Repair of progressive retinal detachment complicating degenerative retinoschisis: surgical management and outcomes in phakic eyes

Abstract Background Degenerative retinoschisis is a common condition defined by the splitting of the neurosensory retina that may rarely be associated with progressive retinal detachment (RD). Here, we aim to describe the anatomic and functional outcomes of surgical treatment of progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) using pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB procedure. Methods A retrospective chart review of patients with PSRDCR between Jan 1, 2008 and Dec 31, 2019 was conducted. Data regarding demographics, surgical approach, and anatomic/functional outcomes were collected. Results Of the 4973 charts with RD repair during the study period, 36 eyes (0.7%) had retinoschisis with RD. 18 eyes met inclusion criteria (0.4%). The median age was 54 years (range 18–74) and all eyes were phakic. All eyes had outer layer breaks (OLBs) and 16 eyes (89%) had identifiable inner layer breaks. All OLBs were posterior to the equator in charts where position was recorded (16 eyes). The single surgery anatomic success (SSAS) and final anatomical success rates were 66% (12/18) and 100%, respectively. Eyes treated with PPV/SB had an SSAS rate of 75% (9/12), while PPV and SB had SSAS rates of 66% (2/3) and 33% (1/3), respectively. Conclusions PSRDCR is an exceedingly rare complication of degenerative retinoschisis associated with an SSAS rate lower than for uncomplicated rhegmatogenous RD. The majority of PSRDCR were repaired via combined PPV/SB in our study, and the rarity of this complication limits statistical support of an optimal surgical method in our and prior studies. The role of SB combined with PPV for PSRDCR requires further investigation.

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Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2016/2193518 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Yasser Helmy Mohamed ◽

Kozue Ono ◽

Hirofumi Kinoshita ◽

Masafumi Uematsu ◽

Eiko Tsuiki ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Multiple Logistic Regression Analysis ◽

University Hospital ◽

Success Rates ◽

Pars Plana ◽

Anatomical Success ◽

Anatomical Success Rate

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD).Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60).Results. This study evaluated 422 eyes of 411 patients with a mean age of57.7±11.2years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean =3.14±1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P=0.002) and the presence of multiple tears (P=0.01).Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

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Advanced Vitrectomy Surgery in Rhegmatogenous Retinal Detachment; Indications and Techniques

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0166 ◽

2019 ◽

pp. 205-210

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Techniques ◽

Scleral Buckling ◽

Treatment Modalities ◽

Success Rates ◽

Retinal Tears ◽

Pars Plana ◽

Anatomical Success ◽

Vitrectomy Surgery

The main goal in the treatment of rhegmatogenous retinal detachment (RRD) is the localization of retinal tears, removal of tractions, and closure of retinal tears. Despite the use of pneumatic retinopexy, scleral buckling, and vitrectomy as standard treatment modalities, the preference for pars plana vitrectomy (PPV) in the treatment of RRD has increased steadily in recent years. The reason for this increase is the widespread use of small-sized transconjunctival surgery, improvement of bimanual surgery, use of liquid perfluorocarbons, improved vitrectomy devices and more safe and successful removing of peripheral vitreous bases, visualization of membranes with vital dyes, safe retinopexy with use of curved laser probe even with phakic cases. Besides these, PPV and advanced surgical techniques are more needed in complicated detachments. Nevertheless, the surgeon has a specially important role in the surgical technique of choice. Although the control of the procedures can be performed much more successfully with the PPV in the case of complicated RRD patients during surgery, anatomical success rates are still not very high. In this article, the applications of advanced vitrectomy surgery in RRD are discussed in detail.

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Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2018/7643174 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Keiko Otsuka ◽

Hisanori Imai ◽

Ayaka Fujii ◽

Akiko Miki ◽

Mizuki Tagami ◽

...

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Success Rates ◽

Significant Difference ◽

Pars Plana ◽

Anatomical Success ◽

Better Than ◽

Baseline Demographic

Aim. To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD).Design. A retrospective nonrandomized clinical trial.Methods. A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed.Results. Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1andp=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and −0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02andp=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63andp=0.21, resp.).Conclusion. The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

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Outcomes of Rhegmatogenous Retinal Detachment

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1073 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Sidrah Riaz ◽

Muhammad Tariq Khan ◽

Khurram Azam Mirza

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Success Rates ◽

Cross Sectional ◽

Pars Plana ◽

Anatomical Success ◽

Anatomical Success Rate

Purpose: To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore. Study Design: Cross sectional Observational study. Place and Duration of Study: Private Vitreo-retinal setup, from March 2017 to April 2019. Methods: Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months. Results: Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up. Conclusion: Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world. Key Words: Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.

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Vitreoschisis and retinal detachment: New insight in proliferative vitreoretinopathy

European Journal of Ophthalmology ◽

10.1177/11206721211057672 ◽

2021 ◽

pp. 112067212110576

Author(s):

Stanislao Rizzo ◽

Lorenzo de Angelis ◽

Francesco Barca ◽

Daniela Bacherini ◽

Lorenzo Vannozzi ◽

...

Keyword(s):

Retinal Detachment ◽

Proliferative Vitreoretinopathy ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Vitreous Cortex ◽

Group A ◽

Pars Plana ◽

Group B ◽

Removal Group ◽

Anatomical Success

Purpose To assess the occurrence of peripheral vitreoschisis-induced vitreous cortex remnants (p-VCRs) in primary rhegmatogenous retinal detachment (RD) and investigate whether the presence of p-VCRs results in a greater risk of RD recurrence, secondary to Proliferative Vitreoretinopathy (PVR) development after pars plana vitrectomy (PPV). Methods Patients who underwent PPV for primary rhegmatogenous RD between January 2016 and December 2018 were included. The presence of residual p-VCRs was confirmed intraoperatively using triamcinolone acetonide (TA). Patients with p-VCRs were divided into two groups: Group A comprised of patients who underwent PPV without p-VCR removal, while Group B included patients who underwent PPV with p-VCR removal. Results Four hundred-thirteen eyes with evidence of p-VCR were analyzed. Two-hundred-twenty-three eyes underwent PPV without VCR removal (Group A), while 190 eyes underwent PPV with p-VCR removal (Group B). Primary anatomical success was 91.5% in the Group A and 95.4% in the group B. Retinal re-detachment due to PVR occurred in 17 (7.6%) eyes in Group A and in four (2.1%) eyes in Group B within the first 3 months (p = 0.01). Among group A, in 11 eyes, there was a diffuse posterior PVR grade C, while six eyes were focal PVR grade C. In Group B, we observed four retinal re-detachment due to focal PVR grade C. Conclusion The presence of p-VCRs seems to be associated with a higher incidence of PVR development and might also result in more complex RD recurrence, this suggests the need for more aggressive VCRs removal during the first surgery.

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Combined Phacoemulsification and Pars Plana Vitrectomy for the Treatment of Cataract in Patients With Noninfectious Uveitis

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420930489 ◽

2020 ◽

Vol 4 (5) ◽

pp. 393-400

Author(s):

Christopher D. Conrady ◽

Akbar Shakoor ◽

Rachel Patel ◽

Marissa Larochelle ◽

Majid Moshirfar ◽

...

Keyword(s):

Surgical Approach ◽

Inflammatory Disease ◽

Chart Review ◽

Retrospective Chart Review ◽

Visual Rehabilitation ◽

Disease Remission ◽

Pars Plana ◽

Vitrectomy Surgery

Purpose: This work evaluates the role of combined phacoemulsification and vitrectomy surgery in the management of cataract associated with noninfectious uveitis. Methods: A retrospective chart review was conducted of all patients aged 7 years or older who underwent a combined surgical approach from 2005 to 2018. Results: Eighty-five eyes of 67 patients were included in the study; 10.7% of eyes had a best-corrected visual acuity (BCVA) of 20/40 or better at time of surgery. At 1-year follow-up, 63.4% of eyes had a BCVA 20/40 or better and 7.6% had a BCVA of 20/200 or worse. There was an overall decrease in cystoid macular edema after surgery compared with preoperatively (47.6% vs 34.5% presurgery and postsurgery, respectively). Complete inflammatory disease remission off immunomodulatory therapy and systemic steroids was achieved in 21.1% of patients. Conclusions: A combined surgical approach is effective in visual rehabilitation in patients with uveitic cataracts and may promote inflammatory disease remission specifically in intermediate uveitis.

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Vitrectomy with Air Endotamponade for Traumatic Cyclodialysis

Journal of Ophthalmology ◽

10.1155/2020/3742306 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Anan Wang ◽

Zhenquan Zhao

Keyword(s):

Surgical Approach ◽

Ultrasound Biomicroscopy ◽

Success Rates ◽

Corrected Visual Acuity ◽

Pars Plana ◽

The Difference ◽

Anatomical Success ◽

Anatomical Success Rate ◽

Cyclodialysis Cleft

Background. Various techniques have been described for repairing cyclodialysis clefts, but there is no consensus regarding the optimal treatment. This study investigated the clinical efficacy of a novel surgical approach that is used to manage traumatic cyclodialysis. Methods. We prospectively enrolled 7 patients (7 eyes) with traumatic cyclodialysis of the concomitant lens and other vitreous diseases. Ultrasound biomicroscopy was used to diagnose cyclodialysis, and all eyes underwent pars plana vitrectomy with air endotamponade. The main outcome measures were postoperative anatomical success rates, best-corrected visual acuity (BCVA), and intraocular pressure (IOP). Results. All patients were male, and their age ranged from 46 to 64 years (mean: 54.3 years). After the surgical intervention, the extent of the cyclodialysis cleft ranged from 1 to 4 clock hours (mean: 2.3 clock hours) and the detached ciliary body of all cases was completely restored; the anatomical success rate was 100%. The BCVA significantly increased from 1.40 ± 0.49 to 0.42 ± 0.31 (P = 0.002). The IOP increased from 8.91 ± 1.77 to 14.67 ± 6.38, but the difference was not significant (P = 0.056). The postoperative IOP of most patients was temporarily elevated or lowered after surgery. At the last follow-up, there were still two abnormal cases, including one with ocular hypertension and one with hypotony. Conclusions. This study revealed that vitrectomy with air endotamponade is an effective and minimally invasive alternative surgical approach for small traumatic cyclodialysis clefts.

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Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy

BMC Ophthalmology ◽

10.1186/s12886-021-02175-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zheng Ying ◽

Casagrande Maria ◽

Dimopoulos Spyridon ◽

Bartz-Schmidt Karl-Ulrich ◽

Spitzer Matin Stephan ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Cataract Surgery ◽

Intravitreal Injection ◽

Pars Plana Vitrectomy ◽

Clinical Evidence ◽

Prognostic Role ◽

Preoperative Visual Acuity ◽

Pars Plana

Abstract Background To evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy. Methods Electronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures were retinal detachment and visual acuity. Results The reasons for endophthalmitis were previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. The first clinical evidence of endophthalmitis was present in median 5 days after the triggering intervention. Twenty-five eyes (21.55%) developed a retinal detachment an average of 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001). Conclusions We emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G Pars Plana Vitrectomy.

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Analysis of retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy

10.21203/rs.3.rs-223374/v1 ◽

2021 ◽

Author(s):

Ying Zheng ◽

Maria Casagrande ◽

Spyridon Dimopoulos ◽

Ulrich Bartz-Schmidt ◽

Martin Spitzer ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Cataract Surgery ◽

Intravitreal Injection ◽

Pars Plana Vitrectomy ◽

Clinical Evidence ◽

Prognostic Role ◽

Preoperative Visual Acuity ◽

Pars Plana

Abstract Background To evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G pars plana vitrectomy. Methods Electronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures are retinal detachment and visual acuity. Results Reason for endophthalmitis was previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. First clinical evidence of endophthalmitis was present in median 5 days after the triggering surgery. Twenty-five eyes (21.55%) developed a retinal detachment in average 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001). Conclusions Modern 23G vitrectomy technique seems not to lower the rate of retinal detachment after vitrectomy for endophthalmitis. And we also emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G pars plana vitrectomy.

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Effects of the Pars Plana Vitrectomy on the Chronic Total Rhegmatogenous Retinal Detachment in the Young Adults

Frontiers in Medicine ◽

10.3389/fmed.2021.755389 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jinguo Yu ◽

Xingxing Hu ◽

Jiangkai Zhang ◽

Han Han ◽

Bo Huang ◽

...

Keyword(s):

Young Adults ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Retrospective Chart Review ◽

Related Factors ◽

Pars Plana ◽

23 Gauge ◽

Second Procedure

Objective: To observe the characteristics and evaluate the efficacy and safety of the chronic total rhegmatogenous retinal detachment (RRD) treatment by the 23-gauge pars plana vitrectomy (PPV) in young adults and to analyze the related factors.Methods: A retrospective chart review was performed for the young adults who underwent the 23-gauge PPV for the chronic total RRD at the Tianjin Medical University General Hospital from 2011 to 2018. A total of 54 eyes of 48 patients were included in this study. The preoperative vision ranged from 2.00 to 1.00. The mean duration of RRD was 9 ± 0.6 months with a range from 4 to 18 months. The proliferative vitreoretinopathy (PVR) grade D1 and grade D2 was diagnosed in 48 eyes and 6 eyes, respectively. About 37 eyes were filled with C3F8 and 17 eyes were filled with silicone oil tamponade. The follow-up ranged from 9 to 78 months with a mean of 23 ± 2.2 months.Results: The postoperative visual acuity increased in all the eyes at the final observation. The retinal attachment was achieved in 49 eyes (90.7%) in the primary PPV. Five eyes (9.3%) with the failed retinal attachment finally achieved the attachment after the second procedure. The postoperative complications mainly included temporary intraocular pressure (IOP) elevation, hyphema, and retinal redetachment.Conclusion: Chronic total RRD can be treated via the 23-gauge PPV with a great anatomical and visual prognosis in the young adult. The successful treatment of the chronic total RRD in young adults is mainly associated with the complete dissection of the severe vitreoretinopathy, especially for the epiretinal membrane at the retinal breaks and degenerations and the subretinal proliferation during surgery.

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