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The tunnel sponge explant for retinal detachment surgery is a modification of the cylindrical, silastic sponge. A central tunnel exists along the length of the sponge allowing a silicone band to be threaded internally. A high, localized indentation can be achieved as well as encirclement with minimal volume displacement of the globe.
Thirty-three cases of aphakic retinal detachment have been treated by pars plana vitrectomy and retinopexy. This procedure allowed us to lower the incidence of postoperative massive periretinal proliferation from 15,4%, in a series that was performed by a classical method, to 6% in the pars plana treated group.
Sixteen patients with phakic, nontraumatic rhegmatogenous retinal detachment were used in a prospective study on the change of the visual field following surgical treatment of the disease. The differential light threshold was measured across the visual field before and after surgery up to 1 year by means of the Octopus automated static perimeter. The visual sensitivity recovered prominently in the initial one to two months, followed by a slight improvement for up to a year. The final prognosis of visual sensitivity was correlated with the duration of detachment, but not with its extent or height. The recovery in the peripheral visual field was less remarkable, with residual slight defect. There was more improvement in visual sensitivity at the fovea than in visual acuity.
A 12-week-old battered infant boy had bilateral retinal detachments. The retina in the left eye was considered inoperable, but retinal detachment surgery was performed in the right eye. This retina was reattached and limited vision was restored. The history, the location of the retinal pathology, and the absence of a lens coloboma helped differentiate this result of physical abuse from a congenital retinal detachment.
Six cases of congenital pit of the optic nervehead associated with posterior serous retinal detachment are presented. All were treated by photocoagulation along the disc margin in the area of retinal detachment. In five cases reattachment of the retina occurred, after the clinical development of a film chorioretinal adhesion at the disc margin, and appeared to be secondary to the treatment. The sixth case (Case 4), although treated, appeared to represent a spontaneous reattachment. This disorder, which frequently results in permanent decrease of central vision, affected the better, or only, eye in two of the six cases herein reported. Fluid, probably from the vitreous cavity, appears to gain access to the subretinal space via the pit. Reattachment in treated cases occurred only if an effective chorioretinal adhesion was created over the entire area of the fistulous detachment at the disc margin. Field defects after treatment appear to be secondary to either the optic pit itself or the longstanding retinal detachment, oftern accompanied by pigmentary degeneration and cystic macular degeneration, rather than juxtapapillary photocoagulation treatment.
2 cases of retinal detachment with ectopia lentis are described. In each, the retinal elevations had surface features consistent with exudative detachments. Following removal of the posteriorly displaced lenses spontaneous retinal attachment was noted. The clinical and surgical course of these patients suggest a diagnosis of lens-induced exudative retinal detachment.
Nine eyes in nine patients with rhegmatogenous retinal detachments of 1-18 years, duration showed clinical evidence of significant retinal neovascularization in the equatorial region. The retinal new vessels showed a sea-fan configuration. Their extent in the periphery of the fundus ranged from 10 degrees to 180 degrees. All retinal detachments were associated with round atrophic retinal holes in the equatorial region. Retinal reattachment was achieved in all eyes with scleral buckling. The retinal new vessels totally regressed within 15 days to 3 months after retinal reattachment. It is believed that the peripheral retinal new vessels were secondary to retinal hypoxia resulting from decreased retinal blood flow in the detached retina.
In Western Australia during the period 1 January 1976 to 31 December 1987 1089 eyes of 1044 patients in hospital were operated upon for primary rhegmatogenous retinal detachment due to causes other than penetrating trauma. Of these eyes 295 (27%) were aphakic or pseudophakic. During this period the annual number of cataract operations in the State increased by a factor of 245%, while aphakic and pseudophakic retinal detachment operations rose by only 55%. The declining risk of retinal detachment following cataract surgery is attributed to improvements in microsurgical techniques. In 1983 and 1984 the incidence of aphakic and pseudophakic retinal detachments dropped significantly (p less than 0.05). At about this time extracapsular cataract surgery became widespread in the State, and this may explain the observed fall in retinal detachment operations. Since 1984 the incidence has risen owing to the rapidly increasing prevalence of pseudophakia in the resident population.
PURPOSE: To determine whether the outcome of primary retinal reattachment surgery in a subregion is improved by surgery being performed in a specialist vitreoretinal unit (VRU). METHODS: A subregional, population-based, retrospective audit cycle of primary retinal reattachment surgery was conducted by independent investigators. The subregion was defined as the catchment area of a teaching hospital (TH) with a specialist VRU and three neighbouring district general hospitals (DGHs). During the initial audit period (January 1989 to December 1990), 142 cases were treated at all four hospitals: TH/VRU (83), DGH-A (15), DGH-B (13), and DGH-C (31). Policy changes after the initial audit led to primary retinal reattachment surgery being predominantly performed by the VRU. During the re-audit period (September 1995 to August 1997), 160 cases were treated at two hospitals: VRU (148) and DGH-C (12). The outcome measure employed was complete retinal reattachment after a single procedure with a minimum follow-up of 12 months. RESULTS: The success rate for primary retinal reattachment surgery in the subregion improved from 76.1% to 88.8% (p = 0.006) following the policy changes. The success rate of the vitreoretinal specialists in the VRU (90%) was greater than the general ophthalmologists in the DGHs (ranging from 47% to 77%), despite case selection by the general ophthalmologists. The number of cases treated by the VRU increased by 156% in the 6.5 year interval between the two audits due to a widespread change in the model of care for primary retinal detachments (both within and outside the subregion). During the re-audit period, the VRU treated 348 primary retinal detachments (including referrals from outside the subregion), achieving a success rate of 86.8% with a single procedure and 97.4% with further surgery. This primary success rate included 35 cases (10%) treated by vitrectomy with silicone oil tamponade who did not undergo silicone oil removal. CONCLUSIONS: The outcome of primary retinal reattachment surgery can be improved if surgery is performed by a specialist VRU. It is suggested that the current standard for retinal reattachment with a single procedure should be set in the region of 85% to 90%. Changing the model of care so that primary retinal reattachment surgery is predominantly performed by a specialist VRU has important resource implications.
We have analyzed the surgery results of rhegmatogenous retinal detachment (RD) on 73 patients (76 eyes) operated on in 2000. Retinal reattachment was achieved on 59 eyes (77.6%) without silicone oil tamponade (SO) and on 17 eyes (22.4%) with the use of permanent silicone oil tamponade. Visual acuity following the operation was improved on 47 eyes (61.8%). Visual acuity 20/20-20/40 was reached on 16 eyes (21.1%), 20/60-20/120 on 35 eyes (46.0%), 20/200-4/200 on 19 eyes (25.0%), worse than 4/200 on 6 eyes (7.9%). Based on contemporary surgical technique the most important criterion of anatomical and functional success with the retinal detachment treatment is the time between RD onset and the time of the surgery, as well as the presence and extent of proliferative vitreoretinopathy.
PURPOSE: To evaluate the role of first operation anatomic success compared with success after reoperation and preoperative characteristics in achieving ambulatory vision (>/=4/200) and good vision (>/=20/100) after repair of complex retinal detachment with vitrectomy and silicone oil tamponade. METHODS: A prospective, observational, multicenter study of patients who underwent vitrectomy with silicone oil for retinal detachments associated with cytomegalovirus necrotizing retinitis or a non-cytomegalovirus necrotizing retinitis etiology, including proliferative diabetic retinopathy, giant retinal tear, proliferative vitreoretinopathy, and ocular trauma. RESULTS: A higher rate of ambulatory vision was achieved in the first operation anatomic success cases, compared with the reoperation cases, for eyes with cytomegalovirus necrotizing retinitis (72% vs 50%, P < 0.01) and eyes without cytomegalovirus necrotizing retinitis (51% vs 38%, P = 0.04). For eyes with cytomegalovirus necrotizing retinitis, preoperative ambulatory vision (RR = 2.3, P < 0.0001) and reoperation (RR = 0.4, P = 0.05) were independent predictors of postoperative ambulatory vision. For eyes without cytomegalovirus necrotizing retinitis, preoperative ambulatory vision (RR = 4.0, p < 0.0001) and retinal detachment etiology (P = 0.02) were prognostic factors. Compared to eyes with trauma, eyes with giant retinal tear, proliferative vitreoretinopathy and proliferative diabetic retinopathy were 2.8 (P < 0.003), 2.2 (P = 0.01) and 1.6 (P = 0.17) times as likely to achieve postoperative ambulatory vision, respectively. Within the giant retinal tear group, a higher rate of ambulatory vision was achieved in the first operation anatomic success cases compared with the reoperation cases (66% vs 31%, P = 0.03). Although not statistically significant, similar outcomes occurred in the proliferative diabetic retinopathy (48% vs 25%) and proliferative vitreoretinopathy groups (54% vs 45%). Similar prognostic relationships were found for good visual acuity outcomes. CONCLUSIONS: First operation anatomic success, preoperative visual acuity, and giant retinal tear or proliferative vitreoretinopathy as the retinal detachment etiology are important factors that predict visual outcome.
Of 471 retinal detachments occurring in aphakic patients after undergoing intracapsular cataract extraction, we reviewed 318 eyes with uncomplicated aphakia (no vitreous loss). Myopic eyes had equatorial breaks 38% of the time versus 19% for nonmyopic eyes. The time interval between aphakia and detachment was shorter for myopic than for nonmyopic eyes. Our results showed a significant incidence of: (1) equatorial breaks in myopic eyes versus nonmyopic eyes (P less than 0.005), and (2) earlier detachments for myopic eyes versus nonmyopic eyes (P less than 0.005). The presence of equatorial breaks seemed to be associated with earlier retinal detachments.
PURPOSE: To investigate retinal microcirculation changes in patients with rhegmatogenous retinal detachment (RRD). METHODS: The tissue blood flow in the macular area was measured in 28 patients with RRD without macular involvement by scanning laser Doppler flowmetry before and after scleral buckling procedures. The mean blood flow (MBF) was calculated by the automatic full-field analysis program. The MBF ratios of the affected eye to the fellow eye (a/f ratio) in patients were compared with those of the right eye to the left eye (R/L ratio) in the control subjects. RESULTS: The mean preoperative a/f ratio in the patients (0.81 +/- 0.11) was lower than the mean R/L ratio in the control subjects (1.02 +/- 0.11, P < 0.0001) and correlated with the extent of RRD (P < 0.05). The mean a/f ratio tended to decrease 2 weeks after surgery (0.72 +/- 0.09) and recovered to an almost normal level after 1 month (0.96 +/- 0.09). The blood-flow change was not influenced by the type of buckling. CONCLUSIONS: The retinal microcirculation in the macular area was disturbed in RRD patients without macular involvement. It correlated with the extent of the RRD, and subsided 1 month after successful scleral buckling procedures.
In 17 cases of recurrent retinal tears occurring after successful retinal detachment surgery, the new tears developed on or near the treated primary tear in seven cases and away from the treated tear in ten cases. It took an average of 25.6 months for the second tears to develop, and almost all of the recurrent tears were the same distance from the limbus as the primary tear. The benefit of the 360 degree encircling band and the relationship of the thermal injury to production of a second tear is discussed.
To determine the increased production and release of vascular endothelial growth factor (VEGF) from the retina in the eye with non-angiogenic retinal detachment in which relative blood supply disturbance may be present, the concentration of VEGF in subretinal fluid and vitreous fluid collected from the eyes was investigated by enzyme linked immunospecific assay. The average concentration of VEGF was 0.5 +/- 1.1 ng/ml (mean +/- standard deviation) in nine samples of vitreous fluid collected from proliferative retinal detachment, and was 1.2 +/- 1.2 ng/ml in eleven samples of subretinal fluid from rhegmatogenous retinal detachment. The concentration of VEGF in six samples of vitreous fluid from angiogenic diabetic eyes (5.0 +/- 2.8 ng/ml) was significantly higher than in the samples from eyes with retinal detachment. The results suggest that the relative ischemic insult to the detached retina increases the release of VEGF into the vitreous cavity and subretinal space. The increased concentration of VEGF does not induce remarkable angiogenesis since the concentration is lower than the biological threshold, or the effect is modulated by inhibitors.
We examined the expression of several proteins normally present in Müller's glia after the production of experimental retinal detachment in adult cats. Retinas were detached for one-half to seven days, after which the tissue was processed for correlative immunocytochemistry and biochemistry. Previous studies demonstrated that the intermediate filament proteins glial fibrillary acidic protein and vimentin, increase after long-term retinal detachment (30 to 60 days), whereas glutamine synthetase, carbonic anhydrase C, and cellular retinaldehyde-binding protein all decrease to barely detectable levels. Alterations in Müller cell protein expression are rapid and specific events that can be detected as early as two days after retinal detachment. By seven days, levels of protein expression are similar to those in the long-term retinal detachments. Within the first week after injury the Müller cell processes hypertrophy and begin forming glial scars, which indicates that early intervention may be required to halt or reverse the effects of detachment.
Three patients with diabetic traction retinal detachment not involving the central macula were treated with the pulsed neodymium-YAG laser. In each case, with energy levels of 9 to 11 mJ, vitreous traction bands were sectioned and the traction retinal detachment diminished or disappeared. Other than a small choroidal hemorrhage in one instance, no adverse side effects occurred. The pulsed neodymium-YAG laser may provide a new therapeutic modality in a few selected cases of diabetic traction retinal detachment.
A case of exudative retinal detachment in a 16-year-old Thai woman with toxemia of pregnancy was reported. The patient developed bilateral retinal detachment during toxemia of pregnancy. After termination of pregnancy, the blood pressure returned to normal level, the subretinal fluid reabsorbed and the retina reattached. The visual acuity improved from 6/60 to 6/9 both eyes.