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.

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.

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.

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.

As-Needed Antihypertensive Therapy in Surgical Patients, Why and How: Challenging a Paradigm

2012 ◽  
Vol 78 (2) ◽  
pp. 250-253 ◽  
Author(s):  
Christopher P. Miller ◽  
Aaron M. Cook ◽  
D. Pharm ◽  
Christopher D. Case ◽  
Andrew C. Bernard
Keyword(s):  
Antihypertensive Therapy ◽  
Medical Center ◽  
Evidence Base ◽  
Prior History ◽  
Emergency General Surgery ◽  
University Of Kentucky ◽  
Asymptomatic Patients ◽  
History Of ◽  
Level I ◽  
The Cost

Hypertension is common in hospitalized patients and there are many causes. Some patients have no prior history of hypertension, few symptoms, and no apparent morbidity related to acute rises in blood pressure. Though there is no established guideline for therapy in these cases, patients often receive therapy directed at the abnormal vital sign. It is hypothesized that this practice is common and the associated costs are significant. Using the inpatient pharmacy database at the University of Kentucky Chandler Medical Center, a verified Level I trauma center and quaternary referral center, patients on the emergency general surgery or orthopedic surgery services receiving intravenous hydralazine, metoprolol, or labetalol were identified. Subjects were analyzed for indications, parameters, associated history of hypertension, and direct costs. Over the 4-month study period, 114 subjects received 522 drug doses. More than half (55%) of subjects had a prior history of hypertension but only 75 per cent were started on their home medication. Of those without hypertension before admission, 18 per cent required therapy at discharge. Labetalol was the most frequently used agent and total pharmacy costs for this cohort of patients was over $1200. Pro re nata (PRN), short-acting antihypertensive therapy has little evidence base in asymptomatic patients, but its prevalence is high on surgical services. The cost is significant, especially when extrapolated to the larger hospital population at this single institution. Further research is warranted to determine the prevalence of this practice in other centers or national regions, as well as its cost and benefit.

scholarly journals Globe Perforation During Peribulbar Anesthesia: Experience of Half a Million Consecutive Injections

2021 ◽  
Author(s):  
Naresh Babu ◽  
Jayant Kumar ◽  
Piyush Kohli ◽  
Ashish Ahuja ◽  
Prerna Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Vascular Complications ◽  
Vitreous Hemorrhage ◽  
Ocular Surgery ◽  
Retinal Breaks ◽  
Peribulbar Block ◽  
The Mean ◽  
Group 2 ◽  
Vascular Occlusions

Abstract Aim: To evaluate the risk factors, clinical presentation, management and outcome of inadvertent globe perforation during peribulbar anaesthesia.Methods: This retrospective study evaluated the medical records of all the patients treated for globe perforation secondary to peribulbar block preceding ocular surgery from 2012 to 2020. The patients were divided into three groups; Group 1 - clear media with no retinal detachment (RD); group 2 - vitreous hemorrhage (VH) without RD; and group 3 - RD with/without VH.Results: Twenty-five patients (25 eyes) were identified. The incidence of globe perforation was 0.002 %. The mean axial length (AL) was 24.7±2.7mm (Range, 20.9-31.2mm). Eleven eyes (45.8%) had AL≥24mm. The most common presenting features were VH (n=14), ocular hypotony (n=7) and RD (n=7). The treatment included laser photocoagulation for the retinal break(s) (n=7) and vitrectomy (n=17). Retinal breaks were identified in all the patients (total breaks, 37). Other complications included full-thickness macular hole (n=5), subretinal haemorrhage (n=4) and retinal vascular occlusions (n=4). Mean presenting best-corrected visual acuity (BCVA) in group 1,2 and 3 were logMAR 0.79±0.73, 1.82±0.78 and 2.13±0.59 respectively. All the patients, except one who did not undergo surgery due to advanced proliferative vitreoretinopathy, had an attached retina at the time of last follow-up. The mean final BCVA was logMAR 0.59±0.79, 0.48±0.26 and 1.25±0.64 respectively. Conclusion: Early intervention can help manage the eyes with inadvertent perforation successfully. The presence of retinal detachment, as well as macular and vascular complications are risk factors for poor prognosis.

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.

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 Ocular ultrasonography for detection of posterior segment pathology in adult patients presenting with blurred vision

2021 ◽  
Vol 25 (3) ◽  
pp. 610-618
Author(s):  
Suaad Musa ◽  
Medya Sedeq
Keyword(s):  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Vitreous Hemorrhage ◽  
Retinal Hemorrhage ◽  
Cross Sectional Study ◽  
Posterior Segment ◽  
Radiology Department ◽  
Medical Conditions ◽  
Blurred Vision ◽  
Cross Sectional

Background and objective: Ocular posterior segment lesions can affect individuals of both sexes at all ages. Such lesions can lead to serious manifestations such as retinal detachment and retinal hemorrhage, leading to permanent loss of eyesight. This study aimed to determine the association between age and gender and changes in ocular posterior segment based on ultrasonography findings. Methods: This prospective cross-sectional study included 50 patients with blurry vision who had been referred from ophthalmology outpatient clinics to the radiology department of Rizgary Teaching Hospital in Erbil, Kurdistan region in Iraq. Required data were collected using a researcher-designed questionnaire, and the patients were examined using a high resolution 7.5-10 MHz linear array ultrasound transducer. Results: The most frequent complications associated with ocular posterior segment pathologies were old vitreous hemorrhage (72%), posterior vitreous detachment (36%), and retinal detachment (34%). Diabetes and hypertension were the most frequent diseases associated with ocular posterior segment pathology. A significant association was seen between the patients' age with old vitreous hemorrhage (P = 0.003). A significant association was seen between the patients’ medical conditions with old vitreous hemorrhage and retinal detachment. There was no significant correlation between the patients’ gender and the studied ocular posterior segment pathologies. Conclusion: Age has a strong correlation with old vitreous hemorrhage, chronic medical conditions such as diabetes, and hypertension correlated with old vitreous hemorrhage and retinal detachment. Keywords: Ocular ultrasonography; Posterior segment pathology; Blurred vision; Age; Gender.

Vitrectomy for Retinal Detachment

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Retinal Detachment ◽  
Penetrating Trauma ◽  
Subretinal Fluid ◽  
Vitreous Hemorrhage ◽  
Scleral Buckling ◽  
Scleral Buckle ◽  
Vitreous Surgery ◽  
Retinal Breaks ◽  
Vitreoretinal Degeneration ◽  
Treat All

Following the introduction of closed vitrectomy techniques by Robert Machemer in the early 1970s, complicated retinal detachments became one of the important indications for vitreous surgery. Most of these were due to proliferative diabetic retinopathy (PDR) or to proliferative vitreoretinopathy (PVR), frequently following failure of routine scleral buckling procedures. As experience in vitreoretinal surgery expanded, the advantages of these techniques in the management of more routine types of retinal detachment became apparent. The popularity of vitrectomy for primary retinal detachments continues to grow, particularly with regard to pseudophakic cases. Indications for performing a vitrectomy rather than a scleral buckle or a pneumatic retinopexy are summarized in Chapter 10. Virtually all authorities note that a vitrectomy is required (along with a broad scleral buckle) in eyes with severe PVR, and the technique is also clearly indicated for cases due to PDR, detachments associated with major vitreous hemorrhage or scarring from penetrating trauma, and those with giant retinal tears. On the other hand, few would suggest a vitrectomy to repair a very shallow and small retinal detachment due to a single break that could be easily closed with a scleral buckle or pneumatic procedure. Between these two extremes, indications remain a matter of personal choice of the surgeon, and they are influenced by his or her training and experiences with a variety of techniques. Most surveys demonstrate a growing popularity of vitrectomy for an increasing percentage of cases. The goals of vitrectomy for retinal detachment are to… 1. Remove axial opacities such a 1. s vitreous hemorrhage or debris. 2. Eliminate vitreoretinal, epiretinal, or subretinal traction. 3. Identify and treat all retinal breaks. 4. Internally reattach the retina. 5. Facilitate placement of a large intraocular tamponade. 6. Avoid complications associated with scleral buckling surgery…. The usual sequence of events includes removal of vitreous gel and epiretinal membranes, identification of retinal breaks, internal removal of subretinal fluid, laser therapy to all responsible breaks and areas of significant vitreoretinal degeneration, and placement of an internal tamponade with gas or silicone oil. Vitrectomy is frequently combined with placement of a scleral buckle.

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