Successful Retinal Detachment Repair Research Articles

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

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

Predisposing characteristics of optical coherence tomography for patients with persistent subretinal fluid after successful repair of rhegmatogenous retinal detachment.

To investigate the predisposing clinical parameters and characteristics of fundus imaging of patients with persistent subretinal fluid (PSF) after successful repair of rhegmatogenous retinal detachment. A retrospective study recruiting 57 patients was conducted. All patients underwent pars plana vitrectomy with silicone oil tamponade. Patients were divided into two groups: patients presenting PSF by the time of silicone oil removal (PSF group), and patients presenting no PSF by the time of silicone oil removal as control group. All patients were followed up for three months or longer after primary surgery. Ophthalmic examinations, including fundus photography and optical coherence tomography (OCT) were performed. There were significant differences between the two groups in terms of average age, durations of preoperative symptoms, and type of retinal breaks (P<0.05). These clinical parameters showed statistical correlations with PSF (P<0.05). The proportions of patients presenting distinctive boundaries of the detached retina on fundus photograph and patients showing a hyperreflective line underlying the detached retina on OCT in the PSF group were both significantly higher than the control group (P<0.05). The macular detachment heights on OCT in PSF group were significantly lower than control group (P<0.05). These imaging characteristics also showed strong correlations with PSF (P<0.05). This study suggests that patients with PSF have younger age, longer symptom duration, and higher incidence of retinal holes. The distinctive detachment boundary on fundus photograph, lower macular detachment height, and hyperreflective line underlying detached retina on OCT may be the predisposing characteristics of PSF.

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

BackgroundTo evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).MethodsRetrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup.ResultsSixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).ConclusionsThe risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

Macular morphologic changes following successful retinal detachment repair by scleral buckling surgery

Background/Aim. Spectral domain optical coherence tomography (SDOCT) is very useful for the accurate examination of macular microstructure. The aim of this study was to evaluate macular morphologic changes after successful retinal detachment (RD) surgery by scleral buckling (SB) using SDOCT and assess their impact on vision repair. Methods. SDOCT examination was performed in 1, 6, and 12 months in 27 eyes following SB surgery with the successful anatomical repair of rhegmatogenous RD, which also affected the macular region. The examination was performed in a 6 mm diameter central macular region and included measurements of the central foveal thickness, average total retinal thickness (TRT), and thickness of the inner and outer retinal layer (ORT) separately. The numerical values of parameters for each operated eye were compared with those of the fellow (control) eye of each patient. The condition of the external limiting membrane (ELM) and inner segment (IS) and outer segment (OS) of the photoreceptors was also examined. Results. The mean TRT and ORT in the reattached regions in the operated eyes were significantly thinner than the corresponding regions of the fellow (control) eye, and throughout the follow-up period, the difference was statistically significant. There was a statistically significant difference in TRT (after 1 month, p = 0.021, after 6 months, p = 0.026, after 12 months, p = 0.027) and ORT (after 1 month, p = 0.018, after 6 months, p = 0.019, after 12 months, p = 0.021) between the eyes with a longer preoperative duration of macular detachment (MD) of 2 weeks and eyes with shorter detachment period. Disruptions of the IS and OS of photoreceptors and ELM on SDOCT examination after one month were observed in 37.04% of eyes, after 6 months in 29.6% of eyes, and at the end of the follow-up period in 14.8% of eyes. A statistically significant difference was found in the frequency of disruptions of the IS and OS, and ELM depending on the pre-operative duration of RD (p = 0.007). Conclusion. The overall decrease in the mean retinal thickness after successful anatomical repair of RD is the result of a decrease in the thickness of the outer retinal layers. The alterations of the ELM, IS and OS of photoreceptors observed on the early SDOCT scans are mostly associated with limited vision recovery. The prolonged MD leads to damaging the neurosensory tissue of the retina and especially the photo-receptors, which may explain the limited visual acuity recovery after successful SB repair of RD.

Longitudinal evaluation of retinal thickness and OCTA parameters before and following silicone oil removal in eyes with macula-on and macula-off retinal detachments.

To investigate the longitudinal retinal vascular and structural alterations by using OCTA following successful repair of retinal detachment (RD) by using silicone oil (SO) endotamponade. A prospective cohort study was performed on 24 eyes of 24 subjects; 17 of them with macula-off and seven with macula-on RD. At least four OCTA scans were generated for each study eye; two before and two after SO removal (SOR). At each session, retinal thickness (RT), vascular density (VD) in the superficial (SCP) and deep capillary plexuses (DCP) and foveal avascular zone(FAZ) size were measured within the fovea, parafovea and whole macular image. The changes in repeated measures of the same parameters especially before and after SOR were performed and compared within macula-on and macula-off groups and between fellow eyes. "In the macula-off eyes, RT measurements within the whole macula, fovea and parafovea reduced as compared with their fellow eyes(p < 0.0001, p = 0.001 and p < 0.0001, respectively) and did not improve after SOR. Additionally, all of the whole macular, foveal, and parafoveal VD measurements at SCP and foveal VD at DCP were less than their fellow eyes after SOR (p = 0.026, p = 0.023 p = 0.026, and p = 0.002, respectively). In macula-on eyes, RT measurements decreased within the parafovea and whole macular area before SOR (p = 0.018 and p = 0.011, respectively) but improved after SOR. Also, VD measurements did not change during follow-up and were not statistically different than their fellow eyes (p > 0.05). FAZ enlargement was found in eyes with macular-off RD after SOR, whereas it was not observed with macular-on RD (p = 0.038and p = 0.237, respectively). Treatment of macula-off RD with SO tamponade has been associated with vascular retinal abnormalities which did not improve following SOR. On the contrary, successful treatment of RD with SO tamponade in macula-on eyes VD measurements of SCP and DCP were not statistically different than their fellow eyes.

CHANGES IN RETINAL MICROCIRCULATION AFTER RHEGMATOGENOUS MACULA-ON AMD MACULA-OFF RETINAL DETACHMENT ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: A PROSPECTIVE STUDY

Introduction. The aim of the study is to evaluate changes in the vascular density and microcirculation of various retinal layers following successful repair of rhegmatogenous retinal detachment without macular area detachment and with macular area detachment using optical coherence tomography angiography and their impact on postoperative clinical outcomes. Materials and Methods: A total of 33 eyes were included in this prospective consecutive observational study: 15 without macular area detachment affected by without macular area detachment and 18 by rhegmatogenous retinal detachment with macular area detachment. All patients were diagnosed as having primary rhegmatogenous retinal detachment (duration of retinal detachment less than 7 days since the onset) and underwent successful surgical treatment within 72 hours after diagnosis. Superficial, deep capillary plexus, and foveal avascular zone area variations were evaluated by optical coherence tomography angiography and correlated with visual acuity during a one-month follow-up. Results: In the without macular area detachment group, the preoperative vascular density of the whole superficial capillary plexus on affected eyes was lower than that of the fellow eyes (p &lt; 0.05). The whole superficial capillary plexus vascular density and the parafoveal superficial capillary plexus vascular density increased during the follow-up period (p &lt; 0.05); moreover, the higher the preoperative whole superficial capillary plexus and parafoveal superficial capillary plexus vascular density, the better the baseline visual acuity (p &lt; 0.05) was. In the macular-on area detachment group, at the first months after surgery, the larger the foveal avascular zone, the lower the visual acuity was (p &lt; 0.05). Conclusions. Consequently, optical coherence tomography angiography is a non-invasive investigation method that enables to assess retinal microcirculation in patients who have undergone surgical treatment for rhegmatogenous retinal detachment. The use of optical coherence tomography angiography offers a potential explanation for the suboptimal restoration of visual acuity despite anatomical restoration of the macula. In the macula-on group, the preoperative vascular density of the entire superficial capillary plexus affected the preoperative visual acuity and was lower than in healthy eyes, but recovered over time. Without macular area detachment superficial capillary plexus vascular density affected preoperative visual acuity, and it was lower than the fellow eye, but recovered over time. In the with macular area detachment group, a larger foveal avascular area was related to a worse visual acuity.

Coming of Age for the Photoreceptor Synapse.

PurposeTo discuss the potential contribution of rod and cone synapses to the loss of visual function in retinal injury and disease.MethodsThe published literature and the authors’ own work were reviewed.ResultsRetinal detachment is used as a case study of rod spherule and cone pedicle plasticity after injury. Both rod and cone photoreceptors terminals are damaged after detachment although the structural changes observed are only partially overlapping. For second-order neurons, only those associated with rod spherules respond consistently to injury by remodeling. Examination of signaling pathways involved in plasticity of conventional synapses and in neural development has been and may continue to be productive in discovering novel therapeutic targets. Rho kinase (ROCK) inhibition is an example of therapy that may reduce synaptic damage by preserving normal synaptic structure of rod and cone cells.ConclusionsWe hypothesize that synaptic damage contributes to poor visual restoration after otherwise successful anatomical repair of retinal detachment. A similar situation may exist for patients with degenerative retinal disease. Thus, synaptic structure and function should be routinely studied, as this information may disclose therapeutic strategies to mitigate visual loss.

Pediatric rhegmatogenous retinal detachment: predictors of anatomic and functional success.

This study describes presenting clinical features and surgical techniques associated with successful repair of pediatric rhegmatogenous retinal detachment (RRD). This is a retrospective case series which involved 242 cases younger than 18years with new-onset RRD with descriptive statistics for the full group. Further exclusion established 168 cases that underwent surgery with minimum 3-month follow-up. Comparison of features associated with successful outcomes was analyzed using Chi-squared tests, logistic regression and univariate generalized equation models. We measured proportion of patients with BCVA ≤ 1.0 logMAR and/or an increase in final BCVA of 0.3 logMAR with respect to baseline and complete reattachment at final visit; 104 eyes (62%) achieved total reattachment, and 91 eyes (54%) achieved visual success. Absence of macular involvement, subtotal RRD and older age group (13-18) were associated with both success measures. There were higher visual and anatomic success rates with primary scleral buckling (SB, 66% and 79%; OR 9.26 and 11.09) and combined SB plus pars plana vitrectomy (PPV, 54% and 58%; OR 5.67 and 3.94) compared with PPV alone (26% and 17%). A majority of patients achieved anatomical success with repair. Trauma and myopia were the most common etiologic associations, with myopic cases having better outcomes. Success was more likely in patients with subtotal RRD or uninvolved macula at presentation; previous intraocular surgery was a risk factor for failure. Younger patients had a higher likelihood of worse outcomes. Initial PPV showed a lower rate of success than either SB or combined SB/PPV.

Active Learning of Contrast Sensitivity to Assess Visual Function in Macula-off Retinal Detachment.

To characterize the contrast sensitivity function (CSF) in patients with successful repair of macula-off rhegmatogenous retinal detachment (RD) using an adaptive computerized contrast testing device. CSF was prospectively measured in macula-off RD patients following successful repair and age-matched controls at W. K. Kellogg Eye Center and Massachusetts Eye and Ear, employing the active learning device Manifold Contrast Vision Meter (Adaptive Sensory Technology, San Diego, CA). Outcome measures included average area under the CSF curve (AULCSF), CS thresholds at 1-18 cycles per degree (cpd) and best correctd visual acuity (BCVA) in RD eyes fellow eyes and controls. A sub-analysis was performed in eyes with BCVA of 20/30 or better. Twenty-three macula-off RD eyes status post repair, fellow healthy eyes and 45 age-matched control eyes underwent CSF testing. The mean BCVA of the 23 RD eyes was 0.250 logMAR, significantly reduced compared to fellow eyes 0.032 (p<0.001) and controls 0.026 (p< 0.00001). There was a statistically significant reduction in AULCSF in RD eyes compared to the fellow eyes (p<0.0001) and to age-matched controls (Z-score -0.90, p<0.0001) and CSF reduction across all spatial frequencies. In the 15 RD eyes with BCVA of 20/30 or better, the mean CSF was significantly reduced compared to fellow eyes (p=0.0158) and controls (p=0.0453). CSF in macula-off RD eyes following repair was significantly reduced compared to fellow eyes and age-matched controls. CSF seems to be a promising visual function endpoint with potential applications in the clinical practice and future clinical trials.

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment.

To provide a detailed description of the natural history of persistent subretinal fluid (SRF) after successful repair of rhegmatogenous retinal detachment (RRD) and its association with visual outcome. This was a prospective long-term follow-up for eyes undergoing scleral buckling (SB) surgery for macula-off RRD. Examinations were carried out preoperatively and postoperatively at 1, 3, 6, 9 and 12mo, until persistent SRF had completely resolved. One month postoperatively, optical coherence tomography (OCT) was used to classify SRF into three patterns: bleb-like loculated (BL), shallow-diffused (SD), and multiple blebs (MB). Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance. Patients were divided into two groups depending on the presence or absence of persistent SRF. A total of 59 patients (59 eyes) were included. There were no statistical differences between two groups at baseline, except for the proportion of patients with high myopia and a younger age. One month after surgery, OCT detected persistent SRF in 49 eyes (83.1%). The 3 morphological patterns of SRF were observed in 27 eyes (55.1%) with BL, 13 eyes (26.5%) with SD, and 9 eyes (18.4%) with MB. The mean time for complete absorption differed significantly across the three SRF patterns (F=8.097, P=0.001), which was 8.8±6.1, 20.1±12.1, and 16.7±10.2mo in BL, SD, and MB, respectively. In 9 of the 13 eyes with SD, the pattern transformed into MB type. In cases involving MB, the size and number of blebs decreased gradually until they had been completely absorbed. Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone (49.0% vs 10%, P=0.034). The final best-corrected visual acuity of two groups was 0.37±0.11 (with SRF) vs 0.34±0.12 (without SRF) logMAR (P=0.499), respectively. High preoperative myopia and younger age are associated with persistent SRF. BL is the most commonly observed pattern with the shortest duration and gradually disappeared. Most cases involving SD SRF transform into MB type during resolution. The size and number of the MBs decrease gradually until they were completely absorbed. The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.

Internal Limiting Membrane Peeling for Persistent Submacular Fluid after Successful Repair of Diabetic Tractional Retinal Detachment.

This study is for reporting the outcomes of internal limiting membrane (ILM) peeling on persistent submacular fluid (PSF) after otherwise successful pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD). In this retrospective case series, five consecutive patients (5 eyes) who exhibited PSF following successful repair of diabetic TRD were included. The second operation was performed to remove ILM. The area of ILM peeling was expanded up to the major vascular arcade. Only air tamponade was used. The median interval between the first PPV and the second PPV with ILM peeling was 4.8 months (range: 4–6 months). PSF resolved completely within one (2 eyes) or 2 months after ILM peeling. The median logMAR best-corrected visual acuity (BCVA) was improved from 1.00 (Snellen equivalent 20/200) to 0.70 (Snellen equivalent 20/100). In conclusion, wide ILM peeling is an effective treatment option for PSF subsequent to successful repair of diabetic TRD. ILM peeling might increase the elasticity of retina, thereby allowing the retina to flatten. This procedure can induce faster retinal reattachment in diabetic TRD involving the macula.

Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.

Imaging analysis with optical coherence tomography angiography after primary repair of macula-off rhegmatogenous retinal detachment.

To evaluate changes in the microcirculation of various retinal layers and choroid following successful repair of macula-off rhegmatogenous retinal detachment (RRD) using optical coherence tomography angiography (OCTA). Twenty-eight patients (28 eyes) who underwent successful repair of macula-off RRD were prospectively investigated. Differences in OCTA characteristics between retinal detachment (RD) and fellow eyes were compared. Quantitative measurements of the retinal capillary and choriocapillary associated with the preoperative and intraoperative factors were analyzed. The mean vessel and parafoveal vessel densities were significantly lower in the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in the RD eyes than the fellow eyes. Presence of preoperative intraretinal separation in the RD eyes was significantly associated with both an enlarged foveal avascular zone (P =0.022) and a lower DCP vessel density (P= 0.031) postoperatively. Eyes with a scleral buckle alone had a greater postoperative subfoveal choroidal thickness (P =0.037). Eyes undergoing vitrectomy alone had a higher postoperative vessel density in the choriocapillaris (P= 0.035). Eyes undergoing a vitrectomy and scleral buckle had a lower SCP (P =0.031) and DCP (P =0.035) vessel density postoperatively. Macula-off RRD may cause not only retinal structural damage but also decreased retinal perfusion even after successful anatomical repair. Our findings suggested that RD eyes had a significantly lower vessel density than fellow eyes after surgery. The combined procedure might result in a lower vessel density, as compared with a scleral buckle or vitrectomy alone.

Macular Microstructure Assessment by Optical Coherence Tomography and Fundus Fluorescein Angiography before and after Silicone Oil Removal

Background: since the early use, silicone oil (SO) has been used as long-term retinal endotamponade to manage complicated retinal diseases such as proliferative vitreoretinopathy, advanced proliferative diabetic retinopathy, and complex retinal detachment. A favorable anatomical success was reported after SO injection. Objective: the aim of this study was to investigate the macular microstructural changes in eyes filled with silicone oil (SO) and course of these changes after SO removal, to determine the possible cause of unexplained visual loss by the use of optical coherence tomography and fundus fluorescein angiography. Patients and Methods: This prospective observational study included a total of 40 eyes of 40 adult patients of both sexes with rhegmatogenous retinal detachment and scheduled for pars plana vitrectomy with silicone oil tamponade attending at ophthalmology outpatient clinic of Al-Azhar University Hospitals. This study was conducted between October 2015 to August 2018. Results: There were insignificant differences in visual prognosis between the group with persistent SRF and the group without. But VA bad prognosis can be explained through the other OCT finding not only the SRF. This confirm our conclusion of the importance of OCT examination after successful retinal detachment repair operation for VA prognosis prediction. In our study there was no difference between OCT finding before SOR and after, this means that duration of 3-month silicon oil tamponading is a safe duration. Conclusion: Delayed or incomplete visual recovery after uncomplicated surgery for macula-off retinal detachment may be related not only to persistent subretinal fluid, but also to other pathological changes.

Opacification of Akreos Hydrophilic Acrylic Lens After Retinal Detachment Repair with Silicone Oil Tamponade: A Case Report.

We report localized opacification of a sclera-fixated Akreos® hydrophilic acrylic intraocular lens after successful repair of rhegmatogenous retinal detachment with silicone oil tamponade in a nondiabetic patient. No intraoperative lens opacification during air–fluid exchange or lens dislocation was encountered. Granular opacities within the optic were noted at 5 months after surgery, and did not relent to scrubbing with a vitrector during oil removal. Akreos lens opacification under silicone oil is not well documented in the literature. Surgeons must be aware of this potential complication, which is known to occur with various types of hydrophilic acrylic lenses after exposure to air or gas.

Rhegmatogenous Retinal Detachment in Children: Clinical Factors Predictive of Successful Surgical Repair

To describe presenting clinical features and surgical techniques that are associated with successful surgical repair of pediatric rhegmatogenous retinal detachment (RRD). Retrospective interventional case series. Two hundred twelve eyes of 191 patients 0 to 18 years of age undergoing surgical repair for RRD between 2001 and 2015 with a minimum follow-up of 3 months. Patients were divided into 3 age groups (0-6 years, 7-12 years, and 13-18 years) and comparisons were made using bivariate and multivariate generalized estimating equation models. A mixed means model was used to examine visual acuity in each age group over time. Complete reattachment of the retina at final follow-up. Of 212 eyes, 166 (78%) achieved total reattachment at final follow-up. Mean follow-up was 36.3 months. Rhegmatogenous retinal detachment associated with Stickler syndrome was more likely to occur in the younger cohorts (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.91), whereas RRD associated with blunt trauma was more likely to occur in the oldest cohort (OR, 2.3; 95% CI, 1.2-4.4). Subtotal RRD was more likely to be repaired successfully than total RRD (OR, 3.6; 95% CI, 1.5-8.4; P= 0.0100), and eyes with previous vitreoretinal surgery were less likely to undergo successful repair (OR, 0.30; 95% CI, 0.12-0.78; P= 0.0258). There was no significant difference between age groups in the rate of surgical success (P= 0.55). There was a significantly higher success rate with primary scleral buckle (SB; 63%; OR, 2.2; 95% CI, 1.1-4.5) and combined SB plus pars plana vitrectomy (PPV; 68%; OR, 2.3; 95% CI, 1.1-5.1) compared with PPV alone (51%). Most pediatric patients with RRD achieved complete reattachment with surgery. Success was more common in patients with a subtotal RRD at presentation. Previous vitreoretinal surgery was a risk factor for failure. Younger patients were more likely to demonstrate RRD involving the macula, but there was no difference between age groups in successful reattachment at final follow-up. Primary PPV showed a lower rate of success than SB or combined SB plus PPV.

Intravitreal Fluocinolone Acetonide (ILUVIEN) Implant for the Treatment of Refractory Cystoid Macular Oedema After Retinal Detachment Repair.

Cystoid macular oedema (CMO) is one of the most frequent postoperative macular complications to cause partial visual recovery after successful retinal detachment (RD) repair. Refractory CMO is difficult to treat and many strategies have been employed with varying degrees of success. We report for the first time the use of ILUVIEN implant to treat refractory CMO after successful RD repair. A 65-year-old female presented with right eye full-thickness macular hole and underwent pars plana vitrectomy, internal limiting membrane peeling and cryotherapy with gas tamponade with 12% C3F8. She subsequently developed right eye macula-on RD and proliferative vitreoretinopathy and required multiple procedures for successful retinal reattachment. Later, she developed CMO that responded to intravitreal triamcinolone injections and intravitreal dexamethasone 0.7-mg implants but recurrence of CMO continued to be a problem. After receiving ILUVIEN intravitreal implant, her visual acuity improved and CMO resolved without recurrence for 13 months. Refractory CMO after RD repair is difficult to treat and in a quarter of cases will not improve without treatment. Our case shows that a single ILUVIEN implant maintained anatomical dry fovea and improved vision. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments.

DEXAMETHASONE INTRAVITREAL IMPLANT FOR THE TREATMENT OF RECALCITRANT MACULAR EDEMA AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate the efficacy of the intravitreal dexamethasone implant as the treatment for recalcitrant macular edema after successful rhegmatogenous retinal detachment repair. A retrospective review of the medical records was performed on 17 consecutive patients (17 eyes) with recalcitrant macular edema associated with rhegmatogenous retinal detachment repair who were treated with a single or multiple injections of an intravitreal dexamethasone 0.7-mg implant (Ozurdex; Allergan Inc) at two centers. Main outcomes of the study were change in logarithm of the minimum angle of resolution visual acuity, measurement of central foveal thickness, and macular cube volume as measured by spectral domain optical coherence tomography and frequency of complications. The mean age was 67 years (range, 51-78 years). All 17 patients received previous topical therapy and 12 of them had previous administration of intravitreal triamcinolone with persistence of macular edema. Baseline mean best-corrected visual acuity was 20/100 (logarithm of the minimum angle of resolution 0.75; range, 0.18-1.3 ±0.37) in the affected eyes. There was a statistically significant improvement in best-corrected visual acuity at 1 month (P < 0.001) and 3 months (P = 0.01). Mean baseline central foveal thickness was 505 μm, and mean macular cube volume was 10.62 mm. There was a statistically significant decrease in central foveal thickness and macular cube volume at 1 month (505-290 μm, P = 0.013 and 10.62-9.13 mm, P < 0.0001) and 3 months (P = 0.01). All patients developed recurrence of macular edema at 3 months, which required retreatment. The average number of implants was 4 (range, 1-14). No adverse effects such as retinal detachment or endophthalmitis occurred. Two patients experienced an increase in intraocular pressure that was controlled with topical therapy. Macular edema that occurs in eyes after successful repair of rhegmatogenous retinal detachment can be chronic and recalcitrant, and may be successfully and safely treated with the dexamethasone intravitreal implant.

Correlation of Fundus Autofluorescence of the Macula with Visual Outcome after Successful Repair of Rhegmatogenous Retinal Detachment

Abstract Background: Successful reattachment of the macula after RD is often associated with incomplete visual recovery. Even with a normal-appearing macula on examination, patients often experience visual impairment. Fundus autfluorescence has been used to investigate the morphological and functional changes occurring after RD repair following vitrectomy. Aim of the Work: To investigate the structure-function relationship of the macula, by correlating fundus autofluorescence and visual acuity following successful repair of rhegmatogenous retinal detachment. Material and Methods: Forty-five eyes underwent surgical repair of RRD followed by FAF imaging one and three months post-operative. FAF findings were correlated with postoperative BCVA. Results: Forty-five eyes achieved complete post-operative reattachment with 95.6% SOSR. Mean preoperative logMAR visual acuity showed significant difference with mean postoperative logMAR BCVA (p 0.001). The values of BCVA showed significant difference between eyes showing hyperautofluorescence on FAF imaging and eyes not showing hyperautofluorescence (p=0.015). Conclusion: Fundus autofluorescence is a recent noninvasive imaging modality that evaluates the function and health of the photoreceptor and the RPE layers showing great advantage in analyzing the macular function abnormality.

Structural Correlation of Spectral Domain OCT and Fundus Autofluorescence (FAF) of the Macula, Following Successful Surgical Repair of Rhegmatogenous Retinal Detachment

Structural Correlation of Spectral Domain OCT and Fundus Autofluorescence (FAF) of the Macula, Following Successful Surgical Repair of Rhegmatogenous Retinal Detachment