scholarly journals Anatomical and Functional Outcomes of Vitrectomy with/without Intravitreal Methotrexate Infusion for Management of Proliferative Vitreoretinopathy Secondary to Rhegmatogenous Retinal Detachment

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Samir El Baha ◽  
Mahmoud Leila ◽  
Ahmed Amr ◽  
Mohamed M. A. Lolah
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Functional Outcomes ◽  
Rhegmatogenous Retinal Detachment ◽  
Visual Outcome ◽  
Rank Test ◽  
Control Groups ◽  
Retinal Reattachment ◽  
The Difference

Purpose. To assess the anatomical and functional outcomes of intravitreal infusion of methotrexate (MTX) during pars plana vitrectomy (PPV) for proliferative vitreoretinopathy (PVR) associated with rhegmatogenous retinal detachment (RRD). Methods. Comparative interventional nonrandomized study including consecutive patients who had vitrectomy for RRD. The study included six groups. Groups I (established PVR), II (high risk of PVR), and III (no risk of PVR) comprised prospectively recruited study eyes, which received PPV and adjuvant intravitreal MTX infusion equivalent to 400 μg/0.1 mL. Groups IA, IIA, and IIIA comprised retrospectively recruited control groups. Main outcome measures were retinal reattachment at the end of 6 months, visual outcome, and complications. Chi-square test or Fisher’s exact test analyzed categorical variables. ANOVA test and Kruskal–Wallis test analyzed quantitative variables. Mann–Whitney U-test and independent t-test evaluated the difference between each group and its control. Comparison between two paired groups was done by Wilcoxon Rank test. The Kaplan–Meier method was used for survival analysis and the log-rank test estimated differences in event-free survival across the groups. P was significant at <0.05. Results. The study included 190 eyes of 188 patients. Study Groups I, II, and III included 42, 35, and 24 eyes, respectively. Mean age was 45 years. Male gender constituted 70% of patients. Mean follow-up period was 6 months. Control Groups IA, IIA, and IIIA included 30, 30, and 29 eyes, respectively. Mean age was 50 years. Male gender constituted 50%. Mean follow-up period was 7 months. Median rate of retinal reattachment was 82% in the study eyes versus 86% in the control eyes. The difference in the retinal reattachment rates between each study group and its respective control was not statistically significant, Group I-IA p =   0. 2 , Group II-IIA p = 0.07 , and Group III-IIIA p = 0.07 . BCVA improved by a mean of 4 lines in the study eyes versus 3 lines in the control eyes. The difference in visual outcome between each study group and its respective control was statistically significant between Groups II-IIA and III-IIIA, p = 0.03 , but not between Groups I-IA, p = 0.07 . We did not detect complications attributed to MTX use in the study eyes. Conclusion. Intravitreal infusion of MTX during PPV is a safe adjuvant therapy in RRD patients with and without PVR. MTX yields superior functional outcomes in patients at high risk of PVR and in patients with no risk of PVR compared to PPV without MTX, but not in cases with established PVR. MTX did not confer an additional advantage in terms of retinal reattachment rate. Summary. Proliferative vitreoretinopathy is a major cause of failure in surgery for rhegmatogenous retinal detachment. Methotrexate as an adjuvant therapy blocks essential drivers in the pathogenetic cascade leading to PVR. Intravitreal infusion has the advantage of blocking the pathology in its nascence and obviates the need for repeated intravitreal injections of the drug.

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)

Retinotomy and retinectomy for anterior inferior proliferative vitreoretinopathy: Can visual outcome be improved?

2021 ◽  
pp. 112067212110128
Author(s):  
Mumin Hocaoglu ◽  
Murat Karacorlu ◽  
M. Giray Ersoz ◽  
Isil Sayman Muslubas ◽  
Serra Arf
Keyword(s):  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Clinical Stage ◽  
Case Series ◽  
Visual Outcome ◽  
Attachment Rate ◽  
Good Visual Outcome ◽  
The Mean

Purpose: To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR). Methods: Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated. Results: Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 ( p < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA ( p = 0.02), previous vitrectomy with gas tamponade ( p = 0.007), and was negatively correlated with number of previous RD operations ( p = 0.01), larger extent of RD ( p = 0.02) and more extensive retinotomy/retinectomy ( p = 0.04). Conclusions: An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.

scholarly journals Anatomical and Visual Outcome of Rhegmatogenous Retinal Detachment Managed with Scleral Buckling at a Tertiary Eye Centre in Nepal

2018 ◽  
Vol 10 (2) ◽  
pp. 151-155
Author(s):  
Roshija Khanal Rijal ◽  
Raghunandan Byanju ◽  
Araniko Pandey ◽  
Deepesh Mourya
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Care Center ◽  
Visual Outcome ◽  
Scleral Buckling ◽  
Interventional Study ◽  
Corrected Visual Acuity ◽  
Common Causes ◽  
The Common

Objective: To study the anatomical status and visual outcome of scleral buckling surgery in rhegmatogenous retinal detachment (RRD) at tertiary eye care center in Nepal. Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with scleral buckling surgery performed in Lumbini Eye Institute, Nepal. All the patients underwent surgery by a single experienced surgeon and had at least 3 months follow up. Result: A total of 50 patients (50 eyes) were operated, 38 males and 12 females, with a mean age of 39.46. Retinal reattachment was achieved in 46 (92%). Improved best corrected visual acuity (BCVA) was seen in 84%, whereas in 8% BCVA was same and deteriorated in another 8%. Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with scleral buckling surgery can give good anatomical and visual outcome.  

scholarly journals Outcome of scleral buckling with or without gas tamponade for recurrent retinal detachment in post-vitrectomy eyes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun-Xing Bai ◽  
Xiao-Jian Zhang ◽  
An-Li Duan ◽  
Xiao-Yan Peng
Keyword(s):  
Retinal Detachment ◽  
Functional Outcomes ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Intraoperative Complications ◽  
Scleral Buckling ◽  
Gas Tamponade ◽  
Pars Plana ◽  
Air Tamponade

Abstract Background Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once. Methods We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed. Results The original PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2–5 operations. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160 ± 20/63 at baseline to 20/80 ± 20/50 at the last visit in the 13 successfully treated eyes (P = 0.025). Conclusions SB can be effective for re-RD after PPV in specific cases.

scholarly journals Outcome of Scleral Buckling With or Without Gas Tamponade for Recurrent Retinal Detachment in Post-vitrectomy Eyes

2020 ◽  
Author(s):  
Jun-Xing Bai ◽  
Xiao-Jian Zhang ◽  
An-Li Duan ◽  
Xiao-Yan Peng
Keyword(s):  
Retinal Detachment ◽  
Functional Outcomes ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Intraoperative Complications ◽  
Scleral Buckling ◽  
Gas Tamponade ◽  
Pars Plana ◽  
Air Tamponade

Abstract Background: Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once.Methods: We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed.Results: The first PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2–5 operations. The re-RD involved the fovea in 7 (50%) eyes. There was no break detected in 2 eyes, suspected break in 5 eyes, 1 break in 4 eyes, 2 breaks in 2 eyes, and 3 breaks in 1 eye. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160±20/63 at baseline to 20/80±20/50 at the last visit in the 13 successfully treated eyes (P=0.025).Conclusions: SB can be effective for re-RD after PPV in specific cases.

scholarly journals Double Retinal Tamponade for Treatment of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy and Inferior Breaks

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mohamed Farouk Abdelkader ◽  
Shaaban Abd-Elhamid Mehany Elwan ◽  
Ahmed Shawkat Abdelhalim
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Case Series ◽  
Short Term ◽  
Retinal Breaks ◽  
Case Series Study ◽  
Retinal Reattachment ◽  
Simultaneous Use ◽  
One Year

Purpose. To evaluate the efficacy and safety of the simultaneous use of short-term perfluoro-n-octane (PFO) with perfluoropropane (C3F8) gas to achieve retinal reattachment in eyes with rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C and multiple retinal breaks including inferior breaks. Design. This is a prospective interventional case series study. Patients and Methods. The study was a prospective noncomparative interventional study. It included 30 eyes of 30 patients who had RRD with PVR grade C and multiple retinal breaks including inferior tears attending the vitreoretinal unit of Minia University Hospital, Egypt. The mean age was 50.2 ± 10.63 years; 18 patients were females and 12 were males. Combined phacoemulsification and 23 G pars plana vitrectomy (PPV) with double retinal tamponade by C3F8 and PFO were done, and PFO was removed in 10–14 days. The patients were followed up for one year. The primary outcome was to achieve successful retinal reattachment, and the secondary outcomes were visual improvement and occurrence of complications. Results. Successful retinal reattachment was obtained in 28 eyes out of 30 (93.3%), and 2 eyes (6.7%) had recurrent RD. Best-corrected distance visual acuity (BCDVA) in logMAR was significantly improved from baseline 1.74 ± 0.05 to 0.93 ± 0.04, 0.82 ± 0.05, 0.80 ± 0.07, and 0.73 ± 0.055 at follow-up visits 3, 6, and 9 months and one year, respectively ( P ≤ 0.001 ). There were no serious ocular complications recorded. Conclusions. The results of this study indicated that primary vitrectomy with simultaneous use of both C3F8 and short-term PFO as retinal tamponades was effective and safe in the management of complex cases of RRD with PVR grade C and inferior breaks. This trial is registered with NCT04168255.

scholarly journals Using Surgical Microscope for Sclera Buckling and Transscleral Cryopexy: An Alternative Procedure of Treatment for Rhegmatogenous Retinal Detachment

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Liu-xue-ying Zhong ◽  
Yi Du ◽  
Wen Liu ◽  
Su-Ying Huang ◽  
Shao-chong Zhang
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Surgical Microscope ◽  
Initial Surgery ◽  
Retinal Breaks ◽  
Retinal Reattachment ◽  
Indirect Ophthalmoscope

Purpose.To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment.Methods.This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ≤ C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens.Results.After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%).Conclusion.Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness.

Sign in / Sign up

Export Citation Format

Share Document