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PubMed2002

Clear lens extraction with intraocular lens implantation during retinal detachment repair in patients with Acquired Immune Deficiency Syndrome (AIDS) [correction of autoimmune deficiency syndrome] and cytomegalovirus retinitis.

OBJECTIVE: To assess the outcomes of clear lens extraction with intraocular lens (IOL) implantation during repair of retinal detachment by vitrectomy with silicone oil tamponade in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twelve eyes of 10 patients with AIDS, CMV retinitis, and retinal detachment. INTERVENTION: All patients underwent phacoemulsification with posterior chamber IOL placement at the time of vitrectomy with silicone oil tamponade for repair of retinal detachment. A targeted postoperative refractive error of -5.00 diopters (D) to -3.00 D was chosen in an attempt to counteract the hyperopic effect of silicone oil. MAIN OUTCOME MEASURES: The following factors were evaluated: postoperative visual acuity, refractive error, and intraoperative and postoperative complications. RESULTS: Median follow-up was 7 months (range, 1-46 months). For patients without macular necrosis, median best-corrected preoperative visual acuity was 20/75 (range, 20/20-20/800), and median best postoperative visual acuity was 20/50 (range, 20/20-20/400). Median final visual acuity was 20/140 (range, 20/25 to count fingers at 1 foot). The median postoperative refractive error (spherical equivalent) was -1.00 D (range, -4.00 D to +7.88 D). Reoperation was required in 3 of 12 eyes for recurrent macular detachment (1 with silicone oil underfill; 2 with proliferative vitreoretinopathy). The macula was attached in all eyes at last follow-up. Reattachment of the peripheral retina was achieved in 10 of 12 eyes. There were no anterior segment complications. CONCLUSIONS: Clear lens extraction with IOL placement during repair of retinal detachment with silicone oil tamponade does not seem to increase complications and may improve long-term visual rehabilitation, improve retinitis management by allowing better posterior segment visualization throughout the postoperative course, and decrease overall cost and morbidity associated with cataract extraction as a second procedure.

AIDS-Related Opportunistic Infections↗
PubMed2000

Simultaneous, bilateral rhegmatogenous retinal detachment.

PURPOSE: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment. METHODS: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998. RESULTS: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100,000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from -3 to -9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period. CONCLUSION: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.

Adolescent↗
PubMed2005

Outcome of scleral buckling for primary rhegmatogenous retinal detachment in Nigeria.

BACKGROUND: The goal was to review the visual and anatomical outcome of scleral buckling for primary rhegmatogenous retinal detachment at a tertiary eye care center in Nigeria between January 1994 and December 2000. MATERIAL/METHODS: This was a retrospective, descriptive case series of all eyes that had undergone scleral buckling over a 7-year study period. Data collected from the case notes included duration of symptoms, visual acuity at presentation and 3 and 6 months post-op, clinical presentation of the detachments, risk factors for retinal detachment, the surgical procedure done, anatomical outcome at discharge and at 3 and 6 months post-op, and intra-op and post-op complications. RESULTS: Ninety-eight eyes of 98 patients underwent scleral buckling for primary rhegmatogenous retinal detachment during the study period. The mean age was 42 years. The male-to-female ratio was 3.7:1. The mean duration of symptoms was 29.7 weeks. Seventy-six eyes (77.6%) had subtotal to total retinal detachment, with 91 (92.9%) eyes having macular detachment. The surgical technique was cryotherapy, sub-retinal fluid drainage, and explant. At 3 months post-op, 40/54 (74.1%) eyes had successful anatomical outcome. Only 52% (21/40) of these eyes had the best corrected visual acuity of 6/60 or better at 3 months post-op. CONCLUSIONS: In Nigeria, and possibly many developing countries, efforts should be made towards early diagnosis and treatment of retinal detachments with adequate expertise and facilities.

Adolescent↗
PubMed1999

Rhegmatogenous retinal detachment after block excision of epithelial implantation cysts and tumors of the anterior uvea.

OBJECTIVE: To report on frequency, time of occurrence, treatment, and final outcome of rhegmatogenous retinal detachment after block excision, combined with corneoscleral tectonic grafts, of intraocular epithelial implantation cysts and tumors of the anterior uvea involving the anterior chamber angle. DESIGN: Noncomparative case series. PARTICIPANTS: The study included 144 patients who had consecutively undergone scleral full-thickness block excision of tumors of the anterior uvea (n = 87) or intraocular epithelial implantation cysts (n = 57). Diameter of the block excision ranged between 5.5 and 20 mm. In 39 patients, the tumor extended posterior to the ora serrata. INTERVENTIONS: Retinal detachment surgery. MAIN OUTCOME MEASURES: Retinal detachment rate, visual acuity, risk factors. RESULTS: Retinal detachment occurred in 10 (6.9%) of 144 patients (2 of 57, or 3.5% of patients with cysts; 8 of 87 or 9.2% of patients with tumors) 3 to 12 months after block excision. Six patients underwent primary pars plana vitrectomy with temporary endotamponade by silicone oil, which was removed 3 to 9 months later. In four patients, a scleral buckling procedure only was performed. After a mean follow-up of 31 months after silicone oil removal or the buckling procedure (median, 30 months; range, 13-42 months), the retina has remained attached in all patients operated on. Visual acuity increased from 2/20 (median; range, light perception-6/20) to 8/20 (median; range, 2/20-12/20). In the eyes with retinal detachment compared to the eyes without retinal detachment, the block excision was significantly larger (13.75+/-4.86 mm vs. 9.41+/-3.02; P = 0.01) and was located significantly more posteriorly (limbus distance of posterior excision margin: 6.75+/-2.87 vs. 4.35+/-3.24 mm; P = 0.01). CONCLUSIONS: Scleral buckling procedures and primary pars plana vitrectomy with temporary ocular endotamponade can give acceptable results in eyes with rhegmatogenous retinal detachment occurring after block excision of epithelial implantation cysts or tumors of the anterior uvea. Despite intraoperative vitreous prolapse or tumor extension posterior to the ciliary body, rhegmatogenous retinal detachment occurs in fewer than 10% of patients undergoing block excision of cysts or tumors of the anterior uvea. Size and posterior location of the block excision are the main risk factors for rhegmatogenous retinal detachment, which becomes unlikely later than 12 months after surgery.

Adolescent↗
PubMed2005

Pediatric rhegmatogenous retinal detachment in East Asians.

PURPOSE: To describe clinical features, predisposing factors, and surgical outcomes of retinal detachment in different age groups in a pediatric population. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: A total of 296 eyes from 278 children younger than 18 years of age underwent the first surgical procedure for rhegmatogenous retinal detachment between 1983 and 2003. They were divided into 3 age groups: 38 eyes in group 1 (0-10 years), 107 eyes in group 2 (11-15 years), and 151 eyes in group 3 (16-18 years). METHODS: Predisposing factors for retinal detachment were classified into 4 categories: (1) high myopia, (2) trauma, (3) congenital or developmental structural ocular abnormalities, and (4) previous intraocular surgery. MAIN OUTCOME MEASUREMENTS: Visual acuity and retinal reattachment. RESULTS: The mean age of the patients was 14.6 years; 73.7% were boys. The mean follow-up period was 51 months. At least 1 predisposing factor could be identified in 282 (95%) of study eyes. High myopia was most common in 111 eyes (38%). Thirty-one percent of eyes experienced trauma, 17% had structural abnormalities, and 5% underwent previous intraocular surgery. Macular involvement was found in 237 eyes (80%). The initial surgery was scleral buckling alone in 224 eyes (76%). Retinal reattachment was achieved in 214 eyes (72%) after the first operation and in 250 eyes (85%) at the end of intervention. Features seen in patients with a poor surgical outcome included congenital anomaly (P<0.001), previous intraocular surgery (P = 0.007), proliferative vitreoretinopathy grade C or worse (P<0.001), macula off (P = 0.001), total retinal detachment (P<0.001), and use of silicone oil (P<0.001). CONCLUSIONS: Myopia is one of the important predisposing factors of pediatric retinal detachment in East Asians. The predisposing factors, clinical features, timing of diagnosis, and frequency of proliferative vitreoretinopathy of retinal detachment are somewhat different in the 3 age groups considered. Because of higher proportions of congenital anomaly, total retinal detachment, proliferative vitreoretinopathy, and a low success rate with poor postoperative compliance, patients in group 1 experienced the lowest final reattachment rate and the worst visual recovery.

Adolescent↗
PubMed2001

Exudative retinal detachment in macular hole surgery using platelet concentrates--a case report.

INTRODUCTION: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. CASE REPORT: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. CONCLUSION: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.

Aged↗
PubMed2002

Rhegmatogenous retinal detachment after transscleral local resection of choroidal melanoma.

OBJECTIVE: To report on the incidence and outcome of rhegmatogenous retinal detachment after transscleral local resection of choroidal melanoma. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred fifty-six patients with choroidal melanoma treated by transscleral local resection between January 1993 and June 2000. INTERVENTION: Transscleral choroidectomy or cyclochoroidectomy for uveal melanoma, with ocular decompression by single-port pars plana vitrectomy and, in most patients, adjunctive ruthenium plaque radiotherapy. MAIN OUTCOME MEASURES: Incidence of rhegmatogenous retinal detachment according to predictive factors and outcomes reported in terms of anatomic success, visual acuity, and ocular conservation. RESULTS: Rhegmatogenous retinal detachment occurred in 28 (18%) eyes and was significantly more common in patients with thick tumors (Cox univariate analysis, P = 0.001) and in males (Cox univariate analysis, P = 0.013), with posterior tumor extension being of borderline significance (Cox univariate analysis, P = 0.069). Surgical treatment of the retinal detachment was performed in 25 patients; it was undertaken at our center in 22 patients and at the referring hospital in 3 patients. Anatomic success was achieved in 21 (84%) of these 25 patients, with 7 eyes retaining counting fingers vision, and 3 eyes seeing 6/60 or better. Ten eyes treated for retinal detachment were enucleated because of recurrent tumor (four eyes), retinal detachment (three eyes), wound dehiscence (one eye), phthisis (one eye), and poor visual acuity (one eye). Eleven eyes known to have a retinal tear underwent prophylactic vitreoretinal surgery at the end of the local resection, with only one (9%) of these subsequently developing retinal detachment. CONCLUSIONS: Rhegmatogenous retinal detachment after transscleral choroidectomy or cyclochoroidectomy for uveal melanoma is a serious complication requiring early vitreoretinal surgery.

Adolescent↗
PubMed1999

Differentiation of degenerative retinoschisis from retinal detachment using optical coherence tomography.

OBJECTIVE: To assess the potential of optical coherence tomography (OCT) to differentiate retinoschisis from retinal detachment. Optical coherence tomography is a noninvasive, noncontact imaging method that produces high-resolution, cross-sectional images of ocular tissue. DESIGN: Retrospective case series. PARTICIPANTS: Thirteen eyes of 12 patients with the differential diagnosis of retinoschisis versus retinal detachment. METHODS: Differentiation between retinoschisis and retinal detachment was established from both ophthalmoscopic and OCT examinations. MAIN OUTCOME MEASURE: Ability of OCT to differentiate retinoschisis from retinal detachment was measured. RESULTS: Thirteen eyes of 12 patients with retinal elevation were examined with OCT. The cross-sectional view produced by OCT was effective in distinguishing retinoschisis from retinal detachment. Optical coherence tomography images of retinoschisis show a splitting of the neurosensory retina. The OCT images of retinal detachment show separation of full-thickness neurosensory retina from the retinal pigment epithelium band. The OCT images correlated with the clinical impression in all 13 cases. CONCLUSIONS: Based on this series of cases, OCT is a potentially useful new test that may be used to distinguish retinoschisis from rhegmatogenous retinal detachment.

Adult↗
PubMed1996

Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses.

BACKGROUND AND OBJECTIVE: Retinal detachment is a complication of dislocated crystalline and intraocular lenses. The purpose of this study was to compare the frequency and management of coexisting or subsequent retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses (PC IOLs). PATIENTS AND METHODS: A retrospective, consecutive series of patients undergoing vitrectomy for dislocated PC IOLs (99 eyes) or removal of retained lens material (80 eyes) were studied. RESULTS: Eyes with retinal detachment and retained lens fragments (2 cases) or dislocated PC IOLs (2 cases), or retinal detachment following vitrectomy for removal of retained lens fragments (2 cases) or repair of dislocated IOL (1 cases) were identified. The prevalence of coexisting or postoperative retinal detachment and retained lens fragments (5% total) was slightly higher than the prevalence of coexisting or postoperative retinal detachment and dislocated PC IOLs (3% total). The retina was reattached in all cases using the standard scleral buckling and vitrectomy techniques. CONCLUSION: The rate of retinal detachment associated with retained lens material is decreased compared with previous reports. This may possibly be a results of increasing attention to minimizing surgical trauma by the cataract surgeon at the time of lens fragment loss and by the vitrectomy surgeon during primary repair.

Aged↗
PubMed1992

[Retinal detachment with posterior chamber lens].

Pseudophakic retinal detachment was seen in 55 cases out of 13,692 patients that underwent cataract surgery and posterior chamber lens implantation in a 5 year period. The six-month incidence was 0.4%. Main risk factors were: myopia, capsular tear resp. zonular dialysis, and male gender. Sulcus- and capsular bag fixation showed the same incidence. 42% of pseudophakic retinal detachments occurred within the first 12 months after cataract surgery and 84% within the first three years. The resulting cumulation rate is discussed. The outcome of detachment surgery was reduced with increased rate of PVR. No typical localisation of retinal holes was found.

Adult↗
PubMed2005

The management of primary rhegmatogenous retinal detachment not involving the fovea.

AIM: To establish the likelihood of, and risk factors associated with, progression of 'macula-on' retinal detachment. METHODS: A multi-centre prospective observational study of patients with acute retinal detachment, not involving the fovea, was conducted over a 6-month period. Data collected included duration of symptoms, visual acuity, presence of posterior vitreous detachment, retinal drawings and subretinal fluid (SRF) distance from the fovea at a minimum of two time points. RESULTS: A total of 82 data sets from 15 institutions were analysed. Of 82 cases 11 (13%) demonstrated progression of fluid. Mean progression in those cases which progressed was 2.3 disc diameters (dd) and the average rate of progression was 1.80 dd/day. Binary regression analysis failed to reveal any statistically significant risk factors for progression. Multiple regression analyses were made to identify risk factors. With distance of SRF from fovea at operation as a function, distance of SRF at presentation was the only statistically significant risk factor. In all, 26% of patients underwent surgery out-of-hours. A total of 83% patients achieved a 6-week best-corrected vision of 6/9 or better. CONCLUSION: Most retinal detachments in this study did not progress within the first few days. The distance of SRF from the fovea at presentation was the only statistically significant risk factor for progression to foveal detachment.

Acute Disease↗
PubMed1993

[Failures of the surgical treatment of rhegmatogenous retinal detachment].

The surgical treatment of rhegmatogenous retinal detachment, has considerably improved. But there are still a lot of failures, at least after the first surgical procedure. Out of a group of 320 retinal detachments, a one stage surgical procedure allowed the retina to reattach in 84% of cases. Out of the 51 failures, we defined 2 subgroups: the early recurrences were mainly caused by undiagnosed breaks or insufficient scleral buckling, and the delayed recurrences by a vitreo-retinal proliferation or a new tear. Though a second operation increased the success rate to 97%, it is certainly desirable to lower the failure rate of the first surgical procedure.

Adult↗
PubMed2000

Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment.

PURPOSE: To evaluate the choroidal drainage route after scleral buckling for retinal detachment. METHODS: We performed wide-angle indocyanine green angiography with a scanning laser ophthalmoscope in 22 eyes of 22 patients with rhegmatogenous retinal detachment that had been treated with scleral buckling and cryopexy. The 22 eyes had at least one retinal break located posterior to the equator where vortex veins were present. The period between angiography and retinal detachment surgery was less than 3 months in 10 eyes, 3 to 12 months in five eyes, and more than 1 year in seven eyes. RESULTS: At the site of the silicone exoplant and cryopexy for retinal breaks, one vortex vein was occluded in seven eyes and two in five eyes. Choroidal veins were congested in the quadrant of the occluded vortex vein in two of 12 eyes that had angiography less than 3 months after retinal detachment surgery. In 10 of 12 eyes that had angiography 3 months or more after retinal detachment surgery, new drainage routes developed that connected the sector of the occluded vortex veins to that of the intact vortex veins with venovenous anastomoses. No venous congestion was found in the areas of the occluded vortex veins in the 10 eyes. Venous collaterals formed between the superior and inferior vortex in all 10 eyes and between the temporal and nasal vortex in two eyes. CONCLUSIONS: New venous drainage routes, which were connected to the intact vortex veins, formed in eyes with occluded vortex veins resulting from scleral buckling surgery and compensated for choroidal venous congestion. The choroidal veins have a great deal of plasticity that enables remodeling of the drainage routes, depending on the pressure gradient.

Adolescent↗
PubMed2004

[Serous retinal detachment in systemic erithematosus lupus during corticosteroid therapy].

CASE REPORT: A young female patient with systemic lupus erithematosus, inactive for a long period, is described. She develops bilateral serous detachments of the retinal pigment epithelium and neurosensory retina after corticosteroid therapy for a residual nephritis. DISCUSSION: This unusual chorioretinopathy has been reported in association with systemic lupus erithematosus and during corticosteroid therapy in many disorders. This patient, with low activity erithematosus lupus, develops serous retinal detachments after receiving corticosteroid therapy that damage the coriocapillary-pigment epithelium barrier, disordered in lupus patients.

Adult↗
PubMed1995

Retinal detachment in black South Africans.

Rhegmatogenous retinal detachments seen in black patients attending King Edward VIII Hospital Ophthalmology Clinic over a 5-year period from January 1987 to December 1991 were reviewed. Penetrating trauma and diabetic retinopathy were excluded. There were 114 detachments in 112 patients, which gave incidence of 0.46/100,000 of the population served per annum. This confirms the low incidence of this disorder found in black patients in other series. Patients were comparatively young (37.5% less than 30 years of age), men outnumbered women 2:1, and the incidence of blunt trauma was high (29.8%). Over one-third (36.6%) presented with a blind or poorly sighted opposite eye. Late presentation was common. Large posterior breaks occurred in 15.7% of detachments with severe proliferative vitreoretinopathy in 33.3%. These last characteristics accounted for the use of vitrectomy with tamponade as a primary surgical procedure in 32.5% of cases and contributed to the relatively low success rate of reattachment (72.8%). Some of the findings may be influenced by social disadvantage, but the reason for the low incidence of retinal detachment in black patients is not known. A stronger adherence of the retina to the retinal pigment epithelium in black patients is postulated.

Adult↗
PubMed2004

Delayed absorption of macular edema accompanying serous retinal detachment after grid laser treatment in patients with branch retinal vein occlusion.

PURPOSE: To study the detailed process of macular edema (ME) absorption after grid laser photocoagulation in patients with branch retinal vein occlusion (BRVO). The influence of pretreatment serous retinal detachment (SRD) at the fovea on patient outcome was also evaluated. DESIGN: Retrospective, interventional, comparative case series. PARTICIPANTS: Thirty-seven BRVO patients presenting with severe ME. METHODS: Patients were treated with grid laser photocoagulation with 6 months of follow-up examinations. Baseline and post-treatment examinations included measurements of visual acuity (VA), fluorescein angiography, and detailed imaging of ME by optical coherence tomography (OCT). Macular thickness was defined as the distance from the inner retinal surface to the outer border of the sensory retina (foveal retinal thickness) and also to the inner border of the retinal pigment epithelium including the SRD (total foveal elevation). MAIN OUTCOME MEASURES: Post-treatment macular thickness with OCT, VA converted to the logarithm of the minimum angle of resolution, and absorption of SRD, and correlations of macular thickness and VA both before and after treatment. RESULTS: Total foveal elevation and VA were significantly improved at 1, 3, and 6 months after treatment. There was also a significant correlation between reduction of total foveal elevation and increase in VA. Fourteen eyes (37.8%) displayed SRD, as evidenced by OCT at the baseline. In eyes without SRD, foveal retinal thickness and VA had significantly improved in a time-dependent manner. However, although SRD itself was almost absorbed 6 months after treatment, the improvement of both VA and total foveal elevation in eyes with pretreatment SRD was not significant compared with baseline conditions. Both post-treatment total foveal elevation and VA of eyes with SRD tended to be worse than eyes without SRD. CONCLUSION: The presence of subfoveal SRD retards the absorption of ME and recovery of VA after grid laser photocoagulation in patients with BRVO.

Absorption↗