Extent Of Retinal Detachment Research Articles

Risk factors for proliferative vitreoretinopathy after retinal detachment surgery: A systematic review and meta-analysis.

To comprehensively investigate risk factors for proliferative vitreoretinopathy (PVR) after retinal detachment (RD) surgery. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until May 22, 2023. Risk factors included demographic and disease-related risk factors. Odds ratios (ORs) and weighted mean differences (WMDs) were used as the effect sizes, and shown with 95% confidence intervals (CIs). Sensitivity analysis was conducted. The protocol was registered with PROSPERO (CRD42022378652). Twenty-two studies of 13,875 subjects were included in this systematic review and meta-analysis. Increased age was associated with a higher risk of postoperative PVR (pooled WMD = 3.98, 95%CI: 0.21, 7.75, P = 0.038). Smokers had a higher risk of postoperative PVR than non-smokers (pooled OR = 5.07, 95%CI: 2.21-11.61, P<0.001). Presence of preoperative PVR was associated with a greater risk of postoperative PVR (pooled OR = 22.28, 95%CI: 2.54, 195.31, P = 0.005). Presence of vitreous hemorrhage was associated with a greater risk of postoperative PVR (pooled OR = 4.12, 95%CI: 1.62, 10.50, P = 0.003). Individuals with aphakia or pseudophakia had an increased risk of postoperative PVR in contrast to those without (pooled OR = 1.41, 95%CI: 1.02, 1.95, P = 0.040). The risk of postoperative PVR was higher among patients with macula off versus those with macula on (pooled OR = 1.85, 95%CI: 1.24, 2.74, P = 0.002). Extent of RD in patients with postoperative PVR was larger than that in patients without (pooled WMD = 0.31, 95%CI: 0.02, 0.59, P = 0.036). Patients with postoperative PVR had longer duration of RD symptoms than those without (pooled WMD = 10.36, 95%CI: 2.29, 18.43, P = 0.012). Age, smoking, preoperative PVR, vitreous hemorrhage, aphakia or pseudophakia, macula off, extent of RD, and duration of RD symptoms were risk factors for postoperative PVR in patients undergoing RD surgery, which may help better identify high-risk patients, and provide timely interventions.

Orbital Lesion as the Initial Manifestation of a Neuroendocrine Tumour

Laser flare photometry provides a non-invasive and objective measurement of the Tyndall effect in the anterior chamber. The laser flare value (measured in photon number per millisecond [pc/ms]) thus quantifies the extent of disruption to the blood-aqueous barrier and can be used in clinical applications to monitor uveitis therapy or to measure the postoperative degree of inflammation. Standardised performance must be observed during measurement. Publications of the last 35years on laser flare photometry deal not only with the measurement procedure but also with its use in clinical practice for different ophthalmological pathologies. Likewise, various influencing factors have already been investigated and described that must be considered when measuring and evaluating laser flare values. The focus of this article is the relevance of laser flare photometry in retinal pathologies. In recently published studies, the level of objective tyndallometry in primary rhegmatogenous retinal detachment is shown to depend on lens status, symptom duration, and extent of retinal detachment. The greater is the area of the retina affected, the greater the disruption of the blood-aqueous barrier appears to be. Elevated laser flare values have also been considered as a predictor for the development of proliferative vitreoretinopathy (PVR). However, based on current knowledge, this assumption must be put into perspective. According to current data, objective tyndallometry can be used to monitor the progression of intraocular inflammation and to quantify the blood-aqueous barrier, and the values correlate with the extent and anatomical features, as well as the symptom duration in retinal detachment. Many influencing factors have already been identified. But further evaluation is desirable and needed. It is still unclear whether laser flare values can be used in the future as a predictor for sequelae such as PVR development.

Preoperative and Postoperative Factors Affecting Functional Success in Anatomically Successful Retinal Detachment Surgery.

To investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery. Seventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated. The mean age was 53.9 ± 17 years (range, 11-85 years). The mean follow-up period was 36.7 ± 16 months (range, 14-72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes. Early intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.

Association between laser flare photometry and symptom duration in primary rhegmatogenous retinal detachment

PurposeThe purpose of this study was to investigate preoperative blood-ocular barrier disruption via laser flare photometry (LFP) in patients diagnosed with rhegmatogenous retinal detachment (RRD), and to analyse possible associations with symptom duration and anatomical parameters.MethodsWe retrospectively analysed consecutive patients presenting with RRD at a single centre between January 2016 and March 2020. LFP was performed in both eyes after pupillary dilatation prior to RRD surgery. Symptom duration, extent of retinal detachment, and lens status were assessed. For statistical analysis, we carried out the unequal variances t test and Welch’s analysis of variance (ANOVA).ResultsWe included 373 eyes of 373 patients (mean age 63.96 years ± 10.29; female:male ratio 1:1.8). LFP values quantified in photon count per millisecond (pc/ms) increased with longer symptom duration when comparing patients with a symptom duration of 0–3 days (n = 158; 9.25 ± 6.21 pc/ms) and ≥ 4 days (n = 215; 11.97 ± 11.58 pc/ms; p = 0.004). LFP values also rose with the number of retinal quadrants affected by RRD (1 quadrant, 6.82 ± 4.08 pc/ms; 2 quadrants, 10.08 ± 7.28 pc/ms; 3 quadrants, 12.79 ± 7.9 pc/ms; 4 quadrants, 31.57 ± 21.27 pc/ms; p < 0.001), macula off status (macula on, 8.89 ± 6.75 pc/ms; macula off, 12.65 ± 11.66 pc/ms; p < 0.001), and pseudophakic lens status (pseudophakia, 12.86 ± 9.52 pc/ms; phakia: 9.31 ± 9.67 pc/ms; p < 0.001).ConclusionIn RRD patients, blood-ocular barrier disruption quantified by LFP is associated with the duration of symptoms and the disease’s anatomical extent. These results warrant further investigation of the potential clinical use of LFP in RRD.

A hybrid 26G needle drainage technique in scleral buckling: A mini scleral cut-down.

To evaluate the efficacy and safety of hybrid 26-gauge needle drainage in scleral buckling for rhegmatogenous retinal detachment (RRD). In this retrospective study, we included patients who underwent scleral buckling surgery along with subretinal fluid (SRF) drainage using the 'Hybrid 26G needle drainage technique'. Pre-operative assessment included the best corrected visual acuity (BCVA), lens status, and extent of retinal detachment. Intra-operative surgical details such as the height of retinal detachment, number of attempts required to drain the fluid, amount of fluid drained, adequacy of break buckle relationship, and any intra-operative or post-operative complications were noted. Post-operatively, the final visual outcome and retina status were assessed at 3 months of follow-up. A total of 10 eyes with primary RRD and proliferative vitreoretinopathy C1 or less were included. Pre-operatively, the mean BCVA was 2.43 ± 1.01 logMAR units, which improved significantly to 0.679 ± 0.45 logMAR units (p value < 0.05) at 3 months of follow-up. Regarding the extent of RRD, five eyes (50%) had a total detachment, two eyes (20%) had a sub-total detachment, and three eyes (30%) had an inferior detachment. Four eyes had shallow detachment, four had a moderate detachment, and two eyes had bullous detachment. Complete drainage of SRF (>75%) was achieved in five patients, and a partial but adequate drainage (50-75%) was achieved in the rest of the five patients. In none of the patients, inadequate or dry tap was encountered. No intra-operative complications were encountered. The retina was attached in eight out of ten eyes at 1 week and at a 1-month follow-up period. Two patients required pars plana vitrectomy for persistent SRF. The retina was attached in all the patients at 3 months of follow-up. The 'Hybrid needle drainage' technique is a safe and effective technique for SRF drainage in scleral buckling surgery.

Association between blood-aqueous barrier disruption and extent of retinal detachment.

To investigate the association between anatomical features of rhegmatogenous retinal detachment (RRD) and the extent of blood-aqueous barrier disorder measured by non-invasiv laser flare photometry. Retrospective evaluation of consecutive patients with RRD that underwent surgery between November 2016 and October 2018. Descriptive evaluation of pre- and postoperative parameters and correlation to preoperative laser flare value, extent of retinal detachment and re-detachment rate were performed. 266 patients (mean age 62.73 ± 10.40 years, 62.8% male) were included. Mean preoperative flare value was 11.0 ± 11.9 pc/ms. In pseudophakia flare values were higher than in phakia (12.7 ± 10.4 pc/ms versus 9.8 ± 12.9 pc/ms; p = 0.042). Flare increased and correlated significantly with the number of affected retinal quadrants (Q) (1 Q 6.4 ± 3.3 pc/ms; 2 Q 10.5 ± 8.8 pc/ms; 3 Q 15.6 ± 9.1 pc/ms; 4 Q 27.5 ± 33.3 pc/ms; p < 0.001; r = 0.40). Macular status correlated significantly with flare values (macula on 8.6 ± 7.1 pc/ms, off 13.1 ± 15.0 pc/ms; p = 0.004; r = 0.17). The level of objective tyndallometry in RRD seems to be influenced by lens status and extent of retinal detachment. Thus, the greater the affected retinal area is, the more blood-aqueous barrier disruption seems to be present.

Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience

ObjectiveTo describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the characteristics of retinal detachments (RD) at a tertiary centre. DesignRetrospective consecutive case series. ParticipantsOne hundred and ninety eyes of 188 patients with primary, rhegmatogenous RD. MethodsPatients with RD who presented over a 1-year period (September 14, 2019 to September 13, 2020). The relationship between demographic, anatomic, and visual acuity parameters were compared before and after onset of the pandemic using generalized estimating equations. Main Outcome MeasuresMacular status and corrected distance visual acuity on presentation. ResultsOne hundred and eighty-seven eyes, divided into 2 cohorts: pre-COVID (n = 100 September 14, 2019 to March 13, 2020) and post-COVID (n = 87, March 14, 2020 to September 13, 2020). Of the eyes, 63.2% (n = 87) presented with macular detachment in the post-COVID group compared with 45% (n = 100) in the pre-COVID group (odds ration [OR], 2.14; 95% confidence interval [CI],1.19–3.86; p = 0.011). As well, eyes in the pre-pandemic cohort had significantly fewer detached quadrants on initial examination (OR, 0.53; 95% CI, 0.30–0.93; p = 0.026). Patients in the post-COVID group had a significantly worse corrected distance visual acuity at baseline (mean difference [MD] = –0.35 logMAR, 95% CI, –0.60 to –0.09; p = 0.008), but not at 1 month or at final follow-up. No differences were seen between groups with respect to demographics, lens status, treatment, time to presentation, or chronicity. Pneumatic retinopexy was the most commonly performed procedure in both cohorts, with a 71.5% success rate. ConclusionsClosures after the COVID-19 pandemic affected the characteristics of RDs at presentation with respect to macular detachment, extent of RD, and presenting visual acuity. At final follow-up, final visual acuity and anatomic outcomes were similar between the 2 groups. These data are helpful for future patient education, triaging, and treatment decision making.

3D Heads-Up Display vs. Standard Operating Microscope Vitrectomy for Rhegmatogenous Retinal Detachment.

Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting.Design: Retrospective cohort study.Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment.Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months.Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery.Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a “learning curve” of the first 35 eyes (p = 0.49).Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.

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.

Microscope-Assisted ab externo Surgery for the Treatment of Primary Rhegmatogenous Retinal Detachment – New Tech Meets Old Art

Aim: To report the outcomes of ab externo surgery using a surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted ab externo surgery) for rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective study. Consecutive charts of patients with RRD who underwent microscope-assisted ab externo surgery were analyzed. The following demographic parameters were analyzed: age (years), gender (male/female), and eye (right/left). Clinical parameters were axial length (AL) measured in millimeters (mm), preoperative best-corrected visual acuity (BCVA) measured in logarithm of minimum angle of resolution (logMAR), intraocular pressure (IOP), and lens status (phakic/pseudophakic). The parameters of RRD were number and type of retinal breaks, location of retinal breaks, extent of retinal detachment (RD) (number of detached quadrants), and macular detachment (MD), as well as retinal breaks not detected preoperatively. Use of cryopexy, circumferential or segmental scleral buckle, drainage of subretinal fluid, injection of air or gas, and duration of surgery were recorded. The postoperative parameters analyzed were BCVA, IOP and recurrence of RD and postoperative complications. Follow-up was established at 3 months. Results: A total of 213 eyes (97 right, 116 left) of 205 patients (114 males, 91 females) affected by primary RRD were included. Fifty-two eyes (24.4%) were affected by high myopia (AL >26.5 mm), and 160 patients (75.1%) were affected by RRD caused by a single retinal break and involving only one quadrant. The superior quadrant was the most frequently involved (49.3%). Forty-two eyes (19.7%) were affected by MD. In 13 eyes (11.3%), retinal breaks were not detected preoperatively. The duration of surgery was 75.5 ± 42 min. No significant BCVA changes were observed in the whole group, whereas a significant improvement of BCVA from the baseline (2.83 ± 0.87 logMAR) to each time point of follow-up was observed in the subgroup of patients affected by MD. Six eyes (2.8%) developed a recurrent RD, secondary to proliferative vitreoretinopathy (3 eyes) and secondary to a new retinal break (3 eyes). Two eyes developed a persistent vitreous hemorrhage, and one eye developed a macular hole after 1 week. PPV was performed for both. Conclusion: Microscope-assisted ab externo surgery is effective and safe, it reduces discomfort, it allows the surgeon to work with both hands free, and provides an adequate visualization of each step being performed.

Suprachoroidal injection of sodium hyaluronate in the treatment of 12 patients with rhegmatogenous retinal detachment

Objective To observe the retinal reattachment of suprachoroidal injection with sodium hyaluronate in the treatment of rhegmatogenous retinal detachment (RRD). Methods Twelve eyes of 12 patients with RRD diagnosed by the examinations of B-mode ultrasound, binocular indirect ophthalmoscope, OCT and scanning laser ophthalmoscope in West China Hospital of Sichuan University from October 2018 to February 2019 were included in this study. There were 7 males and 5 females, aged from 15 to 66 years, with the mean age of 32.40±14.81 years. There were 4 eyes with BCVA 0.4. The extent of retinal detachment involves 1 to 4 quadrants. All eyes were injected with sodium hyaluronate via suprachoroidal space under non-contact wide-angle system. Surgery was performed by the same ophthalmologist with extensive surgical experience. During the operation, the retinal hole was handled with scleral freezing and laser photocoagulation. The follow-up was 2 months. The retinal reattachment was observed. Results Of the 12 eyes, 6 eyes (50.00%) were anatomically reattached, 4 eyes (33.33%) ere partly anatomically reattached with subretinal fluid, 2 eyes (16.67%) were not reattached. The holes in 4 eyes of partly anatomically reattached with subretinal fluid were located on the choroidal pad and the holes were closed, in addition, the subretinal fluid gradually absorbed over time. Two eyes failed in retinal reattachment received vitrectomy with silicone oil tamponade or sclera buckling surgery. No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits. Conclusion Suprachoroidal injection of sodium hyaluronate is an effective and safe treatment for RRD, which can promote retinal reattachment. Key words: Retinal detachment; Sodium hyaluronate; Suprachoroidal injection

Reviving the lost art of scleral buckling surgery for rhegmatogenous retinal detachment: evaluation of risk factors of detachments, poor physiological outcomes, and perspective from a developing country.

Purpose:To evaluate the primary anatomic and physiological success of scleral buckling surgery for rhegmatogenous retinal detachment and factors influencing its outcomes.Methods:This is a prospective analytical study of 92 eyes that underwent scleral buckling at the Lumbini Eye Institute and Research Center, in Lumbini, Nepal. Parameters evaluated which could influence the outcome of the surgery included the lens status, duration of symptoms, locations of breaks, the extent of retinal detachment, and preoperative proliferative vitreoretinopathy.Results:A total of 92 eyes from 88 patients with rhegmatogenous retinal detachment were evaluated; 68 (74%) eyes were of male and 24 (26%) were of female. The mean time of presentation was 4.71 ± 8.45 months. The overall primary anatomical and physiological success was achieved in 79 (84.9%) and 68 (73.9%) of the cases at 6 months. Sixteen cases developed re-detachment (mean duration of 2.8 ± 1.8 months). Eleven of the cases had a successful anatomical outcome and five of the patients had persistent detachment despite second surgery. In phakic patients, the primary success rate was 92.7% whereas in pseudophakic it was 71.4%. Proliferative vitreoretinopathy 10 (63%) was the most common cause of surgical failure. Bilateral buckling at the same setting was done to two patients—both achieving primary success.Conclusion:Scleral buckling is a very good surgical option for rhegmatogenous retinal detachment and represents a surgical technique worth being trained, performed, practiced, and continued despite advancements in modern vitreoretinal surgical devices and preference for vitrectomy and tamponade agents. It may also be successfully tried in cases of bilateral rhegmatogenous retinal detachment if a doubt regarding compliance for follow-up and surgery for the fellow eye exists.

Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment.

Introduction Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

A novel method for automatic retinal detachment detection and estimation using ocular ultrasound image

This paper presents a novel method for automated detection of retinal detachment from ocular ultrasound image using digital image processing and computational techniques. Retinal detachment (RD) is an ocular emergency in which retina gets detached from the tissues lying underneath it and often requires immediate intervention to prevent rapid, irreversible vision loss. Direct fundoscopy and visual field testing are most common methods for the detection of RD. These methods are difficult to perform and they do not completely rule out retinal detachment. Generally, Ophthalmologists use ocular ultrasound to enhance their clinical acumen in detecting RD. Sometimes it is difficult to extract diagnostic features from ultrasound (USG) images due to its poor quality. Also, noise present in the image would cause misinterpretation during visual inspection;this demands development of intelligent and automated techniques for detection of retinal detachment. Further, the paper proposes a novel frame work for accurate and automatic retinal detachment using image processing techniques and mathematical analysis of detached area contour detected within the ocular globe. Furthermore, the estimation of diagnostic parameters, indicative of retinal detachment is also computed. Based on the mathematical analysis, three such parameters, percentage area of detached retina (PADR) compared to the ocular globe, angular width of detachment (α) and maximum radial distance of detachment to choroid layer beneath it (β), are calculated. These estimated parameters are very useful in determining the exact location and extent of retinal detachment. Results obtained through the proposed retinal detachment detection scheme are validated by the radiologist.

Comparison between the scleral buckling under wide-angle viewing systems and conventional scleral buckling for the treatment of rhegmatogenous retinal detachment

Objective To compare the efficacy between the scleral buckling under wide-angle viewing systems (WAVS) and conventional scleral buckling for rhegmatogenous retinal detachment. Methods The data of 108 eyes of 108 patients with rhegmatogenous retinal detachment was collected and retrospectively analyzed. All cases were randowly divided into two groups: 54 eyes underwent scleral buckling under WAVS (Group A), and 54 eyes underwent conventional scleral buckling under indirect ophthalmoscope (Group B). Preoperatively, the difference were not statistically significant between the two groups in age, gender, course of disease, best corrected visual acuities (BCVA), IOP, refractive error, the extent of retinal detachment, with or without macular detachment, subretinal demarcation line and the number of retinal breaks. The follow-up period was 12 months. Results Durations of operation, primary operative success rate, BCVA and complications were compared between the two groups. The durations of operation in Group A (with or without encircling operation) were obviously shorter than those in Group B (t=-12.735, -18.037; P=0.000, 0.000). The primary operative success rate was 94.44% in Group A and 92.59 %in Group B, the difference was not statistically significant (χ2=0.026, P=0.917). The BCVA in Group A was better than that in Group B (P<0.001) at 1 month after surgery. However, the difference was not statistically significant between the two groups at 3 (t=-1.202, P=0.214), 6 (t=-0.084, P=0.657), and 12 monthes (t=-1.216, P=0.355) follow-up visits respectively. Conclusion The efficacy of scleral buckling under WAVS is good with shorter operative time. It may be an alternative choose for rhegmatogenous retinal detachment. Key words: Retinal detachment, rhegmatogenous; Scleral buckling; Wide-angle viewing systems

Comparison of scleral buckling using wide-angle viewing systems and indirect ophthalmoscope for rhegmatogenous retinal detachment.

To compare the effects of scleral buckling using wide-angle viewing systems (WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment. The study was a retrospective analyses of the medical records of 94 eyes (94 patients) with rhegmatogenous retinal detachment. Among them, 47 eyes underwent scleral buckling using WAVS with endoilluminator (Group W), and 47 eyes underwent scleral buckling using indirect ophthalmoscope (Group I). Surgical durations, primary success rate, best-corrected visual acuities (BCVA), delayed subretinal fluid absorptions and surgical complications were compared between the two groups. At baseline, there were no statistical differences between the two groups in patient's age (P=0.997), gender (P=0.853), symptom duration (P=0.216), BCVA (P=0.389), refractive error (P=0.167), intraocular pressure (P=0.595), the number of retinal breaks (P=0.832), the extent of retinal detachment (P=0.246), subretinal demarcation line (P=0.801), and macular detachment (P=0.811). The follow-up period was 12mo. The surgical durations in Group W (with or without encircling buckling) were significant shorter than those in Group I (P<0.001 respectively). The primary success rate was 94.27% in Group W, which was similar to that in Group I (92.38%, P = 0.931). The BCVA in Group W was better than that in Group I (P<0.001) at 1-month follow-up visit. However, there were no significant differences between the two groups at 3-month (P=0.221), 6-month (P=0.674), and 12-month (P=0.363) follow-up visits respectively. Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month (P=0.045) follow-up visit, but there were no significant differences between the two groups at 3-month (P=0.111), 6-month (P=1.000) and 12-month follow-up visits respectively. Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment.

Proton beam irradiation of choroidal hemangiomas after unsuccessful photodynamic therapy

PurposeTo study the outcome of patients treated for a choroidal hemangioma with proton beam irradiation following unsuccessful PDT and compare the therapeutic results with that of a control group that received proton therapy as a primary treatment.MethodsProton beam irradiation was applied to twelve cases of choroidal hemangioma that had been unsuccessfully treated with PDT (N of sessions: 1–5). Their functional results were compared to those of a control group of 48 cases treated only with proton therapy. The latter were matched (4 to 1) for the duration of symptoms before primary treatment, extent of retinal detachment as well as distance to the macula.ResultsThe mean follow‐up following proton beam irradiation therapy was 28 months [range: 6 months‐5 years] in the PDT group and 41 months [range: 6 months‐10 years] in the control group. In all patients, the retinal detachment and macular edema disappeared following proton therapy. In the study group, final visual acuity was ≤0.1 in 25%, 0.2–0.5 in 25% and ≥0.6% in 50% of cases. Visual acuity improved in 50%, remained stable in 42% and decreased in 8% of cases. In the control group, final visual acuity was ≤0.1 in 4%, 0.2‐0.5 in 38% and ≥0.6 in 58% of cases. Visual acuity improved in 65%, remained stable in 29% and decreased in 6% of cases.ConclusionsProton beam irradiation is a valid therapeutic option after inconclusive results following PDT for choroidal hemangioma. Within the limits of this study, therapeutic results were slightly better for those patients that received proton therapy as a primary treatment.

Encircling Narrow Band versus Buckle for Retinal Detachments with Intrabasal or Unseen Retinal Breaks.

Purpose:To compare the results of narrow encircling band surgery with standard encircling scleral buckling for retinal detachments (RDs) with intrabasal or unseen breaks.Methods:In a retrospective study, eyes with intrabasal or unseen breaks underwent narrow band implantation (group N) or standard encircling buckling plus wide tire placement (group W) and were followed for at least one year.Results:A total of 112 eyes including 39 eyes in group N and 73 eyes in group W were studied. Preoperatively visual acuity of eyes in group N was significantly better (1.55 ± 0.9 vs. 1.93 ± 0.9 logMAR, P = 0.043). The two study groups (N and W) were comparable in terms of the extent of RD (2.8 ± 0.96 vs. 2.8 ± 0.93 quadrants), interval to surgery (88.3 ± 176.4 vs. 71.9 ± 135.4 days) and percentage of visible breaks (56.4% vs. 63%), respectively (all P values > 0.05). More atrophic holes were present in group W and more dialyses were reported in group N. The single operation success rate at 12 months was 69.2% in group N and 74% in group W (P = 0.1). The single operation success rate for eyes with unseen breaks was also comparable (66.7% vs. 85.7%, P = 0.157). Final corrected visual acuity was also similar (0.63 ± 0.44 vs. 0.85 ± 0.69 log MAR). The only factor influencing success rate was the type of retinal breaks (P = 0.04). Type of scleral buckling did not affect the single operation success rate (P = 0.460).Conclusion:Narrow encircling band surgery is a possible option with acceptable single operation success rate for RDs with intrabasal or unseen breaks.

Clinical Utility of Ultra-Widefield Imaging with the Optos Optomap Compared with Indirect Ophthalmoscopy in the Setting of Non-Traumatic Rhegmatogenous Retinal Detachment

Purpose: To evaluate the clinical utility of ultra-widefield imaging as an adjunctive tool in the diagnosis, management, and follow-up of eyes with non-traumatic rhegmatogenous retinal detachment. Methods: Retrospective chart review of patients with a rhegmatogenous retinal detachment who received ultra-widefield imaging with the Optos® Optomap® P200Tx. Comparisons were made between UWF imaging and indirect ophthalmoscopy for features of detachments, including extent of detachment, holes, retinopexy, and related pathology. Results: Thirty-six eyes of 34 patients were included. Preoperatively, ultra-widefield imaging more precisely documented the extent of retinal detachments in the superior, inferior, and nasal quadrants in 13.9% of cases. Ultra-widefield imaging failed to detect retinal holes in the superior and inferior quadrants in 11.1% and 19.4% of cases, respectively. In postoperative imaging, UWF photos did not detect retinopexy which was ophthalmoscopy-visible both superiorly and inferiorly in 19.4% of cases. The mean differences in clock hours of the detachments as documented on the clinical exam compared to ultra-widefield imaging in the superior, inferior, temporal, and nasal quadrants were −0.18 ± 0.84, 0.41 ± 1.16, 0.08 ± 1.08, and −0.13 ± 2.25 hours, respectively. Conclusion: Ultra-widefield imaging is a useful adjunct for documentation of rhegmatogenous retinal detachments and their postoperative repair. However, detection of retinal holes, tears, and postoperative scarring is poor, especially in the inferior and superior periphery.

Physiopathology of neovascular glauoma and preventive Anti VEGF injections

AbstractNeovascular glaucoma is a major complication after proton therapy of uveal melanomas, and is provoked by vasoproliferative agents produced by the tumor or ischemic retina. Risk factors for the presence of an ischemic retina at presentation are largest tumor diameter (LTD) tumor height and the extent of retinal detachment. In a prospective study the efficacy of preventive anti VEGF treatment was estimated following Proton Beam radiotherapy of uveal Melanomas associated with an ischemic retinal detachment. None of the treated cases and 32% of the controlled group developped an neovascular glaucoma. The anti VEGF treatment was completed with and extensive laser photocoagulation of the ischemic retina. Anti VEGF treatment associated to retina photocoagulation appears as valuable therapeutic modality in selected cases of uveal Melanomas following Protom Beam radiotherapy.