Type Of Retinal Break Research Articles

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.

Effect of the COVID-19 Pandemic on Surgical Outcomes for Rhegmatogenous Retinal Detachments

We reviewed the medical records of 438 eyes in 431 patients who had undergone surgeries for rhegmatogenous retinal detachments (RRD) or proliferative vitreoretinopathy (PVR ≥ Grade C) to determine whether the COVID-19 pandemic had affected outcomes. The patients were divided into 203 eyes in Group A that had undergone surgery from April to September 2020, during the pandemic, and 235 eyes in Group B that had undergone surgery from April to September 2019, before the pandemic. The pre- and postoperative visual acuity, macular detachment, type of retinal breaks, size of the RRD, and surgical outcomes were compared. The number of eyes in Group A was fewer by 14%. The incidence of men (p = 0.005) and PVR (p = 0.004) was significantly higher in Group A. Additionally, the patients in Group A were significantly younger than in Group B (p = 0.04). The differences in the preoperative and final visual acuity, incidence of macular detachment, posterior vitreous detachment, types of retinal breaks, and size of the RRD between the two groups were not significant. The initial reattachment rate was significantly lower at 92.6% in Group A than 98.3% in Group B (p = 0.004). The COVID-19 pandemic affected the surgical outcomes for RRD with higher incidences of men and PVR, younger aged patients and lower initial reattachment rates even though the final surgical outcomes were comparable.

Clinical characteristics and prognosis of Total Rhegmatogenous retinal detachment: a matched case-control study

BackgroundAlthough many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this study, we investigate the clinical characteristics, risk factors, and prognosis of total RRD.MethodsA retrospective chart review was performed on cases of 44 total RRD and an age- and sex-matched 88 partial RRD. Two groups were compared for clinical characteristics, risk factors, and prognosis.ResultsThe prevalence of total RRD in all cases of retinal detachment was 4.4%. Pseudophakic eye, ocular trauma, and proliferative vitreoretinopathy (PVR) were significantly associated with a risk of total RRD (P = .002, P = .003, and P < .001, respectively). In the total RRD group, retinal breaks were located in both superior and inferior parts of the retina, and macular holes and giant retinal tears were frequently found. The best-corrected visual acuity (log MAR) before surgery and final best-corrected visual acuity after surgery were 2.23 ± 0.45 and 1.88 ± 0.96, which was significantly poorer than in the partial RRD group (P < .001). The success rate after primary surgery was 75.0% in the total RRD group, which was significantly lower than partial RRD group (P < .001). Old age, pseudophakic eye, and macular hole as the type of retinal break were highly associated with low success rate. (P = .010, P = .0500, and P = .002).ConclusionsPatients with total RRD had higher recurrence rate and poorer visual outcome after surgery than patients with focal RRD. Old age, pseudophakic eye, and presence of macular hole were important risk factors for recurrence after total RRD repair. Additional surgical procedures should be considered to combine with vitrectomy to achieve better surgical outcomes in these patients.

Microscope-Assisted ab externo Surgery for the Treatment of Primary Rhegmatogenous Retinal Detachment – New Tech Meets Old Art

Aim: To report the outcomes of ab externo surgery using a surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted ab externo surgery) for rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective study. Consecutive charts of patients with RRD who underwent microscope-assisted ab externo surgery were analyzed. The following demographic parameters were analyzed: age (years), gender (male/female), and eye (right/left). Clinical parameters were axial length (AL) measured in millimeters (mm), preoperative best-corrected visual acuity (BCVA) measured in logarithm of minimum angle of resolution (logMAR), intraocular pressure (IOP), and lens status (phakic/pseudophakic). The parameters of RRD were number and type of retinal breaks, location of retinal breaks, extent of retinal detachment (RD) (number of detached quadrants), and macular detachment (MD), as well as retinal breaks not detected preoperatively. Use of cryopexy, circumferential or segmental scleral buckle, drainage of subretinal fluid, injection of air or gas, and duration of surgery were recorded. The postoperative parameters analyzed were BCVA, IOP and recurrence of RD and postoperative complications. Follow-up was established at 3 months. Results: A total of 213 eyes (97 right, 116 left) of 205 patients (114 males, 91 females) affected by primary RRD were included. Fifty-two eyes (24.4%) were affected by high myopia (AL >26.5 mm), and 160 patients (75.1%) were affected by RRD caused by a single retinal break and involving only one quadrant. The superior quadrant was the most frequently involved (49.3%). Forty-two eyes (19.7%) were affected by MD. In 13 eyes (11.3%), retinal breaks were not detected preoperatively. The duration of surgery was 75.5 ± 42 min. No significant BCVA changes were observed in the whole group, whereas a significant improvement of BCVA from the baseline (2.83 ± 0.87 logMAR) to each time point of follow-up was observed in the subgroup of patients affected by MD. Six eyes (2.8%) developed a recurrent RD, secondary to proliferative vitreoretinopathy (3 eyes) and secondary to a new retinal break (3 eyes). Two eyes developed a persistent vitreous hemorrhage, and one eye developed a macular hole after 1 week. PPV was performed for both. Conclusion: Microscope-assisted ab externo surgery is effective and safe, it reduces discomfort, it allows the surgeon to work with both hands free, and provides an adequate visualization of each step being performed.

Risk of progression in macula-on rhegmatogenous retinal detachment.

To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8±1.4days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p=0.0036) and without (p=0.0014) macular involvement. For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.

Ethnic variation in rhegmatogenous retinal detachments.

We aimed to investigate the clinical variation of rhegmatogenous retinal detachments (RD) in patients of different ethnicities. Patients presenting with a primary RD from two ethnic groups were recruited from our tertiary referral hospital between August 2010 and December 2012. Patients who self-reported their ethnic origin either as European Caucasian (EC) or South Asian (SA) were included. Exclusion criteria included trauma, previous vitreoretinal procedures, age under 18 years, complicated cataract surgery and the presence of syndromes known to be associated with a high prevalence of RD. Detailed phenotypic data were collected. Descriptive and comparative statistical analyses were undertaken. 1269 Patients were recruited. 1173 (92.4%) were EC. Mean age of onset was 58.3 years (EC) and 54.5 years (SA) (P=0.006). 75.3% EC and 58.4% SA were phakic (P<0.001). 12.8% of EC and 19.4% of SA patients had a lattice retinal degeneration in the affected eye (P=0.003). Refractive myopia was greater in SA patients (mean: -6.1DS) than EC (-4.2DS) (P=0.032). Additionally, SA patients had a greater mean axial length (25.65 mm) than EC (25.06 mm) (P=0.014). No differences were demonstrated in laterality, family history, type of retinal break or macular status. SA patients present with RD at an earlier age and have a more severe phenotype than ECs. Future management strategies for RD may need to reflect these differences.

Encircling Narrow Band versus Buckle for Retinal Detachments with Intrabasal or Unseen Retinal Breaks.

Purpose:To compare the results of narrow encircling band surgery with standard encircling scleral buckling for retinal detachments (RDs) with intrabasal or unseen breaks.Methods:In a retrospective study, eyes with intrabasal or unseen breaks underwent narrow band implantation (group N) or standard encircling buckling plus wide tire placement (group W) and were followed for at least one year.Results:A total of 112 eyes including 39 eyes in group N and 73 eyes in group W were studied. Preoperatively visual acuity of eyes in group N was significantly better (1.55 ± 0.9 vs. 1.93 ± 0.9 logMAR, P = 0.043). The two study groups (N and W) were comparable in terms of the extent of RD (2.8 ± 0.96 vs. 2.8 ± 0.93 quadrants), interval to surgery (88.3 ± 176.4 vs. 71.9 ± 135.4 days) and percentage of visible breaks (56.4% vs. 63%), respectively (all P values > 0.05). More atrophic holes were present in group W and more dialyses were reported in group N. The single operation success rate at 12 months was 69.2% in group N and 74% in group W (P = 0.1). The single operation success rate for eyes with unseen breaks was also comparable (66.7% vs. 85.7%, P = 0.157). Final corrected visual acuity was also similar (0.63 ± 0.44 vs. 0.85 ± 0.69 log MAR). The only factor influencing success rate was the type of retinal breaks (P = 0.04). Type of scleral buckling did not affect the single operation success rate (P = 0.460).Conclusion:Narrow encircling band surgery is a possible option with acceptable single operation success rate for RDs with intrabasal or unseen breaks.

Retinal Detachment Following Laser in situ Keratomileusis.

■ OBJECTIVE: To report the clinical characteristics, surgical management and outcome of retinal detachment following laser in situ keratomileusis (LASIK) in myopic patients. ■ PATIENTS AND METHODS: Retrospective review of 10 eyes of 10 myopic patients with retinal detachment who had previously undergone LASIK surgery were analyzed. Included in the study were 7 males and 3 females, aged 22 to 68 years (35.2±2.8). ■ RESULTS: Mean spherical equivalent refraction was -10.51±3.90 D (ranging from -6.37 D to -17.00 D) before surgery. The time interval between the LASIK procedure and the development of retinal detachment varied from two months to nine months (5.2±2.78 months). The number of retinal breaks was one in 7 patients, two in 2 patients and three in 1 patient. The type of retinal breaks included 7 patients with horse shoe tears, 1 patient with a retinal hole, 1 patient with a giant retinal tear, and 1 patient with retinal dialysis. Retinal breaks were located anterior to the equator in 9 patients and posterior to the equator in 1 patient. Retinal reattachment was achieved with one operation in 8 eyes (80%) and the remaining 2 eyes required a second surgery for the reattachment of the retina. ■ CONCLUSION: This study suggests the possible association between retinal detachment and LASIK procedure in patients with myopia. Clinicians should be aware of retinal pathology predisposing to retinal detachment in patients undergoing LASIK.

Retinal Detachment after Branch Retinal Vein Occlusion: Influence of the Type of Break on the Outcome of Vitreous Surgery

Branch retinal vein occlusion (BRVO) is occasionally complicated by two types of retinal breaks (retinal holes without vitreous traction or retinal traction tears) that may lead to a rhegmatogenous retinal detachment (RRD). The authors describe surgical results of vitrectomy for RRD after BRVO and investigate whether there is any difference between clinical features or surgical results from eyes with the two types of retinal breaks. The authors retrospectively studied 25 patients (25 eyes) who underwent vitrectomy for RRD after BRVO. Twelve of 25 eyes (48%) had a detachment secondary to one or more retinal holes (group I), and 13 of the eyes (52%) had one or more retinal tears (group II). Seventeen of the eyes (68%) achieved total retinal reattachment after the initial surgery; 22 (88%) did so by the time of final examination. Patients with retinal holes achieved more favorable final vision than those with retinal tears (P = 0.0391). A higher rate of preoperative macular detachment (P = 0.0112) and a higher rate of recurrent retinal detachment after initial vitrectomy (P = 0.0302) were the factors associated with the reduced final visual acuity in patients with retinal tears. The increased rate of recurrent retinal detachment in patients with retinal tears was associated with a higher rate of existing preretinal neovascular membranes (P = 0.0112) and a trend toward an increased incidence of intraoperative iatrogenic retinal breaks. Among patients who undergo vitrectomy for RRD after BRVO, better surgical results are expected in eyes with retinal holes without vitreous traction than in those with retinal traction tears. This difference is thought to be due to the difference in vitreoretinal anatomy between eyes with the two types of retinal breaks.

Shape, Number and Localization of Retinal Tears in Myopic over 8D, Aphakic and Traumatic Cases of Retinal Detachment

For this experience report we have selected out of a total of 950 eyes with retinal detachment, 373 eyes and have sorted them out into three study groups: myopia over 8 d (197 eyes including 14 bilateral detachments), surgical aphakia (102 eyes) and traumatic detachment (74 eyes). With the help of tables and figures we tried to point out the form, number and localization of retinal tears in the eyes with retinal detachment in the above-mentioned groups. For fundus examinations we used routinely the binocular indirect ophthalmoscope without and with scleral depressor and the Goldmann three-mirror contact glass, also without and with scleral depressor. The striking features of the main types of retinal breaks in the three groups are commented, statistically analysed and compared.

Pigmentation and Retinal Breaks

Of 260 patients with primary, nontraumatic, rhegmatogenous retinal separation analyzed for the presence of retinal or subretinal pigmentation associated with the retinal breaks, some 48.5% of all patients had significant pigmentary changes, especially occurring with lattice degeneration and nonlattice horseshoe tears. Critical analysis of the age of the patient, type of retinal break, vitreoretinal degeneration, and type and extent of pigmentation is essential before ascribing a protective effect of the pigment in the prevention of subsequent retinal separation.

Wagner's hereditary vitreoretinal degeneration and retinal detachment.

Forty-one patients with Wagner's vitreoretinal degeneration were studied. The polymorphous ocular signs of this disease included vitreous changes, myopia, cataract, retinal pigmentation, retinal breaks, patchy areas of thinned pigment epithelium or of chorioretinal atrophy, narrowing or sheathing of the retinal vessels, extensive white with pressure, lattice degeneration, marked meridional folds, optic atrophy and subnormal or normal electroretinograms. The main cause of blindness was retinal detachment of relatively poor surgical prognosis due to a variety of causes. Various types of retinal breaks were found in close association with vitreous and retinal disease. Early diagnosis of this disease is important. Members of the patient's family should be checked for retinal breaks. Prophylactic treatment for retinal detachment should be considered before cataract develops.

Le Decollement de la Retine.

Le Decollement de la Retineis an extremely well constructed book about many pertinent aspects of retinal detachment. The text is written completely in French and should, at some time, be translated to English, so that this massive information will not be overlooked by the non-French-reading ophthalmologists. The subject matter is concerned with alterations of the various diseases of the posterior segment that predispose to retinal detachment. Various degenerative syndromes are explored as to their contribution to the formation of the various types of retinal breaks. The conventional methods of examination of retinal detachments are reviewed, as well as the various types of modern therapy. The preoperative and postoperative management of the retinal detachment patient and the complications that can be encountered are discussed in a comprehensive manner. It is the opinion of the reviewer that this book should be among the reading material for those French-reading ophthalmologists who wish