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PubMed1995

Retinal detachment and herpesvirus retinitis in patients with AIDS.

BACKGROUND: The prolongation of survival of patients with herpesvirus retinitis and AIDS has been associated with a rise in the incidence of retinal detachment. In such cases, however, retinal reattachment may be difficult to achieve, and postoperative visual acuity may be poor despite anatomically successful surgery. METHODS: In order to examine factors affecting the visual outcome of surgery, a retrospective review of 29 patients with retinal detachment, herpesvirus retinitis, and AIDS was performed. Retinal reattachment surgery (32 procedures) or prophylactic laser demarcation (five procedures) was performed in 28 eyes of 23 patients. RESULTS: The macula was attached in 23/28 (82%) eyes at the last outpatient visit. Best postoperative visual acuity (median 6/18, range 6/6-hand movements) was significantly greater than final postoperative acuity (median counting fingers, range 6/6-no perception of light) (Wilcoxon sign rank test, p = 0.003), and was retained for a median of 3 months (1-91 weeks) after surgery. Poor visual outcome as evidenced by submedian final visual acuity was invariably associated with persistence of macular detachment, and significantly associated with the occurrence of optic atrophy (odds ratio = 5, p = 0.02). CONCLUSION: Retinal reattachment surgery appears justified in patients with herpesvirus retinitis and AIDS, but postoperative visual deterioration may occur in association with optic atrophy.

AIDS-Related Opportunistic Infections↗
PubMed1988

[Aphakic versus pseudophakic retinal detachments].

Aphakic retinal detachments and pseudophakic retinal detachments (i.e., detachments following extracapsular cataract extraction and posterior chamber lens implant surgery) from the last 3 1/2 years were studied retrospectively. In the aphakic group, myopia (mean preoperative refraction -2.60) and intraoperative loss of vitreous (10.3%) were found to be risk factors. In the pseudophakic group, male patients predominated (21/26 = 80.8%); furthermore, myopia (mean preoperative refraction -4.60, mean axial length = 24.98 mm) was also a risk factor. Additional risk factors included intraoperative rupture of the capsule (11.5%) as well as postoperative Neodymium-YAG laser capsulotomy (34.6%). There was no appreciable difference between the two groups with regard to the type of detachment. In more than 50% of the cases, retinal tears occurred in the superior temporal quadrant. In 19.4% of the cases with pseudophakic retinal detachment, no foramen could be found; on the other hand, only in 7.7% of the cases in the aphakic group was no retinal hole seen. Surgery was anatomically successful in 92.3% of the pseudophakia cases. In the group with pseudophakic retinal detachment retinal surgery was only successful in 84.6% of the cases.

Cataract Extraction↗
PubMed1998

Tractional retinal detachment after branch retinal vein occlusion. Influence of disc neovascularization on the outcome of vitreous surgery.

OBJECTIVE: This study aimed to investigate the influence of disc neovascularization on the outcome of vitreous surgery for tractional retinal detachment (TRD) after branch retinal vein occlusion (BRVO). DESIGN: The study design was a retrospective case series. PARTICIPANTS: Twenty-two eyes of 22 patients who had undergone vitrectomy for TRD after BRVO at the Osaka National Hospital (Osaka, Japan) or the Surugadai Hospital of Nihon University (Tokyo, Japan) between 1985 and 1995 participated. Seven (32%) of 22 eyes had a TRD secondary to neovascularization of the optic disc (NVD) and neovascularization elsewhere (NVE; group I), and 15 (68%) had a TRD with NVE without NVD (group II). MAIN OUTCOME MEASURES: Visual acuities and retinal reattachment rates were measured. RESULTS: Sixteen (73%) of the 22 study eyes showed severe vitreous hemorrhage before surgery, and 11 eyes (50%) had received laser photocoagulation treatment before surgery. Fourteen (64%) of the study eyes achieved total retinal reattachment after initial vitrectomy, and 19 eyes (86%) were reattached completely at final examination. Thirteen eyes (59%) achieved a visual acuity of better than 0.1. Group I patients had a significantly higher rate of recurrent combined traction rhegmatogenous retinal detachment (P = 0.01) and a significantly worse final visual outcome (P = 0.01). CONCLUSIONS: Better surgical results are expected in eyes without NVD than with NVD among patients who undergo vitrectomy for TRD after BRVO. Although the authors were unable to determine the reason for this difference in the current study, they speculate that the degree of retinal nonperfusion, diffusible angiogenic factors, and distance of the site of occlusion from the disc may each affect visual and anatomic outcomes in these eyes.

Aged↗
PubMed2005

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

BACKGROUND: Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven. OBJECTIVES: The purpose of this review is to evaluate the effectiveness of interventions for asymptomatic retinal breaks and lattice degeneration. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 3 2004) MEDLINE (1966 to July 2004) and EMBASE (1980 to August 2004). Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional study reports. Experts in the field were contacted for details of other published and unpublished studies. SELECTION CRITERIA: This review was designed to include randomised controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment. DATA COLLECTION AND ANALYSIS: One reviewer assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed. MAIN RESULTS: No trials were found that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

Humans↗
PubMed2001

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

BACKGROUND: Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina, because such symptomatic retinal breaks are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven. OBJECTIVES: The purpose of this review is to evaluate the effects of interventions for asymptomatic retinal breaks and lattice degeneration. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL (which includes the Cochrane Eyes and Vision Group specialized register), MEDLINE and EMBASE. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed in an effort to find additional study reports. Experts in the field were contacted for details of other published and unpublished studies. SELECTION CRITERIA: This review was designed to include randomised controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment. DATA COLLECTION AND ANALYSIS: One reviewer assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed. MAIN RESULTS: No trials were found that met the inclusion criteria for this review. REVIEWER'S CONCLUSIONS: No conclusions could be reached about the effects of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

Humans↗
PubMed1996

Giant retinal tear and retinal detachment with underlying retinitis pigmentosa and hearing loss.

Few retinal detachments have been described in patients with retinitis pigmentosa and allied retinal disorders, with only two cases (both with hearing loss) reported in association with giant retinal tears. To further characterise clinical characteristics of giant retinal tear associated with retinitis pigmentosa, we reviewed the course of four eyes of three patients. Unexpectedly, all three individuals also suffered from congenital sensorineural hearing loss. One suffered from associated myopathy. Despite aggressive surgical management, three of the four eyes became blind. The diagnosis of retinal detachment preceded the diagnosis of photoreceptor dystrophy in two of the three patients. To date, giant retinal tears occurring with underlying retinitis pigmentosa have been described in five young individuals, all of whom had associated congenital sensorineural hearing loss.

Adolescent↗
PubMed2006

Ultrastructural changes after artificial retinal detachment with modified retinal adhesion.

PURPOSE: Artificial retinal detachment is increasingly used in submacular surgery. However, overcoming physiological retinal adhesiveness by subretinal fluid injection is suspected to cause cellular damage and thus to limit visual rehabilitation. This experimental study was designed to examine the ultrastructural changes induced by retinal detachment under vitrectomy conditions and to evaluate factors that reduce adhesiveness and minimize cellular damage. METHODS: Twenty-one pigmented rabbits underwent vitrectomy, and the vitreous cavity was perfused for 10 minutes with various solutions. These included variations in osmolarity (314 and 500 mOsM), Ca(2+) ion concentration (Ca(2+)-supplemented, low Ca(2+), active Ca(2+) deprivation via 1 mM EDTA), temperature (19 degrees C and 34 degrees C), and ischemia (5 minutes). Nonvitrectomized eyes served as the control. Consecutively, an artificial bleb detachment was created underneath the visual streak by injecting 1 mL of buffered saline solution subretinally. Eyes were enucleated within 3 minutes, fixed with 2% glutaraldehyde/0.1 M cacodylate buffer (pH 7.4) containing 100 mM sucrose and processed for transmission electron microscopy and scanning electron microscopy. RESULTS: If a Ca(2+)-containing standard solution was used during vitrectomy, retinal adhesiveness was strong, and a forced bleb detachment caused substantial cellular damage characterized by swollen and fragmented photoreceptor outer segments and disruption of retinal pigment epithelial cells. Use of a Ca(2+)-free solution moderately reduced the adhesive strength with consequently less ultrastructural damage. Active Ca(2+)-deprivation further reduced the retinal adhesion, but may have induced damage as suggested by intracellular vacuolization. Hyperosmolarity and ischemic conditions had toxic effects on both the photoreceptors and RPE cells. In contrast, the use of a preheated Ca(2+)-free solution (34 degrees C) substantially reduced retinal adhesiveness under vitrectomy conditions and hence ultrastructural damage. CONCLUSIONS: Artificial retinal detachment causes substantial ultrastructural damage in eyes with physiological retinal adhesiveness if performed under vitrectomy conditions similar to surgery in humans. The use of a preheated Ca(2+)-free physiologic saline solution seems to be suitable to reduce retinal adhesion sufficiently, without causing significant cellular damage.

Adhesiveness↗
PubMed2005

Foveal detachment after successful retinal reattachment for macula on rhegmatogeneous retinal detachment: an ocular coherence tomography evaluation.

PURPOSE: Foveal detachment after apparently successful retinal reattachment surgery for macula-on retinal detachments (RDs) has been previously documented. This pilot study aimed to utilize ocular coherence tomography (OCT) imaging to investigate foveal architecture after routine retinal detachment surgery and correlate this to visual acuity. METHODS: Prospective recruitment of patients attending one unit with macula-on RDs. Patients underwent full clinical examination including OCT preoperatively and RD surgery undertaken by scleral buckling, external drainage and air injection. Postoperatively patients had clinical examinations and OCT at 1 week, 1, 3, 6, and 12 months. RESULTS: A total of 12 consecutive patients were recruited into the study. All had macula-on RDs and normal OCTs at onset. There were no operative or postoperative complications. Retinal reattachment was achieved in all cases within 24 h postoperatively. At 1 month six of 12 patients (50%) showed foveal detachment on OCT, which was invisible on clinical examination. At 3 months, the foveal detachment persisted in four (33%) of these patients. In these cases the foveal detachment persisted at 6 months follow-up, however, a reduction in subfoveal fluid was noted. All cases had foveal reattachment by 12 months postoperatively. Visual acuity was closely correlated to the presence of foveal attachment. DISCUSSION: A high proportion of patients with successful retinal reattachment surgery had foveal detachments postoperatively. This phenomenon was associated with reduced visual acuity. The aetiology of this occurrence is unknown and warrants further investigation as there is the potential of a long-term effect on vision.

Adult↗
PubMed1992

Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks.

Between 1975 and 1989, 11 eyes were treated for retinal detachments with both peripheral and full thickness macular breaks. Long term retinal reattachment was dependent on successful closure of peripheral retinal breaks. Direct treatment of the macular break was necessary in only one case, which redetached 3 months after vitrectomy. Vitrectomy is not the initial treatment of choice for uncomplicated retinal detachments with both peripheral and full thickness macular breaks, unless required for the closure of the peripheral retinal breaks.

Adult↗
PubMed1992

Lattice degeneration of the retina and retinal detachment.

Lattice retinal degeneration is considered the most significant peripheral retinal disorder potentially predisposing to retinal breaks and retinal detachment. Lattice degeneration affects the vitreous and inner retinal layers with secondary changes as deep as the retinal pigment epithelium and perhaps the choriocapillaris. Variations in clinical appearance are the rule; geographically, lattice lesions favor the vertical meridians between the equator and the ora serrata. Lattice degeneration begins early in life and has been reported in sequential generations of the same family. Along with its customary bilateral occurrence, lattice shares other characteristics of a dystrophy. The association between the vitreous and retina in lattice lesions may be responsible for the majority of lattice-induced retinal detachments. The tumultuous event of posterior vitreous separation in the presence of abnormally strong vitreoretinal adherence is the trigger for a retinal tear that, in turn, may lead to retinal detachment. Although retinal holes in young patients with lattice degeneration may play a role in the evolution of retinal detachment, the clinical course of lattice degeneration seems to be one of dormancy rather than of progressive change. This discussion outlines the pathophysiology of lattice retinal degeneration and the relationship of pathophysiology to clinical presentation. The epidemiology of lattice degeneration is summarized, as are the possible precursors to retinal detachment. A clinical characterization of the natural history of lattice degeneration is offered, and interventions for complications are described. To conclude, management strategies from a primary-care standpoint are reviewed.

Cataract Extraction↗
PubMed1988

Photocoagulation to prevent retinal detachment in acute retinal necrosis.

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.

Acute Disease↗
PubMed1992

[Evaluation of the macula which was not involved in retinal detachment after surgical treatment of retinal detachment using scleral indentation. Summary of a doctoral thesis].

The goal of the study was the evaluation of the influence of the nowadays most frequently used surgical methods in cases of retinal detachment on the macula not involved in the detachment. The study takes into account surgical interventions which have the same indications and principles of action. They are based on an extra-scleral indentation--temporary or permanent one--by means of a Lincoff-Kreissig balloon and a meridional silicone sponge implant. The examinations comprised 54 patients. They were divided into 2 groups: 1st group (24 patients) was treated by cryopexy and a Lincoff-Kreissig balloon, the 2nd group (30 patients) by cryopexy and a meridional silicone sponge implant. In all the patients of both groups the retina reattached. During the 5-years observation of patients of the 1st group no macular changes were detected; one did not observe metamorphopsia or disturbances of the color vision. In the 2nd group instead 17 patients claimed metamorphopsia, 20 patients showed disturbances of the color vision and angiography changes involving the macular region (13 patients).

Adult↗
PubMed1988

[Proliferative vitreoretinopathy: relation to the extent of retinal detachment, size of retinal tears and coagulation surface].

Preretinal dispersion of stimulated RPE cells has been suggested as a possible cause of the development of proliferative vitreoretinopathy (PVR). Retinal detachment (RD) and retinal breaks are associated with an exposure of corresponding areas of retinal pigment epithelium (RPE) which has been mechanically stimulated by coagulation. In a prospective, controlled study of 141 patients between 20 and 75 years of age, PVR grades were determined before and RD surgery and within six months following it PVR grades were correlated with the extent of RD, size of breaks, and area of coagulation. The severity of the PVR correlated significantly with both the extent of RD as well as the total number of coagulation exposures. There was a tendency toward higher grades of PVR with larger retinal breaks. The results are compatible with the hypothesis that at least certain variations of PVR are caused by preretinal dispersion of stimulated RPE cells.

Adult↗
PubMed1992

Bullous retinal detachment and multiple retinal pigment epithelial detachments in patients receiving hemodialysis.

Two patients receiving hemodialysis for chronic renal failure developed bilateral bullous retinal detachment associated with multiple underlying serous detachments of the pigment epithelium. Many of the detachments of the pigment epithelium were surrounded by subretinal whitish exudate that was probably fibrinous in type. There was fluorescein angiographic evidence of dehiscence of the pigment epithelium at the margin of some of the pigment epithelial detachments. Failure to recognize the nature of the retinal detachment in one patient resulted in an unsuccessful scleral buckling procedure.

Adult↗
PubMed1979

Spontaneous choroidal detachment and rhegmatogenous retinal detachment.

A 74-year-old woman was found to have a choroidal mass and a retinal detachment. Diagnosis of a spontaneous choroidal detachment combined with a rhegmatogenous retinal detachment could be established. An initial, apparently good surgical result soon changed to a detachment with marked vitreous traction.

Aged↗
PubMed1987

Pars plana vitrectomy for retinal detachment with unseen retinal holes.

A study was made of a consecutive series of 47 cases of rhegmatogenous retinal detachment treated by pars plana vitrectomy in which no holes were identified preoperatively. The view of the fundus during preoperative examination varied from being totally clear to completely obscured by media opacities. The role of pars plana vitrectomy in finding retinal holes peroperatively is considered. The incidence of discovering holes and the locations of those found at the time of surgery are presented. The significance of these findings is discussed. Where the preoperative view was good and the extent of proliferative vitreoretinopathy (PVR) did not exceed grade C2, retinal reattachment was achieved in 75% of the cases. A review made of a similar group of patients treated with conventional retinal buckling before the introduction of pars plana vitrectomy revealed that successful retinal reattachment was achieved in 70% of cases. The study concludes that pars plana vitrectomy, while being necessary for cases of rhegmatogenous retinal detachment when the view of the retina is obscured, will not always reveal the presence of a retinal break. If the preoperative view of the retina was good and the extent of PVR did not exceed grade C2, pars plana vitrectomy did not seem to offer obvious advantages over conventional buckling procedures.

Humans↗
PubMed1990

[A study on treatment of retinal detachment with unseen retinal breaks].

64 cases (66 eyes) of retinal detachment in which no breaks can be found were treated with pars plana vitrectomy, scleral buckling or encircling procedures. The selection of operation depended on the shape and size of retinal detachment, the position of peripheral retinal lattice degeneration, phakia or aphakia, traumatic situation and the appearance of proliferative vitreoretinopathy. The results showed that the detached retina was successfully reattached in 53 eyes (80.3%), 4 eyes were improved (6%), only 9 eyes failed (16.7%). The technic of operation and application are discussed. We consider that suitable active surgical treatment for this kind of cases is encouraging.

Adolescent↗