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PubMed2002

[Surgical treatment of progressive and symptomatic retinal detachment in senile retinoschisis].

BACKGROUND: This is 23-years retrospective study of consecutive, non-selected patients with senile retinoschisis and rare progressive and symptomatic retinal detachment (RD). The presence of RD was manifested by spectrum of retinal pathology of inner and outer layers of senile retinoschisis, ranging from simple holes to giant tears with or without proliferative vitreoretinopathy. The goals of this study were: 1--to evaluate the characteristics of the progressive and symptomatic RD based on detail preoperative examination of the eye, 2--to evaluate the anatomic and functional results of RD surgery. PATIENTS AND METHODS: From 1978 to 1999, RD surgery was performed on 57 eyes of 55 patients (28 men and 27 women) with senile retinoschisis and progressive and symptomatic RD. On average, we observed the patients for approximately 11.3 years after surgery; the minimum follow-up period was 20 months. The patients were divided in two groups according to the preoperative findings and the surgical procedures. Based on the size and the location of the defects of the inner and outer layer of senile retinoschisis and the proliferative vitreoretinopathy these procedures were indicated: 1--Uncomplicated cases of progressive and symptomatic retinal detachment were operated on primary cryopexy and scleral buckling (CSB) with episcleral silicone implants in 45 eyes. 2--Complicated cases of progressive and symptomatic retinal detachment underwent a pars plana vitrectomy (PPV) in 12 eyes: a--primary PPV was used as the primary treatment method in 6 eyes, b--secondary PPV as a secondary treatment method after unsuccessfully primary CSB with episcleral silicone implants in next 6 eyes. RESULTS: Characteristics preoperative findings were: RD in two or more quadrants in 84.2% of the eyes, including macula region in 71.9% of the eyes. Defect of the outer layer of senile retinoschisis was located postequatorial in 80% of the eyes, large retinal tears were found in 53.3% of the eyes and single defect was diagnosed in 68.8% of the eyes. Defect the of inner layer of senile retinoschisis was located equatorial in 69.5% of the eyes, small defects were found in 78.2% of the eyes and multiple defects were diagnosed in 58.6% of the eyes. Defects of the outer and the inner layer of senile retinoschisis were diagnosed in the equal quadrant in 61.4% of the eyes. The results of surgery varied, depending on the size and location of the defects of the inner and outer layer of senile retinoschisis and proliferative vitreoretinopathy: 1--The complete retinal reattachment in group treated with CSB was achieved in 43 eyes (95.5%), the average visual acuity was 0.34-2--The complete retinal reattachment in group treated with PPV was achieved by: a--primary PPV in six eyes, the average visual acuity was 0.37, b--secondary PPV four eyes, the average visual acuity was 0.16. CONCLUSIONS: Characteristic of senile retinoschisis, especially its defects of inner and outer layers is important preoperative finding for optimal indication of primary surgical treatment of progressive and symptomatic retinal detachment. According to our clinical experiences we created the syllabus of the care about the senile retinoschisis and syllabus of surgical treatment of progressive and symptomatic RD. Standard surgical procedures are the CSB and in the last period also primary PPV.

Adult↗
PubMed2005

Retinopathy of prematurity: involution, factors predisposing to retinal detachment, and expected utility of preemptive surgical reintervention.

PURPOSE: To characterize involution of retinopathy of prematurity (ROP) following treatment at threshold, to identify findings during involution that portend development of retinal detachment, and to assess the potential utility of preemptive vitrectomy for eyes with high-risk features. METHODS: The probability of ROP involution and of retinal detachment evolution over time was analyzed in 262 treated eyes of 138 infants in a retrospective observational non-case controlled series. Expected utility of preemptive reintervention in eyes with high-risk features was evaluated using decision analysis. Modifications were devised to enhance classification of advanced ROP. RESULTS: ROP fully involuted in approximately 80% of eyes within 28 days of treatment. Vitreous organization meeting the study's clinically important definition was associated with a 31-fold (5.37 to 183.63; P < .0001) and a 13-fold (2.97 to 58.59; P < .0001) increase in the odds for retinal detachment for right and left eyes, respectively. Vitreous hemorrhage defined as clinically important was associated with a 38-fold (2.69 to 551.19; P = .007) and a 15-fold (1.65 to 144.12; P = .02) increase in the odds for retinal detachment for right and left eyes, respectively. As modeled, an expected utility of 0.85 was calculated for preemptive vitrectomy compared with 0.79 for deferred vitrectomy for eyes with clinically important vitreous organization. CONCLUSIONS: Acute-phase ROP involuted quickly in most eyes. Vitreous organization and vitreous hemorrhage were predictive of eyes that developed a retinal detachment. Decision analysis suggests that preemptive vitrectomy for eyes with vitreous organization meeting specific criteria is not likely to be worse than deferred vitrectomy, and it could be advantageous in some scenarios.

Decision Support Techniques↗
PubMedDate not supplied

Laser pneumatic retinopexy for repair of recurrent retinal detachment after failed scleral buckle--ten years experience.

BACKGROUND: Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years. PATIENTS AND METHODS: We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months follow-up. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina. RESULTS: In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy. CONCLUSION: We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone.

Adolescent↗
PubMed2001

Anatomical and visual outcome of retinal detachment surgery in children.

AIMS: To evaluate the visual and anatomical outcome, as well as complications following surgery, for rhegmatogenous retinal detachment in children at a tertiary referral centre over a 5 year period. METHODS: A retrospective survey of all children (aged 0-16 years) who underwent primary retinal detachment surgery at Queen's Medical Centre between April 1994 and March 1999. RESULTS: 15 consecutive patients were identified with a mean follow up of 14.7 months (range 3-57) and a mean age of 12.4 years. Trauma was the cause in 40% (6/15). Complete retinal reattachment was achieved in 86.6% (13/15). Visual improvement occurred in 53.3% (8/15), worsening of vision occurred in 13.3% (2/15), with no change in the remaining 33.3% (5/15). Visual acuity was D 6/12 in 6.6% (1/15) preoperatively, and 26.6% (4/15) postoperatively. CONCLUSIONS: Retinal detachment in children is rare compared with adults. There are therefore limited data available for this group of patients. These data provide one unit's experience over a 5 year period, and may help provide a basis for information for patients and their parents when discussing the risks and potential benefits of surgery for retinal detachment in the paediatric population.

Adolescent↗
PubMed2002

Management of recurrent retinal detachment in silicone oil-filled eyes.

PURPOSE: To report causes of failure, management options, and outcomes after reoperations for recurrent retinal detachment in silicone oil-filled eyes. METHODS: One hundred eighteen silicone oil-filled eyes with recurrent retinal detachment were managed with revision of vitrectomy with membrane surgery with or without silicone oil removal, just scleral buckling, or both. Anatomical success was defined as complete reattachment of the retina, and functional success was defined as recovery of ambulatory visual acuity of >or=5/200 at the last follow-up (mean follow-up, 29.7 months). RESULTS: In 82.2% of the cases, proliferative vitreoretinopathy was responsible for recurrent retinal detachment in silicone oil-filled eyes. Reoperations without removal of the silicone oil were performed in 65.3% of the cases. Anatomical success occurred in 62.7% of the eyes, and functional success occurred in 52.5%. Silicone oil was removed in 59.5% of the eyes with retinal reattachment; the retina remained attached in 90.9% of the eyes. Predictors of poor anatomical success were presence of posterior diffuse proliferative vitreoretinopathy and combined posterior and anterior proliferative vitreoretinopathy (P <0.02). CONCLUSION: Reoperations for recurrent retinal detachment in silicone oil-filled eyes were successful in nearly two thirds of the cases, and over one half of the eyes recovered ambulatory vision.

Adolescent↗
PubMed1992

[Vitreous surgery for retinal detachment with severe proliferative vitreoretinopathy and probe of failed cause].

Eighty-one cases (81 eyes) of retinal detachment with severe proliferative vitreoretinopathy were treated using vitrectomy, scleral buckling and air or silicone oil tamponade technique. After a follow-up period of 6-28 months, 54 cases obtained anatomic retinal attachment (66.7%). For the serious cases of PVR D3, we also gained a success rate of 50%. Vision improved in 50 cases, whereas 34 cases got a vision better than 0.05. For the failed cases, cause that prevent the retina from attachment was probed. We think that vitrectomy is an essential and important procedure for retinal detachment with severe PVR, membrane peeling is the key of success and prevention of reproliferation can avoid recurrent retinal detachment and further raise the success rate of treatment. A new classification is recommended in this article.

Adolescent↗
PubMed2002

Effect of INS37217, a P2Y(2) receptor agonist, on experimental retinal detachment and electroretinogram in adult rabbits.

PURPOSE: To evaluate the effects of subretinal and intravitreal delivery of INS37217, a P2Y(2) receptor agonist, on subretinal fluid reabsorption in experimentally induced retinal detachments in rabbits, and to characterize the effects of INS37217 on electroretinograms (ERG) in rabbits. METHODS: A single retinal detachment was produced in New Zealand White rabbits by injecting approximately 50 micro L of modified phosphate-buffered saline (MPBS) solution into the subretinal space (SRS). In all experiments, one eye served as the INS37217-treated eye and the contralateral eye served as the vehicle control. In the first series of experiments, each rabbit received a SRS injection of MPBS solution, with or without INS37217 (1 mM). In the second series of experiments, each eye received an SRS injection of MPBS solution, followed by an intravitreal injection of MPBS solution, with or without INS37217 (12, 1.4, and 0.15 mM). A masked observer determined the size of blebs by indirect ophthalmoscopy at 30-minute intervals for up to 3 hours after SRS injections. Optical coherence tomography (OCT) was conducted to provide cross-sectional images of the blebs. Cellular expression of P2Y(2) receptor mRNA was localized by nonradioisotopic in situ hybridization in fresh rabbit retina-RPE tissue sections. Bilateral, full-field scotopic and photopic ERGs were made at 1, 7, and 14 days after a single intravitreal injection of 24 mM INS37217. RESULTS: SRS administration of 1 mM INS37217 significantly enhanced subretinal fluid reabsorption when compared with vehicle controls (P < 0.05; repeated measures ANOVA). Intravitreal administration of INS37217 at 12 and 1.4 mM, but not at 0.15 mM, also significantly enhanced subretinal fluid reabsorption (P < 0.05). P2Y(2) receptor mRNA was observed throughout the RPE and in discrete layers of the retina. INS37217 had no adverse effects on scotopic and photopic ERG amplitude and latency parameters at any of the postadministration time points evaluated. CONCLUSIONS: These results demonstrate that INS37217 enhances subretinal fluid reabsorption in experimental retinal detachment in rabbits and support the development of INS37217 for stimulating subretinal fluid reabsorption in conditions that result in retinal detachment or retinal edema.

Absorption↗
PubMed1992

[Surgery of retinal detachment of patients with pseudophakia using the panfunduscope].

Examination of the extreme periphery of the fundus of patients with pseudophakic retinal detachment is difficult due to poor pupil dilatation, optical aberrations from the intraocular lens, opacification of the posterior capsule or peripheral capsular remnants. Fifty-one patients with pseudophakic retinal detachment were operated on with using the wide angle panfunduscope of Rodenstock. It allows a very satisfactory pre- or intraoperative view of the extreme periphery of the fundus using the slit-lamp of the operative microscope combined with a scleral indentation. In only 3 cases no break was found in spite of pre- and intraoperative examination of the fundus periphery with the panfunduscope. Anatomic success was achieved in 47 out of 48 patients with a minimum of 6 months of follow-up; 3 patients were lost to follow-up. The mean postoperative visual acuity was 0.5. Unlike other methods of fundus examination, such the 3 mirror Goldmann lens or the indirect binocular ophthalmoscope, the panfunduscope allows good visualization of the peripheral retina of patients with pseudophakic retinal detachment using the slit-lamp of the operative microscope combined with a scleral indentation. Thus, small peripheral retinal breaks, often associated with pseudophakic retinal detachment, can be identified.

Adult↗
PubMed1999

Retinal detachment after clear lens extraction for high myopia: seven-year follow-up.

OBJECTIVE: To prospectively evaluate the incidence of complications, particularly retinal detachment, 7 years after clear lens extraction (CLE) for myopia greater than -12 diopters (D). DESIGN: Extended follow-up of noncomparative case series. PARTICIPANTS: Fifty-two eyes of 30 patients with preoperative myopia greater than -12 D, best-corrected visual acuity (BCVA) of 20/100 or better, and intolerance of contact lenses. INTERVENTION: Patients with lattice degeneration, retinal tear, or hole underwent photocoagulation before CLE. The authors performed phacoemulsification through a 3.2-mm-wide incision using primary irrigation and aspiration, widened the incision to 6.5 mm, and implanted a one-piece polymethyl methacrylate intraocular lens (IOL). MAIN OUTCOME MEASURES: The BCVA, uncorrected visual acuity (UCVA), stability of spherical equivalent (SE), neodymium:YAG (Nd:YAG) capsulotomy rate, and complications (especially retinal detachment). RESULTS: At 7 years, the SEs of 29 eyes (59.1%) were within +/-1.0 D of emmetropia and 42 eyes (85.7%) were within +/-2.0 D. Mean SE was -1.01 D (+/-0.94). At 7 years, mean UCVA was 20/80 compared with 20/66 at 1 year. BCVA and UCVA were better in eyes with open capsules versus intact capsules. During the 7 years, 30 eyes (61.2%) required capsulotomy for opacification. Mean time for capsulotomy was 48.4 months after CLE. The authors performed ten argon laser retinal treatments after surgery, with all but one in the first postoperative year. The overall incidence of posterior vitreous detachment was 16.3%. The incidence of retinal detachment during the 7 years was 4 of 49 eyes, or 8.1% (vs. 2.0% at 4 years). One patient had bilateral retinal detachments. CONCLUSION: Despite advances in surgical technique, retinal detachment remains a major concern after CLE for high myopia. In the authors' series, the incidence of retinal detachment after CLE was nearly double that estimated for persons with myopia greater than -10 D who do not undergo surgery. Although CLE has advantages, including rapid and predictable visual rehabilitation, stable refraction, the ability to replace the IOL, and often superb optical quality with no irregular astigmatism, it is invasive and can result in severe vision loss. Long and continuous follow-up of the outcomes of CLE for high myopia is absolutely necessary before the authors can consider CLE as a routine option for patients with high myopia.

Adult↗
PubMed2003

Cataract surgery as a risk factor for retinal detachment in very highly myopic eyes.

PURPOSE: To evaluate the incidence of retinal detachment (RD) after cataract surgery performed by phacoemulsification in very highly myopic eyes. DESIGN: Retrospective, paired-eye, case-control trial. PARTICIPANTS AND INTERVENTION: We assessed the development of RD in 930 eyes from 930 subjects (mean age = 62.5 +/- 8.5 years) affected by very high myopia (between -15 and -30 diopters) undergoing cataract surgery after uncomplicated phacoemulsification (cataract-subjected [CS] eyes). Fellow eyes served as controls. Follow-up was 36 months. MAIN OUTCOME MEASURE: Detachment of the retina. RESULTS: Retinal detachment was observed in 8.0% of CS eyes compared with 1.2% of control eyes (P<0.01, chi-square test). In CS eyes, posterior RD was most common (52.7% of eyes with RD). In control eyes, peripheral detachments with or without macular involvement were most common (47.3% of eyes with RD). CONCLUSION: Cataract surgery, despite the use of a safe technique such as phacoemulsification, increases the risk of RD development in very highly myopic eyes.

Adult↗
PubMed1988

Pneumoretinopexy in the treatment of retinal detachment with macular hole.

Nine eyes of nine patients affected by retinal detachment with macular hole were treated with pneumoretinopexy and postoperative positioning. All the eyes were myopic (mean 13.3 d., sd 3.3), two were amblyopic and one was aphakic. The operative technique included eye softening and intravitreal SF6 gas injection only. Barrage laser photocoagulation was carried out after retinal reattachment. In seven eyes (77.8%) the retina reattached in a mean of three days and the visual acuity improved. No recurrences were observed after a mean of 11.6 months. No severe complications occurred. Vitreous flare was present in 44% and increase of floaters in 55% of the eyes. We believe that pneumoretinopexy can be employed as the first treatment in case of myopic retinal detachment with macular hole.

Aged↗
PubMed2002

Inverse levels of pigment epithelium-derived factor and vascular endothelial growth factor in the vitreous of eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy.

PURPOSE: To determine the vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy. DESIGN: Prospective, noncomparative case series. METHODS: Pigment epithelium-derived factor and vascular endothelial growth factor concentrations were measured by enzyme-linked immunosorbent assay in 26 eyes with retinal detachment, 6 with proliferative vitreoretinopathy, and 14 with an idiopathic macular hole. RESULTS: Pigment epithelium-derived factor concentration in proliferative vitreoretinopathy (0.57 +/- 0.05 microg/ml) was lower (P =.0069), and retinal detachment (2.37 +/- 0.34 microg/ml) was higher (P =.16) than that in macular hole (1.71 +/- 0.22 microg/ml). Vascular endothelial growth factor concentration (168 +/- 139 microg/ml) in proliferative vitreoretinopathy was significantly higher than that in retinal detachment (11 +/- 11 microg/ml, P =.0084) and macular hole (not detectable, P =.0095). CONCLUSION: Lower levels of pigment epithelium-derived factor and higher levels of vascular endothelial growth factor may be related to ocular cell proliferation.

Endothelial Growth Factors↗
PubMed1980

[Prophylaxis of operative macular complications of retinal detachment by microsurgery (author's transl)].

Certain macular lesions which impair the visual results of successful retinal detachment surgery result from the treatment itself. The causes of the macular lesions due to surgery are reviewed. The incidence of those lesions is likely to be decreased by microsurgery which allows for a well controlled surgery. In a series of 100 consecutive retinal detachments successfully operated on by microsurgery--out of 111 consecutive cases operated on--visual acuity of 5/10 or Better was achieved in 45% of the cases, and reading acuity of Parinaud 3 or Better was achieved in 70% of the cases. Neither macular pigment migration nor macular hemorrhage were observed in this series. Nevertheless the incidence of macular pucker due to surgery is 2% and the incidence of cystoid macular edema is 3%. As the incidence of the latter complications is lower in this series than in a previous series the authors believe that the frequency of the macular complications of retinal detachment surgery should be even lower in future with a wider experience of microsurgery.

Cryosurgery↗
PubMed1975

The incidence of retinal detachment after penetrating keratoplasty.

Of 610 penetrating keratoplasties reviewed, retinal detachments did not occur after any phakic graft, or after aphakic or combined (keratoplasty and cataract extraction) procedures unless these were associated with vitreous manipulation. A 5.4% incidence of retinal detachment occurred after keratoplasty that involved vitrectomy. The resultant detachments had a poor prognosis probably because of delayd diagnosis and difficulties in visualization. Vitreous manipulation, therefore, may be essential to graft clarity but it is hazardous.

Cataract Extraction↗
PubMedDate not supplied

Treating cytomegalovirus retinitis-related retinal detachment by combining silicone oil tamponade and ganciclovir implant.

BACKGROUND AND OBJECTIVE: With the efficacy of pars plana vitrectomy and silicone oil infusion in treating cytomegalovirus (CMV) retinitis-related retinal detachment and the success of the ganciclovir implant in controlling CMV retinitis, we sought to evaluate the possible benefits of combining these two procedures in one surgical operation. PATIENTS AND METHODS: A retrospective review of 10 patients was conducted. Each patient was diagnosed with a CMV retinitis-related retinal detachment and treated with pars plana vitrectomy and silicone oil infusion, with simultaneous placement of a ganciclovir implant. Parameters evaluated included location of retinal detachment, reattachment rate, pre- and post-operative Snellen visual acuity, pre- and post-operative CMV retinitis activity and location, and complications of the combined procedure. RESULTS: Overall anatomic reattachment was achieved in all 10 patients. Four patients presented with macular involvement of their retinal detachments. Three of these patients experienced significant post-operative improvement in visual acuity. Surgery preserved visual acuity in the 6 patients who presented with macula attached. Best postoperative acuity was better than or equal to 20/100 in 7 (70%) patients. All 3 CMV retinitis patients with inactive retinitis preoperatively remained free of retinitis for the duration of follow up. At last follow up, 8/10 (80%) showed no active CMV retinitis and no patients experienced progression of their retinitis. CONCLUSIONS: Results of this series indicate that patients benefit from excellent anatomic reattachment rates, preservation or improvement of visual acuity in most cases, and extended control of their CMV retinitis. Combining the two procedures appears viable. Further study is warranted to assess definitive anatomic and functional outcomes resulting from this new technique.

Antiviral Agents↗