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The authors analyse 24 observations of retinal detachment with macular hole in high myopia. All this patients have been treated by C3F8 internal tamponade. Silicon oil has been only used for recurrences. After a study of vitreoretinal connections, the cause of recurrences are analysed according to echometry, detachment degree and proliferative vitreoretinopathy.
The ultrasonic appearance of retinoschisis is a single echo similar to, but of smaller amplitude than that of retinal detachment and separated from the scleral echo by a silent space representing subretinal fluid . Quantitative ultrasonic measurements were made in a series of patients and show a statistically significant difference between the acoustic reflectivities of the separated retina in retinoschisis and retinal detachment.
In 51 patients with retinal detachments silicone sponge implants have been applicated. In 9 of these cases (17,6%) the implants had to be removed 3 weeks to 16 months postoperatively because of inflammatory reactions. The influence of these complications on the healing of the retinal detachment is considered as relatively unimportant. In light- and electron-microscopic examinations we could establish that the reactions are mainly caused by infections (which primarily spread within the caves of the sponge implants). Chronic infections caused by so-called apathogenic bacteria are more frequent than acute infections by so-called pathogenic micro-organisms. A foreign body reaction could be proved only in one case, in which the sponge was loosened and displaced. Defence reactions against the foreign body material probably develop only if mechanical irritation of the tissue is caused by the sponge material.
The unusual association of Best's vitelliform macular dystrophy and a full-thickness macular hole causing retinal detachment is reported. Successful reattachment was achieved with pneumatic retinopexy and postoperative laser photocoagulation. The mechanisms underlying the combination of full-thickness macular hole and retinal detachment in Best's disease remain to be elucidated.
This paper presents the case of a pacient operated for organized hemoftalmus after central retinal vein thrombosis (total vitrectomy) and whom five days after surgery a macular hole was observed and internal indendation with gas was performed. Postoperative evolution was good. Two months after surgery the pacient returns with cvasitotal regmatogen retinal detachment. The possible causes in bringing about of the retinal detachment in this case will be discussed as well as the factors that condition the success in posterior pole surgery.
A case is presented of a two-year-old white female with an optic nerve anomaly and an associated retinal detachment. A unilateral colobomatous disc was noted to be surrounded by a chorioretinal pigmentary alteration in the form of an annulus. A clear zone with absence pigmentation ringed the more central gray-black area. The retinal vessels were noted to come directly out of the deeply colobomatous disc area and to run between the cystic convolutions of the adiacent retinal tissue. A surrounding area of retinal detachment extended for a distance of three disc diameters from the disc. This case is one of a few yet reported in the literature.
The biological lipid levels and hyperglycaemia measured in patients of varying ages with retinal detachment have shown that:--in 59.7% there is a hyperlipaemia or hyperlipoproteinaemia. This is more usually a hyperpre-beta-lipoproteinaemia (37.1%);--in 32% a disturbance of lipid metabolism was associated with a disturbance of glucose metabolism: diabetes or a pre-diabetic state;--49% of patients affected with hyperlipidaemia present with a clinical vascular condition;--42% of all the patients present with a clinical vascular condition. The numbers are considerable and they show the frequency of atherogenic factors in retinal detachment.
BACKGROUND: Perfluoropropane (C3F8) is a valuable adjunct in the management of complex rhegmatogenous retinal detachments, and it has become the most commonly used perfluorocarbon gas. However, there have been few large reports about its complications. This retrospective study was undertaken to evaluate the complications of the use of perfluoropropane gas. METHODS: Perfluoropropane gas was used in the repair of a complex retinal detachment in 157 consecutive eyes. Only eyes that had a follow-up of 6 months or greater were included. Any eyes that had undergone previous vitrectomy and vitreous substitution with gas or silicone oil were excluded. RESULTS: Gas-induced lens opacities developed in 26 (67%) phakic eyes; transient increased intraocular pressure developed postoperatively in 50 (32%) eyes; a transient fibrinous, pupillary membrane developed in 20 (13%) eyes; and a flat anterior chamber developed in 10 (6%) eyes. CONCLUSIONS: Scleral buckle placement and increased gas concentration were found to be risk factors for the development of increased intraocular pressure. Proliferative diabetic retinopathy was associated with a higher development of lens opacities and pupillary membranes. No major complications were associated with the use of C3F8.
Episcleral silicone rods are used as encircling elements in retinal detachment surgery. In order to reinforce the encircling effect and form a stable effective buckle, the episcleral silicone rod is combined with an Arruga suture or a fairly rigid teflon band. The Arruga string (a 2-0 supramid suture) is sewn, in a longitudinal direction, into a solid silicone rod (2 mm in diameter) or into a silicone half-cylinder (diameter 3 or 4 mm). Soft sponge-like rods can also be reinforced with a 2 mm broad teflon band placed on the flat surface of the half-cylindrical silicone element. Drainage of subretinal fluid is usually performed in order to make room for the high circumferential buckle. Experience has shown that this modified encircling procedure is very useful in complicated cases of retinal detachment.
Liquid silicone was used in the surgical treatment of 46 eyes with complex retinal detachment. Forty-six eyes have been followed up for at least 6 months. In 27 of these eyes (58.7%) the retina was totally or partially attached at the 6-month follow-up. Visual improvement was found in 20 of the 46 eyes (43.5%). These results are encouraging considering the poor prognosis of the operated eyes. There were few severe complications during an observation time of 6 months. Liquid silicone was found to be a valuable help in the surgical treatment of severe forms of retinal detachment.
The authors describe 6 cases of tractional retinal detachment without hole formation--five as a result of intraocular metal splinter injuries and the sixth after scleral perforation following windshield injury which was overlooked. Splinter extraction was performed twice through the perforation and three times though the pars plana from the ouside. The time between the injury and appearance of the retinal detachment varied between four months and nine years. In every case there was a diffuse falt detachment without obvious tent formation. Reattachment was successful in five cases by release of the traction from the outside by cerclage with folding of the point of traction in the vitreous body and diathermy with drainage of the subretinal effusion. This method described gives relief only when vitreous strands traverse the whole bulbus crosswise. The follow-up period is up to the present three months to a year.
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INTRODUCTION: One of the principal causes that may contribute to failure in the treatment of retinal detachment without PVR is the inability to detect the retinal break before and during surgery. We propose in these cases the use of exploratory primary vitrectomy allowing the location and the treatment of the retinal break. MATERIAL AND METHODS: We have studied retrospectively 19 cases of retinal detachment without any preoperatively identified break. In 14 cases, it was a pseudophakic detachment (the IOL was in the posterior chamber with an optic between 5 and 6 mm), in 5 cases it was a phakic detachment. Peripheral fundus was examined with the vitrectomy probes with and without perfluorocarbon liquid injection. Cryotherapy or endophotocoagulations have been used to create a chorio-retinal adhesion and a gaz tamponade was used without scleral buckling procedure. RESULT: In 2 cases, no retinal break was found. In the other cases, the retinal tear has been identified during basal vitrectomy in 8 cases, during injection of perfluorocarbon in 2 cases and during the vitrectomy done forward the PFLC in 7 cases. The retinal break was identified as a small retinal tear along the posterior margin of the vitreous base in 15 cases (several in 2 cases) and as atrophic hole in 2 cases. DISCUSSION: Exploratory vitrectomy is an interesting technique to identify a retinal break when a scleral indentation cannot offer a good visualization of the anterior retina or retinal tears. In young phakic patients, a primary vitrectomy may be dangerous but seems to be justified in pseudophakic eyes. The research of the tear is sometimes facilitated by a peroperative tamponade of the retro equatorial retina.
A total of 140 consecutive patients underwent repair of retinal detachment associated with grade C2 to D3 proliferative vitreoretinopathy with perfluoroperhydrophenanthrene (Vitreon) as an intraoperative hydrokinetic tool. In seven patients the Vitreon was left in the eye for extended tamponade. Intraoperative reattachment was obtained in 98% of patients. At the final follow-up examination (mean 7 months) 84% of retinas remained attached, and 92% of patients had stable or improved visual acuity. Vitreon was found to be safe and effective in the repair of complicated retinal detachments. No complications were directly related to Vitreon when used intraoperatively or when left in the eye for extended tamponade.
Among 173 patients who had rhegmatogenous retinal detachment with spared maculas, high percentage achieved anatomic and functional success. We reattached 171 (99%) of the retinas; 150 (76%) of the eyes had final visual acuities of 6/15 (20/50) or better. Eighteen eyes (10%) had final postoperative visual acuities reduced more than two lines from the preoperative level. This reduced visual acuity was primarily related to postoperative changes occurring in the macula. The prognosis both for anatomic reattachment and visual acuity after scleral buckling for rhegmatogenous retinal detachment is significantly better when the macula is spared than when it is not. Large numbers of cryoapplications were not associated with macular complications.
Two sisters had an unusual constellation of findings, including telangiectases [corrected] involving the face and limbs, unclassifiable spondyloepiphyseal dysplasia, hypothyroidism, and tractional retinal detachment preceded by retinal and iris neovascularization. To our knowledge, this combination of defects has not been previously documented in the literature.
By multiple regression analysis we have identified 26 out of 200 observations which significantly affect the visual acuity following retinal detachment surgery. In addition, we have developed a highly significant mathematical model, which is able to predict in rather broad ranges of visual acuity to approximately 67% accuracy. There is still a large percentage of patients for whom we cannot account for the variability in final vision, a problem requiring future investigation. Potentially important factors which were not analyzed in this study include duration of macular detachment, afferent pupil defect, drainage of subretinal fluid, extent of the scleral-buckling procedure, and postoperative follow-up longer than six months. While most of the variables are fixed and cannot be alterd, such as age, senile cataract, and refractive error, improved knowledge of influential factors may allow us to manipulate some of them and provide mechanisms for improving results in recovery or maintenance of macular function after retinal detachment surgery.
PURPOSE: The authors describe the clinical course of a woman who developed two complications following vertical strabismus repair: anterior segment ischemia (ASI) and retinal detachment. METHODS: A 62 year-old woman is described. She presented with new onset proptosis and left hypertropia with significant diplopia in all fields of gaze. This presentation, her 15 year history of thyroid disease, and preoperative computed tomography (CT) of the orbits were consistent with Graves' ophthalmopathy. Vertical strabismus repair was carried out by recessing the left superior rectus muscle and resecting the left inferior rectus muscle. RESULTS: The diplopia was eliminated. The patient developed significant postoperative ASI and iatrogenic rhegmatogenous retinal detachment in the left eye due to unsuspected globe perforation. She was treated with systemic corticosteroids and radial scleral buckling. CONCLUSIONS: Severe ASI following strabismus surgery is a well recognized complication, with age, thyroid ophthalmopathy, and manipulation of the vertical rectus muscles as risk factors. The retinal detachment soon after strabismus surgery was difficult to detect, possibly due to diminished visualization of the posterior segment as a result of ASI.