Inferior Rhegmatogenous Retinal Detachment Research Articles

Rhegmatogenous Retinal Detachment: Progression and Characteristics of Postoperative Demarcation Lines.

To report the characteristics of retinal detachment demarcation lines on infrared (IR) imaging together with retinal detachment progression analysis. We performed a retrospective case series of 25 eyes of 24 patients who underwent macula off Rhegmatogenous retinal detachment (RRD) repair and demonstrated a postoperative demarcation line on in(IR) imaging. All patients had an OCT imaging at baseline capturing the extent of the RRD. Criteria for demarcation lines diagnosis on infrared imaging included a line parallel and with the same contour of the RRD edge. These lines were not observed on IR imaging prior to RRD repair surgery. Demarcation lines' hyperreflectivity was situated in the interdigitation-ellipsoid zone complex. These lines were more obvious on the early postoperative week but faded over time (average disappearance time 2.6 ± 2.9 months). The analysis of retinal detachment progression showed that superior RRDs progressed more than inferior RRDs (611µ Vs 122µ, P=0.02). Among 13 cases with a superior RRD, the temporal border progressed more than the nasal side (697µ Vs 426µ, P=0.01, figure 1). The use of intraoperative perfluorocarbon was associated with less RRD progression (p=0.01). The study concludes that demarcation lines are distinct findings on IR imaging, appearing early but diminishing relatively quickly following RRD repair. It also revealed the characteristics of RRDs progression specifically that inferior RRDs and perfluorocarbon use were associated with less retinal progression.

INFERIOR RETINAL DETACHMENT REPAIR USING VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLING.

To compare outcomes in inferior rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). Patients who underwent surgery for inferior RRD at a tertiary care center between 2014 and 2018 were included. Inferior RRD was defined as RD with tears between 4:00 and 8:00 clock hours in a detached retina. Non-RRD etiologies (e.g., traumatic, tractional), proliferative vitreoretinopathy grade ≥C2, and silicone oil use were excluded. Single-surgery anatomic success was defined as the absence of reoperation for recurrent RRD during follow-up. There were 366 patients included of which 260 (71%) were operated using PPV-SB. Single-surgery anatomic success was achieved in 96 (91%) of patients with pars plana vitrectomy and 227 (87%) of patients with PPV-SB ( P = 0.38) over a median follow-up of 15 months. At the final follow-up, pinhole visual acuity was 0.18 (0.10-0.30) among patients with pars plana vitrectomy and 0.18 (0.10-0.40) among patients with PPV-SB (Snellen equivalent: 20/30; P = 0.03). After adjusting for demographic (i.e., age and sex) and preoperative characteristics (i.e., macula on status, baseline pinhole visual acuity, and grade C1 proliferative vitreoretinopathy), PPV-SB did not alter single-surgery anatomic success ( P = 0.210). Following inferior RRD repair, there were no significant differences in single-surgery anatomic success between patients undergoing pars plana vitrectomy and PPV-SB in this large, retrospective cohort.

Case Series and Review Article: Perfluorocarbon Heavy Liquid as a Short-Term Tamponade after Vitrectomy for Inferior Rhegmatogenous Retinal Detachment

This is to report outcomes of three cases with inferior rhegmatogenous retinal detachment (RRD) which were treated with vitrectomy and perfluorocarbon heavy liquid (PFCHL) insertion as short-term tamponade. We also aim to summarise the surgical outcomes and complications from the recent studies in PFCHL usage in vitrectomy surgeries. The mean tamponade period for our case series was 11 days. Two patients developed ocular hypertension, while another developed hypotony with subsequent retinal redetachment. Migration to the anterior chamber causing pupillary block glaucoma also occurred in one patient, requiring laser peripheral iridotomy. Previous studies reported that PFCHL is particularly useful for more complex cases of retinal detachment including giant retinal tears, inferior retinal tears, chronic rhegmatogenous retinal detachment (RRD), inferior RRD and proliferative vitreoretinopathy (PVR) due to its unique physical properties. However, it is not recommended as tamponade for long duration due to possible retinal toxicity. Otherwise, most of the complications due to PFCHL can be managed either medically or surgically. PFCHL can be a useful post-operative tamponade agent in vitreoretinal surgeries. Close post-operative monitoring is crucial for the potential complications from PFCHL.

Сравнение кругового экстрасклерального пломбирования и ретинотомии в витреоретинальной хирургии «нижних» рецидивов отслоек сетчатки при выраженной стадии передней пролиферативной витреоретинопатии

Purpose. To analyze the results of the treatment of recurrent inferior rhegmatogenous retinal detachments (RRD) complicated by the severe stage anterior proliferative vitreoretinopathy (PVR) in silicone oil (SO) tamponade eyes depending on the volume of surgical intervention: pars plana vitrectomy (PPV) with encircling scleral buckling (SB) versus PPV with retinotomy (RT). Material and methods. 66 patients (66 eyes) with recurrent inferior RRD by the severe stage anterior PVR in silicone oil-filled eyes were included in this retrospective study who were treated in our clinic from 2017 to 2022. 66 eyes were alternatively distributed between 2 groups: PPV with SB (30 eyes), PPV with RT (36 eyes). The outcome measures were anatomical success, which was defined as complete anatomical retinal reattachment and function — best corrected visual acuity (BCVA). Results. 66 patients (66 eyes), 36 men and 30 women, median age 60.0 (50.0; 69.0) years, were included in the study. After surgical treatment, anatomical success was similar in both groups with no statistically significant difference (p = 0.7). When conducting a comparative analysis between the two groups 7 days, 3 and 6 months after surgery, BCVA was statistically significantly higher in the PPV+SB group compared to the PPV+RT group (p = 0.0001). Conclusion. For eyes with recurrent inferior RRD, complicated by an advanced stage of anterior PVR, PPV+SB and PPV+RT allow one to achieve the same anatomical results. According to the functional results, PPV+SB may be a better choice as an alternative to PPV+RT with a statistically significant difference (p = 0.0001). Keywords: recurrence of retinal detachment, scleral buckling, retinotomy, pars plana vitrectomy, silicone tamponade, anterior proliferative vitreoretinopathy

Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study

PurposeTo establish whether Densiron® 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy. DesignCohort study of routinely collected data from the European Society of Retina Specialists (EURETINA) and British and Eire Association of Vitreoretinal Surgeons (BEAVRS) vitreoretinal database between 2015 and 2022. ParticipantsAll consecutive eyes that underwent primary rhegmatogenous retinal detachment surgery using either Densiron® 68 or light silicone oil as an internal tamponade agent. MethodsTo minimize confounding bias, we undertook 2:1 nearest neighbor matching on inferior breaks, large inferior rhegmatogenous retinal detachments, proliferative vitreoretinopathy, and, for visual analyses, baseline visual acuity between treatment groups. We fit regression models including prognostically relevant covariates, treatment-covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals using bias-corrected cluster bootstrapping with 9 999 replications. Main Outcome MeasuresPresence of a fully attached retina and visual acuity at least two months after oil removal. ResultsOf 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomical and visual outcome analyses, respectively. The primary success rate was higher in the Densiron® 68 group (113 of 142; 80%) compared to the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI 1.63 to 2.23, P < 0.001). We also observed a significant improvement favoring Densiron® 68 of -0.26 logMAR in postoperative visual acuity between the two groups (95% CI -0.43 to -0.10, P = 0.002). The anatomical benefit of using Densiron® 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with proliferative vitreoretinopathy Grade C. We found no evidence of visual effect moderation by anatomical outcome or foveal attachment. ConclusionsDensiron achieved higher anatomical success rates and improved visual outcomes compared to conventional light silicone oil in eyes with inferior retinal pathology and severe proliferative vitreoretinopathy.

Coexistence of choroidal melanoma and rhegmatogenous retinal detachment: a case report and literature review

Introduction and importance: The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature. Case presentation: A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration. Clinical discussion: Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD. Conclusions: In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated.

Anatomical and functional outcomes of RETINOTOMY on primary inferior RHEGMATOGENOUS retinal detachment

AbstractPurpose: To analyse the anatomical and functional outcomes of pars plana vitrectomy combined with retinotomy alone in primary inferior rhegmatogenous retinal detachments (RD).Methods: Data from 139 patients who underwent vitreoretinal surgery for inferior RD in Centro Hospitalar Vila Nova de Gaia/Espinho, between 2012 and 2021 by the same surgeon, were analysed. Univariate and multivariate analysis were performed. Outcomes such as visual acuity (VA) and occurrence of complications were studied.Results: From the total 139 eyes analyse, 72 were subject to vitrectomy combined with retinotomy. Among them, 79% had macula‐off at the time of surgery and 94.4% had proliferative vitreoretinopathy (grade B or C). Functional success, with VA improvement or stabilization after surgery, was 75%. VA was significantly improved from 1.61 to 0.73 logarithm of the minimal angle of resolution units (p &lt; 0.001). The anatomic success rate was 95.8% in the first surgery.Conclusions: Inferior RD is a significant clinical and surgical challenge for vitreoretinal surgeons and the choice between the best surgical technique is still controversial. These cases frequently require some additional measures to vitreoretinal surgery due to its high recurrence rate. Our results show that vitrectomy with retinotomy alone on primary inferior RD has high anatomical and functional success rates.

Surgical management of disc pit maculopathy: A case report

AbstractPurpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications.Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided.Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil.Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority.

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.

Heavy Silicone Oil as an Endotamponade in Recurrent or Complicated Retinal Detachment and Macular Hole

Objectives:To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.Materials and Methods:Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.Results:The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients’ median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).Conclusion:Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.

A novel mechanism of macular holes in patients with Behçet's uveitis

To describe two cases of Behçet's retinitis lesions in the macula causing sloughing of retinal tissue forming a full-thickness macular hole. This was a case series study. Case 1 was a 26-year-old presented, known case of Behçet's disease, presented with a large area of retinitis involving the center of the macula with overlying vitritis. One day after the initiation of treatment, vitritis improved, but the retinitis patch sloughed and created a full-thickness macular hole. Case 2 was a 31-year-old male, known case of Behçet's uveitis, who presented vitritis and multiple retinitis patches involving the macula of the left eye. Two weeks after infliximab infusion, the inflammation resolved with medical management, however, the retinitis patch was complicated by a full-thickness macular hole with an inferior rhegmatogenous retinal detachment. Retinitis at the macula can be complicated by a full-thickness macular hole.

Results of pars plana vitrectomy with inferior retinotomy in inferior rhegmatogenous retinal detachments with inferior retinal breaks and proliferative vitreoretinopathy grades B or C

AbstractPurposeTo report the surgical outcomes of pars plana vitrectomy (PPV) with inferior retinotomy without the need for scleral buckling in primary inferior rhegmatogenous retinal detachment (RRD) with inferior retinal breaks and Proliferative vitreoretinopathy (PVR) grades B or C.MethodsRetrospective, consecutive series, single‐center study of patients that underwent PPV with inferior retinotomy for primary inferior RRD with inferior retinal breaks (4:00 to 8:00 clock hours) and PVR grades B or C. Data were obtained from patients’ medical records from October 2014 to November 2020. The primary outcomes of the study were retinal reattachment and visual acuity improvement. Data collected before and after surgery was compared between groups using chi‐square analysis and paired samples t‐test. The resulting p‐values significance level was set at p = 0.05.ResultsThirty‐two patients (32 eyes) met the inclusion criteria. PVR in stage B was present in 19 patients and stage C in 13 patients. Macula‐off RRD was diagnosed in 25 patients while the other 7 patients had RRD with the macula attached. Regarding primary outcomes, 31 out of 32 (97%) patients achieved retinal reattachment with no differences between PVR groups (p = 0.406). The best‐corrected visual acuity (BCVA) improved significantly in eyes with macula‐off RRD at presentation (p &lt; 0.001). Although macula‐attached RRD eyes had higher final BCVA, its improvement was not statistically significant (p = 0.370). Besides one retinal redetachment, no other significant complications were reported after surgery.ConclusionsInferior retinal breaks are associated with surgical failure following PPV for inferior RRD repair, especially if advanced PVR is present. Our results suggest that, in these less common and more challenging cases, PPV with an inferior retinotomy is associated with very favorable anatomic and visual outcomes.

Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks.

PurposeTo describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks.Patients and MethodsThis is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020.ResultsA total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period.ConclusionThe combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.

SIX MONTHS PRIMARY SUCCESS RATE FOR RETINAL DETACHMENT BETWEEN VITRECTOMY AND SCLERAL BUCKLING

Purpose: To compare clinical outcomes between pars plana vitrectomy (PPV), scleral buckling (SB), and PPV+SB for rhegmatogenous retinal detachment in the Japan-RD Registry. Methods: This is a nation-wide, multicenter, observational study based on the registry data between 2016 and 2017. The failure levels were defined as Level 1 (a failure of retinal detachment repair), Level 2 (remaining silicone oil), and Level 3 (multiple surgeries to achieve reattachment). We compared cases treated by SB or PPV in the subgroup of simple rhegmatogenous retinal detachment using multivariate Cox proportional hazard models. Results: A total of 2,775 cases were included. Overall, 6 months any levels of failure in total, SB, PPV, and PPV+SB were 9.2% (n = 256), 6.9% (n = 48), 8.2% (n = 157), and 21.3% (n = 51), respectively. Poor visual acuity at baseline in SB and inferior rhegmatogenous retinal detachment and larger retinal tear in PPV were associated with a higher risk of failure. Pars plana vitrectomy was associated with a higher chance of achieving primary success in cases with simple RRD, especially for cases with superior RRD (adjusted hazard ratio 3.61, 95% confidence interval 2.22–5.94, P &lt; 0.001). Conclusion: In this nationwide study, surgical anatomic outcomes were equally successful in either SB or PPV. There were different baseline characteristics associated with primary success between SB and PPV.

Outcomes and Complications of In-Office Laser Demarcation of Peripheral Rhegmatogenous Retinal Detachments.

To evaluate the outcomes of in-office laser demarcation (LD) for peripheral rhegmatogenous retinal detachments (RRDs). This was a retrospective analysis of peripheral RRDs treated with LD. Patient demographics, visual acuity (VA), and RRD characteristics were recorded. Complications requiring additional procedures were recorded. Multiple logistic regression was used to characterize the association of RRD anatomy to treatment complications. A total of 112 eyes of 107 patients were analyzed with mean follow-up of 20 ± 12 months. VA at baseline and last follow-up was equivalent (0.16 logMAR, Snellen equivalent 20/29). Ninety-five (84.8%) eyes were successfully treated without an additional procedure. In multivariate analysis, the presence of VH (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.1-17; P = .04) and RRDs in the inferior 6 clock hours (OR = 6.2; 95% CI, 1.5-29; P = .01) were associated with complications. LD is successful in treating peripheral RRDs. RRD characteristics less conducive to laser include presence of VH and inferior RRD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:428-434.].

DENSIRON 68 HEAVY SILICONE OIL AS A SHORT-TERM INTRAOCULAR TAMPONADE FOR MACULA-ON INFERIOR RETINAL DETACHMENTS-A CASE SERIES.

To describe our experience using short-term heavy silicone oil (Densiron 68) for macula-on inferior rhegmatogenous retinal detachments with inferior retinal breaks. Retrospective, consecutive, observational case series. Data were retrospectively collected from the medical records of patients who underwent pars plana vitrectomy and Densiron 68 endotamponade for macula-on rhegmatogenous retinal detachment repair. Eight patients were included in the study. The mean patient age was 57.1 ± 12.3 (±SD) years. The mean time to Densiron 68 removal was 57.8 ± 17.8 (±SD) days (ranging from 24 to 83 days). One patient (12.5%) detached three weeks after Densiron 68 removal and required further surgery. All patients were attached at last follow-up with a mean follow-up of 192 days. The mean final best-corrected visual acuity was 20 of 40 (0.29 logarithm of the minimum angle of resolution) similar to the 20 of 45 preoperative best-corrected visual acuity (0.35 logarithm of the minimum angle of resolution, P = 0.501). No significant emulsification was noted before or during the removal of the Densiron 68. Two patients developed an increase in intraocular pressure before Densiron 68 removal that resolved after removal. One patient developed cystoid macular edema that resolved with a short course of topical medications, and one patient had persistent CME that required an intravitreal triamcinolone acetate 1% injection. The high anatomic success rate, good visual outcomes, and minimal complications suggest that Densiron 68 can be considered as a short-term tamponade for macula-on retinal detachments with inferior pathology.

Hemorrhagic complications associated with suprachoroidal buckling

BackgroundMultiple surgical techniques exist for the repair of rhegmatogenous retinal detachments (RRD). Suprachoroidal buckling (SCB), consisting of injecting viscoelastic material in the suprachoroidal space to allow chorioretinal apposition, has been recently described in the repair of RRD. The aim of this study is to report the complications of SCB and to propose measures to decrease their incidence during the learning curve.MethodsA total of 26 eyes of 26 patients who underwent a SCB procedure for the management of RRD secondary to a single or multiple retinal breaks were enrolled. Patients were operated between January 2014 and March 2017 at two academic institutions. Patient and retinal detachment characteristics were obtained from the charts. Surgical videos were reviewed for every case and intraoperative complications were recorded. Complications observed postoperatively were obtained from the charts.ResultsSixteen eyes (62%) underwent SCB alone, 5 eyes (19%) underwent additional gas tamponade and 5 eyes (19%) had combined pars plana vitrectomy. The most common complication was hemorrhage (6 cases, 23%). There were no cases of ischemic choroidal changes or hyperpigmentation at the edge of the dome. All six complications occurred in phakic patients who had inferior RRD with retinal breaks in the inferior quadrants. Isolated subretinal hemorrhage occurred in 4 patients and isolated suprachoroidal hemorrhage in 1 patient, and those did not affect final visual outcome. Extensive combined subretinal and suprachoroidal hemorrhage occurred in one case, and was complicated by phthisis bulbi. Re-detachment occurred in 4/6 (67%) of patients, and 5/6 (83%) of patients required a secondary procedure. Three out of 6 patients (50%) had at least 2 lines of visual acuity improvement.ConclusionSCB performed for RRD can be associated with hemorrhagic complications. The hemorrhages are usually self-limited but may occasionally result in severe visual compromise when involving the suprachoroidal space. Specific surgical measures need to be undertaken in order to decrease the likelihood of complications and further studies are needed to assess the safety and efficacy of this technique.

Intrusion of episcleral buckles: report of two cases and brief review

BackgroundThe authors report two cases of the scleral buckles intrusion and erosion that presented many years after primary surgery with vitreous haemorrhage in one of them. Although the erosion/intrusion of a silicone scleral buckle (SB) is rare, it may have serious consequences and optimal management can be challenging. Therefore, this diagnosis should be considered if attributable signs and symptoms including vitreous haemorrhage occurred after scleral buckling. The authors briefly review the literature on clinical presentation and management of the episcleral silicone buckling erosion and intrusion.Case presentationCase 1: A 48-year-old woman with a history of scleral buckling for an inferior rhegmatogenous retinal detachment presented with visual loss in her right eye. A vitreous haemorrhage was observed. After Close observation, Partial resolution of haemorrhage revealed an intruded sponge segment in inferior vitreous cavity. Case 2: A 26-year-old man was referred for retinal evaluation. Twenty years earlier, he had undergone lensectomy for bilateral childhood cataract. Ten years ago, he had developed an aphakic RRD in the left eye. The detachment was managed with pars plana deep vitrectomy, endolaser, an encircling silicone band, and silicone oil injection. On examination an eroded band was noted.ConclusionAlthough the erosion/intrusion of a silicone episcleral buckle is rare, it may have serious consequences and optimal management can be challenging. Unnecessarily destructive techniques may predispose the eye to this complication and should be avoided. Patients who have a history of SB need lifelong follow-up and this diagnosis should be considered if attributable signs and symptoms occurred.

SEQUENTIAL PNEUMATIC RETINOPEXIES FOR THE TREATMENT OF PRIMARY INFERIOR RHEGMATOGENOUS RETINAL DETACHMENTS WITH INFERIOR BREAKS: The Double-Bubble Approach.

To evaluate a new approach of sequential pneumatic retinopexies for the management of inferior rhegmatogenous retinal detachments (RD) with inferior breaks. Multicenter retrospective consecutive case series of inferior RDs caused by retinal breaks located within the inferior 4 clock hours treated with sequential pneumatic retinopexies, 24 to 48 hours apart. A total of 26 patients with inferior RDs secondary to one or more breaks between the 4 o'clock and 8 o'clock meridians were included from September 2007 to February 2012. The mean follow-up duration was 35.3 weeks. Anatomical success at 8 weeks was achieved in 65.4% of all patients (including those with giant retinal tear and patients with previous RD in the study eye). When excluding patients with giant retinal tear and previous RD in the study eye, the anatomical success rate increased to 70%. Overall, the mean visual acuity improved from 1.00 logMAR (Snellen equivalent 20/200) at baseline to 0.38 logMAR (Snellen equivalent 20/50) at last follow-up. Sequential pneumatic retinopexy offers a new viable surgical option for the treatment of RDs secondary to inferior breaks.

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.