Rhegmatogenous Rhegmatogenous Retinal Detachment Research Articles

Evolution of demarcation line after pneumatic retinopexy—a case report

BackgroundDemarcation line in a rhegmatogenous retinal detachment (RD) is a classic finding noted in chronic cases. In this case report, we describe a case of evolution of post-operative demarcation line after pneumatic retinopexy (PnR) in a subtotal rhegmatogenous RD.Case descriptionA 31-year-old male diagnosed with acute, subtotal, macula-off rhegmatogenous RD in the left eye of 15-day duration underwent PnR on the same day. His presenting visual acuity was 6/48 in the left eye. Transconjunctival cryopexy was performed to the retinal break at the same sitting and 0.5 cc of 100% perfluoroproprane (C3F8) gas was injected in the vitreous cavity and right lateral position was advised to the patient.ResultA pigmentary demarcation line was noted extending the nasal part of the macula along the most dependent part of the detachment on the immediate post-operative day and was more obviously visible on the 2nd and then on the 11th post-operative day. The visual acuity at the last follow-up visit improved to 6/18. Successful reattachment of the retina was noted on the last follow-up visit.ConclusionPost-operative demarcation lines after RD surgery could develop due to subretinal migration of pigments and along the most-dependent part depending upon post-operative positioning of the patient. Careful post-operative positioning, particularly in macula splitting RDs could be important to avoid pigment accumulation along the foveal area.

Surgical Outcomes of Vitrectomy for Primary Treatment of Rhegmatogenous Retinal Detachment in Patients with Atopic Dermatitis.

To investigate the clinical results of vitrectomy alone as the primary treatment for rhegmatogenous retinal detachment (RD) in patients with atopic dermatitis (AD). The medical records of patients with AD treated for rhegmatogenous retinal detachment (RD) were retrospectively reviewed. We investigated the characteristics of retinal breaks and detachments, applied surgical methods, and results. Twenty eyes of 14 patients with AD who presented with rhegmatogenous RD and treated by vitrectomy were included in this analysis. Sixteen eyes (80%) were treated with vitrectomy, either alone or in combination with cataract surgery, and the retina was successfully attached to 94% of the eyes. There were four cases in which vitrectomy was combined with encircling. Reoperation was needed in half of the eyes that received vitrectomy with encircling, which presented nearly total detachment, severe proliferative vitreoretinopathy, and pseudophakia. Vitrectomy alone, in combination with cataract surgery, may be sufficient to treat rhegmatogenous RD in patients with AD. Additional encircling or buckling should still be considered in complicated cases.

Хирургическое лечение регматогенной отслойки сетчатки с массивной пролиферативной витреоретинопатией на фоне рубцовой стадии ретинопатии недоношенных. Клинический случай

Purpose. Demonstration of clinical case of surgical treatment of rhegmatogenous retinal detachment (RD) with massive proliferative vitreoretinopathy (PVR) against the background of cicatricial stage of retinopathy of prematurity (ROP). Material and methods. Patient O. was born at gestational age of 28 weeks with a body weight 1600 g. At age of 4 years, patient diagnosed “retinopathy of prematurity stage II, cicatricial period of the right eye. Subatrophy of the left eye”. At age of 12 years, rhegmatogenous subtotal RD, PVR C 1–12 post, developed against the background of the cicatricial stage of ROP in the right eye. 25G vitrectomy with tamponade perfluorinated compound with replacement for silicone, restrictive laser photocoagulation were performed. Results. Complete attachment of the RD was achieved. The silicone was removed after 6 months. Attachment of the retina was noted during 2 years. Visual acuity (VA) was 0.4. RD recurrence happened 2 years later, VA of the right eye – no light perception. 25G vitrectomy with membrane removal and “Pfocalin” tamponade was performed. During staged surgery: “Pfocalin” was removed, laser photocoagulation and silicone tamponade were performed. VA on the 3rd day – 0.1. Intraocular pressure – 14 mm Hg. After 1 month, the VA of the right eye is 0.1. After 6 months, the VA is 0.2, the retina is attach. Conclusions. 1. Rhegmatogenous RD develops with varying degrees of cicatricial ROP. 2. Despite the successful RD surgery against the background of cicatricial ROP, the stability of visual functions and retinal status, in the long-term period, RD recurrence is possible due to development of severe PVR. 3. The decision to terminate silicone tamponade in such cases should be made on an individual basis. 4. Based on the foregoing, long-term monitoring of patients with regressed stages of ROP is required. Keywords: retinopathy of prematurity, retinal detachment, proliferative vitreoretinopathy.

Vitreoschisis and retinal detachment: New insight in proliferative vitreoretinopathy.

To assess the occurrence of peripheral vitreoschisis-induced vitreous cortex remnants (p-VCRs) in primary rhegmatogenous retinal detachment (RD) and investigate whether the presence of p-VCRs results in a greater risk of RD recurrence, secondary to Proliferative Vitreoretinopathy (PVR) development after pars plana vitrectomy (PPV). Patients who underwent PPV for primary rhegmatogenous RD between January 2016 and December 2018 were included. The presence of residual p-VCRs was confirmed intraoperatively using triamcinolone acetonide (TA). Patients with p-VCRs were divided into two groups: Group A comprised of patients who underwent PPV without p-VCR removal, while Group B included patients who underwent PPV with p-VCR removal. Four hundred-thirteen eyes with evidence of p-VCR were analyzed. Two-hundred-twenty-three eyes underwent PPV without VCR removal (Group A), while 190 eyes underwent PPV with p-VCR removal (Group B). Primary anatomical success was 91.5% in the Group A and 95.4% in the group B. Retinal re-detachment due to PVR occurred in 17 (7.6%) eyes in Group A and in four (2.1%) eyes in Group B within the first 3 months (p = 0.01). Among group A, in 11 eyes, there was a diffuse posterior PVR grade C, while six eyes were focal PVR grade C. In Group B, we observed four retinal re-detachment due to focal PVR grade C. The presence of p-VCRs seems to be associated with a higher incidence of PVR development and might also result in more complex RD recurrence, this suggests the need for more aggressive VCRs removal during the first surgery.

A brief review of the histopathology of proliferative vitreoretinopathy (PVR).

Proliferative vitreoretinopathy (PVR) is thought to represent an exaggerated and protracted scarring process following rhegmatogenous retinal detachment (RD) and following RD surgery. Following detachment, a combination of retinal ischaemia, inflammation and cell proliferation lead to the formation of tractional membranes on the epiretinal and subretinal surfaces and to marked gliosis within the retina that leads to retinal shortening. Both of these factors convert a rhegmatogenous RD into a tractional one are a major feature of RD surgery failure. The major cell types that are involved in PVR are retinal pigment epithelium (RPE), glial cells (principally Muller cells) and inflammatory cells (macrophages and lymphocytes). These cells interact with numerous growth factors and cytokines derived from the breakdown of the blood-retinal barrier and from vitreous contact that trigger a cascade of cellular processes, such as epithelial-mesenchymal transition (EMT), cell migration, chemotaxis, proliferation, elaboration of basement membrane and collagen and cellular contraction, that lead to overt retinal pathology. This review covers the histopathology of PVR and touches upon the cellular processes involved in the pathogenesis of PVR.

Peritomy-sparing scleral buckle

AbstracPurposeTo introduce a modified technique for encircling circumferential scleral buckling without peritomy thorough a small conjunctival opening for the repair of uncomplicated rhegmatogenous retinal detachment (RD).MethodsThis technique was performed in 10 eyes of 10 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling without peritomy. Transconjunctival traction sutures were placed in four rectus muscles. After transconjunctival location of the retinal break, a 5- to 6-mm radial conjunctival incision was performed in 4 quadrants without cutting the limbal conjunctiva–Tenon's capsule. A 240-silicone band in scleral belt loops was used for an encircling circumferential buckle. After drainage and cryopexy, SF6 was used for tamponade. The incision was closed via layered closure only ocassionally.ResultsPrimary attachment success of 100% was achieved by single procedure. The intraoperative and postoperative complications observed included subconjunctival hemorrhage observed in 5 (50%) of eyes. These disappeared in the postoperative period.ConclusionsMinimal conjunctival incision in scleral buckle without peritomy can achieve excellent anatomical success in patients with rhegmatogenous RD without distorting ocular surface anatomy. This is the first description of technique preserving corneal limbus anatomy that could convert buckling surgery to more attractive option for retina surgeons.

Efficacy and safety of primary posterior capsulotomy in combined phaco-vitrectomy in rhegmatogenous retinal detachment.

ObjectiveTo evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy.MethodsA retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy.ResultsThe modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy.ConclusionsA primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.

Outcomes of 27-Gauge Vitrectomy-Assisted Choroidal and Subretinal Biopsy.

To report the initial experience of 27-gauge vitrectomy-assisted choroidal and subretinal biopsy PATIENTS AND METHODS: Retrospective, interventional case series. Eighteen eyes of 18 patients undergoing 27-gauge vitrectomy-assisted choroidal (n = 16) or subretinal biopsy (n = 2). Clinical and lesion characteristics, cytopathology, histology, gene expression profiling (GEP), visual acuity (VA), complications including vitreous hemorrhage (VH), development of rhegmatogenous retinal detachment (RD), and need for additional surgeries were analyzed. Indications were choroidal melanoma (n = 10), indeterminate choroidal (n = 5), and subretinal lesions (n = 3). Mean lesion height was 3.33 mm ± 1.55 mm (range: 0.80 mm to 6.75 mm) and largest diameter was 8.63 mm ± 4.14 mm (range: 3 mm to 15.5 mm). Mean number of intralesional biopsy passes required was 1.76 ± 0.83 (range: one to four). During a mean follow-up of 7.4 months ± 2.7 months (range: 4 months to 14 months), VA was unchanged (0.5 logMAR ± 0.6 logMAR vs. 0.7 logMAR ± 0.84 logMAR; P = .07). Pathologic diagnosis was obtained in 16 of 18 eyes (88.9%), and GEP data were collected for all 11 choroidal melanomas. Post-biopsy VH occurred in 13 of 18 eyes (72.2%) and was severe enough to require a concurrent limited vitrectomy in six eyes (33.3%). These eyes had a greater lesion height compared to eyes not requiring a vitrectomy (4.08 mm ± 1.68 mm vs. 2.76 mm ± 1.43 mm; P = .04). A rhegmatogenous RD requiring repeat surgery developed in two of 18 eyes (11.1%). The authors concluded that 27-gauge vitrectomy-assisted choroidal and subretinal biopsy established a diagnosis in 88.9% of eyes in lesions 0.8 mm or larger. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:406-415.].

Excellent results of scleral buckling in the era of microincision vitreous surgery

Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Materials and Methods: Retrospective analysis of fifty eyes of fifty patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2014 to August 2015. Results: Primary retinal reattachment rate of 41 patients was achieved with single surgery, but final anatomical success was 94% with additional pars plana vitrectomy with silicone oil injection and with vitrectomy with epiretinal membrane removal. The mean follow-up was 6 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Refractive outcomes of combined phacovitrectomy and delayed cataract surgery in retinal detachment

ObjectiveTo compare the accuracy of refractive outcomes between combined pars plana vitrectomy (PPV) and cataract surgery and delayed cataract surgery after PPV in cases with rhegmatogenous retinal detachment (RD). DesignRetrospective case series. ParticipantsThirty-eight eyes underwent combined phacovitrectomy (combined group) and 25 eyes underwent delayed cataract surgery after PPV (delayed group). MethodsRD height was measured using optical coherence tomography. Refractive outcomes were evaluated using mean absolute error (MAE; the difference between final refractive error and target refractive error). ResultsCombined group showed significant myopic shift (mean error; –0.40 ± 1.07 vs 0.07 ± 0.56 D, p = 0.028) and large MAE (0.81 ± 0.81 vs 0.48 ± 0.29 D, p = 0.028) compared with delayed group. Multiple logistic regression analysis revealed that only RD height was significantly associated with MAE greater than 2 D after combined surgery (in 100-µm unit, odds ratio 3.23, 95% CI 1.04–10.02, p = 0.042). RD height was also significantly correlated with the difference in axial length (AL) between 2 eyes of the patients (p = 0.006, r = 0.406) and the difference in AL measured at pre- versus post-RD repair in the delayed group (p < 0.001, r = 0.774). ConclusionsCombined phacovitrectomy in patients with rhegmatogenous RD induced significant myopic shift because of underestimation of AL, especially in patients with high RD height. Thus, in cases with high temporal RD or large AL differences between eyes, either delayed cataract surgery or combined cataract surgery using the contralateral AL is recommended.

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment.

Purpose:To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).Design:Retrospective interventional case series.Materials and Methods:Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013.Results:Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.Conclusion:Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.

Aniseikonia Following Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment

To evaluate the characteristics of aniseikonia in patients with rhegmatogenous retinal detachment (RD) after pneumatic retinopexy. Prospective, interventional case series study. Thirty patients who had undergone pneumatic retinopexy as the initial procedure for rhegmatogenous retinal detachment were selected for this study. The principal outcomes included visual acuity, postoperative aniseikonia measured by the New Aniseikonia Test, anatomical success, and measurement of central retinal thickness using optical coherence topography (OCT). These outcomes were measured postoperatively at 3, 6, and 12 months. The median patient age was 37 years (range, 13-57 years), with 17 cases of macula-off RD and 13 cases of macula-on RD. All of these patients achieved anatomical success, proven by OCT after surgical repair. Three months after pneumatic retinopexy, 18 patients (60.0%) developed micropsic aniseikonia and aniseikonia was diagnosed in 15 patients (88.2%) in the macula-off RD group, leaving 2 patients (11.8%) unaffected. In the macula-on RD group, 3 patients (23.1%) were found to have aniseikonia, while 10 patients (76.9%) were unaffected. The presence of aniseikonia was strongly linked to the difference in central retinal thickness, between the operated eye and the fellow eye, measured at 12 months postoperatively. Aniseikonia after pneumatic retinopexy for rhegmatogenous RD may be related to the preoperative macular status. Macula-off RD patients had a higher incidence of aniseikonia, compared to macula-on RD patients, following retina reattachment. There was a moderate to high correlation between the grading of aniseikonia and the difference in central retinal thickness.

Rhegmatogenous Retinal Detachment in Patients with Acute Syphilitic Panuveitis

Purpose: To describe the clinical characteristics and surgical management of rhegmatogenous retinal detachment (RD) in patients with acute syphilitic panuveitis.Methods: Retrospective case series and comprehensive literature review.Results: Including present and previously reported cases, we identified 11 eyes in 8 patients with acute syphilitic panuveitis that developed a rhegmatogenous RD. Seven of 11 eyes (63.6%) were repaired with a combined scleral buckling, vitrectomy, and endolaser photocoagulation surgery; 1 eye (9.1%) was repaired with scleral buckling only; and 2 eyes (18.2%) with vitrectomy only. Cryotherapy was used to treat a giant retinal tear in 1 eye (9.1%). Four eyes (36.4%) redetached and 3 underwent a second vitrectomy surgery.Conclusions: Although uncommon, rhegmatogenous RD can occur in patients with moderate to severe acute syphilitic panuveitis. We believe scleral buckling, vitrectomy, endolaser photocoagulation, and silicone oil tamponade give the best chance for successful retinal reattachment.

Outcome of surgical management for rhegmatogenous retinal detachment in Behçet's disease.

BackgroundThe purpose of the current study is to evaluate the surgical outcome for rhegmatogenous retinal detachment (RD) associated with Behçet’s disease (BD).MethodsThe current retrospective study included all patients operated for rhegmatogenous RD associated with BD in our institution from June 2007 to June 2012. Surgical repair was done either by scleral buckling (SB) or pars plana vitrectomy (PPV) according to the topography and clinical criteria of the detachment.ResultsThe current study included 7 eyes of 7 patients (6 males and one female). The mean age was 34.3 ± 4.9 years and all patients showed systemic features of BD. In 3 eyes, intravitreal triamcinolone acetonide (IVTA) was injected within 8 weeks prior to the occurrence of rhegmatogenous RD. Five eyes were treated with SB (segmental buckle in 4 cases and encircling buckle in one case) and 2 cases were treated by PPV. One case was initially treated by SB but showed recurrence of RD which was surgically repaired by PPV with successful closure of the retinal break. The retina was successfully reattached in all cases at the end of follow up period (22.0 ± 6.7 months).ConclusionsRhegmatogenous RD in BD can be effectively treated by scleral buckling in selected cases and PPV in more complex cases. Intravitreal injections may be a precipitating factor for rhegmatogenous RD.

Characteristics of Rhegmatogenous Retinal Detachment After Refractive Surgery: Comparison With Myopic Eyes With Retinal Detachment

To evaluate the characteristics of rhegmatogenous retinal detachment (RD) in patients with previous laser in situ keratomileusis (LASIK) and compare them to RD in patients with previous laser assisted subepithelial keratomileusis (LASEK) and myopic patients with no previous refractive surgery. Retrospective, comparative case series. In 106 eyes of 106 patients with RD, patients with previous refractive surgery included 21 eyes after LASIK and 13 eyes after LASEK; 72 myopic patients with refractive errors of -3.0 diopters or less were grouped as the R (-) group. Characteristics of RD included distribution of RD and associated retinal breaks, location and number of retinal breaks, presence of lattice degeneration, and axial lengths. The mean interval between refractive surgery and the onset of rhegmatogenous RD was 63.7 ± 43.5 months, occurring across a broad spectrum of time intervals. There were no significant differences among the LASIK group, the LASEK group, and the R (-) group in axial length (26.8 mm vs 26.4 mm vs 26.9 mm, respectively); in mean number of retinal holes/tears, (2.1/1.5, 0.9/1.4, 1.5/1.6, respectively); or in the presence of lattice degeneration (52.4% vs 46.2% vs 43.1%, respectively). Distribution of RD and associated retinal breaks were also not significantly different; retinal holes and tears were more prevalent in the temporal quadrants, and inferotemporal quadrants were the most commonly detached areas in both the LASEK and LASIK groups and in the R (-) group. Myopia is a well-known risk factor for rhegmatogenous RD and may contribute more to the development of RD in myopic patients after refractive surgery, rather than refractive surgery itself.

Metamorphopsia and Optical Coherence Tomography Findings After Rhegmatogenous Retinal Detachment Surgery

To investigate the relationship between metamorphopsia and macular morphologic changes after successful repair of rhegmatogenous retinal detachment (RD). Prospective, interventional, consecutive study. The study included 129 eyes of 129 patients who had undergone successful retinal reattachment surgery. The severity of metamorphopsia was recorded using M-CHARTS and foveal microstructure was assessed with spectral-domain optical coherence tomography (OCT) at 6-12 months postoperatively. The mean metamorphopsia score was 0.30 ± 0.46, and 50 of 129 patients (39%) had metamorphopsia. Metamorphopsia was more severe in eyes with macula-off rhegmatogenous RD than those with macula-on (P < .001). Eighteen of 50 eyes with metamorphopsia exhibited abnormal structures in the macular region (epiretinal membrane, disruption of the photoreceptor inner and outer segment junction, cystoid macular edema, macular hole, or subretinal fluid), whereas the other 32 eyes showed no morphologic changes with OCT. In these 32 eyes, the horizontal metamorphopsia score (0.86 ± 0.50) was significantly higher than the vertical metamorphopsia score (0.62 ± 0.39, P < .05). Nine of 69 eyes with preoperative macula-on rhegmatogenous RD developed postoperative metamorphopsia. Of the 9 eyes, 6 showed abnormal macular structures and the other 3 had normal-appearing OCT. The macula briefly detached during vitrectomy in these 3 cases. In eyes that remained macula-on throughout surgery and had normal-appearing OCT, metamorphopsia did not develop. In some cases, the reason for metamorphopsia was anatomically obvious. In other cases that were preoperative and intraoperative macula-off, postoperative retinal vertical displacement could cause predominantly horizontal metamorphopsia.

Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

Purpose: To compare the outcomes of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RD). Methods: One hundred and fifteen Eyes undergoing SB or PPV for the treatment of simple rhegmatogenous RD were prospectively identified and followed up at least six months. Anatomic results, functional outcomes and complications were compared between eyes treated with SB and eyes treated with PPV. Results: We detected no significant differences in overall success rates or final vision quality between the two treatment groups. However, the final vision quality of pseudophakic patients treated with PPV was significantly better than the final vision quality of pseudophakic patients treated with SB. Two treatment goups experienced similar rates of intraocular pressure elevation and proliferative vitreoretinopathy development. In phakic patients, the rates of cataract progression were higher in patients treated with PPV than in patients treated with SB. Conclusions: PPV can be an effective method for the treatment of simple rhegmatogenous RD, and maybe considered as a viable alternative to SB for simple cases. However, in phakic patients treated with PPV, simultaneous or follow-up cataract surgery should be considered as adjuvant treatments.

Development of Predictive Models of Proliferative Vitreoretinopathy Based on Genetic Variables: The Retina 4 Project

Machine learning techniques were used to identify which of 14 algorithms best predicts the genetic risk for development of proliferative vitreoretinopathy (PVR) in patients who are experiencing primary rhegmatogenous retinal detachment (RD). Data from a total of 196 single nucleotide polymorphisms in 30 candidate genes were used. The genotypic profile of 138 patients with PVR following primary rhegmatogenous RD and 312 patients without PVR RD were analyzed. Machine learning techniques were used to develop statistical predictive models. Fourteen models were assessed. Their reproducibility was evaluated by an internal cross-validation method. The three best predictive models were the lineal kernel based on the Support Vector Machine (SMV), the radial kernel based on the SVM, and the Random Forest. Accuracy values were 78.4%, 70.3%, and 69.3%, respectively. The more accurate, although complex, algorithm uses 42 SNPs, whereas the simpler one uses only two SNPs, which makes them more suitable for routine diagnostic work. The radial kernel based on SVM uses 10 SNPs. The best individually predictor marker was rs2229094 in the tumor necrosis factor locus. Genetic variables may be useful to predict the likelihood of the development of PVR. The predictive capabilities of these models are as good as those observed with clinical approaches. These results need external validation to estimate the true predictive capability and select the most appropriate ones for clinical use.

Optical Coherence Tomography Evaluation of Detached Macula from Rhegmatogenous Retinal Detachment and Central Serous Chorioretinopathy

To compare structural changes using optical coherence tomography (OCT) and visual acuity (VA) loss in patients with shallow macula-off rhegmatogenous retinal detachment (RD) and central serous chorioretinopathy (CSC) involving the macula. Retrospective, comparative observational study. Fifteen eyes with rhegmatogenous RD and 21 eyes with CSC with comparable height of macular detachment (< or = 550 microm) were evaluated retrospectively. All eyes were subjected to complete ophthalmologic examination, including OCT analysis, and were followed up until complete resolution of RD. The mean height +/- standard deviation at the fovea was 290 +/- 153 microm in rhegmatogenous RD and 310 +/- 141 microm in CSC. Although the duration of symptoms was longer in CSC than in rhegmatogenous RD (35.0 +/- 38.0 days vs 8.3 +/- 8.0 days), initial (0.25 vs 0.64 logarithm of the minimum angle of resolution [logMAR] units; P = .001) and final VA (0.09 vs 0.49 logMAR units; P < .001) were significantly better in CSC. OCT analysis of rhegmatogenous RD showed intraretinal cyst formation, intraretinal separation, and undulation of outer detached retina in 10 (67%), nine (60%), and six (40%) eyes, respectively. Eyes with two or more preoperative structural changes had poorer initial VA than eyes with none or one structural change. In comparison, none of the 21 CSC eyes showed any of these changes (P < .001). Compared with CSC, macula-involving rhegmatogenous RD resulted in more rapid visual loss, despite similar height of foveal detachment. Structural changes on OCT may be correlated with different levels of visual function in these two conditions.

Influence of Persistent Submacular Fluid on Visual Outcome After Successful Scleral Buckle Surgery for Macula-off Retinal Detachment

To determine the influences of the extent and duration of persistent submacular fluid on final visual outcome after successful scleral buckle surgery for acute macula-off rhegmatogenous retinal detachment (RD). Prospective observational case series. Forty-four consecutive patients (44 eyes) who underwent successful scleral buckle surgery for macula-off rhegmatogenous RD were enrolled patients underwent thorough ophthalmologic tests including best-corrected visual acuity (BCVA) assessments and optical coherence tomography (OCT) at one, three, six, nine, and 12 months postoperatively, until at least six months after the disappearance of subretinal fluid (SRF). Patients with persistent submacular fluid one month after surgery were assigned to group A and those without submacular fluid, to group B. In group A, patients whose submacular fluid disappeared before six months were assigned to group A1; the others, to group A2. The natural course of persistent SRF and associations between the extent and duration of SRF and postoperative BCVA were investigated. Twenty-three eyes (52.3%) were in group A and 21 eyes (47.7%) in group B. Twelve eyes (52.2%) were in group A1 and 11 eyes (47.8%) in group A2. SRF disappeared within 12 months after surgery without reoperation in all patients. No significant differences in final visual acuity (VA) were found among groups A, B, A1, and A2. Final VA was not found to be associated with SRF extent or duration. The presence and extent of submacular fluid after successful scleral buckle surgery for acute macula-off rhegmatogenous RD did not influence final VA or anatomic attachment.