Persistent Retinal Detachment Research Articles

Intravitreal bevacizumab injection for persistent serous retinal detachment associated with Vogt–Koyanagi–Harada disease

To introduce a case of Vogt-Koyanagi-Harada (VKH) disease in which the serous retinal detachment (SRD), refractory to the systemic steroid therapy, was resolved in a short time after an intravitreal injection of bevacizumab. Interventional case report to show the effect of bevacizumab for the SRD in a VKH patient. A 42-year-old woman, diagnosed with VKH disease, showed decreased visual acuities and multiple SRDs in both eyes. The best-corrected visual acuity (BCVA) was FC 30 cm in both eyes. On optical coherence tomography (OCT), multiple SRDs were confirmed. On OCT, the height of SRD in the central fovea area was 1119 μm in the right eye and 1151 μm in the left eye. After high-dose steroid treatment for 5 weeks, the SRD in the left eye was completely resolved, however, the SRD in the right eye was persisted. At the time, the height of SRD in the right eye was 884 μm and the BCVA was 0.1. For the treatment of persistent SRD causing a decreased visual acuity despite a long-term high-dose course of systemic steroid therapy, an intravitreal injection of 1.25 mg bevacizumab was performed for the right eye, following an informed consent. One week later, there was fast and complete reabsorption of multiple SRDs in the right eye. The retinal thickness in the foveal area was measured to be 189 μm by OCT and the BCVA was improved to 0.7. An intravitreal injection of bevacizumab combined with systemic steroid in VKH is expected to shorten the time for the persistent presence of SRD and to prevent the permanent visual impairment.

Post-Pneumatic Retinopexy Endophthalmitis: Management of Infection and Persistent Retinal Detachment.

Pneumatic retinopexy is an invasive procedure and requires all asepsis precautions to be followed, possibility of infective endophthalmitis to be kept in mind in clinical settings. This case report illustrates this important complication. A patient underwent pneumatic retinopexy to repair superior half retinal detachment caused by a single horseshoe-shaped tear. Two days later, he developed all signs of infective endophthalmitis. He was managed with intravitreal antibiotics and later vitreous surgery and gas tamponade to repair persistent retinal detachment. At one and half year of follow-up, his vision was 6/9, attached retina and no evidence of recurrence of infection.

Optical Coherence Tomography Analysis of the Macula after Macula-off Rhegmatogenous Retinal Detachment Surgery

Background: To define the incidence, duration, and clinical associations of persistent foveal retinal detachment and central foveal thickness after macula-off rhegmatogenous retinal detachment (RRD) surgery, using optical coherence tomography (OCT). Methods: Prospective study. Thirty-nine patients with macula-off RRD after successful RD repair, from January 2006 to Februrary 2007. Using OCT, we prospectively examined cross-sectional retinal images of 39 eyes of 39 consecutive patients who underwent surgery for the treatment of RRD. The patients were divided into two groups and it was non randomized. Primary scleral buckling (SB) was performed on 18 eyes of 18 patients, and 21 eyes of 21 patients were treated with pars plana vitrectomy (PPV) and SF6 tamponade with or without SB. All eyes underwent clinical examination and OCT postoperatively at two weeks, and one, three, and six months. Postoperative OCT findings and best-corrected visual acuity (BCVA) were analyzed statistically. Results: The patients’ ages ranged from 17 to 63 years (mean, 46.5±15 years). The time from the onset of subjective symptoms to retinal surgery ranged from 4 to 56 days (mean, 15±16 days). BCVA in logMAR units ranged from 0.3 to 1.47 before retinal surgery (mean, 0.96±0.15). OCT showed residual foveal detachment in 11 eyes (28.2%) and in adjacent areas one month after surgery. The remaining 28 retinas (71.8%) were attached when examined tomographically. In six of the 11 eyes (54%) with residual foveal detachment due to subretinal fluid (SRF) on OCT, the retinas reattached spontaneously within six months after surgery. Postoperative BCVA improved over three months in both groups. There was a decrease in the absolute difference value between the central foveal thickness of the lesion eye and that of the contralateral eye in each patient. But the correlation coefficient was not statistically significant (P=0.113). Conclusion: Increased macular thickness due to SRF after retinal detachment surgery may persist for several months, and tends to cause delayed visual recovery.

Intravitreal injection of 0.3 ml of SF6 gas for persistent subfoveal fluid after scleral buckling for rhegmatogenous retinal detachment

To determine the efficacy of intravitreal injection of sulphur hexafluoride (SF6) gas for reducing persistent subfoveal fluid after scleral buckling surgery for macula-off rhegmatogenous retinal detachments. We injected 0.3 ml of SF6 gas into the vitreous cavity of two eyes of two patients with persistent macular retinal detachment 3 and 5 months after successful scleral buckling. Optical coherence tomography was performed before and after surgery. Subfoveal fluid was displaced peripheral to the fovea immediately after gas injection and the fluid was absorbed gradually in both eyes. Persistent subfoveal fluid after scleral buckling may be treated with intravitreal SF6 gas injection.

Trabeculectomy with Mitomycin C for Neovascular Glaucoma: Prognostic Factors for Surgical Failure

To evaluate the prognostic factors for surgical outcomes of trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG). Retrospective cohort study. We reviewed the medical records of 101 patients (101 eyes) with NVG treated at Kumamoto University Hospital. The primary endpoint was persistent intraocular pressure > or = 22 mm Hg, deterioration of visual acuity to no light perception, and additional glaucoma procedures. Multivariate analysis was performed using the Cox proportional hazards model. The mean follow-up period was 29.3 months (range, 0.5 to 142.3 months). The probability of success 1, 2, and 5 years after trabeculectomy was 62.6%, 58.2%, and 51.7%, respectively. The multivariate model showed that younger age (relative risk [RR], 0.96/year; P = .0007) and previous vitrectomy (RR, 1.62; P = .02) were prognostic factors for surgical failure among all NVG patients. Additionally, an eye with unremoved proliferative membrane and/or unrepaired retinal detachment (RD) after vitrectomy (RR, 1.59; P = .05) was a probable prognostic factor in a subgroup of 66 eyes with previous vitrectomy, and having a fellow eye with NVG (RR, 1.73; P = .003) was a significant prognostic factor in 82 eyes with NVG attributable to diabetic retinopathy. The prognostic factors for surgical failure of trabeculectomy with MMC for NVG were younger age and previous vitrectomy in all NVG patients, and having a fellow eye with NVG in patients with disease caused by diabetic retinopathy. Persistent proliferative membrane and/or RD after vitrectomy might contribute to poorer outcomes of trabeculectomy.

Resolution of Persistent Exudative Retinal Detachment in a Case of Sturge-Weber Syndrome with Anti-VEGF Administration

Purpose: Report the resolution of a persistent exudative retinal detachment in a patient with Sturge-Weber syndrome following intravitreal pegaptanib injection. Design: Case report. Methods: A 13-year-old male with Sturge-Weber syndrome presented with a choroidal hemangioma associated with an exudative retinal detachment that failed to resolve 6 months after external beam radiation therapy. Results: A single intravitreal pegaptanib injection resulted in 50% resolution of the detachment within 1 week and complete resolution within a month. Despite anatomic success, vision remained poor. Conclusions: VEGF likely plays a role in the pathogenesis of Sturge-Weber choroidal hemangioma-associated exudative retinal detachment and offers potential treatment.

Poster 17: Congenital Optic Nerve Pit Masquerading as Glaucoma

To evaluate the efficacy of vitrectomy and gas tamponade, without laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with an optic disc pit.Noncomparative interventional case series.Eleven consecutive patients (8–47 years of age) who presented with unilateral macular detachment associated with an optic disc pit.Pars plana vitrectomy, induction of posterior vitreous detachment (PVD), and gas tamponade were performed, with postoperative facedown positioning for 1 week. The presence of a double-layer detachment consisting of an inner layer separation and an outer layer detachment was observed in 10 of 11 eyes either preoperatively or postoperatively. Patients were observed for 10 to 98 months (mean, 47) after surgery.Anatomic outcome and visual acuity were retrospectively analyzed for all eyes. Optical coherence tomography was used to observe anatomic changes in the macula in some eyes.Complete retinal reattachment was achieved in 10 of 11 eyes, although these eyes required nearly 1 year to reach this state. The one eye with persistent retinal detachment was observed to have a marked reduction of the detachment by 10 months postoperatively. No recurrences were observed. Visual acuity improvement was documented in 7 of 11 eyes.These results suggest that vitrectomy with induction of PVD and gas tamponade, without additional laser treatment, is successful in reattaching the macula and improving central vision in most patients with optic disc pit maculopathy.

Intraocular bevacizumab for iris neovascularization in a silicone oil-filled eye.

To report the effectiveness of intravitreal injection of bevacizumab for treatment of iris neovascularization in a silicone oil-filled eye. Case report. A 56-year-old man with recurrent retinal detachment associated with iris neovascularization. Iris neovascularization regressed after treatment with a 1.25-mg intravitreal injection of bevacizumab in the presence of silicone oil. Intraocular injection of bevacizumab is an effective short-term treatment of neovascularization caused by persistent retinal detachment even in the presence of silicone oil. The standard dose of 1.25 mg of bevacizumab may not require adjustment in an aphakic vitrectomized eye.

Indocyanine green angiography in eyes with substantially increased subretinal fluid 1 week after photodynamic therapy.

To investigate the characteristics of eyes in which a serous retinal detachment became substantially more extensive and persisted 1 week after photodynamic therapy (PDT) using indocyanine green (ICG) angiography. Retrospective, interventional case series. The authors reviewed the ICG angiograms of five eyes of five patients with neovascular age-related macular degeneration. In all eyes, the ICG angiograms obtained 1 week after PDT showed a well-demarcated hypofluorescent area corresponding to the treatment spot. Vascular hyperpermeability emanating from the middle and large choroidal vessels was seen within the hypofluorescent area whether the targeted choroidal neovascularization was perfused or not. Choroidal vascular hyperpermeability on ICG angiography is a common finding in eyes with substantially increased subretinal fluid 1 week after PDT. PDT might even affect the middle and large choroidal vessels within the treatment spots under some conditions, leading to a supply of subretinal fluid and causing a persistent serous retinal detachment.

Le décollement de rétine inférieur sous silicone

Silicone oil is a valuable surgical tool to treat severe retinal detachment (RD). However, following surgery, remaining RD or the appearance of inferior RD with silicone tamponade is a delicate situation. Anamnesis and careful examination should provide a suitable treatment. Silicon oil removal will be considered after treatment of this residual RD. The endocular approach may be required: dissection of vitreoretinal proliferation, phakoexeresis, or retinectomy, whereas complementary indentation, subretinal fluid puncture, and scleral shortening are external therapeutic methods. One of the frequent causes of these persistent RDs is the presence or the progression of a more or less large and extended anterior vitreoretinal proliferation, which will sometimes require extended silicon oil tamponade. Indeed, after a certain time has elapsed, the existence of a genuine retinal adhesion disease makes a durable reapplication without internal tamponade impossible.

Transscleral local resection versus iodine brachytherapy for uveal melanomas that are large because of tumour height

To compare visual outcome and ocular complications of transscleral local resection (TSR) with those of iodine-125 plaque brachytherapy (IBT) for uveal melanomas categorised as large because of tumour height. Retrospective study of 87 patients with a uveal melanoma <or=16 mm by largest basal diameter (median, 12.6 vs 14.0 mm for TSR and IBT, respectively) and large by height (median, 11.0 vs 10.6 mm) by the Collaborative Ocular Melanoma Study (COMS) criteria. Thirty-three patients underwent TSR in the United Kingdom and 54 underwent IBT in Finland. Loss of 20/65 and 20/400 vision, local tumour recurrence, cataract, iris neovascularization, glaucoma, maculopathy, optic neuropathy, persistent retinal detachment, and vitreous haemorrhage were analysed using competing risks and logistic regression to control for confounders. All patients save one managed with TSR lost 20/70 vision within 3 years. The 2-year cumulative incidence of losing 20/400 vision was 60% (95% CI, 35-75) for TSR and 75% (95% CI, 59-86) for IBT. The 5-year incidence of local tumour recurrence was 41% (95% CI, 17-63) after TSR and 7% (95% CI, 2-17) after IBT. Glaucoma and optic neuropathy were rare after TSR. Cataract, maculopathy, retinal detachment, and vitreous haemorrhage were common after either treatment. The number of patients needed to treat with TSR instead of IBT was four for one additional patient to benefit by avoiding loss of visual acuity 20/400 for at least 2 years, and the corresponding number was three for one additional patient to experience a local recurrence from TSR. If TSR is further evaluated as an alternative to IBT in avoiding blindness of an eye with a ciliochoroidal melanoma categorised as large by COMS criteria because of its height, special emphasis must be given to increased risk of local tumour recurrence.

25-GAUGE PARS PLICATA VITRECTOMY FOR STAGE 4 AND 5 RETINOPATHY OF PREMATURITY

To describe the authors' technique and initial experience using the 25-gauge vitrectomy system for stage 4 and 5 tractional retinal detachment in retinopathy of prematurity (ROP). Consecutive patients with stage 4 or 5 ROP treated with 25-gauge vitrectomy surgery between July 2003 and May 2004 were studied retrospectively. Eyes with prior vitrectomy surgery were excluded. A modified three-port 25-gauge approach was used in which conjunctival dissection and suturing of sclerotomies was necessary. The primary outcome was anatomic success defined as retinal reattachment. Secondary outcomes were intra- and postoperative complications. Fifteen eyes in 12 infants were identified that had 25-gauge vitrectomy for stage 4 or 5 ROP: 11/15 (73%) had stage 4A; 2/15 (13%), stage 4B; and 2/15 (13%), stage 5. All 15/15 (100%) were referred with incomplete anterior laser ablation of threshold ROP. Six of 15 (40%) required lensectomy at the time of initial pars plicata vitrectomy. Seven of 15 (47%) required more than one retinal surgery for persistent retinal detachment and/or vitreous hemorrhage. Eleven of 15 (73%) eyes had documented retinal reattachment after one or more surgeries at the last follow-up. Complications included vitreous hemorrhage (2) and postoperative cataract (1). Twenty-five gauge vitrectomy is a safe and effective treatment approach for tractional retinal detachments in stage 4 and 5 ROP. Complications may be comparable to vitrectomies performed with two-port 20-gauge vitrectomy. Modifications of the 25-gauge vitrectomy system included conjunctival dissection and suturing of conjunctiva and sclerotomies at the conclusion of the case.

The combined use of perfluorohexyloctane (F6H8) and silicone oil as an intraocular tamponade in the treatment of severe retinal detachment

The purpose of this study was to investigate the combined use of perfluorohexyloctane (F6H8) and 1,000-centistoke silicone oil as a long-term intraocular tamponade in the treatment of complicated retinal detachment. Sixty consecutive eyes affected by complicated retinal detachment with (1) retinal breaks of the lower two quadrants and severe proliferative vitreoretinopathy, (2) inferior giant retinal tear, (3) penetrating trauma or (4) choroidal detachment underwent pars plana vitrectomy using a combined internal tamponade of F6H8 and silicone oil. The double filling (DF) was removed after 40-50 days. The anatomical outcome and the complications due to the DF are reported. Retinal reattachment was achieved in all but one patient. Thirty-eight (63%) eyes needed further surgery with silicone oil tamponade. Silicone oil was successfully removed in 22 eyes. Sixteen (27%) eyes had retained silicone oil at the last follow-up examination. One eye showed persistent retinal detachment despite further surgery. Main complications of the DF were recurrent retinal detachment of the upper retina in six (10%) eyes and membrane formation in 25 (42%) eyes. A combined internal tamponade of F6H8 and silicone oil may be a useful tool in the treatment of complicated retinal detachment involving the lower quadrants of the retina.

Long-term Results of Vitrectomy without Laser Treatment for Macular Detachment Associated with an Optic Disc Pit

To evaluate the efficacy of vitrectomy and gas tamponade, without laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with an optic disc pit. Noncomparative interventional case series. Eleven consecutive patients (8-47 years of age) who presented with unilateral macular detachment associated with an optic disc pit. Pars plana vitrectomy, induction of posterior vitreous detachment (PVD), and gas tamponade were performed, with postoperative facedown positioning for 1 week. The presence of a double-layer detachment consisting of an inner layer separation and an outer layer detachment was observed in 10 of 11 eyes either preoperatively or postoperatively. Patients were observed for 10 to 98 months (mean, 47) after surgery. Anatomic outcome and visual acuity were retrospectively analyzed for all eyes. Optical coherence tomography was used to observe anatomic changes in the macula in some eyes. Complete retinal reattachment was achieved in 10 of 11 eyes, although these eyes required nearly 1 year to reach this state. The one eye with persistent retinal detachment was observed to have a marked reduction of the detachment by 10 months postoperatively. No recurrences were observed. Visual acuity improvement was documented in 7 of 11 eyes. These results suggest that vitrectomy with induction of PVD and gas tamponade, without additional laser treatment, is successful in reattaching the macula and improving central vision in most patients with optic disc pit maculopathy.

Ocular complications after iodine brachytherapy for large uveal melanomas

Purpose To evaluate anterior and posterior segment complications and their management after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. Design Retrospective nonrandomized interventional study. Participants Ninety-six patients with a large uveal melanoma according to the Collaborative Ocular Melanoma Study criteria. Methods The patients underwent primary IBT (median dose to tumor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5–16.8) and 16.5 mm (range, 7.3–25.0), respectively, and the median follow-up time was 3.5 years (range, 0.3–10.4). Cumulative incidence analysis and competing risks regression were used to analyze the time to individual complications and to identify risk factors. Death and secondary enucleation were analyzed as competing risks. Main outcome measures Cataract, iris neovascularization, glaucoma, maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative retinal detachment (RD). Results The 5-year cumulative incidences of cataract, iris neovascularization, and glaucoma were 69% (95% confidence interval [CI], 57%–78%), 62% (95% CI, 50%–71%), and 60% (95% CI, 48%–70%), respectively. Posterior segment complications were less common. The 5-year incidences of maculopathy and optic neuropathy were 52% (95% CI, 35%–65%) and 46% (95% CI, 30%–61%), and those of vitreous hemorrhage and persistent RD were 36% (95% CI, 23%–48%) and 25% (95% CI, 15%–36%), respectively. More than 80% of complications were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developing a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to adjacent tissues, was associated with time to cataract ( P = 0.017), iris neovascularization ( P = 0.087), and RD ( P = 0.046). Maculopathy and optic neuropathy were associated primarily with distance to the fovea ( P = 0.015) and optic disc ( P = 0.015), respectively. Of 57 patients with cataract, 47% underwent cataract extraction, and 12% of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalences of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years. Conclusions The frequency with which ocular complications develop after IBT is notably influenced by competing risks. Cumulative incidence and prevalence analysis provide realistic estimates for patient counseling.

Intraocular dispersion of perfluorocarbon liquids insilicone oil

Purpose To report one case of intraocular emulsification of perfluorocarbon liquids (PFCLs) and silicone oil after vitrectomy surgery. Design Interventional case report. Methods Retrospective review of the clinic, and surgical record of a 39-year old female referred for persistent retinal detachment after vitrectomy surgery; PFCLs and silicone oil were left in the eye at the end of the surgery. Results There was intraocular emulsification of PFCLs into silicone oil. Electron microscope examination of the silicone oil surgically extracted from the eye demonstrated emulsification of small PFCL bubbles into the silicone oil. Conclusion Perfluorocarbon liquids are surgical tools. They should be completely removed from the eye at the end of the surgery; PFCLs and silicone oil tend to emulsify together, originating an opaque fluid, which contains both silicone oil and dispersed PFCL bubbles.

Persistent foveal retinal detachment after successful rhegmatogenous retinal detachment surgery

PURPOSE: To describe the tomographic features of the neurosensory retina after successful rhegmatogenous retinal detachment surgery DESIGN: Cohort study. METHODS: We prospectively examined cross-sectional retinal images using optical coherence tomography (OCT) in 15 eyes of 15 consecutive patients (mean age, 46 years) who underwent scleral buckling surgery for treatment of rhegmatogenous retinal detachment. The retinas appeared reattached upon binocular stereoscopic indirect ophthalmoscopy. All eyes were examined at 1, 3, 6, and 12 months postoperatively. The time from onset of subjective symptoms of retinal detachment to retinal surgery ranged from 4 to 66 days (mean, 14 days). The postoperative OCT findings and best-corrected visual acuity were statistically analyzed using the Mann–Whitney U test. RESULTS: The detached retinas appeared attached on ophthalmoscopy in all eyes 1 month postoperatively. OCT showed residual retinal detachment in four eyes (27%) at the fovea and in three eyes (20%) at the fovea and adjacent area. The remaining eight retinas (53%) were attached when examined tomographically. In six of the seven eyes with residual foveal detachment by OCT, the retinas reattached spontaneously up to 12 months postoperatively. The postoperative best-corrected visual acuity improved gradually during 12 postoperative months in all 15 eyes. A substantial increase in visual acuity occurred when the fovea reattached in the six eyes with residual detachment. CONCLUSIONS: Foveal retinal detachment may persist after successful retinal detachment surgery in eyes in which the fovea appeared to be attached on ophthalmoscopy. The residual foveal detachment may explain, in part, the delayed visual acuity improvement after successful scleral buckling.

Optical coherence tomography of bleb-like subretinal lesions after retinal reattachment surgery

PURPOSE: To report the optical coherence tomographic characteristics of persistent bleb-like subretinal lesions after retinal reattachment surgery, including scleral buckling and cryopexy. METHODS: Case reports. RESULTS: In two eyes of two patients yellow to yellowish-orange bleb-like lesions were found in the posterior pole after retinal reattachment surgery. The common aspects of the surgery were scleral buckling procedures and cryopexy. There were subretinal precipitates in some of the lesions. The lesions showed no associated leakage during fluorescein or indocyanine green angiography. Optical coherence tomography demonstrated that the bleb-like lesions were tiny retinal detachments. CONCLUSION: Optical coherence tomography examination of bleb-like subretinal lesions showed that they were actually retinal detachments. Our patients and previously reported patients developed these lesions after scleral buckling and cryopexy. These lesions may represent persistent retinal detachment because of the presence of protein in the subretinal fluid.

Suprachoroidal hemorrhage during pars plana vitrectomy.

Suprachoroidal hemorrhage is an uncommon but serious complication of pars plana vitrectomy that can be associated with a guarded visual prognosis. Risk factors for development of suprachoroidal hemorrhage during pars plana vitrectomy include high myopia, history of previous retinal detachment surgery, rhegmatogenous retinal detachment, use of cryotherapy, scleral buckling at the time of pars plana vitrectomy, external drainage of the subretinal fluid, intraoperative systemic hypertension, and bucking during general anesthesia. In eyes with suprachoroidal hemorrhage during pars plana vitrectomy, the final visual and anatomic outcomes may be compromised by persistent retinal detachment, secondary glaucoma, and ocular hypotony. In most cases, intraoperative drainage of suprachoroidal hemorrhage is not associated with a better outcome. The prognosis is more favorable if the suprachoroidal hemorrhage is localized and does not extend in to the posterior pole.

Scleral rupture during retinal detachment surgery: risk factors, management options, and outcomes

Objective To evaluate the potential risk factors, management strategies, and outcomes of scleral rupture during retinal detachment (RD) surgery. Design Case-control study. Participants and controls Fourteen consecutive patients with scleral rupture during RD surgery (cases) and 65 consecutive patients who underwent RD surgery without scleral rupture (controls). Intervention Demographic and clinical data were abstracted from patients’ medical records. Outcome measures Visual acuity and retinal attachment status at the last examination. Results Significant risk factors for scleral rupture during RD surgery were reoperation after failed RD surgery (71% vs. 32%), and pre-existing scleral pathologic condition (29% vs. none). The site of rupture was in the bed of a previously placed scleral buckle in all patients with a previous buckling surgery. Repair of the rupture included scleral sutures in eight (57%), scleral patch graft in four (29%), and placement of a scleral buckle over the site in two (14%) eyes. Eleven (79%) underwent vitrectomy with retinal tamponade by gas ( n = 4) or silicone oil ( n = 7). Complications observed postoperatively included vitreoretinal incarceration ( n = 3), vitreous hemorrhage ( n = 2), suprachoroidal hemorrhage ( n = 2) and subretinal hemorrhage ( n = 3). In the 14 eyes with scleral rupture, the final visual acuity was ≥20/40 in 1 (7%), 20/50 to 20/200 in 5 (36%), and <20/200 in 8 (57%). Ten (71%) had proliferative vitreoretinopathy develop. The retina was attached in 7 (50%), 6 (43%) had localized peripheral detachment, and 1 had a total retinal detachment. The vision improved in 4 (29%), was unchanged in 5 (36%), and was worse than before surgery in 5 (36%). In the 65 controls, the visual acuity at the time of the last examination was ≥20/40 in 26 (40%), 20/50 to 20/200 in 21 (32%), and <20/200 in 18 (28%). Sixty three (97%) patients had complete retinal reattachment, 1 (2%) had a localized peripheral RD, and 1 (2%) had an RD involving the posterior pole. After surgery, the vision improved in 45 (69%), was unchanged in 15 (23%), and was worse in 5 (8%) of the control eyes. The visual and anatomic outcomes of the eyes with scleral rupture were significantly worse than in the control group ( P = 0.002 and P < 0.001, respectively). Conclusions Risk factors associated with intraoperative scleral rupture include reoperation for failed RD surgery and pre-existing scleral pathology. Although this complication may be compatible with a good visual outcome in some patients, a high incidence of persistent or recurrent RD with proliferative vitreoretinopathy worsens the visual outcome for most patients with this complication.