Managing PVR in the Era of Small Gauge Surgery

Proliferative vitreoretinopathy (PVR) is the leading cause of failed rhegmatogenous retinal detachment (RRD) surgery. Based upon the presence of clinical features and due to associated underlying risk factors, it is classified into various grades based upon its severity and extent of involvement. Despite excellent skills, flawless techniques, and high-end technology applied in the management of RRD, PVR still occurs in 5–10% of cases. Due to the advancements in wide angle viewing systems, advance vitrectomy machines and fluidics, early identification, use of long-term heavy silicon oil tamponades, high-speed cutters, small-gauge vitrectomies, use of perfluorocarbon liquid (PFCL), and small-gauge forceps and scissors, the success rate in the management of PVR has increased leading to improved anatomical outcomes. However, functional outcomes do not correlate well with improved anatomical outcomes. Various complications occur after RRD repair that are responsible for re-retinal detachment and recurrence of PVR. This article highlights causes, risk factors, classification, grading, diagnosis, and approach to management of PVR and post-PVR surgery complications.

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Long-term visual recovery after scleral buckling procedure of rhegmatogenous retinal detachment involving the macula

Korean Journal of Ophthalmology ◽

10.3341/kjo.2000.14.1.20 ◽

2000 ◽

Vol 14 (1) ◽

pp. 20 ◽

Cited By ~ 8

Author(s):

S D Chang ◽

I T Kim

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Visual Recovery ◽

Scleral Buckling Procedure

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Risk factors for macular pucker after rhegmatogenous retinal detachment surgery

Scientific Reports ◽

10.1038/s41598-021-97738-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Toshiaki Hirakata ◽

Yoshimune Hiratsuka ◽

Shutaro Yamamoto ◽

Koki Kanbayashi ◽

Hiroaki Kobayashi ◽

...

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Surgical Technique ◽

Regression Models ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Repair ◽

Macular Pucker ◽

Logistic Regression Models ◽

Retinal Breaks ◽

Increased Risk

AbstractMacular pucker, also known as an epiretinal membrane, sometimes forms after surgical repair of a rhegmatogenous retinal detachment (RRD) and can decrease visual acuity and cause aniseikonia. However, few reports are evaluating the risk factors of macular pucker using multivariate analysis. To evaluate the risk factors for macular pucker after RRD surgery, 226 patients who underwent RRD surgery and were monitored for greater than 12 months (23.2 ± 6.4 months) after surgery were analyzed retrospectively. Of these cases, macular pucker developed in 26 cases. Multiple logistic regression models of 22 clinical characteristics were performed. An increased risk of macular pucker after RRD surgery was significantly associated with preoperative vitreous haemorrhage (Odds ratio (OR), 4.71; 95% CI 1.19–18.62), multiple retinal breaks (OR, 8.07; 95% CI 2.35–27.71), re-detachment (OR, 19.66; 95% CI 4.87–79.38), and retinal detachment area (OR, 12.91; 95% CI 2.34–71.19). Macular pucker was not associated with the surgical technique. Regardless of the surgical technique used, careful observation for postoperative macular pucker is needed after RRD surgery in high-risk cases. These findings can be used to improve the surgical management of patients with RRD. (183 words).

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Long-term reproducibility of axial length in eyes undergoing combined phacovitrectomy for macular-sparing rhegmatogenous retinal detachment

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2017.0f044 ◽

2017 ◽

Vol 95 ◽

Author(s):

T.S. Kang ◽

Y.I. Shin ◽

J.Y. Kim

Keyword(s):

Retinal Detachment ◽

Axial Length ◽

Rhegmatogenous Retinal Detachment ◽

Macular Sparing

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Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment

International Ophthalmology ◽

10.1007/s10792-017-0591-6 ◽

2017 ◽

Vol 38 (3) ◽

pp. 1275-1283 ◽

Cited By ~ 7

Author(s):

Murat Karacorlu ◽

Isil Sayman Muslubas ◽

Mumin Hocaoglu ◽

Serra Arf ◽

Mehmet Giray Ersoz

Keyword(s):

Prognostic Factors ◽

Retinal Detachment ◽

Functional Outcomes ◽

Rhegmatogenous Retinal Detachment ◽

Morphological Changes ◽

Recent Onset

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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.

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Lens-sparing vitrectomy for stage 4A retinopathy of prematurity in infants with aggressive-posterior ROP: Anatomic and functional results

European Journal of Ophthalmology ◽

10.1177/1120672120946938 ◽

2020 ◽

pp. 112067212094693

Author(s):

Sara Macor ◽

Silvia Pignatto ◽

Antonio Capone Jr ◽

Stefano Piermarocchi ◽

Paolo Lanzetta

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Functional Outcomes ◽

Vitreous Hemorrhage ◽

Functional Results ◽

Postmenstrual Age ◽

Refractive Correction ◽

Anatomic Success

Aim: To assess long-term anatomic and functional outcomes of early lens-sparing vitrectomy (LSV) for stage 4A retinopathy of prematurity (ROP) in infants with aggressive-posterior ROP (AP-ROP) which progressed to retinal detachment despite laser treatment. Methods: Chart review of infants who underwent early 25-gage LSV for stage 4A ROP. Outcomes were anatomic success, mean visual acuity (VA), development of postoperative complications, and refractive changes. Follow-up examinations were performed at 1, 3, 6, 12, and then every 6 months. Results: Ten eyes of seven preterm infants who underwent LSV were included. Mean follow-up was 36 ± 13.4 months and mean postmenstrual age (PMA) at last follow-up was 37 ± 13.7 months. Mean gestational age (GA) and weight at birth was 26 ± 1.4 weeks and 639 ± 180 g. Two eyes had vitreous hemorrhage 4 and 14 days after surgery, respectively. At last follow-up anatomic success was 100%, mean VA was 20/80 and eight eyes (80%) had high myopic refractive correction (mean spherical equivalent –11.25 D). Conclusion: Early LSV for stage 4A ROP with AP-ROP and progression to retinal detachment is efficacious in terms of anatomic and functional outcomes. Anatomic success is associated with visual improvement despite possible myopic refraction changes during follow-up.

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RISK FACTORS FOR RHEGMATOGENOUS RETINAL DETACHMENT IN THE SUBMACULAR SURGERY TRIALS

Retina ◽

10.1097/iae.0b013e3181a0857e ◽

2009 ◽

Vol 29 (6) ◽

pp. 819-824 ◽

Cited By ~ 7

Author(s):

SHARON D. SOLOMON ◽

LI MING DONG ◽

JULIA A. HALLER ◽

MARTA M. GILSON ◽

BARBARA S. HAWKINS ◽

...

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Submacular Surgery

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Long-term Functional Outcomes and Predictors of Shunt-Dependent Hydrocephalus After Treatment of Ruptured Intracranial Aneurysms in the BRAT Trial

Neurosurgery ◽

10.1227/neu.0000000000000677 ◽

2015 ◽

Vol 76 (5) ◽

pp. 608-615 ◽

Cited By ~ 37

Author(s):

Hasan A. Zaidi ◽

Andrew Montoure ◽

Ali Elhadi ◽

Peter Nakaji ◽

Cameron G. McDougall ◽

...

Keyword(s):

Risk Factors ◽

Functional Outcomes ◽

Intraventricular Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Univariate Analysis ◽

Significant Risk ◽

Intraparenchymal Hemorrhage ◽

Fisher Grade ◽

Shunt Dependency

Abstract BACKGROUND: Acute hydrocephalus is a well-known sequela of aneurysmal subarachnoid hemorrhage (SAH). Controversy exists about whether open microsurgical methods serve to reduce shunt dependency compared with endovascular techniques. OBJECTIVE: To determine predictors of shunt-dependent hydrocephalus and functional outcomes after aneurysmal SAH. METHODS: A total of 471 patients who were part of a prospective, randomized, controlled trial from 2003 to 2007 were retrospectively reviewed. All variables including demographic data, medical history, treatment, imaging, and functional outcomes were included as part of the trial. No additional variables were retrospectively collected. RESULTS: Ultimately, 147 patients (31.2%) required a ventriculoperitoneal shunt (VPS) in our series. Age, dissecting aneurysm type, ruptured vertebrobasilar aneurysm, Fisher grade, Hunt and Hess grade, admission intraventricular hemorrhage, admission intraparenchymal hemorrhage, blood in the fourth ventricle on admission, perioperative ventriculostomy, and hemicraniectomy were significant risk factors (P < .05) associated with shunt-dependent hydrocephalus on univariate analysis. On multivariate analysis, intraventricular hemorrhage and intraparenchymal hemorrhage were independent risk factors for shunt dependency (P < .05). Clipping vs coiling treatment was not statistically associated with VPS after SAH on both univariate and multivariate analyses. Patients who did not receive a VPS at discharge had higher Glasgow Outcome Scale and Barthel Index scores and were more likely to be functionally independent and to return to work 72 months after surgery (P < .05). CONCLUSION: There is no difference in shunt dependency after SAH among patients treated by endovascular or microsurgical means. Patients in whom shunt-dependent hydrocephalus does not develop after SAH tend to have improved long-term functional outcomes.

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