Successful Retinal Detachment Repair Research Articles

Subretinal Lavage to Prevent Persistent Subretinal Fluid after Rhegmatogenous Retinal Detachment Surgery: A Study of Feasibility and Safety

Purpose: To report the proof of concept of a surgical innovation. Background: Optical coherence tomography often identifies persistent subretinal fluid (PSF) after apparently successful retinal detachment repair surgery. Based on the literature, we hypothesised that highly viscous PSF, which interferes with the normal function of the retinal pigment epithelium, can lead to these persistent blebs. We therefore devised a novel surgical manoeuvre of subretinal lavage to dilute the subretinal fluid (SRF) during surgery. We expected that this would reduce the incidence of PSF. Methods: We report our experience with a modified surgical drainage technique carried out in 12 eyes of 12 patients with long standing retinal detachments. We implemented subretinal lavage combined with vitrectomy and gas. Results: None of the patients developed PSF. Conclusion: We concluded that the novel technique of subretinal lavage was safe and feasible. We propose that a controlled trial would be worthwhile.

Pathophysiology of persistent submacular fluid after surgery for macula‐involving rhegmatogenous retinal detachment: hypothesis and review

Abstract Purpose To unravel the physiopathology of persistent submacular fluid (PSF) after successful primary rhegmatogenous retinal detachment (RD) repair for macula‐involving RD. To propose therapeutical and preventive measures for this phenomenon. Methods 9 eyes from 9 patients with macula‐involving RD underwent RD repair: 6/9 eyes got buckle surgery and 3/9 eyes got 20 gauge pars plana vitrectomy. The cellular content of subretinal fluid was studied by electron microscopy and anti‐Rhodopsin immunostaining. All eyes were followed further postoperatively for 12 months by spectral domain optical coherence tomography (SD‐OCT) for detection of PSF. Results Three out of nine samples were cell rich with cell counts of 7304/mm2, 20 270/mm2 and 9092/mm2 on cytospin. Six out of nine samples contained less than 1500 cells/mm2 and were scored as scantily cellular. The cells in the samples were predominantly rhodopsin immunopositive and showed structural features of photoreceptors or photoreceptor fragments on electron microscopy. Postoperative SD‐OCT scans demonstrating PSF in 3 eyes corresponded to the 3 cell rich peroperative subretinal samples. Conclusion Subretinal fluid obtained from patients with PSF is cell rich and contains predominantly photoreceptors and photoreceptor fragments. We speculate that a peroperative subretinal lavage might prevent postoperative PSF.

Simultaneous spectral domain OCT and fundus autofluorescence imaging of the macula and microperimetric correspondence after successful repair of rhegmatogenous retinal detachment

Background/aimsTo evaluate the ultrastructural changes in the macula after successful repair of rhegmatogenous retinal detachment (RRD) using simultaneous spectral domain optical coherence tomography (sdOCT) and fundus autofluorescence (FAF) imaging and...

Sympathetic Ophthalmia after successful Retinal Reattachment Surgery with Vitrectomy

To report a case of sympathetic ophthalmia (SO) following one successful pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Case report. A 50-year-old man developed SO 5 weeks after successful repair of rhegmatogenous retinal detachment with PPV and intraocular gas tamponade. The patient presented with bilateral multifocal exudative retinal detachments and inflamed optic nerve with characteristic changes of SO detected by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Prompt use of systemic steroids and cyclosporin A resulted in control of the uveitis with significant visual improvement. PPV should be viewed as a major risk factor for development of SO.

Horizontal and vertical micropsia following macula-off rhegmatogenous retinal-detachment surgical repair

Dysmetropsia or distorted image size perception (smaller: micropsia; larger: macropsia) is known to occur after successful surgical re-attachment for macula-off rhegmatogenous retinal detachment. However, the vertical and horizontal components of size distortion have not been previously quantified separately. The purpose of this article is to describe horizontal and vertical dysmetropsia occurring in patients following pars plana vitrectomy and gas treatment (octafluoropropane, C(3)F(8) or sulfur hexafluoride, SF(6)) for macula-off rhegmatogenous retinal detachment. Four patients (mean+/-SD, 59+/-8 years; three women and one man) who had had pars plana vitrectomy and gas treatment for macula-off rhegmatogenous retinal detachment 6-7 months earlier underwent ocular examination, best corrected visual acuity test, threshold horizontal and vertical dysmetropsia measurement using a computerised version of the New Aniseikonia Test, slit-lamp examination and optical coherence tomography of the macula. All patients had binocular visual complaints including difficulty judging distances or reading, rivalry or asthenopia. The logMAR visual acuity (mean+/-SD) in the operated eye was 0.52+/-0.199 and 0.02+/-0.171 in the unaffected eye. All patients perceived the image as smaller (micropsia) with the affected eye, with differences ranging from -9 to 0%. Four patients showed 3% or more size difference between horizontal and vertical meridians. Dysmetropsia does occur in symptomatic patients following successful surgical repair of macula-off rhegmatogenous retinal detachment by pars plana vitrectomy and gas treatment. The effect on image size is heterogenous across the retinal area affected.

Management of Severe Hypotony with Intravitreal Injection of Viscoelastic

To investigate the effect of an intravitreal injection of sodium hyaluronate 1.4% and 2.3% in the treatment of hypotony. Interventional case series. Intravitreal injection of sodium hyaluronate 1.4% was performed to treat persistent hypotony in three eyes after the successful repair of retinal detachment and in one eye with uveitis. Injection of sodium hyaluronate 2.3% was performed in one eye after the successful repair of retinal detachment with removal of silicone oil. At the last follow-up examination (2-16 months), intraocular pressure increased to at least 5 mm Hg (5-14 mm Hg) in all eyes that had been injected with sodium hyaluronate. Intraocular pressure increased to 38 mm Hg in the eye that had been injected with sodium hyaluronate 2.3% on postoperative day 1 and was 10 mm Hg at three months. Vision improved in all patients. Intraocular injection of sodium hyaluronate 1.4 and 2.3% appears to be efficacious in reversing hypotony in some eyes. Functional and structural findings can also improve.

Intraocular glasses

A 39 year-old man was referred to the retinal clinic after having complained of blurred vision in his right eye. He was highly myopic and had a previous history of successful left retinal detachment repair. On examination we found a vitreous haemorrhage obscuring a clear view of the fundus. We did an ocular ultrasound and found what appears to be a pair of miniature “spectacles” lodged in the vitreous cavity of the right eye. This image represents a chronic inferior retinal detachment with two intra-retinal cysts. Intra-retinal cysts occur in the outer plexiform layer of the retina in retinal detachments that have been present for at least a year.

Use of OCT to demonstrate persistent subretinal fluid after clinically successful retinal detachment repair

Use of OCT to demonstrate persistent subretinal fluid after clinically successful retinal detachment repair

RETINAL DETACHMENT IN MARFAN SYNDROME

Purpose: To report postsurgical findings in patients with Marfan syndrome and retinal detachment (RD). Methods: The authors identified and retrospectively reviewed the charts of one cohort of 12 patients (15 eyes) with Marfan syndrome and RD who were operated on at the Wilmer Institute and a second cohort of 16 such patients (24 eyes) who were operated several years earlier and elsewhere. Results: First cohort—Final visual acuity (VA) was 20/80 or better and the retina was flat in all five phakic eyes (100%). The RD occurred after the eye had undergone lens removal in 10 eyes, 6 of which (60%) had a final VA of 20/80 or better, and 9 of which (90%) had a final VA of 5/200 or better (P = 0.20). Second cohort—The final VA was 20/80 or better and the retina was flat in 6 of the 7 phakic eyes (86%). Among 17 aphakic or pseudophakic eyes, only 5 (29%) had a flat retina and VA of 20/80 or better, whereas 12 (71%) had no light perception (P = 0.03). Conclusions: The results of RD operations done in the past in Marfan patients were worse when the eye was aphakic. In most cases operated more recently, the prognosis for successful RD repair was good regardless of whether the eye was phakic. RETINA 20:358-363, 2000

Neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery

PURPOSE: To report clinical features and surgical management of neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery in nondiabetic patients.METHODS: Seven consecutive eyes of seven nondiabetic patients who developed neovascular complications associated with rubeosis iridis and peripheral retinal detachment after scleral buckling and vitrectomy procedures were retrospectively reviewed. None of the eyes had clinical evidence of anterior segment ischemia or retinal vascular disease, but each eye developed rubeosis iridis and neovascular complications.RESULTS: Of the seven eyes with rubeosis iridis and peripheral retinal detachment, six developed recurrent or progressive vitreous hemorrhage, and three developed progressive neovascular glaucoma. Four eyes underwent a revision procedure to repair the peripheral retinal detachment, and anterior proliferative vitreoretinopathy was found in each of these cases. Rubeosis iridis regressed in all three eyes in which surgery resulted in complete reattachment of the retina. In one eye with persistent peripheral retinal detachment and in the three remaining eyes that did not undergo revision surgery, rubeosis iridis persisted and was associated with long-term neovascular complications. Final corrected visual acuity was 20/70 to 20/400 in three eyes with total retinal reattachment and no light perception to hand motions in four eyes with persistent peripheral retinal detachment and rubeosis iridis.CONCLUSION: Visually significant neovascular complications may occur in eyes that develop rubeosis iridis associated with peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. Successful repair of the peripheral retinal detachment may induce regression of rubeosis iridis, reduce associated complications, and improve the long-term prognosis of these eyes.

The efficacy of silicone oil for complicated retinal detachments in the pediatric population.

To evaluate the efficacy of silicone oil as an intraocular tamponade for complicated retinal detachments in the pediatric population. Case series. Referral practice at a major university hospital eye center. Consecutive referred sample of 48 cases of complicated retinal detachments in children 16 years old or younger. Forty-two percent of the patients had traumatic injuries, and 35 of the eyes had undergone at least one previous retinal surgery. The minimum follow-up was 6 months, with an average follow-up of 23 months. Pars plana vitrectomy, silicone oil injection, and advanced vitreoretinal surgical techniques. Successful repair of complicated retinal detachment, improved visual acuity post-operatively, and frequency of complications. The postoperative visual acuity at the last follow-up examination was counting fingers or better in eight (17%) of the 48 cases, and only two eyes saw 20/200 or better. In the 46 eyes in which the retinal status could be determined, 16 retinas (35%) were successfully reattached at last follow-up. Significant complications included corneal opacification (62%) and hypotony (58%). Postoperative glaucoma was not a problem. In the pediatric population with complicated retinal detachments, silicone oil used for intraocular tamponade has disappointing results due to a low rate of sustained retinal reattachment, poor visual rehabilitation, and a high complication rate.

Macular Changes After Retinal Detachment Surgery

We studied 175 eyes of 175 patients who had successful repair of primary rhegmatogenous retinal detachment. Patients were randomly assigned to be treated with cryotherapy and episcleral sponges or with diathermy, scleral dissection, and encircling silicone bands. Fundus photography and fluorescein angiography were performed six weeks after successful reattachment surgery. Macular complications were discovered in 48 (27%) of the 175 eyes. The most frequent changes were cystoid macular edema in 28 (16%) and preretinal macular membrane in 13 eyes (8%). No significant differences in the incidence of cystoid macular edema were observed between diathermy and cryotherapy. Macular detachment, increased duration of macular detachment, cryotherapy, and pseudophakia were identified as risk factors for certain macular complications.

Prognosis of cystoid macular edema after retinal detachment repair.

Twenty eyes of 20 patients who had undergone successful retinal detachment repair by means of microsurgery had cystoid macular edema (CME) disclosed by fluorescein angiography 10-12 weeks postoperatively. Clinical evaluation war repeated at 6-month intervals for a period of 12-30 months. Sixteen eyes were followed for at least 18 months. CME spontaneously cleared or dramatically decreased in 12 of the 16 eyes (75%), which were followed for at least 18 months. CME had spontaneously cleared in 50% of the eyes by the end of 1 year after surgery. For those eyes with transient CME, the mean visual acuity improved from 0.3 at 3 months postoperatively to 0.6 at the end of the follow-up period. The final visual acuity was 0.4 or better in 83.3% of the eyes with transient CME. None of the eyes with persistent CME developed premacular fibrosis or cystoid macular degeneration during the follow-up period. No prognostic factor for angiographic CME after repair of retinal detachment could be determined in the present series of patients.