Outcome Of Retinal Detachment Surgery Research Articles

Diabetic retinal detachment surgery at a central academic hospital, Johannesburg, South Africa

Background: Tractional retinal detachment surgery outcomes are unpredictable and need to be reviewed regularly in clinical practice settings.Aim: To describe the visual acuity and anatomical outcomes of retinal detachment surgery for diabetic tractional retinal detachment at a central academic hospital.Setting: Johannesburg, South Africa.Methods: This study involves a retrospective case series of patients who had surgery for diabetic tractional retinal detachment at Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2010 and 31 December 2014.Results: A total of 65 patients with diabetic retinal detachment were included in this study. The study consisted of 63% (n = 41) male patients and 37% (n = 24) female patients. The mean age (± standard deviation) was 54 ± 12.2 years. Forty-four patients (68%) had tractional retinal detachment, and 21 (32%) patients had a combined tractional and rhegmatogenous retinal detachment. Twenty-one (32%) patients had detachments associated with vitreous haemorrhage (VH), and 39 (60%) patients had macular-involving detachments. Forty-six (71%) patients obtained vision improvement or stabilisation and reattachment of the retina, 24 (36.9%) patients had visual acuity improvement, 22 (33.9%) patients retained the same visual acuity and 19 (29.2%) patients lost vision. Fifty-five (85%) patients had successful anatomical reattachment of the retina, and 10 (15%) patients had re-detachments after surgery.Conclusion: The majority of patients whose files were reviewed benefited from surgical intervention for diabetic tractional retinal detachment in terms of stabilisation or improvement of vision.Contribution: Tractional detachment surgery outcomes in our setting are comparable to those from elsewhere around the world.

Anatomical and Functional Outcome of Retinal Detachment Surgery

Objective: To study the anatomical status and functional outcome of Pars Plana Vitrectomy surgery in rhegmatogenous retinal detachment (RRD) at a tertiary eye care center in India.
 Material, Patients and Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with Pars Plana Vitrectomy surgery performed in the Regional Institute of Ophthalmology, Prayagraj, India. 40 patients of 40 eyes (26 phakic 65%, 14 pseudophakic 35%) with retinal detachment were treated by primary pars plana vitrectomy with 6 months of follow-up.
 Result: A total of 40 patients (40 eyes) were operated, 18 males and 2 females, with age, ranges from 17 years to 90 years. After surgery, anatomically retinal reattachment was achieved in 40 (100%). Improved best-corrected visual acuity (BCVA) was seen in 38 (90%) patients, whereas in 2 (5%) patient BCVA was not improving and deteriorated from pre-operative in another 2 (5%) patient. There was no significant difference was found in the pseudophakic and phakic eye in functional outcome.
 Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with Pars Plana Vitrectomy surgery can give good anatomical and visual outcome.

Effect of surgeon-related factors on outcome of retinal detachment surgery: analyses of data in Japan-retinal detachment registry

The purpose of this study was to investigate the effects of surgeon-related factors on the surgical outcome of pars plana vitrectomy (PPV) and scleral buckling (SB) surgery on eyes with a rhegmatogenous retinal detachment (RRD). This was a nationwide, multicenter, observational study of the data in the Japan-RD Registry. Registered cases that had undergone surgery for a RRD by 128 accredited surgeons in 26 institutions were studied. The surgeon-related factors that significantly affected surgical success and visual outcomes of simple RRD treated by PPV or SB at 6 months postoperatively were analyzed and compared. Among 3446 registered cases, 2533 cases met the inclusion criteria with 1896 in the PPV group and 637 cases in the SB group. The median total number of lifetime cases was 150 and the rate of surgeries/year was 22. Multivariate regression analyses showed that the number and rate of surgeries/year were not significantly associated with the surgical outcome in the PPV group. However, surgeons with a higher average annual number of surgeries had significantly better surgical outcomes in the SB group (P = 0.038). Analyses of a nationwide registry showed that SB but not PPV surgeries require sufficient experience and case numbers to acquire and maintain skills to treat RRDs successfully.

Vitreous cytokine expression profiles in patients with retinal detachment

To compare the expression profiles of various cytokines and chemokines in vitreous samples from patients with retinal detachment (RD) to those from controls and to analyze their association with various clinical features. In this prospective study, undiluted vitreous fluid was obtained from 41 patients with primary RD and 33 controls with macular hole or vitreomacular traction. A multiplex bead immunoassay was performed to determine the expression of 27 inflammatory mediators. Eleven mediators were significantly upregulated in the vitreous of RD patients compared with controls, including the following: cytokines IL-1ra, IL-6, IL-7, IL-8, IFN-γ; chemokines CCL2, CCL3, CCL4, CXCL10 and CCL11 and growth factor G-CSF. Correlation analyses showed that levels of IL-1ra, CXCL10, CCL11 and G-CSF were positively correlated to the extent of detachment, while those of IL-1ra and CXCL10 were associated with the duration of detachment. There was also a positive association between the concentrations of CXCL10 and CCL11 and preoperative flare values. Additional analysis revealed that flare values and both CXCL10 and CCL11 levels were significantly higher in eyes with grade B or C proliferative vitreoretinopathy (PVR). Our results confirm that RD induces a marked inflammatory response with a complex cytokine network. We identified proteins specifically linked to several clinical features that might contribute to photoreceptor degeneration and PVR-related redetachment. These proteins may represent potential therapeutic targets for improving the anatomical and functional outcomes of RD surgery.

Outcomes of vitreoretinal surgery in retinal detachment associated with morning glory disc anomaly.

Purpose:Morning glory disc anomaly (MGDA) is associated with a high prevalence of retinal detachment (RD), sometimes requiring multiple surgeries. The study aimed to establish the outcomes of RD surgery in such eyes and predict factors influencing the outcome, if any.Methods:It was a retrospective observational study of 9 eyes that underwent pars plana vitrectomy (PPV) for RD associated with MGDA. Clinical and surgical details were correlated with outcomes of surgery as noted at the final follow-up.Results:PPV was performed in 9 eyes. Lensectomy was done in 5 of 9 eyes (55.5%) during PPV. Laser photocoagulation around the disc was performed in 55.5% (5/9) of the eyes. Silicone oil tamponade was used in 77.7% (7/9) of eyes and gas tamponade (14% C3F8) was used in 22.3% (2/9) of eyes. Attached retina at final visit was observed in 66% of the eyes (6/9). Two out of 3 eyes that were seen to have preoperative glial tissue at the disc had poor outcome (odds ratio 10, P = 0.16). Five out of 7 (71%) eyes that had silicone oil tamponade, had an attached retina. No identifiable breaks were noted preoperatively in 5 eyes, of which 4 (80%) had an attached retina postoperatively. Vision improved by 1 line in 67% of the eyes that underwent surgery.Conclusion:MGDA related RD presents a unique set of challenges; meticulous PPV with or without lensectomy can help in achieving a successful anatomical and functional outcome in about two-thirds of patients.

Anatomical outcome of retinal detachment surgery comparing different surgical approach

To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013. All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6months was considered as primary success with one surgery except silicone oil removal. In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV+SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p=0.018) but gender was not (p=0.84). Preoperative lens status did not affect the risk of re-detachment (p=0.36), and there were no differences in outcome between surgeons (p=0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach. There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.

Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

Purpose: Chronically distorted vision is an important adverse outcome in patients with otherwise successfully treated macula-involved retinal detachment (RD). Symptomatic distortion is associated with macular vessel shift on fundus autofluorescence (FAF) imaging. Immediate prone posture has to date been the only mechanism adopted to reduce postoperative FAF shift. The aim of this study was to establish the rates of primary anatomical success and (FAF) macular shift in 67 eyes with macula-involved RD and superior breaks treated with vitrectomy, retinopexy, 0.7–1 mL 100% gas tamponade, and no prone posture. Methods: Single-center, retrospective series. Results: Rates of primary anatomical success and fundus autofluorescent imaging macular shift were 89 and 26%, respectively. Conclusion: Vitrectomy with a 0.7–1 mL expanding gas bubble tamponade and no prone posture were associated with an acceptable rate of primary anatomical success. We found the lowest yet reported rate of FAF shift in patients with macula-involved RD. If confirmed, this simple technique modification could improve the visual outcome of RD surgery whilst facilitating postoperative ambulatory care.

Clinical Outcomes of Retinal Detachment Surgery following Cytomegalovirus Retinitis in Patients on Highly Active Anti-retroviral Therapy for Acquired Immune Deficiency Syndrome

Aim: The objective of this study is to describe the surgical outcomes of patients of HIV on HAART who underwent surgery for CMV retinitis related retinal detachment.Method and materials: A retrospective analysis of the medical records of 40 eyes of 35 consecutive HIV positive patients who underwent surgical repair for CMV retinitis associated rhegmatogenous retinal detachment between January 2000 to August 2010 was done. All patients had an adequate follow up of atleast 6 months.Results: Favourable anatomical outcome was achieved in 78 % of eyes with the eyes having a attached retina, clear media and controlled intraocular pressure.Favourable functional outcome (vision >3/60) was achieved in 56%.Conclusion: Though anatomical outcomes have not changed from the pre HAART era but there has been an increase in favorable functional outcomes possibly due to effects of antiretroviral therapy.

Anatomical and Functional Results of Primary Pars Plana Vitrectomy in Rhegmatogenous Retinal Detachment

It was the aim of this retrospective study to analyse the anatomical success rate and functional outcome of patients with rhegmatogenous retinal detachments treated primarily by pars plana vitrectomy (PPV). 157 of 200 eyes (79%, 89 phakic (57%), 67 pseudophakic (43%), 1 aphakic) with rhegmatogenous retinal detachment were treated by primary pars plana vitrectomy. 132 cases (84%) completed 6 months, 131 (83%) 12 months, and 108 cases (69%) 24 months of follow-up. Selection of surgical methods was guided by recommendations from the SPR study. Different from these recommendations, phakic eyes were treated by primary PPV if the chance of successful scleral buckling was estimated to be < 90%. Initial retinal attachment was achieved in all eyes. In 4 eyes peripheral tractional detachment presented during silicon removal. A second surgical intervention for the treatment of re-detachment became necessary in 8 eyes during follow-up. The rate of permanent single-intervention (except silicon removal) attachment was 92.4%. Finally the retina was completely attached in all eyes. Visual acuity improved from a preoperative level of logMAR 1.01 to 0.48 at month 6, 0.40 at month 12 and 0.33 at month 24. Mean final visual acuity at month 24 was 0.32 in phakic eyes and 0.35 in pseudophakic eye (difference not significant). Significant differences in visual acuity were found in relation to the preoperative status of the fovea. The results of this case series, together with the previous published outcome of a cohort treated in the identical study period by scleral buckling, indicate that the outcome of retinal detachment surgery in an average cohort of patients can be expected to be much better than suggested by results of the SPR study.

Small‐gauge vitrectomy in traumatic retinal detachment

To report the outcome of retinal detachment surgery following trauma treated with small-gauge vitrectomy. Retrospective chart review. Adult patients presenting with a retinal detachment following severe trauma between 2007 and 2009 that underwent vitreoretinal surgery with either 25- or 23-gauge vitrectomy. Data collected included; age, sex, eye, time interval between injury and diagnosis of retinal detachment, anatomical and functional success, complications, and length of follow up. Anatomical and functional outcome. Nineteen consecutive adult patients with traumatic retinal detachment were included. The mean age was 51.4 ± 19.3 years; 68.5% were male. Thirteen patients (68.4%) presented with visual acuity of hand movement or worse including six patients with light perception only. Five eyes achieved 6/60 vision or better, and three eyes had visual acuity of 6/12 or better. During the period of follow up six eyes experienced a recurrent retinal detachment. Traumatic retinal detachment can be successful managed with small-gauge vitrectomy.

Retinal Detachment Surgery at Nepal Eye Hospital

Retinal diseases are one of the important causes of blindness in Nepal. This study is done with objectives of finding the outcome of retinal detachment surgery. A retrospective analysis of 110 patients who underwent retinal detachment surgery over five year period was conducted in Nepal. Retinal re-attachment was achieved in 94.4% and postoperative visual acuity of 6/36 to 6/6 was achieved in 52.7% (As possible risk factors, myopia was present in 34.5% ophkia in 29%, trauma in 9%, and lattice) degeneration was 5.4%. The study has shown a promising result for the retinal detachment surgery.

Neue Entwicklungen in der chirurgischen Therapie der rhegmatogenen Ablatio retinae

The initial surgery is one of the most important factors influencing the anatomic and functional outcome of retinal detachment surgery. With the continual modifications in vitrectomy techniques, the strategy in primary vitrectomy surgery is also changing. Recent developments are the use of 25- and 23-gauge trocar systems and new surgical techniques without the use of perfluorcarbons or gas or silicone oil tamponade. In addition, heavy silicone oils are now entering routine clinical use, especially for proliferative vitreoretinopathy (PVR) redetachments of the lower fundus periphery. Regarding adjunct pharmacologic therapy, daunorubicin and 5-fluorouracil/low molecular weight heparin have been found to improve the results of patients with PVR or at risk for PVR.

Paediatric vs adult retinal detachment

To evaluate the causes, incidences, characteristics, and treatment outcomes of paediatric vs adult retinal detachment. One hundred and sixty (136 patients) out of 2408 consecutive retinal detachments (6.6%) at our facility occurred in children under the age of 18 years. Of them, 144 eyes (90%) of 127 (93%) children were treated and compared with a sample of 56 consecutive retinal detachments in 50 adults (over the age of 18 years). The parameters for comparison included cause, type of retinal detachment, its extent, macular involvement, number of tears, number and types of surgery, and the anatomic and functional surgical outcome. Statistically significant differences were found in the type of retinal detachment. Rhegmatogenous RD was less common (P=0.004), and exudative RD was more common (P=0.021) in the paediatric group. Ocular trauma and ocular syndromes were more common in the paediatric group (P<0.001), while myopia, posterior vitreous detachment, and retinal detachment following cataract surgery were less common in this group compared with adults (P<0.001, <0.001, and 0.001, respectively). Ocular pathologies associated with retinal detachment were more common in the paediatric group (P<0.001). Initial and last visual acuity of >20/400, last visual acuity of >20/40, and retinal complete reattachment were higher in adults (P<0.001). The type of retinal detachment, causes and outcomes were statistically different between paediatric and adult cases. The less successful functional and anatomical outcomes of retinal detachment surgery in children may reflect the different aetiologies and indicate the need for aetiology-specific treatment strategies according to each aetiology.

Actual and theoretical risks for visual loss following use of the implantable contact lens for moderate to high myopia

Purpose To estimate the actual and theoretical risks for visual loss associated with use of the implantable contact lens (ICL). Setting Multicenter clinical trial data. Methods An established model for estimating the risk for visual loss associated with retinal detachment (RD) following clear lens extraction (CLE) was modified to be applicable to the ICL. The risk for developing RD and the outcomes of RD surgery based on current lens extraction and RD repair techniques were updated. Non-RD-related risks for pseudophakia based on United States Food and Drug Administration (FDA) guidelines, actual visual loss data from the FDA ICL study, and calculated risks assuming a large future risk (10 times the current risk) of cataract development were also added. Results The additional risk for visual loss due to cataract surgery is estimated at 0.19% and for subsequent RD assuming 10 times the current rate of cataract is 0.37%. Using an ultraconservative (high) model and adding the actual loss observed with the ICL, the total risk is 1.39%. The risk increases by 0.5% to 0.6% with each 10% increase in cataract incidence (eg, 10% to 20%, 20% to 30%). The risk for visual loss with CLE and/or laser in situ keratomileusis/photorefractive keratectomy in the same range of myopia is possibly 3.0% to 6.5%. Conclusions The ICL represents a viable alternative to currently available refractive procedures based on an analysis of the risk for visual loss.

Functional and anatomic outcome of retinal detachment surgery in pseudophakic eyes

PurposeTo determine the long-term anatomic and functional visual outcome of retinal detachment (RD) surgery in pseudophakic eyes after uncomplicated cataract surgery. DesignAn interventional, retrospective noncomparative case series ParticipantsOne hundred thirty-eight consecutive patients who had undergone uncomplicated extracapsular cataract extraction and intraocular lens implantation followed by rhegmatogenous RD between 1990 and 1995. MethodsOne hundred one eligible patients were examined (inclusion ratio, 73%) a median of 4.3 years after last RD surgery. The best-corrected visual acuity (BCVA), visual fields, retinal status, and patient-rated visual outcome were recorded, the latter by a questionnaire that included self-reported satisfaction, trouble with vision, a modified Cataract Symptom Score, and the VF-14 Visual Functioning Index. Main outcome measuresBCVA, retinal attachment, diameter of visual field, modified Cataract Symptom Score, VF-14 score. ResultsBaseline characteristics of enrolled and nonenrolled patients were comparable, except that nonenrolled patients were older. When RD developed, 55 eyes had an intact posterior capsule, and 46 had a laser posterior capsulotomy (LCT). The BCVAs before (median, logarithm of the minimum angle of resolution [−logMAR] 1.2 versus 1.1, Snellen equivalent 0.063 versus 0.08) and after retinal surgery (median, −logMAR 0.46 versus 0.4, Snellen equivalent 0.35 versus 0.4) were comparable for eyes with and without LCT (P = 0.86). The retina was reattached with one procedure in 75 eyes (74%), with two procedures in 98 eyes (97%), and with three to five procedures in all eyes. The retina remained attached long term in 92 eyes (91%). Redetachment rate (9% versus 9%, P = 1.0) and visual field diameters were comparable for eyes with and without LCT. Overall, 80% of patients were satisfied or very satisfied with their binocular vision, and 62% had no or only a little trouble with binocular vision. Visual performance was similar regardless of presence or absence of LCT (median Cataract Symptom Score, 3.0 versus 3.0, P = 0.76; and median VF-14 score, 87.5 versus 87.5, P = 0.81). ConclusionsNine in 10 pseudophakic retinal detachments remain attached long term, and 8 in 10 patients are satisfied with their binocular vision after surgery. Even though secondary cataract and posterior capsulotomy can cause problems for the retinal surgeon, the anatomic and functional outcomes of pseudophakic RD are not influenced by capsulotomy.

Retinal detachment surgery in Marfan's syndrome.

Retinal detachment is a known complication of Marfan's syndrome. The literature is scarce on the results of surgery in these cases. To determine the functional and anatomic outcome of retinal detachment surgery in Marfan's syndrome. Retrospective review of charts of Marfan's syndrome patients who had retinal detachment surgery at King Khaled Eye Specialist Hospital between 1983 and 1995. Fourteen patients with 16 surgically treated eyes were identified. Retinal detachment was bilateral in 9/13 (69%) patients. The lens was ectopic in all eyes. Retinal breaks were small horseshoe tears or holes located anterior to the equator in 11/16 (69%) eyes. The retina of 12/16 (75%) eyes remained successfully reattached after a follow-up ranging from 4 to 132 months. All 12 eyes had visual acuity of 20/300 or better (range, 20/30-20/300). Eight of these eyes had visual acuity of 20/125 or better. The cause of failure in the remaining four eyes was proliferative vitreoretinopathy. Results of surgical repair of retinal detachment in Marfan's syndrome were better than previously thought. Bilaterality of detachment is extremely high, which justifies considering prophylactic treatment of the fellow eye in these patients.

A multivariate analysis of anatomic success of retinal detachments treated with scleral buckling.

One hundred and twenty-three preoperative, intraoperative, and postoperative variables were evaluated to assess their effect on anatomic success of scleral buckling for retinal detachment. The relative importance of each variable was tested in a logistic regression equation. This equation identified ten significant variables for predicting the outcome of retinal detachment surgery. The significant variables were: preoperative proliferative vitreoretinopathy (adjusted odds ratio, AOR, 13.60), previous buckle by G.F. Hilton (AOR = 8.03), total detachment (AOR = 5.72), preoperative vitreous hemorrhage (AOR = 3.08), tension less than 10 mm Hg (AOR = 2.40), hemorrhagic complications (AOR = 2.62), previous buckles by others (AOR = 2.10), injection into the vitreous at surgery with either saline or balanced salt solution (AOR = 2.32) or air/sulfahexafluoride (AOR = 7.06), and preoperative vision less than 0.3 (20/60 or worse) (AOR = 2.14). The number of cryopexy applications was specifically tested in the equation, but while significant in a univariate analysis, it was not found to be significant in the multivariate analysis.