Persistent hyaloid with retinal detachment.
An 11-year-old female with acquired traction retinal detachment associated with persistent hyaloid responded with retinal reattachment by intravitreous surgical technique and scleral buckling.
Arteries↗
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Rhegmatogenous retinal detachment and uveitis.
PURPOSE: To evaluate the frequency, high-risk factors, and visual prognosis of rhegmatogenous retinal detachment (RRD) in patients with uveitis. DESIGN: Retrospective case-control study. PARTICIPANTS: We included 1387 consecutive patients with uveitis who consulted our uveitis clinic from January 1990 through December 1997 of whom 43 patients (46 eyes) with RRD were identified. The retinal detachment (RD) controls were 212 consecutive patients with RRD (221 eyes, first occurrence of RD, not associated with uveitis) who were admitted for surgery in the period from April 1999 to April 2000. The uveitis control group consisted of 150 age-matched patients (210 eyes) selected from the entire uveitis series. INTERVENTION: Retrospective analysis of clinical data. MAIN OUTCOME MEASURES: The presence of RRD and eventual risk factors for RRD, such as myopia, retinal lattice degeneration, prior intraocular surgery, anatomic location of uveitis, its specific diagnosis, and clinical manifestations. Furthermore, the surgical and nonsurgical outcomes of RRD, as well as the results of various treatment regimens, were analyzed. RESULTS: RRD was identified in 3.1% of the patients with uveitis. RRD was most frequently associated with panuveitis (6.6%). RRD was associated more frequently with infectious (7.6%) than noninfectious uveitis (2.1%). At the onset of RRD, uveitis was active in most (46%) affected eyes. Proliferative vitreoretinopathy was present in 30% of the uveitic RRD eyes at presentation in contrast to 12% of the RRD control eyes. In uveitic RRD, the retina was reattached in 59% of eyes with a single operation; the final anatomic reattachment rate was 88%. Finally, a visual acuity of less than 20/200 was present in 71% of the uveitic RRD eyes, 10% of which had no light perception. CONCLUSIONS: We discovered a high prevalence of RRD in patients with active panuveitis and infectious uveitis and document that uveitis in itself is a risk factor for the development of RRD. The visual prognosis of RRD in uveitis was poor because of the uveitis itself and the frequent development of proliferative vitreoretinopathy.
Adolescent↗
[Retinectomies in the treatment of retinal detachments with vitreoretinal proliferation].
PURPOSE: To investigate the anatomical and functional results of retinectomy in the treatment of complex retinal detachment. METHODS: We reviewed the files of 48 patients who underwent peripheral retinectomy of 90% or more for retinal detachment with anterior proliferative vitreoretinopathy stage A1 (6 cases), A2 (23 cases, A3 (11 cases) or A4 (8 cases). Retinotomy was performed when complete reattachment of the retina posterior to the buckling was not obtained despite careful dissection of the peripheral vitreoretinal contraction. Retinotomy was completed by excision of the anterior retinal flap. After perfluorocarbon liquid injection, laser retinopexy and perfluorocarbon-silicone exchange were performed. RESULTS: Silicone oil was removed from 46 eyes (96%). The retina remained attached in 37 eyes (77%) with a visual acuity of 1/20 or more in 19 of them. Functional results did not correlate with the size of the retinectomy. The major complications were retraction of the retinectomy edge and recurrence of proliferative vitreoretinopathy, responsible for anatomic failure in 9 of the 11 cases. Hypotony (i.e. intraocular pressure of 5 mmHg or less) only occurred in 6 of the 37 successful cases. CONCLUSION: Retinectomy is a useful surgical tool for eyes with advanced proliferative vitreoretinopathy when careful membrane dissection and encircling buckling seem to be insufficient to obtain retinal setting. Its success rate is good and leads to relatively few complaints.
Adolescent↗
Inducible expression of vascular endothelial growth factor in adult mice causes severe proliferative retinopathy and retinal detachment.
Transgenic mice with vascular endothelial growth factor (VEGF) driven by the rhodopsin promoter (rho/VEGF mice) develop neovascularization that originates from the deep capillary bed of the retina and grows into the subretinal space. In rho/VEGF mice, VEGF expression in photoreceptors begins between postnatal days 5 and 7, the period when the deep capillary bed is developing. An important question is whether or not the developmental stage of the deep capillary bed is critical for occurrence of neovascularization. Also, although rho/VEGF mice are extremely useful for the study of ocular neovascularization, there are some applications for which the early onset of VEGF expression is a disadvantage. In this study, we used the reverse tetracycline transactivator (rtTA) inducible promoter system coupled to either the rhodopsin or interphotoreceptor retinoid-binding protein (IRBP) promoter to control the time of onset of VEGF transgene expression in photoreceptors. In the absence of doxycycline, adult double-transgenic rho/rtTA-TRE/VEGF or IRBP/rtTA-TRE/VEGF mice showed little VEGF transgene expression and no phenotype. The addition of doxycycline to the drinking water resulted in prominent transgene expression and evidence of neovascularization within 3 to 4 days. Like rho/VEGF mice, the neovascularization originated from the deep capillary bed of the retina, but it was more extensive and caused outer retinal folds followed by total retinal detachment. Real-time polymerase chain reaction and enzyme-linked immunosorbent assay demonstrated that the mice with inducible expression of VEGF that developed retinal detachment had much higher ocular levels of VEGF mRNA and protein compared to rho/VEGF mice that manifest a much milder phenotype. These data demonstrate that regardless of developmental stage of the vascular bed, increased expression of VEGF in the retina is sufficient to cause neovascularization, and high levels of expression cause severe neovascularization and traction retinal detachment. Mice with inducible expression of VEGF in the retina provide a valuable new model of ocular neovascularization.
Animals↗
[Treatment of retinal detachment with macular hole].
The authors presented 6 cases of macular hole retinal detachment in which pars plana vitrectomy with endo-tamponade was performed; in 4 cases SF6 gas and in 2, with PVR silicone oil was used. Retina was completely attached in 4 eyes. Visual acuity 1/50 to 2/50 was achieved in 5 eyes. Follow-up ranged from 5 to 9 months.
Aged↗
Barrage laser photocoagulation for macula-sparing asymptomatic clinical rhegmatogenous retinal detachments.
PURPOSE: To evaluate the efficacy of barrage laser photocoagulation in containing macula-sparing asymptomatic clinical retinal detachments (RD). METHODS: Consecutive patients presenting with asymptomatic clinical RD were prospectively treated with barrage photocoagulation in 2-3 confluent rows, using frequency-doubled Nd:YAG (532 nm) laser on an indirect-ophthalmoscopic delivery system. The patients were reviewed at 0.5, 1.5, 3, and 6 months, and yearly thereafter. Best-corrected visual acuity (BCVA), and stability/progression of rhegmatous retinal detachment beyond the barrage were noted at each visit. RESULTS: Nineteen phakic eyes of 17 patients (nine female patients), aged 12-58 years (average: 26 years), underwent barrage laser treatment. Two women had bilateral RD. Most detachments were caused by atrophic holes, and involved at least a quadrant of retina. Seven (37%) extended superiorly with breaks above the horizontal raphe. Three eyes had partial demarcation lines, and five had posterior vitreous detachment at presentation. The minimum follow-up was 6 months (mean: 21 months; range: 6-108 months). Pretreatment anatomical and functional status was maintained in 18 (95%) eyes till the final visit. One superotemporal RD progressed across the laser barrier into macula 5 months after photocoagulation, and BCVA dropped to 6/18. Scleral buckling was performed successfully, with visual recovery to 6/6. CONCLUSIONS: Barrage photocoagulation may have a place in management of asymptomatic clinical detachments, as an effective and less morbid alternative to scleral buckling.
Adolescent↗
Pseudophakic retinal detachment.
Our experiences with a small group of patients who had intraocular lens implants performed at the time of cataract extraction, and who subsequently developed retinal detachment are reviewed. The technical problems related to retinal detachment surgery in the presence of intraocular lenses and the results of this surgery are summarized.
Adult↗
[Retinal blood flow changes in eyes with rhegmatogenous retinal detachment and scleral buckling procedures].
Bidirectional laser Doppler technique and monochromatic photography was used to measure the absolute blood flow rate (F) in the major superior or inferior temporal retinal arteries in 3 patients with rhegmatogenous retinal detachment, in 4 patients following unilateral scleral buckling procedures, and in one patient before and after removal of scleral buckling elements. In 2 of the eyes with retinal detachment, F in arteries supplying the detached portion of the retina was approximately 30% lower than in arteries supplying the attached portion. On average, F measured in the arteries supplying the detached portion of the retina in 2 patients was 8.9 +/- 1.3 microliters/min, 67% lower than normal controls. F measured in the arteries supplying the attached portion of the retina in 3 patients was 15.2 +/- 3.9 microliters/min, on average, 43% lower than in normal controls. In 4 patients who had undergone uncomplicated, unilateral scleral buckling procedures, F in an artery of the affected eye was compared with F in the corresponding artery of the fellow eye. F in the artery of the affected eyes was 8.7 +/- 3.2 microliters/min, on average, 59% lower than that of the fellow eyes (p less than 0.05), and 68% lower than in normal controls (p less than 0.0001). Removal of scleral buckling elements in one patient produced a 79% increase in F in the measured artery. Then, F returned to normal levels after removal of scleral buckling elements.
Adult↗
[Retinal detachment: temporary internal tamponade with silicone oil after vitrectomy. Anatomic and functional results].
Forty-seven patients with retinal detachment treated by vitrectomy and silicone oil injection benefited from semi-premature ablation of the oil: after a mean of 5 months for supple retinal detachments and 6 1/2 months for those associated with vitreoretinal proliferation. Ablation was performed after obtaining a solid chorioretinal scar by cryopexy or endodiathermy, usually combined with laser panphotocoagulation. The technique used for ablation is described. After follow up for from 9 months to 3 1/2 years (mean 18 months) two-thirds of the patients had flat retinas. Recurrences developed usually during the first month. An explanation for these relapses is proposed.
Adolescent↗
Management of rhegmatogenous retinal detachment with macula detached. Steroids, choroidal detachment, and acuity.
One hundred thirty-four consecutive eyes with rhegmatogenous retinal detachment involving the macula were evaluated with reference to the effectiveness of systemic steroids in preventing choroidal detachment after scleral buckling surgery and in facilitating both anatomic and functional success. The occurrence of postoperative choroidal detachment was inversely related to the routine intravenous administration of steroids under antibiotic coverage beginning in the recovery room (P = 0.014). Eyes so treated were free of both clinically significant infection and extrusion. The infrequent but worrisome complication of angle closure sufficient to require choroidal tap did not occur among treated eyes. Routine steroid use may have been associated with increased preservation of acuity at the level of 20/200 or better (P = 0.043).
Choroid↗
Retinal detachment surgery without drainage of sub-retinal fluid.
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Adult↗
[Treatment of retinal detachment without drainage of the sub-retinal fluid].
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Adult↗
[A consideration on surgical procedures for retinal detachment from the standpoint of effect on retinal tissue respiration].
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Animals↗
[Idiopathic retinal detachment and congenital anomaly of vitreo-retinal insertion (author's transl)].
V-shaped retinal defects which are usually parallel to the equator, develop as a congenital anomaly at the insertion of vitreous fibrils. The vitreous overlying these retinal areas is without structure. Progressive degenerative-sclerotic areas, equatorial degeneration-or lattice degeneration can develop in the region of these vitreo-retinal adhesions.
Eye↗
Shape, number and localization of retinal tears in myopic over 8D, aphakic and traumatic cases of retinal detachment. An experience report.
For this experience report we have selected out of a total of 950 eyes with retinal detachment, 373 eyes and have sorted them out into three study groups: myopia over 8 d (197 eyes including 14 bilateral detachments), surgical aphakia (102 eyes) and traumatic detachment (74 eyes). With the help of tables and figures we tried to point out the form, number and localization of retinal tears in the eyes with retinal detachment in the above-mentioned groups. For fundus examinations we used routinely the binocular indirect ophthalmoscope without and with scleral depressor and the Goldmann three-mirror contact glass, also without and with scleral depressor. The striking features of the main types of retinal breaks in the three groups are commented, statistically analysed and compared.
Aphakia, Postcataract↗
[Rhegmatogenous retinal detachment in atrophia gyrata: pars plana vitrectomy with silicone oil instillation].
BACKGROUND: Gyrate atrophy is a form of choroidal dystrophia characterized by a genetic defect of the mitochondrial matrix enzyme ornithine ketoacidoaminotransferase on chromosome 10. Apart from rare myopathic problems, cases of choroidal, iridal atrophy, complicated subcapsular cataract, optic atrophy, macular edema, reticular retinoschisis, vasculitis and perivasculitis could be observed so far. To our knowledge, rheumatogenous retinal detachment has been described before. We present a 34-year-old female subject with a retinal detachment of the right eye over 3 quadrants with 3 small round foramina in the area 10 to 11 o'clock. PATIENTS: Concentric defects of the visual field had been known since the age of 4; the patient was slightly myopic. At the age of 31, the patient had undergone cataract extraction with implantation of posterior chamber lenses in both eyes. The ophthalmological examination revealed large areas of choroidal atrophia in both eyes. A determination of visual acuity resulted in hand movements in the right eye and 0.1 in the left eye. The ERG was extinguished. RESULTS: The retina could be fully reattached by pars plana vitrectomy and instillation of silicone oil. At the same time, we performed an excision of secondary cataract. On demission, the visual acuity of the right eye was finger counting. Because a brother of the patient had also suffering from a progressive choroidal atrophy since his childhood, an autosomal recessive disease was suspected. The only abnormality detected was strongly elevated plasma levels of ornithin (7.5 to 14 mg/dl, compared to levels of 0.6 to 2.0 in controls). Urinary excretion of ornithin was also strongly increased. DISCUSSION: To our knowledge there was no previous description of a case of atrophia gyrata in association with rhegmatogenous retinal detachment after intraocular surgery. As the pigment epithelium is missing, intraoperative endolaser-coagulation would be useless. For this reason, and since a tendency for reattachment is lacking consistent with one of the characteristics of this disease, the only approach to this case is intraocular tamponade with silicone oil.
Adult↗
Diffuse chronic retinal pigment epitheliopathy and exudative retinal detachment.
Two patients with bilateral chronic retinal pigment epitheliopathy are presented. Both patients had large areas of pigment epithelial decompensation and small pigment epithelial detachments at the posterior pole. In the macula subretinal fluid was scanty, but the first patient developed an extensive bullous retinal detachment with shifting of subretinal fluid with changes in posture in both eyes, the second patient had similar detachment in one eye. The etiology of the pigment epithelial disorder remained unknown. No inflammatory cells were found in the vitreous specimen or subretinal fluid in the first patient. Treatment with peroral corticosteroids alone or in combination with azathioprine and cyclosporin A, as well as surgery for retinal detachment in one eye, proved unsuccessful. Argon laser coagulation of the decompensated areas in the macula resulted in resorption of subretinal fluid and reattachment of the exudative detachment.
Adult↗
Pseudophakic retinal detachment: anatomic and visual results.
BACKGROUND: Our purpose was to report the anatomic and visual results of pseudophakic retinal detachment surgery in a large series of consecutive cases and to analyze the risk factors for anatomic and functional failure. METHODS: This retrospective study covered 290 primary cases of idiopathic rhegmatogenous retinal detachment operated on by the same surgeon during an 8-year period. Data relating to 26 pre-, per-, and postoperative variables were studied. For the statistical analyses we used both Chi-square and stepwise logistic regression tests. RESULTS: Vitreous loss occurred in 56 cases (19.3%), and the retina detached more than 2 years after lens extraction in 108 cases (37.2%). Breaks could be identified in 249 cases (85.8%), and the macula was involved in 235 (81%). The overall reattachment rate was 85.2% (247/290), and a postoperative visual acuity of 0.5 D or more was attained in 49.6% of cases (144/290). We found no difference between phakoemulsification, extracapsular, intracapsular techniques or between anterior chamber, posterior chamber, iris-fixated lenses as regards anatomic and functional outcomes. Proliferative vitreoretinopathy (PVR) and photoreceptor dysfunction were the main causes of anatomic and functional failure respectively. We identified extensive detachment, preoperative choroidal detachment, intraoperative hemorrhage and surgery for PVR as predictors of anatomic failure, while preoperative inflammation, preoperative PVR of grade B or worse, and surgery for PVR were predictors of functional failure. CONCLUSION: In this series, anatomic and visual results of reattachment surgery were much more affected by detachment features and by PVR than by the techniques and complications of cataract surgery.
Adult↗