Underwent Retinal Detachment Surgery Research Articles

A COMPARATIVE ANALYSIS OF TRAUMATIC RETINAL DETACHMENT AFTER OPEN AND CLOSED GLOBE INJURIES IN CHILDREN.

Pediatric traumatic retinal detachment (RD) resulting from open globe injuries (OGIs) or closed globe injuries (CGIs) presents unique challenges due to complexity often resulting in lifelong sequelae. This study compares pediatric traumatic RD outcomes and prognostic factors following OGI and CGI. A retrospective analysis reviewed 47 cases of pediatric traumatic RD in children (age <18 years), who underwent RD surgery between 2002 and 2021. Among them, 25 cases were caused by CGI and 22 cases by OGI. Demographics, RD characteristics, surgical procedures, and anatomical and functional results were assessed. Predictive factors for visual outcomes were investigated. In the CGI group, mean (±SD) age was 11 years ± 4 years, and 10 years ± 5 years in the OGI group. Closed globe injury traumatic RD had significantly better preoperative (CGI: logarithm of the minimum angle of resolution 1.39 ± 0.19 (mean ± standard error); OGI: logarithm of the minimum angle of resolution 2.12 ± 0.20) and follow-up (CGI: logarithm of the minimum angle of resolution 0.94 ± 0.19; OGI: logarithm of the minimum angle of resolution 1.85 ± 0.20) best-corrected visual acuity (BCVA) ( P < 0.05). Initial BCVA improvement was observed in CGI only. In multivariable analysis, prognostic factors for favorable BCVA outcomes included higher preoperative BCVA, older age, and absence of proliferative vitreoretinopathy ( P < 0.05). Visual prognosis for pediatric traumatic RD remains limited, favoring CGI cases compared with OGI. Baseline BCVA emerged as a major determinant of final visual acuity. Tailored management approaches can optimize treatment results.

Pediatric retinal detachment: Anatomical and visual outcomes from tertiary eye center in Nepal

Abstract Objective: The aim is to evaluate the anatomical and functional outcomes of retinal detachment (RD) surgery in the pediatric population in a tertiary eye hospital in Nepal. Methods: This study is a hospital-based, retrospective cross-sectional study, including patients under 18 years of age, diagnosed with rhegmatogenous RD (RRD) for 5 years from January 2015 to December 2019, who underwent RD surgery. Results: Twenty patients were included in the study (mean age of 10.75 ± 2.63). Male patients were 19 (95%). A history of trauma was seen in 13 (65%) patients. Phakic RRD was observed in 18 (90%) patients and the rest 2 (10%) patients were pseudophakic. Type B proliferative vitreoretinopathy changes were observed in 3 (15%) patients, type C was observed in single patient (5%). Scleral buckling was performed in 7 (35%) patients, while 12 (60%) patients underwent three-port pars plana vitrectomy (PPV) and silicon oil instillation and the remaining single patient (5%) underwent PPV with gas exchange. Lensectomy was performed in 8 (40%) patients. Retinal attachment with a single surgical procedure was seen in 8 (40%) patients, while 12 (60%) patients required multiple surgeries. The mean duration of silicon oil removal was 5 ± 2.78 months (1–11 months). At the end of 6 months, 11 (55%) patients had improved visual acuity of 6/60. Six months postoperatively, 18 (90%) patients had attached retina. Conclusion: Visual improvement and retinal reattachment could be achieved with early diagnosis and intervention in pediatric RRD.

Inflammation status after retinal detachment could be modulate by TP53 gene

Aims/Purpose: The TP53 Arg72Pro polymorphism has been linked to the risk of proliferative vitreoretinopathy (PVR) and may alter the functional prognosis of individuals with retinal detachment (RD). The current study aims to determine the effect of the TP53 Arg72Pro variant on inflammation and apoptosis following RD.Methods: Sixty patients undergoing RD surgery were included in the study. Using the PCR‐RFLP method, the TP53 Arg72Pro polymorphism was identified in peripheral blood. A RD model was also performed in humanized TP53 Arg72Pro KI mice. In human and animal retinal tissues, mRNA expression for genes involved in inflammation and apoptosis were examined using comparative quantitative PCR (qPCR). Immunohistochemistry was performed to study the presence of glial fibrillary acidic protein (GFAP) in the mouse retina. For statistical analysis, the SPSS v15 program was employed.Results: After RD, mice with the proline mutation exhibited increased expression of the inflammatory genes TGFB1, IL1 and IL6. Additionally, after RD, the immunoexpression of retinal GFAP was also raised in the Pro variant. Carriers of the Arg/Arg mutation displayed an increase in the relative mRNA expression of the BAX and CASP3 intrinsic apoptotic genes in retinal tissue after RD in patients and mice model.Conclusions: The human TP53 Arg72Pro genetic variant has been linked to inflammation and retinal cellular death after RD, suggesting that it could be a genetic biomarker for RD prognosis.Funded: Ministerio de Ciencia e Innovación (Spain Government) (PID2020‐114585RA‐I00).

Risk factors for proliferative vitreoretinopathy after retinal detachment surgery: A systematic review and meta-analysis.

To comprehensively investigate risk factors for proliferative vitreoretinopathy (PVR) after retinal detachment (RD) surgery. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until May 22, 2023. Risk factors included demographic and disease-related risk factors. Odds ratios (ORs) and weighted mean differences (WMDs) were used as the effect sizes, and shown with 95% confidence intervals (CIs). Sensitivity analysis was conducted. The protocol was registered with PROSPERO (CRD42022378652). Twenty-two studies of 13,875 subjects were included in this systematic review and meta-analysis. Increased age was associated with a higher risk of postoperative PVR (pooled WMD = 3.98, 95%CI: 0.21, 7.75, P = 0.038). Smokers had a higher risk of postoperative PVR than non-smokers (pooled OR = 5.07, 95%CI: 2.21-11.61, P<0.001). Presence of preoperative PVR was associated with a greater risk of postoperative PVR (pooled OR = 22.28, 95%CI: 2.54, 195.31, P = 0.005). Presence of vitreous hemorrhage was associated with a greater risk of postoperative PVR (pooled OR = 4.12, 95%CI: 1.62, 10.50, P = 0.003). Individuals with aphakia or pseudophakia had an increased risk of postoperative PVR in contrast to those without (pooled OR = 1.41, 95%CI: 1.02, 1.95, P = 0.040). The risk of postoperative PVR was higher among patients with macula off versus those with macula on (pooled OR = 1.85, 95%CI: 1.24, 2.74, P = 0.002). Extent of RD in patients with postoperative PVR was larger than that in patients without (pooled WMD = 0.31, 95%CI: 0.02, 0.59, P = 0.036). Patients with postoperative PVR had longer duration of RD symptoms than those without (pooled WMD = 10.36, 95%CI: 2.29, 18.43, P = 0.012). Age, smoking, preoperative PVR, vitreous hemorrhage, aphakia or pseudophakia, macula off, extent of RD, and duration of RD symptoms were risk factors for postoperative PVR in patients undergoing RD surgery, which may help better identify high-risk patients, and provide timely interventions.

Preoperative Optical Coherence Tomography Findings of Foveal-Splitting Rhegmatogenous Retinal Detachment

Purpose: To assess preoperative optical coherence tomography (OCT) findings of foveal-splitting retinal detachment (RD) and determine postoperative outcomes. Methods: Consecutive patients who underwent RD surgery over a 1-year period were included. Patients diagnosed with a detachment extending to the edge of the fovea on fundus examination (i.e., macula-On/Off) underwent macular OCT scanning. Visual acuity (VA) after 1 year of macula-On/Off, macula-On, and macula-Off eyes was compared. Results: A total of 85 eyes were included, 8 of which had a macula-On/Off RD. On preoperative OCT, all macula-On/Off RD eyes had foveal detachment extending beyond the foveal center over a median distance of 632 µm. Mean VA of the macula-On/Off eyes had improved from 20/160 to 20/40 at 1 year postoperatively (p = 0.035). The preoperative VA of macula-On/Off eyes was significantly better than macula-Off eyes (p = 0.032) and lower than macula-On eyes (p = 0.004). At 1 year, the VA of macula-On/Off eyes was no different from that of the macula-On eyes (p = 0.320), and tended to be better than that of the macula-Off eyes (p = 0.062). Conclusion: Preoperative OCT revealed a shallow RD extending beyond the foveal center in eyes with clinical foveal-splitting RD. These eyes, termed macula-On/Off RD eyes, had a preoperative VA between macula-On and macula-Off eyes, while their final VA was close to those with macula-On RD.

Changes in aniseikonia and influencing-factors following successful macula-off retinal detachment surgery

This study investigated the changes in the severity of aniseikonia after surgery for macula-off retinal detachment (RD), and the relationship between aniseikonia and retinal microstructures. The study included 26 eyes of 26 patients undergoing RD surgery. Visual acuity was measured preoperatively, and at 3, 6, and 12 months postoperatively. Degree of aniseikonia and OCT images were obtained at 3, 6, and 12 months postoperatively. The aniseikonia values (mean ± standard deviation) at 3, 6, and 12 months postoperatively were −5.3 ± 4.2%, −4.4 ± 4.4%, and −3.1 ± 3.2%, respectively. Significant improvement was observed from 3 to 12 months postoperatively (P = 0.001). Twelve months postoperatively, 14 eyes had micropsia, 1 eye had macropsia, and 11 eyes were free of aniseikonia. Stepwise multiple regression analyses revealed that the severity of aniseikonia at 12 months postoperatively was significantly associated with postoperative development of cystoid macular edema (CME) and epiretinal membrane (ERM), as well as area of preoperative RD. In conclusion, although aniseikonia was gradually relieved after RD surgery during a 1-year follow-up period, approximately half of patients had aniseikonia and almost all of them had micropsia. Aniseikonia was associated with presence of postoperative CME, ERM, and area of preoperative RD.

Outcomes of rhegmatogenous retinal detachment surgery in eyes with pre-existing glaucoma drainage devices.

Purpose:To evaluate the outcome of rhegmatogenous retinal detachment (RRD) surgery in eyes with preplaced glaucoma drainage device (GDD) with respect to intraocular pressure (IOP) control as well as success of retinal detachment (RD) surgery.Methods:It is a retrospective case series. The case records of patients who underwent RD surgery after GDD implantation from 2000 to 2014 were screened. The demographic data, ocular examination findings at all visits, details pertaining to retinal detachment and its repair, and the postoperative course was documented.Results:Twelve patients were included in study. The mean age of patients was 24.3 years (median 11 years; range 3-72 years). Male: Female ratio was 3:1. Mean duration between GDD and RD was 24 months (4 days-91 months). Of the ten eyes that underwent surgery, nine eyes underwent pars plana vitrectomy, and in one eye scleral buckling was done. GDD was removed only in one eye. At final follow-up, retina was attached with controlled IOP in 6 (60%) eyes, of which 5 (50%) had improvement in best corrected visual acuity.Conclusion:Pars plana vitrectomy was required in almost all cases for the management of RD in eyes with preplaced GDD. Retinal reattachment with good IOP control could be achieved in 60% of eyes. Removal of the drainage device was not essential for the effective management of the RRD in most cases. With multidisciplinary approach, close follow-up and timely intervention, vision can be preserved along with glaucoma control and successful retinal reattachment.

Cytologic analysis in vitreo‐retinal surgery

AbstractPurpose Proliferative vitreoretinopathy (PVR) is the leading cause of failure in retinal detachment (RD)surgery. The migration of retinal pigment epithelial cells and the proliferation of the extracellular matrix has been associated with PVR. The purpose of this prospective study was to compare the cellular contents of the vitreous of patients undergoing RD surgery with patients scheduled for epiretinal membrane surgery (ERM).Methods The vitreous samples of patients with ERM and RD were obtained at the initial phase of surgery. A immunocytochemical labeling was performed in all cases with AE1/AE3, CD68, Vimentin and GFAP antibodies. The cytological identification was performed by a trained pathologist unaware of immunocytochemical labeling. The concentration of vitreous cells were analyzed semi‐quantitatively.Results 14 vitreous samples were analysed, 9 patients with RD and 5 undergoing ERM. In the RD group, the cytological findings correlated with the results of immunolabeling. Hyalocytes (labeled with vimentin only)were present in all cases, more abundant in RD cases. Macrophages (labeled with vimentin and CD68) were found in 10/14 cases. Macrophages were more abundant in RD cases (p&lt;0,05). Only in one case of RD, GFAP positive cells were found, in which PVR was particularly severe. In 6/14 samples, glial cells were identified with AE1/AE3 without difference between RD and epiretinal membrane cases.Conclusion Vitreous changes observed in patients with retinal detachment appear to involve particularly hyalocytes and macrophages, which could be identified with immunolabeling. Interestingly glial cells (GFAP positive)were only present in severe PVR. A link between this cell population in the vitreous and the clinical outcome remains to evaluated in a prospective study.

The T309G MDM2 Gene Polymorphism Is a Novel Risk Factor for Proliferative Vitreoretinopathy

Proliferative vitreoretinopathy (PVR) is still the major cause of failure in retinal detachment (RD) surgery. It is believed that down-regulation in the p53 pathway could be an important key in PVR pathogenesis. The purpose was to evaluate the impact of T309G MDM2 polymorphism (rs2279744) in PVR. Distribution of T309G MDM2 genotypes among European subjects undergoing RD surgery was evaluated. Proportions of genotypes between subsamples from different countries were analyzed. Also, a genetic interaction between rs2279744 in MDM2 and rs1042522 in p53 gene was analyzed. Significant differences were observed comparing MDM2 genotype frequencies at position 309 of intron 1 between cases (GG: 21.6%, TG: 54.5%, TT: 23.8%) and controls (GG: 7.3%, TG: 43.9%, TT: 48.7%). The proportions of genotypes between sub-samples from different countries showed a significant difference. Distribution of GG genotype revealed differences in Spain (35.1–53.0)/(22.6–32.9), Portugal (39.0–74.4)/(21.4–38.9), Netherlands (40.6–66.3)/(25.3–38.8) and UK (37.5–62.4)/(23.3–34.2). The OR of G carriers in the global sample was 5.9 (95% CI: 3.2 to 11.2). The OR of G carriers from Spain and Portugal was 5.4 (95% CI: 2.2–12.7), whereas in the UK and the Netherlands was 7.3 (95% CI: 2.8–19.1). Results indicate that the G allele of rs2279744 is associated with a higher risk of developing PVR in patients undergoing a RD surgery. Further studies are necessary to understand the role of this SNP in the development of PVR.

Risk stratifying retinal breaks

ObjectiveArgon laser retinopexy has been the primary treatment for retinal breaks for many decades. Prevention of progression to retinal detachment (RD) is the main objective. The benefit of laser retinopexy is well documented, although little has been reported on the risk factors for progression to RD. By addressing this issue, patients at high risk can be identified, and more timely specialist retinal input can be sought. MethodsData over a 6-month period from 45 consecutive patients undergoing laser retinopexy were reviewed. Patients were categorized into complete success (no more than 1 laser treatment), qualified success (no more than 3 laser or cryotherapy treatments), and treatment failure (more than 3 laser or cryotherapy treatments or progression to RD). ResultsComplete success was observed in 53.5% of patients, a further 34.9% of patients achieved a qualified success, and the remainder of the patients (11.6%) fell into the treatment failure category. About 9.3% of patients required cryotherapy, and 7.0% of patients underwent RD surgery. Patients with a bridging blood vessel and vitreous hemorrhage were significantly more likely to be in the treatment failure category than those without. RD was significantly associated with the presence of vitreous hemorrhage. ConclusionsPatients with retinal breaks associated with bridging blood vessels and vitreous hemorrhage are at greater risk for poorer outcome. The area of subretinal fluid was not linked to failure. If complete laser of a tear is not possible or if concerns remain regarding treatment efficacy, prompt referral to a retina specialist for further management is recommended.

A Genetic Case-Control Study Confirms the Implication ofSMAD7andTNF Locusin the Development of Proliferative Vitreoretinopathy

Proliferative vitreoretinopathy (PVR) is still the major cause of failure of retinal detachment (RD) surgery and although the risk for developing this complication is associated with some clinical characteristics, the correlation is far from absolute, raising the possibility of genetic susceptibility. The objective of this study was to analyze the genetic contribution to PVR in patients undergoing RD surgery, the Retina 4 Project. A candidate gene association study was conducted in 2006 in a Spanish population of 450 patients suffering from primary rhegmatogenous RD. Replication was carried out in a larger population undergoing RD surgery at several European centers among 546 new patients. Single nucleotide polymorphism (SNP) of 30 genes known to be involved with inflammation were analyzed. For replication stage, those genes previously detected as significantly associated with PVR were genotyped. Distribution of allelic and haplotypic frequencies in case and control group were analyzed. Single and haplotypic analysis were assessed. The Rosenberg two-stage method was used to correct for single and multiple analyses. After correction for multiple comparisons, four genes were significantly associated with PVR: SMAD7 (P = 0.004), PIK3CG (P = 0.009), TNF locus (P = 0.0005), and TNFR2 (P = 0.019) In the European sample, replication was observed in SMAD7 (P = 0.047) and the TNF locus (P = 0.044). These results confirm the genetic contribution to PVR and the implication of SMAD7 and TNF locus in the development of PVR. This finding may have implications for understanding the mechanisms of PVR and could provide a potential new therapeutic target for PVR prophylaxis.

Intraocular pressure response to acetazolamide in patients with retinal detachment

AbstractPurpose Besides the responsibility of vitreous traction, deficient photoreceptors adherence due to lower fluid transport of the retinal pigment epithelium (RPE) has been hypothezised to be involved in the occurrence of retinal detachment(RD). However this adherence remains difficult to evaluate in patients. Acetazolamide reduces aqueous secretion of the ciliairy body and stimulates fluid absorption by the RPE. Recording the intraocular pressure response to systemic acetazolamide could enable to indirectly evaluate the carbonic anhydrase activity of the RPE.Methods The response to intraveineous acetazolamide was evaluated on the first postoperative day in 30 patients undergoing either RD surgery (n=15) or epiretinal membrane peeling (n=15). Intraocular pressure was measured with a handheld Perkins tonometer in suppine position before (t‐2 min) and after the administration of acetazolamide (t+2 min,t+6min ,t+10 min and t+30 min). The mean variation of the intraocular pressure was compared between the two groups.Results Consecutively to the intraveineous injection of acetazolamide, a reduction of the intraocular pressure was observed in both groups (both n=15). This reduction was significantly lower in the group of patients who underwent RD surgery. The observed difference remained significant until 10 minutes (p&lt;0,01 at t= 2, 6 and 10 min). At t=30 min, the intraocular pressure reduction was comparable in both groups.Conclusion The response to acetazolamide is significantly lower in patients undergoing RD surgery. Further research should aim to confirm the value of the intraocular pressure response to acetazolamide for characterizing photoreceptor adherence.

Longterm incidence of rhegmatogenous retinal detachment and survival in a defined population undergoing standardized phacoemulsification surgery

To determine the longterm risk of pseudophakic retinal detachment (PRD) in a defined population undergoing standardized phacoemulsification surgery at a single centre. We carried out a register-based, retrospective, consecutive, uncontrolled study. All 6352 eyes that underwent cataract surgery at our institution during the years 1996-1998 were included in the study. The main outcome measure was the incidence of surgery for PRD. Cataract-operated eyes were identified by a search in the local hospital registry. Eyes that subsequently underwent surgery for PRD were identified by a search in the Danish Patients Registry (LPR). Follow-up ended by 31 December 2003. Eyes in patients who died before that date were censored. The 8-year cumulated incidence of PRD after phacoemulsification was 0.93 per eye (95% CI 0.65-1.33). This is 8.77 (95% CI 7.12-10.72) times higher than expected in eyes that do not undergo cataract surgery. The incidence rate for retinal detachment was significantly higher in pseudophakic eyes than in the background population for at least 6 years after surgery. Patient mortality was slightly increased for men, but no different for women from that of the background population. For eyes undergoing phacoemulsification surgery, the cumulated incidence of PRD continues to increase for at least 8 years after surgery. Comparison of the cumulated incidence of PRD between different studies requires equal lengths of follow-up.

Scleral rupture during retinal detachment surgery: risk factors, management options, and outcomes

Objective To evaluate the potential risk factors, management strategies, and outcomes of scleral rupture during retinal detachment (RD) surgery. Design Case-control study. Participants and controls Fourteen consecutive patients with scleral rupture during RD surgery (cases) and 65 consecutive patients who underwent RD surgery without scleral rupture (controls). Intervention Demographic and clinical data were abstracted from patients’ medical records. Outcome measures Visual acuity and retinal attachment status at the last examination. Results Significant risk factors for scleral rupture during RD surgery were reoperation after failed RD surgery (71% vs. 32%), and pre-existing scleral pathologic condition (29% vs. none). The site of rupture was in the bed of a previously placed scleral buckle in all patients with a previous buckling surgery. Repair of the rupture included scleral sutures in eight (57%), scleral patch graft in four (29%), and placement of a scleral buckle over the site in two (14%) eyes. Eleven (79%) underwent vitrectomy with retinal tamponade by gas ( n = 4) or silicone oil ( n = 7). Complications observed postoperatively included vitreoretinal incarceration ( n = 3), vitreous hemorrhage ( n = 2), suprachoroidal hemorrhage ( n = 2) and subretinal hemorrhage ( n = 3). In the 14 eyes with scleral rupture, the final visual acuity was ≥20/40 in 1 (7%), 20/50 to 20/200 in 5 (36%), and <20/200 in 8 (57%). Ten (71%) had proliferative vitreoretinopathy develop. The retina was attached in 7 (50%), 6 (43%) had localized peripheral detachment, and 1 had a total retinal detachment. The vision improved in 4 (29%), was unchanged in 5 (36%), and was worse than before surgery in 5 (36%). In the 65 controls, the visual acuity at the time of the last examination was ≥20/40 in 26 (40%), 20/50 to 20/200 in 21 (32%), and <20/200 in 18 (28%). Sixty three (97%) patients had complete retinal reattachment, 1 (2%) had a localized peripheral RD, and 1 (2%) had an RD involving the posterior pole. After surgery, the vision improved in 45 (69%), was unchanged in 15 (23%), and was worse in 5 (8%) of the control eyes. The visual and anatomic outcomes of the eyes with scleral rupture were significantly worse than in the control group ( P = 0.002 and P < 0.001, respectively). Conclusions Risk factors associated with intraoperative scleral rupture include reoperation for failed RD surgery and pre-existing scleral pathology. Although this complication may be compatible with a good visual outcome in some patients, a high incidence of persistent or recurrent RD with proliferative vitreoretinopathy worsens the visual outcome for most patients with this complication.