Retinal Reattachment Procedure Research Articles

Inadvertent intraocular injection of methylprednisolone in a patient with prior superior oblique tuck surgery

Summary Background To report inadvertent intraocular methylprednisolone injection into an eye that had previously undergone superior oblique tuck surgery. Material and methods An observational case report. Results An inadvertent intraocular penetration occurred following periorbital methylprednisolone injection, which was performed via the superonasal quadrant to relieve trochlear pain in an eye that had undergone previous superior oblique tuck procedure. There was immediate loss of vision, afferent pupillary defect, and raised intraocular pressure. Fundoscopy revealed intravitreal and subretinal methylprednisolone with retinal detachment. Immediate removal of intravitreal and subretinal methylprednisolone was performed with a retinal reattachment procedure. Postoperatively, retinal necrosis was noted in the area that was in contact with methylprednisolone. Conclusions This case highlights the risk of inadvertent intraocular penetration while injecting through a limited periorbital space that has been previously operated on.

Update on pneumatic retinopexy.

Pneumatic retinopexy is an effective, cost-efficient procedure for retinal detachment repair. We review the history, indications, procedure, outcomes, economics, and trends regarding this in-office procedure. Pneumatic retinopexy is classically performed in patients with small, superior retinal breaks, but these indications are expanding, with good results. Retinal reattachment rates with pneumatic retinopexy vary from 60% to 91% depending upon patient selection. Pneumatic retinopexy is less costly to perform than scleral buckling and pars plana vitrectomy and avoids many of the complications associated with these procedures. Despite these good results, recent data suggest that the use of pneumatic retinopexy is on the decline. Recent review of the literature and our own personal experience using pneumatic retinopexy in selected cases of retinal detachment indicate that it is an effective and inexpensive procedure that avoids many of the complications that are associated with other retinal reattachment procedures.

Visual recovery in a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision: a case report

IntroductionWe report the case of a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision, who regained counting fingers vision with complete regression of neovascularization following anterior chamber washout, intravitreal bevacizumab, pars plana vitrectomy, and silicone oil placement. This represents a rare case in which a patient with no light perception vision was able to regain functional vision.Case presentationA 63-year-old Caucasian man with a 55-year history of long-standing retinal detachment after trauma presented to our facility with pain and redness, a total hyphema, no light perception vision and an intraocular pressure of 60 mmHg (right eye). He had a history of diabetes mellitus and coronary artery disease. Following anterior chamber washout, he was found to have neovascular glaucoma, for which intravitreal bevacizumab was administered. After washout and intraocular pressure control, his visual acuity improved to light perception. He subsequently underwent vitrectomy, membrane peeling, endolaser and silicone oil placement to reattach his retina, and then a second retinal reattachment procedure. Following these procedures, he had visual recovery to counting fingers vision in his right eye at five metres, complete regression of neovascularization, and intraocular pressure of 10 to 12 mmHg on one antiglaucoma medication.ConclusionFunctional vision can be regained despite long-standing retinal detachment.

Internal Drainage of a Retinal Macrocyst With an Nd:YAG Laser to Aid Primary Retinal Reattachment

Retinal macrocysts are an occasional finding in patients with long-standing retinal detachments. The cysts usually do not require any specific treatment during procedures to repair retinal detachment and resolve spontaneously after retinal reattachment. However, if the cyst is adjacent to a retinal break and prevents its closure, the retinal reattachment procedure can fail. We describe a technique using the Nd:YAG laser to perforate the retinal cyst postoperatively, which allows for subsequent break closure and retinal reattachment.

Giant retinal tear after pneumatic retinopexy

Editor, M ost giant retinal tears are idiopathic (Wilkinson & Rice 1997). Males with pathological myopia are at risk. The second most common cause of giant retinal tears is blunt trauma. Surgical manipulation such as anterior vitrectomy can also be a cause (Wilkinson & Rice 1997). We report a case of giant retinal tear developed after pneumatic retinopexy and illustrate the pathogenesis of this rare and vision-threatening complication. A 54-year-old, non-myopic Chinese man presented with unprovoked floaters in the left eye. Visual acuity (VA) was 20 ⁄ 20 in both eyes. Anterior segments were unremarkable. Fundal examination of the left eye showed a superior rhegmatogenous retinal detachment extending from the 10 to the 2 o’clock position, with a small break and lattice degeneration at 12 o’clock. The right fundus was unremarkable. The patient underwent pneumatic retinopexy with cryopexy around the primary break and injection of 0.3 mL 100% C3F8 gas. Postoperatively, sitting upright with facedown posture was recommended. Ten days later, the superior retinal detachment was completely reattached. However, a giant retinal tear extending from 12 to 4 o’clock with pars plana detachment was noted (Figs 1 and 2). Scleral buckling, pars plana vitrectomy, perfluorocarbon liquid, endolaser, cryopexy and 20% SF6 gas)fluid exchange were performed. The retina remained flat with VA of 20 ⁄ 70 at 8 months postoperatively. There was mild nuclear sclerosis pending cataract extraction. Pneumatic retinopexy is a safe retinal reattachment procedure involving the transconjunctival injection of gas into the vitreous cavity, cryopexy or laser retinopexy, and posturing. Complications of this procedure are rare, and consist of new retinal break formation, subconjunctival gas, subretinal gas, gas entrapment at the pars plana, shift of detachment into previously attached macular and

Is prophylactic 360° laser retinopexy protective?: Risk factors for retinal redetachment after removal of silicone oil

Objectives To identify risk factors for retinal redetachment after removal of silicone oil. To determine the effectiveness of prophylactic laser in preventing retinal redetachment after removal of silicone oil. Design A nonrandomized retrospective comparative interventional trial. Participants Three hundred seventy-six patients undergoing vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment at one institution over a 4-year period. Two hundred eighty-seven patients with fully attached retinas subsequently underwent removal of silicone oil. One hundred thirty-eight cases had undergone prophylactic 360° laser retinopexy before removal of silicone oil, either at the time of their final retinal reattachment procedure (n = 36) or as a separate supplementary procedure (n = 102). Methods A retrospective case note review was performed to identify clinical and demographic factors associated with increased or reduced odds of retinal redetachment after removal of silicone oil. Both univariate and multiple variable analysis were used to identify significant risk factors. Main outcome measures Incidence of retinal redetachment after removal of silicone oil. Results Median follow-up after removal of silicone oil was 272 days. Three hundred sixty–degree prophylactic laser retinopexy was associated with a reduction from 26% to 14% in the incidence of redetachment after removal of silicone oil (adjusted odds ratio, 0.42; 95% confidence interval, 0.22–0.78; P = 0.006). Patients requiring further retinal reattachment surgery after their first oil procedure were at twice the odds of re-detachment after oil removal (adjusted odds ratio, 2.10; 95% confidence interval, 1.03–4.26; P = 0.04). Conclusions The need for retinal reattachment surgery subsequent to a first silicone oil procedure was associated with twice the odds of retinal redetachment after removal of silicone oil. Prophylactic laser retinopexy may halve the incidence of retinal redetachment after removal of silicone oil.

Complications of pneumatic retinopexy.

Pneumatic retinopexy is a retinal reattachment procedure involving transconjunctival injection of gas into the vitreous cavity, combined with cryotherapy or laser retinopexy and followed by postoperative positioning. Although generally a safe procedure, it may be associated with certain adverse outcomes. These most commonly include misplaced gas injection, subretinal gas, vitreous hemorrhage, new retinal breaks, failure to reattach the retina, proliferative vitreoretinopathy, and delayed reabsorption of subretinal fluid. Less common problems include endophthalmitis, macular folds, angle-closure glaucoma, and macular hole. In most cases, complications are successfully managed, and a favorable outcome is achieved.

Pars Plana Cicatrization of Sewn-In Posterior Chamber Intraocular Lens Haptics

The authors describe the unexpected finding of cicatrization of posterior chamber lens haptics to the pars plana. This was found during removal of a secondary, transscleral sewn-in pseudophakos during a retinal reattachment procedure. Ophthalmic history and intraoperative photography revealed pars plana cicatrization of haptics. Despite removal of trans-scleral prolene fixation sutures and application of gentle traction, the posterior chamber lens haptics remained firmly adherent to pars plana retina. The haptics were amputated to prevent significant chorioretinal damage. The conventional belief that all sewn-in posterior chamber intraocular lenses cause little or no scarring response around the haptics may be unfounded.

Pilot trial of transscleral diode laser retinopexy in retinal detachment surgery.

To evaluate the safety and efficacy of the transscleral diode laser for retinopexy in rhegmatogenous retinal detachments. Ten consecutive patients with primary rhegmatogenous retinal detachments underwent scleral buckling surgery, using the transscleral diode laser for retinopexy. Patients were followed up for at least 6 months. Ten patients with primary rhegmatogenous retinal detachments were enrolled. Patients with chronic detachments, a retinal break greater than 90 degrees, history of uveitis or infectious retinopathy, or proliferative vitreoretinopathy were excluded. Retinal reattachment. Secondary measures: visual acuity and complications, including choroidal, retinal, and vitreous hemorrhage, inflammation, and scleral damage. By 6 months, nine of 10 retinas were successfully repaired following only one operation. The retina of the 10th patient redetached at 6 1/2 weeks owing to proliferative vitreoretinopathy. Following a vitrectomy and retinal reattachment procedure, the retina of the 10th patient has remained attached for 1 year. No significant complications were encountered with the laser retinopexy, although small presumed breaks in Bruch's membrane occurred in three eyes and a moderate scleral thermal effect occurred in two. Visual results in the postoperative course were comparable to those achieved previously with cryotherapy. In this pilot series, transscleral diode laser retinopexy served as a safe and effective means of obtaining chorioretinal adhesion in retinal detachment surgery.

Visual Acuity in Infants after Vitrectomy for Severe Retinopathy of Prematurity

During the course of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP), 98 infants (129 eyes) from the randomized segment of the trial developed total retinal detachment from retinopathy of prematurity (ROP) before the 1-year examination. The authors report as a case series the results of acuity card assessment of monocular grating acuity at 1 year in 53 infants (71 eyes) postvitrectomy and in 45 infants (58 eyes) who had retinal detachments but who did not undergo retinal reattachment surgery. The decision to undertake and the surgical technique used for a retinal reattachment procedure was not part of the randomized CRYO-ROP trial. Two eyes of one infant had pattern vision at the lowest measurable threshold after vitrectomy. None of the remaining eyes that had undergone vitrectomy and none of the eyes that did not undergo vitrectomy showed evidence of pattern vision. The relatively poor visual outcomes in this case series suggest that efforts are well-spent in attempting to prevent retinal detachment in ROP.

Expulsive Suprachoroidal Hemorrhage With Scleral Buckling Surgery

Intraocular hemorrhage is one of the most serious complications that can occur during a retinal reattachment procedure. We describe a patient who developed a massive suprachoroidal hemorrhage during a scleral buckling procedure with extrusion of intraocular contents through a penetrating keratoplasty incision. Report of a Case. —A 62-year-old healthy white woman presented with a rhegmatogenous retinal detachment in her left eye on April 26, 1989. She had undergone a combined cataract extraction with lens implant and penetrating keratoplasty in January 1988. Her corneal sutures were removed in November 1988. A neodymium-YAG laser posterior capsulotomy was performed in March 1989. During retinal surgery, cryotherapy under direct visualization was applied to an area of anterior circumferential lattice in the 2 o'clock position and an adjacent retinal tear. The vortex ampulla and veins were not treated. Intrascleral sutures were placed in each quadrant without premature drainage. The buckle and band were put into

Visual Acuity in Infants after Vitrectomy for Severe Retinopathy of Prematurity

During the course of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP), 98 infants (129 eyes) from the randomized segment of the trial developed total retinal detachment from retinopathy of prematurity (ROP) before the 1-year examination. The authors report as a case series the results of acuity card assessment of monocular grating acuity at 1 year in 53 infants (71 eyes) postvitrectomy and in 45 infants (58 eyes) who had retinal detachments but who did not undergo retinal reattachment surgery. The decision to undertake and the surgical technique used for a retinal reattachment procedure was not part of the randomized CRYO-ROP trial. Two eyes of one infant had pattern vision at the lowest measurable threshold after vitrectomy. None of the remaining eyes that had undergone vitrectomy and none of the eyes that did not undergo vitrectomy showed evidence of pattern vision. The relatively poor visual outcomes in this case series suggest that efforts are well-spent in attempting to prevent retinal detachment in ROP.

Retinal relieving incisions.

Retinal relieving incisions were undertaken during closed microsurgery for the treatment of retinal detachment complicated by retinal shortening as a result of incarceration or irresectable epiretinal membranes. In 16 of 20 eyes the retina remained attached after a minimum follow up of six months. Visual acuity of 2/60 or better was achieved in eleven of the 20 eyes and seven eyes had an acuity of 6/60 or better. Retinal relieving incisions are required in a minority of retinal re-attachment procedures and are compatible with useful visual function.

Interaction of intraocular air and sulfur hexafluoride with nitrous oxide: a computer simulation.

The diffusion dynamics of intravitreal gas bubbles injected during retinal reattachment procedures were studied using a mathematical model. This model predicts the effect of 70 per cent nitrous oxide anesthesia on the volume of the intravitreal bubble. The calculations indicate that when 70 per cent nitrous oxide administration is continued following intravitreal gas injection, there is a rapid, almost threefold increase in the volume of the injected bubble. When nitrous oxide is discontinued at the time of intravitreal injection, a maximum initial bubble expansion of only 35 per cent occurs. If nitrous oxide is discontinued 15 minutes prior to intravitreal injection, the mathematical model indicates that, at most, there will be a 15 per cent expansion of the bubble volume. The model calculations indicate that there is little difference in intravitreal bubble volume whether air of 100 per cent oxygen is used during the anesthetic. The two major factors that influence intravitreal bubble volume are the mixture of air or SF6 injected and the pattern of nitrous oxide use during anesthesia. These factors can be controlled. The importance of bubble volume changes on intraocular pressure and retinal blood flow also depend on other factors such as scleral rigidity, blood pressure, the presence of glaucoma, and the size of the injected gas bubble relative to the total vitreal volume.

Accidental Self-inflicted Burns as a Complication of Bilateral Patching

To the Editor. —Bilateral patching is a common practice in the treatment of many eye disorders. Problems arising from bilateral occlusion include dissociative reactions and accidental selfinflicted trauma. We would like to emphasize the dangerous combination of bilateral patching and cigarette smoking. A 72-year-old man was admitted to Barnes Hospital Retina Service, St Louis, for a retinal reattachment procedure to be performed on his left eye. His general medical condition was good. He had no coordination problems and was alert and oriented. No patching was done preoperatively. He underwent an uncomplicated retinal reattachment procedure under local anesthesia and was bilaterally patched on flat bed rest. Two eye patches (Chaston) were secured to the face with 2.5-cm paper tape. On the first postoperative day the patient freed the inferior half of the right patch by releasing the paper tape from his cheek. While the patient attempted to light a cigarette, the