Management of Large Subretinal Gas Bubble After Pneumatic Retinopexy With Head-Positioning Maneuver

Purpose: This work reports on the management of a large subretinal gas bubble after pneumatic retinopexy. Methods: A case report is discussed. Results: We report a case of subretinal gas after pneumatic retinopexy for rhegmatogenous retinal detachment that was managed with a series of head-positioning maneuvers to allow the subretinal gas to migrate into the vitreous cavity through the retinal break. Despite the subretinal bubbles being larger than the retinal break, this approach eliminated the subretinal gas and averted surgical intervention. Conclusions: Subretinal gas after pneumatic retinopexy can be successfully managed by head-positioning maneuvers in some cases, even if the subretinal gas bubble is larger than the retinal break.

Four Cases of Rhegmatogenous Retinal Detachment That Recurred More than 10 Years after Initial Reattachment by Pars Plana Vitrectomy

<b><i>Purpose:</i></b> The purpose of this report was to present our findings in 4 cases of rhegmatogenous retinal detachment (RRD) that recurred 10, 11, 12, and 17 years after a reattachment surgery by pars plana vitrectomy (PPV). <b><i>Methods:</i></b> Four cases of a recurrent RRD had undergone scleral buckling surgery and vitrectomy. <b><i>Patients:</i></b> The recurrence of the RRD was observed 10–17 years after the successful attachment by PPV. The macula was detached in all cases, and none of the eyes had severe proliferative vitreoretinopathy. The cause of the recurrence was a new retinal break in 3 eyes and a reopening of an old retinal break in the other eye. The new breaks had a punched-out shape and had neither a horseshoe tear nor an atrophic hole associated with lattice degeneration. PPV combined with scleral buckling was performed, and a reattachment was achieved in all cases. The best-corrected visual acuity (BCVA) at the last visit ranged from 20/30 to 20/25, but the BCVA in 1 eye was 20/200 because of amblyopia. <b><i>Conclusions:</i></b> We experienced 4 rare cases of a recurrent retinal detachment 10–17 years after the primary RRD. PPV and scleral buckling were effective and the anatomical and the functional outcomes were good.

Clinical Features and Treatment of Inactive Proliferative Diabetic Retinopathy

Background To investigate the clinical features and results after vitrectomy for inactive proliferative diabetic retinopathy (IPDR).Methods Retrospective review of 40 eyes of 21 IPDR patients who underwent 23G or 25G minimally invasive vitrectomy between January 2018 and December 2019 in Tianjin Medical University Eye Hospital.The average follow-up period was 8.7 months. Outcome measures were best-corrected visual acuity (BCVA), clinical features and intraoperative findings of IPDR.Results All eyes were performed with panretinal photocoagulation (PRP) for average 1.6 years before operation. Fundus examination showed the optic disc was pale, and a mass of yellowish-white fibroproliferative membrane was around the optic disc and vascular arcade. Thirty-three eyes (82.5%) were accompanied by tractional retinal detachment, and macula was involved in 9 eyes (22.5%). The vitreous adhered with the retina tightly. The mid-peripheral retina was thin. Thirty-one eyes (77.5%) were accompanied by small branch retinal artery and vein occlusion. Fourteen eyes (35.0%) occurred iatrogenic retinal break during vitrectomy. The median LogMAR of BCVA significantly improved from 1.0 (20/200)preoperatively to 0.92 (20/167) postoperatively (P = 0.000).Conclusions The fundus manifestation of IPDR was quiet and special. Vitrectomy could improve patients’ visual acuity, but the incidence of iatrogenic retinal break was high.Vitrectomy could be performed by well-skilled vitro-retinal surgeons according to the minimum quantitative principle.

Incidence of Retinal Detachment after Macular Surgery

Macular surgery has become an increasingly atraumatic procedure for the eye with the surgical methods that have been further developed in recent years. The most common complications include cystoid macular oedema and retinal detachment, more rarely endophthalmitis. The aim of this retrospective study is to record the number of retinal detachments following elective macular surgery. In this study we included all patients who underwent pars plana vitrectomy (ppV, 20 or 25 gauge) in the years 2009 – 2016. We then identified the patients who were hospitalised again because of retinal detachment. For the affected patients, the rate of retinal detachment, functional outcomes and possible risk factors were recorded. A total of 904 eyes were identified, of which 667 had surgery for epiretinal membrane, 188 for macular hole, and 49 for vitreomacular traction with a 20 or 25 gauge ppV. Of these 904, retinal detachment occurred in 17 (1.88%) cases. The mean time between first ppV and second ppV with retinal detachment was 248 days (3 – 1837 days). Two of the 17 patients had at least one retinal break before or during surgery. The retinal break was located inferior in six cases, superior in four; in four cases PVR retinal detachment and in three cases the foramina were distributed. Mean visual acuity was 0.27 (decimal) before macular surgery and 0.28 at the time of last presentation. Modern vitrectomy techniques reduce the complications in elective macular surgery, but do not replace the surgeonʼs experience.

Effect of prophylactic laser during small-gauge vitrectomy for epiretinal membranes

Purpose: To determine the rate of post-operative retinal detachment after elective pars plana vitrectomy for epiretinal membrane, and to test for the mitigating effect of prophylactic endolaser. Methods: We identified 459 eyes of 411 patients undergoing vitrectomy for epiretinal membrane at Vanderbilt University Medical Center between January 2010 and May 2017. Patients who underwent concurrent endolaser without any identified retinal break were included in the exposure cohort. Patients who underwent no prophylactic retinopexy or ablation were included in the unexposed cohort. Exposure data, demographic data, and outcome data were tabulated for comparison. Results: The final analysis included 343 eyes of 343 patients. Approximately 7% of eyes undergoing ERM surgery were found to have a full-thickness retinal break which was not seen preoperatively. The overall rate of postoperative RD was 2.04%. Postoperative retinal detachment occurred in 0 of the 34 eyes exposed to prophylactic laser, and in 7 of the 309 control eyes. Odds ratio was found to be 0.60 ( p = 0.598 (95%CI 0.0327–10.7), p = 0.72), indicated the results were not statistically significant. Discussion: Looking at patients undergoing routine vitrectomy surgery for epiretinal membrane, no retinal detachments occurred in the group receiving prophylactic treatment, though this association did not reach statistical significance. With modern surgical techniques, post-operative retinal detachment remains relatively rare after vitrectomy for ERM though a thorough intraoperative exam is critical to identify occult retinal breaks.

Chromophore-Assisted Retinal Break Detection to Manage Challenging Situations in Retinal Detachment Redo Surgery

Introduction. The purpose of this case series is to demonstrate that subretinal blue dye injection, with and without 180-degree endolaser retinopexy, can be considered a useful tool in finding occult rhegmatogenous retinal breaks in eyes with recurrent retinal detachment. Case Presentation. Three patients with recurrent retinal detachment were treated between January and March 2018. In all cases, the intraoperative internal search did not demonstrate any obvious break or hole. MembraneBlue-Dual (Trypan Blue 0.15% + Brilliant Blue G 0.025% + 4% PEG) was then injected into the subretinal space using a 41-gauge cannula. The eye was rotated such that the dye was pushed through a tiny break which was causing the retinal detachment. 180-degree laser retinopexy was performed on a single eye. After silicon oil removal and absorption of the gas tamponade, retinas remained attached at three-months follow-up. Conclusions. Chromophore-assisted occult retinal break detection can be considered a useful but not risk-free surgical technique in managing some unexpected and challenging intraoperative situations.

Secondary pneumatic retinopexy for failed scleral buckle

Scleral buckle (SB) is a well-established modality to treat retinal detachment (RD). The surgery can fail because of various reasons. This case highlights the role of secondary pneumatic retinopexy (PR) for dealing with recurrent RD after SB surgery. This modality of treatment could be explored before taking up patients for vitrectomy, especially in cases of retinal break without proliferative vitreoretinopathy. In the case presented, secondary PR could save another major surgery and good outcome was achieved with less invasive option.