Pediatric Vitreoretinal Surgery and Integrated Intraoperative Optical Coherence Tomography.

To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long-acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow-up periods of > or = 12 months. Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.

Internal Limiting Membrane Peeling For Primary Rhegmatogenous Retinal Detachment Repair

Factors Associated with Retinal Detachment after Pediatric Cataract Surgery in the IRIS® Registry.

Intraoperative OCT Features and Postoperative Ellipsoid Mapping in Primary Macula-Involving Retinal Detachments from the PIONEER Study

Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes

Cystoid macular oedema (CMO) is one of the most frequent postoperative macular complications to cause partial visual recovery after successful retinal detachment (RD) repair. Refractory CMO is difficult to treat and many strategies have been employed with varying degrees of success. We report for the first time the use of ILUVIEN implant to treat refractory CMO after successful RD repair. A 65-year-old female presented with right eye full-thickness macular hole and underwent pars plana vitrectomy, internal limiting membrane peeling and cryotherapy with gas tamponade with 12% C3F8. She subsequently developed right eye macula-on RD and proliferative vitreoretinopathy and required multiple procedures for successful retinal reattachment. Later, she developed CMO that responded to intravitreal triamcinolone injections and intravitreal dexamethasone 0.7-mg implants but recurrence of CMO continued to be a problem. After receiving ILUVIEN intravitreal implant, her visual acuity improved and CMO resolved without recurrence for 13 months. Refractory CMO after RD repair is difficult to treat and in a quarter of cases will not improve without treatment. Our case shows that a single ILUVIEN implant maintained anatomical dry fovea and improved vision. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments.

Introduction: Here, we present a case of full-thickness macular hole (FTMH) recurrence following two vitrectomies, accompanied by additional internal limiting membrane (ILM) peeling and gas tamponade. Ultimately, FTMH closure was accomplished by spontaneous retinal detachment around the macular hole and gas tamponade alone. Case Presentation: The patient, a 54-year-old woman with a lamellar macular hole, had a visual acuity of 20/100 in her left eye. The treatment regimen included cataract surgery, a 25-gauge pars plana vitrectomy involving ILM peeling, application of the lamellar hole epiretinal proliferation embedding technique, and subsequent gas tamponade. Closure of the lamellar macular hole was observed a month post-surgery, improving visual acuity to 20/40. However, FTMH developed 3 months after the initial surgery, resulting in visual acuity decline to 20/100. A 25-gauge pars plana vitrectomy was performed with extensive ILM peeling and 20% sulfur hexafluoride gas tamponade. FTMH closure was noted within 19 days after reoperation, enhancing visual acuity to 20/66. Approximately 1.5 months after reoperation, a pinhole-shaped macular hole was identified, and the patient opted for follow-up observation due to her refusal to undergo additional surgery. As the macular hole gradually enlarged resembling retinal detachment, outpatient fluid-gas exchange with 14% perfluoropropane was performed 3.5 months after reoperation. The FTMH closed within a week post-gas injection and remained closed for more than 1 year. Consequently, visual acuity in the left eye was sustained at 20/50. Conclusion: We encountered a case that might highlight the significance of releasing subretinal adhesions surrounding a FTMH for successful closure.

Epiretinal membrane (ERM) formation is a known postoperative complication following retinal detachment (RD) repair surgery. Prophylactic peeling of the internal limiting membrane (ILM) during surgery has been shown to reduce the risk of developing postoperative ERM formation. Some baseline characteristics and degrees of surgical complexity may act as risk factors for ERM development. In this review we aimed to investigate the benefit of ILM peeling in patients without significant proliferative vitreoretinopathy (PVR) who underwent pars plana vitrectomy for RD repair. A literature search using PubMed and various keywords retrieved relevant papers from which data were extracted and analyzed. Finally, the results of 12 observational studies (3420 eyes) were summarized. ILM peeling significantly reduced the risk of postoperative ERM formation (RR = 0.12, 95% CI 0.05–0.28). The groups did not differ in final visual acuity (SMD 0.14 logMAR (95% CI − 0.03–0.31)). The risk of RD recurrence (RR = 0.51, 95% CI 0.28–0.94) and the need for secondary ERM surgery (RR = 0.05, 95% CI 0.02–0.17) were also higher in the non-ILM peeling groups. In summary, although prophylactic ILM peeling appears to reduce the rate of postoperative ERM, this benefit does not translate into consistent visual recovery across studies and potential complications must be considered.

Idiopathic full-thickness macular holes (FTMH) are among the more frequent macular diseases. Pars plana vitrectomy (ppv) with peeling of the ILM is considered the gold standard for FTMH without vitreomacular traction. Although the small-incision, sutureless ppv is a safe procedure, undesirable complications such as retinal detachments (RD) can influence the visual outcome. A retrospective, non-comparative, consecutive case series on 479 eyes with FTMH that underwent 23 gauge ppv (23G-ppv) and peeling of the ILM between February 2011 and January 2016 in two major surgical retinal centres in Germany (Department of Ophthalmology, St. Franziskus Hospital Münster and Eye Clinic Sulzbach, Knappschaft Hospital Saar) to assess the incidence of postoperative RD was performed. Furthermore, best corrected visual acuity (BCVA) in logMAR was compared for a line gain or loss 6 months after surgery. Ten out of 479 patients experienced postoperative RD (2.1%). The median time between surgery and RD was 106.7 days (13–489 days) with two peak time points of occurring RD: after 31 days (60% of patients) and 130 days (30% of patients). Only 1 patient presented the RD after more than a year (489 days) (Table 1). More than 6 months after surgery, BCVA decreased by 1.5 lines (logMAR 1.0 ± 0.64) in the subgroup of patients with RD compared to gain of 3.8 lines (logMAR 0.42 ± 0.28) in the non-RD group. There are several reports about RD following ppv. Rizzo et al. (2010a) found a frequency of 1.4% in 2598 small-incision, sutureless vitrectomies for predominantly macular diseases and an incidence of RD of 1.7% (31 of 1862) after 25- or 23-gauge vitrectomies for epiretinal membranes and macular holes again in a follow-up of 6 month, but a slightly lower rate of RD after conventional 20-gauge ppv (1.2%) (Rizzo et al. 2010b). In a study of more than 600 eyes, Guillaubey et al. could demonstrate a significantly higher rate of RD after 20-gauge macular hole surgery compared to 20-gauge vitrectomies for epiretinal membranes (6.6% versus 2.5%) (Guillaubey et al. 2007). A stronger depression necessary to induce posterior vitreous detachment and traction involving the vitreous base during the complete peripheral ppv could be a risk factor. In addition, eyes with vitreomacular traction seem to have a significantly higher incidence of breaks (Tarantola et al. 2013). Mechanical detachment of the posterior vitreous might be an important risk factor in our study as well as the retinal breaks were located with preference of the inferior hemisphere but not in direct proximity of the sclerotomies and may be responsible for the first peak of RD after 1 month. Ramkissoon et al. (2010) recognized that iatrogenic induction of posterior vitreous detachment significantly (~3-fold) increased the risk of RD (Ramkissoon et al. 2010). Another reason for the emerge of new retinal breaks could be the shrinking and subsequent tearing of the incomplete removed peripheral vitreous which might lead to the second peak of RDs after approximately 130 days. In our cohort, patients with RD had a loss of 1.5 lines (logMAR 1.0 ± 0.64) after 6 months, which can be explained on the one hand by the macula-off situation in 6/10 patients, but also by the postoperative persisting macular hole. However, vitreoretinal surgery of FTMH is a safe procedure and successful in terms of visual acuity. All possible complications should be regularly checked in clinical postoperative follow-up examinations and explained to the patient before surgery. Especially during the period with the highest risk of RD, approximately 1 and 4 months after macular surgery, dilated fundus examinations should be performed.

Myopic traction maculopathy (MTM) can manifest as foveoschisis or macular retinoschisis (MRS), foveal detachment, lamellar macular hole (LMH), and full‐thickness macular hole (FTMH). The specific and core feature of MTM is the presence of MRS. The development of MTM is related to complex forces such as the rigid internal limiting membrane (ILM), extensively adherent posterior hyaloid, posterior staphyloma, and the presence of epiretinal membrane, all coinciding in highly myopic eyes.Parolini et al. proposed a staging system of MTM, based on the predominant traction force. The perpendicular evolution started with inner and outer MRS, predominantly outer MRS, and progressed to foveal detachment and macular detachment. The presence of inner LMH was recognized as a sign of tangential traction, and an intermediate stage before the development of FTMH.Another frequently used classification and staging system focusing on the MRS separates MTM to four types: MRS, MRS with foveal detachment, MRS with LMH, and MRS with LMH and foveal detachment. LMH or FTMH can develop before, at the same time or after the formation of MRS. Because of the complex traction forces, the evolutional processes of MTM may not be straight forward. Spontaneous improvement may occur; those with outer retinoschisis (stage 2a in the Parolini system) might downgrade to stage 1b with the LMH formation possibly because the traction was partially released.There is no consensus regarding surgical indications and optimal treatment strategies. We perform surgery when progressive worsening of best‐corrected visual acuity (BCVA) down to 20/40 has been documented along with structural worsening, or when foveal detachment occurs without concerning the BCVA level.Common applied surgical techniques include ILM peeling, fovea‐sparing ILM peeling, fovea‐sparing ILM peeling combined with inverted ILM flap technique, macular buckling, scleral imbrication, etc. The pros and cons of each procedure will be reviewed and discussed.

The use of systemic mammalian target of rapamycin (mTOR) inhibitor (MTI) therapy may confer benefits against the development of proliferative vitreoretinopathy (PVR). To examine the use of systemic MTI therapy for the prevention of PVR among patients who underwent initial retinal detachment (RD) repair. This was a retrospective cohort study aggregating deidentified electronic health record data from January 2003 to January 2025, from 15 countries. The study included 681 patients who underwent primary RD repair while receiving systemic MTI therapy at least 3 months before and 1 year after initial RD repair. This cohort was compared with a control group of 47 626 patients never exposed to systemic mTOR inhibition. After propensity score matching, outcomes from 681 patients in each cohort were analyzed after 1 year following their initial RD surgery. Patients were stratified by use of systemic mTOR therapy or not using RxNorm code. Relative risk (RR) of developing a PVR-related RD and requiring a subsequent ocular intervention including pars plana vitrectomy (PPV), and complex RD repair within 6 months and 1 year of follow-up. Patients who underwent initial RD repair while receiving systemic MTI therapy were separately compared with a matched cohort of patients with concomitant use of systemic methotrexate (MTX) for the same measures at 6 months and 1 year. A total of 681 and 47 626 patients who underwent initial RD repair with concomitant use of an MTI or not, respectively, were identified prior to PSM. The mean (SD) age in the MTI cohort was 66.5 (15.4) years; 319 (46.8%) were female and 319 (46.8%) were male. In the control cohort, the mean (SD) age was 64.5 (17.6) years; 16 140 (33.9%) were female and 27 858 (58.5%) were male. At 1 year, concomitant use of systemic MTI therapy was associated with a decreased risk of developing a subsequent RD (RR, 0.58; 95% CI, 0.36-0.94; P = .03) compared with matched patients who underwent initial RD repair without exposure to systemic MTI therapy. Moreover, concomitant use of systemic MTI therapy was associated with a decreased risk of requiring subsequent PPV (RR, 0.57; 95% CI, 0.40-0.82; P < .001) and complex RD repair (RR, 0.60; 95% CI, 0.40-0.91; P = .01) when compared with matched patients who underwent initial RD repair without exposure to systemic MTI therapy at 1 year. There was no difference in the development of subsequent RD and need for PPV or complex RD repair when comparing patients who underwent initial RD repair with concomitant systemic MTI therapy to a matched cohort of patients with concomitant use of systemic MTX therapy at 6 months and 1 year. Patients who underwent initial RD repair and were concomitantly being treated with systemic MTI therapy were less likely to develop a subsequent PVR-related RD compared with matched patients not exposed to systemic MTI therapy. Future studies are needed to investigate MTI therapy safety and efficacy profile in this setting of potential PVR prevention.

Visual Outcomes and Complications of Epiretinal Membrane Removal Secondary to Rhegmatogenous Retinal Detachment

To report the conversion and spontaneous reversion of a lamellar hole from full-thickness macular hole after vitrectomy surgery for retinal detachment repair. Case report of a patient with a preexisting lamellar hole who underwent retinal detachment repair. A patient with a history of a lamellar hole developed a fovea-sparing retinal detachment that was repaired by vitrectomy surgery with gas tamponade. Two months after the surgery, he developed a full-thickness macular hole that spontaneously reverted back to a lamellar hole configuration over several months. Although spontaneous closure of full-thickness macular hole after retinal detachment repair has been reported, the conversion and spontaneous reversion of a lamellar hole from full-thickness macular hole after vitrectomy provide insight into the tractional forces involved in the pathophysiology of lamellar and full-thickness macular holes.

This study aimed to determine whether cases of surgical retinal detachment (RD) repair at a tertiary care center from January 1, 2011 to December 31, 2020 increased proportionately to macular surgery cases as a control and to national trends. Current Procedural Terminology codes were used to identify cases of primary RD repair (67107, 67108), complex RD repair (67113), pneumatic retinopexy (67110), and vitrectomy with membrane peeling (67041, 67042) at an academic center and in the Part B National Summary Data Files. Numbers of cases and mean case times at the academic center were determined. We identified 5,183 and 948,831 operative cases locally and nationally, respectively. Between 2011 and 2019, the total volume of RD repair at the academic center increased by 118.7%, compared to 23.3% for cases of membrane peeling. In contrast, surgical RD repairs and membrane peelings increased by 26.0% and 6.8% cases nationally. The ratio of RD repairs to membrane peelings from 2011 to 2019 increased from 1.5 to 2.6 locally compared to 0.6 to 0.7 nationally. Complex RD repairs increased more than primary RD repairs locally (129.3% vs 110.9% cases) and less than primary RD repairs nationally (20.6% versus 30.2% cases). Cases of surgical RD repair increased disproportionately compared to macular surgery at our institution and compared to RD repairs nationwide. [Ophthalmic Surg Lasers Imaging Retina 2023;54:505-511.].

Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the IRIS® Registry (Intelligent Research in Sight)