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The fellow eye of 100 consecutively admitted cases of retinal detachment was studied with three-mirror examination for the presence of lattice degeneration and retinal breaks. Lattice degeneration was found in 18% and retinal breaks in 20% of fellow eyes.
We have made a prophylaxis of retinal detachment resulting from massive endovitreous hemorrage by applying a silicone encirclement on rabbit eyeballs in which we have previously injected autologous blood. Because of the opacity of the means echography has shown us the moment of intervening. Retinal detachment has taken place in the 64,28% of cases, against the 91,3% of a previous experience of ours in which we made no prophylactic.
In a series of 629 consecutive retinal detachments, 20 (3%) eyes had preoperative subretinal fibrosis without preretinal fibrosis. The incidence varied in a linear fashion with the duration of the detachment, varying from 0.8% in cases less than one month old to 22% in cases estimated to be more than two years old. Nineteen of the 20 detachments were anatomically cured by scleral buckling.
PURPOSE: The purpose of the study is to report on a series of patients with retinal detachments that were repaired in an office setting using a temporary Lincoff balloon scleral buckle. METHODS: A retrospective review was performed on 162 consecutive casepatients with retinal detachment repaired in the authors' office between January 1989 and June 1995 using a temporary Lincoff balloon scleral buckle. All procedures were performed using local anesthesia and minimal equipment. RESULTS: The retina was attached completely with a single procedure in 88% of patients. Of the 19 retinas (12%) that failed primary surgery, all except 1 ultimately were reattached using traditional scleral buckling in 14, combined scleral buckling and vitrectomy in 3, and pneumatic retinopexy in 1, for a total success rate of 99.4%. Complications were minimal. CONCLUSION: A temporary Lincoff balloon scleral buckle can be used safely and effectively in an office setting for retinal detachment repair. The results are comparable to other available methods that take more time, involve greater risk, have higher complication rates, and are more costly. This technique represents a viable alternative, particularly in a managed care environment.
PURPOSE: To assess the efficacy and safety of a heavy silicon oil (a silicon oil-RMN3 mixture, a mixed fluorinated and hydrocarbonated olefin) as temporary internal tamponade in selected cases of retinal detachment with inferior breaks. PATIENTS AND METHODS: Forty-six patients were operated on (inferior and/or posterior breaks: 38; proliferative vitreoretinopathy > or =C2: 18; anterior proliferative vitreoretinopathy: 14), with a mean follow-up of 39 months. Seventeen patients were operated on with a heavy silicon oil of a 1.03 g/cm3 density and 29 patients with a silicon oil of a 1.02 g/cm3 density. Heavy silicon oil was removed in 41 patients after a mean of 9.3 weeks. RESULTS: Anatomic success was achieved in 35 cases after a mean follow-up of 39 months. Recurrent retinal detachment with proliferative vitreoretinopathy occurred in eight cases during heavy silicon oil tamponade. The removal was difficult in three cases with the 1.02 g/cm3 density silicon oil. Complications included glaucoma (eight eyes), major emulsification (two eyes), and an intraocular inflammation reaction to topical steroids (five eyes). CONCLUSION: Heavy silicon oil (Oxane Hd) is as safe and effective as standard silicon oil in the treatment of selected retinal detachment, but intraocular manipulations are quite difficult. A prospective study is necessary to compare the efficacy of Oxane Hd and standard silicon oil in selected cases of retinal detachment with inferior breaks and in cases of large inferior retinectomy.
The results of pars plana vitrectomy for diabetic traction-rhegmatogenous retinal detachment were analyzed in 172 eyes, and the factors associated with a final visual acuity of 5/200 or better were identified. Forty-eight percent of eyes had improved vision on final examination. The proportion of eyes with a final visual acuity of 20/100 or better and 5/200 or better remained virtually the same during the ten-year study interval. Preoperative factors associated with a visual acuity of 5/200 or better were a preoperative visual acuity of 5/200 or better, the absence of iris neovascularization, and the absence of retinal detachment involving the macula. The intraoperative factor associated with a final visual acuity of 5/200 or better was the absence of iatrogenic retinal breaks.
Cases of retinal detachment are usually referred by one ophthalmologist to another, because of their complexity. The complicated nature of such cases can be judged by their likely response to conventional methods of retinal reattachment surgery. When the causative retinal breaks cannot be identified or closed by conventional means, it is reasonable to call detachments complicated. The prompt identification of such cases and their referral, if appropriate facilities and expertise to undertake them are not at hand, are essential steps in the correct management of rhegmatogenous retinal detachments.
AIMS: To investigate changes in choroidal blood flow (ChBF) in the foveal region of the human eye with rhegmatogenous retinal detachment induced by scleral buckling. METHODS: ChBF was measured in the foveal region using laser Doppler flowmetry in patients with a rhegmatogenous retinal detachment and no macular involvement before and after scleral buckling. The ChBF ratio was evaluated (ChBF of the affected eye to ChBF of the fellow control eye) to minimise individual variations. RESULTS: Retinal reattachment was confirmed by 2 weeks after scleral buckling in all patients. The ChBF in the foveal region of the affected eyes did not differ from the fellow eyes before scleral buckling. The ChBF ratio significantly (p<0.05) decreased 2 and 4 weeks after scleral buckling compared with that before scleral buckling and returned to baseline 12 weeks after scleral buckling. CONCLUSIONS: The results suggest that ChBF in the foveal region transiently decreases after scleral buckling and recovers to the baseline level within 12 weeks in patients with a retinal detachment and no macular involvement.
PURPOSE: To evaluate the long-term anatomic and visual results of intravitreal injection of pure C3F8 in the management of retinal detachments due to macular holes in myopic eyes. MATERIALS AND METHODS: Twenty one highly myopic eyes (19 patients) with retinal detachments due to macular holes were initially managed by intravitreal injection of pure C3F8. The postoperative follow-up ranged from 6,5 to 45 months (median: 27.5 months). RESULTS: Total retinal reattachment was achieved in 16 eyes (76.2%). Anatomic success was obtained with a single C3F8 injection in 15 eyes, and two injections in one eye. The 5 eyes which failed to reattach after gas injection underwent reoperation using choroidal irritation in the macular area associated with gas injection. The retina was reattached in all eyes. Eleven of the 16 eyes (68.7%) in which the retina was reattached solely with intravitreal gas injection had a nearly normal final near reading visual acuity. In contrast, none of the eyes reattached with the use of choroidal irritation had measurable final visual acuity. CONCLUSION: The results achieved in the present series of patients confirm that intravitreal injection of pure C3F8 is a valuable alternative in the management of retinal detachments due to macular holes in myopic eyes. We recommend this treatment approach as the initial surgical procedure, since more than half of eyes successfully operated on recover useful central vision.
OBJECTIVE: To estimate the incidence and epidemiologic characteristics of rhegmatogenous retinal detachment (RRD) in Beijing, China. DESIGN: Prospective population-based incidence study. PARTICIPANTS: The population of Beijing and its nearby suburbs (N = 6 589 000). MAIN OUTCOME MEASURE: Incident RRD. RESULTS: A total of 526 patients with RRD were newly diagnosed between October 1999 and September 2000. The annual incidence was 7.98/100 000 people (95% confidence interval = 7.30-8.67). People aged 60 to 69 had the highest incidence (22.15/100 000). Incidences of 3 subtypes of RRD were 0.93/100 000 for related to blunt trauma, 0.80/100 000 for aphakic and pseudophakic, and 6.25/100 000 for nontraumatic phakic retinal detachment. A significantly higher incidence was found in males for traumatic detachment, but not for the other 2 subtypes of RRD. High myopia (> or = -6 diopters) was more prevalent in bilateral RRD (57.1%) than in the unilaterally affected patients (32.4%). CONCLUSIONS: The incidence of RRD in Beijing is comparable to most of the reports from the developed countries. It is estimated that there are 9000 to 10 000 new cases of RRD in China each year. As 60% to 70% of the RRD patients live in small towns or remote farming areas with limited access to qualified retina-vitreous surgeons, care for these patients presents a great challenge in China.
We observed proliferative vitreoretinopathy in Labrador retrievers with spontaneous rhegmatogenous retinal detachment. Cellular membranes and their associated connective tissue matrix were prominent on the surfaces of the detached formed vitreous and on the retina. Membrane contraction folded the underlying vitreous and retina and exerted traction on the structures to which they attached. Proliferation occurred in the retinal pigment epithelium under the detached retina and in the nonpigmented ciliary epithelium when it became detached. Retinal pigment epithelial cells, nonpigmented ciliary epithelial cells, macrophages, and glial cells appeared to contribute to the membranes. Our findings suggested a sequence that began with vitreous abnormalities and ended with fibrocellular membranes on the surfaces of the vitreous and the totally detached retina. Because a similar sequence can develop in humans, these dogs may be useful in future studies of proliferative vitreoretinopathy.
We have made a prophylaxis of retinal detachment resulting from massive endovitreous hemorrhage by associating a pars plan vitrectomy and an application of encirclement in rabbit eyeballs, in which we had previously injected autologous blood. Because of the opacity of the means, echography has shown us the moment of internention. The retinal detachment has taken place in yhe 20,83% of cases whereas in our previous experience it had happened in the 91,3% without prophylactic intervention, in the 64.28% after application of encirclement and in the 46.15% after vitrectomy.
AIMS: The vitreous levels of soluble intercellular adhesion molecule 1 (sICAM-1) were investigated in uveitic eyes undergoing vitrectomy for retinal detachment (RD) or other complications, and the presence of this molecule was related to disease activity and vitreous levels of the cytokine tumour necrosis factor alpha (TNF alpha), known to upregulate ICAM-1 expression on various cells. METHODS: Vitreous and serum samples from 23 patients with either active or quiescent uveitis undergoing retinal surgery were examined for the levels of immunoreactive sICAM-1 and TNF alpha by ELISA methods, and for the presence of biologically active TNF alpha. Vitreous from non-uveitic eyes with rhegmatogenous retinal detachment (RRD), macular holes or cadaveric eyes were used as controls. RESULTS: As a whole, vitreous from uveitic eyes complicated or uncomplicated by RRD contained significantly higher levels of sICAM-1 than vitreous from non-uveitic eyes with RRD alone (p < 0.0005), eyes with macular holes (p < 0.0001), or normal cadaveric vitreous (p < 0.0001). The proportion of vitreous containing > 20 ng/ml sICAM-1 (> four times the normal values) was significantly higher in eyes with uveitis complicated by RRD than in those eyes without RRD (Fisher's test, p = 0.02), and although levels of sICAM-1 were higher in eyes with active uveitis than in those with quiet disease (p < 0.02), this could not be dissociated from the increase caused by RRD. There was a relation between the vitreous levels of sICAM-1 and those of immunoreactive TNF alpha (Spearman's correlation coefficient; r = 0.601, p = 0.006), but not between the vitreous levels of sICAM-1 and those of biologically active TNF alpha. CONCLUSION: Increased vitreous sICAM-1 levels and the association of this molecule with the presence of immunoreactive TNF alpha in uveitic eyes confirm the operation of cytokine mediated vascular reactions at the blood-retinal barrier during the development of this condition. The persistence of high vitreous levels of sICAM-1 in eyes with uveitis complicated by RRD despite previous immunosuppression may indicate a low rate of clearance of inflammatory molecules from the vitreous cavity and an exacerbation of the existing inflammatory process by the retinal detachment itself.
BACKGROUND: It has recently been shown that the pain occurring after retinal detachment surgery can be reduced by combined general and retrobulbar anesthesia. This study investigated the effect of retrobulbar anesthesia on the intra- and postoperative stress response and on postoperative pain, vigilance, nausea and vomiting. PATIENTS AND METHODS: In this prospective randomized study, 45 patients were enrolled where scleral buckling surgery for retinal detachment had been performed under general anesthesia. Bupivacain 0.5% (4 ml) was injected retrobulbarly in group I (n = 15) before surgery (preoperative) and in group II (n = 15) after surgery (postoperative), group III did not receive retrobulbar anesthesia. At different times during and after surgery, blood pressure, cortisol and glucose levels, time in the recovery unit, vigilance score, nausea and vomiting were measured and the pain score was determined. The dosages of intraoperative opioid analgetics and of postoperative pain medication were documented. RESULTS: Retrobulbar anesthesia reduces postoperative pain. Intra- and postoperative endogenous stress responses in groups I and II were reduced and the plasma levels of cortisol and glucose in group I were lower than in group II. In group I, nausea, dosages of intraoperative opioid analgetics and postoperative pain medication were reduced, the vigilance was increased and time in the recovery unit was shortened. CONCLUSIONS: The data show that combined local and general anesthesia has several advantages over general anesthesia alone, especially when the retrobulbar injection is given before retinal detachment surgery.
PURPOSE: To inform about retinal detachment in an infant with the ring chromosome 13 as a possible new feature of this syndrome. The finding is able to imitate retinoblastoma, which is closely connected to the deletion of 13q14. METHODS: We report on a girl with many congenital anomalies including hypoplasia of both optic discs and chorioretinal coloboma of the right eye. Chromosomal analysis revealed karyotype 46 XX with a ring chromosome 13. The patient was examined again at 15 months of age, where leukocoria was disclosed in the left eye, emerging from a retrolental greyish-white mass. Even though neither sonography nor CT showed a typical picture for retinoblastoma, this tumor could not be ruled out. Enucleation of the left eye was performed. The globe was then investigated histopathologically. RESULTS: No tumor was found in the removed eye. Microscopic examination showed a detached retina with reactive gliosis and neovascularisation. CONCLUSIONS: The possibility of retinal detachment should be included into differential diagnoses in infants with ring 13 chromosome in cases with a non-specific intraocular mass. The assessment of chromosomal breakpoints in children with this aberration would enable clinicians to determine the real risk of retinoblastoma.
The reattachment rate and the frequency of subretinal fluid drainage were reviewed in 771 eyes with rhegmatogenous retinal detachment that had undergone transscleral retinal detachment surgery between January, 1980 and December, 1989. During this period, the frequency of drainage decreased from 63.6% in 1980 to 14.1% in 1989. This decrease has not been accompanied by any change in the reattachment rate. The difference between visual acuity in eyes that underwent the operation when drainage was performed in only certain selected cases and visual acuity in eyes operated on when drainage was performed more frequently was not statistically significant (P = 0.966). It is suggested that the decrease in the frequency of drainage was due to a carefully followed method of patient management, including preoperative bed rest, use of criteria to establish nondrainage operation, use of transilluminator, and control of intraocular pressure.
PURPOSE: Rupture of the sclera occurring during retinal detachment surgery is generally associated with unfavourable anatomic and visual outcomes. Re-operation after a failed scleral buckle procedure and pre-existing scleral thinning are considered the main risk factors for scleral rupture. CASE REPORT: We describe the management and the favourable outcome of a case of scleral rupture in a 71-year-old woman during re-operation for retinal detachment. CONCLUSIONS: We managed this case of scleral rupture in accordance with current indications concerning the anatomical recovery, by scleral suture and patch graft, restoring IOP by gas tamponade. The positive outcome was partly related to the prompt closure of the retinal hole which led to reattachment, and partly to favourable events such as the moderate intensity of vitreous hemorrhage and the lack of any more serious intraoperative and postoperative complications.
The 'fishmouth phenomenon' seen in some previously treated retinal detachments is associated with large horeshoe tears and scleral buckling techniques. A method of treating patients with this complication is described in which scleral buckling with implant or explant is not used. The technique utilises intravitreal air tamponade with cryopexy and gives good results. The incidence of patients developing the fishmouth phenomenon as a complication of parimary simple retinal detachment surgery is much lower when an intravitreal air technique is used than the expected incidence following a primary scleral buckling operation.