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[Aphakic retinal detachment in myopic eyes].

The incidence of retinal detachment following cataract extraction was studied in a myopic population of 803 eyes, which were selected by a measurement of the axial length out of 3,184 cases consecutively operated on. The incidence of retinal detachment following intracapsular cataract extraction was 1.5%, which was very similar to that after extracapsular cataract extraction: 1.8%, in the lowest range of date published in the literature. The incidence of retinal detachment of the pseudophakic myopic eye (operated on with the extracapsular technique, combined with implantation of a posterior chamber lens, the PMMA optic disc, diameter 5.8 mm with a 10 degrees angulated haptic and modified prolene-C loops) was 1.1%, in which the cases of intraoperative posterior capsule rupture with vitreous loss were included. There was no correlation between the incidence of retinal detachment and axial length. All cases of retinal detachment appeared in eyes with an axial length of 24.2 to 27.0 mm. In 9 of 11 (75%), retinal detachments occurred during the first 18 months after cataract extraction. In our opinion extracapsular cataract extraction with implantation of a posterior chamber lens is the best method of providing postoperative retinal detachment of the cataractous myopic eye. The question of the incidence of retinal detachment following cataract removal by the extracapsular technique and secondary capsulotomy by the Nd-YAG laser is still interesting.

Cataract Extraction↗

[Ciliochoroidal detachment following scleral buckling surgery for rhegmatogenous retinal detachment].

PURPOSE AND METHODS: We observed the peripheral choroid; ciliary body, and depth of the anterior chamber by ultrasound biomicroscopy (UBM) in 31 eyes with rhegmatogenous retinal detachment before and after scleral buckling surgery. Scleral encircling was performed in 11 eyes and segmental scleral buckling in 20 eyes. RESULTS: With UBM, ciliochoroidal detachment was detected in all eyes (100%) following scleral encircling and in 8 eyes (40.0%) following segmental scleral buckling. After scleral encircling procedure, the eyes with preoperatively bullous and wide retinal detachment showed a severe ciliochoroidal detachment and edema of the ciliary body. Shallowing of the anterior camber occurred in all 11 eyes (100%) after scleral encircling and in 12 of 20 eyes (60.0%) after segmental scleral buckling. Marked shallowing with closure of the angle and elevated intraocular pressure occurred in 2 eyes. CONCLUSION: The results showed that careful postoperative examinations for the anterior segments, chamber angle, and intraocular pressure are necessary with slit-lamp examination and applanation tonometry after scleral buckling surgery.

Adult↗

Glial cell reactivity in a porcine model of retinal detachment.

PURPOSE: Detachment of the neural retina from the pigment epithelium causes, in addition to photoreceptor deconstruction and neuronal cell remodeling, an activation of glial cells. It has been suggested that gliosis contributes to the impaired recovery of vision after reattachment surgery that may involve both formerly detached and nondetached retinal areas. Müller and microglial cell reactivity was monitored in a porcine model of rhegmatogenous retinal detachment, to determine whether gliosis is present in detached and nondetached retinal areas. METHODS: Local detachment was created in the eyes of adult pigs by subretinal application of hyaluronate. Retinal slices were immunostained against glial intermediate filaments and K+ and water channel proteins (aquaporin-4, Kir4.1, Kir2.1), and P2Y receptor proteins. In retinal wholemounts, adenosine 5'-triphosphate (ATP)-induced intracellular Ca2+ responses of Müller cells were recorded, and microglial and immune cells were labeled with Griffonia simplicifolia agglutinin isolectin I-B4. K+ currents were recorded from isolated Müller cells. RESULTS: At 3 and 7 days after surgery, Müller cells in detached retinas showed a pronounced gliosis, as revealed by the increased expression of the intermediate filaments glial fibrillary acidic protein and vimentin, by the decrease of Kir4.1 immunoreactivity and of the whole-cell K+ currents, and by the increased incidence of cells that showed Ca2+ responses on stimulation of purinergic (P)2 receptors by ATP. By contrast, the immunohistochemical expression of Kir2.1 and aquaporin-4 were not altered after detachment. The increase in the expression of intermediate filaments, the decrease of the whole-cell K+ currents and of the Kir4.1 immunolabeling, and the increase in the Ca2+ responsiveness of Müller cells were also observed in attached retinal areas surrounding the focal detachment. The density of microglial-immune cells at the inner surface of the retinas increased in both detached and nondetached retinal areas. The immunoreactivities for P2Y1 and P2Y2 receptor proteins apparently increased only in detached areas. CONCLUSIONS: Reactive responses of Müller and microglial cells are not restricted to detached retinal areas but are also observed in nondetached regions of the porcine retina. The gliosis in the nondetached retina may reflect, or may contribute to, neuronal degeneration that may explain the impaired recovery of vision observed in human subjects after retinal reattachment surgery.

Animals↗

Pseudophakic retinal detachment with ruptured posterior lens capsule.

The relationship between retinal detachment and posterior lens capsule rupture in pseudophakic patients was studied. Records of patients with pseudophakic retinal detachment who were admitted to Siriraj Hospital from 1992 to 2004 were reviewed. The patients were divided into 2 main groups: 1) The study group (pseudophakic retinal detachment) 79 eyes (78 cases) which was subdivided into group 1a) pseudophakic retinal detachment with intact posterior lens capsule (50 eyes), and group 1b) pseudophakic retinal detachment with ruptured posterior lens capsule (29 eyes); 2) The control group 99 eyes (90 cases) which was subdivided into group 2a) pseudophakic patients with intact posterior lens capsule (83 eyes), and group 2b) pseudophakic patients with ruptured posterior lens capsule (16 eyes). The relationship between pseudophakic retinal detachment and posterior lens capsule rupture was analyzed by Chi-square test, and risk factors were analyzed by multiple logistic regression. Retinal detachment in pseudophakic patients was found more often in males more than in females, and the average age was 57.9 +/- 11.8 years, the retinal detachment was related to posterior lens capsule rupture (p = 0.003). Patients with pseudophakic retinal detachment with a ruptured posterior lens capsule had a risk 5.7 times greater than pseudophakic patients with an intact posterior lens capsule (adjusted Odds ratio = 5.716, 95% CI = 2.118-15.427). The present study showed that posterior lens capsule rupture increased the risk of retinal detachment. Ophthalmologists should be aware of retinal detachment development after YAG capsulotomy, especially in patients who have other risk factors such as myopia, lattice degeneration, retinal break, or previous retinal detachment surgery.

Adult↗

The expanding role of primary pars plana vitrectomy in the treatment of rhegmatogenous noncomplicated retinal detachment.

The surgical management of rhegmatogenous retinal detachment has evolved dramatically during the past 2 decades. Investigators have introduced and refined alternative techniques to scleral buckling surgery including pneumatic retinopexy and primary pars plana vitrectomy (PPV). Rapid parallel developments in instrumentation, including wide-angle viewing systems, perfluorocarbon liquids, novel vitrectomy machines, intraocular tamponades, and endolaser photocoagulators have led to increasing sophistication in primary PPV surgical techniques for the treatment of rhegmatogenous uncomplicated retinal detachment. However, the precise role of primary PPV in new uncomplicated retinal detachment remains debatable owing to the lack of controlled randomized trials. This article examines primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment and presents the specific types of retinal detachments for which primary PPV may be optimal, according to personal and reported results, the surgical instrumentation and technique, as well as the complications and limitations of this surgical method.

Humans↗

Diplopia after retinal detachment surgery.

Diplopia following retinal detachment usually responds to simple measures. Fifteen out of 311 cases developed diplopia lasting more than three months after conventional retinal detachment surgery. Binocular single vision was restored in 12 of the 15 cases (80%). The mean follow-up was four years. Diplopia was eliminated stepwise. If prisms were ineffective, our first surgical procedure was removal of the scleral buckle. If the retina was flat, we were prepared to remove the buckle early. When diplopia persisted after buckle removal, we proceeded to strabismus surgery. Our most consistent results followed strabismus surgery on the untreated eye. Prisms alone restored binocular single vision in six patients (40%), one of whom preferred to adopt a compensatory head posture. Removal of the scleral buckle restored binocular single vision in three patients (20%), with the help of a prism in one case and a compensatory head posture in another. Binocular single vision was restored after buckle removal and strabismus surgery in three further patients (20%), one requiring a prism in addition. Binocular single vision was not restored in three patients (20%).

Adult↗

Serous retinal detachments in thrombotic thrombocytopenic purpura.

Serous retinal detachments are a rare ocular complication of thrombotic thrombocytopenic purpura (TTP), with only six previous case reports in the literature. We have recently observed two patients with relapsing TTP who developed bilateral serous retinal detachments during acute exacerbations of their disease. In contrast to all but one of the previously described patients, both of our patients survived the episode during which retinal detachments occurred. Hypertension appears to contribute to the development of retinal detachments in TTP, and vigorous efforts at blood pressure control are indicated. Serous retinal detachments may be a more frequent component of chronic relapsing TTP than has been suspected.

Adult↗

Equatorial lens pigmentation, myopia, and retinal detachment.

Five myopic male retinal detachment patients had pigmentation of the lens equator that mildly obscured the view of the ora serrata. It may be related to a prepigmentary glaucoma state or to development of the ciliary ring predisposing to retinal detachment, or both.

Adult↗

Tractional retinal detachment in Usher syndrome type II.

Retinal detachment is a rare complication in patients with retinitis pigmentosa. A case is reported of tractional retinal detachment in a patient with retinitis pigmentosa and sensorineural hearing loss, which was diagnosed as Usher syndrome type II. Because of the poor visual prognosis, the patient refused surgery in that eye. Tractional retinal detachment should be added to the differential diagnoses of visual loss in patients with retinitis pigmentosa.

Audiometry↗

Sutureless scleral buckle for retinal detachment with thin sclera.

Retinal detachment surgery can be hazardous in the presence of thin sclera, with increased risk of inadvertent perforation. We designed polymethylmethacrylate belt loops that can be fixed to the sclera with cyanoacrylate tissue adhesive, allowing 360 degrees scleral buckling to be performed without sutures. We report the successful use of this technique in a three-year-old girl with a rhegmatogenous retinal detachment and blue sclerae.

Child, Preschool↗

[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.

Adolescent↗