Number Of Retinal Breaks Research Articles

Chandelier-assisted scleral buckle surgery - contact versus non-contact wide-angle viewing system (CAB-CNV): A retrospective, multicenter, clinical study.

To investigate and compare the anatomic and functional outcomes of chandelier-assisted scleral buckling (CASB) surgery using contact versus non-contact lens-based wide-angle viewing systems (WAVSs) in rhegmatogenous retinal detachment (RRD) patients. This was a retrospective, multicenter study evaluating the anatomic (reattachment rate) and visual acuity (VA) outcomes at 6 months post-CASB for primary RRD. Forty-seven RRD patients underwent CASB with a non-contact WAVS (Group C1) and 90 with a contact lens WAVS (Group C2). Preoperative parameters including myopia, macula-off RRD, posterior vitreous detachment, number of retinal breaks, and retinal dialysis as the etiology of RRD did not differ significantly between the two groups. The outcomes of retinal attachment (85.11% of C1 patients and 76.67% of C2 patients, P = 0.34) and final visual outcome (VA ≥6/12: C1 = 61.7%; C2 = 46.67%, P = 0.13) were also comparable. Furthermore, no significant difference in postoperative complications such as cataracts, glaucoma, infection, buckle exposure, and buckle failure was observed. Finally, both groups were comparable in terms of re-detachment rates (10.64% in C1 and 23.33% in C2, P = 0.11). The two WAVS approaches used in CASB surgery have comparable surgical and functional outcomes and postoperative complications. The operating surgeon can freely choose between these viewing platforms during the contemporary scleral bucking (SB) surgery without impacting the outcome.

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

Routine Use of Air Tamponade in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Purpose: The aim of this study is to establish if air can be considered as a safe substitute for long-lasting tamponade agents for primary rhegmatogenous retinal detachment (RRD) treatment, regardless of the position or the number of retinal breaks. Methods: In this study, 230 consecutive patients (236 eyes) who underwent a pars plana vitrectomy (PPV) for primary RRD with air or SF₆ tamponade from January 2014 till March 2020 were analyzed. The main outcome measure was the rate of an anatomically attached retina without the presence of any tamponade agent for at least 3 months postoperatively. Results: Our overall success rate in treating RRD with PPV in cases involving superior, inferior, and also multiple breaks is 88.5% (146/165 eyes) with air tamponade and 80.3% (57/71 eyes) with SF₆ 20% tamponade. Preoperative characteristics were almost similar between the two groups. Conclusion: Our study shows encouraging results for RRD treated with air tamponade, not only for superior breaks but also for inferior and multiple breaks. Thorough removal of vitreous traction, aspiration of subretinal fluid, and sealing of all the retinal breaks are mandatory elements to treat RRD. After this is accomplished, air tamponade seems to be a safe and effective agent for primary RRD. In order to clarify the use of intravitreal gases or air in the treatment of primary RRD with PPV, a randomized controlled prospective study should be realized in the future.

Surgical Outcomes of Rhegmatogenous Retinal Detachment with Different Peripheral Vitreous-Shaving Procedures.

PurposeTo compare the surgical outcomes of vitreous surgery for rhegmatogenous retinal detachment (RRD) after two different peripheral vitreous-shaving techniques are performed.MethodsWe reviewed 269 eyes with RRD that were treated with a 25-gauge vitrectomy by a single surgeon between June 2015 and May 2020. The exclusion criteria for the proposed air tamponade selection were as follows: more than two weeks since RRD onset, giant retinal tears, a history of complications following cataract surgery, high myopia, and proliferative vitreoretinopathy classified as grade C or higher. We examined the differences in the therapeutic effect between shaving under slit lamp microscope illumination (group A) and shaving under a wide-angle viewing system (group B).ResultsA total of 269 eyes were included in this study, with 146 eyes in group A and 123 eyes in group B. The primary anatomical success rates did not differ between group A (97.3%; 142/146 eyes) and group B (97.6%; 120/123 eyes; P = 0.102). However, the surgical time was significantly longer in group A (60.2 ± 17.1 min) than that in group B (46.9 ± 12.6 min) (P < 0.001). The multiple linear regression analysis revealed that surgical time was significantly correlated with using the wide-angle noncontact viewing system for vitreous shaving (adjusted R2 = 0.248; beta [standard partial regression coefficient] = −0.447, P < 0.001), the number of retinal breaks (beta = 0.182, P = 0.001), and the quadrant of retinal detachment (beta = 0.205, P < 0.001).ConclusionThe surgical outcomes were similar regardless of the shaving procedure performed, and the surgical time was shortened by using the wide-angle noncontact viewing system for vitreous shaving.

Time to Unplanned Return to the Operating Room and Associated Risk Factors in Patients With Surgical Retinal Detachment Repair

To assess the incidence of unplanned return to the operating room (ROR) at ≤45 days or ≥46 days after primary retinal detachment (RD) surgery and correlate ROR with preoperative risk factors and visual outcomes. Retrospective cohort study. This was a retrospective review of patients with primary RD surgery to assess for unplanned ROR between January 1, 2012 and June 30, 2014, with follow-up of 90 days to 8 years (mean, 1.5 years). We assessed 268 patients receiving 270 primary rhegmatogenous RD surgeries between January 1, 2012 and June 30, 2014 in an academic tertiary referral center. Of the 270 RD surgeries, 82 were complicated (history of proliferative vitreoretinopathy or trauma-related RDs at presentation) and 188 were uncomplicated (RD unrelated to trauma or proliferative vitreoretinopathy at presentation). The ROR rate for all surgeries was 12.2% (33/270) over the follow-up period, with 51.5% (17/33) having reoperations within 45 days. The complicated detachment group had a ROR rate of 14.6% (12/82) over the follow-up period, and 50% of those (6/12) had reoperations within 45 days. The uncomplicated detachment group had a ROR rate of 11.2% (21/188) over the follow-up period. Of those, 52.4% (11/21) had reoperations within 45 days. Given that only 51.5% of all RORs occurred within 45 days, a 45-day ROR surgical quality metric that has been previously used may be of limited value for RD surgery. Factors such as age at presentation, number of retinal breaks, number of detached clock hours, use of silicone oil tamponade for pars plana vitrectomy, history of choroidal detachment, high myopia, ocular trauma, and open globe were associated with increasing risk of ROR. Implementing risk-adjusted metrics may provide a more accurate and useful quality improvement metric for evaluating quality of surgical care in vitreoretinal surgery. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.

Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange.

To observe the efficacy and safety of pars plana vitrectomy (PPV) with eye position guided fluid-air exchange (FAX) and air tamponade in the treatment of rhegmatogenous retinal detachment (RRD). RRD patients without severe proliferative vitreoretinopathy (PVR) C1 or more were enrolled. All patients underwent PPV combining with air tamponade. During operation, the primary retinal break(s) were placed at lower site and subretinal fluid was aspirated through the break(s) at the same time when eye position guided FAX was proceeding. Sufficient laser spots were made to seal the retinal break(s) after FAX, and filtered air was left in vitreous cavity as tamponade agent finally. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure. A total of 37 eyes (20 males and 17 females) with a follow-up time of ≥6mo were included. The range of RRD was 5.6±1.8h, and the number of retinal breaks was 1.9±1.2. The breaks located at inferior quadrants (between 3:00 and 9:00) in 5 cases (13.5%), and both superior and inferior breaks were found in 3 cases (8.1%). A total of 25 cases (67.6%) with macular detached involvement, 9 cases (24.3%) with intraocular lens, and 8 patients (21.6%) were treated with phacoemulsification and intraocular lens implantation together. The success rate of primary retinal reattachment was 100% (37/37). At 6mo postoperatively, BCVA (logMAR) was increased from 1.13±1.07 to 0.23±0.15 (P<0.001). Phacoemulsification combined with intraocular lens implantation was performed in 2 patients (5.4%), and one of them underwent macular epiretinal membrane peeling in addition (2.7%). Furthermore, high intraocular pressure was found in 4 cases (10.8%). PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD, and it has the advantages of short postoperative prone time and fewer operative complications.

PREDICTIVE FACTORS FOR PROLIFERATIVE VITREORETINOPATHY FORMATION AFTER UNCOMPLICATED PRIMARY RETINAL DETACHMENT REPAIR.

To determine predictive factors of proliferative vitreoretinopathy (PVR) formation after uncomplicated primary retinal detachment repair. Retrospective, single-center, case-control study of 74 consecutive patients with (37 eyes) and without (37 eyes) PVR formation after undergoing uncomplicated primary surgery for retinal detachment repair. Logistic regression was used to assess factors associated with PVR formation. Retinal detachment involving the macula was 4.2 times (adjusted odds ratio; 95% confidence interval, 1.4-12.9; P = 0.0119) more likely to have PVR formation compared with those without. Patients who were current or former smokers were 3.6 times (adjusted odds ratio; 95% confidence interval, 1.1-11.7; P = 0.0352) more likely to have PVR formation compared with nonsmokers. Compared with 25-gauge (g) vitrectomy, larger gauge vitrectomy (20 g or 23 g) was 3.6 times (adjusted odds ratio; 95% confidence interval, 1.2-11.3; P = 0.0276) more likely to have PVR formation. Duration of retinal detachment symptoms, high myopia, lens status, lattice degeneration, location of retinal break, number of retinal breaks, and surgical technique (e.g., scleral buckle with or without vitrectomy versus vitrectomy alone) were not found to be predictive of PVR formation. Cigarette smoking and macular involvement are significant risk factors predictive of PVR formation after uncomplicated primary retinal detachment repair.

Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes.

Evaluate the impact of time to surgery and other clinical factors on visual and anatomic outcomes following surgical repair of fovea-sparing rhegmatogenous retinal detachments (RRD). Visual and anatomic outcomes were analyzed for their association with clinical factors, including lens status, preoperative visual acuity (VA), contralateral RRD, RRD symptom duration, time to surgery, single-operation anatomic success, number of quadrants involved, posterior RRD extent, RRD extent closest to the fovea, number of retinal breaks, quadrants with retinal breaks, and surgery performed Saturday or Sunday versus Monday-Friday. Medical records of 423 eyes with fovea-sparing RRD repaired with pneumatic retinopexy (PR), scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) were included. Sixty-seven percent and 89% were operated within 24 and 72h of RRD presentation, respectively. Single-operation anatomic success rates were 59%, 89%, 84%, and 92% for PR, SB, PPV, and PPV/SB interventions, respectively. Final anatomic success was 100%. Three clinical factors correlated with faster time to surgery: shorter symptom duration (p < 0.02), RRD superior location (p = 0.001), and posterior extension into the macula (p = 0.01). The time to surgery did not correlate with visual or anatomic outcomes. Two clinical factors positively correlated with postoperative vision: preoperative VA (r > 0.25, p < 0.04) and single-operation anatomic success (p < 0.04). Surgeries performed on Monday through Friday (n = 411) were associated with better anatomic outcomes compared with the limited number performed on Saturday or Sunday (n = 12) (p = 0.005), although a greater proportion of operated cases over the weekend were PR. In the context of the current series, time to surgery did not correlate with visual or anatomic outcomes following the surgical repair of fovea-sparing RRDs. Preoperative VA and single-operation anatomic success correlated with improved visual outcome.

PROPHYLACTIC PREOPERATIVE LASER RETINOPEXY DOES NOT REDUCE THE OCCURRENCE OF RHEGMATOGENOUS RETINAL COMPLICATIONS IN MACULAR SURGERY.

Knowledge on the utility of prophylactic 360° laser retinopexy before pars plana vitrectomy in the absence of peripheral retinal pathology is limited. This study compares the occurrence of rhegmatogenous events in the setting of small-gauge pars plana vitrectomy with and without prophylactic preoperative laser. Our multicenter, retrospective case-control analysis reviewed patients who underwent epiretinal membrane removal or macular hole repair through 23- or 25-gauge pars plana vitrectomy: 205 controls who did not receive prophylactic laser and 176 cases who received preoperative prophylactic laser retinopexy anterior to the equator. Main outcome measures were the rate and characteristics of postoperative retinal tears and detachments. Patients with previous pars plana vitrectomy or significant retinal disease were excluded. Of those patients with prophylactic laser and those without, there was no significant difference in the number of retinal breaks (1.7% vs. 0.49%, respectively; P = 0.339) or retinal detachments (0% vs. 0.49%, respectively; P = 1.00). Of the lasered group, there was one sclerotomy-related retinal break and two non-sclerotomy-related retinal breaks. Of the nonlasered group, there was one non-sclerotomy-related retinal break and one sclerotomy-related retinal detachment. Preoperative prophylactic peripheral laser retinopexy does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events.

Comparison between the scleral buckling under wide-angle viewing systems and conventional scleral buckling for the treatment of rhegmatogenous retinal detachment

Objective To compare the efficacy between the scleral buckling under wide-angle viewing systems (WAVS) and conventional scleral buckling for rhegmatogenous retinal detachment. Methods The data of 108 eyes of 108 patients with rhegmatogenous retinal detachment was collected and retrospectively analyzed. All cases were randowly divided into two groups: 54 eyes underwent scleral buckling under WAVS (Group A), and 54 eyes underwent conventional scleral buckling under indirect ophthalmoscope (Group B). Preoperatively, the difference were not statistically significant between the two groups in age, gender, course of disease, best corrected visual acuities (BCVA), IOP, refractive error, the extent of retinal detachment, with or without macular detachment, subretinal demarcation line and the number of retinal breaks. The follow-up period was 12 months. Results Durations of operation, primary operative success rate, BCVA and complications were compared between the two groups. The durations of operation in Group A (with or without encircling operation) were obviously shorter than those in Group B (t=-12.735, -18.037; P=0.000, 0.000). The primary operative success rate was 94.44% in Group A and 92.59 %in Group B, the difference was not statistically significant (χ2=0.026, P=0.917). The BCVA in Group A was better than that in Group B (P<0.001) at 1 month after surgery. However, the difference was not statistically significant between the two groups at 3 (t=-1.202, P=0.214), 6 (t=-0.084, P=0.657), and 12 monthes (t=-1.216, P=0.355) follow-up visits respectively. Conclusion The efficacy of scleral buckling under WAVS is good with shorter operative time. It may be an alternative choose for rhegmatogenous retinal detachment. Key words: Retinal detachment, rhegmatogenous; Scleral buckling; Wide-angle viewing systems

The Safety and Efficacy of Adjustable Postoperative Position after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment.

Purpose. To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD). Methods. Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position. Results. 403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%. Conclusion. Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended.

Comparison of scleral buckling using wide-angle viewing systems and indirect ophthalmoscope for rhegmatogenous retinal detachment.

To compare the effects of scleral buckling using wide-angle viewing systems (WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment. The study was a retrospective analyses of the medical records of 94 eyes (94 patients) with rhegmatogenous retinal detachment. Among them, 47 eyes underwent scleral buckling using WAVS with endoilluminator (Group W), and 47 eyes underwent scleral buckling using indirect ophthalmoscope (Group I). Surgical durations, primary success rate, best-corrected visual acuities (BCVA), delayed subretinal fluid absorptions and surgical complications were compared between the two groups. At baseline, there were no statistical differences between the two groups in patient's age (P=0.997), gender (P=0.853), symptom duration (P=0.216), BCVA (P=0.389), refractive error (P=0.167), intraocular pressure (P=0.595), the number of retinal breaks (P=0.832), the extent of retinal detachment (P=0.246), subretinal demarcation line (P=0.801), and macular detachment (P=0.811). The follow-up period was 12mo. The surgical durations in Group W (with or without encircling buckling) were significant shorter than those in Group I (P<0.001 respectively). The primary success rate was 94.27% in Group W, which was similar to that in Group I (92.38%, P = 0.931). The BCVA in Group W was better than that in Group I (P<0.001) at 1-month follow-up visit. However, there were no significant differences between the two groups at 3-month (P=0.221), 6-month (P=0.674), and 12-month (P=0.363) follow-up visits respectively. Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month (P=0.045) follow-up visit, but there were no significant differences between the two groups at 3-month (P=0.111), 6-month (P=1.000) and 12-month follow-up visits respectively. Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment.

Clinical Variables Associated with Failure of Retinal Detachment Repair: The European Vitreo-Retinal Society Retinal Detachment Study Report Number 4

To identify risk factors associated with failure of anatomic reattachment in primary rhegmatogenous retinal detachment repair. Nonrandomized, multicenter, collaborative study. Primary procedures for 7678 rhegmatogenous retinal detachments reported by 176 surgeons from 48 countries. We recorded specific preoperative clinical findings, repair method, and outcome after intervention. We performed univariate, bivariate, and multivariate analyses to identify variables associated with surgical failure. Final failure of retinal detachment repair (level 1), remaining silicone oil at study conclusion (level 2), and need for additional procedures to repair the detachment (level 3). We analyzed 7678 cases of rhegmatogenous retinal detachment repair. Presence of choroidal detachment or significant hypotony was associated with significantly higher level 1 failure rates when grade 0 or B proliferative vitreoretinopathy (PVR) was present and higher level 2 failure rates, regardless of PVR status (P<0.05). Excluding cases with choroidal detachment or hypotony, increasing PVR was associated with increasing level 1 failure rates. The difference between grade B and C-1 PVR was significant (P = 2 × 10(-6)). No difference was observed in level 1 failure rates when operated eyes were phakic versus pseudophakic. Level 1 failure was significantly higher when all 4 quadrants of retina (4.4%) were detached than when only 1 quadrant (0.8%) had subretinal fluid. With grade B or C-1 PVR, cases with large or giant tears had significantly higher level 1 failure rates. No association was observed between number of retinal breaks and failure rates. Multivariate analysis showed grade C-1 PVR, 4 detached quadrants, and presence of choroidal detachment or significant hypotony were independently linked with a greater level 1 failure rate; the presence of a smaller retinal break was associated with a lesser level 1 failure rate. Choroidal detachment, significant hypotony, grade C-1 PVR, 4 detached quadrants, and large or giant retinal breaks were independent explanatory variables of retinal detachment repair failure. In contrast to earlier studies, the significance of phakic versus pseudophakic status was not confirmed.

Characteristics of Rhegmatogenous Retinal Detachment After Refractive Surgery: Comparison With Myopic Eyes With Retinal Detachment

To evaluate the characteristics of rhegmatogenous retinal detachment (RD) in patients with previous laser in situ keratomileusis (LASIK) and compare them to RD in patients with previous laser assisted subepithelial keratomileusis (LASEK) and myopic patients with no previous refractive surgery. Retrospective, comparative case series. In 106 eyes of 106 patients with RD, patients with previous refractive surgery included 21 eyes after LASIK and 13 eyes after LASEK; 72 myopic patients with refractive errors of -3.0 diopters or less were grouped as the R (-) group. Characteristics of RD included distribution of RD and associated retinal breaks, location and number of retinal breaks, presence of lattice degeneration, and axial lengths. The mean interval between refractive surgery and the onset of rhegmatogenous RD was 63.7 ± 43.5 months, occurring across a broad spectrum of time intervals. There were no significant differences among the LASIK group, the LASEK group, and the R (-) group in axial length (26.8 mm vs 26.4 mm vs 26.9 mm, respectively); in mean number of retinal holes/tears, (2.1/1.5, 0.9/1.4, 1.5/1.6, respectively); or in the presence of lattice degeneration (52.4% vs 46.2% vs 43.1%, respectively). Distribution of RD and associated retinal breaks were also not significantly different; retinal holes and tears were more prevalent in the temporal quadrants, and inferotemporal quadrants were the most commonly detached areas in both the LASEK and LASIK groups and in the R (-) group. Myopia is a well-known risk factor for rhegmatogenous RD and may contribute more to the development of RD in myopic patients after refractive surgery, rather than refractive surgery itself.

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.

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR study): Risk assessment of anatomical outcome. SPR study report no. 7

The 'Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study' (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes. Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods. In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p < 0.0001), break extension > 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229). Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD.

Traitement du décollement de rétine rhegmatogène par rétinopexie pneumatique : étude à propos de 50 cas

: To evaluate the effectiveness and safety of pneumatic retinopexy as an alternative technique for rhegmatogenous retinal detachment repair. We conducted a review of 50 patients (50 eyes) who had undergone pneumatic retinopexy as the initial procedure for rhegmatogenous retinal detachment between January 2001 and March 2006. The mean follow-up period was 22 months (range, 6-57 months). Pneumatic retinopexy resulted in reattachment in 35 eyes (70%) with one procedure. The final reattachment rate, after revision, was 94% (47/50 eyes). In seven eyes (14%), the cause of failure was the presence of missed or new retinal breaks. There was no correlation between the initial reattachment rate and the size of detachment, the status of the macula at presentation, the number of retinal breaks, and the type of retinopexy (cryotherapy or laser photocoagulation). A two-line or more improvement in Snellen acuity was achieved in 24 of 35 eyes (68.6%). A postoperative visual acuity equal to or better than 4/10 was significantly correlated with time from first symptom to presentation less than 1 month (p=0.05), preoperative visual acuity equal to or better than 4/10 (p=0.02), and attached macula at presentation (p=0.03). Pneumatic retinopexy appears to be an effective procedure for the initial management of primary rhegmatogenous retinal detachments with superior retinal breaks and without proliferative vitreoretinopathy.

Macula-Off Retinal Detachment – a Matter of Time?

The aim of this study was to determine the influence of the lag time between macular detachment and surgical intervention on post-operative visual acuity gain in patients with rhegmatogenous macula-off retinal detachment. We retrospectively evaluated the medical records of 62 consecutive patients having undergone scleral buckling surgery for rhegmatogenous macula-off retinal detachment. The correlation of gender, age, refraction, number of retinal breaks, development of cataract during follow-up, pre-operative visual acuity and timing of surgical intervention with final visual acuity and post-operative visual acuity gain were determined. Mean follow-up time was 12.7 months. A correlation with final visual acuity was found for pre-operative visual acuity and lag between the beginning of symptoms and surgical intervention. A correlation with visual acuity gain was found only for timing of surgical procedure. When divided into subgroups operated after 0, 1-3, 4-6, or 7-9 days, respectively, visual recovery was better the earlier the patients underwent surgical repair. Compared to surgery at day 0, statistical significance was found only for patients operated 4 or more days after the occurrence of symptoms. The first three days seem to represent a relatively safe period during which surgery for macula-off retinal detachment may be postponed without compromising the patient's visual prognosis.

PRIMARY VITRECTOMY FOR COMBINED RHEGMATOGENOUS RETINAL DETACHMENT AND CHOROIDAL DETACHMENT WITH OR WITHOUT ORAL CORTICOSTEROIDS: A PILOT STUDY

The occurrence of choroidal detachment (CD) in eyes with primary rhegmatogenous retinal detachment (RRD) is relatively uncommon (2%-4.5%). Recent reports suggest that primary vitrectomy yields better anatomic success than scleral buckling. However, for these inflamed eyes with low intraocular pressure, the influence of preoperative oral steroids on reattachment rates has not been elucidated yet. Twenty eyes with combined RRD and CD that underwent primary vitrectomy were randomized to receive oral steroids (for 1 week) or no oral steroids before surgery. Preoperative clinical data such as mean age, lens status, Snellen visual acuity, duration of macular detachment, CD (size and extent), and retinal detachment characteristics (e.g., extent, number of retinal breaks, atrophic or tractional retinal break, size of retinal break, and location of retinal break) were similarly distributed in both groups. Single-operation anatomic success was 81.8% (9/11) among those patients who received preoperative oral steroids and was 66.7% (6/9) among those who did not receive preoperative oral steroids. After reoperation, anatomic success was 100% in both groups. The mean follow-up was 20.1 months. The results suggest that administration of oral steroids before primary vitrectomy in eyes with combined RRD and CD improves reattachment rates.

Retinal Detachment Following Laser in situ Keratomileusis.

■ OBJECTIVE: To report the clinical characteristics, surgical management and outcome of retinal detachment following laser in situ keratomileusis (LASIK) in myopic patients. ■ PATIENTS AND METHODS: Retrospective review of 10 eyes of 10 myopic patients with retinal detachment who had previously undergone LASIK surgery were analyzed. Included in the study were 7 males and 3 females, aged 22 to 68 years (35.2±2.8). ■ RESULTS: Mean spherical equivalent refraction was -10.51±3.90 D (ranging from -6.37 D to -17.00 D) before surgery. The time interval between the LASIK procedure and the development of retinal detachment varied from two months to nine months (5.2±2.78 months). The number of retinal breaks was one in 7 patients, two in 2 patients and three in 1 patient. The type of retinal breaks included 7 patients with horse shoe tears, 1 patient with a retinal hole, 1 patient with a giant retinal tear, and 1 patient with retinal dialysis. Retinal breaks were located anterior to the equator in 9 patients and posterior to the equator in 1 patient. Retinal reattachment was achieved with one operation in 8 eyes (80%) and the remaining 2 eyes required a second surgery for the reattachment of the retina. ■ CONCLUSION: This study suggests the possible association between retinal detachment and LASIK procedure in patients with myopia. Clinicians should be aware of retinal pathology predisposing to retinal detachment in patients undergoing LASIK.