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.

scholarly journals Surgical Management of Traumatic Retinal Detachment with Primary Vitrectomy in Adult Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Katarzyna Nowomiejska ◽  
Tomasz Choragiewicz ◽  
Dorota Borowicz ◽  
Agnieszka Brzozowska ◽  
Joanna Moneta-Wielgos ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Silicone Oil ◽  
Vitreoretinal Surgery ◽  
Eye Injuries ◽  
Primary Vitrectomy ◽  
Eye Trauma ◽  
Open Globe ◽  
Pars Plana ◽  
23 Gauge

Purpose.To evaluate functional and anatomical results of pars plana vitrectomy (PPV) in the retinal detachment (RD) followed by severe eye trauma.Methods.Retrospective analysis of medical records of forty-one consecutive patients treated with 23-gauge PPV due to traumatic RD. Age, gender, timing of PPV, visual acuity, and presence of intraocular foreign body (IOFB) and proliferative vitreoretinopathy (PVR) were included in the analysis.Results.Mean age of patients was 47 years; the majority of patients were men (88%). Closed globe injury was present in 21 eyes and open globe injury in 20 eyes (IOFB in 13 eyes, penetration injury in 4 eyes, and eye rupture in 3 eyes). Mean follow-up period was 14 months; mean timing of PPV was 67 days. Twenty-seven (66%) eyes had a functional success; 32 eyes (78%) had anatomical success. As a tamponade silicone oil was used in 33 cases and SF6 gas in 8 cases.Conclusions.Severe eye injuries are potentially devastating for vision, but vitreoretinal surgery can improve anatomical and functional outcomes. Among analysed pre- and intra- and postoperative factors, absence of PVR, postoperative retinal attachment, and silicone oil as a tamponade were related to significantly improved visual acuity.

Properties of Gases Used in Vitrectomy Surgery in Rhegmatogenous Retinal Detachment

2019 ◽  
pp. 172-175
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Visual Loss ◽  
Rhegmatogenous Retinal Detachment ◽  
Vitreoretinal Surgery ◽  
Scleral Buckle ◽  
Pneumatic Retinopexy ◽  
The World ◽  
Pars Plana ◽  
Vitrectomy Surgery

Despite improvements in vitreoretinal surgery techniques, rhegmatogenous retinal detachment is still one of the major causes of visual loss in the world. Pneumatic retinopexy (PR), scleral buckle, and pars plana vitrectomy (PPV) are the modalities that are used in the treatment of retinal detachment. Intraocular gases, which are frequently used in PR and PPV, are indispensable molecules due to their tamponade effects. In order to get favorable postoperative outcomes, the proper type of gas selection should be made by considering the properties of the gases, indications, potential complications, and findings of the patients together.

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.

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

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.

scholarly journals Sympathetic ophthalmia after vitreoretinal surgery: a report of two cases

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110327
Author(s):  
Junhui Shen ◽  
Zheng Zhang ◽  
Dian Ye ◽  
Zuohui Wen ◽  
Xupeng Shu ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Vitreoretinal Surgery ◽  
Sympathetic Ophthalmia ◽  
Positive Outcomes ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Pars Plana ◽  
23 Gauge

Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.

Vitreoretinal Surgery for Retinal Detachment in Retinochoroidal Colobomata

2008 ◽  
Vol 18 (2) ◽  
pp. 304-308 ◽  
Author(s):  
S.C.B. Teoh ◽  
E.J. Mayer ◽  
R.J. Haynes ◽  
R.H.B. Grey ◽  
A.D. Dick ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Silicone Oil ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Hand Movement ◽  
Vitreoretinal Surgery ◽  
Scleral Buckling ◽  
Tertiary Referral Center ◽  
Near Work

Purpose To report the management and outcome of retinal reattachment surgery in retinochoroidal coloboma. Methods Four patients with retinochoroidal colobomata presented to the Bristol Eye Hospital (a UK tertiary referral center for vitreoretinal surgery) with retinal detachment. INTERVENTION. All were type II colobomatous detachments (three patients with type IIB, one patient with type IID). All eyes underwent vitrectomy with endolaser and/or cryotherapy and three eyes underwent scleral buckling. Two eyes had internal tamponade with gas (SF6, C3F8) while the other two had silicone oil. Endolaser was applied over healthy retinal pigment epithelium. Results At last follow-up, all (100%) remained attached, with no recurrences. Three patients achieved visual acuity of 6/120 or better and were able to perform satisfactory near work with appropriate magnifiers. The last patient began with hand movement vision and retained similar vision but subjectively felt more navigational. Conclusions Good anatomic and functional outcomes can be achieved in this patient group with combined vitrectomy with or without scleral buckling surgery. Endolaser retinopexy is effective over healthy RPE at the margin of the coloboma combined with either gas or oil internal tamponade.

Effectivity of V4 and v4C implantable contact lenses in the treatment of complications after vitreoretinal surgery: A comparative study

2021 ◽  
Author(s):  
Jian-Hai Bai ◽  
Xiao-Xiao Ruan ◽  
Yu Zhang ◽  
Xiao-Min Ding ◽  
Xing-Zhi Yang ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Contact Lenses ◽  
Vitreoretinal Surgery ◽  
Eye Drops ◽  
Arch Height ◽  
Type Group ◽  
Different Types ◽  
Pars Plana

Abstract Objective This study aims to analyze and compare the postoperative ocular parameters of two different types of implantable contact lenses (ICLs) (for retinal detachment) to provide a clinical reference for vitreoretinal surgery. Methods From March 2016 to March 2021, 24 patients (24 eyes) with rhegmatogenous retinal detachment following ICL implantation at the Eye Center of Taizhou Central Hospital were recruited. Based on the different types of ICL, they were divided into the V4 type ICL implantation group (V4 type group) and v4C type ICL implantation group (v4C type group), with 12 cases (12 eyes) in each group. Both groups were treated with pars plana vitrectomy; differences in postoperative ocular complications between the two groups were compared. Results The postoperative uncorrected and best corrected visual acuity for both groups were significantly higher than those preoperatively (P < 0.001); the same applied to the intraocular pressures (P < 0.05). Fluctuation in intraocular pressure was higher in the V4 group than in the v4C group (P < 0.05). The arch height, measured using anterior segment optical coherence tomography on the first day after operation, was lower in the V4 group than in the v4C group (P < 0.05). There was also no significant difference between the two groups before and after the operation (P > 0.05). Conclusion For patients with V4 type ICL implantation and mesh removal, stimulation of the ciliary body and the risk factors for pupil block caused by ciliary muscle spasm should be reduced as much as possible during pars plana vitrectomy. If postoperative complications such as decreased arch height and increased intraocular pressure occur, the application of compound tropicamide eye drops is an effective method to activate the pupil.

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.

scholarly journals Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Paolo Chelazzi ◽  
Claudia Azzolini ◽  
Claudia Bellina ◽  
Francesca Cappelli ◽  
Ilaria Del Genovese ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Surgical Procedure ◽  
Rhegmatogenous Retinal Detachment ◽  
Intraoperative Complications ◽  
Subretinal Fluid ◽  
Vitreoretinal Surgery ◽  
Perfluorocarbon Liquids ◽  
Secondary Endpoints ◽  
Encircling Band ◽  
Pars Plana

Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.

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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