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.

Iatrogenic Subretinal Triamcinolone During Primary Surgical Repair of a Retinal Detachment With a Giant Retinal Tear

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.

scholarly journals Globe Perforation During Peribulbar Anesthesia: Experience of Half a Million Consecutive Injections

2021 ◽  
Author(s):  
Naresh Babu ◽  
Jayant Kumar ◽  
Piyush Kohli ◽  
Ashish Ahuja ◽  
Prerna Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Vascular Complications ◽  
Vitreous Hemorrhage ◽  
Ocular Surgery ◽  
Retinal Breaks ◽  
Peribulbar Block ◽  
The Mean ◽  
Group 2 ◽  
Vascular Occlusions

Abstract Aim: To evaluate the risk factors, clinical presentation, management and outcome of inadvertent globe perforation during peribulbar anaesthesia.Methods: This retrospective study evaluated the medical records of all the patients treated for globe perforation secondary to peribulbar block preceding ocular surgery from 2012 to 2020. The patients were divided into three groups; Group 1 - clear media with no retinal detachment (RD); group 2 - vitreous hemorrhage (VH) without RD; and group 3 - RD with/without VH.Results: Twenty-five patients (25 eyes) were identified. The incidence of globe perforation was 0.002 %. The mean axial length (AL) was 24.7±2.7mm (Range, 20.9-31.2mm). Eleven eyes (45.8%) had AL≥24mm. The most common presenting features were VH (n=14), ocular hypotony (n=7) and RD (n=7). The treatment included laser photocoagulation for the retinal break(s) (n=7) and vitrectomy (n=17). Retinal breaks were identified in all the patients (total breaks, 37). Other complications included full-thickness macular hole (n=5), subretinal haemorrhage (n=4) and retinal vascular occlusions (n=4). Mean presenting best-corrected visual acuity (BCVA) in group 1,2 and 3 were logMAR 0.79±0.73, 1.82±0.78 and 2.13±0.59 respectively. All the patients, except one who did not undergo surgery due to advanced proliferative vitreoretinopathy, had an attached retina at the time of last follow-up. The mean final BCVA was logMAR 0.59±0.79, 0.48±0.26 and 1.25±0.64 respectively. Conclusion: Early intervention can help manage the eyes with inadvertent perforation successfully. The presence of retinal detachment, as well as macular and vascular complications are risk factors for poor prognosis.

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.

Retinal Histology and Anatomical Landmarks in Vitreoretinal Surgery

2021 ◽  
pp. 296-299
Keyword(s):  
Retinal Detachment ◽  
Pigment Epithelium ◽  
Vitreoretinal Surgery ◽  
Interface Problems ◽  
Anatomical Landmarks ◽  
Vitreoretinal Interface ◽  
Pars Plana ◽  
Vortex Vein ◽  
Interphotoreceptor Matrix ◽  
Retina Pigment Epithelium

Awareness of important anatomical landmarks during vitreoretinal surgery contributes to favorable outcomes in the postoperative period. While external anatomical landmarks include pars plana, ora serrata, and vortex veins, long posterior ciliary nerves, vortex vein ampulla, and optic disc constitute the internal anatomical landmarks for vitreoretinal surgery. The forces that prevent the development of retinal detachment by keeping the retina in place are the retina pigment epithelium pump, the interphotoreceptor matrix, the presence of vitreous gel, and intraocular pressure. The main aim of the surgeon should be removing vitreous as much as possible and releasing vitreoretinal tractions which cause retinal detachment and vitreoretinal interface problems.

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.

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.

Posterior pole retinal breaks causing posterior pole retinal detachment in a middle-aged man with retinal vasculitis and moderate myopia

2021 ◽  
Vol 14 (2) ◽  
pp. e239012
Author(s):  
Deepika Chennapura Parameswarappa ◽  
Nidhi Mahendra Vithalani ◽  
Padmaja Kumari Rani
Keyword(s):  
Retinal Detachment ◽  
Retinal Vasculitis ◽  
Vitreoretinal Surgery ◽  
Intravitreal Bevacizumab ◽  
Posterior Pole ◽  
Vitreous Haemorrhage ◽  
Mantoux Test ◽  
Retinal Breaks ◽  
The Right

A 38-year-old man presented with sudden decreased vision in the right eye 3 years ago due to vitreous haemorrhage. During follow-up, right eye fundus showed evidence of vasculitis, non-perfusion areas and neovascularisation elsewhere. Systemic evaluation findings of positive Mantoux test, QuantiFERON Gold test and right apical pleuroparenchymal fibrosis observed on high-resolution CT of the chest were suggestive of postinfection probable tubercular aetiology. He was treated with oral steroids, antitubercular therapy, intravitreal bevacizumab and anterior retinal cryopexy, leading to resolution of vasculitis and vitreous haemorrhage. Later he developed peripheral retinal flap and posterior retinal breaks at 8-month and 11-month follow-up, respectively, which were managed by barrage laser. He maintained a stable visual acuity of 20/20, N6 for the next 2 years. He then presented with sudden decreased vision in the right eye (20/50, N10). Right eye fundus showed posterior pole retinal detachment with lifting of previously barraged posterior retinal breaks. He underwent vitreoretinal surgery with gas tamponade. Recent 1-month postoperative visit showed successful retinal reattachment and visual recovery of 20/20, N6.

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.

scholarly journals Krypton yellow laser for the treatment of macular hole in high myopia without retinal detachment

2008 ◽  
Vol 31 (6) ◽  
pp. 357
Author(s):  
Ji-Ping Cai ◽  
Jin-Wei Cheng ◽  
Xiao-Ye Ma ◽  
Yu-Zhen Li ◽  
You Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Hole ◽  
High Myopia ◽  
Vitamin B1 ◽  
Macular Holes ◽  
Yellow Laser ◽  
Group A ◽  
The Mean ◽  
Group B

Purpose To evaluate the prophylactic effect of krypton yellow laser for the treatment of macular holes in high myopic eyes in order to reduce the risk of retinal detachment. Methods Twenty-seven eyes of 27 patients with high myopia and macular holes were randomly assigned to two groups. Fifteen patients (group A, 15 eyes) were subject to laser photocoagulation around the hole margin along with an oral placebo (vitamin B1), while 12 patients (group B, 12 eyes) were only given the oral placebo (vitamin B1). The incident rate of retinal detachment due to macular hole and the mean best-corrected visual acuity of the two groups before and after treatment were measured. The data were statistically tested by X2 test and Student’s t test. Results The incident rates of retina1 detachment in group A and group B were 20%(3/15) and 58.3%(7/12), respectively (X2=4.201, P0.05). The mean BCVA of group B on the initial examination was 24/200, while the mean BCVA at the final follow-up was 30/200 (P>0.05). No significant difference in initial visual acuity (P>0.05) or final visual acuity (P>0.05) was found between the two groups. Conclusion Krypton yellow laser photocoagulation could reduce the incidence of retinal detachment due to a macular hole in high myopia with acceptable functional results in this study.

Surgery for Myopic Macular Hole Without Retinal Detachment

2012 ◽  
Vol 06 (04) ◽  
pp. 204 ◽  
Author(s):  
Jose Garcia Arumi ◽  
Anna Boixadera ◽  
Vicente Martinez-Castillo ◽  
Miguel Angel Zapata ◽  
Carme Macià ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Vitreoretinal Surgery ◽  
Internal Limiting Membrane ◽  
Success Rates ◽  
Macular Holes ◽  
Myopic Macular Hole ◽  
Anatomical Success

The purpose of this paper is to review the indications, surgical technique and surgical outcome of myopic macular holes (MHs). In myopic MH, the use of optical coherence tomography has been very useful both in the diagnosis and follow-up after surgery due to the difficulty in biomicroscopic diagnosis in high myopes. Myopic MH surgery is more difficult than idiopathic MH surgery due to the increased axial length, retinal pigment epithelium and choroidal atrophy, and thinner retina making internal limiting membrane and posterior hyaloid staining more important. Myopic MH vitreoretinal surgery achieves comparable anatomical success rates when compared with idiopathic MHs except in cases with posterior staphyloma and axial lengths equal to or over 30 mm where a macular buckle may be needed. The closure of myopic MH decreases the risk of retinal detachment secondary to MH.

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