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PubMed1986

The use of silicone oil following failed vitrectomy for retinal detachment with advanced proliferative vitreoretinopathy.

We have used silicone-oil injection in a consecutive series of 44 patients with retinal detachment and advanced proliferative vitreoretinopathy, all of whom had previously failed to reattach with vitrectomy, membrane peeling, and scleral buckling. After a minimal follow-up period of 6 months, complete anatomic retinal reattachment posterior to the encircling scleral buckle was obtained in 64% of these eyes. Ambulatory visual acuity (5/200 or better) was achieved in 57% of the anatomically successful cases. Silicone-oil removal was performed in 69% of the anatomically and visually successful eyes without recurrent retinal detachment. Because of the frequent and severe complications associated with the use of silicone oil, we recommend that silicone-oil injection be considered only when conventional vitreoretinal techniques have failed to achieve retinal reattachment.

Eye Diseases↗
PubMed2006

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): recruitment list evaluation. Study report no. 2.

BACKGROUND: Accompanying the patient recruitment within the "Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment multicentre trial (SPR)", all patients with primary rhegmatogenous retinal detachment (RRD) had to be documented in a detailed recruitment list. The main goal of this analysis was to estimate the prevalence of "medium-severe" RRD (SPR Study eligible) as defined by the SPR Study inclusion criteria. In addition, the detailed anatomical situation of medium-severe RRD is investigated. METHODS: SPR Study recruitment was evaluated via a standardised questionnaire, which contained a coloured fundus drawing and information regarding possible reasons for exclusion from the SPR Study in each case. A team of three experienced vitreoretinal surgeons evaluated all fundus drawings from a 1-year period. The review led to a decision on SPR Study eligibility on the pure basis of anatomical assessment. The main outcome measures were assessment of feasible inclusion into the SPR Study by the evaluation team based on the fundus drawing and anatomical details. RESULTS: A total of 1,115 patients with RRD from 13 European centres were prospectively enrolled in the year 2000. The quality of the drawings sufficed for assessment in 1,107 cases (99.3%). Three hundred and twelve fundus drawings (28.2%) met the anatomic inclusion criteria of the SPR Study. RRD of medium severity is characterised by an average number of 2.6 (SD 2.4) retinal breaks, 5.8 (SD 2.8) clock hours of detached retina, unclear hole situation in 15.1% of cases (n=47), attached macula in 42.9% (n=134), bullous detachment in 15.1% (n=47) and vitreous haemorrhage/opacity in 7.7% (n=24). CONCLUSIONS: In the recruitment lists of the SPR Study of the year 2000, RRD of medium severity was present in nearly one third of the patients with primary RRD. These findings emphasise the clinical relevance of the SPR Study.

Adolescent↗
PubMed2003

Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification.

PURPOSE: To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. SETTING: A private practice, with statistical evaluation at a university department. METHODS: Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. RESULTS: The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. CONCLUSIONS: Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.

Aged↗
PubMed1993

Retinal detachment and degeneration in response to subretinal perfluorodecalin in rabbit eyes.

Perfluorocarbon liquids, including perfluorodecalin (PFD), are useful intraoperative tools in complicated vitreoretinal surgery, such as for giant retinal tears, PVR and intraocular foreign bodies. Due to its high specific gravity (1.91 g/cm3) subretinal complications of PFD may occur. The consequences of subretinal PFD were studied in 23 albino rabbits (28 eyes). Using glass micropipettes (outer diameter of tip 100-120 microns), we injected 50-100 microliters PFD subretinally via the vitreous space. The same volume of BSS was injected into 18 control eyes. Eyes were monitored by indirect ophthalmoscopy and examined by light and electron microscopy at 1, 2 and 3 days, and 1, 2, 4 and 12 weeks. Progressive retinal detachments with newly formed retinal breaks in the inferior quadrants developed in 26 of 28 eyes. As early as 1 day postoperatively, subretinal PFD induced loss of outer and inner segments. Local retinal necrosis occurred in 4 eyes 5-7 days after surgery. A marked vacuole formation in retinal layers and PFD emulsification were regularly seen. The control eyes healed spontaneously. Toxic, mechanical and barrier effects may have caused the retinal damage. We advocate that all PFD be removed from the eye at surgery.

Animals↗
PubMed1993

Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy.

A consecutive series of 114 eyes (112 patients) undergoing pars plana vitrectomy for rhegmatogenous retinal detachment not complicated by severe proliferative vitreoretinopathy is presented (follow up 1 to 4 years; mean 19 months). The indications for vitrectomy fell into two main groups: (1) where the retinal view was poor and vitrectomy was required to clear media opacities to allow identification of retinal breaks (n = 62); and (2) where technically difficult breaks existed and vitrectomy with internal tamponade was used to relieve vitreoretinal traction and facilitate retinal break closure (n = 44). In some of these cases the need for scleral buckling was eliminated. A smaller third group (n = 8) existed where the position of the break(s) was uncertain in the presence of an adequate view. The success rate with one procedure was 74% and with further surgery retinal reattachment was achieved in 92%. At 6 months after further surgery, beyond which interval no new failures were encountered, best corrected visual acuity was improved in 92 eyes (81%), unchanged in 14(12%), and worse in eight (7%). We conclude that pars plana vitrectomy is an effective method for treatment of selected cases of rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy.

Adolescent↗
PubMed1996

[Retinal detachment and posterior lens luxation. Value of liquid perfluorocarbons].

PURPOSE: The purpose of this study is to review the benefits of perfluorocarbon liquids in the surgical treatment of retinal detachment with posterior lens dislocation. METHODS: Three cases of retinal detachment occurring in the presence of a posteriorly dislocated intraocular lens were managed with vitrectomy, fluid perfluorocarbon, scleral buckling and silicone oil injection. The dislocated lens were removed by anterior approach. RESULTS: In all cases a successful retinal reattachment was obtained after one or two surgical procedures.

Aged↗
PubMed1992

[Treatment of retinal detachment with intraocular expandable gas injection].

The injection of expandable gas into the vitreous is a new method for treating retinal detachment. The injected gas bubble seals the retinal break and allows absorption of subretinal fluid. In 12 patients, in all eyes treated by injection of sulfur hexafluoride, the detached retina became reattached. In 3 eyes (25%) detachment recurred. To achieve attachment again, both vitrectomy and the circling band operation were performed in 2 of them, and only the latter operation in the third. Risk factors for redetachment included detachment of the macula, retinal detachment larger than 5-o'clock-hours, and pseudophakia. Proper selection of patients for gas injection is most important.

Gases↗
PubMedDate not supplied

[Photocoagulation in the prevention of retinal detachment in perforating injuries of the eye caused by warfare].

Main indications for application of photocoagulation in the prevention of retinal detachment in penetrating eye war injuries were presented. Photocoagulation was performed when intrabulbar foreign body was present, before its extraction and in the cases of traumatic ruptures of sectorial traumatic tractional retinal detachment. Modified photocoagulation by argon laser, with linked spots in two rows was used since it was shown to be clinically the most suitable.

Eye Foreign Bodies↗
PubMed1997

Pars plana vitrectomy in the treatment of combined rhegmatogenous retinal detachment and choroidal detachment in aphakic or pseudophakic patients.

BACKGROUND AND OBJECTIVE: The presence of extensive choroidal detachment (CD) in eyes with rhegmatogenous retinal detachment (RRD) is a major preoperative complication. Conventional treatment consists of 7 days to a few weeks of systemic and topical steroids followed by scleral buckling and drainage of suprachoroidal fluid. The author studied the usefulness of pars plana vitrectomy in the management of RRD combined with CD. PATIENTS AND METHODS: Ten consecutive patients with RRD complicated by CD were treated with pars plana vitrectomy. Nine had had previous cataract extraction, and one patient had pars plana lensectomy at the time of the surgery. The severity of the CD was evaluated with preoperative ophthalmologic echography. Sclerotomy sites for infusion cannulas were chosen in the area with less CD. Six-millimeter infusion cannulas were used. Pars plana vitrectomy, membrane peeling, and internal fluid-gas exchange with encircling scleral buckle placement were performed in a standard fashion. One patient had silicone oil injected. RESULTS: In each case, suprachoroidal fluid drained spontaneously through the sclerotomy sites around the vitrectomy instruments during the initial course of the operation without extra sclerotomy. Immediate intraoperative retinal reattachment was achieved in 10 cases. The retina remained attached in 9 cases during at least 6 months of follow-up without additional surgery. CONCLUSION: These cases demonstrate the usefulness of pars plana vitrectomy in treating RRD with CD in aphakic or pseudophakic eyes. This method may be an favorable alternative to conventional treatment.

Adult↗
PubMed1988

Surgery of aphakic retinal detachment.

In a prospective study 84 patients with aphakic retinal detachment were treated either by local scleral buckling alone or combined with an encirclement. The rate of surgical reattachment of the retina was found to be similar with either technique over a minimum follow-up period of one year. Simplicity and a low incidence of serious complications of the local procedure merit its application as the initial method of repairing aphakic detachments.

Adult↗
PubMed2005

Bilateral retinal detachment in a patient with Vogt-Koyanagi-Harada syndrome.

We present a 38-year-old woman with bilateral serous retinal detachments and bilateral panuveitis on fundoscopic exam. CT of the orbits and MRI scans revealed bilateral ocular choroidal thickening and bilateral retinal detachments; however, no other CNS or meningeal lesion was detected. This patient met the clinical criteria for Vogt-Koyanagi-Harada (VKH) Syndrome. Review of VKH syndrome as well as the radiographic findings will be discussed.

Adult↗
PubMed1983

Fluorescein angiography after retinal detachment microsurgery.

The eyes of 78 patients who underwent retinal detachment microsurgery (82 eyes) were prospectively evaluated postoperatively with fluorescein angiography. Of these 14.6% showed angiographic evidence of cystoid macular oedema (CMO.). A significantly greater risk of developing cmo was discovered in aphakic eyes (30% CMO.) as compared to phakic eyes (7% CMO.) and in eyes where the maculae were detached pre-operatively (23% CMO.), as compared to eyes where the maculae were attached pre-operatively (5% CMO.). Eyes which had undergone several surgical procedures for retinal reattachment (38% CMO.) were compared to eyes which had undergone only one surgical procedure (6.5% CMO.). It was found that 4.9% of the 82 eyes showed cellophane premacular membrane without dye leakage. A further 6% of the eyes showed premacular membranes associated with dye leakage. No statistically significant risk factor associated with the development of macular pucker was disclosed in this series.

Adolescent↗
PubMed2002

[Treatment of primary retinal detachment. Minimal extraocular or intraocular?].

The developments in treatment modalities for a primary retinal detachment over the last 70 years have been reviewed. There was a change from a surgery limited to the area of the break to a form of prophylactic surgery including the extent of the detachment. In between Rosengren had limited the treatment to the break with an intraocular gas bubble. A change was brought about by Custodis in 1953 who limited surgery to the break and omitted drainage. This procedure had serious postoperative complications which were eliminated by Lincoff by developing the cryosurgical detachment operation which was subsequently refined to extraocular minimal surgery. The ultimate realization of a minimal extraocular approach was the operation with a temporary balloon. Two additional intraocular procedures evolved, pneumatic retinopexy and primary vitrectomy, following one or the other pattern of treatment. With all four methods reattachment can result in 94-99% of the cases but differences can be seen in the morbidity and rate of reoperations.

Catheterization↗
PubMed1994

[Treatment of retinal detachment with a giant rupture].

Results of surgical treatment in 29 cases of retinal detachment caused by giant tear have been reviewed. Two patients have been operated on by scleral buckling procedure, whereas in 27 cases vitreoretinal surgery in combination with silicone oil tamponade has been performed. Anatomic success was achieved in 20 of 29 eyes. After a follow-up period of 6 to 36 months 20 eyes (69%) had visual acuity equal to or better than 0.3. Silicone oil has been successfully evacuated out of 14 eyes with retina remaining attached.

Adolescent↗
PubMed1995

[Use of perfluorodecalin in giant retinal tear retinal detachment surgery].

Perfluorodecalin is used for the treatment of 11 eyes with giant retinal tear retinal detachment surgery. Perfluorocarbon liquids can be used as an operative hydrodynamic tool during vitreous surgery. The high specific gravity of perfluorocarbon liquids allows an easy unfolding of the inverted flap and flattening of the retina, displacing the subretinal fluid and stabilizing the retina for membrane peeling. Endophotocoagulation may be performed under optimal visual condition. The success rate was 81.8% (9/11). The retina failed to reattach in patients with advanced proliferative vitreoretinopathy. The surgical techniques were discussed.

Adolescent↗