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At least 631 records · Page 35Linked to original sources

Results of silicone oil removal in patients with cytomegalovirus retinitis related retinal detachments.

PURPOSE: To evaluate the percentage and risk indicators leading to retinal redetachment in HIV (human immunodeficiency virus) patients with CMV (cytomegalovirus) retinitis related retinal detachments that were repaired with silicone oil, and then subsequently underwent oil removal. DESIGN: Retrospective, noncomparative interventional case series. METHODS: The study cohort consisted of a series of 15 eyes in 14 patients with HIV and CMV retinitis with a retinal detachment (RD) repaired with silicone oil at a single center and followed from the time of the CMV retinitis diagnosis through the time of silicone oil removal. Patient- and eye-specific data regarding demographic and clinical characteristics were collected retrospectively and statistical analyses were performed to compare differences between the eyes that had retinal detachments versus the eyes that remained attached following removal of silicone oil. RESULTS: Eight eyes (53%) redetached after a median of 4.0 months following oil removal. Cataract surgery performed at the time of oil removal was a statistically significant risk factor for redetachment (P = .01). There was a trend for lower CD4 levels to be associated with a higher risk of retinal redetachment. The use of a scleral buckle at the time of surgery (initial RD repair or at the time of oil removal) did not reduce the risk of redetachment. CONCLUSIONS: Approximately half of the eyes with CMV related retinal detachment may safely undergo oil removal. The risk factor for redetachment was simultaneous cataract extraction at the time of silicone oil removal. There was also a trend for lower CD4 levels to be associated with a higher risk of retinal redetachment.

AIDS-Related Opportunistic Infections↗

Regular silicone and fluorosilicone oil in the prevention of retinal detachment caused by experimental proliferative vitreoretinopathy.

The effect of both regular silicone and fluorosilicone in preventing retinal detachment caused by experimental proliferative vitreoretinopathy was studied in rabbit eyes which received 250,000 fibroblasts after vitrectomy and lensectomy. In the control group, 14 out of 20 eyes which received fibroblasts had retinal detachments with disorganization of internal structures. In eyes receiving fibroblast and regular silicone, 4 out of 20 eyes had shallow retinal detachment. In the eyes receiving fibroblasts and fluorosilicone, 5 of 28 eyes had shallow retinal detachment. Our findings indicate that both regular silicone and fluorosilicone were effective in preventing retinal detachments caused by experimental proliferative vitreoretinopathy. There was no statistical difference between the two silicone oils.

Animals↗

[A case of secondary retinal detachment caused by ocular toxocariasis].

PURPOSE: We report a case with bullous retinal detachment secondary to ocular toxocariasis. CASE: A 68-year-old man, who was a professional dog breeder, visited an ophthalmologist because of visual field defect in the left eye, and was referred to our clinic. The patient had bilateral cataract and bullous retinal detachment in the left eye. Fundus examinations after cataract surgery revealed no break but a white mass in the temporal lower peripheral retina of the left eye. Initial treatment with systemic corticosteroids was ineffective. Retinal detachment was treated by retinal cryocoagulation, scleral buckling, and subretinal fluid drainage. Subretinal fluid obtained during the operation showed high antibody titer for Toxocara canis. CONCLUSION: Ocular toxocariasis can cause bullous retinal detachment. To confirm the diagnosis, examination of the antibody titer of Toxocara canis in the subretinal fluid is useful.

Aged↗

An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment.

PURPOSE: To evaluate the various surgical interventions available for uncomplicated rhegmatogenous retinal detachment. METHODS: Reports of controlled clinical trials of surgical interventions (pneumatic retinopexy, scleral buckling and vitrectomy) for uncomplicated rhegmatogenous retinal detachment indexed in MEDLINE from 1968 to January 2006 were included. The primary outcomes evaluated included single-operation reattachment rates, multiple reoperation reattachment rates and improvements in visual acuity (VA). RESULTS: We found five controlled trials (two randomized) comparing the efficacy of pneumatic retinopexy versus scleral buckling. The single-operation reattachment rates were higher for scleral buckling, but the final reattachment rates were similar. We found nine controlled trials (four randomized) evaluating vitrectomy. There were no statistically significant differences between retinal reattachment rates or final visual acuities, except in one randomized and one non-randomized controlled trial in which the VAs were significantly better in the vitrectomy than the scleral buckling group. CONCLUSIONS: Pneumatic retinopexy is a possible alternative to scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment. The rates of missed or new retinal breaks after pneumatic retinopexy, however, are higher than following scleral buckling. The clinical outcomes of vitrectomy for rhegmatogenous retinal detachment compare favourably.

Cryotherapy↗

Concentration of vascular endothelial growth factor in the subretinal fluid of retinal detachment.

The purpose of this study was to investigate the release of vascular endothelial growth factor (VEGF) within the subretinal fluid in eyes with retinal detachment. Subretinal fluid was collected from patients with retinal detachment undergoing surgery for scleral buckling. Serum samples were also collected. The concentration of VEGF in the subretinal fluid and serum was investigated by enzyme-linked immunospecific assay. The average concentration of VEGF in serum samples was 168 +/- 153 pg/ml (mean +/- standard deviation). It was lower than the VEGF concentration in the subretinal fluid (485 +/- 570 pg/ml) in the same 18 patients with retinal detachment (p < 0.05). The average concentration of VEGF was 355 +/- 373 pg/ml in 31 samples of the subretinal fluid collected from simple rhegmatogenous retinal detachment. It was lower than the average concentration of 901 +/- 385 pg/ml in 8 samples of the subretinal fluid from retinal detachment with proliferative vitreoretinopathy (p < 0.05). The results suggest that the relative retinal ischemia in detached retina increases the release of VEGF into the subretinal space. Also, the concentration of VEGF within the subretinal fluid in proliferative vitreoretinopathy was higher than in simple rhegmatogenous retinal detachment.

Adolescent↗

Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning.

PURPOSE: To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning. METHOD: Case report. A 30-year-old man was injured by lightning. RESULTS: The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye. CONCLUSIONS: This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.

Adult↗

Digoxin cannot account for the reported association of EKG abnormalities and rhegmatogenous retinal detachment.

The prevalence of cardiovascular disease (by EKG criteria) in patients with rhegmatogenous retinal detachments has been reported to be more than four times that found in age-matched controls. Adhesion between the retinal pigment epithelium (RPE) and the photoreceptors is facilitated by RPE transport. Because RPE transport is driven by a Na-K ATPase, it has been suggested that the correlation of EKG abnormalities and retinal detachment may be due to clinical use of digoxin, a Na-K ATPase inhibitor frequently given to patients with cardiovascular disease. The prevalence of EKG abnormalities in 299 consecutive patients with primary retinal detachment is about the same as that reported previously. However, 92% of these patients with EKG abnormalities did not take digoxin. Therefore, clinical use of digoxin cannot account for the reported association of EKG abnormalities and rhegmatogenous retinal detachment.

Cardiovascular Diseases↗

Retinal detachment in horses.

Ten horses with partial or total retinal detachment were investigated using light and electron microscopy (TEM, SEM). Several lesions were observed and compared with normal retinal morphology. Three weeks after the initial retinal detachment, hypertrophy of the pigment epithelium with transformation of the apical microvilli could be observed. The lesions were accompanied by progressive degeneration and atrophy of the sensory retina, starting at the photoreceptor outer segments. Hypertrophy of Müller cells was a concomitant finding. Retinal detachment represents a sequel either to inflammatory processes or trauma.

Animals↗

[A comparison of attachment rates between SF6 and silicone oil tamponades following vitrectomy for treatment of complicated retinal detachment].

In this study, 215 eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy (PVR) including giant tears, macular holes, perforating injury and traction caused by retinal vascular diseases were treated by vitrectomy and SF6 or silicone oil. The anatomic attachment rates were compared between gas and silicone oil groups in non-vitrectomized eyes and previously vitrectomized eyes, respectively. Both gas and silicone oil groups showed higher attachment rates in stage C of PVR, giant tears with PVR less than stage C2 and macular holes. The gas group showed lower attachment rates in cases with stage D of PVR, giant tear larger than 180 degrees or with PVR C3 or greater than C3, after perforating injury and traction-rhegmatogenous retinal detachment, while silicone oil group showed better attachment rates. The choice of tamponades should be based on different indications.

Adolescent↗

Retinal detachment following cataract surgery with capsulorhexis.

PURPOSE: To estimate the incidence of retinal detachment after cataract surgery with capsulorhexis. METHODS: A consecutive series of 2,150 cataract operations were followed for incidence of retinal detachment. A series of 1,000 patients from this group were analyzed for high risk factors: myopia, age, sex, operative complications and capsulotomy. RESULTS: With minimum one year follow up in 90% of patients the incidence of retinal detachment was 0.25% (5 cases). CONCLUSION: The true incidence of retinal detachment after cataract surgery remains elusive. There is probably a trend toward lower incidence compared to previous reports.

Adult↗

Changing patterns in the surgery for retinal detachment: 1929 to 2000.

PURPOSE: To examine the development of surgery for retinal detachment in this century and to determine whether the countless innovations and modifications fall into a recognizable pattern. MATERIALS AND METHODS: The authors, whose entire professional life has been devoted to the treatment of retinal detachment, have made a retrospective analysis of their experience in the field of retinal surgery. They have reviewed their notes of the annual meetings of the Retina Society, the Retinological Society, and the biennial meetings of the Gonin Club, all of which they attended, and augmented this with an in-depth review of the literature. RESULTS: Four conceptual advances by Jules Gonin, Bengt Rosengren, Ernst Custodis and Robert Machemer and countless modifications by a new category of specialists, the retinal surgeons, merge into two general patterns for the surgical repair of retinal detachment. The one is a local operation confined to closing the retinal breaks, the other is a circumferential operation intended to barricade the breaks and the peripheral retina. Both were extraocular operations. The more recent intraocular procedures, pneumatic retinopexy and vitrectomy, although apparently unique, nevertheless, fall into one or the other pattern. CONCLUSIONS: Surgery for retinal detachment has improved the prognosis from 0% before 1929 to near 100%. Reducing morbidity and the incidence of reoperation remain a worthy objective for the coming century.

Germany↗

[Rhegmatogenous retinal detachment in children and youth--chosen epidemiological features].

PURPOSE: To assess chosen epidemiological features (risk factors) of rhegmatogenous retinal detachment in young patients. MATERIAL AND METHODS: Retrospective evaluation of patients aged up to 18 years with rhegmatogenous retinal: detachment hospitalized in the Department of Ophthalmology, University of Medical Sciences of Bydgoszcz--in the period between 1993-2003. Studied group comprised 37 patients aged from 2 to 18 years. Excluded were the patients with retinopathy of prematurity. RESULTS: Mean age in the group studied was 12.6 (SD=3.6) years, over 80% were male. In 88.9% at least one risk factor was found--the most common of which was history of trauma (52.7%). Myopia was diagnosed in 27.7% of cases, in 8.3% patients cataract surgery had been performed prior to retinal detachment. In 8.3% of patients in group studied revealed congenital structural abnormalities. One patient (2.8%) had toxocariasis. Bilateral retinal detachment occurred also in one patient. The macula was detached in 75% and total retinal detachment was present in 38.8% of cases. CONCLUSIONS: The most common risk factor in the group studied was history of nonsurgical trauma. Prevalence of macular detachment was noted.

Adolescent↗

[Vitrectomy in retinal detachment caused by diabetic retinopathy].

We reviewed the surgical results obtained in 23 eyes that underwent vitrectomy for diabetic traction retinal detachment. Retinal reattachment was obtained in 75% of eyes, however the functional results were modest, owing to retinal changes related to diabetic retinopathy and/or longstanding macular detachment. Ambulatory vision was obtained in 60% of eyes. 8 eyes (40%) had final visual acuity of 1/20 or better. Four preoperative clinical findings were associated with a poor prognosis = absence of scatter retinal photocoagulation, dense vitreous hemorrhage, iris neovascularization and preoperative visual acuity reduced to "light perception". Iatrogenic retinal breaks were also associated with a poor prognosis.

Adult↗

Caspase activation in an experimental model of retinal detachment.

PURPOSE: To test for apoptotic photoreceptor cell death and caspase activation as a function of time after induction of an experimental retinal detachment. METHODS: Retinal detachments were created in Brown Norway rats by injecting 10% hyaluronic acid into the subretinal space using a transvitreous approach. Light microscopy and terminal dUTP-biotin nick end-labeling (TUNEL) was performed at 1, 3, 5, and 7 days after detachment to assess for the morphologic features associated with apoptosis. Western blot analysis of retinal protein extracts was performed using antibodies against caspase-3, -7, and -9 and poly-ADP ribose-polymerase (PARP) at 1, 3, and 5 days after detachment. RESULTS: Light microscopic analysis of detached retinas showed the presence of pyknotic nuclei in the outer nuclear layer and disruption of the normal organization of the photoreceptor outer segments. TUNEL-staining was positive in the outer nuclear layer only in the detached portions of the retina. Western blot analysis confirmed the time-dependent activation of caspase-3, -7, and -9 and PARP in the detached retinas. No morphologic stigmata of apoptosis or caspase activation was detected in attached retinas. CONCLUSIONS: The apoptotic photoreceptor cell death in experimental retinal detachments is associated with caspase activation.

Animals↗

[Therapy of retinal detachment in Coats' disease].

Coats disease, an idiopathic condition of unknown etiology, includes teleangiectatic and aneurysmatic retinal vessels in association with massive subretinal exudation. Progression to retinal detachment caused by prolonged subretinal exudation means a poor prognosis. Retinal detachment surgery had always been controversial. Twelve patients (aged 7 to 48 years) with retinal detachment and Coats' disease were treated by various operations (cryotherapy, 4X; episcleral buckle, 2X; vitrectomy and gastamponade, 3X; vitrectomy and silicone-oiltamponade, 2X). One case (cryotherapy and cerclage) failed and went on to retinal detachment. In the other 11 cases the retinal was reattached successfully. However, peripheral, small areas remained detached, caused by persistent deposits of subretinal exudation. This means that the underlying Coats' disease is still active and must be treated by laser coagulation. It must also be monitored carefully, to keep an eye on the preretinal vitreous activities leading to detachment.

Adolescent↗

Primary vitrectomy for pseudophakic and aphakic retinal detachments.

PURPOSE: To evaluate primary vitrectomy for the treatment of pseudophakic and aphakic retinal detachments. Primary vitrectomy may enable better identification of retinal breaks than scleral buckling procedures. METHODS: A prospective study was performed of primary vitrectomy for the treatment of 25 consecutive cases of pseudophakic and aphakic retinal detachment. RESULTS: The primary retinal reattachment rate was 84% (21 eyes). Surgical failure resulted from new/missed retinal breaks (2 eyes) and proliferative vitreoretinopathy (2 eyes). The final retinal reattachment rate with further surgery was 96% (24 eyes). There were 7 macula-on detachments which all retained their presenting visual acuity. A visual acuity of 6/18 or better was achieved by 56% of the 18 macula-off detachments. Visualisation of the peripheral retina was impaired in 17 eyes and procedures to improve visualisation were performed in 7 eyes. Retinal breaks were detected in 16 eyes at surgery that had not been identified pre-operatively. Raised intraocular pressure was the most common complication, affecting 10 eyes in the early post-operative period. CONCLUSIONS: Primary vitrectomy offers certain advantages in the treatment of pseudophakic and aphakic retinal detachments. A controlled study is required to determine whether primary vitrectomy achieves a better outcome than scleral buckling procedures for these retinal detachments.

Adult↗

Retinal detachment associated with a macular hole in severely myopic eyes.

PURPOSE: To investigate factors associated with extensive retinal detachment in severely myopic eyes with a macular hole. METHOD: Fifty-two consecutive eyes with a macular hole and severe myopia were retrospectively studied. RESULTS: An extensive retinal detachment, defined as extending beyond the cuff of subretinal fluid, was observed in 37 eyes (71%). Extensive retinal detachment developed in 36 (95%) of 38 eyes with a posterior staphyloma and in one (7%) of 14 eyes without a posterior staphyloma (P<.0001). Extensive retinal detachment also developed in 32 (89%) of 36 eyes with complete posterior vitreous detachment and in five (31%) of 16 eyes without posterior vitreous detachment (P<.0001). CONCLUSION: Posterior staphyloma rather than anteroposterior vitreomacular traction may contribute to the development of retinal detachment associated with a macular hole in severely myopic eyes.

Adult↗

Rhegmatogenous retinal detachments in children: risk factors and surgical outcomes.

PURPOSE: To describe the presenting features and surgical outcomes in a series of children with rhegmatogenous retinal detachments. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-nine eyes of 34 children 18 years of age or younger undergoing surgery for rhegmatogenous retinal detachment. METHODS: Patients were identified by chart review at two affiliated tertiary care centers. Risk factors for retinal detachment were classified into four categories: (1). congenital or developmental structural ocular abnormalities, (2). trauma, (3). previous ophthalmologic surgery, and (4). preceding uveitis. RESULTS: Median age was 10 years, and 79% of patients were boys. Nine patients (26%) had bilateral retinal detachment at presentation, or experienced a detachment in their second eye before their nineteenth birthday. Every eye had at least one risk factor for retinal detachment, and more than half had risk factors in two or more categories. Structural abnormalities were most common (56%). Fifty-one percent of eyes underwent previous surgery, 36% experienced trauma, and 15% had uveitis. Detachments tended to be complex. Median follow-up was 24 months. Retinal reattachment was achieved in 79% of eyes; however, visual recovery was modest. Median preoperative and postoperative visual acuities were counting fingers and 20/400, respectively. Predictors of a poor visual outcome were: unmeasurable or light perception-only preoperative vision (P = 0.0001), macula-off retinal detachment (P = 0.01), the need for vitrectomy surgery (P = 0.01), the presence of proliferative vitreoretinopathy grade C or worse (P = 0.02), and the use of silicone oil (P = 0.02). CONCLUSIONS: Predisposing factors in pediatric retinal detachments, particularly congenital and developmental structural abnormalities, may be more common than previously reported. Modern vitreoretinal surgical techniques can help achieve retinal reattachment in most cases. Many factors contribute to the limited visual recovery in this patient population. Predictors of visual outcomes are similar to those observed in adults. Inability of the clinician to determine confidently the preoperative visual acuity is a newly identified predictor of poor visual outcomes.

Adolescent↗