Related Retinal Detachment Research Articles

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series

BackgroundMacular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD.MethodsClinical records of patients undergoing SB surgery for treatment of RRD at the Xi’an People’s Hospital (Xi’an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed.ResultsAmong 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients.ConclusionsPatients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Retinal detachment following lightning injury mimicking acute retinal necrosis: A case report

A 16-year-old male presented with a diminution of vision after 1 month of lightning injury. Fundus examination showed inferior retinal detachment with multiple sieve-like breaks. After pars plana vitrectomy, he developed mutton fat keratic precipitates and anterior segment inflammation. Sieve-like breaks and mutton-fat keratic precipitates (MF-KPs) led to the diagnostic dilemma of viral etiology. The patient responded well to treatment with steroids and antivirals, showing good visual recovery after silicone oil removal. Lightning strike injury–related retinal detachment can rarely mimic an acute retinal necrosis (ARN)-related retinal detachment (RD).

Features of a well-timed macular hole closure related retinal regmatogenous detachment complicated by macular hole

The literature review deals with the analysis of the timing and surgical techniques of macular hole closure in patients with retinal detachment complicated by macular hole. Modern concepts of treatment tactics for this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.

Surgical Outcomes of Acute Retinal Necrosis–Related Retinal Detachment in Polymerase Chain Reaction–Positive Patients: A Single-Center Experience

To evaluate the clinical features, operative techniques, and surgical outcomes of patients who underwent surgery for acute retinal necrosis (ARN)-related retinal detachment (RD). Retrospective, longitudinal, consecutive case series. Patients with polymerase chain reaction-positive ARN presenting from 2011 to 2021 who underwent vitreoretinal surgery for ARN-related RD at our institution. Univariate, multivariate, and survival analyses were used to determine predictors of anatomic and functional outcomes. Single-surgery anatomic success rate, recurrent RD, and visual acuity (VA) at 1year. Thirty-four eyes of 34 patients (32.4% women, mean age, 45.1 ± 20.4 years) were included for analysis with a median follow-up of 2.5 years (interquartile range [IQR], 0.8-5.5 years). Presenting VA was 1.1±0.8 logarithm of the minimum angle of resolution (LogMAR) (Snellen ∼20/250). The median time from presentation to RD surgery was 1.7 months (IQR, 0.8-4.1 months), and the mean preoperative VA was 1.6 ± 0.8 LogMAR (Snellen ∼20/800). Small-gauge pars plana vitrectomy (PPV) with or without a scleral buckle (SB) was performed for all eyes with an overall single-surgery success rate of 63.6%, with no statistically significant differencesin visual/anatomic outcomes between PPV and PPV/SB cases. Silicone oil was used for tamponade in 33 (97.1%) cases and was removed in 10 (30.3%) with good anatomic and final functional outcomes (Snellen∼20/80). Independent predictors of recurrent RD included the female sex (hazard ratio, 8.38; 95% confidence interval, 2.03-34.68; P < 0.01) and zone 1 retinitis involvement at presentation (hazard ratio, 10.95; 95% confidence interval, 2.12-56.48; P < 0.01). The mean VA at 1 year (VA1year) and at the final follow-up both had a Snellen equivalent of 20/640 (P > 0.05 for both compared with preoperative VA, respectively). Eyes that achieved single-surgery success had VA1year of 20/200 versus hand movements in those with single-surgery failure (P < 0.01). On multivariate linear regression, younger age (P= 0.04) and better presenting VA (P<0.01) were both associated with better VA1year. Moderate single-surgery anatomic success can be achieved with modern vitreoretinal surgical techniques for ARN-related RD, although visual outcomes remain poor. Further studies investigating interventions for increasing single-surgery success rates, for the inflammatory complications of ARN, and for preventing ARN-related RD are needed.

Comparison of heads up three dimensional visualization system to conventional microscope in retinopathy of prematurity related tractional retinal detachment

To report the outcomes, advantages and disadvantages of a heads-up three-dimensional (3D) visualization system compared to the conventional microscope in pediatric tractional retinal detachment (TRD) surgery secondary to advanced stage retinopathy of prematurity (ROP). Medical records of patients with ROP stage 4 or 5 who underwent surgery for tractional retinal detachment at King Khaled Eye Specialist Hospital between September 2017 and July 2019 were identified and reviewed. Eyes were divided into 2 groups, eyes that underwent surgery with a 3D heads-up platform (3D group) and eyes that underwent surgery with a conventional microscope (conventional group). Data were collected on neonatal history, visual acuity, intraoperative complications and success rates between groups.Eighteen eyes of 14 patients who underwent surgical repair of TRD related to ROP. Postoperative outcomes were compared between 10 eyes (7 patients) in the 3D group and 8 eyes (7 patients) in the conventional group There was no statistically significant difference in success rate between both groups (75% conventional group vs 70% 3D group). Partial or complete reattachment was achieved in 7 eyes in 3D group compared to 6 eyes in conventional group. Lower postmenstrual age at the time of the first surgery and presence of retinal breaks were associated with poorer surgical outcome. Heads up 3D visualization system is feasible in tractional retinal detachment related to ROP with similar success rate and no increased risk of complications when compared to conventional microscope. This system may be advantageous in advanced pediatric tractional retinal detachment surgeries.

Relaxing retinotomies and retinectomies in case of proliferative diabetic vitreoretinopathies and tractional retinal detachment

IntroductionRadical anterior vitreous base dissection and lensectomy in combination with inferior 180° retinectomy will improve the anatomic success of complex proliferative diabetic vitreoretinopathies (PVR)-related retinal detachment. Our study aims to describe the anatomical and functional results of pars plana vitrectomy with retinotomies and relaxing retinectomies in patients with tractional retinal detachment in advanced PVR.Patients and methodsA case series study was conducted on 28 eyes of patients with tractional retinal detachment with severe PVR. Preoperative and postoperative complications and final visual outcomes were recorded. The follow-up period was 12 months.ResultsFull reattachment rate was reached intraoperatively in 26 (92.9%) eyes, with final complete reattachment success rate in 22 (78.5%) eyes at least 6 months of follow-up. A total of 17 (60.7%) eyes had their best-corrected visual acuity (BCVA) improved at 6 months postoperatively, and reaching a final BCVA of more than or equal to 2/60 at 6 months. The BCVA remained stable in six (21.4%) eyes and declined in five (17.9%) eyes. The complications postoperatively included secondary glaucoma (three eyes), retinal redetachment (four eyes), and hypotony (two eyes).ConclusionPars plana vitrectomy with relaxing retinotomies and retinectomies is an effective treatment method for complex PVR-related retinal detachment. Improved preoperative visual acuity, lower PVR extension, and silicone oil tamponade use during the early recovery period are essential factors for good anatomical and visual outcomes and a lower rate of complications.

Macular Hole–Related Retinal Detachment in Children with Knobloch Syndrome

To describe the findings and the management of macular hole (MH)-related retinal detachment (RD) in children with Knobloch syndrome. Retrospective interventional case series. Patients with Knobloch syndrome who presented with MH-related RD. Retrospective chart review of patients with Knobloch syndrome who presented with MH-related RD from January 2012 to December 2018. Interventions included pars plana vitrectomy and silicone oil tamponade with or without scleral buckle, drainage retinotomy, or relaxing retinectomy. MH characteristics and surgical anatomical outcome. The study included 9 eyes of 5 patients (age range 2 months to 5 years; median age 5.5 months). Presenting symptoms were poor fixation and nystagmus. The fellow eye of 1 patient had RD due to peripheral breaks. The MH was clinically visible in 8 eyes and detected only by OCT in 1 eye. The RD was shallow and extended to the anterior equator in 7 eyes and localized to a punched-out atrophic lesion in 1 eye. Seven eyes underwent surgical repair. At the last follow-up examination (follow-up range 11 to 42 months; mean 24 months, standard deviation 11.8 months), retinal reattachment with MH closure was achieved in 5 eyes along with marked improvement in fixation. Patients with Knobloch syndrome may develop MH-related RD as early as infancy. The condition may be easily overlooked in children but should be suspected in the setting of high myopia, vitreoretinal degeneration, and encephalocele.

Endoscopy-Assisted Vitrectomy Outcomes During Silicone Oil Removal After Complex Retinal Detachment Repair

Purpose: This retrospective study recorded intraoperative findings during silicone oil removal and postoperative anatomical outcomes comparing endoscopy-assisted pars plana vitrectomy (E-PPV) vs pars plana vitrectomy (PPV) alone after proliferative vitreoretinopathy (PVR)-related retinal detachment (RD) repair. Methods: This single-center retrospective study included patients who underwent PPV for silicone oil removal after RD with PVR from July 2009 to January 2017. Patients with diabetic tractional RD, history of trauma, uveitis, or endophthalmitis were excluded. After 2013, an endoscopic visualization system (E2 MicroProbe; Endo Optiks) was used in a nonrandomized fashion. Data collection included reattachment rate, intraoperative endoscopic findings and phthisis rate. Results: Fifty-four eyes of 54 patients were included. The mean participant age was 58.4 ± 12.9 years and 36 (65.5%) participants were male. The mean (± SD) follow-up duration after oil removal was 24.3 ± 20.1 months. E-PPV combined with wide-angle visualization system was performed in 26 (48.1%) of the patients; the surgical management was modified after endoscopic examination in 17 (65.4%) of the cases. Reattachment rate in the E-PPV group was 96.2% compared with 76.0% in the PPV-alone group ( P = .04). Conclusions: E-PPV for silicone oil removal appears to be advantageous for prevention of RD recurrence, thus achieving better reattachment rates. A thorough examination is facilitated by endoscopic visualization and contributory factors for anterior PVR can be identified and treated.

Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease

To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease. Multicenter, retrospective, interventional case series. A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication. Three-port, transconjunctival, 27-gauge PPV. Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days. Mean follow-up was 715±332 days (median, 514; range, 365-1440 days). Surgical indications included epiretinal membrane (ERM) (n= 121), vitreous floaters (n= 69), diabetic tractional retinal detachment (n= 49), vitreous hemorrhage (n= 40), full-thickness macular hole (n= 33), recurrent proliferative vitreoretinopathy (PVR)-related retinal detachment (n= 18), primary rhegmatogenous retinal detachment (RRD) (n= 17), silicone oil removal (n= 16), dislocated intraocular lens (n= 10), submacular hemorrhage (n= 7), endophthalmitis (n= 6), and retained lens material (n= 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n= 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%). At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates ofpostoperative complications across varied surgical indications, including primary and complex retinal detachment.

Effect of Serial Intrasilicone Oil Bevacizumab Injections in Eyes With Recurrent Proliferative Vitreoretinopathy Retinal Detachment

To investigate the effect of serial intrasilicone oil bevacizumab injections (1.25 mg/0.05 mL) on visual acuity (VA) and anatomic outcomes in eyes undergoing proliferative vitreoretinopathy (PVR)-related retinal detachment (RD) repair. Prospective, nonrandomized, historical-control pilot study. setting: Tertiary care center. Nondiabetic eyes undergoing pars plana vitrectomy (PPV) and silicone oil tamponade with or without scleral buckling procedure (SBP) for recurrent RD due to PVR. Intrasilicone oil injection of 1.25 mg bevacizumab was performed intraoperatively and at postoperative months 1, 2, and 3. Retinal reattachment rate, final VA, and rate of epiretinal membrane (ERM) formation at month 6. Twenty eyes of 20 patients were enrolled and compared to a historical control group composed of 35 age- and sex-matched controls. In the study group, logMAR VA improved from mean 1.78 ± 0.43 (Snellen 20/1205) to 1.43 ± 0.70 (Snellen 20/538, P = .04), retinal reattachment was achieved in 14 of 20 eyes (70%), and ERM formation was observed in 7 of 20 eyes (35%) at 6 months. In the control group, logMAR VA improved from mean 1.50 ± 0.74 (Snellen 20/632) to 1.43 ± 0.58 (Snellen 20/538, P = .64), retinal reattachment was achieved in 25 of 35 eyes (71%), and ERM formation was observed in 7 of 35 eyes (20%) at 6 months. No significant difference in final VA (P = .96), retinal reattachment rate (P = .75), or ERM formation (P = .33) was observed between groups. No intrasilicone oil injection-related adverse events occurred. Serial intrasilicone oil injections of bevacizumab did not improve retinal reattachment rate, improve final VA, or reduce ERM formation in patients undergoing PVR-related RD surgery.

Cytomegalovirus retinitis (CMVR)‐related retinal detachment (RD) surgery in AIDS patients in an Asian population

AbstractPurpose This study reports the outcomes of retinal re‐attachment surgery in patients with Cytomegalovirus retinitis (CMVR)‐related retinal detachment (RD) in an Asian population.Methods Review of CMVR characteristics, surgical outcomes and complications in 19 patients with CMVR‐related RD who underwent surgery from January 2000 to June 2011.Results CMVR was inactive in 73.7% of the patients at the time of surgery. Fourteen (73.7%) of RDs were macula‐off and 4 (21.1%) patients had proliferative vitreo‐retinopathy (PVR). Anatomical success was achieved in 14 patients (73.6%). Eight patients (42.1.%) had improvement of 1 or more lines in BCVA, 7 patients (36.8%) maintained BCVA and 4 patients (21.1%) had poorer BCVA at 6 months after surgery. Of the 13 patients who presented with worse than 6/120 vision, 30.8% regained ambulatory vision or better. Five patients had re‐detachments (26.3%). Six phakic patients (54.5%) developed cataracts post‐surgery at a median interval of 6 months. Seven patients had immune recovery uveitis (IRU) prior to RD. Median durations from CMVR and IRU diagnoses to RD were 2.0 and 1.0 months respectively.Conclusion Surgery for CMVR‐related RD is associated with good anatomical outcomes with most patients maintaining or improving vision. Factors related to better outcomes include smaller CMVR lesion size and the absence of PVR. CD4 counts were not related outcomes. Patients diagnosed with CMVR and IRU require close monitoring for development of RD.

Proliferative Vitreoretinopathy in Human Immunodeficiency Virus-infected Patients in the Era of Highly Active Antiretroviral Therapy

To assess the prevalence of proliferative vitreoretinopathy (PVR) and prognosis of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) surgery in the era of highly active antiretroviral therapy (HAART). Retrospective interventional cohort study. Thirty-five human immunodeficiency virus (HIV)-positive patients with CMV retinitis-related RD who underwent surgical repair were assessed for PVR, CD4-positive T cell counts, and use of HAART. Main outcome measures included anatomic and functional outcomes of RD surgery as well as the presence of PVR and CD4-positive T cell counts. PVR was present in 10 of 35 patients (29%) at the time of the first surgery. The presence of PVR was associated with worse preoperative and postoperative visual acuity (P = .017 and P = .009, respectively), with the CD4-positive T cell counts above 200 cells/microL (P = .054), and with a longer interval between the diagnosis of RD and surgery (P = .025). The odds ratio for development of PVR in patients with CD4-positive T cells above 200 cells/microL was 11.3 (95% confidence interval 1.01-125). PVR was not associated with age, gender, or duration of HIV infection. Anatomic reattachment was obtained in 31 patients (89%), though the functional outcomes were limited. The central location of CMV retinitis was associated with postoperative visual acuity (VA) of less than 0.1 (P = .000). Postoperative logMAR VA was associated with preoperative logMAR VA (P < .001) and development of PVR (P = .009). PVR was present in 29% of CMV retinitis-related RD and was associated with higher CD4-positive T cell counts and longer interval between the diagnosis of RD and surgery.

High myopia-related macular lesions: diagnosis and treatment

High myopia is frequently associated with retinal degenerative changes (such as myopic foveoschisis, macular hole and its related retinal detachment, and choroidal neovascularization) which are the major causes of visual loss in high myopic eyes. Optical coherence tomography may help us to understand the macular lesions in high myopia. Peeling of internal limiting membrane and removal of posterior vitreous cortex at an appropriate time, are believed to facilitate restoring the retinal flexibility and resolution of myopic foveoschisis, and promote the macular hole closure and retinal reattachment. Anti-angiogenesis treatment combined with photodynamic therapy and (or) corticosteroid therapy are the future options to treat myopic choroidal neovascularization. Correctly understanding and mastering the methods and timing of diagnosis and treatment of high myopia-related macular degeneration, and taking targeted interventions to enable patients to be rational and effective treated, are the keys to further reduce the damage of visual function in patients with high myopia. Key words: Myopia; degenerative/complications; Myopia; degenerative/diagnosis; Myopia; degenerative/surgery; Editorial

Results of the ICAPE pilot study: Interactive computer aided patient education pilot study

PURPOSE: To report about the results of the ICAPE (Interactive Computer Aided Patient Education) Pilot Study. STUDY DESIGN: Evaluation of a new technology. METHODS: 144 participants, consisting of 20 patients about to undergo cataract surgery (Group 1), 18 ophthalmologists and ophthalmic registered nurses (Group 2), 18 medical interns (Group 3), and 88 lay-persons (group 4) were shown varying interactive computer animations from the 3D-Eye-Office™ (Eyemaginations™) software package which lasted between 4 minutes (Group 1) and 2 hours (Group 2). These videos explained the physiology and the anatomy of the human visual system, as well as the patho-physiology of myopia, hyperopia, cataracts, diabetic retinopathy, age related macular degeneration, retinal detachment, retinal tears, and glaucoma. They also explained in depth the ophthalmic surgical procedures relating to these diseases and the possible risks and complications. After the participants had viewed the videos, they were asked to fill out questionnaires relating to the quality and usefulness of the videos. RESULTS: 144 participants were asked to answer a total of 1254 questions about a total of 9 ophthalmic subjects taught to them using the 3D-Eye Office™ patient education system. The results of the questionnaires showed overwhelming approval of the quality of the videos from all participant groups. If the results from Groups 1 and 4 are added together and expressed as a percentage, the average approval rating for the videos from patients is 92.7%. If the results from Groups 2 and 3 are added together and expressed as a percentage, the average approval rating for the videos from medical professionals is 88.9%. CONCLUSION: The 3D-Eye Office™ system is a clear and concise method of educating patients about complex subjects in ophthalmology. However, the system should not be used as a replacement for the standard informed consent process, but rather as a precursor to it. This may help to streamline the informed consent process. The 3D-Eye Office™ system could also be very useful in the education of student nurses and non-ophthalmic medical professionals. These points need to be verified in a larger multi center study.

Current understanding and management of retinopathy of prematurity

Retinopathy of prematurity is the leading cause of childhood blindness in industrialized countries and is the fifth leading cause of bilateral childhood blindness worldwide. There have been new insights into understanding the factors involved in the pathogenesis of retinopathy of prematurity and related retinal detachment. This review outlines the current recommendations for initiation, frequency, and duration of screening examinations and describes the infants at the highest risk for developing complications from retinopathy of prematurity. The rationale and timing of treatment are also discussed. Infants who undergo early screening and treatment for retinopathy of prematurity have improved long-term functional and structural outcomes compared with those who receive conventional screening and treatment. Patients undergoing surgical repair of retinopathy of prematurity-related detachments (stage 4A, 4B and 5) can have favorable anatomical and functional outcomes. The increased survival of lower birth weight infants has increased the prevalence of aggressive, posterior retinopathy of prematurity that may be unresponsive to conventional treatment. While full understanding of the mechanisms that underlie the formation of retinopathy of prematurity and related detachments is not complete, progress has been made in identifying risk factors, screening of high-risk patients, and optimizing the timing of surgical interventions to improve structural and functional outcomes.

Spontaneous Resolution of Traumatic Macular Hole–related Retinal Detachment

To report a case of spontaneous resolution of traumatic macular hole-related retinal detachment. Observational case report. Clinical examination and optical coherence tomographic (OCT) evaluation of a patient who experienced spontaneous resolution of a retinal detachment resulting from a traumatic macular hole. A 12-year-old boy developed a macular hole and retinal detachment after blunt ocular trauma. Spontaneous reattachment of the retina and closure of the macular hole were documented at clinical examination and by OCT three weeks after presentation. Spontaneous closure of traumatic macular hole and resolution of associated retinal detachment can occur.

Results of Silicone Oil Removal in Patients With Cytomegalovirus Retinitis Related Retinal Detachments

To evaluate the percentage and risk indicators leading to retinal redetachment in HIV (human immunodeficiency virus) patients with CMV (cytomegalovirus) retinitis related retinal detachments that were repaired with silicone oil, and then subsequently underwent oil removal. Retrospective, noncomparative interventional case series. The study cohort consisted of a series of 15 eyes in 14 patients with HIV and CMV retinitis with a retinal detachment (RD) repaired with silicone oil at a single center and followed from the time of the CMV retinitis diagnosis through the time of silicone oil removal. Patient- and eye-specific data regarding demographic and clinical characteristics were collected retrospectively and statistical analyses were performed to compare differences between the eyes that had retinal detachments versus the eyes that remained attached following removal of silicone oil. Eight eyes (53%) redetached after a median of 4.0 months following oil removal. Cataract surgery performed at the time of oil removal was a statistically significant risk factor for redetachment (P = .01). There was a trend for lower CD4 levels to be associated with a higher risk of retinal redetachment. The use of a scleral buckle at the time of surgery (initial RD repair or at the time of oil removal) did not reduce the risk of redetachment. Approximately half of the eyes with CMV related retinal detachment may safely undergo oil removal. The risk factor for redetachment was simultaneous cataract extraction at the time of silicone oil removal. There was also a trend for lower CD4 levels to be associated with a higher risk of retinal redetachment.

Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula

Purpose To evaluate the postoperative status of the macula after vitreous surgery with internal limiting membrane removal for macular hole related retinal detachment in patients with severe myopia. Design Interventional case series. Methods We prospectively examined 10 eyes with retinal detachment associated with a myopic macular hole from 10 consecutive patients, and performed pars plana vitrectomy with internal limiting membrane peeling. Macular buckling was performed in one eye during the initial treatment and in three eyes during subsequent operations. The main outcome measures were the anatomic reattachment rate and the postoperative status of the macular hole. We examined the macular area pre- and postoperatively with slit-lamp biomicroscopy and with a scanning laser ophthalmoscope. Cross-sectional imaging of the macular area was conducted with optical coherence tomography. Results Successful retinal reattachment was achieved in seven eyes (70%) after the initial surgery and in three eyes (30%) after additional procedures. Visual acuity remained unchanged in two eyes (20%), and improved by two or more logarithmic units of minimum angle of resolution (logMAR) measurement in eight eyes (80%). The macular hole was anatomically closed in only one eye (10%). Postoperative enlargement of the macular hole was observed in seven eyes. Conclusions In highly myopic eyes with macular hole related retinal detachment, closure of the macular hole is difficult to attain despite the complete relief of tangential traction by internal limiting membrane peeling. Results indicate the presence of a possible imbalance between the retina and the choroid–sclera complex associated with axial elongation and posterior staphyloma in highly myopic eyes.

SURGICAL REPAIR OF CYTOMEGALOVIRUS-RELATED RETINAL DETACHMENT WITHOUT SILICONE OIL IN PATIENTS WITH AIDS

Purpose: To analyze visual and anatomic results following surgical repair of cytomegalovirus (CMV)-related retinal detachment (RD) without silicone oil permanent tamponade. Methods: We analyzed five consecutive patients (six eyes) with acquired immunodeficiency syndrome and CMV-related RD that were repaired with pars plana vitrectomy with peeling of the posterior hyaloid, laser photocoagulation, encircling scleral buckle, and intraocular gas tamponade. Results: Preoperative vision ranged from 20/40 to hand motion. Total retinal reattachment was achieved in five of six eyes (83%). Macular reattachment was achieved in all eyes. Mean postoperative visual acuity was 20/40 (range 20/30–20/60). Mean postoperative follow-up was 12 months (range 7–19 months). All patients in this series presented with low preoperative CD4 T-lymphocyte counts (mean, 24 cells per μL) and received highly active antiretroviral therapy. One retina (Patient 1) redetached 7 months after initial repair and was successfully reattached without using silicone oil. Postoperatively, visual acuity remains 20/30, and total retinal reattachment has been maintained for 16 months. Conclusion: Good anatomic and visual success can be achieved and maintained in CMV-related RD without the use of silicone oil.

Laser Photocoagulation Repair of Macula-sparing Cytomegalovirus-related Retinal Detachment

The purpose of the study is to investigate the role of laser photocoagulation in the treatment of macula-sparing cytomegalovirus (CMV)-related retinal detachment (CMVRD) in patients with acquired immune deficiency syndrome (AIDS). Seven macula-sparing CMVRD identified between July 1995 and February 1997 were managed with laser photocoagulation and observed prospectively (group I). Seven CMVRD reattached with pars plana vitrectomy (PPV) and silicone oil injection (group II) between January 1992 and June 1996 were analyzed retrospectively. Patients with AIDS with macula-sparing rhegmatogenous CMVRD with no proliferative vitreoretinopathy and visual acuity better than 20/30 were studied. Demarcation laser photocoagulation (group I) or PPV with silicone oil injection (group II) was performed. Postoperative best-corrected visual acuity (BCVA), temporary or permanent visual loss, CMVRD progression or recurrence, and cataract were measured. Follow-up ranged from 2 to 19 months (mean, 9 months) in group I. Post-treatment BCVA was unchanged in all eyes after laser. One retina redetached 9 months after laser treatment. Final visual acuity was less than 20/40 in one eye because of progressive CMV retinitis. Follow-up ranged from 2 to 24 months (mean, 10.4 months) in group II. All group II RDs were reattached successfully with PPV and silicone oil injection. Best-corrected visual acuity was an average of 1.6 lines worse after vitrectomy. Silicone-induced hyperopic shift caused temporary visual loss in all eyes (mean duration, 5.6 weeks). Delayed visual loss due to cataract formation occurred in five eyes. Three eyes had cataract extraction within 6 months. Two partial redetachments developed. One was repaired with repeat vitrectomy. Final visual acuity was less than 20/40 in five of seven eyes because of progressive CMV retinitis (1), dense cataract (2), uncorrected refractive error (2), and uncertain cause (1). Demarcation laser photocoagulation appears to be an effective treatment for many macula-sparing CMVRD. Loss of BCVA, temporary postoperative visual loss due to silicone-induced refractive error, and delayed visual loss due to cataract after vitrectomy with silicone oil injection may be avoided. Demarcation laser photocoagulation may be an effective alternative to vitrectomy in macula-sparing CMVRD.