Rhegmatogenous Retinal Detachment Research Articles

Glue-Assisted Retinopexy for Retinal Detachments Study Report 2: Fibrin Glue As a Surgical Adjunct in Complex Rhegmatogenous Retinal Detachment

Purpose: To present the successful application of fibrin glue as a surgical adjunct in the management of complex rhegmatogenous retinal detachment (RRD). Methods: In this retrospective case series, fibrin glue was used as a surgical adjunct in 5 cases of complex RRD. In each case, standard pars plana vitrectomy and laser retinopexy were performed by the same surgeon. Fibrin glue was used intraoperatively as a tamponade to seal the breaks because the isolated use of conventional tamponade agents was not feasible given the variable nature of the complex RRDs, the anatomy of the eye, or an inability to maintain postoperative positioning. Results: In 1 patient previously treated for a large corneoscleral tear, fibrin glue was used to seal a large iatrogenic retinal break caused by a fragmatome-related surge that led to a quadrantic RD. In 2 patients treated for combined RRD, fibrin glue was used with silicone oil to manage recurrent RRD with incompletely drained thick subretinal fluid and blood. In 2 other cases, fibrin glue was applied to manage RRD in congenital aniridia with advanced glaucoma and aphakia. In all cases, retinal attachment without serious adverse effects was attained over a follow-up ranging from 4 to 6 months. Conclusions: Fibrin glue is an effective, safe surgical adjunct in complex RRD. It can be used to transiently seal a retinal break when use of a conventional tamponade agent is not possible or not sufficient alone.

Management of macula-on giant retinal tear detachments– outcome of pars-plana-vitrectomy with silicone oil versus gas tamponade

BackgroundTo compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.MethodsAll consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.ResultsOverall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).ConclusionsSurgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.Trial registrationThe trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).

A Modified Suturing Technique to Produce Temporary Scleral Buckling Effect for Noncomplex Rhegmatogenous Retinal Detachment.

To introduce a surgical technique for temporary scleral buckling of noncomplex rhegmatogenous retinal detachment using a combination of nonabsorbable and absorbable sutures that would induce minimal permanent refractive changes. Twenty consecutive patients (20 eyes) with noncomplex rhegmatogenous retinal detachment were prospectively included. Scleral buckling was performed in all eligible subjects, and encircling buckling was added when necessary. The silicone elements were fixed on the sclera with 5-0 nonabsorbable sutures and tightened to form a ridge with 6-0 absorbable sutures. Best-corrected visual acuity, scleral ridge status, axial length, spherical diopter, and cylinder diopter were collected. All patients achieved primary retinal reattachment with significant improvement of best-corrected visual acuity after surgery. Scleral ridge was obvious and in situ at the 1-month follow-up but diminished at the 3-month follow-up. At the 1-month follow-up, axial length increased from 24.78 mm ± 2.14 mm preoperatively to 25.22 mm ± 2.11 mm, and cylinder diopter increased from -1.99 ± 1.03 to -2.95 ± 1.55 (both P < 0.001). At the 3-month follow-up, axial length, spherical diopter, and cylinder diopter decreased significantly compared with the values at the 1-month follow-up (all P < 0.05). No obvious complications were observed during the whole follow-up. Patients who underwent additional encircling buckling exhibited greater changes in axial length and cylinder diopter at the 1-month follow-up (both P < 0.001). The modified technique of scleral buckling with/without encircling buckling using both nonabsorbable and absorbable sutures offers a safe and effective option to repair noncomplex rhegmatogenous retinal detachment, which would offer an adequate temporary scleral buckling effect and induce minimal permanent refractive changes.

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.

Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy.

To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV). In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications. Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD. After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.

A Case of Excessive Axial Length Elongation Following Retinal Detachment Vitrectomy

Purpose: To report a case of excessive axial length elongation following vitrectomy for rhegmatogenous retinal detachment.Case summary: A 21-year-old male patient presented to our hospital with visual impairment. The patient had previously undergone computed tomography in our emergency room for a facial contusion 3 years prior to his current visit. Axial lengths of 27.23 mm in the right eye and 27.62 mm in the left eye were recorded at that time. The patient had no previous ocular history. Fundus examination revealed extensive retinal detachment with macular involvement and hypotony retinopathy in the left eye. Retinal detachment surgery was subsequently performed on the left eye. Following the surgery, intraocular pressure in the left eye increased and intraocular pressure-lowering medications were administered. At 3 months postoperatively, the patient developed additional retinal detachment in the right eye, prompting retinal detachment surgery. Unlike the contralateral eye, the intraocular pressure remained well-controlled postoperatively. Axial length measurement was performed due to the complaint of left eye protrusion. The axial lengths were 27.76 mm and 31.41 mm in the right and left eyes, respectively. There was a significant increase in the axial length of the left eye but not in that of the right eye compared to 3 years prior.Conclusions: Gas tamponade, preoperative ocular hypotension, and postoperative ocular hypertension can cause excessive axial length elongation in cases of rhegmatogenous retinal detachment in young patients with high myopia.

Retrospective case series of high-density silicone oil (Oxane HD) in severe proliferative vitreorretinal retinal detachment patients

BackgroundDescribe complications and clinical outcomes of heavy silicone oil (HSO) Oxane HD® use as an alternative to overcome the challenges of performing vitrectomy to treat tractional and rhegmatogenous retinal detachments with proliferative vitreoretinopathy (PVR).MethodsA retrospective, observational study was performed on patients from one center from August 2014 to Aug 2023. It was included patients who underwent surgery using HSO Oxane HD® to treat rhegmatogenous retinal detachment with PVR or mixed tractional and rhegmatogenous diabetic retinal detachment. Severely ill patients who could not attend to follow up were excluded. The primary outcome was successful retinal attachment at first postoperative month. A descriptive analysis was performed.ResultsAmong the 31 patients, 29 (93.5%) underwent surgeries due to rhegmatogenous retinal detachment and two (6.5%) for diabetic retinal detachment. The primary anatomic success was achieved in 27 (87.1%) patients. At the final visit, 17 (56.6%) had vision better than 20/400 (range, 20/30 to light perception). The vision was stable or improved in 22 (76.8%) patients at the end of follow-up. Nineteen (61.3%) patients required hypotensive eye drops after HSO use and twelve (38.7%) still required hypotensive eye drops at the final follow-up; three (9.7%) patients required additional glaucoma surgeries.ConclusionsHSO is safe and useful for complex retinal detachments cases specially with inferior tears and PVR. Ocular hypertension is frequent and usually clinically controlled with hypotensive eyedrops. Close postoperatively follow-up is advised due to the ocular complications, particularly elevated intraocular pressure and emulsification.

Selective internal limiting membrane peeling for prevention of secondary epiretinal membrane after vitrectomy for rhegmatogenous retinal detachment.

We introduce selective internal limiting membrane (ILM) peeling, a guideline procedure to determine whether to remove the ILM during vitrectomy for rhegmatogenous retinal detachment (RRD). Retrospective case series METHODS: Patients who underwent pars plana vitrectomy for RRD and were followed up for 12 months or longer were included. When vitreous cortex remnants (VCRs) were detected with triamcinolone acetonide, the ILM was removed; otherwise, the ILM was preserved ("selective ILM peeling"). The factors associated with the presence of VCRs and incidence of secondary epiretinal membrane (ERM) were analyzed. VCRs were detected in 87 of 133 eyes (65.4%) in which the ILM was removed. Younger age, better preoperative visual acuity, and vitreous hemorrhage were negatively correlated with the presence of VCRs.No ERM occurred in the eyes after ILM peeling. Among the eyes with ILM preservation, subclinical ERM was noticed in 4 eyes (8.7%), and 1 eye (2.1%) required additional surgery owing to ERM. ERM occurred more commonly in eyes with the ILM preserved (P = .004). However, no differences in the rate of additional surgeries were found between the 2 groups. Selective ILM peeling offers an alternative option to reduce the burden of ILM peeling or additional surgery.

Perfluorocarbon Liquid-Silicone Oil Exchange: The Simplicity and Reliability of the Single Port Technique and a Review of Literature

Purpose: To report the “Single Port Technique” for perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange for the management of giant retinal tear detachments (GRTD). Methods: The previously reported techniques of direct PFCL-SO exchange used 2 ports to achieve the influx and outflux of fluid. The term 'Single Port' refers to the use of only one port as the exclusive port for the inflow of SO and the outflow of fluid meniscus and PFCL, performed alternately. This technique is proposed, with illustrated instructions and a surgical video. Results: The newly proposed “Single Port Technique” offers a straightforward step using a switch between active aspiration by the vitreous cutter and active silicone oil injection through a single port without the need for assistance. This method has been performed by the authors on 29 patients, including 22 GRTD patients and 7 patients with rhegmatogenous retinal detachment caused by dialysis, and it has demonstrated its simplicity and reliability for use with only standard vitrectomy tools and machine settings. Conclusion: The Single Port Technique for PFCL-SO exchange for the management of GRTD and rhegmatogenous retinal detachment caused by dialysis has been tried and tested, and it is a valuable tool that can be easily used by any vitreoretinal surgeon.

SPONTANEOUS RESOLUTION OF SUBFOVEAL PERFLUOROCARBON: CASE REPORT AND REVIEW OF THE LITERATURE

Purpose: To report a case of spontaneous resolution of subfoveal perfluorocarbon liquid (sPFCL). Methods: A 72-year-old male presented with poor vision in the left eye for two months. Ophthalmic examination revealed a visual acuity of counting fingers at 40 cm, pseudophakia, and rhegmatogenous retinal detachment in the left eye. The patient underwent 23G pars plana vitrectomy associated with a scleral buckle and silicone oil. Postoperatively, a retained sPFCL bubble was observed on OCT image. Results: Postoperatively, the sPFCL bubbles disappeared spontaneously by a full-thickness macular hole. Four weeks after surgery, the macular hole was closed, and visual acuity improved with preservation of foveal depression. Conclusion: Because spontaneous resolution rarely occurs, retinal surgeons prefer early evacuation of sPFCL. Herein, we report a new case of spontaneously resolved sPFCL and discuss the mechanisms for its resolution reported in the literature.

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

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

CHARACTERISTICS, OUTCOMES, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES OF MACULAR HOLE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate full-thickness macular holes (FTMHs) that develop after rhegmatogenous retinal detachment (RRD) repair. Retrospective consecutive case series of patients who underwent RRD repair between 2015 and 2021 and subsequently developed FTMH. Twenty-three patients (23 eyes) were included. All eyes underwent pars plana vitrectomy + membrane peel for macular hole (MH) repair. The mean age at RRD diagnosis was 62 years and 52% were male. In total, 78% were macula-off RRDs. Fourteen eyes (60.9%) underwent pars plana vitrectomy alone, 7 (30.4%) underwent pars plana vitrectomy and scleral buckling, 1 (4.3%) underwent scleral buckling only, and 1 (4.3%) underwent pneumatic retinopexy. Median time from RRD repair to MH diagnosis was 116 days. Macula-off RRDs had a significantly lower time to MH diagnosis (mean 154 days, P < 0.05) than macula-on RRDs (mean 875 days). Twenty-one MH (91%) had optical coherence tomography evidence of an epiretinal membrane. Mean logMAR visual acuity at MH diagnosis was 1.05 (∼20/224) and significantly improved to 0.66 (∼20/91) at the final follow-up ( P < 0.001); 100% of MHs closed by the final follow-up. Pars plana vitrectomy for MH after RRD repair has a high closure rate and leads to significant VA improvement. MH formation after RRD repair may be associated with macula-off detachments and epiretinal membrane. Macula-off RRDs develop MH faster than macula-on RRDs.

Quantitative Microvascular Change Analysis Using a Semi-Automated Algorithm in Macula-on Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

The purpose of this study was to objectively evaluate the longitudinal changes observed in the retinal capillaries in eyes with macula-on rhegmatogenous retinal detachment (RRD), assessed with optical coherence tomography angiography (OCTA), and to assess the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. This was a prospective, longitudinal study conducted on consecutive patients who underwent 25 G pars plana vitrectomy for primary RRD. The vessel area density (VAD), vessel skeleton density (VSD), and vessel diameter index (VDI) were assessed in the superficial (SCP) and deep (DCP) capillary plexuses. Twenty-three eyes with macula-on RRD were included in the study. The mean preoperative VDI, VAD, and VSD of the RRD eye were 18.6 ± 1.1, 0.43 ± 0.02, and 0.17 ± 0.01 in the SCP; and 18.6 ± 0.6, 0.38 ± 0.03, and 0.15 ± 0.01 in the DCP, respectively. At month 6, eight (34.8%) eyes achieved a best-corrected visual acuity (BCVA) gain ≥ 0.1 LogMAR. A preoperative VDI > 17.80, VSD > 0.170, and VDI-change > -0.395 in the SCP; and VDI > 18.11 and VDI change > -0.039 in the DCP were predictors of achieving a BCVA-gain ≥ 0.1 LogMAR. The preoperative VDI in SCP and DCP, the preoperative VSD in SCP, and their changes from preoperative values were predictors of visual outcomes. A quantitative OCTA analysis of capillary density and morphology may represent a potential predictive tool for surgical outcomes in RRD. The results reported in this study suggest that OCTA is a useful ancillary test for clinical disease management.

Influence of Vitreous Cortex Remnants on Normal Retinal Anatomy in Eyes with Primary Rhegmatogenous Retinal Detachment

To investigate the influence of vitreous cortex remnants (VCRs) removal on normal retinal anatomy in eyes with rhegmatogenous retinal detachment (RRD). Prospective cohort study. Patients with primary RRD operated with pars plana vitrectomy (PPV). Blue fundus autofluorescence and spectral-domain optical coherence tomography were obtained pre-operatively, and at 1 and 6 months after operation. Primary outcomes: rate of retinal displacement and outer retinal folds at 1 month after operation. continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ), and the logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) at 6 months after operation. One hundred three eyes were included. Intra-operatively, peripheral (p)VCRs were found in 42 eyes (40.8%) and successfully peeled off from ≥ 2 quadrants in 37 eyes. Macular (m)VCRs were detected in 37 (35.9%) and successfully peeled off in 29 eyes. At the end of operation 44.7% and 55.3% of the eyes were tamponaded with 20% sulfur hexafluoride gas and silicone oil 1000 centistokes, respectively. The only variable significantly associated with displacement was the use of gas tamponade vs. silicone oil (p=0.001) whereas no significant association was found between retinal displacement and pVCRs (p=0.58) or number of quadrants from which pVCRs were peeled off (p=0.39). At 1 month post-operatively ORFs were globally detected in 24 eyes (23.3%). Regression analysis showed a direct correlation between ORFs and the intraoperative detection of mVCRs (p=0.02) and an indirect correlation between ORFs and mVCRs peeling (p= 0.004). Macular VCRs peeling did not influence the continuity of ELM and EZ at the 6- month follow-up (FU). Intraoperative absence of mVCRs (p=0.0016) and peeling of mVCRs (p=0.003) were associated with logMAR BCVA ≤ 0.3 at the 6-month FU. Peeling of pVCRs did not seem to influence the rate of retinal displacement while peeling of mVCRs was associated with a reduced risk of developing ORFs without detrimental effect on the continuity of ELM/EZ at 6 month FU. The patients without mVCRs detected intraoperatively or who underwent mVCRs peeling during operation, showed a significantly better VA at the 6-month FU.

Assessment of Zonular Integrity in Phakic Eyes Following Pars Plana Vitrectomy Using Ultrasound Biomicroscopy (UBM): A Prospective Paired Eye Comparative Study.

To assess zonular integrity in phakic patients post vitrectomy using ultrasound biomicroscopy (UBM). Prospective, comparative, non-randomized, double masked, paired eye study. We used ultrasound biomicroscopy (UBM) to evaluate phakic patients with history of unilateral pars-plana vitrectomy. 1.Phakic patients with history of pars plana vitrectomy in one eye as the only procedure. 2.Normal unoperated fellow eye. 3.Complete gas or air resolution from the vitreous cavity at the time of UBM assessment. 1. Monocular patients. 2. History of intraoperative lenticular trauma. 3. The use of silicone oil tamponade. 4. History of trauma or pseudo-exfoliation in either eye.5. History of other ocular conditions that can affect the integrity of zonules, such as uveitis or ectopia lentis. 6. Eyes with extreme myopia/long axial length (> -8.00 D / > 30.0 mm). 7.History of intravitreal injection in either eye. 8. Age less than 18 years. A high frequency (50 MHz) UBM device was used by a masked technician to obtain radial section images from zonular bundles at 8 different clock positions. Image quality was assessed in real time, captured and saved. Two experienced masked observers (HC and CB) then assessed the quality of the images and graded the zonular findings. Only patients with adequate studies have been included. A unique grading system that was specifically devised for this study was used as the following: (0) clear, well-defined zonule(s); (1) uneven, disrupted zonules or stretched zonules; (2) extensive loss of zonules. Each clock hour was graded according to this system and the total score was then calculated for each eye. In the primary outcome, two main groups were analyzed: the vitrectomized, and healthy contralateral non-vitrectomized eyes. The mean total UBM score (TUS) from each group was compared and analyzed. Thirty five patients were recruited into this study. Eleven patients were males and twenty four were females. The mean age was 66.3 years. Thirty patients had vitrectomy for vitreomacular interface disorders (either macular hole or epiretinal membrane), one patient had vitreous hemorrhage and the remaining four patients had rhegmatogenous retinal detachments. With regards to tamponade agents, SF6 was used in 21 (60%) patients, air in 9 (26%) patients, and C3F8 in 5 (14%) patients. The mean UBM total score (TUS) in the vitrectomized eyes was 2.28 (SD: 1.83) versus 2.24 (SD: 1.77) in the non-vitrectomized eyes (p=0.9531. Overall, in the comparative analysis of mean scores based on two-graders' assessments for each clock position in vitrectomized and non-vitrectomized eyes, there were no significant differences noted between the groups. This study found no evidence for a difference in the mean total UBM score (TUS) in eyes following vitrectomy when compared to their contralateral healthy, non-vitrectomized eyes. This likely indicates that vitrectomy may not affect the integrity of zonules in phakic patients, at least for patients with vitreomacular interface disorders undergoing uncomplicated surgery.

Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes.

Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes. To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD. Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal. Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 - 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 - 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment. PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.

Epiretinal membrane formation after rhegmatogenous retinal detachment repair (RRD): A single center study.

Objective: To determine the frequency of patients developing ERM (epiretinal membrane) after surgical procedure for RRD. Study Design: Retrospective study. Setting: Department of Ophthalmology, Madina Teaching Hospital Faisalabad. Period: November 2021 to October 2022. Methods: Involving patients of primary RRD; 160 patients enrolled before the operation, each patient had both of their eyes assessed, and then again after one month, and then three months after the procedure. These assessments comprised a comprehensive ophthalmological evaluation, which consisted of slit-lamp biomicroscopy, OCT scans. On the basis of ERM formation, the participants were divided into two distinct groups. Age, gender, length of retinal detachment in days, existence of PVD, type of surgery done for RRD, and presence or absence of postoperative ERM were some of the demographic and clinical data that were obtained. Results: A total of 160 patients' data was evaluated, and 47 (29.4%) of them had ERM formation following RRD repair. No factor such as age, gender, side of the eye involved and type of surgery has any influence on the outcome of ERM as the p value &lt;0.05. Conclusion: According to the results it can be concluded that ERM is a prevalent complication after SB and PPV surgery dome for RRD but no associations were seen with age, gender, side of the eye involved and type of surgery has any influence on the outcome of ERM.

Prediction of postoperative visual acuity restoration in macula off rhegmatogenous retinal detachment using artificial intelligence

PurposeTo assess feasibility of automatic segmentation of OCT biomarkers of visual acuity (VA) and the possibility of prediction of postoperative VA after successful reattachment in macula off rhegmatogenous retinal detachment (RRD) eyes using artificial intelligence (AI). Designretrospective case control study MethodsPatients operated of pars plana vitrectomy (PPV) for macula-off non-traumatic RRD with available good quality OCT acquisitions were included. Ellipsoid zone(EZ) foveal damage and reflectivity, external limiting membrane(ELM) foveal damage, foveal flattening, outer nuclear layer(ONL) thickness and the presence of cysts and hyperreflective foci(HRFs) was assessed on preoperative OCT B scan images by both a trained segmenter and human graders. Different machine learning(ML)models were tested for detection of cases with VA>0.4 logMar at 6 months from surgery.Segmentation performance of the model was compared with ground truth segmentation provided by human graders. Postoperative VA prediction based on the segmented OCT biomarkers, preoperative VA and age was compared with actual postoperative VA to assess accuracy of the model. ResultsA total of 58 eyes of 58 patients were included. A significant difference in preoperative VA, foveal flattening, foveal EZ and ELM damage, EZ reflectivity and presence of HRF in the ONL was detected between groups(all p < 0.001).The segmenter showed good agreement with human assessment in both qualitative and quantitative variables. The Optimizable Naïve Bayes model was the best performing ML model and showed an accuracy of 86.2 % in detection of cases with postoperative VA>0.4 logMar. ConclusionsThe results confirm the prognostic relevance of EZ and ELM integrity and reflectivity, foveal flattening, ONL cysts and ONL HRF in macula off RRD, and, for the first time in literature, reports feasibility of the segmentation of these factors in preoperative OCT B scan images. We also report good classification performances of Naïve Bayes models based on OCT biomarkers, preoperative VA and age in distinguishing patients that should expect a postoperative VA>0.4 logMar at 6 months from surgery.

Internal limiting membrane peeling in vitreoretinal surgery for rhegmatogenous retinal detachment: clinical results, surgical options, and future prospects

Rhegmatogenous retinal detachment (RRD) is one of the leading causes of primary vision disability, while the majority of RRD patients with RRD are people of active working age. Over the past 50 years, retinal detachment surgery has been progressing rapidly, the rate of success increasing up to 90% or higher. However, the reduction of reoperation risks of reoperations, improvement of functional outcomes and increase of postoperative visual acuity remain topical issues. The main reason for repeated surgical interventions is the proliferative vitreoretinopathy progression, which can lead to epiretinal fibrosis, macular oedema, or retinal detachment recurrence. The review is focused on current literature studies that report the results of internal limiting membrane peeling in cases of RRD surgeries and other optional techniques aimed at reducing the risk of the above mentioned postoperative complications.

Anti-inflammatory potential of simvastatin and amfenac in ARPE-19 cells; insights in preventing re-detachment and proliferative vitreoretinopathy after rhegmatogenous retinal detachment surgery

PurposeRhegmatogenous retinal detachment is a severe vision-threatening complication that can result into proliferative vitreoretinopathy (PVR) and re-detachment of the retina if recovery from surgery fails. Inflammation and changes in retinal pigment epithelial (RPE) cells are important contributors to the disease. Here, we studied the effects of simvastatin and amfenac on ARPE-19 cells under inflammatory conditions.MethodsARPE-19 cells were pre-treated with simvastatin and/or amfenac for 24 h after which interleukin (IL)-1α or IL-1β was added for another 24 h. After treatments, lactate dehydrogenase release, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) processing, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activity, prostaglandin E2 (PGE2) level, and extracellular levels of IL-6, IL-8, monocytic chemoattractant protein (MCP-1), vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor, as well as the production of reactive oxygen species (ROS) were determined.ResultsPre-treatment of human ARPE-19 cells with simvastatin reduced the production of IL-6, IL-8, and MCP-1 cytokines, PGE2 levels, as well as NF-κB activity upon inflammation, whereas amfenac reduced IL-8 and MCP-1 release but increased ROS production. Together, simvastatin and amfenac reduced the release of IL-6, IL-8, and MCP-1 cytokines as well as NF-κB activity but increased the VEGF release upon inflammation in ARPE-19 cells.ConclusionOur present study supports the anti-inflammatory capacity of simvastatin as pre-treatment against inflammation in human RPE cells, and the addition of amfenac complements the effect. The early modulation of local conditions in the retina can prevent inflammation induced PVR formation and subsequent retinal re-detachment.