Treatment Of Rhegmatogenous Retinal Detachment Research Articles

The effect of membrane peeling on the dynamics of anatomical changes in the inner layers of retina after surgical treatment of rhegmatogenous retinal detachment with macular hole

Objective: to determine the effect of membrane peeling on the dynamics of retinal inner layers anatomy changes after surgery for retinal detachment with macular hole. Material and methods. Patients of group 1 (20 patients, 20 eyes) underwent surgical treatment with repair of the rupture using an inverted flap of the internal limiting membrane. Patients of group 2 (20 patients, 20 eyes) did not undergo hole blocking during the first stage of surgery. All patients underwent optical coherence tomography to assess the condition of the inner layers of the retina. Results. One day after surgery, in patients of group 1, the thickness of retinal tissue in the parafoveal zone was 128.2±11.6 nm. In patients of group 2 it was 102.7±6.4 nm (p=0.041). These values remained until the silicone oil was removed. When comparing the indicator of the volume of retinal tissue in the parafoveal zone, there is a decrease in the indicator in patients who underwent membrane peeling, the indicator was 0.645±0.041 mm3, compared with the data of patients of the 1st group, where it was at the level of 0.787±0.52 mm3 (p=0.047). In the temporal quadrant, the difference in indicators persisted until one year after surgery. Conclusion. Membrane peeling leads to damage to the retinal tissue, local defects which can persist up to a year. The outer layers of the retina are damaged throughout the entire area of the macula due to the impact on the supporting plates of the Muller cells and the nerve fiber layer.

The efficacious combined treatment of rhegmatogenous retinal detachment (PVR ≤ C2) with inferior breaks using 25-gauge pars plana vitrectomy and air tamponade.

To examine the surgical results of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for the repair of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. A retrospective consecutive study was conducted from March 2019 to February 2023 on 27 patients with primary RRD with inferior breaks who underwent 25-G PPV with air tamponade. Once the surgery was completed, the patients were monitored for a minimum of 6 months. Postoperative best-corrected visual acuity (BCVA), postoperative complications, and the rate of single surgery anatomical success were the primary outcome measures. The average age of the 12 female and 15 male study participants was 50.2 ± 12.8 years. The follow-up period was 10.3 ± 3.9 months on average. On average, the affected clock hours were 5.6 ± 2.1 hours, and the average number of retinal breaks was 2.2 ± 1.8. Moreover, the final anatomical success rate was 100%, compared to the estimated initial anatomical success rate of 96.30% following a single surgery. At 6 months, we also noticed a significant change in the mean BCVA, which went from 1.62 ± 0.71 logMAR (preoperative) to 0.89 ± 0.61 logMAR (postoperative) (P < .001). On the first day and the week following surgery, the mean intraocular pressure (IOP) was similar (all P > .05). One patient experienced postoperative complications such as retinal redetachment, which was addressed with the same procedure. After surgery, 2 patients had IOP of 35 and 28 mm Hg for 1 week. Two weeks following surgery, their IOP essentially returned to normal after receiving antihypertensive medication. No other notable postoperative complications were observed. According to this research, 25-G PPV with air tamponade has a satisfactory success rate in repairing primary RRD with inferior breaks. This procedure also produces quicker visual recovery and is linked to fewer complications.

Choosing the optimal method for surgical treatment of rhegmatogenous retinal detachment

The problem of the structural and functional effectiveness of episcleral and endovitreal treatment methods of rhegmatogenous retinal detachment remains open to this day.The aim of the study. To assess the clinical effectiveness of surgical treatment of rhegmatogenous retinal detachment using episcleral and endovitreal methods.Material and methods. An analysis of the electronic database and a detailed assessment of the treatment of 285 patients with rhegmatogenous retinal detachment for 2005–2022 were carried out. A comparative analysis was made in two groups: group 1 – patients after episcleral surgery (n = 155); group 2 – patients after endovitreal surgery (n = 130). The initial condition and the extent of surgery were comparable. Results. From 2005 to 2009 in 65.9 % of cases, episcleral buckling predominated; from 2009 to 2021 – posterior closed vitrectomy (in 64.8–88.7 % of cases). The incidence of primary retinal reattachment was 74.2 % and 71.5 %. The number of relapses after vitreoretinal surgery slightly exceeded the values in the group 1 – 28.4 % versus 25.7 %, and in 20% of cases the first relapse occurred before silicone aspiration as a result of subsilicone proliferation. The total number of surgical interventions per person, taking into account mandatory silicone aspiration, in the group 1 was 1.3, in the group 2 – 2.25 for the entire observation period. The visual acuity of patients in group 1 was 2 times higher than that of the comparison group – 0.21 ± 0.02 and 0.1 ± 0.03, respectively (p &lt; 0.05).Conclusion. Episcleral treatment methods of rhegmatogenous retinal detachment are characterized by better anatomical, reconstructive and functional effects with fewer re-operations

Quantitative signs on ultrasound biomicroscopy images associated with the status of silicone oil emulsification within the eye.

Silicone oil (SO) is a commonly used intraocular tamponade in the treatment of rhegmatogenous retinal detachment (RRD). SO emulsification is a common complication after SO injection. This study aimed to investigate correlations between SO emulsification signs on ultrasound biomicroscopy (UBM) and the real number/size of SO droplets. An observational, cross-sectional study. Thirty-five RRD patients (19 males; 35 eyes) who underwent pars plana vitrectomy and SO injection were enrolled in the study. SO emulsification signs on UBM (endothelial deposits, floating droplets, ghost images, hyperoleon, anterior chamber angle impregnation, anterior iris surface impregnation, posterior iris surface impregnation and ciliary body impregnation) were acquired and quantified two days before SO removal, while real number/size of the SO droplets with a diameter in 0.4-20 μm in the first 2 mL washout fluid collected intraoperatively during SO removal were assessed by Coulter counter. Then the correlations between these values were explored. The grade of tissue impregnation and hyperoleon area in the anterior chamber demonstrated significant correlations with the number of large (5-20 μm) SO droplets (r = 0.336; P = 0.048 and r = 0.350; P = 0.039, respectively); however, no significant correlations were observed with the total number of droplets (0.4-20 μm)or the number of small (0.4-5 μm) droplets (both P ＞ 0.05). The UBM quantitative grade of tissue impregnation and hyperoleon area in the anterior chamber could provide a noninvasive overview of the actual degree of SO emulsification before SO removal surgery.

Twelve-Month Outcomes of Three Episcleral Surgeries in Treatment of Rhegmatogenous Retinal Detachment

Introduction: The aim of this study was to compare the long-term outcomes of conventional scleral buckling (CSB), modified scleral buckling (MSB), and scleral encircling (SE) in the treatment of rhegmatogenous retinal detachment and identify factors influencing the outcomes. Methods: This comparative, retrospective cohort study assigned patients to CSB, MSB, and SE groups. The follow-up was 12 months, and the reattachment rate, complication rate, visual acuity, number of newly discovered tears during surgery, and changes in diopters were compared among the three surgeries. Influential factors on anatomical and functional reattachment were identified. Results: There were no significant differences in the primary reattachment rate, overall complication rate, or best corrected visual acuity at 6 or 12 months among the three groups. The MSB group had a higher number of newly discovered tears during surgery compared with the other two groups. At 12 months of post-surgery, the SE group displayed the greatest change of diopter, whereas the MSB group showed the least change. The surgical approach did not influence the primary reattachment rate. Long-term visual outcomes were influenced by factors including sex, preoperative visual acuity, macular status, and duration of symptoms. Conclusion: MSB is an effective method for treating rhegmatogenous retinal detachment. Its advantages include the ability to identify smaller tears and induce minimal changes in diopter.

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle.

To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using a novel foldable capsular buckle (FCB). This was a series of case observation studies. Eighteen patients (18 eyes) who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included. The procedure was similar to conventional scleral buckling, while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad, external indentation instead of the silicone buckle. The retinal reattachment rate, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive dioptre and astigmatism degree, and complications were evaluated and recorded. There were 7 males and 11 females aged 19-58y. The average time course of RRD was 12d, ranging from 7-20d. The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes, with macula-off detachments in 12 eyes. The patients were followed-up for at least 6mo. The final retinal reattachment rate was 100%. The BCVA was significantly improved compared with the baseline (P<0.05). There was no significant change in refractive dioptre or astigmatism degree at each follow-up (all P>0.05). Three patients had transiently high IOPs within one week after surgery. Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed. The success rate of FCB scleral buckling for RRD is satisfactory. This procedure can be expected to be applied in new, uncomplicated cases of RRD.

Outcomes and variables that impact pneumatic retinopexies.

To evaluate the efficacy of pneumatic retinopexy (PR) in patients undergoing PR as primary treatment for rhegmatogenous retinal detachment (RRD) and analyze the factors associated with success and failure in the studied population. A retrospective chart review was done of patients with RRD treated with PR as primary management method treated at New York Eye and Ear Infirmary of Mount Sinai between January 2017 and December 2021. Primary outcome measured success or failure of PR. Secondary outcome measured best corrected visual acuity (BCVA) after PR. A separate risk analysis was done to identify and stratify risks associated with success and failure of PR. A total of 179 eyes from 179 patients were included for final analysis. The 83 patients (46.37%) achieved anatomical reattachment of the retina after primary PR with no need for additional surgery. The 96 patients (53.63%) had a failed primary PR and required a PPV and 6 of them required pars plana vitrectomy (PPV) with scleral buckle (SB). In total, 19 cases (10.61%) were done as temporizing pneumatics, 18 (94.74%) underwent PPV, and 1 (5.26%) did not require further intervention. The visual acuities at postoperative month 1 (POM1) for patients who underwent primary PR successfully and for those that underwent PPV after, were 0.58 (20/80) and 1.03 (20/200) respectively. Patients who met Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria had a statistically significant decreased risk of primary PR failing (hazard ratio 0.29, P=0.00). Majority of missed or new breaks were found superotemporally. PR is a good treatment option for treating RRDs in patients that meet PIVOT criteria and can be conducted as a temporizing measure. PIVOT criteria and fovea on status decrease the risk of PR failure.

CLINICAL OUTCOMES OF SCLERAL BUCKLING COMBINED WITH PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT

Introduction and Objective: The various types of primary interventions for rhegmatogenous retinal detachment (RRD) include pars plana vitrectomy (PPV), scleral buckling (SB), and combination of both. Intraocular tamponade with silicone oil (SO) or expanding gas. This research was conducted to evaluate the clinical outcomes of SB combined with PPV as a treatment for RRD. Methods: This research was prospective descriptive study with total sampling for RRD treated by SB combined with PPV from August 2022 to January 2023 in RSUP. Prof. Dr. R.D. Kandou. BCVA, IOP, clinical findings, intraocular tamponade and complications after the surgery were observed. Results: Most of the patients was male with average age of 28 ± 40 years. RRD was observed in 6 eyes and laterality on right eye. BCVA was 2.5 ± 2 logMAR before the surgery and 2.3 ± 1 logMAR 1 month after the surgery. BCVA day 1, 1 week, 2 weeks and 1 month showed no significant difference after the surgery compared to baseline (p = 0.317, p = 0.949, p = 0.611, p= 0.611 respectively). Preoperative IOP was 7 ± 11 mmHg and 13.6 ± 10 mmHg 1 month after the surgery. IOP 1 week and 1 month showed significant difference (p = 0.027, p=0.011). IOP day 1, 2 weeks and 1 month showed there was no significant difference after the surgery on day 1 and 2 weeks. Conclusion: There were several clinical condition seen such as BCVA after the surgery didn’t improve as expected, subconjunctival bleeding was found the most as postoperative complications. Keyword: Scleral buckling, Pars plana vitrectomy, silicon oil, retinal detachment

Clinical Outcomes of Scleral Buckling combined with Vitrectomy Pars Plana for Rhegmatogenous Retinal Detachment

Introduction &amp; ObjectivesThe various types of primary interventions for rhegmatogenous retinal detachment (RRD) includepars plana vitrectomy (PPV), scleral buckling (SB), and combination of both. Intraocular tamponadewith silicone oil (SO) or expanding gas. This research was conducted to evaluate the clinicaloutcomes of SB combined with PPV as a treatment for RRD.&#x0D; MethodsThis research was prospective descriptive study with total sampling for RRD treated by SB combinedwith PPV from August 2022 to January 2023 in RSUP. Prof. Dr. R.D. Kandou. We observed the BCVA,IOP before and after the surgeries. Clinical findings, intraocular tamponade and complications afterthe surgeries were observed.&#x0D; ResultsMost of the patients was male with average age of 28 ± 40 years. RRD was observed in 6 eyes andlaterality on right eye. BCVA was 2.5 ± 2 logMAR before the surgery and 2.3 ± 1 logMAR 1 monthafter the surgery. Preoperative IOP was 7 ± 11 mmHg and 13.6 ± 10 mmHg 1 month after thesurgery. Macular detachment, 1 Quadrant Detachment, 1 Number of retina break mostly on superotemporalquadrant were found the most. Proliferative vitreoretinopathy was found in 1 eye.Intraoperative triamcinolone used in 4 eyes and perfluorocarbon in 1 eyes. Subconjunctival bleedingwas found the most, followed by corneal edema and subretinal hemorrhage as postoperativecomplications respectively.&#x0D; ConclusionThere were several clinical condition seen such as BCVA after the surgery that didn’t improve asexpected, High IOP found in several eyes and subconjunctival bleeding was the complication foundthe most in these eyes.

Pars Plana Vitrectomy in the Treatment of Rhegmatogenous Retinal Detachment.

The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD). The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results. In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8. In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.

Performance of Automated Machine Learning in Predicting Outcomes of Pneumatic Retinopexy

ObjectiveAutomated Machine Learning (AutoML) has emerged as a novel tool for medical professionals lacking coding experience, enabling them to develop predictive models for treatment outcomes. This study evaluated the performance of AutoML tools in developing models predicting the success of pneumatic retinopexy (PR) in treatment of rhegmatogenous retinal detachment (RRD). These models were then compared with custom models created by ML experts. DesignRetrospective multicenter study. Population539 consecutive patients with primary RRD that underwent PR by a vitreoretinal fellow at six training hospitals between 2002 and 2022. MethodsWe used two AutoML platforms, MATLAB Classification Learner and Google Cloud AutoML. Additional models were developed by computer scientists. We included patient demographics and baseline characteristics, including lens and macula status, RRD size, number and location of breaks, presence of vitreous hemorrhage and lattice degeneration, and physicians’ experience. The dataset was split into a training (n = 483) and test set (n = 56). The training set, with a 2:1 success-to-failure ratio, was used to train the MATLAB models. Since Google Cloud AutoML requires a minimum of 1000 samples, the training set was tripled to create a new set with 1449 datapoints. Additionally, balanced datasets with a 1:1 success-to-failure ratio were created using Python. Main Outcome MeasuresSingle-procedure anatomic success rate, as predicted by the ML models. F2-scores and area under the receiver operating curve (AUROC) were used as primary metrics to compare models. ResultsThe best performing AutoML model (F2-score=0.85, AUROC=0.90; MATLAB), showed similar performance to the custom model (0.92, 0.86) when trained on the balanced datasets. However, training the AutoML model with imbalanced data yielded misleadingly high AUROC (0.81) despite low F2-score (0.2) and sensitivity (0.17). ConclusionsWe demonstrated the feasibility of using AutoML as an accessible tool for medical professionals to develop models from real-world data. Such models can ultimately aid in the clinical decision-making, contributing to better patient outcomes. However, outcomes can be misleading or unreliable if used naively. Limitations exist, particularly if datasets contain missing variables or are highly imbalanced. Proper model selection and data preprocessing can improve the reliability of AutoML tools.

Modification of the Suprachoroidal Buckling Technique for the Treatment of Rhegmatogenous Retinal Detachment.

To describe modification of the suprachoroidal buckling technique for the treatment of rhegmatogenous retinal detachment (RRD), which may improve the safety profile. A single-surgeon foot-pedal-controlled automated suprachoroidal injection (SCI) of sodium hyaluronate 1%, namely ProVisc (Alcon Laboratories, Fort Worth, TX) was used for the treatment of RRD. MicroDose Injection Kit (MedOne Surgical, Sarasota, FL) including a connector and a 1-mL syringe, designed for subretinal injection, was used to adapt Constellation Vision System (Alcon Laboratories) console for SCI of ProVisc from the 1-mL syringe. This approach enables better surgeon control during SCI. Three highly myopic eyes of three patients with primary macula-on RRD and single superior peripheral retinal break were treated. Complete retinal reattachment was achieved in all eyes without complications. Injecting ProVisc under foot-pedal control provides a more precise and potentially safer suprachoroidal buckling technique compared with the manual technique with more variable injection speed and pressure.

Anatomical and Functional Outcome of Treatment of Rhegmatogenous Retinal Detachment with Pars Plana Vitrectomy and Sulfur Hexafluoride Gas Tamponade From Tripoli 2022-23

Objective: To analyze the anatomical success rate and functional outcomes of patients with rhegmatogenous retinal detachment (RRD) who underwent 23-gauge pars plana vitrectomy plus 20% sulfur hexafluoride (SF6) gas endotamponade. Methods: A retrospective, observational, cross sectional study. Fifty-one eyes of 50 consecutive patients underwent 23 gauge pars plana vitrectomy with sulfur hexafluoride gas tamponade were included. The anatomical success rate, visual outcome, and the type and frequency of complications were investigated.

Changes of the morpho-functional parameters of the retina of patients after surgical treatment of rhegmatogenous retinal detachment complicated by macular hole in the early postoperative period

Objective: to realize the effectiveness of surgical treatment of patients with retinal detachment and macular hole PVR C, depending on the method of closing the macular hole. Material and methods. The data of 20 patients (20 eyes) with a diagnosis of retinal detachment with macular hole PVR С were studied. Patients of the 1st group (10 patients, 10 eyes) underwent surgical treatment with closure of the macular hole with an inverted flap of the inner limiting membrane. Patients of the 2nd group (10 patients, 10 eyes) did not undergo closure of the macular hole during the first stage of surgical treatment. Results. In the 1st group, it was possible to achieve closure of the macular hole in 80% of cases. In the 2nd group, a day after the operation, there was a significant decrease in the diameter to 263±46 urn. When re-examined a month later, in 80% of cases, the macular hole was closed. When studying the results of micro-perimetry one day after the operation, positive dynamics was noted. While after a month of observation, the indicators of patients in the second group were significantly higher. Conclusion. The method of surgical treatment of retinal detachment with macular hole showed greater efficiency in refusing to perform membranopiling; in patients of this group, higher functional results were achieved. During the observation period, cases of a decrease in the diameter of an intact macular hole and its complete closure under the action of silicone tamponade were recorded. If necessary, membrane peeling can be delayed during a second silicone oil removal operation.

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.

The effect of patient symptom awareness on the visual outcome in retinal detachment.

To explore whether a patient's prior knowledge of the symptoms associated with rhegmatogenous retinal detachment (RRD) relates to the visual outcome after treatment. We performed a prospective survey study on 126 patients receiving treatment for primary RRD between March and July 2021. Thirty-seven per cent (n = 47) of patients responded that they were aware of the RRD symptoms prior to the detachment. A history of RRD in the fellow eye or knowledge of family members treated for RRD was frequently reported as a reason for the patient's awareness of RRD symptoms. Patients aware of RRD symptoms presented significantly more often with an attached macula (χ2, p = 0.002) and a better visual outcome following surgery (Mann-Whitney U, p = 0.028) compared to patients who were not aware of RRD-related symptoms. Among 76 patients with a myopic refractive error, only 15% (n = 11) indicated that they had been warned about the increased RRD risk related to myopia, suggesting that three-quarters of patients were not actively informed by their eye care professionals. RRD symptom awareness is significantly related to a higher rate of macula-on RRDs and better visual outcomes after treatment. There is limited awareness of increased RRD risk in myopic RRD patients. These findings suggest that counselling individuals at high risk of RRD about related symptoms is inadequate and better counselling may improve visual outcomes following RRD treatment.

Современные представления о склеральном пломбировании в лечении регматогенной отслойки сетчатки

Relevance. Rhegmatogenous retinal detachment (RRD) is a serious problem of modern ophthalmology, leading to an irreversible decrease in vision and, in extreme cases, to its loss. The prevalence of RRD according to various sources varies from 8.9 to 24.4 cases per 100,000 population, in most cases these are patients of working age – 84–89%. Purpose. To analyze the role of extrascleral buckling in treatment of rhegmatogenous retinal detachment. Material and methods. In the search for materials, open electronic databases Google and Google Scholar, PubMed, Embase, MEDLINE and Web of Science were used, 58 sources were analyzed up to 2023. Results. At the beginning of the 20th century, retinal detachment irreversibly led to blindness, but starting from the late 1920s, the first surgical techniques appeared that made it possible to successfully restore its anatomical position. Extrascleral buckling (ESP) became an established treatment for retinal detachment with a long-term success rate of 93%. The vast majority of rebleeds ultimately continued to occur due to missed tears, inaccurate buckling, or inadequate retinopexy. Much has changed since the development in 1971 by R. Machemer of a device for vitrectomy through the pars plana, as a result of which the surgical focus shifted towards the vitreal cavity. Conclusion. Scleral buckling still remains an effective surgical intervention in a certain group of patients with retinal detachment, including combined operations, and its undoubted advantage is the unpretentiousness of technical support. Key words: rhegmatogenous retinal detachment, extrascleral buckling, encircling, cryopexy, encircling tape length

Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society.

Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.