Causes of low visual acuity and the possibility of its improvement after endovitreal surgery of rhegmatogenous retinal detachment

Актуальность. Несмотря на высокую частоту прилегания сетчатки в результате эндовитреальной хирургии, острота зрения в 60% случаев остается низкой или улучшается незначительно. Цель. Оценка эффективности нейропротектора «Цитофлавин» в улучшении остроты зрения после эндовитреальной хирургии регматогенной отслойки сетчатки. Материал и методы. Основная группа наблюдения представлена 20 пациентами с низким зрительным прогнозом, которые получали препарат «Цитофлавин» в послеоперационном периоде (период тампонады силиконом и после удаления силикона). Контрольная группа наблюдения включала 20 человек с низким зрительным прогнозом, получавших стандартное лечение после операции. Критериями оценки эффективности проводимой терапии явились: МКОЗ, амплитуда прироста (АΔ), показателя микроциркуляции (ПМ, перф. ед.), индекса эффективности микроциркуляции (ИЭМ, отн. ед.) относительно исходных, рассчитанная по формуле. Результаты. Результаты исследования показали, что через 6 мес. после операции у пациентов основной группы по сравнению с контрольной МКОЗ выросла более чем в 2 раза (р<0,05). Также при терапии препаратом «Цитофлавин» отмечена более значимая активация хориоретинального кровотока. АΔ, ПМ и ИЭМ у пациентов основной группы исследования к 6 мес. после операции выросла в 2 раза и более (р<0,05), что подтверждает прямую зависимость зрительных функций от состояния и динамики восстановления хориоретинального кровотока. Выводы. При включении нейропротектора «Цитофлавин» в систему медицинской реабилитации пациентов с низким уровнем зрительного прогноза наблюдается повышение МКОЗ в 2 раза и улучшение циркуляторных показателей хориоретинального кровотока более чем в 2 раза.

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Association Between Photoreceptor Regeneration and Visual Acuity Following Surgery for Rhegmatogenous Retinal Detachment

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.15-18403 ◽

2016 ◽

Vol 57 (3) ◽

pp. 889 ◽

Cited By ~ 28

Author(s):

Misato Kobayashi ◽

Takeshi Iwase ◽

Kentaro Yamamoto ◽

Eimei Ra ◽

Kenta Murotani ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment

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Visual Outcomes of Macula-Involving Rhegmatogenous Retinal Detachment in Patients with and Without Age-Related Macular Degeneration

10.21203/rs.3.rs-1178939/v1 ◽

2022 ◽

Author(s):

P. Barrett Paulk ◽

Dala Eloubeidi ◽

John O. Mason III ◽

Christine A. Curcio ◽

Jason N. Crosson ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Degeneration ◽

Rhegmatogenous Retinal Detachment ◽

Age Related Macular Degeneration ◽

Light Perception ◽

Postoperative Visual Acuity ◽

Age Related ◽

Functional Vision ◽

Better Than

Abstract Background Patients presenting with macula-off rhegmatogenous retinal detachment (RRD) with concomitant age-related macular degeneration (AMD) and their treating physicians would benefit from knowledge regarding the visual prognosis after repair. The prognosis for such patients is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD. Methods This was a retrospective chart review of 1,149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls) and 29 AMD eyes. The main outcome measure was postoperative visual acuity in control eyes versus AMD eyes, and this was compared using Fisher’s exact test. Results There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023). More specifically 5.56% of non-AMD eyes and 3.45% of AMD eyes were 20/40 or better, 77.16% of non-AMD and 55.17% of AMD eyes were worse than 20/40 and better than 20/200, 10.49% of non-AMD eyes and 37.93% of AMD eyes were 20/200 or worse, and there were 11 eyes in the non-AMD group with CF, HM, LP, or NLP vision while there was only 1 eye in the AMD group with CF vision. Conclusions Though postoperative visual acuity was worse in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is not likely a clinically significant finding. Rather, it is a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. Our study suggests that approximately 58% of patients with AMD can expect to maintain functional vision better than 20/200. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD. These findings may be helpful in guiding realistic expectations of AMD patients with RRD.

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Internal Limiting Membrane Flap in the Management of Retinal Detachment due to Paracentral Retinal Breaks

Journal of Ophthalmology ◽

10.1155/2019/4303056 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Yen-Chih Chen ◽

Chung-May Yang ◽

San-Ni Chen

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Structural Changes ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Major Complication ◽

Internal Limiting Membrane ◽

Fluid Exchange ◽

Membrane Peeling ◽

Retinal Breaks

Purpose. To describe the technique and outcomes of using either inverted or free internal limiting membrane flap in the management of retinal detachment due to paracentral retinal breaks. Methods. This retrospective observational case series includes nine patients who received surgery for retinal detachment due to paracentral retinal breaks developed either from primary rhegmatogenous origin, or secondary iatrogenic retinal breaks after prior membrane peeling, or during surgery for tractional retinal detachment. Either inverted or free internal limiting membrane flaps were inserted in the identified breaks, followed by air fluid exchange and gas tamponade. Visual acuity and structural changes were evaluated. Results. Nine eyes were included. One had primary rhegmatogenous retinal detachment, one had highly myopic eye with peripapillary atrophic hole, three had secondary retinal detachment after membrane peeling for foveoschisis or macular pucker, one had recurrent retinal detachment due to proliferative vitreoretinopathy, one had combination of tractional and rhegmatogenous retinal detachment, and two had iatrogenic breaks during surgery. The retinal breaks of all eyes were sealed with retina attached postoperatively. Visual acuity in logarithm of minimal angle of resolution improved from 1.18 ± 0.55 preoperatively to 0.74 ± 0.47 postoperatively (p=0.04). Conclusion. Internal limiting membrane flap technique can be a surgical approach selectively for retinal detachment due to paracentral retinal breaks with difficulty for laser application. The retina can be attached successfully and achieve good visual outcome without major complication. This trial is registered with NCT03707015.

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Rhegmatogenous Retinal Detachment Surgery in Elderly People over 70 Years Old: Visual Acuity, Quality of Life, and Cost-Utility Values

PLoS ONE ◽

10.1371/journal.pone.0110256 ◽

2014 ◽

Vol 9 (10) ◽

pp. e110256 ◽

Cited By ~ 2

Author(s):

Yingyan Ma ◽

Xiaohua Ying ◽

Haidong Zou ◽

Xiaocheng Xu ◽

Haiyun Liu ◽

...

Keyword(s):

Quality Of Life ◽

Visual Acuity ◽

Retinal Detachment ◽

Elderly People ◽

Rhegmatogenous Retinal Detachment ◽

Cost Utility ◽

Retinal Detachment Surgery ◽

Utility Values ◽

Surgery In Elderly

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Modelling postoperative visual acuity with and without proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment

Eye ◽

10.1038/eye.2012.153 ◽

2012 ◽

Vol 26 (10) ◽

pp. 1329-1336 ◽

Cited By ~ 2

Author(s):

M Roldán-Pallarés ◽

C Bravo-Llatas ◽

A-S Musa ◽

J Hernandez-Montero ◽

R Fernández-Durango

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Proliferative Vitreoretinopathy ◽

Rhegmatogenous Retinal Detachment ◽

Postoperative Visual Acuity

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Use of Autologous Conditioned Platelet Rich Plasma in the Surgery of Rhegmatogenous Retinal Detachment with Central and Peripheral Tears

Acta biomedica scientifica ◽

10.29413/abs.2019-4.4.8 ◽

2019 ◽

Vol 4 (4) ◽

pp. 61-65

Author(s):

D. G. Arsiutov

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Postoperative Period ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Platelet Rich Plasma ◽

Dentate Line ◽

Retinal Tears ◽

Retinal Reattachment ◽

Late Postoperative Period

Background. The method of the use of autologous conditioned platelet rich plasma is a promising method in the surgery of retinal pathology, particularly in the surgery of rhegmatogenous retinal detachment without the use of additional endolaser photocoagulation, but requires the foundation of its efficiency.Aim: to evaluate the effectiveness of the surgery of rhegmatogenous retinal detachment with central (macular) and peripheral retinal tears, including retinal abruption from the dentate line, with the use of 25, 27-gauge subtotal vitrectomy, pneumoretinopexy and silicone oil tamponade with blocking of retinal defect with the use of autologous conditioned plasma without the use of endolaser photocoagulation around retinal defects.Materials and methods. The surgery included 25, 27-gauge vitrectomy, posterior hyaloid membrane removal, internal limiting membrane removal in case of macular hole, pneumoretinopexy, instiilation in 2–3 layers of autologous conditioned platelet rich plasma, devoid of leukocytes and containing 1.5–3 times more thrombocytes than in whole blood into the area of retinal detachment or along the edge of retinotomy till the retinal defect and nearby intact retina are totally covered. A total of 29 patients with visual acuity from 0.03 to 1.0 underwent the surgery.Results. In the early postoperative period (up to 1 month) 96.6 % of patients showed total retinal reattachment, retinal detachment was blocked, in one patient with multiple retinal tears recurrent retinal detachment was detected; in the early delayed postoperative period (1–3 months) 82.8 % of patients showed total retinal reattachment, in 5 patient retinal reattachment was partial.In the late postoperative period (4–12 months) 86.2 % of patients showed total retinal reattachment, there were 4 recurrent retinal detachments. Patients with recurrent retinal detachment were successfully reoperated. Autologous conditioned plasma was not used during reoperations. Visual acuity of the patients, which underwent surgery in the late postoperative period, was 0.1–1.0.Conclusions. 25, 27-gauge vitreoretinal surgery of rhegmatogenous retinal detachment with central and peripheral retinal tears, including tears with abruption from the dentate line and retinal defects blocking with the use of autologous conditioned plasma rich with thrombocytes without the use of endolaser photocoagulation around retinal defects – is a method which allows to achieve in most cases total retinal reattachment, better functioning of the operated eye.

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Outcome of Scleral Buckling Surgery in Rhegmatogenous Retinal Detachment

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v6i1.5987 ◽

1970 ◽

Vol 6 (1) ◽

pp. 21-24

Author(s):

MI Hossain ◽

MK Hasan ◽

MSM Ali

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Armed Forces ◽

Scleral Buckling ◽

Scleral Buckle ◽

Medical College ◽

Open Globe ◽

Retinal Reattachment ◽

History Of

A longitudinal study was carried out in the vitreo-retina clinic of the National Institute of Ophthalmology andHospital (NIO&H) on 30 eyes of 25 patients who were treated with scleral buckle (SB) surgery during theperiod of October 2004 to September 2005 of either sex. The aim of this study was to determine the outcome ofSB surgery in Rhegmatogenous retinal detachment (RRD). The main entry criteria for this study wereprimary RRD treated with SB and for which 12 weeks of follow-up were available. The eyes with proliferativevitreoretinopathy or with history of SB surgery, vitrectomy, posterior segment open-globe trauma orsignificant concurrent eye disease e.g. amblyopia, macular disease etc were excluded from this study. Overalltwenty-four eyes (80%) achieved retinal reattachment with one SB procedure (encircling or segmental); themedian 12-week visual acuity was 6/12. Three additional eyes (10%) achieved retinal reattachment with onevitreoretinal procedure; the median 12-week visual acuity was 6/9. Three eyes (10%) never achieved retinalreattachment despite one additional vitreoretinal procedure, and 12-week visual acuity was no perception oflight. It can be concluded that SB for primary RRD achieves anatomical efficacy and preservation of centralvision in the majority of eyes.Key words: Scleral buckle; Rhegmatogenous retinal detachment outcome.DOI: 10.3329/jafmc.v6i1.5987Journal of Armed Forces Medical College, Bangladesh Vol.6(1) 2010 p.21-24

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Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9434 ◽

2021 ◽

Author(s):

Matthew R. Starr ◽

Edwin H. Ryan ◽

Anthony Obeid ◽

Claire Ryan ◽

Xinxiao Gao ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Scleral Buckle ◽

Scleral Tunnel ◽

The Mean ◽

Anatomic Success

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.

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Recurrent Retinal Detachment after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

10.21203/rs.2.21163/v1 ◽

2020 ◽

Author(s):

Yan Fu ◽

Yue-ling Zhang ◽

Zhaohui Gu ◽

Ren-Fei Geng ◽

Xin-Yu Yuan

Keyword(s):

Visual Acuity ◽

Risk Factor ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Univariate Analysis ◽

Visual Outcomes ◽

Primary Surgery ◽

Pars Plana

Abstract Background The recurrence of retinal detachment (RD) following rhegmatogenous retinal detachment (RRD) is a relatively common complication that threatens vision and needs further surgery. The purpose of this study is to investigate the risk factors and visual outcomes of recurrent RD following pars plana vitrectomy (PPV) for primary RRD.Methods This was a retrospective follow-up of 343 eyes that underwent initial PPV surgery for primary RRD. Patients were divided into a recurrence group and a reattachment group. The main outcome measures included the causative factors, visual outcomes of RD recurrence, and the perioperative factors most affecting the recurrence of RD.Results After retinal reattachment, we observed recurrence of RD after PPV for primary RRD in 42 out of 343 eyes (12.2%) during the follow-up period. Most recurrence (69%) occurred within 6 months after surgery. Univariate analysis showed that the primary risk factor significantly associated with recurrent RD was the presence of proliferative vitreoretinopathy (PVR) ≥ Grade C ( P = 0.003). Logistic regression analysis showed that a PVR ≥ Grade C (odds ration [OR]: 9.421, 95% confidence interval [CI]: 2.432 - 56.39; P =0.020) was a significant predictor for the development of recurrent RD. The recurrence of RD resulted in a significant decline in best-corrected visual acuity (BCVA) at the last follow-up visit compared with the reattachment group ( P =0.000). Eyes with PVR prior to primary surgery or at the diagnosis of re-detachment showed a worse final BCVA.Conclusions The presence of PVR ≥ Grade C was the predominant risk factor for the recurrence of RD. PVR prior to primary surgery, or at the diagnosis of re-detachment, limited the recovery of final visual acuity.

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