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PubMed1992

Prognostic value of new retinal tears associated with the development of postoperative proliferative vitreoretinopathy.

We prospectively evaluated for the presence of new retinal tears 60 eyes of 60 patients who developed recurrent retinal detachment complicated by proliferative vitreoretinopathy (PVR) after surgery for primary rhegmatogenous retinal detachment. New retinal tears associated with the development or recurrence of postoperative PVR were disclosed in 27 eyes (45%). New tears were categorized into two distinct groups: (1) peripheral new tears and (2) posterior new tears. Peripheral new tears were disclosed in 11 eyes. They were invariably located at the posterior edge of the vitreous base and showed a prevalence in the inferior quadrants. The prognosis for permanent retinal reattachment after reoperation was not influenced by the presence of peripheral new tears. Posterior new tears were disclosed in 19 eyes. They were located in the mid-periphery or close to the posterior pole. They were more frequent in grade D PVR (57.7%) compared with grade C PVR (11.7%) (P less than 0.01). Posterior new tears were associated with a poor prognosis. In grade D PVR the anatomic success rate following repeated surgery was only 13.3% (2/15 eyes), whereas all eyes with grade D PVR and no posterior new tears were successfully reattached (P less than 0.001). Failures to reattach the retina were related to recurrent PVR. It is concluded that the development of posterior new tears in postoperative PVR reflects a severe and active PVR process.

Adolescent↗
PubMed1992

The treatment of bullous rhegmatogenous retinal detachment.

We describe the results of a consecutive series of 97 cases of bullous superior retinal detachment treated by conventional surgery. The retinal detachments were characterized by either a single retinal break or multiple retinal breaks confined within 1 clock hour and no proliferative vitreoretinopathy. The surgery involved sequential drainage of subretinal fluid, injection of air, cryotherapy and the application of local explant. All cases would otherwise be suitable for pneumatic retinopexy. The anatomical success rate was 85.5% with a single operation and 97% with further procedures. We report on the complications encountered and appraise the advantages and disadvantages of this operation. Forty-five of the 97 cases had detachment of the macula for less than 2 weeks, and 35 of the 45 (80%) achieved a visual acuity of 6/18 or better. These visual results challenge the assertion that better visual outcome might be attained with pneumatic retinopexy.

Air↗
PubMed1995

Communication between the subretinal space and the vitreous cavity in the morning glory syndrome.

BACKGROUND: The aim was to describe a pathogenic mechanism for a rhegmatogenous retinal detachment in a 69-year-old man with the morning glory syndrome. METHODS: During vitreous surgery for a retinal detachment, a membrane was removed that covered the optic disc anomaly and produced traction on the peripapillary retina. A retinal hole was found in tissue lying within the optic cup, and the hole was sealed using a autologous plasma-thrombin mixture. Silicone oil was used for retinal tamponade. RESULTS: A retinal hole in tissue lying within the optic cup provided a fluid pathway between the vitreous cavity and the subretinal space. Following vitrectomy surgery, bubbles of silicone oil passed through the retinal hole into the subretinal space of the macula. CONCLUSION: This case demonstrates that a retinal hole in tissue lying within the optic disc anomaly of the morning glory syndrome provides a communication for fluid between the subretinal space and the vitreous cavity, resulting in a rhegmatogenous retinal detachment. Vitreous replacement with silicone oil resulted in the migration of silicone bubbles into the subretinal space.

Aged↗
PubMed1995

Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan.

BACKGROUND: The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan. METHODS: The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area. RESULTS: From a population of 1 840 000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100 000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment-nontraumatic phakic, aphakic, and blunt trauma--were 9.8, 0.5 and 0.2 per 100 000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes. CONCLUSION: Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.

Adolescent↗
PubMed1996

Pressure sore in a patient who underwent repair of a retinal tear with gas injection.

PURPOSE: To demonstrate a pressure sore following strict head positioning in a patient who underwent encircling band, vitrectomy and gas injection. METHODS: A male patient was admitted to the hospital with a large posterior horseshoe tear in the inferior temporal retina with severe vitreous traction and retinal detachment. Encircling band, vitrectomy cryotherapy and gas injection was performed. After surgery the patient was instructed to sit in a face-down position. RESULTS: A pressure sore resulted from prolonged immobility of the right elbow due to face-down positioning following encircling band, vitrectomy and gas injection. CONCLUSION: A patient may rarely have compulsive personality traits that result in extreme compliance to the physician's recommendations; therefore, general instructions given for head positioning should include permission for a change in position when required, at least for brief periods of time.

Gases↗
PubMed1996

Cryopexy in primary rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy?

PURPOSE: To evaluate the role of cryopexy in the stimulation of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment. MATERIALS AND METHODS: A series of 595 eyes of 554 patients with primary rhegmatogenous retinal detachment, referred before any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted. RESULTS: The incidence of postoperative PVR in relation to the methods used for retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PVR was nil in retinal detachments due to atrophic holes in lattice, oral dialyses, and macular holes, regardless of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior edges, regardless of the retinopexy methods (P < 0.00001). In retinal detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retinopexy methods. In contrast, in retinal detachments due to horseshoe tears with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed with laser retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears the incidence of postoperative PVR was not statistically significantly greater in eyes managed with cryopexy (33.3%) than in eyes managed with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly higher in eyes managed with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17 eyes) (P = 0.006). CONCLUSIONS: Cryopexy is not a stimulating factor for postoperative PVR in primary rhegmatogenous retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In contrast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior edges or to retinal tears 180 degrees and over.

Adolescent↗
PubMed1995

Autologous platelet concentrate for the treatment of full-thickness macular holes.

BACKGROUND: To improve the anatomic success rate in the surgery of full-thickness macular holes, we tested, in a prospective pilot study, the effects of autologous platelet concentrate deposited on the macula at the end of surgery. METHODS: Two consecutive groups of patients were compared. Twenty eyes (group 1, mean symptom duration 11 months) were operated on with injection of an autologous platelet concentrate on the macula after fluid-gas exchange. Another 20 eyes (group 2, mean symptom duration 11 months) were subsequently operated on without autologous platelet concentrate. For all stage 3 holes, posterior hyaloid was detached en bloc at the level of the optic disc. The patient was left supine for 24 h after surgery, and then remained face down for 10 days. RESULTS: In group 1, 19 cases were an anatomic success, i.e. there was flattening of the retina surrounding the hole and reattachment of the edge of the hole to the retinal pigment epithelium; in 9 cases the hole was even undetectable. Final visual acuity was 0.5 or more in 9 eyes, and 0.4 or more in 14. Visual acuity improved by two lines or more in 17 of the 19 successfully operated eyes. In group 2, only 13 cases were an anatomic success. The functional results for the successfully operated eyes were identical to those of group 1. CONCLUSION: These results strongly suggested that autologous platelet concentrate could significantly improve the success rate in macular hole surgery and led us to begin a comparative, prospective, randomized trial.

Adult↗
PubMed1995

The effect of normal childbirth on eyes with abnormalities predisposing to rhegmatogenous retinal detachment.

BACKGROUND: Pregnant women who have high myopia, a history of retinal detachment or retinal holes, or have known lattice degeneration are frequently referred to an ophthalmologist for advice concerning the management of pregnancy and labor, i.e. whether a spontaneous vaginal delivery can be allowed and whether prophylaxis for high-risk retinal pathology is indicated. Many obstetricians still believe that pregnant women with ocular abnormalities predisposing to rhegmatogenous retinal detachment should have an instrumental delivery, and a few even advocate cesarian section. Very little has been written about the management of pregnant women with high-risk retinal pathology, and opinions differ considerably. Patient data on this subject are scarce. METHODS: We studied 10 women who had 19 deliveries (10 prospective and 9 retrospective) and who had a history of retinal detachment, had been diagnosed as having extensive lattice degeneration, or had been treated for symptomatic retinal holes or breaks. The women were followed from the third trimester of pregnancy through labor and delivery into the postpartum period, looking for changes in the retinal status. RESULTS: We found no changes in the retinal status in the postpartum examination. CONCLUSION: We conclude that prenatal treatment of asymptomatic retinal pathology is not indicated and that spontaneous vaginal delivery may be allowed to take place in women with high-risk retinal pathology.

Adult↗
PubMed1996

Bilaterality of idiopathic macular holes.

BACKGROUND: There has been wide variation in estimates of the incidence of bilateral idiopathic macular holes in the literature. This report of a large series of patients with macular holes provides further information regarding incidence of bilaterality, interval between onset in the first and the second eye, and visual outcome. METHODS: A retrospective chart review was done of 550 patients with idiopathic macular holes examined at the Bascom Palmer Eye Institute between 1968 and 1994. The incidence of bilaterality was estimated from 365 patients in whom the fellow eye was normal at the initial examination. The rate of onset in the fellow eye was evaluated by survival analysis. Mean follow-up was 31 months (median 17 months). RESULTS: Patients with incomplete macular holes (stage 1, aborted stage 1, lamellar) or full-thickness holes had a 19% incidence of bilaterality at 48 months follow-up. In the subset of 32 patients with full-thickness macular holes in the first eye, 13% developed full-thickness holes in the fellow eye within 48 months. The median interval between the onset in the first and in the second eye was 17.5 months. Visual acuity was excellent and stable in eyes with aborted stage 1 and lamellar holes. The visual acuity in the first eye with full-thickness macular hole decreased to 20/200 or worse in 79% of cases within 36 months' follow-up. CONCLUSION: The incidence of bilaterality and poor visual function in the majority of full-thickness idiopathic macular holes by 3 years' duration should be considered when advising patients and planning management.

Aged↗
PubMed1996

Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment.

BACKGROUND: Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling. METHODS: A retrospective study of 53 patients with a follow-up of 6-45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better. RESULTS: Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11% (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53). CONCLUSION: With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.

Adult↗
PubMed1992

Acute tear of the retinal pigment epithelium.

The fluorescein angiographic findings immediately following a tear of the retinal pigment epithelium are presented and the mechanisms of fluid movement from the retina to the choroid are discussed. Our case represents a clinical correlate to recent experimental reports on fluid movement across the retinal pigment epithelium-Bruch's membrane complex.

Acute Disease↗
PubMed1993

Retinal detachment and degeneration in response to subretinal perfluorodecalin in rabbit eyes.

Perfluorocarbon liquids, including perfluorodecalin (PFD), are useful intraoperative tools in complicated vitreoretinal surgery, such as for giant retinal tears, PVR and intraocular foreign bodies. Due to its high specific gravity (1.91 g/cm3) subretinal complications of PFD may occur. The consequences of subretinal PFD were studied in 23 albino rabbits (28 eyes). Using glass micropipettes (outer diameter of tip 100-120 microns), we injected 50-100 microliters PFD subretinally via the vitreous space. The same volume of BSS was injected into 18 control eyes. Eyes were monitored by indirect ophthalmoscopy and examined by light and electron microscopy at 1, 2 and 3 days, and 1, 2, 4 and 12 weeks. Progressive retinal detachments with newly formed retinal breaks in the inferior quadrants developed in 26 of 28 eyes. As early as 1 day postoperatively, subretinal PFD induced loss of outer and inner segments. Local retinal necrosis occurred in 4 eyes 5-7 days after surgery. A marked vacuole formation in retinal layers and PFD emulsification were regularly seen. The control eyes healed spontaneously. Toxic, mechanical and barrier effects may have caused the retinal damage. We advocate that all PFD be removed from the eye at surgery.

Animals↗
PubMed1993

Differential permeance of retina and retinal pigment epithelium to water: implications for retinal adhesion.

Water movement from the vitreous to the choroid would tend to maintain retinal apposition, if the retina were less permeable than the retinal pigment epithelium (RPE). We used a rabbit model, to test the relative permeability of retina and RPE to tritiated water. The retina was found less permeable than the RPE. This result suggests the presence of a hydrostatic pressure gradient across the retina which could enhance apposition of retina to the RPE.

Animals↗
PubMed1993

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↗
PubMedDate not supplied

Full-thickness macular holes treated with vitrectomy and tissue glue.

In the surgical treatment of full-thickness macular holes good results have been published with the combination of vitrectomy, gas and application of Transforming Growth Factor beta 2. Other authors report a 73% success rate in closing a full-thickness macular hole after vitrectomy and gas tamponade alone. We used, in addition to vitrectomy and gas tamponade, a tissue glue to stimulate adhesion of the elevated cuff of neurosensory retina surrounding a full-thickness macular hole and to close to hole itself. A total of 15 eyes of 13 patients (3 men, 10 women), with stage 3 and 4 macular holes were operated. All of the 13 uncomplicated cases showed complete closure of the macular hole. In one case (8%) the visual acuity decreased one line in spite of a funduscopically closed hole, and in two cases (16%) visual acuity remained the same despite closure. Increased visual acuity was seen in ten cases (76%), eight of which improved more than two lines.

Adult↗
PubMed1997

Peripheral visual field loss after vitreous surgery for macular holes.

BACKGROUND: Vitreous surgery for Idiopathic macular holes can result in both anatomic closure of the hole and visual improvement. In some patients even normal visual acuity is achieved. Postoperative visual field loss is a newly recognized complication. This prospective study evaluates the frequency and significance of scotomas after vitrectomy with gas tamponade for stage I-IV macular holes. METHODS: Over a period of 10 months, a consecutive series of 30 patients and 31 eyes with macular holes underwent pre- and postoperative automatic perimetry (Octopus 07, 70 degrees) and macular perimetry (Octopus M1, 24 degrees) to characterize the pattern of visual field defects after vitrectomy with gas tamponade. Success rates were evaluated and complications were analyzed. RESULTS: Anatomic success after one surgical procedure was achieved in 85% of cases, visual improvement in 58%. Some 70.1% of patients had peripheral scotomas postoperatively; some of these were highly symptomatic and others were detected by visual field testing only. The most consistently affected areas were the temporal and lower periphery of the visual field. The central visual field, however, was not disturbed. CONCLUSION: Visual field loss after otherwise successful surgery for macular holes is an unexpectedly frequent and serious complication. The authors discuss various factors that may contribute to the postoperative scotomas. From the localization of the scotomas it seems most likely that they are caused by the persistent pressure of the gas bubble on the peripheral retina. Further investigations are necessary to confirm this hypothesis, and ways must be found to avoid this complication in order to be able to proceed with this otherwise promising new indication group for vitreous surgery.

Aged↗