Surgery For Rhegmatogenous Retinal Detachment Research Articles

OCT analysis of preoperative foveal microstructure in recent-onset macula-off rhegmatogenous retinal detachment: visual acuity prognostic factors

BackgroundTo evaluate, in patients undergoing macula-off rhegmatogenous retinal detachment surgery (RRD), the correlation between preoperative optical coherence tomography (OCT) morphological features and postoperative visual acuity.MethodsRetrospective interventional non-randomised clinical trial on...

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

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

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

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

PURPOSEFUL GAS-INDUCED RESORPTION OF SUBMACULAR FLUID IN MACULA-OFF RETINAL DETACHMENTS (PERSIMMON STUDY).

To examine the visual outcomes in patients with macula-off rhegmatogenous retinal detachments with intentional submacular fluid retention after pars plana vitrectomy (PPV) or PPV/scleral buckle surgery (PPV/SB). Patients with macula-off retinal detachments were included if they had a PPV or PPV/SB without drainage retinotomy or perfluorocarbon liquid to flatten the retina. The mean age of the patients was 65.0 years. The mean presenting vision was 20.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Six months after repair, the vision improved to 62.9; 75.4% of patients had 20/40 or better at best achieved visual acuity. Pseudophakic eyes had better vision compared with phakic eyes ( P = 0.049). Patients younger than 80 years had better best achieved vision ( P = 0.0118) compared with patients 80 years or older. Patients with initial vision better than or equal to 20/100 had better best achieved vision ( P = 0.016) compared with those with initial vision worse than 20/100. Leaving submacular fluid after macula-off retinal detachments surgery was not detrimental for visual outcomes or anatomic success for retinal detachments repair and may lead to better visual outcomes for patients, specifically for those patients younger than 80 years, who are pseudophakic, and have presenting vision 20/100 or better.

CLINICAL FEATURES AND SURGICAL OUTCOMES OF SCLERAL BUCKLE SURGERY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: MOORFIELDS BUCKLE STUDY.

Long-term study to evaluate the clinical and surgical outcomes of SB surgery for primary rhegmatogenous retinal detachment (RRD) at a large tertiary eye center. Non-comparative, retrospective case series of 589 eyes of 569 patients with primary RRD who underwent SB surgery between 2004 and 2022 with median follow-up of 6 months. Main outcome measures were best-corrected visual acuity (BCVA), surgical outcomes, complications, and classification of RRD. At baseline, 447/589 (76.1%), round hole-RRD and 133/589 (22.7%) retinal dialysis-RRD. Overall primary SB success rate was 83.7% for all RD subtypes, with round hole-RD 84.8% and dialysis-RRD 81.2%. Overall, Baseline BCVA was logMAR 0.42 and final logMAR 0.26 (p<0.0001). In macula-OFF RRD, the BCVA significantly improved from 0.79 to 0.48 logMAR (p<0.0001). Macula-ON RRD patients improved from 0.19 to 0.12 logMAR (p=0.014). Binary logistic regression showed registrar surgeon grade (OR 0.09,95% CI 0.01- 0.55), and partial or complete PVD (OR 0.21,95% CI 0.10 - 0.49) associated with reduced odds of primary success. Higher surgical failure associated with low pre-fellowship SB surgeon experience (p=0.024). We report favourable visual and functional outcomes in a large series of SB for primary retinal detachment, mainly for round hole and retinal dialysis RRD patients.

Functional and perfusion changes associated with silicone oil tamponade after macula-off rhegmatogenous retinal detachment surgery: an optical coherence tomography angiography/microperimetry study

PurposeThe current study utilizes microperimetry and optical coherence tomography angiography (OCTA) to assess the optic nerve head vasculature, retinal microvasculature, and retinal sensitivity before and after silicone oil (SO) removal.MethodsThis prospective observational case series study involved 30 eyes subjected to silicone oil endotamponade. Microperimetry and OCTA were utilized to assess the vascular density (VD) of the macula and optic nerve head, as well as the retinal sensitivity (RS), of the participants preoperatively and 1 month following SO removal. The correlation between the various parameters of OCTA and microperimetry was evaluated.ResultsThere was a significant improvement in the postoperative best-corrected visual acuity (BCVA) (p-value < 0.001) and the postoperative total RS, which was 6.38 ± 2.34 dB as compared to a mean preoperative total RS of 5.04 ± 2.06 dB (p-value < 0.001) and showing a significant increase in all rings. However, there was no significant difference in the pre and postoperative macular VD. On the other hand, there was a significant increase in the postoperative VD of the whole disk and the peripapillary capillary plexus, p-values < 0.001 and 0.002, respectively.ConclusionThe removal of SO resulted in significant improvements in retinal sensitivity, vision, and optic nerve perfusion. However, no significant change was observed in macular VD.Clinical Trials.gov Identifier: NCT04928196.

Outcomes of rhegmatogenous retinal detachment surgery in patients with Stickler syndrome.

Despite recent developments in vitrectomy technology and instrumentation, rhegmatogenous retinal detachment in Stickler syndrome (RDS) remains a challenge for surgeons. RDSs are associated with a higher rate of complications and surgical failures than those not associated with Stickler syndrome. This study is a report about anatomic and visual outcomes of RDS surgery and describes the surgical techniques associated with the treatment of this specific condition. This is a retrospective, interventional, consecutive case series of patients with RDS undergoing retinal reattachment surgery from 1990 to 2020 at the Institute of Ocular Microsurgery (IMO) in Barcelona, Spain. Twenty-four eyes of 18 patients with genetically confirmed Stickler syndrome were included in the study. Ten eyes (41.6%) presented a giant retinal tear. Retinal reattachment was achieved in all cases after an average of 1.21 (range 1-6) surgical interventions. Nineteen eyes (79%) required only one operation to achieve complete retinal reattachment. The most common first surgical procedure was a 4-mm scleral buckle with posterior pars plana vitrectomy and silicone oil endotamponade, performed on 16 (66.6%) of the eyes. The mean follow-up period was 10.2years. Mean preoperative visual acuity LogMar was 1.10 (Snellen equivalent 20/252), which improved to 0.50 (Snellen equivalent 20/63) at final follow-up (p < 0.05). In most RDS cases, anatomic success and visual acuity improvement can be achieved with the first surgical procedure, using a combination of silicone oil tamponade and a 4-mm scleral encircling band. In some early cases of RDS, other less invasive surgical techniques can be used.

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series

BackgroundMacular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD.MethodsClinical records of patients undergoing SB surgery for treatment of RRD at the Xi’an People’s Hospital (Xi’an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed.ResultsAmong 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients.ConclusionsPatients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Correlation between multifocal electroretinogram and optical coherence tomography findings with visual acuity after vitrectomy surgery for retinal detachment: an observational study

BackgroundDespite the marked increase in the anatomical success rates of macula-off rhegmatogenous retinal detachment (RRD) surgery, patients may still complain about unsatisfactory visual outcome. This study aims to correlate the postoperative corrected distance visual acuity (CDVA) with the mf-ERG (multifocal electroretinogram) and OCT (optical coherence tomography) findings following vitrectomy surgery for RRD.Patients and methodsThis retrospective observational study included 40 eyes of 40 patients who underwent successful vitrectomy surgery for macula-off RRD. CDVA, mf-ERG amplitudes, mf-ERG latencies, the central macular thickness (CMT) and the integrity of the inner segment/outer segment (IS/OS) junction assessed by OCT, were evaluated 6 months postoperatively. The correlations between CDVA with mf-ERG amplitudes, mf-ERG latencies, central macular thickness, and IS/OS junction integrity were analyzed.ResultsThere was a statistically significant moderate positive correlation between CDVA of the studied eyes with mf-ERG amplitudes of N1, P1 and N2 in ring 1 (P = 0.008; P < 0.001 and P = 0.004, respectively), CMT (P < 0.001), and the integrity of IS/OS junction (P < 0.001). There was no significant correlation between CDVA and mf-ERG latencies in ring 1 (P > 0.05). Linear regression analysis revealed that CDVA was significantly associated with mf-ERG amplitudes and the IS/OS junction integrity. In addition, there was a strong positive correlation between mf-ERG amplitudes in ring 1 and the IS/OS junction integrity.ConclusionsThe integrated interpretation of postoperative CDVA, multifocal ERG parameters, and OCT findings provides useful information about functional visual recovery and retinal microstructural changes following vitrectomy for macula-off RRD surgery. The positive correlation between the IS/OS junction integrity and the mf-ERG amplitudes was stronger than the correlation between the IS/OS junction integrity and CDVA suggesting that mf-ERG may be superior to CDVA in reflecting the extent of microstructural damage in the photoreceptor layer.Trial RegistrationClinicaltrials.gov, NCT05993208. Registered 15 August 2023 - Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT05993208.

Mean Ocular Perfusion Pressure Effect During Pars Plana Vitrectomy on the Foveal Avascular Zone: A Pilot Study.

Purpose: To evaluate the effect of mean ocular perfusion pressure on the foveal avascular zone (FAZ) area in eyes with successful retinal detachment (RD) surgery. Methods: This prospective pilot fellow eye-controlled study measured the intraoperative mean ocular perfusion pressure in eyes having surgery for rhegmatogenous RD (RRD). Postoperatively, the FAZ area was measured; the change was calculated as the difference in the FAZ area between the operated eye and the contralateral control eye. Results: The study comprised 8 patients with a mean age (±SD) of 53.38 ± 13.92 years. The mean superficial FAZ area was not different between operated eyes and control eyes, while the deep FAZ area was significantly larger in operated eyes. There was a strong negative correlation between the mean ocular perfusion pressure and the change in the deep FAZ area (Spearman ρ, -0.73; P = .04); the correlation between the mean ocular perfusion pressure and the change in the superficial FAZ area was not significant (Spearman ρ, -0.24; P = .57). A significant linear regression was found between the mean ocular perfusion pressure and the change in the deep FAZ area (R2 = 0.388). The predicted enlargement of the deep FAZ area was 0.03 mm with every 1 mm Hg decrease in the mean ocular perfusion pressure. Conclusions: Lower intraoperative mean ocular perfusion pressure is associated with enlargement of the deep FAZ area in eyes having successful RRD surgery.

Case series of branch retinal vein occlusion secondary to rhegmatogenous retinal detachment and its surgical management

BackgroundTo review cases of branch retinal vein occlusion (BRVO) secondary to rhegmatogenous retinal detachment (RRD) and its surgical management and presume their mechanism.MethodsMedical records of patients who underwent surgery for RRD between 2015 and 2019 at a single tertiary care center were retrospectively reviewed. New BRVO secondary to RRD or its surgical procedure was diagnosed based on the fundus examination and its clinical course.ResultsA total of 734 RRD surgeries were performed for five years, and six cases of new BRVOs were noticed in the first year after surgery (incidence was 0.68%: six cases of BRVO / 734 cases of surgical RRD); five cases occurred after vitrectomy, and one occurred after scleral buckling. In three cases, retinal veins were presumed to already be partially occluded related due to a kink of the retinal vein seen before surgery. In the other three cases, the retinal veins were presumed to have incurred damage during vitrectomy.ConclusionIn the present cohort, RRD or its related procedures caused BRVO within a year of surgery at an incidence of 0.68%. The proposed mechanisms are kinks of the retinal vein on the detached retina and damage to the retinal vein during vitrectomy.

Ocular Movement Disorder after Scleral Buckling Surgery in Patients with Retinal Detachment

Purpose: Binocular diplopia is a primary complication that may arise after scleral buckling surgery in patients with rhegmatogenous retinal detachment. This study examined the incidence of and risk factors for binocular diplopia after scleral buckling surgery; it also evaluated the rate of strabismus surgery success in patients with diplopia.Methods: Medical records of 417 patients who underwent scleral buckling surgery for rhegmatogenous retinal detachment at a single institution from January 2017 to June 2022 were retrospectively reviewed. Patients who experienced binocular diplopia for &gt; 6 months were included in the diplopia group.Results: After surgery, 22 patients (5.3%) developed binocular diplopia. There were no significant correlations of diplopia onset with buckle position (i.e., the affected muscle), cryophotocoagulation, subretinal fluid drainage, and the use of gas or oil injections. Prism therapy restored binocular single vision in three patients. Ten patients chose to undergo strabismus surgery, and one patient underwent encircling band removal. All strabismus surgery patients displayed adhesion between the buckle and extraocular muscle. After surgery, 60% of these patients regained binocular single vision.Conclusions: Clear risk factors leading to ocular movement disorders and diplopia after scleral buckling remain undefined. If diplopia persists despite prism-based conservative treatment, strabismus surgery may offer relief.

Effect of external subretinal fluid drainage on persistent subretinal fluid after scleral buckle surgery in macula-involving rhegmatogenous retinal detachment

This study aimed to analyze the duration and causes of persistent subretinal fluid (PSF) after scleral buckle (SB) surgery in patients with macula-involving rhegmatogenous retinal detachment (RRD). Sixty-one eyes of 61 patients with macula-involving RRD who underwent SB surgery between 2016 and 2022 were reviewed retrospectively. PSF was confirmed on optical coherence tomography. The PSF duration after surgery and the analysis of relevant ocular and systemic factors were conducted according to the PSF duration. The mean duration of PSF was 5.9 ± 4.6 months in all eyes and 8.1 ± 5.0 months in eyes not treated with external subretinal fluid (SRF) drainage, which was significantly longer than 4.5 ± 3.7 months in those subjected to external SRF drainage. The mean best-corrected visual acuity improved significantly 3 months after surgery. There were significant visual improvements in the external SRF drainage group compared to the non-drainage group during all follow-up periods. Longstanding shallow RRD was significantly associated with longer PSF duration after SB surgery. External SRF drainage during SB surgery can effectively reduce SRF, shorten the duration of PSF, and accelerate visual improvement.

Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study

PurposeTo establish whether Densiron® 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy. DesignCohort study of routinely collected data from the European Society of Retina Specialists (EURETINA) and British and Eire Association of Vitreoretinal Surgeons (BEAVRS) vitreoretinal database between 2015 and 2022. ParticipantsAll consecutive eyes that underwent primary rhegmatogenous retinal detachment surgery using either Densiron® 68 or light silicone oil as an internal tamponade agent. MethodsTo minimize confounding bias, we undertook 2:1 nearest neighbor matching on inferior breaks, large inferior rhegmatogenous retinal detachments, proliferative vitreoretinopathy, and, for visual analyses, baseline visual acuity between treatment groups. We fit regression models including prognostically relevant covariates, treatment-covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals using bias-corrected cluster bootstrapping with 9 999 replications. Main Outcome MeasuresPresence of a fully attached retina and visual acuity at least two months after oil removal. ResultsOf 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomical and visual outcome analyses, respectively. The primary success rate was higher in the Densiron® 68 group (113 of 142; 80%) compared to the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI 1.63 to 2.23, P < 0.001). We also observed a significant improvement favoring Densiron® 68 of -0.26 logMAR in postoperative visual acuity between the two groups (95% CI -0.43 to -0.10, P = 0.002). The anatomical benefit of using Densiron® 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with proliferative vitreoretinopathy Grade C. We found no evidence of visual effect moderation by anatomical outcome or foveal attachment. ConclusionsDensiron achieved higher anatomical success rates and improved visual outcomes compared to conventional light silicone oil in eyes with inferior retinal pathology and severe proliferative vitreoretinopathy.

Quality of Life after Pars Plana Vitrectomy, Scleral Buckle, or Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment: A Meta-Analysis

Purpose Comparisons of the surgical and anatomic results of rhegmatogenous retinal detachment surgery have been investigated previously. A systematic evaluation of the available evidence comparing quality of life outcomes of either pars plana vitrectomy, scleral buckling, or pneumatic retinopexy has not been evaluated to date. This article analyzes whether pars plana vitrectomy, scleral buckling, or pneumatic retinopexy for the treatment of rhegmatogenous retinal detachment results in differing quality of life outcomes. Methods In February of 2022, a comprehensive search of MEDLINE, EMBASE, CINHAL, and Cochrane Library was conducted for studies on patients treated surgically for rhegmatogenous retinal detachment and included follow-up measurements of quality of life outcomes. Meta-analysis was completed using STATA v. 14.0. The main outcomes of interest were the mean vision-related quality of life score (VRQOL) and SD of VRQOL of each type of surgical procedure. Results In this systematic review of 13 distinct trials including follow-up of patient quality of life after rhegmatogenous retinal detachment surgery (n = 1063), a better correlation was found between higher quality of life outcomes with scleral buckling than with pars plana vitrectomy (SMD = 0.62, CI: [0.31, 0.93]). There was also no signficant difference in quality of life outcomes between pneumatic retinopexy and pars plana vitrectomy (SMD = 0.08, CI: [−0.07, 0.22]). Conclusions Scleral buckling results in better quality of life outcomes for patients when compared to pars plana vitrectomy. Pneumatic retinopexy did not show a difference in quality of life outcomes compared to pars plana vitrectomy.

Influencing factors of visual prognosis in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off retinal detachment

Objective: To investigate the factors influencing visual outcomes in patients with rhegmatogenous retinal detachment (RRD) who developed persistent submacular fluid (PSF) after scleral buckling surgery. Methods: A retrospective case series analysis was conducted. Clinical data were collected from patients who underwent successful scleral buckling surgery for RRD at Beijing Tongren Hospital from June 2020 to December 2022 and were followed up. Patients with RRD involving the macular area preoperatively and graded as C1 or below in proliferative vitreoretinopathy (PVR) were included. Surgical procedures followed a minimally invasive scleral buckling approach. PSF was defined as subretinal fluid persisting for more than 1 month postoperatively. Regular follow-up visits were scheduled at postoperative days 1, 3, 7, 2 weeks, and 1 month, followed by monthly visits until complete PSF absorption. Best-corrected visual acuity (BCVA), intraocular pressure, refractive error, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography (OCT) were performed at each follow-up time point. Eyes were divided into two groups based on whether the final follow-up BCVA was≥0.5 and whether the absorption time of PSF was>6 months, and statistical analysis was performed using the Wilcoxon signed-rank test, chi-squared test, and Mann-Whitney U test. Results: A total of 46 patients (46 eyes) were included in this study, comprising 25 males and 21 females, with a median age of 32.5 (21.0, 57.3) years. The preoperative equivalent spherical refractive error was (-5.27±4.05) D, and the preoperative duration of illness was 30 (14, 92) days. The preoperative BCVA (logarithm of the minimum angle of resolution,logMAR) was 2.00 (1.00, 2.50). Scleral buckle surgery was performed in 28 eyes (60.9%), and 18 eyes (39.1%) underwent scleral buckle surgery combined with encircling. External drainage was performed in 15 eyes (32.6%), while 31 eyes (67.4%) had no external drainage. BCVA (logMAR) at 1 month, 3 months, and the final follow-up postoperatively was 0.60 (0.50, 1.00), 0.40 (0.28, 0.53), and 0.15 (0.00, 0.50), respectively. In the final follow-up, 31 eyes (67.4%) achieved BCVA≥0.5, and 26 eyes (56.5%) had continuous ellipsoid zone on OCT. The differences in BCVA (logMAR) between preoperative, 1 month, 3 months, and the final follow-up were statistically significant (Z=-5.85, -5.63, -4.73;all P<0.001). The absorption time of PSF postoperatively was 6.50 (3.00, 9.00) months, ranging from 2 to 19 months. The eyes with PSF duration<3 months, 3-6 months, and>6 months were 12 eyes (26.1%), 11 eyes (23.9%), and 23 eyes (50.0%), respectively. There were statistically significant differences between the two groups in preoperative BCVA≥0.05, preoperative duration of illness within 1 month, PVR grading, surgical method, and continuous ellipsoid zone on OCT (all P<0.05), while there were no statistically significant differences between the two groups in PSF absorption time, different types of PSF, and intraoperative drainage (all P>0.05). The PSF absorption time in the two groups was 7 (3, 10) months and 6 (4, 8) months, with no statistically significant difference (P>0.05). Conclusions: Preoperative visual acuity, duration of illness, and PVR grading are factors influencing visual outcomes in patients with RRD who have undergone scleral buckling surgery and develop PSF. In contrast, intraoperative drainage, PSF absorption time, and different PSF types are not factors affecting visual prognosis. Although PSF may persist for a long time after scleral buckling surgery, it does not significantly impact long-term visual outcomes.

Evaluation of anterior chamber morphology following scleral buckling with Pentacam

PurposeTo evaluate anterior segment parameter changes following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) using the Pentacam Scheimpflug system. MethodsTwenty-eight phakic eyes of 28 patients who underwent SB surgery for RDD were included. The anterior chamber volume (ACV), central anterior chamber depth (CACD), mean anterior chamber angle (ACA) and ACA in a specific position (buckle quadrant), and central corneal thickness (CCT) were evaluated preoperatively and at 1 day, 1 week, and 1 and 3 months postoperatively by an anterior Pentacam Scheimpflug method. ResultsThe ACV parameters were significantly decreased compared with preoperative levels at 1 day after SB surgery (P = 0.0004), but had no significant differences at 1 week, and 1 and 3 months (P > 0.05). The mean intraocular pressure (IOP) at 1 day was significantly higher than the preoperative level, but no subsequent significant difference was noted between the preoperative IOP and that at 1 week and 1 and 3 months postoperatively (P > 0.05). The CCT at 1 day after surgery increased significantly (P = 0.0122) and subsequently returned to the normal level postoperatively at 1 week and remained stable until 3 months (P > 0.05). The degree of postoperative ACA displayed different changes in the different quadrants and there was a significant increase in the ACA of the buckle quadrants at 1 day (P < 0.0001), 1 week (P = 0.02), and 1 month (P = 0.0266) after surgery, returning to the normal level at 3 months. ConclusionsThe changes of anterior chamber parameters after SB can be demonstrated by Pentacam both objectively and quantitatively. The ACV and CCT changes were mild and resumed their preoperative parameters after 1 week, while the increase of the ACA at the buckle quadrant returned to normal after 3 months. SB surgeries without encircling or conducted with radial buckling might decrease anterior chamber change.

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.

Pars plana vitrectomy in patients aged 85 years and older: a single-centre, retrospective cohort study

PurposeTo describe the epidemiology, indications and surgical results of pars plana vitrectomy (PPV) in patients over 85 years of age.MethodsA retrospective cohort study was performed including all consecutive patients aged 85 years or older who underwent PPV between September 2018 and March 2022 in a single hospital in Madrid, Spain. Data on diagnosis, comorbidities, surgical indication, surgical details, surgical complications and surgical outcomes were collected from medical records.ResultsA total of 124 eyes of 119 patients (56 males, 47.1%) underwent PPV. Median age was 87 years (range 85–96). The most common surgical indications were complications of cataract surgery in 34 patients (28.6%), macular epiretinal membrane in 32 (26.9%), and rhegmatogenous retinal detachment (RRD) in 12 (10.1%). Mean preoperative best corrected visual acuity (BCVA) was 13.33 ± 42.34 ETDRS letters and improved to 40.05 ± 41.04 letters at 3 months (p < 0.001). BCVA had improved in 68.82% of patients at 3 months. Patients with chronic kidney disease (CKD; p < 0.001), RRD (p = 0.003), ocular trauma (p = 0.001) and age-related macular degeneration (AMD; p = 0.002) showed worse BCVA at 3 months from surgery. Patients with better preoperative BCVA (p < 0.001), and those who underwent 25G PPV (p = 0.041) showed better visual outcomes.ConclusionsPPV is an effective technique for improving visual acuity in patients aged 85 years and older with vitreoretinal diseases. Visual outcomes were better when patients had a better preoperative visual acuity and underwent 25G PPV. Patients with a previous diagnosis of AMD or CKD, and those undergoing surgery for ocular trauma or RRD had worse visual outcomes.

Expression of key SARS-CoV-2 entry molecules in surgically obtained human retinal biopsies.

To investigate the presence of ACE2, TMPRSS2 and Furin, i.e., a key player in the ocular infection with SARS-COV-2, in surgically obtained human retinal tissue samples from SARS-CoV-2-negative patients, using gene expression analysis. The mechanisms and entry paths of ocular infections have been ill-defined so far. To better understand the possible entry routes, we used surgically explanted retinal tissue from nine patients that were not infected with SARS-CoV-2 and analyzed the message expression of the three key molecules that confer viral entry into cells using polymerase chain reaction. The median age of the patients (n = 9) included in the study was 52years (IQR 48, 55). Eight patients underwent surgery for rhegmatogenous retinal detachment and one patient for tractional retinal detachment. Gene expression for the proteins studied was detected in all nine patients. The results of analysis by Livak's method (2001) demonstrated a median TMPRSS2 gene expression value of 20.9 (IQR 11.7, 33.7), a median ACE2 gene expression value of 2.09 (IQR 1.14, 2.79) and a median Furin gene expression value of 8.33 (IQR 5.90, 11.8). In conclusion, TMPRSS2, Furin and ACE2 are expressed in the retina and may contribute to the retinal involvement in COVID-19 patients. Expression may vary among individuals, which may explain why some patients may be more prone to retinal involvement during SARS-CoV-2 infection COVID-19 patients than others. Variability in the expression of TMPRSS2, Furin and ACE2 proteins themselves may also explain the presence or development of retinal symptoms of varying severity.