Selection of Surgery for “Routine” Retinal Detachment

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Retinal Detachment ◽  
Geographical Location ◽  
Standard Of Care ◽  
The United States ◽  
Scleral Buckling ◽  
Standards Of Care ◽  
Clinical Criteria ◽  
Demographic Groups ◽  
Anatomical Success

Most rhegmatogenous retinal detachments are blinding disorders unless they are successfully repaired. They were regarded as incurable until the seminal work of Jules Gonin in the 1920s, when an anatomical success rate approaching 50% was first described (see Chapter 1). Anatomical results for routine retinal detachments slowly improved through several decades, reaching the current 85%–90% single-operation success figure for scleral buckling by the 1980s. Unfortunately, a similar improvement in visual results has not occurred because of the profound influence of preoperative macular detachment. Scleral buckling, once the sole standard of care for uncomplicated cases, has become much less popular worldwide with the development of alternative options starting in the mid 1980s. The most enduring of these are pneumatic retinopexy (PR) (described in Chapter 8) and vitrectomy (described in Chapter 9). Vitrectomy was originally reserved for complicated detachments but became popular for more routine cases as experience and equipment improved. Today, particularly in the United States, scleral buckling, PR, and vitrectomy are standards of care that are widely employed in the management of “routine” or “uncomplicated” retinal detachment, but how frequently each is used varies among different demographic groups. For instance, the popularity of PR varies by geographical location and scleral buckling appears less popular in the hands of relatively young vitreoretinal specialists. It can be useful to discuss objective clinical criteria that may favor one technique over another. Demarcation, scleral buckling, PR, vitrectomy, and vitrectomy plus scleral buckling have relative indications and contraindications (Table 10–1), as well as limitations and complications. In this brief chapter, clinical factors that may influence the choice of one technique over another, for the types of cases in which scleral buckling, PR, and/or vitrectomy are neither mandatory nor contraindicated, are discussed. However, it appears clear that we will never universally agree on the “best” operation for a given case, just as a single ice cream flavor will never be favored by all. There are several relatively common types of uncomplicated retinal detachments (Table 10–2), as well as numerous variables associated with all of them (Table 10–3). Management of retinal detachments with each specific technique is described in Chapters 7, 8, and 9.

Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment

2020 ◽  
pp. 112067212094020
Author(s):  
Paolo Radice ◽  
Elisa Carini ◽  
Patrizio Seidenari ◽  
Andrea Govetto
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Vision Loss ◽  
Case Series ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Full Thickness Macular Hole ◽  
Air Tamponade ◽  
Subretinal Fluid Drainage ◽  
Anatomical Success

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

scholarly journals Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Yong-Kyu Kim ◽  
Wontae Yoon ◽  
Jae Kyoun Ahn ◽  
Sung Pyo Park
Keyword(s):  
Retinal Detachment ◽  
High Myopia ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Surgical Approaches ◽  
Success Rates ◽  
Visual Outcomes ◽  
Pars Planitis ◽  
Preoperative Risk Factors ◽  
Anatomical Success

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis.Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups.Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p<0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%,p=0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors.Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

Bilateral Retinal Detachment in Marfan's Syndrome

1998 ◽  
Vol 8 (2) ◽  
pp. 102-105 ◽  
Author(s):  
D. Dotrelova
Keyword(s):  
Retinal Detachment ◽  
Retinal Disease ◽  
Scleral Buckling ◽  
Marfan’S Syndrome ◽  
Marfan's Syndrome ◽  
Retinal Tears ◽  
Scleral Buckling Procedure ◽  
Pars Plana ◽  
Highly Correlated ◽  
Anatomical Success

Purpose Bilateral retinal detachment (RD) in Marfan's syndrome (MS) has a typical preoperative, operative, and post-operative course. This study describes symmetry of retinal tears and bilateral RD surgery in five MS patients over a period of 15 years. Methods Six eyes with uncomplicated RD were operated on using the scleral buckling procedure, and four eyes with complicated RD were operated using a pars plana vitrectomy (PPV) and inner retinal tamponade with silicon oil. Results Complete retinal reattachment was achieved in seven eyes. Partial anatomical success with attached macula was achieved in one eye. The surgery failed in two eyes. Final visual acuity was between 0.66 and 0.33 in three eyes, and between 0.25 and 0.1 in five; two eyes had no light perception. Conclusions The course of the bilateral retinal disease highly correlated with the symmetry of retinal defects.

scholarly journals Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ritesh Shah ◽  
Raghunandan Byanju ◽  
Sangita Pradhan ◽  
Sudha Ranabhat
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Correct Selection ◽  
Success Rates ◽  
Scleral Buckle ◽  
Preoperative Visual Acuity ◽  
Anatomical Success

Introduction. Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method. Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results. A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion. Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

Feasibility of randomized controlled trials (RCTs) for drugs approved by the United States Food and Drug Administration (FDA) based on single arm studies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19115-e19115
Author(s):  
Rebekah Rittberg ◽  
Piotr Czaykowski ◽  
Saroj Niraula
Keyword(s):  
Sample Size ◽  
Solid Tumors ◽  
Disease Incidence ◽  
Standard Of Care ◽  
The United States ◽  
New Drugs ◽  
Standards Of Care ◽  
Clinical Equipoise ◽  
Level Of Evidence ◽  
Approved Drugs

e19115 Background: US FDA introduced an Accelerated Approval (AA) pathway in 1992 to expedite access to promising new drugs, based on the assumption that RCTs would delay introduction or prove unfeasible. One resulting trade-off is an “interim” compromise in acceptable level of evidence: such approvals have increasingly relied on Overall Response Rates (ORR) from Single Arm Studies (SAS). FDA requires confirmation of benefits for such drugs in future RCTs, but that requirement may take years and often never met. Methods: We pooled drugs approved by FDA over 5 years based on ORR observed in SASs for solid tumors. We calculated the differences in ORR between the newly approved drugs and existing standard of care for each cancer sub-type, and designed hypothetical RCTs necessary to detect that difference. RCTs were designed based on power of 0.80, α-error of 5% (two-sided), and 1:1 randomization, using PS software (Vanderbilt University). We estimated accrual time for the RCTs using disease incidence and annual death rates for each cancer subtype in USA using Surveillance, Epidemiology & End Results records. Results: 28 of 129 (22%) FDA approved drugs for solid tumors, from 2015-2019, were based on SAS. Median sample size of 107 patients per approval (range 26-550). Drugs were approved based on median ORR of 38.9% (range 13-78%), compared to median ORR of 24.4% (range 5-62%) for existing standard of care [median difference in ORR 14.9% (range 6-45%)]. Using established statistical standards, median sample size required to conduct RCTs was 206 patients (range 44-1724); based on a conservative accrual rate of 5% of all eligible US patients, for 22 of 24 approvals RCTs with ORR as primary endpoint could have been completed within a timeframe equal to or less than the time used for undertaking the SAS. Drugs for 4 indications of 28 had a lower ORR compared to existing standard of care, while lacking evidence of superiority in any other survival outcome, raising important concerns about the approval process. Conclusions: Feasibility of conducting RCTs with an ORR endpoint within an acceptable time-frame does not appear to be a practical constraint for an overwhelming majority of drugs approved by FDA based on SAS alone. This finding questions the necessity of accepting a lower bar for efficacy and toxicity while approving drugs using the AA pathway, especially when supported by clinical equipoise with existing standards of care. ORR was lower than existing standard of care for 4 indications, putting rationale for these approvals into question.

Advanced Vitrectomy Surgery in Rhegmatogenous Retinal Detachment; Indications and Techniques

2019 ◽  
pp. 205-210
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Treatment Modalities ◽  
Success Rates ◽  
Retinal Tears ◽  
Pars Plana ◽  
Anatomical Success ◽  
Vitrectomy Surgery

The main goal in the treatment of rhegmatogenous retinal detachment (RRD) is the localization of retinal tears, removal of tractions, and closure of retinal tears. Despite the use of pneumatic retinopexy, scleral buckling, and vitrectomy as standard treatment modalities, the preference for pars plana vitrectomy (PPV) in the treatment of RRD has increased steadily in recent years. The reason for this increase is the widespread use of small-sized transconjunctival surgery, improvement of bimanual surgery, use of liquid perfluorocarbons, improved vitrectomy devices and more safe and successful removing of peripheral vitreous bases, visualization of membranes with vital dyes, safe retinopexy with use of curved laser probe even with phakic cases. Besides these, PPV and advanced surgical techniques are more needed in complicated detachments. Nevertheless, the surgeon has a specially important role in the surgical technique of choice. Although the control of the procedures can be performed much more successfully with the PPV in the case of complicated RRD patients during surgery, anatomical success rates are still not very high. In this article, the applications of advanced vitrectomy surgery in RRD are discussed in detail.

scholarly journals Anatomical and functional factors influencing the results of scleral buckling procedure for macula-off rhegmatogenous retinal detachments

2017 ◽  
Vol 74 (3) ◽  
pp. 212-218 ◽  
Author(s):  
Igor Kovacevic ◽  
Aleksandra Radosavljevic ◽  
Ivan Stefanovic ◽  
Bojana Radovic ◽  
Jelena Karadzic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Vitreoretinal Surgery ◽  
Scleral Buckling ◽  
Macular Detachment ◽  
Tertiary Centre ◽  
Retinal Breaks ◽  
Functional Factors ◽  
Surgical Options ◽  
Anatomical Success

Background/Aim. Rhegmatogenous retinal detachment is a potentially blinding condition of the posterior segment of the eye. Currently, the only treatment modality is surgery and surgical options include scleral buckling, pars plana vitrectomy and pneumoretinopexy. Many factors may influence the outcome of the surgery. Well defined indications are essential for achieving the best postoperative results. The aim of this study was to assess anatomical and functional outcome of treatment with scleral buckling for macula- off rhegmatogenous retinal detachments. Methods. This prospective, nonrandomized, interventional study included consecutive patients underwent scleral buckling for macula-off retinal detachment in the tertiary centre for vitreoretinal surgery. Results. A total of 168 consecutive patients (mean age 58.2 ? 13.9 years) were included in the study. Postoperatively, anatomical success was achieved in 152 (90.5%) of the patients. Parameters that influenced the anatomical success included the number of retinal breaks (p = 0.040), lens status (p = 0.041), preoperative proliferative vitreoretinopathy (p < 0.001), patients? age (p = 0.049), and marginally, the presence of typical symptoms (p = 0.057). Duration of macular detachment, previous ocular trauma and refraction of the eye did not affect the anatomical result. Functional success was evaluated using the postoperative visual acuity and depended mainly on the duration of macular detachment prior the surgery. Visual acuity 0.4 or better was significantly more often achieved if duration of macular detachment was up to seven days (p < 0.001). Refraction and patients? age did not influence the functional result. Conclusion. Scleral buckling is an efficient surgical procedure for treatment of patients with retinal detachment. Optimal results are achieved if operation is performed within the first seven days of duration of macular detachment.

scholarly journals Scleral Buckling Surgery in the Treatment of Retinal Detachment in Children – Own Results

2020 ◽  
Author(s):  
Dorota Barchanowska ◽  
Erita Filipek
Keyword(s):  
Retinal Detachment ◽  
Retinopathy Of Prematurity ◽  
Pigment Epithelium ◽  
Test Group ◽  
Scleral Buckling ◽  
Department Of Ophthalmology ◽  
Before And After ◽  
Length Changes ◽  
Anatomical Success ◽  
Neuronal Layer

Abstract Background:Retinal detachment it is a condition in which there is a disconnection between neuronal layer and choroidal layer of the retina, which is the pigment epithelium. The aim of our work was to evaluate the changes of visual acuity to the distance and to the nearest before and after surgery, and during the observation period, the assessment of anatomical length changes of the eyeball , the assessment of the intraocular pressure in the eyes after the procedure, the assessment of changes of the anatomical success to the retina using ultrasound in the projection (B).Methods:An 5- year retrospective study involved 73 children aged 5-17 years ( average age 11 years), who were operated due to retinal detachment. Patients were treated in the years 2013-2018 (June) in Pediatric Department of Ophthalmology in Katowice. The obtained results were subjected to statistical analysis using the STATISTICA 13.3 software program. We used the non- parametric Mann- Whitney U- test.Results:Among a group of operated children in 39% of retinal detachment due to head trauma or orbital area. About 29% children had average or high myopia due to the value-14.0 Dsph. 14% of children had retinal detachment due to retinopathy of prematurity, which had the vitrectomy at the end of the therapy. 18% of retinal detachment are caused by other factors-for example: infection of Toxocara or recurrent uveitis. The effect of application of the retina managed to get in 71% of eyes in the test group. 28% of eyes in this group require additional application of laser retinal as a complement to the residual retinal detachment. So obtained secondary effect of application of retinal eye surgery. While 29% of the eyes needed vitrectomy with vitreoproliferation and in the course of the retinopathy of prematurity.Conclusion:Retinal detachment is a very serious ophthalmologic condition that requires rapid surgical intervention.The latitudinal enlacement treatment is a treatment that does not disturb the proper development of the eyeball. The effect of the treatment is not predictable.The anatomical condition described as the retinal application does not always lead to a functional effect.

scholarly journals Outcomes of Rhegmatogenous Retinal Detachment

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Sidrah Riaz ◽  
Muhammad Tariq Khan ◽  
Khurram Azam Mirza
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Success Rates ◽  
Cross Sectional ◽  
Pars Plana ◽  
Anatomical Success ◽  
Anatomical Success Rate

Purpose:  To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore. Study Design:  Cross sectional Observational study. Place and Duration of Study:  Private Vitreo-retinal setup, from March 2017 to April 2019. Methods:  Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months. Results:  Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up. Conclusion:  Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world. Key Words:  Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.

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