Medium-term tamponade with vitrectomy and perfluorodecalin for the management of complex retinal detachments

Purpose: To describe the clinical presentation, anatomical and visual outcome of a series of patients in our department with complex retinal detachments, managed with vitrectomy and perfluorodecalin (PFD) for medium-term tamponade. Study design: Retrospective case series. Methods: Retrospective analysis of the medical records of all patients in the last 6 years presenting with complex retinal detachment managed with vitrectomy where PFD was used as a medium-term tamponade. Results: A total of 85 eyes in 85 patients were included in the study, with a mean follow-up period of 16.0 ± 2.67 months (range 3–59). About 26 detachments presented with associated PVR-C, and 10 had giant retinal tears. The location of the retinal detachment was inferior in 40% of cases, and total in 18.9% of cases. Anatomical success, defined as retinal reattachment at 12 months, was achieved in 98.8% of cases, and there was a mean improvement in BCVA of logMAR 0.64 ± 0.20, which was statistically significant ( p < 0.001, paired t-test 6.23). Of the 41 phakic eyes included in the study, 20 underwent cataract surgery within the follow-up period. Conclusion: In this case series, we have demonstrated a 98.8% anatomical success and significant improvement in BCVA, with no reports of retinal toxicity. Medium-term tamponade PFD appears to be an efficacious and safe technique for management of a variety of complex retinal detachments, including those secondary to GRT, the presence of PVR-C, inferior location, tractional, traumatic, and re-detachments.

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Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419854283 ◽

2019 ◽

Vol 3 (5) ◽

pp. 341-345

Author(s):

Matthew A. Cunningham ◽

Samantha Fink ◽

Jaya B. Kumar ◽

Elias C. Mavrofrides ◽

S.K. Steven Houston ◽

...

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Case Series ◽

Vitreoretinal Surgery ◽

Visual Outcome ◽

Full Thickness ◽

Tractional Retinal Detachment ◽

Full Thickness Macular Hole ◽

Pars Plana

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.

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Bullous X linked retinoschisis: clinical features and prognosis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310593 ◽

2017 ◽

Vol 102 (5) ◽

pp. 622-624 ◽

Cited By ~ 6

Author(s):

Anne-Marie Hinds ◽

Abigail Fahim ◽

Anthony T Moore ◽

Sui Chien Wong ◽

Michel Michaelides

Keyword(s):

Retinal Detachment ◽

Age Of Onset ◽

Case Series ◽

Peripheral Retina ◽

Exudative Retinal Detachment ◽

Retrospective Case ◽

Tertiary Centre ◽

Unilateral Case ◽

The Mean

Background/AimsA subset of patients with X linked retinoschisis (XLRS) have bullous schisis cavities in the peripheral retina. This study describes the characteristics and prognosis of the bullous form of XLRS.MethodsA retrospective case series was performed of nine patients with molecularly proven bullous XLRS seen at a single tertiary centre.ResultsAll cases of bullous peripheral schisis were bilateral, with one unilateral case at presentation which developed into bilateral bullous schisis over time. The mean age of onset was 1.9 years (range: 1 month–7 years, SD: 2.1 years) and at clinical diagnosis was 5.9 years (range: 1 month–27 years, SD: 9.0 years). Mean follow-up was 11 years (range: 6 months–36 years, SD: 10.8 years). Strabismus was the most common presentation (n=7). Other presenting complaints included decreased vision, floaters and an irregularly shaped pupil. The most frequently associated ocular features were strabismus (100%), vitreous haemorrhage (4/18 eyes, 22%), nystagmus (2/9, 22%) and persistent fetal vasculature (1/18, 6%). Localised tractional detachment was seen in 2/18 (11%) eyes, total detachment that underwent surgical repair in 1/18 (6%) and pigmented demarcation lines in a further 22% of the eyes. There was one eye with exudative retinal detachment.ConclusionIn XLRS, bullous schisis may be congenital or develop soon after birth and most commonly presents with strabismus. Cases may be complicated by some form of retinal detachment, which may be tractional or a Coats-like exudative detachment.

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A Study on Pattern of Retinal Detachment in Patients with Choroidal Coloboma and Its Outcome after Surgery at a Tertiary Eye Hospital in Nepal

Journal of Ophthalmology ◽

10.1155/2019/7390852 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Barsha Suwal ◽

Govinda Paudyal ◽

Raba Thapa ◽

Sanyam Bajimaya ◽

Sanjita Sharma ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Case Series ◽

Visual Outcome ◽

Oil Removal ◽

Common Complication ◽

Silicon Oil ◽

Postsurgical Complications ◽

Anatomic Success

Background. To review the pattern of retinal detachment (RD) in patients with choroidal coloboma and type of reattachment surgery performed and to study its outcome in terms of retinal reattachment, visual acuity, and postsurgical complications. Methods. Observational case series of a single tertiary eye institution of 13 eyes having choroidal coloboma with RD done from January 2015 to June 2017. Results. Mean age of presentation was 29.3 years (Range 14–60 years). Males were two times more affected than females (2.25 : 1). The overall rate of anatomic success achieved after RD repair and silicon oil removal at 6 months was 92.3% (12/13 eyes). Following surgery, visual acuity improved in 6 out of 11 eyes (54.54%), remained unchanged in 4 eyes (36.36%), and worsened in 1 eye (9.1%). The most common complication following surgery was secondary glaucoma in 30.7% (4/11 eyes). Conclusion. The overall anatomic success rate of retina reattachment surgery in colobomatous eye is good, and the visual outcome following surgery can improve in majority of the cases or may remain same in few cases. Hence, timely surgery is advocated. But careful follow-up is required as the risk of postoperative complications is also high.

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Modified Vitrectomy Technique for Phakic Rhegmatogenous Retinal Detachment with Intermediate Break

Journal of Ophthalmology ◽

10.1155/2018/6127932 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Vincenza Bonfiglio ◽

Mario D. Toro ◽

Antonio Longo ◽

Teresio Avitabile ◽

Robert Rejdak ◽

...

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Final Analysis ◽

Nuclear Density ◽

Retinal Break ◽

Vitreous Traction ◽

Anatomical Success ◽

Phakic Eyes

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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Outcomes of 25-Gauge Vitrectomy With Relaxing Retinectomy for Retinal Detachment Secondary to Proliferative Vitreoretinopathy

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419831614 ◽

2019 ◽

Vol 3 (2) ◽

pp. 69-75

Author(s):

Yi Jiang ◽

Daniel J. Oh ◽

Wyatt Messenger ◽

Jennifer I. Lim

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Proliferative Vitreoretinopathy ◽

Silicone Oil ◽

Case Series ◽

High Rate ◽

Retrospective Case ◽

Institutional Review ◽

25 Gauge Vitrectomy

Purpose: The aim of this study is to evaluate visual and anatomic outcomes of 25-gauge vitrectomy with relaxing retinectomies for complex retinal detachment (RD) secondary to proliferative vitreoretinopathy (PVR). Methods: A single-center, retrospective case series of 44 patients who had undergone a 25-gauge vitrectomy with a relaxing retinectomy for the treatment of combined RD and PVR was performed. Preoperative characteristics, intraoperative techniques, and outcomes were analyzed. The rates of attachment, complications, and visual acuity were analyzed. Institutional review board/ethics committee approval was obtained, and the described research adhered to the tenets of the Declaration of Helsinki. Results: At the final follow-up, 27 eyes (61%) had attachment after 1 surgery, 41 eyes (93%) ultimately had attached retinas, 3 eyes (7%) had hypotony, 3 eyes had become phthisical (7%), and 24 eyes (56%) had improved visual acuity. After stratifying by visual outcomes, 20/400 or better best-corrected visual acuity was not associated with age ( P = .66), RD etiology ( P = .61), preoperative hypotony ( P = .60), nor size of retinectomy ( P = .48). Patients achieving 20/400 vision or better were statistically more likely to be pseudophakic ( P = .024) and have silicone oil removal ( P < .0001). Conclusion: The use of 25-gauge vitrectomy and relaxing retinectomy provides a high rate of reattachment and improved visual acuity.

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Surgical and Visual Outcome for Recurrent Retinal Detachment Surgery

Journal of Ophthalmology ◽

10.1155/2014/810609 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Constantin Pournaras ◽

Chrysanthi Tsika ◽

Catherine Brozou ◽

Miltiadis K. Tsilimbaris

Keyword(s):

Retinal Detachment ◽

Functional Outcome ◽

Visual Outcome ◽

Snellen Chart ◽

Anatomic Results ◽

The Mean ◽

Anatomical Success ◽

Better Than ◽

Anatomical Success Rate

Purpose. To evaluate the anatomical and functional outcome of repeated surgeries for recurrent retinal detachment.Methods. We retrospectively reviewed 70 cases with refractory retinal detachment of various etiologies that required multiple operations. Anatomical success (attached retina) or failure (totally/partially-detached retina) was assessed biomicroscopically. The BCVA was used for the evaluation of the functional outcome, at presentation and at the end of follow-up. Various pre-, intra-, and postoperative factors were associated with anatomical success or failure as well as with final functionality.Results. The mean number of surgeries was 4 (range: 2 to 10). The anatomical success rate was 80% (56 attached cases, 14 detached cases). 29% of the attached cases had a BCVA better than 20/40 (Snellen chart). The number of operations doesn’t seem to affect significantly the final visual acuity. The PVR was found to affect both the anatomical and functional outcome (P=0.014&P=0.002, respectively).Conclusions. In the present study, it is suggested that multiple operations for refractory retinal detachment may result in successful anatomic results, with a fare functional outcome at the same time. Eventually, we verified that the existence of PVR worsens the prognosis.

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The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419893816 ◽

2019 ◽

Vol 4 (2) ◽

pp. 91-95

Author(s):

Nicolas A. Yannuzzi ◽

Karen Brown ◽

Natalia F. Callaway ◽

Nimesh A. Patel ◽

Thomas A. Albini ◽

...

Keyword(s):

Retinal Detachment ◽

Clinical Outcomes ◽

Case Series ◽

Tertiary Referral ◽

Retrospective Case ◽

Tertiary Referral Center ◽

Referral Center ◽

Short Time ◽

Anatomic Success

Purpose: This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. Methods: A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). Results: There were 202 eyes of 198 patients with an average of 22 months’ follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more ( P = .92). Conclusions: Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.

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Scleral buckle surgery for pseudophakic and aphakic retinal detachment in western Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i2.5261 ◽

1970 ◽

Vol 3 (2) ◽

pp. 109-117

Author(s):

RN Byanju ◽

S Bajimaya ◽

I Kansakar ◽

A Melamud

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Case Series ◽

Scleral Buckle ◽

Retrospective Case ◽

Repeat Surgery ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity ◽

Aphakic Retinal Detachment

Introduction: Retinal detachment remains one of the most serious complications of cataract surgery. Treatment of this condition has represented a challenge for vitreoretinal surgeons. Scleral buckle (SB) surgery is one of the treatment options in pseudophakic and aphakic retinal detachment (RD). Aims: To find out the anatomical and visual outcome of SB in pseudophakic and aphakic RD. Subjects and methods: Retrospective case series of 46 consecutive eyes of 46 patients with RD (38 pseudophakic and 8 aphakic eyes) that had undergone conventional SB surgery were reviewed from patient files. Postoperative retinal status at 3 weeks, 6 weeks and 3 months were recorded to see the anatomical success rate after retinal reattachment surgery. Best corrected visual acuity (BCVA) at 3 months follow-up was noted. Results: The mean age of the patients was 54.28 ± 13.49 years. Forty eyes (86.9 %) had primary attachment by 6 weeks duration. Five eyes had undergone repeat surgery within a six-week duration (pars plana vitrectomy). Forty patients had follow-up visit to 12 weeks, achieving retinal attachment in 37 eyes (80.5 %). Best corrected visual acuity (BCVA) at 3 months was better than 6/60 in 18 eyes (39.1%), BCVA better or equal to 1/60 but less than 6/60 in 18 eyes (39.1%) and BCVA less than 1/60 in 4 eyes (8.7 %). Conclusion: Conventional scleral buckling has good outcome for pseudophakic and aphakic RD and can be useful for patients in peripheral eye hospitals where patients cannot afford high cost surgeries. Keywords: scleral buckle, pseudophakia, retinal detachment DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5261 Nepal J Ophthalmol 2011; 3(2): 109-117

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Long-term outcomes of pediatric traumatic cataracts and retinal detachments due to self-inflicted injuries

European Journal of Ophthalmology ◽

10.1177/1120672120926452 ◽

2020 ◽

pp. 112067212092645

Author(s):

Tina Felfeli ◽

Kamiar Mireskandari ◽

Asim Ali

Keyword(s):

Retinal Detachment ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Long Term Outcomes ◽

Retrospective Case ◽

Surgical Interventions ◽

Severe Visual Loss

Purpose To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury. Methods A retrospective case series of pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014. Results A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8–16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury. Conclusion Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.

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Characteristics and Outcomes of Retinal Detachment Associated With Atopic Dermatitis: A Retrospective Case Series

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419831618 ◽

2019 ◽

Vol 3 (2) ◽

pp. 80-85

Author(s):

Parampal S. Grewal ◽

Uriel Rubin ◽

Mark D.J. Greve ◽

Rizwan Somani ◽

Chad F. Baker ◽

...

Keyword(s):

Atopic Dermatitis ◽

Retinal Detachment ◽

Case Series ◽

High Rate ◽

Scleral Buckle ◽

Retrospective Case ◽

Lens Subluxation ◽

Physician Awareness ◽

The Mean

Purpose: The purpose of this article is to describe the characteristics and outcomes of retinal detachment (RD) repair associated with atopic dermatitis (AD). Methods: A single-center, retrospective review of all patients with RD associated with AD between January 2007 and December 2017 was conducted. Results: Ten patients (13 eyes) were included with a mean age of 23.5 ± 6.4 years; 6 of the patients were male (60%). The average follow-up was 41.3 ± 34.8 months. Seven eyes developed proliferative vitreoretinopathy (PVR) and recurrent RD (53.8%). The mean number of retinal surgeries was 2.3 ± 1.3. Three eyes had a scleral buckle alone (23.1%), 4 eyes had vitrectomy only (30.8%), and 6 eyes had both scleral buckle and vitrectomy (46.2%). Five eyes had prior cataract surgery (38.5%), 5 eyes had cataract at presentation (38.5%), and 5 eyes developed lens subluxation (38.5%). The mean presenting best-corrected visual acuity (BCVA) was 1.14 logarithm of the minimum angle of resolution (Snellen equivalent, 20/276) and the mean final BCVA was 1.06 (Snellen, 20/230; P = .83). The retina was successfully reattached at final follow-up in all 13 eyes (100%). Conclusions: RD is a challenging complication of AD with a high rate of PVR, recurrent RD, cataract, and lens subluxation. Patient education and physician awareness are necessary for timely diagnosis, appropriate counseling, and optimal surgical planning.

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