Macular Detachment Research Articles

Real-world outcomes and complications of different surgical approaches for significant submacular haemorrhages

Purpose: To evaluate the outcomes and complications after different surgical management of cases with significant sumacular hemorrhage (SMH) of size more than 4 disc diameter (DD). Methods: It was a retrospective interventional study. All consecutive 103 cases of significant SMHs were treated by vitrectomy and divided into three groups. In Group A (<4 weeks, confined to the macula or extending inferiorly, n = 62), vitrectomy, subretinal cocktail of tissue plasminogen activator (tPA), antivascular endothelial growth factor, and air with SF6 gas; in Group B (4–8 weeks, extending beyond macula, n = 31), subretinal tPA followed by SMH drainage either by retinotomy (Group B-1, n = 17) or by temporal 180-degree retinectomy (Group B-2, n = 14) with silicone oil (SO) tamponade; and in Group C (>8 weeks, extending beyond macula, n = 10), SMH removal with autologous retinal pigment epithelium (RPE)-Choroid patch graft transplantations with SO tamponade were performed. Parameters evaluated were best corrected visual acuity (BCVA), Optos, optical computerized tomography, and ultrasonography as required. Results: Significant visual improvement was seen from mean preoperative to mean postoperative BCVA in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.001). Postoperative complications were recurrent SMH (4.84% vs 12.90% vs 10%), vitreous hemorrhage (6.45%, GroupA), hyphema (4.84% vs 12.90% vs 10%), hypotony (nil vs 3.23% vs 20%), macular hole formation (6.45%, Group A), epiretinal membrane (16.13%, Group B), and retinal detachment (3.23%, Group A and 10%, Group C). Conclusion: Surgical approaches for significant submacular hemorrhage are visually awarding, though certain specific complications may arise.

Predisposing characteristics of optical coherence tomography for patients with persistent subretinal fluid after successful repair of rhegmatogenous retinal detachment.

To investigate the predisposing clinical parameters and characteristics of fundus imaging of patients with persistent subretinal fluid (PSF) after successful repair of rhegmatogenous retinal detachment. A retrospective study recruiting 57 patients was conducted. All patients underwent pars plana vitrectomy with silicone oil tamponade. Patients were divided into two groups: patients presenting PSF by the time of silicone oil removal (PSF group), and patients presenting no PSF by the time of silicone oil removal as control group. All patients were followed up for three months or longer after primary surgery. Ophthalmic examinations, including fundus photography and optical coherence tomography (OCT) were performed. There were significant differences between the two groups in terms of average age, durations of preoperative symptoms, and type of retinal breaks (P<0.05). These clinical parameters showed statistical correlations with PSF (P<0.05). The proportions of patients presenting distinctive boundaries of the detached retina on fundus photograph and patients showing a hyperreflective line underlying the detached retina on OCT in the PSF group were both significantly higher than the control group (P<0.05). The macular detachment heights on OCT in PSF group were significantly lower than control group (P<0.05). These imaging characteristics also showed strong correlations with PSF (P<0.05). This study suggests that patients with PSF have younger age, longer symptom duration, and higher incidence of retinal holes. The distinctive detachment boundary on fundus photograph, lower macular detachment height, and hyperreflective line underlying detached retina on OCT may be the predisposing characteristics of PSF.

Unilateral Double Optic Nerve Head Pits with Serous Macular Detachment

Unilateral Double Optic Nerve Head Pits with Serous Macular Detachment

Optimized design of surgical steps in pars plana vitrectomy for macular hole retinal detachment in pathological myopia decreases rate of iatrogenic retinal break and shortens length of operation

BackgroundTo investigate the effect of surgical steps optimization in pars plana vitrectomy (PPV) with internal limiting membrane (ILM) flap for macular hole retinal detachment (MHRD) in pathological myopia.MethodsA retrospective, consecutive, nonrandomized comparative study. High myopic eyes diagnosed with MHRD receiving PPV with ILM flap from March 2019 to June 2020 in Department of Ophthalmology, Xiangya Hospital, Central South University were included in the study. Patients were included into two groups based on different design of surgical steps. In the routine group, extension of posterior vitreous detachment (PVD) towards periphery was performed right after induction of PVD. In the experiment group, the retina was reattached with drainage of subretinal fluid through macular hole before peripheral vitreous was dealt with. Complete ophthalmic examinations were performed before and after surgery. The follow-up time was at least 6 months. The rate of iatrogenic retinal break and length of operation were compared between the two groups.ResultsThirty-one eyes from 31 patients were included in the study with 15 in the experiment group and 16 in the routine group. Demographics showed no statistically significant difference between the two groups. Post-op BCVA, rate of macular hole closure and rate of retinal reattachment were similar in the two groups. The rate of iatrogenic retinal break in the experiment group was significantly lower than that in the routine group (6.7% vs. 37.5%, P < 0.05). The average length of operation was 78.6 ± 18.8 min in the routine group and 64.0 ± 12.1 min in the experiment group (P < 0.05).ConclusionsOptimized design of surgical steps in PPV for MHRD could effectively decrease the rate of iatrogenic retinal tear and shorten the length of operation.

Systemic Inflammatory Marker Levels in Serous Macular Detachment Secondary to Retinal Vein Occlusion.

To evaluate the association of systemic inflammatory marker levels in macular edema with serous macular detachment (SMD) secondary to retinal vein occlusion (RVO). Patients diagnosed with RVO were categorized into two groups based on the presence or absence of SMD: Group 1 included 30 eyes with SMD, while Group 2 included 30 eyes without SMD. Levels of neutrophils, monocytes, lymphocytes, thrombocytes, and mean platelet volume (MPV) were analyzed. Systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated and compared between the two groups. The mean neutrophil levels were significantly higher in Group 1 (P = 0.002). The mean lymphocyte, monocytes, thrombocyte, and MPV levels did not differ significantly between groups. NLR and SII levels were significantly higher in the SMD group (P = 0.004 and P = 0.016, respectively). There was no significant difference between the groups in terms of PLR. The optimal receiver operator characteristic (ROC) cut-off value of NLR for SMD was calculated as 1.55 with 73% sensitivity and 63% specificity (area under the curve [AUC] = 0.714, 95% confidence interval [CI]: 0.584-0.845). The optimal ROC cut-off value of SII for SMD was calculated as 451.75 with 63% sensitivity and 63% specificity (AUC = 0.681, 95% CI: 0.546-0.816). In this study, branch RVO was present in 48 patients, and central RVO was present in 12 patients. Neutrophil, MPV levels, and NLR, PLR, SII ratios were similar between patients with branch and central occlusion. Neutrophil levels, NLR, and SII were found to be significantly higher in eyes with SMD secondary to RVO.

Morphology of Serous Retinal Detachment in Morning Glory Optic Disc Anomaly in a Patient before and after Treatment with Systemic Carboanhydrase Inhibitors

Morning glory optic disc anomaly (MGODA) is a rare congenital defect of the optic nerve head. The optic nerve is enlarged, and its conical excavation is filled with glial tissue. It may be associated with cerebral malformations and ocular complications, whereas serous retinal detachment occurs in 38% of affected patients. Surgical treatment of detachment showed poor visual outcome in the past and conservative treatment options are scarce. A woman with MGODA presented in our clinic with sudden vision loss due to serous retinal detachment. She denied any previous ophthalmological problems and her past medical history was unremarkable. Vision testing showed normal visual acuity in her left eye and finger counting in her right eye. Slit lamp examination was unremarkable. Fundus examination of the right eye showed retinal detachment without holes or traction membranes and an enlarged optic disc with raised peripapillary tissue and glial tissue in the center of the optic disc. Due to the pathognomonic otpic disc finding, we diagnosed MGODA complicated by a serous retinal detachment. We treated the patient with systemic carboanhydrase inhibitors and documented the initial clinical findings as well as the course of disease under treatment by optical coherent tomography (OCT), fundus autofluorescence imaging (FAF), and visual field testing. During follow-up, we detected noticeable subretinal fluid regression and improvement in visual acuity. The application of oral carboanhydrase inhibitors appears to be a valid therapeutic option in patients with MGODA-associated serous macular detachment. OCT and FAF imaging are useful modalities for documentation of subretinal fluid regression and structural changes in the peripapillary region.

Сравнительный анализ хирургического лечения регматогенной отслойки сетчатки с нижней локализацией разрывов с тампонадой витреальной полости газом или силиконом

Purpose. To perform a comparative evaluation of the efficacy and functional results of surgical treatment of rhegmatogenous retinal detachment (RRD) with breaks in the lower hemisphere using gas or silicone tamponade of the vitreal cavity. Material and methods. Seventy-eight patients (78 eyes) with RRD and the location of breaks in the lower hemisphere were examined. Depending on the nature of retinal detachment patients were divided into 2 groups: without macular detachment («Macula-on») – 36 patients (36 eyes) and with retinal detachment in the macular area («Macula-off») – 42 patients (42 eyes). Each group included two subgroups «Gas» and «Silicone» depending on the type of final vitreal tamponade performed with gas (12% gas-air mixture with perfluoropropane C3F8 ) or silicone (Densiron), respectively. The type of tamponade was chosen randomly. Results. Subgroups of patients with different types of tamponade did not differ from each other in clinical and demographic characteristics. In the postoperative period, a complete retinal attachment was achieved in 75 patients (96%). At 6 months postoperatively, retinal light sensitivity (total and in central point) in the Macula-on group was significantly higher after treatment with gas tamponade compared to the final tamponade with silicone. For other parameters in the Macula-on group, the type of tamponade did not play a significant role. In the Macula-off group, neither functional parameters nor optical coherence tomography data at 6 months depended on the type of tamponade. Conclusion. The use of tamponade with an air-gas mixture and silicone in RRD patients with localization of breaks in the lower hemisphere is equally effective in achieving a high frequency of retinal attachment. Patients with RRD without macular involvement had significantly higher retinal light sensitivity (total and in central point) after treatment with gas-air tamponade compared to final tamponade with silicone. Gas-air tamponade has the advantage of not requiring a second surgical intervention and can be recommended for wide use in RRD patients with breaks in the lower hemisphere without significant proliferative vitreoretinopathy. Key words: rhegmatogenous retinal detachment, inferior hemisphere break, gas tamponade, silicone tamponade, photosensitivity

Deficits in mitochondrial TCA cycle and OXPHOS precede rod photoreceptor degeneration during chronic HIF activation

BackgroundMajor retinal degenerative diseases, including age-related macular degeneration, diabetic retinopathy and retinal detachment, are associated with a local decrease in oxygen availability causing the formation of hypoxic areas affecting the photoreceptor (PR) cells. Here, we addressed the underlying pathological mechanisms of PR degeneration by focusing on energy metabolism during chronic activation of hypoxia-inducible factors (HIFs) in rod PR.MethodsWe used two-photon laser scanning microscopy (TPLSM) of genetically encoded biosensors delivered by adeno-associated viruses (AAV) to determine lactate and glucose dynamics in PR and inner retinal cells. Retinal layer-specific proteomics, in situ enzymatic assays and immunofluorescence studies were used to analyse mitochondrial metabolism in rod PRs during chronic HIF activation.ResultsPRs exhibited remarkably higher glycolytic flux through the hexokinases than neurons of the inner retina. Chronic HIF activation in rods did not cause overt change in glucose dynamics but an increase in lactate production nonetheless. Furthermore, dysregulation of the oxidative phosphorylation pathway (OXPHOS) and tricarboxylic acid (TCA) cycle in rods with an activated hypoxic response decelerated cellular anabolism causing shortening of rod photoreceptor outer segments (OS) before onset of cell degeneration. Interestingly, rods with deficient OXPHOS but an intact TCA cycle did not exhibit these early signs of anabolic dysregulation and showed a slower course of degeneration.ConclusionTogether, these data indicate an exceeding high glycolytic flux in rods and highlight the importance of mitochondrial metabolism and especially of the TCA cycle for PR survival in conditions of increased HIF activity.

Commentary: Post-pandemic lessons learnt regarding triage, mitigation, and management of emergency ocular conditions.

Commentary: Post-pandemic lessons learnt regarding triage, mitigation, and management of emergency ocular conditions.

Features of a well-timed macular hole closure related retinal regmatogenous detachment complicated by macular hole

The literature review deals with the analysis of the timing and surgical techniques of macular hole closure in patients with retinal detachment complicated by macular hole. Modern concepts of treatment tactics for this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.

Predictive Risk Factors for Retinal Redetachment Following Uncomplicated Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment

Purpose: To investigate clinical and surgical factors influencing the outcome after primary rhegmatogenous retinal detachment surgery. Methods: A retrospective, single-centre, case-control study of 274 eyes of 274 patients with primary rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) in the period between January 2019 and December 2021, were included in the study. Analysed surgical factors were: combined procedure with phacoemulsification, type of retinopexy (cryocoagulation, endolaser, combined), type of tamponade (gas, silicone oil), and anatomical factors: primary proliferative vitreoretinopathy (PVR) and macular detachment at the time of surgery. Results: Overall retinal re-detachment rate was 10.1%. The main reason for re-detachment was an insufficient retinopexy in 53.6%, followed by PVR (37.3%), and retinal detachment occurred at a different location caused by another break in 9.1%. No significant difference in the rate of re-detachment was found if a phacoemulsification with simultaneous IOL implantation was performed (p = 0.641). No significant difference between the various retinopexy techniques was found (p = 0.309). Risk factors re-detachment were primary PVR (p = 0.0003), silicone oil as initial tamponade (p = 0.0001) as well as macula off detachments (p = 0.034). Conclusions: The present study showed no significant difference between the types of retinopexy and if additional phacoemulsification was performed or not. Factors associated with a higher risk for re-detachment were detached macula at surgery, primary PVR and primary oil-filling.

Effect of the COVID-19 Pandemic on Surgical Outcomes for Rhegmatogenous Retinal Detachments

We reviewed the medical records of 438 eyes in 431 patients who had undergone surgeries for rhegmatogenous retinal detachments (RRD) or proliferative vitreoretinopathy (PVR ≥ Grade C) to determine whether the COVID-19 pandemic had affected outcomes. The patients were divided into 203 eyes in Group A that had undergone surgery from April to September 2020, during the pandemic, and 235 eyes in Group B that had undergone surgery from April to September 2019, before the pandemic. The pre- and postoperative visual acuity, macular detachment, type of retinal breaks, size of the RRD, and surgical outcomes were compared. The number of eyes in Group A was fewer by 14%. The incidence of men (p = 0.005) and PVR (p = 0.004) was significantly higher in Group A. Additionally, the patients in Group A were significantly younger than in Group B (p = 0.04). The differences in the preoperative and final visual acuity, incidence of macular detachment, posterior vitreous detachment, types of retinal breaks, and size of the RRD between the two groups were not significant. The initial reattachment rate was significantly lower at 92.6% in Group A than 98.3% in Group B (p = 0.004). The COVID-19 pandemic affected the surgical outcomes for RRD with higher incidences of men and PVR, younger aged patients and lower initial reattachment rates even though the final surgical outcomes were comparable.

Post-vitrectomy delayed retinal breaks in proliferative diabetic retinopathy

PurposeTo report a series of cases of post-operative new secondary retinal breaks following vitrectomy for proliferative diabetic retinopathy (PDR).MethodsThis retrospective case series included data of patients diagnosed with post-operative retinal breaks following uneventful vitrectomy surgery for PDR from January 2018 to December 2021.ResultsNew post-vitrectomy retinal breaks in PDR were seen in 7% of eyes (n = 10/148 eyes; 10 patients). Age of study patients ranged from 45 to 69 years and there were 8 males. Vitreous surgery was performed for vitreous hemorrhage in six eyes, macular tractional retinal detachment in three eyes and epiretinal membrane in one eye. Tractional fibrovascular proliferation near the retinal break prior to its development was noted either pre- or intra-operatively in 8 eyes. Mean time interval between the vitreous surgery and secondary retinal break development was 6.4 months. Residual fibrous tissue post-surgery adjacent to the break was noted in 4 cases. Sclerosed retinal vessel was noted in 4 eyes and associated inner retinal thinning or schisis in 5 eyes. No retinal detachment was noted in any case. Prophylactic barrage was done in 4 eyes. Last follow-up interval ranged from 4 to 53 months and visual acuity ranged from 6/6 to 6/60. No subretinal fluid, traction or break enlargement was noted at the last visit.ConclusionDelayed post-operative retinal breaks following vitrectomy are uncommon in PDR eyes. Careful preoperative evaluation of the retinal proliferations, intraoperative dissection of the membranes and regular post-operative reviews are vital in anticipating the development of delayed post-vitrectomy retinal breaks. Observation could be the management strategy for these breaks.

Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia.

To compare the efficacy of macular buckling (MB) alone against a combined internal limiting membrane (ILM) inversion flap for full-thickness macular hole (FTMH)-associated macular detachment (MD) in patients with high myopia. This was a prospective interventional case series of patients with high myopia surgically treated with MB alone or combined with an inverted ILM flap for FTMH- associated MD. Best-corrected visual acuity (BCVA) at the 24-month postoperative follow-up, rate of initial retinal reattachment and macular hole closure were measured. A total of 62 eyes from 62 participants (33 in the MB group, 29 in the combination group) were studied. Postoperative BCVA improved significantly in both the combination group (P < 0.001) and the MB group (P = 0.027). The postoperative BCVA at 12 months (P = 0.021) and 24 months (P = 0.041) was significantly better in the combination group than in the MB group. The postoperative BCVA was not significantly different between the eyes with closed and unclosed MH at each follow-up time point (P > 0.05). In the combination group, we observed earlier retinal reattachment and closure of the MH as well as a higher rate of MH closure (82.8% vs. 66.7%) than in the MB group, although this difference was insignificant (P = 0.248). MB combined with the ILM flap inversion technique achieved better postoperative BCVA and a higher success rate of MH closure than MB alone. We believe that combination surgery should be preferentially recommended.

Effect of Duration of Macular Detachment on Visual Prognosis after Surgery for Macula-Off Retinal Detachment: Japan-Retinal Detachment Registry

To evaluate the association between the duration of macular detachment (DMD) and visual prognosis in patients with macula-off rhegmatogenous retinal detachment (RRD). Prospective observational cohort study PARTICIPANTS: This study analyzed 719 eyes with macula-off RRD registered with the Japan-Retinal Detachment Registry created by the Japan Retina and Vitreous Society. We included patients with macular detachment without a history of prior surgery, except cataract surgery and vitrectomy. Reoperation cases, hereditary RD, and macular hole RD were excluded. We compared the visual prognosis between patients with DMD of N days or less and those with DMD of N+1 days or more (N=2-5). For these four comparisons, the inverse probability of treatment weighting (IPTW) methodology was employed, to balance 20 baseline characteristics between the shorter and longer DMD groups. The baseline characteristics included age, sex, axial length, baseline visual acuity, operative procedures, and detailed characteristics of RD. P-values <0.01 were considered statistically significant. The best-corrected visual acuity (BCVA) six months after surgery RESULTS: The final analysis included 719 eyes. For all comparisons, the patients' backgrounds were well balanced after IPTW with standardized differences < 0.10. IPTW regression analysis revealed that the BCVA after six months was significantly better after surgeries for DMD of two days or less than that for DMD of three days or more. Similarly, the six-month BCVA for surgeries for DMD of three days or less was significantly better than that for surgeries for DMD of four days or more (differences in logarithm of the minimum angle of resolution: -0.113, P = 9.1×10-7; -0.076, P = 1.6×10-3, respectively). On the other hand, there were no statistically significant differences for the other comparisons. Earlier surgical treatment within three days from the onset of macular detachment should be considered, after accounting for social circumstances, such as weekends.

Gas tamponade followed by laser treatment for macular retinal detachment secondary to optic pit.

The study aimed to describe anatomic and visual outcomes associated with perfluoropropane intravitreal injection followed by laser treatment for macular retinal detachment secondary to optic disc pit. A single-center, retrospective study. Medical records of all patients treated at a tertiary retina referral center were evaluated between 2011 and 2018 for congenital optic disc pit-associated macular detachment with 0.3 ml 100% perfluoropropane intravitreal injection followed by retinal laser photocoagulation along the temporal optic disc margin as the initial treatment. Six patients with optic disc pit-associated macular detachment were identified, with postoperative follow-up ranging from 13 to 52 months (mean: 28 months). Spectral domain optical coherence tomography (SD-OCT) showed complete fluid resolution without recurrence in five of the six cases. Four cases showed complete reabsorption after Intravitreal perfluoropropane plus laser, one patient needed an extra procedure (pars plana vitrectomy with inner limiting membrane peeling and pedicle flap inversion over the temporal optic disc margin) to achieve complete fluid reabsorption, and one patient had persistent intraretinal fluid and denied additional surgeries. The time between the initial procedure and total fluid reabsorption varied from 6.5 to 41 months (mean: 19.5 months). Best-corrected visual acuity improved after surgery on the last follow-up visit in all cases. 100% perfluoropropane intravitreal injection followed by photocoagulation along temporal optic disc margin was associated with anatomic and visual improvement in most cases, representing an alternative treatment approach for optic disc pit-associated macular detachment.

Resolving Myopic Foveoretinal Detachment by Fovea-Saving Internal Limiting Membrane Peeling: A Case-Series Report

Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretinal detachment (FRD) or macular hole (MH) with or without macular hole retinal detachment (MHRD) as a part of its natural history. Aim: To describe the microstructural and functional results in three highly myopic eyes that underwent macular surgery for early-stage MTM. The last postoperative structural findings were correlated with the final vision and macular automated microperimetry evaluation. Methods: We retrospectively reviewed three highly myopic eyes that underwent successful fovea-saving internal limiting membrane (FS-ILM) macular surgery for chronic FRD at Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations, including SD-OCT, SS-OCT, and microperimetric macular examinations. Results: There was a substantial difference between best-corrected visual acuity (BCVA) preoperatively and postoperatively in all three cases. Postoperative surgery was associated with significant improvement in visual acuity confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR; mean ± SE) was ~0.83 ± 0.15, and the postsurgical value was ~0.43 ± 0.52 (P = 0.00065). The myopic foveoretinal detachment evaluation was ~7.3 ± 3.5 months, with a mean postoperative follow-up time of ~14 ± 4.08 months. Furthermore, postoperative multimodal imaging tests demonstrated an abnormal microstructural foveal SS-OCT pattern without evidence of macular hole (MH) development at the postoperative follow-up. Macular microperimetry confirmed a subclinical reduced macula threshold sensitivity with an anomalous retinal sensitivity analysis map and a stable central foveal fixation site. Conclusions: Even with the successful microstructural disappearance of myopic macular detachment, the last multidisciplinary functional and structural assessments demonstrated different subclinical macular alterations.

Perioperative systemic blood pressure parameters and clinical outcomes following 27g vitrectomy for diabetic tractional detachment repair

BackgroundExtremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.MethodsThis was...

Clinical and Structural Impact of Sub-Macular Fluid Following Pneumatic Retinopexy Repair for Rhegmatogenous Retinal Detachment.

To assess the impact of sub-macular fluid (SMF) following pneumatic retinopexy (PR) for primary rhegmatogenous retinal detachment (RRD) repair. Retrospective review of consecutive patients treated with PR for primary RRD repair. 387 eyes (374 patients) were included, of which 166 underwent OCT imaging following successful PR. Foveal-centered OCT scans were reviewed. SMF occurred in 59 eyes (35.5%) and was associated with macular detachment (p = < 0.001) and phakic lens status (p = 0.007). SMF resolved over an average of 9.39 months and was associated with worse pre-procedure BCVA and delayed visual recovery. Mean final BCVA was 0.277 logMAR (20/40) in eyes with SMF and 0.162 logMAR (20/30) in those without SMF (p < 0.001). SMF was associated with discontinuity of the interdigitation zone (IZ) (p = 0.003), ellipsoid zone (EZ) (p = 0.005), and external limiting membrane (p = < 0.001) following SMF resolution. EZ discontinuity was associated with worse visual prognosis (p = 0.009). Trace SMF detected by OCT is common following successful PR and resulted in delayed visual recovery and increased rates of outer retinal discontinuity following SMF resorption, although the final difference in BCVA in those with and without SMF was minimal.

Anatomical and visual outcome of vitrectomy for giant retinal tear detachment with proliferative vitreoretinopathy: A retrospective, consecutive case series

Aim: To report the anatomical and visual outcome of giant retinal tear (GRT) associated retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR) and determine the effect of presenting clinical and surgical variables Method: Retrospective, non-comparative, consecutive, interventional case series of vitreoretinal surgeries performed in a private tertiary eye unit. Patient demographics, preoperative, and intra-operative variables were assessed and analyzed. Inclusion: Eyes which had surgery for previously unoperated GRT RD with PVR and had &gt; 3 months of follow up. Exclusion: Other primary and secondary forms of RD with no GRT. Results: Thirty-six eyes of 36 patients were evaluated. Male: female ratio = 5:1. Mean age of 45.53 ± 13.2 years (range 12 - 65 years). Left eye, twenty-three eyes (63.9%). Rate of advanced PVR C and D was 83%, four quadrant (total RD) 55.6%, macula detachment 91.7%, giant tear size was 90 to 180 degree and &gt; 180 degree in 55.6% and 33.3% respectively. Single surgery attachment rate was 41.7% and final attachment after a second surgery was 86.1%. Visual outcome was CF or better in twenty-three eyes (63.9%). Recurrent RD in 58.3% was due to postoperative PVR. Gender, age, laterality, PVR grade, giant tear size, quadrants affected by RD had no impact on anatomical outcome (p&gt; 0.05). Significantly, scleral buckle (SB) use did not reduce rate of recurrent RD and had no significant effect on anatomical outcome (p &gt; 0.05). Conclusion: GRT RDs have a higher rate of PVR compared to more commonly encountered RRD. When treating GRT RD with advanced PVR, meticulous membrane removal should be accomplished using vital dyes to aid visualization. This will reduce recurrence of postoperative PVR. Pre-, intra- and post-operative factors, including use of a SB did not affect single surgery success. Visual improvement is limited by the occurrence of PVR.