Presence Of Proliferative Vitreoretinopathy Research Articles

Characteristics of pseudophakic retinal detachment and risk factors of recurrence

BackgroundThe present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes. MethodsThis was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain). ResultsThe mean age of the patients at the time of phacoemulsification was 63.06 ± 10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5–26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ± 4.17 years, which was reduced by half in the event of surgical complications (2.24 ± 2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21). ConclusionsPRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.

Clinical characteristics and optical coherence tomography of concomitant macular hole and rhgematogenous retinal detachment

To study the clinical characteristics of macula off rhegmatogenous retinal detachment (RRD) with peripheral causative breaks and concomitant macular hole (RRD+MH). This is a bi-center study. Consecutive eyes of macula off RRD with or without macular hole (MH) were collected. Eyes in these two groups were compared with best corrected visual acuity in logarithm of minimal angle of resolution (logMAR BCVA), the presence of choroidal detachment (CD), proliferative vitreoretinopathy (PVR) and the extent of RRD. In the group of RRD+MH, regression analysis was used to evaluate the correlation of clinical factors and final logMar BCVA. In addition, optical coherence tomography was performed both pre-and post-operatively if possible. There were 40 eyes in the RRD+MH group and 80 eyes in the control group. Eyes with RRD+MH had worse initial and final logMar BCVA (p < 0.001), higher incidence of CD (p < 0.001), PVR and extensive RRD at baseline (p < 0.001). Among the eyes with RRD+MH, final BCVA was correlated with initial BCVA (p < 0.001, CI 0.637 to 0.837), recurrent RRD (p = 0.004, CI − 0.661 to − 0.126), duration of RRD (p = 0.021, CI − 0.576 to − 0.048) and presence of PVR (p = 0.001, CI − 0.131 to − 0.035). The hole closure rate at final follow up is 87.5%.11 of the 17 eyes had preoperative optical coherence tomography (OCT) obtained had ellipsoid zone lining the bottom of MH. CD, PVR and extensive RRD were more commonly observed in RRD+MH. The morphology of MH may suggest the pathogenesis of MH in RRD+MH include mechanism different from that of idiopathic MH.

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.

Retinal displacement following repair of rhegmatogenous retinal detachment.

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects.

Retinal displacement following successful pars plana vitrectomy for rhegmatogenous retinal detachment

Background The appearance of hyperfluorescent lines next to the retinal blood vessels after successful retinal detachment (RD) surgery was explained by the occurrence of retinal displacement. This can attribute to the metamorphopsia experienced by some patients after their surgeries. Patients and methods A prospective interventional study was performed that included 30 eyes of 30 patients with primary rhegmatogenous RD, who had undergone successful RD surgery via pars plana vitrectomy and silicone oil tamponade. The entire patients had preoperative and postoperative fundus autofluorescence and optical coherence tomography. They were followed up for 3 months after surgery with testing of the best-corrected visual acuity and Amsler grid testing. Results The mean age of the included group was 53.7±9.2 years, and 17 (56.7%) patients were males. The most frequent tear site was upper temporal (43.3%), followed by multiple peripheral (23.33%), upper nasal (13.3%), lower temporal (13.3%), and the least was lower nasal (6.7%). Retinal displacement was detected by hyperfluorescent lines adjacent to the retinal blood vessels in the fundus autofluorescence imaging in 16 eyes (53.3% with 95% confidence interval: 36.7–70.0%). Patients with retinal displacement were significantly younger than patients without (P=0.019). The presence of proliferative vitreoretinopathy was significantly related to the occurrence of displacement (P=0.028). Metamorphopsia was significantly more frequent among patients with displacement (P&lt;0.001). Conclusion Retinal displacement had a high possibility to occur after successful repair of primary rhegmatogenous RD. Young patients and patients with proliferative vitreoretinopathy are at a higher risk for displacement.

Surgical Audit for the Outcome of Primary Rhegmatogenous Retinal Detachment Repair in the Kingdom of Bahrain.

The purpose of the study was to audit the primary and final success rate for primary rhegmatogenous retinal detachment (RRD) surgery performed between 2017 and 2022 at the Department of Ophthalmology in Salmanyia Medical Complex, the Kingdom of Bahrain. In addition, secondary outcomes for our study include assessments of risk factors for recurrence, final visual outcomes and complication rates. Prospective observational study showed data analysis of case series for 75 RRD patients operated during the study period. All patients who met the inclusion criteria were included in the study and evaluated by a specialized vitreoretinal surgeon before and after their operation. All patients were operated by the same surgeon (M.A) in the study period. Data collected from the hospital's electronic medical recording system (I-Seha) include macular state, pre- and postoperative best-corrected visual acuity, duration of symptoms, the presence of proliferative vitreoretinopathy (PVR), retinal breaks and their locations, any ocular comorbidities associated in the perioperative period such as increase in intraocular pressure or development of cataract, and operative notes related to the type of primary, secondary, and tertiary surgery if needed. A total number of 70 eyes from 70 patients with the majority of male patients (74.28%, n = 52) were included in the study. The mean age of the participants was 54.75 years (range: 11-91 years). Most of the patients 48.57% presented within 6 days of symptoms. Nearly 77.1% of the operated cases were macula off, whereas 22.85% were macula on. Thirty-six of the eyes (51.4%) had complex RRD with a combination of PVR (34.2%). Sixty-three of the eyes (51.4%) underwent standard 23G pars plana vitrectomy, while the combined surgery with a scleral buckle was performed on 9 eyes (12.8%). Five patients underwent pneumatic retinopexy and two patients had primary scleral buckles. Combined phacoemulsification with vitrectomy in selected cases was performed on 13 eyes (18.5%). Different tamponading agents were used 35 eyes (50%) silicon oil, 17 eyes (24%) C3F8, and 18 eyes (25%) SF6. The primary reattachment rate after one operation was 77.1% (54 eyes). The final reattachment rate following a second or third procedure was 95.7%. The mean postoperative visual acuity was 6/18 (range: 6/6 to hand motions). Thirty percent of the cohort of patients had a visual acuity of 6/12 or better. Sixteen out of the 70 eyes redetached (22.8%) and 10 of those eyes (62.5%) were classified as "complex" preoperatively which is thought to be a significant risk factor for failure. Our audit overall met international success rates despite the presence of some complex scenarios which required multiple surgical interventions. The primary use of gas or silicon oil did not influence reattachment rates but had a statistical significance when it came to final visual outcomes.

Pediatric rhegmatogenous retinal detachment: A meta-analysis of clinical features, surgical success rate, and prognostic factors.

Pediatric rhegmatogenous retinal detachment (RRD) is an issue of debate regarding its surgical outcomes and prognosis because of diagnosis delay, more complex etiological factors, and a higher prevalence of postoperative complications. This meta-analysis aims to evaluate the anatomical and visual outcomes of pediatric RRD and the factors that influence the treatment results. This is the first meta-analysis on this subject. We searched the relevant publications in the electronic databases of PubMed, Scopus, and Google Scholar. Eligible studies were included in the analysis. Anatomical success after one surgery and the final rates of success were estimated. Subgroup analysis was performed to find the rate of success in patients with different prognostic factors. This meta-analysis showed that the total rate of success after one surgery was about 64%, which implies that performing the first surgery was enough to get anatomical reattachment in most of the patients. The final anatomical rate of success was about 84%. In terms of visual acuity, the pooled results revealed statistically significant (P < 0.001) improvement in postoperative vision, with a 0.42 reduction in log of minimum angle of resolution (logMAR). The final rate of success was significantly lower in eyes with proliferative vitreoretinopathy (PVR) (about 25% lower in eyes with PVR, P < 0.001) and in the presence of congenital anomalies (about 36% lower in congenital cases, P = 0.008). Myopic RRD had a significantly better anatomical success rate. In conclusion, this study shows that there is a high chance of anatomical success after pediatric RRD treatment. The presence of PVR and congenital anomalies was associated with a poorer prognosis.

Effect of race and ethnicity on surgical outcomes for rhegmatogenous retinal detachments

ObjectiveTo evaluate the effect of socioeconomic and demographic factors on outcomes in rhegmatogenous retinal detachments (RRDs). DesignRetrospective cohort study. MethodsA total of 71 white and 124 black and/or Hispanic patients who had surgical repair of RRDs between October 2013 and September 2021 at a single-centre safety net hospital. Main outcomes were single surgery success rates (SSSR) and postoperative visual acuity at 6-month and final follow-up. ResultsBlack and (or) Hispanic patients were significantly younger (black and [or] Hispanic, 50.7 years vs white, 57.6 years; p = 0.003), had lower mean household incomes (black and [or] Hispanic, $80,932 vs white, $92,911; p = 0.007), were more likely to have more than 1 retinal break (black and [or] Hispanic, 65% vs white, 49%; p = 0.04), and had higher rates of proliferative vitreoretinopathy (PVR) at presentation (black and [or] Hispanic, 35% vs white, 18%; p = 0.02). SSSR was similar (black and [or] Hispanic, 73.4% vs white, 73.2%; p = 0.98), but black and (or) Hispanic patients had worse visual acuity postoperatively (black and [or] Hispanic, 20/63 vs white, 20/40 at final follow-up; p = 0.03). While race was linked to visual outcome in univariate testing; multivariate analysis revealed only macula status (p = 0.007 at 6 months; p = 0.01 at final follow-up), presence of PVR (p < 0.001 at both time points), and SSSR (p = 0.003 at final follow-up) as predictors of worse visual outcomes. ConclusionsPreoperative factors such as higher rates of PVR may contribute to worse vision outcomes in black and (or) Hispanic patients undergoing surgical repair for RRD.

The outcomes of primary pars plana vitrectomy alone as a first surgical procedure in pediatric rhegmatogenous retinal detachment.

To evaluate the characteristics and analyze the results of patients who underwent pars plana vitrectomy (PPV) as the first surgery due to rhegmatogenous retinal detachment (RRD) in pediatric age. The records of pediatric patients who underwent PPV alone due to RRD were reviewed retrospectively. The best corrected visual acuity (BCVA) values were recorded before and after the surgery. Complications during and after the operation, postoperative recurrences were followed-up. One hundred and six patients included in the study were followed-up for an average of 24.20±11.38months. The final mean BCVA showed a statistically significant improvement compared to the initial mean BCVA (p < 0.001). During the postoperative follow-up period, recurrent retinal detachment was seen in 31.1% of patients. Anatomical success was achieved at a rate of 68.9% after the first surgery and increased to 95.3% after repeated operations (in 78.3% without any tamponade). Both anatomical and functional success of patients with proliferative vitreoretinopathy (PVR) grade C or worse and patients with macula-off retinal status were poorer (each p value < 0.05). The effect of the etiological factor on anatomical and functional success was not significant (each p value > 0.05). Satisfactory results can be obtained with PPV alone in pediatric RRD. However, it should be noted that postoperative complications and recurrences occur at a high rate and that repeated surgeries are often required. The presence of PVR and macular involvement are seen as negative prognostic factors to the success of surgery.

Heavy Silicone Oil as an Endotamponade in Recurrent or Complicated Retinal Detachment and Macular Hole

Objectives:To evaluate the efficacy and safety of heavy silicone oil as an endotamponade in patients with recurrent or complicated retinal detachment and macular hole.Materials and Methods:Nineteen eyes of 19 patients who underwent heavy silicone oil endotamponade for different indications were included in the study and evaluated by retrospective chart review. At each visit, patients underwent detailed ophthalmological examination and anatomical and functional outcomes, silicone oil emulsification, intraocular inflammation, presence of proliferative vitreoretinopathy, preoperative and postoperative visual acuity, and postoperative complications were recorded.Results:The study included 19 eyes of 19 consecutive patients: 13 women (68.4%) and 6 men (31.6%). The patients’ median age was 60 years (interquartile range [IQR]: 44-70 years) and the median follow-up time was 19 months (IQR: 9-31 months). Indications for heavy silicone oil endotamponade were recurrent retinal detachment in 11 eyes (57.8%), inferior retinal detachment in 5 eyes (26.3%), inferior rhegmatogenous retinal detachment, recurrent macular hole in 2 patients (10.5%), and macular hole in 1 patient (5.2%). Median best corrected visual acuity was 2 logMAR (IQR: 1-2.6) preoperatively and 0.99 logMAR (IQR: 0.4-2) postoperatively (p<0.001). Postoperative anatomical success was achieved in all patients. Densiron 68 was used for endotamponade in 14 patients (73.7%), Densiron XTRA in 3 patients (15.8%), and AlaHeavy 1.07 in 2 patients. Heavy silicone oil emulsification was observed in only 3 patients (15.8%).Conclusion:Although heavy silicone oil has limitations as an endotamponade, such as intraocular pressure increase, emulsification, intraocular inflammation, and the risk of complications during removal, it is a safe and effective alternative in eyes requiring inferior retinal tamponade for indications like proliferative vitreoretinopathy and recurrent macular holes.

Сравнительная оценка эффективности комбинированного метода хирургического лечения регматогенной отслойки сетчатки

Purpose. To optimize the technology of surgical treatment of rhegmatogenous retinal detachment by a combination of vitrectomy of the base of the vitreous body in air with 360° peripheral endolaser retinopexy and to evaluate its clinical and functional effectiveness. Material and methods. The control group included 25 patients (25 eyes) with peripheral vitrectomy under the fluid (BSS) with laser restriction of the retinal tear only. The study group included 25 patients (25 eyes) with peripheral vitrectomy under air in combination with 360° laser retinopexy. Groups were compared in terms of visual acuity, duration of retinal detachment, presence of proliferative vitreoretinopathy, macular condition, number of retinal tears, lens condition (phakic/pseudophakic), and recurrent retinal detachment. The frequency of intraoperative iatrogenic retinal tears that occurred during peripheral vitrectomy was also assessed. Results. In the main group, in one case, an atorogenic rupture was detected during surgery. In the control group, there were 3 cases of touching the periphery of the retina with the appearance of a rupture during vitrectomy in the “shave” mode. There are no statistically significant differences in visual acuity after 3-6 months. During the observation period, no retinal detachment recurrence was detected in the main group in any case. Whereas in the control group there were 2 relapses. Conclusions. The advantage of air vitrectomy is a greater view of the periphery of the retina during surgery, which in many cases does not require additional sclerocompression for better visualization. Also residual vitreous body between tissue-air environments is very well identified. 360° endolaser coagulation is a prophylactic procedure to prevent recurrence of retinal detachment. In addition, in our study, we found that peripheral air vitrectomy combined with 360° laser retinopexy had comparable results to fluid vitrectomy in shave mode, with laser limited only around tears. Keywords: rhegmatogenous retinal detachment, vitrectomy, endolaser coagulation

Anatomical and functional outcomes in combined rhegmatogenous retinal and choroidal detachment pre-treated with systemic corticosteroid: a case series.

Combined rhegmatogenous retinal and choroidal detachment (CRRCD) is a rare phenomenon. It is important that CRRCD is recognised preoperatively so that corticosteroids may be administered as this may make repair surgery easier to do. We here report on the anatomical and visual outcomes of 3 patients treated for CRRCD. Retrospective review of 3 eyes of 3 patients with CRRCD which underwent scleral buckle, vitrectomy, and silicone oil insertion. Data including visual acuity, intraocular pressure, ocular inflammatory status, the presence of subretinal fluid, the presence of retinal breaks, the presence of proliferative vitreoretinopathy, demographic information, medical and ophthalmic history, administration of perioperative corticosteroids, surgical techniques, and complications was collected. Patients were aged 60, 66, and 62years old at the time of surgery. There was a minimum follow-up time of 20months. Initial visual acuity was 4/60. Initial intraocular pressure was 3mmHg, 7mmHg, and 7mmHg. All eyes had deep, inflamed anterior chambers at the time of presentation. All eyes underwent 20-gauge vitrectomy, scleral buckle, and silicone oil insertion. All patients received a perioperative course of oral corticosteroids. Final visual acuity was 6/12, 6/7.5, and 6/18. These 3 patients had good anatomical and functional results following surgery for CRRCD. All patients had visual acuity of 6/18 or better at last review.

FEATURES AND OUTCOMES OF EYES THAT UNDERWENT SURGICAL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS AFTER BEING TREATED FOR ACUTE ENDOPHTHALMITIS.

To evaluate the etiology, clinical course, and outcomes of eyes that suffered postendophthalmitis rhegmatogenous retinal detachments. A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants P.C. from January 2013 to December 2019. Patients were identified as having had endophthalmitis by ICD-9/10 codes. Those with endophthalmitis and/or rhegmatogenous retinal detachment not managed at Associated Retinal Consultants from January were excluded. Charts of 413 patients were reviewed and 19 met inclusion criteria. Incidence of rhegmatogenous retinal detachment following infectious endophthalmitis was 4.6%. The most common inciting events for endophthalmitis was intravitreal injection (9 of 19) and cataract surgery (7 of 19). Fifteen of 19 patients were treated with an injection of intravitreal antibiotics and 4 underwent immediate vitrectomy with antibiotic injection. Biopsy cultures were obtained in 18 of 19 patients and yielded positive growth in 12 (66.7%). Seventeen of the 19 eyes were operable. Final retinal reattachment rate was 88.2% (15 of 17). Mean final logMAR visual acuity was 1.58 (Snellen 20/765). Factors associated with worse final visual acuity after surgical repair included preceding intravitreal injection (P = 0.001), streptococcus species (P = 0.024), presence of proliferative vitreoretinopathy (P = 0.015), and use of silicone oil during primary rhegmatogenous retinal detachment repair (P = 0.010). Rhegmatogenous retinal detachments following endophthalmitis occur infrequently. Although most eyes can be repaired surgically, visual outcomes are often poor, particularly in eyes that were infected with streptococcal species and had associated proliferative vitreoretinopathy.

Predictive Factors for Long-Term Postoperative Visual Outcome in Patients with Macula-Off Rhegmatogenous Retinal Detachment Treated with Vitrectomy

Purpose: The purpose of this prospective study was to evaluate potential predictive factors of long-term postoperative outcomes in patients with macula-off rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). Methods: Participants in this study were 86 patients diagnosed with macula-off RRD, who underwent PPV. Demographic characteristics and preoperative characteristics of RRD were recorded, while best corrected visual acuity (BCVA) was measured preoperatively and at specific postoperative time points (6 weeks and 6, 12, and 24 months). In addition, spectral domain-optical coherence tomography (SD-OCT) characteristics at postoperative week 6 were assessed as potential factors affecting the long-term postoperative visual outcome 24 months after PPV for RRD. Results: Increasing age, duration of RD of more than 1 week, presence of proliferative vitreoretinopathy, increasing central retinal thickness, ellipsoid zone disruption, and external limiting membrane disruption were significantly associated with a worse BVCA. BCVA was not associated with gender, lens status, the location of breaks, the gas tamponade agent used in PPV, the presence of subretinal fluid, and intraretinal fluid. Conclusions: It is important to determine predictive factors for visual outcomes in order to inform patients about their prognosis and help in the decision-making process for patient management.

Immunological biomarkers of the vitreous responsible for proliferative alteration in the different forms of retinal detachment

BackgroundThe purpose of the study was to explore the immunological components that are responsible for the proliferative alterations in the different forms of retinal detachment (RD).MethodsVitreous fluids were collected during 23G pars plana vitrectomy from 54 eyes of 54 patients with different RD types, such as rhegmatogenous RD (RRD) without proliferative vitreoretinopathy (PVR) (n = 30), PVR (n = 16) and proliferative diabetic retinopathy (PDR) with tractional RD (n = 8). Vitreous fluids were obtained from 19 eyes with epiretinal membrane (ERM), which were used as control samples. A multiplex chemiluminescent immunoassay was performed to evaluate the concentrations of 48 cytokines, chemokines and growth factors.ResultsThe expression levels of eotaxin, IFN-gamma, IL-6, IL-8, IL-16, MCP-1, MIF and MIP-1 beta were significantly higher in all RD groups than in the ERM group. The levels of CTACK, IP-10, SCGF-beta, and SDF-1 alpha were significantly higher in patients with diabetic tractional RD and PVR than in other patients. The upregulation of VEGF and IL-18 was detected in PDR.ConclusionsOur results indicate that complex and significant immunological mechanisms are associated with the pathogenesis of different forms of RD: selected cytokines, chemokines and growth factors are upregulated in the vitreous of eyes with RD. The detected proteins are present in different concentrations both in RRD and PVR. In the presence of PVR and PDR, the majority of cytokines are upregulated; thus, they may serve as biomarkers to estimate the progression or severity level of proliferation and later to develop personalized therapeutic strategies to slow down or prevent pathological changes.

Outcome of pediatric retinal detachment using high-density silicone oil.

The high-density silicone oil (Densiron), a mixture of F6H8 with silicone oil, has been used in the management of retinal detachment (RD) complicated by the presence of proliferative vitreoretinopathy (PVR) with varying rate of anatomical success and visual outcomes. We conducted a prospective interventional case series of 22 eyes in 22 children less than 18years diagnosed with complicated retinal detachment complicated by the presence of PVR in inferior quadrant. The mean age of the patients was 8.45 ± 3.36years. There were 14 male and 8 female children. Five patients presented with total RD, 5 had subtotal RD and remaining 10 with inferior retinal detachment. There were 8 children with PVR C1, 13 with PVR C2, 3 with PVR C3. All patient's had macula off RD at presentation. The anatomical success in the form of attached retina was achieved in 21 (95.45%) eyes. Standard three-port pars plana vitrectomy without scleral buckling under general anesthesia was surgical technique employed in all cases. Densiron can be an important tamponade agent in pediatric retinal detachment complicated by PVR with increased success rate of retinal re-attachment.

PHACOVITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR: A Retrospective Review.

To analyze the single surgery success rate and anterior segment complications related to phacoemulsification and intraocular lens implantation in a series of patients undergoing phacovitrectomy for all types of primary rhegmatogenous retinal detachment. We performed a retrospective interventional case series on 302 eyes undergoing phacovitrectomy for primary rhegmatogenous retinal detachment repair between November 1, 2016, and February 2, 2019, in Edmonton, Canada. Primary outcomes included single surgery retinal reattachment rate and anterior segment complications. Secondary outcomes included the effects of proliferative vitreoretinopathy and macula and/or peripheral internal limiting membrane peeling on the rate of surgical success. The single surgery success rate of phacovitrectomy for all types of primary rhegmatogenous retinal detachment was 85.1%. The presence of proliferative vitreoretinopathy was associated with lower surgical success (odds ratio, 0.33; P = 0.01). Macular internal limiting membrane peeling was associated with higher surgical success (odds ratio, 2.4; P = 0.05). Anterior segment complications included posterior capsular opacification (28.8%), posterior synechiae (10.9%), and posterior capsular rupture (2.3%). Phacovitrectomy is a safe and effective treatment option for the primary repair of rhegmatogenous retinal detachments. This study provides evidence to support the safe incorporation of phacoemulsification and intraocular lens implantation with retinal surgery.

Elevated vitreous αB-crystallin in patients with rhegmatogenous retinal detachment and association with proliferative vitreoretinopathy and retinal detachment area.

To investigate the relationship between αB-crystallin levels in the vitreous of patients with rhegmatogenous retinal detachment (RRD) and correlate these levels with the presence of proliferative vitreoretinopathy (PVR) and to the extent of RRD. Prospective, cross-sectional study. Vitreous samples were collected from twenty-six patients with RRD at the surgical repair. PVR was evaluated using the Updated Proliferative Vitreoretinopathy Grade Classification system. RRD area was measured using ultra-widefield retinal photographs. The concentration of αB-crystallin in the vitreous was measured using an enzyme-linked immunosorbent assay kit. The average concentration of αB-crystallin was significantly higher in the PVR Grade B and C group (97.83 ± 69.47) than in the PVR (-) and Grade A group (39.43 ± 13.53ng/mL, P = 0.005). The level of αB-crystallin was also significantly higher in patients with large RD area (RD area > 1/4, 85.52 ± 66.07ng/mL) than in patients with small RD area (RD area ≤ 1/4, 39.20 ± 13.02ng/mL, P = 0.016). The level of αB-crystallin was significantly increased in the vitreous of RRD patients with high-grade PVR and large RD area. This finding suggests that αB-crystallin may function as an endogenous mediator in fibrotic processes in RRD patients.

Localized versus 360° intraoperative laser retinopexy in cases of rhegmatogenous retinal detachment with mild-to-moderate grade proliferative vitreoretinopathy

To compare the efficacy of intraoperative localized and 360° laser retinopexy in cases of rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy and air tamponade. In this interventional, prospective, randomized, comparative study, 93 consecutive cases of RRD were enroled. After randomization 48 eyes received circumferential, while 45 underwent localized intraoperative laser retinopexy. Number and position of the retinal breaks, presence of proliferative vitreoretinopathy and/or lattice degeneration were recorded. Anatomical and visual outcome of the two groups were compared at 6 months postoperatively. Baseline characteristics did not significantly differ between groups. The single-operation reattachment rate was 86.66% in localized group and 89.58% in 360° group. The difference was not significant. (P = 0.46, χ2 test). At 6 months postoperatively, visual acuity (logMAR) was 0.06 ± 0.05 in localized group and 0.05 ± 0.03 in 360° group. The difference was not statistically significant (P = 0.673, t-test). Localized laser resulted to be as effective as 360° laser application; this may lead some advantages in term of lower invasiveness, reduction risk of complications and time saving.

Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients

Purpose: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs. Design: Retrospective, observational, multicentre, case-control study. Methods: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded. Main Outcome Measures: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs. Conclusions: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs.