Horseshoe Tears Research Articles

Оценка взаимосвязи формы клапанного разрыва и границ витреоретинального сращения при помощи широкоугольной спектральной оптической когерентной томографии и мультиспектрального лазерного сканирования

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Preventive laser treatment of tractional symptomatic retinal flap tears: long-term outcomes

Case monitoring of tractional symptomatic flap tears after laser treatment. From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.

ОЦЕНКА ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ ТЕХНОЛОГИИ КОМБИНИРОВАННОГО МИКРОИНВАЗИВНОГО ЛАЗЕР-ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЛОКАЛЬНОЙ РЕГМАТОГЕННОЙ ОТСЛОЙКИ СЕТЧАТКИ

Objective: To evaluate the efficacy and safety of combined laser-surgical treatment of rhegmatogenous retinal detachment (RRD). Methods: The 32 eyes from 32 patients with a local RRD due to horseshoe tear were enrolled. In addition to standard examination, all patients underwent multispectral laser scanning and wide-field optical coherence tomography (WFOCT) to determine the extention and localization of vitreoretinal tractions (VRT). All patients underwent the combined microinvasive laser-surgical technology of RRD treatment, including YAG-laser excision of the VRT area, pneumatic retinopexy, and barrier laser photocoagulation around the retinal tear after complete retinal attachment (2-3 days). The post-operative examination was performed on days 3 and 7, and in 3, 6, 12, 18, and 24 months. The follow-up period was 2 years. Results: Retinal attachment was achieved in 30 patients (93.8%). The retina did not attach in 2 cases (6.4%) – in a patient with pseudophakia and in a patient who did not follow the recommendations on the proper head position after surgery. The recurrence of retinal detachment occurred in 2 cases (6.7%) as a result of the new tears formation in lower parts of the fundus periphery. The rest of the patients had a stable anatomical and functional result and no recurrence of the disease during the follow-up period. In 2 cases (6.7%) post-operative WFOCT revealed an additional zone of VRT in the adjacent areas to primary retinal tear which could not be visualized when retina was detached. These patients underwent additional barrier laser photocoagulation around revealed areas. No relapses occurred in these patients. Clinically insignificant retinal bleeding was observed in 4 cases (12.5%) during combined laser angiotomy. Full haemostasis was achieved by the 3-mirror contact lens pressure on the eye. Conclusions: The presented technology demonstrates efficiency in 93.8% of cases after a single surgical intervention. The advantage of the technology is the complete elimination of VRT, as the main factor of the disease pathogenesis, which increases the anatomical efficacy of surgery and reduces the risk of recurrence. The micro-invasiveness and low trauma of this type of treatment help to minimize complications and accelerate the rehabilitation of patients. Further study of this technology with a large number of patients and a long follow-up period is required. Keywords: Rhegmatogenous retinal detachment, wide-field optical coherence tomography, vitreoretinal traction, YAG-laser retinotomy, pneumatic retinopexy, barrier laser photocoagulation.

CHARACTERISTICS OF RETINAL DETACHMENT PATIENTS WITH PROLIFERATIVE VITREORETINOPATHY AT Dr. SOETOMO GENERAL ACADEMIC HOSPITAL

Introduction: The aim of this study is to evaluate the incidence and characteristics of retinal detachment patients with proliferative vitreoretinopathy.
 Methods: Retrospective review of medical record from primary retinal detachment (RD) patients with proliferative vitreoretinopathy (PVR) between 2013 and 2017 at Outpatient Department of Ophthalmology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. 
 Result: : The number of RD patients with PVR at Dr. Soetomo General Academic Hospital in 2013-2017 was 80 patients (21%), consisting of 59 men and 21 women with mean of age was 47.5 ± 14.3 years. The characteristics of the subjects were phakic 72.5%, aphakic 1.25%, high myopia 23.75%, history of trauma 18.75% and affected to right eye 60%. Retinal characteristics were break conditions in the retina (located at superotemporal (34%), horseshoe tear (56%), and single break (60%)), macula off (90%), area of detachments were 4 quadrants (43,75%), PVR conditions were grade B PVR (45%), mean duration of RD was 156 days, mean length of surgery waiting list was 61.1 days. The majority of treatment types were vitrectomy (70,4%), majority of tamponade using silicone oil (59.3%), majority of pre-operative and post-operative visual acuity were less than 3 meters counting finger, pre-operative (91.25%) , post-operative 1 month (76%) and 6 months (52.5%), and the majority of post-operative retinal reattachment were 77.3%.
 Conclusion: The results of this study indicate the number of RD patients with PVR was lower than previous studies. Various results of patient characteristics can be used as guidelines for ophthalmologists in determining actions and explaining the prognosis of the disease. Further research with a larger sample size and prospective methods will be better able to provide better results.
 Keywords: retinal detachment, proliferative vitreoretinopathy, characteristic pvr

Navigated Retina Laser Therapy as a Novel Method for Laser Retinopexy of Retinal Tears

To describe the use of a navigated laser system for the treatment of retinal tears. A planned pattern laser retinopexy was performed using a navigated laser photocoagulator incorporating rapid panretinal photocoagulation technology with an individualized target overlay to produce a 3 × 3 square pattern surrounding a horseshoe tear. Institutional review board approval was not applicable for this case. Successful laser retinopexy 360° around the tear was achieved. In select cases, a navigated laser system may be utilized for the treatment of retinal tears. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e206-e209.].

Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights.

To investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone. This institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography imageswere reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed. Ninety-two patients with a mean age of 56±13 years completed the 6 monthsfollow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 monthsand 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047). The incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.

Retinal detachment in albinism.

PurposeTo report the visual and anatomic outcomes of albino retinal detachment (ARD) repair.MethodsCollaborative retrospective analysis of ARD. Outcome measures were number of surgical interventions, final retinal reattachment, and best corrected visual acuity (BCVA) at last follow-up.ResultsSeventeen eyes of 16 patients (12 males; mean age =37.8 years) had the following complications at presentation: macula off (14), total (7) or inferior detachment (5), proliferative vitreoretinopathy (5), detectable break (16), lattice (5), horseshoe tears (9), and giant tear or dialysis (4). Mean number of interventions was 1.8 (range =1–5) and included cryopexy (15) with scleral buckle (11), and/or vitrectomy (8). Mean initial BCVA was counting finger (CF) 1 m and at last follow-up (mean 77 months) CF4m with mean improvement of 4.5 lines (early treatment diabetic retinopathy study) (P=0.05). Intraoperative choroidal hemorrhage occurred in three eyes. The retina was finally attached in 14 eyes, with residual inferior detachment in three eyes with silicone oil in situ. Silicone oil was kept in six of seven eyes because of residual inferior detachment (3) and removal of silicone oil, which led to redetachment (1) or fear of redetachment (2).ConclusionRepair of ARD may require several interventions, with the need to keep silicone oil in several cases due to nystagmus and reduced melanin pigment.

Laser Retinotomy with “Ultra Q Reflex” System for the Prevention of Rhegmatogenous Retinal Detachment due to the Peripheral Horseshoe Tears

Purpose. To evaluate laser retinotomy efficacy in the retinal detachment (RD) due horseshoe tear prevention. Patients and methods. 57 eyes of 54 patients with subclinical retinal detachment due to the peripheral horseshoe retinal tear were enrolled. 26 eyes of 25 patients of main group undergone combined laser technology included a barrier retinal photocoagulation of the local detachment zone, accompanied with deffered Nd:YAG laser retinotomy. The barrier retinal photocoagulation alone was performed on 31 eyes of 29 patients in control group to compare postoperation results. The assessment of the peripheral vitreoretinal interface was carried out by fundus ultrasound scanning, multispectral scanning laser imaging and spectral optical coherence tomography. The efficacy of the laser treatment was estimated by local retinal detachment height and area changes, while the safety was estimated by intra- and post-op complications rate. All patients were examined at the baseline, 1 week, 1, 3, 6 and 12 month follow-up. Results. Both main and control groups undergone barrier laser photocoagulation with complete round demarcation of subclinical local retinal detachment. All twenty five patients of main group achieved successful laser resection of retinal horseshore flap without any evidence of clinically significant complications. YAG-laser retinotomy in patients with retinal horseshoe tear resulted in decreased values of local retinal detachment height and area (in 40 and 38% respectively, p < 0.05). At the 12-month follow-up full retinal adhesion has been achieved in 15 eyes (58%), while partial adhesion has been observed in 7 eyes (27%). Obtained data were significantly lower compared with control group where some sings of retinal detachment progression were appeared (in 11 and 4% respectively, p > 0.05). No evidence of clinically significant complications after laser treatment has been revealed. Conclusions. The obtained data have demonstrated the efficacy and the safety of laser retinotomy in traction component reducing and consequent risk of retinal detachment minimising.

Cost-Utility of Evaluation for Posterior Vitreous Detachment and Prophylaxis of Retinal Detachment

To evaluate the costs and cost-utility of examination for posterior vitreous detachment (PVD) and treatment of associated pathology, and of managing various other peripheral retinal disorders to prevent retinal detachment (RD). A decision analysis model of cost-utility. There were no participants. Published retrospective data on the natural course of PVD, retinal tears, and lattice degeneration were used to quantitate the visual benefits of examination and treatment. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility/ambulatory surgical center (ASC)-based setting. Published standards of utility for a given level of visual acuity were used to derive costs and quality-adjusted life years (QALYs). Cost of evaluation and treatment, utility of defined health states, QALY, and cost per QALY. The modeled cost of evaluation of a patient with PVD and treatment of associated pathology in the facility/hospital (nonfacility/ASC)-based setting was $65 to $190 ($25-$71) depending on whether a single or 2-examination protocol was used. The cost per QALY saved was $255 to $638/QALY ($100-$239/QALY). Treatment of a symptomatic horseshoe tear resulted in a net cost savings of $1749 ($1314) and improved utility, whereas treatment of an asymptomatic horseshoe tear resulted in $2981/QALY ($1436/QALY). Treatment of asymptomatic lattice degeneration in an eye in which the fellow eye had a history of RD resulted in $4414/QALY ($2187/QALY). Evaluation and management of incident acute PVD (and symptomatic horseshoe tears) offer a low cost and a favorable cost-utility (low $/QALY) as a result of the minimization of the cost and morbidity associated with the development of RD, thus justifying current practice standards.

Комбинированная лазерная хирургия клапанных разрывов сетчатки в профилактике гемофтальма

Purpose . To estimate clinical results of combined laser technology of vitreous hemorrhages due to retinal vessels avulsion in horseshoe tears prevention. Material and methods . The surgery was performed in 24 eyes of 22 patients with the presence of the blood vessel in the zone of the retinal horseshoe tear. The combined laser technology included the horseshoe tear barrier laser photocoagulation prior to the blood vessel laser photocoagulation with immediate Nd:YAG-laser vessel dissection. All patients were examined by the standard ophthalmoscopy and novel diagnostic modalities, such as ultrasound, digital retinal imaging and scanning laser imaging of the fundus periphery at the baseline, 1, 3and 12-month follow-up. Results. The complete blood vessel dissection has been achieved in all of 24 eyes. The bridge-vessel laser dissection without hemorrhages was in 15 of 19 eyes. Slight hemorrhages in 4 cases during laser surgery were observed. In all 5 eyes with the adjacent vessel the bloodless dissection was also achieved without intraoperative complications. There was no occurrence of bleeding from the dissected vessels for the entire followup period. Conclusion. The combined laser technology of the vitreous hemorrhages prevention has demonstrated positive clinical results in patients with bridging retinal vessels. In case of the tear progression and the risk of adjacent vessel avulsion repeated combined laser dissection can be performed.

Myopic Retinal detachment

SummaryHalf non traumatic retinal detachment (RD) happens in myopic eyes with a ten folds risk in eyes over three diopters. Most of RD are related with an atrophic round hole or a horseshoe tear in the periphery. Retinal detachments in highly myopic eyes are characterized by the location of the breaks posteriorly to the equator, the presence of para vascular breaks, or the presence of posterior pole RD without break associated with staphyloma or foveoschisis. Treatment of RD is challenging because of the difficulty of placing a posterior buckle, the increased risk of anterior segment ischemia and a higher risk of PVR in case of relapse. Most of patients are treated by primary vitrectomy with the use of dye or triamcinolone to facilitate visualization of posterior hyaloid during cortical vitreous peeling. The primary success rate ranges between 75 and 90% after single procedure using gas tamponnade. Encircling band, macular buckling, or silicone oil are only used if a second procedure is needed.

CLINICAL PRESENTATIONS AND OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN RETINITIS PIGMENTOSA.

To describe the clinical presentations and outcomes of rhegmatogenous retinal detachments (RRD) in eyes with retinitis pigmentosa. A retrospective review of all patients of retinitis pigmentosa with RRD from January 1990 to December 2013 at a tertiary eye care institute. Of total 28,622 patients of retinitis pigmentosa over a 23-year period, 17 eyes of 17 patients had RRD. Mean age at presentation was 34.53 ± 16.42 years (median 32 years). Median duration of decreased vision attributed to RRD was 6 months. Ten eyes (59%) had cataract and 3 eyes (18%) had history of cataract surgery. Thirteen eyes (76%) had inferior retinal detachment; 9 eyes (53%) had lattice with retinal holes; and 8 eyes (47%) had atrophic retinal holes. There were no horse-shoe tears, giant retinal tears, dialysis, and macular holes related RRD. Majority (82%) of retinal breaks were in the inferotemporal quadrant. Only 3 eyes (18%) had proliferative vitreoretinopathy at presentation. Twelve eyes at presentation had best-corrected visual acuity <20/200 and 6 eyes had only light perception. The macula was involved by the detachment in all cases. Mean preoperative visual acuity was 1.4 ± 0.88 logarithm of the minimum angle of resolution (median 1.3, range 3-0.1; 20/502). Surgery was not advised in 6 eyes (35% patients); 5 eyes (30%) underwent scleral buckling and 6 eyes (35%) underwent vitrectomy. Median follow-up was 5 months. Reattachment rate at last follow-up was 91% (15 eyes). Mean postoperative best-corrected visual acuity recorded was 1.06 ± 0.8 (median 1, range 3-0.1; 20/229) (P = 0.15). Eight eyes at last visit had best-corrected visual acuity <20/200. Of the 11 eyes operated, 4 improved in vision and 7 retained the preoperative vision. The incidence of RRD in retinitis pigmentosa is very low. Presentation, although delayed, is at a younger age. Horse-shoe tears and proliferative vitreoretinopathy are uncommon; cataract is a common coexisting pathology. Surgical reattachment rates appear high and recurrent RRD is uncommon. However, visual gain is limited by the underlying retinal degenerative condition.

Comparative analysis of the characteristics of bilateral rhegmatogenous retinal detachment

To investigate the characteristics of bilateral rhegmatogenous retinal detachment (RRD) in a hospital-based population. Six hundred and three patients diagnosed with bilateral RRD in the Beijing Tongren Hospital between January 2000 and January 2014 were identified and included into the study. The clinical features including the age when retinal detachment occurrence, time interval between the occurrence of the bilateral RRDs, predisposing characteristics such as myopia, trauma, et al. were recorded by a chart review. Out of 8 283 patients treated for primary RRD in the study period, (7.30±2.45)%(603 patients) developed a RRD in the contralateral eye, with a mean age of (30.76 ± 15.31)years (range: 2-68) when the first RRD occurred. 4.8% of the patients primarily presented with a simultaneous bilateral RRD. Most RRD occurred firstly in the left eye (52.90%). Compared with the follow eye, the first RRD occurred with more macula detachment (P=0.03, OR: 1.59, 95%CI: 1.04-2.45) and retinal proliferation (P=0.04, OR: 1.57, 95% CI: 1.02-2.42), the visual outcome was more worse. Mean interval between the bilateral RRDs was (3.73±7.05) years (mean±standard deviation, range: 0-56 years) The younger, more severe symptoms of the firstly occurred RRD, the shorter interval between the bilateral RRD. Time interval between the bilateral RRD was shorter in those RRD firstly occurred with macula detachment, giant tears, horse-shoe tear, located in the temporal superior region, or with retinal degeneration. Compared with highly myopic eyes, the interval between the bilateral RRD were shorter in moderately myopic eyes. For patients newly diagnosed with RRD, regardless of age, are required to a lifelong follow-up for the contralateral eye, especially within one year. Patients who were young, with heavier symptoms, low to moderate myopia or present with retinal degeneration, should be closely followed up in a short time after the first RRD occurred.

Prognostic Factors of Anatomical Success in Scleral Buckling for High Myopic Rhegmatogenous Retinal Detachment

Purpose: To assess the prognostic factors associated with anatomical success of scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) in high myopia patients. Methods: The medical records of RRD in highly myopic eyes treated with SB from January 2009 to December 2013 were reviewed retrospectively. Cases with history of intraocular surgery including phacoemulsification and vitrectomy were excluded. Correlations between anatomical success and the parameters of age, sex, preoperative visual acuity, axial length, presence of large tear, presence of horseshoe tear, the number of tears, involved fovea, and extent of detachment were analyzed. Results: This study included 80 eyes of 80 patients. Average age and axial length were 32.3 ± 13.4 and 26.753 ± 0.961 mm, respectively. Sixty-nine eyes (86.3%) were reattached following primary surgery. Univariate analysis revealed that age (p = 0.011), presence of large tear (p = 0.002), and presence of horseshoe tear (p = 0.044) were correlated with anatomical success after SB. Based on multivariate logistic regression analysis, age was the sole independent prognostic factor (odds ratio = 1.086, 95% confidence interval = 1.022~1.154, p = 0.004). Conclusions: A younger age is associated with a higher rate of primary anatomical success of SB for RRD in highly myopic eyes. In young, highly myopic patients with RRD, SB should be considered as the primary procedure. J Korean Ophthalmol Soc 2016;57(10):1586-1591

PRIMARY SCLERAL BUCKLING FOR PEDIATRIC RHEGMATOGENOUS RETINAL DETACHMENT.

To evaluate the anatomical outcomes of primary scleral buckling (SB) procedures for pediatric rhegmatogenous retinal detachments. Retrospective consecutive case series. One hundred and four eyes of 99 consecutive nonselected pediatric patients undergoing primary SB were identified. Baseline factors recorded were demographics, presenting clinical examination findings, previous ocular surgery, predisposing factors. Intraoperative factors recorded were the type of buckle, number and distribution of retinal breaks, number of retinal quadrants detached, macular status (involved vs. uninvolved), the use of subretinal fluid drainage, and surgical complications. Anatomical reattachment rate at last follow-up. Subgroup analysis was carried out to identify any predisposing factors for failure of primary surgery, effect of age on outcome, intraoperative pathology, effect of posterior versus anterior SB, and redetachment and secondary-procedure complications specific to SB. The initial surgery was segmental SB alone in 87 eyes (83.6%). Retinal reattachment was achieved with 1 operation in 73% (76 of 104 eyes). Of the 28 cases that redetached, 14 eyes underwent a repeat SB procedure (success rate of this second operation: 85.7% [12 of 14 eyes]), 13 eyes underwent vitrectomy (success rate of this second operation: 38.4% [5 of 13 eyes]), and 1 case was not reoperated. Overall, the final success rate was 94% (98 of 104 eyes). Factors associated with a statistically significant increased risk of failure included more than one break; three or more quadrants of detachment; horseshoe tears; no breaks seen on preoperative examination; Stickler syndrome. In selected cases, primary SB is an effective treatment for pediatric, rhegmatogenous retinal detachment.

Clinical characteristics of familial exudative vitreoretinopathy associated rhegmatogenous retinal detachment

Objective To investigate the clinical characteristics and surgical management of the familial exudative vitreoretinopathy (FEVR)-associated rhegmatogenous retinal detachment (RRD). Methods Retrospective noncomparative case series. Thirty-three eye of 32 patients were diagnosed FEVR-associated RRD by Fluorescein fundus angiography. There were 26 males and 6 females. The male to female ratio is 4.3∶1 with an average age of 19.35±8.83 years. The detection of best corrected visual acuity (BCVA), refraction status, fundus photograph and fluorescein fundus angiography(FFA)were underwent in all patients. FEVR was confirmedby FFA and positive family history. The BCVA, refraction status, morphology of retinal detachment, location, size and shape of retinal hole, presence and grade of proliferative vitreoretinopathy (PVR), and subretinal proliferation were recorded. Results As for the refractive status, the scope of refraction was + 2.0 D to -13.0 D andthe BCVA were range from light perception to 0.7. Atrophy holes which located at the temporal half were responsible for retinal detachment in all cases. Besides, horseshoe tears were noted in 6 eyes (18.18%), while macular tears were noted in 2 eyes of RRD (6.06%). The PVR greater than stage C2 was noticed in 10 eyes (30.30%), while subretinal proliferation was presented in 23 eyes (69.70%). Conclusions Male predominance, juvenile onset and associated with moderate to high myopia are the main characteristics in FEVR-associated RRD. Atrophy holes at the temporal half and the subretinal proliferations were most commonly in FEVR-associated RRD. Detailed fuduns and FFA examination of the fellow eye should be undergone to avoid misdiagnosis. Key words: Retinal diseases/congenital; Retinal detachment/diagnosis; Fluorescein angiography; Diagnostic imaging

Demarcation laser photocoagulation induced retinal necrosis and rupture resulting in large retinal tear formation

Retinal tears after laser photocoagulation are a rare complication that occurs after intense laser. It is talked about among retina specialist occurring particularly at the end of a surgical case while applying endophotocoagulation; to the best our knowledge, there are no reports in the literature of a large retinal tear induced after attempted in-office demarcation laser photocoagulation (DLP) that simulated a giant retinal tear. DLP has been employed in the management of selected cases of macula sparring rhegmatogenous retinal detachment (RRD). Even though extension of the retinal detachment through the "laser barrier" is considered a failure of treatment, few complications have been described with the use of this less invasive retinal detachment repair technique. We describe a case of a high myopic woman who initially was treated with demarcation laser photocoagulation for an asymptomatic retinal detachment associated with a single horseshoe tear and a full thickness large retinal tear was created where the laser was placed. Intense laser photocoagulation resulted in abrupt laser induced retinal necrosis and rupture creating this large retinal break. Proper laser technique should reduce the risks associated with this procedure.

Scleral buckling surgery using multiple radial buckles: A valid option?

PurposeTo determine whether radial buckling surgery using two or more radial buckles with or without circumferential silicone tires is still a treatment option for rhegmatogenous retinal detachment (RRD) in the current scenario. MethodsRetrospective chart review. Patients with RRD with two or more horse-shoe tears with/without proliferative vitreoretinopathy up to grade C1 who underwent buckling surgery using at least two radial buckle segments without encircling bands or drainage and with at least a 3year follow up were included in the study. Data collected included demographics, corrected distance visual acuity (CDVA) at baseline and final follow up, details of the examination, surgical procedure(s) and complications noted, if any. Appropriate statistical analysis was done. Statistical significance was set at p<0.05. Outcome measuresProportion of patients who had an attached retina at final follow up, improvement in CDVA and complications. Results25 patients (25 eyes; 12 males and 13 females; 9 pseudophakic) were included. Median age35.15±8.32years. Median baseline CDVA: 1.97±1.12 logMAR. Median final CDVA: 0.65±0.37 logMAR (significant improvement). Most common presenting complaint was decreased vision (87.5%). Number of radial buckle segments placed varied between 2 and 4 per eye. One patient required vitrectomy for persistent retinal detachment. One required buckle removal for infection 5years after the primary procedure. One patient required strabismus surgery. Median follow up12.25years±2.14years. None of the other patients had any complications. ConclusionRadial buckling surgery (two or more segments) is a reasonably safe and valid alternative to vitrectomy for RDs with multiple breaks in different planes.

Clinical observation of persistent submacular fluid after scleral buckling surgery

Objective To observe the occurrence and evolution of persistent submacular fluid (SMF) after scleral buckling surgery (SB) in rhegmatogenous retinal detachment,and then to study the related factors of persistent SMF and the effect of persistent SMF on visual outcome.Methods Ninety eyes of 89 patients with rhegmatogenous retinal detachment which had been performed SB were included in this study.Best corrected visual acuity (BCVA),intraocular pressure,slit-lamp microscopy,three mirror contact lens,indirect ophthalmoscopy and B-scan ultrasonography were measured for all patients.There were 21 eyes with atrophic holes while 42 eyes with horse-shoe tears,22 eyes with old retinal detachment while 68 new suffered eyes.Thirty-two eyes underwent scleral encircling surgery (SE) and 58 eyes underwent segmental scleral buckling surgery (SSB).The patients were divided into SMF group and non-SMF (NSMF) group according to the results of optical coherence tomography (OCT) at 1 month postoperatively.Thorough ophthalmologic examinations were performd at 1,3,6 and 12 months after surgery to the patients,further observations were continued to carry out unless the abnormality had resolved for at least 6 months.Results Patients who underwent SE (20 eyes,62.5 ％) had a higher incidence of persistent SMF at 1 month after surgery than those who underwent SSB (23 eyes,39.7 ％),the difference was significant (x2 =5.024,P＜ 0.05).Persistent SMF was more frequent in eyes with atrophic holes (66.7％) than that with horseshoe tears (38.1％),the difference was significant (x2 =4.582,P＜0.05).Persistent SMF was found in 72.7％ old retinal detachment eyes and in 39.7％ new suffered eyes,showed a striking differences (x2=7.264,P＜0.01).There was no significant difference in BCVA among SE and SSB groups at every time point (t=0.659,0.699,1.108,1.037,1.902; P＞0.05).The SMF group have a similar BCVA with NSMF group 1 and 3 months after surgery (t=1.812,1.957; P＞0.05),whereas the SMF group showed worse BCVA than NSMF group from since 6 months after surgery (t=2.324,2.147,2.184; P＜0.05).Conclusions Persistent SMF is more frequent after SE than SSB,the type of retinal breaks and old retinal detachment may be the potential influencing factors.Persistent SMF after SB may affect the final visual outcome. Key words: Retinal detachment/surgery; Tomography, optical coherence; Subretinal fluid; Scleral buckling

Donor tissue characteristics in preparation of DMEK grafts.

The aim of the study was to determine donor tissue characteristics that contribute to longer peeling times or tissue tears during peeling during Descemet membrane endothelial keratoplasty (DMEK) graft preparation. The data analyzed included donor age, gender, postmortem tissue age, contralateral eye data, peel time, and peel complications of 116 consecutive DMEK donor tissues, which were prepared by a single surgeon with the submerged cornea using backgrounds away (SCUBA) technique. The mean peel time was 10.1 ± 3.3 minutes (range, 6-24 minutes). Tears were noted in 7 cases (6%) and occurred more commonly with longer peel times. Three of the torn grafts had either peripheral tears or small, noncentral buttonholes or horseshoe tears and were successfully transplanted, for a transplant rate of 97%. However, the host stroma in these cases took longer to clear postoperatively. The donor gender and postmortem day of peeling did not have any statistical significance for the peeling time or tear rate (P > 0.05). Interestingly, tissue from donors older than 65 years had slightly faster peel times, but this difference did not reach statistical significance (≤65 = 11.0 ± 4 minutes; >65 = 9.3 ± 3.1 minutes; P = 0.07) and had equal rates of graft tears (6%). Most importantly, however, there was a strong correlation between peel times for the 2 eyes from the same donor (r = 0.78, P = 0.03), and the risk of a tear during peeling in the second eye was much greater if the first graft also had a tear during preparation (odds ratio = 7.2, P = 0.02). Exclusion of the contralateral eye tissue when there was difficulty in graft peeling for the first eye may prove to be a unique quality of DMEK donor tissue.