Aphakic Retinal Detachment Research Articles

A study to assess the outcome of optical penetrating keratoplasty in a tertiary health care centre in north India

Blindness is one of the major problems in the world and more so in developing countries which opacity results in significant morbidity both in terms of loss of vision and socio-economic reasons corneal blindness is one of the major causes of visual deficiency. The solution to this problem is keratoplasty. The main purpose of this study is to analyze the indications, visual outcome, postoperative complications, and follow-up of corneal transplants done for optical purposes. 20 patients posted for optical penetrating keratoplasty in the Department of Ophthalmology, Guru Gobind Singh Medical College & Hospital, Faridkot were taken for the study. In our study, the final vision at the end of six months was more than 6/60 in 1 case, in the range of 4/60 to 6/60 in 7 cases. So, overall, 40% of patients achieved the vision of 4/60 or more. Vision is 3/60 or less in 12 (60%) cases. Complications like a recurrence of host disease occurred in 2 cases (10%), aphakic retinal detachment in one case, 6 (30%) cases developed postoperative glaucoma, 7 cases (35%) had epithelial defects, allograft rejection in 3 cases (15%), endophthalmitis in one case, graft infection in 2 (10%) cases. The results of this study show that penetrating keratoplasty helps patients regain vision which makes them able to move independently.

Vitrectomy Versus Combined Vitrectomy-Scleral Buckling for the Treatment of Pseudophakic and Aphakic Retinal Detachment

There is a disagreement on the ideal intervention for pseudophakic and aphakic retinal detachment. The goal of this thesis is to outline the difference between the two surgical approaches in getting higher reattachment rates and better visual outcomes. The study is a prospective randomised study to evaluate the efficacy of vitrectomy alone versus a combination of both vitrectomy and scleral buckling in the treatment of pseudophakic and aphakic retinal detachment. Aim: The aim of this study is to compare the anatomical and functional results of primary vitrectomy alone versus vitrectomy-scleral buckling for pseudophakic and aphakic retinal detachment. Patients and Methods: A total of 30 eyes with pseudophakic or aphakic retinal detachment will be divided into two groups. Fifteen consecutive pseudophakic or aphakic eyes with retinal detachment will be operated by vitrectomy-scleral buckling (Group-A) and Fifteen additional patients will be operated by vitrectomy alone (Group-B). Results: The two groups of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 25 patients, remained the same in 2 patients, and decreased in 1 patient. Conclusion: This randomised study shows the same anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together and SF6 gas injection with or without a scleral buckling for pseudophakic retinal detachment.

Vitrectomy Versus Combined Vitrectomy-Scleral Buckling for the Treatment of Pseudophakic and Aphakic Retinal Detachment

There is a disagreement on the ideal intervention for pseudophakic and aphakic retinal detachment. The goal of this thesis is to outline the difference between the two surgical approaches in getting higher reattachment rates and better visual outcomes. The study is a prospective randomised study to evaluate the efficacy of vitrectomy alone versus a combination of both vitrectomy and scleral buckling in the treatment of pseudophakic and aphakic retinal detachment.

Vitrectomy Versus Combined Vitrectomy-Scleral Buckling for the Treatment of Pseudophakic and Aphakic Retinal Detachment

There is a disagreement on the ideal intervention for pseudophakic and aphakic retinal detachment. The goal of this thesis is to outline the difference between the two surgical approaches in getting higher reattachment rates and better visual outcomes. The study is a prospective randomised study to evaluate the efficacy of vitrectomy alone versus a combination of both vitrectomy and scleral buckling in the treatment of pseudophakic and aphakic retinal detachment.

Aphakic Retinal Detachment; Risk Factors, Pathogenesis, Clinical Characteristics, and Management

Aphakia is one of the major risk factors for rhegmatogenous retinal detachment (RD). Predisposing factors such as myopia, male gender, vitreous loss, young age facilitate the development of RD. Generally, aphakic RD does not any symptoms. Retinal breaks are located more in the superior retinal quadrant, equatorial, or near the Ora Serrata and are tended to small size. Pars plana vitrectomy and/or scleral buckling have a similar functional and anatomical outcome in treatment.

A study on post-operative change in intraocular presuure and anterior chamber depth after retinal detachment surgery

Effect of these procedures on the intra-ocular pressure has not received much attention, so it shall be the endeavour of this study to see how different steps in the surgical procedure for retinal detachment surgery influence the intraocular pressure both on the table and in the immediate post-operative period along with changes induced in the anterior segment. We have added an attempt to evaluate the post operative changes in the intra-ocular pressure and anterior chamber depth was analysed. The study was conducted in 50 consecutive cases of both phakic and aphakic retinal detachments, attending the retinal services at Dr VRK Womens Medical College & Tertiary Hospital during the year June2018 – May 2019. The preoperative and immediate post operative intra ocular pressure and anterior chamber depth were measured and serial changes tabulated and analysed. We conclude that, No significant change in anterior chamber depth and width of the angle of the anterior chamber is observed.

Clinical efficacy of minimally invasive vitreous surgery for special rhegmatogenous retinal detachment in children and adolescents

Objective To observe the clinical efficacy of minimally invasive vitreous surgery (MIVS) for special rhegmatogenous retinal detachment (RRD) in children and adolescents. Methods A retrospective clinical comparative study. Fourteen eyes with special type of RRD in 14 children and adolescents who received the MIVS treatment from January 2014 to January 2019 in Ophthalmology Department of The First Affiliated Hospital Ophthalmology of Air Force Military Medical University, were included in this study. Among them, 8 eyes from 8 males and 6 eyes from 6 females. The age of them ranged from 5 to 17, with the mean age of 12.64±4.11 years. The course of disease was ranged from 1 d to 1 year, and the average of it was 30 d. All the eyes developed the special type RRD, including pseudophakic and aphakic retinal detachment, giant retinal tear with retinal detachment, choroidal detachment associated with retinal detachment, and RRD with ocular dysplasia. In the 14 eyes, there was 2 eyes with retinal detachment in 1 quadrant, 4 eyes in 2 quadrants, 1 eye in 3 quadrants and 7 eyes in total 4 quadrants. All the eyes were treated with 23G or 25G MIVS and filled with irrigation solution, air and silicone oil. In addition, 10.4 months' follow-up for average after surgery were taken to observe the occurrence of retinal reattachment, BCVA and related complications in the eyes. Results In the 14 eyes, 13 (92.9%) of them attained retinal reattachment and 1 eye (7.1%) got a poor retinal reattachment after one operation. At the last follow-up, all the 14 eyes (100.0%) attained retinal reattachment and 5 of them at the filling state of silicone oil. The vision of 8 eyes (57.1%) were improved, 4 eyes (28.6%) have no notable changes and 2 eyes decreased (14.3%). During the operation, iatrogenic retinal breaks were occurred in 1 eye, and silicone oil entered underneath the retina in 1 eye. After the operation, 1 eye suffered a relapse of retinal detachment after the removal of silicone oil and then were filled with it again. Conclusions MIVS is a safe and effective way to treat the special type RRD among the children and adolescents. The rate of retinal reattachment is 92.9% after one surgery and 100.0% at the last follow-up. Therefore, MIVS can help most of eyes with special type RRD to get a stable and improved vision. Key words: Retinal detachment/surgery; Vitreoretinal surgery; Child; Adolescent

A 21-Year Study of Vitreoretinal Surgery for Aphakic Retinal Detachment: Long-Term Surgical Outcomes and Complications

To determine the characteristics and outcomes of primary retinal detachment (RD) surgery in aphakic patients. Retrospective case series. Sixty eyes with primary aphakic RD (ARD) in 51 patients. A consecutive series of patients who underwent vitreoretinal surgery for primary rhegmatogenous ARD was analyzed retrospectively between 1997 and 2018 at Moorfields Eye Hospital. Best-corrected visual acuity (BCVA), surgical outcomes, and complications. Mean BCVA improved from 1.31 to 1.08 logarithm of the minimum angle of resolution (logMAR; P= 0.081) over a mean follow-up period of 8.2 years. Macula-off retinal detachments showed significantly improved BCVA from 1.72 to 1.1 logMAR (P= 0.007). Mean age was 38.8 years, and the most common cause of aphakia was congenital cataract surgery (55%). The macula was attached in 45% eyes, and grade C proliferative vitreoretinopathy (PVR) was present in 12%. Operations performed were vitrectomy (88%), combined vitrectomy and scleral buckle (8%), and encirclement (3%). The final anatomic success rate was 88%, and PVR was a significant predictor of redetachment (P= 0.03; odds ratio, 20.7; 95% confidence interval, 2.8-152.2). Raised intraocular pressure was the most common postoperative complication at 30%, with a rate of de novo postoperative glaucoma of 6.7% at final follow-up. We report high rates of primary and overall anatomic success for surgery in ARD surgery. Grade C PVR was a positive predictor for surgical failure. Final visual outcomes were limited by ocular comorbidity, and we report significant improved visual outcomes for macula-off ARD.

Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial.

To compare the visual and anatomical outcomes of four surgical techniques to manage pseudophakic and aphakic retinal detachment (PARD). In a multicenter randomized clinical trial, 211 eyes of 211 patients with PARD and proliferative vitreoretinopathy (PVR) grade B or less were randomly assigned to one of the four treatment groups: (1) scleral buckling (SB), 50 eyes, (2) vitrectomy without band, 51 eyes, (3) vitrectomy with encircling band (EB), 58 eyes, and (4) triamcinolone acetonide (TA) assisted vitrectomy, 52 eyes. Patients were followed for 12months after the surgery. The best-corrected visual acuity (BCVA) and retinal reattachment rate at each follow-up time point were considered as the primary outcome measures. PVR, macular pucker, and cystoid macular edema were considered as the secondary outcomes. Visual improvement was achieved in all treatment groups relative to the baseline at all time points (all Ps < 0.001). There were no statistically significant differences among the groups with regard to BCVA changes. However, there was a significant difference in the slope of visual improvement curve: the SB group had a more rapid visual improvement compared to the vitrectomy with buckle group at month 12 (P = 0.032). The retinal reattachment rates at month 12 were 75, 64.7, 68.5, and 66.7% in SB, vitrectomy without buckle, vitrectomy with EB, and TA-assisted vitrectomy groups respectively (P > 0.99). There were no statistically significant differences among the groups in terms of adverse events. SB, TA-assisted vitrectomy, and vitrectomy with and without buckle had comparable outcomes in the management of PARD.

EPIRETINAL MEMBRANE AFTER PARS PLANA VITRECTOMY FOR PRIMARY PSEUDOPHAKIC OR APHAKIC RHEGMATOGENOUS RETINAL DETACHMENTIncidence and outcomes

To compare outcomes of eyes that did or did not develop an epiretinal membrane (ERM) after repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment by pars plana vitrectomy alone. Interventional, prospective, consecutive case series. Of 312 consecutive eyes that underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment, 28 (8.97%) developed ERM during the postoperative period. Best-corrected visual acuity (BCVA) and fundus examinations were performed 1 month and 3, 6, and 12 months postoperatively. Eyes with an ERM more often had a break at the equator (odds ratio, 3.92; 95% confidence interval, 1.3–11.2; P < 0.011). At ERM diagnosis, BCVA ranged from 20/400 to 20/25 with a mean of 20/100 (0.75 logarithm of the minimum angle of resolution), and BCVA at the final visit ranged from 20/200 to 20/25 with a mean of 20/63 (0.53 logarithm of the minimum angle of resolution). Of the 22 eyes that underwent surgical removal of the ERM, BCVA was ≥ 20/40 in 5 (22.7%) before the surgical procedure and in 13 (59%) at the final follow-up visit. The incidence of ERM after pars plana vitrectomy alone for the repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment was similar to reported incidences after scleral buckling. Best-corrected visual acuity improved after surgical removal of ERM, although eyes with the macula detached had lower final BCVA.

ENDOSCOPE-ASSISTED VITRECTOMY IN THE MANAGEMENT OF PSEUDOPHAKIC AND APHAKIC RETINAL DETACHMENTS WITH UNDETECTED RETINAL BREAKS

To demonstrate the efficacy of endoscope-assisted pars plana vitrectomy in treating patients with retinal detachments with no retinal breaks detected preoperatively. Medical records of 20 consecutive eyes with pseudophakic and aphakic rhegmatogenous retinal detachments but without retinal breaks detected preoperatively were reviewed. In each case, endoscope-assisted pars plana vitrectomy was performed. In 19 of 20 eyes, breaks were identified with the help of an endoscope during surgery. To treat breaks, transscleral cryopexy or endolaser was performed under the endoscopic vision. The retina was reattached after a single surgery in all cases. No serious complication related to the operation was experienced. Endoscope-assisted vitrectomy is useful in the management of pseudophakic and aphakic retinal detachments with undetected retinal breaks preoperatively.

Paediatric retinal detachments: clinical characteristics and surgical outcomes

Abstract Purpose To evaluate the clinical characteristics and surgical outcomes of paediatric retinal detachment in an Asian population. Methods A retrospective case series of all patients aged 18 years and under who underwent retinal detachment surgery at the Singapore National Eye Centre from 1994 to 2008. Results 133 eyes in 116 patients were treated for retinal detachment over 15 years. 88 patients (75.9%) were male. The mean age was 14.0 years (range 3 to 18 years; median 15 years). Retinal detachment was caused by trauma in 13.5% (18 eyes). Myopia was the most common risk factor, present in 57 eyes (42.9%). 9% (12 eyes) had pseudophakic retinal detachment and 3.0% (4 eyes) had aphakic retinal detachment. The mean duration from onset of symptoms to presentation was 43 days (+/‐92.4). Initial visual acuity (VA) was 6/12 or better in 19.5% of eyes, while 53.9% of eyes had VA worse than 6/60 at presentation. The macula was still attached in only 22.1% of eyes. 85% of eyes had one retinal detachment surgery performed. 74% of our patients were treated with a sclera buckling procedure at the first instance. 18.3% had a combined vitrectomy with sclera buckling. Only 7.6% had primary vitrectomy as the initial treatment. 85% (113) of eyes achieved anatomical success defined by a completely attached retina on last followup, at least 6 months after last surgical procedure. 43.7% of eyes achieved a final postoperative VA of 6/12 or better. 76.2% of eyes had VA 6/60 or better. Conclusion Paediatric retinal detachments are characterised by delayed diagnosis, high incidence of macular involvement on presentation and a male predominance. In our series, myopia was the most common risk factor, which is not unexpected given the high incidence of childhood myopia in our population.

A review of 50 cases of Aphakic Detachment in Peshawar, North West Frontier Province of Pakistan

This prospective study was conducted at Khyber Teaching Hospital Peshawar, North West Frontier Province (NWFP) of Pakistan over the period of 16 months. It was to assess the demographic pattern, mode of presentation, treatment modalities and postoperative result of aphakic retinal detachment. This study also compared the incidence of aphakic retinal detachment in intracapsular versus extracapsular cataract extraction as well as the duration between cataract surgery and retinal detachment. A total of 50 patients were recruited in this prospective study. A Proforma was specially designed for this purpose. Detailed history with reference to age, sex, presenting complaints, spectacle wear, previous ocular surgery, duration of surgery/laser treatment, systemic and family history was taken. All patients had detailed ophthalmic examination, underwent conventional retinal reattachment surgery, and were followed up for 6 months. Of the total number studied, 86% of the patients were males; only 14% were females, with a mean age of 58 years. The overall anatomical success was achieved in 40 (80%) eyes. The visual acuity of 6/12 and better was achieved in 8 (16%) eyes. 20 (40%) eyes attained a vision of 6/18 to 6/36. 12 (24%) eyes had a vision between 6/60 to CF 3m. The vision could not be improved beyond CF 3m in 10 (20%) eyes. Vitreous loss during cataract surgery is the most common cause of aphakic retinal detachment. The risk is maximal in the first and second year. The overall anatomical attachment achieved through conventional retinal detachment surgery is 80%.

Clinical characteristics and therapeutic effect of retinal detachment in aphakic and pseudophakic eyes in 805 patients

Objective To observe the clinical characteristics and therapeutic effect of aphakic retinal detachment (ARD) eyes and pseudophakic retinal detachment (PPRD) eyes.Methods The clinical data of 805 patients,including 321 ARD and 484 PPRD eyes were retrospectively analyzed.The patients'visiual acuity,refraction,intraocular pressure were examined,and the patients also underwent slit-lamp microscopy and direct and (or) indirect ophthalmoscopy.The preoperative best-corrected visual acuity (BCVA) was between light perception (LP) and 0.6.Mainly according to the PVR grade and retinal holes position to take the scleral buckling or vitrectomy combined with scleral buckling.The 805 eyes were divided into 1995-1999 group (243 eyes) and 2000-2007 group (562 eyes) according to operative time.The follow-up ranged from 3 to 25 months,with an average of 12.3 months.The success standard of surgery was set as anatomic retinal reattachment and the last follow-up time was considered as the judgment time.The surgical complications were recorded at each follow-up time points.The composition of PPRD,the visual acuity,ocular lesions,surgical methods and results before operation and visual acuity after operation in two groups were analyzed and compared by Mantel-Haenszel chi-square test.Results The average interval from lens extraction to RD occurrence was 15.4 months in PPRD eyes and 39.1 months in ARD eyes.The final total anatomic success rate was 95.9%,and was 93.5% in the scleral buckle eyes and 97.2% in vitrectomy eyes.The BCVA was better than 0.3 after operation only in 11.9% of the 805 patiens,and the visual acuity increased more than 2 lines in 67.3%.Compared with the ARD eyes,early onset,high proportion of total posterior vitreous detachment,severe PVR,wide RD range,low detection rate of retinal hole and low antomic success rate were found in PPRD eyes.Compared with the 1995-1999 group,the proportion of vitreous surgery,anatomic success rate and better visual acuity were found in 2000-2007 group.Conclusions The ocular lesions of ARD and PPRD is more complicated,the therapeutic effect are improving in recent years. Key words: Retinal detachment/etiology; Retinal detachment/diagnosis; Retinal detachment/surgery; Aphakia; Aphakia,postcataract; Phakic intraocular lenses

Anatomic and Visual Outcomes of Scleral Buckling Versus Primary Vitrectomy in Pseudophakic and Aphakic Retinal Detachment: Six-Month Follow-up Results of a Single Operation—Report No. 1

Anatomic and Visual Outcomes of Scleral Buckling Versus Primary Vitrectomy in Pseudophakic and Aphakic Retinal Detachment: Six-Month Follow-up Results of a Single Operation—Report No. 1

Anatomic and Visual Outcomes of Scleral Buckling versus Primary Vitrectomy in Pseudophakic and Aphakic Retinal Detachment: Six-Month Follow-up Results of a Single Operation—Report No. 1

To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment. Prospective, randomized, multicenter clinical trial. Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment. Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle. Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia. There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73-2.24), indicating no statistically significant difference. Proliferative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications. Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation.

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4–3.6% for ICCE and between 0.55–1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75–1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.

Combined Scleral Buckle and Pars Plana Vitrectomy as a Primary Procedure for Pseudophakic Retinal Detachments

Pseudophakic and aphakic retinal detachments are associated with a lower percentage of successful primary repair with standard scleral buckling surgery, than phakic retinal detachments. The objective of this study was to determine whether a combined scleral buckle and vitrectomy, as a primary procedure, offers any advantage over conventional scleral buckling in primary pseudophakic and aphakic retinal detachments, without proliferative vitreoretinopathy. This was a prospective, non-randomized clinical study. Ninety-four consecutive pseudophakic and aphakic retinal detachments were included in the study. All patients were operated upon by the same surgeon. Each patient underwent a combined scleral buckle and pars plana vitrectomy with perfluorocarbon injection and air-fluid exchange. Each patient was followed by the operating surgeon for a minimum of 6 months. Patients were followed with respect to anatomic reattachment, visual acuity improvement, and surgical complications. All eyes were anatomically reattached after a single operation. All demonstrated an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure. We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments.

Combined Pars Plana Vitrectomy and Scleral Buckling for Pseudophakic and Aphakic Retinal Detachments in Which a Break Is Not Seen Preoperatively

This study presents a group of patients with a pseudophakic or aphakic retinal detachment (RD) and an unseen retinal break who were treated with a pars plana vitrectomy (PPV), fluid-air exchange, internal drainage, and endolaser in addition to a scleral buckle (SB) procedure. The charts of 10 consecutive patients with a pseudophakic or aphakic RD and an unseen retinal break who were treated with a PPV, fluid-air exchange, internal drainage, endolaser, and an SB were reviewed for preoperative and postoperative visual acuity, postoperative status of the retina, and surgical complications. All of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 7 patients, remained the same in 2 patients, and decreased in 1 patient. This pilot study shows good anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together with an SB for pseudophakic or aphakic patients with an RD and an unseen break.