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Lin JB, Narayanan R, Philippakis E, Yonekawa Y, Apte RS. Retinal detachment. Nat Rev Dis Primers 2024; 10:18. [PMID: 38485969 DOI: 10.1038/s41572-024-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.
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Affiliation(s)
- Jonathan B Lin
- Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Elise Philippakis
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rajendra S Apte
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Developmental, Regenerative, and Stem Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Li C, Fu Y, Liu S, Yu H, Yang X, Zhang M, Liu L. The global incidence and disability of eye injury: an analysis from the Global Burden of Disease Study 2019. EClinicalMedicine 2023; 62:102134. [PMID: 37599904 PMCID: PMC10432781 DOI: 10.1016/j.eclinm.2023.102134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background The aim of the present study was to estimate the incidence, years lived with disability (YLDs), and cause of eye injury at global, regional, and national levels by age and sex based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods This is a retrospective demographic analysis based on aggregated data. GBD 2019 included the burden of eye injury worldwide and its temporal and spatial characteristics in the past three decades. The Bayesian meta-regression tool and DisMod-MR 2.1 were used to analyse the estimates based on a linear regression mode of the age-standardised rates (ASR). Average annual percent change (AAPC) was calculated to represent the temporal trends of the ASR. Findings Globally, there were 59,933.29 thousand (95% uncertainty interval [UI]: 45,772.34-77,084.03) incident cases and 438.4 thousand (95% UI: 132.44-898.38) YLDs of eye injury in 2019. Both the ASR of incidence and YLDs decreased from 1990 to 2019, with AAPC -0.46 (95% confidence interval [CI]: -0.52 to -0.39) and -0.45 (95% CI: -0.52 to -0.39), respectively. Males had higher rates of incidence and YLDs in all age groups. Young and middle-aged adults had higher disease burdens. Regionally, Australasia had the highest ASR of YLDs to be 9.51 (95% UI: 3.00-19.58) per 100,000. Nationally, New Zealand had the highest burden of eye injury to be 11.33 (95% UI: 3.57-23.10) per 100,000. Foreign bodies, exposure to mechanical forces, and falls were the main causes of global eye injury burden in 2019, and there was an increased worldwide burden due to road injuries and executions and police conflict compared with 1990. Interpretation Our findings suggest that the incidence and burden of eye injury have decreased over the last 30 years, while the absolute number of eye injuries has substantially increased, representing a major public health concern. Males and young adults were affected to a greater degree than females and elder individuals. More attention should be paid to road injuries and executions and police conflict in order to prevent eye injury. Funding Guangdong Provincial People's Hospital (GDPH) Supporting Fund for Talent Program (KY0120220263).
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Affiliation(s)
- Cong Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- School of Medicine South China University of Technology, Guangzhou, Guangdong, 510006, China
| | - Yongyan Fu
- Department of Ophthalmology, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Shunming Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, Guangdong, 510080, China
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Macular Disease Research Laboratory, Department of Ophthalmology, Sichuan University, West China Hospital, Chengdu, Sichuan, 610041, China
| | - Lei Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
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López-Cañizares A, Al-Khersan H, Fernandez MP, Lin BR, Goduni L, Berrocal AM. Smith-Lemli-Optiz syndrome: importance of ophthalmology referral and follow-up. J AAPOS 2022; 27:100-102. [PMID: 36563894 DOI: 10.1016/j.jaapos.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disorder caused by mutations in the 7-dehydrocholesterol reductase (DHCR7) gene, located on chromosomal region 11q13. This results in reduced cholesterol and increased 7-dehydrocholesterol (7DHC) levels. Accumulation of 7DHC in patients with SLOS can affect multiple organs and display a broad phenotypic expression. Ophthalmic abnormalities related to SLOS are variable but the most common is blepharoptosis. Over 50% of these patients present with self-injurious behavior, such as head banging, which can result in ocular complications and blindness. We report the first case of peripheral avascularity of the retina in a patient with SLOS. Physicians should be aware of the potential ocular complications associated with SLOS and confounding factors, such as prematurity, given that referral is usually delayed due to the lack of awareness of these potentially blinding associations. This case highlights the importance of early referral and continuous ophthalmologic follow-up in preventing further deterioration of visual development and complications that can lead to blindness.
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Sato T, Kuniyoshi K, Kodama T, Kusaka S. Recurrent proliferative vitreoretinopathy in a patient with morning glory syndrome and intellectual disability. Am J Ophthalmol Case Rep 2022; 26:101416. [PMID: 35243156 PMCID: PMC8857424 DOI: 10.1016/j.ajoc.2022.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To report a case of morning glory syndrome (MGS) with retinal detachment, in whom unusually severe proliferative vitreoretinopathy (PVR) developed after surgery. Observations A 6-year-old boy with intellectual disability underwent vitrectomy for retinal detachment associated with MGS in the left eye. Vitrectomy was performed five times. C3F8 gas tamponade was used for the first and second surgeries. However, the retina developed PVR with a nearly 360-degree giant retinal tear after the second surgery. The third surgery required 360-degree retinotomy, followed by short-term perfluoro-n-octane (PFO) tamponade, which was removed ten days later. During the fourth surgery, the retina was found to be flipped over in a funnel-shape on the retinal pigment epithelium under the PFO. Silicone oil (SO) tamponade was used. During the fifth surgery, the retina was flipped over under the SO again. We found that the patient shook his head rapidly and vigorously while crying. Conclusions and importance We speculate that excessive head shaking associated with the patient's intellectual disability induced an unusual shape of the retina under PFO or SO. Although difficult to achieve, postoperative resting seems important in preventing such complications in intellectually disabled patients with retinal detachment. Severe proliferative vitreoretinopathy developed after surgery for retinal detachment associated with morning glory syndrome. The retina was flipped over under perfluorocarbon liquid or silicone oil. Such unusual complications may have occurred by the excessive head shaking associated with the patient's intellectual disability.
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