Modified Vitrectomy Technique for Phakic Rhegmatogenous Retinal Detachment with Intermediate Break

Purpose. To evaluate the effects of a modification of the traditional 25-gauge pars plana vitrectomy technique in the treatment of uncomplicated macula-on rhegmatogenous retinal detachment (RRD) with intermediate retinal break(s) and marked vitreous traction in the phakic eye. Methods. Prospective, noncomparative, and interventional case series. All consecutive phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, with at least 1 year of postoperative follow-up, were enrolled. In all eyes, “localized 25-gauge vitrectomy” under air infusion with localized removal of the vitreous surrounding the retinal break(s), in association with laser photocoagulation and air tamponade, was performed. The primary end point was the rate of primary retinal attachment. Secondary end points were cataract progression and assessed by digital Scheimpflug lens photography (mean change of nuclear density units) and the rate of complications. Results. Thirty-two phakic eyes were included in the final analysis. At 12 months, the primary outcome of anatomical success was achieved in 94% of eyes. The mean nuclear density units did not change significantly at any time point during the follow-up. After localized vitrectomy, one eye developed an epiretinal membrane, and one eye developed cystoid macular edema; no other significant complications were reported. Conclusions. “Localized vitrectomy” has a high anatomical success rate in phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, without causing progression of cataract.

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Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v6i4.1737 ◽

1970 ◽

Vol 6 (4) ◽

pp. 466-471 ◽

Cited By ~ 1

Author(s):

R Thapa ◽

MK Shrestha ◽

R Gurung ◽

S Ruit ◽

G Paudyal

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Retinal Break ◽

Distance Visual Acuity ◽

Pneumatic Retinopexy ◽

Study Results ◽

Corrected Distance Visual Acuity

Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of < 6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, Nepal doi: 10.3126/kumj.v6i4.1737 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 466-471

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

European Journal of Ophthalmology ◽

10.1177/1120672120940209 ◽

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.

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Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311787 ◽

2018 ◽

Vol 103 (4) ◽

pp. 481-487 ◽

Cited By ~ 1

Author(s):

Viviana Cacioppo ◽

Andrea Govetto ◽

Paolo Radice ◽

Gianni Virgili ◽

Antonio Scialdone

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Key Factor ◽

Subretinal Fluid Drainage ◽

Functional Deterioration

PurposeTo investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.MethodsThis institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.ResultsNinety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).ConclusionThe incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.

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Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series*

Journal of International Medical Research ◽

10.1177/0300060517724931 ◽

2017 ◽

Vol 46 (1) ◽

pp. 316-325 ◽

Cited By ~ 3

Author(s):

Chuandi Zhou ◽

Qiurong Lin ◽

Yuxin Wang ◽

Qinghua Qiu

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Success Rates ◽

Pneumatic Retinopexy ◽

The Mean ◽

Final Operation

Objective To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD). Methods Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA). Results In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40. Conclusions Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

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212 Outcomes Of 25-Gauge Pars Plana Vitrectomy Surgery in Primary Rhegmatogenous Retinal Detachment in Pakistan: A Multi-Center Study

British Journal of Surgery ◽

10.1093/bjs/znab259.019 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Z M Hussain ◽

M A Awan ◽

M A R Siddiqui

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Tertiary Care ◽

National Study ◽

P Value ◽

Retinal Surgery ◽

Pars Plana ◽

Anatomical Success

Abstract Aim To evaluate the primary anatomical success and visual outcomes in patients with rhegmatogenous retinal detachment (RRD) undergoing 25-gauge pars plana vitrectomy (25g PPV) surgery in Pakistan. Method This is a five-year retrospective, interventional cohort study of 418 consecutive patients with RRD who underwent 25g PPV. Surgeries were performed by two experienced surgeons at tertiary care hospitals in Pakistan. Consecutive patients, who underwent 25 g PPV surgery as treatment for RRD between October 2013-October 2018 were included. We excluded patients who had a history of previous retinal surgery or who did not complete the 4-8 weeks primary outcome visit. Data was collected from the patient’s files by using a pro forma. SPSS version 23.0 (IBM SPSS Statistics, Armonk, NY) was used. A p-value of < 0.5 was considered significant. Results We identified 452 patients through coding system of hospitals who underwent 25g PPV surgery between October 2013-October 2018. Secondary retinal surgery and incomplete follow up cases were excluded. A total of 441 patients’ files were reviewed for the study, out of which 418 patients met the criteria for final analysis. Males were in a higher number 284 (67.9 %). The average age was 49±15.8. In our study, 186 (44.4%) patients were phakic at the time of presentation. At 2 months follow up, the primary anatomical success rate was 87.1 %. Conclusions Surgical outcomes of RRD with 25g PPV surgery in our study were similar to the outcomes reported in the developed world. We propose a prospective multicenter national study to prospectively evaluate the risk factors for RRD surgical failure in the Pakistani population.

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Six-Year Outcomes of 25-Gauge Chandelier Illumination-Assisted Scleral Buckling

BioMed Research International ◽

10.1155/2021/4628160 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Hui Li ◽

Conghui Zhang ◽

Jiayi Wei ◽

Khusbu Keyal ◽

Fang Wang

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Average Length ◽

Insertion Site ◽

Case Series ◽

Final Analysis ◽

Ultrasound Biomicroscopy ◽

Scleral Buckling ◽

Long Term Results ◽

Fundus Photography

Objectives. To report the long-term results of scleral buckling using 25-gauge chandelier illumination. Methods. The medical records of all patients presenting to Shanghai Tenth People’s Hospital with simple rhegmatogenous retinal detachment (RRD) from June 2013 to Oct 2015 were retrospectively reviewed in this consecutive case series. All patients underwent preoperative and postoperative best corrected visual acuity (BCVA), B-ultrasound, fundus photography, and optical coherence tomography examination. Ultrasound biomicroscopy (UBM) was obtained postoperatively. Results. Ten patients (10 eyes) were included in the final analysis. Of 10 patients, the average age was 49.3 ± 18.9 years old, the average duration of RRD was 30.9 ± 53.3 days, and the mean follow-up period was 6.2 ± 0.9 years. There were nine eyes with myopia and four eyes with macular detachment. The primary anatomical success rate was 90%. Five eyes underwent 360-degree band with element surgery, and five eyes underwent element surgery alone. The average length of encircling band and element was 68.2 ± 1.3 mm and 10.5 ± 2.5 mm, respectively. There were no intraoperative or postoperative complications that occurred. The final BCVA was greater than or equal to 20/40 in nine eyes, of which four eyes achieved 20/20. UBM examination of the 25-gauge chandelier insertion site revealed no tissue proliferation. Conclusions. For simple rhegmatogenous retinal detachment treatment, 25-gauge chandelier illumination-assisted scleral buckling is a kind of effective and safe method.

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Chromophore Assisted Retinal Break Detection To Manage Challenging Situations In Retinal Detachment Redo Surgery

10.21203/rs.2.9496/v1 ◽

2019 ◽

Author(s):

Antonio Berarducci ◽

Martina Colasante ◽

Antonio Laborante

Keyword(s):

Retinal Detachment ◽

Trypan Blue ◽

Case Series ◽

Subretinal Space ◽

Blue Dye ◽

Retinal Break ◽

Case Presentation ◽

Silicon Oil ◽

Retinal Breaks

Abstract BACKGROUND: The purpose of this case series is to demonstrate that subretinal blue dye injection, with and without 180 degree endolaser retinopexy, can be considered a useful tool in finding occult rhegmatogenous retinal breaks in eyes with recurrent retinal detachment. CASE PRESENTATION: Three patients with recurrent retinal detachment were treated between January and March 2018. In all cases the intraoperative internal search did not demonstrate any obvious break or hole. Membraneblu-dual (Trypan Blue 0,15% + Brilliant Blu G 0,025% + 4% PEG) was then injected into the subretinal space using a 41 Gauge cannula. The eye was rotated such that the dye was pushed through a tiny break which was causing the retinal detachment. A 180 degree laser retinopexy was performed on a single eye. After silicon oil removals and absorption of the gas tamponade respectively, retinas remained attached at three months follow up. CONCLUSIONS: Chromophore assisted occult retinal break detection can be considered a useful and safe surgical technique in managing some unexpected and challenging intraoperative situations. Keywords: chromophore, subretinal, occult, retinal, detachment

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Chromophore-Assisted Retinal Break Detection to Manage Challenging Situations in Retinal Detachment Redo Surgery

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/1389434 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Antonio Berarducci ◽

Martina Colasante ◽

Antonio Laborante

Keyword(s):

Retinal Detachment ◽

Case Series ◽

Subretinal Space ◽

Blue Dye ◽

Oil Removal ◽

Retinal Break ◽

Brilliant Blue G ◽

Case Presentation ◽

Retinal Breaks

Introduction. The purpose of this case series is to demonstrate that subretinal blue dye injection, with and without 180-degree endolaser retinopexy, can be considered a useful tool in finding occult rhegmatogenous retinal breaks in eyes with recurrent retinal detachment. Case Presentation. Three patients with recurrent retinal detachment were treated between January and March 2018. In all cases, the intraoperative internal search did not demonstrate any obvious break or hole. MembraneBlue-Dual (Trypan Blue 0.15% + Brilliant Blue G 0.025% + 4% PEG) was then injected into the subretinal space using a 41-gauge cannula. The eye was rotated such that the dye was pushed through a tiny break which was causing the retinal detachment. 180-degree laser retinopexy was performed on a single eye. After silicon oil removal and absorption of the gas tamponade, retinas remained attached at three-months follow-up. Conclusions. Chromophore-assisted occult retinal break detection can be considered a useful but not risk-free surgical technique in managing some unexpected and challenging intraoperative situations.

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Long-term Clinical Results of Vitrectomy and Scleral Buckling in Treatment of Rhegmatogenous Retinal Detachment

The Scientific World JOURNAL ◽

10.1155/2019/5416806 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

I. Schmidt ◽

N. Plange ◽

G. Rößler ◽

H. Schellhase ◽

A. Koutsonas ◽

...

Keyword(s):

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Clinical Results ◽

Scleral Buckling ◽

Long Term Results ◽

Encircling Band

Purpose. Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD). Methods. 155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic. Results. Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively. Conclusion. Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.

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Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2018/7643174 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Keiko Otsuka ◽

Hisanori Imai ◽

Ayaka Fujii ◽

Akiko Miki ◽

Mizuki Tagami ◽

...

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Success Rates ◽

Significant Difference ◽

Pars Plana ◽

Anatomical Success ◽

Better Than ◽

Baseline Demographic

Aim. To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD).Design. A retrospective nonrandomized clinical trial.Methods. A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed.Results. Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1andp=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and −0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02andp=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63andp=0.21, resp.).Conclusion. The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

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