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PubMed2003

[Treatment of retinal detachment of the course of retinopathy of prematurity].

Cryo- and laser therapy of stage 3 have reduced, but not eliminated the occurrence of retinal detachment in stages 4a, 4b and 5 of ROP. In this disease the treatment of these stages is still the greatest challenge to the ophthalmologist. Therefore, the aim of this paper is to present our up-to-date possibilities of treatment of different kinds of retinal detachments in ROP, including segmental scleral buckling, encircling scleral buckling, scleral resection, vitrectomy and its modifications in ROP. Guidelines of surgery of retinal detachment in active stage 4 and 5 of retinopathy of prematurity have been described.

Cryosurgery↗

PubMed1999

Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments.

OBJECTIVE: To determine the incidence and associations of glaucoma after pars plana vitrectomy (PPV) and silicone oil injection (SOI) for complicated retinal detachments and the response to treatment. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 150 eyes of 150 patients who had completed a minimum of 6 months of follow-up were included in this study. Analysis included clinical records of all consecutive cases of complicated retinal detachment that underwent PPV with SOI between July 1991 and February 1996. INTERVENTION: Surgical intervention for vitreoretinal pathology included standard three-port PPV and additional procedures as appropriate for the retinal pathology, and SOI. Procedures for the control of glaucoma were silicone oil removal (SOR), trabeculectomy with mitomycin C, cyclocryotherapy, semiconductor diode laser contact transscleral cyclophotocoagulation (TSCPC) and anterior chamber tube shunt to encircling band (ACTSEB). MAIN OUTCOME MEASURES: Presence of glaucoma (predefined as intraocular pressure [IOP] > or = 24 mmHg, which also was > or = 10 mmHg over the preoperative level, sustained for > or = 6 weeks) and the result of medical and surgical management were the main outcome measures. Demographic, preoperative, intraoperative, and postoperative parameters including the age of the patient, etiology of retinal detachment, refractive status, pre-existing glaucoma, aphakia, diabetes mellitus, presence of silicone oil (SO) in the anterior chamber, emulsification of SO, rubeosis iridis, and anatomic success were evaluated by univariate and multivariate logistic regression analyses to assess their predictive value in the causation of glaucoma and to determine factors prognosticating response to treatment. RESULTS: The main indications for PPV+SOI were proliferative vitreoretinopathy (57%; 85 of 150), proliferative diabetic retinopathy (15%; 23 of 150), and trauma (14%, 21 of 150). Glaucoma occurred in 60 eyes (40%) at 14 days median (range, 1 day-18 months). Elevation of IOP could be attributed directly to SO in 42 (70%) eyes. Glaucoma was controlled in 43 (72%) of 60 eyes on treatment (with medicines alone in 30%; SOR and medicines in 25%; trabeculectomy with mitomycin C/ACTSEB/cyclocryotherapy or TSCPC in 17%); 28% (17 of 60) remained refractory. Independent predictive factors for glaucoma on multivariate analysis were rubeosis iridis (odds ratio, 10.76), aphakia (odds ratio, 9.83), diabetes (odds ratio, 6.03), SO in anterior chamber (odds ratio, 4.74), and anatomic failure (negative risk factor; odds ratio, 0.11). Poor prognostic factors for the control of glaucoma were SO emulsification (odds ratio, 15.34) and diabetes (odds ratio, 6.03). CONCLUSION: Glaucoma is a frequent and often a refractory complication of PPV with SOI and has a multifactorial etiology. Aggressive medical and surgical management with SOR, trabeculectomy with mitomycin C, glaucoma shunts, and cyclodestructive procedures shows modest success in controlling IOP.

Adolescent↗

PubMed1984

Bilateral retinal detachment in a case of Reiter's disease.

A patient is described who developed co-existent Reiter's disease and bilateral non-traumatic retinal detachment. Although numerous ophthalmological disorders are associated with Reiter's disease and HLA-B27, to our knowledge this is the first report of co-existent retinal detachment. Although this relationship may be fortuitous, there are a number of immunological mechanisms common to both entities. Retinal detachment, unlike bilateral conjunctivitis and acute anterior uveitis, may be clinically asymptomatic and its sequelae prevented by appropriate ophthalmological assessment.

Adult↗

PubMed2004

Assessment of delays in presentation of patients with retinal detachment to a tertiary referral centre.

The referral pathway of patients with retinal detachment from primary care providers to a tertiary care ophthalmic unit was examined, in order to determine the length and source of any delays between the onset of symptoms and arrival at the hospital. A prospective survey of all symptomatic patients (n = 60) admitted for primary rhegmatogenous retinal detachment surgery was carried out over an 8 week period. Twenty-one patients were referred by their optometrists and 18 by their general practitioners. The remainder were referred by local accident and emergency and ophthalmic departments or presented directly to the tertiary referral centre. Patients who presented to their optometrists were symptomatic for an average of four times longer. More than half the patients thought that the time to initial presentation was the most significant delay. Referral from optometrists via general practitioners and local ophthalmic clinics was considerably longer. Increased awareness of symptoms, necessity of urgent referral and knowledge of available services locally may reduce delay for those who require emergency sight-saving surgery.

Adolescent↗

PubMed2001

[Fourier analysis of macular local electroretinogram in retinal detachment].

OBJECTIVE: To understand the sites and physiological characteristics of macular dysfunction in retinal detachment (RD) by evaluating fundamental harmonic (1f) and second harmonic (2f) components of flicker local electroretinogram (LERG). METHODS: LERG were recorded in 128 eyes of 120 patients to a flicker sinusoidally to 31Hz with a hand-held stimulator with direct visualization of the fundus through dilated pupils. RESULTS: Compared to controls, patients showed losses of both fundamental and second harmonic amplitudes. The abnormality rates of fundamental amplitude in groups with RD affected time < 1 weeks, 1 approximately weeks, 2 approximately weeks, 4 approximately weeks and > 8 weeks were 15%, 25%, 47%, 76% and 91% respectively; and the abnormality of rates fundamental-second harmonic amplitude ratios (1f/2f) were 5%, 14%, 28%, 64% and 87% respectively. On average, 2f decreased more quikly than 1f and 1f/2f tended to increase with the course of disease. The results show both 1f and 2f descend in the RD eyes with or no macular detachment (P < 0.05). 2f just descend obviously in the 48 macular detachment eyes (P < 0.01), so that 1f/2f ascend in these eyes(P < 0.05). There was a significant relation between amplitudes of LERG in the detached eyes before surgery and best postoperational correct vision in the attached eyes. CONCLUSION: In the eyes with retinal detachment, both receptoral and postreceptoral sites contribute to macular dysfunction. The level of macular dysfunction in the eyes with or no macular detachment is different. It would be of clinical value to obtain a fundamental-second harmonic ratio in order to assess the disturbance in the different site of macular. In our opinion: macular flicker local electroretinogram is an important indicator of prognosis to the functional recovery of the attached eye after corrective surgery.

Adolescent↗

PubMed2000

Photoreceptor-specific expression of platelet-derived growth factor-B results in traction retinal detachment.

Expression of platelet-derived growth factor (PDGF)-A and PDGF-B is increased in patients with proliferative retinopathies in which traction retinal detachments occur. Previous studies have demonstrated that increased expression of PDGF-A in the retina of transgenic mice results in retinal gliosis due to proliferation of astrocytes with different retinal phenotypes based on the time of onset and location of the PDGF-A production. In this study, we investigated the effects of PDGF-B in the retina using gain-of-function transgenic mice that express PDGF-B in photoreceptors. These mice show proliferation of astrocytes, pericytes, and, to a lesser extent, endothelial cells, resulting in ectopic cells on the surface and extending into the retina. The sheets of cells exert traction on the retina resulting in traction retinal detachments similar to those seen in humans with proliferative retinopathies. These studies suggest that PDGF-B has more dramatic effects in the retina than PDGF-A, because it acts on additional cell types, in particular on pericytes, which have a highly developed contractile apparatus. These studies in the retina suggest a means that could be used in other tissues throughout the body to achieve graded PDGF effects. They also provide a new model of traction retinal detachment that can be used to investigate new treatments for patients with proliferative retinopathies.

Animals↗

PubMed2005

Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air.

OBJECTIVE: To determine the role of pars plana vitrectomy without scleral buckling and air as a tamponade with 24 hours of prone positioning in the management of inferior breaks in primary pseudophakic rhegmatogenous retinal detachment. METHODS: Prospective, noncomparative, interventional case series. Fifteen consecutive eyes (15 patients) with primary pseudophakic rhegmatogenous retinal detachment with causative breaks located between the 4-o'clock and 8-o'clock positions underwent pars plana vitrectomy with air tamponade. The prone position was maintained for 24 hours. Anatomic and functional results are presented. RESULTS: The anatomic reattachment rate was 93.3% after 1 procedure and 100% at the 6-month visit. Mean preoperative best-corrected visual acuity was 20/60 (range, 20/400 to 20/25) and mean postoperative best-corrected visual acuity was 20/30 (range, 20/100 to 20/20). In 1 case the retina redetached at the second week because of an undetected break. Postoperative epiretinal membrane was observed in 1 case. CONCLUSION: Pars plana vitrectomy and air tamponade with only 24 hours of prone positioning postoperatively is effective in the management of primary pseudophakic rhegmatogenous retinal detachment with causative breaks between the 4-o'clock and 8-o'clock positions.

Adult↗

PubMed1984

[Retinal detachment in children and adolescents].

During a 4-year period 22 eyes with rhegmatogenous retinal detachment in children and young adults up to 20 years of age were operated on. This group comprised 6.3 percent of all rhegmatogenous retinal detachments operated on during the same period. In 9 eyes (40.9%) the detachment was due to a direct ocular trauma. In the remaining cases the main etiological factors were: myopia with or without lattice degeneration (5 eyes), retinopathy of prematurity (2 eyes), hereditary vitreoretinal degeneration (1 eye), uveal coloboma (2 eyes), aphakia after congenital cataract (1 eye), sex-linked juvenile retinoschisis (1 eye), and central retinal vein occlusion (1 eye), Conventional surgical procedures using episcleral or intrascleral implants or an encircling band combined with cryotherapy were used. After a follow-up of 7 months to 3.3 years (mean 1.5 years) the retina was flat in 18 cases (82%) and still detached in those with uveal coloboma (2 eyes), hereditary vitreoretinal degeneration (1 eye), and central retinal vein occlusion (1 eye). All traumatic detachments were flat.

Adolescent↗

PubMed1994

A masked prospective evaluation of outcome parameters for cytomegalovirus-related retinal detachment surgery in patients with acquired immune deficiency syndrome.

PURPOSE: The management of cytomegalovirus (CMV)-related rhegmatogenous retinal detachments in patients with acquired immune deficiency syndrome (AIDS) has been the subject of recent attention and controversy because of the high degree of variability in visual outcome, as well as significant differences in the reported incidence of profound postoperative optic atrophy. This study was designed to evaluate the various parameters affecting postoperative visual outcome, and to quantitate the degree of postoperative optic disc pallor. METHODS: The results of 65 consecutive surgeries for CMV-related retinal detachments in 51 patients with AIDS were prospectively studied. Postoperative vision, survival, optic disc pallor, and retinitis extent were analyzed. Serial photographs of optic discs underwent masked evaluation. RESULTS: Mean postoperative survival was 30 weeks (range, 2-146 weeks). Mean best postoperative visual acuity was 20/66 (range, 20/20-2/200) and mean final postoperative visual acuity was 20/100 (range, 20/25-no light perception). Analysis of visual outcome for eyes with no macular or papillo-macular retinitis showed a best postoperative visual acuity of 20/60 (range, 20/25-2/200) and mean final postoperative visual acuity of 20/80 (range, 20/25-no light perception). Postoperative vision was not affected by the presence of a preoperative macular detachment, with both groups (macula on or off detachments), achieving a best postoperative visual acuity of 20/60 in the absence of macular retinitis. Mild postoperative optic disc pallor was observed in 30% of surgical eyes at the final postoperative visit, and moderate pallor was noted in 13%. The mean degree of optic disc pallor was not different from the degree of optic disc pallor seen in fellow, nonsurgical eyes with CMV retinitis (surgical versus fellow nonsurgical eyes, 29% +/- 23% versus 26% +/- 30%; P = 0.64). CONCLUSION: In this largest reported series of reattachment surgery for CMV-related retinal detachments, patients are experiencing increased postoperative survival, good vision, and relative optic nerve health.

AIDS-Related Opportunistic Infections↗

PubMed1983

Erosion of implants in retinal detachment surgery.

We analyzed erosion of intrascleral implants in 728 eyes that underwent scleral buckling procedures for retinal detachment surgery over the past 25 years. Types of implants included polyethylene tubes, solid silicone implants with and without silicone circling bands, and gelatin implants. The use of solid silicone implants and circling bands rather than polyethylene tubes has greatly reduced, but not eliminated, the problem of erosion. Erosion occurred in 62.3% of eyes with polyethylene tubes and in 3.8% of eyes with solid silicone implants with silicone circling bands. Factors associated with erosion included thin sclera, multiple operations, and glaucoma. Complications resulting from erosion were subretinal and vitreous hemorrhage, retinal detachment, and phthisis bulbi. Erosion is a problem that may appear up to 21 years after the scleral buckling procedure. The great number of retinal detachment repairs performed over the past 25 years make erosion of the intrascleral implant a concern of ophthalmologists today and a continued problem for the future.

Biodegradation, Environmental↗

PubMed1980

Ultrastructure of traction retinal detachment in rhesus monkey eyes after a posterior penetrating ocular injury.

We studied the ultrastructural characteristics of an experimental model of traction retinal detachment secondary to a penetrating eye injury in the rhesus monkey. Cells with the characteristics of myofibroblasts were present in the intravitreal fibrous tissue and in epiretinal membranes. These cells were probably derived from many sources, and were capable of contraction through the mechanism of intracytoplasmic contractile proteins such as actin or myosin. The morphologic observations supported our hypothesis that traction retinal detachment is a cell-mediated event analogous to the processes of wound healing and wound contraction. The force of contraction is mediated by cell-to-cell and cell-to-vitreous connections and by glial bridges that connect epiretinal membranes to the retina. These ultrastructural studies, which provide insight into the pathogenesis of traction retinal detachment in the experimental animal model, may well have significant clinical relevance.

Animals↗

PubMedDate not supplied

Perfluoro-N-octane (PFO) in the repair of complicated retinal detachments due to severe proliferative diabetic retinopathy.

PURPOSE: To report our experience with perfluoro-N-octane (PFO) in the surgical management of complicated retinal detachments due to proliferative diabetic retinopathy. METHODS: Retrospective review of 18 consecutive eyes of 18 patients with tractional or combined tractional and rhegmatogenous retinal detachments due to severe proliferative diabetic retinopathy managed by pars plana vitrectomy and the intraoperative use of PFO. Preoperative characteristics, intraoperative findings and procedures and postoperative results were recorded. RESULTS: The mean preoperative acuity was 2/200 (range, 20/25 to light perception). The mean final visual acuity was 4/200 (range, 20/20 to no light perception). With a mean follow-up of 6 months, there was an 89% anatomic reattachment rate at the last visit and visual acuity was stable or improved in 72% of eyes. CONCLUSIONS: In our experience, PFO is a helpful surgical adjunct in the anatomic reattachment of tractional or combined tractional and rhegmatogenous diabetic retinal detachments. Visual acuity was stabilized or improved in the majority of eyes.

Adult↗

PubMedDate not supplied

[Miragel in surgery of retinal detachment].

The authors presented results of the surgical treatment of 33 patients with retinal detachment, in whom Miragel implants were used for scleral buckling. The studies have confirmed that Miragel is a very good material for retinal detachment surgery and its application on a larger scale is recommended.

Adolescent↗

PubMed1998

Use of silicone oil in the treatment of complicated retinal detachment: results from 1981 to 1994.

PURPOSE: To evaluate the advantages and disadvantages of the retention and removal of silicone oil in the treatment of complicated retinal detachments. METHODS: The records of 344 patients (348 eyes) that underwent vitrectomy and silicone oil injection for complicated retinal detachments were abstracted and analysed. The anatomical and functional results, complications and influencing factors are discussed. The outcome in eyes after removal of the silicone oil was compared with the outcome in a comparable group of eyes in which the silicone oil was retained. RESULTS: The overall retinal reattachment rate was 63% (220/348). The final vision of 5/300 or better was 52% (115/220) in those eyes with totally attached retinas. The silicone oil-related complications included keratopathy (23%) and secondary glaucoma (11%). Comparing removal of silicone oil with retention of silicone oil, we found: (i) there was no statistical difference in the redetachment rate (19 vs 17%); (ii) oil-removed eyes had a better final vision (P < 0.05); and (ii) keratopathy (13 vs 23%), secondary glaucoma (11 vs 25%) and optic nerve atrophy (4 vs 18%) were significantly lower in oil-removed eyes. CONCLUSION: Silicone oil injection is useful in the treatment of complicated retinal detachments. For reducing the incidence of complications, early removal of silicone oil is recommended in those cases in which the retina is attached, all breaks adequately closed and traction relieved.

Adolescent↗

PubMed1987

Effect of silicone oil on experimental traction retinal detachment.

The use of silicone oil as a retinal tamponade in the treatment of proliferative vitreoretinopathy is often complicated by membrane reproliferation. We studied the development of traction retinal detachments following the intravitreal injection of 15,000 retinal pigment epithelial cells in silicone-, perfluoropropane-, and fluid-filled rabbit eyes. By 28 days a higher proportion of silicone-filled eyes (83%) had severe proliferative vitreoretinopathy than either the perfluoropropane-filled (30%) or fluid-filled (10%) eyes. An in vitro proliferation assay using the vitreous samples showed that the silicone-filled vitreous had increased mitogenic activity for retinal pigment epithelial cells compared with the gas-filled or fluid-filled vitreous. Silicone oil appears to increase proliferation by stimulating the release of more or different mitogenic factors as well as by concentrating active factors into a smaller volume near the retina.

Animals↗

PubMed1984

Prevention of aphakic retinal detachment by retinocryocoagulation.

A retrospective study of 36 second eyes with cataract, who have undergone prophylactic retinocryocoagulation prior to cataract extraction, is presented. All 36 patients suffered an aphakic retinal detachment in the first eye in the past. Postoperative complications included iritis, transient cycloplegia and retinal hemorrhages; two patients developed retinal tears following cataract surgery. During the average followup period of 8.4 years, no retinal detachment occurred among this group of patients. This study strongly supports the value of preventive treatment (retinocryocoagulation) of the second eyes prior to cataract extraction, which have a high risk of aphakic retinal detachment.

Aphakia, Postcataract↗

PubMed2007

Results of high-density silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia.

BACKGROUND: To evaluate the use of high-density silicone oil (HDSO) as a tamponade agent for retinal detachment secondary to myopic macular hole. METHODS: 12 eyes of 12 patients with macular hole retinal detachment underwent pars plana vitrectomy, internal limiting membrane peeling and HDSO tamponade. No posturing was required postoperatively and HDSO was removed 3-4 months later. Outcome measures included macular hole closure and retinal attachment rates, best-corrected visual acuity (BCVA), and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 67.8 years and the mean spherical equivalent refractive error was -13.4 diopters. After the removal of HDSO, 10 (83%) eyes had macular hole closure with retinal reattachment without any tamponade. One eye had retinal reattachment after re-operation and the other refused further surgery. At the last follow-up, the median BCVA improved from 20/800 to 20/600 (p = 0.046). A transient increase in intraocular pressure was observed in 5 (42%) eyes and one eye each developed mild oil emulsification and transient peripheral choroidal detachment. None of the eyes was found to have severe intraocular inflammation postoperatively. CONCLUSIONS: HDSO seemed to be an effective tamponade agent for myopic macular hole retinal detachment. Further prospective controlled studies seem warranted.

Aged↗

PubMed2004

Use of silicone oil in the management of complex retinal detachment--an Indian experience.

BACKGROUND AND OBJECTIVE: In the management of complicated retinal detachments (RD), temporary silicone oil tamponade has been increasingly used. This study reports results and complications of temporary silicone oil tamponade that was used to treat complicated RD associated with multiple etiologies. MATERIALS AND METHODS: Between 1988 and 1998, a total of four thousand four hundred and eighty-eight (4488) eyes underwent vitreous surgery and silicone oil tamponade. Outcome measures were: anatomic and functional success and postoperative complications such as cataract, corneal changes, hypotony, and glaucoma. An eye was considered an anatomic success if there was a complete retinal reattachment or macular attachment. Functional success was defined as attainment of visual acuity of 5/200 or better. Multiple logistic regression analysis was performed to elucidate the relationship between various pre- and postoperative variables and outcome measures. Mean follow-up was 17 months, and median, 8 months. RESULTS: Overall, anatomic success was achieved in 73% of the eyes, and functional success, in 47%. After removal of silicone oil, recurrence of retinal detachment was observed in 9% of the eyes; a high percentage (70%) of eyes attained functional success. Postoperative cataract was observed in 65.3%, abnormal corneas in 21.3%, hypotony in 16.9%, and glaucoma in 16.4% of the eyes. CONCLUSIONS: Despite the onset of complications related to silicone oil usage, a high rate of reattachment of the retina was observed following vitrectomy and silicone oil tamponade in the management of complex RD associated with multiple etiologies.

Adult↗