Inferior Retinal Detachment Research Articles

Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment.

We report a novel surgical sandwich technique using a combination of intraocular perfluoropropane (C3F8) and silicone oil for inferior retinal detachment (RD). After conventional pars plana vitrectomy and posterior vitreous detachment induction, fluid-gas exchange using 14% C3F8 was done. This was followed by silicone oil injection using automated infusion pump to 50% fill of the vitreous cavity under direct visualization to achieve formation of two bubbles – gas bubble superiorly and silicone oil inferiorly. The patient was subsequently asked to maintain upright position. The two immiscible bubbles of C3F8 and silicone oil provide tamponade to superior and inferior retina, respectively. With time, gas bubble reduces in size with a gradual superior shift of silicone oil. This novel sandwich technique achieves complete attachment of retina and reduces the risk of retinal redetachment in inferior RDs by adequately tamponading the inferior retina.

Diplopisiz Oküler Distopi ve Eksudatif Retina Dekolmanına Yol Açan Maksiller Sinüs Mukoseli

Mucocele is a cystic lesion occuring by the obstruction of drainage of normal paranasal sinus secretions due to infections, trauma, and rarely tumor. This lesion can impress to orbital contents by eroding orbital bone and it can be confused with malignant tumors. Most mucoceles originate from frontal and ethmoid sinuses, whereas maxillary and sphenoid sinus presentation is rare. In this case report we have presented a maxillary sinus mucocele case leading to asymptomatic inferior exudative retinal detachment and pushing up glob. A 43-year-old woman presented with swelling on her right malar region and lower eyelid lasting one year and increasing last three months. The patient had upward ocular dystopia and an exudative retinal detachment not extending the macula at the inferior retinal area in her right eye. She had diagnosed right maxillary sinus tumor suspicion by clinical examination and imaging methods. Operation was performed by the earnose-throat department. While ocular dystopia completely recovers, exudative retinal detachment was still present at the postoperative first day. As a result, maxillary sinus mucocele can lead to findings such as ocular dystopia without diplopia and exudative retinal detachment, and clinical signs may mimic the tumor.

Analysis of clinical features and visual outcomes of pars planitis.

To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey. Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA). Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84±8.26 (range 4-36)years. Mean follow-up period was 61.3±52.15 (range 9-172)months. Mean BCVA was 0.58±0.36 (range 0.03-1.00) (0.40±0.45 logMAR) at presentation, and 0.81±0.28 (range 0.10-1.00) (0.14±0.27 logMAR) at final visit (P=0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed. Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.

Gas Tamponade for Retinectomy in PVR-Related Retinal Detachments: A Retrospective Study.

IntroductionThe purpose of the study was to evaluate the anatomical and functional results in patients with proliferative vitreoretinopathy (PVR) treated with retinectomy and perfluoro-octane gas (C3F8) as a tamponade agent.Methods12 patients with inferior and anterior complicated PVR-related retinal detachment, who were treated with retinectomy, where C3F8 was used as the tamponade agent were examined. Primary outcome was the anatomical success, while visual acuity, existence of an epiretinal membrane (ERM) and intraocular pressure (IOP) postoperatively were secondary outcomes.ResultsThe primary success rate was 75% (mean follow-up of 9.8 months). Reoperation was needed on 25% of patients after the retinectomy procedure. Preoperative best corrected visual acuity (BCVA) was poor due to macular involvement in all cases. BCVA was improved in three patients (25%), remained stable in 25% and deteriorated in 16.7%. Two patients were lost during the follow-up period. Postoperative ERM formation was noted in 33.3% of patients. One patient developed hypotony, while no other complications were observed.ConclusionRetinectomy with C3F8 as the tamponade agent provides anatomical and functional restoration at a 75% primary success rate in PVR-related retinal detachment.

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.

25-GAUGE PARS PLANA VITRECTOMY AND SF6 GAS FOR THE REPAIR OF PRIMARY INFERIOR RHEGMATOGENOUS RETINAL DETACHMENT.

To compare anatomical and functional outcomes of 25-gauge pars plana vitrectomy (PPV) and sulfur hexafluoride gas between inferior and superior rhegmatogenous retinal detachment (RRD). A retrospective cohort study of patients with RRD who underwent 25-gauge PPV. Group A consisted of patients with an identified inferior retinal break (4-8 o'clock hours). Group B consisted of patients with an identified superior retinal break. Overall, 59 eyes of 59 patients with a mean age of 60.0 ± 12.3 years were included, with 57.6% being males; 25 with inferior breaks (Group A) and 34 with superior breaks (Group B). The mean follow-up time was 4 months (range 2-16 months). Single-surgery anatomical success was achieved in 96% (24/25) of Group A and 82.4% (28/34) of Group B patients (P = 0.22) with final anatomical success achieved in all cases. In regression analysis, break location (superior versus inferior) did not significantly account for the variation in single-surgery success or visual outcomes. Favorable results were achieved using 25-gauge vitrectomy and sulfur hexafluoride gas for primary RRD treatment. No differences in anatomical and functional success rates were observed between inferior and superior retinal break-associated RRD.

Occupational eye hazard – a case of perforating industrial nail injury to the eye

Purpose: To report the management and outcome of an unusual case of occupational perforating ocular industrial nail injury involving the posterior pole. Methods: Observational case report. A 48-year-old Chinese male construction worker presented with perforating industrial nail injury.Results: The patient underwent primary globe repair and foreign body removal followed by staged pars plana vitrectomy with endophotocoagulation and cyclopropane gas tamponade for repair of the vitreous incarceration at the posterior exit wound, a subsequent laser retinopexy with silicone oil tamponade for an inferior retinal detachment extending from the perforation site and finally silicone oil removal with a scleral fixated intraocular lens implant. His best-corrected visual acuity improved to 20/100 six months after the initial injury. Conclusion: Perforating ocular injuries involving the posterior pole often present with severe visual impairment and significant management challenges. We report a case of perforating ocular nail injury, which was managed successfully with staged surgical procedures.

Beyond-the-edge proliferation after relaxing retinectomy

To report beyond-the-edge proliferation (BTEP) after relaxing retinectomies (RR) i.e. fibrous sheets stretched between the RR edge and the far periphery; to evaluate the tractional potential and report the long-term course of BTEP. Retrospective review of the medical records of 83 patients having undergone a RR between January 2009 and December 2014 to identify patients with BTEP. Six patients aged 31 to 76 were identified. Retinectomy had been performed for traumatic retinal incarceration in one case and anterior PVR in 5 cases. BTEP occurred within weeks of the RR (earliest: 5 weeks). It was discovered intraoperatively in two patients with silicone oil tamponade, at 7 weeks and 6 months respectively after RR. It recurred over a few months after excision in 5 patients, causing inferior tractional retinoschisis in 4 patients and inferior tractional retinal detachment in two patients. BTEP is an unusual form of proliferative vitreoretinopathy developing despite the absence of the usual vitreo-retinal support (excised during RR), probably through compartmentalization and cell migration along the inferior interface between silicone oil or gas and the aqueous humour. BTEP can cause serious retinal traction, develops over weeks after the RR and recurs frequently a few months after excision.

Inferior retinotomy and silicone oil tamponade for recurrent inferior retinal detachment and grade C PVR in eyes previously treated with pars plana vitrectomy or scleral buckle.

BackgroundOne of the most challenging problems in vitro-retinal surgery is the recurrence of retinal detachment in the context of high-grade proliferative vitreoretinopathy (PVR). The aim of our retrospective study was to assess the surgical outcomes of pars plana vitrectomy, 180° inferior retinotomy and silicone oil tamponade combined with phacoemulsification and IOL implantation for recurrent inferior retinal detachment with grade C PVR in phakic eyes. The study was carried out at tertiary referral centre - University Hospital of Rome “Tor Vergata”.MethodsRetrospective analysis of 33 eyes affected by recurrent inferior retinal detachment and grade C PVR after primary encircle scleral buckling (SB group – 12 eyes), or pars plana vitrectomy (PPV group – 21 eyes). All patients subsequently underwent PPV and silicone oil tamponade at our Institution. The first outcome measure was retinal reattachment, and second outcomes were reoperation rates, best-corrected visual acuity (BCVA) and postoperative complications.ResultsAll patients in the SB group and 19 (90 %) patients of the PPV group achieved retinal reattachment. Final BCVA was better in the SB group (p = 0.045). Two eyes in the PPV group required a third vitrectomy with heavy silicone oil tamponade. Postoperative complications included silicone oil in a deep anterior chamber (3 eyes in each group), untreatable hypotony in 1 eye in the PPV group (that led to enucleation due to phthisis bulbi), and elevated intraocular pressure in 3 patients (2 eyes in the PPV group).ConclusionsPhacoemulsification with IOL implant, PPV with silicone oil tamponade associated with 180° inferior retinotomy may lead to better anatomical success in patients who have previously undergone SB procedure for inferior retinal detachment repair compared with eyes that underwent a primary PPV.

Les décollements de rétine rhegmatogènes inférieurs traités par cryo-indentation

To investigate the epidemiological, clinical, therapeutic and prognostic factors in cases of inferior rhegmatogenous retinal detachments (RD) treated by scleral buckling surgery. A retrospective chart review was performed on 45 patients (45 eyes) with inferior RD with only inferior tears (4:00-8:00), who had been treated by scleral buckling surgery over a 6-year period from 2006 to 2011. The parameters studied included patient demographics, refractive status, time until consultation, clinical exam data, treatment modalities and functional and anatomic results. Forty-five cases were included in this study (45 eyes), with an average patient age of 44.5 years (14 to 75 years) and a slight male predominance (56%). Myopia was observed in 60%. Mean time until consultation was 3.5 months. Visual acuity on admission was less than 1/10 in 53.33%. Macular detachment was found in 80%. Causative lesions were holes in 26 eyes. Proliferative vitreoretinopathy was essentially stage B in 48.9%. Scleral buckling surgery was performed in all patients, with drainage of subretinal fluid in 37.8%. Retinal reattachment was obtained in 36 eyes (80%) with a final visual acuity greater than or equal to 1/10 in 71.11%. The mean follow-up in our study was 6.62 months. Inferior retinal detachment has a predilection for young myopes. The time until consultation is often long, and extraocular surgery, although difficult, exhibits documented efficacy.

SUPPLEMENTAL SCLERAL BUCKLING FOR INFERIOR RETINAL DETACHMENT IN SILICONE OIL-FILLED EYES

To evaluate the efficiency of treating selected cases of inferior retinal detachment in silicone oil-filled eyes using a supplemental scleral buckling with external drainage of subretinal fluid, versus performing a second vitreoretinal surgery and silicone oil endotamponade. A prospective interventional pilot study that was performed on silicone oil-filled eyes with inferior retinal detachment. Twenty-three eyes of 23 consecutive patients were alternatively distributed between 2 groups: Group A included 12 eyes treated with supplemental scleral buckling with drainage of subretinal fluid and without the removal of silicone oil, and Group B included 11 eyes treated with silicone oil removal, vitreoretinal surgery, and reinjection of silicone oil. The preoperative data included indications and details of primary vitreoretinal surgery, cause of retinal redetachment, subretinal fluid, grade of proliferative vitreoretinopathy, lens status, and the duration between primary vitreoretinal surgery and reoperation. The postoperative examination included the best-corrected visual acuity, retina status, proliferative vitreoretinopathy, silicone oil, and any reported complication. Follow-up examinations were scheduled at Day 1, weekly for 1 month, and monthly thereafter till the end of the follow-up period which extended for at least 2 months after silicone oil removal. The average number of detached clock hours per eye was 2.7 in Group A and 2.4 in Group B, caused by a mean of 1.58 ± 0.80 break per eye in Group A and 1.48 ± 0.66 break per eye in Group B. The mean interval between the primary vitreoretinal surgery and the scleral buckling procedure in Group A patients was 2.83 ± 1.22 months (range, 1-5 months), while in Group B, the mean interval between the primary and the secondary vitreoretinal surgeries was 3.00 ± 1.61 months (range, 1-6 months). The mean operative time was statistically significantly (P < 0.05) shorter in Group A (38.7 ± 11.2 minutes) than in Group B (65.3 ± 15.1 minutes). The mean follow-up duration was 15.00 ± 3.22 months in Group A and 14.18 ± 2.99 months in Group B. After silicone oil removal, the retina was attached in 10 of the 12 eyes (83.3%) and redetached in 2 eyes (16.7%) in Group A, while in Group B, the retina was attached in 9 of the 11 eyes (81.8%) and redetached in 2 eyes (18.2%) after silicone oil removal. The mean logarithm of the minimum angle of resolution best-corrected visual acuity has improved from 1.82 ± 0.72 to 1.36 ± 0.52 in Group A patients (P > 0.05) and from 1.93 ± 0.74 to 1.55 ± 0.63 in Group B patients (P > 0.05) at the end of the follow-up duration. For selected cases of inferior retinal detachment in silicone oil-filled eyes, supplemental scleral buckling could be as effective as a second vitreoretinal surgery. Scleral buckling could offer a faster, less invasive, and better economic alternative to repeated vitreoretinal surgery for treatment of such cases.

FOREIGN BODY RESPONSE WITHIN POSTOPERATIVE PERFLUORO-N-OCTANE FOR RETINAL DETACHMENT REPAIR

To describe the clinical and histopathologic characteristics of inflammatory deposits occurring within intermediate duration postoperative perfluoro-n-octane (PFO) for inferior retinal detachment repair. Prospective interventional case series of consecutive patients with inferior retinal detachment treated with intermediate duration postoperative vitreous cavity PFO endotamponade were analyzed by ophthalmoscopy for the presence of inflammation and white deposits. Ten consecutive samples developing white deposits were analyzed microscopically. Clinical variables were analyzed. One hundred and eighty-one eyes of 181 patients were included (mean age = 52.4 ± 14 years; mean follow-up = 29.7 ± 14 months). Fifty of 181 patients (28%) developed a characteristic foreign body response with abundant white deposits within indwelling PFO. Ten consecutive samples analyzed histologically contained abundant macrophages, the absence of additional inflammatory cells, and intracytoplasmic optically lucent inclusions. Foreign body response was associated with longer duration of PFO (P = 0.003). Perfluoro-n-octane foreign body response was not associated with age (P = 0.136), ethnicity (P = 0.101), visual outcome (P = 0.157), or persistent intraocular pressure elevation (P = 0.381). A stereotypical foreign body response occurs in ∼ 30% of patients with postoperative vitreous cavity PFO and becomes clinically apparent at 7 days to 10 days after initial placement for rhegmatogenous retinal detachment repair. The response consists almost exclusively of macrophages and does not seem to be related to either long-term intraocular pressure elevation or visual outcome. The response may be related to the duration of indwelling PFO and may limit visualization of the retina during PFO removal.

F6H8 as an Intraoperative Tool and F6H8/Silicone Oil as a Postoperative Tamponade in Inferior Retinal Detachment with Inferior PVR

Purpose. To evaluate the effectiveness and safety of perfluorohexyloctane (F6H8) for intraoperative flattening of the retina and of F6H8/silicone oil (SO) 1000 cSt as a postoperative tamponade for inferior retinal detachment with inferior proliferative vitreoretinopathy. Methods. This is a retrospective review of 22 patients who underwent pars plana vitrectomy using F6H8 as an intraoperative tool to flatten the retina. At the end of the surgery a direct partial exchange between F6H8 and SO 1000 cSt was performed, tamponing the eye with different ratios of F6H8/SO (70/30, 60/40, 50/50, 40/30, and 30/70). Anatomical and functional results and complications were evaluated over the follow-up period (mean 22.63 months). Results. F6H8 was efficacious for intraoperative flattening of the retina. Twenty-one of the 22 patients achieved a complete retinal reattachment. Postoperative visual acuity (VA) ranged from light perception to 20/70, with 72% of patients obtaining VA better than 20/400. No emulsification/inflammation was observed whatever the ratio of F6H8/SO used. With higher ratios of F6H8/SO (70/30 and 60/40) cloudiness of the tamponade was observed. A transparent mixture was present with all the other ratios. Conclusions. The surgical technique adopted is very simple and safe. The optimal F6H8/SO ratio seems to be between 50/50 and 30/70.

BULLOUS HEMORRHAGIC RETINAL DETACHMENT BECAUSE OF MASSIVE SUBRETINAL HEMORRHAGE IN PATIENTS WITH AGE-RELATED MACULAR DEGENERATION

The authors investigated the surgical outcomes of massive subretinal hemorrhage draining via a retinotomy procedure in bullous hemorrhagic retinal detachment (HRD). Clinical records of consecutive patients with age-related macular degeneration who underwent surgery for bullous HRD were reviewed. Outcomes included anatomical success, visual acuity, and postoperative complications. Seventeen consecutive eyes of 17 patients were included in this series. Of the 17 eyes, 8 eyes had total HRD and 9 eyes had half total inferior HRD including the macula. The mean interval between initial symptom presentation and operation was 22.6 ± 11.7 days. All patients underwent pars plana vitrectomy and internal drainage of the subretinal hemorrhage through a posterior drainage retinotomy. The mean follow-up period was 37.1 months (range, 12-66 months). Finally, successful retinal reattachment was achieved in 15 of the 17 eyes (88.2%), but 2 remained nonprogressive localized inferior retinal detachment because of proliferative vitreoretinopathy. All preoperative visual acuities were hand movements or worse, and 10 eyes (58.8%) achieved a postoperative minimum functional vision of 20/1000 or better. Successful retinal reattachment and achievement of minimum functional vision is possible after PPV and retinotomy with evacuation of a massive subretinal hemorrhage for bullous HRD secondary to age-related macular degeneration.

Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment.

To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP) were recorded and analyzed. Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye. Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

PARS PLANA VITRECTOMY WITH MEDIUM-TERM POSTOPERATIVE PERFLUORO-N-OCTANE FOR RECURRENT INFERIOR RETINAL DETACHMENT COMPLICATED BY ADVANCED PROLIFERATIVE VITREORETINOPATHY

To describe a series of patients with recurrent inferior retinal detachment complicated by proliferative vitreoretinopathy (PVR) treated with pars plana vitrectomy and postoperative perfluoro-n-octane (PFO). Consecutive patients with recurrent inferior retinal detachment and Grade C PVR were prospectively treated with 25-gauge pars plana vitrectomy and postoperative "medium-term" PFO for 2- to 3-week duration. All patients had subsequent PFO removal in a planned staged procedure. Forty-four eyes of 44 patients were included. Mean follow-up time was 30.71 ± 12.92 months. Successful reattachment was achieved in 86% of eyes (38/44). Reattachment rates were statistically equivalent between eyes with and without previous scleral buckle. Reasons for redetachment were recurrent inferior PVR (four of six) and new superior break without PVR (two of six). Additional complications observed were cataract progression requiring surgery (42%), persistent intraocular pressure elevation (36%), and transient inflammation (32%). Macula-off status (P = 0.02) and persistent intraocular pressure elevation (P = 0.02) were factors associated with worse visual outcome. Medium-term PFO was found to be an efficacious technique for operative management of recurrent inferior retinal detachments complicated by Grade C PVR. The method of primary repair (scleral buckle vs. pars plana vitrectomy) did not affect reattachment rates. Transient inflammation and intraocular pressure elevation are potential complications associated with this technique. Persistent intraocular pressure elevation was associated with worse visual outcome.

HIGH-DENSITY SILICONE OIL DENSIRON-68 AS AN INTRAOCULAR TAMPONADE FOR PRIMARY INFERIOR RETINAL DETACHMENTS

To evaluate the effectiveness and safety of the heavy silicone oil Densiron-68 as an internal retinal tamponade after vitrectomy in patients with primary inferior rhegmatogenous retinal detachment. A retrospective consecutive case series involving inferior rhegmatogenous retinal detachment in 42 patients recruited between 2007 and 2010 was completed. All patients underwent primary vitrectomy followed by injection of Densiron-68. Each patient was then examined at 1 week, 1 month, 3 months, and 6 months after its removal. Included patients had a rhegmatogenous retinal detachment with at least 1 retinal break between 4 and 8 clock hours and completed 6 months of follow-up after removal of Densiron-68. Assessments for reattachment of the retina, visual acuity, and any complications from the surgery were recorded. Thirty-nine of 42 patients completed all follow-up visits. Anatomical success was achieved in 85% (33 of 39) of cases with one procedure, increasing to 95% (37 of 39) with additional surgery. The mean visual acuity improved from mean logarithm of the minimum angle of resolution of 1.29 ± 0.61 preoperatively to 0.87 ± 0.67 postoperatively. The most common complications were cataracts (83%, 10 of 12), posterior capsular opacification (22%, 6 of 27), and ocular hypertension (15%, 6 of 39). High anatomical success rates can be achieved with primary vitrectomy for inferior rhegmatogenous retinal detachment with the use of Densiron-68.

Surgical approach and optic coherence tomographic evaluation of optic disc anomaly in association with serous macular detachment

Serous macular detachment (SMD) may accompany optic disc pit (ODP) and cause visual loss if untreated. We want to present different therapeutic approaches and interesting optical coherence tomography (OCT) findings in three consecutive cases. In this case series, two patients with SMD and one patient with partial macular detachment and inferior retinal detachment accompanying ODP were evaluated before and after surgical intervention clinically and by spectral-domain OCT. The patients were 44 (case 1), 22 (case 2) and 24(case 3) years old. Pars plana vitrectomy (PPV)+silicone oil+laser, PPV+sulfur hexafluoride gas (SF6)+laser and pneumatic retinopexy were applied, respectively. The patients were followed for 18, 15 and 14months. Preoperative best-corrected visual acuities (BCVAs) were 5/100, 7/10 and counting fingers at 1m. Vision improved in all cases with resolution of subretinal fluid. Final BCVAs were 3/10, 10/10 and 1/10, respectively. OCT images revealed optic disc anomaly details and changes after surgical intervention, photoreceptor outer segment alterations at the detached area and macular surface changes. Surgical intervention should be tailored individually in cases with SMD. OCT is efficient for in vivo evaluation of this pathological condition and anatomical outcomes of surgery.

Bilateral exudative retinal detachments in Sturge-Weber syndrome

An 11-year-old girl with a port-wine stain on both sides of her face (fi gure A, B) presented after reporting progressive diffi culty reading. Visual acuity in the right eye was 20/100 and in the left eye she could count fi ngers only. Fundus examination of the right eye showed an inferior retinal detachment with retinal pleats (fi gure C, arrow). A subretinal peripapillary lesion was also seen. Dilated examination of the left eye showed a bullous retinal detachment that could be seen through the pupil Lancet 2013; 382: 259

The use of Densiron-68™ as a perioperative surgical tool

Agents such as Densiron-68™, with specific gravity slightly greater than that of water (1.06g/cm(3)), have been developed to tamponade the inferior retina following retinal detachment repair procedures. The minimal force that would result from the sinking of such an agent in balanced saline solution is not considered sufficient to permit the use of Densiron-68™ as a surgical tool to displace subretinal fluid and stabilise the retina perioperatively. We report five cases where Densiron-68™ was instilled directly into a saline-filled eye with an unstable retinal detachment. The detachment was reduced and the Densiron-68™ left in situ. Four cases involved giant retinal tears and the fifth an inferior retinal detachment with no breaks identified. The injection of Densiron-68™ as a single manoeuvre to flatten the retina and to simultaneously provide postoperative tamponade was successfully used in these five patients. Six months after removal of Densiron-68™ the retina remained flat in all five cases. This previously unfamiliar technique provides an additional surgical option to gain control in cases of complicated retinal detachment with a mobile retina, especially if inferior tamponade is required.