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PubMedDate not supplied

Miotics and retinal detachment: upgrading the community standard.

The majority of ophthalmologists who responded to a questionnaire regarding the relationship between miotics and retinal detachment felt that such a relationship does exist, and that myopia and aphakia/pseudophakia predispose to the formation of new retinal breaks or to retinal detachment from pre-existing breaks with miotics. Horseshoe breaks and dialyses are pre-existing lesions that should be treated prophylactically prior to miotic therapy. Patients with no predisposing pathology or whose eyes have lattice degeneration or operculated breaks should be warned of possible retinal detachment prior to starting miotics. Not performing a peripheral retina examination prior to prescribing a miotic is acceptable, but not optimal, medical practice. Examining the peripheral retina or obtaining a retina consultation prior to prescribing a miotic may be beneficial to the patient and could be invaluable in the defense of litigation.

Humans↗

PubMed2000

Ocular-central nervous system lymphoma mimicking posterior scleritis with exudative retinal detachment.

OBJECTIVE: We describe an unusual ocular presentation of ocular-central nervous system lymphoma in a young patient. DESIGN: Interventional case report and literature review. METHODS: A previously well 24-year-old white woman presented with left eye pain and reduced vision. Episcleral injection, globe tenderness, an afferent pupil defect, and exudative retinal detachment were present. Computed tomographic scan of the head and orbits demonstrated scleral thickening, retinal detachment, and no other abnormality. A provisional diagnosis of posterior scleritis with exudative retinal detachment was made. Investigation for underlying connective tissue diseases was negative. There was an initial prompt response to corticosteroid therapy. The patient's symptoms and signs then recurred, and a left third cranial nerve palsy developed. Systemic investigations including lumbar puncture ultimately led to the diagnosis of primary T-cell central nervous system (CNS) lymphoma. Serologic tests for human immunodeficiency virus were negative. MAIN OUTCOME MEASURES AND RESULTS: The patient underwent orbital and cranial irradiation and intrathecal and systemic chemotherapy. Despite an initial response to treatment, she returned with a recurrence of the lymphoma in the anterior segment of the left eye. Her systemic disease progressed rapidly, and she died shortly thereafter. CONCLUSIONS: This patient's young age and initial presentation mimicking posterior scleritis with unilateral exudative retinal detachment, without evidence of vitreous involvement, are highly unusual for ocular involvement in primary CNS lymphoma. A review of the literature highlights the atypical nature of this presentation.

Adult↗

PubMed2006

Visual recovery after scleral buckling procedure for retinal detachment.

PURPOSE: To evaluate prognostic factors for visual and anatomic outcomes, including complications after scleral buckling procedure (SBP) for primary rhegmatogenous retinal detachments. DESIGN: Retrospective, consecutive, nonrandomized, comparative interventional case series. PARTICIPANTS: Patients undergoing SBP for primary rhegmatogenous retinal detachment performed by a single surgeon. METHODS: The patients' medical records were reviewed. Preoperative and intraoperative factors analyzed for their association with visual acuity and anatomic outcomes included macular detachment, duration of macular detachment, preoperative visual acuity, lens status, refractive error, extent of detachment, number of breaks, internal gas tamponade, and drainage of the subretinal fluid. Secondary outcomes included frequency of further surgery, complications, and fellow eye retinal detachment. The fellow eye of the patients was excluded from consideration of prognostic factors. MAIN OUTCOME MEASURES: Best-corrected visual acuity at 2 months and at final follow-up examination as well as anatomic factors including retinal reattachment at 1 day, 2 months, and last follow-up examination. RESULTS: There were 672 patients studied, including 457 (68%) with macular detachment. The use of gas, drainage of subretinal fluid, and lens status did not influence final anatomic or visual results. Macular detachment was the most important prognostic factor for anatomic (P = 0.031) and visual acuity success (P<0.001). Better preoperative visual acuity (P<0.001), fewer quadrants involved by the detachment (P<0.001), and lack of high myopia (P = 0.001) were important positive prognostic factors for visual acuity. The duration of macular detachment was not of prognostic value up to 30 days' duration. CONCLUSIONS: Visual recovery after retinal reattachment was most dependent on macular involvement. Duration of macular detachment had surprisingly little influence on postoperative visual acuity.

Adolescent↗

PubMed1987

Juvenile retinal detachment.

The features and prognoses of 802 cases (908 eyes) of retinal detachment from 8 months to 19 years of age were studied with the patients divided into three age groups: 65 eyes in group I (0-9), 259 eyes in group II (10-14), and 584 eyes in group III (15-19). Eyes in group I were different from the others in many respects. In group I, traumatic detachments, preoperative complications, four-quadrant detachments, and eyes with undetected breaks were more frequent, and the prognosis was worse than in the other groups. Holes with lattice degenerations were most frequent in group III eyes having no history of trauma. Group III resembled adult retinal detachment and group II was thought to be the transitional type.

Adolescent↗

PubMed2000

Demarcation laser photocoagulation of selected macula-sparing rhegmatogenous retinal detachments.

OBJECTIVE: To report a series of macula-sparing rhegmatogenous retinal detachments (MSRRDs) treated with demarcation laser photocoagulation (DLP). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Thirty-one patients (34 eyes) with primary or recurrent MSRRDs without associated visual field loss, necrotizing retinitis, or proliferative vitreoretinopathy (PVR), managed with DLP from November 1992 through May 1999. INTERVENTION: Demarcation laser photocoagulation consisting of a triple row of confluent laser burns. MAIN OUTCOME MEASURES: Best corrected postoperative visual acuity and MSRRD progression or recurrence. RESULTS: Thirty-four primary and recurrent MSRRDs were treated by DLP, which consisted of a triple row of confluent laser burns. Macula-sparing rhegmatogenous retinal detachments were located in all quadrants and affected 10% to 45% of the retina. Findings associated with MSRRDs included lattice degeneration (12 eyes), vitreous hemorrhage (4 eyes), and demarcation line (9 eyes). Symptoms (photopsias or floaters) were associated with 14 MSRRDs. Eight eyes were myopic and 11 were pseudophakic. Thirty-two MSRRDs were shallow, two were dome shaped, and all were smooth without corrugations. Follow-up ranged from 1.5 to 80 months (mean, 15.8 months; median, 17 months). Thirty-three of 34 detachments remained stable after DLP. Three flattened spontaneously. One eye was managed with scleral buckle 6 weeks after DLP. Progression was attributed to incomplete laser treatment. Best corrected postoperative visual acuity was the same or improved in all but one eye, in which a cataract developed. CONCLUSIONS: Demarcation laser photocoagulation is an effective method to manage acute or chronic, primary or recurrent MSRRDs without associated PVR that are shallow and smooth without corrugations. Demarcation laser photocoagulation is an alternative to both observation and surgical repair for these select MSRRDs.

Adolescent↗

PubMed1998

Long-term results after scleral buckling surgery in uncomplicated juvenile retinal detachment without proliferative vitreoretinopathy.

PURPOSE: To evaluate long-term anatomic and functional results of scleral buckling surgery in retinal detachment without proliferative vitreoretinopathy in juvenile patients. METHODS: A total of 33 eyes of 31 patients were operated on. Surgical techniques included segmental buckle (23 eyes), radial buckle (5 eyes), encircling band (4 eyes), and temporary balloon buckle (1 eye). The average age at time of surgery was 15.3 years and the average follow-up time was 8.9 years. Retinal detachment was associated with the following risk factors: myopia (14 eyes), blunt trauma (8 eyes), and aphakia (3 eyes). In 9 eyes, no risk factors were present. Fifteen eyes had a detached macula. In addition to anterior and posterior segment examination, binocular functions and ocular motility were evaluated. RESULTS: Retinal reattachment required one operation in 29 eyes, two operations in three eyes, and three operations in one eye. In one eye, pars plana vitrectomy had to be performed to reattach the retina. At the end of follow-up, retinal reattachment was achieved in all eyes. Visual acuity of 20/40 or better was achieved by 39.4% preoperatively and 60.6% postoperatively; in 52.4%, binocular functions were normal. CONCLUSION: Scleral buckling procedures allow favorable anatomic and functional results in juvenile retinal detachment without proliferative vitreoretinopathy.

Adolescent↗

PubMed2003

Intrusion of an encircling buckle after retinal detachment surgery.

PURPOSE: To report a patient with intrusion of the encircling buckle late postoperatively after surgical treatment of a rhegmatogenous retinal detachment. DESIGN: Interventional case report. METHODS: We performed an encircling buckle procedure on a 77-year- old woman with a rhegmatogenous retinal detachment. Four years after the operation, the encircling buckle intruded into the vitreous cavity. RESULTS: After 3 months of diagnosis of the intrusion, the retina was detached totally. CONCLUSIONS: Intrusion of the encircling buckle without any additional segmental buckling element is a very rare late complication of retinal detachment surgery.

Aged↗

PubMed2004

Visual outcome in primary macula-off rhegmatogenous retinal detachment treated with scleral buckling.

BACKGROUND AND PURPOSE: To evaluate the visual outcome of primary macula-off rhegmatogenous retinal detachment after successful scleral buckling. METHODS: A retrospective, non-controlled case series study was conducted in 93 patients (93 eyes) who underwent primary successful scleral buckling procedure for retinal detachment. Factors including duration of macular detachment, patient age, preoperative best-corrected visual acuity (VA), surgical management of subretinal fluid, and refractive error were analyzed statistically to determine their association with final visual outcome. RESULTS: Postoperative VA of 20/50 or better was found in 53.6% of eyes with duration of macular detachment within 7 days, and 29.7% of eyes with macular detachment for more than 7 days (Fisher's exact test, p = 0.019). VA better than 20/50 was found in 61% of eyes with preoperative VA better than 20/400 and in 33.9% with preoperative VA worse than 20/400 (Fisher's exact test, p = 0.008). Patients aged 30 years or less achieved better mean postoperative VA than those aged 31 to 50 and those aged 50 years and older (ANOVA, p = 0.003). Patients with low-grade myopia (< -6D) regained significantly better mean postoperative VA as compared with high myopia (> -6D) and emmetropic eyes (0 to +3D) (ANOVA, p < 0.001). Subretinal fluid drainage procedure did not affect postoperative visual result. Multivariate logistic regression analysis revealed that the duration of macular detachment was the only variable affecting the visual result. CONCLUSION: Scleral buckle surgery performed within the first week, preoperative vision more than 20/400, age younger than 30 years old, and low-grade myopia were associated with significantly better visual recovery from macular-off rhegmatogenous retinal detachment.

Adolescent↗

PubMed1998

Transscleral diode laser retinopexy in retinal detachment surgery: results of a multicenter trial.

PURPOSE: To evaluate the safety and efficacy of transscleral diode laser for retinopexy in rhegmatogenous retinal detachment surgery in a multicenter trial. METHODS: Seventy-two patients with primary rhegmatogenous retinal detachments were enrolled. No patient with chronic detachment, a retinal break greater than 90 degrees, history of uveitis or infectious retinopathy, or proliferative vitreoretinopathy was enrolled. RESULTS: Information from follow-up of 6 months or longer was available on 65 eyes. Retinas were attached at 6 months with a single operation in 58 (89%) of these eyes. Complications included apparent pinpoint breaks in Bruch's membrane in 15 eyes, scleral-thermal effect in 14 eyes, and limited hemorrhage, which was intraretinal in 10 eyes and extended into the vitreous in 3 eyes. In one case, hemorrhage was judged perhaps to have contributed to initial surgical failure. The other complications had no known adverse effects. Complications were significantly associated with the physician's experience in using transscleral laser retinopexy. CONCLUSIONS: In this multicenter study, transscleral diode laser retinopexy served as a safe and effective means of creating chorioretinal adhesion during retinal reattachment surgery. Minor complications were minimized by increasing experience with the technique.

Adolescent↗

PubMedDate not supplied

Transforming growth factor beta(2) increases in subretinal fluid in rhegmatogenous retinal detachment with subretinal strands.

PURPOSE: To compare transforming growth factor (TGF) beta(2) levels in subretinal fluid of rhegmatogenous retinal detachment with or without subretinal strand formation. METHODS: We assessed total and mature TGF-beta(2) levels in subretinal fluid obtained from 24 eyes with rhegmatogenous retinal detachment using an enzyme-linked immunosorbent assay. Group I comprised 18 specimens from eyes without subretinal strands, while group II comprised 6 specimens from eyes with subretinal strands. RESULTS: Total and mature TGF-beta(2) levels were higher in group II than in group I (p=0.01 and p=0.07, respectively). CONCLUSION: The concentrations of total and mature TGF-beta(2) were higher in cases of rhegmatogenous retinal detachment associated with subretinal strand formation compared to those without subretinal strand formation.

Body Fluids↗

PubMed1978

The prognosis of retinal detachment due to lattice degeneration.

In a series of 553 consecutive retinal detachments, 29% (120) were due to lattice degeneration. Forty-five percent of these were due to atrophic holes in the lattice degeneration and 55% were due to tears caused by traction posterior to or at the end of a patch of lattice. In phakic patients, retinal detachments due to atrophic holes were most common in young myopes. Detachments due to traction tears were seen in older, less myopic patients. The incidence of massive periretinal proliferation was less (5%) in detachments due to lattice degeneration than in detachments not due to lattice degeneration (6.5%).

Adolescent↗

PubMed1999

Management of CMV retinal detachments in the new era of antiretroviral therapy.

In the past, retinal detachment occurred at a rate of 38% after one year of cytomegalovirus retinitis (CMVR). The current rate of detachment may be reduced by improved therapies for CMVR. In addition, the number of new patients acquiring CMVR has fallen, resulting in a lower incidence of these detachments. Another important effect of the new era of antiviral therapy on CMVR-related detachments includes longer patient survival with a need to select surgical strategies that will provide the best long-term visual outcome while still recognizing the unique difficulties posed by detachments in necrotic retinas. Vitrectomy with planned removal of silicone oil, scleral buckle, vitrectomy with gas tamponade, and laser demarcation are strategies that may provide excellent visual and anatomic results for retinal detachments with various characteristics. The final selection of the surgical approach depends on the mechanical factors of the detachment and patient factors such as immune status, expected survival, control of retinitis, and visual needs.

Anti-HIV Agents↗

PubMed2001

Characteristics and outcomes of paediatric rhegmatogenous retinal detachment treated by segmental scleral buckling plus an encircling element.

PURPOSE: To evaluate the outcome of paediatric rhegmatogenous retinal detachment treated by segmental scleral buckling plus an encircling element. METHODS: A retrospective review was carried out of 15 consecutive paediatric patients (16 eyes). RESULTS: Thirteen of the 15 patients were male (87%), 2 (13%) were female. Their average age was 10.9 years (range 6-18 years; median 10 years). Retinal detachment was caused by trauma in 9 of 16 eyes (56%), high myopia in 5 of 16 eyes (31%) and had an unknown cause in 2 of 16 eyes (13%). Diagnosis was delayed by more than 1 month in 10 of 16 eyes (63%). The visual acuity was 6/60 or worse and the macula was detached on presentation in 13 of 16 eyes (81%). Two of 16 eyes (13%) had mild proliferative vitreoretinopathy. Final reattachment was achieved in all cases. Of 11 eyes with a follow-up of 6 months or more, there was improvement in visual acuity in 7 (63%), and a best-corrected visual acuity of 6/20 or better in 5 (46%). CONCLUSION: Paediatric rhegmatogenous retinal detachment is characterised by a delay in diagnosis and a high degree of macular involvement on presentation. Anatomical reattachment with segmental scleral buckling plus an encircling element was successful in all eyes, and improvement of visual acuity was achieved in one-half of the eyes which had a follow-up of 6 months or more.

Adolescent↗

PubMed2004

Effect of internal limiting membrane removal in treatment of retinal detachment caused by myopic macular hole.

The purpose of this study was to evaluate the anatomical outcomes of vitrectomy with internal limiting membrane removal in highly myopic eyes with retinal detachment caused by a macular hole. Nineteen, consecutive, highly myopic eyes with full thickness macular hole with retinal detachment were treated by vitrectomy with internal limiting membrane removal, endolaser photocoagulation on the center of the hole and fluid gas exchange. In five eyes with other peripheral breaks, scleral buckling (3 cases), encircling (1 case) and barrier laser (1 case) were combined. In 15 eyes (79.0%) the macular hole was closed after the initial surgery. In 4 eyes (21%) the macular hole was reopened, but these were successfully treated with fluid gas exchange (1 case) or macular buckling (3 cases). The visual acuity was improved in 15 eyes (79.0%). In conclusion, these results suggest that the removal of the perifoveal internal limiting membrane may be an important adjuvant in the treatment of the myopic macular hole with retinal detachment.

Adult↗

PubMed1977

Complicated retinal detachment and its management with pars plana vitrectomy.

Fifty patients with retinal detachment accompanied by vitreous haemorrhage, perforating eye injuries, intraocular foreign bodies, massive preretinal retraction,.giant tears greater than 180 degrees, and proliferative retinopathies underwent pars plana vitrectomy, cryocoagulation, scleral buckling, and intravitreal gas injection. Intraoperative complications included minimal to moderate bleeding and iatrogenic retinal tears, but no retinal dialysis was produced at the pars plana sclerotomy site. Postoperative complications included recurrent vitreous haemorrhage, rubeosis, haemolytic, erythroclastic, or neovascular glaucoma, transient increase of intraocular pressure, uveitis, and macular pucker. Phthisis bulbi occurred in 6 eyes; in 3 of these eyes enucleation was required. Successful reattachment was accomplished in 56% of these complicated retinal detachments, most of which had been considered inoperable by conventional techniques. Visual improvement was achieved in 46% of eyes. Follow-up ranged from 6 to 29 months.

Humans↗

PubMedDate not supplied

A simple way to prevent indocyanine green from entering the subretinal space during vitrectomy for retinal detachment due to myopic macular hole.

PURPOSE: To present a safe and simple method of preventing indocyanine green (ICG) from entering the subretinal space in patients undergoing vitrectomy for retinal detachment caused by myopic macular hole. PATIENTS AND METHODS: Four consecutive highly myopic eyes (three phakic, one pseudophakic) with retinal detachment due to myopic macular hole were operated on by pars plana vitrectomy. The ICG-assisted peeling of the internal limiting membrane was performed after temporarily closing the macular hole by means of a small bubble of perfluorocarbon liquid (PFCL) in order to prevent ICG from entering the subretinal space. RESULTS: Retinal reattachment was successful in all patients, and anatomic closure of the macular hole occurred during the follow-up period (range 3 to 10 months). CONCLUSIONS: A small bubble of PFCL prevents ICG dye from entering the subretinal space during vitrectomy for retinal detachment due to macular hole in highly myopic eyes.

Coloring Agents↗

PubMed1991

[Analysis of patients with retinal detachment surgery performed at the Eye Clinic of the ILF of the Regional Hospital in Ustí nad Labem 1987-1989].

In a group of 104 patients operated at the Ophthalmological Clinic in Ustí nad Labem on account of retinal detachment in 1987-1989 the authors investigated the anatomical and functional results of the operation during an average period of 15 months. Anatomical attachment of the retina was achieved in 82%; 52% of the patients improved from the functional aspect. In addition to vision on admission, discharge and during the last check-up the authors evaluated the extent of retinal detachment, the site of fissures, the number of myopes and aphakic subjects in the group and the period of retinal detachment before operation. There were 37.5% myopes and 27.9% aphakic patients and artephakia was recorded in 4.8%. The duration of detachment of the retina before operation was 7.4 weeks (3 days to 2 years). An association between the development of retinal detachment and injury was proved in six patients (5.8%).

Adult↗

PubMed1993

[Silicone oil in surgery of complicated retinal detachment].

Silicone oil has established itself as an internal tamponade in the treatment of complicated retinal detachments. The most common indications are PVR, advanced proliferative diabetic retinopathy, giant tears and severe trauma to the posterior segment of the eye. Other rarer indications have meanwhile been added. By its use success rates can be achieved that were thought impossible only ten years ago. Serious complications such as secondary glaucoma and keratopathy, much dreaded in the early years of its use, are better understood and are generally not considered contraindications anymore. Secondary glaucoma occurs in about 20% of eyes, has a wide variety of causes and is rarely attributable to the silicone oil itself, provided purified and highly viscous oil is used. The development of keratopathies has been greatly reduced by the introduction of the Andoiridectomy and this complication is now largely confined to eyes with severe trauma, hypotony or aniridia. Toxic effects of silicone oil have so far not been convincingly demonstrated. Whereas similar results can be obtained by the use of long-acting intraocular gases in milder cases of the conditions described, silicone oil tamponade has proved to be an effective treatment in the more advanced forms of complicated retinal detachments.

Diabetic Retinopathy↗