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Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study.

PURPOSE: To investigate the findings in optical coherence tomography (OCT) in eyes with metamorphopsia after scleral buckling surgery for macula-off retinal detachment. METHODS: A total of 46 patients (46 eyes) with macula-off retinal detachment were prospectively studied 2 months after successful scleral buckling surgery. Patients were examined with the Amsler grid, fundus biomicroscopy and OCT. RESULTS: At the 2 month follow-up, 31/46 (67%) patients had metamorphopsia; 24/31 (77%) of these patients had an abnormal macular structure on OCT and 7/31 (23%) showed a normal macula. However, of the 15 patients in the non-metamorphopsia group, 4/15 (27%) had an abnormal macula and 11/15 (73%) had a normal macula (p = 0.0015). The most common finding on OCT was neurosensory retinal detachment. CONCLUSIONS: Metamorphopsia after scleral buckling surgery in macula-off detachment is more common in patients in whom abnormal macular structure is seen on the OCT scan compared to those showing a normal macular structure. Neurosensory retinal detachment is the most common pathology in these patients.

Adolescent↗

Screening for retinal detachment.

There is a reasonable basis for examination of patients with acute symptoms of posterior vitreous detachment, and this is current practice for patients who present with such symptoms. Significant morbidity is associated with detachment of the macula before treatment of retinal detachment, and in most cases, this occurs before presentation. There may be benefit in public information campaigns in an attempt to encourage patients to present earlier. A small reduction in the proportion of patients who present for surgery with a detached macula would produce a significant decrease in visual morbidity. With the current state of evidence, however, there is no justification for the general screening of patients for retinal detachment, or for predisposing lesions.

Humans↗

[Comparison of scleral buckling and vitrectomy for superior retinal detachment caused by flap tears].

PURPOSE: We compared the surgical results of vitrectomy and scleral buckling for uncomplicated superior retinal detachment caused by flap tears. SUBJECTS AND METHODS: Included in the study were 225 phakic eyes of 225 patients undergoing primary surgery from January 1990 to December of 1996 for superior retinal detachment caused by flap tears; all eyes had been followed for longer than six months after surgery. The choice of procedures was based on each surgeon's preference. The cases were evaluated retrospectively and the surgical outcome and the rate of complications compared between the two groups of eyes. RESULTS: Initial and final anatomical success rate were 92% and 100% after each procedure. Redetachment after the first procedure was due to new retinal breaks in 5 eyes, reopening of original breaks in 2 eyes of vitrectomy cases, and malpositioned buckle in 11 eyes of scleral buckling cases. Proliferative vitreoretinopathy occurred in 3 eyes of vitrectomy cases. CONCLUSION: Primary vitrectomy was as successful as scleral buckling for superior rhegmatogenous retinal detachment. Although a high incidence of postoperative cataract formation was a major drawback, vitrectomy had some advantages over to scleral buckling.

Adult↗

[Retinal detachment in the eyes with retinopathy of prematurity].

In the period of 1983-1988 among 57 retinal detachments in children and youth in 8 cases (10 eyes) the authors found the retinopathy of prematurity as a cause of retinal detachment. The characteristic picture of changes in these eyes was discussed. Combined surgical procedures were performed in 7 cases achieving a cure in 6. Emphasized was the significance of periodical examinations of these eyes with the aim of eventual prophylaxis of retinal detachment and of therapy of amblyopia.

Adolescent↗

Bilateral retinal detachment in association with preeclampsia.

Bilateral, serous, non-rhegmatogenous retinal detachment is a rare complication of preeclampsia. Duke-Elder and Dobree (1967) stated than Van Graefe reported the first case in 1855. Since then 24 further cases have been reported--Wagener (1933), Wahrsinger (1943), Singh (1953), Bosco (1961), Gitter (1968), Klein (1968), Kenny (1972), Mabie (1980) and Oliver (1980). The incidence over the past 40 years appears to be decreasing and probably reflects the lower incidence of severe preeclampsia as a result of better antenatal care. These detachments are bilateral, serous and non-rhegmatogenous i.e. atraumatic. They often only involve the posterior pole. Bosco (1961) arrived at an incidence of 1 in 18,524 pregnancies. Previous case reports have suggested a higher incidence in primigravidas and all previous cases have occurred antenatally. In all but 1 previous case (Mabie, 1980), the detachment occurred concomitantly with hypertensive retinopathy. We report a multigravida with preeclampsia who, in the absence of any hypertensive retinopathy, developed bilateral, bullous retinal detachments in the puerperium.

Adult↗

Photorefractive keratectomy for visual rehabilitation of anisometropia induced by retinal detachment surgery.

PURPOSE: To evaluate the efficacy of unilateral photorefractive keratectomy to correct anisometropia induced by retinal detachment surgery. METHODS: Photorefractive keratectomy was performed in 10 eyes of 10 patients with anisometropia induced by previous retinal detachment surgery. The Aesculap Meditec MEL 60 excimer laser was used. RESULTS: Preoperative mean spherical equivalent refraction was -5.20 D. Mean postoperative spherical equivalent refraction was -0.25 D after a mean follow-up of 12.9 months. Mean preoperative spherical equivalent refraction difference between two eyes of 4.87 D was decreased to a mean 0.60 D postoperatively (t-test, P < .0001). All patients were free of anisometropic symptoms after laser surgery. CONCLUSION: Unilateral photorefractive keratectomy seems to be an effective method to correct anisometropia induced by conventional retinal detachment surgery, especially for patients with spectacle and contact lens intolerance.

Adolescent↗

Rhegmatogenous retinal detachment in infancy.

A 5-week-old male infant had small stature, microphthalmia, bilateral rhegmatogenous retinal detachments, ventricular septal defect, and fundus lesions suggestive of previous chorioretinitis. Diagnostic workup failed to disclose a cause of the intraocular disorder. Bilateral retinal detachment surgery, performed when the boy was 2 and 3 months of age, has appeared successful 12 months postoperatively. This may be a description of the youngest patient with rhegmatogenous retinal detachments that were subsequently repaired.

Body Height↗

Scleral buckling methods for rhegmatogenous retinal detachment.

Scleral buckling techniques are effective in treating most eyes with rhegmatogenous retinal detachment, and usually the final visual result is limited only by possible preexisting macular damage due to the detachment. Still, a variety of techniques are used, including exoplant or implant methods for the scleral buckle; cryotherapy, diathermy, or photocoagulation to cause the chorioretinal adhesion; and drainage or nondrainage of subretinal fluid. Also, recent development of alternative surgical techniques such as vitreous surgery and/or intraocular gas injection have raised questions about the current role of scleral buckling methods. This article reviews the principles and techniques of scleral buckling for retinal detachment and describes the methods we have found most useful.

Anesthesia, General↗

[Surgery for retinal detachment in the years 1989-1994].

PURPOSE: Evaluation of early and long-term results of retinal detachments operated in the recent years. MATERIAL AND METHODS: 99 eyes of 98 patients were examined. The conventional methods of retinal detachment surgery have been applied, mostly (above 75%) encirclement with subretinal fluid drainage. RESULTS: Anatomical reattachment was applied in 81.8% of cases, but after follow-up, meanly 2.5 years this percent was 66.2% in the majority of cases functional results were also good; in 18.5% of the eyes with anatomical reatachment visual acuity did not improve. CONCLUSION: Encirclement of the eyeball with subretinal fluid drainage is the basic and the most useful method of surgical treatment in most cases of retinal detachment.

Adolescent↗

Comparison of silicon oil removal with various viscosities after complex retinal detachment surgery.

BACKGROUND: Despite the progress in vitreoretinal surgery and the importance of silicone oil as an adjunct for the treatment of complex forms of retinal detachment, controversy still surrounds the issue of selecting the proper oil viscosity for clinical use. Herein, we evaluate the outcomes of retinal detachment (RD) surgery after removing silicone oils of different viscosities. METHODS: In this retrospective cohort study, eighty-two eyes with surgically re-attached retinas, of which 53 were filled with 5000 cs silicone oil and 29 with 1000 cs silicone oil were enrolled. We evaluated the outcomes and complications following silicone oil removal. Final anatomic success (stable re-attachment), final visual acuity (VA) and intraocular pressure (IOP)were recorded and analysed. RESULTS: Of 82 eyes, 41 had proliferative vitreoretinopathy (PVR), 24 were associated with intraocular foreign bodies, 10 had endophthalmitis and 7 had proliferative diabetic retinopathy with tractional retinal detachment. Prior to silicone oil removal, the retina was attached in all eyes, 29% had VA > or = 6/120 and 52% had IOP > or = 21 mmHg. After silicone oil removal, the retina remained attached in 59(72%) of the eyes, 34% had VA > or = 6/120 and 9% had IOP > or = 21 mmHg. Comparing 1000 cs and 5000 cs silicone oil filled eyes, redetachment occurred more frequently in the latter group especially in cases with associated PVR. Final VA worse than 6/120 was associated with initial VA < 6/120 (OR = 32.2 95%CI 7.4-140.2) and use of 5000 cs silicone oil (OR = 7.9 95%CI 1.9-32.2). No factor was significantly associated with final IOP > or = 21 mmHg. CONCLUSION: In complicated retinal detachment surgery, use of 5000 cs silicone oil may be associated with a poorer anatomic and visual outcome compared with 1000 cs silicone oil. However there was no difference between the two viscosities in IOP elevation. A randomized controlled study is necessary to further evaluate such a possibility.

Cohort Studies↗

Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy.

PURPOSE: To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. METHODS: A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. RESULTS: The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. CONCLUSIONS: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

Choroid Diseases↗

Choroidal metastasis and rhegmatogenous retinal detachment.

The association of a rhegmatogenous retinal detachment (RRD) with a uveal metastasis is an exceptional occurrence. In this article, the authors report the first successfully treated case (to their knowledge) of a patient with one eye in whom both the RRD and the metastasis is treated successfully. The RRD was operated on using a buckling procedure with cryopexy of the retinal break and drainage of the subretinal fluid. The metastasis, originating from an invasive canalicular carcinoma of the breast, was irradiated several days after surgery with a linear accelerator. The primary tumor was treated with systemic hormonotherapy. One and a half years after surgery, the patient is still alive. Visual acuity in the eye is 20/30, the retina is flat and no signs of tumor recurrence have been observed.

Aged↗

High TGF-beta2 levels during primary retinal detachment may protect against proliferative vitreoretinopathy.

PURPOSE: Transforming growth factor (TGF)-beta2 and hepatocyte growth factor (HGF) have been implicated in the pathogenesis of proliferative vitreoretinopathy (PVR) after retinal detachment surgery. The exact role of these factors in the early events, immediately after primary retinal detachment, is not yet known, and determining their roles was therefore the purpose of this study. METHODS: Subretinal fluids were collected prospectively from 144 patients during surgery for scleral buckling. TGF-beta2 and HGF were measured with commercially available ELISA kits. Thirty patients in whom a redetachment caused by postoperative PVR developed, were compared with 114 patients with an uncomplicated retinal detachment. The controls included 18 vitreous samples from patients with macular hole or pucker. Multivariate regression analysis was used to compare the relative roles of growth factors and clinical factors in the development of PVR. RESULTS: The median amount of subretinal TGF-beta2 was approximately two times lower in patients with postoperative PVR (1.9 ng/mL) than in the uncomplicated detachment group (3.3 ng/mL; P=0.002). TGF-beta2 levels in the PVR-positive group were similar to control vitreous levels (1.8 ng/mL). Subretinal HGF concentrations were not significantly different between the two groups of patients (PVR positive: 8.8 ng/mL; PVR negative: 8.9 ng/mL), but were higher than control vitreous levels (4.6 ng/mL; P=0.01). Stepwise multivariate logistic regression analysis revealed that of all factors under study, decreased TGF-beta2 content was the exclusive predictor of postoperative PVR (P=0.01). CONCLUSIONS: High TGF-beta2 levels in subretinal fluid at the time of primary retinal detachment may protect a patient against subsequent development of PVR.

Adolescent↗

Retinal detachment in ocular toxoplasmosis.

PURPOSE: To report on the clinical course and prognosis of retinal breaks and detachment occurring in patients with ocular toxoplasmosis. DESIGN: Retrospective cross-sectional observational study. PARTICIPANTS: One hundred fifty consecutive patients with ocular toxoplasmosis. INTERVENTION: A review of all records of patients with ocular toxoplasmosis who had consulted our department from 1990 through 1997 was performed. MAIN OUTCOME MEASURES: The presence of retinal detachment or breaks and possible risk factors, such as age, myopia, the interval between the last recurrence of inflammation and the onset of retinal detachment, severity of vitritis, previous treatment methods, and the location of the retinal abnormalities, were analyzed. RESULTS: We found a frequency of 6% (9/150) for retinal detachment and an additional 5% (7/150) for retinal breaks among our patients with ocular toxoplasmosis. Attacks of active ocular toxoplasmosis preceding the retinal detachment or retinal breaks were characterized by severe intraocular inflammation. The frequency of myopia in our patients with retinal detachment or retinal breaks was significantly higher than in patients with ocular toxoplasmosis without retinal detachment or retinal breaks. The functional prognosis for the patients with retinal detachment was poor; legal blindness (visual acuity < or = 20/200) resulting from retinal detachment occurred in five of the nine patients. CONCLUSIONS: Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with myopia and severe intraocular inflammation.

Adolescent↗

[Prognosis of the retinal detachment in children (author's transl)].

Following features seem to characterize retinal detachments in children. High rate of difficult anatomical problems: invisible retinal breaks, macular or paramacular breaks, giant breaks or desinsertions (37% of our cases). High rate of severe traumatic macular lesions. Important delay in treatment with prolonged macular impairment. These facts explain the prognosis. Difficulties in the treatment of retinal breaks explain anatomical results (75% cure rate vs 78,6% for all the retinal detachments treated). In the same way they explain the high rate of multiple operations. Macular impairment and multiple operations explain visual results: 1/3 of the non amblyopic eyes recover a visual acuity comparable to the initial. So, the macular in children does not seem to have a special functional recuperation ability. Two supplementary facts may be mentioned. Delay in treatment has no adverse effect in anatomic prognosis. Non giant "simple" desinsertions expose to a noticeable risk of massive vitreous retraction.

Adolescent↗

Retinal detachment surgery following implantation of a keratoprosthesis. A case report.

Retinal detachment is an eye with a keratoprosthesis usually has an extreme poor prognosis. We describe the successful repair of a total retinal detachment following implantation of a new type Worst-keratoprosthesis in the only eye of a 70-year-old patient. A vitrectomy, epiretinal peeling, 180 degrees superior retinotomy, subretinal membrane peeling and an injection of perfluorooctane were performed to flatten the retina. After the endophotocoagulation a perfluorooctane-silicone oil exchange was performed. An additional intervention was necessary to treat a redetachment. After 3 months follow-up the retina has remained attached and the patient regained ambulatory vision.

Aged↗

Scleral pockets and lyophilized sclera in retinal detachments.

For our buckling operations in retinal detachment, we prefer lyophilized sclera because it is well tolerated without tissue reaction, and very easy to handle. Its inertness is demonstrated by histopathological examination of sclera fragments taken during reoperations.

Freeze Drying↗

Management of glaucoma after retinal detachment surgery.

Secondary glaucoma may complicate retinal detachment surgery. Intraocular pressure (IOP) elevation has been described after scleral buckling procedures and vitrectomy with intravitreal injection of gas or silicone oil. Angle-closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Medical therapy and laser iridoplasty are usually successful in controlling IOP, but the presence of conjunctival scarring and recession and retinal hardware after scleral buckling procedures can make surgical management challenging. Intravitreal injection of expansile gases like sulfur hexafluoride (SF6) and perfluoropropene (C3F8) may produce secondary angle-closure glaucoma with or without pupillary block. Aspiration of a portion of the intraocular gas may be needed, especially if IOP is elevated to a level that may compromise ocular perfusion. Glaucoma also can develop after intravitreal injection of silicone oil secondary to pupillary block, inflammation, synechial angle closure, rubeosis iridis, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. A prophylactic inferior iridectomy at the time of surgery serves to prevent pupillary block. Patients with medically uncontrolled glaucoma after silicone oil injection may require oil removal with or without concurrent glaucoma surgery.

Fluorocarbons↗