Long-standing Retinal Detachment Research Articles

Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?

We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥20/50 and a PDR-associated macula-involving TRD of >6 months duration with a minimum follow-up of 12-months. There were 58 patients analyzed over an average follow-up period of 27.6 (±7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (-0.30 ±0.52 logMAR). Although the rates of maintaining ≥20/200 Snellen VA and ≥20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥2 lines of VA during the study period (p=0.002). Patients presenting with good VA and a PDR-associated macula-involving TRD of >6 months were more likely to gain ≥2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred.

A rare case of spontaneous anterior dislocation of cataractous lens in coloboma

We present a case of a young patient who developed leukocoria as a result of spontaneous anterior dislocation of lens in conjunction with an iridolenticular coloboma. Patient presented to us owing to sudden onset accentuation of leukocoria since she had no perception of light due to a long-standing retinal detachment. The catarctous lens was extracted by manual small incision surgery, preventing further complications from arising and improving cosmetics.

Application of immersion B-scan ultrasonography in diagnosis of complex retinal detachment, persistent hyperplastic primary vitreous and intraocular tumors

To evaluate the diagnostic value of panoramic immersion B-scan ultrasonography (Pano-immersion B-scan, PIB) in complex retinal detachment (RD), persistent hyperplastic primary vitreous (PHPV) and intraocular tumors. The clinical data of 44 patients collected from May 2012 to December 2019 in Chinese PLA General Hospital was retrospectively studied. All of these patients underwent PIB of the eye, because it was difficult to diagnose by routine ocular fundus examination, conventional ultrasound or/and ultrasonic biomicroscope (UBM) due to opacity of refractive media, pupillary occlusion, large involvement or special location of the lesion. The imaging features of difficult cases in PIB were analyzed. The diagnosis accuracy rating of PIB were evaluated and contrasted with conventional ultrasound or UBM by the standard of intraoperative diagnosis or/and pathological results. According to intraoperative diagnosis or pathological results as gold standard, among the 44 cases, there were 19 cases missed diagnosis, misdiagnosed or difficult-to-diagnose by conventional ultrasound or UBM, including 4 cases of long-standing RD difficult to diagnose, 4 cases misdiagnosed, and 11 cases incompletely observed or miss diagnosed. The diagnostic accuracy rate of PIB and conventional ultrasound or UBM were 100% (44/44) and 56.82% (25/44), and the sensitivity of them were 100% and 56.82%. All the patients underwent PIB and were diagnosed as RD (15 cases), retinal and choroidal detachment (4 cases), subchoroidal hematocele (1 case), vitreous opacity and/or organic membrane formation (4 cases), PHPV (12 cases), iris and/or ciliary body tumors (3 cases), and choroidal tumors (6 cases). According to the intraoperative diagnosis or pathological results, the diagnostic coincidence rate of PIB was 100%, which was significantly higher than conventional ultrasound and UBM. PIB can help to accurately diagnose complex RD, PHPV, and intraocular masses with special location or/and excessive size. It has important diagnostic value for patients with equivocal findings at conventional ultrasound examination.

Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma.

To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences.

Successful scleral buckling for long-standing retinal detachment with subretinal proliferation 4-year after strabismus surgery.

Successful scleral buckling for long-standing retinal detachment with subretinal proliferation 4-year after strabismus surgery.

Observation on the efficacy of the minimal scleral buckling surgery in the treatment of long-standing retinal detachment

Observation on the efficacy of the minimal scleral buckling surgery in the treatment of long-standing retinal detachment

Large drusen in long-standing retinal detachment.

Drusen are seen as an end result of various biochemical insults to the retina and have been described in various clinical settings. We would like to report the histopathology of a case of large drusen, seen associated with chronic retinal detachment in a case of childhood trauma, where the eye was eviscerated for other reasons.

Case report of a choroidal ganglioneuroma

PurposeTo describe an extremely rare ganglioneuroma of the choroid.MethodsA 68 year old man was referred for longstanding retinal detachment on his right eye. There was loss of vision to <0.01 without pain or trauma. The left eye was normal. He was in normal good health. A retinal detachment with subretinal mass mid‐peripheral was detected and a metastatic disease was the most probable diagnosis. After general investigations and full body scan, no other suspicious tumors were found. After consultations the patient choose to have his eye enucleated and the eye was sent for histopathology.ResultsPathology examination revealed a broad and flat choroidal tumor consisting of mature nerves and ganglion cells. A retinal detachment with atrophy of photoreceptor layers, and large zones with hemorrhage were present. There were no signs of atypia, pleiomorphisme or malignancy remarked. The abnormal tissue stained positive with S100, neuron specific enolase, neurofilamnet and synoptophysine. Ki67 was negative.ConclusionsAn unexpected diagnosis of benign ganglioneuroma of the choroid was established. This is an extremely rare tumor an a non‐Neurofibromatosis‐1 adult man.

Retinal pigment epithelial cell multinucleation in the aging eye - a mechanism to repair damage and maintain homoeostasis.

SummaryRetinal pigment epithelial (RPE) cells are central to retinal health and homoeostasis. Dysfunction or death of RPE cells underlies many age‐related retinal degenerative disorders particularly age‐related macular degeneration. During aging RPE cells decline in number, suggesting an age‐dependent cell loss. RPE cells are considered to be postmitotic, and how they repair damage during aging remains poorly defined. We show that RPE cells increase in size and become multinucleate during aging in C57BL/6J mice. Multinucleation appeared not to be due to cell fusion, but to incomplete cell division, that is failure of cytokinesis. Interestingly, the phagocytic activity of multinucleate RPE cells was not different from that of mononuclear RPE cells. Furthermore, exposure of RPE cells in vitro to photoreceptor outer segment (POS), particularly oxidized POS, dose‐dependently promoted multinucleation and suppressed cell proliferation. Both failure of cytokinesis and suppression of proliferation required contact with POS. Exposure to POS also induced reactive oxygen species and DNA oxidation in RPE cells. We propose that RPE cells have the potential to proliferate in vivo and to repair defects in the monolayer. We further propose that the conventionally accepted ‘postmitotic’ status of RPE cells is due to a modified form of contact inhibition mediated by POS and that RPE cells are released from this state when contact with POS is lost. This is seen in long‐standing rhegmatogenous retinal detachment as overtly proliferating RPE cells (proliferative vitreoretinopathy) and more subtly as multinucleation during normal aging. Age‐related oxidative stress may promote failure of cytokinesis and multinucleation in RPE cells.

Acanthamoeba Keratitis in an HIV Positive Daily Disposable Contact Lens Wearer

A 43 year old HIV positive myopic man presented with a linear epithelial lesion of his right cornea and a visual acuity of 6/6. A longstanding retinal detachment in the left eye had resulted in a vision of count fingers (CF). Over the next three months, the patient’s visual acuity in his right eye dropped to CF. The case illustrates some typical difficulties involved in diagnosing Acanthamoeba keratitis and demonstrates that therapeutic deep lamellar keratoplasty may be useful as an initial surgical option when medical management fails to control infection

Advanced Coats' disease treated with intravitreal bevacizumab combined with laser vascular ablation.

PurposeTo evaluate the impact of intravitreal bevacizumab combined with laser vascular ablation in the management of advanced Coats’ disease presenting with exudative retinal detachment.MethodsThis was a retrospective review of 24 children that presented with exudative retinal detachments associated with advanced Coats’ disease. Mean patient age was 62 months (range 9–160 months). Presenting signs included retinal detachment in 24 children (100%), vascular telangiectasia in 24 children (100%), and retinal ischemia in 24 children (100%). Twenty of 24 children presented with elevated, vascular leakage in the fovea (83%). Two children presented with sub-retinal fibrosis associated with presumed long-standing retinal detachment without evidence of rhegmatogenous retinal detachment. Ten patients exhibited vascular alterations in the periphery of the second eye without clinical evidence of exudation. All 24 children were treated with a large-spot-size diode laser directly to areas of abnormal telangiectatic vasculature. All 24 children received intravitreal bevacizumab injection.ResultsAll 24 children had resolution of exudative retinal detachment, ablation of vascular telangiectasia, and anatomic improvement of the retina. No child exhibited progressive retinal detachment and no eye required enucleation. No cases of neovascular glaucoma were seen. Fellow eyes with peripheral vascular alterations showed no progression to exudative vasculopathy during the observation period. Intravitreal bevacizumab injection was not associated with endophthalmitis or systemically-observed complications.ConclusionRepetitive intravitreal bevacizumab combined with laser vascular ablation may be utilized effectively for advanced Coats’ disease presenting with exudative retinal detachment.

Scleral buckling for the management of inferior stationary long-standing rhegmatogenous retinal detachment in the juvenile age group

DesignA retrospective noncomparative interventional clinical case series was performed between 2009 and 2012.Patients and methodsFourteen eyes of 14 young patients with chronic inferior rhegmatogenus retinal detachment showing focal proliferative vitreoretinopathy, subretinal bands, demarcation line, and inferior retinal breaks were managed with a segmental circumferential inferior 180 silicone tire and a 360 encircling circumferential band.ResultsAnatomical success was achieved in 13 eyes (92.86%), improved vision in nine eyes (64.29%), and stationary vision in five eyes (35.71%).ConclusionScleral buckling proved safe and effective in the management of long-standing rhegmatogenous retinal detachment in a juvenile age group with subretinal fibrosis and focal surface proliferative vitreoretinopathy.

Early reactional hyperplasia and neuronal differentiation of the ciliary epithelium (CE) in experimental retinal detachment (RD) with proliferative vitreoretinopathy (PVR) in the porcine eye

AbstractPurpose Rare quiescent retinal progenitor cells (RPCs) have been isolated in the adult mammalian (including human) CE. We have reported a CE proliferation with retinal neuronal and photoreceptor cell (rhodopsin+) differentiation in three human eyes eviscerated for longstanding RD and PVR. The CE strongly expressed EGFR. We have hypothezised that the disease RD and PVR might stimulate a dormant population of RPCs in the CE in presence of a niche constituted by EGF. The aim of the present work was to study the CE in the porcine eye with experimental DR and PVR.Methods Two porcine eyes with experimental surgical RD and PVR enucleated at Day 15 and Day 35 were studied with light microscopy and immunocytochemistry with antibodies against EGFR, Ki67, CD133, NSE, rhodopsin, GFAP. The fellow porcine eyes, one non operated porcine eye, and one human eye exenterated for orbital tumor served as controlsResults Wwe observed in the CE of both porcine eyes a discrete hyperplasia of the non pigmented CE with an overexpression of EGFR and an expression of NSE. All CE controls were negative for NSE. Ki 67, CD133, GFAP and rhodopsin were negative in the CE of the eyes with RD and of the control eyesConclusion The CE of the porcine eye in vivo with shorter duration experimental RD and PVR showed hyperplasia with neuronal differentiation, in presence of an overexpression of EGFR, as in the human eye with longer duration RD. Photoreceptor differentiation was not observed in the porcine CE at this stage.

Intraocular osseous metaplasia

Heterotropic bone formation or intraocular osseous metaplasia is a rare finding. Trauma, chronic inflammation, and long-standing retinal detachment are some of the common etiological factors associated with the onset of intraocular ossification. We report a case of a 16-year-old girl with a history of blunt trauma 6 years back, who complained of right eye blindness. Right eye enucleation was done which on histopathological examination revealed pre-retinal lamellar bone with fatty marrow. We diagnosed her case as intraocular ossification in phthisis bulbi.

Intraretinal cyst secondary to longstanding retinal detachment

To describe the diagnosis and management of an intraretinal cyst. A 34-year-old man with a history of retinal detachment presented sudden loss of vision in the left eye. Visual acuity was hand movement. Examination revealed hematic vitreous haze and ultrasound showed a rounded mobile object in the vitreous cavity. After differential diagnosis ruled out cysticercosis, pars plana vitrectomy revealed a neovascularized intraretinal macrocyst attached to a posterior flap of a 13-year-old retinal tear. Retinotomy and retinectomy were performed, removing this cyst located in the upper retina together with a portion of detached retina. At 1 year, the retina had adapted and the vitreous cavity was clear. Final visual acuity was 18/20. Intraretinal cysts are usually asymptomatic and associated with long-standing retinal detachment, as seen in our clinical case. Periodic fundus examination is essential for their detection. Surgical treatment of the underlying condition usually leads to complete resolution.

The Use of Continuous Silicone Oil Infusion as a Peroperative Tool to Facilitate Break Localisation, Vitreous Base Dissection and Drainage of Subretinal Fluid

Introduction: We introduce the use of low-molecular-weight silicone oil as an infusion and as a peroperative tool to facilitate three specific surgical steps, namely internal search for retinal breaks, vitreous base shaving and drainage of subretinal fluid. Method and Patients: Ethics committee approval was obtained to test this novel agent in a small number of cases as a pilot study. Following vitrectomy the posterior retina was reattached and stabilised using perfluorocarbon liquid (PFCL). The infusion of balanced salt solution was then stopped and replaced with 5 mPas silicone oil. Subsequent surgery was assessed as to whether the infusion was helpful in the three surgical steps. Five cases were selected for this pilot study. Three presented with long-standing rhegmatogenous retinal detachment (RRD) of 2 or more months: 1 had dense vitreous haemorrhage and no fundal view at presentation; 2 had proliferative vitreoretinopathy. Of the remaining 2 cases, 1 had a giant retinal break and the other case had a combined diabetic tractional retinal detachment and RRD. Results: Additional retinal breaks were found in 2 patients. The silicone oil joined with the PFCL to form a single bubble. The vitreous base along with the operculum of any retinal break was reflected anteriorly. The infusion of oil stabilised the anterior retina, making it possible to shave the vitreous closely in all 5 patients. Visualisation of the vitreous gel was also improved. There was a clear interface between vitreous and oil because of the large difference between the refractive indices of vitreous and oil. Four of the 5 patients had a total reattachment with one procedure. In the 2 cases in which 5,000 mPas silicone oil was used for long-term postoperative tamponade, no emulsification was observed. Follow-up of patients ranged from 6 to 13 months. There were no additional serious adverse reactions recorded. Conclusion: We found that the experience of using silicone oil was very highly positive.

Visual recovery in a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision: a case report

IntroductionWe report the case of a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision, who regained counting fingers vision with complete regression of neovascularization following anterior chamber washout, intravitreal bevacizumab, pars plana vitrectomy, and silicone oil placement. This represents a rare case in which a patient with no light perception vision was able to regain functional vision.Case presentationA 63-year-old Caucasian man with a 55-year history of long-standing retinal detachment after trauma presented to our facility with pain and redness, a total hyphema, no light perception vision and an intraocular pressure of 60 mmHg (right eye). He had a history of diabetes mellitus and coronary artery disease. Following anterior chamber washout, he was found to have neovascular glaucoma, for which intravitreal bevacizumab was administered. After washout and intraocular pressure control, his visual acuity improved to light perception. He subsequently underwent vitrectomy, membrane peeling, endolaser and silicone oil placement to reattach his retina, and then a second retinal reattachment procedure. Following these procedures, he had visual recovery to counting fingers vision in his right eye at five metres, complete regression of neovascularization, and intraocular pressure of 10 to 12 mmHg on one antiglaucoma medication.ConclusionFunctional vision can be regained despite long-standing retinal detachment.

Scleral buckling treating long-standing retinal detachment with sub-retinal membrane proliferation

Objective To discuss the effect of scleral buckling in long-standing retinal detachment with sub-retinal membrane proliferation. Methods 47 cases of long-standing retinal detachment with sub-retinal membrane proliferation were treated by scleral buckling from January 2006 to January 2010. The reattachment rate, visual acuity and surgical complications were analyzed. Results All the cases were followed up for 6 to 36 months. Out of 47 cases, the retina was reattached in 39 cases (83.0%) and the best corrected visual acuity was improved in 37 cases. PVR was worse in three cases which were treated by vitrectomy later. Conclusions Scleral buckling is effective in treating selective case of long-standing retinal detachment with sub-retinal membrane proliferation. It contributes to retina reattachment and visual improvement to some degree. Key words: scleral buckling; long-standing retinal detachment

Hemorrhagic intraretinal macrocyst: Differential diagnoses and report of an unusual case

Retinal ‘cysts’ may be single or multiple, ranging from two-to-ten disc diameters in size, and occur in eyes with longstanding retinal detachment. The authors describe a retinal macrocyst larger than ten disc diameters, with a blood-filled cavity, and its ultrasound findings. Improved retinal nourishment following retinal reattachment gradually reverses the process responsible for cystic degeneration, with the eventual collapse of the cyst (within days or weeks). Surprisingly, this giant cyst did not collapse for almost three years despite retinal reattachment. The internal mobile echogenic contents were suggestive of blood. The possible reason of blood in the cyst could be rupture of the retinal blood vessels in the cyst cavity. This could be a recurrent phenomenon, which did not allow the cyst to collapse. The Hemorrhagic Intraretinal Macrocyst needs to be differentiated from mimicking clinical conditions, namely, retinoschisis, choroidal melanoma, subretinal abscess, choroidal hemangioma, and the like. It could take up to a few years to collapse spontaneously, following successful retinal reattachment.

A Case of Cholesterosis Bulbi with Secondary Glaucoma Treated by Vitrectomy and Intravitreal Bevacizumab

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.