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.

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.

scholarly journals Parsplana vitrectomy alone versus parsplana vitrectomy combined with phacoemulsification for the treatment of rhegmatogenous retinal detachment: a randomized study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paolo Mora ◽  
Stefania Favilla ◽  
Giacomo Calzetti ◽  
Giulia Berselli ◽  
Lucia Benatti ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Randomized Study ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Retinal Reattachment ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Background To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD). Methods Subjects aged 48–65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group). Results In this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003). Conclusions In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months. Trial registration ISRCTN15940019. Date registered: 15/01/2021 (retrospectively registered).

scholarly journals Parsplana Vitrectomy Alone Versus Parsplana Vitrectomy Combined With Phacoemulsification for The Treatment of Rhegmatogenous Retinal Detachment: A Randomized Study

2021 ◽  
Author(s):  
Paolo Mora ◽  
Stefania Favilla ◽  
Giacomo Calzetti ◽  
Giulia Berselli ◽  
Lucia Benatti ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Randomized Study ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Retinal Reattachment ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract BACKGROUND: To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD).DESIGN: parallel, randomized trial.METHODS: subjects aged 48 - 65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group).RESULTS: in this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003).CONCLUSIONS: In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months.TRIAL REGISTRATION: ISRCTN15940019Date registered: 15/01/2021 (retrospectively registered)

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.

Retinal Detachment after Vitrectomy; Risk Factors, Pathogenesis, Clinic, and Management

2020 ◽  
pp. 201-205
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Surgical Instruments ◽  
Entry And Exit ◽  
Retinal Breaks ◽  
Entry Points ◽  
Retinal Tears ◽  
Vitreous Traction ◽  
Pars Plana

Intraoperative iatrogenic retinal tears leading to postoperative retinal detachments secondary to vitrectomy are an important sight-threatening complication of pars plana vitrectomy. Peripheral vitreous traction and retinal tears that incompletely removed, surgical instruments causing shrinkage on the basis of vitreous and incarceration of the vitreous to the entry points of the surgical instruments during entry and exit can be counted among the main causes of tears. In addition, small ruptures that may have been missed before the operation may cause retinal detachment after PPV. In order to reduce postoperative RD, it is based on the principle of detecting and treating the retinal breaks, if it is formed. Removing the peripheral vitreous completely without traction during PPV is important in preventing the formation of new tears.

Rhegmatogenous Retinal Detachment: Pathophysiology and Risk Factors

2019 ◽  
pp. 138-141
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Cataract Surgery ◽  
Rhegmatogenous Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Retinal Diseases ◽  
Retinal Tears ◽  
Lattice Degeneration ◽  
Major Factors

Rhegmatogenous retinal detachment is one of the most important retinal diseases requiring urgent surgical treatment. To be aware of the pathophysiology of the disease and to know the risk factors; it is crucial to prevent the development of the disease or overcome the complications that may arise and understand the surgical treatment principles. Major factors in the development of RRD: retinal tears, vitreous liquefaction, and detachment, traction on the retina surface. Myopia, previous cataract surgery, trauma, posterior vitreous detachment, lattice degeneration are the most important risk factors.

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.

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

2020 ◽  
pp. bjophthalmol-2020-315945
Author(s):  
Takayuki Baba ◽  
Ryo Kawasaki ◽  
Keita Yamakiri ◽  
Takashi Koto ◽  
Koichi Nishitsuka ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Cataract Surgery ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Study Data ◽  
Giant Retinal Tear ◽  
Retinal Breaks ◽  
Surgical Methods ◽  
Pars Plana ◽  
Registry Report

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.

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.

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