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PubMed1993

Changes in refraction after retinal detachment surgery corrected by extended wear contact lenses for early visual rehabilitation.

The encircling band used in conventional retinal detachment surgery creates a circular indentation of the eye and thus may increase the anterior-posterior axial length. The myopia induced by encircling elements in retinal detachment surgery varies between 0 and 3 D. In a series of 25 patients, the average change in refraction after surgery was -2.25 D. To achieve early visual rehabilitation, patients were fitted with extended-wear soft contact lenses 7 to 10 days after surgery. The patients were followed for up to 6 months and contact lenses were exchanged according to changes in refraction. Visual rehabilitation using extended-wear lenses was immediate and excellent. The contact lenses were tolerated well. Two patients developed a minor corneal infiltrate under the soft lens and were withdrawn from the study.

Adult↗
PubMed1984

[Use of silicone oil for temporary tamponade in the treatment of retinal detachment with vitreoretinal retraction. 2. Aspects, prevention and treatment of complications].

A retrospective study of 36 cases of retinal detachment with vitreoretinal retraction, greatly improved immediately after intravitreal cavity injection of silicone was definitely responsible for two complications: cataract and chronic corneal edema. Their onset requires routine extraction of the silicone, recurrence of the retinal detachment developing in only 50% of cases. Used as a transient procedure, the injection of silicone into the vitreal cavity appears to be a relatively simple surgical procedure for detachments requiring prolonged internal tamponade.

Cataract↗
PubMed2006

[Incidence and prophylaxis of retinal detachment following pars plana vitrectomy].

PURPOSE: The aim of this study was to investigate the incidence of retinal detachment (RD) following pars plana vitrectomy and the efficacy of prophylactic means by cryoapplication central to the superior sclerotomies. PATIENTS AND METHODS: From February 2002 to January 2005 a total of 2,298 eyes received a pars plana vitrectomy in our department. Excluding eyes with previous peripheral coagulation therapy, preexisting retinal detachment, and endophthalmitis 1,640 eyes could be reexamined at least 6 months after surgery (mean: 17+/-12 months). The incidence of RD was compared between two groups: one with intraoperative cryoapplication central to the superior sclerotomies (n=533) and one without any prophylactic treatment (n=1,107). RESULTS: A total of 66 rhegmatogenous RD occurred during the follow-up, 23 with prophylactic cryotherapy and 43 without. This difference does not reach the level of significance. Only a subgroup of eyes operated on for macular pucker and venous occlusions showed a strong trend to prove the efficacy of prophylactic cryotherapy (p=0.07). Comparing the first 934 surgeries performed with the last 706 the incidence of RD decreased from 5.25 to 2.41%. CONCLUSIONS: The incidence of RD could be decreased significantly during the period investigated. Cryoapplication at the superior sclerotomies failed to reach statistical significance in the total group, though the results in eyes in two special subgroups showed a strong trend towards a protective effect of cryoapplication (p=0.07). Other factors may have contributed to the reduction of RD after pars plana vitrectomy.

Comorbidity↗
PubMed2006

Anatomical and functional outcome of surgery of primary rhegmatogenous retinal detachment in high myopic eyes.

PURPOSE: To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. METHODS: We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. RESULTS: Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. CONCLUSIONS: The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.

Adolescent↗
PubMed1979

Visual acuity following retinal detachment surgery.

A poor visual acuity following an anatomical cure of a retinal detachment was in this series always associated with a change in macular morphology, the commonest maculopathy being the appearance of a cellophanemembrane. Factors influencing the visual prognosis are duration and extent of the detachment, involvement of the macula, the age of the patient and the presence of pre-operative periretinal membrane formation. The type of buckling procedure is not related to the visual outcome and while the conversion of the procedure into an intra-ocular operation, either by way of drainage of subretinal fluid or by intra-vitreal injection, can cause serious complications we suggest that uncomplicated drainage of subretinal fluid has not been a cause of macular pucker in this series but that this conditions is related to the indication for drainage, namely a varying degree of rigidity of the retina due to periretinal membrane formation.

Age Factors↗
PubMed1990

Cyanoacrylate tissue adhesive in the management of recurrent retinal detachment caused by macular hole.

Nine eyes of nine patients with rhegmatogenous retinal detachment caused by a macular hole were treated by the transvitreal application of cyanoacrylate tissue adhesive to the macular hole. Eight of the nine eyes had previously failed conventional vitreous surgery with gas tamponade and laser photocoagulation. Eight eyes (89%) were completely reattached with a minimum follow-up of three months. In the successfully treated eyes, post-operative visual acuity was 20/200 in two eyes, 20/400 to 5/200 in five eyes, and less than 5/200 in one eye. Direct sealing of macular holes in difficult cases may obviate the need for extended intraocular tamponade or macular buckling with their associated complications.

Aged↗
PubMed1997

Photoreceptor outer segments in aqueous humor from dogs with rhegmatogenous retinal detachments.

OBJECTIVE: To determine whether photoreceptor outer segments can be found in aqueous humor from dogs with rhegmatogenous retinal detachment (RRD). DESIGN: Case series. ANIMALS: 4 dogs with unilateral RRD, 2 dogs with bilateral RRD, 1 dog with unilateral non-RRD, and 1 dog with glaucoma without retinal detachment. PROCEDURE: Aqueous humor samples were fixed in 2% glutaraldehyde and examined by means of transmission electron microscopy. RESULTS: Outer segments were found in aqueous humor from 7 of 8 eyes with RRD but were not found in aqueous humor from dogs with non-RRD or glaucoma. CLINICAL IMPLICATIONS: Photoreceptor outer segments may move into the anterior chamber of eyes with RRD.

Animals↗
PubMed1990

Comparative study of different techniques of intraocular gas tamponade in the treatment of retinal detachment due to macular hole.

The injection of sulfur hexafluoride (SF6) or perfluoropropane (C3F8) was used as a method of internal tamponade in 43 eyes affected by retinal detachment due to macular hole. The technique of ocular hypotension prior to gas injection varied according to the characteristics of each case, using vitrectomy and SF6 30% in 8 cases (group 1), fluid-gas (SF6) exchange through the pars plana in 10 cases (group 2), paracentesis of the anterior chamber prior to injection of SF6 in 12 cases (group 3) and injection of C3F8 without drainage in 13 cases (group 4). Retinal reattachment was initially achieved in 87 (group 1), 83.3 (group 2), 100 (group 3) and 92.3% (group 4), but 4 recurrences yielded a 6-month follow-up cure of 75 (group 1), 75 (group 2), 91 (group 3) and 84% (group 4). Postoperative complications included proliferative vitreoretinopathy (7%), endophthalmitis (2.3%) and subretinal hemorrhage (2.3%). The use of intraocular gas tamponade appears to be a procedure with an acceptable complication rate in the treatment of retinal detachment due to macular hole. This study suggests the use of paracentesis and SF6 in phakic eyes, C3F8 in aphakic eyes and vitrectomy plus 30% SF6 in eyes with proliferative vitreoretinopathy or vitreoretinal traction adjacent to the macular hole.

Adolescent↗
PubMed2006

Characterization of cytokine responses to retinal detachment in rats.

PURPOSE: Photoreceptor apoptosis is associated with retinal detachment (RD) induced photoreceptor degeneration. Previously, we demonstrated the importance of caspase activation for RD-induced photoreceptor death in a rat model of RD. However, extracellular signals that precede the activation of caspases and photoreceptor degeneration remain unclear. The aim of this study is to characterize the molecular and cellular responses that occur after RD. The expression of cytokines, chemokines, and growth factors were examined in a rat model of RD. METHODS: RD was induced in adult rats by subretinal injection of sodium hyaluronate. Retinal tissues were collected at various times (1, 3, 6, 24, and 72 h) after the induction of detachment. To screen for expressional changes in response to RD, major candidates for cytokines, chemokines, and growth factors were broadly examined by quantitative real time polymerase chain reaction (QPCR). To identify the cellular sources of the expressed genes, cells from various layers of the retina were obtained using laser capture microdissection (LCM), and their mRNAs were isolated. Protein expression was quantified by immunohistochemistry and Enzyme Linked-Immuno-Sorbent Assay (ELISA). To assess the potential of early response genes after RD to induce photoreceptor degeneration, exogenous recombinant proteins were subretinally injected and the photoreceptor cell death was assessed using a TdT-dUTP terminal nick-end labeling (TUNEL) assay at 24 h after RD. RESULTS: At 72 h after RD a significant increase in mRNA levels for tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), monocyte chemotactic protein-1 (MCP-1), and basic fibroblast growth factor (bFGF) were detected in the neural retina. LCM revealed increased expression of mRNA for bFGF and MCP-1 in all retinal layers, though bFGF was especially evident in the outer nuclear layer (ONL) and MCP-1 in the inner nuclear layer (INL). TNF-alpha was increased in the ONL and the INL, and IL-1beta was increased in the ganglion cell layer. Time course experiments showed that TNF-alpha, IL-1beta and MCP-1 increased within 1 h after RD, while bFGF was increased by 24 h. Increased protein expression for TNF-alpha, IL-1beta, and MCP-1 was demonstrated by ELISA at 6 h after RD. Immunohistochemistry showed TNF-alpha and bFGF expression in the whole retina, with IL-1beta specifically expressed in astrocytes and MCP-1 in Müller cells. Subretinal administration of MCP-1 significantly increased TUNEL-positive cells in the ONL 24 h after RD, while injection of vehicle control, TNF-alpha, or IL-1beta showed no effect. CONCLUSIONS: Retinal glial cells, including astrocytes and Müller cells, are a major source of cytokine induction after RD. The increased expression and release of MCP-1 may be an important cause of photoreceptor degeneration associated with RD. This study helps to understand the mechanisms of RD-induced photoreceptor degeneration. Our results may provide new therapeutic targets to prevent photoreceptor degeneration following RD.

Animals↗
PubMed2004

Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 2. Second eye involvement and retinal detachment.

PURPOSE: To describe the course of cytomegalovirus (CMV) retinitis in patients with AIDS in the era of highly active antiretroviral therapy (HAART). DESIGN: Multicenter, prospective, observational study. PARTICIPANTS: Two hundred seventy-one patients with AIDS and CMV retinitis. METHODS: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and fundus photographs. MAIN OUTCOME MEASURE: Second (contralateral) eye involvement among patients with unilateral disease and retinal detachment (RD). RESULTS: The overall rate of second eye involvement among patients with unilateral CMV retinitis was 0.07 per person-year (PY); among those with CD4+ T-cell counts of <50/microl it was 0.34/PY, compared with 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). Risk factors for contralateral eye involvement included low CD4+ T-cell count and detectable CMV load. The overall rate of RD was 0.06/PY; among those with CD4+ T-cell counts of <50/microl it was 0.30/PY, compared with 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). Risk factors for RD included a low CD4+ T-cell count and larger area of CMV retinitis. CONCLUSIONS: Compared with the rates reported in the pre-HAART era of second eye involvement (approximately 0.40/PY) and RD (approximately 0.50/PY), the rates of these events were reduced among patients in the HAART era. However, among patients with CD4+ T-cell counts of <50/microl, the rates were more similar to those from the pre-HAART era.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The macular buckling procedure in the treatment of retinal detachment in highly myopic eyes with macular hole and posterior staphyloma: mean follow-up of 15 years.

PURPOSE: To evaluate the long-term anatomical and functional results of the macular buckling procedure in myopic macular hole with retinal detachment and posterior staphyloma. METHODS: Twenty-five consecutive highly myopic eyes with retinal detachment, macular hole, and posterior staphyloma, which were operated between February 1983 and April 1992, were retrospectively studied. The last examination was in June 2002. Follow-up of the 25 patients ranged from 10 years to 19 years (mean, 15 years). Macular buckling with an episcleral sponge was the initial and only procedure. In all operated eyes, anchoring of the sponge was away from the posterior pole. Best-corrected visual acuity was evaluated before and after surgery. The axial length of the eyeball was also measured by A-scan ultrasonography before treatment. RESULTS: Twenty-two of 25 eyes were successfully treated with a single procedure. In the remaining three eyes, retinal reattachment was obtained after a second buckling operation, which was considered necessary due to loosing of the sponge fixation sutures in two cases and the location of the hole beside the buckle in one case. The mean overall visual acuity was improved after treatment. CONCLUSIONS: The macular buckling procedure with anchoring of the sponge away from the posterior segment provided efficient scleral indentation of long duration for closure of the macular hole and retinal reattachment.

Adult↗
PubMed1995

Conventional retinal surgery for rhegmatogenous retinal detachment with proliferative vitreoretinopathy.

During the last two years, 79 consecutive patients (i.e. eyes) with rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR), stages B and CP according to the classification of Machemer and associates, were treated. Conventional retinal surgery (scleral buckling) was used. Retina was successfully reattached in 54 (68.4%) eyes in the early postoperative period. Thirty-five (81.4%) out of 43 patients with PVR detachment stage B, and 19 (52.8%) out of 36 patients with PVR detachment stage CP achieved total retinal attachment. The difference was statistically significant (p = 0.006). In stage CP, larger areas of retinal involvement by fixed retinal folds are inversely related to the rate of anatomical success. A higher degree of preoperative PVR means less success of conventional retinal detachment surgery, so it is advised to apply a conventional surgical technique up to CP-6 stage of PVR, whereas in more advanced stages of PVR pars plana vitrectomy is needed.

Adult↗
PubMed2005

Surgical outcomes in rhegmatogenous retinal detachment at Srinagarind Hospital.

OBJECTIVES: To evaluate the surgical outcome for patients with rhegmatogenous retinal detachment and to find out the factors influencing the anatomic reattachment and visual results. MATERIAL AND METHOD: Retrospective review of the medical records of patients for the following details: age, sex, time to diagnosis, time to surgery, phakic status, types, numbers and locations of the retinal breaks, macular status, presence of proliferative vitreoretinopathy (PVR), types of surgical procedures, anatomic reattachment and visual improvement. RESULTS: Two hundred and twelve patients were surgically treated by pneumatic retinopexy, scleral buckling, pars plana vitrectomy or combined procedures. Initial anatomic reattachment was found in 157 cases (74.06%) and final reattachment in 193 cases (91.04%). Several factors including age, phakic status, number of the retinal breaks, macular detachment, PVR and types of surgical procedures have been identified to have a correlation with the anatomic success rate. Types of surgical procedures and time to surgery within 8 weeks of detachment have also been demonstrated to have a correlation with final visual improvement. However, only types of surgical procedures had statistically significant difference. Pneumatic retinopexy had a lower anatomic reattachment rate, but obtained a higher visual improvement than did other surgical procedures. Moreover, after repeated pneumatic retinopexy or further surgical procedures, the final anatomic success rate improved from 65.52% to 92.24%. CONCLUSION: Surgical outcomes for rhegmatogenous retinal detachment are comparable to other studies. Types of surgical procedures had a significant correlation with anatomic reattachment and final visual improvement.

Adult↗
PubMed1989

[Results of vitrectomy for diabetic traction retinal detachment involving the macula; a comparison of six-month and three-year postoperative findings].

Three-year follow-up examinations were performed on 45 cases that underwent pars plana vitrectomies for diabetic retinopathy complications from 1982 to 1983. All of these cases had traction retinal detachment involving the macula. Visual improvement was noted in 27 eyes (60%) and 11 eyes (24%) had worse visual acuity at 6 months after surgery. Final visual improvement was noted in 21 eyes (47%) at the there-year follow-up examinations. Five (11%) of the 45 cases had better visual acuity at the three-year examination than at six months, 18 (40%) had the same visual acuity, but 22 (49%) had poorer vision at the three-year examination. Out of those cases, 28 eyes (62%) had totally attached retina 6 months after operation and the results in those eyes were quite stable at three years. Of these, 19 (68%) had the same or better visual acuity at three years compared with six months. But if retinal detachment was present at 6 months, the prognosis was very poor at the three-year examination with a visual acuity of less than hand motions. Reattachment of the retina is most important to maintain good prognosis for surgical treatment for diabetic retinopathy with traction retinal detachment.

Adult↗
PubMed1998

[Surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments].

To evaluate the efficasy of primary vitrectomy for uncomplicated rhegmatogenous retinal detachment associated with posterior hyaloid separation, a series of 63 eyes were reviewed retrospectively. The criteria for vitrectomy included not only eyes with posterior retinal breaks but also those with multiple peripheral retinal breaks. The reattachment rate was 92.1% (58 eyes) after the initial surgery, and finally this increased to 100%. Of the 46 eyes with macular detachment, good visual rehabilitation, i.e., visual acuity improved by 5 or more lines, was obtained in 71.8% (33 eyes) one month postoperatively. There was no statistically significant difference in the reattachment rate whether an encircling procedure was also done or not. In eyes with lens opacity, cataract surgery was also done and intraocular lenses were implanted uneventfully in all but one myopic case. No serious complications such as proliferative vitreoretinopathy were found throughout the follow-up period except for the high incidence (53.8%) of cataractous progression. The results indicate that vitrectomy, removing the peripheral vitreo-retinal traction directly, is an effective procedure for primary rhegmatogenous retinal detachment. Vitrectomy combined with cataract surgery is also proposed as a valuable strategy in selected cases to maintain visual rehabilitation.

Cataract Extraction↗
PubMed1980

[Transient retinal detachment and hyposphagma in a patient with non-Hodgkin lymphoma of the T cell type (author's transl)].

A 21-year-old male patient with non-Hodgkin lymphoma of the "convoluted' T cell type and marked involvement of skin and central nervous system presented in the early stages of the disease with subconjunctival bleeding of the eyeballs and massive serious retinal detachment near the optic disc in both eyes. In addition, there was a severe disseminated intravascular coagulation (DIC) caused by the lymphoma. It appears that the non-haemorrhagic retinal detachment on both sides is due to a neoplastic lymphocellular infiltration with high affinity of this malignant lymphoma to the central nervous system. Treatment of the underlying disease and of DIC with rapid onset of total remission lead to resorption of the conjunctival haemorrhages and fast reduction of the retinal detachment.

Adult↗
PubMedDate not supplied

Treatment of retinal detachments due to macular holes.

The authors successfully treated seven consecutive cases of retinal detachment due to macular holes using vitrectomy, an intravitreal bubble, and postoperative prone positioning. In five cases with preoperative posterior vitreous detachment, laser photocoagulation was applied to the edges of the macular hole after the retina had been flattened. No photocoagulation was used in the two cases without preoperative posterior vitreous detachment.

Aged↗
PubMed2002

Functional and anatomic outcome of retinal detachment surgery in pseudophakic eyes.

PURPOSE: To determine the long-term anatomic and functional visual outcome of retinal detachment (RD) surgery in pseudophakic eyes after uncomplicated cataract surgery. DESIGN: An interventional, retrospective noncomparative case series PARTICIPANTS: One hundred thirty-eight consecutive patients who had undergone uncomplicated extracapsular cataract extraction and intraocular lens implantation followed by rhegmatogenous RD between 1990 and 1995. METHODS: One hundred one eligible patients were examined (inclusion ratio, 73%) a median of 4.3 years after last RD surgery. The best-corrected visual acuity (BCVA), visual fields, retinal status, and patient-rated visual outcome were recorded, the latter by a questionnaire that included self-reported satisfaction, trouble with vision, a modified Cataract Symptom Score, and the VF-14 Visual Functioning Index. MAIN OUTCOME MEASURES: BCVA, retinal attachment, diameter of visual field, modified Cataract Symptom Score, VF-14 score. RESULTS: Baseline characteristics of enrolled and nonenrolled patients were comparable, except that nonenrolled patients were older. When RD developed, 55 eyes had an intact posterior capsule, and 46 had a laser posterior capsulotomy (LCT). The BCVAs before (median, logarithm of the minimum angle of resolution [-logMAR] 1.2 versus 1.1, Snellen equivalent 0.063 versus 0.08) and after retinal surgery (median, -logMAR 0.46 versus 0.4, Snellen equivalent 0.35 versus 0.4) were comparable for eyes with and without LCT (P = 0.86). The retina was reattached with one procedure in 75 eyes (74%), with two procedures in 98 eyes (97%), and with three to five procedures in all eyes. The retina remained attached long term in 92 eyes (91%). Redetachment rate (9% versus 9%, P = 1.0) and visual field diameters were comparable for eyes with and without LCT. Overall, 80% of patients were satisfied or very satisfied with their binocular vision, and 62% had no or only a little trouble with binocular vision. Visual performance was similar regardless of presence or absence of LCT (median Cataract Symptom Score, 3.0 versus 3.0, P = 0.76; and median VF-14 score, 87.5 versus 87.5, P = 0.81). CONCLUSIONS: Nine in 10 pseudophakic retinal detachments remain attached long term, and 8 in 10 patients are satisfied with their binocular vision after surgery. Even though secondary cataract and posterior capsulotomy can cause problems for the retinal surgeon, the anatomic and functional outcomes of pseudophakic RD are not influenced by capsulotomy.

Adult↗