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Wang KY, Adams OE, Yu MD, Yonekawa Y. The necessity and role of scleral buckling for rhegmatogenous retinal detachment. Curr Opin Ophthalmol 2024; 35:376-381. [PMID: 38820007 DOI: 10.1097/icu.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE OF REVIEW With a decline in the use of scleral buckling for rhegmatogenous retinal detachment (RRD) repair in recent years, this review seeks to provide a summary of the most recent research findings regarding the role of scleral buckling in the repair of RRD. RECENT FINDINGS Many recent studies have compared visual and anatomic outcomes between scleral buckling and pars plana vitrectomy (PPV) for RRD repair. Some suggest superior outcomes with primary scleral buckling, particularly in younger, phakic patients, and in association with other risk factors that we review. Children do best with primary scleral buckling surgery. Functionally, scleral buckling may also result in lower rates of retinal displacement compared to PPV. When PPV is necessary, a supplemental buckle may benefit certain patients, while the advantage remains unclear in other clinical scenarios and necessitates further investigation. SUMMARY Scleral buckling is an important technique for the repair of RRD and it is crucial to continue training retina surgeons in this technique to maximize patient outcomes.
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Affiliation(s)
- Kristine Y Wang
- Wills Eye Hospital/Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Gisquet C, Ndiaye NC, Dubroux C, Angioi-Duprez K, Berrod JP, Conart JB. Retinal redetachment after silicone oil removal: a risk factor analysis. BMC Ophthalmol 2024; 24:346. [PMID: 39148018 PMCID: PMC11325823 DOI: 10.1186/s12886-024-03618-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024] Open
Abstract
PURPOSE To report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors. METHODS Retrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes. RESULTS The median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06). CONCLUSION A retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate. TRIAL REGISTRATION NUMBER ID NCT05647928 (12th April 2022).
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Affiliation(s)
- Clément Gisquet
- Department of Ophthalmology, University Hospital of Nancy, Rue du Morvan, Vandoeuvre-les-Nancy, 54500, France.
| | - Ndeye Coumba Ndiaye
- UMR Inserm U1256 NGERE (Nutrition-Genetics and Exposure to Environmental Risks), Université de Lorraine, Nancy, France
| | - Chloé Dubroux
- Department of Ophthalmology, University Hospital of Nancy, Rue du Morvan, Vandoeuvre-les-Nancy, 54500, France
| | - Karine Angioi-Duprez
- Department of Ophthalmology, University Hospital of Nancy, Rue du Morvan, Vandoeuvre-les-Nancy, 54500, France
| | - Jean-Paul Berrod
- Department of Ophthalmology, University Hospital of Nancy, Rue du Morvan, Vandoeuvre-les-Nancy, 54500, France
| | - Jean-Baptiste Conart
- Department of Ophthalmology, University Hospital of Nancy, Rue du Morvan, Vandoeuvre-les-Nancy, 54500, France
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Lena ER, Patil NS, Popovic MM, Eshtiaghi A, Dhoot AS, Muni RH, Kertes PJ. Evaluation of Pars Plana Vitrectomy With and Without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Detachment Due to Inferior Retinal Breaks: A Systematic Review. Ophthalmic Surg Lasers Imaging Retina 2024:1-9. [PMID: 39231113 DOI: 10.3928/23258160-20240801-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
In this systematic review, the efficacy of scleral buckle (SB) with pars plana vitrectomy (PPV) was compared to PPV alone in eyes with rhegmatogenous retinal detachment (RRD) due to inferior retinal breaks (IRB). Measured outcomes included final best-corrected visual acuity (BCVA), anatomic success, and complication rates in randomized controlled trials and observational studies from 2000 to 2022. Among four studies (696 eyes), three studies demonstrated no significant difference between PPV and PPV/SB for final BCVA, whereas one study reported better BCVA with added SB. PPV/SB yielded comparable single-surgery anatomical success (SSAS) and final anatomical success (FAS) in three studies relative to PPV alone (P < 0.05); however, one study reported better SSAS with added SB. Stratifying by lens status revealed a SSAS benefit with PPV/SB in phakic eyes (P = 0.046). No significant difference was seen in complication rates. In conclusion, PPV and PPV/SB were associated with similar functional outcomes and risk profile, whereas SSAS may be improved with PPV/SB in phakic eyes with RRD due to IRB. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Davidović S, Babović S, Miljković A, Pavin S, Bolesnikov-Tošić A, Barišić S. Updates on Treatment Modalities for Primary Rhegmatogenous Retinal Detachment Repair. Diagnostics (Basel) 2024; 14:1493. [PMID: 39061630 PMCID: PMC11276041 DOI: 10.3390/diagnostics14141493] [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: 06/11/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Rhegmatogenous retinal detachment, a severe eye condition, presents anatomic separation of the neurosensory retina from its outermost layer-the retinal pigment epithelium. Early recognition of this relatively common finding and proper referral of patients to the retinal surgery department is essential in order to minimize its consequent possible severe reduction in vision. Several major surgical methods for the repair of primary rhegmatogenous retinal detachment have been in use over the last several decades, and they all aim to find and close the break in the retina that has caused the detachment. Surgery can be performed as pneumatic retinopexy, pars plana vitrectomy, and/or episcleral surgery (buckling). General surgical trends for reattaching the retina include moving from extraocular to intraocular surgery and from bigger gauge to smaller gauge via minimal invasive vitrectomy surgery (MIVS), with implementing shorter-lasting intraocular tamponades. Surgical options for rhegmatogenous retinal detachment treatment nowadays emphasize gaining retinal reattachment, preferably with one surgery and with minimum damage to the eye. The procedure should not bring secondary eye conditions and complications with severe impairment of visual acuity, and it should be performed on as much as a smaller budget, with possibly peribulbar anesthesia, enabling the patient the quickest possible recovery. It should be adjusted to the patient's condition, not to the surgeon's skills or preferences.
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Affiliation(s)
- Sofija Davidović
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Siniša Babović
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Aleksandar Miljković
- Department for Ophthalmology, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Svetlana Pavin
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
| | - Ana Bolesnikov-Tošić
- University Clinic for Anesthesiology, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia;
| | - Sava Barišić
- University Eye Clinic, University Clinical Center of Vojvodina, Hajduk Veljkova 1–9, 21000 Novi Sad, Serbia; (S.B.); (S.P.); (S.B.)
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Corcóstegui I, Subirás J, Corcóstegui B. Outcomes of rhegmatogenous retinal detachment surgery in patients with Stickler syndrome. Graefes Arch Clin Exp Ophthalmol 2024; 262:2093-2099. [PMID: 38358525 DOI: 10.1007/s00417-024-06406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Despite recent developments in vitrectomy technology and instrumentation, rhegmatogenous retinal detachment in Stickler syndrome (RDS) remains a challenge for surgeons. RDSs are associated with a higher rate of complications and surgical failures than those not associated with Stickler syndrome. This study is a report about anatomic and visual outcomes of RDS surgery and describes the surgical techniques associated with the treatment of this specific condition. METHODS This is a retrospective, interventional, consecutive case series of patients with RDS undergoing retinal reattachment surgery from 1990 to 2020 at the Institute of Ocular Microsurgery (IMO) in Barcelona, Spain. RESULTS Twenty-four eyes of 18 patients with genetically confirmed Stickler syndrome were included in the study. Ten eyes (41.6%) presented a giant retinal tear. Retinal reattachment was achieved in all cases after an average of 1.21 (range 1-6) surgical interventions. Nineteen eyes (79%) required only one operation to achieve complete retinal reattachment. The most common first surgical procedure was a 4-mm scleral buckle with posterior pars plana vitrectomy and silicone oil endotamponade, performed on 16 (66.6%) of the eyes. The mean follow-up period was 10.2 years. Mean preoperative visual acuity LogMar was 1.10 (Snellen equivalent 20/252), which improved to 0.50 (Snellen equivalent 20/63) at final follow-up (p < 0.05). CONCLUSION In most RDS cases, anatomic success and visual acuity improvement can be achieved with the first surgical procedure, using a combination of silicone oil tamponade and a 4-mm scleral encircling band. In some early cases of RDS, other less invasive surgical techniques can be used.
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Affiliation(s)
| | - Javier Subirás
- Vitreo-Retinal Department, Institute of Ocular Microsurgery, Barcelona, Spain
| | - Borja Corcóstegui
- Vitreo-Retinal Department, Institute of Ocular Microsurgery, Barcelona, Spain
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Bansal A, Naidu SC, Figueiredo N, Alrabiah M, Hamli H, Wong DTW, Muni RH, Altomare F. 38-Gauge Cannula-Based Endodrainage of Posteriorly Trapped Intraoperative Subretinal Fluid during Vitrectomy for Retinal Detachment. Ophthalmol Retina 2024; 8:727-729. [PMID: 38527570 DOI: 10.1016/j.oret.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Aditya Bansal
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, Kentucky
| | - Sumana C Naidu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Figueiredo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Mahmoud Alrabiah
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Hesham Hamli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - David T W Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Ocular Oncology Services, Princes Margaret Cancer Hospital, University of Toronto, Toronto, Ontario, Canada.
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Tzoumas N, Yorston D, Laidlaw DAH, Williamson TH, Steel DH. Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study. Ophthalmology 2024; 131:731-740. [PMID: 38104666 DOI: 10.1016/j.ophtha.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To establish whether Densiron 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment (RD) surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy (PVR). DESIGN Cohort study of routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal database between 2015 and 2022. PARTICIPANTS All consecutive eyes that underwent primary rhegmatogenous RD surgery using Densiron 68 or light silicone oil as an internal tamponade agent. METHODS To minimize confounding bias, we undertook 2:1 nearest-neighbor matching on inferior breaks, large inferior rhegmatogenous RDs, PVR, and, for visual analyses, baseline visual acuity (VA) between treatment groups. We fit regression models including prognostically relevant covariates, treatment-covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals (CIs) using bias-corrected cluster bootstrapping with 9999 replications. MAIN OUTCOME MEASURES Presence of a fully attached retina and VA at least 2 months after oil removal. RESULTS Of 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomic and visual outcome analyses, respectively. The primary success rate was higher in the Densiron 68 group (113 of 142; 80%) compared with the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI, 1.63-2.23, P < 0.001). We also observed a significant improvement favoring Densiron 68 of -0.26 logarithm of the minimum angle of resolution (logMAR) in postoperative VA between the 2 groups (95% CI, -0.43 to -0.10, P = 0.002). The anatomic benefit of using Densiron 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with PVR grade C. We found no evidence of visual effect moderation by anatomic outcome or foveal attachment. CONCLUSIONS Densiron achieved higher anatomic success rates and improved visual outcomes compared with conventional light silicone oil in eyes with inferior retinal pathology and severe PVR. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Nikolaos Tzoumas
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Sunderland Eye Infirmary, Sunderland, United Kingdom
| | | | | | - Tom H Williamson
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David H Steel
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Sunderland Eye Infirmary, Sunderland, United Kingdom.
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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] [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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Huang YT, Yang CH, Chen SJ, Cheng CK, Ho TC, Wu TT, Sheu SJ, Hsieh YT, Chang CJ, Wu JS, Liu L, Chen SN. Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society. J Chin Med Assoc 2024; 87:25-32. [PMID: 37815297 DOI: 10.1097/jcma.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Jen Chang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jian-Sheng Wu
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, Eye center, China Medical University Hospital, Taichung, Taiwan, ROC
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Doukkali S, Hébert M, You E, Bourgault S, Caissie M, Tourville É, Dirani A. Bilateral sequential and simultaneous rhegmatogenous retinal detachments: anatomic and functional outcomes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00245-4. [PMID: 37640227 DOI: 10.1016/j.jcjo.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/02/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To assess the anatomic and functional outcomes in sequential and simultaneous bilateral rhegmatogenous retinal detachment (BRRD) repair. DESIGN Retrospective cohort study. PARTICIPANTS A total of 218 eyes in 109 patients. METHODS Patients diagnosed with BRRD between 2014 and 2020 at the University Centre of Ophthalmology-CHU de Québec-Laval University were reviewed. Main outcomes were single-surgery anatomic success (SSAS) and final pinhole visual acuity (PHVA) in logMARs. RESULTS Of the 109 patients, 86 (79%) were male, and median (Q1, Q3) age at presentation for the first eye was 60 years (range, 54-66 years). Of these patients, 92% (n = 100) had sequential BRRD and 8% (n = 9) simultaneous BRRD. Median (Q1, Q3) duration of symptoms was shorter for second eyes (first, 7 days [range, 3-15 days] vs second, 4 days [range, 2-10 days]; p = 0.028). Second eyes also had less retinal tears (first, 2.94 ± 2.76 tears vs second, 2.38 ± 1.79 tears; p = 0.031) and better median preoperative PHVA (first, 0.46 logMAR [range, 0.14-2.30 logMAR] vs second, 0.24 logMAR [range, 0.06-0.95 logMAR]; p = 0.012). SSAS was achieved in 100 (92%) and 101 (93%) of first and second eyes, respectively (p = 1.00). Final PHVA was better for the first eye (first, 0.14 logMAR [range, 0.04-0.30 logMAR] vs second, 0.20 logMAR [range, 0.04-0.43 logMAR]; p = 0.010) but comparable at 3 months (first, 0.30 logMAR [range, 0.14-0.48 logMAR] vs second, 0.34 logMAR [range, 0.13-0.70 logMAR]; p = 0.36). CONCLUSIONS SSAS was similar for both eyes. The subsequent eye was more likely to be treated earlier with less advanced presentations, but at 3 months, PHVA was not significantly different between eyes. Difference in final PHVA may be attributable to longer follow-up in first eyes.
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Affiliation(s)
| | - Mélanie Hébert
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC
| | - Eunice You
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC
| | - Serge Bourgault
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC
| | - Mathieu Caissie
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC
| | - Éric Tourville
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC
| | - Ali Dirani
- Department of Ophthalmology, Hospital Saint-Sacrement, Laval University, Quebec, QC.
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Shukla D, Dhawan A, Kalliath J. MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES. Retina 2023; 43:905-912. [PMID: 36791344 DOI: 10.1097/iae.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To report the anatomical and functional outcomes of medium-term perfluoro-n-octane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs). METHODS We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA). RESULTS The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was ≤counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. best-corrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA ≥20/200 and 21 (60%) regained ambulatory vision (≥5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications. CONCLUSION We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.
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Affiliation(s)
| | - Anuradha Dhawan
- Calderdale Huddersfield Foundation NHS Trust Hospital, UK; and
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Casparis H. What Defines Successful Surgery for Diabetic Tractional Retinal Detachment? JAMA Ophthalmol 2023; 141:195-196. [PMID: 36633861 DOI: 10.1001/jamaophthalmol.2022.5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heather Casparis
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Ryan EH, Mittra RA. Surgeon Judgment and the Role of Scleral Buckle in Addition to Vitrectomy in Eyes with Retinal Detachments. Ophthalmol Retina 2022; 6:869-870. [PMID: 36192088 DOI: 10.1016/j.oret.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 10/14/2022]
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Cruz-Pimentel M, Huang CY, Wu L. Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment. Clin Ophthalmol 2022; 16:1971-1984. [PMID: 35733617 PMCID: PMC9208732 DOI: 10.2147/opth.s359309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.
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Affiliation(s)
- Miguel Cruz-Pimentel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Chyong Yng Huang
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes Paseo Colon, San José, Costa Rica
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes Paseo Colon, San José, Costa Rica
- Illinois Eye and Ear Infirmary, Department of Ophthalmology, School of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Correspondence: Lihteh Wu, Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colon, San Jose, CR, USA, Tel +506 2222-1115, Email
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