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[Concentration of selected cytokines in subretinal fluid in patients with retinal detachment (IL-8, TNF-alpha, IFN-gamma)].

PURPOSE: The aim of this study was to evaluate the presence of IL-8, TNF-alpha, IFN-gamma in subretinal fluid of patients with rhegmatogenous retinal detachment. MATERIAL AND METHODS: We studied 15 patients operated on retinal detachment. The presence of cytokines was evaluated using immunoenzymatic assay. RESULTS: IL-8, TNF-alpha and IFN-gamma were found in all subretinal fluid samples. The concentration of cytokines in patients with retinal detachment lasting to 2 months was higher than in cases of retinal detachment over 2 months.

Adolescent↗

Tritiated uridine labeling of the retina: changes after retinal detachment.

As part of a study designed to examine the response of photoreceptor cells to outer segment injury (retinal detachment), the pattern of RNA labeling ([3H]uridine incorporation) has been determined in detached cat retinas. Retinas were experimentally detached from the adjacent cellular layer (the retinal pigment epithelium:RPE) by injecting fluid into the extracellular space between the retina and RPE. Twenty-four hours before the animals were killed they received intravitreal injections of [3H]uridine. Autoradiograms were prepared from plastic sections 1.0 micron thick taken from detached retinal regions and, because the detachments do not encompass all of the retina, from nearby attached retinal regions. Twenty-four hours after retinal detachment there is a decrease in labeling intensity of the photoreceptors and Müller's glia in the region of detachment (compared to cells in nearby attached regions). Seventy-two hours after retinal separation, the same result is obtained in the photoreceptors, but labeling intensity is greatly increased in both the nuclei and cytoplasm of Müller's glia. The decrease in [3H]uridine labeling of the photoreceptors correlates with a decreased staining intensity of the cytoplasm and ultrastructural signs of necrosis. The striking change in the pattern and intensity of labeling of the Müller cells precedes extensive hypertrophy of these cells and the appearance within their cytoplasm of numerous 10-nm diameter filaments. Two weeks, and also 1 month, after detachment the pattern and labeling levels are similar to those observed 1 day after retinal separation. These data suggest a highly localized change in metabolism because the change in RNA labeling is restricted to the region of detached retina.

Animals↗

[Choice of technique in rhegmatogenous retinal detachment (author's transl)].

If not complicated by vitreous- or retinal traction the rhegmatogenous retinal detachment has an extraordinarily good chance to be healed surgically. The principle to safely seal the retinal hole by a circumscribed and controlled plombage from the outside of the eye - successfully developed as a surgical method by Custodis - appears now to be accepted everywhere. Nowadays the mayor modifications of this principle are widely used in retinal detachment surgery. The author outlines different clinical pictures patients may present with before surgery. He points to the surgical ways adequate to the given situation. The pros and cons of each approach are discussed. Generally spoken, the author prefers episcleral implants placed whether radially or circumferentially as the case may require. However, other techniques such as intrascleral implants are considered to have also their indications.

Diagnosis, Differential↗

Treatment of retinal tears and lattice degenerations in fellow eyes in high risk patients suffering retinal detachment: a prospective study.

BACKGROUND/AIMS: Fellow eye prophylaxis for retinal detachment (RD) is still a controversial issue since opinions are not unanimous regarding the kind of lesions to be treated or the method of treatment. This prospective clinical study aimed to follow the course of vitreoretinal conditions in 150 high risk fellow eyes. METHODS: 150 consecutive patients with unilateral rhegmatogenous RD were included in this study. Inclusion criteria were good explorability of fellow eye retinal periphery and one of the following conditions in the fellow eye-aphakia, pseudophakia with capsulotomy, high myopia (>-6D), contralateral eye to a giant retinal tear. Prophylactic treatment (photocoagulation or scleral buckling) was performed in the presence of retinal tears and lattice degenerations. The state of the vitreous body was determined at the beginning of the study and at the end, when RD occurred. RESULTS: Follow up ranged from 36 to 132 months. 95 fellow eyes were subjected to laser treatment; five eyes underwent prophylactic surgical treatment. Initially, in the treated group posterior vitreous detachment (PVD) was present in 100 eyes (100% of cases), but as a complete PVD only in 42 of them (42%). 10 eyes in the treated group developed RD during the follow up period. In five of these cases the partial PVD had progressed and a retinal tear in a previously healthy area was the cause of the retinal detachment. In the other five eyes RD apparently developed from previously treated lesions. Progression of PVD was evident in four out of these five eyes. The untreated eyes had no visible degenerative lesions. During follow up eight eyes developed RD. These eyes had no PVD at the beginning of the study, but showed a partial PVD at the time of the diagnosis of RD. CONCLUSION: Fellow eyes with pre-existing retinal tears and PVDs can go on to retinal detachment in spite of laser prophylactic treatment. When PVD is not detectable or a partial PVD is present, the progression of posterior vitreous separation can account for retinal tears and RDs arising in formerly healthy areas.

Adult↗

Rhegmatogenous retinal detachment in myopic eyes after laser in situ keratomileusis. Frequency, characteristics, and mechanism.

PURPOSE: To report the characteristics and frequency of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for the correction of myopia in a large case series. SETTING: Private practices, Caracas, Venezuela. METHODS: Five refractive surgeons and 31 739 myopic eyes that had surgical correction of a mean myopia of -6.01 diopters (D) (range -0.75 to -29.00 D) participated in this study. Laser in situ keratomileusis was performed in all eyes. Patients were followed for a mean of 36 months (range 6 to 48 months). The clinical charts of patients who developed RRD after LASIK were reviewed. RESULTS: Twenty eyes (17 patients) developed RRD after LASIK. Rhegmatogenous retinal detachments occurred a mean of 13.9 months (range 1 to 36 months) after LASIK. The mean pre-LASIK myopia in eyes that developed an RRD was -7.02 D (range -1.50 to -16.00 D). Most RRDs and retinal breaks occurred in the temporal quadrants (71.4%). Rhegmatogenous retinal detachments were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The frequency of RRD after LASIK was 0.06%. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for the correction of myopia is infrequent. If managed promptly, RRD will result in good vision. Before LASIK is performed, patients should have a thorough dilated indirect fundoscopy with scleral depression and treatment of any retinal lesion predisposing to the development of an RRD.

Adolescent↗

Retinal tears and retinal detachment as factors affecting visual outcome after cataract extraction complicated by posteriorly dislocated lens material.

PURPOSE: To evaluate the incidence and effect on visual acuity of complicating factors such as retinal tears (RTs) and rhegmatogenous retinal detachment (RRD) in eyes with posteriorly dislocated lens fragments after cataract extraction. METHODS: Retrospective consecutive series of patients presenting at a referral vitreoretinal practice with posteriorly dislocated lens material after cataract extraction over a period of 8 years. The presence of RT, RRD, endophthalmitis, and choroidal hemorrhage was noted, and their effect on visual outcome was studied. RESULTS: A total of 307 eyes with posteriorly dislocated lens material after cataract extraction were identified. Fifty-eight eyes (19%) were managed medically (Group I), whereas the other 249 eyes (81%) underwent pars plana vitrectomy for removal of the lens material (Group II). Indications for surgical management included uncontrolled inflammation, elevated intraocular pressure, and large lens fragments. No eyes in Group I developed RT or RRD. Of the 249 Group II eyes, 13 (5%) were found to have RT, and 25 (10%) developed RRD. In Group II, choroidal hemorrhage and endophthalmitis were noted in 12 (5%) and 4 (2%) eyes, respectively. Fifty-one (88%) of 58 eyes in Group I and 138 (55%) of 249 eyes in Group II achieved a final visual acuity of 20/40 or better. Seven (54%) of the 13 eyes with RT and 9 (36%) of the 25 eyes with RRD achieved a final visual acuity of 20/40 or better. In the RRD group, 9 (56%) of the 16 macula-on eyes achieved a final visual acuity of 20/40 or better, whereas none of the 9 macula-off eyes had a final visual acuity of 20/40 or better. None of the 4 eyes with endophthalmitis and only 1 (8%) of the 12 eyes with choroidal hemorrhage had a final visual acuity of 20/40 or better. Five (62%) of eight eyes with retinal detachment treated with pneumatic retinopexy needed further treatment with scleral buckle to achieve anatomical reattachment. CONCLUSION: A good visual outcome (20/40 or better) is possible in eyes with posteriorly dislocated lens fragments after cataract extraction, even when retinal tears or macula-on retinal detachment is present. The presence of a macula-off retinal detachment, however, has a significant adverse effect on the visual outcome. Pneumatic retinopexy is not associated with retinal reattachment in many cases and is not preferred.

Adult↗

[Preventive treatment of retinal detachment of the contralateral eye. Results of 5 years follow-up of 109 eyes].

In 1987, we presented a study of 141 eyes treated prophylactically following retinal detachment in the fellow eye. A hundred and nine of these patients are reviewed with a minimum follow-up of five years. Only the evolution was studied, whether a peripheral retinal lesion was present or not at the time of prophylactic treatment. The examiner noted if new lesions had occurred, or if lesions present at the time of the first examination had developed: lattice degeneration or snail track developing into a retinal tear, hole or tear causing a retinal detachment, contained or not by laser treatment. Our study contained sixty two myopes. Fifty eyes had visible, dangerous lesions, and fifty nine a normal retina. Forty five circular barrages with four anterior radial rows returning to the ora serrata were performed, and sixty four barrages with tight anterior grids and a localised barrage of visible lesions. The results were judged on one criterion only: retinal detachment requiring emergency surgery. Only one retinal detachment occurred behind the barrage, caused by proliferative vitreoretinopathy due to multiple tears, and surgical results were good. Eight tears appeared in front of the barrage, five of these in healthy retina. Two very posterior tears behind the barrage were blocked with no problem by laser treatment. Four localised detachments occurred in front of the barrage, three of these without anterior grid treatment. The advantage of this is undeniable since out of sixty three cases treated in this way, only three tears were seen to be blocked by the laser shots, and one anterior localised detachment where the anterior grid was insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[The surgical results in rhegmatogenous retinal detachment].

The paper present the functional and anatomic results obtained in 376 retinal detachment operations done in the Ophthalmological Clinic from Cluj-Napoca. The following types of operations were done: cerclage Arruga, scleral indentation, surface diathermy, laser photocoagulation. The retrospective study revealed percentages of 73.41% the anatomic reapplication and 50% in functional recovery. The negative influencing factors of the prognosis were: aphakia, large and old retinal detachments, macular region affectation.

Adult↗

Anatomical recovery following retinal detachment: clinicopathological correlations.

The histological findings in experimental retinal detachment and reattachment of the cat retina are described. Loss of photoreceptor outer segments, mounding of the apical surface of the retinal pigment epithelium, and loss of the apical villi of the retinal pigment epithelium are prominent features of the detached cat retina. Reattachment within the first week of retinal detachment is followed by good photoreceptor regeneration and orientation. Longer term detachment of 2 to 6 weeks results in poorer photoreceptor outer segment regeneration and orientation 4 weeks following reattachment surgery. These experimental results are consistent with clinical data concerning visual recovery following retinal reattachment surgery.

Animals↗

[Undergoing retinal detachment and primitive ocular hypertension (author's transl)].

In a survey of 907 patients undergoing retinal detachment surgery, primitive ocular hypertension was found in 3,85%. This ocular hypertension was most often bilateral (85,7%) with open angle (88%) and was found at the time of retinal surgery or on the follow up (54,3%). Retinal detachments in these patients offered no particular character. This percentage of 3,85% is not greater than the percentage of primitive ocular hypertensions in a normal population over 40 years old. However the analysis of our data leads us to think that the presence of ocular hypertension increases the risk of retinal detachment when the patient is aphakic.

Adult↗

The kinase inhibitor PKC412 suppresses epiretinal membrane formation and retinal detachment in mice with proliferative retinopathies.

PURPOSE: Platelet-derived growth factor (PDGF) is an important stimulatory factor for proliferative retinopathies. Expression of PDGF-B in the retinas of transgenic mice (hemizygous rho/PDGF-B mice) results in rapid-onset retinal detachment caused by proliferation of glial cells, endothelial cells, and pericytes, whereas expression of PDGF-AA (homozygous rho/PDGF-A or PDGF-AA mice) causes slowly progressive retinal detachment from proliferation of glial cells. In this study, we investigated the effect in rho/PDGF-B and rho/PDGF-AA mice of several different receptor kinase inhibitors. METHODS: Hemizygous rhoPDGF-B or homozygous rho/PDGF-A mice were treated orally with PKC412 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases and several isoforms of PKC), PTK787 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases), SU1498 (an inhibitor of VEGF receptor kinases), imatinib mesylate (an inhibitor of PDGF, c-kit, and v-abl receptor kinases), or vehicle, and at appropriate time points epiretinal membrane (ERM) formation and retinal detachment were quantified. RESULTS: In either rho/PDGF-B or rho/PDGF-A mice, oral administration of PKC412 or PTK787, but not SU1498 or imatinib mesylate, significantly reduced ERM formation. PKC412 reduced the incidence of severe retinal detachments in both models and PTK787 did so in homozygous rho/PDGF-A mice. CONCLUSIONS: These data indicate that PKC412 (and possibly PTK787) has appropriate activity and sufficient intraocular bioavailability after oral administration to prevent retinal detachment in models of proliferative retinopathy. PKC412 should be considered for treatment of vascular and nonvascular proliferative retinopathies in humans.

Angiogenesis Inhibitors↗

Rate of resolution of exudative retinal detachment after plaque radiotherapy for uveal melanoma.

OBJECTIVES: To determine the clinical relevance of exudative retinal detachment (ERD) and the rate of ERD resolution after plaque radiotherapy of posterior uveal melanomas. METHODS: Retrospective, nonrandomized study of 135 consecutive patients with posterior uveal melanoma treated by iodine 125 plaque radiotherapy. Extent of ERD and tumor thickness were assessed before radiotherapy and at postoperative follow-up visits. Local tumor control was assessed at each follow-up visit. RESULTS: An ERD was present in 71 patients (53%) and was a risk factor for local treatment failure (P =.03). The ERD resolved after radiotherapy in 59 (83%) of the 71 patients. The ERD resolved within 1 year in 64 patients (90%) (mean time to resolution, 5.6 months). The rate of ERD resolution correlated with the rate of decrease in tumor thickness (P =.004). The ERD did not resolve and the tumor thickness continued to increase in 5 patients, who required further intervention. A recurrent retinal detachment developed in 5 patients, who were diagnosed as having rhegmatogenous retinal detachment (3 patients) and lipid exudation secondary to tumor vasculopathy (2 patients). Two patients with local tumor recurrence did not develop a recurrent ERD. Local tumor control was achieved in 130 patients (96%). CONCLUSIONS: An ERD may be a risk factor for local failure after plaque radiotherapy for uveal melanoma. If an ERD does not resolve within 9 to 12 months of radiotherapy and the tumor is not regressing, treatment failure should be suspected. A recurrent ERD does not necessarily represent local tumor recurrence.

Adult↗

Laser therapy for rhegmatogenous retinal detachment.

Traditional techniques for managing uncomplicated macula-sparing rhegmatogenous retinal detachments include scleral buckling and pneumatic retinopexy. Demarcation laser photocoagulation is associated with less morbidity than these techniques and may be equally as effective in stabilizing selected macula-sparing retinal detachments.

Humans↗

Pseudophakic retinal detachment.

In 40 cases of pseudophakic retinal detachment 88% of the retinas were reattached, and 20% of the patients had a final visual acuity of 6/12 or better. Poor visualization of the fundus in 38% of the cases and the inability to find retinal breaks in 20% of the cases were major problems in management.

Adult↗

Axial length of eyes with rhegmatogenous retinal detachment.

We conducted a prospective study of 226 eyes with nontraumatic rhegmatogenous retinal detachment; we examined patient characteristics as well as changes in axial length and corneal curvature induced by scleral buckling surgery. Eyes with a round hole in lattice degeneration were characterized by axial length that was longer than that of eyes with retinal tears with and without lattice degeneration. Sex and age also correlated significantly with axial length. Surgically induced changes in axial length depended upon the procedures performed, but the retinal detachment surgery primarily caused a change in the refractive status.

Adult↗

Pseudophakic retinal detachments in the presence of various IOL types.

A series of 600 pseudophakic retinal detachments in 578 patients undergoing surgical repair between 1974 and 1984 was reviewed. Patients with previous retinal surgery of less than six months follow-up were excluded. The series included 395 iris-fixated (IF) lenses, 130 anterior chamber (AC) lenses, and 75 posterior chamber (PC) lenses. The overall success rate for retinal detachment was 88% but was significantly better in the PC lens group and significantly worse in the AC lens group. Forty-one percent of all cases achieved 20/40 visual acuity or better, although the AC lens group did worse (28%), while the PC lens group did significantly better (48%). Risk factors that were predictive of failure also were identified. Many of these factors occurred more frequently in the AC lens group and probably are related to the overall worse outcome in eyes with AC lens implants. The implications of these results for retinal and cataract surgeons are discussed.

Humans↗