SYMPOSIUM on retinal detachment.
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Humans↗
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Results for “Retinal Detachment”
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[Discussion on traumatic retinal detachment].
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Humans↗
[Retinal detachment with giant tears].
Retinal detachments are one of the greatest challenge for the vitreoretinal surgeon. Giant tears have a special place among them because they need a special equipment and experience. We are presenting here our experience concerning this type of tears.
Humans↗
Recurrent retinal detachment more than 1 year after reattachment.
PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.
Adolescent↗
[Microsurgery of retinal detachment in children].
We conducted a retrospective study of 84 retinal detachments in 69 consecutive children under 15 years of age, operated using microsurgical techniques. The goal of this study was to evaluate the prognosis following this surgical approach. Trauma was the most frequent etiology (34.6% of eyes), followed by high myopia (31% of eyes). The other etiologies were varied. Cicatricial retinopathy of prematurity was the most common of them (9.5% of eyes). The series was characterised by the severity of retinal detachment at initial presentation with total retinal detachment in 44% of eyes, detached macula in 70.3% of eyes and severe PVR in 29.8% of eyes. Sixty nine of the 84 eyes were operated on. Thirty two eyes were managed using transscleral microsurgery and 37 eyes (53.6%) required vitrectomy. Permanent retinal reattachment was achieved in 51 of the 69 eyes (73.9%). The present series of retinal detachments in children was highly heterogeneous. Retinal detachments related to retinogenic retinal breaks (atrophic holes and oral dialyses) were more common compared with adult retinal detachments. Their prognosis after surgery was excellent. In contrast traction retinal detachments and detachments related to vitreogenic retinal tears were characterised by a more guarded prognosis. However microsurgical techniques have made the most severe cases, such as grade D2-D3 PVR, giant tears with an inverted posterior flap and detachments after penetrating eye injuries, amenable to surgical management with encouraging results.
Adolescent↗
[Statistical study of aqueous flare in rhegmatogenous retinal detachment].
Inflammation of the anterior chamber in rhegmatogenous retinal detachment was studied in 338 eyes with a laser flare cell meter. The mean flare value, 32.84 +/- 81.39 pc/msec, was significantly higher (p < 0.0001) than the 5.01 +/- 2.05 pc/msec of the control group of 133 normal eyes. Clinical findings of retinal detachment were grouped into 11 factors and each factor was divided into 34 details. The following details were proven by t-test to cause significant elevation of the flare value: (1) duration of more than 3 months, (2) hypotony of less than 9 mmHg, (3) aphakia, (4) retinal breaks in the ora area or the posterior area, (5) extension of retinal detachment with more than 2 quadrants, and (6) choroidal detachment. The correlation coefficients of the 6 clinical factors showed significant elevation of flare value in the following order: (1) presence or absence of choroidal detachment (0.396), (2) extension of retinal detachment (0.375), (3) intraocular pressure (-0.28), (4) duration of retinal detachment (0.18), (5) location of the break (0.15), and (6) presence or absence of the lens (0.134).
Adult↗
Retinal detachment in Marfan's syndrome. Characteristics and surgical results.
BACKGROUND: The presence of a rhegmatogenous retinal detachment in a patient with Marfan's syndrome is manifested by narrow pupils, dislocated lenses, and a spectrum of pathology ranging from simple holes to giant tears with or without proliferative vitreoretinopathy. PATIENTS AND METHODS: Thirteen patients (18 eyes) with Marfan's syndrome underwent surgery for retinal detachment. Characteristic findings were a retinal detachment in three or more quadrants (12 eyes), a single tear smaller than 30 degrees (eight eyes), a tear between 80 degrees and 120 degrees (five eyes), equatorial and postequatorial tears (11 eyes), and advanced proliferative vitreoretinopathy (seven eyes). Nine uncomplicated retinal detachments were managed with scleral buckling, and nine complicated retinal detachments were managed with pars plana vitrectomy, scleral buckling, and retinal tamponade, mostly with silicon oil. RESULTS: The results of surgery varied, depending on the nature of the retinal tear and the presence of proliferative vitreoretinopathy. Complete retinal reattachment was achieved in 89% of uncomplicated retinal detachments and in 56% of complicated retinal detachments. Additional partial anatomic success was achieved in two eyes with complicated retinal detachments where the macula was attached. Visual acuity improved significantly in five eyes with uncomplicated retinal detachments (median final vision, 20/80) and in six eyes with complicated retinal detachments (median final vision, 20/200). CONCLUSION: The results of surgical treatment for retinal detachments in patients with Marfan's syndrome were comparable with those in patients without Marfan's syndrome. In seven cases of retinal detachment in patients with Marfan's syndrome, we were able to reattach the retina without removing the dislocated intraocular lens.
Adolescent↗
Elevated intraocular pressure secondary to rhegmatogenous retinal detachment.
Elevated intraocular pressure secondary to rhegmatogenous retinal detachment was described by Ariah Schwartz in 1972, an entity commonly known as Schwartz's syndrome. Photoreceptor outer segments identified in the aqueous of patients with this syndrome are thought to play a role in the elevation of the intraocular pressure. We present two patients with open angles and elevated intraocular pressure associated with retinal detachment. Retinal reattachment surgery resulted in normalization of the intraocular pressure. Electron microscopic examination of aqueous specimens from our patients demonstrated a predominance of photoreceptor outer segments in varying stages of degeneration. In these specimens, inflammatory cells, fibrin, and pigment granules were rarely observed or were absent. We review the literature regarding the epidemiology, clinical characteristics, and pathogenesis of Schwartz's syndrome.
Aged↗
Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy.
Traumatic hemorrhagic retinal detachment may prevent successful visual rehabilitation of eyes with severe posterior segment injury. We managed 19 consecutive cases of traumatic hemorrhagic retinal detachment with pars plana vitrectomy, scleral buckling, and fluid-gas exchange, with or without internal drainage of subretinal hemorrhage. We based our approach on the amount of subretinal hemorrhage present and the location of associated retinal breaks. Internal drainage of subretinal hemorrhage was performed in 16 eyes to allow adequate retinopexy to hemorrhagically elevated retinal breaks (9 eyes), to remove massive subretinal hemorrhage (4 eyes), and to allow intraoperative reattachment when the retina exhibited bullous retinal detachment (3 eyes). Overall, with a minimum of 6 months of follow-up, anatomic reattachment was achieved in 13 (68%) of 19 eyes, and functional success (visual acuity 5/200 or better) was achieved in 6 (32%) of 19 eyes. Anatomic failure resulted from proliferative vitreoretinopathy (4 eyes) and globe atrophy (2 eyes). Drainage of subretinal blood appeared to be beneficial for hemorrhagically elevated retinal tears to allow adequate retinopexy and may help to accomplish long-term anatomic attachment in eyes with massive subretinal hemorrhage or bullous retinal detachment.
Adolescent↗
Management of retinal detachment with choroidal coloboma.
Seventeen eyes with retinal detachment secondary to retinal breaks in the colobomatous area were managed by vitrectomy procedures. Endodrainage was done through the break in the colobomatous area, with simultaneous fluid-air exchange. Endolaser photocoagulation was performed along the colobomatous margin posteriorly, while the anterior portion was treated by transscleral cryopexy. Silicone oil was then exchanged with air. In nine cases, the silicone oil had to be removed for complications such as emulsification, glaucoma, and keratopathy; in three of these eyes, oil removal resulted in recurrent retinal detachment. At the 2-month follow-up visit, there was 100% anatomic success, and 12 eyes (70.6%) recovered visual acuity of 10/200 or better. Of the 11 eyes with follow-up of more than 6 months, in 9 (81.8%) the retina remained reattached at last-follow up, and in 6 eyes (54.5%) a visual acuity of 10/200 or better was obtained.
Adolescent↗
Experimental retinal detachment. XI. Furosemide-inhibitable fluid absorption across retinal pigment epithelium in vivo.
Rhegmatogenous retinal detachments were created in one eye of each of six cynomolgus monkeys. Total vitrectomy alone was performed in the fellow eyes. The rate of disappearance of fluorescein sodium injected into the vitreous cavity was measured with kinetic vitreous fluorophotometry. Intravitreal 10(-4)M probenecid was used to inhibit active outward transport of fluorescein. In eyes with retinal detachment, the rate of fluorescein loss from the vitreous cavity was decreased 44% and 22% following intravitreal injection of 10(-4) and 10(-5)M furosemide (Lasix), respectively. Intravitreal 10(-4)M furosemide decreased the rate of fluorescein loss in fellow eyes by 35%. The rate of fluorescein loss via the anterior chamber accounted for only 1% to 8% of the total rate of vitreous fluorescein loss. Thus, it is concluded that intravitreal absorption across the retinal pigment epithelium.
Absorption↗
Natural history of asymptomatic clinical retinal detachments.
PURPOSE: To determine the natural history of asymptomatic, clinical rhegmatogenous retinal detachment. DESIGN: Single observer, prospective, consecutive, observational case series. METHODS: Consecutive patients were included who were referred to the author's clinical practice with rhegmatogenous retinal detachment extending greater than two disk-diameters posterior to the equator. Patients whose eye had an intraocular procedure within the past year or who had a history of symptomatic retinal detachment in the fellow eye were excluded. Eighteen eyes of 16 patients were followed for an average of 46 months. The main outcome measure was progression of asymptomatic retinal detachment to symptomatic retinal detachment. RESULTS: None of the 18 asymptomatic, clinical, rhegmatogenous retinal detachments became symptomatic. The posterior margin of one retinal detachment slightly progressed 4 months into the study and then stabilized for 4 years and remained asymptomatic. CONCLUSIONS: Asymptomatic, clinical, rhegmatogenous retinal detachments can probably be safely observed for many years.
Adult↗
The repair of rhegmatogenous retinal detachments. American Academy of Ophthalmology.
Current techniques of rhegmatogenous retinal detachment repair allow most retinal detachments to be repaired successfully. The success of repair depends on a careful preoperative examination and choice of an appropriate surgical procedure. The surgical procedure must be tailored to the individual eye based on a detailed preoperative examination of the retina and vitreous. Postoperative complications are not infrequent compared to many other ophthalmic surgical procedures such as cataract extraction and strabismus repair. The surgeon must observe the eye carefully in the postoperative period to monitor and treat any complications as they arise. Improvements in surgical techniques coupled with a better understanding of the pathophysiology of rhegmatogenous retinal detachment continue to improve the anatomic and functional success of retinal detachment repair.
Humans↗
Decreased levels of cGMP in vitreous and subretinal fluid from eyes with retinal detachment.
BACKGROUND: Cyclic guanosine monophosphate (cGMP) is produced in different retinal cells, including photoreceptor cells, wherein cGMP mediates photo-transduction. CGMP is degraded by phosphodiesterases (PDE). The aim was to investigate whether retinal detachment alters intraocular cGMP levels in human eyes. METHODS: cGMP and PDE were determined in vitreous fluid from 50 eyes with a retinal detachment (group I) and in 20 control samples (group II) of vitreous fluid from eyes without retinal detachment. Group III consisted of subretinal fluid samples from 70 eyes with retinal detachment. RESULTS: cGMP in vitreous fluid from eyes with retinal detachment (6.5 (SD 1.7) nM) was decreased compared to controls (67.1 (10.0) nM) (p<0.0001). In subretinal fluid, the mean level of cGMP was 2.4 (0.2) nM. No PDE could be detected in any of the intraocular fluid samples of patients nor controls. A decrease in the mean level of cGMP in subretinal fluid of eyes with retinal detachment correlated with a longer duration of detachment (r = -0.45, p = 0.007). CONCLUSIONS: Retinal detachment was found to be associated with a decrease in vitreous cGMP concentration. In subretinal fluid, a low cGMP level correlated inversely with the duration of the detachment.
Adolescent↗
Apoptotic photoreceptor degeneration in experimental retinal detachment.
PURPOSE: To investigate the possibility that cell death in retinal detachment may occur by reactivation of apoptotic programmed cell death mechanisms. METHODS: Unilateral retinal detachments were created in adult cats using 0.25% sodium hyaluronate; detached and control retinas were studied at different intervals. Internucleosomal DNA fragmentation (one of the landmarks of apoptosis) was investigated in tissue sections with the TUNEL technique, which uses terminal transferase to label with biotinylated nucleotides the 3' ends of DNA fragments. Sections also were labeled with propidium iodide, which intensely stains pyknotic nuclei. In addition, one time point was selected for analysis with electron microscopy. RESULTS: TUNEL-positive (T+) and propidium iodide-positive (PI+) cells almost never were observed in retinas from control eyes, but they were abundant at defined time points after retinal detachment, appearing almost exclusively in the photoreceptor layer. Their frequency was particularly high 1 to 3 days after detachment but declined rapidly over the next several weeks. T+ cells were still present 28 days after retinal detachment. Electron microscopy also revealed evidence of apoptotic cells after retinal detachment. CONCLUSIONS: Results are consistent with the hypothesis that photoreceptor degeneration after retinal detachment occurs through apoptosis, usually associated with intrinsic, programmed cell death mechanisms. The detection of a rapid wave of photoreceptor degeneration seems to suggest that early therapeutic interventions might be recommended; agents capable of interfering with the apoptotic mechanism could have a role in the prevention of cell losses that represent a critical complication of retinal detachment.
Animals↗
Role of cardiovascular disease in the pathogenesis of rhegmatogenous retinal detachments.
In 100 patients with fresh rhegmatogenous retinal detachments complete ocular and physical examinations including electrocardiograms were carried out. The incidence of coronary artery disease and systemic hypertension in these patients with retinal detachments was much greater than that found in the general population of similar age and sex. A vascular theory is proposed to explain these findings in light of our current concepts of the pathogenesis of retinal detachments. It is also suggested that retinal detachments may be one element of a generalized vasculopathy that involves the coronary arteries, the pulmonary vasculature, and perhaps the renal circulation in patients with systemic hypertension.
Adolescent↗
Late recurrences after successful surgery for retinal detachment with macular hole.
Six myopic eyes affected by retinal detachment with macular hole which had been successfully reattached developed recurrent retinal detachment 7-78 months postoperatively. The mean interval between surgery and the recurrent retinal detachment was 13.4 months in five eyes managed with gas tamponade and no choroidal irritation. In an eye managed by scleral buckling with choroidal irritation, the recurrent retinal detachment occurred 78 months postoperatively. The retina was reattached following reoperation in all eyes. However, an eye successfully reattached without choroidal irritation developed four recurrences during the follow-up period. The pathogenesis of late recurrences after successful surgery for retinal detachment with macular hole remains speculative. A number of clinical findings suggest that vitreous traction plays a decisive role.
Adult↗
Retinal detachment in the rat.
Retinal detachment is uncommon in the rat. Retinal atrophy, rosette formation and folding of the retina are some of the sequelae following reattachment.
Animals↗