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PubMedDate not supplied

Cyclotorsional diplopia following retinal detachment surgery.

Four patients reporting symptoms of torsional diplopia following retinal detachment repair were seen. One patient most likely had a pre-existing, partially compensated superior oblique palsy as the cause of her vertical deviation and excyclotorsion. A second was found to have the superior oblique tendon adherent anteriorly to the encircling band and buckle just behind the superior rectus insertion, resulting in incyclotorsion. Release of these restrictions reduced the torsion to a small, asymptomatic degree. The third and fourth patients had excyclotorsion for unexplained reasons. Removing the scleral exoplant and Harada-Ito type surgery on the superior oblique tendon did not relieve the symptoms and only minimally reduced the excyclotorsion in one patient. A second procedure, with advancement of the anterior portion of the superior oblique tendon, successfully eliminated cyclotorsional symptoms.

Adolescent↗
PubMed1986

Effects of retinal detachment surgery on standing potential.

We studied the effects of retinal detachment surgery on the standing potential of the human eye using the electrooculographic technique. Before and two weeks after surgery, we measured the relative base value (rBV) which is the base value of the affected eye divided by the base value of the fellow eye. The rBV distributed around 1.0 before surgery and decreased below 1.0 two weeks after surgery. The change in the rBV through surgery represented by the value R is defined as preoperative rBV minus postoperative rBV divided by preoperative rBV; this was closely correlated with the area of the scleral buckling. The decrease in the rBV was thought to represent the reduction in the standing potential of the operated eye, probably due to circulatory disturbance of the choroid.

Adolescent↗
PubMed2001

[Anatomic results of buckle surgery for retinal detachments with undetected break].

BACKGROUND AND OBJECTIVE: The treatment of retinal detachment (RD) with unseen break has not been clearly defined. The aim of this study was to evaluate the results of scleral buckle surgery as the primary treatment for RD with unseen break without initial proliferative vitreoretinopathy. MATERIAL AND METHODS: This study included charts of 100 consecutive patients: 63 pseudophakic cases, 37 phakic cases, undergoing a scleral buckle, 51 of which were circumferential and 49 localized. RESULTS: The primary reattachment rate was 75%. There was no statistical difference according to the status of the lens and the extent of the circumferential versus localized buckle. The reattachment rate at 6 months was 92% with a mean of 1.2 operations per patient. CONCLUSION: An unseen break is an unfavorable factor for the anatomic success of scleral buckle, whether it be circumferential or localized. The better results of vitrectomy in pilot studies justify a controlled randomized study comparing it to conventional buckle surgery for RD with unseen break, particulary for phakic patients.

Humans↗
PubMedDate not supplied

Complications associated with vortex vein damage in scleral buckling surgery for rhegmatogenous retinal detachment.

PURPOSE: To further understand postoperative complications after vortex vein damage during scleral buckling surgery. METHODS: The records of 34 patients (34 eyes) with vortex vein damage during scleral buckling surgery for rhegmatogenous retinal detachment were reviewed and compared with the records of 410 eyes undergoing similar surgery without vortex vein damage. RESULTS: Postoperative complications were noted in 16 eyes (47%) of the damaged vortex vein group. The incidence of choroidal detachment, vitreous opacities, intraocular pressure elevation, and vitreous hemorrhage were 27%, 18%, 9%, and 6%, respectively, with a higher incidence than in the group without vortex vein damage. Other complications included development of epiretinal membrane (9%), subretinal hemorrhage (3%), and anterior segment ischemia (3%). Serous choroidal detachment occurred in the early postoperative days and subsided within 3 weeks. Vitreous opacification became marked in the later periods and continued for 2 months or longer. The incidence of postoperative choroidal detachment in the vortex vein damage group was related to the patient's age (P = .002) and the cutting of the vortex veins (P = .048), but was not related to preoperative conditions of retinal detachment or the number of vortex veins damaged. All the eyes except one achieved retinal reattachment after initial surgery. CONCLUSIONS: Choroidal detachment and vitreous opacity are common after scleral buckling surgery with vortex vein damage. Although intervention of the vortex veins during scleral buckling surgery is acceptable when performing otherwise difficult to achieve ample scleral indentation, it should be minimized to avoid increased incidence of postoperative complications.

Adolescent↗
PubMed1986

[Surgical pupillary dilatation within the scope of complicated retinal detachment surgery].

During vitreoretinal surgery 14 aphakic patients with complicated retinal detachment were treated with 2 new techniques for surgical dilatation of a miotic and rigid pupil. In 4 cases, iris excision was not performed in the upper part of the pars pupillaris, as usual, but in the lower part. As a result, peripheral anterior synechiae due to silicone oil injection did not occur postoperatively. In the other 10 cases the pupil was temporarily stretched during the operation with 4 iris loop sutures. These sutures were laid in such a way that a retraction of the iris in the main directions of the 4 quadrants was made possible, thereby forming a large square pupil. Postoperatively, no iris damage was found in those cases where miosis had only developed during surgery. In the case of a preoperatively miotic and rigid pupil, stretching caused multiple small sphincter tears in most cases. A few weeks after surgery these patients again showed constriction of the pupil. Their pupils reacted to light, miotics, and mydriatics, but reactions were diminished.

Diabetic Retinopathy↗
PubMed1975

Role of non-drainage of subretinal fluid in re-operation for retinal detachment.

In a study of 194 re-operations for retinal detachment in which one-third of the cases were managed without drainage of subretinal fluid, it was found that a number of failures occurred after non-drainage. Analysis of these failures shows that more than half could have been avoided if the correct choice of cases suitable for management without drainage of subretinal fluid had been made. It is felt that with careful attention to the criteria which are used to decide on the choice of surgical technique, the results obtained by the non-drainage method should be as good in the more complicated case as they have already been shown to be in the primary case. Because the drainage of subretinal fluid carries with it a risk of surgical complications and these complications may contribute to the development of massive preretinal retraction, management of the re-operation should be carried out without drainage of subretinal fluid whenever possible.

Drainage↗
PubMed2001

Electrophysiology of rabbit Müller (glial) cells in experimental retinal detachment and PVR.

PURPOSE: To determine the electrophysiological properties of Müller (glial) cells from experimentally detached rabbit retinas. METHODS: A stable local retinal detachment was induced by subretinal injection of a sodium hyaluronate solution. Müller cells were acutely dissociated and studied by the whole-cell voltage-clamp technique. RESULTS: The cell membranes of Müller cells from normal retinas were dominated by a large inwardly rectifying potassium ion (K+) conductance that caused a low-input resistance (<100 M(Omega)) and a high resting membrane potential (-82 +/- 6 mV). During the first week after detachment, the Müller cells became reactive as shown by glial fibrillary acidic protein (GFAP) immunoreactivity, and their inward currents were markedly reduced, accompanied by an increased input resistance (>200 M(Omega)). After 3 weeks of detachment, the input resistance increased further (>300 M(Omega)), and some cells displayed significantly depolarized membrane potentials (mean -69 +/- 18 mV). When PVR developed (in 20% of the cases) the inward K+ currents were virtually completely eliminated. The input resistance increased dramatically (>1000 MOmega), and almost all cells displayed strongly depolarized membrane potentials (-44 +/- 16 mV). CONCLUSIONS: Reactive Müller cells are characterized by a severe reduction of their K+ inward conductance, accompanied by depolarized membrane potentials. These changes must impair physiological glial functions, such as neurotransmitter recycling and K+ ion clearance. Furthermore, the open probability of certain types of voltage-dependent ion channels (e.g., Ca2+-dependent K+ maxi channels) increases that may be a precondition for Müller cell proliferation, particularly in PVR when a dramatic downregulation of both inward current density and resting membrane potential occurs.

Animals↗
PubMed1975

The Arruga suture for retinal detachment 17 years on.

A brief description is given of the experience gained in the use of the 'Arruga suture' method in 64 eyes out of a total of 356 operated on for retinal detachment. The encouraging results in those eyes in which the method was used as a primary procedure and the absence of complications suggest that the 'Arruga suture' should be considered in selected cases of retinal detachment--particularly in cases of aphakic detachment.

Adult↗
PubMed1989

Acute leukemia presenting as a unilateral exudative retinal detachment.

The leukemias commonly involve the eyes and adnexae. It is unusual, however, for leukemia to present with visual complaints. Furthermore, there are only rare case reports of leukemic patients presenting with bilateral exudative retinal detachments. We report a unique case of a boy who presented with visual loss due to a unilateral exudative retinal detachment. A systemic evaluation discovered acute lymphocytic leukemia (ALL). There was rapid settling of the exudative detachment and improvement in vision while the patient received chemotherapy and radiotherapy for the ALL.

Biopsy↗
PubMedDate not supplied

Retinal detachment 7 years after prophylactic schisis cavity excision in juvenile X-linked retinoschisis.

A 7-year-old boy with X-linked juvenile retinoschisis developed a retinal detachment at the site of previous prophylactic excision of a schisis cavity. The patient underwent a scleral buckle procedure, pars plana vitrectomy, membrane peel, and silicone oil injection with successful reattachment. At last follow-up, the visual acuity was 20/400 and the retina was attached. Prophylactic excision of a schisis cavity may be complicated by retinal detachment several years after the surgery. Given the favorable natural history of schisis cavities in X-linked juvenile retinoschisis, the decision to perform prophylactic excision should be undertaken cautiously after full consideration of the potential complications.

Basement Membrane↗
PubMed2004

Hepatocyte growth factor and its role in the pathogenesis of retinal detachment.

PURPOSE: Hepatocyte growth factor (HGF) regulates barrier function of retinal pigment epithelial (RPE) cells. The purpose of this study was to determine whether overexpression of HGF in the RPE induces retinal detachment (RD). METHODS: E1/E3-deleted adenoviral vectors encoding HGF (Ad CMV.HGF), green fluorescent protein (Ad CMV.GFP), or connective tissue growth factor (AdCMV.CTGF) were injected subretinally in adult pigmented rabbits (5 x 10(4) plaque-forming units [pfu]/eye). Animals were observed for up to 28 days with fundus photography. HGF expression in the retina and vitreous was determined using immunohistochemistry, and ELISA. Histopathologic examinations were performed with light and electron microscopy. RESULTS: Control eyes injected with AdCMV.GFP showed GFP expression almost exclusively in the RPE monolayer. Eyes injected with AdCMV.HGF showed strong HGF immunopositivity in RPE cells at the injection site. Elevated HGF levels were found in the vitreous peaking at postinjection day 7, diminishing to baseline by postinjection day 28. Eyes injected with AdCMV.HGF developed chronic RD and chronic inflammation in the choroid within the time frame of HGF expression. Groups of proliferating RPE cells were seen in the subretinal space in the region of the RD, and in some cases multilayered cellular membranes developed. No RD and minimal morphologic changes were seen in the eyes injected with AdCMV.GFP or AdCMV.CTGF. CONCLUSIONS: Overexpression of HGF in RPE induces chronic, serous RD with subretinal proliferation of RPE. This work provides insight into the pathogenesis of RD and suggests that HGF should be further investigated as a target for therapeutic intervention in RD.

Adenoviridae↗
PubMed1994

[Rhegmatogenous retinal detachment operated by extraocular implants. Apropos of 74 cases].

In a series of 88 cases of rhegmatogenous retinal detachments, 14 have been treated by vitrectomy and 74 by scleral buckling with or without intraocular gas tamponade. In 69 cases of the second group (93%) the retina was reattached with an extraocular intervention although 10 cases needed a second intervention. The 5 remaining cases (7%) needed a vitrectomy because of PVR. The reason for failure of extraocular technique is usually related to undertreatment of retinal tears.

Diabetic Retinopathy↗
PubMed2000

[Analysis of retinoic acid in subretinal fluid in patients with rhegmatogenous retinal detachment].

To investigate the relationship between the level of retinoic acid (RA) in the subretinal fluid (SRF) and the extent of the vitreoretinopathy in 56 patients with rhegmatogenous retinal detachment, we studied the levels of RA in both SRF and serum using high liquid chromatography and also examined those levels in part of patients who took oral vitamin A 150,000 U.d-1. The results were that the level of RA in the SRF increased with the grade of the proliferative vitreoretinopathy (PVR); the levels of RA in both SRF and serum were significantly higher in the cases with vitamin A than those without. We conclude that retinoic acid metabolism between retinal pigment epithelial cells and neural epithelia was unbalanced after retinal detachment. Oral vitamin A is helpful to inhibit the genesis and development of the proliferative vitreoretinopathy.

Adolescent↗
PubMedDate not supplied

Intravascular lymphoma presenting as bilateral panophthalmitis and retinal detachment in a dog.

A seven-year-old, spayed female boxer was presented for sudden blindness and red eyes of one week's duration. Ophthalmic examination revealed bilateral uveitis with complete bullous retinal detachments. Initial diagnostic testing failed to reveal evidence of systemic disease. Cytopathology of subretinal aspirates confirmed the presence of macrophages with intracytoplasmic retinal pigment, epithelial and choroidal pigment, and monocytes. Tentative diagnoses were idiopathic uveitis and retinal detachment. The dog was treated with immunosuppressive doses of prednisone. The retinas reattached and vision returned. By two months, the dog became blind and systemically ill. Postmortem and histopathological examinations revealed intravascular lymphoma in multiple organs, including the eyes.

Animals↗
PubMedDate not supplied

[Vitrectomy in treatment of retinal detachment with proliferative vitreoretinopathy].

The authors presented their experiences concerning the treatment of 26 eyes (in 25 patients) with retinal detachment complicated by PVR in which pars plana vitrectomy and silicone oil tamponade were applied. The patients have been previously operated with traditional methods however without success. Positive results, it is retinal attachment completely or in the superior and central part of the fundus with residual detachment inferiorly were achieved in 19 eyes (73%). An useful visual acuity (> 1/50) was achieved in 12 eyes and in 7 (27%) it was better than 5/50. Our results confirmed that this method (pars plana vitrectomy with silicone oil tamponade) is a method of choice in complicated retinal detachment, in which traditional methods failed.

Adult↗
PubMed2003

Management of macular holes that develop after retinal detachment repair.

PURPOSE: To study the characteristics and management of macular holes that develop after prior rhegmatogenous retinal detachment (RD) repair. DESIGN: Retrospective, interventional, consecutive case series. METHODS: The setting was a clinical practice. The case records of all of our patients (n = 12) who developed a new full-thickness macular hole after prior RD repair over an 8-year period were examined. Patients who developed a macular hole after prior RD repair were offered either surgical repair of the macular hole or continued observation. For eyes that underwent macular hole repair, main outcome measures included macular attachment status and postoperative visual acuity. RESULTS: Twelve full-thickness macular holes were detected in a series of 2,380 eyes (0.5% prevalence), which had undergone surgery for prior primary RD. Ten macular holes developed after scleral buckling surgery, two after pneumatic retinopexy, and none were seen after primary vitrectomy. The fovea had been detached in 11 of the 12 eyes at the time of RD. The median time to macular hole diagnosis after RD repair was 3.4 months (range, 0.3-161 months). Eight of the eight eyes (100%) undergoing surgical repair achieved macular reattachment with a median of 3.5 lines of visual improvement at a median of 14.8 months of follow-up. Seven of these eight eyes had an improvement in visual acuity of at least 3 Snellen lines, and four of the eight had at least 20/40 visual acuity postoperatively. Four eyes with macular holes were observed. CONCLUSIONS: Macular holes developed in less than 1% of eyes that had previously undergone repair of rhegmatogenous RD. In our series, these atypical holes were seen predominantly after macula-off detachments, most commonly occurring after scleral buckling procedures. They were effectively repaired using conventional pars plana vitrectomy with long-acting gas tamponade and a variety of adjuvant therapies. A good visual outcome is possible with this approach.

Adult↗
PubMed2004

Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks.

BACKGROUND: There is controversy about the most appropriate operating methods for complicated rhegmatogenous retinal detachment (RD) including multiple tears, and surgical techniques may be changed according to the preference of the surgeon. In this retrospective study, we compared the surgical results of conventional buckling surgery and vitrectomy with silicone oil tamponade for rhegmatogenous (RD) with multiple breaks. METHODS: Thirty patients who underwent scleral buckling surgery (group 1) and 22 patients who underwent pars plana vitrectomy with silicone oil tamponade (group 2) as the primary surgery for rhegmatogenous RD with multiple breaks were included in this study. The follow-up period was longer than 6 months after surgery. The anatomical success rates and complications were evaluated for both groups. RESULTS: Retinal reattachment was achieved in 24 of 30 eyes (80%) in group 1 and in 20 of 22 eyes (90.9%) in group 2 after the initial surgery. In group 1, subretinal hemorrhage developed due to the drainage of subretinal fluid in 2 eyes (6.6%) intraoperatively. Elevated intraocular pressure (3.3%), ocular motility disturbances (13.2%), and proliferative vitreoretinopathy (3.3%) were seen in the postoperative period. In group 2, iatrogenic breaks (7.3%) and lens damage (9.09%) occurred during the operation. Macular pucker (4.5%), postoperative cataract progression (22.7%), ocular hypertension (9.09%) and PVR (9.09%) were noted postoperatively. CONCLUSIONS: Both surgical procedures can achieve favorable and comparable anatomic outcomes in the majority of patients in the treatment of RD with multiple breaks. Intra-and postoperative complications are different in the two procedures.

Adolescent↗