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The use of sodium hyaluronate (Healon) in the treatment of complicated cases of retinal detachment.

Thirty-six eyes with retinal detachment and various degrees of proliferative vitreoretinopathy were operated with conventional buckling techniques and the additional use of intravitreal injected sodium hyaluronate (Healon). Eighteen eyes (50%) had re-attached retina 6 months post-operatively. The re-attachment rate depended upon the severity of the proliferative vitreoretinopathy. Three of 4 eyes with grade B, 4 of 5 with grade C-1, 8 of 13 with grade C-2, 2 of 11 with grade C-3 and 1 of 3 eyes with grade D-1 were reattached. Major complication occurred in 3 aphakic eyes where persistent intraocular pressure rise to 60-70 mmHg necessitated removal of Healon to normalize the intraocular pressure. In one eye Healon passed through a retinal rupture to the subretinal space.

Adolescent↗

[Prophylactic treatment of retinal detachment].

The indications for and results of prophylactic treatment of retinal detachment during a period of five years are reported and compared with the results in the literature. Half of the cases (3 out of 6 eyes) which developed a retinal detachment had been horse-shoe tears combined with a vitreous hemorrhage. For this reason a small buckle operation is recommended in these cases, to prevent further traction. Lattice degeneration should rather be observed than treated, except in special cases: This includes eyes where the fellow eye had a detachment from a lattice degeneration, cases in which one eye is blind from an uncured detachment or has no useful visual acuity, and eyes whose fellow eye has giant tears. In aphakic eyes treatment of lattice degeneration is recommended, because the incidence of detachment from these areas is high, especially in young aphakic cases. In one aphakic eye which had been photocoagulated several times the formation of a preretinal membrane was observed.

Female↗

[Analysis and treatment of eye motility disorders following retinal detachment surgery].

Despite the most careful retinal detachment surgery saving the eye muscles and the fascial structures, an extraocular muscle imbalance may occur. This can be expected especially when for scleral buckling procedures large implants or exoplants were used, or had to be placed under a rectus muscle. In some cases, however, postoperative diplopia results from decompensation of preexisting heterophoria or congenital ocular motor imbalance. A clear-cut differential diagnosis to separate these entities is essential for therapeutic considerations.

Aged↗

[Two cases of retinal detachment following laser in Situ keratomileusis repaired by scleral buckling surgery].

BACKGROUND: As laser in situ keratomileusis (LASIK) becomes the treatment of choice in the field of refractive surgery, postoperative rhegmatogenous retinal detachment has also begun to occur. However, since it has not been reported yet here in Japan, we report two cases of retinal detachment following LASIK with suggestions based on our experience. CASES: A 34-year-old male(Case 1) and a 26-year-old male(Case 2) suffered from retinal detachment one month and eight months after LASIK, respectively. Contributing retinal breaks were a horseshoe tear in Case 1 and atrophic holes in the lattice degeneration in Case 2. Each patient underwent partial scleral buckling with no intraoperative complication, resulting in successful retinal reattachment. Postoperatively, myopic changes developed and persisted one month in Case 1 and several months in Case 2. CONCLUSIONS: Great attention should be paid to the possibility of postoperative myopia after a repair of retinal detachment following LASIK. Thus, we stress the necessity of close cooperation between LASIK surgeons and vitreoretinal surgeons to settle the matter.

Adult↗

Retinal detachment in preeclampsia.

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.

Adult↗

Levels of some cytokines in subretinal fluid in proliferative vitreoretinopathy and rhegmatogenous retinal detachment.

PURPOSE: To determine the cytokine-mediated pathways of inflammation in the clinical course of proliferative vitreoretinopathy (PVR). METHODS: Cytokines IL-2, IL-6, INF-gamma were measured by enzyme-linked immunosorbent assays. Aspirates of subretinal fluid were obtained from 14 eyes with PVR and six with uncomplicated rhegmatogenous retinal detachments. Aspirates obtained via pars plana from ten cadaver vitreouses of normal eyes were used as controls. RESULTS: Subretinal fluids from eyes with PVR, uncomplicated rhegmatogenous retinal detachment and cadaver vitreous contained low concentrations of IL-2, with inconsequential differences between groups. IL-6 and IFN-gamma were twice as high in the subretinal fluid from eyes with rhetmatogenous retinal detachment as in cadaver vitreous. INF-gamma was elevated up to six times in eyes with PVR compared to controls. Fibronectin was found in a larger proportion of eyes with PVR than with uncomplicated rhegmatogenous retinal detachment and cadaver vitreous from healthy persons. CONCLUSIONS: These are only preliminary investigations and are too few for statistical analysis. The results suggest that cytokine-mediated pathways of inflammation are involved in the pathogenesis of rhegmatogenous retinal detachment and in cellular interactions leading to the development of PVR.

Body Fluids↗

[New approach for management of retinal detachment with macular hole].

Three kinds of unconventional methods were used to treat retinal detachment with macular hole in 17 cases (17 eyes). A combination of vitrectomy, transscleral drainage and intraocular air injection was used for the cases of retinal detachment with macular hole and evident vitreous traction. Transscleral drainage combined with air injection was used for those of macular hole without vitreous traction. For the cases of combined peripheral and macular holes, we treated only peripheral holes, ignoring the macular hole. After a 3-16 months follow-up, 15 out of the 17 eyes obtained retinal anatomic reattachment (88.2%), 10 eyes had their vision improved, 4 eyes remained unchanged, 9 eyes obtained a visual acuity of better than 0.05 postoperatively. Compared with the conventional method of macular buckling, these procedures have the advantages of less damage to macula, less complications and more satisfactory visual improvement.

Adult↗

Traumatic retinal detachment.

Six hundred forty-three patients had retinal detachment surgery during 81/2 years; 17.6% were under the age of 30 years. Analysis of this group of patients showed that males were more commonly affected than females (68%). Trauma was the most frequent cause, reported in 40% of cases. Dialysis was the commonest retinal break, occurring in 51% of patients, and 73% of these occurred in the inferior temporal quadrant. In patients with a history of trauma, the type of the retinal break produced and operative success was related to the severity of ocular damage, with more successful outcomes in nontraumatic cases and fewer of these in cases of ocular perforation.

Adolescent↗

Management of retinal breaks and conditions predisposing to retinal detachment.

This update discusses the available evidence and provides recommendations regarding when to observe and when and how to treat prophylactically retinal breaks in eyes. These recommendations include eyes with conditions predisposing to rhegmatogenous retinal detachment, such as those with retinal degeneration, aphakia, fellow eyes of a rhegmatogenous retinal detachment, or eyes of patients with inherited vitreoretinopathies.

Animals↗

Macular recovery after retinal detachment.

Macular recovery after surgery for retinal detachment (RD) depends on preoperative and postoperative predictive factors. Preoperative visual acuity is the main preoperative factor correlating positively with good macular recovery. Preoperative factors, which influence macular recovery negatively, include duration of macular detachment, height of macular detachment and vitreomacular traction. Postoperative factors, which influence macular recovery negatively, include cystoid macular oedema, epiretinal membranes, retinal folds, subretinal retinal pigment epithelium (RPE) migration and persistent subretinal fluid on optical coherence tomography (OCT). According to the latest available data, a detached macula has to be reattached within 5 days to optimize functional recovery. However, new therapeutic options such as exposure to hyperoxia or different growth factors may help to improve the final visual outcome in the presence of an already detached macula.

Humans↗

Seasonal variations in retinal detachment in Northern Finland and Novosibirsk.

Retinal detachments have a tendency to occur more commonly in spring and summer than in winter. Two new series are presented here, the first collected in Northern Finland at latitudes 64 degrees-70 degrees and the second from Novosibirsk, at a much lower latitude, 55 degrees N, but with an equally long winter. A statistically significant seasonal variation is found in both. The highest incidence peak is seen in June in Oulu and in July in Novosibirsk, the difference between the prevalence curves was, however, not statistically significant. The Oulu series shows a statistically highly significant seasonal variation in low refractive errors but no seasonal difference in high myopia and aphakia.

Climate↗

Argon laser photocoagulation in the management of retinal detachment and predisposing lesions.

During the years 1979-1982 we treated by argon laser photocoagulation 863 eyes of 551 patients affected by peripheral retinal degenerations and breaks. No case of progression to retinal detachment has been registered so far. In the same period, we treated 42 patients affected by retinal detachment of different topography (three posterior pole and 39 peripheral detachments) and size (mostly limited detachments, 12 as large as a quadrant, two larger than a quadrant). In 41 of these 42 eyes, the retina is still firmly attached after a 1- to 4-year follow-up, while in one case it was necessary to proceed surgically following a relapse. While argon laser photocoagulation is certainly the first choice treatment of retinal degenerations and breaks, it also appears to be a reliable alternative to scleral buckling in the management of specific cases of retinal detachment.

Adult↗

[Sub-retinal fluid interleukin-10 (Il-10) and interleukin-13 (Il-13) concentration in patients with retinal detachment].

PURPOSE: To evaluate the presence of IL-10 and IL-13 in subretinal fluid of patients with rhegmatogenous retinal detachment. MATERIAL AND METHOD: The studies comprised 14 patients on with retinal detachment operated. The presence of cytokines was evaluated using immunoenzymatic assay. RESULTS: IL-10 and IL-13 were found in all subretinal fluid samples. Our results suggest that the presence of IL-10 and IL-13 has the influence on suppression of inflammatory agent release and activity during retinal detachment.

Adolescent↗

[Treatment of retinal detachment caused by posterior pole dehiscence].

20 eyes have been treated for a retinal detachment due to a posterior pole break. Three successive, different operative techniques were used: macular silastic sponge, vitrectomy plus internal tamponade by silicone oil, vitrectomy plus internal tamponade by air or by a mixture of air 60% and SF6 40%. Macular sponges obtained a good rate of retinal reattachment (83.3%) but fonctionnal results are poor (no measurable visual acuity in the macular break cases). Vitrectomy plus silicone oil does not yield better anatomical results than sponges (66.6% succes rate) but the visual function is better preserved (2 measureable visual acuities on 3 macular break cases). Vitrectomy plus gas gave us the best anatomical (100% success rate) and functional results (4 measurable usual acuities on 6 macular break cases). Retinopexy is not necessary when the vitrectomy-gas technique is used. On the contrary, retinopexy is recommended when the vitrectomy-silicone technique is used in order to remove the silicone oil as safely as possible: this causes a dilemma in the case of a macular break. We think at the present time that vitrectomy-gas is the best way to treat these particular retinal detachments.

Humans↗

A colour-flicker analysis of visual function in patients with retinal detachment.

Patients with a history of retinal detachment were examined by the following tests: (1) setting of an isoluminant match between yellow and green constituent squares of a checkerboard and (2) measurement of the flicker fusion frequency for a contrast-reversal of this yellow-green pattern. The results suggest that the test may provide useful data for assessing the severity of any damage to a given part of the retina. The fusion frequencies range from over 10 Hz (normal) to about 2 Hz for a severely impaired retina. The data for the relative amounts of red and green light needed to achieve a match rarely show any abnormality; thus, a standard anomaloscope test or pseudoisochromatic plates would not detect these deficiencies.

Adult↗

[Analysis of 100 cases of retinal detachment treated with conventional surgery in the years 1997-1998].

PURPOSE: The observed increasing number of severe cases of retinal detachment was the ground of the attempt to state the causes of this phenomenon. MATERIAL AND METHODS: Retrospective evaluation of 100 consecutive cases of retinal detachment operated on with conventional methods between September 1997 and October 1998 was performed. The following data were analysed: sex and age of patients, period between the first symptoms and time of diagnosis and surgery. The clinical characteristics of retinal surgery comprise: extent of detachment, macular involving, type and number of breaks, degenerations and PVR. RESULTS: In the majority of cases very severe retinal detachments were observed, including 3-4 quadrants, with large tears or multiple breaks, with PVR B or C. Duration of the detachment ranged from several days in very few cases to several months, on average lasting several weeks. Attachment of the retina was achieved in 80 cases, improvement of the visual acuity in 47. CONCLUSION: Our data indicate the necessity to improve the early diagnosis of retinal detachment and changes predisposing to its development.

Adolescent↗

[Immunoreactive disorders and their correction in patients with rhegmatogenous retinal detachment complicated by vitreoretinal proliferation].

Examination of the immunologic state of 73 patients with rhegmatogenous retinal detachment complicated by vitreoretinal proliferation has revealed correlation between the severity of the latter and disturbances in the immune state of the patient's body. 44% of patients with the stage C and 62% of patients with the stage D have immunodeficiency expressed by reduced level of T- and B-lymphocytes and their subpopulation. It is shown that disturbances in immunoreactivity can serve as an unfavourable sign for prognosis of effectiveness of surgical intervention in patients with rhegmatogenous retinal detachment. In 70% of the patients these disturbances lead to unfavourable outcome of the operation. For normalization of the revealed disturbances in the immune state, immunomodulator thymaline was used in a complex treatment of 17 patients. The preparation rose the effectiveness of the treatment in 78% of patients and reduced the number of postoperative complications. It is recommended to study the immunologic state of the patient with rhegmatogenous retinal detachment complicated by vitreoretinal proliferation for the purpose of its further correction and a higher effectiveness of surgical treatment of such patients.

Adjuvants, Immunologic↗

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes.

PURPOSE: This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents success and complication rates, and examines variations in outcome. METHODS: Sampling and recruitment details of this nationwide cross-sectional survey of 768 patients of 167 consultant ophthalmologists having their first operation for rhegmatogenous retinal detachment have been described. The main clinical outcomes detailed here are anatomical reattachment at 3 months after surgery and complications related to surgery. Consultants with a declared special interest in retinal surgery and able to perform pars plana vitrectomy were designated specialists for the analyses. RESULTS: Overall reattachment rate with a single procedure was 77% (95% CI 73.9-80.2). There were significant differences in reattachment rates between specialists and non-specialists. Without allowing for case-mix, specialists had a reattachment rate of 82% (95% CI 77.9-85.7) with a single procedure and non-specialists 71% (95% CI 65.9-76.0). Allowing for case-mix, there was a significant difference between specialists and non-specialists for grade 2 detachments of 87% and 70% respectively (P < 0.0001). Analysing detachments by break type, the largest difference between specialists and non-specialists was observed for retinal detachments secondary to horseshoe tears, 80% and 68% respectively (P < 0.003). Specialists met the standards set for primary reattachment rates, while non-specialists did not. Over a third of patients had at least one complication reported at some point during the audit period. CONCLUSIONS: Significant differences were seen in reattachment rates between specialists and non-specialists, overall and for specific subgroups of patients. This study provides relevant, robust and valid standards to enable all surgeons to audit their own surgical outcomes for primary retinal detachment repair in rhegmatogenous retinal detachments, identify common categories of failure and aim to improve results.

Adolescent↗