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Analysis of glycosaminoglycans of subretinal fluid in rhegmatogenous retinal detachment--preliminary report.

To determine the correlation between the types of glycosaminoglycans (GAGs) and the features of rhegmatogenous retinal detachment, we analyzed the types of GAGs in the subretinal fluid of 20 eyes with rhegmatogenous retinal detachment. The GAGs were analyzed by cellulose acetate two-dimensional electrophoresis. Hyaluronic acid alone (HA type) was found in 10 of the 20 eyes. A combination of chondroitin sulfate (chSA) and HA was present (chSA type) in 3 of the 20 eyes. A combination of dermatan sulfate (DS) and HA (DS type) was present in 7 of the 20 eyes. No correlation was found between the type of GAGs and the extent, the duration of detachment, location, size or type of break in the 20 eyes. Some correlation was found between the type of GAGs and the grade of vitreous haze, proliferative vitreoretinopathy (PVR) and the number of surgeries. Retinal detachment with a demarcation line resulted in subretinal strand formation in the DS type eyes, while no such formation was seen in the subretinal space of the eyes of the chSA type. Vitreous haze of grade ( ) was seen in one eye of the DS type, but not seen in the other types. All 3 eyes with PVR of grade C were the DS type. The 2 eyes with reoperated surgeries were the DS type. The presence of DS may indicate an advanced condition of retinal detachment.

Adult↗

Exudative retinal detachment in hemoglobin SC disease.

A 21-year-old black man with hemoglobin SC disease had a unilateral exudative retinal detachment. A large area of sea fan neovascularization was identified in this eye at the superotemporal border of the detachment; no retinal holes were present. Following closure of the neovascularization by argon laser photocoagulation using feeder vessel technique, the retina flattened and the exudation cleared. However, multiple holes developed in thin ischemic retina at foci of vitreoretinal traction. Although many retinal vascular diseases may cause exudative detachments, to the authors' knowledge, this is the first definite case of exudative retinal detachment in a patient with a sickling hemoglobinopathy.

Adult↗

Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review.

PURPOSE: To determine the risk for rhegmatogenous retinal detachment (RRD) after phacoemulsification. SETTING: Private and public facility, Auckland, New Zealand. METHODS: A retrospective study of 1793 consecutive patients having cataract surgery by phacoemulsification was performed. Patients younger than 40 years were excluded, as were patients who had cataract surgery after ocular trauma. Patients having cataract surgery combined with other ocular procedures such as keratoplasty, glaucoma drainage surgery, or posterior segment surgery were similarly excluded. RESULTS: Rhegmatogenous retinal detachment occurred in 1.17% of the patients having cataract surgery. The risk was greater in patients younger than 50 years (5.17%) and less in those older than 70 years (0.64%). The median interval between cataract surgery and development of the retinal detachment was 39 months. The rate of retinal detachment was greater with complicated cataract surgery, but there was no increased risk for those eyes requiring neodymium:YAG laser capsulotomy. CONCLUSIONS: The overall risk for RRD after cataract surgery by phacoemulsification was small. However, in the younger patient, the risk for pseudophakic detachment was higher. In light of this finding, the requirement for cataract surgery in this group should be reassessed.

Adult↗

Management of viral retinitis-associated retinal detachment in AIDS.

We retrospectively reviewed the results of surgery in 27 cases of retinal detachment related to viral necrotising retinitis in acquired immune deficiency syndrome (AIDS). Vitrectomy and silicone oil tamponade were performed in all cases. Scleral buckling was applied to 9 eyes. Silicone oil was left in the eye in all cases. Mean follow-up period was 13 weeks. Post-operative flattening of the retina at the posterior pole was achieved in 89% of the eyes. Anatomical results were not related to the intraoperative use of an encircling procedure. Visual acuity improved by 2 Snellen lines or more in 40% of cases and 67% of the eyes retained a post-operative ambulatory vision. Phacosclerosis and optic atrophy developed in 29% and 22% of cases, respectively. Vitrectomy and silicone oil tamponade without scleral buckling are effective in the management of retinitis-associated retinal detachments. This procedure is short and can be performed under local anaesthesia.

AIDS-Related Opportunistic Infections↗

Circumferential argon laser photocoagulation for prevention of retinal detachment.

Circumferential argon laser photocoagulation was administered as preventive treatment for retinal detachment in 53 eyes with extensive areas of lattice degeneration and/or retinal breaks and at least one additional high-risk factor for retinal detachment. Laser burns were applied in several continuous rows 360 degrees around the peripheral retina at the junction between the posterior border of the lesions and the unaffected retina. The retina posterior to the treated areas remained attached in 51 eyes (96.2%) during a mean follow-up period of 85.8 months (range 6 months to 18 years). The treatment did not affect visual acuity. The only complication was the appearance in 2 eyes (3.8%) of a delicate epiretinal membrane which, however, did not require surgical intervention.

Adolescent↗

A new technique of treating rhegmatogenous retinal detachment using the Q-switched Nd:YAG laser.

In eyes with retinal detachment and a horseshoe break, vitreous traction on the retina has been relieved by severing the flap of the break with the aid of the Q-switched Nd:YAG laser. The retina often flattens in eyes with shallow retinal detachment after this treatment; the breaks then can be sealed off with argon laser. In cases of retinal detachment treated with expanding gas, fewer recurrences were observed when vitreous traction had been relieved by Nd:YAG laser treatment.

Argon↗

Oxycephaly, bilateral ectopia lentis, and retinal detachment.

We report the case of a man with oxycephaly, bilateral ectopia lentis, and total retinal detachment in one eye. Although the association of retinal detachment with ectopia lentis is well known, this is the first report to our knowledge of a craniosynostosis, specifically oxycephaly, being associated with ectopia lentis and retinal detachment.

Adult↗

Use of perfluorocarbon liquid in the repair of retinoschisis retinal detachments.

BACKGROUND AND OBJECTIVES: To determine the effectiveness of perfluorocarbon liquid in the repair of retinoschisis-associated retinal detachments. PATIENTS AND METHODS: Four patients with either degenerative or juvenile X-linked retinoschisis had rhegmatogenous retinal detachments that were repaired with the use of perfluorocarbon liquid during vitrectomy. The patients' ages ranged from 17 to 78 years and the postoperative follow-up was at least 6 months. RESULTS: All of the patients had complete anatomic repair of the retinoschisis-associated retinal detachments. The postoperative visual acuity was 20/200 or better in all of the patients and 20/40 or better in half of the patients. CONCLUSIONS: The use of perfluorocarbon liquid is an effective adjunct in the management of rhegmatogenous retinal detachments associated with degenerative and juvenile X-linked retinoschisis.

Adolescent↗

Levels of basic fibroblast growth factor, glutamine synthetase, and interleukin-6 in subretinal fluid from patients with retinal detachment.

PURPOSE: To investigate the presence of basic fibroblast growth factor, glutamine synthetase activity, and interleukin-6 in subretinal fluid from patients with retinal detachment. METHODS: In a prospective study we measured basic fibroblast growth factor, glutamine synthetase activity, interleukin-6, and total protein in subretinal fluid samples from 96 eyes from 94 consecutive patients with a retinal detachment corrected by a conventional scleral buckling operation in our clinical practice. As controls, vitreous fluid samples from eyes with a macular hole (n = 6) or pucker (n = 11) were used. Laboratory data of the patient group were compared with the control group and correlated with various clinical data. RESULTS: Levels (median, range) of basic fibroblast growth factor, glutamine synthetase activity, interleukin-6, and total protein were significantly higher in patients than in controls (P <.0001). An increased level of glutamine synthetase and total protein correlated with a longer duration of the retinal detachment (r =.4, P =.002, and r =.34, P =.001, respectively). Interleukin-6 and basic fibroblast growth factor levels did not correlate with the duration of the detachment. After multivariate logistic regression analysis, no significant relation was found between any of the tested subretinal proteins and a low visual outcome or redetachment. CONCLUSIONS: We found increased levels of basic fibroblast growth factor and glutamine synthetase in subretinal fluid from patients with retinal detachment. Basic fibroblast growth factor and glutamine synthetase may play a role in the pathogenesis and recovery after retinal detachment. The questions of whether the increased levels of basic fibroblast growth factor and glutamine synthetase result from leakage of dying glia cells (including Müller cells) and neurons and if basic fibroblast growth factor is actively produced to protect the photoreceptor cells need further research.

Adolescent↗

[Retinal detachment recurrences. 1. Frequency and risk factors (author's transl)].

Retinal detachment recurrence is defined the reappearance of a detachment after an initial complete success, whatever the delay between surgery and recurrence. This eliminates immediate failures due to inadequate buckles or major complications during surgery, exsudative retinal detachments that reattach spontaneously within a few days and cases where it is not sure that the retina had been completely reattached initially (cloudy media). Employing these criteria, a retrospective study demonstrated 130 eyes with recurrences out of a total of 1237 eyes operated between 1-10-69 and 31-12-79 (10,5 per cent rate); recurrences occurred in this series between 3 days and 7 years after initial surgery, 53,5 per cent of them within an interval of less than 3 months. The most important recurrence risk factors appear to be: detachment due to a retinal tear and not a hole, bullous detachment, abnormal vitreous but not full blown, massive vitreo-retinal retraction and massive intraocular bleeding during subretinal fluid drainage.

Drainage↗

Retinal detachment following phacoemulsification.

In a consecutive series of 1,500 eyes in which phacoemulsification had been performed, the incidence of subsequent retinal detachment was 3.6%. Vitreous loss occurred in 4.2% (63) of the 1,500 cases, and in this group of eyes the incidence of retinal detachment was 14% (9). The characteristics of retinal breaks and the configurations of retinal detachments following phacoemulsification were in general similar to cases following intracapsular surgery. The surgical reattachment rates in these eyes compared favorably to previous reports on the repair of retinal detachments.

Adult↗

Retrospective study of retinal detachment following neodymium:YAG laser posterior capsulotomy.

A retrospective study of 1,000 cases that had Nd:YAG laser posterior capsulotomy after cataract surgery is presented. We analyzed the correlation of the patient's age, axial length of the eye, method of cataract surgery, and laser parameters (exposures, energy, and burst mode) with the incidence of retinal detachment (1.6% overall). The highest risk for retinal detachment (12.3%) was in patients with an axial eye length of 26.1 mm to 28.0 mm. The average age of patients with retinal detachments was 60.6 years, ten years younger than the collective average age. Laser parameters, such as energy, exposures, and burst mode, and the method of cataract surgery (extracapsular or phacoemulsification) did not correlate with the incidence of retinal detachment. After surgical treatment of the 16 retinal detachments, a good postoperative visual acuity (better than 20/40) was achieved in most cases.

Adolescent↗

[The application of retinotomy and retinectomy for complicated retinal detachment].

OBJECTIVE: To investigate the techniques, therapeutic effects, indications, complications and control of retinotomy and retinectomy for complicated retinal detachment. METHODS: Based on the preliminary report of retinotomy and retinectomy, 36 eyes of 36 patients of complicated retinal detachment were operated on and followed-up for 3-12 months. The operative technique included buckling, vitrectomy, peeling, retinotomy and retinectomy, intraocular tamponade and laser treatment. RESULTS: Retina was reattached in 32 eyes in operation. Retinal detachment was recurrent in 8 eyes in followed-up in which retina was reattached again in 3 eyes by second operation. The last successful rate was 75% (in 27 eyes). The visual acuity was worse than funger conter in 33 eyes and worse than 0.05 in 3 eyes before operation. The visual acuity was better than 0.05 in 20 eyes (55.5%) after operation. The complications included bleeding, retinotomy expanding, complicated cataract, hypotony and so on. CONCLUSION: Retinotomy and retinectomy can improve the curative effect of complicated retinal detachment. But the complications of these operation were severe. The indications should be well controlled.

Follow-Up Studies↗

Silicone oil in the repair of pediatric complex retinal detachments: a prospective, observational, multicenter study.

OBJECTIVE: To report anatomic and visual acuity outcomes, as well as complications, after using 1000-centistoke silicone oil as a retinal tamponade for the treatment of complex retinal detachments in a pediatric population. DESIGN: A prospective, observational, multicenter study. PARTICIPANTS: The study cohort consisted of 205 patients 16 years of age or younger (211 eyes) treated at community and university-based ophthalmology clinics for complex retinal detachments associated with trauma, proliferative vitreoretinopathy (PVR), giant retinal tear (GRT), or retinopathy of prematurity (ROP). INTERVENTION: Vitrectomy surgery for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade. MAIN OUTCOME MEASURES: Anatomic outcomes include complete retinal attachment and macular attachment. Visual acuity outcomes include ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications include rates of secondary intraocular pressure (IOP) elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. All outcome measures were assessed 6, 12, and 24 months after surgery and at last examination. RESULTS: At the 6-month examination, the retina was completely attached in 43 (57%) of 76 eyes in the trauma group, 24 (63%) of 38 PVR eyes, 23 (68%) of 34 GRT eyes, and 6 (33%) of 18 ROP eyes. The macula was attached in 60 (79%), 33 (87%), 26 (76%), and 8 (44%) eyes, respectively. Ambulatory vision was achieved in 19 (25%) eyes in the trauma group, 18 (47%) PVR eyes, 19 (56%) GRT eyes, and 4 (22%) ROP eyes. Visual acuity was preserved in 53 (70%), 26 (68%), 28 (82%), and 9 (50%) eyes, respectively. The corresponding rates of complications for traumatic, PVR, GRT, and ROP eyes were: elevated IOP-3 (4%) of 76, 1 (3%) of 38, 1 (3%) of 34, and 0 (0%) of 18; hypotony--9 (12%), 3 (8%), 2 (6%), and 2 (11%); corneal opacity--25 (33%), 8 (21%), 15 (44%), and 5 (28%); emulsification--4 (5%), 1 (3%), 3 (9%), and 1 (6%); and cataract in phakic eyes--1 (33%) of 3, 2 (67%) of 3, 2 (50%) of 4, and 1 (33%) of 3. CONCLUSIONS: Retinal reattachment and preserved visual acuity were achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complete retinal and macular attachment was achieved less frequently in ROP eyes than in eyes in the other diagnostic groups. Use of 1000-centistoke silicone oil can be considered in the management of pediatric complex retinal detachments associated with multiple etiologies.

Adolescent↗

Removal of the internal limiting membrane under perfluorocarbon liquid to treat macular-hole-associated retinal detachment.

PURPOSE: To demonstrate the advantages and efficacy of internal limiting membrane removal under perfluorocarbon liquid in macular-hole-associated retinal detachment. DESIGN: Interventional case series. METHOD: Four patients with macular-hole-associated retinal detachment underwent pars plana vitrectomy, retinal reattachment with endodrainage through the macular hole, perfluoro-n-octane injection to seal the macular hole, indocyanine green injection under the perfluoro-n-octane bubble and removal of the indocyanine green-stained internal limiting membrane. Visual acuity and anatomic results were recorded, with a mean follow-up period of 18 months. RESULTS: Postoperatively, the retina was reattached in all four patients and closure of the macular hole was achieved in three eyes. Visual acuity improved in all eyes. CONCLUSIONS: In retinal detachment resulting from macular hole, staining of the internal limiting membrane with indocyanine green injected under perfluoro-n-octane can facilitate peeling of the membrane without exertion of excessive retinal traction and may prevent passage of indocyanine green into the subretinal space.

Aged↗

Tomographic features of serous retinal detachment in Vogt-Koyanagi-Harada syndrome.

To clarify the nature of serous retinal detachment in Vogt-Koyanagi-Harada (VKH) syndrome, 42 consecutive eyes of 21 patients with acute phase VKH syndrome were examined using optical coherence tomography (OCT). OCT revealed two patterns of serous retinal detachment. Twenty-nine eyes (69%) had a true retinal detachment, 17 eyes (40%) had intraretinal fluid accumulation in the outer retina, and 4 eyes had both. Intraretinal fluid accumulation appeared as an oval space in the outer retina. On fluorescein angiography, the eyes with intraretinal fluid accumulation showed more severe dye leakage from the retinal pigment epithelium.

Acute Disease↗

Orbital squamous cell carcinoma following retinal detachment surgery.

BACKGROUND: Orbital squamous cell carcinoma following retinal detachment surgery is a rare condition. A proposed pathogenesis involves implantation of conjunctival squamous epithelium at the time of surgery, with subsequent malignant transformation. METHODS/RESULTS: An 81-year-old Caucasian man presented with a six-month history of a discharging painful red right eye. Ten years earlier a right scleral buckling with an encircling sponge exoplant had been performed. Examination revealed exposure of the sponge, and a large mass in the superomedial conjunctival fornix. Computed tomography revealed a mass invading around the globe in the region of the exoplant. Biopsy revealed squamous cell carcinoma. Orbital exenteration was performed. CONCLUSION: Orbital squamous cell carcinoma may arise following retinal detachment surgery presumably due to iatrogenic conjunctival implantation deep in the orbit.

Aged↗

Retinal detachment in the second eye.

Bilateral retinal detachment (RD) occurred in 13% of 737 patients, with an interval between detachments of up to 30 years. Bilateral RD was more common in male patients and in those having more than 3 diopters of myopia. Detachment in the second eye was caused by retinal breaks in previously observed degeneration in 43% and in unsuspected diseased retina 57%. A significant number of patients with bilateral RD had multiple breaks. Aphakic RD occurred in bilateral RD and in unilateral RD patients at a comparable frequency; 28% of bilateral (mean duration, four years) and 35% of unilateral aphakic RDs occurred within one year of cataract surgery. Symptoms from retinal breaks were not reliable prognostic factors; only 39% of patients had warning before RD. Patients with bilateral RD had more reoperations with fewer successes, factors suggesting greater severity than unilateral RD.

Adolescent↗