Vitrectomy For Rhegmatogenous Retinal Detachment Research Articles

Evaluation of post-operative foveal location and microstructural changes after pars plana vitrectomy for rhegmatogenous retinal detachment using enhanced-depth imaging optical coherence tomography

BackgroundPatients who had successful rhegmatogenous retinal detachment (RRD) surgery often complained of metamorphopsia due to postoperative fovea displacement and alteration of the foveal microstructure. The papillo-foveal distance (PFD) is correlated bilaterally. Therefore, PFD from the fellow healthy eye could be used to determine the change of foveal position in eyes with successful RRD repair. Ultra-high-resolution optical coherence tomography (UHR-OCT) could explain incomplete visual recovery by demonstrating foveal misalignment and changes in foveal microstructure. The rationale of the study is to assess the changes in the foveal location and microstructural layers after successful retinal reattachment and correlate them with visual dysfunction.Patients and methodsA prospective interventional cross-sectional controlled study included patients who had successful retinal reattachment and complained of defective vision or metamorphopsia. The primary outcome measure is to evaluate the post-operative foveal location. The secondary outcome measures are the assessment of metamorphopsia, the evaluation of the foveal microstructural changes, and the correlation between foveal shift, metamorphopsia, foveal microstructure, and visual function. We used a standard Amsler chart to detect subjective metamorphopsia and a modified Amsler chart to quantify metamorphopsia. We used the enhanced-depth imaging optical coherence tomography (EDI-OCT) to detect changes in PFD and the foveal microstructure. p < 0.05.ResultsThe study included 50 study eyes and 50 control eyes. The male gender constituted 70%. The mean age was 53 years. The mean baseline BCVA was 0.001. The incidence of foveal displacement was 70%. Disorganized retinal inner layers (DRIL) occurred in 56% of eyes, and disorganized retinal outer layers (DROL) occurred in 72% of eyes. The mean postoperative BCVA was 0.3. The subjective metamorphopsia was mild in 39%, moderate in 24%, severe in 33%, and very severe in 3% of eyes. The mean quantitative metamorphopsia was 587 mm. PVR correlated significantly with the foveal shift. DROL correlated significantly with subjective metamorphopsia. There was a statistically significant difference between subjective metamorphopsia and quantitative metamorphopsia.ConclusionFoveal displacement and metamorphopsia after successful retinal reattachment pose significant morbidity. UHR-OCT is pivotal in evaluating the anatomical outcome after successful retinal re-attachment surgery and its relation to visual function.

A study of metamorphopsia following rhegmatogenous retinal detachment surgery

AbstractPurposeOur objective was to quantitatively investigate metamorphopsia in patients who had undergone pars plana vitrectomy for rhegmatogenous retinal detachment at the Department of Ophthalmology of the University of Szeged. We aimed to compare our findings with perioperative clinical data, and in particular the patients' optical coherence tomography (OCT) results.Materials/MethodsOur study is a retrospective analysis of data from 23 patients who had undergone surgery for retinal detachment. We evaluated best corrected visual acuity (BCVA), metamorphopsia (MM) using M-CHARTS, and macular morphological abnormalities using OCT images in patients who attended regular follow-up visits 1–6 months after the surgery.ResultsThe mean preoperative BCVA of the patients was 0.4, while the mean postoperative BCVA was 0.6, indicating a significant improvement (P = 0.03). We observed a negative correlation between preoperative BCVA and postoperative MM (Pearson's r = −0.27), indicating that lower preoperative BCVA was associated with higher postoperative MM. Additionally, we noted a strong trend between disintegration of the ellipsoid zone (EZ), abnormality of the external limiting membrane (ELM), and MM (P = 0.051 and 0.072 respectively).ConclusionsWhile no significant correlation was found between MM and specific perioperative factors, we observed a notable trend between EZ disintegrity and MM, as well as abnormal ELM and MM. This trend is anticipated to become significant with higher numbers of patients.

Intravitreal methotrexate as an adjuvant in vitrectomy in cases of retinal detachment with proliferative vitreoretinopathy.

To compare the rate of re-detachment in patients with rhegmatogenous retinal detachment and Grade-C PVR following vitreoretinal surgery, with and without serial intravitreal injections of methotrexate. It was a randomized control trial. Patients aged more than 18 years undergoing pars plana vitrectomy for rhegmatogenous retinal detachment with PVR grade C or more were included in the study. Patients treated with intravitreal injection of methotrexate were grouped as cases and those not injected served as controls. The cases received 3 intravitreal injections of methotrexate at monthly intervals. Patients were evaluated on Day 1, 1st month, 2nd month, 3rd month and 6th month in terms of BCVA, rate of re-attachment and grade of PVR. The case group had 23 patients and the control group had 20 patients. 2 patients in the case group were lost to follow-up after the first follow-up, so they were excluded. So 21 patients in case group and 20 patients in control group were followed up. Six months after surgery, 15 'cases' had completely attached retina whereas 6 patients had partial detachment with macula on. There was no patient amongst the cases with macula-off retinal re-detachment. Out of 20 patients in the control group, 9 had a complete retinal attachment, 4 had partial detachment with macula-on and 7 had partial detachment with macula-off. There was statistically significant difference in macula off retinal detachment rates (p-value- 0.003). Serial intravitreal methotrexate injections reduce the incidence of re-detachment in patients undergoing PPV for RRD with PVR-C. Further investigation into this promising therapeutic approach is warranted. What is known Methotrexate is an anti-inflammatory agent which is safe for intravitreal use There are case series retrospective and prospective studies suggesting potential benefit of intravitreal methotrexate in preventing re-detachment due to PVR What is new First randomized control trialstudying the efficacy of intravitreal methotrexate in preventing re-detachmentdue to PVR Our study showed statisticallysignificant difference in macula off retinal detachment between the 2 groups at6 months of follow up.

Time-Driven, Activity-Based Cost Analysis of Pars Plana Vitrectomy in Rhegmatogenous Retinal Detachment at a Large Academic Center.

Purpose: To perform a time-driven, activity-based cost analysis of retinal detachment (RD) surgery and compare it with reimbursement rates. Methods: This economic analysis at a single academic institution used time-driven, activity-based costing methodology to determine the cost of rhegmatogenous RD repair with primary pars plana vitrectomy. A process flow map was created to highlight each surgical case's operative episodes, including clinical follow-ups. Time logs were obtained from the electronic health record for each operative phase and clinical follow-up. The overhead and anesthesia costs were collected from the institution's cost accounting system. The direct material and personnel costs were obtained from internal financial data. Results: Seventy-six cases that met the inclusion criteria were included in the cost analysis study. The time-driven, activity-based cost of RD was $6247.17, and the reimbursement was $5442.91. Therefore, each procedure had a net negative loss of $804.26. To break even, the average operation time would need to be reduced from the determined average of 90.49 minutes to 64.90 minutes. Conclusions: This study found that Medicare underestimates the true cost of RD surgery. Changes in referral patterns may be motivated by reimbursement rates lower than the cost of the procedure, which could ultimately affect patient access to care.

The role of vitreous cortex remnants in secondary macular hole formation and spontaneous closure following vitrectomy for rhegmatogenous retinal detachment

BackgroundMacular hole (MH) formation after rhegmatogenous retinal detachment (RRD) surgery is rare, and in most cases, additional surgical procedures are required to repair MH. Spontaneous closure of the MH is even rarer. In this study, we aimed to report a series of cases of spontaneous closure of the secondary MH and provide a review of the literature. MethodsWe retrospectively collected the cases of secondary MH formation following vitrectomy in RRD patients followed by spontaneous closure. Ophthalmological data at presentation and during follow-up were collected and analyzed. ResultsWe reported a total of three RRD patients aged 31,67,12 years, including two females and one male. The three patients underwent pars plana vitrectomy (PPV) with either silicone oil tamponade or air tamponade. Optical coherence tomography (OCT) revealed a second full-thickness MH formation with remnant vitreous cortex bridging in the macular region during early follow-up. Observations of the cases revealed subsequent remnant vitreous cortex traction remission and spontaneous closure of MH during follow-up, although with subsequent thin macular and abnormal macular structure. ConclusionThe progression of secondary MH formation in the cases may be related to vitreomacular traction (VMT) by the posterior vitreous cortex remnant after PPV, and the release of VMT may help the spontaneous closure of the MH after PPV for RRD.

Retinal displacement following direct versus indirect fluid exchange in pars Plana vitrectomy for rhegmatogenous retinal detachment.

To compare the occurrence and characteristics of retinal displacement following direct perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange versus indirect PFCL for air and air for SO exchange methods during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). A comparative case series study was conducted on 58 eyes with recent RRD, undergoing standard three-port PPV with SO tamponade. Fluid exchange was performed using either direct or indirect methods. Postoperatively, a comprehensive ophthalmic examination and fundus autofluorescence (FAF) imaging were conducted at one month. The presence, amount, and direction of retinal displacement were assessed based on FAF imaging and compared between the direct and indirect fluid exchange groups. FAF imaging at one month revealed retinal displacement in 41.4% of eyes in the direct group and 62.1% in the indirect group, with no statistical difference between them (P = 0.537). However, the mean displacement was significantly higher in the indirect group (282.61 ± 110.83 µm) compared to the direct group (220.33 ± 39.67 µm, P = 0.04). The direction of displacement (downward or upward) did not differ significantly between the groups (P = 0.093). While the occurrence and location of postoperative retinal displacement did not significantly differ between direct and indirect fluid exchange methods during PPV for RRD, eyes treated with the direct method exhibited lower mean displacement compared to the indirect method. These findings suggest potential benefits of the direct exchange approach in minimizing retinal displacement following surgery.

FIVE-YEAR CHANGES IN METAMORPHOPSIA AND THE ASSOCIATION OF OUTER RETINAL LAYERS AFTER VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT INVOLVING THE MACULA.

To evaluate the 5-year changes in metamorphopsia and outer retinal morphology after vitrectomy for macula-off rhegmatogenous retinal detachment. The authors included 21 eyes from 21 patients with macula-off rhegmatogenous retinal detachment who underwent pars plana vitrectomy. Metamorphopsia was quantified using M-CHARTS. Using spectral-domain optical coherence tomography, the authors assessed the risk factors for metamorphopsia severity 5 years after surgery. Metamorphopsia scores substantially improved from 1 month to 5 years postoperatively; however, they remained unchanged from 1 year to 5 years postoperatively. Overall, 11 patients (52.4%) had metamorphopsia 5 years postoperatively. The metamorphopsia scores in eyes with a continuous interdigitation zone and ellipsoid zone at 5 years were considerably lower than those in eyes with a disrupted interdigitation zone. Multiple regression analysis revealed that the metamorphopsia score at 5 years was markedly associated with the score at 1 month and continuous interdigitation zone. No statistically significant change was observed in metamorphopsia scores after 1 year postoperatively, and >50% of the patients had metamorphopsia at 5 years postoperatively. The improvement was associated with lower metamorphopsia scores at 1 month and continuous interdigitation zone at 5 years. Moreover, the study revealed that early metamorphopsia was a poor prognostic marker for long-term functional deficits.

Primary Internal Limiting Membrane Peel and Its Effects on Epiretinal Membrane After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To determine the effect of internal limiting membrane (ILM) peel in post-operative development of epiretinal membrane and to see visual outcomes of patients undergoing pars plana vitrectomy with and without ILM peel. Study Design: Quasi experimental study. Place and Duration of Study: Retina clinic of Al-Ibrahim Eye Hospital from July, 2022 to Dec, 2022. Methods: A total of 60 eyes which underwent pars plana vitrectomy (PPV) with silicone oil for Rhegmatogenous retinal detachment (RRD) were included. Patients with previous vitreoretinal surgery or ocular trauma, macular diseases or coexisting conditions that could affect the outcomes or complicate the surgery were excluded. Group A included patients with ILM peel and Group B included patients with no ILM peel (30 eyes each). Frequency was calculated for gender, epiretinal membrane formation. and was compared between both groups using chi square. Results: Mean age in group A was 47.63 ± 8.61 years and in group B was 45.36 ± 6.63 years. Gender distribution showed 66.6% males in group A and 43.3% in group B. After 3 months the group A had significantly lower frequency of ERM formation (3.33%) as compared to group B (16.67%) with p &lt;0.05. However, post operativevisual acuity was not significantly different between the two groups (p &gt; 0.05). Conclusion: This study shows that primary ILM peel diminishes the development of ERM and decreases the need for second surgical procedure. However, postsurgical visual acuity between the two groups showed no significant difference.

The Effect of Steroid Intervention before Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment: A Meta-Analysis and Systematic Review

Purpose This meta-analysis discusses the effectiveness of steroid intervention before vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment. Methods We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies published until August 2023. We included studies involving: patients with rhegmatogenous retinal detachment associated with choroidal detachment with proliferative vitreoretinopathy; an experimental group that was not administered steroids and a control group that was administered steroids; and assessment of visual acuity, retinal reattachment rate, and complications. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis. Results Two randomized controlled trials and four case-control studies involving 490 eyes were included in the meta-analysis. There were no significant differences in the primary and final retinal reattachment rates after surgery between the steroid and non-steroid groups (primary retinal reattachment rate: odds ratio = 1.01, 95% confidence interval = 0.63–1.63, p = .41; final retinal reattachment rate: odds ratio = 0.82, 95% confidence interval = 0.43–1.59, p = .33). There was no statistically significant difference in postoperative visual acuity improvement between the two groups (odds ratio = 1.19, confidence interval = 0.63–2.25, p = .69). In addition, subgroup analyses of different types of steroids showed that systemic and local administration of steroids had similar results for retinal reattachment rate and visual acuity improvement. Conclusion Patients with rhegmatogenous retinal detachment associated with choroidal detachment who did not receive preoperative steroids achieved the same effect as patients with rhegmatogenous retinal detachment associated with choroidal detachment who did receive preoperative steroids in terms of retinal reattachment rate and visual acuity. It is recommended that patients with rhegmatogenous retinal detachment associated with choroidal detachment undergo surgery as promptly as possible.

Selective internal limiting membrane peeling for prevention of secondary epiretinal membrane after vitrectomy for rhegmatogenous retinal detachment.

We introduce selective internal limiting membrane (ILM) peeling, a guideline procedure to determine whether to remove the ILM during vitrectomy for rhegmatogenous retinal detachment (RRD). Retrospective case series METHODS: Patients who underwent pars plana vitrectomy for RRD and were followed up for 12 months or longer were included. When vitreous cortex remnants (VCRs) were detected with triamcinolone acetonide, the ILM was removed; otherwise, the ILM was preserved ("selective ILM peeling"). The factors associated with the presence of VCRs and incidence of secondary epiretinal membrane (ERM) were analyzed. VCRs were detected in 87 of 133 eyes (65.4%) in which the ILM was removed. Younger age, better preoperative visual acuity, and vitreous hemorrhage were negatively correlated with the presence of VCRs.No ERM occurred in the eyes after ILM peeling. Among the eyes with ILM preservation, subclinical ERM was noticed in 4 eyes (8.7%), and 1 eye (2.1%) required additional surgery owing to ERM. ERM occurred more commonly in eyes with the ILM preserved (P = .004). However, no differences in the rate of additional surgeries were found between the 2 groups. Selective ILM peeling offers an alternative option to reduce the burden of ILM peeling or additional surgery.

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.

Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning.

Purpose: To evaluate the anatomic and visual outcomes of primary vitrectomy for rhegmatogenous retinal detachment (RRD) repair using no amount of postoperative prone positioning to clarify the role of face-down posturing for RRD reattachment. Methods: This retrospective consecutive interventional case series comprised patients who had primary vitrectomy for RRD repair. The surgical outcomes, single-surgery anatomic success rate, and postoperative best-corrected visual acuity (BCVA) were assessed. The primary objective was to evaluate the anatomic and visual outcomes of vitrectomy RRD reattachment using no postoperative prone positioning. Results: This study comprised 116 eyes of 116 patients. Single-surgery anatomic success was achieved in 112 (96.5%) of 116 eyes. The single-surgery anatomic success rate was 100% in phakic patients (n = 56) and 93% in pseudophakic patients (n = 60), with both groups having an improvement in the mean BCVA. Conclusions: Primary vitrectomy with no postoperative prone positioning is a successful surgical intervention for RRD repair. The anatomic closure rate in this study is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and a significant improvement in BCVA, primarily using 14% perfluoropropane for gas tamponade.

SURGICAL DRAINAGE METHODS DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Systematic Review and Meta-Analysis.

To assess efficacy and safety outcomes of subretinal fluid drainage methods during pars plana vitrectomy for rhegmatogenous retinal detachment. A systematic search strategy was conducted for studies published between January 2000 and October 2022. Included studies reported on either the safety or efficacy of two or more drainage methods during pars plana vitrectomy for patients with rhegmatogenous retinal detachment. Two randomized and five observational studies consisting of 1,524 eyes were included. Best-corrected visual acuity at the last study observation and primary reattachment rates were similar across groups. A significantly lower risk of epiretinal membrane formation was associated with draining subretinal fluid through preexisting retinal breaks (risk ratio = 0.70, 95% confidence interval = [0.60, 0.83], P = <0.01, I 2 = 0%) or with perfluorocarbon liquid (risk ratios = 0.70, 95% confidence interval = [0.59, 0.83], P = <0.01, I 2 = 0%) compared with posterior retinotomy. The risk of an abnormal foveal contour was significantly greater in perfluorocarbon liquid-treated eyes relative to posterior retinotomy (risk ratios = 1.56, 95% confidence interval = [1.13, 2.17], P = <0.01, I 2 = 0%). No significant differences were observed in the final best-corrected visual acuity at the last study observation and primary reattachment rates across different drainage methods. There remains limited information on the topic, so future research is warranted.

Outcomes of short- versus long-acting gas tamponades in vitrectomy for rhegmatogenous retinal detachment.

In vitrectomy for rhegmatogenous retinal detachment, long-acting gas tamponades (LGT) such as C3F8 or C2F6 may improve surgical success rate due to their prolonged effect compared to a short-acting gas tamponade (SGT) with SF6. On the other hand, SGT allow a significantly faster visual rehabilitation after surgery and may reduce the risk of gas-related complications. As comparative data in retinal detachment surgery is limited, we assessed the outcomes of vitrectomies using either LGT or SGT. We retrospectively analyzed 533 eyes of 524 consecutive patients diagnosed with primary rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy (PVR) and treated by vitrectomy at two clinical sites. Depending on the site the patients presented at, they received either preferentially LGT (study site 1) or SGT (study site 2). Retinal re-detachment rates during a period of 6 months following surgery were analyzed. At study site 1, 254 of 278 eyes (91.4%) were treated by LGT (C3F8 72.3%; C2F6 19.1%), whereas at study site 2, 246 of 255 eyes (96.5%) received SGT (SF6). Rates of retinal re-detachment in the LGT- and SGT-treated groups were similar with 23 of 254 eyes (9.1%) and 24 of 246 eyes (9.8%), respectively (p = 0.9). Median time to re-detachment was 5.7 weeks in the LGT-treated group and 4.4 weeks in the SGT-treated group (p = 0.4). In rhegmatogenous retinal detachment repair by vitrectomy, the use of SGT results in comparable rates of successful retinal re-attachment as LGT. Given the faster visual rehabilitation with SGT, these results suggest SGT as a sensible alternative to LGT in surgery of retinal detachment without PVR.

Scleral Buckling VS Pars Plana Vitrectomy: World's Perspective

Objective: The objective is to find out the preferred surgical approach of retinal surgeons from different part of the world for the management of rhegmatogenous retinal detachment.&#x0D; Materials and Methods: We did a survey via a questionnaire regarding the management of rhegmatogenous retinal detachment whether retinal surgeons prefer scleral buckling or pars plana vitrectomy for rhegmatogenous retinal detachment. This survey included 109 retinal surgeons from 18 different countries across the world.&#x0D; Results: Out of 109 surgeons, 91.7% surgeons perform scleral buckling. The monthly number of buckling surgeries was 5 or less than 5 for 68.8% retinal surgeons while 22% said that they do more than 5 scleral buckling. Scleral buckling was the procedure of choice for 85.3% surgeons if a detachment fits in for the criteria of buckling. In comparison of buckling, vitrectomy was preferred by 66% retinal surgeons while 41.3% surgeons said that they would perform scleral buckling. The number of vitrectomies was 5 or less than 5 for 28.4% retinal surgeons, 17.4% do more than 5 while 33% do not perform vitrectomy. The number of vitrectomies per month for all sort of rhegmatogenous retinal detachment was 5 or less than 5 by 75.2% surgeons while more than 5 vitrectomies was done by 7.3% surgeons.&#x0D; Conclusion: In this study we concluded that most of the retinal surgeons prefer scleral buckling as the procedure of choice for rhegmatogenous retinal detachment than vitrectomy as it gives a higher anatomical success rate with less pre- and post-operative complications.

THE ROLE OF INTRAVITREAL METHOTREXATE AS AN ADJUNCT TO LOCAL OR SYSTEMIC CORTICOSTEROIDS IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT AND CHOROIDAL DETACHMENT: A Pilot Study.

To evaluate the role of repeated intravitreal methotrexate as an adjunct to pars plana vitrectomy in the management of rhegmatogenous retinal detachment with choroidal detachment. The authors compared anatomical and visual outcomes of rhegmatogenous retinal detachment with choroidal detachment eyes that underwent pars plana vitrectomy with (Group B) or without repeated intravitreal methotrexate (Group A). The study included 25 eyes of 25 patients, 16 eyes in Group A and nine in Group B. Both groups had similar baseline characteristics. In Group A, successful retinal attachment was achieved in 50% as compared with 89% in Group B; however, the difference was not statistically significant ( P = 0.08). Also, Group B had a significantly greater change in visual acuity from baseline to the last follow-up visit (1.6 + 1.5 logMAR units) compared with Group A (1.18 + 1 logMAR units) ( P = 0.05). There were no significant safety concerns with the use of intravitreal methotrexate. Repeated intravitreal methotrexate after vitrectomy for rhegmatogenous retinal detachment with choroidal detachment improves outcomes without posing major safety concerns. Nonetheless, further investigation is necessary to establish the optimal intravitreal methotrexate dosage and duration to prevent recurrence effectively.

Secondary full thickness macular holes following vitrectomy for rhegmatogenous retinal detachment: Clinical data, surgical outcome and prognosis

Aims/Purpose: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.Methods: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.Results: Out of 9317 eyes following PPV 28 eyes (mean age 58.7 ± 9.6 yrs, 50% male, 60.7% right eyes) could be included. The interval between vitrectomy and MH formation was 46.9 ± 80.3 (range: 1–373) months. 15 eyes showed history of macular involving RRD, 7 macular sparing RRD. Sulphur‐hexafluoride (SF6) 20–25% was used as endotamponade in 18 cases for RRD repair, silicone oil (Sil5000® and Sil2000®) in 4 cases. Six cases were not assessable due to earlier external surgery. In secondary MH re‐PPV with SF6 20–25% endotamponade in 21 eyes (thereof with an ILM flap in 8 cases), Sil5000® in 6 eyes and Densiron® in one eye was performed. A primary closure rate of 88.2% with gas was achieved with a final best corrected visual acuity of 0.67 ± 0.99 logMAR. Degree of myopia, which correlated with functional results (p = 0.019) and earlier time of onset (p = 0.007), as well as timing of cataract surgery (p &lt; 0.001) could be identified as risk factor for secondary MH development.Conclusions: Secondary MH after RRD repair is rare. In our study with the largest cohort studied so far, we can identify risk factors that lead to earlier MH formation. Myopia was shown to be a prognostic factor for functional outcome.

A novel predictor of persistent ocular hypotony after pars plana vitrectomy for rhegmatogenous retinal detachment: The initial intraocular pressure difference between the eye with RRD and the fellow eye.

To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients' demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal.

Comparison of anatomical and functional outcomes of pars plana vitrectomy for rhegmatogenous retinal detachment with phaco-vitrectomy

Comparison of anatomical and functional outcomes of pars plana vitrectomy for rhegmatogenous retinal detachment with phaco-vitrectomy

A Comparison of Adjustable Positioning and Free Positioning After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Prospective Randomized Controlled Study

A Comparison of Adjustable Positioning and Free Positioning After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Prospective Randomized Controlled Study