Rhegmatogenous Retinal Detachment Research Articles

VITRECTOMY AND COMPLETE DRAINAGE OF SUPRACHOROIDAL FLUID WITHOUT PERIOPERATIVE STEROIDS FOR RHEGMATOGENOUS RETINAL DETACHMENT COMBINED WITH CHOROIDAL DETACHMENT: A RANDOMIZED CLINICAL TRIAL.

To investigate the surgical effect of complete drainage of suprachoroidal fluid (SCF) before vitrectomy to avoid perioperative steroids in rhegmatogenous retinal detachment combined with choroidal detachment (RRD-CD) eyes. It was a prospective, randomized controlled trial. 58 eyes were randomly divided into the no steroids (NS) group and local steroids (LS) group, 29 eyes each, respectively. Patients in the LS group received a single preoperative periocular injection of methylprednisolone, while SCF drainage was performed before vitrectomy in eyes of the NS group. Follow-up assessments were performed at 1 week, 1 month, 3 months, 6 months postoperatively. The postoperative retinal reattachment rate was similar in the NS and LS groups (96.6% vs 93.1%, p = 1.00). Best-corrected visual acuity was improved in 72.4% and 75.9% in the NS and LS groups, respectively. Inflammation occurred in 5 eyes (17.2%) in the NS group and 6 eyes (20.7%) in the LS group (p = 0.74). Hypotony occurred in 11 (37.9%) and 14 (48.3%) eyes in the LS and NS groups (p = 0.43), respectively. Macular chorioretinal folds were found in 21 (72.4%) and 22 (75.9%) eyes in the LS and NS groups (p = 0.76), respectively. Hypotony and chorioretinal folds disappeared after 1 week postoperatively. Preoperative steroids may not be necessary for RRD-CD patients if the SCF is completely drained before vitrectomy. Postoperative retinal reattachment does not depend on the use of preoperative steroids; instead, surgeons should focus on improving surgical techniques in RRD-CD to improve the retinal reattachment rate.

Vitrectomy With Short-Term Perfluorocarbon Liquid Tamponade for Retinal Detachment With Inferior Retinal Breaks and Proliferative Vitreoretinopathy.

Purpose: To assess and compare the results of pars plana vitrectomy (PPV) with short-term perfluorocarbon liquid (PFCL) tamponade and combined PPV with scleral buckling to treat rhegmatogenous retinal detachment (RRD) with inferior retinal breaks complicated by proliferative vitreoretinopathy (PVR). Methods: The medical records of patients who had vitreoretinal surgery for RRD with inferior retinal breaks complicated by PVR were reviewed. Group 1 had PPV with PFCL, and Group 2 had PPV with scleral buckling. Silicone oil tamponade was used in all cases of PPV with scleral buckling. The anatomic and functional outcomes and duration of surgery were compared between the 2 groups. Results: Group 1 comprised 48 eyes and Group 2, 36 eyes. No statistically significant differences were found in the demographic and baseline clinical characteristics between the groups (P > .05). The mean (±SD) duration of the initial surgery was 42.82 ± 15.25 minutes (range, 25-65) in Group 1 and 81.46 ± 37.48 minutes (range, 45-115) in Group 2. The difference was significant (P < .001). At the end of the follow-up period, recurrent RD occurred in 3 eyes (6.2%) in Group 1 and 2 eyes (5.5%) in Group 2, with no significant difference (P > .05). There was no significant difference between the groups in the mean best-corrected visual acuity or mean intraocular pressure at 6 months (P > .05). Seven eyes (14.5%) in Group 1 had anterior chamber cells and flares after the initial surgery. The inflammation resolved with topical steroid application. Conclusions: The results of PPV with PFCL are similar to those of PPV with scleral buckling for managing RRD with inferior retinal breaks complicated by PVR. Favorable anatomic and functional outcomes are maintained.

Simple ab externo lens capsule removal in intraocular lens reuse and intrascleral fixation for intracapsular lens dislocation: A case report.

This study aimed to report and recall a simple method to remove the lens capsule ab externo when performing intrascleral fixation of an intracapsular intraocular lens (IOL) dislocation with reuse of the IOL. A 43-year-old Japanese male patient underwent pars plana vitrectomy, phacoemulsification, and IOL fixation for rhegmatogenous retinal detachment in the right eye 10 years prior. A 3-piece IOL was intraocularly fixed during the initial procedure. In December 2023, the patient presented with intracapsular IOL dislocation in his right eye, causing the IOL to descend into the vitreous cavity enveloped by its entire capsule. During surgery, an intravitreal dislocated IOL was placed over the iris with the entire capsule. The haptics on 1 side of the IOL were placed outside the eye through the corneoscleral wound. Subsequently, the lens capsule and Soemmerring's ring surrounding the haptics were removed. After the haptics were placed back over the iris, the same extraction procedure was performed for the remaining haptics. The IOL was intrasclerally fixed using a flange technique through the intrascleral tunnel at the 4 and 10 o'clock positions. One week postsurgery, the best-corrected visual acuity of the right eye was 20/16, and the corneal endothelial cell density was recorded as 2923 cells/mm2 (preoperative: 1650 cells/mm2). In cases of 3-piece IOL dislocation, employing the ab externo technique for lens capsule extraction has been proven to be a straightforward and efficient method. This approach facilitates the removal of the lens capsule around the IOL. If subsequent damage to the IOL is identified, it allows for easy conversion to replacement.

Increased risk of cystoid macular edema after cataract surgery in eyes previously vitrectomized for idiopathic epiretinal membrane.

To assess the rate and risk factors of cystoid macular edema (CME) both after isolated vitrectomy and after subsequent phacoemulsification in eyes with primary non-complicated rhegmatogenous retinal detachment (RRD) or idiopathic epiretinal membrane (ERM). Retrospective observation of institutional patients undergoing vitrectomy for RRD or vitrectomy with internal limiting membrane peeling for ERM from 2016 to 2021, further analyzing those who later underwent phacoemulsification. The CME rate was assessed within the first 6 months after both vitrectomy and cataract surgery. We included 187 phakic eyes with ERM and 311 with RRD undergoing isolated vitrectomy. Post-vitrectomy CME occurred in 12.8% of ERM cases compared to 1% in RRD cases (p<0.0001). Stage-4 ERMs and intraoperative laser were found associated with CME. After uncomplicated phacoemulsification, the CME rate was higher in eyes vitrectomized for ERM (13.8%) compared to RRD (2%, p=0.0055). Post-vitrectomy CME was found to be associated with an increased risk of post-cataract CME (OR 13.588, p=0.0187). In eyes undergoing phacoemulsification post-vitrectomy, the risk of CME is higher when vitrectomy was performed for ERM compared to RRD. The ERM-related intraretinal changes, together with the required surgical stress, may play a role in making these eyes more susceptible to CME.

Retinal detachments secondary to inferior retinal breaks: anatomic outcomes following the use of different surgical techniques

PurposeTo compare the anatomical and functional outcomes of pars plana vitrectomy (PPV) alone versus PPV with the addition of a scleral buckle in treating inferior rhegmatogenous retinal detachments (RRDs).MethodsComparative, retrospective...

Beyond the Surface: Investigating Silicone Oil's Impact on Macular Perfusion in Macula-off Rhegmatogenous Retinal Detachment via OCTA.

This study aims to compare macular vessel density (VD) in eyes with macula-off rhegmatogenous retinal detachment (RRD) after vitrectomy with gas or silicone oil (SO) tamponade. Patients with macula-off RRD who underwent vitrectomy with either gas or SO tamponade were included. Best-corrected visual acuity (BCVA) and VD in superficial and deep retinal capillary plexuses (SCP and DCP), choriocapillaris (CCP), and foveal avascular zone (FAZ) were assessed using optical coherence tomography angiography (OCTA). Comparisons were made with the unaffected fellow eye. Fifty patients (average age: 57.9±9.1 years) participated, with 26 eyes undergoing SO tamponade and 24 gas tamponade. No significant differences were found in baseline characteristics. Postoperative BCVA significantly improved in both groups. In the SO group, BCVA improved from 2.00±0.77 logMAR (20/2000 Snellen) to 0.95±0.52 logMAR (20/178 Snellen). In the gas tamponade group, BCVA improved from 2.12±0.70 logMAR (20/2636 Snellen) to 0.70±0.55 logMAR (20/100 Snellen) (p<0.001 for both groups). Moreover, the gas tamponade group achieved significantly better postoperative BCVA compared to the silicone oil group (p<0.05). SO tamponade group exhibited significantly lower VD in SCP, DCP, and CCP quadrants (p<0.05), while gas tamponade showed no significant differences. This study reveals a decrease in VD in SCP, DCP, and CCP induced by SO tamponade, suggesting potential toxic effects on macular perfusion. Gas tamponade resulted in superior BCVA outcomes and preserved VD. Further investigation into SO's underlying mechanisms and careful patient selection is warranted. Gas tamponade may offer better outcomes for macula-off RRD.

Changing age pattern and diverse outcomes of herpes zoster ophthalmicus: exploring the temporal trend, decrease in incident age and influence of treatment strategies.

Herpes Zoster Ophthalmicus (HZO) is a disease commonly affecting the elderly and immunocompromised. Over the last several years, a trend towards decreasing incident age, albeit with varying clinical features, has been observed. This temporal trend towards the younger age group necessitates a detailed evaluation to determine possible causes of its occurrence in this population. This is a hospital-based retrospective study. 154 datasheets were initially identified. After excluding non-relevant data sheets (88), 56 relevant and complete records were subjected to comprehensive analysis in adherence to the inclusion criteria. Most commonly affected age group was < 40years, with the mean age being 38. Conjunctivitis was the most frequent occurrence seen in 82.05%. Keratitis was seen in varying forms as, epithelial (64.44%), stromal (15.3%) & nummular (3.57%). Anterior uveitis in 35.89%, posterior uveitis (retinitis, neuro-retinitis) in 7.69% of cases, posterior segment involvement (rhegmatogenous retinal detachment, optic atrophy) in 8.8%, secondary glaucoma in 28.2%, optic neuritis in 5.3% while orbital apex and cavernous sinus involvement were seen in one case. This study reflects a temporal shift in the incidence of HZO towards the younger age group. The proportion of younger patients with HZO is increasing with some male preponderance. Identifiable factors contributing to potential risk, recurrence, and chronicity of HZO are related to demographics, immune status, dietary, environmental associations, vaccination status, and previous history of recurrences. Reported outcomes can be valuable in understanding the evolving patterns of HZO and improving patient care, public health and vaccination policies.

Comparative proteomic analysis of human vitreous in rhegmatogenous retinal detachment and diabetic retinopathy reveals a common pathway and potential therapeutic target

BackgroundThe vitreous humor serves as a window into the physiological and pathological processes of the eye, particularly the retina. Diabetic retinopathy (DR), a leading cause of blindness, involves hyperglycemia-induced damage to retinal cells, leading to ischemia and elevated nitric oxide levels, culminating in vascular proliferation. Rhegmatogenous retinal detachment (RD) results from a break in the neuroretina, triggering ischemia, photoreceptor death, and cellular proliferation. Proliferative vitreoretinopathy (PVR) further complicates these conditions through fibrous proliferation. Despite their prevalence and potential for blindness, our understanding of the molecular mechanisms underlying these vitreoretinal diseases is incomplete.Methods and resultsTo elucidate disease mechanisms and identify potential therapeutic targets, we conducted a comparative proteomic analysis of vitreous samples from DR, RD, and macular pucker (P) patients, which were chosen as controls. LC–MS analysis identified 988 quantifiable proteins, with distinct clustering observed among disease groups. Differential expression analysis revealed 202 proteins in RD vs. P and 167 in DR vs. P, highlighting distinct proteomic signatures. Enrichment analysis identified glucose metabolism as an altered process in both diseases, suggesting common pathways despite differing etiologies. Notably, aldo–keto reductase family 1 member B1 (AKR1B1) has emerged as a potential key player in both DR and RD, indicating its role in glucose metabolism and inflammation. In silico drug screening identified diclofenac, an approved ophthalmic non-steroidal anti-inflammatory drug (NSAID), as a potential therapeutic agent targeting AKR1B1.ConclusionOur study revealed distinct proteomic signatures and common pathways in vitreoretinal diseases, highlighting AKR1B1 as a potential therapeutic target. Using diclofenac during diagnosis and postoperative care for diabetic retinopathy or rhegmatogenous retinal detachment may reduce complications, lower costs, and improve quality of life. Future research will focus on confirming AKR1B1’s role in vitreoretinal diseases and understanding diclofenac’s mechanism of action.

Operative Times in Scleral Buckle Surgery: Influencing Factors and Cost Analysis.

Purpose: To determine the various factors affecting the duration of scleral buckle surgery, the percentage of profitable scleral buckle cases, and the operational break-even point. Methods: This single-center retrospective consecutive series comprised patients diagnosed with primary rhegmatogenous retinal detachment (RD) repaired with scleral buckling between 2019 and 2021. The primary outcome was operative time. Factors associated with longer surgery time were identified using regression analysis. A time-driven activity-based cost analysis was performed. Results: Following are the mean values: duration of 108 primary RD scleral buckle repairs, 106 ± 35 minutes (range, 52-231; median, 98); number of breaks, 2.15 ± 1.5 (range, 0-10); extent of the RD, 4.3 ± 2.0 clock hours (range, 0-9); duration of follow-up with a retina physician, 489 ± 355 days (range, 0-1316). Twenty eyes (19%) required subsequent RD repair. A regression analysis showed the following main risk factors for prolonged duration of RD repair via scleral buckling: number of breaks (β = 5.98; P = .005), use of radial elements (β = 52.09; P = .001), and gas injection (β = 31.27; P < .001). The median cost per case was $7674.64, which was $2713.64 (55%) more than the maximum Medicare reimbursement of $4961.00. The break-even time was 54.43 minutes. Conclusions: Independent risk factors for a prolonged duration of primary scleral buckle surgery include multiple breaks, use of radial elements, and gas injection. These additive steps could justify a separate complex Current Procedural Terminology code. The large majority of cases were not profitable, with losses proportional to operative time. This study demonstrates the clear need for greater reimbursements and economic incentives for scleral buckle surgery.

Evaluation of post-operative foveal location and microstructural changes after pars plana vitrectomy for rhegmatogenous retinal detachment using enhanced-depth imaging optical coherence tomography

BackgroundPatients who had successful rhegmatogenous retinal detachment (RRD) surgery often complained of metamorphopsia due to postoperative fovea displacement and alteration of the foveal microstructure. The papillo-foveal distance (PFD) is correlated bilaterally. Therefore, PFD from the fellow healthy eye could be used to determine the change of foveal position in eyes with successful RRD repair. Ultra-high-resolution optical coherence tomography (UHR-OCT) could explain incomplete visual recovery by demonstrating foveal misalignment and changes in foveal microstructure. The rationale of the study is to assess the changes in the foveal location and microstructural layers after successful retinal reattachment and correlate them with visual dysfunction.Patients and methodsA prospective interventional cross-sectional controlled study included patients who had successful retinal reattachment and complained of defective vision or metamorphopsia. The primary outcome measure is to evaluate the post-operative foveal location. The secondary outcome measures are the assessment of metamorphopsia, the evaluation of the foveal microstructural changes, and the correlation between foveal shift, metamorphopsia, foveal microstructure, and visual function. We used a standard Amsler chart to detect subjective metamorphopsia and a modified Amsler chart to quantify metamorphopsia. We used the enhanced-depth imaging optical coherence tomography (EDI-OCT) to detect changes in PFD and the foveal microstructure. p < 0.05.ResultsThe study included 50 study eyes and 50 control eyes. The male gender constituted 70%. The mean age was 53 years. The mean baseline BCVA was 0.001. The incidence of foveal displacement was 70%. Disorganized retinal inner layers (DRIL) occurred in 56% of eyes, and disorganized retinal outer layers (DROL) occurred in 72% of eyes. The mean postoperative BCVA was 0.3. The subjective metamorphopsia was mild in 39%, moderate in 24%, severe in 33%, and very severe in 3% of eyes. The mean quantitative metamorphopsia was 587 mm. PVR correlated significantly with the foveal shift. DROL correlated significantly with subjective metamorphopsia. There was a statistically significant difference between subjective metamorphopsia and quantitative metamorphopsia.ConclusionFoveal displacement and metamorphopsia after successful retinal reattachment pose significant morbidity. UHR-OCT is pivotal in evaluating the anatomical outcome after successful retinal re-attachment surgery and its relation to visual function.

Early Retinal Detachments Following Open Globe Repair: Incidence and Risk Factors

Purpose: Risk factors for the development of rhegmatogenous retinal detachments (RRDs) in the early postoperative period following open globe repair (OGR) are not well understood. RRDs are often diagnosed late after OGIs, which can negatively impact visual prognosis. We assessed the incidence and risk factors that predict the development of this complication. Methods: We conducted a retrospective case-control study of all OGIs at a single ocular trauma center from January 2016 to September 2021 where at baseline the retina was attached. Cases were defined as postoperative RRDs that developed within 90 days of OGR. Results: Of 96 eyes included, 40 (41.7%) subsequently developed RRD. Univariate analysis revealed initial visual acuity (VA) of light perception (LP) or worse (OR 7.64; 95% CI, 3.03-19.22; p &lt; .01), zone 3 injuries (OR 7.54; 95% CI, 2.64-21.54; p &lt; .01), no view of the lens (OR 4.26; 95% CI, 1.77-10.26; p &lt; .01), and the presence of injuries external to the globe (OR 5.33; 95% CI, 2.09-13.63; p &lt; .01) to be associated with early RRD development. On multivariate analysis, presenting VA of LP (p &lt; .001), the presence of external injuries (p = .001), and zone 3 injuries (p = .037) remained significant. Of the 40 patients with early RD, 34 (85%) remained attached following repair, with variable visual outcomes. Conclusion: Presenting VA of LP, zone 3 injuries, and external injuries to the globe confer increased risk of early postoperative RRD after OGR. The majority of RRDs can be successfully repaired.

Suprachoroidal Space in Rhegmatogenous Retinal Detachment Assessed with Optical Coherence Tomography: Implications for Potential Future Therapeutic Interventions.

To comprehensively investigate the suprachoroidal space (SCS) in the context of rhegmatogenous retinal detachment (RRD) using swept-source optical coherence tomography (SS-OCT). We conducted a post hoc analysis of 90 consecutive patients with a primary RRD. Baseline SS-OCT scans were graded for the presence and thickness of the suprachoroidal space. Available scans of the fellow eye were graded for comparison. The suprachoroidal space was visible in 31.6% (24/76) of gradable RRD scans, with a mean thickest location measuring 67.0µm (SD 25.9), mean thinnest location of 33.8µm (SD 11.1), and mean average thickness of 50.0µm (SD 16.8). Additionally, the SCS was detectable in 28.3% (13/46) of available fellow eye scans, with a mean thickest location measuring 47.0µm (SD 41.7), thinnest location of 25.2µm (SD 27.6) and mean average thickness of 35.8µm (SD 31.4). A statistically significant difference was found between RRD and fellow eyes in all measurements of SCS thickness. In RRD, the suprachoroidal space serves as a crucial fluid reservoir influenced by dynamic shifts in intraocular hydrostatic and oncotic pressures. We found significant SCS engorgement in RRD eyes compared to fellow eyes, which may facilitate intra-SCS therapies such as suprachoroidal viscopexy (SCVEXY) or other pharmacologic interventions.

Thirteen year experience of vitrectomy and air tamponade for primary retinal detachment repair with clinical outcomes.

To report outcomes of pars plana vitrectomy (PPV) with air tamponade for primary rhegmatogenous retinal detachment (RRD) and investigate the impact of vitreous cortex remnants (VCR) on surgical outcomes. A retrospective review of 900 patients treated for uncomplicated primary RRD between 2007 and 2020. Exclusion criteria included axial length > 26mm, prior retinal surgery, giant retinal tear, PVR grade > B, and inadequate follow-up. Primary outcomes were retinal reattachment rate and best-corrected visual acuity (BCVA). Of 900 patients, 397 met inclusion criteria. Primary reattachment rate was 88.4%, with significant BCVA improvement. Forty-six eyes experienced RRD recurrence. Complications included cataracts (38.8%), IOP rise (11.4%), and macular edema (8.3%). Better final BCVA was associated with preoperative macular non-involvement and absence of reinterventions. No significant association was found between RRD recurrence and various factors, including VCR removal. Air tamponade is a safe and effective option for primary RRD treatment. It has no negative effect on the environment and creates less discomfort for patients. VCR removal did not significantly reduce RRD recurrence in the overall number of cases. Further research will help determine the role of VCR in RD recurrence and define in which cases their removal might be beneficial.

Acute infectious endophthalmitis after chandelier-assisted scleral buckling surgery.

To report a rare case of acute bacterial endophthalmitis that developed after scleral buckling surgery performed with non-contact wide-angle viewing system (WAVS) and chandelier endoillumination. A 63-year-old man underwent scleral buckling surgery using a WAVS with chandelier endoillumination for rhegmatogenous retinal detachment repair in his left eye. Seven days after the surgery, the patient noticed a marked decrease in his vision with ocular pain. No anterior chamber inflammation or exudates were found. No focal congestion or exudates were noted at the sclerotomy site. Posterior segment examination revealed severe vitreous haze and yellowish exudates in the vitreous cavity. Ocular ultrasound revealed dense vitritis, complete posterior vitreous separation, a fully attached retina, and a peripheral scleral buckle indent. Vitreous biopsy combined with pars plana vitrectomy with intravitreal antibiotic injections was done immediately, and Staphylococcus epidermidis was detected in the vitreous fluid. Following surgery, the inflammation and infection subsided and the visual acuity recovered to 6/9 in 6 weeks. Infectious endophthalmitis is a rare occurrence after chandelier-assisted scleral buckling (SB) surgery, characterized by ocular pain and a sudden decline in vision as key symptoms. Clinicians should be cognizant of the possibility of its occurrence following SB surgery, especially when utilizing the WAVS with chandelier endoillumination.

REMOTE FUNCTIONAL RESULTS PATIENTS WITH MACULAR HOLE AND RHEGMATOGENOUS RETINAL DETACHMENT SURGICAL TREATMENT WITH DIFFERENT VOLUMES OF PRESERVATION OF THE INTERNAL LIMITING MEMBRANE ACCORDING TO MICROPERIMETRY DATA

Rationale: Macular hole is a defect of the retina in the foveolar zone. In combination with rhegmatogenous retinal detachment, this disease can lead to irreversible deterioration of visual functions and requires immediate surgical treatment. One of the trends in modern ophthalmic surgery is to increase the area of preservation of the internal limiting membrane during the macular hole blocking. Despite this, microperimetry data indicate the appearance of microscotomas at the point of peeling initiation and a general decrease in the photosensitivity of the retinal tissue in the membrane removal zone.Objective: to analyze the dynamics of changes in the retinal functional parameters of patients with macular hole and rhegmatogenous retinal detachment according to microperimetry data after surgical treatment in the late postoperative period.Methods: Data from 40 patients (40 eyes) diagnosed with macular hole and rhegmatogenous retinal detachment were prospectively studied. Patients in group 1 (20 patients, 20 eyes) underwent surgical treatment, including three-port 25G vitrectomy, perfluoroorganic compound, vitreous body sanitation at the periphery, and silicone tamponade. Membrane peeling was performed during the second operation to remove silicone. Patients in group 2 underwent vitrectomy, membrane staining under the perfluorine layer, membrane peeling with closure of the macular hole with an inverted flap, vitreous body sanitation during the first intervention. The operation was also completed with silicone tamponade. During the second intervention, silicone oil was removed from the vitreous cavity.Results: When comparing the light sensitivity index of the retinal tissue in the foveolar zone between the groups, a reliable difference in the indices by 1.2 times continued to persist up to one and a half years after the final stage of surgical treatment, there was a predominance of values in patients of the 1st group with a completely preserved membrane (p = 0.043 in comparison with the data of patients of the 2nd group). In three peripheral zones of the macula, during the long-term observation period up to one and a half years after surgery, the indices of patients of the 1st group prevailed by 1.5 times (p = 0.041 in comparison with the data of patients of the 2nd group).Conclusion: based on the analysis of the dynamics of the functional indices of the retina of patients after surgical treatment of macular hole in combination with rhegmatogenous retinal detachment, the refusal to perform membrane peeling on the detached retina during the first stage of surgical intervention allows to avoid aggressive mechanical trauma to the retinal tissue.

RESULTS OF TREATMENT OF PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT WITH RUPTURE IN THE LOWER HEMISPHERE DEPENDING ON THE SURGICAL METHOD

Purpose: To evalute the efficacy of short-term tamponade of the vitreal cavity by perfluorinated compound and to analyze the morphological changes after surgical treatment of the patients with rhegmatogenous retinal detachment with rupture in the lower retinal hemisphere.Material and methods: The analysis of surgical treatment of 31 patients with the diagnosis of primary rhegmatogenous retinal detachment in combination with proliferative vitreoretinopathy с type 1–2 with inclusion of the macular zone, with the localization of the rupture in the lower retinal hemisphere. All patients were divided into two groups depending on the tamponade vitreous cavity. I group (n = 15): first stage – vitreoretinal surgery with a tamponade of the vitreous cavity of perfluoroorganic compounds for 14 days, second stage – removal of perfluoroorganic compounds from the vitreous cavity + facoemulsification with implantation of the intraocular lens + tamponade of the natural gas mixture (С2F6). Monitoring for at least 6 months after perfluorinated compound or silicone oil removal.Results: The preliminary results of the study showed a high effectiveness of short-term perfluorinated compound tamponade compared to the silicone oil tamponade in patients with rhegmatogenous retinal detachment with rupture in the lower hemisphere. In all 1st group patients complete retinal reattachment was achieved in all observation periods. In 2nd group, partial retinal reattachment in the lower departments in the long-term postoperative period was detected in 37.5% of cases. There was no cystic macular edema in Group 1 patients, while it occurred in Group 2 patients in 18.7%. Epiretinal fibrosis was detected in Group 1 patients in 14.3% of cases and in Group 2 patients in 31.2% of cases during the whole observation period.Conclusion: The results of the conducted study confirm the effectiveness of the use of short-term tamponade of the vitreous cavity of perfluorinated compound in the treatment of patients with retinal detachment at the localization of a tear in the lower retinal hemisphere. This method improves the anatomical results of vitreoretinal surgery in this category of patients and helps to reduce the number of postoperative complications.

INTERNAL LIMITING MEMBRANE PEELING IN CASE OF RHEGMATOGENOUS RETINAL DETACHMENT AS A PREVENTIVE MEASURE FOR EPIRETINAL MEMBRANE

Rhegmatogenous retinal detachment (RRD) is one of the general determinants of the primary sight disability. However, employable people represent the majority of patients with RRD.Over the past 50 years, retinal detachment surgery had rapid progress, and the rate of success surgery increased up to 90% and higher. However, reducing the risks of reoperations, improving functional outcomes and increasing postoperative visual acuity remain topical issues at present.The main reason for second surgical interventions is progression of the proliferative vitreoretinopathy, which can lead to epiretinal membrane, macular oedema, and to recurrence of the retinal detachment.We reviewed current literature studies that report the results of internal limiting membrane peeling in cases with RRD and other alternative techniques aimed at reducing the risk of mentioned above postoperative complications.

Rhegmatogenous Retinal Detachment Secondary to Type I Stickler Syndrome: Diagnosis, Treatment and Long-Term Outcomes.

This study aimed to clarify the genetic diagnosis of rhegmatogenous retinal detachment (RRD) secondary to type I Stickler syndrome (STL1) and evaluate the anatomical and functional outcomes of surgical treatment. This retrospective study included 11 patients with RRD secondary to STL1. Familial and sporadic cases of STL1 were diagnosed at the Eye & ENT Hospital, Fudan University, between 2017 and 2023. To clarify the genetic diagnosis, next-generation sequencing was performed in suspected STL1 cases. Further, standard ocular examinations and surgical treatment were performed. Nine variants of COL2A1, including four novel mutations (c.394G>T, c.2977G>T, c.3003+2dup, and c.3853G>C), were screened and identified. The pathogenicity of all variants was conclusively demonstrated. Among patients who underwent vitrectomy, the mean age at RRD was 11.5 years, and the mean follow-up was 32.9 months. The average number of surgical procedures required during the follow-up was two; 90.9% of eyes achieved final attachment, and best corrected visual acuity (BCVA) significantly improved in 81.8% of the eyes, with a middle postoperative logMAR BCVA of 0.52 compared with the preoperative value (p = 0.0148). High intraocular pressure (81.8%) and cataract (72.7%) were the most common complications. Our study expands the spectrum of COL2A1 mutations and provides a novel diagnostic strategy for STL1. By combining clinical manifestations with genetic testing, STL1 could be accurately diagnosed. With proper surgical treatment and long-term follow-up, the prognosis of RRD in patients with STL1 could be improved.

Association between ocular diseases and screen time and sedentary time derived from job-exposure matrices

After developing job-exposure matrices (JEMs) for screen and sedentary time, we aimed to assess the associations between the JEM-derived exposures and various ocular diseases. We collected data from patients hospitalized from 2005 to 2021. JEMs were developed from 41,718 patients with occupational information and screen and sedentary times. The adjusted means of screen and sedentary time were calculated for 143 occupational groups and categorized into three classes based on the tertiles. The associations between ocular diseases and these JEM-derived exposures were examined using multivariable conditional logistic regression for 727,589 patients. The odds ratios of the class with highest screen time were 1.05 (95% confidence interval, 1.01–1.09) for cataract, 1.24 (1.06–1.45) for primary open-angle glaucoma (POAG), 1.26 (1.06–1.49) for rhegmatogenous retinal detachment (RRD), 1.49 (1.26–1.76) for ptosis, and 0.39 (0.27–0.57) for pterygium. The odds ratios of the class with highest sedentary time were 1.05 (1.01–1.09) for cataract, 1.24 (1.05–1.46) for RRD, 1.68 (1.42–1.99) for ptosis, and 0.60 (0.42–0.84) for pterygium. Both screen and sedentary time were positively associated with cataract, RRD and ptosis. Interestingly, POAG had a positive association with only screen time. Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary."I have confirmed that the content is correct. No amendments are necessary.Please check article title if captured correctly."?>"I have confirmed that the content is correct. No amendments are necessary.

Using Real-World Data to Assess the Association of Retinal Detachment With Topical Pilocarpine Use

PurposeTo examine the association between topical pilocarpine and the risk of new-onset rhegmatogenous retinal detachment (RRD). DesignRetrospective clinical cohort study. MethodsWe used an aggregated electronic health records research network, TriNetX, to examine the risk of RRD (ICD-10: H33.0x) following the initiation of pilocarpine. The primary study group included adult patients over 40 years who received topical pilocarpine (1.25% or any dose with the exclusion of other indications) for the first time. Our control group consisted of patients with presbyopia who were started on artificial tears and had no history of topical pilocarpine use during the study period. We matched both cohorts using propensity score matching (PSM) based on demographics, systemic comorbidities, and known risk factors for RRD. ResultsAfter matching, the three-month risk of RRD was significantly higher in the pilocarpine group (0.53%) compared to the control (0.25%) (RR: 2.18, 95% CI: 1.07-4.45, p=0.03). The 6-month risk of RRD remained elevated at 0.60% in the study group versus 0.31% in the control group (RR: 1.93, 95% CI: 1.01-3.67, p=0.04). At one year, the risk increased to 0.78% in the pilocarpine group and 0.33% in the control group (RR: 2.33, 95% CI: 1.28-4.27, p=0.005). A Cox proportional hazards model indicated that pilocarpine use was associated with a 3.14-fold increased risk of RRD (95% CI: 1.66-5.93, p<0.001) compared to controls, after adjusting for demographics and comorbidities. Additional risk factors for RRD included male sex (aHR: 2.36, p=0.001), myopia (aHR: 2.36, p=0.001), vitreous degeneration (aHR: 2.22, p=0.020), lattice degeneration (aHR: 3.71, p=0.010), and pseudophakia (aHR: 3.48, p<0.001). ConclusionsOur study quantified the increased risk of RRD associated with topical pilocarpine use.