Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV

Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis was a prospective, nationwide, multicentre, observational study. Data from the Japanese Retina and Vitreous Society registry from 2016 to 2017 were used to determine the association between preoperative clinical factors, surgical procedures and postoperative BCVA at 6 months. Japanese individuals >40 years of age were included. Eyes with proliferative vitreoretinopathy were included. The primary outcome was the percentage of eyes that achieved 20/25 vision.ResultsOf the 3219 registered cases, 2192 met the inclusion criteria (344 SB, 1738 PPV, 110 PPV+SB). Cases with preoperative BCVA (≤0 logarithm of the minimum angle of resolution (logMAR) units) had good postoperative BCVA (OR=3.97, CI 2.87 to 5.51). Older age (>70 years), low intraocular pressure (<10 mm Hg), high myopia (<−5 dioptres), multiple retinal breaks (>4), giant retinal tear (>90°), wide retinal detachment (>3 quadrants) and macula-off detachment were associated with less probability of postoperative 20/25 vision (OR=0.39, 0.64, 0.62, 0.60, 0.12, 0.51 and 0.36, respectively). Postoperative BCVA was 0.03±0.23 and 0.10±0.32 logMAR units after SB and PPV, respectively. The percentage of cases that achieved 20/25 vision was not significantly different after PPV or SB if cases that had concurrent cataract surgery were excluded (p=0.251).ConclusionsBetter BCVA in patients with RRD who had undergone PPV was observed. However, if concurrent cataract surgery is not performed, BCVA will be comparable with either PPV or SB.

Download Full-text

Scleral buckling—a brief historical overview and current indications

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04562-1 ◽

2019 ◽

Vol 258 (3) ◽

pp. 467-478

Author(s):

Aijing Wang ◽

Martin P. Snead

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Techniques ◽

Scleral Buckling ◽

Effective Technique ◽

Retinal Breaks ◽

Retinal Tears ◽

Pars Plana ◽

Retinal Hole ◽

The Right

AbstractThe key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

Download Full-text

Clinical Research. Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks

Clinical and Experimental Ophthalmology ◽

10.1046/j.1442-9071.2003.00686.x ◽

2003 ◽

Vol 31 (5) ◽

pp. 403-407 ◽

Cited By ~ 34

Author(s):

Hem K Tewari ◽

Sachin Kedar ◽

Atul Kumar ◽

Sat P Garg ◽

Lalit K Verma

Keyword(s):

Retinal Detachment ◽

Clinical Research ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Retinal Breaks ◽

Pars Plana

Download Full-text

Aphakic Retinal Detachment; Risk Factors, Pathogenesis, Clinical Characteristics, and Management

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0211 ◽

2020 ◽

pp. 148-152

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Male Gender ◽

Retinal Breaks ◽

Vitreous Loss ◽

Pars Plana ◽

Anatomical Outcome ◽

Aphakic Retinal Detachment

Aphakia is one of the major risk factors for rhegmatogenous retinal detachment (RD). Predisposing factors such as myopia, male gender, vitreous loss, young age facilitate the development of RD. Generally, aphakic RD does not any symptoms. Retinal breaks are located more in the superior retinal quadrant, equatorial, or near the Ora Serrata and are tended to small size. Pars plana vitrectomy and/or scleral buckling have a similar functional and anatomical outcome in treatment.

Download Full-text

Nonperfused Peripheral Retinal Area in Eyes with Chronic Rhegmatogenous Retinal Detachment

Case Reports in Ophthalmology ◽

10.1159/000509157 ◽

2020 ◽

Vol 11 (2) ◽

pp. 385-390

Author(s):

Tomoaki Tatsumi ◽

Takayuki Baba ◽

Hirotaka Yokouchi ◽

Shuichi Yamamoto

Keyword(s):

Retinal Detachment ◽

Fluorescein Angiography ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Wide Area ◽

Peripheral Retina ◽

Retinal Area ◽

Retinal Breaks ◽

Pars Plana ◽

Bullous Retinal Detachment

We report two cases of chronic rhegmatogenous retinal detachment with a nonperfused peripheral retinal area. Case 1 was an 84-year-old woman who presented with a bullous retinal detachment of the inferior retina and a best-corrected visual acuity of 20/500. A small horseshoe tear was detected in the peripheral superior retina. Fluorescein angiography showed a wide area of nonperfused retina in the inferior retina. The retina was successfully reattached by scleral buckling surgery. Case 2 was a 40-year-old woman who presented with a shallow retinal detachment involving the macula. There were multiple retinal breaks at the pars plana that were secondary to blunt trauma. Fluorescein angiography revealed a wide area of nonperfused retina in the inferior peripheral retina. She underwent scleral buckling surgery, and the retina was successfully reattached. Our findings indicate that clinicians should examine the peripheral retina carefully especially with fluorescein angiography to search for nonperfused areas in eyes with chronic rhegmatogenous retinal detachment.

Download Full-text

Iatrogenic Subretinal Triamcinolone During Primary Surgical Repair of a Retinal Detachment With a Giant Retinal Tear

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420974550 ◽

2020 ◽

pp. 247412642097455

Author(s):

Kunyong Xu ◽

Eric K. Chin ◽

David R.P. Almeida

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Repair ◽

Vitreoretinal Surgery ◽

Subretinal Space ◽

Perfluorocarbon Liquid ◽

Retinal Tear ◽

Giant Retinal Tear ◽

Mechanical Removal ◽

Pars Plana

Purpose: We describe the outcome of a 23-year-old man undergoing vitreoretinal surgery for a macula-off rhegmatogenous retinal detachment secondary to a giant retinal tear. Methods: Patient underwent combined 25- gauge 3-port pars plana vitrectomy with scleral buckle, perfluorocarbon liquid, and perfluoropropane gas tamponade. During surgery, triamcinolone inadvertently entered the subretinal space and was retained. Results: The subretinal triamcinolone deposits spontaneously absorbed over a 2-month period. No adverse sequelae were associated with this complication. Conclusion: This may support avoiding aggressive mechanical removal of iatrogenic subretinal triamcinolone in the context of retinal detachment repair.

Download Full-text

A Case of Retinal Detachment in Retinitis Pigmentosa

European Journal of Ophthalmology ◽

10.1177/112067210701700433 ◽

2007 ◽

Vol 17 (4) ◽

pp. 677-679 ◽

Cited By ~ 3

Author(s):

M.N. Demir ◽

N. Ünlü ◽

Z. Yalniz ◽

M.A. Acar ◽

F. Örnek

Keyword(s):

Retinal Detachment ◽

Retinitis Pigmentosa ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Young Patients ◽

Scleral Buckling ◽

Oil Removal ◽

Pars Plana ◽

The Right

Purpose To report case of retinitis pigmentosa in association with rhegmatogenous retinal detachment. Methods An eight year old boy complained of a sudden visual loss. The patient had night blindness, bone spicule-like hyperpigmentation, pale optic disc in both eyes, and the retina was totally detached in the right eye. Results He was initially treated with conventional scleral buckling surgery, then pars plana vitrectomy with silicone tamponade was performed and retinal reattachment was established. After the phacoemulsification combined with silicone oil removal the final visual acuity of counting fingers was obtained. Conclusions The association of retinitis pigmentosa and rhegmatogenous retinal detachment is uncommon in young patients.

Download Full-text

Repair of Primary Noncomplex Rhegmatagenous Retinal Detachment

US Ophthalmic Review ◽

10.17925/usor.2013.06.02.135 ◽

2013 ◽

Vol 06 (02) ◽

pp. 135 ◽

Cited By ~ 1

Author(s):

Eric W Schneider ◽

Mark W Johnson ◽

◽

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Treatment Modalities ◽

Current Evidence ◽

Surgical Approaches ◽

Short Discussion ◽

Pneumatic Retinopexy ◽

Pars Plana

With the development of pars plana vitrectomy in the 1970s and pneumatic retinopexy in the 1980s, the primacy of scleral buckling for repair of rhegmatogenous retinal detachment (RRD) came under challenge. While a degree of consensus exists for certain forms of complex RRD, there remains little agreement concerning the optimal treatment of primary noncomplex RRD. This debate is further muddied by application of adjuvant procedures to supplement the primary surgical approach. This article aims to present the current evidence regarding repair of primary noncomplex RRD. A brief summary of primary surgical approaches—pneumatic retinopexy, scleral buckling, and pars plana vitrectomy—will be presented along with a short discussion on potential adjuvant procedures. The remainder of the article focuses on reported outcomes for the different treatment modalities for primary noncomplex RRD.

Download Full-text

Repair of Traumatic Rhegmatogenous Retinal Detachment Combined with Congenital Falciform Retinal Detachment

Case Reports in Ophthalmology ◽

10.1159/000485550 ◽

2018 ◽

Vol 9 (1) ◽

pp. 55-59

Author(s):

Fukutaro Mano ◽

Kuo-Chung Chang ◽

Tomiya Mano

Keyword(s):

Retinal Detachment ◽

Patient Outcomes ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Retrospective Case ◽

Hand Motion ◽

Corrected Visual Acuity ◽

Pars Plana Lensectomy ◽

Pars Plana

Purpose: To report a case of surgical repair of traumatic rhegmatogenous retinal detachment combined with congenital falciform retinal detachment (FRD). Methods: A retrospective case report. Results: A 36-year-old man with traumatic rhegmatogenous retinal detachment complicating a previously known FRD was successfully treated despite residual FRD following pars plana lensectomy, vitrectomy, and encircling scleral buckling. His best corrected visual acuity improved from hand motion at 50 cm to 20/1,000. Conclusion: We concluded that the root of the FRD is susceptible to trauma because of the contraction of fibrovascular tissue. The early intervention of modern vitrectomy to traumatic rhegmatogenous retinal detachment complicating a previously known FRD is an important consideration for enhanced quality of care and optimal patient outcomes.

Download Full-text