Retinal Detachment Repair Research Articles

VALIDATION OF M-CHARTS FOR QUANTITATIVE ASSESSMENT OF METAMORPHOPSIA FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To validate the quantitative assessment of metamorphopsia in rhegmatogenous retinal detachment (RRD) using M-CHARTS by determining its correlation with subjective reporting of metamorphopsia with a validated metamorphopsia questionnaire (modified MeMoQ). The Research Ethics Board approved a prospective observational study carried out at St. Michael's Hospital, Toronto, Canada. Patients with primary, unilateral RRD and healthy controls were included. Metamorphopsia at 3 months was assessed with modified MeMoQ and M-CHARTS. One hundred patients (50 with RRD, 50 controls) were included. Seventy percent (35/50) of the RRD group had metamorphopsia with M-CHARTS and 80% (40/50) with MeMoQ. The modified MeMoQ and total M-CHARTS scores were significantly higher in patients with RRD compared with controls ( P < 0.0001). Cronbach's alpha reliability coefficient was 0.934 in the RRD group. Horizontal, vertical, and total M-CHARTS scores were significantly correlated with MeMoQ scores (r s =0.465, P = 0.0007; r s =0.405, P = 0.004; r s =0.475, P = 0.0005, respectively). M-CHARTS was 72.7% sensitive and 94.6% specific for detection of metamorphopsia (positive score≥0.2), with an area under the receiver operating characteristic curve=0.801. A stronger correlation was found in patients who scored ≥0.2 on the M-CHARTS and reported metamorphopsia with the MeMoQ (r s =0.454, P = 0.001). The authors have validated M-CHARTS as a tool to quantitatively assess metamorphopsia in patients with RRD, which is significantly correlated with patient-reported outcomes using the MeMoQ. A total score of ≥0.2 with M-CHARTS was more strongly correlated with MeMoQ.

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.

Outcomes of short- versus long-acting gas tamponades in vitrectomy for rhegmatogenous retinal detachment.

In vitrectomy for rhegmatogenous retinal detachment, long-acting gas tamponades (LGT) such as C3F8 or C2F6 may improve surgical success rate due to their prolonged effect compared to a short-acting gas tamponade (SGT) with SF6. On the other hand, SGT allow a significantly faster visual rehabilitation after surgery and may reduce the risk of gas-related complications. As comparative data in retinal detachment surgery is limited, we assessed the outcomes of vitrectomies using either LGT or SGT. We retrospectively analyzed 533 eyes of 524 consecutive patients diagnosed with primary rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy (PVR) and treated by vitrectomy at two clinical sites. Depending on the site the patients presented at, they received either preferentially LGT (study site 1) or SGT (study site 2). Retinal re-detachment rates during a period of 6 months following surgery were analyzed. At study site 1, 254 of 278 eyes (91.4%) were treated by LGT (C3F8 72.3%; C2F6 19.1%), whereas at study site 2, 246 of 255 eyes (96.5%) received SGT (SF6). Rates of retinal re-detachment in the LGT- and SGT-treated groups were similar with 23 of 254 eyes (9.1%) and 24 of 246 eyes (9.8%), respectively (p = 0.9). Median time to re-detachment was 5.7 weeks in the LGT-treated group and 4.4 weeks in the SGT-treated group (p = 0.4). In rhegmatogenous retinal detachment repair by vitrectomy, the use of SGT results in comparable rates of successful retinal re-attachment as LGT. Given the faster visual rehabilitation with SGT, these results suggest SGT as a sensible alternative to LGT in surgery of retinal detachment without PVR.

Association of Cutaneous Keloids, Hypertrophic Scarring, and Fibrosis with Risk of Postoperative Proliferative Vitreoretinopathy

To assess an association between cutaneous keloids, hypertrophic scarring, and fibrosis (KHF) with risk of post-operative proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) repair. Retrospective population-based cohort study PARTICIPANTS: Patients ≥ 18 years who underwent initial RD repair with pars plana vitrectomy with or without scleral buckle (SB) (Current Procedural Terminology (CPT) 67108), pneumatic retinopexy (67110), and primary SB (67107) from January 1, 2003 - March 1, 2023. A de-identified electronic health record database through TriNetX, a global health research network, was used to analyze patients. Patients were queried for International Statistical Classification of Diseases (ICD)-10 codes L91.0 (hypertrophic scar) and L90.5 (scar conditions and fibrosis of skin). Frequency of subsequent diagnosis of PVR (H35.2), and CPT codes for secondary surgery including complex RD repair (67113) was determined. Proliferative diabetic retinopathy (PDR) (ICD-10 H10.35/H11.35) patients were excluded. Descriptive statistics (Z-test) and propensity score matching (PSM) was used to match for age, sex, and race. Prevalence of H35.2 and CPT 67113 within 180 days after RRD repair in KHF cohort versus non-KHF cohort. Among patients with CPT 67108, 1,061 patients in each cohort (KHF and non-KHF) were analyzed after PSM. The mean (SD) age was 60.7 (15.2) years. Within 180 days, 10.1% of patients in the KHF cohort and 3.4% in the non-KHF cohort had a diagnosis of PVR (H35.2) (p=0.00, OR 3.2; 95% CI, 2.13-4.71). 8.3% of patients in the KHF cohort and 5.4% of patients in the non-KHF cohort underwent complex RD repair (CPT 67113) (p=0.008; OR 3.2; 95% CI, 1.13-2.25). When including all RD repair types (CPT 67108, 67110, 67107), the rate of PVR diagnosis was still significantly greater in the KHF vs non-KHF cohort (9.0% vs 4.2%, p < 0.01; OR 2.28 (1.64-3.16). A dermatologic history of keloids, hypertrophic scarring, or fibrosis may be a risk factor for proliferative vitreoretinopathy after retinal detachment repair.

Vitreous Biomarkers for Proliferative Vitreoretinopathy Prognostication in Patients Undergoing Primary Retinal Detachment Repair.

To compare baseline levels of exploratory biomarkers in the vitreous fluid of patients with primary retinal detachment who subsequently develop proliferative vitreoretinopathy (PVR) versus those who do not. In this exploratory case-control study, we evaluated the baseline protein biomarker levels from a biobank containing the vitreous fluid of patients who had undergone primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Undiluted samples were collected at the time of PPV and stored at -80°C. Samples from 13 patients who developed PVR within 6months (PVR group) and 13 age- and gender-matched controls who did not develop PVR (control group) were included. Protein abundance levels were evaluated using a proximity extension assay, and a confirmatory enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of vimentin. Baseline vimentin (Normalized Protein eXpression [NPX], 8.6 vs. 6.4, P < 0.0001) and heme oxygenase 1 (NPX 8.9 vs. 7.0, P < 0.001) levels were found to be elevated in vitreous fluid of patients who subsequently developed PVR compared to those who did not. Confirmatory analysis using ELISA demonstrated mean vimentin concentrations of 7254 vs. 2727 ng/mL in the PVR versus control groups (P = 0.0152). The odds ratio for developing PVR was 14 (confidence interval, 1.4-168; P = 0.03), assuming a baseline vimentin threshold of 7500 ng/mL. Vimentin is an intermediate filament protein expressed by retinal glial cells, and our data combined with prior evidence suggest that it may serve as an early vitreous biomarker for subsequent PVR formation and reactive gliosis. Furthermore, we found, for the first time, elevated baseline levels of heme oxygenase 1, a measurable indicator of oxidative stress. Our positive findings could impact clinical care for retinal detachment patients by facilitating risk stratification for targeted interventions or closer monitoring in those at the highest risk of developing PVR.

Morphological and Clinical Characterization of Foveal Bulge Sign Three Years After Retinal Detachment Repair: A Longitudinal Prospective Evaluation.

To evaluate optical-coherence-tomography (OCT)-morphological and clinical parameters three years after primary rhegmatogenous retinal detachment (RRD) repair surgery and the role of postoperative foveal bulge sign. Of the 32 initially enrolled patients with primary RRD 20 (14 fovea-on, 6 fovea-off) completed this prospective study. Preoperatively and 3 years after surgery best corrected visual acuity (BCVA) and OCT including macula status, central retinal thickness (CRT), central choroidal thickness (CCT), thickness of each single retinal layer, integrity of cone-interdigitation-zone (CIZ) and ellipsoid zone (EZ), and presence of foveal bulge were evaluated. Preoperatively fovea-off RRD patients show significantly thinner CCT, inner nuclear layer (INL) and inner plexiform layer (IPL) compared to fovea-on RRD patients, whereas only IPL and INL were significantly thicker compared to the fellow eye. Three years after surgery this thickening recovered. Final BCVA did not differ statistically significantly between fovea-off and fovea-on patients, no difference in CIZ-integrity or presence of foveal bulge was observed. Presence of foveal bulge at 3 years showed significantly better final BCVA and was associated with intact preoperative CIZ-integrity and postoperative EZ- and CIZ-integrity. The preoperative fovea status showed no correlation to the postoperative presence of foveal bulge. Three years after RRD repair retinal layers show similar thickness. The presence of foveal bulge is associated with better final BCVA. Sufficient pre- and postoperative CIZ-integrity as well as postoperative CIZ-integrity seem to be strongly associated with the restoration of foveal bulge. No correlation was found with the preoperative macular status or BCVA.

Optical coherence tomography angiography of the foveal avascular zone after successful macula‐off rhegmatogenous retinal detachment repair

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA).Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls.Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) (p &lt; 0.001). FAZ was significantly larger (323.09 ± 129.03 μm2 vs. 245.27 ± 93.15 μm2; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm (p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 (p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 (p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm (p &lt; 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness (r = −0.520, p = 0.016) and CFT (r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters.Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome.

Repair of Rhegmatogenous Retinal Detachment in Choroideremia Secondary to Posterior Extramacular Retinal Hole.

Repair of Rhegmatogenous Retinal Detachment in Choroideremia Secondary to Posterior Extramacular Retinal Hole.

OUTCOMES OF PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT REPAIR USING SILICONE OIL TAMPONADE IN VITREORETINAL SURGERY

In a prospective observational study, we aimed to determine anatomical and functional outcomes, as well as possible complications, following pars plana vitrectomy (PPV) with silicone oil (SO) tamponade for primary, uncomplicated rhegmatogenous retinal detachments. This study was conducted from August 2023 to November 2023. During the study, 32 patients underwent surgical repair through PPV and SO injection. PPV over scleral buckling was chosen when cataracts or vitreous hemorrhages hindered proper fundus visualization. Patients received comprehensive ocular assessments, including best-corrected visual acuity, anterior segment examination, IOP measurements via applanation, and fundus examinations at different intervals: 1 day, one week, one month, and three months. Intraocular pressure exceeding 21 mmHg was defined as increased IOP. Our study included 32 patients (22 men and ten women) of Asian ethnicity who underwent retinal detachment repair by PPV and SO injection. The patients had an average age of 57.8 ± 10.1 years (34–76 years) at the time of intervention. The follow-up period was three months. An anatomical success rate, defined as retinal reattachment three months after SO removal, was achieved in 29 eyes (90.6%). Final best-corrected visual acuity (BCVA) improved 26 looks (81.2%), with a mean gain of 3 Snellen lines. BCVA remained unchanged in 4 eyes (12.5%) and deteriorated in 2 eyes (6.3%), with a mean loss of 2 Snellen lines. During the 3-month follow-up period, 17 eyes (53.1%) experienced increased intraocular pressure (IOP). Out of these, 15 patients had transient ocular hypertension, requiring topical treatment during the immediate postoperative period (within one month). Only one eye (5.9%) required filtrating drainage surgery for IOP control. Notably, no eyes developed optic neuropathy due to elevated IOP during this short-term follow-up. Pars plana vitrectomy (PPV) combined with silicone oil (SO) injection is a safe and effective surgical approach for treating primary uncomplicated rhegmatogenous retinal detachment. Our series indicates that PPV and SO injection lead to good anatomical and functional outcomes, with high reattachment rates and low rates of proliferative vitreoretinopathy. Although cataract formation and elevated intraocular pressure (IOP) are common complications, they can be successfully controlled.

Disparity in Medicare Reimbursement Between Female and Male Vitreoretinal Surgeons.

Purpose: To quantify the Medicare reimbursement disparity between female and male vitreoretinal surgeons. Methods: Reimbursement reports were obtained from the US Center for Medicare and Medicaid Services from 2013 through 2020, which detail all Medicare Part B services. A vitreoretinal surgeon was defined as any provider with at least 10 charges of a Healthcare Common Procedure Coding System code related to vitrectomy or retinal detachment repair. Providers were grouped by sex, and the average total reimbursement rate and additional secondary statistics to quantify the reimbursement disparity were identified. Results: On average, female vitreoretinal surgeons were reimbursed 65% that of their male counterparts in 2020, $1.66 million to $2.56 million. The percentage of the average male vitreoretinal specialist's total reimbursement that the average female vitreoretinal specialist received decreased 8.8% from 2013 to 2020, from 73.8% to 65.0%. Conclusions: The reimbursement that the average female vitreoretinal surgeon receives from Medicare is only two thirds that of the average male vitreoretinal surgeon. In addition, there was no identifiable improvement in this disparity over the study period. Further efforts must be taken to establish concerted efforts to improve the reimbursement disparity and to identify the systematic inequities that led to its presence in the first place.

REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial

BackgroundFew large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade.MethodsEligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8–10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results.DiscussionThis will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina’s recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary.Trial registrationClinicalTrials.gov NCT05863312. Registered on 18 May 2023.

An Unusual Case of an Open Globe due to Airbag Injury and Scleral Lens Use

A 30-year-old woman who wears scleral contact lenses for keratoconus was brought to the emergency room after a motor vehicle collision where a deployed airbag hit her left eye. The patient was taken to the operating room for globe exploration and found to have two large scleral lacerations (one superiorly and one temporally) with significant uveal prolapse. After primary repair, she developed a retinal detachment with proliferative vitreoretinopathy, vitreous hemorrhage and a full hyphema. She underwent a vitrectomy, retinal detachment repair and penetrating keratoplasty corneal transplant. We believe the extent of her trauma is due to a unique mechanism of injury in which the scleral lens acted like a punch, creating two scleral lacerations, and expulsing the ciliary body. To our knowledge, this is the first report of scleral lens induced open globe trauma.

CHARACTERISTICS, OUTCOMES, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES OF MACULAR HOLE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate full-thickness macular holes (FTMHs) that develop after rhegmatogenous retinal detachment (RRD) repair. Retrospective consecutive case series of patients who underwent RRD repair between 2015 and 2021 and subsequently developed FTMH. Twenty-three patients (23 eyes) were included. All eyes underwent pars plana vitrectomy + membrane peel for macular hole (MH) repair. The mean age at RRD diagnosis was 62 years and 52% were male. In total, 78% were macula-off RRDs. Fourteen eyes (60.9%) underwent pars plana vitrectomy alone, 7 (30.4%) underwent pars plana vitrectomy and scleral buckling, 1 (4.3%) underwent scleral buckling only, and 1 (4.3%) underwent pneumatic retinopexy. Median time from RRD repair to MH diagnosis was 116 days. Macula-off RRDs had a significantly lower time to MH diagnosis (mean 154 days, P < 0.05) than macula-on RRDs (mean 875 days). Twenty-one MH (91%) had optical coherence tomography evidence of an epiretinal membrane. Mean logMAR visual acuity at MH diagnosis was 1.05 (∼20/224) and significantly improved to 0.66 (∼20/91) at the final follow-up ( P < 0.001); 100% of MHs closed by the final follow-up. Pars plana vitrectomy for MH after RRD repair has a high closure rate and leads to significant VA improvement. MH formation after RRD repair may be associated with macula-off detachments and epiretinal membrane. Macula-off RRDs develop MH faster than macula-on RRDs.

Orbital compartment syndrome following primary scleral buckle surgery.

To illustrate a patient with orbital compartment syndrome following scleral buckle placement that was successfully treated with canthotomy and cantholysis. Observational case report. A 26-year-old male underwent a primary scleral buckle repair for a chronic rhegmatogenous retinal detachment. On post-operative day four, the patient presented to the emergency room with pain and increased intraocular pressure (IOP). Initial treatment with conservative IOP lowering agents was unsuccessful. The patient was diagnosed with delayed orbital compartment syndrome and was successfully managed with lateral canthotomy and inferior cantholysis in addition to aggressive steroid and antibiotic medical management. Following scleral buckle placement with sub-tenon's anesthesia block, there may be a delayed presentation of orbital compartment syndrome. Recognition and management of this rare complication is important for preventing irreversible blindness.

Role of Intrasilicon Oil Methotrexate Injection to Prevent Development of Proliferative Vitreoretinopathy

Purpose: To determine the role of intra-silicon oil methotrexate injection to prevent Proliferative Vitreoretinopathy. Study Design: Quasi experimental Study. Place and Duration: Ophthalmology department of Sahiwal Teaching Hospital, Sahiwal from February 2022 to August 2022. Methods: Study included patients of either gender, older than 19 years with rhegmatogenous retinal detachment with Proliferative vitreoretinopathy (PVR) grade B or less. There were two groups and each group had fifty-one patients. All patients underwent pars plana vitrectomy and silicon oil tamponade. Group 1 was control group. Group 2 had intravitreal injections of methotrexate 500mg at the end of surgery. We repeated the injections at 1st, 2nd, and 4th week postoperatively. Results: There were 56 (54.9%) male and 46 (45.1%) female patients. Postoperatively visual acuity improved in thirty cases (58.82%) in group 1 and in forty-two cases (82.35%) in group 2. Postoperatively PVR developed in 11 (21.57%) patients in group 1 while in group 2 no patient had PVR. Recurrent Retinal detachment occurred in 9 (19.61%) patients in group 1 and 3 (5.88%) patients in group 2. Chi square test demonstrated statistically significant difference in the frequency of development of PVR and re-detachment of retina between two groups, p&lt;0.05. Conclusion: Methotrexate is an effective adjuvant used in Pars plana Vitrectomy for rhegmatogenous retinal detachment repair. It prevents Proliferative vitreoretinopathy resulting in better surgical and functional outcome.

Effect of Oral Riboflavin and Direct-sun UV-A on Tumor Necrosis Factor Alpha (TNF-α) Concentrations in Tears of Mild-Moderate Keratoconus Patients

Purpose: To determine the role of intra-silicon oil methotrexate injection to prevent Proliferative Vitreoretinopathy. Study Design: Quasi experimental Study. Place and Duration: Ophthalmology department of Sahiwal Teaching Hospital, Sahiwal from February 2022 to August 2022. Methods: Study included patients of either gender, older than 19 years with rhegmatogenous retinal detachment with Proliferative vitreoretinopathy (PVR) grade B or less. There were two groups and each group had fifty-one patients. All patients underwent pars plana vitrectomy and silicon oil tamponade. Group 1 was control group. Group 2 had intravitreal injections of methotrexate 500mg at the end of surgery. We repeated the injections at 1st, 2nd, and 4th week postoperatively. Results: There were 56 (54.9%) male and 46 (45.1%) female patients. Postoperatively visual acuity improved in thirty cases (58.82%) in group 1 and in forty-two cases (82.35%) in group 2. Postoperatively PVR developed in 11 (21.57%) patients in group 1 while in group 2 no patient had PVR. Recurrent Retinal detachment occurred in 9 (19.61%) patients in group 1 and 3 (5.88%) patients in group 2. Chi square test demonstrated statistically significant difference in the frequency of development of PVR and re-detachment of retina between two groups, p&lt;0.05. Conclusion: Methotrexate is an effective adjuvant used in Pars plana Vitrectomy for rhegmatogenous retinal detachment repair. It prevents Proliferative vitreoretinopathy resulting in better surgical and functional outcome.

Microvascular changes after pars plana vitrectomy for rhegmatogenous retinal detachment repair: A comparative study based on gas tamponade agent.

The purpose of this study was to investigate the effect of gas tamponade on microvascular changes in patients with rhegmatogenous retinal detachment (RRD), who underwent pars plana vitrectomy (PPV), using optical coherence tomography angiography (OCTA). Participants in this study were 48 patients with RRD, who were treated with PPV and gas tamponade without internal limiting membrane peeling. All participants underwent slit-lamp examination, fundoscopy, spectral domain-optical coherence tomography and optical coherence tomography angiography at month 6 postoperatively. The fellow untreated eyes were also examined and served as the control data. A statistically significant enlargement in the foveal avascular zone (FAZ) in both the superficial (p = 0.002) and the deep capillary plexus (p = 0.01) was noticed 6 months postoperatively in patients with RRD treated with PPV compared to the fellow eyes. The foveal avascular zone perimeter was increased in the operated eyes in the deep capillary plexus (p = 0.0003) and the foveal avascular zone circularity was decreased in both the superficial (p = 0.045) and the deep capillary plexus (p < 0.001) compared to the fellow eyes. The vessel density was not significantly different between the operated and the fellow eyes in the superficial and the deep capillary plexus. The vessel density and the foveal avascular zone parameters were comparable between the C3F8 and SF6 groups. Specific microvascular indices as measured by OCTA were statistically different between the operated and the fellow eyes in the superficial and deep capillary plexus. C3F8 and SF6 as gas tamponades did not seem to differ in their impact on the microvascular parameters.

Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant.

To assess the risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant (Ozurdex®) of patients with macular oedema (MO) secondary to rhegmatogenous retinal detachment repair (RRDR). This was a retrospective, consecutive cohort study conducted in patients who underwent RRDR between January 2014 and December 2020 in the Rothschild Foundation Hospital and experienced postoperative MO (POMO) with a follow-up of at least 18 months. Of the 1152 patients screened, 36 eyes (3.1%) experienced POMO. The mean follow-up duration was 45.2 months (18.0-80.5 months). Twenty-five eyes (69.4%) were resistant to first-line therapy and received at least one Ozurdex® injection (mean number: 2.7 [1-12]). The multivariate analysis showed an increased risk of resistance in patients who underwent perfluorocarbon liquid (PFCL)-assisted drainage (adjusted odds ratio: 8.65; 95% confidence interval: 1.97-15.33; p = 0.01). Significant differences in best-corrected visual acuity and central macular thickness were found between before Ozurdex® injection and the last follow-up visit: from 0.57 ± 0.47 LogMAR to 0.34 ± 0.32 LogMAR (p = 0.02) and from 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p = 0.001), respectively. The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were associated with a higher resistance and a poorer response to Ozurdex®. Two patients (8%) experienced hypertony, that was well controlled with hypotonic drops. MO secondary to RRDR is challenging. Ozurdex® could be reasonably proposed as first-line treatment, at least when MO occurs following PFCL-assisted drainage, given the favourable long-term benefit/risk ratio.

An Evaluation of the Repeatability of Visual Function Following Surgical Repair of Macula-Off Rhegmatogenous Retinal Detachment.

To evaluate the reliability and reproducibility of visual function assessments for patients with macula-off rhegmatogenous retinal detachment (RRD). This prospective study included patients with unilateral macula-off RRD of <10-day duration successfully treated with a single, uncomplicated surgery at least 1 year following repair. Visual function assessments were performed at time of enrollment and 1 month later. Testing included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-contrast visual acuity (VA) 2.5% and 5%, contrast sensitivity assessment with Mars and Gabor patches, reading speed (acuity, speed, and critical print size), color vision testing (protan, deutan, and tritan), and microperimetry. Spectral-domain ocular coherence tomography (SD-OCT) was performed. Paired t-statistics were used to compare values between visits and between the study and fellow eyes. Fourteen patients (9 male, 5 female) with a mean age of 69 years at time of surgery were evaluated. Correlation coefficients across the two visits were highest for ETDRS BCVA (0.97), tritan color vision testing (0.96), and low-contrast VA 5% (0.96), while the average t-statistic was largest for low-luminance deficit (4.2), ETDRS BCVA (4.1), and reading speed critical print size (3.7). ETDRS BCVA did not correlate with SD-OCT findings. ETDRS BCVA can be considered a highly reliable and reproducible outcome measure. LLVA, protan color discrimination, contrast sensitivity, and reading speed may be useful secondary outcome measures. This study provides guidance on the selection of visual function outcome measures for clinical trials of patients with macula-off RRD.

Risk Factors Associated with Cystoid Macular Edema among Patients Undergoing Primary Repair of Rhegmatogenous Retinal Detachment

To investigate predictors of the development and resolution of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. Retrospective cross sectional study. Patients who underwent primary repair of uncomplicated RRD. Demographics, ophthalmic history, visual acuity, RRD features, time to development/resolution of CME, OCT characteristics of CME/epiretinal membrane (ERM), type of surgery, and treatments were collected. Logistic regressions were used to identify predictors of CME development and resolution. Predictors of CME development and resolution. A total of 708 eyes were included, of which 55 (7.8%) developed CME. Factors associated with an increased risk of CME development included total number of retinal detachment surgeries (odds ratio [OR] 1.66 [1.24-2.23], P < 0.001), prior intraocular surgery (OR 4.43 [1.19-16.51], P= 0.03), and presence of ERM after surgery (OR 4.49 [2.30-8.74], P < 0.001). Patients undergoing pars plana vitrectomy (PPV) were more likely to develop CME compared with patients undergoing scleral buckling (SB; OR 3.09 [1.18-8.10], P= 0.02). A longer average time to CME detection was associated with lower CME resolution (OR 0.94 [0.89-0.998], P= 0.04). In patients who developed an ERM postsurgically, those who developed CME after ERM had a lower rate of resolution compared with those who developed CME before ERM (P= 0.03). Cystoid macular edema may be more likely to develop in patients undergoing PPV than SB, those who underwent more surgeries for RRD repair, those who had prior intraocular surgery, or those who developed an ERM after RRD repair. Resolution of CME may be affected by the time to detection of CME and ERM development. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.