Rhegmatogenous Retinal Detachment Repair Research Articles

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 < 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 < 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 < 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.

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.

Macular edema after surgery to treat rhegmatogenous retinal detachment: 1-year follow-up, incidence, and associated risk factors.

To clarify the postoperative incidence of macular edema in patients undergoing surgery to repair rhegmatogenous retinal detachment and identify the associated risk factors. In this prospective, observational study, 79 patients who underwent surgery to correct rhegmatogenous retinal detachment using pars plana vitrectomy with silicone oil injection were analyzed. Patients were followed up postoperatively at 7, 30, 90, 180, and 365 days. At each visit, optical coherence tomography was performed to assess the presence or absence of macular edema. were analyzed as possible risk factors for macular edema: age, sex, macular status (attached or detached), presence of vitreoretinal proliferation, history of previous intraocular surgery, reported time of symptoms suggestive of rhegmatogenous retinal detachment up to the date of surgery, and the surgical modality performed. The 1-year macular edema prevalence rate was 26.6%. In the adjusted analysis, older patients had a higher risk of macular edema, and each 1-year increase in age increased the risk of macular edema by 6% (95% confidence interval = 1.00-1.12). The macular status, vitreoretinal proliferation, the surgical technique used, prior intraocular surgery, and the intraocular lens status were not identified as risk factors. However, the incidence of macular edema increased up to 180 days after surgery, peaking at 10.6%, and then decreased until 365 days after surgery. Macular edema was a common complication after surgery to treat rhegmatogenous retinal detachment, with its incidence peaking between 30 and 180 days after surgery. Age was an important risk factor for macular edema in this cohort.

POSTOPERATIVE PHOTORECEPTOR INTEGRITY AND ANATOMICAL OUTCOMES BASED ON PRESENTING MORPHOLOGIC STAGE OF RHEGMATOGENOUS RETINAL DETACHMENT.

To evaluate outer retinal recovery on postoperative optical coherence tomography (OCT) based on presenting morphologic stage of rhegmatogenous retinal detachment (RRD). Retrospective cohort of consecutive primary fovea-involving RRDs, referred from January 2012 to September 2022. Baseline OCTs were assessed for morphologic stage of RRD. Postoperative OCT scans were graded at 3, 6, and 12 months for external limiting membrane, ellipsoid zone and interdigitation zone discontinuity, epiretinal membrane formation and severity, and residual subfoveal fluid. Three hundred and fifty-one patients were included. Increasing baseline morphologic stage of RRD was significantly associated with external limiting membrane, ellipsoid zone, and interdigitation zone discontinuity at all time points postoperatively ( P < 0.001) and was shown to be an independent predictor of foveal photoreceptor integrity after adjusting for height of detachment, time to surgery, and duration of fovea involvement ( P < 0.001). Earlier stages were associated with residual subfoveal fluid ( P < 0.001). There was no association between the stages of RRD and epiretinal membrane severity. However, late stages presented with earlier development of epiretinal membrane ( P = 0.012). Increasing morphologic stage of RRD is associated with delayed recovery of outer retinal bands in the first year and faster development of epiretinal membrane after RRD repair. The results of this study suggest that the stages may serve as a prognostic biomarker for postoperative photoreceptor recovery.

Outcomes of Scleral Buckling After Failed Pneumatic Retinopexy.

Purpose: To assess the visual and anatomic outcomes of eyes that had secondary scleral buckle (SB) surgery after unsuccessful pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective study, performed over a 12-year period, comprised patients who had secondary SB procedures after failed primary PR. Clinical parameters (eg, best-corrected visual acuity [BCVA], lens status, macula status, details of RRD and subretinal fluid) were assessed at presentation, before additional procedures, and at follow-up (6 months, 1 year, and last visit). Statistical comparisons were made using Brown-Forsythe and Welch analysis-of-variance tests, with significance levels set at P < .05. Results: Fifty-four eyes with adequate follow-up were included. Forty-four (81.5%) of 54 eyes had successful retinal reattachment with secondary SB alone. The remaining eyes had subsequent pars plana vitrectomy (PPV). Patients presenting with macula-on RRD who had successful secondary SB had no statistically significant change in BCVA from baseline (mean final, 0.23 ± 0.25 logMAR [Snellen 20/34]; P = .999). There was a statistically significant improvement in BCVA in patients presenting with macula-off RRD who had successful secondary SB (mean final, 0.32 ± 0.36 logMAR [20/42]; P < .001 and mean change, -1.06 ± 0.85 logMAR). Ten patients presenting with macula-off RRD who had failed secondary SB had a significant improvement in the final BCVA (mean final, 0.22 ± 0.28 logMAR [20/33]; P = .044), despite the need for an additional PPV to achieve reattachment. Conclusions: Secondary SB remains a good option for RRD repair after unsuccessful PR and may avoid the need for PPV.

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.

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.

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.

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.

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.

NATIONWIDE DEMOGRAPHIC DISPARITIES IN UNITED STATES EMERGENCY DEPARTMENT VISITS IN PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT.

Within the evolving landscape of healthcare in the United States (US), delineating the demographic nuances and financial implications of emergent conditions, such as rhegmatogenous retinal detachment (RRD), is paramount. This study seeks to analyze the demographic and hospital billing amount/cost of service disparities in RRD visits to emergency departments (EDs) nationwide. We conducted a retrospective, cross-sectional, population-based study using International Classification of Diseases, 10th revision , and Current Procedural Terminology codes in the 2016 to 2019 Nationwide Emergency Department Sample databases to identify RRD visits. The analysis included demographics, hospital billing amount, and cost of service of RRD ED management. A total of 12,492 RRD encounters were identified with men constituting 64% and a prominent age group being 50 to 64 years (49.3%). Most patients (90%) were managed in metropolitan teaching hospitals, predominantly in the southern U.S. region (56.1%). Private insurance covered 45% of patients. Same-day RRD repair odds increased in November and December. Whites had a higher likelihood for same-day treatment. Hospital billing amount rose from $23,600 in 2016 to $30,354 in 2019, with stable mean total cost of service. Rhegmatogenous retinal detachment ED visit incidence did not show seasonal variation ( P = 0.819). Most patients with RRD in U.S, EDs were middle-aged men, with Whites more likely to receive same-day repair. There was no sex bias observed in same-day repair decision-making. Although hospital billing amount increased over the study period, total cost of service remained stable. The incidence of RRD ED visits showed no seasonal variation.

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.