure was the anatomic success of single surgery. The characteristics of the group were studied, including the number and types of previous detachment repair attempts, as well as the subsequent surgeries. Results Fourteen eyes from 14 patients were included. Anatomic success with single surgery was achieved in 11 of 14 (79%) of the operated eyes using this technique, and eventual success was achieved in all eyes (100%). Among the failed repairs prior to ILM peeling, 8/14 eyes had scleral buckles, 7/14 had silicone oil tamponade, and two had inferior retinectomies. There was no subsequent development of epiretinal membranes after ILM peeling. Conclusion ILM peeling in conjunction with vitrectomy and peeling of peripheral membranes is an effective technique with a high anatomic success rate in the challenging scenario of PVR-related recurrent detachments. We describe the technique as an alternative to the traditional retinectomy. PMID:22570543
The aim of this paper is to report the incidence of retinal pigment epithelial (RPE) tears in patients treated with ranibizumab for subfoveal fibrovascular retinal pigment epithelial detachment (FVPED) due to occult age-related macular degeneration (AMD). Thirty patients were treated according to the following schedule: saturation phase, further treatment was based on activity of the degeneration process. Visual acuity (VA), optical coherence tomography (OCT) and fluorescein angiography (FA) parameters were evaluated and compared. Patients had a mean improvement of +4.7 ± 8.1 letters at month 12. The mean number of needed injections was 6.8 ± 1.8 (range, 3 to 9). RPE tears in fovea occurred in 8 cases (27% of all patients). Analysis of variance revealed significant upper mean values of ETDRS letters for the subgroup without RPE tears. Mean values of PED height were significant upper for RPE tears without baseline. Statistical analysis revealed that in the subgroup without RPE tears mean values of VA significantly differed in succeeding periods compare to baseline (P<0.001). Visual improvement or stabilization was observed in 90.9% of patients without RPE tears (significant improvement of 15 or more letters in 22.7% - 5/22) and in 87.5% of patients with RPE tears (significant improvement was not observed). Baseline leakage parameters, lesion and leakage parameters at month 12 were significantly higher in patients with RPE tears. The chi-square test revealed statistically significant associations between RPE tears and subretinal fluid in OCT (P<0.05) at month 12. In eyes with FVPED and RPE tears treated with ranibizumab, stabilization of visual acuity without significant improvement is predictable. One of the risk factors common to RPE tears may be baseline leakage parameters and pretreatment distorted RPE contour in OCT. During ranibizumab therapy in eyes with RPE tears, upper parameters of FVPED height may occur without significant differences in fovea and macula
Huang, Ying-Chen; Lai, Chi-Chun; Wu, Wei-Chi
The integration of quadruple therapy in a 13-year-old boy with stage 3B Coats' disease achieved retinal reattachment and visual improvement. Scleral buckling might play a role in retinal detachment in Coats' disease, although it has previously been considered insignificant. Instead of performing vitrectomy and internal drainage with a drainage hole in the retina, less-invasive procedures that do not require retinotomy appear to be beneficial in cases of advanced Coats' disease. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:865-868.].
Stamenković, Miroslav; Stefanović, Ivan; Senćanić, Ivan; Jakšić, Vesna; Mavija, Milka; Babović, Siniša
Among the proposed operative techniques for retinal detachment (RD) the most commonly applied are classical method with scleral buckling and pars plana vitrectomy (PPV). The aim of this paper was to determine which surgical intervention of these two leads to better morphological results in terms of the applied retina and better functional outcomes in terms of visual acuity (VA) of the operated eye in patients with RD. A retrospective study on the comparative section of the effects of scleral buckling surgery and PPV in uncomplicated rhegmatogenous RD was performed. In a 2-year period 97 patients, i.e. 98 eyes with RD were operated on (68 eyes with scleral buckling surgery vs 30 by PPV). In the group with classically operated detachment, the retina was applied in 52 (76.5%) cases vs 30 (100%) patients in PPV group (p < 0.05). Postoperative VA in logMAR was significantly better in both groups compared to preoperative VA: in the classically operated was 1.89 ± 1.04 preoperatively vs 0.98 ± 0.70 postoperatively, while in the PPV group, preoperative value was 2.56 ± 0.67 vs 1.31 ± 0.74 postoperatively (p = 0.001). PPV in uncomplicated forms of RD gives better anatomical results than scleral buckling surgery. VA was significantly improved in both observed groups, while its mean value was postoperatively better in the group that was operated with the classical method. The reason for this could be due to better VA in baseline in the scleral buckling surgery group.
The mechanism of subretinal fluid accumulation in optic disc pit maculopathy is unknown. A 67-year-old Japanese woman complaining of blurred vision in her right eye presented with a best-corrected visual acuity of 20/200. Slit-lamp biomicroscopy and optical coherence tomography examination showed maculopathy typically associated with optic disc pits, except that the patient had no optic disc pit. Long-acting gas tamponade was required to achieve reattachment of the retina and retinoschisis after initial failure of surgery using surgically induced vitreous detachment without either fluid-air exchange or gas injection. Vitreous traction may not have played a major role in introducing fluid into the submacular space in this case. Gas tamponade may be indispensable to achieve surgical success. This may also pertain to some cases of optic nerve pits.
Rizzo, Stanislao; Virgili, Gianni
Purpose. To compare the vitrectomy time, clinical outcomes, and complications between 27-gauge (27-G) and 25-gauge (25-G) vitrectomy in patients with primary rhegmatogenous retinal detachment (PRRD). Methods. Prospective, nonrandomized, comparative, interventional study. Forty consecutive patients with PRRD were recruited. Twenty patients underwent the 27-gauge procedure and twenty patients had the 25-gauge procedure. The main outcome measure of the study was the actual vitrectomy time. Results. The mean duration of vitreous removal was 23.2 min (SD 6.5) with 27-G vitrectomy and 19.6 min (SD 7.3) with 25-G vitrectomy, resulting in a difference of 3.6 min (95% confidence interval (95%CI): −8.0 to 0.8 mins, p = 0.11). Mean logMAR visual acuity improved from 1.70 ± 1.18 preoperatively to 0.12 ± 0.14 at final postoperative visit (p < 0.001) in the 27-G group and from 1.52 ± 1.15 preoperatively to 0.22 ± 0.30 at final postoperative visit (p < 0.001) in the 25-G group. The anatomical success rate after a single operation was 90.0% and 85.0% in the 27-G and in the 25-G groups (p = 0.63), respectively. Intraoperative iatrogenic retinal breaks (IRBs) occurred in 2 eyes in the 27-G group and 1 eye in the 25-G group. Conclusions. Twenty-seven-gauge vitrectomy may be a safe and effective surgery for the treatment of PRRD. PMID:28367324
Rizzo, Stanislao; Polizzi, Silvio; Barca, Francesco; Caporossi, Tomaso; Virgili, Gianni
Purpose. To compare the vitrectomy time, clinical outcomes, and complications between 27-gauge (27-G) and 25-gauge (25-G) vitrectomy in patients with primary rhegmatogenous retinal detachment (PRRD). Methods. Prospective, nonrandomized, comparative, interventional study. Forty consecutive patients with PRRD were recruited. Twenty patients underwent the 27-gauge procedure and twenty patients had the 25-gauge procedure. The main outcome measure of the study was the actual vitrectomy time. Results. The mean duration of vitreous removal was 23.2 min (SD 6.5) with 27-G vitrectomy and 19.6 min (SD 7.3) with 25-G vitrectomy, resulting in a difference of 3.6 min (95% confidence interval (95%CI): -8.0 to 0.8 mins, p = 0.11). Mean logMAR visual acuity improved from 1.70 ± 1.18 preoperatively to 0.12 ± 0.14 at final postoperative visit (p < 0.001) in the 27-G group and from 1.52 ± 1.15 preoperatively to 0.22 ± 0.30 at final postoperative visit (p < 0.001) in the 25-G group. The anatomical success rate after a single operation was 90.0% and 85.0% in the 27-G and in the 25-G groups (p = 0.63), respectively. Intraoperative iatrogenic retinal breaks (IRBs) occurred in 2 eyes in the 27-G group and 1 eye in the 25-G group. Conclusions. Twenty-seven-gauge vitrectomy may be a safe and effective surgery for the treatment of PRRD.
Mariotti, Cesare; Nicolai, Michele; Longo, Antonio; Viti, Francesca; Bambini, Elisa; Saitta, Andrea; Pirani, Vittorio; Orsini, Emanuele; Baruffa, Daniela; Reibaldi, Michele
To compare the changes in postoperative peripapillary retinal nerve fiber layer (p-RNFL) thickness after vitrectomy for epiretinal membrane in eyes with preexisting posterior vitreous detachment (PVD) and eyes with surgically induced PVD. This study included consecutive patients who underwent 25-gauge vitrectomy for epiretinal membrane. Eyes were divided, according to intraoperative PVD status, into a preexisting PVD group and surgically induced PVD group. Best-corrected visual acuity, p-RNFL thickness, and central retinal thickness were performed before and at 1, 3, and 6 months after surgery. One hundred and twenty eyes of 120 patients were enrolled: 64 eyes in the preexisting PVD group and 56 eyes in the surgically induced PVD group. In the preexisting PVD group at 6 months, the mean global p-RNFL thickness did not change, whereas it was reduced in the temporal sector (P = 0.034). In the surgically induced PVD group at 6 months, significant decreases were observed in global p-RNFL thickness (P = 0.027), temporal (P = 0.021), temporal inferior (P = 0.030), and nasal inferior sectors (P = 0.010). At 6 months, the two groups differed significantly in temporal (P < 0.001) and temporal inferior sectors (P = 0.004). The preoperative mean best-corrected visual acuity improved significantly at 6 months in both groups. Postoperative p-RNFL thickness after vitrectomy for epiretinal membrane tended to decrease in the temporal sector in all eyes and in the temporal inferior and nasal inferior sectors in eyes with surgically induced PVD.
Wei, Yong; Wang, Ningli; Zu, Zhongqiao; Bi, Chuncao; Wang, Huaizhou; Chen, Fenghua; Yang, Xingguang
To compare the outcomes of pars plana vitrectomy (PPV) with or without the adjuvant surgical procedures: triamcinolone acetonide (TA) assistance and/or internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD). Case-control study. Pars plana vitrectomy combined with 2 kinds of adjuvant surgical procedures were used on 96 highly myopic eyes with MHRD. These eyes were assigned to 4 groups randomly: Group 1, non-TA-assisted PPV and without ILM peeling; Group 2, non-TA-assisted PPV with ILM peeling; Group 3, TA-assisted PPV and without ILM peeling; Group 4, TA-assisted PPV with ILM peeling. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity were measured. The rates of both retinal reattachment and macular hole closure were higher in Group 2 (84.0 and 44.0%) and Group 3 (80.8 and 46.2%) than Group 1 (73.9 and 17.4%); however, there were no differences between Group 2 and Group 3 (P > 0.05). The rates of macular hole closure were extremely low in Group 1 and also in eyes with extreme long axial lengths (≥29.0 mm), "severe" chorioretinal atrophy, and posterior staphyloma. Pars plana vitrectomy with either TA assistance or ILM peeling was effective for the treatment of highly myopic MHRD. If you peel the ILM, adding TA does not affect closure rates; and if TA is used to visualize the vitreous, ILM peeling may not be necessary in MHRD. There was a lower anatomical success rate in MHRD with extreme long axial lengths, severe chorioretinal atrophy, and posterior staphyloma.
Natarajan, S; Malpani, A; Nirmalan, P K
In the presence of proliferations anteriorly, adequate excision of the vitreous base is essential. To enable a good vitreous base excision, removal of lens often becomes necessary as it may be damaged while attempting to remove peripheral vitreous. To avoid damage or the need to remove the crystalline lens we have used a new modified curved vitreous cutter along with a wide angle observation system binocular indirect ophthalmomicroscope (BIOM). Use of BIOM during vitreous surgery enables easy viewing of the retinal periphery without the need for scleral depression. Sclerotomies are made as for any regular three-port vitrectomy procedure and the vitrectomy is carried out using the curved vitreous cutter, including the vitreous base, avoiding damage to the crystalline lens. The modified curved vitreous cutter is helpful in removing the peripheral vitreous without damaging the crystalline lens, giving the patient the advantage of intraocular lens implantation at a later date.
Mulder, Douwe J.; Schalkwijk, Casper G.; Scheijen, Jean L.; Smit, Andries J.; Los, Leonoor I.
Purpose Advanced glycation endproducts (AGEs) and their precursors α-dicarbonyls are implicated in the progression of diabetic retinopathy. The purpose of this study was to assess AGEs and α-dicarbonyls in the vitreous of patients with type 2 diabetes mellitus (T2DM) with early stages or absence of diabetic retinopathy. Methods We examined vitreous samples obtained during vitrectomy from 31 T2DM patients presenting themselves with rhegmatogenous retinal detachment and compared these to 62 non-diabetic rhegmatogenous retinal detachment patients, matched on age, estimated glomerular filtration rate, smoking, intra-ocular lens implantation, and proliferative vitreoretinopathy. AGEs (pentosidine, Nε-(carboxymethyl)lysine, Nε-(carboxyethyl)lysine, and 5-hydro-5-methylimidazolone) and α-dicarbonyls (3-deoxyglucosone, methylglyoxal, and glyoxal) were measured by ultra performance liquid chromatography or high performance liquid chromatography. Skin autofluorescence was measured by the AGE Reader. Results Mean age was 64 ± 7.6 years for T2DM patients and 63 ± 8.1 years for controls. For T2DM patients, median diabetes duration was 2.2 (0.3–7.4) years. Non-proliferative diabetic retinopathy was present in 1 patient and classified as absent or background retinopathy in 30 patients. Vitreous levels of pentosidine (2.20 vs. 1.59 μmol/mol lysine, p = 0.012) and 3-deoxyglucosone (809 vs. 615 nmol/L, p = 0.001) were significantly elevated in T2DM patients compared to controls. Other AGEs and α-dicarbonyls in the vitreous were not significantly different. There was a trend for increased skin autofluorescence in T2DM patients as compared to controls (p = 0.07). Conclusions Pentosidine and 3-deoxyglucosone concentrations were increased in the vitreous of rhegmatogenous retinal detachment patients with a relatively short duration of diabetes compared to non-diabetic rhegmatogenous retinal detachment patients. PMID:28264049
Kobayashi, Misato; Iwase, Takeshi; Yamamoto, Kentaro; Ra, Eimei; Murotani, Kenta; Terasaki, Hiroko
To determine the perioperative factors that are significantly correlated with the final visual acuity following reattachment of a macula-off rhegmatogenous retinal detachment (RRD) by vitrectomy. Twenty-nine eyes of 29 patients with a successfully reattached RRD by vitrectomy were retrospectively analyzed. Spectral-domain optical coherence tomographic images of the macular regions were used to measure the thicknesses of the retinal layers and the integrity of the microstructures of the photoreceptors at 2 weeks, 1, 2, 3, 6, 9, and 12 months following the vitrectomy. The best-corrected visual acuities (BCVA) were evaluated at the same times. The improvement of the BCVA from the preoperative BCVA to that at postoperative Week 2 (-0.67 ± 0.69 logMAR units) was the largest change between adjacent observation periods for the entire study duration. It was significantly greater than the improvement between Week 2 and Month 12 (-0.32 ± 0.22 logMAR units; P<0.001). The thickness of the ellipsoid zone (EZ)-retinal pigment epithelium (RPE) increased significantly with time (P<0.001). The final BCVA was significantly correlated with the BCVA at Week 2 (r = 0.61, P<0.001), the EZ-RPE thickness at Week 2 (r = -0.40, P = 0.035), the integrity of the external limiting membrane (ELM) (r = -0.61, P = 0.003), and an intact EZ (r = -0.66, P = 0.001) at Week 2. Multiple stepwise regression analyses of the final BCVA showed that the BCVA at Week 2 (P = 0.017) and the integrity of the EZ at Week 2 (P = 0.006) were independent predictors of the final BCVA. The significantly better BCVA and presence of an intact EZ at 2 weeks following vitrectomy and their significant correlations with the BCVA at Month 12 indicate that these perioperative values can be used to predict the BCVA at Month 12 after a reattachment of macula-off RRD following vitrectomy.
This paper reviews recent ophthalmological manuscripts pertaining to wasting retinal nerve fibers, retinopathy related to systemic lymphomas, hypertensive retinopathy, diabetic retinopathy, retinal oxalosis, macular and foveal anomalies, retinal pigment epithelium, retinitis pigmentosa, retinoblastoma, histoplasmosis, toxoplasmosis, and retinal tears and detachments.
Lanchares, Elena; del Buey, María A.; Cristóbal, José A.; Ascaso, Francisco J.
A finite element model (FE) of the eye including cornea, sclera, crystalline lens, and ciliary body was created to analyze the influence of the silicone encircling bandwidth and the tightness degree on the myopia induced by scleral buckling (SB) procedure for rhegmatogenous retinal detachment. Intraocular pressure (IOP) was applied to the reference geometry of the FE model and then SB surgery was simulated with encircling bandwidths of 1, 2, and 2.5 mm. Different levels of tightening and three values of IOP were applied. The anterior segment resulted as unaffected by the surgery. The highest value of Cauchy stress appeared in the surroundings of the implant, whereas no increment of stress was observed either in anterior segment or in the optic nerve head. The initial IOP did not appear to play any role in the induced myopia. The wider the band, the greater the induced myopia: 0.44, 0.88, and 1.07 diopters (D) for the 1, 2, and 2.5 mm bandwidth, respectively. Therefore, patients become more myopic with a wider encircling element. The proposed simulations allow determining the effect of the bandwidth or the tightness degree on the axial lengthening, thus predicting the myopic increment caused by the encircling surgery. PMID:27413542
Lanchares, Elena; Del Buey, María A; Cristóbal, José A; Calvo, Begoña; Ascaso, Francisco J; Malvè, Mauro
A finite element model (FE) of the eye including cornea, sclera, crystalline lens, and ciliary body was created to analyze the influence of the silicone encircling bandwidth and the tightness degree on the myopia induced by scleral buckling (SB) procedure for rhegmatogenous retinal detachment. Intraocular pressure (IOP) was applied to the reference geometry of the FE model and then SB surgery was simulated with encircling bandwidths of 1, 2, and 2.5 mm. Different levels of tightening and three values of IOP were applied. The anterior segment resulted as unaffected by the surgery. The highest value of Cauchy stress appeared in the surroundings of the implant, whereas no increment of stress was observed either in anterior segment or in the optic nerve head. The initial IOP did not appear to play any role in the induced myopia. The wider the band, the greater the induced myopia: 0.44, 0.88, and 1.07 diopters (D) for the 1, 2, and 2.5 mm bandwidth, respectively. Therefore, patients become more myopic with a wider encircling element. The proposed simulations allow determining the effect of the bandwidth or the tightness degree on the axial lengthening, thus predicting the myopic increment caused by the encircling surgery.
da R Lucena, D; Ribeiro, J A S; Costa, R A; Barbosa, J C; Scott, I U; de Figueiredo-Pontes, L L; Jorge, R
To compare the amount of intraoperative intraocular bleeding in patients with diabetes with macula-involving tractional retinal detachment (TRD) undergoing pars plana vitrectomy (PPV) with and without preoperative intravitreal bevacizumab (IVB) injection. An institutional study was carried out with consecutive patients with diabetic retinopathy and macula-involving TRD of recent (3 months) onset who were randomly assigned to PPV only (PPV group) or PPV combined with one IVB (1.5 mg/0.06 ml) injection 2 weeks prior to surgery (bevacizumab (BEV)/PPV group). All patients underwent 23-gauge PPV 3 weeks after baseline. The main outcome measure was erythrocyte count in the fluid retrieved from the vitrectomy cassette using a Neubauer counting chamber. The study included 20 patients. The mean erythrocyte count was 14,865x10(3) (SD 19,332x10(3); median 4,500x10(3)) cells in the BEV/PPV group, and 176,240x10(3) (SD 108,375x10(3); median 166,600x10(3)) cells in the PPV group. The mean erythrocyte count was significantly lower in the BEV/PPV group than in the PPV group (p<0.0001). No major adverse events were identified. Preoperative IVB injection was associated with reduced intraocular bleeding during 23-gauge PPV for diabetic macula-involving TRD. Further studies are needed to confirm our preliminary findings. NCT00690768.
Ashish, M; Alok, S; Elesh, J; Shubhi, T
The aim of this case report is to discuss issues related to management of one eyed pregnant female. A 26-year-old female (Patient A) and 28-year-old female (Patient B) both in second trimester and one eyed presented to our outpatient department with diminution of vision due to rhegmatogenous retinal detachment (RRD). Retina was attached in Patient A following scleral buckling surgery but Patient B required pars plana vitrectomy with silicon oil tamponade. Best corrected visual acuity in both patients did improve from 1/60 to 6/24 and 6/18, respectively at 6 months follow-up. Exudative RDs are known to occur in pregnancy as a complication of preeclampsia, but RRD in pregnancy although co-incidental poses certain challenge with regard to management of such cases especially if the patient is one-eyed. Things to consider for management include (1) type of anesthesia (2) surgical positioning (3) positioning after surgery (4) anti-glaucoma medication if required (5) corticosteroid treatment in pregnancy (6) to provide them ambulatory vision as early as possible. With proper management and monitoring it is possible to provide them with early ambulatory vision without offering any harm to her pregnancy and fetus. PMID:27057392
Kiseleva, O A; Ziangirova, G G; Iomdina, E N; Aliev, T I
The paper presents the results of experimental use of a polyglycolide material-based filling for temporary episcleral filling in retinal detachment. Thorough comparative morphological and biomechanical studies of 120 experimental eyes in different periods after scleroplasty, by using an inflatable balloon catheter, homoscleral and polyglycolide fillings, have indicated that the polyglycolide filling material is completely lysed by ocular tissues within 60-90 days, which rules out a repeated surgical intervention for removal of temporary filling (for example, an inflatable balloon catheter), by preserving the constancy of the depth of scleral pressing-in. The short existence of a chemically indifferent polyglycolide filling in the ocular tissues excludes its negative effect on the surrounding structures of the eye, minimizes the likelihood of the occurrence of early postoperative complications, but thereby leading to a substantial increase in the biochemical stability of the scleral-and-chorioretinal complex in the early postoperative periods and ensuring increased resistance to dynamic loads, by forming a stable scleral-and-chorioretinal adhesion 3 months after surgery. The findings suggest that the designed polyglycolide explant has advantages and that it is expedient to introduce the new Russian resolving polyglycolide fiber explants into clinical practice (for scleroplastic operations).
Reibaldi, Michele; Russo, Andrea; Longo, Antonio; Bonfiglio, Vincenza; Uva, Maurizio G.; Gagliano, Caterina; Toro, Mario D.; Avitabile, Teresio
Purpose To report a case of rhegmatogenous retinal detachment with a high risk of proliferative vitreoretinopathy (PVR) effectively treated with episcleral surgery and an intravitreal dexamethasone 0.7-mg implant. Methods A 35-year-old Caucasian man with a macula-off rhegmatogenous subtotal retinal detachment that had persisted for 1 month in his myopic left eye presented several risk factors that could have led to the development of PVR after retinal detachment surgery. His best corrected visual acuity was hand motion. He received an intravitreal dexamethasone 0.7-mg implant (Ozurdex®) after episcleral surgery to prevent this complication. Results At least 9 months after surgery, no sign of PVR or pucker has developed in the treated eye. Visual acuity improved to 0.2, the retina was attached and no complications were observed. Conclusion Intravitreal dexamethasone 0.7-mg implant (Ozurdex) could be considered as off-label treatment following episcleral surgery to prevent PVR. PMID:23687501
Elaraoud, Ibrahim; Andreatta, Walter; Jiang, Li; Damer, Kenan; Al-Ibrahim, Jalil
A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg. Fundal examination was significant for bilateral 360-degree choroidal detachments with exudative retinal detachment involving the maculae. These findings were confirmed using wide-field fundus photography, B-scan ultrasonography, and optical coherence tomography. Fundus fluorescein angiography did not reveal any evidence of retinal vasculitis. Indocyanine green chorioangiography of the posterior pole showed multiple areas of focal choroidal hypoperfusion. Extensive systemic investigation demonstrated no infectious, neoplastic, or inflammatory cause, and the patient did not complain of any systemic symptoms. Treatment with high-dose intravenous methylprednisolone was administered and this brought about complete resolution of both choroidal and retinal detachments, with partial visual recovery. PMID:28203189
Elaraoud, Ibrahim; Andreatta, Walter; Jiang, Li; Damer, Kenan; Al-Ibrahim, Jalil
A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg. Fundal examination was significant for bilateral 360-degree choroidal detachments with exudative retinal detachment involving the maculae. These findings were confirmed using wide-field fundus photography, B-scan ultrasonography, and optical coherence tomography. Fundus fluorescein angiography did not reveal any evidence of retinal vasculitis. Indocyanine green chorioangiography of the posterior pole showed multiple areas of focal choroidal hypoperfusion. Extensive systemic investigation demonstrated no infectious, neoplastic, or inflammatory cause, and the patient did not complain of any systemic symptoms. Treatment with high-dose intravenous methylprednisolone was administered and this brought about complete resolution of both choroidal and retinal detachments, with partial visual recovery.
Seibel, Ira; Cordini, Dino; Willerding, Gregor; Riechardt, Aline Isabel; Joussen, Antonia Maria
Background Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome. Methods This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy. Results The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months. Conclusion Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection. PMID:27175359
Background Scleral buckling surgery and pars plana vitrectomy are competing methods in the treatment of retinal detachment. The recent development of spectral-domain optical coherence tomography (SD-OCT) has dramatically improved the visualization of the photoreceptor layer relative to conventional OCT, and offers new opportunities to investigate the discordances between anatomic and functional outcomes after retinal detachment surgery. Hence, the study aim was to use SD-OCT to compare the postoperative macular recovery between scleral buckling and vitrectomy for macular-off rhegmatogenous retinal detachment. Methods In this retrospective observational case series, we observed 32 patients who underwent scleral buckling surgery (group 1) and 26 patients who underwent pars plana vitrectomy (group 2) as the primary surgery for macula-off rhegmatogenous retinal detachment. OCT was used to examine microstructural changes in the macular area. Results The mean visual acuity improvement was 0.4 ± 0.8 logMAR in group 1 and 0.7 ± 0.9 logMAR in group 2. As detected by SD-OCT, subretinal fluid was present in 26 of the group 1 eyes (81.3%) and 5 of the group 2 eyes (19.2%) at 8 weeks postoperatively. This difference was statistically significant (Fisher’s exact test, P < 0.05). Moreover, detection by SD-OCT revealed epiretinal membranes in 5 of the group 1 eyes (15.6%) and 11 of the group 2 eyes (42.3%), a difference that was statistically significant (Fisher’s exact test, P < 0.05). Conclusions Macular recovery and the mean visual acuity differed between the 2 groups of patients. With the help of SD-OCT, we observed that subretinal fluids could persist for a relatively longer period after scleral buckling. Based on our results, we conclude that primary vitrectomy surgery is a better choice for macular recovery of the macula-off rhegmatogenous retinal detachment. PMID:23587195
Summary Background The aim of this paper is to report the incidence of retinal pigment epithelial (RPE) tears in patients treated with ranibizumab for subfoveal fibrovascular retinal pigment epithelial detachment (FVPED) due to occult age-related macular degeneration (AMD). Material/Methods Thirty patients were treated according to the following schedule: saturation phase, further treatment was based on activity of the degeneration process. Visual acuity (VA), optical coherence tomography (OCT) and fluorescein angiography (FA) parameters were evaluated and compared. Results Patients had a mean improvement of +4.7±8.1 letters at month 12. The mean number of needed injections was 6.8±1.8 (range, 3 to 9). RPE tears in fovea occurred in 8 cases (27% of all patients). Analysis of variance revealed significant upper mean values of ETDRS letters for the subgroup without RPE tears. Mean values of PED height were significant upper for RPE tears without baseline. Statistical analysis revealed that in the subgroup without RPE tears mean values of VA significantly differed in succeeding periods compare to baseline (P<0.001). Visual improvement or stabilization was observed in 90.9% of patients without RPE tears (significant improvement of 15 or more letters in 22.7%–5/22) and in 87.5% of patients with RPE tears (significant improvement was not observed). Baseline leakage parameters, lesion and leakage parameters at month 12 were significantly higher in patients with RPE tears. The chi-square test revealed statistically significant associations between RPE tears and subretinal fluid in OCT (P<0.05) at month 12. Conclusions In eyes with FVPED and RPE tears treated with ranibizumab, stabilization of visual acuity without significant improvement is predictable. One of the risk factors common to RPE tears may be baseline leakage parameters and pretreatment distorted RPE contour in OCT. During ranibizumab therapy in eyes with RPE tears, upper parameters of FVPED height may occur
Ben Yahia, Salim; Kahloun, Rim; Abroug, Nesrine; Kaibi, Imene; Laadhari, Ghassen; Jelliti, Bechir; Khairallah, Moncef
The purpose of this study is to compare the effect of topical diclofenac and topical dexamethasone on anterior chamber flare and postoperative pain following rhegmatogenous retinal detachment (RRD) surgery. This prospective study included 40 eyes of 40 patients treated for RRD. Twenty-eight patients underwent scleral buckling and 12 patients underwent 20-gauge pars plana vitrectomy (PPV). For each surgical procedure, patients were postoperatively randomly divided into two groups: the first group received topical dexamethasone phosphate 0.1 % four times daily for 28 days; the second group received topical diclofenac sodium 0.1 % three times daily for 28 days. The inflammatory reaction in the anterior chamber was measured with laser flare photometry preoperatively and 1, 7, 14, 28, and 90 days postoperatively. Pain level was evaluated with Scott's visual analog scale at day 1, 7, 14, and 28 postoperatively. For patients treated with scleral buckling, there was no significant difference between the two groups regarding mean aqueous flare at day 1 (p = 0.096), day 7 (p = 0.435), day 14 (p = 0.510), day 28 (p = 0.583), and day 90 (p = 0.423). The group who received diclofenac had significantly lower pain score at days 7, 14, and 28 (p = 0.048, p = 0.017, and p = 0.028, respectively). For patients treated with PPV, there was no significant difference between the two groups regarding mean aqueous flare at day 1 (p = 0.400), day 7 (p = 0.728), day 14 (p = 0.843), day 28 (p = 0.939), and day 90 (p = 0.568). Patients who received diclofenac had significantly lower pain score at days 7, 14, and 28 (p = 0.032, p = 0.030, and p = 0.023, respectively). Topical diclofenac seems to be as potent as topical dexamethasone in managing postoperative inflammatory response induced by surgery for RRD with better analgesic effect. Both of them are consequences of blood-aqueous barrier and blood-retinal barrier breakdown.
Lindsell, Luke B; Sisk, Robert A; Miller, Daniel M; Foster, Robert E; Petersen, Michael R; Riemann, Christopher D; Hutchins, Robert K
Objective To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs). Methods The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR). Results Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PPV group (P=0.62). Postoperative anterior chamber fibrin was highly correlated with PVR formation (PVR 13% vs no PVR 0.7%, P=0.003; odds ratio =68.37, P=0.007). Separate analysis of medium- to high-complexity cases showed similar SSAS (PPV 86% vs SB with PPV 83%, P=0.45). Conclusion SB with PPV versus PPV alone were similarly efficacious for repair of primary RRDs of varying complexity. SSAS rates, PVR incidence, and final visual acuities were not significantly different. PMID:28053500
Curti, Stefania; Coggon, David; Hannerz, Harald; Mattioli, Stefano
To investigate the relationship between rhegmatogenous retinal detachment (RRD) and frequent heavy lifting in a Danish working population through national register data. A dynamic cohort of all men aged 20-59 years in Denmark was followed through the Danish Occupational Hospitalisation Register from 1995 to 2010 for diagnosed RRD. Occupational categories were classified according to their potential for heavy lifting in 4 main groups: heavy lifters, manual workers unlikely to be heavy lifters, other manual workers and non-manual workers unlikely to be heavy lifters. The age-standardised rate of diagnosed RRD for heavy lifting occupations was compared with that experienced by the other 3 occupational categories. Rate ratios (RRs) and 95% CIs were estimated through a Poisson regression model adjusted for calendar period and age group. The highest age-standardised rate of diagnosed RRD was recorded among non-manual workers performing occupational activities unlikely to be associated with heavy lifting (18.0 cases per 100,000 person-years). The RR for workers in jobs expected to entail a high frequency of heavy lifting compared with manual workers whose occupation was unlikely to be associated with heavy lifting was 0.91 (95% CI 0.73 to 1.14), while in comparison with other manual workers, it was 0.93 (95% CI 0.78 to 1.11). The RR compared with non-manual workers in occupations unlikely to entail heavy lifting was 0.51 (95% CI 0.43 to 0.60). These findings do not support an association of occupational heavy lifting with diagnosed RRD. The epidemiological evidence for this association is still inconclusive. Future studies should use a more specific measure of exposure to resolve the outstanding uncertainties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Curti, Stefania; Coggon, David; Hannerz, Harald; Mattioli, Stefano
Objectives To investigate the relationship between rhegmatogenous retinal detachment (RRD) and frequent heavy lifting in a Danish working population through national register data. Methods A dynamic cohort of all men aged 20–59 years in Denmark was followed through the Danish Occupational Hospitalisation Register from 1995 to 2010 for diagnosed RRD. Occupational categories were classified according to their potential for heavy lifting in 4 main groups: heavy lifters, manual workers unlikely to be heavy lifters, other manual workers and non-manual workers unlikely to be heavy lifters. The age-standardised rate of diagnosed RRD for heavy lifting occupations was compared with that experienced by the other 3 occupational categories. Rate ratios (RRs) and 95% CIs were estimated through a Poisson regression model adjusted for calendar period and age group. Results The highest age-standardised rate of diagnosed RRD was recorded among non-manual workers performing occupational activities unlikely to be associated with heavy lifting (18.0 cases per 100 000 person-years). The RR for workers in jobs expected to entail a high frequency of heavy lifting compared with manual workers whose occupation was unlikely to be associated with heavy lifting was 0.91 (95% CI 0.73 to 1.14), while in comparison with other manual workers, it was 0.93 (95% CI 0.78 to 1.11). The RR compared with non-manual workers in occupations unlikely to entail heavy lifting was 0.51 (95% CI 0.43 to 0.60). Conclusions These findings do not support an association of occupational heavy lifting with diagnosed RRD. The epidemiological evidence for this association is still inconclusive. Future studies should use a more specific measure of exposure to resolve the outstanding uncertainties. PMID:26561504
Oellers, Patrick; Stinnett, Sandra; Hahn, Paul
Purpose Valved cannulas are a recent addition to small-gauge pars plana vitrectomy (PPV) and provide stable intraocular fluidics. The goal of this study was to compare outcomes and postoperative complication rates of valved vs nonvalved cannula small-gauge PPV for repair of retinal detachments (RDs) complicated by Grade C proliferative vitreoretinopathy (PVR). Methods A retrospective chart review of 364 consecutive eyes with either valved or nonvalved cannula PPV for RD repair was performed. The primary outcomes were single surgery and final anatomic success and change in best-corrected visual acuity for repair of RDs complicated by Grade C PVR. Results We identified 36 eyes in the valved group and 31 eyes in the nonvalved group with Grade C PVR RD. The single surgery success was 83% vs 77% (P=0.555) and the final anatomic success was 94% vs 87% (P=0.404) in the valved vs nonvalved eyes, respectively. The mean final visual acuity gain was −0.36 logarithm of the minimum angle of resolution (logMAR; approximate Early Treatment Diabetes Retinopathy Study [ETDRS] score =17 letters) in valved eyes vs −0.33 logMAR (approximate ETDRS score =16 letters) in nonvalved eyes (P=0.81). Postoperative complication rates including postoperative day 1 hypotony, hypertony, and anterior chamber fibrin formation; postoperative retention of intraocular or subretinal perfluorocarbon liquid; and subsequent epiretinal membrane peel were not statistically different between groups. Conclusion Valved cannula PPV yields equivalent visual acuity and anatomic outcomes without increased postoperative complication rates compared to traditional nonvalved cannula PPV for Grade C PVR-associated RD repair. PMID:27313445
Liu, Haiyang; Zhu, Hong; Li, Tong; Zhang, Pengfei; Wang, Ning; Sun, Xiaodong
This study investigated the neuroprotective effect against photoreceptor cell death using prolyl-4-hydroxylases inhibitor (PHI), an HIF-1α stabilizer, in experimental retinal detachment (RD). RD was created in Brown Norway rats by subretinal injection of 1% sodium hyaluronate. FG-4592 (a PHI, 25 mg/kg) or a vehicle was administered every 2 days with retro-orbital injection. Photoreceptor death was evaluated by TdT-dUTP terminal nick-end labeling (TUNEL) assay 3 days after RD and by the thickness of the outer nuclear layer 7 days after RD. The mitophagy-related markers Hypoxia Inducible Factor 1α (HIF-1α), BCL2/adenovirus E1B 19 kDa protein-interacting protein 3 (BNIP3), autophagy-related gene 5 (Atg5), microtubule-associated protein 1 light chain 3 beta (LC3B), and FUN14 domain containing 1 (FUNDC1) were detected by Western blot and immunofluorescence. Transmission electron microscopy was used to observe ultramicro-morphological changes. Mitochondrial damage was evaluated by the measurement of reactive oxygen species (ROS) by in situ ROS detection with dihydroethidium. The accumulation of HIF-1α and BNIP3 significantly increased after PHI treatment (P < 0.05), the pattern of Atg5 and LC3 changed, and FUNDC1 and LC3 were colocated. More autophagic vacuoles engulfing mitochondria were observed in transmission electron microscopy sections after PHI treatment when compared with the control. ROS significantly decreased in the PHI-treatment group (P < 0.05). This resulted in reduced TUNEL-positive photoreceptors 3 days after RD and an increased thickness of the outer nuclear layer 7 days after RD (P < 0.05). HIF-1α stabilization as a result of PHI treatment, along with the enhancement of mitophagy, could provide protection against photoreceptor injury following RD, which might be mediated by excessive ROS generation.
Fife, Daniel; Zhu, Vivienne; Voss, Erica; Levy-Clarke, Grace; Ryan, Patrick
A recent Canadian case-control study reported a 4.5-fold increased risk of retinal detachment (RD) during oral fluoroquinolone use. Of the fluoroquinolone-exposed cases, 83 % were exposed to ciprofloxacin. We sought to replicate this finding, and assess whether it applied to all fluoroquinolones. In two large US healthcare databases, we performed three case-control analyses: one replicating the recent study; one addressing additional potential confounders; and one that increased sample size by dropping the Canadian study's requirement for a prior ophthalmologist visit. We also performed a self-controlled case-series (SCCS) analysis in which each subject served as his or her own comparator. In the replication case-control analyses, the adjusted odds ratios (ORs) for any exposure to fluoroquinolones or ciprofloxacin were approximately 1.2 in both databases, and were statistically significant, and the ORs for current exposure were modestly above 1 in one database, modestly below 1 in the other, and not statistically significant. In the other case-control analyses, the ORs were close to 1. In a post hoc age-stratified case-control analysis, we observed an association of RD with fluoroquinolone exposure among older subjects in one of the two databases. All estimates from the SCCS analyses were below 1.2 and none was statistically significant. The present study does not confirm the recent Canadian study's finding of a strong relationship between RD and current exposure to fluoroquinolones. Instead, it found a modest association between RD and current or any exposure to fluoroquinolones in the case-control analyses, and no association in the SCCS analyses.
Balaratnasingam, Chandrakumar; Yannuzzi, Lawrence A.; Curcio, Christine A.; Morgan, William H.; Querques, Giuseppe; Capuano, Vittorio; Souied, Eric; Jung, Jesse; Freund, K. Bailey
Purpose Drusenoid pigment epithelial detachments (PEDs) are a defined path to atrophy in age-related macular degeneration (AMD). We analyzed the relationships between retinal pigment epithelium (RPE) and drusen volume changes during the PED lifecycle, using spectral-domain optical coherence tomography (SD-OCT). Methods Twenty-one cases of drusenoid PED tracked using SD-OCT through periods of growth and collapse were evaluated. Volumetric calculations and piece-wise linear regression analysis were used to determine the breakpoint between growth and collapse. Spectral-domain OCT scans were independently evaluated for the appearance of intraretinal hyperreflective foci, acquired vitelliform lesions (AVLs), and disruptions to the RPE+basal lamina band. Timing of these events with respect to the breakpoint was statistically evaluated. Morphometric characteristics of drusenoid PEDs were correlated with rate of PED collapse and final visual acuity. Results Mean age of subjects was 75.3 years and mean period of follow up was 4.1 years (median 4.5 years; range, 0.6–6.6 years). The lifecycle of drusenoid PEDs was asymmetric, in that the rate of collapse (0.199 mm3/month) is significantly faster (P < 0.001) than the rate of growth (0.022 mm3/month). Appearance of intraretinal hyperreflective foci and AVLs preceded the breakpoint (both P < 0.001). The timing of disruptions to the RPE+basal lamina band did not differ from the breakpoint (P = 0.510). Maximal height, volume, and diameter of drusenoid PEDs were inversely correlated with final visual acuity (all P < 0.001) and positively correlated with the rate of PED collapse (all P < 0.001). Conclusions Spectral-domain OCT signatures, plausibly attributable to anteriorly migrated RPE and disintegration of the RPE layer, precede or occur simultaneously with changes in volume of drusenoid PED during the lifecycle of this lesion. PMID:27760262
Sorkin, Nir; Einan-Lifshitz, Adi; Ashkenazy, Zach; Boutin, Tanguy; Showail, Mahmood; Borovik, Armand; Alobthani, Murad; Chan, Clara C; Rootman, David S
To present a modified surgical technique to perform Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes and to analyze its safety and efficacy. A retrospective analysis of previously vitrectomized eyes that underwent DMEK at Toronto Western Hospital was performed. The modified DMEK technique that was used included placement of a posterior pars plana infusion to reduce fluctuations in the anterior chamber depth and its excessive deepening. Twelve eyes of 12 patients (5 females and 7 males) aged 65.3 ± 21.5 years were included. Mean best-corrected visual acuity improved significantly from 1.72 ± 0.62 logMAR (mean Snellen ∼20/1040) preoperatively to 1.01 ± 0.64 logMAR (mean Snellen ∼20/200) at 6 months postoperatively (P = 0.017). Mean donor endothelial cell density was 2658 ± 229 cells/mm preoperatively and 1732 ± 454 cells/mm at 6 months after the procedure (mean percentage cell loss of 31.8%) (P = 0.046). There were no significant intraoperative complications, and no graft failures. One eye had graft detachment, which resolved after 2 rebubbling procedures. One eye had retinal detachment, which was corrected surgically. The use of posterior pars plana infusion in previously vitrectomized eyes stabilizes the anterior segment during DMEK, allowing for performance of DMEK surgery, and can potentially reduce intraoperative and postoperative complications.
Lin, Xiaofeng; Sun, Xuyuan; Wang, Zhenfang; Jiang, Zhaoxin; Liu, Yaqin; Wang, Peijuan; Gao, Qianying
Purpose We previously designed a novel foldable capsular vitreous body (FCVB) to treat severe retinal detachment and evaluated its performance in a 1-year follow up study. The purpose of this study was to determine the efficacy and safety of a silicone oil (SO)-filled FCVB in a 3-year follow-up. Methods Standard three-port pars plana vitrectomy was performed, and the FCVB was triple folded and implanted in the vitreous cavity of three eyes. The SO then was injected into the capsule to support the retina. The eyes were examined using Goldmann applanation tonometry, fundus photography, optical coherence tomography (OCT), noncontact specular microscopy, and ultrasound biomicroscopy over a 3-year implantation period. Results At the 3-year follow-up, retinal reattachment was achieved in all three cases, with steady intraocular pressure. The visual acuity showed slight fluctuations, and it was slightly increased compared to baseline. Optical coherence tomography revealed decreased retinal thickness and an altered retinal structure in the implanted eyes compared to the control eyes. No keratopathy, glaucoma, SO leakage, SO emulsification, or other apparent complications occurred during the observation period. Conclusion The SO-filled FCVB was effective and safe as a vitreous substitute in three eyes over a 3-year observation period. Translational Relevance Silicone oil emulsification is a severe complication after retinal detachment surgery. On the basis of animal experiments, we investigated a new strategy and product, the FCVB, to overcome this complication. In this pilot study, FCVB limited SO emulsification and migration. This study could lay the foundation for a further multicenter clinical trial. PMID:26855843
Carpineto, Paolo; Aharrh-Gnama, Agbeanda; Ciciarelli, Vincenzo; Borrelli, Enrico; Petti, Francesco; Aloia, Raffaella; Lamolinara, Alessia; Di Nicola, Marta; Mastropasqua, Leonardo
To evaluate signal transduction and early apoptosis protein levels in subretinal fluid collected during scleral buckling surgery for macula-off rhegmatogenous retinal detachment (RRD). Our aim was to assess both their relation with RRD features and their influence on the posttreatment outcome. Thirty-three eyes of 33 RRD patients scheduled for scleral buckle surgery were enrolled in the study. Undiluted subretinal fluid samples were collected during surgery and analyzed via magnetic bead-based immunoassay. All patients underwent a complete ophthalmologic evaluation at baseline and at each follow-up visit (months 1, 3, and 6). Moreover, both at baseline and at the postsurgery month 6 visit, the patients were tested by means of spectral-domain optical coherence tomography (SD-OCT) in order to evaluate the average ganglion cell-inner plexiform complex thickness, as well as the photoreceptor inner segment/outer segment junction status. Patients' clinical features (retinal detachment size, detachment duration, and occurrence of proliferative vitreoretinopathy) were associated with several early apoptotic factors (caspase-8, caspase-9, and B-cell lymphoma 2 [Bcl-2]-associated death promoter [BAD]). Furthermore, both early apoptosis factors (caspase-8, Bcl-2, and p53) and signal-transduction proteins (ERK 1/2) were found to influence the postsurgery month 3 OCT characteristics. Signal-transduction proteins and early apoptosis proteins are associated with different clinical features and postsurgery outcomes.
Vardanyan, A H; Hovakimyan, A V; Hambartsumyan, A V
The aim of the current study is the efficiency assessment of C3F8 gas usage in posterior vitrectomies in patients having retinal detachment of different etiologies with presence of proliferative vitreoretinopathies and retinal tears. 34 patients have undergone posterior vitrectomy with the usage of perfluoropropane C3F8 gas for providing internal tamponade. Total attachment of retina has been attached in all 34 cases and C3F8 gas has been injected in each eye. The most frequent complications that have been revealed after the usage of C3F8 gas and their management are reflected in the article. Thus, we came to a conclusion that vitrectomy in combination with episcleral buckling, transvitreal drainage of subretinal liquid, diode endolaser coagulation of retina and internal tamponade with C3F8 gas is effective and pathogenetikally proved method for treatment of rhegmatogenous retinal detachments complicated with severe vitreoretinopathies. The achievement of perfect anatomical results depends on manifestation degree of proliferative vitreoretinopathy. This study was supported by grant of the Ministry of Health of Armenia.
Grigorian, E N; Anton, H J
Morphological changes and proliferative activity of the neural retina cells after the neural retina detachment were studied in the newts subjected to microgravity in a clinostat. According to theoretical calculations, simulated microgravity could vary from 3.21 x 10(-2) to 8.05 x 10(-3) g. These conditions had a positive effect on morphological and functional restoration of the neural retina according to various criteria. Specifically, the increased number of Mullerian glial cells, increased relative volume of the plexiform layers, decreased mortality of the detached neural retina cells and increased redifferentiation of the retinal pigment epithelium and reattachment of the neural retina were observed. These changes were mainly found in the dorsal and central areas of the neural retina.
Tolou, C; Mahieu-Durringer, L; Cassagne, M; Hamid, S; Billette de Villemeur, R; Gualino, V; Susini, A; Pagot Mathis, V; Gallini, A; Soler, V
Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. Observational, cross-sectional, multicentric study, carried out over a 6-month period. time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center. Copyright © 2015. Published by Elsevier Masson SAS.
Brillat, Eva; Rouberol, Frédéric; Palombi, Karine; Quesada, Jean-Louis; Bernheim, Diane; Albaladejo, Pierre; Aptel, Florent; Romanet, Jean-Paul; Chiquet, Christophe
The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD). Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding. Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09). This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.
... is cataract surgery different for someone with high myopia? Oct 01, 2015 Can I Fly with Central ... for Early Alzheimer’s Detection? Aug 08, 2016 Eye Exercises May Improve Vision Around Blind Spot Sep 29, ...
Thimons, J J
Posterior vitreous detachment is an expected consequence of aging, but it can also be the initiating cause of a retinal detachment. To understand the mechanism of posterior vitreous detachment and its sequelae, it is necessary to appreciate the anatomy of the vitreous, its development, and the pathogenesis of vitreous degeneration. This paper is a discussion of these considerations, the types of complications that may result from vitreous detachment, the proper examination of patients who present with the symptoms of vitreous detachment, and appropriate patient management.
[Retinal detachment after perforating injuries of the eye. I. Analysis of anamnestic data related to the injury, analysis of deficiencies in the primary care of the eye injury and principles of prevention of post-traumatic retinal detachment].
In 1977-1987 the authors operated by the cryosurgical method 69 patients on account of detachment of the retina. The detachment occurred in 37 patients after simple perforation of the eye and in 32 patients after perforation with a foreign intraocular body. In all patients the perforation penetrated as far as the vitreous body. In the first part of the paper the authors analyze in detail anamnestic data related to the injury: age, mechanism of injury, rapidity and method of surgical treatment, chemical nature of foreign body and its size, rapidity and method of extraction of the foreign body. In the subsequent part the authors define the principles of prevention of post-traumatic detachment of the retina during surgical treatment of the injury. Finally the basic shortcomings of primary treatment of the injury from the aspect of detachment of the retina are outlined, as recorded in the group treated by the authors.
Imai, Hisanori; Tagami, Mizuki; Azumi, Atsushi
Purpose The aim of this study is to report the result of scleral buckling (SB) using a combination of a noncontact wide-angle viewing system and a cannula-based 25 G chandelier endoilluminator. Methods Retrospective analyses of the medical records of 79 eyes of 79 patients with primary uncomplicated rhegmatogenous retinal detachments who had underwent SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator were performed. Results There were 50 men and 29 women. The mean ± standard deviation age was 43.7±16.0 years. Their preoperative best-corrected visual acuity (BCVA) was 0.31±0.65 logMAR units. The final BCVA was 0.10±0.31 logMAR units, which was significantly better than the preoperative BCVA (P<0.01). The initial and final anatomical success rates were 92.4% and 100%, respectively. Backward logistic multiple regression analysis revealed no relationship between explanatory variables and the primary anatomic success (P=0.104). Conclusion SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator is a modified new technique and may be a valid option for the management of rhegmatogenous retinal detachments. PMID:26635466
Grannis, Charity H; Dewan, Vinay N; Wang, Robert C
To describe a case of a patient with multiple myeloma without extraocular end-organ damage but with cystoid macular edema and macular detachments who was treated with bortezomib and dexamethasone. There was a complete resolution of retinal and subretinal fluid and significant improvement of vision. The patient's ocular disease was monitored with visual acuity, dilated fundus examinations, and optical coherence tomography before, during, and after treatment. The patient in this case report was a 43-year-old African American man with a medical history of untreated, "smoldering" multiple myeloma, hypertension, hyperlipidemia who presented to our clinic with progressive painless loss of vision in both eyes over 6 weeks. Before treatment with bortezomib and dexamethasone, the patient had complaints of confusion, muscle stiffness, joint pain, and 20-lb unintentional weight loss; however, he did not have hypercalcemia, renal insufficiency, anemia, or bone lesions typical of active multiple myeloma. The bilateral cystoid macular edema and subfoveal neurosensory retinal detachments, noted on presentation and confirmed by optical coherence tomography, completely resolved over the course of treatment with bortezomib and dexamethasone. This case of bilateral cystoid macular edema and subfoveal neurosensory retinal detachments is remarkable for both its presentation and response to therapy. The macular edema and macular detachments along with nonspecific complaints of confusion, muscle stiffness, joint pain, and weight loss were the presenting signs and symptoms; signs typically used as guides to initiate treatment for multiple myeloma were not present. Macular edema in the context of paraproteinemia is usually associated with Waldenstrom's macroglobulinemia and has classically been reported as "silent" with respect to fluorescein angiography. Our patient has multiple myeloma and demonstrated leakage on fluorescein angiography. The case is also notable in that there was
Matsumura, Takehiro; Takamura, Yoshihiro; Tomomatsu, Takeshi; Arimura, Shogo; Gozawa, Makoto; Kobori, Akira; Inatani, Masaru
To evaluate the efficacy of the inverted internal limiting membrane (ILM) flap technique in vitrectomy for macular hole (MH) with retinal detachment (RD) compared with vitrectomy using ILM peeling. A retrospective case series study was performed. Twenty-two eyes of 22 patients who underwent vitrectomy for MH with RD and followed-up more than 12 months after the surgery were included in this study. We retrospectively reviewed the medical records of patients who underwent vitrectomy with inverted ILM flap technique or vitrectomy with ILM peeling. Ten patients who had been treated vitrectomy with inverted ILM flap technique, and 12 patients who had been treated vitrectomy with ILM peeling were analyzed. We evaluated changes in best-corrected visual acuity (BCVA) before and after surgery, closing rates of MH, and retinal reattachment rates and compared between both groups. MH was closed and RD was reattached postoperatively in 9 eyes (90%) in the inverted ILM flap group. In the ILM peeling group, the MH was closed in 4 eyes (33.3%) and the retinas were reattached in 6 eyes (50%) after surgery. Significant improvement in BCVA after surgery (P = 0.0017) was only found in the inverted ILM flap group. Higher rates of closed MH and retinal reattachment, and small but significant improvement in BCVA were found in the inverted ILM flap group. Based on our data, the inverted ILM flap technique may be useful in vitrectomy for MH with RD.
Matsumura, Takehiro; Takamura, Yoshihiro; Tomomatsu, Takeshi; Arimura, Shogo; Gozawa, Makoto; Kobori, Akira; Inatani, Masaru
Purpose To evaluate the efficacy of the inverted internal limiting membrane (ILM) flap technique in vitrectomy for macular hole (MH) with retinal detachment (RD) compared with vitrectomy using ILM peeling. Methods A retrospective case series study was performed. Twenty-two eyes of 22 patients who underwent vitrectomy for MH with RD and followed-up more than 12 months after the surgery were included in this study. We retrospectively reviewed the medical records of patients who underwent vitrectomy with inverted ILM flap technique or vitrectomy with ILM peeling. Ten patients who had been treated vitrectomy with inverted ILM flap technique, and 12 patients who had been treated vitrectomy with ILM peeling were analyzed. We evaluated changes in best-corrected visual acuity (BCVA) before and after surgery, closing rates of MH, and retinal reattachment rates and compared between both groups. Results MH was closed and RD was reattached postoperatively in 9 eyes (90%) in the inverted ILM flap group. In the ILM peeling group, the MH was closed in 4 eyes (33.3%) and the retinas were reattached in 6 eyes (50%) after surgery. Significant improvement in BCVA after surgery (P = 0.0017) was only found in the inverted ILM flap group. Conclusions Higher rates of closed MH and retinal reattachment, and small but significant improvement in BCVA were found in the inverted ILM flap group. Based on our data, the inverted ILM flap technique may be useful in vitrectomy for MH with RD. PMID:27764184
Chapin, Ethan A.; Luna, Gabriel; Linberg, Kenneth A.; Fisher, Steven K.
Purpose To study the fate of Müller’s glia following experimental retinal detachment, using a “pulse/chase” paradigm of bromodeoxyuridine (BrdU) labeling for the purpose of understanding the role of Müller cell division in subretinal scar formation. Methods Experimental retinal detachments were created in pigmented rabbit eyes, and 3 days later 10 µg of BrdU was injected intravitreally. The retinas were harvested 4 h after the BrdU was administered (i.e., day 3) or on days 4, 7, and 21 post detachment. The tissue was fixed, embedded in agarose, and sectioned at 100 µm. The sections were labeled with various combinations of probes, including anti-vimentin and anti-S100 (as markers for Müller cells), anti-BrdU, anti-phosphohistone H3 (to identify mitotic cells), and the isolectin B4 (to identify macrophages and microglia). Images were captured using an Olympus Fluoview 500 confocal microscope. To aid in our understanding of how Müller cell nuclei undergo cell division, two additional procedures were used: 1) electron microscopy of normal cat and rabbit retinas and 2) a new method using 5-fluorouracil and subsequent anti-BrdU labeling to detect all Müller cell nuclei, using confocal imaging. Results Three days after detachment, anti-vimentin labeled all Müller cells, some of which were also labeled with anti-BrdU. On day 4, many of the anti-BrdU-labeled Müller cell nuclei appeared in columns with one labeled nucleus in the inner nuclear layer and another directly sclerad to it in the outer nuclear layer. By day 7, most anti-BrdU-labeled nuclei were observed in subretinal scars. At 3 weeks, some anti-BrdU-labeled nuclei that remained within the retina did not express vimentin or S100. Anti-phosphohistone H3-labeled (i.e., mitotic) cells, some of which were also labeled with anti-BrdU, were only observed in the outer nuclear layer on day 4, and these nuclei were surrounded by an accumulation of vimentin filaments. Isolectin B4-labeled microglia and
Kim, Jin Young; Park, Sung Pyo
This case report describes macular hole (MH) formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A 58-year-old man referred with a macula-off superior RRD, in whom vitrectomy was performed. MH with vitreomacular traction (VMT) caused by the posterior vitreous cortex remnants developed 2 weeks after vitrectomy. Four weeks postoperatively, optical coherence tomography revealed resolution of the VMT and spontaneous closure of MH without providing any treatment. This is the first report of an MH formation and spontaneous closure after vitrectomy for RRD. This suggests that the VMT mediated by the posterior vitreous cortex remnants has an important role in the development of secondary MH. PMID:26655006
Bhat, Vishalakshi; D’Souza, Palmeera; Shah, Parag K.; Narendran, V.
Purpose: To review the surgical outcomes of intravitreal bevacizumab (IVB) along with subretinal fluid drainage with cryotherapy in patients with stage 3B Coats’ disease. Materials and Methods: A retrospective study of seven cases of stage 3B Coats’ disease, who underwent subretinal fluid drainage with cryopexy, from May 2011 to March 2014. Five eyes received additional IVB at the end of surgery. Green laser therapy was performed on telangiectatic vessels postoperatively. Results: The mean age was 34 months (range, 10-84 months). Mean follow-up was 19 months. Six patients (85.7%) had an attached retina at final follow-up. Three out of four patients (75%) that received IVB developed tractional retinal detachments (TRDs). Two eyes that did not receive bevacizumab did not develop any traction. None progressed to neovascular glaucoma or phthisis bulbi. Conclusion: Simultaneous injection of bevacizumab along with subretinal drainage and cryotherapy for advanced Coats’ disease could not avoid TRD. PMID:27162454
Fernández-Vega Sanz, Álvaro; Rangel, Carlos Mario; Villota Deleu, Eva; Fernández-Vega Sanz, Beatriz; Sánchez-Ávila, Ronald Mauricio
Objective. Serous retinal detachment (SRD) is a common anatomical complication associated with dome-shaped macula (DSM) and staphyloma margin in myopic patients. Here we described the anatomical and functional outcomes obtained with the use of oral spironolactone, a mineralocorticoid antagonist, in the management of myopic patients with SRD associated with DSM and staphyloma margin. Methods. We evaluated both eyes of twelve myopic patients with long-standing SRD associated with DSM or staphyloma margin. The patients were treated daily for six months with oral spironolactone 50 mg. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT), determined by optical coherence tomography, were evaluated on the first day and on monthly follow-up visits. Results. Pretreatment BCVA (mean ± standard deviation) was 0.406 ± 0.324 LogMAR, and posttreatment BCVA was 0.421 ± 0.354 LogMAR (P = 0.489). Pretreatment CRT was 323.9 ± 78.6 μm, and after six months of treatment it was significantly lower, 291.2 ± 74.5 μm (P = 0.010). There were no treatment-related complications. Conclusions. We evaluated a novel treatment for SRD associated with DSM and staphyloma margin in myopic patients. After six months of treatment with the mineralocorticoid antagonist spironolactone, the subretinal fluid and CRT were significantly reduced; however, there was no improvement in BCVA. PMID:26942003
... be serious enough to cause blindness. Examples are Macular degeneration - a disease that destroys your sharp, central vision Diabetic eye disease Retinal detachment - a medical emergency, when the retina is ... children. Macular pucker - scar tissue on the macula Macular hole - ...
... is cataract surgery different for someone with high myopia? Oct 01, 2015 Can I Fly with Central ... for Early Alzheimer’s Detection? Aug 08, 2016 Eye Exercises May Improve Vision Around Blind Spot Sep 29, ...
... is cataract surgery different for someone with high myopia? Oct 01, 2015 Can I Fly with Central ... for Early Alzheimer’s Detection? Aug 08, 2016 Eye Exercises May Improve Vision Around Blind Spot Sep 29, ...
Tosi, Gian Marco; Marigliani, Davide; Bacci, Tommaso; Romeo, Napoleone; Balestrazzi, Angelo; Martone, Gianluca; Caporossi, Tomaso
Purpose. To evaluate the effectiveness and safety of perfluorohexyloctane (F6H8) for intraoperative flattening of the retina and of F6H8/silicone oil (SO) 1000 cSt as a postoperative tamponade for inferior retinal detachment with inferior proliferative vitreoretinopathy. Methods. This is a retrospective review of 22 patients who underwent pars plana vitrectomy using F6H8 as an intraoperative tool to flatten the retina. At the end of the surgery a direct partial exchange between F6H8 and SO 1000 cSt was performed, tamponing the eye with different ratios of F6H8/SO (70/30, 60/40, 50/50, 40/30, and 30/70). Anatomical and functional results and complications were evaluated over the follow-up period (mean 22.63 months). Results. F6H8 was efficacious for intraoperative flattening of the retina. Twenty-one of the 22 patients achieved a complete retinal reattachment. Postoperative visual acuity (VA) ranged from light perception to 20/70, with 72% of patients obtaining VA better than 20/400. No emulsification/inflammation was observed whatever the ratio of F6H8/SO used. With higher ratios of F6H8/SO (70/30 and 60/40) cloudiness of the tamponade was observed. A transparent mixture was present with all the other ratios. Conclusions. The surgical technique adopted is very simple and safe. The optimal F6H8/SO ratio seems to be between 50/50 and 30/70.
Tee, J J L; Veckeneer, M; Laidlaw, D A
Purpose To investigate the incidence and natural history of persistent subfoveolar fluid (PSF) following surgery for macular off rhegmatogenous retinal detachment and the effect of PSF on photoreceptor structure and final visual acuity. Methods Retrospective study of 61 cases with post-operative optical coherence tomography (OCT) performed within 12 weeks of surgery. Based on aetiology, cases were categorized into tractional retinal tears (TRT) group or atrophic round holes and dialyses (RHD) group to investigate the incidence and duration of PSF. A Kaplan–Meier graph was plotted to compare survival time of subfoveolar fluid for both groups. Following secondary reclassification of cases into those with and without PSF, the effect of PSF on final visual acuity and photoreceptor structure was investigated with Mann–Whitney U-test used for comparison. Spearman's correlation testing was used to probe associations between time to recorded resolution of PSF with final visual acuity and photoreceptor structure. Results Incidence of PSF was greater in the RHD group and persisted for longer compared with TRT group. No detectable adverse effect of PSF on final visual acuity was seen however an individual case of severe photoreceptor atrophy was observed. No significant correlation was found between the time to recorded resolution of PSF and the final visual acuity or to photoreceptor grading scores. Conclusions A difference in incidence of PSF was detected between the aetiological groups. PSF was ubiquitous and slow to resolve in the RHD group. Most cases of PSF resolve without adverse sequelae; however, progressive photoreceptor atrophy and sub-optimal visual outcome may result in a minority. PMID:26742870
Tosi, Gian Marco; Bacci, Tommaso; Romeo, Napoleone; Balestrazzi, Angelo; Martone, Gianluca; Caporossi, Tomaso
Purpose. To evaluate the effectiveness and safety of perfluorohexyloctane (F6H8) for intraoperative flattening of the retina and of F6H8/silicone oil (SO) 1000 cSt as a postoperative tamponade for inferior retinal detachment with inferior proliferative vitreoretinopathy. Methods. This is a retrospective review of 22 patients who underwent pars plana vitrectomy using F6H8 as an intraoperative tool to flatten the retina. At the end of the surgery a direct partial exchange between F6H8 and SO 1000 cSt was performed, tamponing the eye with different ratios of F6H8/SO (70/30, 60/40, 50/50, 40/30, and 30/70). Anatomical and functional results and complications were evaluated over the follow-up period (mean 22.63 months). Results. F6H8 was efficacious for intraoperative flattening of the retina. Twenty-one of the 22 patients achieved a complete retinal reattachment. Postoperative visual acuity (VA) ranged from light perception to 20/70, with 72% of patients obtaining VA better than 20/400. No emulsification/inflammation was observed whatever the ratio of F6H8/SO used. With higher ratios of F6H8/SO (70/30 and 60/40) cloudiness of the tamponade was observed. A transparent mixture was present with all the other ratios. Conclusions. The surgical technique adopted is very simple and safe. The optimal F6H8/SO ratio seems to be between 50/50 and 30/70. PMID:24672710
A case of postvitrectomy hemorrhage with secondary glaucoma successfully treated with an office-based fluid to fluid exchange is described. A 25 Ga trocar was placed 3 mm from the sclerocorneal limbus at the 2 o'clock position and connected to a 250 cc elevated bottle of balanced salt solution (BSS) through an intravenous (IV) line and an infusion cannula. Afterward, a 25 Ga needle was inserted 3 mm from the limbus at the 5 o'clock position approximately. The BSS fluid entered the eye through the 25 Ga trocar lavaging the vitreous cavity and the anterior chamber. About 4 to 6 cc of hemorrhagic fluid egressed the eye through the 25 Ga needle. PMID:28321352
Patel, K H; Chow, C C; Rathod, R; Mieler, W F; Lim, J I; Ulanski, L J; Leiderman, Y I; Arun, V; Chau, F Y
Purpose The aim of this study is to report the short-term efficacy of aflibercept in the treatment of neovascular age-related macular degeneration (AMD) with associated retinal pigment epithelial detachment (PED) which is refractory or develops tachyphylaxis to bevacizumab and ranibizumab. Methods The method comprised a retrospective review of the medical records of patients with neovascular AMD and associated PEDs recently treated with aflibercept and previously treated with bevacizumab and ranibizumab. Results Three eyes of three female patients of ages 49, 55, and 65 years old with large serous PEDs and subretinal fluid (SRF) associated with occult choroidal neovascularization and neovascular AMD were treated with aflibercept after intravitreal bevacizumab and/or ranibizumab failed to resolve the lesions. All had complete resolution of SRF and complete or near-complete resolution of the PEDs after aflibercept injections over a 3-month period. Visual acuity improved in all three eyes. Conclusion Intravitreal aflibercept may be an effective treatment option for serous PED in neovascular AMD patients after bevacizumab and ranibizumab have previously failed. Larger studies with longer follow-up are required to determine the role of aflibercept in treatment of PED in neovascular AMD. PMID:23558214
Peng, Jie; Zhang, Qi; Jin, Haiying; Fei, Ping; Zhao, Peiquan
To present the use of a 24-G Optiva® i.v. catheter for external drainage of subretinal fluid (SRF) in bullous exudative retinal detachment (RD). Thirteen eyes with bullous exudative RD were included in our study. SRF drainage was accomplished via a transconjunctival scleral incision with a 24-G catheter followed by laser treatment, vitrectomy, or anti-VEGF treatment, as needed. Data on age, indications, visual acuities, the number of drainage times, drainage duration, complications, and fundoscopy were collected. Two females and 11 males, with a mean age of 4.2 ± 2.7 years, were included. Surgical indications included exudative RD caused by Coats disease (12 eyes) and Sturge- Weber syndrome (1 eye). Successful drainage was achieved in all cases. The mean duration of the SRF drainage procedure was 63.5 ± 16.9 s. Except for 1 case of localized subretinal haemorrhage, no complications were noted. External drainage of SRF using a 24-G Optiva® i.v. catheter is safe, efficient, and useful. © 2017 S. Karger AG, Basel.
Kayama, Maki; Nakazawa, Toru; Thanos, Aristomenis; Morizane, Yuki; Murakami, Yusuke; Theodoropoulou, Sofia; Abe, Toshiaki; Vavvas, Demetrios; Miller, Joan W.
Photoreceptor apoptosis is a major cause of vision loss in many ocular diseases. Significant progress has been made to elucidate the molecular pathways involved in this process, yet little is known about proteins counteracting these apoptotic pathways. It is established that heat shock proteins (HSPs) function as molecular helper proteins (chaperones) by preventing protein aggregation and facilitating refolding of dysfunctional proteins, critical to the survival of all organisms. Here, we investigated the role of HSP70 on photoreceptor survival after experimental retinal detachment (RD) in mice and rats. We found that HSP70 was up-regulated after RD and associated with phosphorylated Akt, thereby preventing its dephosphorylation and further activation of cell death pathways. Administration of quercetin, which inhibits HSP70 and suppresses Akt phosphorylation significantly increased photoreceptor apoptosis. Similarly, RD-induced photoreceptor apoptosis was augmented in mice carrying hypomorphic mutations of the genes encoding HSP70. On the other hand, administration of geranylgeranylacetone, which induces an increase in HSP70 significantly decreased photoreceptor apoptosis after RD through prolonged activation of Akt pathway. Thus, HSP70 may be a favorable potential target to increase photoreceptor cell survival after RD. PMID:21356360
Gao, Xinxiao; Guo, Jia; Meng, Xin; Wang, Jun; Peng, Xiaoyan; Ikuno, Yasushi
To evaluate the anatomical and visual outcomes by par plana vitrectomy with or without internal limiting membrane (ILM) peeling in highly myopic eyes with macular hole retinal detachment (MHRD). MEDLINE (Ovid, PubMed) and EMBASE were used for data collection up to September 30, 2015. The parameters of anatomical success, macular hole closure and improved best corrected visual acuity (BCVA) at or beyond 6 months after operation were assessed as the primary outcome measurement. The meta-analysis was performed with the fixed-effects model. Seven comparative analyses involving a total of 373 patients were included in the present meta-analysis. Statistically the pooled data showed significant relative risk (RR) in terms of primary reattachment between ILM peeling and non-peeling groups (RR, 1.19; 95 % CI, 1.04 to 1.36; P = 0.012). An effect favoring ILM peeling with regard to macular hole closure was also detected (RR, 1.71; 95 % CI, 1.20 to 2.43; P = 0.003). However, no statistically significant difference was found in the improved BCVA (logarithm of the minimum angle of resolution) at 6 months or more (95 % CI, -0.31 to 0.44; P = 0.738). There is no proved benefit of postoperative visual improvement. However, the available evidences from this study suggested a superiority of ILM peeling over no peeling for myopic patients with MHRD.
Collin, Gayle B.; Hubmacher, Dirk; Charette, Jeremy R.; Hicks, Wanda L.; Stone, Lisa; Yu, Minzhong; Naggert, Jürgen K.; Krebs, Mark P.; Peachey, Neal S.; Apte, Suneel S.; Nishina, Patsy M.
Human gene mutations have revealed that a significant number of ADAMTS (a disintegrin-like and metalloproteinase (reprolysin type) with thrombospondin type 1 motifs) proteins are necessary for normal ocular development and eye function. Mutations in human ADAMTSL4, encoding an ADAMTS-like protein which has been implicated in fibrillin microfibril biogenesis, cause ectopia lentis (EL) and EL et pupillae. Here, we report the first ADAMTSL4 mouse model, tvrm267, bearing a nonsense mutation in Adamtsl4. Homozygous Adamtsl4tvrm267 mice recapitulate the EL phenotype observed in humans, and our analysis strongly suggests that ADAMTSL4 is required for stable anchorage of zonule fibers to the lens capsule. Unexpectedly, homozygous Adamtsl4tvrm267 mice exhibit focal retinal pigment epithelium (RPE) defects primarily in the inferior eye. RPE dedifferentiation was indicated by reduced pigmentation, altered cellular morphology and a reduction in RPE-specific transcripts. Finally, as with a subset of patients with ADAMTSL4 mutations, increased axial length, relative to age-matched controls, was observed and was associated with the severity of the RPE phenotype. In summary, the Adamtsl4tvrm267 model provides a valuable tool to further elucidate the molecular basis of zonule formation, the pathophysiology of EL and ADAMTSL4 function in the maintenance of the RPE. PMID:26405179
... of vision. Treatment How does vitreous detachment affect vision? Although a vitreous detachment does not threaten sight, ... hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience ...
Sasaki, H; Shiono, A; Kogo, J; Yomoda, R; Munemasa, Y; Syoda, M; Otake, H; Kurihara, H; Kitaoka, Y; Takagi, H
PurposeTo determine whether the inverted internal limiting membrane (ILM) flap technique contributes to high reattachment and closure rates in patients with macular hole-associated retinal detachment (MHRD).Patients and methodsIn all, 15 eyes of 15 patients with MHRD undergoing 25-gauge pars plana vitrectomy with the inverted ILM flap technique or ILM peeling. The patients were divided into the inverted ILM flap technique group (6 eyes) and ILM peeling group (9 eyes). The logarithm of minimal angle of resolution best-corrected visual acuity (BCVA) and retinal attachment and macular hole closure rates were compared between the two groups before and after surgery.ResultsNo significant differences were found in the pre- and postoperative BCVA at 1 and 3 months after surgery in either group (inverted ILM flap technique group, preoperatively 1.04±0.55, 1 month 0.95±0.30, 3 months 0.83±0.22; ILM peeling group, preoperatively 1.00±0.44, 1 month 1.05±0.38, 3 months 1.06±0.49; P>0.05, respectively). The postoperative BCVA at 6 months after surgery was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, 0.62±0.35; ILM peeling group, 1.02±0.41, P=0.045). The improvement in BCVA was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, -0.41±0.29; ILM peeling group, 0.02±0.36; P=0.021). The primary macular hole closure rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary reattachment rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary macular hole closure and reattachment rates were not significantly different in both groups (P=0.056, respectively).ConclusionThe inverted ILM flap technique is a useful procedure for MHRD in highly myopic eyes.
Gharbiya, M; Malagola, R; Mariotti, C; Parisi, F; De Vico, U; Ganino, C; Grandinetti, F
Purpose To determine the predictive value of markers for persistent subretinal fluid (SRF) absorption and the influence of subfoveal fluid on visual outcome after scleral buckle (SB) surgery for rhegmatogenous retinal detachment (RRD). Patients and methods This was a retrospective, observational study. We reviewed the medical records of 64 eyes of 64 patients who underwent SB surgery for macula-off RRD. Patients underwent clinical examination and spectral-domain optical coherence tomography before surgery, at 1 month and every 3 months postoperatively. The height and width of SRF bleb(s) were measured over time. Results Persistent SRF at 1 month was observed in 40 eyes (62.5%). SRF blebs were first detected 1.7±2.2 months postoperatively. In 29 cases that could be fully followed up, SRF blebs were completely absorbed 7.8±4.4 months postoperatively. Resolution of fluid was associated with an improvement of VA (P=0.003). Serial measurements of SRF bleb size showed that bleb width decreased significantly at all time points during the 12-month follow-up period (P<0.05), while significant bleb height decrease occurred from postoperative sixth month only (P<0.05). There was no correlation between VA outcomes and subfoveal bleb height or width (P>0.05). The cut-off value of the bleb width-to-height ratio level for predicting bleb absorption at 6 months was 7, with 89% sensitivity and 83% specificity. Conclusions Visual improvement may occur with late resolution of residual subfoveal fluid. A bleb width-to-height ratio >7 indicates a higher risk of SRF to persist beyond 6 months after surgery. PMID:26139048
Jiann, Lim Yeou; Ismail, Zuhaila; Shafie, Sharidan; Fitt, Alistair
In this paper, a phenomenon of fluid flow through a detached retina is studied. Rhegmatogeneous retinal detachment happens when vitreous humour flow through a detached retina. The exact mechanism of Rhegmatogeneous retinal detachment is complex and remains incomplete. To understand the fluid flow, a paradigm mathematical model is developed and is approximated by the lubrication theory. The numerical results of the velocity profile and pressure distribution are computed by using Finite Element Method. The effects of fluid mechanical on the retinal detachment is discussed and analyzed. Based on the analysis, it is found that the retinal detachment deformation affects the pressure distribution. It is important to comprehend the development of the retinal detachment so that a new treatment method can be developed.
Ma, Yingyan; Ying, Xiaohua; Zou, Haidong; Xu, Xiaocheng; Liu, Haiyun; Bai, Lin; Xu, Xun; Zhang, Xi
To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness. Elderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People's Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70-79 and age over 80 years. Sensitivity analyses were performed to test stability of the results. 98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70-79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years. RRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization's recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients.
Kawaguchi, Tatsushi; Spencer, Doran B; Mochizuki, Manabu
Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis.
Mazinani, B; Baumgarten, S; Schiller, P; Agostini, H; Helbig, H; Limburg, E; Hellmich, M; Walter, P
Purpose Scleral buckling is currently used in addition to vitrectomy for the treatment of pseudophakic retinal detachment (PRD) to better support the vitreous base and better visualisation of the periphery. Aims The aims of this study are to evaluate (1) whether the combination of 20 G vitrectomy and scleral buckling is superior to 20 G vitrectomy alone (control) (confirmatory), and (2) whether transconjunctival 23/25 G vitrectomy is non-inferior to 20 G vitrectomy (both without scleral buckling) regarding operation success (exploratory). Methods The VIPER (Vitrectomy Plus Encircling Band Vs. Vitrectomy Alone For The Treatment Of Pseudophakic Retinal Detachment) study is an unmasked, multi-centre, three-arm randomised trial. Patients with PRD were eligible, excluding complicated retinal detachment or otherwise severe ophthalmologic impairment. Patients were randomised to one of three interventions: 20 G vitrectomy alone (control C), combination of 20 G vitrectomy and circumferential scleral buckling (experimental treatment E1) or 23/25 G vitrectomy alone (experimental treatment E2). The primary endpoint is the absence of any indication for a retina re-attaching procedure during 6 months of follow-up. Secondary endpoints include best corrected visual acuity, retina re-attaching procedures, complications and adverse events. Results From June 2011 to August 2013, 257 patients were enrolled in the study. The internet randomisation service assigned 100 patients each to the treatment arms C and E1, and 57 patients to treatment E2. The imbalance is due to the fact that several retinal surgeons did not qualify for performing E2. The random assignment was stratified and balanced (ie, 1:1 or 1:1:1 ratio) by surgeon. Conclusions The described study represents a methodologically rigorous protocol evaluating the benefits of three different vitrectomy approaches to PRD. The projected results will help to establish their overall efficacy and will permit
The heat exhaust is one of the main conceptual issues of magnetic fusion reactor. In a standard operational regime the large heat flux onto divertor target reaches unacceptable level in any foreseeable reactor design. However, about two decades ago so-called ``detached divertor'' regimes were found. They are characterized by reduced power and plasma flux on divertor targets and look as a promising solution for heat exhaust in future reactors. In particular, it is envisioned that ITER will operate in a partly detached divertor regime. However, even though divertor detachment was studied extensively for two decades, still there are some issues requiring a new look. Among them is the compatibility of detached divertor regime with a good core confinement. For example, ELMy H-mode exhibits a very good core confinement, but large ELMs can ``burn through'' detached divertor and release large amounts of energy on the targets. In addition, detached divertor regimes can be subject to thermal instabilities resulting in the MARFE formation, which, potentially, can cause disruption of the discharge. Finally, often inner and outer divertors detach at different plasma conditions, which can lead to core confinement degradation. Here we discuss basic physics of divertor detachment including different mechanisms of power and momentum loss (ionization, impurity and hydrogen radiation loss, ion-neutral collisions, recombination, and their synergistic effects) and evaluate the roles of different plasma processes in the reduction of the plasma flux; detachment stability; and an impact of ELMs on detachment. We also evaluate an impact of different magnetic and divertor geometries on detachment onset, stability, in- out- asymmetry, and tolerance to the ELMs. Supported by the U.S. Department of Energy Office of Science, Office of Fusion Energy Sciences under Award Number DE-DE-FG02-04ER54739 at UCSD.
Treatment of retinal detachment with an encircling band and buckle implant: A comparative pilot study between poly (styrene-b-isobutylene-b-styrene) (SIBS) and trimethyl terminated polydimethylsiloxane (PDMS)
Aguilar, Mariela; Yamamoto, Hideo; Espana, Edgar; Acosta, Ana Carolina; Orozco, Marcia; Aly, Mohamed; Arrieta, Esdras; Hernandez, Eleut; Martin, John; Dubovy, Sander; Smiddy, William; Pinchuk, Leonard; Parel, Jean-Marie
Purpose: To demonstrate the biocompatibility of SIBS implants as compared to PDMS implants in the treatment of retinal detachment in New Zealand White (NZW) rabbit model. 1,2 Introduction: Scleral encircling bands, fixation rings and buckles are utilized for closure of retinal breaks and retina reattachment. The FDA approved PDMS-implant is associated with several post-operative complications, involving thick-fibrotic encapsulations. SIBS, an elastomeric triblock copolymer, was recently FDA approved for use in a cardiovascular drug eluting stent (TAXUS TM, Boston Scientific Corp., MA) and showed excellent biocompatibility and slow drug release capability. Materials and Methods: SIBS (9-mol%-styrene) implants were fabricated (InnFocus LLC, USA) to match PDMS implants (Labtician, Inc, Canada) dimensions. 5 NZW rabbits received SIBS and 4, PDMS-implants. Post-operative exam sequence: day 1 and 2, week 1, 2, 3, 4 and 6, and monthly thereafter for up to 1 year. Anatomohistopathology exams sequence: one SIBS animal at 6 weeks and one animal of each treatment group at 3 and 6-months, and two at 12-months. Results: SIBS compared to PDMS animals exhibited less inflammation and a better buckling effect during the first 6 weeks. At POD 9 months, the conjunctival injection in the SIBS rabbit was none as opposed to the PDMS value and the buckling effect for both groups were equal. There were no visible signs of encapsulation with SIBS. There were no infections in the 9 animals and none of the implants extruded thus far (<10 months). Conclusion: SIBS encircling bands, sleeves, and buckle implants are well tolerated in the rabbit model.
Effectiveness of combined macular buckle under direct vision and vitrectomy with ILM peeling in refractory macular hole retinal detachment with extreme high axial myopia: a 24-month comparative study.
Ma, Jin; Li, Honghui; Ding, Xiaohu; Tanumiharjo, Silvia; Lu, Lin
To evaluate the efficacy of a combined macular buckle under direct vision and 23-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in refractory macular hole retinal detachment (MHRD) with extreme high axial myopia. Prospective, randomised controlled study. The study included 98 eyes of 98 patients of MHRD with extreme high axial (>30 mm) myopia. Patients were randomly assigned to undergo PPV with ILM peeling (group 1, n=52) or PPV with ILM peeling combined with macular buckle under direct vision (group 2, n=46). Complete ocular examination included best-corrected visual acuity (BCVA) (LogMAR), applanation tonometry, optical biometry, slit-lamp biomicroscopy, colour fundus photography, ultrasound examination and optical coherence tomography at baseline and every follow-up visit. Initial retinal reattachment rate was significantly higher in group 2 than in group 1 at 12-month postoperatively (χ(2) test, p=0.020). Macular hole closure rate in group 2 was significantly higher than that in group 1 at 3, 12, 18 and 24 months postoperatively (Fisher's exact test, p<0.05). In initial retinal reattachment cases, the mean BCVA decreased significantly in group 2 than in group 1 at 3 months postoperatively (Wilcoxon matched pairs signed rank test, p=0.036), and had increased significantly in group 2 than in group 1 since 6 months postoperatively (Wilcoxon matched pairs signed rank test, p<0.05). Mean axial lengths in group 2 were significantly shorter than that of group 1 at each follow-up time point (Wilcoxon matched pairs signed rank test, p<0.05). Combined macular buckle under direct vision and PPV with ILM peeling is more effective in treatment of MHRD with extreme high axial (>30 mm) myopia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Mutation in type II procollagen (COL2A1) that substitutes aspartate for glycine alpha 1-67 and that causes cataracts and retinal detachment: evidence for molecular heterogeneity in the Wagner syndrome and the Stickler syndrome (arthro-ophthalmopathy)
Körkkö, J; Ritvaniemi, P; Haataja, L; Kääriäinen, H; Kivirikko, K I; Prockop, D J; Ala-Kokko, L
A search for mutations in the gene for type II procollagen (COL2A1) was carried out in affected members of a family with early-onset cataracts, lattice degeneration of the retina, and retinal detachment. They had no symptoms suggestive of involvement of nonocular tissues, as is typically found in the Stickler syndrome. The COL2A1 gene was amplified with PCR, and the products were analyzed by denaturing gradient gel electrophoresis. The results suggested a mutation in one allele for exon 10. Sequencing of the fragment demonstrated a single-base mutation that converted the codon for glycine at position alpha 1-67 to aspartate. The mutation was found in three affected members of the family available for study but not in unaffected members or 100 unrelated individuals. Comparison with previously reported mutations suggested that mutations introducing premature termination codons in the COL2A1 gene are a frequent cause of the Stickler syndrome, but mutations in the COL2A1 gene that replace glycine codons with codons for bulkier amino acid can produce a broad spectrum of disorders that range from lethal chondrodysplasias to a syndrome involving only ocular tissues, similar to the syndrome in the family originally described by Wagner in 1938. Images Figure 2 Figure 3 Figure 4 PMID:8317498
Yamada, Toshiyuki; Nanashima, Naoki; Shimizu, Takeshi; Nakazawa, Yosuke; Nakazawa, Mitsuru; Tsuchida, Shigeki
From our stock of SDRs (Sprague-Dawley rats), we established a mutant strain having small opaque eyes and named it HiSER (Hirosaki small-eye rat). The HiSER phenotype is progressive and autosomal recessive. In HiSER eyes, disruption and involution of the lens, thickening of the inner nuclear layer, detachment and aggregation of the retina, rudimentary muscle in the ciliary body and cell infiltration in the vitreous humour were observed. Genetic linkage analysis using crossing with Brown Norway rat suggested that the causative gene(s) is located on chromosome 10. Microarray analysis showed that the expression level of the Cryba1 gene encoding βA3/A1-crystallin on chromosome 10 was markedly decreased in HiSER eyes. Genomic PCR revealed deletion of a 3.6-kb DNA region encompassing exons 4-6 of the gene in HiSERs. In HiSER eyes, a chimaeric transcript of the gene containing exons 1-3 and an approximately 250-bp sequence originating from the 3'-UTR of the Nufip2 gene, located downstream of the breakpoint in the opposite direction, was present. Whereas the chimaeric transcript was expressed in HiSER eyes, neither normal nor chimaeric βA3/A1-crystallin proteins were detected by Western blot analysis. Real-time RT (reverse transcription)-PCR analysis revealed that expression level of the Nufip2 gene in the HiSER eye was 40% of that in the SDR eye. These results suggest that the disappearance of the βA3/A1-crystallin protein and, in addition, down-regulation of the Nufip2 gene as a consequence of gene rearrangement causes the HiSER phenotype.
Retinitis Pigmentosa; Macula Off; Primary Open Angle Glaucoma; Hereditary Macular Degeneration; Treated Retina Detachment; Retinal Artery Occlusion; Retinal Vein Occlusion; Non-Arthritic-Anterior-Ischemic Optic-Neuropathy; Hereditary Autosomal Dominant Optic Atrophy; Dry Age Related Macular Degeneration; Ischemic Macula Edema
Chawla, Rohan; Tripathy, Koushik; Gogia, Varun; Venkatesh, Pradeep
We describe two young immunocompetent women presenting with bilateral retinitis with outer retinal necrosis involving posterior pole with centrifugal spread and multifocal lesions simulating progressive outer retinal necrosis (PORN) like retinitis. Serology was negative for HIV and CD4 counts were normal; however, both women were on oral steroids at presentation for suspected autoimmune chorioretinitis. The retinitis in both eyes responded well to oral valaciclovir therapy. However, the eye with the more fulminant involvement developed retinal detachment with a loss of vision. Retinal atrophy was seen in the less involved eye with preservation of vision. Through these cases, we aim to describe a unique evolution of PORN-like retinitis in immunocompetent women, which was probably aggravated by a short-term immunosuppression secondary to oral steroids.
... Action You are here Home › Retinal Diseases Listen Retinitis Pigmentosa What is retinitis pigmentosa? What are the symptoms? ... is available? What treatment is available? What is retinitis pigmentosa? Retinitis pigmentosa, also known as RP, refers to ...
Freeman, H M
INCIDENCE OF RETINAL BREAKS AND DETACHMENT IN FELLOW EYES. The fellow eyes of 226 giant retinal breaks were followed in order to determine the incidence and natural course of chorioretinal and vitreous pathology. During the period of observation which ranged from 18 months to 16 years, the incidence of retinal breaks and retinal detachment increased from 36.1 percent to 51.3 percent. By the end of the follow-up period, the incidence of bilateral giant retinal breaks was 12.8 percent; retinal tears 11.9 percent, retinal holes 10.2 percent, retinal dialysis 0.4 percent, and retinal detachment 15.9 percent. The average duration of follow-up was 3.7 years, therefore, the incidence of retinal breaks in fellow eyes is probably significantly higher. VITREORETINAL CHANGES PRECEDING THE DEVELOPMENT OF RETINAL BREAKS. Syneresis, liquefaction, and condensation of the vitreous base were observed in the majority fellow eyes that developed retinal tears or giant retinal breaks. Follow-up of fellow eyes revealed that the development of a giant retinal break is often preceded by increasing white with pressure associated with increasing condensation of the vitreous base. MANAGEMENT OF FELLOW EYES. Bcause of the high incidence of retinal breaks developing in the fellow eye, regular and thorough examination of the vitreous and retinal breaks even though the fundus may appear normal at the initial examination. PROPHYLACTIC TREATMENT. This study suggests that prophylactic treatment is beneficial in the management of fellow eyes of giant retinal breaks. During this study, retinal breaks developed in 27.3 percent of untreated eyes and in 2.4 percent of eyes treated prophylactically. PROPHYLACTIC TREATMENT OF FELLOW EYES OF GIANT RETINAL BREAKS. Its seems prudent to prophylactically treat retinal holes or dialyses in eyes without retinal detachment with cryotherapy. Scleral bucking seems justified in the prophylactic treatment of eyes with retinal tears of lattice-like degeneration with
Wurm, Antje; Pannicke, Thomas; Iandiev, Ianors; Bühner, Eva; Pietsch, Uta-Carolin; Reichenbach, Andreas; Wiedemann, Peter; Uhlmann, Susann; Bringmann, Andreas
Detachment of the neural retina from the pigment epithelium may be associated with tissue edema; however, the mechanisms of fluid accumulation are not understood. Because retinal detachment is usually not accompanied by vascular leakage, we investigated whether the osmotic swelling characteristics of retinal glial (Müller) cells are changed after experimental detachment of the porcine retina. Osmotic stress, induced by application of a hypotonic bath solution to retinal slices, caused swelling of Müller cell bodies in 7-day-detached retinas, but no swelling was inducible in slices of control retinas. Müller cell somata in slices of retinal areas that surround local detachment in situ also showed osmotic swelling, albeit at a smaller amplitude. The amplitude of osmotic Müller cell swelling correlated with the decrease in the K+ conductance, suggesting a causal relationship between both gliotic alterations. Further factors implicated in Müller cell swelling were inflammatory mediators and oxidative stress. We propose that a dysregulation of the ion and water transport through Müller cells may impair the fluid absorption from the retinal tissue, resulting in chronic fluid accumulation after detachment. This knowledge may lead to a better understanding of the mechanisms involved in retinal degeneration after detachment.
Duretz, T.; Schmalholz, S. M.; Gerya, T. V.
Our study investigates the dynamics of slab detachment and evaluates the amount of time necessary for slabs to detach. We combine both the results of two-dimensional numerical modeling with the prediction of a one-dimensional analytical solution for viscous necking under gravity. This tidy suggest that the dominant deformation mechanisms leading to slab detachment is viscous necking, independently of the depth of slab detachment. Localised simple shear may also occur when the slab dip is moderate, especially in the colder parts of the slab. Brittle fracturing, or breaking, plays a minor role during the slab detachment process. 2D thermo-mechanical simulations indicate that the duration of slab detachment is short (< 4 Ma) and can occur in less than 0.5 Ma. No simple correlation between the slab detachment depth and duration was found. Our results suggest that deep slab detachments (> 250 km) can also occur within a short time (< 1 Ma). On the other hand, slab detachments taking place between 35 and 250 km depth may last less than 2 Ma. This aspect has implications for geodynamic interpretations using slab detachment as explanation for processes such as melting, exhumation or surface uplift.
Saxena, S; Gopal, L
Advances in the surgical instrumentation and vitreoretinal techniques have allowed intraoperative reapproximation of retina to a more normal position. The use of intravitreally injected liquid materials (viscoelastic liquids, liquid perfluorocarbons and silicone oil), as adjunctive agents to vitreo-retinal surgery play an important role in facilitating retinal reattachment. These materials are used as intraoperative instruments to re-establish intraocular volume, assist in separating membranes adherent to the retina, manipulate retinal detachments and mechanically flatten detached retina. Over the longer term, silicone oil maintains intraocular tamponade. One should be cognizant of the potential uses, benefits and risks of each of these vitreous substitutes.
Mackool, R J; Holtz, S J
Four eyes of three patients had extensive postoperative Descemet membrane (DM) detachment. Blood was present just anterior to the DM in three of the four eyes and later converted to and persisted as pigment. Haziness of the cornea at the level of the DM could be seen with reattachment. Detachments of the DM are classified as planar when there is 1 mm or less separation of the DM from its overlying stroma in all areas. Nonplanar DM detachments exceed 1 mm of separation. Planar detachments have a much better prognosis than nonplanar detachments do, with or without descemetopexy. Repair of DM detachments, when necessary, should include air injection, with the lease possible instrumentation of the DM.
Xu, G Z; Li, W W; Tso, M O
This paper examined the role of apoptosis in human retinal degenerations including pathologic myopia, age-related macular degeneration, serous retinal detachment, retinal lattice, and paving stone degenerations. Thirty-seven enucleated human eyes with 1 of the above-mentioned retinal degenerations were studied by histopathology and by TdT-mediated biotin-dUTP nicked-end labelling (TUNEL) technique. Tunnel labelling characteristic DNA fragmentation of apoptosis was observed in photoreceptor cells in 2 of the 4 eyes with pathologic myopia and in 4 of 16 eyes with age-related macular degeneration, 2 of which were exudative and 2 of which were atrophic. However, only a few scattered photoreceptor cells were labelled in 4 of 8 eyes with serous retinal detachment secondary to malignant melanoma of the choroid. Moreover, none of the photoreceptors cells in the 4 eyes with retinal lattice degeneration and 6 eyes with retinal paving stone degeneration were labelled. Apoptosis is 1 of the important pathways of photoreceptor cell degeneration in pathologic myopia and age-related macular degeneration.
Prabhushanker, M; Topiwalla, Tasneem T; Ganesan, Geetha; Appandaraj, Sripal
Post typhoid fever immune related reactions affecting the eye is a rare finding which can have various presentations in which typhoid retinopathy is not a well recognized sequelae. Here we present a case of 59 year old male who presented with right eye sudden painless loss of vision 4 weeks after typhoid fever which was diagnosed and treated successfully. His BCVA was 2/60 in right eye and 6/6 in left eye. Fundus examination showed retinitis along with macular serous detachment in right eye and retinitis in left eye. Significant improvement in BCVA in right eye was observed after treatment with oral steroid with resolving retinitis lesions. Diagnosis of post typhoid immune mediated retinitis was made with good resolution following treatment. Immune mediated retinitis is a rare sequelae to typhoid infection which can be successfully treated with systemic steroids with good resolution of the lesions.
Regel, Liya L.; Wilcox, William R.; Popov, Dmitri
Our long term goal is to develop techniques to achieve detached solidification reliably and reproducibly, in order to produce crystals with fewer defects. To achieve this goal it is necessary to understand thoroughly the physics of detached solidification. It was the primary objective of the current project to make progress toward this complete understanding. 'Me products of this grant are attached. These include 4 papers and a preliminary survey of the observations of detached solidification in space. We have successfully modeled steady state detached solidification, examined the stability of detachment, and determined the influence of buoyancy-driven convection under different conditions. Directional solidification in microgravity has often led to ingots that grew with little or no contact with the ampoule wall. When this occurred, crystallographic perfection was usually greatly improved -- often by several orders of magnitude. Indeed, under the Soviet microgravity program the major objective was to achieve detached solidification with its resulting improvement in perfection and properties. Unfortunately, until recently the true mechanisms underlying detached solidification were unknown. As a consequence, flight experiments yielded erratic results. Within the past three years, we have developed a new theoretical model that explains many of the flight results. This model gives rise to predictions of the conditions required to yield detached solidification.
pigmentosa , and retinal detachment10. mfERG response characteristics have been shown to vary depending on the part of the retina that is affected by a...DoD Controlling Office is (insert controlling DoD office). 20100715258 Functional and behavioral metrics for evaluating laser retinal damage Cheryl...potential for and severity of laser eye injury and retinal damage is increasing . Sensitive and accurate methods to evaluate and follow laser retinal
Tokumaru, G K
Retinal capillary hemangioma (angiomatosis retinae; von Hippel's disease) is a relatively uncommon vascular tumor. When seen in association with systemic angiomas, it is known as von Hippel-Lindau disease. Untreated, these tumors can cause numerous sight threatening sequelae, including exudative and tractional retinal detachment. Recently, the dye yellow laser has been demonstrated to be a safe and effective method of ablating retinal hemangiomas. This paper discusses the case of a retinal hemangioma that was successfully treated with the dye yellow laser. The current treatment modalities of retinal hemangiomas are reviewed, as well as recent literature on the tunable organic dye laser and its utilization in the treatment of retinal vascular disorders.
Muraoka, Yuki; Tsujikawa, Akitaka; Kumagai, Kyoko; Akagi-Kurashige, Yumiko; Ogino, Ken; Murakami, Tomoaki; Miyamoto, Kazuaki; Yoshimura, Nagahisa
We studied morphologic changes of the retinal vasculature in eyes with central retinal vein occlusion (CRVO) through the use of optical coherence tomography (OCT). Major retinal vessels in 35 eyes from 35 consecutive patients with acute CRVO were examined prospectively and longitudinally with sequential thin sectioning and circumpapillary scanning. Anteroposterior venous tortuosity associated with CRVO was quantified on longitudinal OCT images of a randomly selected major temporal vein. On OCT sections of a given vein, we identified the innermost and outermost points of the vessel wall. The degree of anteroposterior venous tortuosity was defined as the difference between the vertical distances from the retinal pigment epithelium to the center of the venous lumen at these two points. The OCT images revealed that the major retinal veins traveled tortuously through the swollen neurosensory retina from the inner retinal surface to the retinal pigment epithelium. The degree of anteroposterior venous tortuosity was correlated with poor visual acuity (r = 0.457, P = 0.017), increased mean foveal thickness (r = 0.671, P < 0.001), and the height of foveal detachment (r = 0.414, P = 0.032). In 4 (11%) eyes, a localized retinal detachment was detected around the optic disc, which correlated with anteroposterior venous tortuosity. In 14 (40%) eyes, elongated major retinal veins disrupted the boundary between retinal vessels and parenchyma, which resulted in juxtavenous splitting of the neurosensory retina. In eyes with CRVO, OCT can be used to visualize anteroposterior venous tortuosity and associated structural changes to the retinal parenchyma.
Meire, F M; De Laey, J J; Van Thienen, M N; Schuddinck, L
Fibromuscular dysplasia of the arteries (FMD) is a segmental angiopathy which may produce obstruction of the carotid, cerebral, renal, mesenteric, coronary or iliac arteries. Except for lesions related to arterial hypertension, retinal manifestations have not yet been reported. This paper describes the case of a 10-year-old boy with progressive deafness, a history of an unexplained stroke and progressive occlusions of the retinal arterioles in the fundus periphery. This resulted in retinal neovascularization and recurrent retinal and vitreous hemorrhages. Despite repeated photo- and cryocoagulation the eyes progressed to a tractional retinal detachment which was successfully treated by vitrectomy and scleral buckling. The diagnosis of FMD was made on the basis of a histopathological examination of a temporal artery biopsy. The child also presented an asymptomatic but severe aneurysmal dilatation of the aorta and CT scan and MRI showed dilated cerebral arteries. The father of our patient had died at the age of 27 years either from myocardial infarction or rupture of a dissecting aortic aneurysm. He was highly myopic and had lost one eye from retinal detachment. The younger brother of our patient also presents aneurysmal dilatation of the aorta and tortuous cerebral vessels. Ocular examination is still normal. The findings in this family are compatible with an autosomal dominant inheritance with variable expression.
Khan, Mehnaz; Hamid, Rizwan; Recchia, Franco M
To describe novel retinal findings in an infant with muscle-eye-brain disease and suggest a novel mechanism for congenital retinal detachment. Case report. A 7-week-old, white, female infant presented with total retinal detachment, peripheral retinal avascularity, and neovascularization of the right eye. In the left eye, there was hypoplastic optic nerve, no identifiable foveal avascular zone, and a small area of avascularity in the temporal peripheral retina. Genetic testing ultimately confirmed the diagnosis of muscle-eye-brain disease, a disorder of aberrant neuronal migration. This case describes retinal findings that, to our knowledge, have not been reported in previous cases of muscle-eye-brain disease: peripheral avascularity, leading to retinal detachment in one eye, and foveal dysplasia. It is speculated that aberrant retinal vasculogenesis arose from disordered migration and patterning of retinal neurons.
Krasheninnikov, S. I.; Kukushkin, A. S.; Pshenov, A. A.
Regime with the plasma detached from the divertor targets (detached divertor regime) is a natural continuation of the high recycling conditions to higher density and stronger impurity radiation loss. Both the theoretical considerations and experimental data show clearly that the increase of the impurity radiation loss and volumetric plasma recombination causes the rollover of the plasma flux to the target when the density increases, which is the manifestation of detachment. Plasma-neutral friction (neutral viscosity effects), although important for the sustainment of high density/pressure plasma upstream and providing the conditions for efficient recombination and power loss, is not directly involved in the reduction of the plasma flux to the targets. The stability of detachment is also discussed.
Krasheninnikov, S. I.; Kukushkin, A. S.; Pshenov, A. A.
Regime with the plasma detached from the divertor targets (detached divertor regime) is a natural continuation of the high recycling conditions to higher density and stronger impurity radiation loss. Both the theoretical considerations and experimental data show clearly that the increase of the impurity radiation loss and volumetric plasma recombination causes the rollover of the plasma flux to the target when the density increases, which is the manifestation of detachment. Plasma-neutral friction (neutral viscosity effects), although important for the sustainment of high density/pressure plasma upstream and providing the conditions for efficient recombination and power loss, is not directly involved in the reduction of the plasma flux to the targets. The stability of detachment is also discussed.
Sweigard, J. Harry; Matsumoto, Hidetaka; Smith, Kaylee E.; Kim, Leo A.; Paschalis, Eleftherios I.; Okonuki, Yoko; Castillejos, Alexandra; Kataoka, Keiko; Hasegawa, Eiichi; Yanai, Ryoji; Husain, Deeba; Lambris, John D.; Vavvas, Demetrios; Miller, Joan W.; Connor, Kip M.
Degeneration of photoreceptors is a primary cause of vision loss worldwide, making the underlying mechanisms surrounding photoreceptor cell death critical to developing new treatment strategies. Retinal detachment, characterized by the separation of photoreceptors from the underlying retinal pigment epithelium, is a sight-threatening event that can happen in a number of retinal diseases. The detached photoreceptors undergo apoptosis and programmed necrosis. Given that photoreceptors are nondividing cells, their loss leads to irreversible visual impairment even after successful retinal reattachment surgery. To better understand the underlying disease mechanisms, we analyzed innate immune system regulators in the vitreous of human patients with retinal detachment and correlated the results with findings in a mouse model of retinal detachment. We identified the alternative complement pathway as promoting early photoreceptor cell death during retinal detachment. Photoreceptors down-regulate membrane-bound inhibitors of complement, allowing for selective targeting by the alternative complement pathway. When photoreceptors in the detached retina were removed from the primary source of oxygen and nutrients (choroidal vascular bed), the retina became hypoxic, leading to an up-regulation of complement factor B, a key mediator of the alternative pathway. Inhibition of the alternative complement pathway in knockout mice or through pharmacological means ameliorated photoreceptor cell death during retinal detachment. Our current study begins to outline the mechanism by which the alternative complement pathway facilitates photoreceptor cell death in the damaged retina. PMID:26203084
Hanson, David R.
A rock detachment evaluation device (10) having an energy transducer unit 1) for sensing vibrations imparted to a subject rock (172) for converting the sensed vibrations into electrical signals, a low band pass filter unit (12) for receiving the electrical signal and transmitting only a low frequency segment thereof, a high band pass filter unit (13) for receiving the electrical signals and for transmitting only a high frequency segment thereof, a comparison unit (14) for receiving the low frequency and high frequency signals and for determining the difference in power between the signals, and a display unit (16) for displaying indicia of the difference, which provides a quantitative measure of rock detachment.
Serna-Ojeda, Juan Carlos; Pinkus-Herrera, Christian Denisse; Moreno-Londono, Maria Victoria; Rodriguez-Loaiza, Jose Luis; Gonzalez-Gonzalez, Maria Cristina
The purpose of this paper is to report the case of a 62-year-old male diagnosed with a retinal macrocyst secondary to a long-standing retinal detachment in his right eye. At fundoscopy examination, an oval, elevated retinal lesion in the superior nasal quadrant was noted. Ultrasonography was performed, with a B-mode echography showing an oval, anechoic image and a standardized A-mode echography with a reflectivity spike higher than 98%, which was compatible with a retinal macrocyst. The patient refused surgical treatment for the retinal detachment and was followed for 14 months with stable visual acuity and no clinical or echographic changes. PMID:25028580
Stewart, Michael W
Cytomegalovirus (CMV) retinitis is the most common cause of vision loss in patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis afflicted 25% to 42% of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, with most vision loss due to macula-involving retinitis or retinal detachment. The introduction of HAART significantly decreased the incidence and severity of CMV retinitis. Optimal treatment of CMV retinitis requires a thorough evaluation of the patient’s immune status and an accurate classification of the retinal lesions. When retinitis is diagnosed, HAART therapy should be started or improved, and anti-CMV therapy with oral valganciclovir, intravenous ganciclovir, foscarnet, or cidofovir should be administered. Selected patients, especially those with zone 1 retinitis, may receive intravitreal drug injections or surgical implantation of a sustained-release ganciclovir reservoir. Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. Immune recovery uveitis and retinal detachments are important causes of moderate to severe loss of vision. Compared with the early years of the AIDS epidemic, the treatment emphasis in the post- HAART era has changed from short-term control of retinitis to long-term preservation of vision. Developing countries face shortages of health care professionals and inadequate supplies of anti-CMV and anti-HIV medications. Intravitreal ganciclovir injections may be the most cost effective strategy to treat CMV retinitis in these areas. PMID:20463796
Carr, Ronald E.
The author describes the etiology of retinitis pigmentosa, a visual dysfunction which results from progressive loss of the retinal photoreceptors. Sections address signs and symptoms, ancillary findings, heredity, clinical diagnosis, therapy, and research. (SBH)
Carr, Ronald E.
The author describes the etiology of retinitis pigmentosa, a visual dysfunction which results from progressive loss of the retinal photoreceptors. Sections address signs and symptoms, ancillary findings, heredity, clinical diagnosis, therapy, and research. (SBH)
Plasma detachment research in linear devices, sometimes called divertor plasma simulators, is reviewed. Pioneering works exploring the concept of plasma detachment were conducted in linear devices. Linear devices have contributed greatly to the basic understanding of plasma detachment such as volume plasma recombination processes, detached plasma structure associated with particle and energy transport, and other related issues including enhancement of convective plasma transport, dynamic response of plasma detachment, plasma flow reversal, and magnetic field effect. The importance of plasma detachment research using linear devices will be highlighted aimed at the design of future DEMO.
Pezzulo, Giovanni; Castelfranchi, Cristiano
In situated and embodied approaches it is commonly assumed that the dynamics of sensorimotor engagement between an adaptive agent and its environment are crucial in understanding natural cognition. This perspective permits to address the symbol grounding problem, since the aboutness of any mental state arising during agent-environment engagement is guaranteed by their continuous coupling. However, cognitive agents are also able to formulate representations that are detached from the current state of affairs, such as expectations and goals. Moreover, they can act on their representations before--or instead of--acting directly on the environment, for example building the plan of a bridge and not directly the bridge. On the basis of representations, actions such as planning, remembering or imagining are possible that are disengaged from the current sensorimotor cycle, and often functional to future-oriented conducts. A new problem thus has to be acknowledged, the symbol detachment problem: how and why do situated agents develop representations that are detached from their current sensorimotor interaction, but nevertheless preserve grounding and aboutness? How do cognitive agents progressively acquire a range of capabilities permitting them to deal not only with the current situation but also with alternative, in particular future states of affairs? How do they develop the capability of acting on their representations instead of acting directly on the world? In a theoretical and developmental perspective, we propose that anticipation plays a crucial role in the detachment process: anticipatory representations, originally detached from the sensorimotor cycle for the sake of action control, are successively exapted for bootstrapping increasingly complex cognitive capabilities.
Ocular vascular diseases such as diabetic retinopathy, retinal vein occlusion, and age-related macular degeneration, whose population increases along with aging, have become leading causes of severe visual disturbance. Macular edema and serous retinal detachment are associated with abnormal vascular leakage and tractional retinal detachment, and neovascular glaucoma is caused by retinal neovascularization. Such ocular vascular diseases are caused by vascular cell aging and vascular damage associated with lifestyle-related diseases including diabetes mellitus, hypertension, hyperlipidemia, and obesity. In the present study, we investigated molecular mechanisms in such vascular deficiencies using vascular cell biology methodology, and we propose novel strategies for the treatment of such vascular diseases. Along with aging, oxidative stress and physical stress, such as mechanical stretch, continuously and directly insult vascular cells. Such stress induces apoptosis by intracellular signaling through stress kinases in cultured retinal vascular cells. Inhibition of such stress kinases could be an effective treatment to protect the vascular cells against age-related damage. In a retinal vascular developmental model, pericyte loss causes pathology mimicking macular edema and proliferative diabetic retinopathy. Angiopoietin 1 (Ang 1) secreted by pericytes suppresses oxidative stress-induced intracellular signaling through stress kinases linked to cell apoptosis and normalizes such retinal pathology. This suggests that the paracrine action of Ang 1 in the pericytes is necessary to sustain normal retinal vasculature, and that Ang 1-triggered intracellular signaling is useful for the treatment of vascular cell pathology associated with pericyte loss. In diabetic retinopathy and retinal vein occlusion, retinal vessels regress along with retinal vascular cell apoptosis, and the retina becomes ischemic followed by pathological retinal neovascularization. VEGF has been
Rosenbaum, James T.; Sibley, Cailin H.; Lin, Phoebe
Purpose of review Ophthalmologists and rheumatologists frequently miscommunicate in consulting on patients with retinal vasculitis. This report seeks to establish a common understanding of the term, retinal vasculitis, and to review recent papers on this diagnosis. Recent findings 1) The genetic basis of some rare forms of retinal vascular disease have recently been described. Identified genes include CAPN5, TREX1, and TNFAIP3; 2) Behçet’s disease is a systemic illness that is very commonly associated with occlusive retinal vasculitis; 3) retinal imaging including fluorescein angiography and other newer imaging modalities has proven crucial to the identification and characterization of retinal vasculitis and its complications; 4) although monoclonal antibodies to IL-17A or IL-1 beta failed in trials for Behçet’s disease, antibodies to TNF alpha, either infliximab or adalimumab, have demonstrated consistent benefit in managing this disease. Interferon treatment and B cell depletion therapy via rituximab may be beneficial in certain types of retinal vasculitis. Summary Retinal vasculitis is an important entity for rheumatologists to understand. Retinal vasculitis associated with Behçet’s disease responds to monoclonal antibodies that neutralize TNF, but the many other forms of non-infectious retinal vasculitis may require alternate therapeutic management. PMID:26945335
Geng, Shuang; Ye, Jun-jie; Zhao, Jia-liang; Li, Tai-sheng; Han, Yang
Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS. It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4(+) T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients). Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4(+) T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6 ± 25.3) × 10(6)/L (range, (0 - 85) × 10(6)/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed. CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.
de Hoz, Rosa; Rojas, Blanca; Ramírez, Ana I.; Salazar, Juan J.; Gallego, Beatriz I.; Triviño, Alberto; Ramírez, José M.
Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes and Müller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors. Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases. The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies. PMID:27294114
de Hoz, Rosa; Rojas, Blanca; Ramírez, Ana I; Salazar, Juan J; Gallego, Beatriz I; Triviño, Alberto; Ramírez, José M
Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes and Müller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors. Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases. The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies.
Haze, Masaya; Kobayashi, Takatoshi; Kakurai, Keigo; Shoda, Hiromi; Takai, Nanae; Takeda, Sayako; Tada, Rei; Maruyama, Kouichi; Kida, Teruyo; Ikeda, Tsunehiko
Purpose The purpose of this study was to report the case of a patient who underwent vitrectomy for bilateral rhegmatogenous retinal detachment caused by cytomegalovirus (CMV) retinitis while undergoing steroid and immunosuppressant therapy for systemic lupus erythematosus (SLE). Case Report We report on a 29-year-old female who was undergoing steroids and immunosuppressants treatment for SLE at Osaka Medical College Hospital, Takatsuki City, Japan. Examination of the patient due to prolonged and worsening diarrhea revealed positive test results for C7-HRP, and she was diagnosed with CMV colitis. She was subsequently admitted to the hospital and started on intravenous ganciclovir for treatment. Approximately 1.5 months later, her primary complaint was deterioration of the upper visual field in her left eye, and she was then referred to the Department of Ophthalmology. Numerous granular exudative spots were found around the lower retinal area of her left eye with retinal breaks that had developed in an area of retinal necrosis that resulted in retinal detachment. After time was allowed for the patient's general condition to improve, a vitrectomy was performed on that eye. The patient subsequently developed a similar retinal detachment in her right eye, for which she underwent a vitrectomy. Although the patient required multiple surgeries on both eyes, her retinas currently remain reattached and the inflammation has subsided. Conclusion The findings of this study show that strict attention must be paid to SLE patients on immunosuppressive therapy due to the possible association of CMV retinitis. PMID:27462259
Mazuruk, K.; Volz, M. P.; Croell, A.
Bridgman crystal growth can be conducted in the so-called "detached" solidification regime, where the growing crystal is detached from the crucible wall. A small gap between the growing crystal and the crucible wall, of the order of 100 micrometers or less, can be maintained during the process. A meniscus is formed at the bottom of the melt between the crystal and crucible wall. Under proper conditions, growth can proceed without collapsing the meniscus. The meniscus shape plays a key role in stabilizing the process. Thermal and other process parameters can also affect the geometrical steady-state stability conditions of solidification. The dynamic stability theory of the shaped crystal growth process has been developed by Tatarchenko. It consists of finding a simplified autonomous set of differential equations for the radius, height, and possibly other process parameters. The problem then reduces to analyzing a system of first order linear differential equations for stability. Here we apply a modified version of this theory for a particular case of detached solidification. Approximate analytical formulas as well as accurate numerical values for the capillary stability coefficients are presented. They display an unexpected singularity as a function of pressure differential. A novel approach to study the thermal field effects on the crystal shape stability has been proposed. In essence, it rectifies the unphysical assumption of the model that utilizes a perturbation of the crystal radius along the axis as being instantaneous. It consists of introducing time delay effects into the mathematical description and leads, in general, to stability over a broader parameter range. We believe that this novel treatment can be advantageously implemented in stability analyses of other crystal growth techniques such as Czochralski and float zone methods.
Yoshikawa, S.; Chance, M.
Recently a tokamak plasma was observed in TFTR that was not limited by a limiter or a divertor. A model is proposed to explain this equilibrium, which is called a detached plasma. The model consists of (1) the core plasma where ohmic heating power is lost by anomalous heat conduction and (2) the shell plasma where the heat from the core plasma is radiated away by the atomic processes of impurity ions. A simple scaling law is proposed to test the validity of this model.
Venkatesh, Ramesh; Gurav, Prachi; Dave, Prachi Abhishek; Roy, Sankhadeep
We describe a case of a 65-year old man diagnosed with retinal vasoproliferative tumour secondary to posterior uveitis. The fluorescein angiography shows an interesting meteor-like leak emanating from the tumour and rising towards the superior retina in the later frames of the angiogram. Pictorially, we call it the "Retinal Meteor" and also describe the possible mechanism for this pattern of leakage.
Jones, B W; Kondo, M; Terasaki, H; Lin, Y; McCall, M; Marc, R E
Retinal photoreceptor degeneration takes many forms. Mutations in rhodopsin genes or disorders of the retinal pigment epithelium, defects in the adenosine triphosphate binding cassette transporter, ABCR gene defects, receptor tyrosine kinase defects, ciliopathies and transport defects, defects in both transducin and arrestin, defects in rod cyclic guanosine 3',5'-monophosphate phosphodiesterase, peripherin defects, defects in metabotropic glutamate receptors, synthetic enzymatic defects, defects in genes associated with signaling, and many more can all result in retinal degenerative disease like retinitis pigmentosa (RP) or RP-like disorders. Age-related macular degeneration (AMD) and AMD-like disorders are possibly due to a constellation of potential gene targets and gene/gene interactions, while other defects result in diabetic retinopathy or glaucoma. However, all of these insults as well as traumatic insults to the retina result in retinal remodeling. Retinal remodeling is a universal finding subsequent to retinal degenerative disease that results in deafferentation of the neural retina from photoreceptor input as downstream neuronal elements respond to loss of input with negative plasticity. This negative plasticity is not passive in the face of photoreceptor degeneration, with a phased revision of retinal structure and function found at the molecular, synaptic, cell, and tissue levels involving all cell classes in the retina, including neurons and glia. Retinal remodeling has direct implications for the rescue of vision loss through bionic or biological approaches, as circuit revision in the retina corrupts any potential surrogate photoreceptor input to a remnant neural retina. However, there are a number of potential opportunities for intervention that are revealed through the study of retinal remodeling, including therapies that are designed to slow down photoreceptor loss, interventions that are designed to limit or arrest remodeling events, and
Pshenov, A. A.; Kukushkin, A. S.; Krasheninnikov, S. I.
Three issues related to the physics of divertor detachment are analyzed in detail: the criteria for the onset of complete divertor detachment, the role of neutrals in "symmetryzation" of detachment in the inner and outer divertors, and the transition to divertor detachment. The results of comprehensive 2D numerical simulations with the SOLPS4.3 package are compared with some experimental data and predictions based on simplified analytical models. It is shown that it is the ratio of the upstream plasma pressure to the specific power flux entering the recycling region that controls the local onset of detachment on a specific flux tube. Pup/qreclycl≥(Pup/qreclycl) crit remains the valid criterion also in the presence of seeded impurity, if the impurity radiation and hydrogen recycling regions are spatially separated. Detailed analysis indicates that the reverse plasma flow forming on the most heat loaded flux tubes in the outer divertor under the influence of the neutrals coming from the deeply detached inner divertor plays the key role in the detachment "symmetryzation" and allows the outer divertor to reach the detached regime. Finally, it is demonstrated that a gradual increase of the perpendicular heat transport in the edge plasma during transition to the detached regime can make this transition bifurcation-like.
Heimann, H; Jmor, F; Damato, B
The most common intraocular vascular tumours are choroidal haemangiomas, vasoproliferative tumours, and retinal haemangioblastomas. Rarer conditions include cavernous retinal angioma and arteriovenous malformations. Options for ablating the tumour include photodynamic therapy, argon laser photocoagulation, trans-scleral diathermy, cryotherapy, anti-angiogenic agents, plaque radiotherapy, and proton beam radiotherapy. Secondary effects are common and include retinal exudates, macular oedema, epiretinal membranes, retinal fibrosis, as well as serous and tractional retinal detachment, which are treated using standard methods (ie, intravitreal anti-angiogenic agents or steroids as well as vitreoretinal procedures, such as epiretinal membrane peeling and release of retinal traction). The detection, diagnosis, and monitoring of vascular tumours and their complications have improved considerably thanks to advances in imaging. These include spectral domain and enhanced depth imaging optical coherence tomography (SD-OCT and EDI-OCT, respectively), wide-angle photography and angiography as well as wide-angle fundus autofluorescence. Such novel imaging has provided new diagnostic clues and has profoundly influenced therapeutic strategies so that vascular tumours and secondary effects are now treated concurrently instead of sequentially, enhancing any opportunities for conserving vision and the eye. In this review, we describe how SD-OCT, EDI-OCT, autofluorescence, wide-angle photography and wide-angle angiography have facilitated the evaluation of eyes with the more common vascular tumours, that is, choroidal haemangioma, retinal vasoproliferative tumours, and retinal haemangioblastoma. PMID:23196648
Weiland, James D.; Humayun, Mark S.
Retinal prosthesis have been translated from the laboratory to the clinical over the past two decades. Currently, two devices have regulatory approval for the treatment of retinitis pigmentosa. These devices provide partial sight restoration and patients use this improved vision in their everyday lives. Improved mobility and object detection are some of the more notable findings from the clinical trials. However, significant vision restoration will require both better technology and improved understanding of the interaction between electrical stimulation and the retina. This paper reviews the recent clinical trials, highlights technology breakthroughs that will contribute to next generation of retinal prostheses. PMID:24710817
Kuming, B S
A group of patients is described who developed the clinical features of foveomacular retinitis. No causative factors were isolated, and all patients strongly denied any type of sun gazing. It is possible that there is a group of patients who have the features of foveomacular retinitis but have not had any direct exposure to the sun. These patients would then constitute a primary type of foveomacular retinitis, as opposed to a secondary type which has a known cause and is synonymous with solar retinopathy.
Kuming, B S
A group of patients is described who developed the clinical features of foveomacular retinitis. No causative factors were isolated, and all patients strongly denied any type of sun gazing. It is possible that there is a group of patients who have the features of foveomacular retinitis but have not had any direct exposure to the sun. These patients would then constitute a primary type of foveomacular retinitis, as opposed to a secondary type which has a known cause and is synonymous with solar retinopathy. Images PMID:3790482
Shinoda, K; Inoue, M; Ishida, S; Kawashima, S; Wakabayashi, T; Suzuki, S; Katsura, H
Progressive outer retinal necrosis syndrome (PORN) is a variant of necrotizing herpetic retinopathy and the majority of the described cases were related to acquired immunodeficiency syndrome. We present a patient who is HIV negative with nephrotic syndrome and prednisolone use for 4 months who showed clinical features of PORN. Low CD4 counts and lymphocytopenia suggested immunosuppression. In the left eye, tractional retinal detachment at the posterior pole followed by incomplete posterior vitreous detachment developed. In addition to intravenous administration of acyclovir, vitreous surgeries including stripping of the posterior hyaloid and silicone-oil tamponade were successfully performed to repair the retinal detachment in the left eye and to prevent it in the right eye.
Yau, K; Li, W W; Yew, D T
Protein metabolism was investigated in detached hamster retinas. By sucking off 0.2 ml of aqueous humor from the anterior chamber through limbic insertion of a 27-gauge needle, a tractional force pulled off the neural retina from the retinal pigment epithelium and created a simple detachment without retinal breaks in the right eyes of the hamsters. The left eyes were left untouched as normal controls and sham controls were induced by simple limbic insertion without suction. The animals were sacrificed at selected intervals of 1, 3, 6, 9, 16, 24, 32 days after the operation. Subsequently, scintillation counting and autoradiography were employed to study retinal protein metabolism using leucine uptake as an index. After tritiated leucine uptake, scintillation counting of radioactive substance indicated that detached retinas had taken in less tritiated leucine than normal controls from day 1 to 6 after the operation, but this change had normalized by day 9. For autoradiography, the change in leucine uptake rate was shown to be different in different layers. All the retinal cells seemed to show a decreased leucine uptake with the exception of the outer nuclear layer, in which leucine appeared to be significantly upregulated. This paper illustrates the patterns of protein metabolism and their change after traumatic detachment as well as their possible recovery. Copyright 2000 S. Karger AG, Basel
Nishina, Sachiko; Suzuki, Yumi; Yokoi, Tadashi; Kobayashi, Yuri; Noda, Eiichiro; Azuma, Noriyuki
To investigate the clinical features and prognosis of congenital retinal folds without systemic associations. Retrospective observational case series. The characteristics, clinical course, ocular complications, and best-corrected visual acuity (BCVA) of eyes with congenital retinal folds were studied during the follow-up periods. The affected and fellow eyes were examined by slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and fundus fluorescein angiography. The parents and siblings of each patient also underwent ophthalmoscopic examinations. The BCVA was measured using a Landolt ring VA chart. One hundred forty-seven eyes of 121 patients with congenital retinal folds were examined. Fifty-five patients (45.5%) were female. The fold was unilateral in 95 patients (78.5%), and 69 of those patients (72.6%) had retinal abnormalities in the fellow eye. The meridional distribution of folds was temporal in 136 eyes (92.5%). The family history was positive in 32 patients (26.4%). Secondary fundus complications, including fibrovascular proliferation and tractional, rhegmatogenous, and exudative retinal detachments, developed in 44 eyes (29.9%). The BCVAs could be measured in 119 eyes and ranged from 20/100 to 20/20 in 5 eyes (4.2%), 2/100 to 20/200 in 45 eyes (37.8%), and 2/200 or worse in 69 eyes (58.0%). The follow-up periods ranged from 4 to 243 months (mean, 79.7 ± 58.9 months). These clinical features suggested that most congenital retinal folds may result from insufficient retinal vascular development, as in familial exudative vitreoretinopathy, rather than persistent fetal vasculature. Adequate management of active retinopathy and late-onset complications, especially retinal detachment, is required. Copyright © 2012 Elsevier Inc. All rights reserved.
Munteanu, M; Giuri, Stela; Rosca, C; Boruga, O; Chercota, V; Stanca, H T
Choroidal hemangiomas are benign vascular hamartomas that typically present from second to fourth decade of life, when they can cause visual disturbance due to exudative retinal detachment. They represent uncommon benign choroidal vascular tumors, usually occuring sporadically in the absence of systemic disease. We report the case of a young female patient, presenting a juxtapapillary circumscribed choroidal haemangioma complicated with serous macular detachment. The patient underwent photodynamic therapy with verteporfin (PDT). Systematic follow-up using ophthalmoscopy, ultrasonography, Fluorescein angiography and Indocyanine green angiography was performed. The patient presented regression with flattening of tumour, resolution of the subretinal fluid, and significant improvement of vision. Mostly asymptomatic, the choroidal hemangiomas can be associated with serous retinal detachment, leading to reduced vision and metamorphopsia; in those cases, the long term visual prognosis is poor, even in adequately treated patients. PDT is effective in eliminating the subretinal fluid and improving vision in patients with circumscribed choroidal hemangioma.
Eldon, David; Kolemen, Egemen; Barton, Joseph L.; ...
A new control system at DIII-D has stabilized the inter-ELM detached divertor plasma state for H-mode in close proximity to the threshold for reattachment, thus demonstrating the ability to maintain detachment with minimal gas puffing. When the same control system was instead ordered to hold the plasma at the threshold (here defined as Te = 5 eV near the divertor target plate), the resulting Te profiles separated into two groups with one group consistent with marginal detachment, and the other with marginal attachment. The plasma dithers between the attached and detached states when the control system attempts to hold at the threshold. The control system is upgraded from the one described in and it handles ELMing plasmas by using real time Dα measurements to remove during-ELM slices from real time Te measurements derived from divertor Thomson scattering. The difference between measured and requested inter-ELM Te is passed to a PID (proportionalintegral-derivative) controller to determine gas puff commands. While some degree of detachment is essential for the health of ITER’s divertor, more deeply detached plasmas have greater radiative losses and, at the extreme, confinement degradation, making it desirable to limit detachment to the minimum level needed to protect the target plate. However, the observed bifurcation in plasma conditions at the outer strike point with the ion B ×more » $$\
Lim, Eun-Hae; Kim, Chul Gu; Cho, Sung Won; Lee, Tae Gon
Purpose To identify the unique pathologic findings of retinal angiomatous proliferation (RAP) in optical coherence tomography (OCT). Methods Retrospectively, 29 eyes of 25 patients with age-related macular degeneration and complicated RAP were analyzed. All 29 eyes had choroidal neovascularization (CNV) in the area of pigment epithelial detachment (PED) or adjacent to it, which was visible with fluorescein angiography or indocyanine green angiography. Cross-sectional images were obtained by OCT scanning through the CNV lesions. Results Six distinctive findings of OCT included drusen (100%), inner retinal cyst (80%), outer retinal cyst (68%), fibrovascular PED (84%), serous retinal detachment (40%), and PED (68%). Conclusions Through analysis of OCT findings, we revealed six different types of lesions distinctive of RAP which may provide helpful diagnostic information for subsequent treatment and predicting the prognosis of RAP. PMID:24082773
Hayreh, Sohan Singh; Zimmerman, M. Bridget
Purpose To investigate systematically the retinal changes in branch retinal vein occlusion (BRVO) and their natural history. Methods The study comprised 214 consecutive BRVO patients (144 major BRVO and 72 macular BRVO eyes) seen within 3 months of onset, Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Results Initially retinal hemorrhages were moderate to severe in the perifovea and macula in at least 65% in major and 52% in macular BRVO; at the fovea it was 51% in major and 36% in macular BRVO. Initially macular edema was more marked in major BRVO than in macular BRVO (p=0.007). Major BRVO had a significantly higher rate of development of serous macular detachment (p=0.002), epiretinal membrane (p=0.008), serous retinal detachment (p=0.002), perivenous sheathing (p<0.0001), optic disc pallor (p<0.0001), and lipid deposit (p<0.0001) compared to macular BRVO. Retinal and disc neovascularization was seen only in major BRVO. The time to resolution of BRVO was significantly longer for major BRVO compared to macular BRVO (p=0.0002). Conclusion Major and macular BRVOs are two distinct clinical entities Initial and final fundus findings in the two types differ markedly. PMID:25574785
Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.
Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.
Barrett, Steven F.; Jerath, Maya R.; Rylander, Henry G., III; Welch, Ashley J.
Laser induced retinal lesions are used to treat a variety of eye diseases such as diabetic retinopathy and retinal detachment. An instrumentation system has been developed to track a specific lesion coordinate on the retinal surface and provide corrective signals to maintain laser position on the coordinate. High resolution retinal images are acquired via a CCD camera coupled to a fundus camera and video frame grabber. Optical filtering and histogram modification are used to enhance the retinal vessel network against the lighter retinal background. Six distinct retinal landmarks are tracked on the high contrast image obtained from the frame grabber using two-dimensional blood vessel templates. The frame grabber is hosted on a 486 PC. The PC performs correction signal calculations using an exhaustive search on selected image portions. An X and Y laser correction signal is derived from the landmark tracking information and provided to a pair of galvanometer steered mirrors via a data acquisition and control subsystem. This subsystem also responds to patient inputs and the system monitoring lesion growth. This paper begins with an overview of the robotic laser system design followed by implementation and testing of a development system for proof of concept. The paper concludes with specifications for a real time system.
Hayreh, Sohan Singh; Zimmerman, M Bridget
To investigate systematically the retinal and optic disk changes in central retinal vein occlusion (CRVO) and their natural history. This study comprised 562 consecutive patients with CRVO (492 nonischemic [NI-CRVO] and 89 ischemic CRVO [I-CRVO] eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Retinal and subinternal limiting membrane hemorrhages and optic disk edema in I-CRVO were initially more marked (P < 0.0001) and took longer to resolve (P < 0.015) than that in NI-CRVO. Initially, macular edema was more marked in I-CRVO than that in NI-CRVO (P < 0.0001) but did not significantly differ in resolution time (P = 0.238). Macular retinal epithelial pigment degeneration, serous macular detachment, and retinal perivenous sheathing developed at a higher rate in I-CRVO than that in NI-CRVO (P < 0.0001). Ischemic CRVO had more retinal venous engorgement than NI-CRVO (P = 0.003). Fluorescein fundus angiography showed significantly more fluorescein leakage, retinal capillary dilatation, capillary obliteration, and broken capillary foveal arcade (P < 0.0001) in I-CRVO than NI-CRVO. Resolution time of CRVO was longer for I-CRVO than NI-CRVO (P < 0.0001). Characteristics and natural history of fundus findings in the two types of CRVO are different.
Hayreh, Sohan Singh; Zimmerman, M. Bridget
Purpose To investigate systematically the retinal and optic disc changes in central retinal vein occlusion (CRVO) and their natural history. Methods The study comprised 562 consecutive CRVO patients [492 non-ischemic (NI-CRVO) and 89 ischemic CRVO (I-CRVO) eyes] seen within 3 months of onset, Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Results Retinal and sub-internal limiting membrane hemorrhages, and optic disc edema in I-CRVO were initially more marked (p<0.0001), and took longer to resolve (p<0.015) than in NI-CRVO. Initially, macular edema was more marked in I-CRVO than NI-CRVO (p<0.0001), but did not significantly differ in resolution time (p=0.238). Macular retinal epithelial pigment degeneration, serous macular detachment, and retinal perivenous sheathing developed at a higher rate in I-CRVO than in NI-CRVO (p<0.0001). I-CRVO had more retinal venous engorgement than NI-CRVO (p=0.003). Fluorescein fundus angiography showed significantly more fluorescein leakage, retinal capillary dilatation, capillary obliteration, and broken capillary foveal arcade (p<0.0001) in I-CRVO than NI-CRVO. Resolution time of CRVO was longer for I-CRVO than NI-CRVO (p<0.0001). Conclusion Characteristics and natural history of fundus findings in the two types of CRVO are different. PMID:25084156
Schweitzer, Kelly D.; Eneh, Amaka A.; Hurst, Jonathan; Bona, Mark D.; Rahim, Karim J.; Abouammoh, Marwan; Sharma, Sanjay
Purpose The purpose of the study is to determine the validity of an original patient symptom diary in recording symptoms of posterior vitreous detachment (PVD). Methods In this prospective cohort study, all patients presenting to the Hotel Dieu hospital emergency eye clinic between September 2008 and July 2009 diagnosed with acute PVD were offered enrollment in the study. Patients were given the Queen’s University posterior vitreous detachment patient diary at the initial visit after detailed eye examination, assessment of risk factors for retinal tears and detachments and a thorough explanation of their presenting complaints to record their symptoms related to PVD. At a random point during their six-week follow up, the patients were verbally asked the same questions being recorded in the diary over the phone. At the six-week follow up visit, the diaries were collected and the verbal results were compared with the written results. Results There was substantial to near perfect agreement between the verbal questions and written answers. Cohen’s kappa scores for flash frequency, flash intensity, floater frequency, and floater type were 0.6229, 0.6389, 0.6495, and 0.8603, respectively. Conclusions The Queen’s University posterior vitreous detachment patient diary is a useful tool for investigating the quantity, quality and change in symptoms of patients presenting with PVD in the first 6 weeks of initial presentation. PMID:23960920
Ittner, Erica A; Bhakhri, Raman; Newman, Tricia
Necrotising retinopathies can be visually devastating. Most often associated with the viral family Herpesviridae and seen in both immune-competent and immunocompromised hosts, possible complications of necrotising retinopathies include progressive retinal necrosis with or without macular involvement, optic neuropathy and ultimately, secondary retinal detachment. Examples include progressive outer retinal necrosis, acute retinal necrosis and cytomegaloviral retinitis. If diagnosed early and treated aggressively, visual complications can be prevented; however, there is no current consensus on the most appropriate antiviral regimen for each of the different varieties of necrotising herpetic retinopathy. This paper reviews aspects of varieties of necrotising herpetic retinopathy, including pathophysiology, treatment and diagnostic testing. © 2016 Optometry Australia.
SHIRLEY, S Y
Retinal burns can be produced by direct gazing at the sun. This lesion is caused by the thermal effects of the visible and near infrared rays focused on the pigment structure behind the retina. It is rarely seen, as the normal eye will tolerate only fleeting glances at the sun, but is fairly common during a solar eclipse. A case of solar retinitis is presented in which treatment with corticosteroids lessened the retinal edema but the patient suffered a bilateral central scotoma and vision reduced to the 20/40 level. In viewing a solar eclipse a No. 4 density filter is recommended; as a rough test this filter will abolish the readability of print on a 60-watt incandescent frosted electric light bulb.
Shirley, S. Y.
Retinal burns can be produced by direct gazing at the sun. This lesion is caused by the thermal effects of the visible and near infrared rays focused on the pigment structure behind the retina. It is rarely seen, as the normal eye will tolerate only fleeting glances at the sun, but is fairly common during a solar eclipse. A case of solar retinitis is presented in which treatment with corticosteroids lessened the retinal edema but the patient suffered a bilateral central scotoma and vision reduced to the 20/40 level. In viewing a solar eclipse a No. 4 density filter is recommended; as a rough test this filter will abolish the readability of print on a 60-watt incandescent frosted electric light bulb. ImagesFig. 1Fig. 2 PMID:13977409
Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy . Arch. Ophthalmol. 1990; 108:1281-1286 46. Hanscom TA, Diddle KR. Early... plana vitrectomy and internal drainage. Arch. Ophthalmol. 1990;108:973-978 44. Vander JF, Federman JL, Greven C et al. Surgical removal of massive...hotocoagulation. A. Periphery of the lesion. The inner par of the OPL was replaced by processes of the Muller cells (Mu). Degenerated synaptic terminals
Douglas, D E
Retine, so named by Albert Szent-Györgyi, an inhibitor of the growth of transplanted malignant tumours in animals, is present in all mammalian tissues and in urine. Its inhibitory activity was extensively investigated by Szent-Györgyi, but its exact chemical identity was not determined. Details of the reported physical and chemical properties of retine and its ubiquitous occurrence identify it as being identical to a complex mixture of lipid 2,4-diketones of similar ubiquitous occurrence. This lipid mixture has been extensively studied, and individual members have been synthesized.
Eldon, D.; Kolemen, E.; Barton, J. L.; Briesemeister, A. R.; Humphreys, D. A.; Leonard, A. W.; Maingi, R.; Makowski, M. A.; McLean, A. G.; Moser, A. L.; Stangeby, P. C.
A new control system at DIII-D has stabilized the inter-ELM detached divertor plasma state for H-mode in close proximity to the threshold for reattachment, thus demonstrating the ability to maintain detachment with minimal gas puffing. When the same control system was instead ordered to hold the plasma at the threshold (here defined as T e = 5 eV near the divertor target plate), the resulting T e profiles separated into two groups with one group consistent with marginal detachment, and the other with marginal attachment. The plasma dithers between the attached and detached states when the control system attempts to hold at the threshold. The control system is upgraded from the one described in Kolemen et al (2015 J. Nucl. Mater. 463 1186) and it handles ELMing plasmas by using real time D α measurements to remove during-ELM slices from real time T e measurements derived from divertor Thomson scattering. The difference between measured and requested inter-ELM T e is passed to a PID (proportional-integral-derivative) controller to determine gas puff commands. While some degree of detachment is essential for the health of ITER’s divertor, more deeply detached plasmas have greater radiative losses and, at the extreme, confinement degradation, making it desirable to limit detachment to the minimum level needed to protect the target plate (Kolemen et al 2015 J. Nucl. Mater. 463 1186). However, the observed bifurcation in plasma conditions at the outer strike point with the ion B × \
Dedania, Vaidehi S; Ozgonul, Cem; Zacks, David N; Besirli, Cagri G
To develop an anatomical classification scheme for combined hamartoma of the retina and retinal pigment epithelium (RPE) and specify recommendations for follow-up interval. Retrospective review of patients with combined hamartoma of the retina and RPE examined during a 7-year period (2008-2015). The clinical presentation, fundus examination, and optical coherence tomography were analyzed. Lesions were classified based on location, fundus features, and optical coherence tomography findings. Lesion location: macular/peripapillary-Zone 1; mid-periphery-Zone 2; and far periphery-Zone 3. Associated fundus findings: no retinal traction-Stage 1; retinal traction and/or retinoschisis-Stage 2; and retinal detachment-Stage 3. Optical coherence tomography findings: epiretinal component only-A; partial retinal involvement-B; and complete retinal and RPE involvement-C. Complete ophthalmologic evaluation is recommended at least every 6 months for patients younger than 12 years, with more frequent follow-up in patients with: lesions in the macula/peripapillary (Zone 1) or with retinal traction, retinoschisis, or retinal detachment (Stage 2 and 3). Surgical intervention is recommended in patients with vision loss secondary to macular traction or retinal detachment. A new clinical classification system is proposed for evaluating and managing patients with combined hamartoma of the retina and RPE. The zone and stage of combined hamartoma of the retina and RPE lesion will assist in determining follow-up interval and surgical intervention. Application of a uniform classification scheme will facilitate assessment and comparison of findings across different studies.
The present paper reviews recent studies of retinal pathology from the American and British Journals of Ophthalmology during a one-year period (1973-1974). Selection is on the basis of potential value to clinical optometrists. Certain underlying factors in several types of retinal degeneration are first discussed, followed by characteristics of diabetic maculopathy and of other types of macular degeneration including that due to aging. Some material is presented on retinopathies related to sickle cell traits, to viral and worm infections, and to injury. Following a review of certain recent studies of retinoschisis, retinoblastoma, and retrolental fibroplasia, a concluding section deals with retinal detachments and breaks.
Jolivet, Laurent; Lecomte, Emmanuel; Huet, Benjamin; Denèle, Yoann; Lacombe, Olivier; Labrousse, Loïc; Le Pourhiet, Laetitia; Mehl, Caroline
Low-angle normal faults accommodate a large part of continental post-orogenic extension. Besides the intrinsic rheological characteristics of the continental crust that may lead to the formation of shallow-dipping shear zones at the brittle-ductile transition, the role of pre-existing low-angle structures such as large thrusts has been proposed by several authors. We explore this question with the example of the North Cycladic Detachment System (NCDS) that is composed of a series of distinct detachments cropping out on the islands of Andros, Tinos and Mykonos, separating the Cycladic Blueschists in the footwall from the Upper Cycladic Nappe in the hanging wall. We show that these extensional structures are part of a single large-scale structure (more than 200 km along strike) that reactivates the Vardar suture zone. It extends eastward on Ikaria and westward offshore Evia and Thessalia where it probably connects to recent shallow-dipping normal faults evidenced on published seismic reflection profiles. The NCDS started its activity in the Oligocene concommitantly with the Aegean extension, and was still active in the Late Miocene. It has exhumed a series of metamorphic domes from southern Evia to Mykonos below low-angle detachment systems, made of low-angle normal faults and low-angle ductile shear zones. The ductile shear zones and the faults were created with a low dip and they kept the same attitude throughout their exhumation. We identify three main detachments that are part of a continuum of extension on the NCDS : Tinos detachment, Livada detachment and Mykonos detachment. A fourth detachment (Vari detachment) is the reactivation of an Eocene exhumation-related structure. Deformation in the footwall is characterized by intense stretching and flattening. Using the spatial evolution observed along strike from Andros to Mykonos we construct a history of formation of the NCDS starting with the reactivation of former thrusts leading to the exhumation of high
Vela, M A; Campbell, D G
This is the first report describing the syndrome of hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered eyes. Four patients had a history of advanced primary open-angle glaucoma treated with multiple medical therapies, including timolol for 11 to 36 months. They then underwent filtration surgery, which failed in two cases. Timolol and/or acetazolamide therapy was instituted 1 to 18 months following surgery. The patients then developed hypotony and ciliochoroidal detachment, which resolved spontaneously after cessation of the pharmacologic aqueous suppressant therapy. In three of the cases, the episode of hypotony and ciliochoroidal detachment recurred after a second challenge with timolol and/or acetazolamide therapy. Inflammation, tumor, wound leakage, retinal detachment and cyclodialysis cleft were excluded. A mechanism of formation of ciliochoroidal detachment in this syndrome is proposed. Long-term timolol therapy followed by filtration surgery and its attendant postoperative hypotony and ciliochoroidal detachment sensitizes the ciliary epithelium. Subsequent pharmacologic aqueous suppressant therapy results in almost total reduction of aqueous production, causing hypotony and ciliochoroidal detachment.
Zhai, Yi-Ran; Zhao, Yong; Zhong, Jie; Li, Ke; Lu, Cui-Xin; Zhang, Bing
A new sphere-mapping algorithm called sector mapping is introduced to map sector images to the sphere of an eyeball. The proposed sector-mapping algorithm is evaluated and compared with the plane-mapping algorithm adopted in previous work. A simulation that maps an image of concentric circles to the sphere of the eyeball and an analysis of the difference in distance between neighboring points in a plane and sector were used to compare the two mapping algorithms. A three-dimensional model of a whole retina with clear retinal detachment was generated using the Visualization Toolkit software. A comparison of the mapping results shows that the central part of the retina near the optic disc is stretched and its edges are compressed when the plane-mapping algorithm is used. A better mapping result is obtained by the sector-mapping algorithm than by the plane-mapping algorithm in both the simulation results and real clinical retinal detachment three-dimensional reconstruction.
Ilin, A. V.; Díaz, F. R. Chang; Squire, J. P.; Breizman, B. N.; Novakovski, S. V.; Sagdeev, R. Z.
We present kinetic and MHD simulations of plasma detachment in the exhaust of the Variable Specific Impulse Magnetoplasma Rocket (VASIMR). The detachment is associated with a transition from subalfvenic to superalfvenic plasma flow in the magnetic nozzle. As a result, the kinetic energy of the outgoing plasma flow is greater than the magnetic field energy in the exhaust area, so that the plasma is no longer confined by the magnetic field. We model the outgoing plasma flow under the assumptions that the plasma is collisionless and has a constant electron temperature. Particle simulations show that the ion motion may become nonadiabatic in the exhaust area as the magnetic field decreases downstream. This effect should facilitate the detachment.
Chen, Wei; Wu, Ying; Zheng, Mi; Gu, Qing; Zheng, Zhi; Xia, Xin
AIM To develop a reliable, reproducible rat model of retinal vein occlusion (RVO) with a novel photosensitizer (erythrosin B) and study the cellular responses in the retina. METHODS Central and branch RVOs were created in adult male rats via photochemically-induced ischemia. Retinal changes were monitored via color fundus photography and fluorescein angiography at 1 and 3h, and 1, 4, 7, 14, and 21d after irradiation. Tissue slices were evaluated histopathologically. Retinal ganglion cell survival at different times after RVO induction was quantified by nuclear density count. Retinal thickness was also observed. RESULTS For all rats in both the central and branch RVO groups, blood flow ceased immediately after laser irradiation and retinal edema was evident at one hour. The retinal detachment rate was 100% at 3h and developed into bullous retinal detachment within 24h. Retinal hemorrhages were not observed until 24h. Clearance of the occluded veins at 7d was observed by fluorescein angiography. Disease manifestation in the central RVO eyes was more severe than in the branch RVO group. A remarkable reduction in the ganglion cell count and retinal thickness was observed in the central RVO group by 21d, whereas moderate changes occurred in the branch RVO group. CONCLUSION Rat RVO created by photochemically-induced ischemia using erythrosin B is a reproducible and reliable animal model for mimicking the key features of human RVO. However, considering the 100% rate of retinal detachment, this animal model is more suitable for studying RVO with chronic retinal detachment. PMID:24790863
Jabs, Douglas A; Ahuja, Alka; Van Natta, Mark; Lyon, Alice; Srivastava, Sunil; Gangaputra, Sapna
To describe the 5-year outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the era of highly active antiretroviral therapy (HAART). Prospective, multicenter, observational study. A total of 503 patients with AIDS and CMV retinitis. Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and retinal photographs. Participants were classified as having previously diagnosed CMV retinitis and immune recovery (CD4+ T cells ≥ 100 cells/μl), previously diagnosed retinitis and immune compromise, and newly diagnosed CMV retinitis (diagnosis <45 days before enrollment). Mortality, retinitis progression (movement of the border of a CMV lesion ≥ ½ disc diameter or occurrence of a new lesion), retinal detachment, immune recovery uveitis (IRU), and visual loss (< 20/40 and ≥ 20/200). Overall mortality was 9.8 deaths/100 person-years (PY). Rates varied by group at enrollment from 3.0/100 PY for those with previously diagnosed retinitis and immune recovery to 26.1/100 PY for those with newly diagnosed retinitis. The rate of retinitis progression was 7.0/100 PY and varied from 1.4/100 PY for those with previously diagnosed retinitis and immune recovery to 28.0/100 PY for those with newly diagnosed retinitis. The rate of retinal detachment was 2.3/100 eye-years (EY) and varied from 1.2/100 EY for those with previously diagnosed retinitis and immune recovery to 4.9/100 EY for those with newly diagnosed retinitis. The rate of IRU was 1.7/100 PY and varied from 1.3/100 PY for those with previously diagnosed retinitis and immune recovery at enrollment to 3.6/100 PY for those with newly diagnosed retinitis who subsequently experienced immune recovery. The rates of visual loss to < 20/40 and to ≤ 20/200 were 7.9/100 EY and 3.4/100 EY, respectively; they varied from 6.1/100 EY and 2.7/100 EY for those with previously diagnosed retinitis and immune recovery to 11.8/100 EY and 5.1/100 EY for those with newly diagnosed
Retinitis pigmentosa (RP) is an inherited retinal dystrophy caused by the loss of photoreceptors and characterized by retinal pigment deposits visible on fundus examination. Prevalence of non syndromic RP is approximately 1/4,000. The most common form of RP is a rod-cone dystrophy, in which the first symptom is night blindness, followed by the progressive loss in the peripheral visual field in daylight, and eventually leading to blindness after several decades. Some extreme cases may have a rapid evolution over two decades or a slow progression that never leads to blindness. In some cases, the clinical presentation is a cone-rod dystrophy, in which the decrease in visual acuity predominates over the visual field loss. RP is usually non syndromic but there are also many syndromic forms, the most frequent being Usher syndrome. To date, 45 causative genes/loci have been identified in non syndromic RP (for the autosomal dominant, autosomal recessive, X-linked, and digenic forms). Clinical diagnosis is based on the presence of night blindness and peripheral visual field defects, lesions in the fundus, hypovolted electroretinogram traces, and progressive worsening of these signs. Molecular diagnosis can be made for some genes, but is not usually performed due to the tremendous genetic heterogeneity of the disease. Genetic counseling is always advised. Currently, there is no therapy that stops the evolution of the disease or restores the vision, so the visual prognosis is poor. The therapeutic approach is restricted to slowing down the degenerative process by sunlight protection and vitaminotherapy, treating the complications (cataract and macular edema), and helping patients to cope with the social and psychological impact of blindness. However, new therapeutic strategies are emerging from intensive research (gene therapy, neuroprotection, retinal prosthesis). PMID:17032466
Jackson, T L; Donachie, P H J; Sparrow, J M; Johnston, R L
Aim To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract extraction. Methods Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11 618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS). Results The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication—the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2–1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively. Conclusion VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes. PMID:23449509
Rowley, S A; Vijayasekaran, S; Yu, P K; McAllister, I L; Yu, D-Yi
Aim: To investigate the retinal toxicity of intravitreal injection of a novel fibrinolytic tenecteplase in rabbit eyes. Methods: Tenecteplase (25–350 μg in 0.1 ml BSS) was injected into the vitreous cavity of normal rabbit eyes. Control (fellow) eyes received 0.1 ml of BSS. One day, 1 week, and 2 months post-injection, the eyes were examined by slit lamp biomicroscopy, indirect ophthalmoscopy, and electroretinography, and then harvested for histopathological examination. Results: No evidence of retinal toxicity was seen with tenecteplase doses up to and including 50 μg. At a dose of 150 μg ophthalmoscopy was normal, but histology showed mild retinal damage in the inner nuclear layer and electroretinography showed a temporary reduction in B-wave amplitude. At doses of 200 μg and above, there was evidence of retinal toxicity on electroretinography, ophthalmoscopy, and histology. Ophthalmoscopic findings included vitreal fibrosis, retinal necrosis and tractional retinal detachment and light microscopy revealed necrosis of retinal pigment epithelium and other retinal layers. Damage was centred around the injection site but was more widespread with the higher doses. Conclusion: A dose of 50 μg tenecteplase appears safe for intravitreal injection in the rabbit. Tenecteplase could have potential applications in the treatment of submacular haemorrhage and retinal vein occlusion. PMID:15031179
Sezgin, Efe; van Natta, Mark L; Ahuja, Alka; Lyon, Alice; Srivastava, Sunil; Troyer, Jennifer L; O'Brien, Stephen J; Jabs, Douglas A
To evaluate the effects of previously reported host genetics factors that influence cytomegalovirus (CMV) retinitis incidence, progression to acquired immune deficiency syndrome (AIDS), and efficacy of highly active antiretroviral therapy (HAART) for mortality, retinitis progression, and retinal detachment in patients with CMV retinitis and AIDS in the era of HAART. Prospective, multicenter, observational st