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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Postoperative Choroidal Vascular Biomarkers in Eyes with Rhegmatogenous Retinal Detachment-Related Giant Retinal Tears. Int J Retina Vitreous 2023; 9:45. [PMID: 37528479 PMCID: PMC10391839 DOI: 10.1186/s40942-023-00482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE Choroidal vascularity index (CVI) and choriocapillaris flow area (CFA) are perfusion biomarkers relevant to retinal disease management. There is limited knowledge regarding these biomarkers in eyes that have been successfully treated for rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs). This study aimed to analyze the relationship between choroidal perfusion biomarkers and functional outcomes in surgically treated eyes with GRT-associated RRD and their fellow eyes. METHODS A total of 33 GRT eyes and 29 fellow eyes were included in this study. All RRD-GRT eyes were treated with vitrectomy and categorized into two groups based on whether additional scleral buckles (SB) were placed. Visual and choroidal features were compared between the groups. RESULTS The subjects had an average age of 55.18 years, a mean time of 2.36 weeks before surgery, and a mean follow-up time of 25.9 months. Best-corrected visual acuity (BCVA) was substantially worse in GRT eyes (1.9 logMAR) than in fellow control eyes (0.23 logMAR) but substantially improved after surgery (0.59 logMAR). There were no differences in the presurgical characteristics and BCVA between the eyes that did and did not undergo SB. Long-term CVI and CFA were lower in eyes with GRT than in their fellow eyes. Among eyes with GRT, those with SB had significantly lower CVI and CFA. Correlation analysis revealed that the CVI and CFA were positively correlated with visual outcomes (negative correlation with logMAR). CONCLUSION Despite successful surgical repair, long-term functional and choroidal evaluations showed permanent changes in eyes with GRT. Positive correlations between perfusion biomarkers and visual function suggest that better choroidal vasculature is associated with better visual outcomes. The results of this study highlight the benefits of analyzing choroidal vasculature biomarkers and the relationship between the choroidal anatomy and vision.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC, Medical and Surgical Assistance Institution (Nonprofit Organization) Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC, Medical and Surgical Assistance Institution (Nonprofit Organization) Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
- Institute of Ophthalmology. Fundacion Conde de Valenciana, Medical and Surgical Assistance Institution (Nonprofit Organization) Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Calle Chimalpopoca 14. Col Obrera, 06800, Mexico, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC, Medical and Surgical Assistance Institution (Nonprofit Organization) Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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San Martín Varela JA, Gallegos Morales MA, Verdaguer Díaz JI, Zacharias Santamaría SJ, Carpentier Giglio CA, Filsecker López LH, Ibañez Langlois S, López Astaburuaga JM, Orellana Ríos JA, Pérez Argandoña EA, Ried Undurraga JM. Retinal Detachment Associated With Giant Retinal Tears: Surgical Management and Outcomes in the Past 2 Decades. JOURNAL OF VITREORETINAL DISEASES 2023; 7:293-298. [PMID: 37927327 PMCID: PMC10621706 DOI: 10.1177/24741264231171458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To describe the surgical outcomes of rhegmatogenous retinal detachments (RRDs) associated with giant retinal tears (GRTs) and define factors associated with primary anatomic failure. Methods: This retrospective consecutive study comprised primary GRT-RRD surgeries between 1999 and 2021 at a single institution. Exclusion criteria were a follow-up of less than 3 months and incomplete surgical data. Results: The series included 69 eyes (64 patients). Single-surgery anatomic success (SSAS) was achieved in 75% and final anatomic success (FAS) in 90%. The mean logMAR visual acuity improved from 1.5 ± 1.1 to 0.6 ± 0.9. Preoperative factors significantly associated with redetachment were proliferative vitreoretinopathy (PVR) (odds ratio [OR], 6.2; P < .01), hypotony (OR, 13.6; P < .01), and a 180-degree or larger GRT (OR, 3.3; P = .04). All cases were treated with pars plana vitrectomy (PPV) and perfluoro-N-octane (PFCL). Perfluoropropane (C3F8) was used in 59% and silicone oil in 41%; the redetachment rate was significantly lower in gas cases (15% vs 39%) (P = .02). An encircling band, placed in 84% eyes, had a tendency to reduce redetachment (22% vs 36%) (P = .32). Lensectomy was performed in 61% of phakic eyes, with no effect on redetachment (20% vs 21%) (P = .92). On multivariate analysis, PVR and hypotony were significantly associated with redetachment. Conclusions: PPV with PFCL achieved high SSAS and FAS rates. PVR and hypotony were the main preoperative factors associated with anatomic failure. In cases without PVR, C3F8 tamponade significantly increased SSAS. Encircling scleral buckling showed a nonsignificant tendency toward an increase in SSAS. Lensectomy had no effect on SSAS.
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Lee IJ, Benjamin JE, Ghorayeb GR. Incidence of Epiretinal Membrane Formation After Pars Plana Vitrectomy for Giant Retinal Tear-Associated Retinal Detachment. Clin Ophthalmol 2023; 17:1415-1420. [PMID: 37220588 PMCID: PMC10200112 DOI: 10.2147/opth.s407699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To report the incidence of postoperative epiretinal membrane (ERM) formation after primary pars plana vitrectomy (PPV) for giant retinal tear associated retinal detachment (GRT-RD) repair as well as its clinical characteristics and visual outcomes at a level one trauma and tertiary referral academic center. Patients and Methods Patients with primary RD repair for GRT-RD at West Virginia University from September 2010 to July 2021 were identified using the ICD-10 codes (H33.031, H33.032, H33.033 and H33.039). Imaging studies including optical coherence tomography (OCT) were manually reviewed pre- and post-operatively for ERM formation after PPV for GRT-RD repair in patients who underwent PPV or combined PPV and scleral buckle (SB). Univariate analysis was performed to analyze clinical factors for ERM formation. Results The study included 17 eyes of 16 patients who underwent PPV for GRT-RD. Postoperative ERM was observed in 70.6% (13 of 17 eyes) of the patients. Anatomic success was achieved in all patients. The mean (range) preoperative and final best corrected visual acuity (BCVA) in logMAR units by macula status was 0.19 (0-0.5) and 0.28 (0-0.5) for macula-on and 1.7 (0.5-2.3) and 0.7 (0.2-1.9) for macular-off GRT-RDs. Clinical variables including use of medium-term tamponade with perfluorocarbon liquid (PFCL), cryopexy, endodiathermy, number of tears or total clock hours of tears did not correlate with an increased risk of ERM formation. Conclusion Post-vitrectomized eyes for GRT-RD repair have a significantly higher incidence of ERM formation, nearing 70% in our study. Surgeons may consider prophylactic ILM peel at the time of removal of tamponade agents or weigh in ILM peel at the time of primary repair, a more challenging surgical technique in our opinion.
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Affiliation(s)
- Ivan J Lee
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, WV, USA
| | - James E Benjamin
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, WV, USA
| | - Ghassan R Ghorayeb
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, WV, USA
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Khanna S, Rodriguez SH, Blair MA, Wroblewski K, Shapiro MJ, Blair MP. Laser Prophylaxis in Patients with Stickler Syndrome. Ophthalmol Retina 2021; 6:263-267. [PMID: 34774838 DOI: 10.1016/j.oret.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the association between laser prophylaxis, retinal detachment, and visual acuity among patients with Stickler syndrome DESIGN: Retrospective comparative case series PARTICIPANTS: Patients with Stickler syndrome INTERVENTION: Patients received extended vitreous base laser (EVBL), non-protocol laser (NPL), or no laser prophylaxis of any kind MAIN OUTCOME MEASURES: The two main outcome measures that were examined were rates of retinal detachment and visual acuity in these patients. RESULTS 230 eyes of 115 patients were included in this study. 59 patients were female (51%). The median age at laser prophylaxis was 9.5 years old (6-13), and the median age of patients with RD was 11 years old (7-18). 92 of those eyes did not undergo any laser, 9 received NPL, and 129 received EVBL. Of the 129 eyes who underwent EVBL, 4 (3%) had an RD, compared to the 74 eyes (73%) which had an RD that did not receive laser treatment or had NPL (P<0.001). Eyes with EVBL had about 8 lines better vision, on average, compared to those without laser or NPL (-0.86 logMAR, 95% CI -1.1- -0.64, P< 0.001). CONCLUSIONS EVBL appears to reduce the rate of subsequent RD and is associated with better visual acuity in patients with Stickler syndrome.
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Affiliation(s)
- Saira Khanna
- Department of Ophthalmology and Visual Sciences, University of Chicago Medical Center, Chicago, IL
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Sciences, University of Chicago Medical Center, Chicago, IL
| | | | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | | | - Michael P Blair
- Department of Ophthalmology and Visual Sciences, University of Chicago Medical Center, Chicago, IL; Retina Consultants, Ltd, Des Plaines, IL.
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Kunikata H, Aizawa N, Sato R, Nishiguchi KM, Abe T, Nakazawa T. Successful surgical outcomes after 23-, 25- and 27-gauge vitrectomy without scleral encircling for giant retinal tear. Jpn J Ophthalmol 2020; 64:506-515. [PMID: 32686061 DOI: 10.1007/s10384-020-00755-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Retinal detachment due to giant retinal tears (GRTs), tears larger than 90°, is rare and difficult to treat. Here, we show and compare surgical results of 23-, 25- and 27-gauge (G) micro-incision vitrectomy surgery (MIVS) for GRT. STUDY DESIGN Retrospective and interventional case series. METHODS Retrospective review of 41 eyes of 38 patients with GRT who underwent MIVS. Surgical outcomes after MIVS, including reattachment rates and postoperative complications, were compared between instrument gauges. All patients were followed for at least 6 months postoperatively. RESULTS MIVS with 23G, 25G and 27G instruments was performed in 7, 19 and 15 eyes, respectively. Silicone oil (SO) was used in 34 of 41 eyes (83%) with a mean removal time of 43.8 days after first surgery. Best-corrected visual acuity (BCVA) was recovered or maintained in 39 eyes (95%). Reattachment was attained after initial surgery in 38 of 41 eyes (93%) (23G: 6/7 [86%]; 25G: 17/19 [89%]; 27G: 15/15 [100%]). Final reattachment was eventually achieved in all eyes (two eyes needed support from scleral encircling). Postoperative complications occurred in 16 eyes (39%) (23G: 3/7 [43%]; 25G: 8/19 [42%]; 27G: 5/15 [33%]), including macular pucker, cystoid macular edema, macular hole, subretinal perfluorocarbon liquid, retinal folds, vitreous hemorrhage and redetachment. There were no significant differences between the three groups in rate of high myopia, GRT size, operation time, phacovitrectomy rate, SO usage rate, initial reattachment rate, final reattachment rate, preoperative BCVA, final BCVA or rate of postoperative complications. CONCLUSION Despite occasional postoperative complications, primary MIVS, regardless of gauge size, appears to be a safe and feasible option for GRT surgery.
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Affiliation(s)
- Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Risa Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji M Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Giant retinal tears (GRTs) are full-thickness circumferential tears of more than 90 degrees of the retina that are associated with vitreous detachment. They are related to ocular trauma, high myopia, aphakia, pseudophakia, genetic mutations involving collagen and young age. GRTs comprise 1.5% of all rhegmatogenous retinal detachments and the average age of incidence is 42 years. GRTs are more common in males, as 72% of all cases occur in males. The incidence of GRTs in the general population is estimated to be 0.05 per 100,000 individuals. Common techniques used in the management of GRTs include fluid-air exchange, pneumatic retinopexy, scleral buckling, primary vitrectomy with gas or silicone oil tamponade, and combined scleral buckle-vitrectomies. However, management of GRTs poses a great challenge to physicians due to the high risk of intra- and post-operative complications and the many technical difficulties involved. The advent of perfluorocarbon liquids (PFCL) and the use of micro-incisional surgery for the treatment of GRTs has provided new opportunities for the management of GTRs. Today, retinal reattachment can be achieved in 94-100% of cases.
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Affiliation(s)
- Maria H Berrocal
- Department of Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Megan L Chenworth
- School of Medicine, University of Pennsylvania Perelman, Pennsylvania, USA
| | - Luis A Acaba
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Gopal L, Sharma T, Bhende PS. Giant Retinal Tear. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND A giant retinal tear is a full-thickness retinal break that extends circumferentially around the retina for 90 degrees or more in the presence of a posteriorly detached vitreous. It causes significant visual morbidity from retinal detachment and proliferative vitreoretinopathy. The fellow eye of patients who have had a spontaneous giant retinal tear has an increased risk of developing a giant retinal tear, a retinal detachment or both. Interventions such as 360-degree encircling scleral buckling, 360-degree cryotherapy and 360-degree laser photocoagulation have been advocated by some ophthalmologists as prophylaxis for the fellow eye against the development of a giant retinal tear and/or a retinal detachment, or to prevent its extension. OBJECTIVES To evaluate the effectiveness of prophylactic 360-degree interventions in the fellow eye of patients with unilateral giant retinal tear to prevent the occurrence of a giant retinal tear, a retinal detachment or both. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 11), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 December 2011. In addition, we searched the proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) up to 2008 for information about other relevant studies. SELECTION CRITERIA Prospective randomised controlled trials (RCTs) comparing one prophylactic treatment for fellow eyes of patients with giant retinal tear against observation (no treatment) or another form of prophylactic treatment. In the absence of RCTs, we planned to discuss case-control studies that met the inclusion criteria but we would not conduct a meta-analysis using these studies. DATA COLLECTION AND ANALYSIS We did not find any studies that met the inclusion criteria for the review and therefore no assessment of methodological quality or meta-analysis could be performed. MAIN RESULTS No studies met the inclusion criteria for this review. AUTHORS' CONCLUSIONS No strong evidence in the literature was found to support or refute prophylactic 360-degree treatments to prevent a giant retinal tear or a retinal detachment in the fellow eye of patients with unilateral giant retinal tears.
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Affiliation(s)
- Ghee Soon Ang
- Aberdeen Royal InfirmaryDepartment of OphthalmologyForesterhillAberdeenUKAB25 2ZN
| | - John Townend
- University of AberdeenDepartment of Public HealthSchool of Medicine, Polwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | - Noemi Lois
- Grampian University Hospitals NHS TrustOphthalmology DepartmentForesterhillAberdeenUKAB25 2ZN
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