Vitreoretinal

2014 ◽  
pp. 475-514
Author(s):  
Alastair K.O. Denniston ◽  
Philip I. Murray
Keyword(s):  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Epiretinal Membranes ◽  
Anatomy And Physiology ◽  
Retinal Degenerations ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Clinical Presentations ◽  
Vitreoretinal Disease ◽  
Wide Range

‘Vitreoretinal’ provides the reader with a practical approach to the assessment and management of vitreoretinal disease. After outlining the relevant anatomy and physiology of the relevant structures, the chapter addresses the key clinical presentations arising from vitreoretinal disease, notably peripheral retinal degenerations, retinal breaks, posterior vitreous detachment, retinal detachment (rhegmatogenous, tractional and exudative), retinoschisis, epiretinal membranes, macular holes and a wide range of rarer conditions. Using a patient-centred approach the key clinical features, investigations and treatment (medical and surgical) are described for each condition.

Vitreoretinal

2018 ◽  
pp. 521-567
Keyword(s):  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Epiretinal Membranes ◽  
Anatomy And Physiology ◽  
Retinal Degenerations ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Clinical Presentations ◽  
Vitreoretinal Disease ◽  
Wide Range

‘Vitreoretinal’ provides the reader with a practical approach to the assessment and management of vitreoretinal disease. After outlining the relevant anatomy and physiology of the relevant structures, the chapter addresses the key clinical presentations arising from vitreoretinal disease, notably peripheral retinal degenerations, retinal breaks, posterior vitreous detachment, retinal detachment (rhegmatogenous, tractional and exudative), retinoschisis, epiretinal membranes, macular holes and a wide range of rarer conditions. Using a patient-centred approach the key clinical features, investigations and treatment (medical and surgical) are described for each condition.

scholarly journals Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Matteo Forlini ◽  
Purva Date ◽  
Domenico D’Eliseo ◽  
Paolo Rossini ◽  
Adriana Bratu ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Epiretinal Membrane ◽  
Posterior Vitreous Detachment ◽  
Multicenter Trial ◽  
Study Data ◽  
Surgical Time ◽  
Epiretinal Membranes ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Group A

Purpose. To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. Methods. In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. Results. We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p = 0.49 ). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group ( p = 0.22 ). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences ( p = 0.18 ). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group ( p < 0.001 ). Conclusion. A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

Prevention of Retinal Detachment

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
High Risk ◽  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Vitreous Hemorrhage ◽  
Evidence Base ◽  
Asymptomatic Patients ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Uncommon Disease ◽  
History Of

Retinal detachment is an uncommon disease, affecting approximately 1 in 10,000 people in the general population per year. However, the incidence of retinal breaks is relatively high, affecting 5% to 7% of the population. Obviously, many retinal breaks have minimal, if any, risk for the possible development of a retinal detachment. This includes macular holes that occur as a degenerative process, and asymptomatic, small, round atrophic holes near the ora serrata. However, equatorial horseshoe tears with relevant symptoms progress to retinal detachment in most cases. Probably all surgeons would agree that a large horseshoe tear near the equator in the superior temporal quadrant, with new-onset symptoms of fl ashes and fl oaters and associated vitreous hemorrhage, should be treated prophylactically to avoid retinal detachment. In contrast, most would not advise treatment of a small, round atrophic hole near the inferior ora serrata in an asymptomatic patient with no history of prior detachment. Between these two obvious examples lies a broad spectrum of retinal breaks for which the surgeon must exercise judgment about instituting prophylactic treatment. Most of the breaks reported in surveys of asymptomatic patients or in autopsy series are of the atrophic type, and only a small proportion are horseshoe tears. Although there are no specific rules for the selection of patients for treatment, and each case has to be judged on its own characteristics, the application of evidencebased medicine to this topic has modified the opinions of many regarding the genuine value of prophylactic therapy for most retinal breaks. The American Academy of Ophthalmology has used this approach in developing a Preferred Practice Pattern (PPP) entitled “Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration,” the latest version of which was published in 2008. The evidence base described in this PPP will be employed in the following discussion. Characteristics associated with a relatively high risk of retinal detachment in an eye with visible retinal breaks are listed in Table 6–1. Symptoms and signs of PVD place an eye at particularly high risk. Additional factors include a variety of hereditary, congenital, acquired, and iatrogenic problems.

scholarly journals Spectral Domain Optical Coherence Tomography in the Diagnosis and Management of Vitreoretinal Interface Pathologies

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Yoreh Barak ◽  
Mark A. Ihnen ◽  
Shlomit Schaal
Keyword(s):  
Optical Coherence Tomography ◽  
Image Interpretation ◽  
Posterior Vitreous Detachment ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Vitreoretinal Interface ◽  
Epiretinal Membranes ◽  
Macular Holes ◽  
Practice Knowledge ◽  
Sd Oct

The introduction of spectral domain optical coherence tomography (SD-OCT) has enhanced Vitreoretinal Interface (VRI) imaging considerably and facilitated the diagnosis, followup, prognosis determination, and management of VRI-associated pathologies. HR-OCT became a common practical tool seen in almost every ophthalmology practice. Knowledge of SD-OCT image interpretation and recognition of pathologies are required for all ophthalmologists. This paper methodically reviews the normal aging process of the VRI and discusses several commonly encountered VRI pathologies. The role of SD-OCT imaging in VRI-associated disorders such as posterior vitreous detachment, vitreomacular traction syndrome, idiopathic epiretinal membranes, lamellar holes, pseudoholes, and full thickness macular holes is portrayed. Future perspectives of new OCT technologies based on SD-OCT are discussed.

Vitreous Changes and Retinal Detachment in Highly Myopic Eyes

1996 ◽  
Vol 6 (1) ◽  
pp. 50-58 ◽  
Author(s):  
M. Stirpe ◽  
K. Heimann
Keyword(s):  
Retinal Detachment ◽  
Vitreoretinal Surgery ◽  
Vitreoretinal Interface ◽  
Clinical Appearance ◽  
Giant Retinal Tear ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Group A ◽  
Smooth Membrane ◽  
Group 2

This report on 496 highly myopic eyes that underwent transcleral or vitreoretinal surgery for retinal detachment (RD) focuses particularly on how changes in the vitreous gel and the resulting modifications of the vitreoretinal interface produce typical characteristics and complications. According to the pattern of vitreous modifications the 496 eyes were divided into five groups: 1) eyes with uniform PVD (108 eyes) 2) eyes with PVD spreading towards the upper quadrants (231 eyes) 3) eyes with extensive vitreous liquefaction (EVL) and condensations of the vitreous base (51 eyes) 4) eyes with posterior vitreous lacuna (PVL, 87 eyes) 5) eyes with very limited PVD (19 eyes). Age, degree of myopia, surgical procedures and final results are reported for each group. A strong correlation was observed between vitreous changes and clinical picture of RD especially in the group of PVL and EVL. In the PVL group a higher degree of myopia was found and more pronounced posterior staphyloma. Frequently the posterior hyaloid, in the form of a thin, extremely smooth membrane, was hard to separate from the inner posterior retina during surgery. Posterior retinal breaks, including macular holes, were found in 56% of eyes. The presence of EVL with condensation of the vitreous base was correlated with giant retinal tear (GRT) in 70% of cases (36 of 51 eyes). Sixteen GRT were also found in the group of uniform PVD, but these were less extensive and located more posteriorly than in the EVL group. In the former group there were better surgical results because of a lower incidence of PVR. In 46% of the eyes of our series (group 2), PVD extended mostly in the upper quadrants with no vitreous detachment inferiorly. In these cases there was a clinical appearance of inferior vitreous collapse. These eyes had 92% of peripheral superior retinal breaks. Relapses of RD in this group almost invariably occurred in the inferior quadrants.

scholarly journals Retinal Complications Associated With Pars Plana Vitrectomy for Macular Holes or Epiretinal Membranes in Eyes With Previous Retinal Detachment Repair

2014 ◽  
Vol 132 (1) ◽  
pp. 118 ◽  
Author(s):  
Ravi S. J. Singh ◽  
Douglas J. Covert ◽  
Christopher R. Henry ◽  
Sandeep K. Bhatia ◽  
Jason Croskrey ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Epiretinal Membranes ◽  
Macular Holes ◽  
Pars Plana ◽  
Retinal Complications

History of Surgery for Retinal Detachment

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Subretinal Fluid ◽  
Diagnostic Technique ◽  
History Of Ophthalmology ◽  
Subretinal Space ◽  
Retinal Breaks ◽  
History Of ◽  
Clinical Description ◽  
Indirect Ophthalmoscope

The evolution of the retinal reattachment operation is one of the most remarkable chapters in the history of ophthalmology. Gonin’s operation for repair of the detached retina ranks with Daviel’s cataract extraction, von Graefe’s peripheral iridectomy, and Machemer’s vitrectomy as one of history’s most important surgical treatments for blinding eye diseases. The entity of retinal detachment was recognized early in the eighteenth century by de Saint-Yves, who reported the gross pathologic examination of an eye with a detached retina. The first clinical description did not appear until almost a century later, in 1817, when Beer detected a retinal detachment without the benefit of an ophthalmoscope. Von Helmholtz’s invention of the direct ophthalmoscope in 1851 was a giant step forward in diagnostic technique, and a rapid succession of ophthalmoscopic observations of retinal detachments soon followed. In the same year, Coccius reported the ophthalmoscopic detection of breaks in the detached retina. Von Graefe theorized in 1858 that retinal detachment was caused by a serous effusion from the choroid into the subretinal space. When he observed a retinal break, he assumed that it was secondary to the detachment and represented the eye’s attempt to cure itself. Supposing that the development of a break would allow the subretinal fluid to pass from the subretinal space into the vitreous cavity, he attempted unsuccessfully to treat detachments with deliberate incision of the retina. Girard-Teulon invented the reflecting binocular indirect ophthalmoscope in 1861. This potentially important contribution was generally overlooked by the profession, and more than 80 years transpired before Schepens developed the selfilluminating binocular indirect ophthalmoscope. In 1869 Iwanoff described the entity of posterior vitreous detachment, which is now recognized as a prerequisite to the development of most retinal detachments. The following year de Wecker suggested that retinal breaks cause detachment due to the resultant passage of vitreous fluid through the break into the subretinal space. Unfortunately, his accurate interpretation was not generally accepted. In 1882 Leber reported his observation of retinal breaks in 14 of 27 retinal detachments, and he correctly inferred the role of vitreous traction in the pathogenesis of breaks. Unfortunately, he later altered this opinion.

scholarly journals Complications of Macular Peeling

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Mónica Asencio-Duran ◽  
Beatriz Manzano-Muñoz ◽  
José Luis Vallejo-García ◽  
Jesús García-Martínez
Keyword(s):  
Diabetic Retinopathy ◽  
Retinal Detachment ◽  
Surgical Technique ◽  
Macular Edema ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Epiretinal Membranes ◽  
Macular Holes ◽  
Retinal Disorders

Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications.

scholarly journals Case Report of a Family Affected by Stickler Syndrome in Which Rhegmatogenous Retinal Detachment Occurred in Five Eyes of Three Siblings

2018 ◽  
Vol 9 (1) ◽  
pp. 1-8
Author(s):  
Daisaku Kimura ◽  
Takaki Sato ◽  
Shou Oosuka ◽  
Ryohsuke Kohmoto ◽  
Masanori Fukumoto ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Case Series ◽  
Postoperative Outcome ◽  
Scleral Buckling ◽  
Stickler Syndrome ◽  
Single Family ◽  
Vitreous Surgery ◽  
Retinal Breaks

Purpose: Stickler syndrome is an autosomal dominant inherited disorder that is well known to be highly associated with the development of rhegmatogenous retinal detachment. In this study, we report the case of a family affected by Stickler syndrome in which rhegmatogenous retinal detachment developed in 5 eyes of 3 siblings. Case Series: For treatment, we performed vitreous surgery on 1 eye of the eldest son, and bilateral scleral buckling surgery on the 2 younger children. A good postoperative outcome was obtained on the 4 eyes that underwent scleral buckling surgery, yet the prognosis was poor on the 1 eye that underwent vitrectomy due to redetachment of the retina and corneal complication. Since vitreous surgery was quite difficult due to strong vitreoretinal adhesion, we created an artificial posterior vitreous detachment via the bimanual technique combined with encircling. For the scleral buckling surgery, broad scleral extrusion was needed to seal multiple retinal breaks. Conclusions: The findings of this study showed a high prevalence of rhegmatogenous retinal detachment in a single family with Stickler syndrome. In these cases, scleral buckling surgery was effective for treating the detached retina, and some prophylactic treatment, such as laser photocoagulation to prevent the occurrence of rhegmatogenous retinal detachment, should be considered for such cases in the future.

scholarly journals Incidence and Risk Factors of Iatrogenic Retinal Breaks: 20-Gauge versus 25-Gauge Vitrectomy for Idiopathic Macular Hole Repair

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Norio Fujiwara ◽  
Goji Tomita ◽  
Fumihiko Yagi
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Gauge Group ◽  
Posterior Vitreous Detachment ◽  
Idiopathic Macular Hole ◽  
Gauge Groups ◽  
Vitreous Detachment ◽  
Retinal Breaks ◽  
Lattice Degeneration ◽  
25 Gauge Vitrectomy

Purpose. We compared the incidences of iatrogenic retinal breaks and postoperative retinal detachment between eyes that underwent 20-gauge vitrectomy and those that underwent 25-gauge vitrectomy for idiopathic macular hole repair. Methods. This retrospective nonrandomized consecutive observational case series included 185 eyes of 183 patients (130 eyes of 129 patients and 55 eyes of 54 patients in the 20- and 25-gauge groups, respectively). We assessed the relationship between the incidence of retinal breaks and postoperative retinal detachment and related this to posterior vitreous detachment and lattice degeneration. Results. The incidences of iatrogenic retinal breaks were 36.9% and 12.7% in the 20-gauge and 25-gauge groups, respectively. These groups did not differ in their respective frequencies of posterior vitreous detachment (the 20-gauge group: 31.5% and the 25-gauge group: 27.3%) and lattice degeneration (the 20-gauge group: 14.6% and the 25-gauge group: 7.3%). Among eyes without lattice degeneration, the 20-gauge group showed a higher incidence of iatrogenic retinal breaks than the 25-gauge group. However, among the eyes with lattice degeneration, the frequency of retinal breaks did not differ between the two surgery types, and four cases of postoperative retinal detachment were reported in both groups. Conclusions. The incidence of retinal breaks related to idiopathic macular hole surgery is higher among patients undergoing 20-gauge vitrectomy than among those undergoing 25-gauge vitrectomy. Posterior vitreous detachment and lattice degeneration are associated with considerably increased incidences of retinal break.

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