Duration Of Detachment Research Articles

Contributions of Grain Damage, Thermal Weakening, and Necking to Slab Detachment

We investigate the impact of three coupled weakening mechanisms on the viscous detachment of a stalled lithospheric slab: structural weakening due to necking, material weakening due to grain size reduction, using a two-phase grain damage model, and thermal weakening due to shear heating (thermal damage). We consider a combined flow law of dislocation and diffusion creep. To understand and quantify the coupling of these three nonlinear weakening processes, we derive a mathematical model, which consists of three coupled nonlinear ordinary differential equations describing the evolution of slab thickness, grain size and temperature. With dimensional analysis, we determine the dimensionless parameters which control the relative importance of the three weakening processes and the two creep mechanisms. We derive several analytical solutions for end-member scenarios that predict the detachment time, that is the duration of slab detachment until slab thickness becomes zero. These analytical solutions are then tested against numerical solutions for intermediate cases. The analytical solutions are accurate for end-member scenarios where one of the weakening mechanisms and one of the creep mechanisms is dominant. Furthermore, we use numerical solutions of the system of equations to systematically explore the parameter space with a Monte Carlo approach.. The numerical approach shows that the analytical solutions typically never deviate by more than 50% from the numerical ones, even for scenarios where all three weakening and both creep mechanisms are important. When both grain and thermal damage are important, the two damage processes generate a positive feedback loop resulting in the fastest detachment times. For Earth conditions, we find that the onset of slab detachment is controlled by grain damage and that during later stages of slab detachment thermal weakening becomes increasingly important and can become the dominating weakening process. We argue that both grain and thermal damage are important for slab detachment and that both damage processes could also be important for lithosphere necking during continental rifting leading to break-up and ocean formation.

Anatomical and Visual Outcomes of Scleral Buckling Surgery in Rhegmatogenous Retinal Detachment.

PURPOSE:The aim of this study is to evaluate the short anatomical and visual outcomes of scleral buckling surgery in relation to the pattern of presentation of rhegmatogenous retinal detachment (RRD) in the presence of different situations and risk factors.METHODS:A total of 206 eyes of 203 patients who underwent scleral buckling surgery for RRD were evaluated in this retrospective study. Information retrieved included patient demographics, duration of symptoms, and presenting vision, lens status, site of a retinal break, extent of retinal detachment, the involvement of the fellow eye, macular involvement, presence of lattice degeneration, and associated refractive errors. Postoperative retinal reattachment, postoperative visual acuity, the need for further surgical intervention, intraoperative, and postoperative complications were also evaluated. Proportions and percentages were used to analyze data.RESULTS:Primary anatomical reattachment was seen in 172 eyes (83.5%) after the complete resolution of the tamponade used. The mean best-corrected visual acuity improved from 2.81 logarithms of the minimum angle of resolution (LogMar) preoperatively to 1.21 LogMar postoperatively, the most important factors that appeared statistically significantly affecting the anatomic and visual outcome were the duration of macular detachment (P = 0.036), the status of the lens; phakic eyes gave better visual outcome than aphakic and pseudophakic eyes (P < 0.05).CONCLUSION:Scleral buckling procedure showed high structural and visual success rates, improvement of visual acuity was found to correlate well with the shorter duration of macular detachment and pseudophakic eyes. We believe that scleral buckling, when done appropriately in the appropriate cases, gives the maximum visual outcome with the least cost and need for consecutive procedures.

Prevalence and risk factors for outer retinal layer damage after macula-off retinal detachment

PurposeTo report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine its associated preoperative risk factors.Methods253 eyes successfully operated for macula-off...

Loss of retinal tension and permanent decrease in retinal function: a new porcine model of rhegmatogenous retinal detachment.

PurposePermanent loss of visual function after rhegmatogenous retinal detachment can occur despite successful surgical reattachment in humans. New treatment modalities could be explored in a detachment model with loss of retinal function. In previous porcine models, retinal function has returned after reattachment, regardless of height and duration of detachment. Difference in retinal tension between the models and the disease might explain these different outcomes. This study investigates, for the first time in an in vivo porcine model, another characteristic of rhegmatogenous retinal detachment – the loss of retinal tension.MethodsLeft eyes (n = 12) of 3‐month‐old domestic pigs were included. Baseline multifocal electroretinogram (mfERG) and a fundus photograph were obtained following anaesthesia (isoflurane). The pigs were vitrectomized, saline was injected subretinally, and the RPE was removed. The eyes were evaluated at 2, 4 and 6 weeks after surgery. Four eyes were enucleated at each evaluation for histologic examinations.ResultsA retinal detachment structurally resembling rhegmatogenous retinal detachment was induced in 11 out of 12 pigs. MfERG amplitudes were significantly decreased despite partial reattachment four and 6 weeks after detachment. The retinal thickness decreased with 27%, the inner nuclear layer degenerated, Müller cells hypertrophied, and outer segments were lost. In the ganglion cell layer, cellularity increased and there was cytoplasmic staining with Cyclin D1. Vimentin and GFAP staining for glial cells increased. After 2 weeks of detachment, the ganglion cells had lost their nucleus and nucleolus.ConclusionsLoss of retinal tension in the detached retina seems to induce permanent damage with loss of retinal function. Death of ganglion cells, observed as soon as 2 weeks after detachment, explains the permanent loss of retinal function. The new model enables investigations of time‐relationship between retinal detachment and lasting damage in addition to exploration of novel treatment modalities.

Visual acuity and contrast sensitivity outcomes based on photoreceptor layer after retinal reattachment surgery

Aims: To evaluate correlation between photoreceptor layer thickness with visual acuity and contrast sensitivity in primary retinal reattachment after vitrectomy. Methods: Twenty seven eyes of 27 patients (mean age 45.6±12.7 years) with successfully retinal reattached were analyzed. Snellen chart visual acuity (VA) to evaluate best-corrected visual acuity (BCVA) converted to the logarithm of the minimum angle of resolution scale (logMAR) and contrast sensitivity in photopic and mesopic illumination using Lea Symbol Flip Chart, funduscopy examination and High Definition Optical Coherence Tomography (HD-OCT) were used to measure retinal condition and photoreceptor layer thickness. Results: Nineteen (70.4%) cases of total 27 cases were reported with macularon RRD. The thickness of the photoreceptor layer was 43.8±10.8 µm which was significantly correlated with BCVA (logMAR 0.3-2.4, mean 1.0) with p is less 0.005 and also with contrast sensitivity in mesopic with p 0.033 (p ≤ 0.05). Contrast sensitivity in photopic was better than in mesopic. Foveal anatomic abnormalities were detected in six eyes (22.2%), that was disruption of inner segment (IS)/outer segment (OS) junction and also disruption of external limiting membrane (ELM). Duration of detachment also significantly correlated with BCVA with mean 36±29 days. The macular status before surgery determines the quality of vision, whereas the macular-on rhegmatogen retinal detachment gives visual acuity, contrast sensitivity, that is better in both photopic and mesopic, than macular-off. Conclusion: Photoreceptor layer thickness significantly correlated with visual acuity and contrast sensitivity in mesopic illumination, whereas thicker the photoreceptor, better the visual acuity and mesopic contrast sensitivity.

Vitreous Cytokine Expression and a Murine Model Suggest a Key Role of Microglia in the Inflammatory Response to Retinal Detachment.

PurposeRetinal detachment (RD) separates the retina from the underlying retinal pigment epithelium, resulting in a gradual degeneration of photoreceptor (PR) cells. It is known that RD also results in an inflammatory response, but its contribution to PR degeneration is unknown. In this study we examine the inflammatory responses to RD in patient vitreous and validate a mouse experimental RD as a model of this phenomenon.MethodsMultiplex bead arrays were used to examine cytokine levels in vitreous samples from 24 patients with macula-off rhegmatogenous retinal detachment (RRD) undergoing reattachment surgery and from 10 control patients undergoing vitrectomy for vitreous opacities or epiretinal membrane. Activation of the innate immune response was then examined in a mouse model of RD.ResultsTwenty-eight factors were significantly increased in vitreous from RD patients versus controls. Notable were the cytokines MCP-1 (CCL2), IP-10 (CXCL10), fractalkine (CX3CL1), GRO (CXCL1), MDC (CCL22), IL-6, and IL-8, which all exhibited relatively high concentrations and several-fold increases in the vitreous of RD patients. Concentrations of various analytes correlated with a range of clinical variables such as duration of detachment and visual acuity. Retinal detachment in the mouse resulted in cytokine mRNA expression changes consistent with human RD vitreous results, as well as microglial proliferation and migration toward the outer retina.ConclusionsThe findings suggest that an inflammatory response involving microglia is a component of the reaction to retinal detachment that may impact visual acuity after surgical repair and that mouse experimental RD can serve as a model to study this effect.

Macula off retinal detachments. How long can they wait before it is too late.

To determine the association between the duration of macula off detachment and the visual outcome following corrective surgery. Retrospective review of the medical records of patients who underwent surgery for macula off detachment over a 5 year period (April 1994- March 1999). There were 104 patients in the study. Patients with macula off detachments wait a mean of 2.6 weeks (0.3 SE mean) before presentation and 1.8 weeks (0.2 SE of mean) thereafter before surgery. The mean duration of detachment prior to surgical repair was 4.2 weeks (0.3 SE mean). 78% of patients achieved a postoperative improvement in visual acuity. 36.5% achieved functional visual success of 6/12 at 3 months, which increased to 51% at final discharge. There was no significant difference in visual outcomes for patient undergoing internal vs external procedures (p=0.188). The preoperative visual acuity was the most significant predictor of post operative visual acuity (p<0.0005). Less than 40% of macula off detachments of >=6 weeks duration will achieve a vision of 6/12 or better compared with 68.2% of patients with macula off detachments of <=1 week. The best mean postoperative vision (LogMAR 0.35) was seen in patients with detachment of <1 week duration. Patients <60 years are more likely to achieve visual improvement despite the duration of the detachment. Macula off detachments of >6 weeks duration have a significantly poor postoperative visual prognosis. Awareness of this visual prognosis can assist in planning the timing of surgery to ensure an acceptable result. (Eur J Ophthalmol 2005; 15: 109-17).

Retinal Nerve Fiber Layer Changes Following Primary Retinal Detachment Repair with Silicone Oil Tamponade and Subsequent Oil Removal.

Purpose:To evaluate the correlation between the retinal nerve fiber layer (RNFL), particularly the temporal RNFL (TRNFL), and visual outcomes following surgery for rhegmatogenous retinal detachment (RRD).Methods:This retrospective study was performed at a tertiary center; 32 patients underwent single and successful vitrectomy for total RRD using silicone oil as tamponade. Data were collected after oil removal. RNFL thickness and central foveal thickness (CFT) were measured using spectral domain optical coherence tomography. RNFL thickness and CFT of normal eyes were acquired as a control to calculate percentage changes in the affected eyes. The correlation between postoperative best-corrected visual acuity (BCVA) and TRNFL changes was the primary outcome measure.Results:Postoperative BCVA correlated negatively with retinal detachment (RD) duration (Pearson coefficient 0.56, P = 0.001) and percentage loss in TRNFL thickness (Pearson Coefficient 0.41, P = 0.02). The macula lost the maximum RNFL thickness (26%). The mean percentage loss of TRNFL was significantly higher in patients with postoperative BCVA <6/60 (42.63% vs. 24.06%, P = 0.009). Patients with postoperative BCVA <6/60 had a significantly longer mean RD duration (29 days) than those with postoperative BCVA >6/60 (17.5 days) (P = 0.026).Conclusion:When eyes with RRD are successfully repaired using silicone oil tamponade, the thickness of the RNFL decreases, particularly in the macula, and less macular neuronal loss is associated with better visual outcomes.

Anatomical and functional factors influencing the results of scleral buckling procedure for macula-off rhegmatogenous retinal detachments

Background/Aim. Rhegmatogenous retinal detachment is a potentially blinding condition of the posterior segment of the eye. Currently, the only treatment modality is surgery and surgical options include scleral buckling, pars plana vitrectomy and pneumoretinopexy. Many factors may influence the outcome of the surgery. Well defined indications are essential for achieving the best postoperative results. The aim of this study was to assess anatomical and functional outcome of treatment with scleral buckling for macula- off rhegmatogenous retinal detachments. Methods. This prospective, nonrandomized, interventional study included consecutive patients underwent scleral buckling for macula-off retinal detachment in the tertiary centre for vitreoretinal surgery. Results. A total of 168 consecutive patients (mean age 58.2 ? 13.9 years) were included in the study. Postoperatively, anatomical success was achieved in 152 (90.5%) of the patients. Parameters that influenced the anatomical success included the number of retinal breaks (p = 0.040), lens status (p = 0.041), preoperative proliferative vitreoretinopathy (p &lt; 0.001), patients? age (p = 0.049), and marginally, the presence of typical symptoms (p = 0.057). Duration of macular detachment, previous ocular trauma and refraction of the eye did not affect the anatomical result. Functional success was evaluated using the postoperative visual acuity and depended mainly on the duration of macular detachment prior the surgery. Visual acuity 0.4 or better was significantly more often achieved if duration of macular detachment was up to seven days (p &lt; 0.001). Refraction and patients? age did not influence the functional result. Conclusion. Scleral buckling is an efficient surgical procedure for treatment of patients with retinal detachment. Optimal results are achieved if operation is performed within the first seven days of duration of macular detachment.

Subretinal Fluid Levels of Signal-Transduction Proteins and Apoptosis Molecules in Macula-Off Retinal Detachment Undergoing Scleral Buckle Surgery.

To evaluate signal transduction and early apoptosis protein levels in subretinal fluid collected during scleral buckling surgery for macula-off rhegmatogenous retinal detachment (RRD). Our aim was to assess both their relation with RRD features and their influence on the posttreatment outcome. Thirty-three eyes of 33 RRD patients scheduled for scleral buckle surgery were enrolled in the study. Undiluted subretinal fluid samples were collected during surgery and analyzed via magnetic bead-based immunoassay. All patients underwent a complete ophthalmologic evaluation at baseline and at each follow-up visit (months 1, 3, and 6). Moreover, both at baseline and at the postsurgery month 6 visit, the patients were tested by means of spectral-domain optical coherence tomography (SD-OCT) in order to evaluate the average ganglion cell-inner plexiform complex thickness, as well as the photoreceptor inner segment/outer segment junction status. Patients' clinical features (retinal detachment size, detachment duration, and occurrence of proliferative vitreoretinopathy) were associated with several early apoptotic factors (caspase-8, caspase-9, and B-cell lymphoma 2 [Bcl-2]-associated death promoter [BAD]). Furthermore, both early apoptosis factors (caspase-8, Bcl-2, and p53) and signal-transduction proteins (ERK 1/2) were found to influence the postsurgery month 3 OCT characteristics. Signal-transduction proteins and early apoptosis proteins are associated with different clinical features and postsurgery outcomes.

Incidence and risk factors of cystoid macular edema after retinal detachment surgery

PurposeTo evaluate the incidence rate of cystoid macular edema (CME) after uncomplicated primary operation on retinal detachment (RD) and to identify risk factors associated with postoperative CME.MethodsRetrospective interventional case series of consecutive patients that underwent one RD repair either by primary vitrectomy or external procedure during a 3 years period starting on January 2012. Postoperative CME was defined as poor visual recovery associated with intraretinal hyporeflective cysts on optical coherent tomography scans (OCT) engendering central macular thickening.ResultsA total of 403 eyes were studied with a mean follow‐up of 6 months. The incidence of CME was 7% after pars plana vitrectomy (22/317 eyes) and 2.3% after external procedure (2/86 eyes). Risk factors for CME were : a smaller axial length (p &lt; 0.005), a higher duration of macular detachment (p &lt; 0.029), a lower visual acuity at presentation (p &lt; 0.022), an history of posterior capsular rupture (p &lt; 0.01) and the use of cryopexy during surgery (p = 0.035). After 6 month follow‐up CME persisted in 12/24 patients. Mean visual acuity was 0.28 logMAR in eyes without CME versus 0.4 logMAR in eyes with persistent CME.ConclusionsThe incidence of CME after RD repair was 7% after primary vitrectomy, and 2.3% after primary scleral buckling. Patients might benefit from increase use of OCT during follow‐up of retinal detachment surgery to detect macular pathology. Visual prognosis was good in 50% patients.

Duration of rhegmatogenous retinal detachment predicts recovery of retinal sensitivity

The decision to treat a disease is often based on the presence or absence of symptoms, one prototype case being rhegmatogenous retinal detachment. Detachment of the neural retina from the pigment epithelium is a major cause of anatomical and functional dysfunction of the retina, where retinal recovery is inversely related to duration of detachment. The purpose of retinal reattachment is to effect recovery of the photoreceptors and pigment epithelium from degeneration. The aim of this study was to determine the critical duration of rhegmatogenous retinal detachment resulting in optimal retinal recovery after reattachment. A prospective study was conducted at a private hospital in Yogyakarta. Thirty five eyes were involved in this study. Three months after reattachment, central retinal recovery was measured by means of a Goldmann manual kinetic perimeter. The results showed that retinal recovery developed three months after surgery if the onset of rhegmatogenous retinal detachment was less than 28 days before surgery. The results were not significant if the onset of rhegmatogenous retinal detachment was more than 35 days. Although the Goldmann manual kinetic perimeter can efficiently detect central retinal sensitivity, it should be supported by more sensitive tools to evaluate the anatomy and function of the retina.

Visual recovery after retinal detachment with macula-off: is surgery within the first 72 h better than after?

AimsTo investigate the influence of lag time between the onset of central visual acuity loss and surgical intervention of macula-off retinal detachment.MethodsThis retrospective case series examined all consecutively treated eyes...

360° laser retinopexy in preventing retinal re-detachment after 23-gauge vitrectomy for primary repair of retinal detachment

Aims: To evaluate the role of intraoperative 360° laser retinopexy in the prevention of retinal re-detachment in cases of primary rhegmatogenous retinal detachment (RRD). Settings and Design: Prospective randomized controlled trial, 80 eyes of 80 patients with primary RRD. Subjects and Methods: Totally, 80 eyes of 80 patients with primary RRD will be divided into two groups. In Group (A), laser will be applied to all existing breaks as well as 360° laser retinopexy anterior to the equator will be performed while Group (B) laser will be applied only to the retinal breaks and will not receive the 360° laser treatment. Follow-up was for 3 months after clearance of the tamponading agent. Statistical Analysis Used: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474): Duration of detachment and preoperative visual acuity. Specifically, for every day more of duration of detachment, the odds of re-detachment increased by a factor of 1.007 (P < 0.01). Likewise, for every day more of duration of detachment, the odds of re-detachment was increased by a factor of 8.840 if a preoperative visual acuity of hand motion with bad projection (HMBP) or worse was present (P = 0.05). Conclusions: We concluded that prophylactic intraoperative 360° laser retinopexy did not have a statistically significant role in the prevention of retinal re-detachment after primary retinal repair. The statistically significant preoperative risk factors that have a poor prognostic effect on surgical outcomes are preoperative visual acuity of ≤ HMBP or worse and a longer duration of the retinal detachment.

Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature.

To systematically review the influence of the lag time between macula-off retinal detachment and surgical intervention on postoperative visual acuity as main outcome measure. Systematic review and meta-analysis of articles published from 1995 to October 2013 of patients with macula-off retinal detachment and treated with scleral buckling or pars plana vitrectomy. Eligible data were pooled in a meta-analysis, analyzing the odds ratio between different durations of ≤ 3, ≤ 4, ≤ 7, and ≤ 10 days, comparing a final visual acuity of ≤ 0.4 logMAR with >0.4 logMAR, using a random-effects model. Last, the number needed to treat was calculated. Fourteen articles were eligible, of which 9 studies contained data that were suitable for meta-analysis. Patients who were operated with scleral buckling (n = 602) within 3 days since macular detachment had a statistically significant better chance of reaching a final visual acuity of 0.4 logMAR or better compared with a longer duration of macular detachment, with an odds ratio for ≤ 3 days versus 4 days to 7 days of 2.86 (95% confidence interval, 1.37-5.99) and an odds ratio for ≤ 3 days versus >3 days of 3.09 (95% confidence interval, 1.56-6.12), and with a number needed to treat of 4. For pars plana vitrectomy, the limited amount of data precluded a meta-analysis with substantial results. This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome.

Postoperative recovery of visual function after macula-off rhegmatogenous retinal detachment.

PurposeTo determine which factors affect the recovery of visual function in macula off rhegmatogenous retinal detachment (RRD).MethodsIn a prospective study of forty-five patients with a primary macula-off RRD of 24 hours to 6 weeks duration, the height of the macular detachment was determined by ultrasonography. At 12 months postoperatively, best corrected visual acuity (BCVA), contrast acuity, and color confusion indexes (CCI) were obtained.ResultsMacular detachment was present for 2–32 (median 7) days before repair. A shorter duration of macular detachment was correlated with a better CCI saturé (p = 0.0026) and lower LogMAR BCVA (better Snellen visual acuity)(p = 0.012). Also, a smaller height of macular detachment was correlated with a lower LogMAR BCVA (p = 0.0034). A younger age and lower pre-operative LogMAR BCVA at presentation were both correlated with better postoperative contrast acuity in the total group (age: p = 1.7×10−4 and pre-operative LogMAR BCVA: p = 0.0034).ConclusionFunctional recovery after macula-off RRD is affected by the duration and the height of the macular detachment. Recovery of contrast acuity is also affected by age and BCVA at presentation.Meeting presentationARVO annual meeting 2013, May 7, Seattle, Washington, United States of America.Trial registration:trialregister.nl NTR839

Predicting Visual Outcomes for Macula-Off Rhegmatogenous Retinal Detachment with Optical Coherence Tomography

Purpose. We evaluated the ability of novel optical coherence tomography (OCT) parameters to predict postoperative best-corrected visual acuity (BCVA) in macula-off rhegmatogenous retinal detachment (RRD) eyes. Methods. We reviewed the medical records of 56 consecutive eyes with macula-off RRD. Clinical findings were analyzed including the relationship between preoperative OCT findings and 6-month postoperative BCVA. Results. Six-month postoperative BCVA was significantly correlated with preoperative findings including retinal height at the fovea, total and inner layer cross-sectional macular area within 2 mm of the fovea, and preoperative BCVA (P < 0.001, P < 0.001, P = 0.001, and P < 0.001, resp.). Multiple regression analysis revealed that the duration of macular detachment and total cross-sectional macular area were independent factors predicting 6-month postoperative BCVA (P = 0.024 and P = 0.041, resp.). Conclusions. Measuring preoperative total cross-sectional area of the macular layer within 2 mm of the fovea with OCT is a useful and objective way to predict postoperative visual outcome in eyes with macula-off RRD.

Incidence and Pattern of Retinal Detachment in a Tertiary Eye Hospital in Nigeria

Objectives: The aim was to determine the hospital incidence, pattern and clinical presentation of retinal detachment at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all retinal detachment patients seen at the Guinness Eye Center Onitsha between June 1997 and May 2012 were reviewed. Information on age, gender, symptoms duration, type and anatomic location of detachment, presenting visual acuity, and predisposing factors were analyzed. Results: A total of 93 patients (99 eyes) were seen with a male preponderance (M:F = 2:1) and age range 10-89 years; median - 61 years; mode - 55 years; incidence - 0.13%. Rhegmatogenous retinal detachment comprised 93.6%. Symptoms duration was 5 days to 8 years; median - 9 months; mode - 6 months. All the affected eyes had low vision with 79.8% blind; of the unaffected eyes, 40.2% had low vision with 24.7% being blind. Trauma was the precipitating factor in 33 (35.5%) patients. Proliferative vitreoretinopathy, 19 (19.2%) eyes, and lattice degeneration, 13 (13.1) eyes, were the commonest ocular risk factors. Common ocular co-morbidities in the affected eyes were cataract, 13 (13.1%) eyes; uveitis, 9 (9.1%) and glaucoma, 6 (6.1%) eyes. Supero-temporal, subtotal and total detachment constituted 84.8%; the macula was detached in 91.4%. The tears in eyes with rhegmatogenous detachment ranged from 1 to 6, with 51 (54.8%) having multiple tears. 10 (10.8%) eyes had giant tears; 6 (6.5%) had dialysis and 3 (3.2%) had coexisting macula holes; in 73.1% the tears were located in the superior retina. Conclusions: Retinal detachment incidence is low in our hospital; most patients presented late with severe visual loss. A community-based study will provide more information on the magnitude of the problem. Education of the public on retinal detachment symptoms, the predisposing/precipitating factors and the need for early reporting to hospital are required.

Combined phacoemulsification and sutureless vitrectomy for treatment of rhegmatogenous retinal detachment

Purpose: To report the success rate and possible complications of combined phacoemulsification and sutureless 23 gauge vitrectomy for treatment of rhegmatogenous retinal detachment (RRD). Patients and Methods: Thirty patients with RRD were included in the study. All patients were examined for the extent of detachment, number and location of retinal breaks, and degree of proliferative vitreoretinopathy (PVR). Combined phacoemulsification, intraocular lens implantation, 23 gauge vitrectomy, laser retinopexy, and 12% C3F8 injection were done for all patients. All eyes were followed for 3 months. The primary outcome measures were single operation success rate and change in best-corrected visual acuity (BCVA). Any intraoperative and postoperative complications were reported and analyzed. Results: The mean age of the patients was 43.9 ± 10.11 years; mean duration of detachment was 17.3 ± 5.53 days while mean preoperative BCVA measured by logarithm of the minimum angle of resolution (Log MAR) was 2.1 ± 0.71. Single operation success rate was achieved in 25 eyes (83.3%), 5 eyes (16.7%) showed failure of complete attachment after absorption of gas bubble. The mean postoperative BCVA was significantly better than the preoperative value (1.00, 1.1 after 6 weeks and 3 months, respectively, P < 0.01). The most common postoperative complications were reversible corneal edema that occurred in 11 eyes (36.6%), fibrinous uveitis in 8 eyes (26.6%) and posterior capsular opacification in 16 eyes (53.3%). Preoperatively, 1 eye (3.3%) had BCVA ≤1 (Log MAR) in comparison to 17 eyes (56.7%) and 18 eyes (60%) after 6 weeks and 3 months respectively. Conclusion: Combined phacoemulsification and sutureless vitrectomy with gas tamponade is safe and effective single surgical procedure for selected patients with RRD.

Clinical survey and analysis of persistent submacular fluid on optical coherence tomography after surgery for rhegmatogenous retinal detachment

To investigate the incidence, duration and consequences of persistent submacular fluid after pars plana vitrectomy (PPV) and scleral buckling surgery (SB) in rhegmatogenous retinal detachment, thus to explore the clinical association between persistent SMF and different surgical methods, and simultaneously, to study the effect of persistent submacular fluid on visual outcome. It was a retrospective case-series study. Ninety-two qualified eyes including 54 eyes of males and 38 eyes of females with rhegmatogenous retinal detachment which had been performed PPV or SB were recruited. The average age of the patients was (45.8 ± 15.3) years with a age-range from 15 to 76 years. The inclusion criteria was as follows, the macula-off rhegmatogenous retinal detachments without macular hole and obvious proliferative vitreoretinopathy, the retina was completely reattached 1 month after operation and no redetachment was found by ophthalmoscope and B scan till the last follow-up, the minimal follow-up time was 1 year and the submacular fluid must have been dissolved for at least 6 months. All patients underwent thorough ophthalmologic examinations before and after operation, Those patients in whom a persistent submacular fluid was seen on optical coherence tomography (OCT) at 1 month after operation performed follow-up with repeat of the investigations at 3, 6 and 12 months after surgery, If the abnormality resolved, further observations were continued to undertake for 6 months or more till the last follow-up.Rank-sum test, χ²-test and Fisher exact test were applied respectively to analyze for statistical analysis. The incidence of persistent submacular fluid at 1 month after surgery in the PPV and SB group was 13.9% (5/36) and 48.2% (27/56).Six months later however, the figure expressed as percentage was 2.8% (1/36) and 23.2% (18/28) correspondingly. Persistent submacular fluid was more frequent in eyes with inferior breaks (64.3%) than that with superior ones (13.9%), making a significant differences (χ² = 17.38, P < 0.01) . The persistent submacular fluid group showed worse best-corrected visual acuity than no persistent submacular fluid group 6 and 12 months after surgery (t = 2.525, t = 2.254, both P < 0.05). Comparing the visual acuity (VA) between the eyes with or without persistent submacular fluid 6, 12 months after surgery and the latest followed-up among the ever suffered eyes, a statistically significant differences presented in late stages(average VA: 0.47 ± 0.29, 0.30 ± 0.16; 0.44 ± 0.28, 0.27 ± 0.15;0.42 ± 0.22, 0.27 ± 0.19; t = 2.114, 2.207, 2.068; all P < 0.05), though there were no significant differences in the first three months (average VA: 0.70 ± 0.33, 0.63 ± 0.37; 0.50 ± 0.25,0.45 ± 0.22; t = 0.556, 0.601; both P > 0.05). Persistent submacular fluid presents in both surgical procedures but it is more frequent after buckling surgery than vitrectomy, the selection of patients, the location of retinal breaks and the duration of detachment may be the potential influencing factors. Persistent submacular fluid after retinal detachment surgery is responsible for delayed recovery, and may affect the final visual outcome. The longer it lasts, the more harm may it do.