Laser Retinopexy Research Articles

Intraoperative findings and postoperative results associated with cataract surgery performed after retinal reattachment surgery in dogs-36 cases (41 eyes).

To report intraoperative findings and complications associated with cataract surgery performed after retinal reattachment surgery (RR) via pars plana vitrectomy (PPV) using perfluoro-n-octane (PFO), laser retinopexy, and silicone oil tamponade in dogs. Retrospective record review of dogs that underwent post-RR cataract surgery. Signalment, time between RR and cataract surgery, type of lens extraction, postoperative visual status, and intra- and postoperative complications were recorded. Cataract formation or progression after RR was categorized as early (≤12months) or late (>12months). A total of 36 dogs (41 eyes) were included. Average time between RR and cataract surgery was 665days (median: 546). Early postoperative incidence of cataracts occurred in 19 eyes (46.3%). Types of lens extraction included phacoemulsification with intraocular lens (86.1%, 31/36 dogs), phacoemulsification alone (11.1%, 4/36 dogs), and intracapsular lens extraction (2.8%, 1/36 dogs). Visual improvement occurred in 95.1% of eyes (39/41) immediately postoperatively. Long term, 93.9% of eyes (31/33) maintained vision at 1month, 85.2% of eyes (23/27) at 3months, 77.3% of eyes (17/22) at 6months, and 60% (12/20) at 12months postoperatively. The most common postoperative complications were glaucoma (29.3%, 12/41 eyes), corneal ulceration (24.4%, 10/36 eyes), fibrin formation (21.9%, 9/41 eyes), and silicone oil migration into the anterior chamber (19.5%, 8/41 eyes). Post-RR cataract surgery should be considered in dogs with vision loss from cataracts after RR. In most eyes, vision was maintained up to 1year postoperatively.

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

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

Lyophilized amniotic membrane patch (LAMPatch) as a replacement of tamponades in the treatment of primary rhegmatogenous retinal detachment

BackgroundThe basis of retinal detachment repair is sealing the retinal breaks. In order to seal the retinal breaks, chorioretinal adhesion around these lesions has to be achieved. Laser retinopexy is not immediate thus necessitates the use of a temporal endotamponade to maintain both tissues in apposition. We propose the use of a patch of lyophilized human amniotic membrane (LAMPatch) in order to occlude the retinal tear effectively until the chorioretinal adhesion is settled, overcoming the risks and limitations of the current tamponades.Methods23-gauge vitrectomy was performed on eyes with primary retinal detachment with single retinal breaks of less than one-hour extension. A LAMPatch was deployed over the retinal breaks after retina was repositioned with perfluorocarbon. Neither gas nor silicon oil were injected.ResultsSix eyes of six patients with total or partial retinal detachment were included. Retinas remained reattached in all cases until the end on follow-up (3, 5 months). Best-corrected visual acuity at 1-week postop was between 20/30 and 20/100. Neither elevations of intraocular pressure, cataracts nor signs of inflammation were registered during follow-up. No second surgeries were needed.ConclusionThis technique has proven to be safe and effective in this small case series. No intraocular pressure rise, inflammation or cataracts were registered until last follow-up visit.

Safety and efficacy of the use of navigated retinal laser as a method of laser retinopexy in the treatment of symptomatic retinal tears.

To investigate the safety and efficacy of the use of navigated retinal laser as a delivery method of laser retinopexy in the treatment of symptomatic retinal tears. We conducted a retrospective observational study of 69 patients presenting to a district general hospital in the United Kingdom with a diagnosis of symptomatic retinal tear who underwent retinopexy using a navigated retinal laser (Navilas 577s). Patients were followed up at two weeks or later to assess the efficacy and safety of the use of navigated retinal laser for retinopexy treatment. In total, 72 retinal tears in 69 patients were identified in our cohort. Of these cases, 70 (97.2%) retinal tears were treated with retinopexy using a navigated laser with a median treatment time 200 seconds. Two retinal tears could not be imaged on the navigated laser system and so underwent cryopexy. In 67/70 (95.7%) of retinal tears, one session of laser treatment using the navigated laser system was sufficient for primary management. The remaining three tears required a second session. No retinal tears treated with navigated laser treatment progressed to retinal detachment. There were no other complications seen with the use of this laser. The use of navigated retinal laser as a method of laser retinopexy for the treatment of retinal tears shows comparable safety and efficacy with other studies using traditional retinal laser systems.

Acute retinal necrosis: Clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction-positive patients.

To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6-25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1-2 quadrant vs 3-4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD.At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

First postoperative day review in eyes undergoing pars plana vitrectomy, encirclement and endotamponade to check intraocular pressure: Is it necessary?

To assess the proportion of patients with raised intraocular pressure (IOP) (≥ 30 mmHg) on the first postoperative day following pars plana vitrectomy (PPV), encirclement and endotamponade and assess the number requiring alteration in management to address elevated IOP. To establish whether review on day one is required. Retrospective case note review of consecutive patients who underwent 23-gauge PPV, 276-encirclement and endotamponade under the care of a single surgeon. All patients as standard received prophylactic anti-glaucoma medication post-surgery (eye drops) to take home but initiate only after day-one review. Statistical analysis was carried out using student t tests and Fisher's exact tests. Sixty-six patients were examined over a 2-year period. Mean day-one IOP was 22.2 mmHg (SD 7.3, 95% CI 20.4-24.0). Eleven patients (16.7%) had IOP ≥ 30 mmHg. Five patients (7.6%) had management changing decisions made at the day-one postoperative visit. Lens status, endotamponade, preoperative IOP, surgeon grade, cryopexy versus laser retinopexy or preoperative administration of once only 500 mg dose of intravenous acetazolamide did not influence IOP, with no significant difference between these subgroups. No cases of hypotony occurred. A significant minority of patients had elevation of IOP above 30 mmHg, a number of whom required treatment changes to address this. No preoperative risk factors were identified indicating those at risk of high IOP. It is important to identify these potentially harmful IOP elevations, and therefore day-one review is imperative and should be continued.

Localized versus 360° intraoperative laser retinopexy in cases of rhegmatogenous retinal detachment with mild-to-moderate grade proliferative vitreoretinopathy

To compare the efficacy of intraoperative localized and 360° laser retinopexy in cases of rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy and air tamponade. In this interventional, prospective, randomized, comparative study, 93 consecutive cases of RRD were enroled. After randomization 48 eyes received circumferential, while 45 underwent localized intraoperative laser retinopexy. Number and position of the retinal breaks, presence of proliferative vitreoretinopathy and/or lattice degeneration were recorded. Anatomical and visual outcome of the two groups were compared at 6 months postoperatively. Baseline characteristics did not significantly differ between groups. The single-operation reattachment rate was 86.66% in localized group and 89.58% in 360° group. The difference was not significant. (P = 0.46, χ2 test). At 6 months postoperatively, visual acuity (logMAR) was 0.06 ± 0.05 in localized group and 0.05 ± 0.03 in 360° group. The difference was not statistically significant (P = 0.673, t-test). Localized laser resulted to be as effective as 360° laser application; this may lead some advantages in term of lower invasiveness, reduction risk of complications and time saving.

Outcomes following Laser Retinopexy for Retinal Tears: A Comparative Study between Trainees and Specialists

Objective: To compare the outcomes of laser retinopexy for the treatment of retinal tears between residents and specialists, and to identify tear characteristics associated with the risk of progression to retinal detachment (RD). Methods: A retrospective review of 307 eyes treated by laser retinopexy, categorized by the performing physician, either a resident (217 cases) or a specialist (90 cases). Recorded parameters included the number, size, and location of the retinal tears, the presence of bridging vessels, vitreous hemorrhage (VH), or subretinal fluid (SRF), the need for additional laser, progression to RD, and surgery. Results: Additional laser was performed in 42.3% of cases in the resident group and 35.5% in the specialist group (p = 0.26). Progression to RD occurred in 6.9% of cases in the resident group and 5.5% in the specialist group (p = 0.66). The presence of VH and SRF were associated with an increased risk of progression to RD (p < 0.0001 and 0.003, respectively). A higher proportion of cases with SRF were treated by specialists (p = 0.006). Conclusions: Laser retinopexy is safely and effectively performed by residents, with no worse outcomes than procedures performed by specialists. A high rate of additional laser may be needed to achieve RD prophylaxis, and higher-risk cases can be identified at presentation and then referred to specialists.

Analysis of Emergent Nonhospital-Based Retina Consultation Requests in an Academic Nonhospital-Associated Retina Practice

To evaluate the outcomes of after-hour encounters concerning patients referred by eye physicians to on-call retina services for emergent evaluation not seen in or referred by an emergency department. Retrospective study. Patients seeking treatment at 3 private practice institutions over a 2-year period between 2017 and2018. A retrospective chart review was conducted comprising all patients who sought treatment emergently and after clinic hours from 3 academic nonhospital-associated retina-only private practice institutions over a 2-year period. Patient presenting symptoms, diagnosis given at time of after-hours appointment, duration of symptoms, source of after-hours consultation (patient or provider), procedure performed at appointment, and appointments that led to surgery. Nine hundred eighty-seven charts were reviewed. Provider referrals accounted for 49.13% (n= 485) and patient-derived referrals accounted for 50% (n= 493) of appointments. New patients accounted for 27.6% (n= 146) of patient-derived and 85.2% (n= 413) of provider-derived referrals. The most common presenting symptoms were flashes and floaters (42.5%; n= 420), decrease in visual acuity (32.1%; n= 317), generalized eye pain (7.4%; n= 73), visual field disturbance (4.3%; n= 42), and postoperative ocular pain (3.4%; n= 34). An in-office procedure was performed at the time of examination in 18% of encounters (n= 178), with most of these being laser retinopexy. Surgery was performed within 24 hours in 18% (n= 180), within 48 hours in 20.6% (n=203), within 72 hours in 21.7% (n= 214), and within 96 hours in 22.6% (n= 223) of the appointment. When combined with procedures, 36.2% (n= 358) of encounters led to urgent intervention within 24 hours. If a provider called about an existing patient, 37.5% of these appointments (n= 27) led to surgery versus 12.8% (n=49) if an existing patient self-referred. If a provider called about a new patient, 31.7% of these appointments (n= 131) led to surgery versus 10% (n= 14) if a new patient self-referred. At these 3 private practice retinal specialty clinics, 41% of after-hours appointment requests resulted in an intervention within 96 hours, and 36% of these patients underwent an intervention within 24 hours.

MANAGEMENT OF GIANT RETINAL TEARS USING TRANSSCLERAL DIODE LASER RETINOPEXY AND SHORT-TERM POSTOPERATIVE TAMPONADE WITH PERFLUORO-N-OCTANE.

To determine the results of pars plana vitrectomy for giant retinal tear detachments using transscleral diode laser retinopexy and short-term postoperative tamponade with perfluoro-n-octane (PFnO). Twenty consecutive patients with fresh giant retinal tears were enrolled in a single-arm prospective study. One case was withdrawn for technical reasons. The remainder all underwent pars plana vitrectomy, PFnO injection, transscleral diode laser retinopexy to the edge of the giant retinal tear, and short-term postoperative heavy liquid tamponade. None of the cases had scleral buckling or lensectomy. Nineteen cases (18 male and 1 female) with a mean age of 41 years (range 10-69 years) were followed up for a period of 6 months. Postoperative tamponade with PFnO was maintained for a mean of 7.6 days (range 4-21 days), after which it was exchanged for sulfur hexafluoride (SF6), perfluoropropane (C3F8) gas, or balanced salt solution. Final reattachment rate was 100%, with 3 (15.7%) patients requiring additional surgery. Best-corrected visual acuity at final follow-up was 20/40 or better in 11 eyes (58%), between 20/60 and 20/200 in 7 (37%), and 20/400 in 1 (5%). In this series of acute giant retinal tears, transscleral diode laser retinopexy together with the use of PFnO for short-term postoperative tamponade achieved excellent anatomical and visual results.

Preventive laser treatment of tractional symptomatic retinal flap tears: long-term outcomes

Case monitoring of tractional symptomatic flap tears after laser treatment. From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.

FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4).

To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.

360-degree intra-operative laser retinopexy for the prevention of retinal re-detachment in patients treated with primary pars plana vitrectomy.

To investigate the effect of 360° intra-operative laser retinopexy (ILR) for the prevention of retinal re-detachment in patients treated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). A retrospective single-institution cohort study was performed. Consecutive patients with primary uncomplicated RRD who underwent 23-gauge PPV with gas endotamponade between July 2013 and July 2016 were included in the study (n = 151). Two cohorts were compared: one which received laser retinopexy only around identified tears/holes/lattice zones (Control group, n = 86), and one which received additional 360° intra-operative laser retinopexy (360° ILR group, n = 65). Retinal re-detachment was seen in 4/65 eyes (6%) in the 360° ILR group compared to 18/86 eyes (21%) in the control group. In multiple logistic regression, the 360° ILR was associated with a 75% reduction in the odds of retinal re-detachment compared to control (OR = 0.248, 95% CI [0.079-0.772], p = 0.016). There was no statistically significant difference in the incidence of epiretinal membrane formation between the two groups. Intra-operative 360° laser retinopexy during PPV with gas endotamponade resulted in a significant reduction in the odds of postoperative retinal re-detachment in eyes with uncomplicated primary RRD.

Delayed Retinal Breaks and Detachments after Acute Posterior Vitreous Detachment

To determine the incidence and timing of delayed retinal breaks and retinal detachments (RDs) after acute posterior vitreous detachment (PVD) and associated risk factors. Retrospective case-control study. Acute PVD eyes treated between October 2015 and August 2018 at a single academic retina practice. Eyes with a PVD diagnosis and history of extended ophthalmoscopic examination on presentation were identified using diagnostic billing codes. The number of eyes with a history of laser retinopexy, cryotherapy for retinal tear, or RD repair was determined using procedural billing codes, and the duration between initial and treatment visits was measured. Records of eyes with a delayed retinal break or RD and of a reference group comprising the first 100 presenting eyes with no initial or delayed retinal break or RD were reviewed to determine and compare the presence of select risk factors on initial examination. Development of a delayed retinal break or RD. Of 7999 eyes with acute PVD, 1280 (16.0%) showed a retinal break and 499 (6.2%) showed an RD on presentation. Delayed retinal breaks and RDs were found in 209 (2.6%) and 80 (1.0%) eyes, respectively. Of delayed breaks, 116 (55.5%) were found in 6 weeks or less and 93 (44.5%) were found more than 6 weeks after presentation. Of delayed RDs, 26 (32.5%) were found in 6 weeks or less and 54 (67.5%) were found more than 6 weeks after presentation. Compared with the reference group, vitreous hemorrhage (hazard ratio, 2.53 [P < 0.001] and 2.80 [P= 0.001]) and male gender (hazard ratio, 1.36 [P= 0.03] and 1.87 [P= 0.02]) were risk factors for delayed retinal breaks and RDs, respectively. Pseudophakia (hazard ratio, 2.10; P= 0.004) was also a risk factor for delayed RD; older age (odds ratio, 0.96; P= 0.01) was slightly protective. Vitreous hemorrhage was a risk factor for earlier retinal breaks (≤6 weeks vs. >6 weeks; odds ratio, 3.58; P < 0.001). Clinically significant rates of newly detected retinal breaks and RDs may occur after acute PVD, suggesting that repeat examination may be prudent in these patients.

Navigated Pattern Laser System Versus Single-Spot Laser System for Postoperative Laser Retinopexy

Purpose: To compare three 360°-laser retinopexy (LRP) approaches (using navigated pattern laser system, single-spot slit-lamp (SL) laser delivery and single-spot indirect-ophthalmoscope (IO) laser delivery) in regard to procedure duration, procedural pain score, technical difficulties and the ability to achieve surgical goals. Patients and Methods. Eighty-six rhegmatogenous retinal detachment patients (86 eyes) were included in this prospective randomized study. Ten patients were underwent scleral buckling procedure, 37 patients were underwent vitrectomy, 7 patients had a combined procedure, and 32 patients had silicone oil tamponade. The mean procedural time, procedural pain score (using 4-point Verbal Rating Scale), number of laser burns, and achievement of the surgical goals were compared between three groups (pattern LRP (NAVILAS laser system), 36 patients; SL-LRP, 28 patients; and IO-LRP, 22 patients). Results. In the pattern LRP group, the time needed for LRP and pain level (12.4 ± 5.4 min and 1.1 ± 0.5 scores, respectively) were statistically significantly lower, whereas the number of applied laser burns (1108.7 ± 345.5) was higher compared to those in the SL-LRP group (21.7 ± 7.6 min, 1.8 ± 0.5 scores, and 714.5 ± 219.8 burns) and in the IO-LRP group (17.0 ± 10.1 min, 1.9 ± 0.5 scores, and 408.1 ± 95.5 burns). In the pattern LRP, SL-LRP, and IO-LRP groups, surgical goals were fully achieved in 28 (77.8 %), 17 (60.7 %), and 13 patients (59.1 %), respectively (p &gt; 0.05). In the pattern LRP, SL-LRP and IO-LRP groups, the mean duration of follow-up after silicone oil removal was 6.6 ± 3.1 months, 8.1 ± 4.5 months and 7.1 ± 4.1 months, respectively (ANOVA3x, p = 0.35), with re-detachment found in 1 case (8.3 %), 2 cases (18.2 %), and 1 case (11.1 %), respectively. Conclusions. The navigated pattern approach allows improving the treatment time and pain in postoperative 360° LRP. Moreover, 360° pattern LRP is at least as effective in achieving the surgical goal as the conventional (slit-lamp or indirect ophthalmoscope) approaches with a single-spot laser.

Erosive Retinopathy and Retinal Detachment From Depot Intravitreal Triamcinolone Acetonide Injection at the End of Pars Plana Vitrectomy.

Intravitreal triamcinolone acetonide (IVTA) used as a surgical adjuvant for pars plana vitrectomy (PPV) can stain cortical vitreous, control postoperative inflammation, and reduce retinal edema. Sterile endophthalmitis uncommonly complicates office-based IVTA injection. The authors report a new complication of IVTA depot injection at the end of PPV. Retrospective records review of all patients treated at the Cincinnati Eye Institute with PPV between January 1, 2011, and December 31, 2017, who developed a triad of sterile endophthalmitis, atrophic retinal breaks under the depot IVTA in the inferior retina, and rhegmatogenous retinal detachment (RRD). Eyes with flap tears, solely superior breaks, or stretch holes from proliferative vitreoretinopathy causing RRD were excluded. Eight eyes of eight patients (four males and four females; mean age: 73.7 years) who received 4 mg or 8 mg IVTA depot at the end of PPV surgery presented at a mean of 23.5 days following PPV with RRD (one macula-involving, seven macula-sparing), requiring treatment with PPV in six eyes and laser retinopexy alone in two eyes. Seven eyes that underwent membrane peeling (MP) received IVT to prevent cystoid macular edema (CME) and one eye with prior MP was treated for CME. Mean vitreous inflammation was 2+ cell at 1 week postoperatively. Two patients had documented sterile endophthalmitis within the first week requiring vitreous cultures and antibiotics injections. Visual acuity (VA) for eyes requiring PPV for RD repair declined from 20/90 preoperatively to 20/212 at 6 months postoperatively. VA for eyes amenable to laser alone improved from 20/53 to 20/35. All eyes remained attached, with the exception of one patient who refused further treatment after developing recurrent detachment from PVR. Particle-induced sterile endophthalmitis from IVTA depot at the end of PPV surgery resulted in atrophic inferior retinal breaks and RRD as a newly described entity coined "erosive retinopathy." All retinal detachment surgeries required silicone oil tamponade. Poor visual outcome at 6 months was common for eyes requiring PPV for RD repair. The authors recommend avoiding IVTA depot injection at the end of PPV. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:613-619.].

Vitreomacular interface alterations following peripheral laser retinopexy: Interface changes after laser.

To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR). Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group). In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05). These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.

Pneumatic Retinopexy in Rhegmatogenous Retinal Detachment : Case Series

&#x0D; &#x0D; &#x0D; In the case of rhegmatogenous retinal detachment (RRD), pneumatic retinopexy is an alternative choice besides scleral buckling and pars plana vitrectomy. This case series describes two cases of RRD with superotemporal tear treated succesfully with pneumatic retinopexy. The expandable gas used in this study was 0.4 cc perfluoropropane (C3F8) gas, patient’s head is immediately positioned face down (prone), then slowly turned into an upright position in accordance with the tear for 1-3 days. Laser retinopexy using an argon laser is performed after the retina is properly reattached. Ten months after pneumatic retinopexy, the VA of RE in case I remained at 6/18 with reattached retina. At four weeks, VA of RE in case II was at 3/60 with reattached retina. VA of both cases was relatively satisfactory with retinal reattachment in a single procedure. The anatomical and functional success of pneumatic retinopexy is related to macular status before surgery, retinal detachment area, phakic status, or the presence of PVR and high myopia. &#x0D; &#x0D; &#x0D;

Karakteristik Laser Retinopexy pada Pasiendengan Tear Retina di Divisi Vitreoretina RS Cipto Mangunkusomo Periode Januari – Desember 2018

Retinal detachment is a serious condition that threatens vision so that it can cause complications of blindness. The only treatment for retinal detachment is surgery, where not all surgical procedures in retinal detachment cases have a good success rate. Therefore, it is very important to be able to find tears in the retina, before developing further into detachments. Retinopexy lasers performed with the aim of causing adhesion around the tear in the retina, have been recommended as an action to prevent complications of retinal detachment. Retinopexy laser has an important role in patients with retinal tear who have symptoms of floaters and flashing and persistent traction in the retina especially in the area around the retinal tear, because symptomatic retinal tear is likely to develop into a complication of retinal detachment. However, although laser retinopexy is often recommended, in fact, the effectiveness of this action is still controversial.

Pneumatic Vitreolysis for the Treatment of Vitreomacular Traction Syndrome

Objectives:To evaluate the posterior vitreous release rates after a single injection of expansile gas in patients with vitreomacular traction (VMT) syndrome with or without associated full-thickness macular hole (FTMH).Materials and Methods:Thirteen eyes of 12 consecutive patients with VMT (11 eyes) or VMT+FTMH (2 eyes) were reviewed retrospectively. Intravitreal injection of 0.3 mL of pure sulfur hexafluoride (SF6) (9 eyes) or perfluoropropane (C3F8) (4 eyes) was performed. Bobbing the head forward and backward similar to ‘drinking bird’ head movements was instructed until VMT release. Full ophthalmic examination and optical coherence tomography was performed at each visit.Results:VMT was released in all patients (100%) and mean release time was 5.2 days (1-19 days). Macular hole closure was not achieved in either of the two eyes with FTMH. Mean central subfield thickness decreased significantly from 361 μm to 263 μm (p=0.007). The mean pretreatment visual acuity was 0.44 LogMAR, which significantly improved to 0.25 LogMAR at the last visit (p=0.003). One of 13 eyes had retinal tear after the procedure which was successfully treated with laser retinopexy. Gas migration to the anterior chamber occurred in one patient. No other complications were observed.Conclusion:Pneumatic vitreolysis with C3F8 and SF6 gases is a relatively safe, low-cost, and minimally invasive treatment modality for VMT. However, FTMH closure could not be achieved with pneumatic vitreolysis.