Vitrectomy For Retinal Detachment Research Articles

A Case of Excessive Axial Length Elongation Following Retinal Detachment Vitrectomy

Purpose: To report a case of excessive axial length elongation following vitrectomy for rhegmatogenous retinal detachment.Case summary: A 21-year-old male patient presented to our hospital with visual impairment. The patient had previously undergone computed tomography in our emergency room for a facial contusion 3 years prior to his current visit. Axial lengths of 27.23 mm in the right eye and 27.62 mm in the left eye were recorded at that time. The patient had no previous ocular history. Fundus examination revealed extensive retinal detachment with macular involvement and hypotony retinopathy in the left eye. Retinal detachment surgery was subsequently performed on the left eye. Following the surgery, intraocular pressure in the left eye increased and intraocular pressure-lowering medications were administered. At 3 months postoperatively, the patient developed additional retinal detachment in the right eye, prompting retinal detachment surgery. Unlike the contralateral eye, the intraocular pressure remained well-controlled postoperatively. Axial length measurement was performed due to the complaint of left eye protrusion. The axial lengths were 27.76 mm and 31.41 mm in the right and left eyes, respectively. There was a significant increase in the axial length of the left eye but not in that of the right eye compared to 3 years prior.Conclusions: Gas tamponade, preoperative ocular hypotension, and postoperative ocular hypertension can cause excessive axial length elongation in cases of rhegmatogenous retinal detachment in young patients with high myopia.

38-Gauge Cannula-Based Endodrainage of Posteriorly Trapped Intraoperative Subretinal Fluid during Vitrectomy for Retinal Detachment

The DRAIN STUDY evaluated a novel use of a 38-gauge Polytip® cannula for posteriorly trapped intraoperative subretinal fluid endo-drainage during pars plana vitrectomy in rhegmatogenous retinal detachment. Sixteen patients underwent this procedure, with an 81% single surgery success rate at 3 months postoperatively. Median visual acuity improved from 20/300 to 20/80. Two cases developed cystoid macular edema and epiretinal membrane. No postoperative residual subretinal fluid was observed. The 38-gauge cannula-based SRF drainage proved effective, offering an alternative to conventional methods for managing posteriorly trapped intraoperative subretinal fluid.

Long-term Comparison of Choroidal Thickness between Scleral Encircling and Combined with Trans-pars Plana Vitrectomy in Retinal Detachment

Purpose: To compare the subfoveal choroidal thickness (SFCT) before and after scleral encircling (SE), with or without trans-pars plana vitrectomy (TPPV), in patients with monocular primary rhegmatogenous retinal detachment (RRD).Methods: We retrospectively analyzed patients who underwent SE for monocular primary RRD between January 2019 and June 2021 and underwent optical coherence tomography during follow-up. SFCT was measured independently at three regions before the surgery and 1, 2, 3, and 6 months after the surgery. The values were manually analyzed by two independent ophthalmologists.Results: Of the 33 eyes included in the study, 18 (54%) underwent SE alone, while 15 (46%) underwent SE with TPPV. SFCT gradually decreased after surgery in all patients (<i>p</i> < 0.05). The SFCT was significantly greater 6 months postoperatively in the SE alone group (260.51 ± 78.30 μm) compared to the SE with TPPV group (225.55 ± 75.24 μm) (<i>p</i> < 0.05). Macular detachment patients had significantly greater preoperative SFCTs (276.46 ± 20 μm) compared to others (223.93 ± 20 μm) (<i>p</i> < 0.05). Preoperative SFCT was significantly related to visual acuity (<i>p</i> < 0.05), while the remaining SFCT values did not have any significant effects.Conclusions: In primary RRD eyes, SFCT decreased over time after SE, more so when TPPV was also performed. Further studies are required to investigate the mechanism of SFCT change and its impact on RRD.

Swept-Source OCT Mid-Peripheral Retinal Irregularity in Retinal Detachment and Posterior Vitreous Detachment Eyes.

Irregularities in retinal shape have been shown to correlate with axial length, a major risk factor for retinal detachment. To further investigate this association, a comparison was performed of the swept-source optical coherence tomography (SS OCT) peripheral retinal shape of eyes that had either a posterior vitreous detachment (PVD) or vitrectomy for retinal detachment. The objective was to identify a biomarker that can be tested as a predictor for retinal detachment. Eyes with a PVD (N = 88), treated retinal detachment (N = 67), or retinal tear (N = 53) were recruited between July 2020 and January 2022 from hospital retinal clinics in South Australia. The mid-peripheral retina was imaged in four quadrants with SS OCT. The features explored were patient age, eye axial length, and retinal shape irregularity quantified in the frequency domain. A discriminant analysis classifier to identify retinal detachment eyes was trained with two-thirds and tested with one-third of the sample. Retinal detachment eyes had greater irregularity than PVD eyes. A classifier trained using shape features from the superior and temporal retina had a specificity of 84% and a sensitivity of 48%. Models incorporating axial length were less successful, suggesting peripheral retinal irregularity is a better biomarker for retinal detachment than axial length. Mid-peripheral retinal irregularity can identify eyes that have experienced a retinal detachment.

Pupillotonia after endolaser retinopexy during vitrectomy for retinal detachment: a prospective cohort study comparing circumferential and focal retinopexy

PurposeTo determine differences in postoperative pupil diameter in eyes that undergo pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with endolaser retinopexy (ELR), comparing 360° vs focal ELR.MethodsPatients with...

Retinal Shape-Based Classification of Retinal Detachment and Posterior Vitreous Detachment Eyes.

Retinal detachment is a sight-threatening emergency, with more than half of those affected suffering permanent visual impairment. A diagnostic test to identify eyes at risk before vision is threatened would enable exploration of prophylactic treatment. This report presents the use of irregularities in retinal shape, quantified from optical coherence tomography (OCT) images, as a biomarker for retinal detachment. OCT images were taken from posterior and mid-peripheral retina of 264 individuals [97 after a posterior vitreous detachment (PVD), 99 after vitrectomy for retinal detachment and 68 after laser for a retinal tear]. Diagnoses were taken from history, examination and OCT. Retinal irregularity was quantified in the frequency domain, and the distribution of irregularity across the regions of the eye was explored to identify features exhibiting the greatest difference between retinal detachment and PVD eyes. Two of these features plus axial length were used to train a quadratic discriminant analysis classifier. Classifier performance was assessed by its sensitivity and specificity in identifying retinal detachment eyes and visualised with a receiver operating characteristic (ROC) curve. Validation set specificity was 84% (44/52 PVD eyes correctly labelled) and sensitivity 35% (23/64 retinal detachment eyes identified, p = 0.02). Area under the ROC curve was 0.75 (95% confidence intervals 0.58-0.85). Retinal detachment eyes were significantly more irregular than PVD eyes in the superior retina (0.70mm versus 0.49mm, p < 0.05) and supero-temporal retina (1.12mm versus 0.80mm, p < 0.05). Lower sensitivity (16/68, 24%) was seen for eyes with a retinal tear without detachment, that were intermediate in size between retinal detachment and PVD eyes. Axial length on its own was a poor classifier. Neither irregularity nor classification were affected by surgery for retinal detachment or the development of PVD. The classifier identified 1/3 of retinal detachment eyes in this sample. In future work, these features can be evaluated as a test for retinal detachment prior to PVD.

Characteristics of Eyes Developing Retinal Detachment After Anti-vascular Endothelial Growth Factor Therapy for Retinopathy of Prematurity.

BackgroundWe investigated the incidence and clinical characteristics of eyes showing retinal detachment (RD) after anti-vascular endothelial growth factor (VEGF) for retinopathy of prematurity (ROP).MethodsA retrospective chart review of 76 consecutive eyes of 45 patients (18 girls and 27 boys) with stage 3 ROP who received anti-VEGF therapy between January 2012 and August 2020 with a minimum follow-up of 6 months was conducted. Eyes were divided into two groups: the vitrectomy (V) group that required vitrectomy for RD after anti-VEGF therapy and the non-vitrectomy (non-V) group that did not require vitrectomy. Data were collected from patient charts, including sex, postmenstrual age (PMA) at birth, birth weight, PMA at anti-VEGF therapy, comorbidities, reactivation, examination interval, and subsequent vitrectomies.ResultsThe median PMA at birth was 24.7 (range, 22.1–29.3) weeks. Twenty-seven eyes (35.1%) exhibited ROP reactivation at 6.4 ± 3.1 weeks after anti-VEGF therapy. The V group included six eyes of five patients, all of whom exhibited reactivation and developed RD 10.1 ± 6.5 weeks after anti-VEGF therapy. The types of RD were conventional (classic) in two eyes and circumferential (unique to RD after anti-VEGF) in four eyes. Three eyes required repeated vitrectomy. All eyes, except one eye in the V group, achieved retinal attachment at the last examination. The non-V group included 70 eyes of 40 patients, of which 21 exhibited reactivation and were treated successfully with laser (17 eyes) or second anti-VEGF (4 eyes). The proportion of eyes with plus disease was significantly higher in the V group (50.0%) than in the non-V group (10.0%) (P = 0.035). V group included 3 of 22 eyes (13.6%) in which the interval between the last examination and the diagnosis of reactivation was <1 week and 3 of 5 eyes (60.0%) in which the interval was more than 1 week (P = 0.024). The two groups showed no significant differences in the other factors.ConclusionApproximately 8% of eyes developed RD about 10 weeks after anti-VEGF therapy for ROP. Eyes with history of plus disease should be carefully monitored at appropriate intervals after anti-VEGF therapy for ROP.

Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review

BackgroundPostvitrectomy endophthalmitis is a rare and serious complication following vitreoretinal surgeries. Morganella morganii, an emerging gram-negative, facultative anaerobic rod, is related to severe nosocomial infections in various organs and thus has gained importance in recent decades. Morganella morganii infection following intraocular surgery is rarely reported.Case presentationWe report an immunocompetent patient with Morganella morganii-related endophthalmitis after vitrectomy for retinal detachment who presented with hand motion visual acuity, hypopyon and a unique retrolental exudative membrane. Initially, the patient was unresponsive to empirical intravitreal ceftazidime and vancomycin but recovered with vision preservation (20/63) after surgical removal of the membrane and silicone oil tamponade.ConclusionsMorganella morganii intraocular infection is often devastating, likely due to its high multidrug-resistance rate via intrinsic ß-lactamase production, multiple acquired traits related to additional genetic mechanisms, and fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation. The above characteristics of M. morganii may lead to an inadequate response to empirical intravitreal antibiotics, and early surgical intervention should be considered.

Silicone sponge intrusion after scleral buckling surgery followed by vitrectomy for retinal detachment

Background: This study reports a case of silicone sponge intrusion as a late complication of scleral buckling surgery. Case presentation: A 57-year-old man underwent a silicone sponge scleral buckling surgery 19 years ago due to retinal detachment of his left eye. Visual acuity impairment of his left eye was noted. His best-corrected visual acuity (BCVA) was 20/80 (logMAR 0.6). Intraocular lens-capsular bag-capsular tension ring luxation with implant extrusion was observed in the inferior nasal quadrant. The patient underwent pars plana vitrectomy with retropupillary iris-claw lens implantation. His BCVA improved to 20/20. Conclusion: Although silicone sponge intrusion is a rare complication of scleral buckling procedures, it may lead to serious complications. The intruding sponge may be left intact unless there is a significant threat to the integrity of ocular structures. Manipulation of the encircling band or buckle does not necessarily alter the visual acuity or the status of the retina.

Outcomes of vitrectomy for retinal detachment in a patient with Ehlers\u2013Danlos syndrome type IV: a case report

BackgroundThe Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by fragile blood vessels and an increased tendency for bleeding and scarring. Here, we report the outcome of a pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment in a patient with EDS type IV (vascular type).Case presentationA 40-year-old Slovenian man with high myopia, unilateral bullous retinal detachment, and vitreous hemorrhage was referred for surgery. The patient had a history of colon perforation, muscle and arterial rupture in both lower limbs, and recurrent shoulder joint luxations. Genetic testing revealed a pathogenic mutation in the COL3A1 gene. The patient underwent a 25-gauge three-port pars plana vitrectomy. The tendency for bleeding during surgery was prevented by endodiathermy applied to the edges of the retinal breaks. Endolaser photocoagulation was performed under air. The surgical procedure was completed with the injection of gas tamponade, followed by the patient remaining for a few days in a face-down position. Mild postoperative vitreous hemorrhage was resorbed in first week after the surgery. Postoperative extensive pigment dispersion on the posterior lens face persisted for several weeks. After the gas tamponade had resorbed, the retina was flat and remained attached during the follow-up period. Eight months after the surgery, visual acuity continued to improve from a preoperative 6/38 to 6/6.6 (Snellen chart) at the last checkup.ConclusionA small-gauge pars plana vitrectomy with gas tamponade and laser photocoagulation under air may successfully achieve reattachment of the retina in patients with high myopia with EDS type IV and restore visual acuity.

Intravitreal Dexamethasone Implant for Postoperative Macular Oedema Secondary to Vitrectomy for Epiretinal Membrane and Retinal Detachment: A Systematic Review and Meta-Analysis.

Purpose To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies. Methods Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well. Results Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = −0.28, 95% CI = −0.37, −0.20; p < 0.001), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = −0.31, 95% CI = −0.40, −0.22; in the RD group, MD = −0.22, 95% CI = −0.41, −0.03), with no difference between the two groups (p=0.41). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = −129.75, 95% CI = −157.49, −102.01; p < 0.001). In the ERM group, a significant CMT reduction was shown following DEX (MD = −133.41, 95% CI = −155.37, −111.45; p < 0.001), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = −128.37, 95% CI = −253.57, −3.18; p=0.040), with significant heterogeneity. No difference in CMT improvement was found between the two groups (p=0.94). Conclusion This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy.

Способ прогнозирования развития макулярного отека после микроинвазивной витрэктомии по поводу отслойки сетчатки

Способ прогнозирования развития макулярного отека после микроинвазивной витрэктомии по поводу отслойки сетчатки

Human Amniotic Membrane Patching-Assisted Vitrectomy in Retinal Detachment

In this report we briefly discuss the technical aspects and potential benefits of a new innovative technique using a human amniotic membrane (hAM) to seal retinal break causative of the RD during PPV namely human Amniotic Membrane Patching -Assisted Vitrectomy (hAMP-V).

Prognostic Factors for Outcome after Vitrectomy for Retinal Detachment Secondary to Cytomegalovirus Retinitis in Patients with AIDS: A Retrospective Single-center Analysis

ABSTRACT Purpose: To analyze the clinical characteristics and relevant prognostic factors of vitrectomy for retinal detachment (RD) secondary to cytomegalovirus retinitis (CMVR) in patients with acquired immune deficiency syndrome (AIDS). Methods: This study involved 39 eyes that underwent vitrectomy. Best-corrected visual acuity (BCVA), CD4+ cell counts, retinal attachment rate, and prognostic factors were assessed 1, 3, and 6 months postoperatively. Results: The rate of retinal attachment at 1 month (87.2%) was higher than at 3 (82.1%) and 6 (71.8%) months. Factors significantly related with recurrent RD at 6 months were CD4+ cell count <50 cell/µL (p = .000) and relaxed retinotomy (p = .002). Factors significantly related with the visual (≤logMAR1.0) prognosis at 6 months include band keratopathy (p = .015) and macular involvement by the RD (p = .012). Conclusion: CD4+ cell counts <50 cell/µL and relaxed retinotomy are associated with worse prognosis, while band keratopathy and macular involvement by the RD are related to poorer vision.

Characters of Epiretinal Membranes in Patients With Previous Vitrectomy for Retinal Detachment

Characters of Epiretinal Membranes in Patients With Previous Vitrectomy for Retinal Detachment

Changes in Retinal Vessel and Retinal Layer Thickness After Vitrectomy in Retinal Detachment via Swept-Source OCT Angiography.

PurposeTo compare postvitrectomy retinal and choroidal vessel density (VD) and retinal layer thickness between eyes with macula-off and macula-on rhegmatogenous retinal detachment (RRD) using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) and to identify OCTA factors associated with visual outcomes.MethodsWe retrospectively reviewed 31 eyes that underwent pars plana vitrectomy for primary RRD. Eyes with macula-off and macula-on RRD were compared with healthy fellow eyes. Both OCT and OCTA were performed 6 months after surgery, and the macula-off RRD group was divided into two subgroups according to the presence of an outer retinal defect. The correlations between postoperative best-corrected visual acuity (BCVA) at 6 months and SS-OCT and OCTA measurements were analyzed.ResultsTwenty eyes with macula-off RRD and 11 eyes with macula-on RRD were included. In the macula-off RRD group, the central retinal thickness was significantly decreased 6 months postoperatively compared with the fellow eyes (228.9 ± 29.7 µm and 253.6 ± 27.7 µm, P = 0.009). In the outer retinal defect group, the choriocapillaris plexus (CCP) VD was significantly decreased compared with the fellow eyes (56.4% ± 4.8% and 60.2% ± 4.0%, P = 0.026). In the macula-off RRD group, the postoperative BCVA at 6 months correlated significantly with the ratio of the center CCP VD of the detached eyes to that of the fellow eyes (R2 = 0.207, P = 0.025).ConclusionsThe CCP VD could be related to the anatomical restoration of the outer retinal layer in macula-off RRD. The CCP VD as determined by OCTA could be an indicator of the visual outcome after surgery in macula-off RRD.

Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial

AimTo study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsIn a...

INNER MACULAR CHANGES AFTER VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING FOR RHEGMATOGENOUS RETINAL DETACHMENT: Similarity With Alport Syndrome.

The internal limiting membrane (ILM), the innermost basement membrane of the retina, is peeled occasionally during vitreous surgery. This study aimed to investigate the effect of ILM loss on the retina. We used optical coherence tomography to retrospectively evaluate retinal changes in 26 eyes (11 ILM-peeled and 15 ILM-unpeeled eyes) of 26 patients after vitrectomy for retinal detachment. In addition, we studied six eyes of three patients with Alport syndrome, in which ILM is genetically impaired. We observed significant inner retinal displacement of the foveal pit toward the optic disk with inner retinal thickening in the nasal area (fellow, 191.9 ± 24.3 μm vs. affected, 210.3 ± 31.4 μm; P = 0.048), inner retinal thinning in the temporal area (fellow, 174.3 ± 18.3 μm vs. affected, 142.2 ± 23.6 μm; P < 0.001), foveal thickening (ILM-unpeeled, 217.0 ± 39.4 μm vs. ILM-peeled, 302.0 ± 86.2 μm; P = 0.006), inner retinal dimples predominantly in the temporal area, and deviation between the foveal pit and foveal bulge. Eyes with Alport syndrome exhibited similar findings. Internal limiting membrane loss seems to cause characteristic inner retinal changes of the macula in both congenital and acquired conditions.

Effect of Type of Head Positioning on Retinal Displacement in Vitrectomy for Retinal Detachment

Effect of Type of Head Positioning on Retinal Displacement in Vitrectomy for Retinal Detachment

Complications Associated with the Use of Expandable Gases in Vitrectomy.

Intraocular gases have been used in vitreoretinal surgery for over 40 years. The aim of this study was to review the complications related to the use of expandable gases in vitrectomy and their management. A PubMed, Cochrane Library, and Embase search was conducted using the terms “intraocular gas” and “vitrectomy for retinal detachment.” Of the articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Intraocular pressure elevation was reported in up to 58.9% patients after vitrectomy with expandable gas administration for retinal detachment. Vitreoretinal surgery is known to induce cataract development. With that, cataract progression is associated with lens exposure to intraocular gas, the duration of such exposure, patient's age, and the magnitude of vitreous removal. With intraocular gas, the posterior surface of the lens becomes a strongly refractive factor, resulting in high myopia and temporary vision impairment. Other complications related to the use of expandable gases include anterior chamber and subconjunctival gas displacement. Single reports on subretinal and cranial gas migration were published. In vitrectomy for uncomplicated retinal detachments, attempts to shift from expandable gases towards air are observed. Nevertheless, gas tamponade remains a reasonable choice for patients suffering from retinal detachment.