Advanced Proliferative Vitreoretinopathy Research Articles

Burkholderia cepacia, a cause of post pars plana vitrectomy silicone oil related endophthalmitis: clinico-pathological presentation and outcome of management

AimTo report the long-term outcome of the management of a series of culture proven post pars plana vitrectomy endophthalmitis in which the infective agent was in the silicone oil used as an endotamponade. The isolates were Burkholderia cepacia and Pseudomonas aeruginosa.MethodA retrospective interventional reporting of a series consisting of a cluster of five cases.CasesFive consecutive patients received the same batch of 5000-centistoke silicone oil as endotamponade at the conclusion of vitreoretinal surgery and presented with features of acute intraocular inflammation, which was due to an infective cause. The infective organism isolated from the mixture of silicone oil and fluid was B. cepacia in three out of the initial cluster of four eyes and P. aeruginosa in the fifth eye.Outcome of managementThe initial 4 eyes evolved into eyes with poor vision (hand motion, perception of light and no perception of light), advanced proliferative vitreoretinopathy, hypotony, phthisis bulbi and cornea opacity. The poor visual outcome was deemed to be consequent to delay in removal of the silicone oil, despite use of intravitreal, systemic and topical antibiotics. The fifth case, because of the heightened index of suspicion gained from the preceding four cases, had a prompt removal of the silicone oil, vitreal lavage with antibiotics, and intravitreal injection of antibiotics and steroid. He regained a 6/9 vision.ConclusionGram-negative bacilli can colonize silicone oil resulting in post pars plana vitrectomy endophthalmitis. The index of suspicion for this should be high and can be managed successfully with prompt removal of the silicone oil, microbial sensitive antibiotic lavage of the vitreous cavity, followed by a repeat tamponade.

Anatomical and visual outcomes of retinectomy in eyes with advanced proliferative vitreoretinopathy

Background: Visual and anatomical success of inferior retinectomy in proliferative vitreoretinopathy complicating recurrent retinal detachment (RD). Aims: The aim of this study was to evaluate anatomical and visual outcomes of retinectomy in eyes with recurrent RD with advanced proliferative vitreoretinopathy. Settings and Design: Institutional, observational, cross-sectional retrospective study. Subjects and Methods: Records of 56 eyes of 56 patients with recurrent RD and proliferative vitreoretinopathy (PVR) were evaluated, three-port incision sclerotomies followed by standard vitrectomy were done. Retinal reattachment was achieved with the aid of perfluorocarbon and retinectomy. Retinectomy was performed at the time of surgery based on retinal shortening (inferior 180°). Silicon oil (SO) was used as a tamponade. Retinal attachment and visual acuity (VA) after 6 months were evaluated. Statistical Analysis Used: Chi-squared test. Results: In all 52 of 56 (93%) eyes, retinal reattachment was successful, with a mean follow-up of 25 months (range, 6–70 months). After retinal reattachment, VA improved or stabilized in 39 of 56 patients (70%). Conclusion: When combined with anterior base dissection, inferior retinectomy may be useful in the surgical treatment of complex PVR-related RD. It was found that with lensectomy, radical anterior base dissection, and inferior retinectomy, anatomic success rates are improved and visual function can be maintained.

Observer variation in quantitative assessment of retinal shortening with ultrasound in patients of total rhegmatogenous retinal detachment.

Purpose:To evaluate the interobserver variation in the assessment of retinal length to choroidal length ratio (RCR) as a marker for proliferative vitreoretinopathy (PVR) in cases of rhegmatogenous retinal detachment (RRD).Methods:This was a double-masked, prospective study at a tertiary center. Ultrasound was used to calculate RCR in 50 eyes with total RRD by two observers. Both observers were trained after the first round of calculations, and all the calculations were repeated as before. Difference between the RCR values was stratified into four categories (<0.01, 0.01–0.05, 0.06–0.1, and >0.1) for descriptive analysis. A difference of 0.05 was set as the maximal limit for defining interobserver agreement. Correlation between RCR and interobserver difference was assessed.Results:The mean interobserver difference in RCR values was found to be 0.06 ± 0.0 (P = 0.41) and was reduced to 0.04 ± 0.02 (P = 0.81) following training. The interobserver difference was <0.1 in 82% of the cases before training and in 98% of cases after training. The worst interobserver agreement was noted in cases with RCR < 0.8, and there was a good negative correlation between RCR and interobserver difference (r = −0.6, P ≤ 0.001).Conclusion:There is good interobserver agreement in assessing RCR with ultrasound in eyes with RRD, which improves further with training. RCR needs careful assessment in eyes with very low RCR. This technique may be useful in prognostication of surgical outcomes in cases with advanced PVR.

Personalized Proteomics in Proliferative Vitreoretinopathy Implicate Hematopoietic Cell Recruitment and mTOR as a Therapeutic Target

To profile vitreous cytokine expression of proliferative vitreoretinopathy (PVR) patients. Case-control study. Liquid biopsies were collected from 2groups: control subjects (n= 3) undergoing pars plana vitrectomy to remove an epiretinal membrane (ERM), and test subjects (n= 7) with varying degrees of PVR. A high-throughput cytokine screen measured expression of 200 cytokines. Cytokine expression patterns were prospectively validated in separate cohorts of control patients and those with PVR-A, PVR-B, and PVR-C (n= 10 for each group). Expression changes were evaluated by analysis of variance (significant P value < .05), hierarchical cluster algorithm, and pathway analysis, to identify candidate pathways for prospective studies. In PVR vitreous, 29 cytokines were upregulated compared to controls. Early PVR vitreous showed upregulation of T-cell markers, profibrotic cytokines, and cytokines downstream of mTOR activation (IL-2, IL-6, and IL-13), whereas in late PVR vitreous, cytokines driving monocyte responses and stem-cell recruitment (SDF-1) prevailed. Prospective validation confirmed the differential expression of specific cytokines from PVR-A to C. Early PVR is characterized by activation of Tcells and mTOR signaling, whereas advanced PVR is characterized by a chronic monocyte response. PVR might be treated by rational repositioning of existing drugs that target mTOR and IL-6. Our analysis demonstrates that successful therapeutic intervention will be highly dependent on the specific therapeutic target and the stage of PVR. This study provides insights into cytokines that will serve as biomarkers and therapeutic targets. These biomarkers will help design clinical trialsthat intervene at appropriate times.

Anatomical and functional outcomes of retinectomies in retinal detachments complicated by proliferative vitreoretinopathy

PurposeTo study anatomical and functional outcomes of retinectomies in rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy. MethodsThis is a retrospective interventional consecutive case series of eyes with rhegmatogenous retinal detachments complicated by advanced proliferative vitreoretinopathy and managed by relaxing retinectomy over a period of seventeen years. Three-port pars plana vitrectomy included core vitrectomy and removal of all epi-retinal membranes. On failure to flatten, retina was cut and excised. Basal vitrectomy and removal of anterior flap of retina then followed. Silicone oil was used as temponade in majority of cases. The dependent variables were anatomical and functional outcomes. The statistical analysis was performed on SPSS 21. ResultsSeries included 370 eyes of 337 patients. Mean follow up was 39months. Scleral explant was used in 90(24.39%) cases. Two hundred and nine (56.49%) eyes were operated with trans conjunctival sutureless vitrectomy technique. Procedure was bilateral in 33 patients (09.79%). Retina attached in 311(84.05%) eyes after initial surgery. Final re-attachment after one or more surgeries was achieved in 344(92.97%) eyes. Two hundred and eleven (57.02%) cases achieved visual acuity of 6/60 or better. ConclusionRelaxing retinectomies have good and encouraging anatomical and functional outcomes. This surgery can be effectively carried out with trans conjunctival sutureless vitrectomy technique.

Pediatric Traumatic Retinal Detachments: Clinical Characteristics and Outcomes.

To compare clinical characteristics and surgical outcomes of retinal detachment (RD) after open globe injuries (OGIs) and closed globe injuries (CGIs). One hundred ten eyes of 110 patients aged 17 years or younger who underwent primary RD repair after OGI and CGI between 2010 and 2013 were reviewed retrospectively. Cataract (59.8% vs. 21.7%; P = .002) and vitreous hemorrhage (54% vs. 13%; P < .001) were significantly higher in OGIs than CGIs. Anatomical success rates were 75.9% in OGI and 82.6% in CGI (P = .586). Final visual acuity of 20/200 or greater was obtained in 23% of OGIs and 47.8% of CGIs (P = .035). Advanced proliferative vitreoretinopathy was associated with poor anatomical and visual outcome in both OGIs and CGIs. In OGIs, macular detachment was associated with poor visual outcome, and in CGIs, vitrectomy and macular detachment were associated with poor visual outcome. Visual outcomes were not compatible with anatomical success in both groups. Advanced PVR seems to be the most prominent factor that influences the anatomical and functional success rates in both OGI and CGI. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:143-150.].

Missed retinal breaks in rhegmatogenous retinal detachment.

To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.

Peripheral 360 Degree Retinotomy, Anterior Flap Retinectomy, and Radial Retinotomy in the Management of Complex Retinal Detachment

To compare the outcomes for patients with rhegmatogenous retinal detachment (RRD) and patients with retinal detachment (RD) following penetrating injury after combined 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced proliferative vitreoretinopathy (PVR). Retrospective, comparative, interventional case series. Twenty-four eyes (60%) of 24 patients diagnosed with RRD and 16 eyes (40%) of 16 patients diagnosed with RD after penetrating injury whose surgery involved 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced PVR (grade D) were included in the analysis. The primary outcome was anatomic surgical success. Secondary outcomes were change in visual acuity (VA) and postoperative complications. The mean number of previous interventions in the RRD and trauma groups were 1.04 and 1.31, respectively (P = .13). After 51.5 (± 52.7) months of mean follow-up, the complete retinal reattachment rates for the RRD and trauma groups were 79% (19/24) and 75% (12/16), respectively (P > .99). The final mean VA was 2.2 logMAR (20/2000) in both groups, with improvement in the RRD group (P = .04). The most common postoperative complications in the RRD and trauma groups, respectively, were persistent hypotony in 6 eyes (25%) and 5 eyes (31%) (P = .73), corneal damage in 8 eyes (29%) and 6 eyes (38%) (P = .34), and epiretinal membrane in 5 eyes (20.8%) and 4 eyes (25%) (P > .99). Only 25% of the eyes (10/40) had VA of 20/200 or better. The aim of peripheral 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy is to obtain retinal reattachment, which is otherwise unachievable.

ANATOMICAL AND VISUAL OUTCOMES AFTER TWO-PORT PARS PLANA VITRECTOMY REOPERATION UNDER SILICONE OIL FOR EPIMACULAR MEMBRANE OR RECURRENT RETINAL DETACHMENT

To describe the anatomical and visual outcomes in a series of patients undergoing two-port pars plana vitrectomy reoperation under silicone oil for recurrent retinal detachment (RD) due to proliferative vitreoretinopathy or epimacular membrane (EMM) after RD repair. This study is a prospective, consecutive, interventional case series of patients presenting with recurrent RD or EMM under silicone oil. Two-port 25-gauge pars plana vitrectomy reoperation without an infusion port was performed in all cases. Thirty-nine patients were included. Reoperation pathology included recurrent RD with proliferative vitreoretinopathy (n = 33) and EMM alone (n = 6). The mean number of previous retinal surgeries was 2.4 ± 1.1 (range, 1-5). The mean overall follow-up was 24 ± 3.7 months. The mean visual acuity change from baseline at final follow-up was an improvement of 0.74 ± 0.63. Macular reattachment was achieved in 29 of 33 patients with RD, and EMMs were successfully removed in all patients. Two-port pars plana vitrectomy reoperation is an efficacious method for repair of consecutive RD due to proliferative vitreoretinopathy or EMM in patients with previous RD repair with silicone oil. Significant visual improvement with a low complication rate may be achieved in patients with advanced proliferative vitreoretinopathy or EMM under silicone oil.

Expression of IGFBP-6 in a proliferative vitreoretinopathy rat model and its effects on retinal pigment epithelial cell proliferation and migration.

To investigate the expression of insulin-like growth factor binding protein-6 (IGFBP-6) in a proliferative vitreoretinopathy (PVR) model and its effects on proliferation and migration in retinal pigment epithelial (RPE) cells. A PVR Wistar rat model was established by the intravitreal injection of RPE-J cells combined with platelet-rich plasma (PRP). The expression levels of IGFBP-6 were tested by ELISA. ARPE-19 cell proliferation was evaluated by the MTS method, and cell migration was evaluated by wound healing assays. The success rate of the PVR model was 89.3% (25/28). IGFBP-6 was expressed at higher levels in the vitreous, serum and retina of rats experiencing advanced PVR (grade 3) than in the control group (vitreous: 152.80±15.08ng/mL vs 105.44±24.81ng/mL, P>0.05; serum: 93.48±9.27ng/mL vs 80.59±5.20ng/mL, P<0.05; retina: 3.02±0.38ng/mg vs 2.05±0.53ng/mg, P<0.05). In vitro, IGFBP-6 (500ng/mL) inhibited the IGF-II (50ng/mL) induced ARPE-19 cell proliferation (OD value at 24h: from 1.38±0.05 to 1.30±0.02; 48h: from 1.44±0.06 to 1.35±0.05). However, it did not affect basal or VEGF-, TGF-β- and PDGF-induced cell proliferation. IGFBP-6 (500ng/mL) reduced the IGF-II (50ng/mL)-induced would healing rate [24h: from (43.91±3.85)% to (29.76±2.49)%; 48 h: from (66.09±1.67)% to (59.88±3.43)%]. Concentrations of IGFBP-6 increased in the vitreous, serum, and retinas only in advanced PVR in vivo. IGFBP-6 also inhibited IGF-II-induced cell proliferation in a not dose or time dependent manner and migration. IGFBP-6 participates in the development of PVR and might play a protective role in PVR.

USING SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING TO IDENTIFY THE PRESENCE OF RETINAL SILICONE OIL EMULSIFICATION AFTER SILICONE OIL TAMPONADE

To describe small hyperreflective areas using spectral-domain optical coherence tomography (SD-OCT) imaging in eyes that have had silicone oil tamponade. Retrospective case series of 11 eyes of 11 patients. The authors retrospectively identified patients who underwent vitrectomy and silicone oil tamponade secondary to a rhegmatogenous retinal detachment (nine patients), panuveitis with retinal necrosis (one patient), or recurrent full-thickness macular hole surgery (one patient) who had manifestations of silicone oil emulsion on SD-OCT imaging. Patients were monitored during the postoperative period by clinical examination and using SD-OCT. A model eye in which emulsified silicone oil had been injected in the anterior chamber was used to obtain anterior segment SD-OCT images for comparison. The mean age of our patients was 50 years (range, 39-76 years). In eight eyes, the SD-OCT examination was carried out after silicone oil removal, and in three eyes, the SD-OCT examination was carried out with the oil in situ. Of the nine eyes treated for rhegmatogenous retinal detachment, five had a relieving retinectomy for advanced anterior proliferative vitreoretinopathy or for traumatic retinal incarceration (one eye). The eye treated for full-thickness macular hole had a vitrectomy, internal limiting membrane peel, and silicone oil injection for recurrent macular hole. Ten eyes showed hyperreflective, spherical, tiny droplets using SD-OCT imaging. These were thought to represent silicone oil droplets intraretinally or underneath epiretinal membranes, and one eye showed hyperreflective areas subretinally (retina detached). One additional patient was found to have tiny intravitreal silicone oil droplets after silicone oil removal. Similarly, the silicone oil appeared as multiple hyperreflective spherical droplets as detected by SD-OCT. Anterior segment studies of silicone oil emulsification in the experimental model revealed a similar appearance to that seen with in vivo SD-OCT imaging. The authors have found small hyperreflective areas intraretinally, subretinally, and underneath epiretinal membranes on SD-OCT in eyes that have had silicone oil tamponade for a variety of indications. The authors have seen a similar appearance when silicone oil emulsification is examined in vivo. The authors conclude that the hyperreflective areas are likely (but not certain) to be very small bubbles of emulsified silicone. Further studies are required to determine the incidence, clinicopathologic, and functional significance of probable silicone oil emulsification and deposition within the retinal layers.

Twenty-Three-Gauge Pars Plana Vitrectomy With Inferior Retinectomy and Postoperative Perfluoro-n-Octane Retention for Retinal Detachment Repair.

The objective of this article was to study outcomes following use of perfluoro-n-octane (PFO) as a short-term postoperative vitreous substitute in patients undergoing pars plana vitrectomy for a recurrent rhegmatogenous retinal detachment (RRD) with advanced proliferative vitreoretinopathy requiring an inferior retinectomy. A retrospective consecutive chart review. The charts of subjects who underwent RRD repair by pars plana vitrectomy with short-term postoperative PFO, vitreous substitution were retrospectively reviewed. The primary outcome was the anatomic success rate following retinectomy and short-term PFO retention. The secondary outcomes were change in best corrected visual acuity (BCVA) and occurrence of complications related to short-term PFO retention. The anatomic success rate at the final follow-up was 91.7% (11/12). A total of 7 (58.3%; confidence interval, 32%-80.7%) of 12 patients achieved a final BCVA better than initial BCVA. There were no significant complications related to short-term PFO retention. Perfluoro-n-octane is efficacious and safe as a short-term vitreous substitute for repair of a recurrent RRD with advanced proliferative vitreoretinopathy requiring an inferior retinectomy.

Outcomes of Retinectomy of 180° or more in Retinal Detachment with Advanced Proliferative Vitreoretinopathy

Aim: To study the functional and anatomic outcomes of retinectomy of 180° or more in eyes with rhegmatogenous retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR) Grade D. Materials and methods: A retrospective analysis of 51 eyes that underwent pars-plana vitrectomy (PPV) with 180° or more of retinectomy for RD with PVR Grade D was done. Main outcome measures included retinal reattachment, visual outcomes and complications at a follow-up of 12 months. Separate analysis for these parameters was also carried out for subgroup of one-eyed patients. Results: Overall retinal reattachment was achieved in 86.3% cases with mean improvement in BCVA of 0.59 ± 0.91 (statistically highly significant) at final follow-up. In subgroup of one-eyed patients (n = 11), retinal reattachment was achieved in 81.8% eyes with mean improvement of 0.52 ± 0.62 (significant) and 45.4% patients gained ambulatory vision. Main complications included recurrent PVR, optic atrophy, secondary glaucoma and hypotony. Conclusion: Retinectomies of 180° or more can help alleviate intractable traction in eyes with advanced PVR to achieve significant anatomical and functional improvement. This approach was found to be particularly valuable in one-eyed patients in order to achieve ambulatory vision.

Vitreous Vascular Endothelial Growth Factor Concentrations in Proliferative Diabetic Retinopathy versus Proliferative Vitreoretinopathy

Purpose: To assess vitreous vascular endothelial growth factor (VEGF) concentrations in proliferative diabetic retinopathy (PDR) in comparison to proliferative vitreoretinopathy (PVR). Patients and Methods: Vitreous samples were collected from 69 eyes of 69 patients with traumatic lens dislocation (n = 10), grade B PVR with rhegmatogenous retinal detachment (n = 13), grade C PVR with rhegmatogenous retinal detachment (n = 14), PDR with vitreous hemorrhage (n = 18), and PDR with vitreous hemorrhage and tractional retinal detachment (n = 14). Vitreous fluid samples were obtained at vitrectomy, and the levels of VEGF were measured by enzyme-linked immunosorbent assay. Results: The mean vitreous level of VEGF was 15.14 ± 5.22 pg/ml in eyes with grade B PVR, 99.15 ± 38.58 pg/ml in eyes with grade C PVR, 4,534.01 ± 1,193.28 pg/ml in eyes with vitreous hemorrhage secondary to PDR, 5,157.29 ± 969.44 pg/ml in eyes with vitreous hemorrhage and tractional retinal detachment secondary to PDR, and 16.19 ± 5.76 pg/ml in eyes of the control group with traumatic lens dislocation. Vitreous VEGF concentrations were significantly higher in the patients with grade C PVR, PDR with vitreous hemorrhage and PDR with vitreous hemorrhage and tractional retinal detachment in comparison to the control patients (p < 0.05). A significant alteration was not observed in patients with grade B PVR (p = 0.55). Conclusions: Vitreous VEGF concentrations are increased in PDR and grade C PVR. The high VEGF concentrations could suggest a possible effect of VEGF on advanced PVR.

Combined Large Radial Retinotomy and Circumferential Retinectomy in the Management of Advanced Proliferative Vitreoretinopathy

Combined Large Radial Retinotomy and Circumferential Retinectomy in the Management of Advanced Proliferative Vitreoretinopathy

Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante

To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90 masculine to 210 masculine were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. The retinas of eight patients were attached (80%) after a mean follow-up of 16.2 +/- 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10%) case, and there was no attachment of the retina in two (20%) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50%) cases. Good results (80%) and improvement of the visual acuity (50%) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Triamcinolone Acetonide as an Adjuvant in the Surgical Treatment of Retinal Detachment With Proliferative Vitreoretinopathy

To report the efficacy of intravitreal triamcinolone acetonide as an adjuvant in the surgical management of cases with advanced proliferative vitreoretinopathy (PVR). Patients with complicated rhegmatogenous retinal detachment and PVR grade C2 or greater were recruited for this interventional, noncomparative, prospective study. All patients underwent three-port pars plana vitrectomy, membrane peeling, laser photocoagulation, and silicone oil injection to reattach the retina followed by 0.1 mL (4 mg) of triamcinolone acetonide injected through the pars plana into the silicone oil. All patients had supplemental laser therapy around retinal breaks and retinectomy edges at 1 to 2 weeks postoperatively. Patients included 15 males and 9 females, with an average age of 53.6 years (range: 15 to 84 years) and PVR grade C2 to PVR C9. The mean follow-up period was 11.0 months (range: 3 to 26 months). Twenty-one (87.5%) patients had attached retinas at the final followup visit. Visual acuity improved in all patients following surgery (P < .05). Triamcinolone acetonide may have potential as an adjuvant in the treatment of retinal detachment with PVR. Further research is required to evaluate the efficacy of this adjuvant treatment.

Traitement des décollements de rétine par déchirure géante: Étude rétrospective à propos de 23 cas

Report of anatomic and functional results of retinal detachment with giant retinal tear. Retrospective study of 23 cases of retinal detachment resulting from retinal tear of 90 degrees or more: five had a history of ocular trauma, 14 had myopia, and six had no risk for giant retinal tear. Episcleral surgery was performed on cases of giant retinal tear less than 180 degrees , with no advanced proliferative vitreoretinopathy and no inversion of the retinal flap. A vitrectomy was performed on other cases. Scleral buckle was associated with vitrectomy in cases of advanced vitreoretinopathy. The degree of success in the primary surgery was 50% in vitreoretinal surgery, 75% in vitreoretinal surgery with an encircling scleral buckle, and 86.4% in episcleral surgery. Of the seven failed cases, six patients underwent second-intention surgery: vitrectomy in four cases (primary surgery: the first case, episcleral surgery; the next two cases, vitrectomy; and in the fourth, vitrectomy with an encircling scleral buckle). In the last two cases, vitrectomy with scleral buckle was used (the primary surgery in both cases was vitreoretinal surgery). The final success rate was 78.2%, and the average follow-up was 32 months. Through the last test, postsurgery acute vision improved in 16 cases. Vitrectomy is often recommended to repair retinal detachment with giant retinal tear. However, episcleral surgery can be used if the giant tear is less than 180 degrees , the proliferative vitreoretinopathy is not advanced, and the retina flap is not inverted. The scleral buckle must be associated with the vitrectomy in cases of inferior giant retinal tear even if the proliferative vitreoretinopathy is not advanced.

Preservation of anterior capsule during vitrectomy and lensectomy for retinal detachment with proliferative vitreoretinopathy

Purpose To report a series of 15 eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy (PVR) or at high risk for advanced PVR, which underwent pars plana vitrectomy (PPV) and lensectomy (PPL) with preservation of the anterior capsule. Design Retrospective noncomparative case series. Participants Fifteen consecutive patients with retinal detachment and varying degrees of PVR in one eye. Methods All eyes had undergone PPV and PPL with preservation and polishing of the anterior capsule and had at least 6 months of follow-up. Of the 15 eyes, grade C PVR was present preoperatively in 11 and was anterior in 5. Seven of 15 eyes had gas and 8 of 15 had silicone oil tamponade. Eight of 15 eyes had subsequent posterior chamber intraocular lens (PCIOL) placement; 5 eyes had simultaneous silicone oil removal. One eye had a PCIOL placed at the time of the PPL. Main outcome measures Visual acuity, retinal reattachment, complications of gas or silicone oil tamponade, and anterior capsular clarity. Results Fourteen eyes had complete retinal reattachment at the final visit (1 of 15 had macular redetachment only). Final visual acuity was better or equal to preoperative acuity in all eyes, improving by 4 ± 4 lines overall. No eyes had corneal decompensation, pupillary block, or other vision-threatening anterior segment complication. The anterior capsule remained centrally clear in the 13 eyes that did not have a primary central capsulotomy. One eye with minimal preoperative PVR developed hypotony. Conclusions Vitreoretinal surgeons can preserve the anterior capsule in eyes with retinal detachment and PVR to help prevent intraoperative and postoperative complications of gas or silicone oil, simplify future PCIOL placement, and maintain a normal iris appearance.

Management of severe proliferative vitreo-retinopathy with perfluorocarbon liquids and silicone oil.

12 patients of retinal detachment with advanced proliferative vitreoretinopathy were managed with intraoperative perfluoro-N-octane and postoperative silicone oil injection from March 1994 to June 1996 in Kaohsiung Medical University Hospital. The combined intraoprative procedures included posterior vitrectomy (12 eyes), membrane peeling (12 eyes), lower peripheral iridectomy (8 eyes), endo-photocoagulation (8 eyes), retinotomy (8 eyes), and retinal fixation with tack (1 eye). After a minimum of 10 months of follow up, the retina was successfully reattached in 10 (84%) of the 12 eyes, 5 of these eyes had stable tractional detachments on the anterior part of the scleral buckle. Seven patients (58.3%) regained vision of 5/200 or better. The rate of improvement by listing best corrected visual acuity after operation was 75%. We think that the ability to readily remove additional pre-retinal fibrous tissue after the retina was flattened with perfluorocarbon liquids allowed the surgeon to perform a further complete membrane dissection. It can therefore improve the success rate of surgery and hence decrease the rate of complications that was previously thought to be caused by sillicone oil.