Primary Retinal Reattachment Rate Research Articles

The Effect of Steroid Intervention before Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment: A Meta-Analysis and Systematic Review

Purpose This meta-analysis discusses the effectiveness of steroid intervention before vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment. Methods We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies published until August 2023. We included studies involving: patients with rhegmatogenous retinal detachment associated with choroidal detachment with proliferative vitreoretinopathy; an experimental group that was not administered steroids and a control group that was administered steroids; and assessment of visual acuity, retinal reattachment rate, and complications. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis. Results Two randomized controlled trials and four case-control studies involving 490 eyes were included in the meta-analysis. There were no significant differences in the primary and final retinal reattachment rates after surgery between the steroid and non-steroid groups (primary retinal reattachment rate: odds ratio = 1.01, 95% confidence interval = 0.63–1.63, p = .41; final retinal reattachment rate: odds ratio = 0.82, 95% confidence interval = 0.43–1.59, p = .33). There was no statistically significant difference in postoperative visual acuity improvement between the two groups (odds ratio = 1.19, confidence interval = 0.63–2.25, p = .69). In addition, subgroup analyses of different types of steroids showed that systemic and local administration of steroids had similar results for retinal reattachment rate and visual acuity improvement. Conclusion Patients with rhegmatogenous retinal detachment associated with choroidal detachment who did not receive preoperative steroids achieved the same effect as patients with rhegmatogenous retinal detachment associated with choroidal detachment who did receive preoperative steroids in terms of retinal reattachment rate and visual acuity. It is recommended that patients with rhegmatogenous retinal detachment associated with choroidal detachment undergo surgery as promptly as possible.

Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia.

PurposeTo investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area.MethodsThis retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained.ResultsA total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > −3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was −8.66 ± 0.92 (range: −3.00–−12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important.ConclusionIn the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.

INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE COEXISTENT WITH RHEGMATOGENOUS RETINAL DETACHMENT.

To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique. Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported. The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent). Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.

Efficacy of PPV Combined with Air Tamponade for Treatment of Inferior Retinal Breaks.

Purpose To observe the efficacy and safety of pars plana vitrectomy (PPV) combined with filtered air tamponade in the treatment of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Methods This retrospective study included 20 patients (20 eyes) with inferior retinal breaks in RRD; all underwent PPV combined with filtered air tamponade. Preoperative examinations included BCVA, IOP, anterior segment, fundus and locations, numbers, and sizes of retinal breaks and ocular B-mode ultrasonography. Postoperative examinations included BCVA, IOP, residual gas volume, retinal reattachment, and complications. Results After follow-up for 1 year, the primary retinal reattachment rate was 95% and the final reattachment rate was 100%. Pre- and postoperative BCVA averaged 1.51 ± 0.63 and 0.97 ± 0.58 logMAR, respectively; the difference was statistically significant (P < 0.001). Average pre- and postoperative IOP were not statistically different. The average volume of residual gas on the first day after the surgery was 77.5%; the gas was absorbed in all patients within 2 weeks; no significant postoperative complications were observed. Conclusion PPV combined with filtered air tamponade is a safe and effective treatment for RRD with inferior retinal breaks. Notably, the retinal reattachment rate is high, gas absorption is rapid, and incidence of complications is low.

Microscope-Assisted Episcleral Surgery with Encircling Buckles and Chandelier Endoillumination for Primary Rhegmatogenous Retinal Detachment in Phakic and Pseudophakic Patients: A 12-Month Comparative Study

Introduction: The aim of the study was to compare postoperative outcomes after microscope-assisted encircling buckle and chandelier endoillumination for primary rhegmatogenous retinal detachment (RRD) in phakic and pseudophakic (PFK) patients. Methods: 121 eyes of 117 patients were divided into 2 groups depending on the lens status (group 1, PFK, 53 eyes; group 2, phakic, 68 eyes). The main outcomes include retinal reattachment rate (RRR) and best-corrected visual acuity (BCVA) at 1 week, 1, 3, 6, and 12 months. Results: The overall primary RRR was 91.7% (111/121). In group 1, the primary RRR was 90.6% (48/53), whereas in group 2 it was 92.6% (63/68). The mean preoperative BCVA improved in both groups at 12 months. Undetected retinal breaks were found in 9.9% of cases. When an encircling 5-mm oval sponge was used, no additional exoplants were required and transcleral drainage was performed in 89.7% of the eyes. In group 1, among the 5 PFK eyes with persistent RRD, 4 eyes had a sulcus intraocular lens. Conclusions: Microscope-assisted episcleral surgery with chandelier endoillumination is an effective technique for primary RRD in both phakic and PFK eyes with uncomplicated cataract surgery. Chandelier endoilluminators help to visualize undetected retinal breaks, especially in PFK eyes. In case of a circumferential 5-mm oval sponge, additional exoplants are not required and transcleral drainage is strongly recommended to flatten the retina by closing the causative breaks.

3D Heads-Up Display vs. Standard Operating Microscope Vitrectomy for Rhegmatogenous Retinal Detachment.

Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting.Design: Retrospective cohort study.Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment.Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months.Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery.Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a “learning curve” of the first 35 eyes (p = 0.49).Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.

Pneumatic Retinopexy in Patients with Primary Rhegmatogenous Retinal Detachment Meeting PIVOT Trial Criteria

To identify the proportion of patients with primary rhegmatogenous retinal detachment (RRD) presenting to a retina practice that meet 'Pneumatic Retinopexy versus Vitrectomy for the Management of Primary RRD' (PIVOT) trial criteria and to assess anatomic and functional outcomes of pneumatic retinopexy (PnR) in this population. Retrospective consecutive case series. Patients with primary RRD treated between October 2009 and November 2017 at an academic vitreoretinal practice in Canada. Medical records of all cases >18 years old with primary RRD were reviewed and the proportion of patients meeting PIVOT criteria was determined. Patients that met PIVOT criteria who underwent PnR with a follow-up >3 months were included for further analysis. The primary outcome was the primary retinal reattachment rate at 12 months among patients meeting PIVOT criteria undergoing PnR. A total of 1,091 patients were identified, of which 577 (52.9%) met PIVOT criteria. Of these, 482/577 (83.5%) underwent PnR, but 54/482 (11.2%) were excluded as these had been enrolled in the PIVOT trial, and another 40/482 (8.3%) were excluded due to short follow-up (<3 months). Therefore, data pertaining to 388 patients is included in our analysis. 79.4% (308/388), 78.2% (280/358), 76.5% (241/315) and 73.9% (178/241) of patients who followed up at 3, 6, 12, and 24 months, respectively, had primary anatomic reattachment. A total of 20.6% (80/388) of patients did not reattach with the initial PnR or re-detached in the early post-procedure period (3 months), 2.1% (8/388) of patients re-detached between 3-12 months, and 1.3% (5/388) re-detached after 1 year. Phakic lens status was the only significant predictor of PnR success at 12 months in a multivariate logistic regression analysis (P= 0.006). Mean logMAR VA improved from 0.90 ± 0.90 (Snellen 20/159) at baseline t 0.34 ± 0.40 (Snellen 20/44) at 12 months (P < 0.001). Over 50% of patients presenting to an academic tertiary retina practice with primary RRD met PIVOT criteria and were eligible for PnR. Evidence from this study demonstrates a durable primary anatomic retinal reattachment rate with PnR in patients fulfilling PIVOT criteria, with similar results to those encountered in the PIVOT trial.

Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system.

PurposeTo examine outcomes of 23-gauge (23G) pars plana vitrectomy (PPV) for complex diabetic tractional retinal detachment (TRD) in Chicago’s Cook County Health and Hospitals System (CCHHS).Materials and methodsThis is a retrospective noncomparative study of diabetic TRD cases that underwent PPV at CCHHS. Primary retinal reattachment rate, visual function, and postoperative complications were analyzed.ResultsSixty nine consecutive cases were included. Primary reattachment and final attachment were achieved in 68/69 eyes (98.6%). Secondary retinal detachment was noted in 1 eye (1.4%). Vitreous hemorrhage requiring repeat PPV developed in 5 eyes (7.2%) and reoperation due to other complications was required in 4/69 eyes (5.8%). Perfluoropropane (C3F8) gas tamponade was used in 91.3% of eyes and silicone oil in 8.7% of eyes. Mean LogMAR visual acuity significantly improved from 1.84 ± 0.61 to 0.93 ± 0.66, (P<0.0001). Vision was stabilized or improved in 66 eyes (95.7%). Visual acuity of 20/200 or better was achieved in 49/69 eyes (71.0%) and 20/50 or better in 16/69 eyes (23.2%).ConclusionsEven in patients with severe and advanced diabetic TRD pathology and unique demographics as seen in CCHHS, modern vitrectomy techniques can provide excellent anatomical and visual outcomes.

Anatomical and visual outcomes of phacoemulsification and 23-gauge pars plana vitrectomy assisted with perfluorocarbon and 27-gauge twin-chandelier endoillumination for primary rhegmatogenous retinal detachment

Context: Anatomical and visual outcomes of phacoemulsification and 23-gauge (23G) pars plana vitrectomy (PPV) assisted with perfluorocarbon liquid (PFCL) and 27-gauge twin-chandelier endoillumination for primary rhegmatogenous retinal detachment (RRD). Aims: This study aims to determine the anatomical and visual outcomes of phacoemulsification and 23G PPV for primary RRD assisted with 27-gauge (27G) transconjunctival twin-chandelier endoillumination and bimanual vitreous base shaving under PFCL. Settings and Design: A prospective single tertiary center cohort study of 65 consecutive eyes by a single surgeon between August 2013 and June 2014. Subjects and Methods: The primary outcome measure was the primary retinal reattachment rate. The secondary outcome measure was best-corrected visual acuity (BCVA). All patients were reviewed postoperatively up to 4 months. Statistical Analysis Used: Chi-squared, Student's t-test, and one-way ANOVA test were used in this study. Results: At 4 months, overall retinal reattachment was 83.1% with a single operation and 87.7% with a second surgery. After exclusion of the proliferative vitreoretinopathy (PVR) cases, the primary retinal reattachment rate improved to 93.9% and secondary retinal reattachment rate was 98.0%. The mean BCVA improved from logMAR 1.06–0.83 (P = 0.002). PVR (P = 0.0001), silicone oil tamponade (P = 0.002), macula-off RD (P = 0.12), location of RRD (P = 0.09), and delay of more than 7 days for surgery (P = 0.09) were associated with a higher redetachment rate. The main postoperative complications were small bubbles of PFCL in the posterior segment (18.5%) and subretinal PFCL (3.1%). Conclusions: Chandelier endoillumination and PFCL-assisted 23G PPV with phacoemulsification has reattachment rates and visual outcomes similar to the current standard of RRD repair of different complexities. This surgical technique can be considered an alternative method of repairing RRD, with some advantages.

Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure.

Purpose To assess the outcome of sutureless encirlcing number 41 band and transscleral laser retinopexy in uncomplicated rhegmatogenous retinal detachment (RRD), using a wide-angle viewing system (WAVS) and chandelier endoillumination. Methods Prospective intervention study included 30 eyes of 30 patients presenting with RRD of recent onset indicated for SB. All cases were treated by sutureless encircling number 41 band and transscleral laser retinopexy. Visualization was provided by the Resight WAVS and a single 27-gauge chandelier endoillumination. Anatomical and visual outcomes were evaluated. Results The mean age of our group was 49.8 ± 12.3 years, and the mean duration of RD was 7 (0–50) days. Twenty-four eyes (80.0%) were phakic while the remaining 6 eyes (20%) were either pseudophakic or aphakic. The primary retinal reattachment rate was 83.3% (25 out of 30 eyes). LogMAR visual acuity improved from 1.3 (0.30–2.0) preoperatively to 1.0 (0.40–1.60) at first month (p = 0.002) and to 0.70 (0.20–1.92) at third month (p < 0.001). Conclusion Sutureless encircling number 41 band with chandelier-assisted transscleral laser retinopexy is a safe and effective technique for managing uncomplicated RRD. It provides a high primary success rate while eliminating the complications of cryotherapy, sutures, and broad buckles.

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.

Excellent results of scleral buckling in the era of microincision vitreous surgery

Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Materials and Methods: Retrospective analysis of fifty eyes of fifty patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2014 to August 2015. Results: Primary retinal reattachment rate of 41 patients was achieved with single surgery, but final anatomical success was 94% with additional pars plana vitrectomy with silicone oil injection and with vitrectomy with epiretinal membrane removal. The mean follow-up was 6 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment.

Purpose:To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).Design:Retrospective interventional case series.Materials and Methods:Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013.Results:Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.Conclusion:Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study

To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes. In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula. Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them. Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.

Complications after external retinal surgery in pseudophakic retinal detachment--are scleral buckling operations still current?

After conventional buckling procedures for pseudophakic retinal detachment the primary reattachment rate is 60 to 90% according to literature. Primary vitrectomy may be advantageous in these cases. The purpose of this study was to investigate the spectrum and role of potential side effects like anisometropia and diplopia, to find arguments for or against primary vitrectomy. Also risk factors for pseudophakic retinal detachment were analyzed in our study group, because they may be different from former studies, which were mostly undertake at the time of ec cataract extraction. The data from 115 patients (120 eyes) with pseudophakic retinal detachment, who undergone buckling procedure between 1991 and 1996 were retrospectively reviewed. We analyzed the retinal reattachment rate, choroidal detachment, postoperative visual acuity, refraction, occurrence of diplopia, anisometropia and metamorphopsia. The primary retinal reattachment rate was 83.3%. There was a retinal redetachment rate of 16.7%. The primary PVR-rate was 4.2%. After the first reoperation an reattachment rate of 91.6% could be achieved, after the second one an overall rate of 95%. A choroidal detachment occurred in 29.2%. Postoperatively (26.5 months +/- 17.2) we found a cellophane maculopathy in 26.5% with consecutive metamorphopsia in 12.1%. 13 patients (15.9%) complained about diplopia, which had to be corrected by operation in 2 cases and prismatic glasses in 4 cases. Anisometropia could be deserved in 16.4%. The buckling procedures caused refractive changes of -1.80 dpt +/- 1.78 after an encircling band and +0.38 dpt +/- 1.01 after a plombage (average -1.05 +/- 1.86). 20% of patients treated with an encircling band developed anisometropia and only 8.3% of patients with a plombage. Postoperatively the visual acuity raised significantly from 0.3 to 0.6 (median). Best visual recovery could be observed in patients, who underwent only one operation. The primary retinal reattachment rate in pseudophakic retinal redetachment after conventional buckling procedures in our patients are comparable to those in the literature. In spite of phacoemulsification the risk-factors for pseudophakic retinal detachment has not changed. A considerable number of patients complained about postoperative complications like anisometropia and diplopia, which could be avoided by primary vitrectomy. To compare anatomic and functional results of both procedures a randomized prospective study should be undertaken.