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At least 145 records · Page 8Linked to original sources
PubMed2003

Rhegmatogenous retinal detachment in the fellow phakic eyes of patients with pseudophakic rhegmatogenous retinal detachment.

PURPOSE: To determine the risk and clinical characteristics of rhegmatogenous retinal detachment (RD) in the fellow phakic eyes of patients with a pseudophakic retinal detachment (PPRD) in one eye. METHODS: The authors conducted a computer-generated chart review to find 64 consecutive patients with a PPRD in one eye and were phakic in the fellow eye. The clinical information was collected on all patients to investigate the risk and clinical characteristics of RD in the fellow eyes while still phakic. Information was also obtained on the fellow eyes that underwent cataract surgery and developed a PPRD. RESULTS: Sixty-four patients with a PPRD in one eye were phakic in the fellow eye. During an average follow-up of 57.4 months, five (7.8%) fellow eyes developed retinal detachment while still phakic. In addition to the five eyes with a phakic RD, 10 originally phakic fellow eyes underwent cataract surgery. Of these, one (10%) suffered an RD. CONCLUSION: Fellow eyes of patients with a PPRD have a significant risk of RD even if they do not undergo cataract surgery.

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PubMed2005

Simultaneous bilateral exudative retinal detachment and peripheral necrotizing retinitis as presenting manifestations of concurrent HIV and syphilis infection.

PURPOSE: To describe an unusual case of simultaneous bilateral exudative retinal detachment and peripheral necrotizing retinitis as presenting manifestations of concurrent HIV and syphilis infection. CASE REPORT: A previously healthy 35-year-old Caucasian male was first seen for bilateral sudden visual loss. Ophthalmoscopy showed bilateral exudative retinal detachment involving the posterior pole and a placoid-like area of peripheral necrotizing retinitis in his left eye. Physical examination revealed anal condylomata and aphthous oral lesions. Laboratory investigations confirmed the diagnosis of concurrent HIV and syphilis infection. Ocular lesions resolved in response to anti-syphilitic medication administered for three weeks. DISCUSSION: This case demonstrates the importance of considering syphilis as a cause of atypical retinitis in the HIV-positive population.

Adult↗
PubMed1996

Combat eye injury: laser photocoagulation prophylaxis of retinal detachment.

Traumatic retinal detachment can occur in combat eye injuries and has numerous complications. We presume that the incidence would be much higher if we omitted to perform argon laser prophylactic treatment in cases of (1) traumatic retinal rupture, (2) retained retinal foreign body (before and after surgery), and (3) vitreoretinal proliferation with or without sector traction detachment. In these cases we performed a modified method of blockade with confluent, two-row laser spots, which proved to be more efficient clinically and formed stronger retina-choroid adhesions in experimental studies. In a total of 78 performed laser coagulations, retinal detachment occurred in three, all of them with already present traction retinal detachment.

Eye Foreign Bodies↗
PubMedDate not supplied

[Immunopathologic study of retinal detachment with vitreo-retinal proliferation].

Immunopathological studies were performed on biopsies or autopsies of pars plana samples from patients with retinal detachment, with or without vitreo-retinal proliferation. Immunoglobulins and complement deposits have been found in vitreo retinal proliferation, together with a deviant expression of HLA-DR and DQ antigens by pigmented epithelial cells of the ciliary body. Gamma interferon is able to induce this expression in vitro, and the inducing effect of this lymphokine and other mediators has been tested on pigment epithelium cultures. Cultured pigment epithelial cells expressed HLA-DR and DQ antigens after being stimulated by very low doses of gamma interferon. The precise target of this immune reaction is still impossible to determine, but its consequences could be the release of growth factors as FGF, which has been found at very high levels in pigmented and non pigmented cells of pars plana and ciliary processes. Our work asserts the existence of auto-immune phenomena in retinal detachment with vitreo-retinal proliferation as well as in proliferative diabetic retinopathy, their exact involvement remaining to determine.

HLA-DQ Antigens↗
PubMed1998

Cyanoacrylate glue in the repair of retinal detachment associated with posterior retinal breaks in infants and children.

PURPOSE: To share the authors' experience with cyanoacrylate glue in posterior retinal breaks associated with retinal detachments in infants and children. METHODS: A retrospective study was performed of four consecutive pediatric patients who underwent vitreoretinal surgery for retinal detachment associated with posterior retinal breaks, for which cyanoacrylate glue was used. RESULTS: In three of the four patients, successful retinal reattachment with visual function was achieved by vitreoretinal surgery and cyanoacrylate placed on the apposed edges of posterior retinal breaks or used to plug a break (postoperative follow-up was 1.5-2 years). In two successful cases, the glue was applied onto the break while the retina was detached, which resulted in closure of the retinal breaks and reattachment of the retina in both cases. CONCLUSIONS: Cyanoacrylate creates a permanent closure of retinal breaks and may be useful in select cases of infant retinal detachment with posterior retinal breaks in which current available treatment failed or would fail.

Administration, Topical↗
PubMed1995

Results of rhegmatogenous retinal detachment repair in cytomegalovirus retinitis with and without scleral buckling.

PURPOSE: To determine if scleral buckling is of any benefit in surgical repair of cytomegalovirus (CMV)-associated retinal detachment if combined with vitrectomy, silicone oil, and inferior midperipheral endolaser. MATERIALS AND METHODS: Twenty-two consecutive eyes with CMV-associated retinal detachments were repaired with vitrectomy and endolaser to all breaks and to the inferior midperipheral retina using silicone oil without scleral buckling (group 1, control group) between July 1987 and May 1992. Results were compared with another series of 56 consecutive eyes undergoing vitrectomy, silicone oil injection, endolaser to all breaks, and 360 degrees encircling scleral buckling (group 2, study group) between June 1992 and July 1993. RESULTS: Total retinal reattachment rates were 84% for group 1 and 86% for group 2. Rates of macular reattachment were 91% for group 1 and 91% for group 2. Mean best postoperative refracted visual acuity was 20/66 for group 1 and 20/67 for group 2. Median best postoperative refracted visual acuity was 20/74 for group 1 and 20/80 for group 2. These differences in results between the two groups were not statistically significant. Mean postoperative refractive error was +3.95 for group 1 and +4.92 for group 2. Patients who underwent surgery with the macula attached had a better postoperative visual outcome. CONCLUSION: Scleral buckling may not be necessary in CMV-related retinal detachment if repaired with vitrectomy, silicone oil, and inferior midperipheral endolaser. Elimination of scleral buckling may reduce intraoperative time, patient morbidity, and the risk of an accidental needle stick. Patients with macula-on retinal detachments also should be considered for surgery before macular detachment.

AIDS-Related Opportunistic Infections↗
PubMed1996

Cataract extraction after silicone oil repair of retinal detachments due to necrotizing retinitis.

Cataract is common after silicone oil repair of retinal detachment due to necrotizing retinitis in acquired immunodeficiency syndrome. Surgical management has not been reported. Twenty-two eyes of 19 patients were reviewed. The majority underwent phacoemulsification with a posterior chamber convexoplano implant without iridotomy Complications included capsular fibrosis and hyphema. Unpredictable refractions in the first 16 eyes prompted refinement of lens calculations and resulted in a reduction in refractive errors. A 3-step modification of intraocular lens calculations is recommended: (1) use of specific sound velocities to calculate axial length; (2) use of convexoplano lenses; and (3) addition of a constant to the lens power to compensate for the refractive index of silicone oil. Good surgical technique and accurate lens calculations should improve management of cataracts that arise after retinal detachment repair with silicone oil in patients with acquired immunodeficiency syndrome.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features, surgical techniques, and long-term results.

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.

Adult↗
PubMed1997

Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS (SOCA) Research Group in Collaboration with the AIDS Clinical Trials Group (ACTG).

PURPOSE: To determine the incidence and risk factors for rhegmatogenous retinal detachment in a population of patients with newly diagnosed cytomegalovirus retinitis. METHODS: Analysis of selected baseline and time-dependent data on patients enrolled in a multicenter, prospective, randomized, controlled clinical trial of therapy with foscarnet vs ganciclovir. RESULTS: In 316 eyes with cytomegalovirus retinitis at baseline, the risk of rhegmatogenous retinal detachment in an eye involved by cytomegalovirus retinitis was 18.9% at 6 months (95% confidence interval [CI], 14.0% to 23.8%) and 37.9% at 1 year (95% CI, 30.5% to 45.3%). Retinal detachment was not associated with the type of anticytomegalovirus therapy (intravenous foscarnet or ganciclovir) to which the patient was assigned. Extent of retinal involvement by cytomegalovirus retinitis, higher patient age, and lower CD4+ T-cell counts were associated with an increased risk of retinal detachment; myopia was not. CONCLUSIONS: Retinal detachment in patients with cytomegalovirus retinitis is unrelated to the type of intravenous therapy used or to refractive error. The median time to retinal detachment in an involved eye with cytomegalovirus retinitis and free of retinal detachment at baseline was 18.2 months. Strategies to reduce the extent of retinitis and possibly the number of reactivations may reduce the incidence of retinal detachment.

AIDS-Related Opportunistic Infections↗
PubMed2003

[Surgical treatment of complicated retinal detachment].

Treatment of retinal detachment advanced markedly during the 20th century. The surgical approach to rhegmatogenous retinal detachment was first established by Joules Gonin, and treatment of traction retinal detachment by vitrectomy was developed by Robert Machemer. Although favorable outcomes are obtained in most cases of retinal detachment using current vitreoretinal surgical techniques, several special types of complicated retinal detachment can be refractory to treatment. The biologic mechanism and the strategy for treatment of a complicated retinal detachment will be discussed in this lecture. A discrepancy in the length between the retina and the outer shell, specifically in the extension of the sclera or shortening of the retina, is commonly seen in refractory cases. To correct this, shortening of the sclera should be the primary treatment approach. Relaxing retinotomy should not be a primary procedure in most cases, since retinotomy encourages further shortening of the retina. Equal extension of the scleral wall is frequently seen in eyes with Marfan's syndrome, buphthalmos, and blue sclera, and the discrepancy is corrected by equal shortening of the sclera by encircling and not by focal shortening of the sclera. Unequal extension of the sclera occurs in posterior staphyloma in highly myopic eyes, morning glory syndrome, and posterior coloboma of the choroid. Focal expansion of the posterior sclera should be corrected by placement of a posterior buckle or circumferential lamellar scleral resection and shortening in the same quadrant. Circumferential surgical shortening of the sclera is also indicated in extreme shortening of the retina in congenital retinal folds with persistent fetal vasculature. In cases with associated retinal detachment with retinal folds, radial surgical shortening of the sclera or radial buckling of the sclera corresponding to the retinal fold is indicated, and retinotomy must be avoided. In comparison, in the presence of the retinal shortening and folding that develops postnatally in retinopathy of prematurity, familial exudative vitreoretinopathy, and incontinentia pigment, spontaneous release of the shortening can be expected following surgical removal of the preretinal fibrous tissue, and associated encircling procedures can be effective in selected cases. Inadequate surgical procedures such as creation of multiple iatrogenic retinal breaks to remove extensive subretinal tissue, excessive photocoagulation for retinal angiomatous lesions, and inadequate indications for vitrectomy to treat a special form of rhegmatogenous retinal detachment frequently result in the most complicated form of traction retinal detachment. A large circumferential retinotomy is beneficial rather than multiple small breaks. Penetrating diathermy through a lamellar scleral flap and encircling carries less risk of inducing traction retinal detachment compared with excessive photocoagulation. For oral breaks or ciliary epithelial breaks commonly seen with blunt ocular trauma or atopic dermatitis, a scleral implant more anterior to the extraocular muscle insertion combined with separate encircling is safer and more effective than primary vitrectomy.

Humans↗
PubMed1987

Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis.

Seventeen patients with the acquired immune deficiency syndrome and cytomegalovirus retinitis were treated with the antiviral drug ganciclovir (9-[1,3-dihydroxy-2-propoxy-methyl]-guanine, DHPG). Eight eyes of five patients developed rhegmatogenous retinal detachment after initiation of treatment. Multiple breaks in areas of peripheral, healed, atrophic retina accounted for the detachments. All seven eyes that underwent surgery had extensive retinal detachments that were reattached with vitrectomy and silicone oil. Retinotomy and retinal tacks were necessary in two cases that were complicated by severe proliferative vitreoretinopathy. In the fellow eye of one patient, laser treatment was used prophylactically to wall off a peripheral patch of healed retinitis. Endoretinal biopsies and culture were taken in five eyes; evidence of persistent cytomegalovirus was seen in two cases despite concurrent and clinically effective antiviral therapy.

AIDS-Related Complex↗
PubMed1994

Management of retinal detachments secondary to cytomegalovirus retinitis.

Nine patients with acquired immune deficiency syndrome underwent surgery for rhegmatogenous retinal detachments related to cytomegalovirus (CMV) retinitis. The patients were followed for at least 6 months or until death. Two patients with localized peripheral detachments for 3 to 4 clock hours or less initially underwent laser retinopexy. Although in both cases the treatment ultimately failed, one patient maintained 20/20 vision for 5 months. In four patients in whom the retinal detachment was more extensive but could be explained on the basis of a single or multiple well-defined peripheral break(s), a scleral buckle procedure was performed, with anatomic success in three, two of whom maintained 20/40 vision for 7 and 8 months. Six patients with retinal detachments associated with multiple atrophic holes that were not amenable to scleral buckling were treated with pars plana vitrectomy, air-fluid exchange and endolaser, with anatomic success in three; the visual acuity ranged from 20/30 to 20/400. One patient with failed pars plana vitrectomy underwent repeat vitrectomy with long-term internal tamponade by silicone oil, and he regained hand movements vision. We suggest a graduated approach to the management of retinal detachments secondary to CMV retinitis tailored to each patient based on the number and location of the retinal breaks, the extent of the detachment, the extent of necrotic retina and the overall health of the patient.

AIDS-Related Opportunistic Infections↗
PubMed1989

Pseudophakic retinal detachments. The relationships between retinal tears and the time following cataract surgery at which they occur.

The types and locations of retinal tears associated with 268 pseudophakic retinal detachments were studied as a function of the time at which they occurred following cataract surgery. Retinal detachments occurring more than two years following cataract extraction were significantly more likely to have their most posterior retinal break located at the posterior margin of the vitreous base than at or behind the equator. This distribution of tears was not observed in detachments occurring within six months of cataract surgery, with equatorial tears being significantly more common in early onset detachments than in those occurring after two years. The anterior tears which cause most retinal detachments long after cataract extraction are due to persistent chronic traction upon the vitreous base rather than to acute posterior vitreous detachment.

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