Laser Retinopexy Research Articles

Cost Drivers of Pars Plana Vitrectomy for Retinal Detachment: Time-Driven Activity-Based Costing Analysis.

Introduction: To determine drivers of day-of-surgery costs for pars plana vitrectomy (PPV) in the management of retinal detachment (RD) repair, the mainstay treatment, based on surgical complexity and intraoperative factors. Methods: Economic analysis was performed using time-driven activity-based costing methodology for patients who had standard (Current Procedural Terminology [CPT] code 67108) or complex (CPT 67113) RD repair with PPV at the University of Michigan in 2021. Data were obtained via the electronic health record and previous literature. PPV expenses were determined with time-driven activity-based costing, a cost calculation that incorporates time and key resource costs, and were analyzed using univariate and multivariate regression. Results: The analysis included 412 PPVs (270 standard and 142 complex based on CPT code). The operating room time was significantly increased in complex cases (P < .01). Univariate analysis found that complex PPV, cryopexy, staining agent use, retinectomy, simultaneous scleral buckling, perfluoro-N-octane (PFO) use, silicone oil tamponade, and perfluoropropane tamponade were associated with a statistically significant difference in costs (P < .01); use of laser retinopexy was not significantly associated (P = .7190). Multivariate analysis found that standard PPV cost an average $5132.33 and significant incremental costs were found for complex PPV (+$1185.55; P < .001), cryopexy (+$465.02; P = .032), staining (+$525.16; P = .04), PFO use (+$1089.54; P < .0001), retinectomy (+$2031.17; P < .0001), and simultaneous scleral buckling (+$916.34; P = .006). Conclusions: The intraoperative factors that increase operating room time and ultimately the incurred cost of complex PPV cases vs standard PPV were identified and economically defined. These findings can improve practice patterns by optimizing costs for effective surgical planning in the management of RD repair.

SUCCESSFUL TREATMENT OF VON HIPPEL-LINDAU DISEASE-ASSOCIATED RETINAL CAPILLARY HEMANGIOBLASTOMA WITH BELZUTIFAN IN A PEDIATRIC PATIENT.

The authors describe a case of a retinal capillary hemangioblastoma (RCH) in a pediatric patient with von Hippel-Lindau (VHL) syndrome that was successfully treated with systemic belzutifan. The clinical course was documented with serial fundus examinations and multimodal imaging, including Optos widefield fundus photography and optical coherence tomography. A literature review was conducted to look for similar cases and/or discussion. A left RCH was noted on a standard VHL surveillance retinal examination of a then 15-year-old male patient with VHL syndrome. Over the course of 17 months, this RCH was treated with focal laser therapy, photodynamic therapy, cryotherapy, bevacizumab injection, and endolaser ablation. Complications of these treatments included subretinal fluid and vitreomacular traction necessitating laser retinopexy, scleral buckle, and pars plana vitrectomy with membrane stripping. After a 6-month interval from the last local therapy (endolaser treatment), there was minimal regression of the lesion, and many concerning features persisted. At 22 months from presentation, the patient started belzutifan 120 mg PO daily with subsequent regression in size and less perfusion to the hemangioblastoma within 4 months. The patient is tolerating the systemic belzutifan with only the expected normocytic anemia and has not required transfusion therapy after 12 months of treatment. von Hippel-Lindau disease is a rare and serious condition associated with multiple types of benign and malignant tumors. Belzutifan is tolerated in the adolescent population and can provide a systemic treatment alternative for VHL-associated RCH.

Retinal redetachment after silicone oil removal: a risk factor analysis

PurposeTo report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors.MethodsRetrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes.ResultsThe median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06).ConclusionA retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate.Trial registration numberID NCT05647928 (12th April 2022)

Prognostic Factors for Recurrent Rhegmatogenous Retinal Detachment after Silicone Oil Removal.

To investigate the prognostic factors for recurrent rhegmatogenous retinal detachment following silicone oil removal. This retrospective review included 147 consecutive patients with rhegmatogenous retinal detachment treated with silicone oil tamponade at a high-volume referral-based tertiary hospital between January 2012 and May 2022. All patients underwent follow-up for a minimum of 6 months after subsequent silicone oil removal. The primary outcome measure was the rate of recurrent retinal detachment following silicone oil removal, and the secondary outcome was best-corrected visual acuity after silicone oil removal. The mean silicone oil tamponade duration was 4.7 ± 5.01 months (range, 1-38 months; median, 3 months), and the recurrent retinal detachment rate after silicone oil removal was 15.6%. Logistic regression analysis revealed that argon endolaser photocoagulation during silicone oil removal (odds ratio [OR], 0.309; 95% confidence interval [CI], 0.106-0.898; p = 0.031) was associated with a lower rate of anatomical success after silicone oil removal. Demographics, preoperative ocular characteristics, proliferative vitreoretinopathy, previous scleral encircling or buckling, previous retinectomy, concomitant phacoemulsification, duration of silicone oil tamponade, and gas tamponade after silicone oil removal were not significantly associated with recurrent retinal redetachment after silicone oil removal. Duration of silicone oil tamponade (OR, 1.226; 95% CI, 1.073-1.402; p = 0.003) and recurrent retinal detachment after silicone oil removal (OR, 3.400; 95% CI, 1.311-8.817; p = 0.012) were associated with poor visual outcomes after silicone oil removal. Among all factors examined in this study, including the duration of silicone oil tamponade, laser retinopexy was the only significant prognostic factor for recurrent retinal detachment after silicone oil removal. A longer duration of silicone oil tamponade was associated with worse visual outcomes and a lower rate of visual improvement after silicone oil removal.

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Deep Learning for prediction of late recurrence of retinal detachment using preoperative and postoperative ultra-wide field imaging.

To elaborate a deep learning (DL) model for automatic prediction of late recurrence (LR) of rhegmatogenous retinal detachment (RRD) using pseudocolor and fundus autofluorescence (AF) ultra-wide field (UWF) images obtained preoperatively and postoperatively. We retrospectively included patients >18 years who underwent either scleral buckling (SB) or pars plana vitrectomy (PPV) for primary or recurrent RRD with a post-operative follow-up >2 years. Records of RRD recurrence between 6 weeks and 2 years after surgery served as a ground truth for the training of the deep learning (DL) models. Four separate DL models were trained to predict LR within the 2 postoperative years (binary outputs) using, respectively, UWF preoperative and postoperative pseudocolor images and UWF preoperative and postoperative AF images. A total of 412 eyes were included in the study (332 eyes treated with PPV and 80 eyes with SB). The mean follow-up was 4.0 ± 2.1 years. The DL models based on preoperative and postoperative pseudocolor UWF imaging predicted recurrence with 85.6% (sensitivity 86.7%, specificity 85.4%) and 90.2% accuracy (sensitivity 87.0%, specificity 90.8%) in PPV-treated eyes, and 87.0% (sensitivity 86.7%, specificity 87.0%) and 91.1% (sensitivity 88.2%, specificity 91.9%) in SB-treated eyes, respectively. The DL models using preoperative and postoperative AF-UWF imaging predicted recurrence with 87.6% (sensitivity 84.0% and specificity 88.3%) and 91.0% (sensitivity 88.9%, specificity 91.5%) accuracy in PPV eyes, and 86.5% (sensitivity 87.5%; specificity 86.2%) and 90.6% (sensitivity 90.0%, specificity 90.7%) in SB eyes, respectively. Among the risk factors detected with visualisation methods, potential novel ones were extensive laser retinopexy and asymmetric staphyloma. DL can accurately predict the LR of RRD based on UWF images (especially postoperative ones), which can help refine follow-up strategies. Saliency maps might provide further insight into the dynamics of RRD recurrence.

Indications and Outcomes of Laser Retinopexy in Eyes With High-Risk Lattice Degeneration.

Purpose: To examine the characteristics of eyes with high-risk lattice degeneration treated with laser retinopexy and determine the indications, safety, and outcomes of the treatment. Methods: This interventional single-surgeon consecutive retrospective study was conducted at Wills Eye Hospital between 2014 and 2021. The series included eyes with lattice degeneration with high-risk lesions. Documented characteristics and outcomes of these eyes and fellow eyes were documented. Results: The study comprised 167 eyes of 143 patients (53.3% women; mean age [±SD], 50 ± 17 years). Complications after laser treatment included new posterior vitreous detachment (PVD) (n = 21), epiretinal membrane (ERM) (n = 13), retinal detachment (RD) (n = 5), and additional laser required (n = 22). Eyes that developed ERMs were more likely to develop PVDs (odds ratio, 5.39; 95% CI, 1.57-18.47). Patents who developed ERMs were older (mean, 60 ± 7 years vs 49 ± 17 years; P = .016), as were those developing PVDs (mean, 59 ± 8 years vs 48 ± 17; P = .005). No eye with a new ERM required surgery (n = 13). Four eyes with a new RD required laser retinopexy alone; 1 eye was treated surgically. No eye had an RD at the most recent evaluation. Conclusions: Despite high-risk lesions in areas of lattice degeneration, few eyes developed RDs after prophylactic laser retinopexy. Older patients may have a higher risk for ERM or PVD after laser treatment. Eyes with post-laser PVD were more likely to develop an ERM.

Glue-Assisted Retinopexy for Retinal Detachments Study Report 2: Fibrin Glue As a Surgical Adjunct in Complex Rhegmatogenous Retinal Detachment.

Purpose: To present the successful application of fibrin glue as a surgical adjunct in the management of complex rhegmatogenous retinal detachment (RRD). Methods: In this retrospective case series, fibrin glue was used as a surgical adjunct in 5 cases of complex RRD. In each case, standard pars plana vitrectomy and laser retinopexy were performed by the same surgeon. Fibrin glue was used intraoperatively as a tamponade to seal the breaks because the isolated use of conventional tamponade agents was not feasible given the variable nature of the complex RRDs, the anatomy of the eye, or an inability to maintain postoperative positioning. Results: In 1 patient previously treated for a large corneoscleral tear, fibrin glue was used to seal a large iatrogenic retinal break caused by a fragmatome-related surge that led to a quadrantic RD. In 2 patients treated for combined RRD, fibrin glue was used with silicone oil to manage recurrent RRD with incompletely drained thick subretinal fluid and blood. In 2 other cases, fibrin glue was applied to manage RRD in congenital aniridia with advanced glaucoma and aphakia. In all cases, retinal attachment without serious adverse effects was attained over a follow-up ranging from 4 to 6 months. Conclusions: Fibrin glue is an effective, safe surgical adjunct in complex RRD. It can be used to transiently seal a retinal break when use of a conventional tamponade agent is not possible or not sufficient alone.

Experience in managing patients with X-linked congenital retinoschisis

AIM: To describe the clinical manifestations and management experience of patients with X-linked congenital retinoschisis (XLRS).&#x0D; MATERIAL AND METHODS: The study was conducted in the ophthalmology department of the multidisciplinary clinical medical center Bonum (Yekaterinburg). Two brothers with XLRS were under observation. They underwent complete ophthalmological examinations, including electrophysiological examinations, optical coherence tomography (OCT), and fundus photoregistration. The mother refused genetic testing.&#x0D; RESULTS: Both siblings had early (up to 1 year) manifestations of central foveolamellar and peripheral bullous retinoschisis. The parents are phenotypically healthy, and the relatives have no hereditary eye diseases. The younger brother had a progressive peripheral retinoschisis and underwent barrier laser retinopexy; as a result, the progression stopped at the last examination. Acetazolamide 125 mg given orally daily for 4 weeks did not have a noticeable effect on the volume of bullous cavities. The older brother had been under observation for 4 years, and spontaneous closure of retinal cavities on the periphery in one eye and retinal detachment in the other after surgical treatment of retinoschisis were observed.&#x0D; CONCLUSION: Clinical cases of long-term follow-up of two brothers with XLRS are described. OCT is indicated to diagnose, assess the length and the state of the vitreoretinal interface, and monitor XLRS. Electroretignography is a specific and sensitive method for the complex diagnosis of XLRS. Barrier laser retinopexy is indicated for progressive peripheral retinoschisis. The efficacy and safety of carbonic anhydrase inhibitors in patients with XLRS require further study.

Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated With Epiretinal Membrane Formation.

Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:326-333.].

ULTRA-WIDEFIELD IMAGING DETECTION RATE IN IDENTIFYING PERIPHERAL RETINAL TEARS IN SINGLE VERSUS MONTAGE OF PERIPHERAL STEERING.

To compare the detection rate of orthogonal, directed peripheral steering, and automontaged images with ultra-widefield imaging and the factors influencing the ability to identify retinal breaks. Retrospective cohort study. Three hundred and seventy-six treatment-naive eyes (349 patients) that underwent laser retinopexy for retinal breaks between 2015 and 2021 were included. Pretreatment ultra-widefield orthogonal, peripheral steering, and automontage were cross-referenced to scleral-depressed examination to determine whether images successfully visualized all retinal breaks. Total relative retinal area (RRA) visualized was divided by its optic disk area (pixels) to calculate relative retinal area. Potential associations were assessed by linear regression analysis. One hundred and sixty two eyes (154 patients) met inclusion criteria. Orthogonal, peripheral steering, and automontage images showed detection rates of 47.5%, 90.7%, and 80.0%, respectively. Relative retinal area increased from orthogonal versus montage by 34.7% ± 26.5% (mean ± SD), which increased the detection rate by 90.8% ( P = 0.006). In linear probability models, vertical meridian tears decreased probability of identification in orthogonal, peripheral steering, and automontage by -26.6%, -86.2%, and -68.7%, respectively ( P < 0.001), and horizontal meridian tears increased the probability by 62.2%, 92.9%, and 85.5%, respectively, ( P < 0.001). Tears posterior to the equator in orthogonal images increased the probability (91.4%, P < 0.001). Artifacts such as lids/lashes, reflection, and face guard decreased the probability in directed peripheral steering by -28.6%, -50.0%, and -66.7%, respectively, ( P = 0.020, P = 0.049, and P = 0.016). Using directed peripheral steering and automontage increases RRA and detection rate of identifying peripheral retinal breaks. Tears in horizontal meridians or posterior to the equator increase the probability of identification. Common ultra-widefield imaging artifacts can significantly limit the probability of identifying retinal tears.

Simplified segmental scleral buckling without localization and cryopexy: A retrospective comparison with conventional segmental scleral buckling

Abstract: PURPOSE: The aim of this study was to propose a simplified segmental scleral buckling (SSSB) technique that does not require break localization for less-experienced vitreoretinal surgeons. MATERIALS AND METHODS: This retrospective study compared the clinical results of 46 conventional and 23 SSSB (conventional segmental SB [CSSB] and SSSB, respectively) procedures in a tertiary referral retinal center in Taiwan between 2008 and 2019. In the CSSB group, breaks were localized during surgery. In the SSSB group, a wider sponge band and a longer scleral buckle were used to maximize the chances of sealing the retinal breaks based on the preoperative fundus examination findings and to minimize the positioning error caused by cyclotorsion, without performing indirect ophthalmoscopy. The primary outcome was assessed after 6 months. Patient characteristics, surgical parameters, and outcomes were compared between groups. The main outcomes were the duration of surgery, changes in visual acuity, primary success rate, rhegmatogenous retinal detachment recurrence rate, and the frequency of further laser photocoagulation. RESULTS: SSSB had a shorter duration than CSSB and was associated with more frequent use of longer and wider explants and need for further laser retinopexy. Both groups showed high primary success rates (95.65%). CONCLUSION: The primary success rates for the SSSB and CSSB groups were comparable and equally high. SSSB required laser retinopexy more frequently and was a shorter procedure.

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

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

Recurrences and Macular Complications after Perfluorocarbon-Liquid-Free Vitrectomy for Primary Rhegmatogenous Retinal Detachment.

This study investigates factors associated with recurrent rhegmatogenous retinal detachment (RRD), macular complications, and visual outcomes after pars plana vitrectomy (PPV) without perfluorocarbon liquids (PFCLs) for primary RRD. A longitudinal cohort study included consecutive patients with RRD who underwent PFCL-free PPV. Postoperative visual acuity and spectral-domain optical coherence tomography findings [cystoid macular edema (CME), epiretinal membrane (ERM), ellipsoid zone/interdigitation zone (EZ/IZ) damage] were collected. Logistic regression and linear mixed models analyzed rates and risk factors for RRD recurrence, CME, ERM, EZ/IZ damage, and visual acuity at 12months. 346 eyes with RRD were studied. Single-operation success rates were 96% and 93% for uncomplicated (n = 274 eyes) and complicated (n = 72 eyes) RRD, respectively. Factors associated with RRD recurrence were posterior retinal breaks [odds ratio (OR) = 10.7 compared to peripheral retinal breaks, p = 0.008], silicone oil tamponade (OR = 5.66 compared to gas, p = 0.01), and sectorial laser retinopexy (OR = 4.34 compared to 360° laser retinopexy, p = 0.007). The prevalence of CME, ERM, and EZ/IZ damage at 12months was 10%, 9%, and 6%, respectively. Eyes with EZ/IZ defects had worse postoperative visual acuity in both uncomplicated and complicated RRD. Proliferative vitreoretinopathy (OR = 2.95, p = 0.03) and silicone oil tamponade (OR = 3.70 compared to gas, p = 0.05) were associated with EZ/IZ damage. PFCL-free PPV demonstrated satisfactory single-operation success rates for uncomplicated and complicated RRD, with a low prevalence of macular complications. Analyzing factors associated with RRD recurrence can provide provisional recommendations for PFCL-free approaches in the absence of randomized trials.

Vitreoretinopathy-Associated Pediatric Retinal Detachment Treatment Outcomes: IRIS® Registry (Intelligent Research in Sight) Analysis.

To determine the treatment patterns and outcomes of pediatric retinal detachments (RDs) associated with hereditary vitreoretinopathies. Retrospective cohort analysis using IRIS® Registry (Intelligent Research in Sight) database. Patients < 18 years old with a rhegmatogenous RD and a systemic disorder associated with vitreoretinal degeneration (e.g., Stickler syndrome) or other malformation of the vitreous from 2013-2019. Cases were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9, ICD-10) diagnostic codes from the IRIS® Registry cohort. Other hereditary vitreoretinopathies that are not encoded by specific ICD code(s) were captured by text search. Nonspecific vitreous abnormality ICD codes were also included. Exclusion criteria included traumatic retinal detachments using ICD codes for ocular trauma and serous or exudative retinal detachment. Surgical procedures were identified using Current Procedural Terminology (CPT) codes for repair of retinal detachment. Baseline demographic information collected included age, gender, race/ethnicity, geographic region of the provider location, and health insurance status. Main outcomes measured in this study were average time to first surgery, number of eyes presenting with bilateral detachments, and choice of initial surgical procedure. A total of 2115 eyes of 1722 patients were identified (mean age, 10.4 years; 58% male). The median time to first surgery was 7 days (interquartile range, 40 days). One thousand four hundred seven eyes of 1134 patients had ≥ 1 year of follow-up, with 506 eyes (36%) developing a fellow eye RD. Thirty-three percent of patients presenting with bilateral detachments, and 349 eyes had initial RD surgery within 1 year of the index date documented by CPT code. Fellow eye detachment occurred a mean of 32 days after initial presentation. The mean number of surgeries per eye within 1 year was 1.68. Best-corrected visual acuity did not improve from a baseline 20/54 to 20/62. The initial procedure was most commonly complex RD repair (n = 176), followed by scleral buckle (n = 102), pars plana vitrectomy (n = 89), laser (n = 59), cryotherapy (n = 5), and pneumatic retinopexy (n = 5). There were 51 new diagnoses of glaucoma and 37 new diagnoses of aphakia within 1 year after the surgical procedure. IRIS Registry data provide insight into rare pediatric vitreoretinopathy-associated RDs, which have a high rate of reoperation and fellow eye involvement. Proprietary or commercial disclosure may be found after the references.

Management of Retinal Detachment With a Coexistent Macular Hole: Submacular Placement of Retinal Autograft Through a Macular Hole.

In this article, a submacular autologous neurosensory retinal transplantation technique is presented in patients with large macular hole (MH) accompanying retinal detachment. In the surgical procedure, 23-G pars plana vitrectomy and peripheral vitrectomy were performed. An autologous neurosensory retinal patch, which should be larger than the diameter of the MH, was released from a suitable quadrant. The retinal patch was grasped using a 23 gauge microforceps and then passed through the MH and placed under the macula. Liquid perfluorocarbon (PFCL) was injected, and the retina was reattached. A subfoveal autologous neurosensory retinal patch was repositioned in the center of the MH with gentle manipulation under fluid perfluorocarbon, if necessary. Laser retinopexy was applied to peripheral tears under PFCL Subsequently, a 5,000-cSt silicone oil-PFCL exchange was also performed. Four eyes of four patients were operated on using the technique described earlier. Silicone oil was removed from two patients, and the macular holes were closed in all patients at the last follow-up. This technique has been beneficial in refractory MHs and can improve the visual potential in eyes with MHs.

Netzhautriss – optometrisches Management

Purpose. This case report describes the optometric manage- ment of a peripheral retinal tear that was discovered during an optometric eye examination. It is intended to sensitize optometrists and ophthalmic opticians to the topic of retinal tears and retinal detachment. Material and Methods. During an optometric eye examina- tion, the fundus was examined using an ultra-widefield laser scanning ophthalmoscope. A retinal tear was detected in the fundus periphery. Results. After the comprehensive optometric examination, the patient was informed about the finding of a peripheral retinal tear and its consequences and referred to an eye clinic. At the eye clinic, the diagnosis was confirmed. Treatment consisted of preventive laser retinopexy to reduce the risk of subsequent tear extension and retinal detachment. Conclusion. The retinal tear presented in this case report was detected as an incidental finding. The patient was referred to an eye clinic for specialist diagnosis and preventive treat- ment. The case shows that a comprehensive optometric eye examination not only enables the management of relevant refractive errors, but can also make a contribution in terms of preventive health care. Optometric involvement in eye care has the potential to lead to earlier diagnosis, allowing treatment strategies to be implemented at an earlier stage. Together, earlier diagnosis and earlier intervention can lead to better long-term health outcomes. Keywords Fundus examination, fundus periphery, retinal tear, retinal detachment, retinopexy

In-Office Suprachoroidal Viscopexy for Rhegmatogenous Retinal Detachment Repair

In-office suprachoroidal viscopexy (SCVEXY) is a minimally invasive technique for rhegmatogenous retinal detachment (RRD) repair that can be performed with no incision, no tamponade agent, and no positioning requirements. This technique has the potential to be a step forward in the armamentarium to treat RRDs. To describe in-office SCVEXY for RRD repair. In this single-case report with short follow-up, a man in his 50s with pseudophakia and recent visual loss presented to St Michael's Hospital, Unity Health Toronto, with a fovea-off RRD in the right eye, extending from 6 to 10 o'clock, with no visible causative retinal break. Injection of suprachoroidal sodium hyaluronate, 1%, in the region of the suspected break, using a 30-gauge needle with a custom-made guard that exposed only 1 mm of the needle. Ability to perform in-office SCVEXY and to obtain a visible choroidal indentation. After the procedure, a dome-shaped choroidal convexity was present in the superior temporal area. The patient achieved macular reattachment in less than 24 hours with no postoperative abnormalities, such as outer retinal folds, residual subfoveal fluid, or retinal displacement, with rapid recovery of the outer retinal bands on optical coherence tomography. The optical coherence tomography scans acquired in the area of the choroidal convexity demonstrated the location of the viscoelastic material in the suprachoroidal space. Laser retinopexy was applied in the suspected region of the retinal tear, and the patient was able to resume normal activity immediately after the procedure with no restrictions. Suprachoroidal viscopexy is feasible as an in-office technique to create a temporary choroidal buckle for RRD repair. It is a minimally invasive procedure with the potential to maximize anatomical outcomes of integrity and postoperative functional outcomes in RRD because its mechanism of action does not require drainage of subretinal fluid or intraocular gas tamponade. Nevertheless, this was a single-case report with short follow-up, which limits the ability to determine the procedure's benefits, potential adverse events, failure rates, and best-case selection. Further work is required to refine the procedure and assess its efficacy and safety.

Morphological Evaluation of Transscleral Laser Retinopexy in Rabbits: Comparison of Optical Coherence Tomography and Histologic Examinations.

Transscleral retinopexy is a preventive technique used against retinal detachment. Fundus examination can allow the monitoring of morphological retinal changes in the progression of photocoagulation lesions, without offering details on the morphological changes by the retinal lesion. The aim of the study was to assess the progression of photocoagulation lesions induced by transscleral retinopexy (840 nm diode laser), by comparing the optical coherence tomography (OCT) and histological images over a period of six weeks on eight pigmented New Zealand healthy rabbits (four males and four females; n = 16 eyes). All rabbits underwent transscleral retinopexy on their left eye on day 0 (D0). Measurements of the photocoagulation lesions were obtained in vivo on D0, D7, D15, D21, and D42 by acquiring OCT images of both eyes from all rabbits. On D1, D7, D21, and D42, two rabbits were euthanized, and their eyes were enucleated. A significant effect by time on the decrease in the central retinal thickness of the photocoagulation lesion was observed from D1 to D7 (p = 0.001); however, no such effect was observed on the horizontal length ((HL) p = 0.584) of the lesion surface. The reliability between the OCT and histological measurements, which were evaluated using intraclass correlation coefficients, was excellent for measuring the retinal thickness at the center (ICC = 0.91, p < 0.001), moderate for the right side of the retinal lesions (ICC = 0.72, p = 0.006), and not significant for the left side and HL (p = 0.055 and 0.500, respectively). The morphological changes observed in the OCT and histopathological images of the photocoagulation lesions were qualitatively described over time. OCT is an effective tool for monitoring changes in photocoagulation lesions. Some measurements and qualitative changes showed an adequate correlation between the OCT and histological findings.

A Case of Full-thickness Macular Hole Formation Secondary to Laser Retinopexy

Purpose: To report a case of full-thickness macular hole (FTMH) formation secondary to demarcation laser retinopexy in a retinal break with localized retinal detachment patient.Case summary: A 59-year-old male visited our clinic with ocular discomfort in both eyes. Uncorrected visual acuity (UCVA) was 0.63 in right eye. Large retinal break in 1:30 o/c, localized retinal detachment and laser marking scars all around the right eye were found in fundoscopic exam. Posterior-vitreous detachment or vitreomacular traction was not observed in optical coherence tomography (OCT). Demarcation laser retinopexy was performed around the margin of retinal detachment and peripheral degenerative lesions. Three months after demarcation laser retinopexy, UCVA in right eye of the patient was decreased to 0.16 and full thickness macular hole was observed on OCT examination. Pars planar vitrectomy, internal limiting membrane peeling, and SF6 gas tamponade were performed in the right eye. One month after the surgery, closure of FTMH was observed. Three months after surgery, there were no recurrence of FTMH in the right eye.Conclusions: Demarcation laser photocoagulation of localized retinal detachments may predispose to FTMH formation. Even though it can be occurred rarely, follow-up check-up is necessary in consideration of the possibility of FTMH, which can cause serious visual loss.