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PubMedDate not supplied

[The differential diagnosis between symptomatic and idiopathic retinal detachments].

The paper presents a synthesis of today's means for differential diagnosis between symptomatic and idiopathic retinal detachment, considering that the retinal detachment remains an ocular emergency, with high invalidity potential. The characteristic difficulties of this diagnosis are also detailed. The different medical attendance of the two types of retinal detachment requires a rigorous differential diagnosis, according the leading part to the ophthalmological examination. There are also illustrated up-to-date diagnosis tests, less invasive and more informative, such as: CT and MRI. The survey highlights the value still relative of the majority of these investigations and the fundamental significance of the histological examination.

Diagnosis, Differential↗

PubMed1982

Standardized echography (ultrasonography) for the detection and characterization of retinal detachment.

Thirty-five patients with clear media and retinal detachment were studied prospectively to determine the reliability and accuracy of ultrasound in this diagnosis. The extent of detachment was identified correctly within three clock hours in 33 of 35 cases (94.2%). The average height of detachment was 6.12 mm. In 27 of 31 cases (87%), the retinal tear was located within two clock hours of the superior most margin of detachment seen echographically, and in 23 of 31 cases (74%) within two clock hours of the highest elevation of the retina echographically. In 29 of 35 cases (82%) echographic determination of detachment margins was within one clock hour of clinical observation. Retinal detachments greater than 4.5 mm in maximal height appeared clinically bullous. Ultrasound correctly identified 26 of 29 maculae detached before operation (90%). Ultrasound correctly identified all seven cases with advanced massive periretinal proliferation. Mean standardized reflectivity (delta dbs) was 13.9 with 95% confidence levels of 12.7 to 15.2. A stronger correlation existed between height of retinal detachment and reflectivity, than clinical appearance of retina. Based on the findings, it was concluded that standardized echography is a highly reliable technique for the detection and characterization of retinal detachment in eyes with opaque media.

Adolescent↗

PubMed2001

Primary vitrectomy for the management of rhegmatogenous retinal detachment associated with choroidal detachment.

PURPOSE: To evaluate the role and the results of primary vitrectomy in treating cases with coexisting rhegmatogenous retinal detachment and choroidal detachment. METHODS: Eleven consecutive eyes with coexisting rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C were included. Release of traction on the breaks was achieved by vitrectomy and augmented by episcleral buckle if needed. Perfluorocarbon liquids were used to drain the subretinal fluid through the vitrectomy sclerotomies. The breaks were treated by endolaser under perfluorocarbon liquids. Postoperative tamponade was done by C3F8 gas or silicone oil. Cases were followed up for at least 3 months. RESULTS: Retinal reattachment could be achieved and maintained in all cases by one or more surgeries. No recurrence of choroidal detachment has occurred. In each case, choroidal detachment was drained through the sclerotomies and retinal detachment was repaired. CONCLUSION: Primary vitrectomy represents an effective line in the management of rhegmatogenous retinal detachment with coexisting choroidal detachment in phakic or nonphakic eyes. SUMMARY: Primary vitrectomy is recommended for the management of choroidal detachment associated with retinal detachment.

Aged↗

PubMed2003

Modified technique to create retinal detachment during macular translocation surgery.

PURPOSE: To report a modified technique for creating total retinal detachment during macular translocation surgery with a 360-degree retinotomy. DESIGN: Interventional case series. METHODS: After vitrectomy, BSS Plus (Alcon, Fort Worth, TX, USA) was injected into the subretinal space with a 39-gauge needle to create a small retinal detachment. The tip of a 20-gauge silicone-tipped needle was then placed in the hole created by the needle, and BSS Plus was injected subretinally at a high flow rate. RESULTS: In 10 eyes (10 patients), we created one iatrogenic retinal hole in seven eyes and two holes in three eyes. The time needed to create total retinal detachment was decreased. CONCLUSIONS: Our technique seems to make creation of a total retinal detachment easier compared with the previous standard procedure and may reduce postoperative complications following macular translocation surgery with a 360-degree retinotomy.

Bicarbonates↗

PubMed1979

Retinal detachment following phacoemulsification.

We reviewed the characteristics of 100 retinal detachments which followed phacoemulsification. The characteristics of retinal breaks and the configurations of the detachments were in general similar to cases of retinal detachments following intracapsular surgery. There was a suggestion that detachments occurring within 6 months of cataract surgery appeared to be statistically different from those occurring more than 1 year following phacoemulsification. The former group of detachments tended to be more 'phakic' in nature than those occurring relatively late. The surgical reattachment rates in these eyes compared favorably to previously published figures on the repair or retinal detachment following intracapsular surgery.

Adult↗

PubMed1983

Management of retinal detachment following congenital cataract surgery.

Retinal detachment complicating previous congenital cataract surgery poses problems in management, especially related to difficulties in ophthalmoscopic visualization of breaks. The recent introduction of closed microsurgical techniques has significantly improved the prognosis in such cases.

Adolescent↗

PubMed1986

A comparison of the influence of temporary balloon buckles and permanent episcleral silicone sponges on postoperative ocular motility in retinal detachment surgery.

The influence of retinal surgery on ocular motility was examined in 60 patients with rhegmatogenous retinal detachment caused by one tear. Thirty patients were treated with cryotherapy and an episcleral radial silicone sponge explant. The remaining 30 patients were treated with a Lincoff temporary balloon buckle procedure. Extensive pre- and postoperative orthoptic examinations showed the impairment of ocular motility to be significantly less with the balloon-buckle procedure.

Eye↗

PubMed2002

[Vitrectomy without scleral buckle versus ab-externo approach for pseudophakic retinal detachment: comparative retrospective study].

PURPOSE: Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD. PATIENTS AND METHODS: The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months. RESULTS: The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity was 0.5 or better in 44% of cases in the vitrectomy group and 37.5% in the ab-externo group. The duration of the surgery was significantly lower in the ab-externo group, whereas the hospital stay tended to be lower in the vitrectomy group. In the vitrectomy group, postoperative PVR developed in 3 eyes and new or undetected breaks were responsible for failure of the initial procedure in 2 eyes. CONCLUSION: Primary vitrectomy appears to be as effective as scleral buckling procedures for the treatment of pseudophakic RD.

Aged↗

PubMed1975

Macular vision following retinal detachment surgery.

We studied 100 retinal detachment patients with macular involvement who had successful scleral buckling procedures using encircling fascia lata. Aphakic patients and patients with pre-existing ocular pathology in addition to the detachment were not excluded from the series. Follow-ups of one year or more (average 26.1 months) were available for 77 of the patients. Forty-four of these patients (56.5%) achieved acuities of 20/60 or better. The duration of the detachment was an important prognostic factor; one month was the critical period for the duration of the detachment. The existence of preoperative ocular pathology in addition to the detachment was also an important prognostic indicator. There was no significant difference in the visual acuities of phakic versus aphakic patients. Half of the patients studied with respect to refractive error became more myopic with an average change of -1.01 diopters.

Adult↗

PubMed1991

Experimental traction retinal detachment in the cat.

We developed a reproducible model of traction retinal detachment (TRD) in the cat eye by creating a serous retinal detachment and then injecting 2.5 x 10(5) kitten dermal fibroblasts into the vitreous cavity at the site of a retinal wound. Serous detachments were produced by exposing an area of retina to focused light after intravenous injection of rose bengal (a photosensitizing dye). TRD developed rapidly within the first 2 weeks after fibroblast injection, accompanied by the formation of vitreoretinal strands and, to a lesser degree, epiretinal and/or subretinal proliferation. Histopathology demonstrated fibroblasts within the vitreous or along the posterior hyaloid face. Focal deposits of fibroblasts were occasionally found on the inner surface of the retina and/or in the subretinal space. Fibroblast proliferation was confirmed by uptake of radiolabeled thymidine. Deposition of collagen was noted at as early as 3 days after fibroblast injection. Neovascularization was not observed. Control eyes that did not receive fibroblasts showed resolution of serous detachment without retinal traction. In all eyes, retinal degeneration and thinning were seen in the area of previous photodynamic treatment. In this model of TRD, anteroposterior traction (due to vitreous strands) predominates, as is observed in experimental posterior penetrating ocular injury induced by intravitreal blood injection, which also results in vitreous strand formation. Our model, however, enables clinical assessment of TRD in the cat without the media opacification produced by vitreous blood.

Animals↗

PubMed1976

The use of solid soft silicone rubber exoplants in retinal detachment surgery.

A method of retinal detachment surgery utilizing soft solid silicone rubber exoplants is described along with its use in typical cases. Solid silicone rubber, long used as a scleral implant, is a well-tolerated exoplant scleral buckling material which has been found to provide excellent long-term results. The surgical procedure described is relatively short in duration and has a minimum of operative and postoperative complications.

Humans↗

PubMed1998

The use of pneumatic retinopexy to delay surgical repair of a retinal detachment associated with the ganciclovir intraocular device.

Rhegmatogenous retinal detachments are associated with cytomegalovirus (CMV) retinitis and the use of the ganciclovir intraocular device. Pars plana vitrectomy with silicone oil tamponade is the preferred technique to repair such detachments. The authors describe the use of pneumatic retinopexy as part of a treatment strategy in the management of multiple retinal detachments in a patient with CMV retinitis treated with ganciclovir implants. Pneumatic retinopexy may benefit patients when the causative retinal break is superior and is located in an area of retina uninvolved with CMV infection, because it can be used to delay surgical intervention.

AIDS-Related Opportunistic Infections↗

PubMed1980

Retinal detachment following congenital cataract surgery. I. Preoperative findings in 114 eyes.

One hundred fourteen eyes of patients with retinal detachment occurring after congenital cataract surgery were studied. Retinal detachment was typified by high incidences of men, myopia, preference for the second and fourth decades of life, and a fairly long interval after cataract surgery. Frequently found were the following: (1) undetected retinal breaks, (2) high incidences of small oval or round holes in the upper nasal quadrant near the ora serrata, (3) retinal detachment in more than one quadrant, and (4) extensive vitreous and preretinal traction. Preoperative examination was often hampered by a small, bound-down pupil, nystagmus, extreme photophobia, and an inability to move the eye in desired directions. The major factor in the pathogenesis of retinal detachment after congenital cataract surgery appears to be chronic vitreoretinal traction in the anterior vitreous caused by cataract removal.

Adolescent↗

PubMed1992

[Characteristics and prognosis of retinal detachment following uncomplicated extracapsular extraction of the crystalline lens].

In a retrospective study dealing with 52 eyes, we compare the features and prognosis of retinal detachment following intracapsular cataract extraction, non complicated extracapsular cataract extraction, extracapsular cataract extraction followed by YAG laser posterior capsulotomy, extracapsular cataract extraction complicated by peroperative rupture of the posterior capsule with phakic retinal detachment. Our results show several common features between retinal detachment after non complicated cataract extraction and phakic retinal detachment. Cataract extraction, no matter the technique, is not per se an anatomic or functional prognosis factor for a subsequent retinal detachment.

Aged↗

PubMed1979

[Biomicroscopy of the fundus in retinal detachment surgery (author's transl)].

Biomicroscopy of the fundus during retinal detachment surgery has the same advantages as indirect ophthalmoscopy. In addition to this, it offers three main advantages over indirect ophthalmoscopy: the observation of the fundus, in an optical cross section of the tissues, the high variation of magnification available, and the observation of the fundus without switching off the light of the operating room. Since 1976--biomicroscopy of the fundus during retinal detachment surgery has been easily performed with the surgical mobile slit lamp manufactured by the firm Zeiss. The angle of the surgical slit lamp can be reduced to 5 degrees. The slit lamp can be used either with the Zeiss OPMI 1 operating microscope or with the Zeiss OPMI 6 operating microscope. The microscope, the contact lens and the surgical instrumentation specialy fitted for biomicroscopy of the fundus during retinal detachment surgery are described. The surgical technique is dealt with, pointing out the practical details which allow for overcoming the own difficulties of biomicroscopy of the fundus during surgery.

Fundus Oculi↗

PubMed1980

Silicone sponge implant in combination with episcleral implant for retinal detachment surgery.

The results of retinal detachment surgery performed in 50 patients utilizing a silicone sponge episcleral implant combination placed beneath an encircling band have been reviewed. Anatomical reattachment has been achieved in 48 (95%) procedures and complications associated with this technique have been infrequent. The modification described emphasizes the stability and permanency of the sponge episcleral implant combination placed beneath the encircling band without the placement of additional buckling or anchoring sutures. This procedure is used for the treatment of communicating radial folds and fishmouth tears in primary operations or reoperations.

Adult↗

PubMed2001

Pigment epithelium-derived factor in the vitreous is low in diabetic retinopathy and high in rhegmatogenous retinal detachment.

PURPOSE: To report the levels of pigment epithelium-derived factor in the vitreous of patients with diabetic retinopathy, rhegmatogenous retinal detachment, and idiopathic macular hole. METHODS: Using enzyme-linked immunosorbent assay, we measured the levels of pigment epithelium-derived factor in the vitreous of 34 eyes of 33 patients who underwent vitrectomy for the treatment of diabetic retinopathy (17 eyes of 16 patients), rhegmatogenous retinal detachment (10 eyes), and idiopathic macular hole (seven eyes). RESULTS: The vitreal concentration of pigment epithelium-derived factor was 1.15 +/- 0.23 microg/ml (mean +/- standard error) in eyes with diabetic retinopathy, 3.28 +/- 0.69 microg/ml in rhegmatogenous retinal detachment, and 1.71 +/- 0.39 microg/ml in idiopathic macular hole. The pigment epithelium-derived factor level in rhegmatogenous retinal detachment was significantly higher than that in diabetic retinopathy (P =.0008) and idiopathic macular hole (P =.034). For eyes with diabetic retinopathy, the pigment epithelium-derived factor level was 0.88 +/- 0.21 microg/ml in proliferative diabetic retinopathy and 2.43 +/- 0.37 microg/ml in nonproliferative diabetic retinopathy (P =.0083). Additionally, the pigment epithelium-derived factor level in active diabetic retinopathy (0.70 +/- 0.22 microg/ml) was significantly lower than the level in inactive diabetic retinopathy (1.79 +/- 0.35 microg/ml; P =.018). CONCLUSIONS: These results suggest that pigment epithelium-derived factor inhibits angiogenesis and that lower levels of pigment epithelium-derived factor may be related to the angiogenesis in diabetic retinopathy and result in active proliferative diabetic retinopathy. The results also suggest that higher levels of pigment epithelium-derived factor in the eyes with rhegmatogenous retinal detachment may act as a neuroprotective agent for the detached retina.

Adult↗

PubMed1988

Laser iris retraction for angle-closure glaucoma after retinal detachment surgery.

Twelve patients with retinal detachment with postoperative angle closure due to ciliary body edema, refractory to topical cycloplegics and corticosteroids, were managed by peripheral iris retraction with argon laser photocoagulation. This gonioscopic procedure results in immediate visualization of angle structures and prompt reduction of intraocular pressure (IOP). Routine tonometry and appropriate gonioscopy are essential to diagnose this form of glaucoma, which does not have a pupillary block component. Timely use of laser iris retraction reduces the risk of chronic glaucoma secondary to synechial closure. In this series, only two of ten patients, not previously known to have glaucoma, require long-term medication to control IOP.

Aged↗