Incidence Of Rhegmatogenous Retinal Detachment Research Articles

Climate and Rhegmatogenous Retinal Detachment: A Comprehensive Review and Future Research Guidelines.

Does weather affect the rate of developing rhegmatogenous retinal detachment (RRD)? This comprehensive review investigates the findings of the most recent studies on the relationship between RRD and climatic or seasonal factors. An extensive search across PubMed, Embase, and Google Scholar databases resulted in 112 initial results, from which 18 studies published between 1980 and 2024 were selected. The selection criteria were based on the studies' relevance to our topic. We analyzed their methodology, geographic scope, and key findings. Data extraction encompassed study design, sample size, sex ratio, incidence rates, results, and identified limitations. Eight studies found no statistically significant relationship between seasonal variations and the incidence of RRD. Conversely, seven studies reported an increased incidence of RRD during the summer months. Additionally, secondary analyses of factors, such as ambient temperature, atmospheric pressure, and daylight hours, showed varied and sometimes conflicting results. A summary of common limitations and biases was synthesized into a table, providing guidelines for future research exploring this topic. This comprehensive review highlights the complex interaction between environmental factors and RRD incidence. The conflicting results across different studies suggest a need for further research in this area. Future studies should address the identified limitations and biases to provide a clearer understanding of the relationship between climate and RRD. By utilizing the guidelines from our review, future research could aim to minimize confounding factors and improve the robustness of their findings. Understanding these interactions can be used to develop preventive strategies and enhance clinical practices to reduce the burden of RRD.

Meteorological factors and rhegmatogenous retinal detachment in metropolitan France

Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition with rising global incidence. Identifying factors contributing to seasonal variations in RRD would allow a better understanding of RRD pathophysiology. We therefore performed a retrospective case series study investigating the relationship between RRD occurrence and meteorological factors throughout metropolitan France (the METEO-POC study), particularly the mean temperature over the preceding 10-day period (T-1). Adult patients having undergone RRD surgery and residing in one of the three most populated urban areas of each French region were included (January 2011–December 2018). The study involved 21,166 patients with idiopathic RRD (61.1% males, mean age 59.8–65.1 years). RRD incidence per 100,000 inhabitants increased from 7.79 to 11.81. RRD occurrence was not significantly associated with mean temperature over T-1 in the majority of urban areas (31/36). In a minority of areas (5/36) we observed correlations between RRD incidence and mean temperature over T-1, however these were extremely weak (r = 0.1–0.2; p < 0.05). No associations were found between RRD incidence and secondary outcomes: mean daily temperature over the 10 days prior T-1, minimum/maximum temperatures, rainfall, duration of sunshine, atmospheric pressure, overall radiation, relative humidity, wind speed. Overall, we found no relationships between meteorological parameters and RRD occurrence.

Clinical characteristics and optical coherence tomography of concomitant macular hole and rhgematogenous retinal detachment

To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI − 0.661 to − 0.126), duration of RRD (p = 0.021, CI − 0.576 to − 0.048) and presence of PVR (p = 0.001, CI − 0.131 to − 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.

The role of phacoemulsification surgery in the incidence rate of rhegmatogenous retinal detachment.

To investigate changes in the incidence rate of primary rhegmatogenous retinal detachment (RRD) surgery over time and to determine to what extent these changes can be attributed to pseudophakia. This nationwide cohort study was based on national patient registries. The study population comprised individuals at risk of RRD aged 40 years and above from 2006 to 2021 in Denmark. The primary outcome was RRD incidence, and the exposure was phacoemulsification surgery. A chart review was conducted to validate and examine the lens status of the outcome. The crude and age-adjusted incidence rate of RRD in the Danish population increased significantly during the study period. The largest increase in RRD was seen in phakic RRD (phRRD) (65%), whereas pseudophakic RRD (pRRD) accounted for 35% of the total increase. A chart review revealed that 17% of phRRDs were misclassified as pseudophakic, resulting in pRRD accounting for a total of 45% of the increase in RRD. The prevalence of pseudophakia in Denmark grew significantly for all age groups and for both sexes (p = 10-6) from 2006 to 2021, but the 1-year incidence of pRRD in the pseudophakic population was constant throughout the entire period. The incidence rate of RRD is continuing to increase in Denmark. The increase in phRRD remains undetermined, and while the risk of pRRD seemed to be constant during the study period, 45% of the overall increase in RRD could be attributed to the rise of a growing pseudophakic population.

Characteristics and Risk Factors for Rhegmatogenous Retinal Detachment Related to Endophthalmitis.

Purpose: To evaluate the risk factors for the development of concurrent or delayed-onset rhegmatogenous retinal detachment (RRD) related to endophthalmitis as well as the anatomic and visual outcomes with subsequent RRD repair. Methods: In this retrospective case study, a 2-tailed t test (continuous) and Fisher exact test were used to determine statistical significance of the observed findings. The relative risk (RR) and 95% CIs were calculated to assess statistical significance. Results: Of the 170 patients included, 22 were found to have a concurrent or subsequent RRD. Initial treatment with pars plana vitrectomy (PPV) (RR, 3.544; 95% CI, 1.650-7.614), aphakia (RR, 4.150; 95% CI, 1.434-12.011), endogenous endophthalmitis (RR, 2.684; 95% CI, 1.065-6.764), and posterior synechiae (RR, 3.026; 95% CI, 1.408-6.505) were statistically significant risk factors for RRD. Anatomically successful repair was achieved in 77.7% of patients. Conclusions: In addition to preexisting risk factors, the initial treatment of endophthalmitis may be a significant risk factor for RRD development, with a higher incidence of subsequent RRD in patients who have PPV as the initial treatment for endophthalmitis.

INCIDENCE AND DEPENDENCE OF FUNCTIONAL RETINAL CHANGES IN RHEGMATOGENOUS DETACHMENT IN PATIENTS OF DIFFERENT AGE GROUPS

Introduction. Rhegmatogenous retinal detachment results from retinal rupture causing the accumulation of fluid with the separation of the neurosensory retina from the main pigment epithelium. This condition is known as the most common type of retinal detachment. Patients with newly developed retinal detachment typically experience a sudden loss of vision, accompanied by floating opacities and metamorphopsia, or a "dark veil," that interferes with vision. The annual incidence of retinal detachment has been estimated in different countries and regions for a long time and ranged from 6.9 to 26.2 cases per 100,000.&#x0D; Aim of this study is to investigate the incidence rate of rhegmatogenous retinal detachment among individuals of different age groups.&#x0D; Materials and methods. 240 patients with rhegmatogenous retinal detachment operated during 2022-2023 were included in this retrospective study. The criteria for inclusion were the following: a case of retinal detachment with onset between January 2022 and October 2023. Exclusion criteria include: 1) traction-induced retinal detachment (eg, proliferative diabetic retinopathy), iatrogenic injury, or eye tumor; 2) subclinical RBS, which could be cured by one laser treatment of the retina; 4) a history of penetrating eye injury; 5) retinal detachment caused by a macular tear.&#x0D; Results and conclusions. Following the analysis of the incidence of rhegmatogenous retinal detachment, it was observed that this condition predominantly occurs in men (62.5% of cases), particularly in the older age group (60-70 years). The average duration of detachment before surgical intervention is 18.4±2.4 days. Early detection of rhegmatogenous retinal detachment leads to a reduced risk of total retinal detachment with macular involvement, as evidenced in our study (63.3% macula-off in men compared to only 28.8% macula-off in women).

Posterior vitreous detachment and retinal tear – a prospective study of community referrals

BackgroundRetinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care.MethodsProspective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD.Results1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than ‘PVD-only’ eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05).Conclusions and RelevanceThis large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination.

Epidemiological characteristics of primary rhegmatogenous retinal detachment in the Udmurt Republic

Primary rhegmatogenous retinal detachment (RRD) is a severe, potentially disabling ophthalmic pathology that requires timely surgical treatment to prevent progressive loss of vision.Purpose. To analyze the incidence of RRD in the Udmurt Republic for the three-year period and to study an influence of clinical and sociodemographic factors to an occurrence of the studied pathology.Methods. Retrospective assessment of 523 clinical cases of the first time diagnosed primary rhegmatogenous retinal detachment for the period from 2019 to 2021 was conducted. Data analysis was performed on the basis of the Republican Ophthalmological Clinical Hospital of the Ministry of Health of Udmurt Republic.Results. The overall annual average RRD in the Udmurt Republic was 11.5 per 100,000 inhabitants (95% CI, 10.7–11.9). Men on average is more often than women (37.37 vs 32.17 respectively, p &lt; 0.05). However, in the group of 50 years and older the female sex prevails. The highest incidence was found in the age group of 60–69 years in both sexes. A right eye was affected more often (51.43%) than a left one (45.89%) but equally in both men and women (p = 0.515). In the most subjects (50.48%) refraction was myopic. It was found that the age of myopes among all the patients with RRD was statistically significantly less than among hypermetropes (p = 0.008) and emmetropes (p &lt; 0.001). Previous cataract extraction was noted in 21.22% that was 2.38 times more often in men (28%) than in women (15%, p &lt; 0.001) and the age was comparable.Conclusion. The obtained results of the rhegmatogenous retinal detachment incidence among the population of the Udmurt Republic are comparable with the incidence data of the most countries in Western Europe. The most significant risk factors for Udmurtia are male gender, old age, myopia and pseudophakia.

Outcomes of air versus sulfur hexafluoride tamponade in primary rhegmatogenous retinal detachment in phakic eyes

Purpose To evaluate the outcomes of using air versus sulfur hexafluoride (SF6) gas tamponade in management of primary rhegmatogenous retinal detachment (RRD). Study design Retrospective case-series comparative study. Patients and methods We collected data from 120 patients in three tertiary university hospitals, that were diagnosed as primary RRD due to upper retinal break in the period from January 2021 to November 2022 and had undergone 23-G lens-sparing pars-plana vitrectomy with either air tamponade (Air group) or SF6 gas tamponade (SF6 group) and were followed up for 6 months. We analyzed the final visual outcomes between both groups. Results The mean age of the studied patients was 51±13 years (Air group=60 eyes, SF6 group=60 eyes). The mean axial length in Air group was 26.59±1.84 mm, the mean axial length was 26.46±1.49 mm in SF6 group. Best-corrected visual acuity was improved in both groups at the sixth month. In Air group 18.33% had recurrent RRD, while 10% in SF6 group. No significant difference regarding metamorphopsia was reported. Higher rate for cataract progression was noted among SF6 group. Conclusions Both Air and SF6 gas showed favorable results regarding the final visual outcome. Air is a less expensive tamponade with less timing for postoperative-prone positioning. Cataract progression was higher among SF6 group, however, the incidence of recurrent RRD was lower among SF6 group. Missed break was the primary cause for failed retinal reattachment.

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment

BackgroundTo determine the incidence and characteristics of the multiple subretinal particles (SRPs) present after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsThe medical records of 224 eyes of 224 patients that underwent PPV for RRD were reviewed. The presence of SRPs in the subretinal fluid blebs and the presence of subretinal deposits were determined by optical coherence tomography (OCT) and fundus autofluorescence (FAF). The characteristics of the FAF and infrared reflectance (IR) images of a scanning laser ophthalmoscope in eyes with SRPs (SRPs group) were compared to that of eyes without SRPs (control group).ResultsSRPs were observed in 27 eyes (12%), and they were completely resolved in 20 eyes (74%) after 6 months. The incidence of macula-off RRD (85%) and preoperative precipitates (41%) were significantly higher in the SRPs group than that in the control group (64%, P = 0.046; 12%, P = 0.002). The axial length was significantly shorter in the SRPs group than that in the control group (25.04 ± 1.54 mm, 26.00 ± 1.78 mm, P = 0.012). The preoperative and postoperative best-corrected visual acuity were not significantly different between the two groups (P = 0.702, P = 0.337). The subretinal fluid bleb determined by OCT were hyperfluorescent in the FAF images in 24 eyes (89%), and the subretinal deposits were hypofluorescent with solid appearance by OCT other than fluid in 3 eyes (11%). The hypofluorescent subretinal deposits in the FAF images were bright in the IR images in 2 eyes.ConclusionsThe SRPs consist of lipofuscin-related hyperfluorescent subretinal fluid and the subretinal deposits containing bright IR melanin particles of proliferating retinal pigment epithelial cells.

Validation des critères d’identification des patients opérés d’un décollement de rétine rhegmatogène au CHU de Toulouse

Seasonal variations seem to modify the incidence of rhegmatogenous retinal detachment (RRD), with a summer peak, although the meteorological parameters involved have not been studied in France. In order to conduct a national study evaluating the association between the occurrence of RRD and various climatological variables (METEO-POC study), we need to establish a national cohort of patients having undergone surgery for RRD. The data of the National Health Data System (SNDS) allow the realization of epidemiological studies concerning various pathologies. However, as these databases were initially intended for medical administrative use, the identification of the pathologies coded in these databases must be validated before any use for research purposes. In order to carry out a cohort study using SNDS data, the objective of this study is to validate the identification criteria for patients having undergone RRD surgery at Toulouse University Hospital. We compared the cohort of RRD surgery patients at Toulouse University Hospital from January to December 2017 assembled from SNDS data with the cohort of patients meeting the same selection criteria assembled from Softalmo software data. With a positive predictive value of 82.0%, a sensitivity of 83.8%, a specificity of 69.9%, and a negative predictive value of 72.5%, we can consider that our eligibility criteria are performing well. Since the selection of patients via SNDS data is reliable at Toulouse University Hospital, we can use it at the national level for the METEO-POC study.

Incidence of rhegmatogenous retinal detachments is increasing in Wenzhou, China.

To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments (RRDs) in the Wenzhou area in 2015 to 2019. All newly developed RRD cases among residents of the Wenzhou area, from January 2015 to December 2019, were retrospectively retrieved from hospital records. Annual population data were extracted from the Wenzhou Statistical Yearbook. There were 3629 eligible cases. The average incidence of RRD was 7.79 cases per 100 000 population (95% confidence interval, 7.24-8.34), and the incidences were 7.99 and 7.56 for males and females, respectively. The annual incidence increased gradually from 7.26 cases per 100 000 in 2015 to 10.00 cases per 100 000 in 2019, with an overall increase of 37.74%. The highest rate of increase occurred in the age group from 60 to 69 years. Of 2750 eyes with axial length (AL) data, 1675 (60.91%) had an AL greater than 24 mm. A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.

Incidence of Rhegmatogenous Retinal Detachment Following Macular Surgery in France Between 2006 and 2016

To report the incidence of postoperative rhegmatogenous retinal detachment after macular surgery in France between 2006 and 2016, and identify associated factors. Nationwide, population-based, cohort study. All surgical procedures for an epiretinal membrane or a macular hole performed in France from January 1, 2006 to October 31, 2016 were identified in the French national administrative database (Programme de Médicalisation des Systèmes d'Information). The incidence of rhegmatogenous retinal detachment occurring within 90 days of a macular surgical procedure was investigated. From January 1, 2006 to October 31, 2016, 152,034 macular surgical procedures for epiretinal membranes or macular holes were recorded in France. Of these, 3605 cases of rhegmatogenous retinal detachment occurring within 90 days of the procedure were found. The incidence of rhegmatogenous retinal detachment was 2.37% overall, 1.95% for epiretinal membrane surgery, and 3.43% for macular hole surgery. In multivariable Poisson regression analysis, rhegmatogenous retinal detachment was associated with macular hole surgery (incidence rate ratio [IRR], 1.76; 95% CI, 1.63-1.90; P < .001), history of cataract extraction in the previous year (IRR, 1.20; 95% CI, 1.08-1.34; P=.001), age <60 years (P < .001), and male sex (IRR, 1.63; 95% CI, 1.51-1.76; P < .001). The incidence of rhegmatogenous retinal detachment within 90 days of macular surgery was 2.37% overall in France between 2006 and 2016, and it was higher for macular hole surgery than for epiretinal membrane surgery.

Successful surgery and institutional incidence of rhegmatogenous retinal detachments in Teaching Hospital, Kurunegala, Sri Lanka: 3-year results from a tertiary care centre in North-Western province of Sri Lanka

Introduction: Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition if not treated. Major proportion of RRDs in Teaching Hospital were complex RRDs.Objectives: To assess the surgical success (reattachment) and other characteristics of RRD repairs and to determine the yearly institutional incidence of RRDs in Teaching Hospital, Kurunegala, Sri Lanka.Methods: Observational study of retrospective case review of RRDs operated by single vitreoretinal surgeon from 30.09.2018 to 30.09.2021. Retinal reattachment is the primary outcome measure. Modalities of treatment were either pars planar vitrectomy (TPPV) or scleral buckling (SB). Perfluoropropane or Silicone oil 1000cst was used as tamponading agent indicated by the complexity of RRD. All the cases were performed without endolaser, or a wideangle viewing system and cryopexy used for primary sealing of tears. When indicated TPPV was combined with SB. Failed SBs reoperated with TPPV and tamponade.Results: Study involved 309 eyes of 306 patients where 248 (80.26%) eyes of 246 offered TPPV and 61 (19.74%) eyes out of 60 offered SB. Mean age was 51.32y (7-80y) and 198 (65%) males and 108 (35%) females. Mean number of surgical interventions 1.608 (1-6). Overall surgical success over 3 years in TPPV group was 87.096% (216/248) and in SB group 77.049% (47/61) and average surgical success in both groups was 82.072% (263/309). Steady rise in surgical success in TPPV group observed over years achieving 93.55% in 2021. Average institutional incidence of RRDs was 1.346 per 100 eye admissions to eye unit.Conclusion: In a low facility setup for vitreoretinal services high success rate achieved has helped to prevent blindness due to RRD.

Incidence of Rhegmatogenous Retinal Detachment (RRD) in a Tertiary Care Center of Pakistan.

BackgroundRegardless of the advancements in ophthalmology, rhegmatogenous retinal detachment (RRD) remains a substantial issue for physicians. The present study assessed the incidence of RRD among our population.MethodologyA cross-sectional study was performed at the Layton Rehmatullah Benevolent Trust (LRBT) between June 2020 and May 2021. All the patients of RRD, irrespective of gender, within the age bracket of 20 years or more and diagnosed by a consultant ophthalmologist were included in the research study. Patients with serous retinal or tractional detachment and RRD with vitreous leakage were excluded from the study. A slit lamp and dilated fundus examination was performed preoperatively to assess the type of retinal detachment and associated factors as mentioned above. All data were collected on predesigned pro forma.ResultsAbout 25,000 individuals were presented to the outpatient department during the study period. Out of these, 100 patients were diagnosed with RRD. The incidence rate of the RRD in our center was 0.4%. There were a majority of the males. The mean age of patients did not vary significantly with respect to gender (p < 0.797). The most common type of RD was the total RD with a frequency of 53 cases followed by inferior RD with 19 cases. The majority of those with total RRD were males, i.e., 37%; however, the difference was statistically insignificant (p = 0.476). The study revealed that most of the RRD was diagnosed in patients < 45 years of age; however, the difference was not statistically significant (p < 0.227).ConclusionThe present study highlighted the incidence of RRD and explored the sociodemographic and other clinical features in the Pakistani population. However, it is possible that the RRD condition is still under-diagnosed in our hospital settings. Further exploration is warranted to study comprehensively the risk factors associated with RRD.

Incidence, Risk Factors, and Outcomes of Rhegmatogenous Retinal Detachment after Intravitreal Injections of Anti-VEGF for Retinal Diseases: Data from the Fight Retinal Blindness! Registry

To report the estimated incidence, probability, risk factors, and 1-year outcomes of rhegmatogenous retinal detachment (RRD) in eyes receiving intravitreal injections (IVTs) of VEGF inhibitors for various retinal conditions in routine clinical practice. Retrospective analysis of data from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! Eyes of patients starting IVTs of VEGF inhibitors (ranibizumab, aflibercept, or bevacizumab) for neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion from January 1, 2006, to December 31, 2020. All eyes that developed RRD within 90 days of IVTs were defined as cases with RRD and were matched with control eyes. Estimated incidence, probability, and hazard ratios (HRs) of RRD were measured using Poisson regression, Kaplan-Meier survival curve, and Cox proportional hazards models. Locally weighted scatterplot smoothing curves were used to compare visual acuity (VA) between cases and matched controls. Estimated incidence of RRD. We identified 16 915 eyes of 13 792 patients who collectively received 265 781 IVTs over 14 years. Thirty-six eyes were reported to develop RRD over the study period. The estimated incidence (95% confidence interval [CI]) per year per 1000 patients and per 10 000 injections was 0.77 (0.54-1.07) and 1.36 (0.95-1.89), respectively. The probability of RRD did not significantly increase at each successive injection (P= 0.95) with the time of follow-up. Older patients (HR [95% CI]= 1.81 [1.21-3.62] for every decade increase in age, P < 0.01) were at a higher risk of RRD, whereas patients with good presenting VA (HR [95% CI]= 0.85 [0.70-0.98] for every 10-letter increase in VA, P= 0.02) were at a lower risk. Neither the type of retinal disease (P= 0.52) nor the VEGF inhibitor (P= 0.09) was significantly associated with RRD risk. Cases with RRD lost 3 lines of vision on average compared with the prior RRD VA and had significantly fewer injections than matched controls over the year after the RRD. Rhegmatogenous retinal detachment is a rare complication of VEGF inhibitor IVT in routine clinical practice with poor visual outcomes at 1 year.

Commentary: Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes

The principal indication for glaucoma drainage devices (GDDs) is usually glaucoma refractory to filtering surgery.[1] Currently, commonly available GDDs are either valved like the Ahmed glaucoma valve (AGV; New World Medical Inc., Rancho Cucamonga, CA, USA) or non-valved GDDs like the Baerveldt glaucoma implant (BGI; Abbott Medical Optics, Abbott Park, IL, USA) and Aurolab aqueous drainage implant (AADI; Aurolab, Aravind Eye Hospital, Madurai, India), which have been shown to be safe and effective in both pediatric and adult populations. AADI has certain advantages over AGV. Since it is indigenously manufactured, it is highly cost-effective when compared to AGV. Studies have shown that it has a higher success rate, achieves significantly lower intraocular pressure (IOP), and the patients require less number of anti-glaucoma medications postoperatively. Some studies also indicate that the long-term IOP control is better with AADI when compared to that with AGV.[123] Postoperative posterior segment complications that may arise after usage of GDDs are hypotony and its consequences like hypotony maculopathy, serous choroidal effusion, choroidal detachment, suprachoroidal hemorrhage, retinal detachment, and endophthalmitis.[45] Overall, retinal complications have been described in 14%-50% of eyes with GDD implantation and majority occur within 35 days after GDD implantation.[5] Rhegmatogenous retinal detachment (RRD) occurs in approximately 5% of eyes after aqueous humor shunt implantation, with most occurring within 4 months of surgery.[6] Khan et al.[7] reported the incidence of RRD after AADI and AGV implantation to be 5.4% and 4.3%, respectively. The present authors analyzed the outcomes of 10 cases of RRD/1158 (0.86%) cases after AADI implantation.[8] Few points are to be kept in mind in these cases. As has been pointed out by the authors, some predisposing factors for the development of retinal detachment may have been there, such as uveitis, vitreous incarceration, scleral perforation, and retinal dialysis after pars plana tube placement. Nowadays, vitrectomy is often the preferred mode of treatment than scleral buckling procedure. Intraoperative choroidal drainage is often required as these RRDs are frequently associated with choroidal detachment. Rarely, suprachoroidal hemorrhage (SCH) is also a concomitant complication and intraoperative drainage of SCH is sometimes required. Moreover, retinal detachment after appositional choroidal effusion or expulsive hemorrhage can result in retinal adhesions, which are to be tackled meticulously. Use of heavy fluid perfluorocarbon liquid is particularly beneficial for retinal reattachment. Silicone oil is the preferred mode of endotamponade and it is recommended to use it at the end of surgery. Postoperative visual prognosis is often compromised as the chance of recurrence of retinal detachment is high. The present authors have also highlighted that poor visual recovery is primarily due to recurrent RRD as well as preexisting glaucoma. Tube blockade by silicone oil droplets may result in rise of IOP postoperatively, further worsening the glaucoma status. Many times, migration of emulsified silicone oil particles into the subconjunctival space through both the valved and non-valved devices has been reported.[910] When a scleral buckle is to be placed in a case with a preexisting GDD, utmost care should be taken to avoid the displacement of the tube placed in the anterior chamber. Studies have also shown the occurrence of phthisis bulbi following aqueous humor shunt implantation.[11] So, as has been concluded by the authors, vitrectomy with silicone oil tamponade appears to be the preferred approach in the management of these eyes, with IOP being well controlled post-vitrectomy, but it should be kept in mind that the visual outcomes are largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma.

The effect of age on phenotype of primary rhegmatogenous retinal detachment.

To evaluate the influence of age on the clinical characteristics of primary rhegmatogenous retinal detachments (RRD). We conducted a retrospective review of a prospectively collected dataset. Data regarding adult patients (aged 16-100 years) who had undergone primary RRD repair, were extracted from two online databases. Baseline demographics, preoperative clinical characteristics and surgical management details were collected. Age-based groups (16-30, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80) were compared using univariate analysis, with multivariate testing for interaction of age with sex, laterality and pseudophakia. In total, 8,133 eyes were analysed, of which the majority (59%) were in the 50-69 age-range peaking at 60, with a male predominance (64%). Myopia was significantly more frequent in patients aged <50 years. The presence of posterior vitreous detachment increased up to 50 years, then remained >95%. Foveal involvement, grade C proliferative vitreoretinopathy, total RD and greater RD extent were more common and progressively increased after 60 years, with worsening visual acuity. Isolated superior RRDs became more prevalent with age reaching a plateau in the age-range 50-69, before reducing again; conversely, isolated inferior RRDs were commoner in those <30, with a minimum in the 70-79 age-range. The incidence of fellow-eye RRD decreased linearly with age. Age appeared a key variable in RRD phenotype influencing a wide range of RRD characteristics. The higher incidence of myopia, PVD absent and bilateral RRD in patients <40 years and the significant phenotypical differences in the under 40 and over 50 age-groups highlight that there are several discrete forms of RRD.

Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in These Cases.

Marfan Syndrome is an autosomal dominant disease with multiple ocular abnormalities including ectopia lentis and a high incidence of rhegmatogenous retinal detachment (RRD). The management of RRD may be challenging in cases of aphakic patients with Marfan. To report on the management of four cases of simultaneous RRD and aphakia with vitrectomy, silicone oil tamponade, and retropupillary iris-claw intraocular lens (IOL) implantation in patients with Marfan that have been operated at the Jules-Gonin Eye Hospital between 2019 and 2020. Ages at presentation were 20, 30, 32, and 31 years, respectively. All patients had a history of extraction of a dislocated lens. None of the patients had a previous posterior vitrectomy. Two patients had records of previous measurements for IOL calculation by optical biometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) about 1 year prior to the RRD development. In two cases, measurements for IOL calculation by optical biometry were based on the contralateral eye. All patients underwent 23 G vitrectomy, peripheral iridotomy, and retropupillary iris-claw IOL. No intraoperative complications were encountered. All patients had silicone oil tamponade, one of which required heavy silicone oil. Silicone oil was removed 3 months following primary surgery. Minimum follow-up was 1 year. The single surgery anatomic success rate was 100%. All patients had visual acuity of at least 0.8 at the last follow-up (1.25, 1.0, 0.8, and 0.8 respectively). The targeted refractive results were accurately achieved in all four cases postoperatively. One patient presented ocular hypertension 2 weeks after surgery due to presumed steroid response and was managed conservatively. None of the patients had silicone oil migration into the anterior chamber. Retropupillary iris-claw IOL implantation in cases of RRD and aphakia creates a barrier to tamponades from the posterior segment, effectively preventing them from entering the anterior segment of the eye. Therefore, the management of aphakia and retinal detachment with simultaneous vitrectomy and a retropupillary iris-claw IOL may be a successful strategy in reducing postoperative complications in patients with Marfan syndrome.

Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes.

Purpose:To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings.Methods:Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best-corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively.Results:Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6–83 years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days-72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 ± 0.15 which improved to 2.29 ± 0.58 at final follow-up; however, only one eye had vision ≥ 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ≤ 21 mmHg in 5 out of 6 eyes with anatomic successConclusion:The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma.