scholarly journals ASSESSMENT OF EFFICACY AND SAFETY OF COMBINED MICROINVASIVE LASER-SURGICAL TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT

2020 ◽  
pp. 535-541
Author(s):  
A.V. DOGA ◽  
◽  
D.O. SHKVORCHENKO ◽  
L.A. KRY ◽  
M.R. TAEVERE ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Laser Photocoagulation ◽  
Rhegmatogenous Retinal Detachment ◽  
Wide Field ◽  
Efficacy And Safety ◽  
Pneumatic Retinopexy ◽  
Retinal Tear

Objective: To evaluate the efficacy and safety of combined laser-surgical treatment of rhegmatogenous retinal detachment (RRD). Methods: The 32 eyes from 32 patients with a local RRD due to horseshoe tear were enrolled. In addition to standard examination, all patients underwent multispectral laser scanning and wide-field optical coherence tomography (WFOCT) to determine the extention and localization of vitreoretinal tractions (VRT). All patients underwent the combined microinvasive laser-surgical technology of RRD treatment, including YAG-laser excision of the VRT area, pneumatic retinopexy, and barrier laser photocoagulation around the retinal tear after complete retinal attachment (2-3 days). The post-operative examination was performed on days 3 and 7, and in 3, 6, 12, 18, and 24 months. The follow-up period was 2 years. Results: Retinal attachment was achieved in 30 patients (93.8%). The retina did not attach in 2 cases (6.4%) – in a patient with pseudophakia and in a patient who did not follow the recommendations on the proper head position after surgery. The recurrence of retinal detachment occurred in 2 cases (6.7%) as a result of the new tears formation in lower parts of the fundus periphery. The rest of the patients had a stable anatomical and functional result and no recurrence of the disease during the follow-up period. In 2 cases (6.7%) post-operative WFOCT revealed an additional zone of VRT in the adjacent areas to primary retinal tear which could not be visualized when retina was detached. These patients underwent additional barrier laser photocoagulation around revealed areas. No relapses occurred in these patients. Clinically insignificant retinal bleeding was observed in 4 cases (12.5%) during combined laser angiotomy. Full haemostasis was achieved by the 3-mirror contact lens pressure on the eye. Conclusions: The presented technology demonstrates efficiency in 93.8% of cases after a single surgical intervention. The advantage of the technology is the complete elimination of VRT, as the main factor of the disease pathogenesis, which increases the anatomical efficacy of surgery and reduces the risk of recurrence. The micro-invasiveness and low trauma of this type of treatment help to minimize complications and accelerate the rehabilitation of patients. Further study of this technology with a large number of patients and a long follow-up period is required. Keywords: Rhegmatogenous retinal detachment, wide-field optical coherence tomography, vitreoretinal traction, YAG-laser retinotomy, pneumatic retinopexy, barrier laser photocoagulation.

scholarly journals Long-term outcomes combined minimally invasive laser surgical technique for local rhegmatogenous retinal detachment

2021 ◽  
Vol 21 (2) ◽  
pp. 63-68
Author(s):  
A.V. Doga ◽  
◽  
D.O. Shkvorchenko ◽  
L.A. Kryl ◽  
M.R. Taevere ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Detachment ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Rhegmatogenous Retinal Detachment ◽  
Wide Field ◽  
Optical Coherence ◽  
Long Term Outcomes ◽  
Retinal Tear

Aim: to evaluate the long-term clinical efficacy of the combined (laser plus surgical) minimally invasive technique for rhegmatogenous retinal detachment (RRD). Patients and Methods: treatment results of 41 patients (41 eyes) with local RRD resulting from horseshoe retinal tear were analyzed. All patients underwent wide-field optical coherence tomography (OCT) to localize and measure pathological vitreoretinal adhesions at the site of retinal tear. The next step was a combined laser surgical procedure that included Nd: YAG dissection of pathological vitreoretinal adhesion zone, pneumatic retinopexy (10% C3F8), and barrier laser retinal photocoagulation (LRP) after reattachment. Postoperatively, eye exams were performed after 3 and 7 days, 3, 6, 12, 18, and 24 months. Results: complete reattachment was achieved in 38 patients (92.7%) on day 2 or 3. No reattachment was seen in three patients (7.3%); of them, subretinal gas migration was observed in two patients (4.9%), and partial reattachment was detected in one patient (2.4%) with pseudophakia. Recurrent RRD occurred in 3 patients (7.9%) because of new inferior retinal breaks. In four patients (10.5%), postoperative wide-field OCT of the area of the initial retinal tear performed after reattachment revealed additional pathological vitreoretinal adhesions in the adjacent areas (that were not identified preoperatively). These patients underwent additional LRP around the areas of pathological vitreoretinal adhesions. No recurrent RRDs were seen during follow-up. Conclusion: combined minimally invasive laser surgical technique for local PPDs demonstrated high efficacy (92.7%). This technique was the effective in local retinal detachment resulting from a single superior horseshoe retinal tear in patients with crystalline lens. In some cases, pseudophakia is a technical obstacle to this procedure. Postoperative wide-field OCT is recommended to detect additional pathological vitreoretinal adhesions and to perform LRP around them to reduce the risks of recurrent RRDs greatly. Keywords: rhegmatogenous retinal detachment, optical coherence tomography, Nd: YAG laser retinotomy, vitreoretinal traction. For citation: Doga A.V., Shkvorchenko D.O., Kryl L.A. et al. Long-term outcomes combined minimally invasive laser surgical technique for local rhegmatogenous retinal detachment. Russian Journal of Clinical Ophthalmology. 2021;21(2):63–68. DOI: 10.32364/2311-7729-2021-21-2-63-68.

scholarly journals Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Young Do Yeo ◽  
Yu Cheol Kim
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Clinical Findings ◽  
Symptom Duration ◽  
Retinal Damage ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Abstract Rhegmatogenous retinal detachment (RRD) is a vision-threatening pathology. Optical coherence tomography (OCT) is useful for evaluating retinal damage and visual prognosis in patients with RRD. Outer retinal undulation (ORU) is often observed on preoperative OCT in RRD. Therefore, we evaluated the correlation between ORU seen on preoperative OCT and pre/post-operative factors in RRD. Patients with RRD (114 eyes) underwent reattachment surgery and ≥ 6 months of follow-up. According to the condition of the macula on preoperative OCT, cases were divided into macula-on RRD (65 eyes) or macula-off RRD (49 eyes). Patients were classified into acute (< 10 days), subacute (10–30 days), and chronic (> 30 days) symptom duration groups. Clinical findings, histories, and relationships with OCT findings, including ORU, were analyzed. Subacute symptom duration was significantly associated with ORU on preoperative OCT (p = 0.001) and had a higher prevalence of ORU (73.7%) than did acute (OR = 4.48) or chronic (OR = 7.467) durations. Ellipsoid zone (EZ) disruption was significantly associated with poorer best-corrected visual acuity (BCVA) than normal EZ integrity at 6 months postoperatively (p = 0.012). ORU on preoperative OCT suggests a 10–30 days morbidity duration in RRD. EZ integrity is useful for predicting postoperative BCVA in macula-off RRD.

scholarly journals Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal

1970 ◽  
Vol 6 (4) ◽  
pp. 466-471 ◽  
Author(s):  
R Thapa ◽  
MK Shrestha ◽  
R Gurung ◽  
S Ruit ◽  
G Paudyal
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Case Series ◽  
Retinal Break ◽  
Distance Visual Acuity ◽  
Pneumatic Retinopexy ◽  
Study Results ◽  
Corrected Distance Visual Acuity

Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of < 6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, Nepal   doi: 10.3126/kumj.v6i4.1737   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 466-471  

YAG-laser retinotomy in the complex treatment of horseshoe tear and rhegmatogenous retinal detachment

2021 ◽  
pp. 222-225
Author(s):  
A.V. Doga ◽  
◽  
L.A. Kryl ◽  
P.L. Volodin ◽  
D.O. Shkvorchenko ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Laser Photocoagulation ◽  
Rhegmatogenous Retinal Detachment ◽  
Complex Treatment ◽  
Yag Laser ◽  
Surgical Technology ◽  
Retinal Tear ◽  
Vitreoretinal Traction ◽  
Retinal Tears ◽  
Main Factor

Horseshoe-shaped retinal tear leads to rhegmatogenous retinal detachment (RRD) in 61-83% of cases. Vitreoretinal traсtion is the main factor in the development of horseshoe tears and RRD. In this aspect, YAG-laser retinotomy is promising, which makes it possible to eliminate the traction component by excision area of the horseshoe tear with vitreoretinal adhesion (VRA). Purpose. To analyze the results of YAG-laser retinotomy in the treatment of patients with complicated horseshoe tears and rhegmatogenous retinal detachment. Material and methods. The study included 97 patients (100 eyes). Of these, 54 patients (57 eyes) with complicated horseshoe retinal tears and 43 patients (43 eyes) with local RRD. Patients with complicated horseshoe tears underwent YAG-laser retinotomy at the base of the horseshoe tear. Patients with local RRD underwent a combined laser-surgical technology, which included YAG-laser retinotomy of the horseshoe tear area with vitreoretinal adhesion, pneumatic retinopexy and barrier laser photocoagulation. Results. In the group of patients with complicated horseshoe tears, complete retinal attachment was achieved in 15 eyes (58%), partial retinal attachment - in 7 eyes (27%). In the group of patients with local RRD complete retinal attachment was achieved in 40 patients (93%). There was a stable anatomical result and no changes in functional parameters. Conclusion. YAG-laser retinotomy eliminates vitreoretinal traction in the area of horseshoe tear and prevents the development of rhegmatogenous retinal detachment. Application of YAG-laser retinotomy as the first step of a microinvasive combined laser-surgical technology for the treatment of RRD makes it possible to obtain a high anatomical result, reduce the risk of retinal redetachment, and also preserve the initially high visual functions of patients.

scholarly journals Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series*

2017 ◽  
Vol 46 (1) ◽  
pp. 316-325 ◽  
Author(s):  
Chuandi Zhou ◽  
Qiurong Lin ◽  
Yuxin Wang ◽  
Qinghua Qiu
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Case Series ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Success Rates ◽  
Pneumatic Retinopexy ◽  
The Mean ◽  
Final Operation

Objective To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD). Methods Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA). Results In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40. Conclusions Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

scholarly journals Preferences and Trends in Management of Rhegmatogenous Retinal Detachment in Pakistan

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Muhammad Amer Awan ◽  
Javeria Muid
Keyword(s):  
Retinal Detachment ◽  
Private Practice ◽  
Local Anaesthesia ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
University Hospital ◽  
Pneumatic Retinopexy ◽  
Retinal Tear ◽  
Pars Plana

Purpose:  To report the preferences and trends in managing Rhegmatogenous retinal detachment (RRD) in Pakistan. Study Design:  Cross sectional survey. Place and Duration of Study:  Shifa International Hospital, Islamabad, from December 2018 to January 2019. Method:  A survey was conducted in which the vitreo-retinal (VR) surgeons were asked to respond to 10 questions. The questions were meant to assess their practice and management strategies in treating RRD. Duration of survey was 1 month. Results:  Sixty-two VR surgeons of Pakistan responded to this survey. Most of the VR surgeons belonged to Punjab (56%) followed by Sindh (25%). Regarding their primary practice setting 50% of VR surgeons worked both in government and private practice, 30% practiced in academic/university hospital and 20% of them had only private practice. Seventy percent of VR surgeons in Pakistan preferred local anaesthesia. In non-posterior vitreous detachment (PVD) RRD, majority (69%) performed segmental buckling (SB) with or without encirclement. In pseudophakic superior macula on RRD with a single retinal tear 50% preferred pars plana vitrectomy (PPV) followed by SB in 25% and pneumatic retinopexy in 18%. In inferior macula off RRD with a retinal tear at 7 0’clock position, 56% of the VR surgeon performed PPV alone or combined with SB. Conclusion:  There is an increased trend towards PPV as a primary procedure for RRD in Pakistani VR surgeons. Local anaesthesia is the preferred anesthesia. Key Words:  Rhegmatogenous retinal detachment, Retinal break, Pars Plana Vitrectomy, Pneumatic Retinopexy.

Extrascleral Filling Using Endoillumination the First Experiencethe

2020 ◽  
pp. 43-49
Author(s):  
V.Y. Markevich ◽  
◽  
T.A. Imshenetskaya ◽  
O.A. Yarmak ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Subretinal Fluid ◽  
Crystalline Lens ◽  
Vitreous Cavity ◽  
Macular Area ◽  
General Group ◽  
Anatomical Outcome

Purpose. To study the effectiveness of extrascleral filling (ESF) using endoillumination in the surgical treatment of patients with primary rhegmatogenous retinal detachment (RRD). Material and methods. The material for the study was the data of a comprehensive clinical examination and surgical treatment by ESF method using endoillumination in 17 patients (17 eyes) with RRD. In 7 cases (41%), the macular area was involved in the detachment process. In 5 cases (29.4%), local scleral filling was performed. In the remaining 12 cases (70.6%), the local ESF was supplemented with a circling silicone element. Surgical intervention was supplemented by transscleral drainage of subretinal fluid (SRF) in 10 cases (59%) and pneumatic retinopexy with SF6 gas 50% in 8 cases (48%). Results. In the general group of patients, best corrected visual acuity (BCVA) increased from 0.35 to 0.46. In the subgroup of patients with a detached macular area, the positive dynamics is more pronounced, BCVA increased from 0.1 to 0.28. The progression of proliferative vitreoretinopathy caused the recurrence of retinal detachment in two patients (11.8%). Recurrences were diagnosed after 3 and 5 months, respectively. In both cases, a vitrectomy with tamponade of the vitreous cavity with silicone oil 5000 Cst was performed. The percentage of successful anatomical outcome after the first operation in our study was 82%. The percentage of successful achievement of the final anatomical result was 94%. In two cases, additional injection of SF6 gas into the vitreous cavity was required. Conclusion. This type of surgical treatment is an effective method of surgical treatment of patients with RRD. In our study, the successful anatomical outcome after the first operation was recorded in 82% of patients, which correlates with the data of the authors who also used this method (83–92%). Surgeons who performed surgical treatment using this technique in our study note improved workplace ergonomics when visualizing the fundus using an operating microscope and endoillumination compared with indirect ophthalmoscopy. Other teams of authors came to this conclusion as well. In our study, there were no complications associated with the introduction of a light pipe into the vitreous cavity (iatrogenic crystalline lens injury, endophthalmitis), which indicates the safety of this type of surgical treatment.

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