Horseshoe Tears Research Articles

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens.

To investigate the clinical characteristics, treatment methods and outcomes of rhegmatogenous retinal detachment (RRD) in highly myopic eyes with implantable collamer lens (ICL). High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed. Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient. A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included. The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo (range, 1-60mo). At the initial visit for RRD, giant retinal tear (GRT), horseshoe tear, simple round hole, and horseshoe tear combined with round hole were detected in 3, 3, 2, and 1 eye(s), respectively, with macula-off in eyes. Eight patients received surgical treatment, and one patient was treated by retinal laser photocoagulation alone. The ICL was preserved in 7 eyes. At the last follow-up, the mean best corrected visual acuity (BCVA) improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR (P=0.035), and no case of recurrent retinal detachment was found. The morphological presentation of retinal breaks is diverse in this study. The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data, companied with acceptable visual and anatomical outcomes.

Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital.

Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. A total of 87 patients were identified-mean age of 60 ± 12years and 54% female. Follow-up ranged from 1week to 11months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.

IMAGING RHEGMATOGENOUS RETINAL LESIONS AND PERIPHERAL VITREORETINAL INTERFACE WITH WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY.

Analyze the peripheral vitreoretinal interface with widefield optical coherence tomography. Retrospective chart analysis and widefield optical coherence tomography in 120 consecutive cases of rhegmatogenous pathology. There were 166 lesions in 120 eyes, including 106 horseshoe tears, 22 operculated holes, 30 nonoperculated holes, six giant tears, and two peripheral lamellar defects followed for 6.1 ± 1.2 months. Posterior vitreous detachment was present in all eyes (101/101, 100%) with tears and operculated holes, but only in 5/19 eyes (26.3%) with nonoperculated holes ( P < 0.001). Axial vitreous traction was evident at the anterior edge of horseshoe tears (106/106, 100%), but not the posterior border (18/106, 17%, P < 0.001). Operculated holes located posterior to the vitreous base were free from vitreous traction, displaying a morphology similar to the macular hole. Nonoperculated holes were farther anterior with signs of tangential traction in 23/30 (76.7%) cases. Peripheral vitreoschisis was more often associated with nonoperculated holes (25/30, 83.3%), than horseshoe tears (17/106, 16%; P < 0.001). Horseshoe tears and nonoperculated holes were more often associated with retinal detachment (58/106 [54.7%] and 15/30 [50%], respectively) than operculated holes (5/22, 22.7%), P = 0.023. Peripheral vitreoretinal interactions are similar to vitreomaculopathies, with axial and vitreoschisis-related tangential traction playing different roles in different rhegmatogenous pathologies. Peripheral optical coherence tomography improves understanding of pathophysiology and risks of retinal detachment.

Выяснение взаимосвязи между формированием регматогенной отслойки сетчатки и проведенной ИАГ-дисцизией вторичной катаракты

Aim. Retrospective analysis of case histories of patients operated at Khabarovsk branch of S. N. Fedorov “NMRC “MNTK “Eye microsurgery” for rhegmatogenous retinal detachment in 2013–2016, who had previously undergone Nd:YAG laser posterior capsulotomy. Methods. Method of continuous sampling was used. During the study period, 19 cases of retinal detachment were identified in patients who had previously undergone Nd:YAG laser posterior capsulotomy. There were 5 women (26 %), 14 men (74 %). Mean age of patients was 63±0.5 years (from 59 to 65 years). Probable causes of retinal detachment development were analyzed. Results. It was revealed that in the early postoperative period development of retinal detachment is caused by formation of retinal horseshoe tears and more often in patients with hyperopia, emmetropia and myopia of low degree. In the late postoperative period, development of retinal detachment is associated with progression of predictively dangerous forms of peripheral retinal degeneration and more often in patients with high myopia. Conclusion. Thorough examination of periphery of the retina in early and late postoperative periods and carrying out barreer laser coagulation of the retina are measures of prevention of retinal detachment after Nd:YAG laser posterior capsulotomy. Key words: secondary cataract; Nd:YAG laser posterior capsulotomy; retinal detachment.

The Sensitivity of Ultra-Widefield Fundus Photography Versus Scleral Depressed Examination for Detection of Retinal Horseshoe Tears

Ultra-widefield (UWF) imaging is commonly used in ophthalmology in tandem with scleral depressed examinations (SDE) to evaluate peripheral retinal disease. Because of the increased reliance on this technology in tele-ophthalmology, it is critical to evaluate its efficacy for detecting the peripheral retina when performed in isolation. Therefore, we sought to evaluate UWF imaging sensitivity in detecting retinal horseshoe tears (HSTs). Retrospective clinical validity and reliability study. A single-institutional retrospective analysis was performed on patients at the Shiley Eye Institute, University of California, San Diego. Patients with HSTs seen on SDE who underwent treatment with laser were included in the study. A total of 140 patients with HSTs in the right and/or left eyes met the inclusion criteria. Those with concomitant ruptured globes, retinal detachments, and vitreous hemorrhages were excluded. A total of 123 patients with 135 HSTs were included in the final analysis. The primary outcome was the number of HSTs detected by UWF imaging. A secondary outcome was HST location. Sensitivity was measured with respect to HST location, and statistical significance was calculated by Fisher exact testing. A total of 69 (51.1%) HSTs were visualized on UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF imaging in capturing HSTs was 7 of 41 (17.1%), 8 of 25 (32.0%), 7 of 14 (50.0%), and 47 of 55 (85.5%) for the superior, inferior, nasal, and temporal quadrants, respectively. Sensitivities between HST visibility and location were statistically significant (P < .001). Nearly half of HSTs were missed by UWF imaging. This study demonstrates that UWF imaging alone is not sufficiently sensitive to exclude the presence of HSTs.

Clinical Outcomes of Symptomatic Horseshoe Tears After Laser Retinopexy.

Purpose: To determine the clinical course of patients treated for acute symptomatic horseshoe retinal tears (HSTs). Methods: A retrospective chart review was performed of patients presenting between January 2014 and December 2021 with acute onset of floaters and/or flashes who were found to have horseshoe retinal tear HRT(s) without retinal detachment (RD). Patients were included if they had at least 3 months of follow-up. Exclusion criteria were a rhegmatogenous RD (RRD) at initial presentation, asymptomatic HST(s), operculated hole, atrophic hole, retinal dialysis, history of trauma, or previous retinal surgery. Charts were reviewed for subsequent new HST(s), progression to RRD, and development of epiretinal membrane (ERM). Characteristics, including age, sex, eye laterality, phakic status, high myopia, lattice degeneration, and vitreous hemorrhage (VH) at initial presentation, were also noted. The main outcome measures were the percentage and timing of subsequent new HST(s), progression to RRD, and development of ERM. Results: The study included 216 eyes (199 patients). The mean age was 60.4 years. Of the eyes, 27.3% had lattice degeneration and 6.5% high myopia. At presentation, 25.9% of eyes had a VH. Twenty-seven eyes (12.5%) experienced new tear(s); 63.0% occurred between 1 month and 3 months. Progression to RRD occurred in 15 eyes (6.9%); 53.3% occurred within 3 months. On multivariate logistic regression, VH was a significant risk factor (odds ratio, 6.48; P = .002) for progression to new HST(s) or RRD. Conclusions: Eyes treated for acute symptomatic HSTs require ongoing follow-up. Although new retinal tears and progression to RRD tends to occur within 3 months, these events can occur later.

Horseshoe retinal tear: factors that determine the risk of developing rhegmatogenous retinal detachment

This study aimed to determine the main risk factors for RRD development based on the analysis of the condition of vitreoretinal interface in the area of horseshoe tears, both isolated and those that resulted in retinal detachment. A total of 88 patients with horseshoe retinal tears (43 patients with RRD due to the horseshoe tear and 45 with isolated horseshoe tears) were included in the study. All patients underwent wide-field multispectral laser scanning and optical coherence tomography to determine the shape of the horseshoe tear and the extent of vitreoretinal adhesion (VRA). Cluster analysis was used to differentiate horseshoe tears by shape. Spearman's correlation analysis was used to identify the relationship between the shape of the horseshoe tear and localization of VRA. Spearman's correlation analysis revealed a strong negative correlation between the length-to-width ratio of the horseshoe tear and the extent of VRA. Cluster analysis helped determine four shapes of horseshoe tears, each corresponding to a certain localization of VRA. Analysis of RRD risk, depending on the characteristics of the horseshoe tear, showed that the most significant risk factor for the development of RRD is the presence of a horseshoe tear with width greater than its length, which is characterized by a larger VRA area. The study established that the larger the horseshoe tear width and the smaller its length, the larger the VRA area and, consequently, the higher the risk of RRD development. Horseshoe retinal tears with a length-to-width ratio of less than 1/1 are the most dangerous in terms of RRD risk, which is important to consider when selecting the treatment tactics.

Reusable Fundus Model for Laser Retinopexy Simulation and Training.

To describe a simulation technique for laser barrier retinopexy as an option for ophthalmologists in training to practice slit lamp and laser indirect ophthalmoscopy (LIO) retinopexy. A commercially available fundus model and laser printer labels were used to simulate laser retinopexy of horseshoe tears (HST). At two time points, seven first-year residents and seven second-year residents were asked to complete three rows of laser burns around HSTs and the times were recorded. Second-year residents completed simulated retinopexies in less time than first-year residents on both the slit lamp (P = .001) and with LIO (P = .001). Second-year residents were also statistically more efficient when retested at the second time point (P = .003 and P = .005, slit lamp and LIO, respectively). This novel educational model is able to capture differences in training level and increased experience among ophthalmology trainees, and may be beneficial as part of a structured teaching program. [Ophthalmic Surg Lasers Imaging Retina 2022;53:606-609.].

Retinal Detachments Associated With Topical Pilocarpine Use for Presbyopia

To present a case series of retinal detachments associated with the use of pilocarpine for presbyopia. Multicenter case series of 3 eyes from 2 patients. Patient 1, a 47-year-old man, presented with flashes and floaters in both eyes. The patient had started pilocarpine 1.25% drops 1 month prior for presbyopia in both eyes. He noted the onset of flashes and floaters 3 days after he initiated the drops. A dilated examination revealed an inferotemporal retinal detachment in the right eye with an associated retinal tear inferotemporally. The left eye demonstrated a retinal detachment in the superior quadrant with an associated horseshoe tear at 12 o'clock. Patient 2, a 46-year-old man, presented 5 weeks after initiating topical pilocarpine 1.25% drops for presbyopia. He noted a nasal visual field defect in his left eye that progressed to include his central vision. A dilated examination revealed a superior retinal detachment from 11 to 3 o'clock with subretinal fluid extending into the macula. Pilocarpine and other miotics have long been suspected to be associated with an increased risk of retinal detachment. Prior to prescribing pilocarpine for presbyopia, physicians should inform patients of this potential adverse event and consider that these patients undergo a screening dilated examination, particularly if they are myopic, to determine if they are at higher risk for retinal detachment. Before the initiation of therapy, patients should be appropriately informed regarding symptoms of retinal tears or detachment, which include flashes, floaters, and visual field loss.

Модифицированная комбинированная лазерная ангиотомия при клапанных разрывах сетчатки в профилактике гемофтальма

Purpose. To compare the efficacy and safety between modified laser angiotomy and classical combined angiotomy. Material and methods. Treatment outcomes of 51 patients (51 eyes) with horseshoe retinal tear complicated by the presence of retinal vessels in the area of the tear were analyzed. The patients were divided into two groups: a retrospective group (n= 36) which were treated by classical combined angiotomy and a prospective group (n= 15) treated by modified angiotomy. In addition to standard examination, all patients underwent optical coherence tomography (OCT) to identify vitreoretinal traction fixed to the vessel. Efficacy and safety were compared between technologies, including the rate of vitreous hemorrhages, the laser parameters, and the rate of complications. The follow-up period was 6 months. Results. Analysis of OCT scans revealed vitreoretinal fixation in the area of the retinal tear flap, also associated with a bridge vessel in all patients. During photocoagulation of a retinal vessel, choroidal bleeding was noted in 2 cases in the first group and in 1 case in the second group. During the YAG-laser angiotomy, this complication occurred in 3 cases in the first group and was absent in the second group. There were no vitreous hemorrhages in both groups during follow up period. Conclusion. Retinal vessel coagulation followed by YAG laser angiotomy is a reliable way to prevent vitreous hemorrhages in patients with peripheral retinal tears complicated by the presence of retinal vessels. The proposed modification of laser angiotomy, which consists in coagulation of a segment of the retinal vessel with an intact area of 0.05-1.0 mm in its middle and YAG laser angiotomy in the center of this area, allows the use of fewer pulses with lower pulse energy, which appears to reduces rate of choroidal bleeding. Keywords: horseshoe tear, angiotomy, vitreous hemorrhage, vitreoretinal traction.

Vitreoretinal specialists compared with residents on outcomes of primary laser retinopexy in preventing retinal detachment in 958 eyes

ObjectiveRetinal tears are the most common vitreoretinal (VR) emergency and retinopexy aims to reduce the risk of rhegmatogenous retinal detachment (RRD). Currently retinal laser is a required competence by the...

The development of epiretinal membrane following rhegmatogenous retinal detachment repair: incidence, risk factors, and outcomes.

To investigate the incidence, risk factors, and visual outcomes of epiretinal membrane development following rhegmatogenous retinal detachment repair. This was a retrospective study of 309 eyes that underwent initial surgery for primary uncomplicated rhegmatogenous retinal detachment. Examinations were conducted preoperatively and then postoperatively at 1, 3, 6, and 12 months. The study patients were categorized into two groups depending on the presence or absence of the epiretinal membrane. The incidence of postoperative epiretinal membrane was 28.5%; 42.7% of these patients had severe epiretinal membrane development and therefore underwent the epiretinal membrane removal. Logistic regression analyses revealed that giant retinal tears (OR: 2.66; 95% CI: 1.045-6.792, p=0.040) and horseshoe tears (OR: 0.534; 95% CI: 0.295-0.967, p=0.039) were the significant predictors of postoperative epiretinal membrane. Triamcinolone acetonide staining was significantly associated with the prevention of epiretinal membrane (p=0.022). A total of 34 patients showed a better or an equal final best-corrected visual acuity; of which 4 eyes were evaluated at the final follow-up visit and exhibited a reduced best-corrected visual acuity. Our analysis demonstrated that horseshoe tears and giant retinal tears represent the risk factors for the postoperative epiretinal membrane. Triamcinolone acetonide staining had a significant preventive effect on the postoperative epiretinal membrane. Furthermore, a second round of pars plana vitrectomy, including membrane removal, led to a significant improvement in the final best-corrected visual acuity as per the last follow-up examination, albeit the recovery was limited.

Rhegmatogenous retinal detachment in Coats\u2019 disease: a case report

BackgroundCoats’ disease was originally defined as a unilateral idiopathic exudative retinopathy in young males, characterized by abnormal retinal vascular telangiectasia with intraretinal and subretinal lipid exudation. The retinal detachment is usually exudative. Herein, we describe a case of rhegmatogenous retinal detachment with detectable retinal break in a patient with Coats’ disease.Case presentationA 15-year-old Indo-Aryan male patient presented with sudden painless diminution of vision in his right eye of 4 days duration. Upon examination, the anterior segment in both eyes and left fundus was within normal limits. Dilated fundus evaluation of the right eye revealed telangiectasia of the retinal vessels, with subretinal exudation in superotemporal and superonasal quadrants and presence of subretinal fluid in the superotemporal area extending into fovea. There was also presence of single flap horseshoe tear in the superotemporal quadrant at around the 10 o’clock position in the equatorial region, with no secondary changes. The retina was reattached with encircling band buckle combined with vitrectomy and silicon oil tamponade. Seven months post vitrectomy, lenticular opacification developed, for which he underwent silicon oil removal, along with lens aspiration and implantation of foldable intraocular lens. Over the period of 1 year, his best corrected visual acuity improved from 6/60 to 6/18 in the affected eye at the last follow-up visit. The recovery was uneventful following the subsequent surgery.ConclusionCoats’ disease has a remarkable diversity in clinical presentation and morphology. The disease can also present with an underlying break, which may not be attributed to any iatrogenic modality. The treatment modalities in coats’ disease should be tailored individually due to the low incidence of the disease and the great variation in severity upon presentation. Prompt management restores the best possible anatomical outcome and maintains good vision.

Влияние локализации витреоретинального сращения на конфигурацию клапанного разрыва и вероятность развития регматогенной отслойки сетчатки

Purpose. To evaluate the relationship between the shape of horseshoe tear and the localization of vitreoretinal tractions (VRT) using methods of the peripheral vitreoretinal interface visualization and classify horseshoe tears by shape for surgical planning. Material and methods. We studied horseshoe tears parameters of 52 patients (52 eyes). The localization of VRT was determined by wide-field OCT, the horseshoe tear shape was determined as the ratio of length to width of the tear (l/b) by multispectral laser scanning. The ratio of the obtained data was evaluated by the Spearman correlation analysis. We used Ward's method of hierarchical clustering to classify the horseshoe tears by shape. The obtained data were used to perform YAG- laser excision of the vitreoretinal adhesion zone in patients with rhegmatogenous retinal detachment as part of the combined microinvasive laser-surgical technology. Results. The l/b ratio ranged from 1/4 to 3/1. A strong negative correlation has been revealed between the horseshoe tear shape and the fixation of vitreoretinal tractions (rs -0.95; p &lt;0.05). Horseshoe tears were identified in 4 groups using Ward's method of clustering. Each group corresponded to a specific localization of VRT. The extension of VRT beyond the tear was associated with a high risk of rhegmatogenous retinal detachment. Conclusion. A significant correlation has been found between the studied factors confirm the possibility of using data on the horseshoe tear shape for an approximate evaluation of vitreoretinal adhesion localization. The obtained data allows to determine the exact VRT excision zone when performing combined laser-surgical technology without the need for preoperative wide-field OCT. Key words: rhegmatogenous retinal detachment, wide-field OCT, horseshoe tear, vitreoretinal traction, YAG – laser retinotomy.

Лазерная ретинотомия в комплексном лечении осложненных клапанных разрывов и локальной регматогенной отслойки сетчатки

Horseshoe-shaped retinal tear leads to rhegmatogenous retinal detachment (RRD) in 61-83% of cases. Vitreoretinal traсtion is the main factor in the development of horseshoe tears and RRD. In this aspect, YAG-laser retinotomy is promising, which makes it possible to eliminate the traction component by excision area of the horseshoe tear with vitreoretinal adhesion (VRA). Purpose. To analyze the results of YAG-laser retinotomy in the treatment of patients with complicated horseshoe tears and rhegmatogenous retinal detachment. Material and methods. The study included 97 patients (100 eyes). Of these, 54 patients (57 eyes) with complicated horseshoe retinal tears and 43 patients (43 eyes) with local RRD. Patients with complicated horseshoe tears underwent YAG-laser retinotomy at the base of the horseshoe tear. Patients with local RRD underwent a combined laser-surgical technology, which included YAG-laser retinotomy of the horseshoe tear area with vitreoretinal adhesion, pneumatic retinopexy and barrier laser photocoagulation. Results. In the group of patients with complicated horseshoe tears, complete retinal attachment was achieved in 15 eyes (58%), partial retinal attachment - in 7 eyes (27%). In the group of patients with local RRD complete retinal attachment was achieved in 40 patients (93%). There was a stable anatomical result and no changes in functional parameters. Conclusion. YAG-laser retinotomy eliminates vitreoretinal traction in the area of horseshoe tear and prevents the development of rhegmatogenous retinal detachment. Application of YAG-laser retinotomy as the first step of a microinvasive combined laser-surgical technology for the treatment of RRD makes it possible to obtain a high anatomical result, reduce the risk of retinal redetachment, and also preserve the initially high visual functions of patients.

Результаты лечения локальной регматогенной отслойки сетчатки с использованием микроинвазивной комбинированной лазер-хирургической технологии

Rhegmatogenous retinal detachment (RRD) is one of the leading causes of vision loss world-wide. Despite advances in surgical techniques, rates of redetachment and vision loss remain high. Patients with RRD require a secondary surgery approximately 10 – 40% of the time. To achieve a high anatomical result, reduce the risk of reoperations and maintain high visual functions, it is necessary to develop and analyze microinvasive technologies to eliminate the main cause of RRD - the traction component. Purpose. To evaluate the results of microinvasive combined laser-surgical technology for RRD treatment. Material and мethods. The study included 43 eyes of 43 patients who underwent microinvasive laser-surgical technology for rhegmatogenous retinal detachment treatment, which included 3 consecutive steps: 1) YAG-laser excision of the horseshoe tear zone with vitreoretinal adhesion (VRA); 2) pneumatic retinopexy with 12% C3F8 (immediately after the first step); 3) barrier laser photocoagulation after complete retinal attachment (2-3 days after pneumatic retinopexy). The results were evaluated for anatomical efficacy (rates of retinal attachment and the occurrence of recurrent rhegmatogenous retinal detachment), functional efficacy (uncorrected (UCVA) and bestcorrected (BCVA) visual acuity, intraocular pressure (IOP)), and safety of technology (any intra- and postoperative complications). Results. In 40 patients (93%), the retina was attached with one surgical intervention. The success rate was significantly lower in patients with pseudophakia and a large retinal tear after YAG-laser excision of VRA zone. UNCA, BCVA and IOP after microinvasive combined laser-surgical technology was not significantly different from the initial values (p&gt;0,05). Сlinically significant complications included gas migration into the subretinal space and epiretinal membrane formation. Conclusion. Microinvasive combined laser-surgical technology is characterized by high single surgery success rate (93%), preservation of initially high visual functions, a low rate of redetachment (7,5%) and clinically significant complications (7%). Key words: rhegmatogenous retinal detachment, optical coherence tomography, horseshoe tear, YAG-laser retinotomy, pneumatic retinopexy, vitreoretinal traction.

Primary retinopexy in preventing retinal detachment in a tertiary eye hospital: a study of 1157 eyes.

Retinopexy is the most common vitreo-retinal procedure performed in the eye emergency department and significantly reduces the risk of a rhegmatogenous retinal detachment (RRD). There are various indications for retinopexy, with the most common being horseshoe-tears (HST). Multiple treatment techniques exist, ranging from slit-lamp laser-retinopexy, indirect laser-retinopexy or cryopexy. We report on our primary retinopexy 6-month RRD rate, repeat retinopexy rate and compare outcomes of different indications and treatment modalities. Retrospective consecutive case series of 1157 patients attending Birmingham and Midlands Eye Centre, UK between January 2017 and 2020. The RRD rate at 6 months was 3.9%, with 19.1% requiring subsequent retinopexies. Multivariate Cox survival regression analysis showed that significant risk factors for RRD following primary retinopexy included male gender (p = 0.012), high myopia (≤ - 6.00D, p = 0.004), HST (compared to round holes, p = 0.026) and primary cryopexy (compared to slit-lamp laser, p = 0.014). HST was the most common indication for retinopexy (812 [70.2%]) in which 118 (14.5%) had multiple tears. Slit-lamp laser was used in 883 (76.3%) of cases. The rate for subsequent epiretinal membrane peel surgery was 3 (0.3%) and was higher in eyes that required multiple retinopexy procedures (p = 0.035). With our large cohort of patients over three years, we provide additional evidence on the RRD and subsequent retinopexy rate after primary retinopexy. Further retinopexy is a common occurrence, particularly in high-risk retinal tears such as HST. Strict monitoring and prompt follow-up after retinopexy is important to prevent progression to RRD and should be of priority in the clinicians post-retinopexy management plan, particularly in those with associated risk factors.

Non-contact navigated laser retinopexy for peripheral retinal tears and rhegmatogenous degenerations: first experience

To evaluate the first outcomes of non-contact navigated laser retinopexy for peripheral tears and rhegmatogenous degenerations of the retina. This prospective single-center interventional pilot study included 58 patients (68 eyes), among which 19 males and 39 females aged 47.5±16.9 years with peripheral retinal degenerations and symptomatic retinal tears who received non-contact laser retinopexy with the Navilas 577s navigated laser system and non-contact PRP widefield objective. All patients (68 eyes) underwent laser treatment for the following disorders: horseshoe tear in 13 eyes, retinal hole in 11 eyes, operculated retinal hole in 3 eyes, lattice degeneration in 19 eyes, snail track degeneration in 1 eye, vitreoretinal tufts in 16 eyes, and progressing bullous retinoschisis in 5 eyes. Pain intensity was assessed using a four-point verbal rating scale. All patients were followed up for 5 to 21 months (9.0±3.3 months on average). Stable condition of the retina was observed in 65 cases (95.5%). In 3 eyes (4.4%), newly formed retinal tears prompted additional laser treatment: horseshoe tear in 2 eyes and retinal hole in 1 eye. The mean pain score during non-contact navigated laser retinopexy was 0.9±0.5. No complications associated with laser treatment were observed. Non-contact navigated laser retinopexy performed with the Navilas 577s navigated laser system is a safe and well-tolerated procedure with effectiveness comparable to conventional laser retinopexy.

Pneumoretinopexy versus scleral buckling in retinal detachments with superior breaks: A comparative analysis of outcome and cost.

Purpose:The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to scleral buckling (SB) in rhegmatogenous retinal detachments (RRDs) with superior breaks.Methods:Data of RRD with superior breaks, from 2013 through 2016, treated either with PR or SB surgery at a tertiary eye-care center were retrospectively reviewed. Treatment outcomes, procedural costs, refractive shift, surgical time, and complications, namely, cataract and glaucoma, were analyzed.Results:Thirty-two cases treated by PR (n = 15) and SB surgery (n = 17) fulfilled the selection criteria. Macula off RRD (91%) was the commonest presentation. Baseline parameters like duration of vision loss, presenting vision, and ocular characteristics were comparable. Single surgery retinal reattachment (66.7% PR vs. 76.5% SB) was analogous (P = 0.698). Retinal reattachment with secondary intervention was achieved in all cases at the last follow-up. Average vision gain in logMAR of 0.8 in PR and 0.6 in SB was not significantly different (P = 0.645) between the two groups, with SB group having a 1.9 Dioptre myopic shift and PR group none. Surgical time was shorter in PR versus SB at 15 versus 85 min and surgical cost (including additional surgery) was 50% less in PR. Complications like cataract progression (P > 0.99) and glaucoma (P = 0.71) were analogous among the groups. Horse-shoe tears were associated with failed primary surgery in 60% of PR and 75% of SB procedures.Conclusion:In RRDs secondary to superior breaks, PR proved to be faster, more economical, and less tissue manipulative than scleral buckle surgery, with equivalent efficacy and safety profile.

Bilateral retinal detachment imaged by Mirante color photography and retro mode illumination

A highly myopic 45-year-old man with bilateral rhegmatogenous retinal detachments was imaged using Mirante Scanning Laser Ophthalmoscope (SLO) device by Nidek (Nidek Co, Ltd., Gamagori, Nidek). (A, B) The widefield color fundus photographs show the full extent of the retinal detachment in both eyes and peripheral retinal breaks. A large horseshoe tear and a smaller tear are observed superotemporally (A), whereas a single break is observed superotemporally (B). The prominent corrugations/retinal folds associated with the detachment are clearly evident.