Successful Retinal Detachment Surgery Research Articles

Reasons for reduced vision after anatomically successful retinal detachment surgery

AbstractPurpose To identify the cause of reduced visual acuity in patients with successful anatomical result after retinal detachment surgery.Methods We retrospectively reviewed files of patients that underwent retinal detachment surgery in our clinic. Patients with anatomically successful operation and a postoperative visual acuity ≥ 0.18 logMAR were identified. Patients were called and they underwent thorough re‐examination including BCVA after refraction, slit lamp examination, fundus biomicroscopy, OCT and fluorescein angiography if considered necessary.Results We reviewed the files of 78 patients with anatomically successful operation. 26 patients (33%) had a visual acuity better than 0.18 LogMAR. The remaining 52 (67%) patients had a visual acuity ranging from 1.1 LogMAR to 0.18 LogMAR. The reduced visual acuity was attributed to anterior segment problems in 8 patients (15.4%) (in 7 patients to cataract and 1 to bullous keratopathy), to cystoid macular edema in 18 patients (34.6%), to residual subretinal fluid in 5 patients (9.6%), to macular atrophic changes in 5 patients (9.6%), to epiretinal membrane in 11 patients (21.2%), to macular hole in 3 patients (5.8%), to optic nerve atrophy in 1 patient (1.9%) , while in 1 patient (1.9%) no apparent reason for reduced vision was found.Conclusion Macular changes represent the most frequent reason for reduced visual acuity after anatomically successful retinal detachment surgery. Strategies to prevent or improve these alterations might improve the functional result of retinal detachment surgery.

Photoreceptor Disruption Related to Persistent Submacular Fluid after Successful Scleral Buckle Surgery

PurposeTo investigate serial changes in photoreceptor status and associated visual outcome in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment.MethodsThis was a prospective observational case series including 76 consecutive patients who underwent successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment with symptom duration ≤90 days at a single tertiary hospital. Optical coherence tomography (OCT) and visual acuity examination were performed at one month and three months postoperatively and at three-month intervals until the submacular fluid disappeared. Main outcome measures were postoperative photoreceptor status on OCT and visual acuity.ResultsForty-two patients (55.3%) showed persistent submacular fluid at postoperative one month. Of 42 patients with persistent submacular fluid, three (7.1%) showed photoreceptor disruption on OCT. None of the 34 patients without persistent submacular fluid showed photoreceptor disruption. Two patients (4.8%) had progressive photoreceptor disruption, and one patient (2.4%) had early photoreceptor disruption. All three patients showed photoreceptor reappearance and limited visual restoration after absorption of submacular fluid. Final visual acuities were significantly worse in these three patients (20 / 1000, 20 / 133, and 20 / 133) compared to those of the other patients (mean, 20 / 30) with persistent submacular fluid and intact photoreceptors.ConclusionsEven after successful scleral buckle surgery for rhegmatogenous retinal detachment, photoreceptor disruption can occur related to persistent submacular fluid and may be a cause of poor visual outcome.

Persistent subretinal fluid due to central serous chorioretinopathy after retinal detachment surgery

BackgroundThe causes of persistent submacular detachment after successful rhegmatogenous retinal detachment (RRD) surgery remain unknown. Its presence is associated with poor postoperative visual acuity, but due to its spontaneous resolution no additional therapeutic or diagnostic procedure is recommended.Case reportA case of central serous chorioretinopathy (CSC) that simulated persistent subfoveal fluid after RRD surgery is presented.ConclusionTo the authors’ knowledge, no other case of visual impairment after successful retinal detachment surgery due to CSC has been reported in the PubMed database. In view of this report, CSC should be considered in the differential diagnosis of persistent subretinal fluid after successful retinal detachment surgery.

SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY STUDY OF RETINAS WITH A NORMAL FOVEAL CONTOUR AND THICKNESS AFTER RETINAL DETACHMENT SURGERY

The purpose was to study the disruption of the inner segment (IS) and outer segment (OS) junction associated with suboptimal visual outcome after successful retinal detachment surgery with an otherwise normal foveal contour and thickness. A comparative study of 2 groups, i.e., group I-suboptimal visual outcome (visual acuity <20/40) and group II-optimal visual outcome (visual acuity> or =20/40), with 7 eyes of 7 patients in each group rhegmatogenous retinal detachment surgery with an otherwise normal foveal contour and thickness on spectral domain-optical coherence tomography was evaluated for disruption of the IS and OS junction at 6 weeks using the crosshair protocol through the fovea. A 5 x 5-mm grid raster protocol (E MM5)imaged 256 squares of retina and the number of squares with IS and OS junction disruption was correlated with best-corrected visual acuity. Disruption of the IS and OS junction was seen in all 7 eyes of group I (100%)compared with 2 eyes in group II (28%), which was an obvious statistical difference (P =0.021). Also, a statistically significant correlation existed (r = 0.84, P < 0.05) when best-corrected visual acuity was plotted against the number of squares with IS and OS disruption. There was a statistically insignificant (P = 0.09) trend noted toward greater IS and OS junction disruption in eyes with prior macula off rhegmatogenous retinal detachments on univariate analysis. Disruption of the IS and OS junction could be a surrogate measure of the structural and functional health of the photoreceptors and can explain poor visual outcome in postsuccessful retinal detachment surgery with an otherwise normal foveal contour and thickness.

Massive coats disease-like tumor after retinal detachment.

To describe two patients with peripheral Coats disease-like tumor reaction years after surgical repair for rhegmatogenous retinal detachment. Retrospective review of two clinical cases. Patient 1 presented with visual deterioration caused by a retinal angiomatous tumor and lipid exudates originating from telangiectatic vessels on the scleral buckle 8 years after vitrectomy and encircling band surgery for a giant retinal tear. In Patient 2, a vascularized retinal mass was detected during vitrectomy for a vitreous hemorrhage 24 years after scleral buckling procedures. Both patients were highly myopic and had no history of scleral perforation or angiomatous proliferation before surgery. They underwent vitrectomy and removal of the vascularized tumor. Histologic examination revealed wide lacunae filled with erythrocytes, connective tissue strands with inflammatory cells, and capillaries that showed thickened multilamellar basement membranes. Secondary Coats disease-like tumor reaction may occur as a late complication years after successful retinal detachment surgery and may be caused by a chronic ischemic and inflammatory stimulus induced by prominent buckling elements in highly myopic eyes.

Selective retina therapy (SRT) of chronic subfoveal fluid after surgery of rhegmatogenous retinal detachment: three case reports

Shallow subfoveal fluid accumulation after successful surgery for retinal detachment can be the reason for compromised visual acuity. To date, therapeutical options to tackle this problem have not been established. Selective retina therapy (SRT) is a new laser technology that uses a train of mus-laser pulses to selectively damage retinal pigment epithelial (RPE) cells while sparing retinal structures. We treated three patients with chronic subfoveal fluid accumulation after retinal detachment surgery. The median period between retinal surgery and SRT treatment was 7 months. For SRT, we used a prototype frequency-doubled, Q-switched Nd:YLF laser (lambda = 527 nm). Each laser exposition contained 30 pulses (t = 1,7 micros, 100 Hz, E = 100-400 microJ). Two of the three patients were treated subfoveally. OCT III (optical coherence tomography) examinations were performed to evaluate changes in subretinal fluid accumulation. In all three patients, we observed complete resolution of subfoveal fluid within 1-5 months. Follow-up has been 16 months to 2 years. Visual acuity improved in all patients. In one patient, cystoid macular edema developed 3 months after treatment. Additional SRT treatments were not necessary. SRT is a safe treatment. Visual acuity improved after SRT, even in subfoveal irradiations. SRT is an option to support subretinal fluid reabsorption. In this situation where no other therapeutical options are established, SRT may be a beneficial treatment for chronic subfoveal fluid accumulation after retinal detachment surgery.

Atypische Makulaforamina nicht idiopathischer Genese

Therapeutic strategies for macular holes have been optimised during the last years. However, little is known about atypical macular holes. This study was conducted to analyse the clinical and anatomic outcome in secondary macular holes of different origins. In a retropective analysis 60 eyes with atypical macular holes that underwent surgical repair were identified. Demografic data, lens status, macular situation, best corrected visual acuity (BCVA) pre- and postoperative and complications were documented. After exclusion of patients with trauma, vitreomacular traction syndrome and epiretinal gliosis four subgroups were analysed. Group I: after retinal detachment (n = 6), Group II: with retinal vein occlusion (n = 5), Group III: associated with diabetic macular oedema (n = 6), Group IV: during/after internal limiting membrane peeling (n = 3). I. Four of six eyes showed a macular hole after successful retinal detachment surgery and two eyes in the presence of retinal detachment. Five of six eyes showed postoperative closure of the macular hole. BCVA improved in four eyes, worsened in one eye and remained unchanged in one. II. In five eyes a secondary macular hole occurred after retinal vein occlusion. After vitrectomy and gas tamponade a successful hole repair was observed in all eyes. Improvement of BCVA occurred in four eyes and remained unchanged in one eye. III. In six eyes a secondary macular hole developed after rupture of cysts in diabetic macular oedema. Four of six holes were closed successfully after vitrectomy. Improvement of BCVA was seen in two eyes, impaired BCVA in one eye and in one eye vision remained unchanged. IV. This group consists of two eyes with a macular hole after vitrectomy and membrane peeling and one eye with an iatrogenic intraoperatively created macular hole. After vitrectomy and gas tamponade, anatomic success was achieved in two eyes. Improvement of BCVA was observed in two eyes, in one eye BCVA deteriorated markedly. In spite of the different underlying diseases and pathomechanisms, secondary macular holes can be treated successfully in the majority of cases. Visual recovery was moderate in patients with diabetic macular oedema but marked in the other subgroups. Therefore, vitrectomy seems reasonable also in non-atypical macular holes of various origins.

Blockade of Endothelinergic Receptors Prevents Development of Proliferative Vitreoretinopathy in Mice

Proliferative vitreoretinopathy (PVR) is characterized by severe glial remodeling. Glial activation and proliferation that occur in brain diseases are modulated by endothelin-1 (ET-1) and its receptor B (ETR-B). Because retinal astrocytes contain ET-1 and express ETR-B, we studied the changes of these molecules in an experimental mouse model of PVR and in human PVR. Both ET-1 and ETR-B immunoreactivities increased in mouse retina after induction of PVR with dispase. Epi- and subretinal outgrowths also displayed these immunoreactivities in both human and experimental PVR. Additionally, myofibroblasts and other membranous cell types showed both ET-1 and ETR-B immunoreactivities. In early stages of experimentally induced PVR, prepro-ET-1 and ETR-B mRNA levels increased in the retina. These mRNA levels also increased after retinal detachment (RD) produced by subretinal injection. Treatment of mice with tezosentan, an antagonist of endothelinergic receptors, reduced the histopathological hallmarks of dispase-induced PVR: retinal folding, epiretinal outgrowth, and gliosis. Our findings in human and in dispase-induced PVR support the involvement of endothelinergic pathways in retinal glial activation and the phenotypic transformations that underlie the growth of membranes in this pathology. Elucidating these pathways further will help to develop pharmacological treatments to prevent PVR. In addition, the presence of ET-1 and ETR-B in human fibrous membranes suggests that similar treatments could be helpful after PVR has been established.

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.

Retinal Thickening After Successful Surgery for Macula-Off Retinal Detachment

Purpose: To study changes in retinal thickness after reattachment of the retina after scleral buckling surgery for rhegmatogenous retinal detachment. Methods: In this retrospective study, patients were classified into three subgroups according to preoperative macular status. Retinal thickness within 3 mm of the center was measured with optical coherence tomography. Results: Foveal retinal thickness at a mean of 2 years postoperatively was significantly increased in patients with preoperatively detached macula. Additionally retinal thickness in the fovea and postoperative visual acuity was positively correlated. Conclusions: Successful surgery for macula-off retinal detachment is associated with significant thickening of the neurosensory retina when examined with optical coherence tomography 6 months postoperatively.

Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment

This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV). Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months. Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 (n=22), postoperative OCT showed persistent foveal detachment in 63% of cases (n=14) at 1 and 3 months. At 6 and 12 months, 36% (n=8) and 9% (n=2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 (n=21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1-3 months. No foveal abnormality was seen at 6 and 12 months postoperatively. A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.

Functional assessment of reattached macula in nine cases with excellent Snellen acuities

To compare the macular functions of patients with excellent visual acuity after retinal detachment (RD) surgery, with the healthy fellow eye. Of 214 patients, nine patients, who were successfully operated because of unilateral RD involving the macula and achieved excellent visual acuity, were analysed. The fellow eyes of the patients were taken as the control group. The macular functions were evaluated with visual acuity, contrast sensitivity, colour vision, visual field, and pattern VEP in operated and nonoperated eyes. There was no significant difference in visual acuity, contrast sensitivity, colour vision, and VEP outcomes between operated and nonoperated eyes. However, it was seen that the mean deviation in the visual field was significantly higher in the operated eyes (5.8+/-1.8 dB) when compared with the undetached fellow eyes (3.1+/-1.8 dB), (t=12.5; P=0.013). Even though the visual acuity, colour vision, contrast sensitivity, and VEP results returned to normal after a successful RD surgery, we found that the mean deviation measured by the visual field, which reflects the retinal sensitivity, was still significantly low after nearly 5 years follow-up.

Metamorphopsia after successful retinal detachment surgery: an optical coherence tomography study

To investigate the findings in optical coherence tomography (OCT) in eyes with metamorphopsia after scleral buckling surgery for macula-off retinal detachment. A total of 46 patients (46 eyes) with macula-off retinal detachment were prospectively studied 2 months after successful scleral buckling surgery. Patients were examined with the Amsler grid, fundus biomicroscopy and OCT. At the 2 month follow-up, 31/46 (67%) patients had metamorphopsia; 24/31 (77%) of these patients had an abnormal macular structure on OCT and 7/31 (23%) showed a normal macula. However, of the 15 patients in the non-metamorphopsia group, 4/15 (27%) had an abnormal macula and 11/15 (73%) had a normal macula (p = 0.0015). The most common finding on OCT was neurosensory retinal detachment. Metamorphopsia after scleral buckling surgery in macula-off detachment is more common in patients in whom abnormal macular structure is seen on the OCT scan compared to those showing a normal macular structure. Neurosensory retinal detachment is the most common pathology in these patients.

Persistent foveal retinal detachment after successful rhegmatogenous retinal detachment surgery

PURPOSE: To describe the tomographic features of the neurosensory retina after successful rhegmatogenous retinal detachment surgery DESIGN: Cohort study. METHODS: We prospectively examined cross-sectional retinal images using optical coherence tomography (OCT) in 15 eyes of 15 consecutive patients (mean age, 46 years) who underwent scleral buckling surgery for treatment of rhegmatogenous retinal detachment. The retinas appeared reattached upon binocular stereoscopic indirect ophthalmoscopy. All eyes were examined at 1, 3, 6, and 12 months postoperatively. The time from onset of subjective symptoms of retinal detachment to retinal surgery ranged from 4 to 66 days (mean, 14 days). The postoperative OCT findings and best-corrected visual acuity were statistically analyzed using the Mann–Whitney U test. RESULTS: The detached retinas appeared attached on ophthalmoscopy in all eyes 1 month postoperatively. OCT showed residual retinal detachment in four eyes (27%) at the fovea and in three eyes (20%) at the fovea and adjacent area. The remaining eight retinas (53%) were attached when examined tomographically. In six of the seven eyes with residual foveal detachment by OCT, the retinas reattached spontaneously up to 12 months postoperatively. The postoperative best-corrected visual acuity improved gradually during 12 postoperative months in all 15 eyes. A substantial increase in visual acuity occurred when the fovea reattached in the six eyes with residual detachment. CONCLUSIONS: Foveal retinal detachment may persist after successful retinal detachment surgery in eyes in which the fovea appeared to be attached on ophthalmoscopy. The residual foveal detachment may explain, in part, the delayed visual acuity improvement after successful scleral buckling.

Changes of cone electroretinograms to colour flash stimuli after successful retinal detachment surgery

AIMTo examine the changes in the short wavelength (S) and mixed long (L) and middle (M) wavelength sensitive cone (L,M-cone) electroretinograms (ERGs) after successful retinal detachment surgery.METHODSCone ERGs elicited by...

Visual recovery after retinal detachment.

Visual recovery after successful surgery for the macula-off rhegmatogenous retinal detachment continues to be an important topic for ophthalmologists. Recent studies have shown that despite the intuitive notion regarding outcomes in macula-off detachment, there is no improvement in final visual acuity despite more expedient repair within the first week. Macula-off detachments can therefore be treated with less urgency and can wait for the next scheduled available operating room time. Surgeons involved in retinal detachment surgery should be aware that visual function based on acuity testing may continue to improve in the long term, most notably in those with the following patient characteristics: younger age, no or mild myopia (less than -5.00 D), and shorter duration of macular detachment (30 days or less).

Cone Electroretinograms in Response to Color Stimuli After Successful Retinal Detachment Surgery

Cone electroretinograms (ERGs) in response to different color flashes were examined using a Ganzfeld stimulus in 19 eyes after successful retinal detachment surgery. In the operated eyes, the short wavelength sensitive (S-) cone b-wave was reduced more than the mixed long (L-) and middle (M-) wavelength sensitive cone b-waves. The ratio of the S-cone ERG b-wave amplitude between operated eyes and fellow eyes was significantly lower than the L- and M-cone ERG b-waves ( P < .01). These ERG results indicated that the S-cone system is more impaired than the L- and M-cone systems after retinal detachment surgery.

Detached retina affects morphologic and biochemical changes in the retina adjacent to bullous retinal detachment in rabbits

PURPOSE. Long-term results, more than 10 years after successful retinal detachment surgery, have shown gradually decreasing visual acuity in some cases. It is unclear if reduced functional recovery postoperatively is caused by anatomic changes or biochemical disorders. To determine the etiology of the reduced visual acuity, we cytochemically examined the changes in the cellular responses of the edges of retinal detachments. METHODS. We histochemically studied the glucose-6-phosphatase (G6P) and 5'-nucleotidase (5'-Nase) activity in the rabbit retina. Experimental rhegmatogenous retinal detachment was produced in a rabbit model after partial vitrectomy, followed by retinal tear formation. RESULTS. Although 5'-Nase activity gradually decreased during the period of detachment, activity was still detectable after 24 weeks. G6P activity increased in the region of the detached neural retina. Around the border of the detached retina, the decrease in 5'-Nase activity extended approximately 140 micrometers into the adjacent attached retina at 2 weeks after detachment and 270 micrometers at 24 weeks. CONCLUSIONS. These observations suggest that some anatomical and biochemical damages may occur in the retina adjacent to bullous retinal detachment and may explain the reduction in postoperative vision in some clinical cases.

Motility and binocular function after radial episcleral buckle

The incidence of motility disturbances induced by episkleral buckle operations for retinal detachment has been reported to range between 7 and 77%. We anticipated a relation between the buckle size and the incidence and extent of motility disturbances. We examined 45 patients 2 to 4 years after successful retinal detachment surgery with a radial buckle. The buckle diameter was 3-11 mm. Patients were examined for diplopia and heterophoria in the primary position and in 20 degrees secondary and tertiary gaze deviations. Stereopsis was determined using the TNO plates. Refractive error and visual acuity were also measured. Heterophoria measurements in the various directions of gaze revealed a hypermotility in 22/45 cases. A hypomotility was encountered only in one of the 45 cases. In 40 of the 45 cases the field of binocular single vision had a radius of at least 20 degrees. 39 of the 45 patients had stereopsis (after macular detachment 17/22, without macular detachment 22/23). 7/32 patients with a buckle of > or = 5 mm reported on diplopia, but none of the 13 patients with a buckle of < or = 4 mm. Heterotropia in the primary position was found in one of the 45 cases. He had three buckles, a 10.5 mm buckle under the superior rectus muscle of one eye and a 4 and 7.5 mm buckle under the inferior oblique and rectus muscles of the other eye. The resulting vertical deviation was successfully treated with prisms. Motility disturbances in the upper field of gaze were found in 2 of 45 cases with buckles of 5 and 7.5 mm. Diplopia was not permanent in these cases. Hypermotility towards the position of the buckle may be explained by a deviation of the adjacent rectus muscles, after sharp preparation and shrinkage of the intermuscular septum. Since motility disturbances were encountered only with buckles of > or = 5 mm, small buckles (< or = 4 mm) should be applied whenever possible.

Late recurrences after successful surgery for retinal detachment with macular hole.

Six myopic eyes affected by retinal detachment with macular hole which had been successfully reattached developed recurrent retinal detachment 7-78 months postoperatively. The mean interval between surgery and the recurrent retinal detachment was 13.4 months in five eyes managed with gas tamponade and no choroidal irritation. In an eye managed by scleral buckling with choroidal irritation, the recurrent retinal detachment occurred 78 months postoperatively. The retina was reattached following reoperation in all eyes. However, an eye successfully reattached without choroidal irritation developed four recurrences during the follow-up period. The pathogenesis of late recurrences after successful surgery for retinal detachment with macular hole remains speculative. A number of clinical findings suggest that vitreous traction plays a decisive role.