Multiple Retinal Breaks Research Articles

Acute Retinal Necrosis: A Review of Diagnosis and Management

Acute retinal necrosis (ARN) is a profound infection of the retina, marked by acute panuveitis, retinal periarteritis, and widespread necrotizing retinitis. The etiology of ARN involves human herpesviruses, such as herpes simplex virus (HSV) and varicella-zoster virus (VZV), which can lead to severe visual impairment or even blindness. A diagnosis of ARN is based on clinical characteristics and disease progression according to the standard diagnostic criteria established by the American Uveitis Society (AUS) in 1994. The polymerase chain reaction(PCR) of aqueous specimens can enable identification of the type of virus. Early initiation of antiviral medication is essential for treatment efficacy to stop lesion progression, accelerate the healing process, and prevent contralateral eye involvement. Ocular complications of ARN include atrophic retina, multiple retinal breaks, rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD), optic atrophy, macular edema, epiretinal membrane (ERM), and retinal and optic disc neovascularization. This review summarizes the clinical features, diagnostic criteria, and recently recommended ARN management.

Risk of primary failure under Densiron-68 in rhegmatogenous retinal detachment with multiple retinal breaks involving both superior and inferior retina: a retrospective case-control study

Purpose To estimate risk of primary failure during the use of Densiron-68 in rhegmatogenous retinal detachment (RRD) cases with multiple superior and inferior retinal breaks as well as to detect possible confounder predictors of primary failure. Methods This is a retrospective case-control study. Data was collected for 52 eyes with hematogenous retinal detachment with multiple retinal breaks who were treated via pars plana vasectomy using Densiron-68 as a tamponed agent. Pars plana vasectomies had been performed from March 2014 to November 2019. Eyes were categorized into two groups based on retinal status in presence of Densiron-68 1 month postoperatively (PO). Group A: primary failure group (n=18 eyes) and group B: Reattachment group (n=34 eyes). In each group we observed patients records to identify distribution of retinal breaks (superior and inferior, inferior only), and to identify other confounding risk factors for primary failure; including, number of retinal breaks, age, sex, duration of symptoms, uveitis, RD Quadrants, macula status, giant retinal tear (GRT) or Dialysis, proliferative vitreoretinopathy (PVR) and grade of PVR, inferior retinectomy, and Hypotony. Results Group A (n=18) included 13 eyes with superior and inferior breaks (SIRB) (72.2%), associated with 2.94±0.73 retinal breaks, 12 eyes with PVR (66.7%), and 3.39±0.92 quadrants of detachment. Group B(n=34) included 13 eyes with superior and inferior breaks (SIRB) (38.2%), associated with 2.4±0.5 retinal breaks, three eyes with PVR (8.8%), and 2.32±0.91 quadrants of detachment. The odds ratio for primary failure with SIRB was 4.2. Conclusion There are higher odds of primary failure following the use of Densiron-68 in cases with multiple retinal breaks that involve both superior and inferior retina, especially with a larger number of retinal breaks, a larger number of quadrants, and in the presence of PVR. We do not recommend using Densiron-68 for these cases.

Pneumatic retinopexy for rhegmatogenous retinal detachment: The importance of a primary retinal break

A 38-year-old pregnant woman presented to the retina clinic with complaints of sudden vision loss in her right eye for 1 week. The clinical examination of the right eye revealed a macula-off rhegmatogenous retinal detachment with multiple retinal breaks in different meridians, posterior retinal breaks, inferior peripheral retinal degeneration, and the patient's inability to maintain a prone position due to her pregnancy. She was advised to undergo pneumatic retinopexy, transscleral cryopexy, and the steam-roller technique for post-operative positioning for her right eye. Her retina was well-attached on postoperative day 1, and her findings remained stable at her last follow-up appointment. The patient's visual acuity improved from 6/75 to 6/12 at the final follow-up visit. In a patient with rhegmatogenous retinal detachment, it is essential to accurately identify and treat primarily the causative retinal break.

Successful management of an unusual extra-ocular foreign body.

A 25 yr old male†, industrial worker by profession, presented to the emergency setting of Government Medical College, Chandigarh, in July 2020, with a rare foreign body impaction. This was after he sustained occupational ocular trauma while cutting iron sheets with a manual work tool machine. He was not wearing any ocular protective gear. Ocular examination revealed impaction of multiple round brass foreign bodies in the right lower lid (Fig. 1A) and closed globe injury to the globe with vitreous haemorrhage and peri-papillary retinal pallor (Fig. 1B). Non-contrast computed tomography orbit showed metallic foreign bodies abutting the globe but not causing globe rupture (Fig. 2A: axial view; Fig. 2B: coronal view; Fig. 2C: sagittal view). The foreign bodies were removed (Fig. 1. inset) and the lid and canalicular repair was done. Pars plana vitrectomy was done to clear the vitreous haemorrhage. During the procedure, fibrogliotic bands with pigmentary alterations and multiple retinal breaks were noticed inferonasally due to coup injury at the site of the impact. Differential diagnoses of chorioretinitis sclopetaria, choroidal rupture and commotio retinae were kept in mind. The breaks in the region of chorioretinitis sclopetaria were lasered using a 532 nm laser. At 12 months of follow up, the visual acuity was 20/40 with attached retina (Fig. 3A and B) and no complaints of epiphora were noted. To the best of our knowledge, the impaction of multiple foreign bodies with stacking in the extra-ocular space has not been reported previously in the spectrum of work-tool related eye injuries. A team approach by oculoplastic and retina surgeons may be required for successful management of complex occupational ocular trauma.Fig. 1: (A) Photograph showing three metallic foreign bodies stacked one above the other in the lower eyelid in the medial aspect. (B) Fundus picture showing diffuse retinal opacification around optic disc and the fundus details are masked by overlying vitreous haemorrhage (inset). Photograph showing three (two are stacked together) 15 mm round smooth disc-shaped brass foreign bodies removed from the orbit.Fig. 2: Computed tomographic scan showing metallic foreign body in the inferior orbit abutting the globe with intact inferior wall of the orbit (A, axial scan, B, coronal scan, C, sagittal scan).Fig. 3: (A) Follow-up facial photograph of the patient showing repaired eyelid after removal of the foreign bodies with puncta well opposed to the globe. (B) Fundus montage of the right eye, after pars plana vitrectomy showing inferonasal chorioretinitis sclopetaria (arrow) with laser done for retinal breaks (arrowheads).Conflicts of Interest: None.

Risk factors for macular pucker after rhegmatogenous retinal detachment surgery

Macular pucker, also known as an epiretinal membrane, sometimes forms after surgical repair of a rhegmatogenous retinal detachment (RRD) and can decrease visual acuity and cause aniseikonia. However, few reports are evaluating the risk factors of macular pucker using multivariate analysis. To evaluate the risk factors for macular pucker after RRD surgery, 226 patients who underwent RRD surgery and were monitored for greater than 12 months (23.2 ± 6.4 months) after surgery were analyzed retrospectively. Of these cases, macular pucker developed in 26 cases. Multiple logistic regression models of 22 clinical characteristics were performed. An increased risk of macular pucker after RRD surgery was significantly associated with preoperative vitreous haemorrhage (Odds ratio (OR), 4.71; 95% CI 1.19–18.62), multiple retinal breaks (OR, 8.07; 95% CI 2.35–27.71), re-detachment (OR, 19.66; 95% CI 4.87–79.38), and retinal detachment area (OR, 12.91; 95% CI 2.34–71.19). Macular pucker was not associated with the surgical technique. Regardless of the surgical technique used, careful observation for postoperative macular pucker is needed after RRD surgery in high-risk cases. These findings can be used to improve the surgical management of patients with RRD. (183 words).

Assessment of epiretinal membrane formation using en face optical coherence tomography after rhegmatogenous retinal detachment repair.

To investigate epiretinal membrane (ERM) formation using en face optical coherence tomography (OCT) after vitrectomy for rhegmatogenous retinal detachment (RRD). We retrospectively reviewed the medical records of 64 consecutive eyes (64 patients) with RRD treated by vitrectomy without ERM and internal limiting membrane peeling. ERMs and retinal folds were detected by B-scan and en face imaging. The maximum depth of retinal folds (MDRF) was quantified using en face imaging. ERM severity was staged using B-scan imaging. Main outcome measures were ERM detection rate with B-scan and en face imaging, MDRF, ERM staging, postoperative best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution), and risk factors for ERM formation. The detection rate for ERM formation was significantly higher with en face imaging (70.3%) than with B-scan imaging (46.9%; P = 0.007). There was no significant difference in postoperative BCVA between eyes with ERM formation (0.06 ± 0.26) and those without ERM formation (0.01 ± 0.14; P = 0.298). Forty of 45 (88.9%) eyes with ERM formation were classified as stage 1. Twenty-seven of 45 (60.0%) eyes with ERM formation developed parafoveal retinal folds. The mean MDRF was 27.4 ± 32.2 μm. Multiple retinal breaks and a maximum retinal break size of ≥ 2 disc diameters were significantly associated with ERM formation (P = 0.033 and P = 0.031, respectively). Although ERM formation was observed in 70.3% patients after RRD repair, the formed ERM was not severe and had minimal impact on the postoperative visual acuity.

Double Retinal Tamponade for Treatment of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy and Inferior Breaks.

Purpose To evaluate the efficacy and safety of the simultaneous use of short-term perfluoro-n-octane (PFO) with perfluoropropane (C3F8) gas to achieve retinal reattachment in eyes with rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C and multiple retinal breaks including inferior breaks. Design This is a prospective interventional case series study. Patients and Methods. The study was a prospective noncomparative interventional study. It included 30 eyes of 30 patients who had RRD with PVR grade C and multiple retinal breaks including inferior tears attending the vitreoretinal unit of Minia University Hospital, Egypt. The mean age was 50.2 ± 10.63 years; 18 patients were females and 12 were males. Combined phacoemulsification and 23 G pars plana vitrectomy (PPV) with double retinal tamponade by C3F8 and PFO were done, and PFO was removed in 10–14 days. The patients were followed up for one year. The primary outcome was to achieve successful retinal reattachment, and the secondary outcomes were visual improvement and occurrence of complications. Results Successful retinal reattachment was obtained in 28 eyes out of 30 (93.3%), and 2 eyes (6.7%) had recurrent RD. Best-corrected distance visual acuity (BCDVA) in logMAR was significantly improved from baseline 1.74 ± 0.05 to 0.93 ± 0.04, 0.82 ± 0.05, 0.80 ± 0.07, and 0.73 ± 0.055 at follow-up visits 3, 6, and 9 months and one year, respectively (P ≤ 0.001). There were no serious ocular complications recorded. Conclusions The results of this study indicated that primary vitrectomy with simultaneous use of both C3F8 and short-term PFO as retinal tamponades was effective and safe in the management of complex cases of RRD with PVR grade C and inferior breaks. This trial is registered with NCT04168255.

Hemorrhagic complications associated with suprachoroidal buckling

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

Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV

Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis...

SUPRACHOROIDAL BUCKLING FOR THE MANAGEMENT OF RHEGMATOGENOUS RETINAL DETACHMENTS SECONDARY TO PERIPHERAL RETINAL BREAKS.

To evaluate functional and anatomical outcomes of eyes undergoing suprachoroidal buckling for the management of peripheral retinal breaks in rhegmatogenous retinal detachment. Retrospective cohort study of 41 eyes of 41 patients undergoing suprachoroidal buckling for the management of rhegmatogenous retinal detachment secondary to single or multiple retinal breaks. Suprachoroidal indentation was achieved through the introduction of filler material using a 23-gauge (23-G) olive-tipped, suprachoroidal cannula. This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition. Healon5 (Abbott Medical Optics) was used as filler material in all eyes. Combined 25-G vitrectomy was performed in 5 eyes. Cryopexy and laserpexy were used in 37 and 4 eyes, respectively. Mean visual acuity gain was the primary outcome measure. Final retinal reattachment rate, single-surgery reattachment rate, and complications were secondary outcome measures. Mean best-corrected distance visual acuity improved from 20/1,100 to 20/42. Single surgery reattachment rate was 92.7% (38/41 eyes). Final retinal reattachment was achieved in all 41 eyes (100%). There was no statistically significant difference in visual acuity gain or anatomical reattachment in terms of retinal break quadrant or extent. No major complications were observed. Two localized suprachoroidal hemorrhages occurred at the entry site for the cannula. These resolved without further intervention. Suprachoroidal buckling using a specially designed cannula is a safe and effective procedure for the management of rhegmatogenous retinal detachment secondary to peripheral retinal breaks.

Catheter-guided suprachoroidal buckling of rhegmatogenous retinal detachments secondary to peripheral retinal breaks.

To evaluate functional and anatomic outcomes of eyes undergoing suprachoroidal buckling (SCB) using a specially designed catheter for the management of rhegmatogenous retinal detachment (RRD) secondary to peripheral retinal breaks. Retrospective cohort study of 62 eyes of 62 patients. Subjects underwent SCB for the management of RRD secondary to single or multiple retinal breaks. Suprachoroidal indentation was achieved through the introduction of viscoelastic material in the suprachoroidal space overlying the break using an illuminated, 450μm-wide, flex-tip catheter. This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition. Forty-seven eyes (80%) underwent SCB alone, while 15 eyes (20%) were combined with 25-G pars-plana vitrectomy. Cryopexy and laserpexy were used in 38 (61%) and 24 of eyes (39%) respectively. Mean pre-operative best-corrected visual acuity (BCVA) improved from logMAR 0.82 (20/132) to 0.22 (20/33) (p < 0.0001). The single surgery reattachment rate was 92% (57/62.) Final retinal reattachment was achieved in all eyes (100%). No significant difference was observed in single-surgery anatomic success rates when stratified by lens status, macular involvement, or break location. There were no major intra- or post-operative complications. Suprachoroidal buckling using a special-design, flexible catheter is a safe and effective procedure for the management of RRD secondary to peripheral retinal breaks.

Artificial vitreous body: Strategies for vitreous body substitutes

Although numerous advances have been made in technology and techniques of pars plana vitrectomy and tamponades, there are still unsolved issues, such as proliferative vitreoretinopathy (PVR), multiple retinal breaks and persistent hypotonia. All available internal tamponades (e.g, gases, oils and fluorocarbons) are hydrophobic, so they approximate the neurosensory retina to the retinal pigment epithelium due to buoyant force and surface tension. Even though these tamponade materials exhibit various beneficial attributes in the clinical application, the hydrophobic nature has clear disadvantages and compartmentalization and significant incidence of PVR development still occur. An ideal vitreous body substitute should mimic the native human vitreous body, in both form and function. Vitreous body substitutes, such as hydrogels fulfill the biophysical needs in a similar manner to the natural vitreous body by providing an internal tamponade effect through swelling pressure and viscosity. New approaches range from cross-linked semisynthetic to synthetic polymers. These hydrogels have a good biocompatibility, optical clarity, a refractive index and rheological properties that are similar to the natural human vitreous body and are able to act as anti-adhesive and anti-migrative agents and can therefore reduce PVR. Furthermore, hydrogels could also serve as controlled-release drug-delivery systems for anti-proliferative, neuroprotective or nutritive drugs.

Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy.

To describe the clinical characters of rhegmatogenous retinal detachment (RRD) associated with massive spontaneous suprachoroidal hemorrhage (SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy. A retrospective review of 6 cases (6 eyes) of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage, phacoemulsification (PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported. In the 6 affected eyes of 6 patients (3 men and 3 women; mean age, 53.83y; range 34-61y), preoperative visual acuity ranged from faint light perception (LP) to counting finger (CF). The average interventional duration from visual decreased to surgery was 12.8 d (range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm (range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes. Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo (Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5 eyes (83.33%) and no change in 1 eye (16.67%). Ocular hypertension ocurred in 1 eye (16.67%), which was successfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy (PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4 eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively. RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.

The clinical observation of segmental scleral bulking in treatment of rhegmatogenous retinal detachment with multiple retinal breaks

Objective To observe the effect of segmental scleral buckling on the treatment of rhegmatogenous retinal detachment (RRD) with multiple retinal breaks.Methods This is a retrospective study.Seventeen patients (17 eyes) suffering from RRD with multiple retinal breaks were enrolled in this study.There were 8 eyes with the retinal breaks located in different quadrants and 9 eyes located in different latitudes within the same quadrant.Three were 3 eyes with 2 retinal breaks,5 eyes with 3 retinal breaks,9 eyes with more than 3 retinal breaks.The forms of retinal breaks included U-shaped break (4 eyes),tear break (1 eye),degenerative break (3 eyes) or U-shaped breaks combined with degenerative breaks (7 eyes),U-shaped break.s combined with tear breaks (1 eye),tear breaks combined with degenerative breaks (1 eye).The best corrected vision acuity (BCVA) was count finger to 0.8.The segmental scleral buckling was performed in all patients with the reasonable combination of silicon sponges and tires.The mean followup was 9.3 months (from 6 to 12 months).The BCVA,retinal attachment and complications were observed in the follow-up.Results Fifteen eyes were reattached without recurrent of retinal detachment (88.2％).One eye with recurrent retinal detachment after 3 months due to proliferative vitreoretinopathy,and was partly reattached after vitrectomy combined with silicon oil tamponade.Retina remained detached in 2 eyes (11.8％),including 1 eye reattached after combined with gas tamponade,and 1 eye with vitrectomy.Sixteen eyes were completely reattached (94.1％),including 14 eyes were underwent only 1 operation (82.4％).The BCVA were improved more than 2lines in 9 eyes (52.9％),1 to2linesin5 eyes (29.4％),and only 3 eyes (17.7％) without improvement.All patients have no serious complications during the operations.Conclusion For certain patients suffering from RRD with multiple retinal breaks,a reasonable design of segmental scleral buckling can effectively increase the success rate of retinal reattachment (82.4％). Key words: Retinal detachment/surgery; Scleral buckling

The Pattern and Distribution of Retinal Breaks in Eyes With Rhegmatogenous Retinal Detachment

To identify which presenting features of rhegmatogenous retinal detachment (RRD) suggest the presence of multiple retinal breaks and to ascertain relevant patterns in retinal break location. Observational single-center case series. We collected data from 851 eyes undergoing surgery for RRD between January 2001 and September 2011. Data recorded included patient demographics; extent of RRD; and the size, location, and number of retinal breaks. Statistical regression was used to identify risk factors for the presence of multiple breaks and to analyze patterns in break location. Of 851 patients, 7 patients were excluded because of insufficient data. Of 844 patients analyzed, 60% were male. The mean age was 62 years. Three hundred twenty-eight eyes (38.9%) had solitary breaks, whereas 58.8% had breaks in more than 1 quadrant. The superotemporal (ST) quadrant was involved most frequently (582 eyes; 69%). The superonasal and inferotemporal quadrants were involved in 341 (40%) and 274 (32%) eyes, respectively. The inferonasal (IN) quadrant was involved the least frequently (144 eyes; 17%). Of 328 eyes with only 1 break, it was most likely to be in the ST quadrant (182 eyes; 55%) and least likely to be in the IN quadrant (19 eyes; 6%). The risk of having multiple breaks was highest for patients with inferior breaks. Eyes with an IN quadrant break were almost twice as likely to harbor further breaks compared with eyes with an ST quadrant break. Vitreous hemorrhage at presentation was associated with larger breaks. ST quadrant breaks were most likely to be detached (92%), whereas IN quadrant breaks were least likely to be detached (60%). The ST quadrant is the most likely location for retinal breaks, the most frequently involved quadrant in eyes with solitary breaks, and has the highest proportion of detached breaks. By contrast, the IN quadrant is the least likely location for a break, the least frequently involved quadrant in eyes with solitary breaks, and the most likely location for attached breaks. The presence of an inferior (especially IN quadrant) retinal break should raise suspicion that the eye harbors further breaks.

QUANTITATIVE ANALYSIS OF RHEGMATOGENOUS RETINAL DETACHMENT ASSOCIATED WITH CHOROIDAL DETACHMENT IN CHINESE USING UBM

To investigate the characteristics of rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) in a Chinese population by using ultrasound biomicroscope (UBM). A random prospective study was used to assess 1,389 patients (1,408 eyes) with rhegmatogenous retinal detachment. Comprehensive standardized ophthalmic examinations included intraocular pressure (IOP) by Goldmann applanation tonometer and the entire ocular fundus by Goldmann three-mirror lens, B-type ultrasound, and UBM. A total of 1,389 patients with rhegmatogenous retinal detachment participated in the study, including 906 men and 483 women. Two hundred and sixty-three eyes (18.79%) had RRDCD and the age of patients ranged from 9 to 82 years (median, 50.8 ± 17.7 years). Patients with high myopia (-6.00 diopters or more) represented 31.94% and more frequently experienced low intraocular pressure and multiple retinal breaks. In 263 RRDCD eyes, the results of UBM showed that ranges of choroidal detachment (CD) were <1 quadrant in 9 (3.42%) eyes, from 1 to 2 quadrants in 37 (14.07%) eyes, from 2 to 3 quadrants in 13 (4.94%) eyes, and from 3 to 4 quadrants in 204 (77.57%) eyes. ultrasound biomicroscope also showed that the angular ranges of CD were between 3.31° and 45.65° (mean, 15.98 ± 9.29°). In addition, UBM showed the mean values of CD angle for the superior (15.42 ± 9.40°), nasal (14.08 ± 8.66°), inferior (15.03 ± 9.05°), and temporal (15.96 ± 9.22°) sides. No statistically significant differences were found among any of these comparisons (F value = 2.011, P > 0.05). Retinal detachment associated with CD occurs more frequently in older people or in patients with high myopia, who usually present with low intraocular pressure and multiple retinal breaks. UBM examination can reduce false-negative rate of RRDCD, determine CD degree quantitatively, and guide classification and treatment. UBM combined with B ultrasound testing can provide a precise diagnosis of rhegmatogenous retinal detachment degree and may have important clinical significance for preoperative diagnosis of anterior proliferative vitreoretinopathy and determining operative strategy and postoperative prognosis.

The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

PurposeTo investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment.MethodsWe retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded.ResultsPostoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker.ConclusionsIn our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.

Ophthalmic Evaluation and Management of Traumatic Accidents Associated with Retinal Breaks and Detachment: A Retrospective Study

This retrospective study reviews a group of patients with retinal breaks or retinal detachment following ocular trauma. A total of 94 patients were included in the study. They underwent closed globe injuries causing multiple retinal breaks or retinal detachment at time of presentation in the emergency department. Analysis concerned epidemiologic, clinical, and therapeutic aspects, both in short-term (1 and 3 months) and long-term (6-12 months) follow-up. A total of 85% of patients were male, involved in work-related injuries, and complaining visual function decrease. Retinal breaks were mostly singular, U-shaped, and located in the upper temporal quadrant. At presentation, visual acuity ≥5/10 and Ocular Trauma Score of 4 were the most represented. Fifty-eight patients (61.70%) underwent repair within 48 hours of the trauma, 27 (28.73%) within 7 days, and 9 (9.57%) more than 7 days after trauma. Procedures performed were photocoagulation with argon laser (52%), episcleral buckle (34.45%), or vitrectomy associated with episcleral buckle and intraoperative argon laser (13.55%). A total of 92% of patients treated within 48 hours had better or unchanged visual acuity in 6-12 months of follow-up. All patients treated more than 7 days after trauma had worse visual acuity (p<0.01 with Student t test). Detailed clinical history, well-done preoperative examination, early diagnosis, and prompt parasurgical or surgical repair are significant prognostic factors for better visual outcome and lower incidence of relapse.

The Predisposing Pathology and Clinical Characteristics in the Scottish Retinal Detachment Study

To describe the predisposing pathology and clinical features of all incident cases of rhegmatogenous retinal detachment (RRD) recruited in Scotland during a 2-year period. Prospective surveillance study of incident cases of RRD. All incident cases of RRD recruited as part of the Scottish Retinal Detachment Study. During a 2-year period, we coordinated a comprehensive system in which every case of primary RRD presenting to 1 of 6 vitreoretinal surgical sites in Scotland was examined and approached for study inclusion. Rhegmatogenous retinal detachment incidence, predisposing features, and clinical characteristics. A total of 1202 cases were recruited. Detailed clinical information was available on 1130 (94%) of cases. By causative break, the proportions of RRD were horseshoe tear (HST) associated with posterior vitreous detachment (PVD) in 86.2%, giant retinal tear (GRT) and PVD in 1.3%, non-PVD round hole (RH) in 4.9%, retinal dialysis in 5.9%, and retinoschisis RRD in 1.6%. One in 10 cases reported significant ocular trauma. One in 5 cases were pseudophakic. Round hole RRD more frequently presented with multiple retinal breaks compared with HST RRD (67.8% vs. 48.7%; P = 0.003). In PVD-associated RRD, 56.1% (95% confidence interval [CI], 53.8-58.3) of breaks were identified in the superotemporal retina. In non-PVD RRD, 54.6% (95% CI, 47.9-61.1) of breaks were inferotemporal, followed by superotemporal in 34.9% (95% CI, 28.7-41.5). Lattice degeneration was present in 18.7% of affected eyes and more common in RH RRD (35.7%) than in HST RRD (19.3%) (P = 0.003). Seven percent reported an affected first-degree relative, and these cases were significantly more myopic than nonfamilial cases. More than 85% of RRD cases are associated with PVD and related tractional tears. Non-PVD RH RRD occurred in younger and more myopic individuals. The majority of cases are caused by more than 1 retinal break, and the macula is affected in more than 50% at presentation. Ocular trauma, previous cataract surgery, family history, and lattice degeneration are important predisposing features.

Massive vitreous gel incarceration into the subretinal space following traumatic retinal detachment in a young patient: a case report

PurposeThis paper reports a young patient with a traumatic rhegmatogenous retinal detachment and massive vitreous gel incarceration into the subretinal space, who was successfully treated with 23-gauge transconjunctival vitrectomy.Case reportAn 11-year-old boy was referred to the authors’ clinic with traumatic retinal detachment in the right eye, 2 weeks after ocular contusion in a baseball accident. At the time of the injury, emergency fundus examination by his local doctor had revealed vitreous hemorrhage in the inferior quadrant of the right eye. Visual acuity was 1.5. He had continued to play baseball as usual for 2 weeks after the injury. At his first visit to the authors’ clinic, fundus examination showed a highly bullous retinal detachment involving the inferior two quadrants, associated with multiple irregular retinal breaks. There was an oval hole in the inferior quadrant which was 10-disc diameter × 5-disc diameter in size and was surrounded by edematous and hemorrhagic retina. The macula remained attached. Absolute rest for 4 hours in the supine position with binocular occlusion did not diminish the height of the retinal detachment. A 23-gauge three-port pars plana vitrectomy combined with 360° circumferential buckling was performed under general anesthesia. The lens was retained. Incarceration of massive vitreous gel, including vitreous hemorrhage into the subretinal space through the largest break, was observed during vitrectomy. Reattachment of the retina was achieved by fluid–air exchange and internal tamponade using SF6 gas. At follow-up at 9 months, the retina remained attached and visual acuity in the right eye was 1.2.