Rhegmatogenous Retinal Detachment Repair Research Articles

Epiretinal Membrane Formation Following Rhegmatogenous Retinal Detachment Repair: A Retrospective Cohort Study.

This study aimed to investigate the incidence of and risk factors for epiretinal membrane (ERM) formation following primary rhegmatogenous retinal detachment (RRD) repair. This comparative, retrospective, single center cohort study included eyes with primary RRD treated between 2011 and 2023 at Massachusetts Eye and Ear, Boston, Massachusetts, with pars plana vitrectomy (PPV), scleral buckle (SB), PPV+SB, or pneumatic retinopexy (PnR). Demographic, clinical, and surgical parameters were collected from medical records. The primary outcome was the risk of ERM formation, while the secondary outcome was the risk of ERM requiring surgery. Univariable and multivariable Cox regression was performed, and a hazard ratio (HR) and 95% confidence interval (95%CI) were reported. Overall, 394 eyes were included. The mean age was 58.49±12.8 years and most patients were male. There was a significantly lower risk of ERM formation following SB compared to PPV in the univariable analysis (HR=0.22, 95%CI=0.08-0.60, p=0.003); however, there was no significant association between treatment modality and ERM formation on multivariable Cox regression controlling for confounding factors (p=0.24). ERM formation was found more commonly in patients who were older (HR=1.03 per 1 year increase in age, 95%CI=1.01-1.04, p=0.001), those with worse baseline visual acuity (HR=1.36, 95%CI=1.09-1.71, p=0.008), and those with macula-off RRDs (HR=2.16, 95%CI=1.41-3.32, p<0.001). Surgical modality does not have a significant impact on the risk of ERM following retinal detachment repair. However, age, baseline visual acuity, and macular status are important predictors of ERM formation after RRD repair.

Clinical and Optical Coherence Tomography Features of Subretinal Fibrin Glue after Glue-Assisted Vitrectomy for Rhegmatogenous Retinal Detachment Repair. GUARD Study – Report 3:

Purpose: To highlight the clinical and optical coherence tomography (OCT) features of subretinal fibrin glue and its resolution over time in patients who have undergone glue- assisted retinopexy for Rhegmatogenous Retinal Detachments (RRD). Methods: A report of 2 cases with subretinal migration of fibrin glue. Both the cases were assessed with clinical examination, serial fundus photos and serial OCT scans through the area of subretinal fibrin immediately after surgery, at 1 week, 2 weeks and at 6 weeks. Results: In both the cases of intraoperative subretinal glue migration during glue-assisted vitrectomy for RRD repair, the subretinal glue had a characteristic appearance and course of evolution. On examination and color photography, the glue had an amorphous whitish appearance with wispy edges. This corresponded to subretinal hyperreflective material (SHRM) on OCT with a layered appearance. By two weeks after surgery, the subretinal glue demonstrated substantial regression on retinal examination and on OCT scans. At 6 weeks visit, the entire glue was noted to be resorbed along with an intact photoreceptor outer segments/Ellipsoid Zone layer Conclusion: In summary, this report describes the clinical and OCT appearance of subretinal migration of fibrin glue. Subretinal fibrin appears whitish on examination and corresponds to layered SHRM without shadowing on OCT. It appears to resorb spontaneously within weeks with apparent recovery of the overlying photoreceptors.

GORE-TEX SUTURE-ASSOCIATED ENDOPHTHALMITIS IN A SCLERAL-SUTURED INTRAOCULAR LENS.

To describe a unique case of Gore-Tex (Gore Medical, AZ) suture-associated delayed-onset endophthalmitis in a patient with a history of scleromalacia, pathologic myopia, multiple prior vitrectomies in the setting of a scleral-sutured intraocular lens (IOL). A 69-year-old man complained of blurry vision and eye pain 21 months after implantation of a scleral-sutured IOL and was found to have an exposed Gore-Tex suture with scleromalacia, vision loss to hand motion, a hypopyon, and vitritis. He was diagnosed with culture-positive endophthalmitis. He had a previous history of a rhegmatogenous retinal detachment repair and subsequent dislocated IOL in this eye treated with a scleral-sutured IOL. A vitreous tap and injection of broad-spectrum antibiotics and suture removal at the slit lamp were performed at the time of presentation. One week later, he underwent pars plana vitrectomy and removal of the IOL. After the tap and inject and subsequent lens removal, his vision has returned to his preoperative vision of 20/100 with refraction. Gore-Tex suture is a nonabsorbable and flexible option with great tensile strength that has emerged as a favored alternative to polypropylene for the use in transscleral fixated IOLs. Although endophthalmitis and suture erosion are known complications of this procedure, this report describes one of the first cases of Gore-Tex suture-associated endophthalmitis.

Optimizing Surgical Management for Rhegmatogenous Retinal Detachment in Eyes with Active Retinoblastoma: A Safety-Driven Approach.

Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12-180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread.

Impact of drainage retinotomy on surgical outcomes of retinal detachment: insights from the Japan-Retinal Detachment Registry

We investigated the impact of drainage retinotomy on the outcome of pars plana vitrectomy for repair of rhegmatogenous retinal detachment (RRD). This study was a retrospective observational multicenter study. All patients were registered with the Japan-Retinal Detachment Registry. We analyzed 1887 eyes with RRD that had undergone vitrectomy and were observed for 6 months between February 2016 and March 2017. We compared the baseline characteristics and postoperative outcomes between eyes with and without drainage retinectomy. We then performed propensity score matching using preoperative findings as covariates to adjust for relevant confounders. Of 3446 eyes, 1887 met the inclusion criteria. Among them, 559 eyes underwent vitrectomy with drainage retinotomy, and 1328 eyes underwent vitrectomy without drainage retinotomy. After propensity score matching, each group comprised 544 eyes. There was no significant difference between the two groups in BCVA at 6 months after vitrectomy (0.181 vs. 0.166, P = 0.23), the primary anatomical success rate (6.3% vs. 4.4%, P = 0.22), or the rate of secondary surgery for ERM within 6 months (1.5% vs. 1.3%, P = 1.0). Drainage retinectomy does not increase the risk of decreased postoperative BCVA, surgical failure, or secondary surgery for ERM within six months outcomes.

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.

Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning

Purpose: To evaluate the anatomic and visual outcomes of primary vitrectomy for rhegmatogenous retinal detachment (RRD) repair using no amount of postoperative prone positioning to clarify the role of face-down posturing for RRD reattachment. Methods: This retrospective consecutive interventional case series comprised patients who had primary vitrectomy for RRD repair. The surgical outcomes, single-surgery anatomic success rate, and postoperative best-corrected visual acuity (BCVA) were assessed. The primary objective was to evaluate the anatomic and visual outcomes of vitrectomy RRD reattachment using no postoperative prone positioning. Results: This study comprised 116 eyes of 116 patients. Single-surgery anatomic success was achieved in 112 (96.5%) of 116 eyes. The single-surgery anatomic success rate was 100% in phakic patients (n = 56) and 93% in pseudophakic patients (n = 60), with both groups having an improvement in the mean BCVA. Conclusions: Primary vitrectomy with no postoperative prone positioning is a successful surgical intervention for RRD repair. The anatomic closure rate in this study is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and a significant improvement in BCVA, primarily using 14% perfluoropropane for gas tamponade.

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment

PurposeTo analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity.Patients and methodsRetrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative.ResultsThere was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal.ConclusionThinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

Scleral buckling with adjuvant pneumatic retinopexy versus scleral buckling alone for rhegmatogenous retinal detachment

To compare the efficacy of scleral buckling with adjuvant pneumatic retinopexy (SB with PR) and scleral buckling (SB) alone for primary rhegmatogenous retinal detachment (RRD). This retrospective and comparative study included patients who underwent SB with PR (n = 88) or SB alone (n = 161) for primary RRD. The primary anatomical success rate for SB with PR was 81.8%, whereas that for SB alone was 80.7% (P = 0.836). Among patients who achieved primary anatomical success, those in the SB with PR group showed postoperative epiretinal membrane (ERM) formation more frequently than those in the SB alone group (11 of 72 [15.3%] vs. 6 of 130 [4.6%]) (P = 0.009). The mean time to subretinal fluid absorption was not significantly different between the SB with PR and SB alone groups (11.2 ± 6.2 vs. 11.4 ± 5.8 months, P = 0.881). In the SB with PR group, retinal detachment involving ≥ three quadrants was a significant risk factor for surgical failure (hazard ratio, 3.04; P = 0.041). Adjuvant pneumatic retinopexy does not provide additional benefit in improving the surgical outcomes of SB for primary RRD repair.

Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated with Epiretinal Membrane Formation.

Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Assessment of Microvascular Changes After Rhegmatogenous Retinal Detachment Repair Using Wide-Field Swept-Source Optical Coherence Tomography Angiography.

Our objective was to evaluate retinal microvascular changes and visual outcomes following rhegmatogenous retinal detachment (RRD) repair using wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). The study included 116 eyes of 111 patients with macula-off (n = 68) or macula-on (n = 48) RRD treated with a single successful procedure, 79 fellow eyes, and 183 eyes of control patients imaged with WF SS-OCTA (3 ×3, 6 ×6, and 12 ×12 mm images). Mixed-effects multiple linear regression models were used for statistical analysis. Vessel density (VD) and vessel skeletonized density (VSD) of the superficial capillary plexus (3 ×3 mm scans) and full-thickness retina (12 ×12 mm) were significantly reduced in RRD eyes compared to fellow and control eyes. Decreased VSD and VD in all layers (3 ×3 mm and 6 ×6 mm) were significantly associated with greater preoperative extent of retinal detachment (P < 0.05) and poorer postoperative best-corrected visual acuity (BCVA) in RRD eyes (P < 0.05). Macula-off status was associated with increased foveal avascular zone irregularity (12 ×12 mm, P = 0.02). Decreased VD on WF SS-OCTA is associated with poorer postoperative BCVA following RRD repair. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

PURPOSEFUL GAS-INDUCED RESORPTION OF SUBMACULAR FLUID IN MACULA-OFF RETINAL DETACHMENTS (PERSIMMON STUDY).

To examine the visual outcomes in patients with macula-off rhegmatogenous retinal detachments with intentional submacular fluid retention after pars plana vitrectomy (PPV) or PPV/scleral buckle surgery (PPV/SB). Patients with macula-off retinal detachments were included if they had a PPV or PPV/SB without drainage retinotomy or perfluorocarbon liquid to flatten the retina. The mean age of the patients was 65.0 years. The mean presenting vision was 20.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Six months after repair, the vision improved to 62.9; 75.4% of patients had 20/40 or better at best achieved visual acuity. Pseudophakic eyes had better vision compared with phakic eyes ( P = 0.049). Patients younger than 80 years had better best achieved vision ( P = 0.0118) compared with patients 80 years or older. Patients with initial vision better than or equal to 20/100 had better best achieved vision ( P = 0.016) compared with those with initial vision worse than 20/100. Leaving submacular fluid after macula-off retinal detachments surgery was not detrimental for visual outcomes or anatomic success for retinal detachments repair and may lead to better visual outcomes for patients, specifically for those patients younger than 80 years, who are pseudophakic, and have presenting vision 20/100 or better.

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). Research Ethics Board approved, 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. 100 patients(50 with RRD,50 controls) were included. 70%(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 to 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(rs=0.465,p=0.0007;rs=0.405,p=0.004;rs=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 ROC curve=0.801. A stronger correlation was found in patients who scored ≥0.2 on the M-CHARTS and reported metamorphopsia with the MeMoQ(rs=0.454,p=0.001). We 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 metamorphopsia questionnaire(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.

Characteristics and Risk Factors for Rhegmatogenous Retinal Detachment Related to Endophthalmitis.

Purpose: To evaluate the risk factors for the development of concurrent or delayed-onset rhegmatogenous retinal detachment (RRD) related to endophthalmitis as well as the anatomic and visual outcomes with subsequent RRD repair. Methods: In this retrospective case study, a 2-tailed t test (continuous) and Fisher exact test were used to determine statistical significance of the observed findings. The relative risk (RR) and 95% CIs were calculated to assess statistical significance. Results: Of the 170 patients included, 22 were found to have a concurrent or subsequent RRD. Initial treatment with pars plana vitrectomy (PPV) (RR, 3.544; 95% CI, 1.650-7.614), aphakia (RR, 4.150; 95% CI, 1.434-12.011), endogenous endophthalmitis (RR, 2.684; 95% CI, 1.065-6.764), and posterior synechiae (RR, 3.026; 95% CI, 1.408-6.505) were statistically significant risk factors for RRD. Anatomically successful repair was achieved in 77.7% of patients. Conclusions: In addition to preexisting risk factors, the initial treatment of endophthalmitis may be a significant risk factor for RRD development, with a higher incidence of subsequent RRD in patients who have PPV as the initial treatment for endophthalmitis.

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.

Secondary full thickness macular holes following vitrectomy for rhegmatogenous retinal detachment: Clinical data, surgical outcome and prognosis

Aims/Purpose: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.Methods: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.Results: Out of 9317 eyes following PPV 28 eyes (mean age 58.7 ± 9.6 yrs, 50% male, 60.7% right eyes) could be included. The interval between vitrectomy and MH formation was 46.9 ± 80.3 (range: 1–373) months. 15 eyes showed history of macular involving RRD, 7 macular sparing RRD. Sulphur‐hexafluoride (SF6) 20–25% was used as endotamponade in 18 cases for RRD repair, silicone oil (Sil5000® and Sil2000®) in 4 cases. Six cases were not assessable due to earlier external surgery. In secondary MH re‐PPV with SF6 20–25% endotamponade in 21 eyes (thereof with an ILM flap in 8 cases), Sil5000® in 6 eyes and Densiron® in one eye was performed. A primary closure rate of 88.2% with gas was achieved with a final best corrected visual acuity of 0.67 ± 0.99 logMAR. Degree of myopia, which correlated with functional results (p = 0.019) and earlier time of onset (p = 0.007), as well as timing of cataract surgery (p &lt; 0.001) could be identified as risk factor for secondary MH development.Conclusions: Secondary MH after RRD repair is rare. In our study with the largest cohort studied so far, we can identify risk factors that lead to earlier MH formation. Myopia was shown to be a prognostic factor for functional outcome.