Vitreoretinal Surgery For Retinal Detachment Research Articles

Anatomical and visual outcomes after vitreoretinal surgery in paediatric retinal detachment

Paediatric vitreoretinal surgery (PVRS) has unique set of challenges compared to surgery in adult eyes. An understanding of ocular growth and development is an important consideration in PVRS. Changes in ciliary body dimensions with age may affect how sclerotomies are placed, so as to avoid iatrogenic damage to the peripheral retina.To study the visual and anatomical outcomes after vitreoretinal surgery in paediatric age group after retinal detachment. In this prospective interventional study, 20 consecutive patients aged 18 years or younger undergoing vitreoretinal surgery for retinal detachment were included. A detailed ocular and systemic history was recorded from all patients. Pre and postoperative data were collected. All the evaluated eyes were followed up to 3 months. Outcome of surgery was measured in terms of improvement in visual acuity and retinal status.Twenty eyes of 20 patients were evaluated with male predominance (75%) and mean age of the patient was 16.4±2.01. Most common etiology was found to be trauma (65%) followed by myopia (30%). Pars plana vitrectomy (PPV) was done in 50% patients, lensectomy with vitrectomy was done in 15%, scleral buckle (SB) surgery was done in 25% cases, where as PPV-SB was done in 10% cases. Improvement in visual acuity was noted in 85% cases. Primary anatomical success was achieved in 80% cases. PPV was the major surgical procedure in our study due to complexity of RD. Postoperative visual rehabilitation was also done to fight amblyopia as far as possible.

Impact of Silicone Oil Removal on Macular Perfusion.

(1) Background: Silicone oil (SO) can be used as an endotamponade during vitreoretinal surgery for retinal detachment. There is emerging evidence that SO filling of the vitreous cavity and its removal may impact macular perfusion. So far, studies have not focused on choroidal sublayer perfusion, yet. (2) Methods: Optical coherence tomography angiography was applied in 19 patients with SO endotamponade before and four weeks after removal of SO. (3) Results: Perfusion of choriocapillaris increased significantly after SO removal, while perfusion of Haller’s and Sattler’s layer decreased significantly. (4) Conclusions: Removal of SO impacts choroidal perfusion and leads to a perfusion shift within choroidal sublayers. This study underlines that it is worth to conduct larger prospective studies that evaluate the choroidal perfusion and its functional implications in more detail.

A case of adult-onset cyclic esotropia combined with hypotropia

A 39-year-old woman presented with 48 hours periodic esotropia and hypotropia after vitreoretinal surgery for retinal detachment and then loss of vision in the left eye. The ocular motility revealed the limitation of supraduction and abduction of the left eye on strabismic days and full duction on good days. After strabismic surgery only for correcting esotropia, the patient changed to hypotropia on the previous strabismic days and exotropia on the previous good days alternatively in a 48-hour period. Its pathogenesis is still unknown. We supposed the patient had similar neurological mechanisms as ocular neuromyotonia and secondary cyclic oculomotor palsy.

Familial Exudative Vitreoretinopathy (FEVR); Pathophysiology, Findings, Diagnosis, and Treatment

Familial exudative vitreoretinopathy (FEVR) is an inherited disease occurring due to defective retinal angiogenesis. FEVR patients have an avascular peripheral retina which, depending on the degree of ischemia, causes the secondary complications of the disease (retinal neovascularization, exudation, hemorrhage, and retinal detachment) Mutations in the NDP, FZD4, LRP5, TSPAN12 and ZNF08 genes have been shown to contribute to FEVR. Cases can be inherited in an autosomal dominant, autosomal recessive, or X-linked manner, or can affect individuals with no family history. Examination with wide-field fluorescein angiography is essential and can identify the disease in its earlier stages, enabling the timely treatment, in addition to helping identify asymptomatic family members. The current treatment modalities involve laser photocoagulation of the avascular peripheral retina for neovascular complications and vitreoretinal surgery for retinal detachment. Studies are ongoing to better understand the pathogenesis of FEVR and to improve treatment

Outcomes of vitreoretinal surgery in retinal detachment associated with morning glory disc anomaly.

Purpose:Morning glory disc anomaly (MGDA) is associated with a high prevalence of retinal detachment (RD), sometimes requiring multiple surgeries. The study aimed to establish the outcomes of RD surgery in such eyes and predict factors influencing the outcome, if any.Methods:It was a retrospective observational study of 9 eyes that underwent pars plana vitrectomy (PPV) for RD associated with MGDA. Clinical and surgical details were correlated with outcomes of surgery as noted at the final follow-up.Results:PPV was performed in 9 eyes. Lensectomy was done in 5 of 9 eyes (55.5%) during PPV. Laser photocoagulation around the disc was performed in 55.5% (5/9) of the eyes. Silicone oil tamponade was used in 77.7% (7/9) of eyes and gas tamponade (14% C3F8) was used in 22.3% (2/9) of eyes. Attached retina at final visit was observed in 66% of the eyes (6/9). Two out of 3 eyes that were seen to have preoperative glial tissue at the disc had poor outcome (odds ratio 10, P = 0.16). Five out of 7 (71%) eyes that had silicone oil tamponade, had an attached retina. No identifiable breaks were noted preoperatively in 5 eyes, of which 4 (80%) had an attached retina postoperatively. Vision improved by 1 line in 67% of the eyes that underwent surgery.Conclusion:MGDA related RD presents a unique set of challenges; meticulous PPV with or without lensectomy can help in achieving a successful anatomical and functional outcome in about two-thirds of patients.

Choroidal neovascular membrane following vitreoretinal surgery for retinal detachment

Purpose: Choroidal neovascular membrane can arise secondary to many other causes other than aging. No cases have been reported on CNVM post vitrectomy for retinal detachment. We present two cases of classical sub-foveal CNVM occurring following VR surgery in retinal detachment patients. Method: A retrospective analysis of databases was done at our centre. Around 800 VR surgeries were done of which 300 were macular surgeries over a period 3 years from 2014 to 2017. All cases were operated by a single surgeon with 3 port 23- gauge vitrectomy. Two cases of retinal detachment developed CNVM after silicon oil removal. Results: The prevalence of CNVM formation after macular surgery at our institution was 2 out of 300 (0.66%) patients from a period of Jan 2015 to Dec 2018. The time period for the formation of CNVM was around 7 months after vitrectomy and 2 weeks after Silicon oil removal in both patients. Discussion: After all the literature search for knowing the reported cases and the pathophysiology for CNVM occurring post Retinal detachment surgery we attribute it to post-operative inflammation, silicon oil induced retinal toxicity, weakening of retinal layers and retinal photo toxicity. Conclusion: Despite the fact that CNV post retinal detachment surgery is rare, we suggest that it must be included in the consent process prior to surgery, as patients should be warned about potential guarded visual outcome. Further research is needed to evaluate the possible mechanisms and risk factors that lead to formation of CNVM after retinal detachment surgery.

Postoperative Pain Management in Vitreoretinal Surgery for Retinal Detachment: A Systematic Review of Randomized Controlled Trials

Purpose:The purpose of this study is to examine the evidence for postoperative pain management in patients undergoing vitreoretinal surgery for retinal detachment by systematic review.Methods:A systematic review of the literature was performed using multiple databases in July 2016 and September 2017. Two independent reviewers screened titles and abstracts and analyzed selected papers in detail. Included studies assessed patients undergoing vitreoretinal surgery for retinal detachment and described postoperative pain management. Risk of bias was assessed using the criteria outlined in the “risk of bias” tool in the Cochrane Handbook for Systematic Reviews of Interventions.Results:Nine randomized controlled studies comprising 517 patients met the inclusion criteria. Pain management included perioperative peribulbar, sub-Tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress. Pain scores were assessed with nominal, numerical, and visual analog scales. Risk of bias was low for 2 studies, unclear for 4 studies, and high for 3 studies. All studies reported better postoperative pain scores with the active treatment group except for a single study comparing retrobulbar chirocaine with and without clonidine. No serious adverse events were reported for any of the studies.Conclusion:Heterogeneity of studies did not allow for meta-analysis, but qualitative analysis suggests that pain relief can be achieved in the short term with a variety of treatment interventions. Additional study is required to specifically examine pain management strategies according to the characteristics of the anesthesia and surgery as well as the needs of the patient.

Treated retinal breaks: clinical course and outcomes.

To report rates and timing of retreatments, new break formation, and vitreoretinal surgical intervention after initial treatment of retinal breaks, and to identify factors associated with increased rates of additional vitreoretinal interventions. Retrospective, consecutive case series of all patients who were diagnosed with a retinal break and underwent laser retinopexy for prophylaxis of retinal detachment at the Bascom Palmer Eye Institute, Miami, FL, from 2013 through 2016 were reviewed. The main outcome measure was if additional laser treatment or vitreoretinal surgical procedure was performed after the initial laser retinopexy. Additional laser retinopexy was performed in 75 (18.7%) of 401 study eyes over 113 sessions: 58 (51.3%) sessions to retreat the original tear and 55 (48.7%) to treat a new tear. Vitreoretinal surgery for retinal detachment after the initial laser retinopexy was performed in 23 (5.7%) eyes. Risk factors associated with vitreoretinal surgery after initial laser treatment included superotemporal location (OR = 3.62; p= 0.008), vitreous hemorrhage (OR = 2.62; p= 0.017), and multiple breaks (OR = 2.60; p= 0.014). Additional treatment is often performed after the initial treatment of a retinal break. Although progression to retinal detachment is not common, regular follow-up examinations are recommended.

Favorable outcome after choroidal drainage for postoperative kissing suprachoroidal hemorrhage following trabeculectomy in a high myopic vitrectomised eye

A 39-year-old lady with past history of vitreoretinal surgery for retinal detachment and cataract surgery with Intraocular lens implantation was diagnosed as uncontrolled glaucoma. She had high myopia. She underwent Trabeculectomy and following which she presented with massive suprachoroidal hemorrhage in the first postoperative day with severe loss of vision. This case depicts the risk of suprachoroidal hemorrhage in a high myopic vitrectomised eye following glaucoma filtration surgery. It also demonstrates a favorable outcome following intervention for postoperative Suprachoroidal hemorrhage. At present, there is no evidence in literature of such event in a high myopic Vitrectomised eye following Trabeculectomy.

Surgical correction of persistent adult-onset cyclic strabismus

A 24-year-old man developed cyclic esotropia following vitreoretinal surgery for retinal detachment in his right eye. He underwent right eye medial rectus recession (6mm) and lateral rectus resection (8.5mm) under local anesthesia for the correction of cyclic esotropia. Following surgery, he developed a unique pattern of cyclic strabismus that involved alternation between esotropia and exotropia every 24hours. To treat this condition, the patient underwent lateral rectus recession (8.5mm) and medial rectus posterior fixation of medial rectus in the right eye. Following surgery, he was corrected for heterotropia on both esotropic and exotropic days.

Dealings between Cataract and Retinal Reattachment Surgery in PVR.

Introduction. To evaluate the impact of the eye lens status and oil side effects on the outcome of vitreoretinal surgery in retinal detachment with proliferative vitreoretinopathy (PVR) and a temporary silicone oil tamponade (SOT). Methods. 101 eyes were analyzed retrospectively and 103 eyes prospectively in regard to their retinal reattachment success rate and key factors for the outcome. Subgroup analysis of 27 eyes with Scheimpflug lens photography (SLP) before and after retinal reattachment service with SOT was performed. For SLP (65% phakic eyes) a Pentacam densitometry reference body with 3 mm diameter was chosen and 3 segments (anterior/mid/posterior) were evaluated separately after a quality check. Results. The retinal reattachment rate was highest in the prospective pseudophakic group (p = 0.039). Lens transparency loss occurred earlier in middle aged patients than in younger patients. Besides the nucleus, layers posterior and anterior to it showed specific transparency changes. The emulsification rate was higher when eyes had been operated on in the anterior chamber before retinal reattachment service. Conclusions. Retinal reattachment surgery seems to benefit from preoperative cataract removal. We found significant lens changes in the nucleus as well as in the layers anterior and posterior to it. This corresponds to the histology of the lens epithelium published before.

Analysis of the causes of blindness and low vision after vitreoretinal surgery for retinal detachment

Objective To analyse the causes of blindness and low vision after vitrectomy for retinal detachment.Methods A retrospective analysis about 90 eyes of 90 cases was carried out.The causes of blindness and low vision were analyzed if best corrected visual acuity was less than 0.3 in 1 week and 1 month after operation.Results The results suggested that the incidences of low vision were 55.5％ and 47.8％ in 1 week and 1 month after operation.While the incidences of blindness were 23.4％ and 16.7％.The leading causes of blindness and low vision were preoperative retinal dysfunction and the presence of postoperative complications.Conclusion Vitrectomy operation is an effective method for retinal detachment.It is the original disease that affects visual acuity recovery.Early treatment for retinal detachment and dealing with postoperative complications are keys to obtain better vision. Key words: Surgery, vitreoretinal; Detachment, retinal; Blindness; Vision, low; Cause

Entfernung von zentral gelegenem, subretinalem Perfluorcarbon

Subretinal perfluorocarbon liquid (PFCL) droplets are occassionally seen after vitreoretinal surgery for retinal detachment. Usually they are located peripherally without causing complications and therapeutic consequences. In contrast, centrally located PFCL droplets affect final visual outcomes. In animal experiments subretinal PFCL has caused direct toxic effects on photoreceptor cells and retinal pigment epithelium. We report about the rare event of a centrally located subretinal PFCL droplet in 2 patients, their surgical removal and functional outcome. In both patients a PFCL droplet remained subretinally after primary vitrectomy for a rhegmatogenous retinal detachment. In patient 1 the PFCL droplet was located subfoveally for 6 weeks, in patient 2 underneath the papillomacular bundle for 8 weeks causing severe visual loss. In both patients the PFCL was removed transretinally through a 32 gauge cannula. Vision and central scotoma improved in both patients markedly. No complications due to the mini-retinotomy could be observed. Centrally located PFCL droplets are decreasing vision and should be surgically removed. A transretinal removal of subretinal PFCL droplets is possible and the iatrogenic damage seems acceptable.

Misleading Goldmann applanation tonometry in a post-LASIK eye with interface fluid syndrome

A 21-year-old myope presented with decreased vision and corneal edema following vitreoretinal surgery for retinal detachment. While intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT) was low, the digital tonometry indicated raised pressures. An interface fluid syndrome (IFS) was suspected and confirmed by clinical exam and optical coherence tomography. A tonopen used to measure IOP through the peripheral cornea revealed elevated IOP which was the cause of the interface fluid. Treatment with IOP-lowering agents resulted in complete resolution of the interface fluid. This case is being reported to highlight the fact that IFS should be suspected when there is LASIK flap edema and IOP readings using GAT are low and that GAT is not an optimal method to measure IOP in this condition. Alternative methods like tonopen or Schiotz tonometry can be used.

Use of tissue adhesives in ophthalmology

Use of tissue adhesives in ophthalmology

Outcomes of Vitreoretinal Surgery for Retinal Detachment after LASIK for Myopia

To report and compare outcomes of vitreoretinal surgery for repair of retinal detachment in myopic patients with and without previous laser-assisted in situ keratomileusis (LASIK). This is a descriptive retrospective observational study with a control group for comparison that consisted of the analysis of clinical and surgical charts of patients who underwent vitreoretinal procedures for retinal detachment at the Fundación Oftalmologica Nacional between January 1995 and December 2002. The authors identified those myopic patients who had previous history of LASIK and an age- and myopia-matched control group without refractive surgery. The sample contains 24 myopic eyes of 22 patients with previous LASIK and 23 myopic eyes without previous LASIK in the control group, matched by age and myopia. Mean refractive error was -9.4 D before LASIK for the cases group and -11.2 for the control group. Poor preoperative best-corrected visual acuity was present in 71% of cases and 61% of controls (p=0.489). Macula off retinal detachment was found in 17 eyes in both groups. Five eyes required at least two procedures, achieving 91% (20 eyes) reattachments at the end of follow-up in each group. Final best-corrected visual acuity was better than 20/100 in 15 eyes (62.5%) in the LASIK group and 17 eyes (74 %) in the control group (p=0.659). Retinal detachment in patients with previous myopic LASIK has similar characteristics as in myopic patients without refractive surgery. Current vitreoretinal surgery is of good prognosis as the retina was successfully reattached in most cases in both groups.

Outcome of Eyes Developing Retinal Detachment During the Early Treatment for Retinopathy of Prematurity Study (ETROP)

To report the structural and visual outcomes of eyes in which retinal detachment developed from retinopathy of prematurity (ROP) in the Early Treatment of Retinopathy of Prematurity (ETROP) Study. Method Infants in the ETROP Study with bilateral high-risk prethreshold ROP had 1 eye randomized to early treatment, with the fellow eye managed conventionally. In infants with asymmetric disease, the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management. When a retinal detachment was detected, observation or vitreoretinal surgery (ie, scleral buckling and/or vitrectomy) was provided at the discretion of the individual investigator. At 9 months corrected age, retinal examinations were performed and visual acuities were assessed by masked testers using grating acuity. The ETROP Study enrolled 401 patients with high-risk prethreshold ROP. Retinal detachments occurred in 89 eyes of 63 patients. Follow-up was available for 78 eyes of 56 patients. The detachments were bilateral in 21 patients (38%) and were classified as stage 4A in 30 eyes, stage 4B in 14 eyes, and stage 5 in 16 eyes. Detachments were not classified in 18 eyes. Twelve eyes of 11 patients were observed and 66 eyes of 52 patients underwent vitreoretinal surgery. Attachment of the macula at 9 months persisted or was achieved in 17 (30%) of 56 eyes after vitrectomy with or without scleral buckle, in 6 (60%) of 10 eyes after scleral buckle only, and in 2 (17%) of 12 eyes followed up without surgery. Favorable visual acuity (> or =1.85 cycles/degree) was found in 13 (17%) of the 78 eyes. All 6 eyes that maintained normal visual acuity (> or =3.70 cycles/degree) had a stage 4A detachment (1 of 6 managed by observation, 3 of 6 by scleral buckle, and 2 of 18 by vitrectomy). Eleven eyes with stage 5 detachment underwent vitreoretinal surgery, resulting in 6 with no light perception, 3 with light perception only, and 2 with detection of only the low vision card. In the ETROP Study, the outcome of retinal detachment owing to ROP was generally poor. Vitreoretinal surgery for retinal detachment was associated with macular attachment in 16 of 48 eyes. Normal acuity was maintained after surgical repair of stage 4A retinal detachment in 5 (21%) of 24 eyes. Vitreoretinal surgery for stage 5 disease was associated with some structural successes but poor functional outcomes.

Vitreoretinal surgery for retinal detachment after intraocular lens implantation

目的 探讨人工晶状体植入术后视网膜脱离的手术方法并评价其疗效.方法 2000年1月～2002年6月经玻璃体视网膜联合术治疗人工晶状体植入术后视网膜脱离31例(31眼)的临床资料作回顾分析.手术采取玻璃体切除、剥离视网膜前膜、激光封闭视网膜裂孔及眼内长效气体或硅油填充等方式.结果随访期为12～39月,平均22月.随访时视网膜复位29眼,占93.55%.有27眼(占87.11%)视力提高,其中≥0.1者22眼,最好视力为0.8.结论人工晶状体植入术后视网膜脱离使眼内病变复杂,易致严重PVR.应用玻璃体视网膜联合术,可使视网膜得以有效复位。

A cost-utility analysis of interventions for severe proliferative vitreoretinopathy

PURPOSE: The purpose of this study was to report a reference case, patient preference-based, incremental, cost-utility analysis for treatments of retinal detachment associated with severe proliferative vitreoretinopathy (PVR). DESIGN: Computer-based economic model utilizing data from the Medicare health insurance system in the United States. METHODS: A cost-utility analysis compared vitreoretinal surgery using expanding gases and silicone oil therapy to the natural course of retinal detachment associated with severe PVR. The model applies long-term published visual data from the Silicone Study Group, time tradeoff utility analysis, decision analysis with Markov modeling, and discounting of costs and health benefits as per the Panel on Cost-Effectiveness in Health and Medicine. The major outcome measure was in year 2000 United States dollars per quality-adjusted life-year ($/QALY) gained. RESULTS: Vitreoretinal surgery for retinal detachment complicated by severe PVR, as compared with no treatment, resulted in a mean gain of 0.128–0.200 discounted (3% annual rate) quality-adjusted life-years per treated patient. Silicone oil ($/QALY gained of $40,252) was slightly more cost-effective than perfluoropropane (C 3F 8) gas ($/QALY gained of $46,926) in eyes with PVR without previous vitrectomy, whereas C 3F 8 gas ($/QALY gained of $46,162) was more cost-effective than silicone oil ($/QALY gained of $62,383) with previous vitrectomy and PVR. Sensitivity analysis resulted in a $/QALY gained of $13,347 when 10% of opposite eyes had a severe visual loss to $202,128 when a discount rate of 10% was utilized and opposite eyes initially had good vision. CONCLUSIONS: The incremental expense of interventions for retinal detachment associated with PVR is cost-effective when compared with other widely accepted interventional therapies across diverse medical specialties.

Vitreous changes and retinal detachment in highly myopic eyes.

This report on 496 highly myopic eyes that underwent transcleral or vitreoretinal surgery for retinal detachment (RD) focuses particularly on how changes in the vitreous gel and the resulting modifications of the vitreoretinal interface produce typical characteristics and complications. According to the pattern of vitreous modifications the 496 eyes were divided into five groups: 1) eyes with uniform PVD (108 eyes) 2) eyes with PVD spreading towards the upper quadrants (231 eyes) 3) eyes with extensive vitreous liquefaction (EVL) and condensations of the vitreous base (51 eyes) 4) eyes with posterior vitreous lacuna (PVL, 87 eyes) 5) eyes with very limited PVD (19 eyes). Age, degree of myopia, surgical procedures and final results are reported for each group. A strong correlation was observed between vitreous changes and clinical picture of RD especially in the group of PVL and EVL. In the PVL group a higher degree of myopia was found and more pronounced posterior staphyloma. Frequently the posterior hyaloid, in the form of a thin, extremely smooth membrane, was hard to separate from the inner posterior retina during surgery. Posterior retinal breaks, including macular holes, were found in 56% of eyes. The presence of EVL with condensation of the vitreous base was correlated with giant retinal tear (GRT) in 70% of cases (36 of 51 eyes). Sixteen GRT were also found in the group of uniform PVD, but these were less extensive and located more posteriorly than in the EVL group. In the former group there were better surgical results because of a lower incidence of PVR. In 46% of the eyes of our series (group 2), PVD extended mostly in the upper quadrants with no vitreous detachment inferiorly. In these cases there was a clinical appearance of inferior vitreous collapse. These eyes had 92% of peripheral superior retinal breaks. Relapses of RD in this group almost invariably occurred in the inferior quadrants.