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PubMed1986

Traumatic retinal detachment--mechanisms and management.

Experience has shown that the overwhelming majority of traumatic retinal detachments are rhegmatogenous in origin. Retinal breaks are predominantly located within the vitreous base region but may occur at sites of focal scleral impact or from posterior vitreous avulsion. Although the use of scleral buckling techniques alone may be sufficient, closed microsurgery may be required to relieve trans-gel or surface retinal traction and to facilitate the identification and permanent closure of retinal breaks. Prophylactic measures including the use of closed microsurgery play a vital role in the management of traumatic retinal breaks and prevention of complex retinal detachment.

Cryosurgery↗

PubMed1986

[Synthetic absorbable PDS explant for the treatment of retinal detachment].

The following article discusses the experimental and clinical reasons for using absorbable synthetic explants in retinal surgery. We have carried out experimental studies with absorbable synthetic explants bandmade from absorbable sewing threads: PG910, PGA and PDS; proving that these explants are well tolerated by the organism. Their reabsorption time is from 45 days using PG910, to 8 months using PDS; these periods are sufficient for proper anatomical healing of the retina to take place. We present 13 cases of extraction of Teflon explants after retinal detachment surgery; in none of these cases did re-detachment of the retina occur. Consequently, this induced us to introduce absorbable synthetic explants into retinal detachment surgery, using absorbable threads, having previously carried out an experimental study on rabbits. We present 10 cases of retinal detachment operated on with PDS from 95 cases operated on using absorbable synthetic explants; 100% anatomical healing of the retina was achieved. We consider this type of explant to be the ideal material for retinal detachment healing, due to the fact that its period reabsorption, being longer than those of the other explants, allows a longer indentation period.

Absorption↗

PubMed2004

Distribution of p27(KIP1), cyclin D1, and proliferating cell nuclear antigen after retinal detachment.

PURPOSE: To examine the expression of the p27(KIP1), cyclin D1, and proliferating cell nuclear antigen (PCNA) in the retina and retinal pigment epithelium (RPE) after retinal detachment. METHODS: Normal eyes and eyes at 2 or 4 days after retinal detachment with the C57B16 mouse were analyzed by immunocytochemistry using anti-p27(KIP1), anti-cyclin D1, and anti-proliferating cell nuclear antigen (PCNA) antibodies as well as anti-glutamate synthetase (GS) antibody. RESULTS: The p27(KIP1) positive nuclei were distributed in the inner nuclear layer (INL) and the RPE of the normal mice eye. In the INL, p27(KIP1) was detected in the middle sublayer, where the nuclei of glutamate synthetase positive Müller cells were situated. In contrast, cyclin D1 was not detected either in the retina or in the RPE. At 2 and 4 days after the retinal detachment, RPE cells under the detached retina were negative for p27(KIP1) and positive for cyclin D1 and PCNA. In the INL of the detached retina, p27(KIP1) was detected after 2 days, but was not detected after 4 days. In contrast, PCNA was not detected in the INL after 2 days, but was detected after 4 days. Cyclin D1 was detected in the middle sublayer of the INL at both 2 and 4 days after the retinal detachment. CONCLUSION: These results suggested that degradation of p27(KIP1) and expression of cyclin D1 was involved in the proliferation of the Müller cells as well as RPE cells after retinal detachment.

Animals↗

PubMed1992

Macular pucker after retinal detachment surgery.

To better understand postsurgical macular pucker in rhegmatogenous retinal detachment, we reviewed a consecutive series of 277 eyes in 268 patients in whom retinal detachment had spared the macular area and in whom no preretinal membrane with distortion of the retinal vessels had been present preoperatively. Postoperatively, 17 eyes (6.1%) developed obvious macular pucker; 260 eyes (93.9%) did not. Using the Mantel-Haenszel chi-square test, we found that patient age, preoperative vitreous hemorrhage, large retinal breaks of more than three disc diameters, and cryoapplication were significant precipitating factors of postoperative macular pucker. These findings are consistent with the view that dispersion of retinal pigment epithelial cells through the retinal break into the vitreous cavity is the major cause of this disorder. Minimal use of cryotherapy is recommended in treating elderly patients who have a large retinal break or a preoperative vitreous hemorrhage.

Adolescent↗

PubMed1990

Serous retinal detachment following glaucoma filtering surgery.

We report the occurrence of serous retinal detachment in association with choroidal effusion and hypotony in six eyes that had undergone glaucoma filtering surgery. Hypotony with choroidal effusion was documented in five patients before the onset of serous retinal detachment. While one patient underwent vitrectomy, treatment was conservative in the other patients. Serous retinal detachment and choroidal effusions resolved spontaneously as the intraocular pressure normalized. Although one patient regained preoperative visual acuity, all other patients lost at least one line of Snellen acuity.

Adolescent↗

PubMed1990

Results and complications of conventional repair of bullous retinal detachment using posterior segment air injection.

The aims of this retrospective study were to determine the outcome of retinal detachment repair using the drainage, air injection, cryotherapy and explant surgical sequence ('D-ACE' technique) for bullous retinal detachments and also to identify the complications attributable to the injection of the gas. The D-ACE technique was used to repair 206 detachments over a ten year period of which 138 (67%) were successfully re-attached with a single operation. The sub-group of these patients (n = 66) with bullous retinal detachments who would be considered suitable for repair using the technique of pneumoretinopexy (PR) showed a single operation success rate of 85% after D-ACE. Complications attributable to the gas injection occurred in 18 eyes (8.5%). In only four of these (1.9%) did retinal surgery ultimately fail as a result of complications caused by injection of the gas, which represents 10% of all the failures. The results of this series show that the serious complication rate from injecting air into the vitreous cavity is low and that the success rate for treating relatively uncomplicated bullous retinal detachments using the D-ACE technique compares favourably with the results of other published series using either the D-ACE procedure or pneumoretinopexy.

Air↗

PubMed2006

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients.

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.

Cataract Extraction↗

PubMed2004

[Contusive retinal detachment: a retrospective review of 48 patients].

PURPOSE: Analysis of the epidemiological, clinical and therapeutic characteristics of retinal detachment after ocular blunt trauma. MATERIAL AND METHODS: We retrospectively reviewed 48 patients with isolated retinal detachment after ocular blunt trauma, studying their epidemiological characteristics (age, sex and trauma circumstances), their clinic details and the surgical techniques used. RESULTS: The average age of our patients was 39.3 Years; most were male (75%). Assault and home accidents were the most common cause of ocular trauma (83.2%). Total retinal detachment was noted in 47.9%. Of the retinal breaks found, dialysis at the ora serrata was observed in 22%, atrophic holes in 33.9%, retinal breaks in 40.6% and giant tears in 4.2%. Most of the breaks were situated at the lower temporal quadrant. Forty one out of the 48 patients were operated on, with surgical treatment consisting in episcleral surgery in 38 cases and vitreoretinal surgery in three cases. Complete anatomical success was achieved in 92.7%. CONCLUSION: This survey shows that the prognosis of retinal detachment after ocular blunt trauma remains favorable given the young age and the absence of advanced vitreoretinal proliferation, but this should not affect the importance of prevention.

Accidents, Home↗

PubMed2004

Retinal detachment in atopic dermatitis can masquerade as acute panuveitis with rapidly progressive cataract.

PURPOSE: To report two cases of retinal detachment in young patients with atopic dermatitis masquerading as acute panuveitis. DESIGN: Retrospective observational clinical case reports. PATIENTS: Patients with atopic dermatitis presenting with acute panuveitis and subsequently diagnosed with retinal detachment at the Singapore National Eye Centre. METHODS: A review of the clinical case records. RESULTS: Two young patients aged 19 and 21 years with a history of atopic dermatitis presented with acute unilateral moderately severe panuveitis. Both developed rapidly progressing cataracts that made detailed visualization of the fundus difficult. Hypotony persisted in one eye despite partial response of uveitis to therapy. The other patient developed ocular hypertension when the vision in the affected eye suddenly deteriorated. Both eyes demonstrated partial response to steroid therapy. The diagnosis of shallow retinal detachment with anteriorly located incriminating retinal breaks was made after partial resolution of vitreous haze in one case and on repeated ultrasonography in the other case. CONCLUSION: A high index of suspicion is required when examining young patients with atopic dermatitis who present with acute panuveitis and a rapidly progressive cataract, which may mask the presence of a shallow retinal detachment.

Acute Disease↗

PubMed1982

An unusual case of retinoschisis and retinal detachment.

An unusual case of retinoschisis and associated retinal detachment in a 61-year-old man is reported. The case involved a retinoschisis area with 22 outer-layer retinal holes and two inner-layer retinal holes in the superior nasal quadrant of the left eye. The retinal detachment extended posteriorly beyond the schisis area. The patient's condition was managed with a combination of cryotherapy and a scleral buckle. Postoperatively, the did well despite the presence of a choroidal detachment that resolved in one month. Cases previously reported have not precisely listed the number of retinal holes. This case is unusual in that there are an unusually large number of retinal holes.

Cryosurgery↗

PubMed2006

Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome.

PURPOSE: To determine the efficacy of optical coherence tomography (OCT) in the management of retinal detachment in morning glory syndrome (MGS). DESIGN: Prospective, interventional case series. METHODS: Five eyes of five consecutive MGS patients who developed retinal detachment between August 2000 and June 2004 were enrolled and examined by OCT at presentation of retinal detachment. Four eyes were found to have a slit-like break at the margin of the excavation by careful OCT scanning 360 degrees around the excavation. All four eyes underwent pars plana vitrectomy, gas injection and postoperative laser photocoagulation. Postoperative OCT was performed to confirm the closure of the retinal break and reattachment of the retina. RESULTS: Optical coherence tomography detected a slit-like break at the margin of excavation in four of five patients. The retina reattached in all five eyes over the subsequent 3-50-months (average 28 months) follow-up period. Postoperative OCT showed retinal break closure at the margin of the excavation. In the one eye in which no retinal break could be detected by OCT, the retina was reattached after pars plana vitrectomy and removal of gel-like tissue. CONCLUSIONS: Optical coherence tomography is beneficial in the detection of subtle slit-like breaks at the margin of excavation in retinal detachment in MGS. It provides good guidance in subsequent surgery and is very helpful in confirming the closure of the retinal break.

Adult↗

PubMed2002

[Posterior vitrectomy for dislocated nuclear fragments during phakoemulsification: incidence, risk factors and prognosis of postoperative retinal detachment].

INTRODUCTION: Dislocated nuclear fragments during phakoemulsification are a well-known complication. The treatment is often surgical, and serious complications, among which a retinal detachment may occur. The purpose of this study was to evaluate its incidence, risk factors, and prognosis. METHODS: This retrospective study included a consecutive series of 24 eyes undergoing posterior vitrectomy for dislocated nuclear fragments during phakoemulsification. The main outcome measures were the postoperative retinal detachment (incidence, risk factors, prognosis). RESULTS: Two retinal detachments occurred after vitrectomy, an incidence of 8%. In both cases, a significant inflammation of the anterior chamber and corneal decompensation were noted before vitrectomy. More than 50% of the nucleus was dislocated. Intraocular implant manipulation did not intervene in either case. Two tears occurred during vitrectomy in one case. The prognosis of the detachment, with proliferation, was poor in both cases. DISCUSSION: and conclusion: The high incidence of retinal detachment compares with that observed after phakoemulsification complicated by vitreous loss. Anterior segment deterioration, which compromises posterior segment visualization, and dislocation of more than 50% of the nucleus, that increases the risk of fragments falling on the retina during vitrectomy, may increase the occurrence of retinal detachment with a poor prognosis because of periretinal proliferation.

Adolescent↗

PubMed2001

Exudative retinal detachment in relapsing polychondritis : case report and literature review.

OBJECTIVE: To report the atypical ocular symptoms (arterialized conjunctival vessels, exudative retinal detachment) that can be the presenting manifestations of relapsing polychondritis. DESIGN: Observational case report and literature review. METHODS: A complete ocular and systemic evaluation was performed on a patient with relapsing polychondritis and exudative retinal detachment. MAIN OUTCOME MEASURES: Retinal, choroidal, and scleral findings. RESULTS: A 73-year-old man with relapsing polychondritis presented with a unilateral large bullous exudative retinal detachment and marked choroidal and scleral thickening bilaterally. CONCLUSIONS: Ophthalmologists should consider relapsing polychondritis in the differential diagnosis of exudative retinal detachment. A combination of echographic and laboratory findings can assist in the accurate diagnosis of this rare condition.

Aged↗

PubMed1998

Bullous retinal detachment in a patient with central serous chorioretinopathy.

Bullous retinal detachment, a severe and atypical presentation of central serous chorioretinopathy (CSCR), may develop in association with the use of systemic steroids. A 42-year-old man presented with a 2-month history of poor visual acuity in his right eye. A tentative diagnosis of Harada's syndrome was made and the patient was treated with large doses of systemic corticosteroids for 1 month, without improvement. Fundus examination showed bullous detachment with shifting subretinal fluid in both eyes. Fluorescein angiography demonstrated multiple leaking points with pigment epithelium detachment in both eyes. A diagnosis of bilateral severe CSCR was made and systemic steroid therapy was withdrawn. Several sessions of argon laser photocoagulation to the areas of fluorescein leakage in both eyes and transscleral drainage of subretinal fluid in the right eye were performed. Two months later, the retinae became attached in both eyes. Visual acuity in the right eye was limited by submacular fibrosis, while the visual acuity of the left eye was not affected. In summary, this case should alert physicians to suspect CSCR in patients with exudative retinal detachment, as the use of steroids is usually not only unnecessary but can also be harmful.

Adult↗

PubMed1999

[Bilateral retinal detachment in toxemia of pregnancy].

In this article, we present two cases of bilateral retinal detachment in toxemia of pregnancy. The first case describes 31-year old patient admitted to hospital due to toxemia of pregnancy in the 38th week of the second pregnancy. Medical examination following admission showed blood pressure 180/130 mm Hg oedema of face and legs. Accessory investigations displayed proteinuria, leukocyturia, bacteriuria. At the fundus of eye the features of initial retinopatia hypertonica were discovered. On the fifth day of the patient's hospitalization because of the worsening of general health condition and sudden blood pressure increase, the pregnancy was delivered by cesarean section. Some hours after awakening the patient reported the loss of vision of both eyes. Ophthalmological examination showed the occurrence of retinal detachment. Tearing wasn't found. When the protein deficiency was supplemented and antiinflammatory and oedema--reducing treatment was administered the blood pleasure stabilized retina attached itself and visual functions returned. In the second case 22-year old patient was admitted to hospital at term of labour with blood pressure 150/90 mm Hg and a little proteinuria. On the second day of hospitalization the pregnancy was delivered through natural passages. A few hours after the delivery the patient reported indistinct vision and blurring of the image. Through ophthalmological examination retinal detachment was stated. Tearing was not found. Thanks to bed regime and resorbing treatment total retinal attachment was gained and visual functions returned. This case suggests that retinal detachment of pregnant woman does not have to be proceeded by symptoms of toxemia of pregnancy and the period of delivery may accelerate and release mechanisms damaging choriocapillaries, which causes the flow of liquid from vessels of chorioidea to subretinal space.

Adult↗

PubMedDate not supplied

Laser in situ keratomileusis for correction of myopia in eyes after retinal detachment surgery.

PURPOSE: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) for correction of myopia in eyes with previous retinal detachment surgery. METHODS: A retrospective review was conducted of all consecutive eyes that underwent LASIK after retinal detachment surgery. Data was collected regarding previous ocular surgery and its time prior to LASIK, intra- and postoperative complications, and visual outcome measures pre- and postoperatively. RESULTS: Ten eyes with previous retinal detachment surgery were scheduled for LASIK. One eye was excluded from data analysis as LASIK was aborted due to inadequate microkeratome suction because of conjunctival scarring. Nine eyes underwent an uneventful LASIK procedure. On average, LASIK was performed 130+/-123 months following retinal detachment surgery. Postoperative LASIK follow-up was 14.8+/-12.5 months. No significant intraoperative, postoperative, or retinal complications were observed. The mean preoperative spherical equivalent refraction was -9.00+/-3.00 diopters (D), uncorrected visual acuity (UCVA) was 0.06+/-0.02, and best spectacle-corrected visual acuity (BSCVA) was 0.64+/-0.16. At the end of follow-up, the mean spherical equivalent refraction was 0.65+/-0.88 D, mean UCVA was 0.57+/-0.14, and mean BSCVA was 0.72+/-0.19. Differences between BSCVA before and after LASIK were statistically significant (P=.038). At final follow-up, the safety index was 1.22 and efficacy index was 1.01. CONCLUSIONS: Laser in situ keratomileusis was found to be a safe and efficient option for treating refractive errors in eyes with previous retinal detachment surgery.

Adult↗

PubMed1996

[Follow-up of vitrectomy for central retinal detachment and optic disk pit].

BACKGROUND: The exact pathogenesis of central retinal detachment associated with optic disc pit is still unknown. Vitrectomy has proven to be the most effective therapy. PATIENTS AND METHODS: In two patients with macular detachment associated with optic disc pit, a pars-plana-vitrectomy with surgical posterior vitreous detachment and gastamponade was performed. We report on the interesting clinical course of these patients. RESULTS: After the gas bubble was absorbed, we observed a displacement of the subretinal fluid inferiorly in both patients. Schisislike changes persisted in the macular area. After several months the subretinal fluid resolved completely. CONCLUSION: The fluid displacement and the resolution-characteristics of the subretinal fluid after vitrectomy in cases of retinal detachment associated with optic disc pit are completely different from other rhegmatogenous retinal detachments. The gas bubble separates the central retinoschisis from the peripheral rhegmatogenous part. The reason for delayed resolution remains unclear. It may be due to tangential vitreous traction in the periphery.

Adult↗

PubMed1999

Vitrectomy for rhegmatogenous or tractional retinal detachment with familial exudative vitreoretinopathy.

OBJECTIVE: To examine the anatomic features and surgical indications of familial exudative vitreoretinopathy (FEVR) complicated with rhegmatogenous or tractional retinal detachment. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty-eight eyes of 25 patients who had either clinically suspected or fully diagnosed FEVR. Of these, 25 had rhegmatogenous retinal detachment, 2 had tractional retinal detachment, and 1 had tractional retinal detachment plus vitreous hemorrhage. INTERVENTIONS: The authors carefully observed the vitreoretinal interface during surgery, studied the clinical and anatomic features of FEVR, and then evaluated the surgical results. RESULTS: The vitreoretinal adhesions were so strong in the peripheral avascular area that iatrogenic retinal breaks easily occurred in 22 of 28 eyes. In all cases, the bimanual technique with vitreous scissors and forceps was required to dissect the posterior vitreous membrane from the retinal surface. The retina was reattached in 24 of 28 cases (85.7%), and visual acuity improved in 20 eyes (71.4%). CONCLUSION: Dissection of the vitreous in the peripheral avascular area is very difficult in FEVR, and those patients for whom this procedure was not successfully performed may have a poorer prognosis.

Adolescent↗