Rhegmatogenous Retinal Detachment Research Articles

Climate and Rhegmatogenous Retinal Detachment: A Comprehensive Review and Future Research Guidelines

Climate and Rhegmatogenous Retinal Detachment: A Comprehensive Review and Future Research Guidelines

Change in Axial Length and Astigmatism after Scleral Buckling in Patients of Rhegmatogenous Retinal Detachment

Purpose: To determine changes in axial length and corneal astigmatism caused by scleral buckling in patients of uncomplicated retinal detachment undergoing scleral buckling procedure. Study Design: Quasi-experimental design. Place and Duration of Study: Peshawar Medical College and Allied hospitals, Pakistan from December, 2020 to May, 2021. Methods: This study included60 patients of uncomplicated rhegmatogenous retinal detachment, recruited through consecutive sampling technique and managed with primary scleral buckling. After a detailed history and complete examination including A-scan and Keratometric readings, patients underwent scleral buckling procedure. Changes in axial length and corneal curvatureswere measured at 6 months follow up. Quantitative analysis was done using paired T test. Results: Mean age of the sample was 41.95±13.67 years. The sample consisted of 42 males and 18 females. Encircling Band was used in 46 patients, segmental circumferential tire was used in 58 patients in one or more quadrants depending on the extent of the retinal detachment. Two patients underwent additional surgeries. The pre-operative mean axial length (AL) was 23.44±1.51 mm and post-operative AL at 6 months was 24.25±1.61mm (p < 0.05). The pre-operative and post-operative astigmatism were 1.08±0.43 and 1.75 ± 0.33 diopter respectively (p < 0.05). Conclusion: Scleral buckling led to a significant increase in axial length and astigmatism over a 6-month period. These changes suggest that scleral buckling can alter the optical properties of the eye, potentially affecting visual acuity and requiring careful consideration of these factors in post-operative management.

Acute Retinal Necrosis: A Review of Diagnosis and Management

Acute retinal necrosis (ARN) is a profound infection of the retina, marked by acute panuveitis, retinal periarteritis, and widespread necrotizing retinitis. The etiology of ARN involves human herpesviruses, such as herpes simplex virus (HSV) and varicella-zoster virus (VZV), which can lead to severe visual impairment or even blindness. A diagnosis of ARN is based on clinical characteristics and disease progression according to the standard diagnostic criteria established by the American Uveitis Society (AUS) in 1994. The polymerase chain reaction(PCR) of aqueous specimens can enable identification of the type of virus. Early initiation of antiviral medication is essential for treatment efficacy to stop lesion progression, accelerate the healing process, and prevent contralateral eye involvement. Ocular complications of ARN include atrophic retina, multiple retinal breaks, rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD), optic atrophy, macular edema, epiretinal membrane (ERM), and retinal and optic disc neovascularization. This review summarizes the clinical features, diagnostic criteria, and recently recommended ARN management.

ORAL CURCUMIN TO REDUCE RISK OF PROLIFERATIVE VITREORETINOPATHY FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To evaluate outcomes of patients who underwent rhegmatogenous retinal detachment repair and were started on oral curcumin for proliferative vitreoretinopathy (PVR) prevention. Retrospective, observational case series of eyes of patients undergoing high-risk rhegmatogenous retinal detachment repair that was started on curcumin postoperatively. Recommended dosage was 500 mg twice daily for 30 days followed by 500 mg daily for 60 days. The primary outcome was recurrent PVR-related rhegmatogenous retinal detachment within 6 months and a single-surgery retinal reattachment rate. Secondary outcomes included epiretinal membrane formation, visual acuity, and curcumin safety profile. Thirty-two eyes of 31 patients met the study inclusion criteria. Postoperatively, 2 eyes developed a PVR-related detachment (6.3%), and 2 eyes redetached due to new breaks without PVR (6.3%). Overall, single-surgery retinal reattachment rate was 87.5%. Single-surgery retinal reattachment rate without silicone oil was 92.6% (25/27). Of the 12 cases with Grade C PVR-related retinal detachment, the single-surgery retinal reattachment rate was 91.7%. Postoperatively, 7 eyes developed an epiretinal membrane (21.9%), of which 3 underwent epiretinal membrane removal (9.4%). No patient had gastrointestinal upset or anemia. This proof-of-concept clinical study suggests that oral curcumin is well tolerated and warrants further investigation for its potential to reduce the risk of PVR after rhegmatogenous retinal detachment repair in eyes at higher risk of PVR.

IMAGING PREDICTORS OF FUNCTIONAL OUTCOMES AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To evaluate the microstructural optical coherence tomography and fundus autofluorescence imaging predictors of visual acuity, metamorphopsia, and aniseikonia following rhegmatogenous retinal detachment repair. This is a multicenter retrospective study of patients with primary rhegmatogenous retinal detachment who underwent repair. Best-corrected visual acuity, metamorphopsia, and aniseikonia were formally tested at 3 months postoperatively. Metamorphopsia and aniseikonia were quantitatively assessed with M-CHARTS and the New Aniseikonia Test, respectively. High-resolution spectral-domain optical coherence tomography and fundus autofluorescence images were obtained at 3 months postoperatively. Images were assessed for discontinuity of the outer retinal bands on optical coherence tomography and retinal displacement detected by retinal vessel printings on fundus autofluorescence by two masked graders with disagreements adjudicated by a third senior masked grader. Multiple linear regression models were used to determine the predictors of postoperative visual acuity, metamorphopsia, and aniseikonia. Six hundred fourteen eyes of 614 patients were included in this study. Regression analysis indicated that significant early postoperative (at 3 months) imaging predictors of visual acuity were discontinuity of the external limiting membrane (P = 0.001) and the presence of retinal vessel printings on fundus autofluorescence (P = 0.033). Discontinuity of interdigitation zone was a significant predictor of metamorphopsia [horizontal metamorphopsia (P =0.004); vertical metamorphopsia (P = 0.056); average of horizontal metamorphopsia + vertical metamorphopsia (P = 0.008)], and presence of retinal vessel printings was a significant predictor of aniseikonia (P = 0.04). Discontinuity of the external limiting membrane and retinal displacement were significant predictors of postoperative visual acuity following rhegmatogenous retinal detachment repair. Discontinuity of the interdigitation zone and retinal displacement were significant predictors of metamorphopsia and aniseikonia, respectively.

Cost Analysis of Scleral Buckle and Pars Plana Vitrectomy for Retinal Detachment Surgery.

To compare the cost and utility of scleral buckle (SB) and pars plana vitrectomy (PPV) techniques for repairing moderately complex rhegmatogenous retinal detachment (RRD). A cost-utility analysis was conducted using data from the Primary Retinal Detachment Outcomes Study (PRO) and a study conducted by the author. Total costs, patient utility over a lifetime, and cost per quality-adjusted life year (QALY) were calculated for each surgical procedure. The cost of scleral buckle surgery was €287.93, with an estimated lifetime QALY of 7.49. Costs per QALY were €38.44. According to the PRO study and Belin et al, total costs were $5975, with a lifetime QALY of 5.4 and costs per QALY of $1106. The cost of pars plana vitrectomy (PPV) was €1468.26, with an estimated lifetime QALY of 6.84 and costs per QALY of €214.65. Based on the PRO study and Belin et al, total costs were $8125, with a lifetime QALY of 4.7 and costs per QALY of $2196. Repairing moderately complex RRD presents a highly cost-effective profile for both SB and PPV techniques, well below recommended QALY thresholds. SB demonstrated a slightly more favorable profile compared to PPV.

Comparison between Epiretinal Membrane Component in Proliferative Vitreoretinopathy and Other Fibroproliferative Diseases: A Scoping Review

The growth of proliferative vitreoretinopathy epiretinal membrane (PVR-ERM) is a major complication of rhegmatogenous retinal detachment (RRD). Despite surgery, adjunct treatment is necessary to control the aberrant wound healing response that occurs in PVR-ERM to prevent its recurrence. Existing studies on adjunct agents target pathways in the pathogenesis of PVR-ERM. We conducted a scoping review of composition of PVR-ERMs and other fibroproliferative ERMs. After literature search, 12 articles were included into the study. Outcome measured was gene expression, growth factors, extracellular matrix components, and enzymes.Among these studies, 9 compared PVR-ERM with PDR-ERM, 2 compared PVR-ERM with iERM, and 1 compared PVR-ERM with secondary ERM. Higher expression of certain genes or a higher concentration of particular factors can be observed throughout PVR, PDR, iERM, or secondary ERM.TGF-β, MALAT1 gene, and fibronectin are distinct factors that might play a bigger role on the pathogenesis of PVR compared to other fibroproliferative diseases.

Scleral Rupture during Scleral Buckle and Cryotherapy for Rhegmatogenous Retinal Detachment: A Case Report.

Scleral Rupture during Scleral Buckle and Cryotherapy for Rhegmatogenous Retinal Detachment: A Case Report.

Retinal vascular changes after Silicon Oil removal in the Eye with Rhegmatogenous Retinal detachment

BackgroundThis study aims to examine vessel density changes in the optic nerve and macula following silicone oil removal (SOR) surgery in eyes with rhegmatogenous retinal detachment (RRD) at different time points by Optical Coherence Tomography Angiography (OCTA) in compared to the contralateral eye.MethodsA total of 43 eyes from 43 patients with silicone oil in their eyes for 3–9 months underwent OCT-A using AngioVue and optic disc-associated vessel density (VD) and thickness, macular-associated VD and thickness, Foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), Acircularity index (AI), vessel density within a 300 μm wide region of the FAZ were compared between eyes. OCTA scans were performed one week before SOR and one month and three months after SOR.ResultsThe mean age of participants was 52.8 years (SD = 15.85) and a median visual acuity was 0.8 (range: 0.5-1.0). Notably, male participants constituted 67.4% of the sample. The preoperative mean value BCVA (logMAR) of patients was 0.73, and 3 months post-oil removal was 0.7727. Regarding optic disc parameters, RNFL thickness and vessel density (VD) measurements Peripapillary, whole disc, inside disc, and Disc Angio (superior, Nasal, inferior, temporal) did not change.In analyzing macular thickness parameters, all of them (Whole and Fovea, parafoveal, and Perifovea) remained unchanged. Examining macular vessel density parameters revealed no significant changes across superficial and deep retinal layers. Finally, the comparison of the foveal avascular zone (FAZ) area and flow density (FD) parameters demonstrated consistent measurements with non-significant alterations observed in FAZ size (p = 0.6) and FD values (p = 0.49) over the monitored duration.ConclusionThere was no change in peripapillary VD and macular vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after silicone oil removal. FAZ and full retinal thickness remained stable 3 month after SOR. Clinical trial number: Not applicable.

Evaluation of the relationship between the real-time changes of macular structure and visual function in patients with rhegmatogenous retinal detachment after silicone oil tamponade

PurposeTo evaluate the relationship between the real-time changes of macular structure and visual function in rhegmatogenous retinal detachment (RRD) patients. MethodsForty-six patients were enrolled in this retrospective study. The best corrected visual acuity (BCVA) and macular structural changes were analyzed within 3 months after silicone oil tamponade. ResultsThe mean final BCVA was significantly better than the preoperative BCVA (P = 0.002). The parafoveal thickness became thinner, the proportion of subretinal fluid (SRF) decreased, and the proportion of intact external limiting membrane (ELM) increased within 3 months postoperatively. The recovery stage and the integrity of ELM in the SRF (-) group were significantly faster than that in the SRF (+) group (all P < 0.05). The central foveal thickness (CFT), the inferior and temporal thickness of the parafovea, and the integrity of the ELM were significantly correlated with BCVA at each time point (all P < 0.05). Long duration of preoperative RRD, thinner CFT at 1 month postoperatively, and without integrity of ELM at 3 months postoperatively were associated with poor final BCVA recovery (R2 = 0.462). ConclusionsThe macular microstructural tended to restore integrity within 3 months. The presence of SRF in macula delayed the recovery of RRD patients but did not affect the visual function.

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.

Prevalence of Fovea Plana in patients with rhegmatogenous retinal detachment

Purpose To assess the prevalence of fovea plana in patients with rhegmatogenous retinal detachment and compare characteristics of the detachment between patients with and without fovea plana. Methods This retrospective, cross-sectional, case–control study included individuals with rhegmatogenous retinal detachment. We collected demographics and data on the operated eye, spherical equivalent, best-corrected visual acuity, lens status, macula status, number of retinal holes or tears, and presence of intravitreal hemorrhage, macular hole, epiretinal membrane, posterior vitreous detachment and proliferative vitreoretinopathy. The type of surgery, the tamponade, and cataract surgery following retinal surgery were also recorded. Spectral-domain optical coherence tomography macular cubes were used to evaluate the fovea by using the Spectralis HRA-OCT device (Heidelberg Engineering, Germany). Images were graded by two different investigators and a third investigator in case of disagreement. Results We included 204 individuals; 35 (17.2%) had fovea plana, a proportion significantly higher than in the general population (p = 0.041). Individuals with and without fovea plana did not differ in any of the characteristics mentioned above apart from posterior vitreous detachment, which was more frequent in those with than without fovea plana (p = 0.038). Conclusion The prevalence of fovea plana is higher in patients with rhegmatogenous retinal detachment, which suggests an association between fovea plana and potential vitreoretinal interface changes.

Factors associated with postoperative visual function after rhegmatogenous retinal detachment with foveal detachment

Factors associated with postoperative visual function after rhegmatogenous retinal detachment with foveal detachment

Retinal displacement following direct versus indirect fluid exchange in pars Plana vitrectomy for rhegmatogenous retinal detachment.

To compare the occurrence and characteristics of retinal displacement following direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange versus indirect PFCL for air and air for SO exchange methods during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). A comparative case series study was conducted on 58 eyes with recent RRD, undergoing standard three-port PPV with SO tamponade. Fluid exchange was performed using either direct or indirect methods. Postoperatively, a comprehensive ophthalmic examination and fundus autofluorescence (FAF) imaging were conducted at one month. The presence, amount, and direction of retinal displacement were assessed based on FAF imaging and compared between the direct and indirect fluid exchange groups. FAF imaging at one month revealed retinal displacement in 41.4% of eyes in the direct group and 62.1% in the indirect group, with no statistical difference between them (P = 0.537). However, the mean displacement was significantly higher in the indirect group (282.61 ± 110.83 µm) compared to the direct group (220.33 ± 39.67 µm, P = 0.04). The direction of displacement (downward or upward) did not differ significantly between the groups (P = 0.093). While the occurrence and location of postoperative retinal displacement did not significantly differ between direct and indirect fluid exchange methods during PPV for RRD, eyes treated with the direct method exhibited lower mean displacement compared to the indirect method. These findings suggest potential benefits of the direct exchange approach in minimizing retinal displacement following surgery.

Anatomic and Visual Outcomes of Scleral Buckle in Primary Rhegmatogenous Retinal Detachment in the Era of Pars Plana Vitrectomy

Introduction: To determine the presenting clinical characteristics of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling and the impact on final visual outcomes and to determine the postoperative primary attachment rate, complications, and subsequent management. Methods: This retrospective observational study comprised patients with RRD who had scleral buckling surgery from January 2016 to December 2021 with a minimum follow-up of 6 months. Results: The study comprised 307 eyes of 290 patients; 97% of eyes were phakic. Primary anatomic attachment was achieved in 93% of eyes. Macula-on detachment had a significant relationship with visual gain, while age, refractive status, number of breaks, configuration of the detachment, traumatic etiology, and lens status did not. Eyes with recurrent detachment did not have a significant visual gain after subsequent pars plana vitrectomy (PPV). Conclusions: Most eyes that underwent scleral bucking were phakic. Macular status played a significant role in the visual prognosis. The primary anatomic attachment rate after scleral buckling surgery is comparable to that after PPV. Thus, scleral buckling is far from being a procedure of the past. Multiple breaks, inferior detachments, and traumatic etiology do not appear to adversely affect the visual outcomes. Multiple vitreoretinal surgeries may not result in a visual gain in cases of recurrent detachment.

Proliferative vitreoretinopathy and its relationship with inflammatory serum biomarkers.

To analyze if a relationship between levels of inflammatory serum biomarkers and severity of primary proliferative vitreoretinopathy (PVR) exists. A retrospective case-control study. The healthy adult patients with rhegmatogenous retinal detachment and primary PVR were included in the PVR group. For the control group, healthy adults who underwent cataract surgery were included. The grade of PVR was classified according to the Retinal Society Terminology Committee. Blood samples were obtained before surgery, and processed in MYTHIC 18. Measures of interest were neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), the time between the decrease in visual acuity and surgery, PVR grade, type of surgery, final best corrected visual acuity, and rate of re-detachment. Totally 240 patients were included, 120 in each group, 79 (65.8%) and 56 (46.7%) were male in the PVR and control group, respectively. PVR A had greater levels of monocytes (0.28±0.18 vs 0.12±0.32, P=0.002), neutrophils (4.59±1.51 vs 3.92±1.27, P=0.006), and LMR (9.32±4.42 vs 7.43±3.90, P=0.01). PVR B had a greater monocyte count (0.30±0.13 vs 0.12±0.32, P=0.001), and PVR C demonstrated higher levels in monocytes (0.27±0.12 vs 0.12±0.32, P=0.004), neutrophils (4.39±1.13 vs 3.92±1.27, P=0.004), and LMR (9.63±3.24 vs 7.43±3.90, P=0.002) compared to control, respectively. An LMR cut-off value of 9.38 predicted PVR with a sensibility of 54.2% and specificity of 77.5% and NLR cut-off of 1.70 predicted PVR with a sensibility of 62% and specificity of 54.2%. Patients with primary PVR demonstrate greater neutrophil, monocyte, and LMR levels than the control group. Cut-off values obtained from ratios could be useful in a clinical setting when no posterior view of the fundus is possible due to media opacity.

SEQUENTIAL PARS PLANA VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENTS WITH PERIPHERAL BREAKS AND CONCOMITANT NONCAUSATIVE MACULAR HOLE IN NONHIGHLY MYOPIC PATIENTS.

To present the anatomical and functional results of sequential pars plana vitrectomy for treating rhegmatogenous retinal detachment with peripheral breaks and concomitant noncausative macular holes (MHs) in nonhighly myopic patients. Medical records of patients who underwent rhegmatogenous retinal detachment surgical repair between 2017 and 2023 were reviewed. Of 980 patients with rhegmatogenous retinal detachment, 10 had concurrent MH and underwent sequential pars plana vitrectomy for rhegmatogenous retinal detachment repair and air endotamponade, followed by MH repair using the inverted internal limiting membrane flap technique and C2F6 endotamponade after a minimum of 1 week. The main outcomes measured were best-corrected visual acuity change, retinal reattachment rate, MH closure rate, and closure type. The retinal reattachment rate was 90% after the primary surgery and 100% after subsequent surgery. Macular hole closure was achieved in all cases. Macular hole diameters ranged from 291 to 702 µm. Anatomical recovery showed mainly 1A closure types (90%). Functional recovery demonstrated significant best-corrected visual acuity improvement, with a mean visual acuity gain of 1.58 ± 0.41 the logarithm of the minimum angle of resolution. For this infrequent pathology, sequential surgery using the inverted internal limiting membrane flap technique and air/gas endotamponade yielded favorable anatomical and functional outcomes. This controlled and standardized approach using sequential surgeries contributes to the achievement of consistent results.

Factors affecting the development of cystoid macular edema following pars plana vitrectomy with silicone oil placement: a retrospective cohort study

BackgroundCystoid macular edema (CME) can develop following silicone oil placement in complex vitreoretinal surgeries, contributing to poor visual outcomes. In this study, we investigated the clinical and surgical characteristics associated with the development of CME following the use of silicone oil (SO) in pars plana vitrectomy (PPV) surgeries.MethodsWe conducted a retrospective chart review of patients who underwent implantation of SO during PPV from 2010 to 2020 by a single surgeon. Patient demographics, type of oil, duration of oil tamponade, retinectomy size, diabetic status, lens status, prior panretinal photocoagulation, visual acuity, and incidence of CME were reviewed.ResultsThis study included 43 eyes from 40 patients who underwent SO tamponade for retinal detachment (RD) surgery. The mean duration of SO tamponade was 15.7 ± 12.7 months (range: 1–58 months). The most common indication for surgery was diabetic tractional RD (32.7%), followed by traumatic RD (16.3%) and rhegmatogenous RD with proliferative vitreoretinopathy (11.6%). Of the 43 eyes, 18 (41.9%) developed CME for the first time after PPV with SO placement, with 8 (44%) resolving within a year of oil removal. The mean duration for the development of CME was 9 months. A logistic regression model showed that a scleral buckle procedure and poor initial vision were statistically significant factors for predicting the development of CME (ORs: 11.65 and 16.06, respectively). Overall, 91% of the patients had stable or improved vision after surgery.ConclusionsThe use of a scleral buckle procedure and poor initial vision are significant factors for predicting CME following silicone oil tamponade in PPV surgeries, with 41.9% of patients developing CME with an average duration of 9 months. Recognizing such factors can lead to early monitoring and prompt management of CME.Meeting presentationPartial analyses were presented at the ASRS 2020 conference.Clinical trial numberNot applicable.

Vitreoschisis-induced vitreous cortex remnants in proliferative vitreoretinopathy: A comprehensive review from basic research to clinical practice.

Proliferative vitreoretinopathy (PVR) significantly impacts the prognosis of rhegmatogenous retinal detachment (RRD), one of the most critical and increasing causes of vision loss in the Western world. Despite advancements in surgical instruments and techniques, the failure rate due to PVR remains substantial, necessitating additional surgeries and often leading to unsatisfactory visual outcomes. This comprehensive review explores the role of vitreoschisis-induced vitreous cortex remnants (VCR) as a critical, previously under-recognised factor contributing to PVR. Vitreoschisis, a phenomenon where the inner lamellae of the posterior vitreous cortex detach while the outermost layers remain attached to the retina, creates VCR that may contain hyalocytes and serve as scaffolds for fibrocellular proliferation. These remnants are difficult to visualise without triamcinolone acetonide (TA) staining, leading to their frequent lack of recognition in clinical practice. Moreover, removing VCR can be challenging and time-consuming, often requiring meticulous surgical techniques to avoid retinal damage and ensure complete elimination. This review consolidates insights from basic research and clinical practice, emphasising the importance of complete vitreous removal and effective VCR detection and removal to mitigate PVR risks. It highlights the histopathological and clinical evidence supporting the hypothesis that VCR, containing hyalocytes, play a pivotal role in preretinal membrane formation. The review also discusses epidemiological data, surgical management strategies and potential future directions, including improved visualisation techniques and the development of new surgical tools and methods. This review aims to improve surgical outcomes and reduce the frequency and burden of RRD-related complications by addressing VCR as a critical factor in PVR.

Safety and efficacy of subthreshold micropulse yellow laser for persistent subretinal fluid after scleral bucking a randomized clinical trial

Persistent subretinal fluid (PSF) after scleral bucking of rhegmatogenous retinal detachment may delay recovery and affect the final visual quality, but with no effective treatment. This study firstly investigated the safety and efficacy of 577 nm yellow subthreshold micropulse laser (SML) on PSF after scleral bucking surgery. This double-masked randomized clinical trial was conducted from December 2020 to October 2022 at Chongqing Aier Eye Hospital. Participants with PSF last for 1 month after scleral bucking surgery with break closed and retina reattachment were recruitment. These participants were treated by 577 nm yellow SML or sham treatment. Funduscopy, optical coherence tomography (OCT) volume change, best corrected vision acuity (BCVA) and visual field test were evaluated for six mouths follow-up. A total of 24 participants were randomized into SML group or Sham group equally. Compared with Sham group, the OCT volume within 6 mm of macular fovea was significantly less in SML group 6 months after therapy (P = 0.048). There were no statistically significant differences of OCT volume at 1, 2 and 3 months from baseline between groups. BCVA of ETDRS letters had no statistically significant difference. Pattern Standard Deviation amelioration (P = 0.039) had statistically significance in SML group compared with Sham group. There were no complications in the 2 groups. These preliminary findings suggest that 577 nm yellow SML therapy could accelerate PSF absorption after scleral bucking surgery.Trial registration: Chinese Clinical Trial Registry No. ChiCTR2000037838, 02/09/2020, https://www.chictr.org.cn/showproj.html?proj=51885.