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.

scholarly journals The Impact of the Covid-19 Pandemic on Rhegmatogenous Retinal Detachment Treatment Patterns

2021 ◽  
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedures ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Retinal Breaks ◽  
Surgery Outcomes ◽  
Potential Factors ◽  
Subretinal Fluid Drainage ◽  
The Impact

Abstract Background: To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 pandemic. Material and Methods:A retrospective cohort of RRD patients was analyzed. Patients were divided into the COVID-19 pandemic group and pre-COVID-19 group according to their presentation. The presurgery characteristics, surgical procedures, and surgery outcomes were collected. The potential factors related to the choice of pars plana vitrectomy (PPV) or scleral buckling (SB) were analyzed using logistic regression. The differences in the procedure choice under specific conditions were compared. Surgery outcomes were compared between the two groups.Results:In the COVID-19 pandemic group, less patients received SB (27.8%, 41.3%, p=0.02) while more patients received PPV (72.2%, 58.6%, p=0.02); in patients who received SB, fewer patients received subretinal fluid drainage (45.4%,75.7%, p=0.01); in patients who received PPV, fewer patients received phacovitrectomy (7.0%, 21.0%, p=0.02). The choice of PPV was related to older age (1.03, p=0.005), the presence of RRD with choroidal detachment (RRD-CD) (2.92, p=0.03), pseudophakia (5.0, p=0.002), retinal breaks located posterior to the equator(4.87, p<0.001), macular holes (9.76, p=0.005), and a presurgery visual acuity (VA) less than 0.02 (0.44 , p=0.03). Fewer phakia patients with retinal breaks located posterior to the equator (1/28, 11/30, p=0.01) and fewer patients with chronic RRD and subretinal strand (1/9, 9/16, p=0.03) received SB in the COVID-19 pandemic group. More patients with improved VA (55.7%, 40.2%, p=0.03) in the COVID-19 pandemic group. The overall single-surgery retinal attachment rate was similar in the two groups (94.9%, 94.5%, p=0.99).Conclusions:During the COVID-19 pandemic, the main reason for the increased number of PPV in RRD treatment was that more complicated cases were presented. However, the surgeons were conservative in procedure choice in specific cases. The adjustments on RRD treatments leads to comparable surgery outcomes.

scholarly journals The impact of the COVID-19 Pandemic on rhegmatogenous retinal detachment treatment patterns

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedures ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Retinal Breaks ◽  
Surgery Outcomes ◽  
Potential Factors ◽  
Subretinal Fluid Drainage ◽  
The Impact

Abstract Backgrounds To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 Pandemic. Methods A retrospective cohort of RRD patients was analyzed. Patients were divided into the COVID-19 pandemic group and pre-COVID-19 group according to their presentation. The presurgery characteristics, surgical procedures, and surgery outcomes were collected. The potential factors related to the choice of pars plana vitrectomy (PPV) or scleral buckling (SB) were analyzed using logistic regression. The differences in the procedure choice under specific conditions were compared. Surgery outcomes were compared between the two groups. Results In the COVID-19 pandemic group, less patients received SB (27.8, 41.3%, p = 0.02) while more patients received PPV (72.2, 58.6%, p = 0.02); in patients who received SB, fewer patients received subretinal fluid drainage (45.4,75.7%, p = 0.01); in patients who received PPV, fewer patients received phacovitrectomy (7.0, 21.0%, p = 0.02). The choice of PPV was related to older age (1.03, p = 0.005), the presence of RRD with choroidal detachment (RRD-CD) (2.92, p = 0.03), pseudophakia (5.0, p = 0.002), retinal breaks located posterior to the equator (4.87, p < 0.001), macular holes (9.76, p = 0.005), and a presurgery visual acuity (VA) less than 0.02 (0.44, p = 0.03). Fewer phakia patients with retinal breaks located posterior to the equator (1/28, 11/30, p = 0.01) and fewer patients with chronic RRD and subretinal strand (1/9, 9/16, p = 0.03) received SB in the COVID-19 pandemic group. There were more patients with improved VA (55.7, 40.2%, p = 0.03) in the COVID-19 pandemic group. The overall single-surgery retinal attachment rate was similar in the two groups (94.9, 94.5%, p = 0.99). Conclusions During the COVID-19 Pandemic, the main reason for the increased number of PPV in RRD treatment was that more complicated cases were presented. However, the surgeons were conservative in procedure choice in specific cases. The adjustments on RRD treatments lead to comparable surgery outcomes.

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 The Impact of the Covid-19 Pandemic on Rhegmatogenous Retinal Detachment Treatment Patterns

2021 ◽  
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedures ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Retinal Breaks ◽  
Surgery Outcomes ◽  
Potential Factors ◽  
Subretinal Fluid Drainage ◽  
The Impact

Abstract Background: To describe changes in rhegmatogenous retinal detachment (RRD) surgical procedures in Beijing during the COVID-19 pandemic. Material and Methods:A retrospective cohort of RRD patients was analyzed. Patients were divided into the COVID-19 pandemic group and pre-COVID-19 group according to their presentation. The presurgery characteristics, surgical procedures, and surgery outcomes were collected. The potential factors related to the choice of pars plana vitrectomy (PPV) or scleral buckling (SB) were analyzed using logistic regression. The differences in the procedure choice under specific conditions were compared. Surgery outcomes were compared between the two groups.Results:In the COVID-19 pandemic group, less patients received SB (27.8%, 41.3%, p=0.02) while more patients received PPV (72.2%, 58.6%, p=0.02); in patients who received SB, fewer patients received subretinal fluid drainage (45.4%,75.7%, p=0.01); in patients who received PPV, fewer patients received phacovitrectomy (7.0%, 21.0%, p=0.02). The choice of PPV was related to older age (1.03, p=0.005), the presence of RRD with choroidal detachment (RRD-CD) (2.92, p=0.03), pseudophakia (5.0, p=0.002), retinal breaks located posterior to the equator(4.87, p<0.001), macular holes (9.76, p=0.005), and a presurgery visual acuity (VA) less than 0.02 (0.44 , p=0.03). Fewer phakia patients with retinal breaks located posterior to the equator (1/28, 11/30, p=0.01) and fewer patients with chronic RRD and subretinal strand (1/9, 9/16, p=0.03) received SB in the COVID-19 pandemic group. More patients with improved VA (55.7%, 40.2%, p=0.03) in the COVID-19 pandemic group. The overall single-surgery retinal attachment rate was similar in the two groups (94.9%, 94.5%, p=0.99).Conclusions:During the COVID-19 pandemic, the main reason for the increased number of PPV in RRD treatment was that more complicated cases were presented. However, the surgeons were conservative in procedure choice in specific cases. The adjustments on RRD treatments leads to comparable surgery outcomes.

Evaluation of hyaloid–retinal relationship during triamcinolone-assisted vitrectomy for primary rhegmatogenous retinal detachment

2018 ◽  
Vol 28 (5) ◽  
pp. 607-613 ◽  
Author(s):  
Dheepak Sundar ◽  
Brijesh Takkar ◽  
Pradeep Venkatesh ◽  
Rohan Chawla ◽  
Shreyas Temkar ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Vitreous Surgery ◽  
Vitreous Detachment ◽  
Retinal Breaks ◽  
Vitreoretinal Degeneration ◽  
Type 3

Aims: To determine hyaloid–retinal relationship in primary rhegmatogenous retinal detachment during vitreous surgery. Methods: This is a prospective, interventional study of patients (n = 72) undergoing triamcinolone-assisted 25G vitreous surgery for primary rhegmatogenous retinal detachment. Hyaloid–retinal relationship was noted intraoperatively to identify regions and patterns of firm attachment and was classified into subgroups. Analysis was done to determine association between hyaloid–retinal relationship patterns and preoperative findings: posterior vitreous detachment, proliferative vitreoretinopathy, type of retinal tear, the presence of peripheral degenerations, and postoperative outcomes. Results: Three patterns of hyaloid–retinal relationship were identified: type1 (complete absence of posterior vitreous detachment (21%)), type 2 (incomplete posterior vitreous detachment (47%)) and type 3 (complete posterior vitreous detachment (32%)). Posterior vitreous detachment in some form was present in 84% of the cases with retinal tears as the causative break but none of the cases with retinal holes (p < 0.001). None of the cases with vitreoretinal degeneration had complete posterior vitreous detachment (p = 0.001). 69% of proliferative vitreoretinopathy–C cases had type 1 hyaloid–retinal relationship as compared to 11% cases with no proliferative vitreoretinopathy (p < 0.001). Proliferative vitreoretinopathy-related anatomical failure was seen in 7.5%, and 80% of these eyes with recurrent RD had type 1 hyaloid–retinal relationship (p<0.001). Nearly half the patients diagnosed as complete posterior vitreous detachment preoperatively were found to have incomplete posterior vitreous detachment intraoperatively. Conclusions: Majority of the cases with rhegmatogenous retinal detachment have some form of strong vitreoretinal adhesion. Hyaloid–retinal relationship varies with types of retinal breaks, retinal degeneration, and proliferative vitreoretinopathy. Intraoperative hyaloid–retinal relationship is frequently different from that assessed before surgery and the proposed classification may improve surgical decision making and prognostication.

scholarly journals Drain fluid cryo-explant technique for treatment of superior bullous rhegmatogenous retinal detachment in young adults

2021 ◽  
Vol 13 ◽  
pp. 251584142098821
Author(s):  
Kamal A.M. Solaiman ◽  
Ashraf Mahrous ◽  
Hesham A. Enany ◽  
Ashraf Bor’i
Keyword(s):  
Young Adults ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Secondary Outcome ◽  
Eligibility Criteria ◽  
Retinal Breaks ◽  
Complicated Cataract ◽  
Drain Fluid ◽  
The Mean

Purpose: To evaluate the efficacy of the drain fluid cryo-explant (DFCE) technique for the management of uncomplicated superior bullous rhegmatogenous retinal detachment (RRD) in young adults. Patients and methods: A retrospective study that included eyes with uncomplicated superior bullous RRD in patients ⩽40 years old. DFCE technique consists of sequential drainage of subretinal fluid, intravitreal fluid injection, cryotherapy, and placement of a scleral explant(s). The primary outcome measure was anatomical reposition of the retina after a single surgery. Secondary outcome measures included improvement in best corrected visual acuity (BCVA) and any reported complication related to the procedure. Results: The study included 51 eyes which met the study eligibility criteria. The mean duration of detachment was 19.7 ± 6.4 days. A single retinal break was found in 31 eyes (60.8%), and more than one break were found in 20 eyes (39.2%). The mean number of breaks per eye was 1.72 ± 1.04. The mean detached area per eye was 7.21 ± 3.19 clock hours, and the macula was detached in 22 eyes (43.1%). Flattening of the retina and closure of all retinal breaks was achieved in all eyes after a single surgery. Late recurrence of retinal detachment occurred in two eyes (3.9%) due to proliferative vitreoretinopathy (PVR). No complicated cataract or iatrogenic retinal breaks were detected in all eyes. Conclusion: DFCE technique could be effectively used for treatment of uncomplicated superior bullous RRD in adults ⩽40 years. It is safe and provides good visualization during surgery with no iatrogenic retinal breaks or complicated cataract.

Management of Scleral Rupture during Retinal Detachment Surgery: A Case Report

2002 ◽  
Vol 12 (6) ◽  
pp. 553-555 ◽  
Author(s):  
P. Carpineto ◽  
M. Ciancaglini ◽  
S. Scaramucci ◽  
M. Nubile ◽  
L. Mastropasqua
Keyword(s):  
Case Report ◽  
Retinal Detachment ◽  
Vitreous Hemorrhage ◽  
Positive Outcome ◽  
Favourable Outcome ◽  
Moderate Intensity ◽  
Scleral Buckle ◽  
Retinal Detachment Surgery ◽  
Patch Graft ◽  
Retinal Hole

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.

Combined Surgery in Rhegmatogenous Retinal Detachment (Scleral Buckle Vitrectomy): Indications and Applications

2019 ◽  
pp. 201-204
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Scleral Buckle ◽  
Combined Surgery ◽  
Primary Vitrectomy

Supplemental scleral buckling techniques in vitrectomy for the repair of rhegmatogenous retinal detachment to achieve higher reattachment rates are not widely used but may be useful especially in complicated cases. In this article, the positive and negative aspects of adding scleral buckle to primary vitrectomy will be examined by looking at relevant studies.

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