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PubMed2000

[Retinal detachment with anterior proliferative vitreoretinopathy and its surgical treatment].

OBJECTIVE: To explore the clinical characteristics and surgical results of retinal detachment in eyes with anterior proliferative vitreoretinopathy (PVR). METHODS: 83 patients (83 eyes) of retinal detachment with grade C-D PVR were studied. Different surgical methods were used in treating anterior PVR and posterior PVR, respectively. RESULTS: Among the 83 patients, anterior PVR was in 34 eyes (41.0%) and posterior PVR 49 eyes (59.0%). The anterior PVR occurred in younger patients, mean age 28.5 years, more in male patients (85.3%) and more in grade D of PVR (55.9%); in the posterior PVR, the mean age was 38.9 years, 63.3% of patients were male and 24.5% of patients were in grade D of PVR. Eighty-three patients had a mean postoperative follow-up of 12.9 months. Complete retinal re-attachment occurred in 24 eyes (70.6%) with anterior PVR and in 38 eyes with posterior PVR (77.6%; chi(2) = 0.51, P > 0.1). The final corrected visual acuity >or= 0.05 was in 11 eyes with anterior PVR (32.4%) and in 22 eyes with posterior PVR (44.9%; chi(2) = 1.32, P > 0.1). CONCLUSIONS: Eyes with anterior PVR have different clinical characteristics and worse surgical conditions when compared with eyes of posterior PVR. However, by the use of modern vitreoretinal surgery, the outcome in eyes with anterior PVR may become similar to that of posterior PVR.

Adult↗
PubMed1987

Relative afferent pupillary defect in eyes with retinal detachment.

Relative afferent pupillary defects were measured before and after surgery in 38 patients with unilateral rhegmatogenous retinal detachment. All 38 patients were measured preoperatively and the mean (+/- SD) pupillary defect was 1.4 +/- 0.7 log units. The afferent pupillary defect decreased in 36 of the 38 patients after successful scleral buckling operations (postoperative mean = 0.4 +/- 0.3 log units). Twenty patients had defects postoperatively of 0.3 log units or less, and seven of these had no measurable defects at all. A prediction model, using the variables of total number of peripheral quadrants detached and whether the macula was detached, yielded the following prediction equation: Relative afferent pupillary defect (log units) = 0.35 X (total quadrants) + 0.68 X macula detachment. This means that the detachment of each peripheral quadrant of retina caused about 0.35 log units of defect, whereas detachment of the macula caused 0.68 log units. The standard error of this estimate was rather large (+/- .65 log units); therefore, the size of the afferent pupillary defect can only roughly predict the extent of the retinal detachment and vice versa.

Humans↗
PubMed1977

[Indications, technics and results of cataract surgery on an eye effected with healed or present retinal detachment or predisposed to detachment].

This communication is a survey of 53 cataract operations followed up during a period of 1-6 years, with an average of 4 years, and performed on patients who had a high risk of subsequent retinal detachment because of a preceding detachment on the fellow eye or on the cataractous eye, because of peripheral retinal degenerations, or a history of hereditary retinal detachment. Most of the operations were performed under general anesthesia and ocular hypotony. In all the cases, a limbal-based conjonctival flap with a double line of sutures (scleral and conjonctival), an iridectomy in segment, a zonulolysis and a cryoextraction, were done. As for the retina, 18 eyes received a coagulation before the cataract extraction by galvano- or cryocoagulation or even by xenon photocoagulation. Among them 3 had a detachment after the cataract extraction, but 2 of them were cured by a new operation. 15 eyes had peripheral retinal lesions which were coagulated after the cataract extraction by cryo-, laser or xenon coagulation. Nevertheless 2 had a detachment. 13 patients with a detachment on the fellow eye or in the family, had no peripheral lesion and were not coagulated. None of them had a retinal detachment after the cataract extraction. Finally the eyes operated upon a short time after the cataract extraction suffered severe complications: reopening of the cataract incision, loss of vitreous and finally loss of 2 eyes out of 3.

Cataract↗
PubMed1988

Vitrectomy for macular pucker. Use after treatment of retinal tears or retinal detachment.

We review our experience and present an analysis of 119 consecutive cases of macular pucker treated by vitrectomy and removal of the epiretinal tissue following treatment for acute retinal tears (16 eyes) or rhegmatogenous retinal detachment (103 eyes). Vision improved postoperatively in 104 (87%) of the 119 eyes. Final visual acuity of 20/60 or better was achieved in 38 (75%) of 51 cases in which the macula had not been detached previously and in 12 (24%) of 52 cases with prior macular detachment. Two preoperative factors were associated with a final visual acuity of 20/100 or better: (1) macula not involved by the original retinal detachment, and (2) thin epiretinal membrane.

Adolescent↗
PubMed1981

[Relapsing corticodependent posterior pole serous retinal detachment (author's transl)].

A case of serous retinal detachment and episcleritis in a 26 years old woman is reported. The detachment, always, unilateral, disappeared in a few days with corticotherapy, but relapsed eight times in a year when steroids were discontinued (4 times in R.E. and 4 in L.E.). No systemic pathology was found. The detiology probably involved a localized auto immune process. Based on the angiographic findings typical of a central serous chorioretinopathy) and the evolution (similar to Harada's disease) this case supports the hypothesis that relates both diseases as belonging in to the same nosologic spectrum.

Adrenal Cortex Hormones↗
PubMed2006

[Heavy silicone oil as internal tamponade for retinal detachment: efficacy and tolerance].

INTRODUCTION: To evaluate the tolerance and efficacy of heavy silicone oil as internal tamponade for retinal detachment surgery. PATIENTS AND METHODS: Sixty-six eyes requiring heavy silicone oil for retinal detachment, with at least 1 month follow-up, were retrospectively studied. Preoperative status, surgical technique, tolerance, and anatomical and functional results were analyzed from the patient's file. Indications for heavy silicone injection were inferior retinotomy or inferior retraction in 65% of cases. PVR grade C was present in at least 63% of cases. Retinotomy was performed in 45% of cases. An exchange procedure was performed versus DKline in 65% of cases. Mean follow-up was 7 +/- 4 months. RESULTS: At the end of follow-up, 59% of eyes had a completely reattached retina, 32% without internal tamponade. Another surgery was necessary in 54% of cases. During follow-up, mean intraocular pressure was normal, and there was a significant intraocular inflammation in three cases (4.5%). In seven cases of the 44 ablations of heavy silicone oil, an adherence of residual bubbles was present. Redetachment occurred after ablation for anatomical success in 41% of cases. BCVA was better than 0.05 (20/400) in 54% of cases at the end of follow-up. CONCLUSION: Heavy silicone was well tolerated and seems not to be pro-inflammatory in our study. It is a good alternative to standard silicone for inferior retinotomy and inferior breaks without PVR. It is not a treatment of inferior retraction, and is not a long-term internal tamponade. During the ablation of heavy silicone oil, adherence of residual bubbles is possible, in which case a coaxial light or an endoillumination could be needed during ablation.

Adolescent↗
PubMed1994

Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery.

PURPOSE: To identify the clinical risk factors for the development of severe proliferative vitreoretinopathy (PVR) after retinal detachment surgery. METHODS: A retrospective study of 1020 patients with either no PVR or with PVR of grade C1 or less at initial examination was conducted. After surgery, severe PVR was defined as grade C2 or worse. The data relating to 94 variables were evaluated by univariate analysis and stepwise logistic regression. RESULTS: Severe PVR developed after surgery in 107 patients (10.5%). Ten significant predictive variables were identified: minor intra- or postoperative hemorrhage, grade A preoperative PVR, preoperative choroidal detachment, giant tears, air tamponade, detachment involving more than 2 quadrants, cumulative break area larger than 3 optic disks, postoperative choroidal detachment, signs of uveitis at initial examination, and grade B preoperative PVR. CONCLUSION: The results indicate that in addition to the size of breaks, extent of detachment, and presence of preoperative inflammation or low-grade PVR, iatrogenic problems also are important factors in the pathogenesis of severe PVR after surgery for retinal detachment.

Aged↗
PubMed2003

Ethnic differences in the demand incidence of retinal detachments in two districts in the West Midlands.

AIM: To evaluate the epidemiological characteristics of rhegmatogenous retinal detachments (RRDs) in two defined populations in the West Midlands of England. METHODS: A 5-year retrospective study of patients who underwent surgical repair of their RRD between April 1994 and March 1999. Statistical analysis was done by the Statistical Program for Social Sciences (SPSS) version 10.0. RESULTS: The total demand incidence of RRD was 11.3 and 6.3 per 100,000 in Wolverhampton and Walsall, respectively. The Asian subgroup had a low demand incidence of 4.6 and 2.0 per 100,000 in each area, respectively. In Wolverhampton the highest age-specific demand incidence was in the 70 to 79-year age group at 29.1 per 100,000, whereas in Walsall it was 98.6 per 100,000 in the 85+ age group. Nontraumatic phakic detachments had the highest demand incidence of 9.7 per 100,000, whereas nontraumatic pseudophakic and aphakic R/D were much lower at 1.2 and 0.3 per 100,000, respectively. There was a 1 : 1.5 female-to-male ratio, with a mean age of 57.8 years (95% CI 54.7-61.0) in females and 55.5 years (95% CI 53.1-57.9) for males. A total of 41.6% (142) of patients presented initially to the Wolverhampton Eye Infirmary Accident and Emergency Department (A&E). CONCLUSION: This is the first UK-based study. The demand incidence in Caucasians is similar to worldwide figures. Asians have a three times lower incidence of retinal detachments. The demand incidence increases with age. Females have a higher mean age than males. Males (89.5%) were more likely to suffer from traumatic detachments. Younger patients were more likely to present to the optometrist initially. Less than half of the patients will present initially to the eye A&E.

Adolescent↗
PubMed1979

Retinal detachment surgery without cryotherapy.

The authors have performed 43 retinal detachment operations omitting the use of cryotherapy or any other type of retinal adhesion. Only a full thickness buckling procedure has been performed with drainage of subretinal fluid in some cases. The cases were carefully selected and the follow-up period has been from 1 to 3 1/2 years. Redetachment has not occurred if the original hole was free of traction (round holes) but has so far occurred in 3 cases where traction was present.

Cryosurgery↗
PubMed1986

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.

Adult↗
PubMed1981

[Autoimmunity against the retina in idiopathic retinal detachment. Study of 50 cases].

Auto-immunity against the retina was studied on fifty patients suffering from retinal detachment. The results of the present study confirm the development of auto-immunity against the retina in long standing retinal detachments, which has already been demonstrated by other authors. In addition, the present study shows a significant correlation between the development of auto-immunity against the retina and the surgical treatment on one hand, and evidence of epiretinal proliferation and retraction on the other hand. It is suggested that auto-immunity against the retina may be the result of endocular inflammation which may be one of the causes of epiretinal proliferation and retraction.

Adolescent↗
PubMedDate not supplied

Air pump for retinal detachment with macular hole.

From 1984 to 1992, 128 eyes with substantial retinal detachment due to macular hole underwent vitrectomy at the Ideta Eye Hospital. In the first 76 eyes treated, air was injected by syringe after removal of the vitreous (group A); in the subsequent 52 eyes, air was injected by a pump while subretinal fluid was aspirated through the macular hole (group B). The rates of retinal reattachment after the first surgery were 63.2% in group A and 82.7% in group B (P < .05). Thus, using the air pump was more effective than air injection.

Adult↗
PubMed1999

Pneumatic retinopexy in the treatment of primary rhegmatogenous retinal detachment.

PURPOSE: To review the management by pneumatic retinopexy of 31 primary rhegmatogenous retinal detachments performed between August 1994 and December 1997. METHODS: Ocular indications included superior retinal breaks, no evidence of proliferative vitreoretinopathy (PVR) and ability to posture. Patients with inferior breaks and/or areas of vitreoretinal degeneration were excluded. Surgery was performed under local anaesthetic using sulphur hexafluoride (SF6) or perfluoropropane (C3F8) gas injection. Transconjunctival cryotherapy or laser retinopexy was used to create permanent retinal adhesion. The mean length of patient follow-up was 11 months (range 5-24 months). RESULTS: Thirty-one patients (20 men, 11 women) with a mean age of 63.4 years (range 29-81 years) underwent pneumatic retinopexy which resulted in initial retinal reattachment in 22 patients. Two detachments recurred in the first month and a third at 4 months post-operatively, giving an anatomical reattachment rate with one procedure in 19 out of 31 eyes (61%). Of the 12 failures, 7 were reattached with one additional operation and one case reattached after multiple procedures, giving an overall reattachment rate of 87%. Post-operatively, new or missed breaks were present in 7 patients (22%) and PVR developed in 4 patients (13%). There was no difference in age, gender or extent of detachment between the failed and reattached groups and pseudophakia did not appear to be a poor prognostic factor. CONCLUSION: Pneumatic retinopexy can be a useful alternative to conventional rhegmatogenous retinal detachment surgery in carefully selected cases. A larger study addressing the influence of non-ocular factors is warranted.

Adult↗
PubMed1984

Scleral buckling for retinal detachment in patients with retinoblastoma.

Three children (two girls and one boy) with bilateral retinoblastoma each developed a presumed rhegmatogenous retinal detachment in one eye. All three eyes had previously received radiation and cryotherapy. In each case the retinal detachment responded promptly to conventional surgical methods via scleral buckling in the area of treated retinoblastoma and presumed retinal break. All three eyes have retained useful vision for follow-up periods of 3.5 to 12 years.

Eye Neoplasms↗
PubMed1984

The importance of fluid absorption, traction, intraocular currents, and chorioretinal scars in the therapy of rhegmatogenous retinal detachments. XLI Edward Jackson memorial lecture.

The combination of traction on the retina and of intraocular currents in the presence of a retinal hole is the cause of rhegmatogenous retinal detachment. The strong suction forces of the pigment epithelium and choroid counteract such a development. Chorioretinal scars serve as a seal against currents. Eliminating the effects of traction and of intraocular currents and making use of the absorption forces of the pigment epithelium and choroid are the primary aims in successfully treating rhegmatogenous retinal detachment. Direct closure of the retinal hole is not always necessary.

Adult↗
PubMed1984

Experimental serous retinal detachment and focal pigment epithelial damage.

We made small nonrhegmatogenous retinal detachments (blebs) in rabbits over regions of retinal pigment epithelium (RPE) that were damaged mechanically or by laser photocoagulation. Fluorescein diffused readily into blebs made over damaged RPE, but the subretinal fluid was resorbed more quickly than from blebs overlying normal RPE. Thus, focal damage appears to facilitate water movement from, rather than into, the subretinal space. We conclude from these data that central serous chorioretinopathy is not caused simply by a passive "leak" through the RPE barrier, and the effects of photocoagulation in this disease cannot be explained simply as sealing such a leak.

Animals↗