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PubMed1978

[Measurement of subretinal fluid in retinal detachment (author's transl)].

In surgery for retinal detachment, such as shortening of the eyeball, volume reducing, and indentating operations, knowledge of the volume of the subretinal fluid is important. A method based on ultrasonography was developed to measure the volume of subretinal fluid preoperatively. After establishing a topography of the fundus, the height of retinal detachment can be measured by ultrasonography at 49 defined points. The diameter of the eyeball is measured at 12 different points. From the height of retinal detachment and the diameter of the eyeball it is possible to calculate the subretinal space, which is divided into 60 segments. The total volume of subretinal fluid is calculated by adding the volumes of these 60 segments. The calculus is programmed on a computer.

Body Fluids↗

PubMed2001

[Stickler's syndrome (dystrophia vitreoretinalis hereditaria). Results of surgery for retinal detachment].

OBJECTIVE: Stickler's syndrome (SS) is an autosomal dominant hereditary disease of the collagenous connective tissue where impaired development of the vitreous body gel and peripheral retina and detachment of the retina are associated with general manifestations. The objective of the retrospective study was to evaluate the long-term results of surgery of retinal detachment in SS. PATIENTS: The group of patients comprised 7 patients, 6 men and 1 woman aged 4 to 45 years, average age 16.8 years. Autosomal dominant heredity was obvious in 6 members (85.7%) of two families. General manifestations of SS included abnormalities of the facial skeleton (6 patients), cleft palate (4 patients), impaired hearing (2 patients), marfanoid habitus (2 patients) and hyperextensibility of the joints (4 patients). In the eyes with SS was manifested by myopia from -1 to -9 D and a liquid vitreous body. Multiple foci of lattice degeneration supplemented the finding in 6 patients (85.7%). Detachment of the retina was a manifestation of SS in 12 of 14 eyes (85.7%). It was manifested in 5 of 7 patients concurrently or within 12 years in both eyes. The causes of retinal detachment were multiple equatorial and postequatorial tears due to lattice degeneration in 8 eyes (66.7%) or a giant tear in 4 eyes (33.3%). Advanced proliferative vitreoretinopathy (PVR) was associated with retinal detachment in 8 eyes (66.7%) and in 6 eyes (50%) it was not possible to assess the beginning of retinal detachment. RESULTS: In 3 of 5 patients with bilateral retinal detachment the adverse course of retinal detachment on the first eye was followed 8 to 12 years previously in another department: two retinal detachments with giant tears were evaluated as inoperable and one inveterated detachment with advanced PVR was operated unsuccessfully. Retinal detachment was operated in 9 eyes of 7 patients, in two patients both eyes were operated simultaneously. The patients were followed up after surgery for 11 months to 15 years, on average for 65 months. A cryosurgical approach was used in 6 retinal detachments (66.7%), accentuated cerclage with drainage of subretinal fluid in 5 and radial plombage in one eye. The retina attached in 5 of 6 eyes (83.3%) and the final visual acuity was 0.25-0.1, mean 0.66. Pars plana vitrectomy (PPV) and implantation of silicone oil (ISO) were the final surgical solution in 3 eyes of 3 patients (33.3%). In one eye with retinal detachment with a circumferential width of 320 degrees and advanced PVR PPV and ISO were the primary operation, in two eyes re-operation on account of a relapse of retinal detachment with advanced PVR after an unsuccessful cryosurgical operation. Anatomical and functional success was achieved in 2 of 3 eyes (66.7%), in one eye after removal of silicone oil from the eye. The final visual acuity of successfully operated eyes was 0.2 and 0.16. CONCLUSIONS: Retinal detachment in SS usually affects both eyes, the second eye may be affected after many years. The cause of retinal detachment are multiple tears or a giant tear. Early surgery of retinal detachment has as a rule a favourable effect, while late diagnosis of retinal detachment in children leads frequently to blindness. Dispensarization and regular ophthalmological check-ups of patients with SS are an essential prerequisite of successful prevention and treatment of retinal detachment.

Abnormalities, Multiple↗

PubMed1996

[Has the incidence of postoperative PVR in rhegmatogenous retinal detachment decreased?].

PURPOSE: To determine whether the incidence of severe postoperative PVR in primary rhegmatogenous retinal detachment has decreased over the last twelve years. MATERIALS AND METHODS: We prospectively evaluated 595 eyes of 554 consecutive patients with primary rhegmatogenous retinal detachment, referred before any failed attempt to reattach the retina, managed by the same surgeon between March 1983 and December 1994. The eyes were divided into two consecutive series: 275 eyes operated on from March 1983 through February 1988 (series no. 1), and 320 eyes operated on from February 1988 through December 1994 (series no. 2). We conducted univariate and multivariate statistical analyses to compare the incidence of postoperative PVR in the two consecutive series. RESULTS: The overall incidence of postoperative PVR was 8.72% (24/275 eyes) in series no. 1, versus 2.81% (9/320 eyes) in series no. 2 (p < 0.01). The incidence of postoperative PVR in retinal detachments due to atrophic holes in lattice degeneration, oral dialyses, and macular holes in myopic eyes, was nil in both series. The incidence of postoperative PVR in retinal detachments due to horseshoe tears with mobile posterior edges was 1.16% (1/86 eyes) in series no. 1, and 0% (0/109 eyes) in series no. 2. The incidence of postoperative PVR in retinal detachments associated with horseshoe tears with curled posterior edges was 21.15% (11/52 eyes) in series no. 1 versus 3.2% (3/93 eyes) in series no. 2 (p < 0.001). The incidence of postoperative PVR in giant tears was 35.5% (11/31 eyes) in series no. 1. and 14.7% (5/34 eyes) in series no. 2 (chi square = 3.77; at the limit of significance). The incidence of postoperative PVR in retinal detachments du to paravascular tears of the post-equatorial region in myopic eyes was 25% (1/4 eyes) in series no. 1, and 14% (1/7 eyes) in series no. 2. CONCLUSION: In our own experience, the incidence of postoperative PVR in primary rhegmatogenous retinal detachment has decreased at a statistically significant level since 1988. We believe that the decreased incidence of postoperative PVR in our most recent series is mainly related to the use of laser photocoagulation retinopexy rather than cryopexy in the management of high risk eyes (retinal detachments associated with horseshoe tears with curled posterior edges, and giant tears).

Adolescent↗

PubMed2005

Involution of retinopathy of prematurity after laser treatment: factors associated with development of retinal detachment.

PURPOSE: To identify specific features during the process of involution of retinopathy of prematurity after treatment at threshold that are associated with development of a retinal detachment. DESIGN: Retrospective case series. METHODS: The evolution of retinal detachments over time was analyzed retrospectively in 262 treated eyes of 138 infants. Specific features hypothesized to be associated with development of a retinal detachment were analyzed, including vitreous organization defined as clinically important, active stage 3 disease and active plus disease more than 21 days after treatment, and vitreous hemorrhage defined as clinically important. RESULTS: A retinal detachment developed in 36 (13.7%) of 262 eyes. Vitreous organization meeting our clinically important definition was associated with a 31-fold (confidence interval [CI] 5.37-183.63; P < .0001) and 13-fold (CI 2.97-58.59; P < .0001) increase in the odds for retinal detachment for right and left eyes, respectively. Vitreous hemorrhage defined as clinically important was associated with a 38-fold (CI 2.69-551.19; P = .007) and 15-fold (CI 1.65-144.12; P = .02) increase in the odds for retinal detachment for right and left eyes, respectively. The timing of retinal detachment relative to vitreous hemorrhage was not determined. Prolonged activity of Stage 3 disease or plus disease more than 21 days after treatment was not associated with development of a retinal detachment. CONCLUSIONS: Clinically important vitreous organization and vitreous hemorrhage were predictive for development of a retinal detachment. Evaluation of preemptive reintervention strategies for eyes at highest risk for developing a retinal detachment may be reasonable.

Female↗

PubMedDate not supplied

Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments.

BACKGROUND: Several surgical techniques to repair rhegmatogenous retinal detachment have been developed. Recently, both the method of reattaching the retina and of obtaining an early visual recovery are considered important factors when determining which surgical techniques to perform to treat retinal detachment. CASES: The surgical outcome in a series of 63 consecutive patients, who were treated at Osaka Rosai Hospital between 1993 and 1996, was reviewed retrospectively to evaluate the efficacy of primary vitrectomy to treat uncomplicated rhegmatogenous retinal detachment associated with posterior hyaloid separation. The criteria for vitrectomy included the presence of not only posterior retinal breaks, but also of multiple peripheral retinal breaks. OBSERVATIONS: The reattachment rate after the first surgery was 92.1% (58 eyes), and by the final examination it increased to 100%. Of the 46 eyes with macular detachment, good visual rehabilitation and a visual acuity improvement of 5 or more lines was obtained in 33 eyes (71.7%) by 1 month postoperatively. No statistically significant difference in the reattachment rate was found when eyes that underwent an encircling procedure were compared with those that did not. In eyes with lens opacity, cataract surgery was also performed and intraocular lenses were implanted uneventfully in all but one case with myopia. There was a high incidence (53.8%) of cataract progression in phakic eyes. However, no other serious complications, such as proliferative vitreoretinopathy, were found throughout the follow-up period. CONCLUSIONS: The results indicate that vitrectomy performed to alleviate peripheral vitreoretinal traction is an effective surgical technique to treat primary rhegmatogenous retinal detachment. Vitrectomy combined with cataract surgery may also be a valuable surgical option in selected cases to maintain long-standing visual rehabilitation.

Adult↗

PubMed1978

Rhegmatogenous retinal detachment following chorioretinal inflammatory disease.

Preexisting ocular inflammatory disease was responsible for 44 cases (1.7%) of rhegmatogenous retinal detachment in a large series of consecutive retinal detachments. Characteristics of retinal detachments following ocular inflammatory disease include a longer duration of the detachment, fewer observable retinal breaks, a higher incidence of visible vitreous membranes and preoperative macular puckers, a younger age distribution, and a higher incidence of phakic patients. In comparing the group of postinflammatory rhegmatogenous retinal detachments with detachments not associated with inflammation, the following characteristics did not show any statistically significant difference: sex, the eye involved, the status of the ciliary epithelium, the presence or types of retinal folds, the rate of operative complications, or the rate of reattachment at six months.

Adult↗

PubMed1997

[Toxoplasmic chorioretinitis complicated by retinal detachment].

PURPOSE: To describe and analyse relationship between chorioretinal toxoplasmosis and retinal detachment. PATIENTS AND METHODS: Seven immunocompetent patients examined and treated between November 1992 and March 1996, with ocular toxoplasmic retinochoroiditis and retinal detachment. RESULTS: Of the 7 patients examined, 5 had active retinochoroiditis and 2 had typical inactive scars. Of the patients with active focus 3 had giant retinal tears, one had a posterior retinal tear and one had a retinal tear located at the edge of an atrophic scar. Of the patients with inactive lesions, one had tractional retinal detachment and the other presented with a complete retinal detachment, multiples tears and PVR. Five patients were treated by corticosteroid without antitoxoplasmic drug before they were referred. The seven patients underwent endo-ocular surgery with silicon oil or long actic gas tamponade. Three patients developed PVR and redetachment of the retina and two patients underwent further surgery. Good anatomical result was obtained in 6 patients. CONCLUSION: Retinal detachment associated with toxoplasmic retinochoroiditis is rare. However it represents a serious complication. Steroid administrated to salvage vision may then worsen the clinical course, these may be justified to reduce hypersensitivity to toxoplasma antigen, but they should be combined with an antimicrobial agent.

Adult↗

PubMed1986

Intravitreous fibronectin and platelet-derived growth factor. New model for traction retinal detachment.

In proliferative vitreoretinopathy and trauma, traction retinal detachments result from cellular migration into the vitreous cavity with contractile membrane formation. Cleary and Ryan have established the efficacy of intravitreous injection of autologous blood in reproducing this pathologic process in the rabbit eye. It has previously been shown that two serum components, fibronectin and platelet-derived growth factor, stimulate cellular migration. We now show that contractile membranes and traction retinal detachments occur in 72% of rabbit eyes within three weeks following intravitreous injection of fibronectin and platelet-derived growth factor. These results provide a straightforward new model to study the development of intravitreous cellular membranes and traction retinal detachments.

Animals↗

PubMed1992

[The recovery of the local ERG recorded from reattached retina after retinal detachment].

The functional recovery of the reattached retina after retinal detachment was investigated electrophysiologically. Experimental retinal detachment approximately 4 mm in diameter was made in the rabbit eye by injecting Hanks' solution (HS) or sodium hyaluronate (HNa) into the subretinal space. Local ERG (LERG) was recorded from the spontaneously reattached retina by a double-barreled microelectrode. The retinal detachments caused by HA reattached at an average of 321 +/- 56 minutes after making the detachment, while the detachments by HNa at 20.8 +/- 1.8 days. The recovery of the amplitudes of b-wave and slow P III of the LERG was slower and worse in HNa group than in HS group. In both groups, the amplitudes of the b-waves recovered earlier than the slow P IIIs. Result indicated that earlier reattachment is related to favorable recovery of the retinal function, and that the inner retina generating the b-wave restores its function earlier than the distal retina generating the slow P III.

Animals↗

PubMed1995

Laser indirect ophthalmoscope photocoagulation and scleral depression for rhegmatogenous retinal detachment.

BACKGROUND: Transconjunctival cryotherapy or laser photocoagulation with simultaneous Eisner funnel scleral depression has been used to treat selected cases of rhegmatogenous retinal detachment. There are no studies to date reporting the use of the laser indirect ophthalmoscope coupled with scleral depression for treating retinal detachment. METHODS: 16 consecutive patients (18 retinal detachments in 17 eyes) were enrolled in a prospective, uncontrolled clinical trial using the laser indirect ophthalmoscope with scleral depression as the sole treatment for retinal detachment. The region immediately surrounding the break where subretinal fluid was present was directly treated rather than demarcated. All patients were treated with local anesthesia in an outpatient setting. RESULTS: Complete retinal reattachment was initially achieved in 14 (78%) of 18 eyes after scleral depression and laser alone. Significant postoperative complications of scleral depression with laser indirect ophthalmoscope photocoagulation included macular pucker (2 eyes), late recurrent rhegmatogenous retinal detachment without proliferative vitreoretinopathy (1 eye), and late recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy (2 eyes). Failure of initial treatment to flatten the retina, late recurrent retinal detachment, macular pucker, or proliferative vitreoretinopathy led to scleral buckling and/or vitrectomy in 6 (86%) of the 7 eyes with clinical detachment and 3 (30%) of the 10 eyes with localized detachment. Final retinal reattachment at the last follow-up examination was achieved in all 17 eyes with subsequent surgical procedures. CONCLUSION: Although scleral depression with laser indirect ophthalmoscope photocoagulation is a noninvasive outpatient surgical procedure that is capable of flattening selected retinal detachments, its use cannot be recommended because of the relatively high rate of postoperative complications requiring further surgical procedures.

Adult↗

PubMed2002

[Subretinal fluid drainage in rhegmatogenous retinal detachment].

Subretinal fluid drainage during retinal surgery is a tricky manoeuver that remains controversial. In this study, we carried out a comparative retrospective study about 265 cases with retinal detachment that had a primary episcleral surgery. We compared the results of the group operated with subretinal fluid drainage (199 cases) to the group without (66 cases). The complications met were retinal haemorrhages in 14 cases (7%) and retinal incarceration in one case (0.5%). Anatomical results were 91.45% in the group with drainage and 93.93% in the group without. There was no statistical difference between the two groups. The complications of the subretinal fluid drainage are extremely rare and have no repercussion if it is well checked. Subretinal fluid drainage remains the surgeon decision. It is achieved by most retinal surgeons (75%).

Adolescent↗

PubMed1985

Experimental retinal detachment. VIII. Retinochoroidal horseradish peroxidase diffusion across the blood-retinal barrier.

Unilateral rhegmatogenous retinal detachments in 13 cynomolgus monkeys were studied with horseradish peroxidase (HRP). When injected subretinally in six eyes, HRP did not diffuse anteriorly into the sensory retina and penetrated posteriorly through the zonulae occludentes of the retinal pigment epithelium (RPE) in only two eyes. In seven eyes, tracer was detected after intravitreal HRP injection throughout the sensory retina, the basal lamina of retinal blood vessels, and the subretinal space, but did not penetrate through the RPE. In 13 control eyes (with vitrectomy), intravitreal HRP penetrated the sensory retina and the basal lamina surrounding inner retinal blood vessels. These results confirm that the zonulae occludentes of the RPE and retinal blood vessels remain intact in most eyes after rhegmatogenous retinal detachment. Furthermore, the HRP staining patterns suggest a posteriorly directed movement of fluid across the RPE and possible fluid absorption by retinal blood vessels.

Animals↗

PubMed1986

Seasonal variations in rhegmatogenous retinal detachment as related to meteorological factors.

The seasonality of rhegmatogenous retinal detachment was investigated in 363 consecutive patients over the period 1974-1983 and compared to meteorological parameter variations over the same period. A highly significant correlation between rhegmatogenous retinal detachment incidence and light flux values was found. Light is suggested to act as a precipitating factor for rhegmatogenous retinal detachment in a damaged retina. The possible mechanisms by which the light could be responsible for retinal detachment occurrence are discussed.

Adult↗

PubMed1983

Pars plana vitrectomy for complicated retinal detachments.

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.

Adolescent↗

PubMed2006

Risk factors for retinal detachment after cataract surgery: a case-control study.

PURPOSE: To determine risk factors for rhegmatogenous retinal detachment after cataract surgery. DESIGN: Retrospective case-control study. PARTICIPANTS AND CONTROLS: A consecutive series of 63298 cataract surgery procedures in 45520 patients performed between August 1994 and March 2003 was identified. After exclusions for incomplete data, 249 cases of pseudophakic retinal detachment were matched with 845 controls that had cataract surgery on the same day, but without subsequent retinal detachment. METHODS: Details were extracted from the clinical records. A conditional logistic regression model for matched case-control groups was used. Multiple regression analysis was performed to estimate the odds ratio for each variable, with adjustment for the effects of other variables selected from the candidate pool. MAIN OUTCOME MEASURES: Occurrence of rhegmatogenous retinal detachment. RESULTS: The major risk factors (odds ratio [OR], 95% confidence interval [CI], P value) for detachment were posterior capsule tear (OR, 19.9; CI, 10.8-36.7; P<0.001), zonule dehiscence (OR, 12.4; CI, 3.8-41.2; P<0.001), retinal detachment in fellow eye (OR, 12.3; CI, 5.2-29.1; P<0.001), axial length >23 mm (OR, 3.2; CI, 2.0-5.0; P<0.001), and male gender (OR, 2.2; CI, 1.4-3.3; P<0.001). For patients aged >64 years, the odds ratio was linearly reduced for each subsequent decade. Differences in the surgical technique (i.e., phacoemulsification vs. extracapsular extraction), type of anesthetic, prior glaucoma, or subsequent neodymium:yttrium-aluminum-garnet laser posterior capsulotomy were not significantly related to retinal detachment. Approximately 37% (CI, 35%-38%) of retinal detachment was attributable to posterior capsule tear. CONCLUSIONS: Patient characteristics rather than surgical complications constitute the major risks factors for retinal detachment after cataract surgery.

Adolescent↗

PubMed1985

Post-operative outcome in rhegmatogenous retinal detachment.

Anatomic and visual results of retinal detachment surgery were analyzed in 352 consecutive eyes operated on for rhegmatogenous type of retinal detachment in 1978-1981 at the University Eye Hospital in Helsinki. From 1978-79 to 1980-81, both the re-attachment rate and the visual results improved significantly (P less than 0.05). In the latter period, the retina was re-attached in 87% and partially re-attached in 2%. In the same period, a good visual acuity (VA greater than or equal to 0.5) was achieved in 39%, reasonable (VA 0.4-0.15) in 28%, and an ambulatory vision (VA 0.1-CF2m) in 16%, whereas 18% of the eyes became blind (VA CF1m or worse). A favourable outcome was related to good pre-operative visual acuity, short duration and limited extent of detachment as well as sparing of the macula. Among factors which predicted an unfavourable outcome were aphakia, failure to detect retinal breaks, signs of proliferative vitreoretinopathy, multiple operations and old age. Poor outcome was more common after encircling as compared with localized procedures, but the success rate of the various types of operations was not comparable because encircling procedures were selected for more severe cases.

Adolescent↗

PubMed1979

[Morphological and metabolic findings in retinal detachment].

The authors investigated retinal structure and metabolism under normal conditions and after experimental detachment for 7--10 days and for 30--40 days in 80 experimental animals. Labeled protein predecessors were selected as indicators of retinal-cell element viability. Tey included the amino and 35S-methionine acids glycine (marked with 14C or 3H) and 35S-methionine. Metachromatic staining was employed to demonstrate retinal mucopolysaccharides. Histologic sections were analyzed in 15 patients with retinal detachment. Comparing the data obtained at early and developed stages of the process, they discovered the sequence of changes. Comparative analysis of the morphologic changes caused by retinal detachment in rabbits and human patients showed their similarity. The authors propose and substantiate the hypothesis that detachment extension into intact areas is caused by tension in the already detached retinal areas due to shrinkage of the tissues. It was established that labeled protein predecessors can penetrate into all layers of detached retina through the central artery. Hence it is possible to maintain retinal viability during the preoperative period by employing drugs.

Animals↗

PubMed2006

Increased glutamate levels in the vitreous of patients with retinal detachment.

Experimental models have implicated glutamate in the irreversible damage to retinal cells following retinal detachment. In this retrospective study we investigated a possible role for glutamate and other amino acid neurotransmitters during clinical rhegmatogenous retinal detachment (RRD). Undiluted vitreous samples were obtained from 176 patients undergoing pars plana vitrectomy. The study group consisted of 114 patients (114 eyes) with a rhegmatogenous retinal detachment. Controls included 52 eyes with an idiopathic macular hole or idiopathic epiretinal membrane and 10 eyes with a traction retinal detachment due to proliferative diabetic retinopathy. Vitreous concentrations of glutamate, gamma-aminobutyric acid (GABA), taurine, glycine, and aspartate were determined by high-pressure liquid chromatography (HPLC). Multivariate analysis was used to examine a possible association between amino acid neurotransmitter levels and several clinical variables including visual acuity. The mean vitreous concentration of glutamate in eyes with a rhegmatogenous retinal detachment (16.6 +/- 5.6 microM) was significantly higher as compared to the controls (13.1 +/- 5.2 microM) (P = 0.001). Taurine levels were also increased in RRD, whereas no significant difference could be observed in glycine, aspartate and GABA levels when comparing RRD with controls. A correlation was found between increased vitreous glutamate and a lower pre-operative visual acuity. No association was, however, observed between post-operative visual acuity and the level of any of the five amino acid neurotransmitters. RRD was associated with a significantly increased vitreous glutamate concentration. Using visual acuity as a functional parameter in this study, we could not demonstrate a correlation between vitreous glutamate, or any of the other tested amino acid neurotransmitters and visual outcome.

Aspartic Acid↗