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PubMed1998

[Rhegmatogenous retinal detachment and hypertension: Schwartz-Matsuo syndrome].

PURPOSE: To assess the usefulness of electron microscopy of the aqueous cells when confronted with the clinical association of rhegmatogenous retinal detachment after trauma, high intraocular pressure (IOP) and aqueous cells. METHOD: We report a clinical history of a 50-years-old man who had ocular trauma with perforation in 1944, intraocular lens for traumatic cataract in 1988, Yag capsulotomy in 1993 and retinal detachment with oral dialysis, high IOP and aqueous cells in anterior chamber in 1995. During the surgical therapy we performed an anterior chamber puncture to analyse the aqueous cells. An electron microscopic study was performed on 0.2 ml of aqueous humor mixed in the same volume of 2.5% glutaraldehyde and fixed with 1% osmium acid. RESULTS: Electron microscopic ultrastructural study of the aqueous cells showed numerous photoreceptor outer segments, some of them appearing degenerated. CONCLUSION: The combination of rhegmatogenous retinal detachment with tears near the ora serrata, high IOP and aqueous cells in the anterior chamber should lead the physician to do an anterior chamber puncture and analyse the aqueous cells structure. The combination of those three clinical signs associated with the photoreceptor outer segments in the anterior chamber allowed to diagnose the Schwartz-Matsuo syndrome.

Aqueous Humor↗
PubMed2002

Use of perfluorohexyloctane as a long-term internal tamponade agent in complicated retinal detachment surgery.

PURPOSE: To report the use of perfluorohexyloctane, a liquid semifluorinated alkane that is heavier than water, as an internal tamponade agent in surgery for complicated retinal detachments. DESIGN: A consecutive interventional case series from three study centers. METHODS: In 23 consecutive eyes (23 patients, 19 men and four women, mean +/- standard deviation (SD) age of 58.5 years +/- 16.1) perfluorohexyloctane was used for long-term internal tamponade. Included were eyes with complicated retinal detachment involving the lower two quadrants of the fundus. Excluded were patients with diseases in the fellow eye or severe systemic disease. A pars plana vitrectomy was performed, including membrane peeling and retinotomy where necessary. RESULTS: The mean duration for perfluorohexyloctane being left in situ was 76 days (SD 37.64) (range, 35-202 days). Four weeks following the removal of perfluorohexyloctane 19 of the 23 patients had total reattachment of the retina; three eyes had a recurrence of retinal detachment. One patient was lost to follow-up. The mean follow-up after perfluorohexyloctane removal was 97 days (range, 48 to 169 days). Cataract formation or progression was noted in nine of the 10 eyes. There were two cases with high intraocular pressures. Dispersion into small droplets was observed as early as 3 days postoperatively in three of the 23 patients. At least 12 of the 23 patients had an obvious dispersion by the time of perfluorohexyloctane removal. There was no sign of optic atrophy, retinal necrosis, or retinal vascular occlusion. CONCLUSION: Perfluorohexyloctane was tolerated as a long-term internal tamponade agent without obvious signs of damage to the retina or optic disk. Of all the complications noted, the most common was that of dispersion of the perfluorohexyloctane bubble into droplets.

Cataract↗
PubMed1990

Retinal detachment in highly myopic eyes due to macular holes and epiretinal traction.

We operated on four highly myopic eyes with recurrent retinal detachment due to macular holes. A thin layer of epiretinal tissue was present over the posterior retina in each eye, probably causing tangential traction on the retina and accounting for the recurrent detachment. Biopsy of the tissue from one case showed mainly acellular material resembling cortical vitreous. Recognizing this clinical condition may permit successful treatment of certain cases with recurrent retinal detachment in highly myopic eyes with macular holes.

Adult↗
PubMed1986

Repair of retinal detachments with temporary balloon buckling.

Between 1982 and 1984, the temporary balloon buckle, as described by Lincoff and Kreissig in 1978, was successfully used in 52 eyes. The indications were retinal detachments with only one break or with closely grouped breaks together not exceeding one clock hour of the fundus. No consideration was given to the duration and extent of retinal detachment and macular involvement, or to the degree of myopia and recent vitreous hemorrhage. Excluded were cases with incipient proliferative vitreoretinopathy. The operation was successful in 50 of the 52 eyes. It was unsuccessful in one eye, in which, despite several subsequent conventional interventions, proliferative vitreoretinopathy developed, and in a second eye, in which a circumscribed retinal elevation around a large flap tear persists. In 17% of cases (9 of 52 eyes) fresh retinal defects were discovered 1 week to 6 months postoperatively. All were successfully treated with laser therapy. As a result, we consider temporary balloon buckling a simple and curative technique for a selected group of patients presenting retinal detachments.

Adult↗
PubMed1995

[Retinal detachment in pseudophakia].

The author evaluates the prevalence and results of surgical treatment of retinal detachment (RD) after implantation of intraocular lenses in a group of 10,185 eyes operated at the First and Second Ophthalmological Clinic from 1988 to the end of 1993. Retinal detachment was observed in 0.4% of artephakic eyes. A striking risk factor for the development of RD was in particular loss of the vitreous body during cataract operation, a previous injury, myopia and YAG capsulotomy. The presence of an intraocular lens did not influence in a substantial way the selection of the surgical procedure. In cases with a complicated finding in the anterior segment and the retina the authors selected more frequently pars plana vitrectomy (PPV) with internal tamponade with an expansive gas or silicone oil (in 44.3% eyes). The retina became attached in 90.4% of the eyes, while in patients operated by cryosurgery anatomical success was achieved in 82.1% of the eyes and in the group operated by PPV with internal tamponade in 100% of the eyes. Functional improvement, as compared with the condition before surgery of RD, was achieved in 48.9% of successfully operated eyes. In the PPV group the authors observed, however, substantially poorer functional results as compared with cryosurgery. In complicated artephakic RD PPV with internal tamponade contributed to a striking improvement of anatomical results but the poorer functional results after PPV in complicated RD provide evidence of a poorer prognosis of artephakic RD, as compared with aphakic ones.

Adult↗
PubMed1982

Lysosomal hyaluronidase in the subretinal fluid of patients with rhegmatogenous retinal detachments.

A biochemical analysis of 66 samples of subretinal fluid from patients with primary rhegmatogenous retinal detachment showed that 46 contained hyaluronic acid. Seventeen samples that did not contain hyaluronic acid disclosed hyaluronidase activity. Hyaluronidase activity in the subretinal fluid increased with the duration of the detachment but there was no correlation between enzyme activity and the age of the patient or the extent of the retinal detachment.

Adult↗
PubMed1996

Preoperative vitreous hemorrhage associated with rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy?

BACKGROUND: We conducted a prospective clinical study to elucidate the role of preoperative vitreous hemorrhage in the development of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment. MATERIALS AND METHODS: We prospectively evaluated 409 eyes of 390 patients affected by primary rhegmatogenous retinal detachment referred before any failed attempt to reattach the retina. Single and multiple logistic regression analysis were used to test 14 categories of variables. RESULTS: Postoperative PVR occurred in 48 (11.7% of 409 eyes). Postoperative PVR developed in 41 (11.8%) of the 347 eyes with no preoperative vitreous hemorrhage, and 7 (11.3%) of the 62 eyes with preoperative vitreous hemorrhage (P = 0.90). The results of multiple logistic regression analysis showed that only four variables were significant factors which had independently and jointly an effect on the risk of postoperative PVR: (1) 90 degrees or greater circumferential extent of the retinal tears; (2) preoperative PVR grade B; (3) preoperative PVR grade C-D; and (4) the use of cyrotreatment as the method of retinopexy. CONCLUSION: With the surgical techniques currently used, mild preoperative vitreous hemorrhage is not an independent risk factor for postoperative PVR in primary rhegmatogenous retinal detachment. The role of moderate and severe vitreous hemorrhage remains to be fully evaluated in a larger series of eyes.

Adolescent↗
PubMedDate not supplied

Pars plana vitrectomy without long-acting gas tamponade for primary rhegmatogenous retinal detachment.

PURPOSE: To report the anatomical and visual results of primary pars plana vitrectomy (PPV) without long-acting gas tamponade to repair primary rhegmatogenous retinal detachments (RRDs). METHODS: Twenty-seven consecutive patients (27 eyes) with peripheral retinal tears and new RRDs were treated according to the surgical protocol. Patients underwent PPV with fluid-air exchange and endolaser treatment to repair the RRD. Neither long-acting gas nor silicone oil tamponade was combined with PPV. All patients were followed from 6 to 26 months with an average follow-up of 11 months. Reattachment of the retina and visual outcome were compared to the results of previously published studies. RESULTS: Reattachment was achieved in 24 of 27 eyes (89%) with a single operation, and in all 27 (100%) eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 0.4, and the median final visual acuity was 1.0. CONCLUSIONS: Primary PPV with fluid-air exchange alone and laser treatment is a safe, effective method for the repair of primary retinal detachments. The anatomical reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for primary PPV combined with long-acting gas tamponade.

Aged↗
PubMed1991

Retinal detachment with high myopia in the Rubinstein-Taybi syndrome.

A case of rhegmatogenous retinal detachment with high myopia is presented in a 17 year old boy with the typical characteristics of the Rubinstein-Taybi syndrome. Although multiple eye anomalies are known to occur in this syndrome, the occurrence of retinal detachment has not been reported up to now. The importance of including a thorough fundus examination in the routine eye examination of these patients is emphasized.

Adolescent↗
PubMed2002

Triple cycle audit of primary retinal detachment surgery.

PURPOSE: To determine the effect of increasing subspecialisation on the results of retinal detachment surgery in one city. METHODS: Three audit cycles over a 10-year period when major subspecialisation and organisational changes were occurring. Retrospective case note reviews of all primary surgery for rhegmatogenous retinal detachments in each of the audit periods. Statistical analyses used contingency table/chi-square methods for comparing all three audits and Fisher's exact test/mean odds ratio with 95% confidence intervals (CIs) for the Audit 1 vs Audit 3 comparison. RESULTS: A marked improvement in success rates occurred: primary reattachment rose from 67% in Audit 1 to 87% in Audit 3 (P = 0.0004), and final success from 84% to 97% (P = 0.0003). There was a dramatic change in operative techniques over the same period: the percentage of vitrectomies increased from 1.5% in Audit 1 to 48% in Audit 3, while that of 'open' conventional procedures decreased from 78% to 32%. However, the improvement in anatomical success was not mirrored by an increase in the percentage of patients with 6/12 or better visual acuity postoperatively (55% in Audit 1, 49% in Audit 3; P = 0.34, mean odds ratio = 0.78; 95% CI 0.48-1.2). The percentage of patients with 6/18-6/36 post op visual acuity did increase in Audit 3 (18% in Audit 1; 29% in Audit 3; P = 0.03, mean odds ratio = 1.9; CI 1.1-3.3), and the percentage with 6/60 or worse decreased (27% in Audit 1, 20% in Audit 3; P = 0.26, mean odds ratio = 0.71; CI 0.40-1.2). CONCLUSIONS: With increased subspecialisation there has been an increase in anatomical success, but the goal of 100% reattachment is still not being attained. There remains scope for further improvement in anatomical and functional outcomes.

England↗
PubMed1994

Management of retinal detachment.

I present what, in my opinion, is the optimal technique of managing primary simple retinal breaks and retinal detachment. For the preoperative examination, I recommend indirect stereoscopic ophthalmoscopy with scleral depression. The macula and suspected small peripheral breaks are studied with the biomicroscope and a three-mirror contact lens. Retinal breaks without retinal detachment are treated with cryotherapy if they are located anteriorly; with laser photocoagulation if they are posterior. Breaks with frank detachment can be treated with Lincoff's balloon, a procedure I prefer over pneumatic retinopexy. Multiple retinal breaks and those associated with fairly extensive chorioretinal degeneration are best treated with a permanent scleral buckling, the various modalities of which, along with their indications, I discuss in some detail.

Catheterization↗
PubMed2001

Finding the retinal break in rhegmatogenous retinal detachment.

The development of subretinal fluid is governed by a limited number of anatomical factors and gravity. As a result, rhegmatogenous retinal detachments form in a predictable manner around the retinal break of their origin. The shape of the detachments points to the position of the break. The purpose of this review is to describe the characterstic contours of subretinal fluid in rhegmatogenous retinal detachments, and to highlight some rules and methodology which can help in the detection of the retinal break in phakic, psuedophakic and recurrent retinal detachments.

Cryosurgery↗
PubMed1997

[Vitreoretinal complications in cataract surgery. I. Retinal detachment].

The authors investigate in a retrospective study complications of cataract operations which were performed in their department during the last 2.5 years by vitreoretinal surgery. They divided the operations into three basic groups: retinal detachment, luxation of the lens into the vitreous body and endophthalmitis. The largest group was formed by pseudophakic detachments--0.29% of operated cataracts. Luxation of the lens into the vitreous body and endophthalmitis treated by vitrectomy accounted for 0.06% each of operated cataracts. In the first part of the paper the authors analyze peroperative complications of cataract surgery, risk factors enhancing the risk of retinal detachment and evaluate anatomical and functional results of operations of pseudophakic retinal detachments. Peroperative rupture of the posterior capsule before cataract surgery was found in 63.6% of pseudophakic detachments, anterior vitrectomy was performed in 40%, YAG capsulotomy preceded the development of detachments in 13.3% of patients. The retina was applied in 76.4% of the eyes. Functional improvement was recorded in 65.8%, deterioration in 15.6% and an unaltered function after surgery was recorded in 18.6% eyes.

Aged↗
PubMed2003

[Vascular flow in patients with retinal detachment in the color Doppler's ultrasonography].

UNLABELLED: For many years now Doppler's ultrasonography has been broadly applied in ophthalmology. Recently it has been communicated, that there is a possibility of assessing the disorders of retinal circulation in the process of retinal detachment. PURPOSE: Our research had to establish, whether after the scleral buckling treatments executed due to the retinal detachment, there is a change in the blood flow in the vessels of the eyeballs. MATERIAL AND METHODS: The observations were conducted in 30 eyes of 15 people, who were diagnosed with opening-related retinal detachment. The colour Doppler's ultrasonography was performed by using ATL Ultramark 9HDI apparatus with a linear sound of the frequency range from 7.5 to 10 MHz. The anatomic structures of the eye socket in the transverse and arrow plane were assessed. The flow spectrum was measured according to the PD method (pulsating Doppler) in the central artery of the retina at the distance of approximately 2-4 mm from the optic disc and in the ophthalmic artery. The analysis of the spectrum allowed one to determine the values of the pulsation indexes-PI, and resistance indexes-RI, in the ophthalmic artery and in the central artery of the retina of the healthy eye, and of the eye with detached retina 2-3 days before and in 5-7 days after the operative procedure. RESULTS: After radial and circumferential buckling treatments, the conducted research found no increased resistance of the flow in the arteries, namely: the central artery of the retina and the ophthalmic artery. The condition for the maintenance of the correct parameters of the blood flow was the intraocular pressure. At the same time, in the eyes with detached retina, the decrease in the resistance of the flow in the ophthalmic artery was observed, which was being brought back to normal after the operative treatment.

Adult↗
PubMed2001

The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment.

PURPOSE: To evaluate the anatomic and functional outcome of vitreoretinal surgery in eyes with pathologic myopia and macular hole and to determine if surgery improves visual acuity. METHODS: Twenty-four consecutive highly myopic eyes with full-thickness macular hole without posterior retinal detachment were treated by vitrectomy. Posterior hyaloid dissection, removal of epiretinal and internal limiting membranes (ILM) if thickened, instillation of platelet concentrate, and flushing with 25% sulfur hexafluoride were performed. RESULTS: Patients' refractive error ranged between -8.0 and -17.5 diopters, and axial length ranged from 27.1 to 31.4 mm. Two epimacular membranes and 10 macular ILM were removed. Ten patients also underwent phacoemulsification and intraocular lens implantation at the same procedure. Mean preoperative best-corrected visual acuity was 20/200. Successful anatomic macular hole closure occurred 6 months postoperatively in 100% of eyes after one (21 eyes, 87.5%) or two surgeries (3 eyes, 12.5%). Visual acuity improved three or more lines in 83.3% of patients. Mean postoperative visual acuity was 20/70. No retinal detachment was observed during the follow-up period, which ranged from 12 to 45 months. CONCLUSION: Our results suggest that vitreoretinal surgery may effectively manage myopic macular holes, thus improving anatomic and visual outcomes. By closing the hole, vitreoretinal surgery may decrease the risk of posterior retinal detachment in highly myopic eyes.

Adult↗
PubMedDate not supplied

Retinal detachment: imaging of surgical treatments and complications.

Rhegmatogenous retinal detachment occurs in 5%-7% of the population with a peak prevalence between 40 and 80 years of age. The objects of treatment are to create a chorioretinal scar at the site of the retinal tear and to mechanically appose the detached sensory retina to the underlying retinal pigment epithelium. This apposition is achieved by means of scleral buckling or intraocular tamponade. In scleral buckling, the eye wall is indented under the retinal tear with a silicone buckling element. In intraocular tamponade, the eye is filled with a bubble of air, gas, or silicone oil. In patients treated with these techniques, neuroimaging commonly demonstrates incidental orbital findings. Familiarity with these techniques is essential if the radiologist is to differentiate normal postoperative findings from ocular disease. Furthermore, the ability to recognize the appearance of uncomplicated ocular surgery is a prerequisite for aiding the surgeon in diagnosis of postoperative complications.

Humans↗
PubMed1982

Syphilitic retinal detachment and uveal effusion.

A 32-year-old man developed a recurrent nonrhegmatogenous retinal detachment, uveal effusion, and visual loss as a result of latent secondary syphilis. Treponemes were found in the subretinal fluid and the Treponema pallidum hemagglutination test demonstrated substantially higher titers in the subretinal fluid than in the serum (1: 2,569 vs 1: 16). Despite scleral dissection and a scleral implant and treatment with penicillin, the patient's visual loss persisted and the last examination showed a thickened choroid, a flat nonrhegmatogenous retinal detachment, and reaccumulation of subretinal fluid.

Adult↗
PubMed2001

Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment.

AIMS: To determine whether it is necessary to support inferior retinal breaks with a scleral explant during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RD). METHODS: A prospective study was carried out on nine eyes of nine consecutive patients undergoing PPV for primary RD with associated inferior retinal breaks and no significant proliferative vitreoretinopathy. RESULTS: Eight eyes were successfully reattached with a single operation. No cases presented with redetachment because of failed closure of the original inferior breaks. CONCLUSIONS: It is not necessary to support inferior retinal breaks with a scleral explant during PPV for primary RD repair in selected cases.

Adult↗