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PubMedDate not supplied

Pars plana lensectomy, pars plana vitrectomy, and silicone oil tamponade as initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVES: To evaluate visual acuity and anatomic outcomes, and complications, following pars plana lensectomy, pars plana vitrectomy, and silicone oil tamponade (PPL/PPV/SO) in the initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective, noncomparative, consecutive case series including all patients who underwent PPL/PPV/SO for the initial management of cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR at Bascom Palmer Eye Institute between 1989 and 2000. Main outcome measures included visual acuity and rates of retinal reattachment and reoperation. RESULTS: The study included 22 eyes of 22 patients. The mean follow-up was 15.2 months. Preoperatively, 13 of 22 (59%) fellow (non-study) eyes had vision of light perception or worse, and 7 (32%) had vision of no light perception. The number of study eyes with a best-corrected vision of 20/400 or better increased from 5 (23%) preoperatively to 12 (55%) at 6 months (P < .05) and 15 (68%) at final follow-up (P < .05). The macula was attached at final follow-up in 20 (91%) eyes. In 14 (64%) eyes, silicone oil was removed at a mean of 8.4 months following retinal detachment repair; postoperative vision was 20/400 or better in 11 (79%) of these eyes at 6 months and 13 (93%) at final follow-up. In contrast, only 1 of 8 (13%) eyes with retained silicone oil achieved a postoperative vision of 20/400 or better (P < .05). CONCLUSIONS: Initial management with PPL/PPV/SO can achieve favorable anatomic and visual outcomes in selected patients with cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR. This surgical approach should be especially considered in patients with traction/rhegmatogenous retinal detachment involving the macula in one eye and poor vision in the fellow eye.

Adult↗

PubMedDate not supplied

Detection of HIV-RNA in aqueous humor and subretinal fluid in an HIV carrier with rhegmatogenous retinal detachment.

BACKGROUND: Although human immunodeficiency virus (HIV)-related ocular complexes are commonly observed in acquired immune deficiency syndrome (AIDS) patients, it has not been previously reported that HIV had already invaded the ocular tissues of HIV carriers. CASE: A 56-year-old woman was diagnosed as having rhegmatogenous retinal detachment with a retinal tear in the 6-o'clock position in her right eye. No signs of ocular manifestations except the retinal detachment were observed. A blood examination revealed that she was already infected with HIV-1, and she was categorized as an HIV carrier. OBSERVATIONS: Aqueous humor and subretinal fluid samples were obtained at the time of surgery for rhegmatogenous retinal detachment. Reverse-transcription polymerase chain reaction and Southern blotting at three regions of the HIV, LTR, gag, and env, confirmed the HIV infection in both aqueous humor and subretinal fluid. During the approximately 2-year follow-up after surgery, the patient did not show any signs of retinitis, uveitis, or other ocular manifestations. CONCLUSIONS: This is the first report to reveal that HIV can invade the eye in the early stage of HIV infection. This infection may be related to HIV-related ocular complexes, which suppress the local immunological response.

Aqueous Humor↗

PubMed2002

Corneal topographic changes after retinal detachment surgery.

PURPOSE: To evaluate the changes in corneal topography after scleral buckling surgery for retinal detachment. METHODS: Twenty-one eyes of 21 patients with the diagnosis of retinal detachment were included in this prospective study. Scleral buckling surgery was performed on all patients. The corneal topography of each was measured before surgery and at 1 week and 1 and 6 months after surgery by computer-assisted videokeratoscopy using the EyeSys 2000 Corneal Analysis System. Changes in corneal videokeratographies were analyzed using the Holladay Diagnostic Summary (HDS) software package. RESULTS: A statistically significant central corneal steepening (average, 1.8 diopter) was noted 1 week after surgery. The total and irregular astigmatic components both revealed a significant but transient increase in the first postoperative month. All these topographic changes persisted for as long as 6 months but returned to preoperative values afterward. CONCLUSION: Scleral buckling was found to induce transient changes in corneal topography producing both myopia and corneal astigmatism. Videokeratography is helpful for documenting such corneal changes after scleral buckling surgery for retinal detachment.

Aged↗

PubMed2002

Retinal detachment in East Africa.

PURPOSE: To report the causes of retinal detachment in an African setting and the outcome after surgery. DESIGN: Noncomparative interventional case series. PARTICIPANTS: A total of 361 eyes in 345 patients. METHODS: Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression. MAIN OUTCOME MEASURES: Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation. RESULTS: The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up. CONCLUSIONS: Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.

Female↗

PubMed1994

Anterior proliferative vitreoretinopathy in trauma and complicated retinal detachment. A histopathologic study.

Anterior vitreoretinal proliferations are frequent sequelae of retinal detachment repair and severe trauma. Cellular proliferations can form membranes extending anteriorly from the peripheral retina. These membranes have the capability to contract and may lead to detachment of both the peripheral retina and, in more advanced stages, the ciliary body. Because the vitreous base and vitreous remnants are leading structures for cellular proliferation, complete removal of the anterior vitreous base in particular is important in cases of severe trauma or complicated retinal detachment. In 11 cases of anterior proliferative vitreoretinopathy examined histopathologically, we found overlying membranes and cellular infiltration of the vitreous in close correlation with the amounts of vitreous remnants present. Visualization of the peripheral retina and pars plana can rarely be accomplished in the presence of the crystalline lens or pseudophakia. Therefore, the removal of the anterior vitreous is often incomplete. To achieve complete dissection of the anterior vitreous, we remove even a clear lens during the first surgical intervention in selected cases.

Adult↗

PubMed2001

Rhegmatogenous retinal detachment in morning glory syndrome pathogenesis and treatment.

We report a case of morning glory syndrome with retinal detachment. A slit-like retinal break at the edge of the excavated disc anomaly provided a direct communication between the subretinal space and the vitreous cavity. Retinal reattachment and useful vision was achieved after a single procedure of vitrectomy and gas tamponade. We believe that identification of the retinal break, removal of epipapillary fibroglial tissue and its traction force, the avoidance of perfluorocarbon liquid and the appropriate use of long-acting gas as endotamponade, all contributed to the favorable outcome. This is more evidence supporting the rhegmatogenous theory of retinal detachment in morning glory syndrome. A literature review of the clinical presentations and treatments of similar cases is included.

Adult↗

PubMed1996

[Retinal detachment despite preventive coagulation].

From 1974 to 1989 a total of 3447 cases of retinal detachments were treated surgically in three departments of ophthalmology in Hamburg. It was found that 245 (7.2%) of these eyes had previously been subjected to prophylactic coagulation because of lattice degeneration, tears, and retinoschisis. Retinal detachment followed the coagulation in 45% within 1 year in 45% of cases within 10 years in a further 45%, and after 11 years or longer in a further 5%. (In 5% the time of coagulation was unknown). The retinal defects responsible for detachment were within or at the border of the coagulation scars in 66% of cases. In this group the time interval between the coagulation and the occurrence of retinal detachment was half that in the eyes in which defects developed in the untreated retina. The obvious faults of the prophylactic coagulation are discussed.

Adolescent↗

PubMed1999

Visual and surgical outcomes of retinal detachment following macular hole repair.

OBJECTIVE: To characterize 20 cases of retinal detachment (RD) following surgical repair of macular holes. METHODS: Retrospective review of 20 eyes in 16 patients (4 patients [25%] had bilateral macular hole repairs with subsequent RD) who developed RD in the same eye in which surgical repair of a macular hole had been performed. RESULTS: Twenty detachments in 16 patients were reviewed. The average duration between macular hole repair and presentation of RD was 5.5 weeks. The inferior retina was involved more frequently than the superior retina. A total of 76% of all breaks were located inferiorly. Ten of the 20 eyes were asymptomatic at the time the detachment was diagnosed. Of the 20 eyes, 19 underwent surgical repair, all with anatomic reattachment. At final follow-up, the macular hole was closed in all 20 eyes, and 60% of the patients had final visual acuity improved by 2 lines or more over that before their macular hole repair. CONCLUSION: Retinal detachment is a complication of macular hole surgery. These detachments tend to occur within the first 2 months of follow-up, and have a high success rate of anatomic reattachment with surgery. The occurrence of RD does not preclude improved final visual acuity.

Aged↗

PubMed1993

[Perfluoropropane for the treatment of retinal detachment].

Perfluoropropane (C3F8) is an ideal intravitreal gas tamponade in retinal detachment surgery and vitrectomy, as it is nontoxic, expansive and slowly absorbable. Domestic C3F8 of 99.7% purity was produced and used in 1990. An initial series of 120 cases received the pure or air-mixed C3F8 injection into the vitreal cavity during the retinal reattachment procedure. Application of the gas simplified the treatment of macular holes with retinal detachment, facilitated the replacement of everted retinal flaps of giant tears, and flattened the retina with vitrectomy.

Adolescent↗

PubMed1998

[Surgical treatment of retinal detachment in pseudophakia: comparison between vitrectomy and scleral buckling].

OBJECTIVE: For the primary treatment of pseudophakic retinal detachment, vitrectomy could be preferred to episcleral buckle because it does not induce myopia, it clears opacities of the posterior capsule and/or of the vitreous and allows a good visualization of the fundus. This study was determined to compare the anatomic and functional results of vitrectomy and episcleral buckle. METHODS: from 1990 to 1995, 93 pseudophakic eyes were operated on for retinal detachment. 75 eyes were treated with episcleral buckle (group I) and 18 eyes were treated with vitrectomy (group II). In the latter group, 4 eyes had a giant tear, and 4 other eyes had a macular hole associated with high myopia. The anatomic and functional results were analyzed retrospectively. RESULTS: The retina was reattached with one operation in 67 eyes of group I (89%) and 16 of group II (89%). More than one month after the first operation, the retina redetached in 6 eyes of Group I (8%) and one eye of group II (6%). The causes of failure were a) new or missed retinal tears [Group I: 10 eyes (13%), group II: 3 eyes (17%)] and b) vitreoretinal proliferation (group I: 4 eyes, group II: 0). The number of subsequent reoperations for failures or recurrences was higher in group I than in group II. At the final examination, the retina was attached in 73 eyes of group I (97%) and in 18 eyes of group II (100%). The Kruskal-Wallis test did not detect any difference between the two groups concerning the pre- or postoperative visual acuities. CONCLUSION: Vitrectomy seems as effective as episcleral buckle for the treatment of pseudophakic retinal detachment and offers additional advantages.

Adolescent↗

PubMed2004

Late retinal detachment in patients born prematurely: outcome of primary pars plana vitrectomy.

OBJECTIVE: To describe the indications and results of pars plana vitrectomy for rhegmatogenous retinal detachment in patients born prematurely. PATIENTS AND METHODS: Between 1995 and 2001, primary vitrectomy for retinal detachment was performed in a consecutive series of 11 eyes of 10 patients. Gestational age ranged from 26 to 30 weeks, and birth weight ranged from 810 g to 1475 g. RESULTS: Myopia was found in 9 of 11 eyes. Two patients initially had a vitreous hemorrhage. One of these children was previously treated with cryotherapy during the acute phase of stage 3+ retinopathy of prematurity. Three eyes had a normal posterior pole and only mild peripheral retinal changes. Primary vitrectomy was performed in all 11 eyes. Patients received follow-up for 7.2 months to 6.6 years (mean, 2.7 years). Three eyes with severe cicatricial changes due to retinopathy of prematurity needed multiple procedures with silicone oil tamponade for reattachment. In 10 (90%) of 11 eyes, the retina was completely attached at the last follow-up visit. Visual acuity ranged from light perception to 20/25 in the affected eye. CONCLUSIONS: Patients born prematurely may develop late-onset retinal detachment due to vitreoretinal changes caused by retinopathy of prematurity. Primary vitrectomy is an effective treatment technique for retinal detachment in patients born prematurely.

Adolescent↗

PubMed1990

[Retinal detachment in pseudophakic patients. Apropos of 39 cases].

Pseudophakic Retinal Detachment (PRD) is of major concern, because since 1981, the number of patients receiving implants per year has been higher than that not implanted in the United States. Recently, the number of PRD has exceeded that of Aphakic Retinal Detachment (A.R.D.). This has been observed over the last two years in our unit. We report on 39 cases treated in the unit of Pr METGE between April 1986 and April 1988; P.R.D. characteristics, surgical procedures and anatomic results are presented. We have distinguished 4 types of P.R.D. Differences in prognosis may be imputed to the larger number of undetected tears and the more advanced vitreo-retinal proliferation in PRD as compared with A.R.D. Surgical procedures in PRD are identical with those of A.R.D., and implant may be maintained. Reinterventions, vitrectomy, and internal tamponnement are more frequently needed. The best prognosis observed in our patients occurred for PRD following ECCE + posterior chamber lens without peroperatory complications.

Humans↗

PubMedDate not supplied

Treatment of retinal detachment with giant tear by pneumatic retinopexy.

Nine eyes suffering from retinal detachment with giant tear were treated successfully by pneumatic retinopexy, followed by conventional buckling procedures and cryopexy. The retina in six of the nine eyes reattached after initial operation, whereas two required additional injection of SF6 gas. The remaining eye, having developed low-grade proliferative vitreoretinopathy (PVR C1), was treated successfully with vitrectomy. Visual outcome was rather poor immediately after the procedures due to vitreous opacity caused by gas injection. However, all cases showed excellent visual acuity five months after surgery. Visual field examined in six cases after surgery showed no significant constriction. If the retinal flap is mobile, pneumatic retinopexy may be effective in treating retinal detachment with giant tear.

Adult↗

PubMed1998

[Ultrasonic diagnosis of retinal detachment after internal tamponade with silicone oil].

The authors evaluate the results of ultrasound examination of 20 patients with retinal detachment (20 eyes) after pars plana vitrectomy with silicone oil tamponade. Ultrasound diagnostic method is necessary in cases with non-transparent optic media. Silicone oil in the space of vitreous cavity has a character of a swimming water-drop and his physical properties can change the echography results. Between the eye-wall and silicone oil is a virtual space, which could be well visualised by ultrasound. The patients are divided into 2 groups. In the 1st group there were 7 eyes with transparent optic media and retina was detached under the silicone oil. By ultrasound the retina detachment echo was localised between the echos of silicone oil and eye wall. In the 2nd group there were 13 eyes with non-transparent optic media. In 6 cases (41.6%) the retinal detachment echo was visualised. The retinal detachment was confirmed by vitreo-retinal surgery.

Adult↗

PubMedDate not supplied

[Retinal detachment following posterior capsulotomy using a YAG laser].

This work analyzes 9 cases of retinal detachment occurred after posterior capsulotomy with Yag laser. No relationship has been found between the timing of the Yag capsulotomy after cataract extraction, and seriousness or precocity of the retinal detachment. The size of the capsulotomy does not seem to play a main part either. The study shows the part of the posterior capsule and the importance of associated risks (myopia, peripheral degenerative lesions, previous retinal detachment in the fellow eye). The role of the Yag laser treatment seems doubtful.

Cataract Extraction↗

PubMed1981

Absorbable implants in nondrainage procedures for repair of retinal detachment.

Our experience in 1,700 consecutive cases of retinal surgery for the repair of nontraumatic, rhegmatogenous retinal detachments using a modified technique involving a nondrainage procedure with an absorbable implant was presented. We found that 228 of these 1,700 cases fell into our criteria for the use of this technique. We discussed the indications and contraindications for both the operative procedure and for the absorbable implant, and it is our belief that this technique is a valuable addition to the methods available to the retinal surgeon for the treatment of certain selected cases of retinal detachment.

Drainage↗

PubMed1979

Retinal telangiectasias associated with longstanding retinal detachment as a prognostic sign.

The authors present 26 cases (28 eyes) of rhegmatogenous retinal detachment, lasting more than 6 months, in which retinal telangiectasias appear in the periphery of the retina as a secondary phenomena, seemingly related to hypoxic factors. A comparison is made with a control group of 25 cases of longstanding retinal detachment taken at random in order to establish statistical differences. Considerations regarding their pathogenesis and their value as a prognostic sign are made.

Adolescent↗

PubMed2001

[Vitreoretinal surgery with intraocular C3F8 tamponade for retinal detachment due to macular hole without face-down positioning].

OBJECTIVE: To evaluate the effectiveness of vitreoretinal surgery with 16% perfluoropropane (C3F8) tamponade without face-down positioning in treatment of retinal detachment due to macular hole. METHODS: Twenty-seven consecutive eyes in 27 patients with retinal detachment due to myopic macular hole underwent closed vitrectomy, membrane peeling, gas-fluid exchange with C3F8 tamponade in the whole vitreous chamber. In 3 eyes, phacoemulsification was performed, and 2 of them received intraocular lens implantation. Postoperatively, except avoiding the supine position, the body position was not restricted. RESULTS: Twenty-one cases (78%) obtained successful retinal reattachment without the postoperative face-down positioning. In another 6 cases, because of the relatively quick absorption of the gas, the white macular hole and the subretinal proliferation, the operation was not successful, the hole being not sealed and the retinal detachment at the lower part still existing. In the 3 cases with quick absorption of the gas, on the 10th day after the operation, the body position was changed into a face-down one. In 2 of them, the retinal reattachment occurred. After > 6 months of follow-up, the retinal reattachment remain the same in 22 cases (81%), the macular hole was healed, and the visual acuity was elevated to > or = 0.1 in 19 cases. The main complications were lens opacity in 6 cases (31%), temporary elevation of intraocular pressure in 3 cases (11%). CONCLUSION: Use the methods for the treatment of macular hole and retinal detachment mentioned above may obtain relatively good therapeutic results, particularly suitable for senile and unhealthy cases.

Aged↗