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Thirty six retinal detachments in 33 patients with Wagner-Stickler syndrome are reported. The results of surgery are correlated with the types of break (giant retinal tear or multiple breaks), the surgical approach (conventional buckling or closed microsurgery) and the presence or absence of proliferative vitreoretinopathy. Overall, 27 detachments were successfully reattached.
The authors describe a myopic patient with a full-thickness macular hole that was accompanied by both retinal detachment and retinoschisis. A 51-year-old woman presented with a localized retinal elevation of three disc diameters around the macular hole in a myopic eye. Optical coherence tomography (OCT) showed features of both retinal detachment and retinoschisis. After vitreous surgery and postoperative intraocular gas tamponade, the macular elevation resolved, and separation of the neurosensory retina from the retinal pigment epithelium band disappeared on the OCT images. OCT is a useful tool for examining macular conditions associated with a macular hole in myopic patients.
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Three eyes of two patients with posterior retinal detachments associated with high myopia were treated with photocoagulation therapy only. Complete flattening of the retina was achieved in all eyes. Chorioretinal contact did not appear to be required in order for photocoagulation therapy to be effective. Although initially confined to rest, it was apparent that bed rest was not essential for the gradual absorption of subretinal fluid. Posterior vitreous detachments were present in all eyes. Although visual acuities were not greatly improved, subjective improvement was considered excellent in all cases.
The purpose of this paper is to describe an original technique for surgical treatment of idiopathic retinal detachment. Since 1971, the authors use human organic implants (lyphoylised scléral tissue). These implants are included and tied in front of the retinal tears, to obtain a large and deep scléral indentation. There is neither immunological rejection nor local inflammation. The results of 455 cases of retinal detachment are reported and analysed. This operative procedure gives 80 p. 100 of good résults. At this day, 1000 patients has been operated with this surgical procedure, at the University Eye Clinic A. of Lyons.
Five hundred and eighty-six phakic retinal detachments were studied to characterize the features of 111 cases with a history of trauma and to establish improved guidelines for medico-legal determinations. Twenty-eight percent of contusion detachments were myopic, nine times higher than expected. Myopes typically developed giant tears and nasal dialyses (p less than 0.001); emmetropes developed inferotemporal dialyses (p less than 0.005). Lattice degeneration did not increase post-traumatic detachments risk. Dialyses and giant tears caused 69% of traumatic detachments and 6% of nontraumatic detachments (p less than 0.001). Forty-seven percent of contusion detachments had no late objective evidence of trauma. Five percent of detachments with a history of trauma were not caused by trauma (false positives).
A group of eyes with clear media and diabetic traction retinal detachments treated with vitreous surgery were statistically analyzed to identify those parameters that would allow us to improve case selection. The configuration of the retinal detachment proved to be important, with hammock and flat diffuse central detachments having a good prognosis, and highly elevated, atrophic detachments such as table-top and tent-shaped demonstrating a poor prognosis. Eyes with florid diabetic retinopathy did less well than those with more inactive forms of retinopathy. Preretinal membranectomy, although accompanied by an increased rate of iatrogenic retinal tears, has a definite role in the treatment of more complex traction detachments and increases the number of eyes that may benefit from surgery. Eyes with preoperative vision better than 5/200 did significantly better than eyes with poorer preoperative vision.
A 54-yr-old U.S. Army Reserve helicopter pilot was evaluated at Brooks AFB, TX for a flying waiver with a history of intracerebral hematoma, superior oblique palsy, rhegmatogenous retinal detachment and bilateral cataract extractions with intraocular lens replacements. The USAF has waivered flyers with category 5 severe head injury (includes intracerebral bleed) in 7 (44%) of 16 cases evaluated and submitted after a 5-yr uneventful observation period, but never with an intracerebral bleed (0 of 3). Flyers with rhegmatogenous retinal detachment have been cleared for a waiver by ophthalmologists in 40 (89%) of 45 cases: the USAF ultimately granted 28 (62%) of the 45 flyers waivers with the others denied for additional diagnoses. Of the 45 detachments, 17 (38%) were asymptomatic and discovered during routine eye evaluation. Increased "G" exposure has not been shown to increase the risk of either retinal detachment or intraocular lens displacement. Of 54 intraocular lenses in the USAF Study Group, 50 (93%) are located in the posterior chamber. Waivers have been granted for 38 (86%) of 44 flyers with intraocular lens replacements; only 3 (7%) of 44 have been denied waivers for ophthalmological complications. The preferred cataract surgery for aviators is extracapsular cataract extraction with placement of a posterior chamber intraocular lens, yielding the best visual results with fewest complications. This pilot was denied waiver recommendation because his neurological observational period had not yet lasted 5 yr, although he would have received a favorable recommendation for his ophthalmological diagnoses.
This survey has been carried out over 186 operations for retinal detachment during which a voluntary or accidental drainage took place in 2/3 of the cases. Its frequency is studied according to the type of the detachment, its age, the duration of the preperatory rest, the number of operations and the surgical technique. The postsurgical evolution of detachments with drainage shows that the vitreous is more frequently clouded, later cleared up, and that there are more choroidal detachments and more retinal hemorrhages. The frequency of the early retinal flattening, the only one which has been studied, is not increased by drainage. It is no use debating the opportunity of drainage because indeed it is often imposed on the surgeon a as a last resort by the type of the detachment. The means for limiting its frequency are reviewed.
PURPOSE: To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment. DESIGN: Prospective, randomized, multicenter clinical trial. PARTICIPANTS: Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment. INTERVENTION: Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle. MAIN OUTCOME MEASURES: Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia. RESULTS: There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73-2.24), indicating no statistically significant difference. Proliferative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications. CONCLUSIONS: Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation.
The retrospective study of our patients operated on for an idiopathic macular hole shows 2 cases of presumed exudative retinal detachment appearing 24 to 36 hours after surgery. This complication, to our knowledge, has never been reported. We describe these 2 cases and discuss on one hand, the arguments for an exudative etiology of the retinal detachment, and on the other hand, the possible causes of this unusual complication.
PURPOSE: To report a case of a giant pigment epithelial tear and transient exudative retinal detachment occurring in a patient with hypotonic choroidal effusions after trabeculectomy. METHODS: Case report and brief literature review. RESULT: The retinal and choroidal detachments settled, disclosing an extremely large crescentic pigment epithelial defect in the temporal midperiphery. CONCLUSIONS: An exudative retinal detachment secondary to a peripheral pigment epithelial rip may complicate choroidal effusions. Recognition of this association may prevent unnecessary investigation or surgery.
OBJECTIVE: To review the results of 2 different surgical approaches in the management of primary rhegmatogenous retinal detachments (RDs) with undetected retinal breaks. DESIGN: Retrospective, consecutive, interventional case series. PARTICIPANTS: Medical records of 44 patients with uncomplicated macula-involving primary rhegmatogenous-appearing RDs, but without retinal breaks detected preoperatively or intraoperatively, were reviewed. METHODS: All study patients were operated by the same surgeon between 1989 and 2004 using 2 approaches: 26 (59%) patients underwent a scleral buckling procedure (SBP) with or without subretinal fluid drainage, whereas 18 (41%) patients underwent scleral buckling combined with pars plana vitrectomy (PPV), fluid-gas exchange, and broad application of endolaser. MAIN OUTCOME MEASURES: Single operation and final postoperative anatomic success, and 2-month postoperative and final best-corrected visual acuity (VA) (negative logarithm of the minimum angle of resolution [logMAR]). RESULTS: Mean preoperative VAs were 1.73 logMAR units (median, 1.60; range, 0.48-2.60) in the combined surgery group and 1.52 logMAR units (median, 1.30; range, 0.30-2.60) in the scleral buckling group. Neither preoperative (P = 0.33), 2-month postoperative (P = 0.53), best-corrected (P = 0.98), nor final (P = 0.46) mean VA showed any statistically significant differences between the 2 treatment groups. A single operation reattachment rate of 72% (13/18 cases) was achieved in the combined surgery group, compared with 61.5% (16/26 cases) in the scleral buckling group (P = 0.17, log rank test). Immediate anatomic success rates were 89% after combined treatment and 38.5% after scleral buckling alone (P = 0.002). At the final visit, the retina was attached in 15 (83.3%) patients who received the combined treatment and in 22 (84.6%) patients who underwent scleral buckling (P = 0.900). Intraoperative subretinal hemorrhage occurred in 1 (5.6%) patient from the combined surgery group and in 2 (7.7%) patients from the scleral buckling group. Retinal incarceration in the drainage sclerotomy occurred in 1 (3.8%) case during the SBP. Proliferative vitreoretinopathy sufficient to require reoperation developed in 1 (5.6%) eye of the combined surgery group and in 3 (11.5%) eyes of the scleral buckling group. CONCLUSIONS: Scleral buckling is as effective in the management of uncomplicated rhegmatogenous RDs with undetected breaks as is surgery combining scleral buckling and PPV.
Following several referrals for 'assessment', obstetricians in the West Midlands Health Region were surveyed regarding patients perceived to be at high risk of retinal detachment during the second stage of labour. A questionnaire was sent to 95 practicing obstetricians. This was a four-item questionnaire, based on four identifiable categories of referral to the ophthalmologist, by the obstetricians. It also covered the perceptions of the obstetricians of the ocular problem in relation to their obstetric clinical decision. With a 70% response rate, a significant number of obstetricians consider that certain ophthalmic conditions predispose to retinal detachment during labour. Even though they hold this view, the obstetricians generally do not modify their obstetric practice in response to any perceived ophthalmic risk. Such a view is not borne out by current literature, with no evidence to support a causative link between labour and rhegmatogenous (versus serous) retinal detachment, even in eyes predisposed to that condition.
Ninety-nine (11.6%) of 850 phakic retinal detachment patients had bilateral detachments. The incidence of bilaterality was greater in nontraumatic detachments (13.4%) than traumatic detachments (3.8%). Patients were divided into two refractive classes: (1) myopic, containing refractive errors of -2.50 diopters or more, and (2) nonmyopic, containing all other refractive errors. The rate of bilaterality in nontraumatic detachments varied with refractive class and lattice degeneration: nonmyopic without lattice (8.1%), nonmyopic with lattice (14.2%), myopic without lattice (16.3%), and myopic with lattice (24.6%). Mean age in years at onset of the initial detachment varied with refractive class and lattice degeneration: nonmyopic without lattice (59.1), nonmyopic with lattice (55.8), myopic without lattice (49.2), and myopic with lattice (28.2). Lattice degeneration reduced the interval between detachments. Annual risks of fellow eye detachments were calculated for four groups: nonmyopic without lattice (0.12%), nonmyopic with lattice (0.95%), myopic without lattice (1.3%), and myopic with lattice (0.98%).
BACKGROUND: Giant retinal tears were previously described in patients affected by panuveitis. We report the case of a patient presenting giant retinal tears in both eyes affected by ocular syphilis. PATIENT AND METHOD: A 45-year-old patient presented a 5 days history of sudden bilateral drop of vision, two weeks after penicillin therapy for secondary syphilis. The best visual acuity was 0.5 RE and light perception LE. Biomicroscopy showed an intense vitritis associated with bilateral giant tear and retinal detachment. Both TPHA and VDRL were positive. Lumbar puncture showed lymphoplasmocytosis with intrathecal synthesis of IgM. RESULTS: Topical steroids treatment was applied and intravenous penicillin was given during 14 days. Pars plana vitrectomy with silicon oil tamponade was performed in association with endophotocoagulation in the left eye and cryocoagulation in the right eye. Vitreous PCR was negative. Evolution was successful with an attached retina. CONCLUSIONS: This represents the first reported case of giant retinal tear with retinal detachment in a patient presenting a syphilitic panuveitis.
PURPOSE: To evaluate the ability of delayed hyperoxia to slow or prevent degenerative and gliotic changes initiated by retinal detachment. DESIGN: An experimental study. METHODS: Rhegmatogenous detachments were produced in the right eyes of eight cats. After 1 day in room air (21% O(2)), four cats were placed in chambers with the O(2) concentration regulated at 70%; the other four were left in room air. At 7 days the retinas were harvested and examined by light and confocal microscopy. Cell specific antibodies, TUNEL and proliferation assays, outer segment length, and photoreceptor counts, were used to assess the condition of the retina. The contralateral unoperated eyes were used as controls. RESULTS: Animals maintained in elevated O(2) showed a dramatic preservation of rod and cone outer segments as well as in the organization of the outer plexiform layer. The number of surviving photoreceptors was increased in the hyperoxia-treated animals. Neurite sprouting, a characteristic of detached retina, was rarely observed in the experimental eyes. Proliferation of non-neuronal cells was reduced, but not halted, by hyperoxia. GFAP and vimentin expression was not effected by hyperoxia; these intermediate filament proteins increased in Müller cells similar to that observed in control detachments. CONCLUSIONS: Exposure to hyperoxia, delayed by 1 day after the onset of retinal detachment, was highly effective in preserving photoreceptor cells and in reducing proliferation within the retina. It did not, however, reduce the hypertrophy of Müller glia. There were no apparent detrimental effects of exposure to 70% O(2) for 6 days. These results suggest that human patients may benefit from breathing elevated oxygen levels while awaiting reattachment surgery, even if the hyperoxia is delayed relative to the time of detachment.
PURPOSE: To evaluate the prognostic value of axial length and epiretinal membrane (ERM) separation during vitrectomy for retinal detachment due to macular hole in high myopia. PATIENTS AND METHODS: Thirty-two consecutive highly myopic eyes (31 patients) with retinal detachment due to a macular hole were retrospectivly studied. All eyes underwent pars plana vitrectomy with gas tamponade (C3F8). An epiretinal membrane was removed in 9 cases. The 32 cases were divided into 3 groups: anatomical success after the initial surgery (group 1, 15 cases); anatomical success after two surgical procedures without silicone oil (group 2, 5 cases), and silicone oil tamponade (group 3, 12 cases). RESULTS: Retinal reattachment occurred in 15 cases (46.8%) after the initial surgery. The difference of axial length between the 3 groups was not significant. The rate of anatomical success without silicone oil was 88.8% (8/9 cases) when an ERM was peeled and the number of peelings was significantly higher (p=0,04) in group 1 than in group 3. CONCLUSION: The axial length was not a pronostic factor of silicone oil tamponade in this study. The success rate was higher when an ERM was peeled. However, considering the technical difficulty in removing the ERM completely, gas tamponade seems to be the better initial treatment.