Recurrent Recurrent Retinal Detachment Research Articles

Serial Intravitreal Methotrexate Injections to Combat Recurrent Proliferative Vitreoretinopathy in a Pediatric Patient

Purpose: To describe the use of serial intravitreal methotrexate to combat proliferative vitreoretinopathy (PVR) in a pediatric patient with recurrent retinal detachment (RD). Methods: A retrospective case analysis was performed. Results: A 6-year-old patient with bilateral panuveitis presented with recurrent RD in the right eye. After treatment with 2 RD surgeries performed elsewhere, the patient developed PVR that necessitated 5 additional surgeries for recurrent detachment. The patient subsequently received a total of 8 injections of methotrexate 400 µg/0.1 mL (0.1 mL) in the operating room at 1- to 2-week intervals over a 3-month period. Through 13 months of follow-up after the first methotrexate injection, there was no evidence of recurrent RD, PVR, or epiretinal membrane formation. Conclusions: Frequent serial intravitreal methotrexate injections apparently played a role in preventing recurrent PVR formation in this pediatric patient with a history of intraocular inflammation and recurrent RD.

The Effect of Combining Scleral Buckle Surgery with Pars Plana Vitrectomy for Treatment of Recurrent Retinal Detachment Secondary to Proliferative Vitreoretinopathy.

The objectiove of the study is to evaluate and compare the outcomes of pars plana vitrectomy (PPV) and PPV combined with scleral buckle (SB) in vitrectomised cases with recurrent retinal detachment (RD) and to analyze the effects of adding SB to the procedure. Patients with recurrent RD due to grade C proliferative vitreoretinopathy (PVR) were included in this retrospective comparative case series. Patients who underwent re-PPV with or without SB were included and two groups (re-PPV; re-PPV+SB) were compared in terms of anatomical and functional success. Sixty-five cases were included in the study: 32 underwent re-PPV and 33 underwent re-PPV+SB procedures. Reattachment was achieved in 59.4% of the re-PPV group versus 81.8% of the re-PPV+SB group (p=0.047). Although preoperative BCVA was worse in the re-PPV+SB group (p=0.005), postoperative BCVA at the last visit was similar in both groups (p=0.065). In the treatment of recurrent RD with grade C PVR, combining the SB procedure with PPV contributes to anatomical and functional outcomes.

Deep Learning for Automatic Detection of Recurrent Retinal Detachment after Surgery Using Ultra‐Widefield Fundus Images: A Single‐Center Study

It is important to detect recurrent retinal detachment (RD) among patients after retinal reattachment surgery. The application of deep learning (DL) methods to detect recurrent RD with ultra‐widefield (UWF) fundus images is promising, but the feasibility and efficiency have not been studied. A DL system with ResNet‐50 and Inception‐ResNet‐V2 is developed and internally validated to identify recurrent RD and retina reattachment after surgery. The performance is further validated and compared with human ophthalmologists in a prospective dataset assessed by area under curve (AUC), accuracy, sensitivity, and specificity. Five hundred fifty‐four UWF fundus images from 173 RD patients (mean [standard deviation] age: 39.2 ± 16.2 years; male: 115 [66.5%]) are used to develop the DL system. DL shows AUCs of 0.912 (95% confidence interval [CI]: 0.855–0.968) and 0.906 (95% CI: 0.818–0.995) for the two models. Eighty‐nine UWF fundus images from 23 RD patients (mean [standard deviation] age: 31.4 ± 12.3 years; male: 15 [65.2%]) are collected as prospective dataset. DL also shows the ability to detect recurrent RD with the AUCs of 0.929 and 0.930 for the two models, respectively. DL reaches a similar and even better diagnostic performance than junior ophthalmologists and performs much better than medical students.

Recurrent retinal detachment after diabetic vitrectomy.

To investigate the characteristics of recurrent retinal detachment (RD) after diabetic vitrectomy (DV). Consecutive cases underwent vitrectomy for recurrent RD after DV was collected and separated into the following four groups for analysis: rhegmatogenous RD (RRD), pure tractional RD (Proliferative Subgroup 1), combined RD with proliferative tissue within the equator (Proliferative Subgroup 2), and combined RD with both posterior and peripheral proliferations (Proliferative Subgroup 3). Of the 41 cases enrolled, retinal reattachment was achieved in 73.2%. Over all, visual acuity was statistically better after operation (p = 0.001). All cases in the RRD group (four cases) had reattachment and a better final vision (p = 0.008). In the proliferative subgroups, those with pure tractional RD (Subgroup 1, seven cases) had the best visual acuity at the time of recurrent RD (p = 0.002). Subgroups 2 and 3 showed statistically significant better final visual acuity (p = 0.045 and 0.019, respectively). Poor preoperative vision (p = 0.001), non-attachment (p = 0.004), and neovascular glaucoma (p = 0.001) were associated with poor prognosis. Visual acuity may improve after operation for recurrent RD after diabetic vitrectomy. Visual prognosis was better in cases with pure RRD. In the proliferative subgroups, vision was impaired by the development of neovascular glaucoma and retinal non-attachment.

Surgical outcomes of Pars Plana Vitrectomy for recurrent retinal detachment in eyes previously treated with Pars Plana Vitrectomy or Scleral Buckling

To report anatomical and functional outcomes of pars plana vitrectomy (PPV) for recurrent retinal detachment (RD) after failed scleral buckling (SB) or primary PPV. Retrospective analysis of 59 eyes with recurrent RD treated previously with SB or PPV was performed. All eyes underwent 23 gauge PPV. The primary outcome was single surgery success rate (SSSR) for retinal reattachment at the final visit. Secondary outcomes were visual acuity change and number of reoperations. SSSR was 77.4% in the SB group and 67.9% in the PPV group (P=0.41). The mean change in visual acuity was not significantly different between the two groups (P=0.35). The mean number of reoperations was 1.2±0.5 and 1.4±0.6 in the SB and PPV groups, respectively (P=0.38). PPV was found to be an effective technique for the management of recurrent RD after SB and PPV surgeries. However, the small sample size and the retrospective design prevent any claims of advantages or disadvantages of one surgical technique over the other.

5-Fluorouracyl added infusion fluid in patients with recurrent rhegmatogeneous retinal detachment

PurposeTo compare the efficacy of 5-fluorouracil (5-FU) added the infusion fluid with a control group in the event of grade C PVR in recurrent retinal detachment (RD). MethodsThe records of the patients with recurrent retinal detachment with grade C PVR who underwent vitrectomy for retinal detachment surgery between April 2003 and October 2004 were reviewed retrospectively for this comparative study. The recurrent retinal detachment patients with grade C PVR who underwent vitrectomy and had a minimum post-operative follow-up period of 12 months were included. The patients were divided into two groups as study and control groups. 5-FU (200 microgram/ml) and low-molecular-weight-heparin (LMWH) (5 IU/ml) was added into the infusion solution of the study group. Primary outcome measure of this study was the single operation anatomical success at month 12. ResultsA total of 43 eyes of 43 patients were included. The control group was consisted of 26 eyes (60.5%) and the 5-FU group was consisted of 17 eyes (39.5%). At month 12, single operation anatomical success was obtained in 14 of the 26 patients (53.8%) in the control group and in 16 of the 17 patients (94.1%) in the 5-FU group (p = 0.005). ConclusionFavorable outcomes were obtained in the patients with recurrent RD and grade C PVR in whom 5-FU and LMWH added infusion fluid which was used during vitrectomy.

Anatomical and visual outcomes of retinectomy in eyes with advanced proliferative vitreoretinopathy

Background: Visual and anatomical success of inferior retinectomy in proliferative vitreoretinopathy complicating recurrent retinal detachment (RD). Aims: The aim of this study was to evaluate anatomical and visual outcomes of retinectomy in eyes with recurrent RD with advanced proliferative vitreoretinopathy. Settings and Design: Institutional, observational, cross-sectional retrospective study. Subjects and Methods: Records of 56 eyes of 56 patients with recurrent RD and proliferative vitreoretinopathy (PVR) were evaluated, three-port incision sclerotomies followed by standard vitrectomy were done. Retinal reattachment was achieved with the aid of perfluorocarbon and retinectomy. Retinectomy was performed at the time of surgery based on retinal shortening (inferior 180°). Silicon oil (SO) was used as a tamponade. Retinal attachment and visual acuity (VA) after 6 months were evaluated. Statistical Analysis Used: Chi-squared test. Results: In all 52 of 56 (93%) eyes, retinal reattachment was successful, with a mean follow-up of 25 months (range, 6–70 months). After retinal reattachment, VA improved or stabilized in 39 of 56 patients (70%). Conclusion: When combined with anterior base dissection, inferior retinectomy may be useful in the surgical treatment of complex PVR-related RD. It was found that with lensectomy, radical anterior base dissection, and inferior retinectomy, anatomic success rates are improved and visual function can be maintained.

Outcomes of Recurrent Retinal Detachment Surgery following Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

ABSTRACTAim: To study the anatomical and functional outcomes of recurrent retinal detachment (RD) surgery following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Methods: Retrospective analysis of 133 consecutive cases of recurrent RD. Inclusion criteria: age ≥18 years, recurrent RD following PPV ± encircling band for rhegmatogenous RD. Exclusion criteria: age <18 years, post-endophthalmitis/tractional/exudative/combined RD, post-scleral buckle, primary surgery done at another institute. The final anatomical and functional outcomes, and their association with clinico-surgical factors, were analyzed. Results: Proliferative vitreoretinopathy (PVR) ≥ Grade C in re-detached retina (OR, 2.49; 95% CI, 1.02–6.09; P = 0.045) and need for multiple resurgeries (OR, 6.48; 95% CI, 2.51–16.69; P < 0.0001) were significant risk factors for the final anatomical failure. Eyes with PVR ≥ Grade C (OR, 0.31, 95% CI, 0.12–0.80; P = 0.013) in primary RD, and with multiple breaks (OR, 0.24; 95% CI, 0.06–0.96; P = 0.044) at the time of recurrent RD, were less likely to have final BCVA ≥20/200. The visual acuity at the time of recurrent RD had a moderately positive correlation (r = 0.454, P < 0.001), and the delay in recurrence of RD had a weakly positive correlation (r = 0.214, P = 0.046) with the final BCVA. Conclusions: PVR ≥ Grade C and multiple resurgeries are associated with higher incidence of anatomical failure in recurrent RD surgery. Multiple breaks are associated with a poorer visual outcome, whereas a better baseline visual acuity and delayed recurrence of RD after primary repair are associated with a better visual outcome.

Epiretinal membrane and cystoid macular edema as predictive factors of recurrent proliferative vitreoretinopathy.

PurposeProliferative vitreoretinopathy (PVR) is the most common cause of recurrent retinal detachment (RD). We sought to determine the predictive factors of recurrent PVR formation and the need for additional vitreoretinal surgical intervention after uncomplicated primary RD repair.MethodsThis is a retrospective single-center case–control study of consecutive patients with PVR formation after uncomplicated RD repair. Logistic regression was used to assess factors associated with recurrent PVR formation.ResultsThirty-seven eyes (37 patients) who had recurrent RD secondary to PVR formation were included. Among those, 27 eyes needed one additional surgery, whereas the remainder 10 eyes required two or more additional surgeries. In the univariate analysis, patients who had cystoid macular edema (CME) after the second surgery were 8.33 times (crude odds ratio [COR], 95% confidence interval [CI]: 1.23–56.67, p=0.0302) more likely to have recurrent PVR formation compared to those who did not have CME after the second surgery. Similarly, those who had epiretinal membrane (ERM) after the second surgery were 8.00 times (COR, 95% CI: 1.43–44.92, p=0.0182) more likely to have recurrent PVR formation compared to those who did not have ERM after the second surgery. In the multivariate analysis, patients who had ERM after the second surgery were 8.20 times (adjusted odds ratio [AOR], 95% CI: 1.08–62.40, p=0.0422) more likely to develop recurrent PVR compared to those who did not have ERM after the second surgery, when adjusted for age, sex, and CME after the second surgery.ConclusionERM and CME are potential predictive factors for recurrent PVR formation after uncomplicated primary RD repair. Early recognition and treatment of ERM and CME may be critical to prevent subsequent PVR formation and improve visual outcomes.

ANATOMICAL AND VISUAL OUTCOMES AFTER TWO-PORT PARS PLANA VITRECTOMY REOPERATION UNDER SILICONE OIL FOR EPIMACULAR MEMBRANE OR RECURRENT RETINAL DETACHMENT

To describe the anatomical and visual outcomes in a series of patients undergoing two-port pars plana vitrectomy reoperation under silicone oil for recurrent retinal detachment (RD) due to proliferative vitreoretinopathy or epimacular membrane (EMM) after RD repair. This study is a prospective, consecutive, interventional case series of patients presenting with recurrent RD or EMM under silicone oil. Two-port 25-gauge pars plana vitrectomy reoperation without an infusion port was performed in all cases. Thirty-nine patients were included. Reoperation pathology included recurrent RD with proliferative vitreoretinopathy (n = 33) and EMM alone (n = 6). The mean number of previous retinal surgeries was 2.4 ± 1.1 (range, 1-5). The mean overall follow-up was 24 ± 3.7 months. The mean visual acuity change from baseline at final follow-up was an improvement of 0.74 ± 0.63. Macular reattachment was achieved in 29 of 33 patients with RD, and EMMs were successfully removed in all patients. Two-port pars plana vitrectomy reoperation is an efficacious method for repair of consecutive RD due to proliferative vitreoretinopathy or EMM in patients with previous RD repair with silicone oil. Significant visual improvement with a low complication rate may be achieved in patients with advanced proliferative vitreoretinopathy or EMM under silicone oil.

Heavy silicone oil (Densiron® 68) in proliferative vitreoretinopathy: 4 years of experience

MethodProspective observational study including 10 patients (age range: 27–74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months. ResultsThe mean length of time before Densiron® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1000/5000 silicone oils has proven to be unsatisfactory.

Aceite de silicona pesado (Densiron® 68) en vitreorretinopatía proliferativa: 4 años de experiencia

MethodProspective observational study including 10 patients (age range: 27-74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months. ResultsThe mean length of time before Densiron® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1,000/5,000 silicone oils has proven to be unsatisfactory.

SCLERAL BUCKLE REMOVAL IN THE VITRECTOMY ERA

To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal. A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present). Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD. Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.

Influence of Postoperative Lens Status on Intraocular Pressure in Proliferative Vitreoretinopathy

To determine the influence of lens status on postoperative intraocular pressure (IOP) in eyes undergoing vitrectomy for repair of recurrent retinal detachment (RD) resulting from proliferative vitreoretinopathy (PVR). Retrospective, consecutive, nonrandomized, single-center series. One hundred and forty-five eyes with recurrent RD resulting from PVR were reviewed retrospectively. In all, 99 eyes underwent relaxing retinotomy at the time of surgery (68.4%). Perfluorocarbon gas (n = 60) or silicone oil (n = 85) were used as postoperative tamponades. For analysis, eyes were subdivided first based on tamponade and retinotomy status. The resultant groups then were divided further by lens status into 2 groups: aphakic eyes (aphakic group) and phakic and pseudophakic eyes (nonaphakic group). Surgical reattachment was achieved in all eyes except one. Eyes receiving both silicone oil and relaxing retinotomy had the worst baseline characteristics compared with those receiving other interventions. In this subset of eyes, a significantly lower proportion of hypotony was found in those eyes that were aphakic after surgery when compared with those eyes that were nonaphakic (P = .037). Surgical management of PVR often results in ultimate retinal reattachment. In eyes receiving both relaxing retinotomy and silicone oil, higher IOPs and a lower proportion of hypotony are found where a native lens or intraocular implant is absent. Removal of the lens or intraocular implant may be considered for those eyes at greatest risk of hypotony.

Influence of Relaxing Retinotomy on Surgical Outcomes in Proliferative Vitreoretinopathy

This study sought to determine the influence of relaxing retinotomy (RR) incisions upon surgical outcomes in the repair of recurrent retinal detachment (RD) attributable to proliferative vitreoretinopathy (PVR). Retrospective, consecutive, nonrandomized, single-center series. Eighty-one eyes with recurrent RD attributable to PVR were retrospectively reviewed. Exclusion criteria were giant retinal tear, uveitis, trauma, proliferative diabetic retinopathy, and age under 18 years. A total of 52 eyes underwent RR at the time of surgery (64.2%); 29 eyes were repaired without this technique. Perfluorocarbon gas (n = 34) or silicone oil (n = 47) was used as postoperative tamponade. Statistical analyses were performed using the Fisher exact test. Eyes that received RR had significantly higher rates of anterior PVR (P = .009). Eyes receiving silicone oil for postoperative tamponade had worse baseline characteristics compared with those receiving gas. The use of RR in eyes receiving gas tamponade had no marked influence on the initial anatomic outcomes, with recurrent retinal detachment occurring in five of 14 eyes that received an RR and seven of 20 eyes that did not receive an RR (P = .62). Eyes in which silicone oil was used as a postoperative tamponade had a significantly lower rate of recurrent RD requiring additional surgery when RR was employed (one of 38 eyes) when compared with eyes that did not receive an RR (three of nine eyes, P = .02). Ultimately, surgical reattachment was attained in all eyes except one. Eyes that received gas tamponade without RR had significantly better median vision (P = .008). Surgical management of PVR often results in ultimate retinal reattachment. An RR incision does not appear to influence initial anatomic repair when gas tamponade is used after vitrectomy surgery for PVR. However, RR may increase the initial surgical success rate in eyes receiving silicone oil tamponade for PVR. In eyes undergoing RR for the treatment of severe PVR, the use of silicone oil may increase the initial rate of reattachment compared with the use of gas tamponade.

A pilot study on the use of silicone oil–RMN3 as heavier-than-water endotamponade agent

This work was conducted to report an interventional non-comparative pilot study using Oxane HD, a mixture of ultra-purified silicone oil and RMN3, a partially fluorinated olefin, as heavier-than-water internal tamponade. Twenty-eight consecutive patients were recruited for this study. Indications included recurrent retinal detachment (RD) with proliferative vitreoretinopathy (PVR) (stage > or =C2) arising from inferior or posterior tears, recurrences after vitreoretinal surgery, penetrating trauma and combined rhegmatogenous and choroidal detachment. The patients underwent a pars plana vitrectomy, membrane peeling, and Oxane HD was used as long-term internal tamponade. Oxane was removed after 88 days (range 45-96 days) and exchanged with BSS in five eyes, long-acting gas in 14 eyes and with silicone oil in nine eyes. Retinal reattachment was achieved in 15 eyes. The overall anatomical success rate obtained using Oxane HD was 53.5%. In 15 patients with previous marked scleral buckling, the success rate was 26%: in nine patients recurrent RD occurred in the inferior sector, in five patients new tears were detected in the lower sectors; membrane formation was observed in 15 eyes. In 13 patients without marked scleral indent, the success rate was 84.6%. There was no evidence of dispersion and excessive inflammation. Oxane HD may be a useful tool in complicated RD with large inferior breaks, inferior PVR or combined rhegmatogenous, and choroidal detachment without marked scleral buckling, which put the eye profile out of shape, led to a higher failure rate and reduced the tamponading effectiveness of Oxane HD.

COMBINED CATARACT SURGERY AND VITRECTOMY FOR RECURRENT RETINAL DETACHMENT

To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.