Pli maculaire compliquant la chirurgie du décollement de rétine

The impact of short-term postoperative face-up position on unintentional retinal displacement after pars plana vitrectomy for rhegmatogenous retinal detachment

OBJECTIVE

To assess the effectiveness and safety of a rigorous short-term supine position in preventing inadvertent retinal displacement after pars plana vitrectomy (PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD).

METHODS

We conducted a retrospective observational analysis of a case series at two ophthalmological surgical centers. We included eyes diagnosed with macula-off RRD that maintained a strict face-up position for three hours immediately after PPV with intraoperative perfluorocarbon liquid (PFCL) and 20% sulfur hexafluoride (SF6) tamponade. Fundus autofluorescence (FAF) imaging was performed at one month post-operatively to identify unintentional retinal displacement through the detection of retinal vessel prints (RVPs) on FAF imaging using an ultrawide-field (UWF) imaging system.

RESULTS

A total of 29 eyes with macula-off RRD were included in the study. The average age of the participants was 59.62 years. RRD involved one quadrant in two eyes, two quadrants in fourteen eyes, three quadrants in seven eyes, and four quadrants in six eyes. UWF-FAF imaging at one month follow-up after complete reattachment of the retina revealed RVPs in seven out of the 29 eyes (24.13%), with a mean displacement of 0.22 mm. In every case the displacement occurred downward.

CONCLUSION

Our results suggest that adhering to a strict face-up position for three hours after PPV with PFCL and gas tamponade for macula-off RRD may lead to a low frequency and severity of inadvertent post-operative retinal displacement.

Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds

PURPOSE

To describe a novel surgical technique to unfold congenital falciform folds.

METHOD

A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five-gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months.

RESULTS

Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 ( P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes.

CONCLUSION

The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.

Laser treatment of macular retinal folds in late postoperative period after retinal detachment repair

Macular retinal folds are a rare yet grave complication of surgical rhegmatogenous retinal detachment repair. Clinical symptoms vary depending on the location and severity of folding. Fold located in the periphery of the ocular fundus can be asymptomatic, but macular retinal folds cause diminished visual acuity and metamorphopsia. Currently, the most effective treatment for retinal folds is repeat surgery. Its serious disadvantage is the risk of complications in the early postoperative period, including hemophthalmia, inflammation, secondary glaucoma, cataracts, RRD recurrence, macular tears, retinal vascular occlusion, etc. The clinical case described below demonstrates the potential of combination laser therapy for the treatment of macular retinal folds based on the use of modern diagnostic and therapeutic methods.

[Subretinal air injection for treatment of retinal folds after retinal detachment surgery]

Hintergrund

Faltenbildungen der Netzhaut stellen ein Problem v. a. nach Vitrektomie oder Buckelchirurgie mit Gaseingabe dar. Liegen diese Falten im Makulabereich, wirkt sich das meist erheblich auf das Sehvermögen des Patienten aus. Im Folgenden wird eine Behandlungstechnik solcher Falten beschrieben.

Methode

In einem Zeitraum von Januar 2017 bis Juni 2020 wurden 6 Patienten mit der im Folgenden beschriebenen Behandlungstechnik operiert. Es erfolgte die erneute Abhebung der Netzhaut mittels Balanced Salt Solution (BSS), gefolgt von einer subretinalen Eingabe gefilterter Luft. Das Ausstreichen der Falte erfolgte mithilfe von Perfluorcarbon (PFC). Eine postoperative Drainage der subretinalen Luft und Flüssigkeit erfolgte nicht, die Spontanresorption wurde abgewartet.

Ergebnisse

Bei keinem Patienten kam es zu einer Visusverschlechterung nach erneuter Netzhautabhebung. Eine Verbesserung der Sehschärfe zeigte sich bei 4 von 6 Fällen. Eine Verminderung der Metamorphopsien konnte bei 5 von 6 Patienten erreicht werden, 2 Patienten gaben an, die Metamorphopsien gar nicht mehr wahrzunehmen. Nur 1 Patient berichtete über einen gleichbleibend verzerrten Seheindruck trotz anatomisch glatter zentraler Netzhaut.

Schlussfolgerung

Bei kritischer Indikationsstellung stellt unsere Behandlungstechnik eine sichere und erfolgreiche Vorgehensweise zur Behandlung von Netzhautfalten im Bereich der Makula nach Ablatiooperation dar.

Inner, outer, and full-thickness retinal folds after rhegmatogenous retinal detachment repair: A review

Partial-thickness folds of the inner retina and outer retina, as well as full-thickness retinal folds, may occur after the repair of rhegmatogenous retinal detachment. Although these can look similar on clinical examination, imaging with optical coherence tomography facilitates differentiation. With optical coherence tomography analysis, inner retinal folds exhibit corrugations of the inner retina while outer retinal folds display hyperreflective lesions located just above the retinal pigment epithelium that may extend into the outer nuclear layer. In the case of a classic full-thickness retinal fold, all layers of the neurosensory retina may separate together from the retinal pigment epithelium with retinal reduplication and base-to-base photoreceptor orientation. We review the pathogenesis, risk factors, prevention, and management options of retinal folds. As the terminology for retinal folds is diverse, we highlight optical coherence tomography-based descriptions for retinal folds that have been used in the literature. Factors predicting visual recovery, mechanisms of spontaneous fold regression, and the effect of internal limiting membrane peeling on the incidence of folds are potential areas of future study.

Impact of postoperative positioning on the outcome of pars plana vitrectomy with gas tamponade for primary rhegmatogenous retinal detachment: comparison between supine and prone positioning

PURPOSE

To compare the postoperative anatomic success rates and the frequency of complications between prone or supine postoperative positioning after transconjunctival sutureless vitrectomy (TSV) for rhegmatogenous retinal detachment (RRD).

METHODS

All patients underwent primary 27-gauge TSV for the treatment of primary RRD. Patients were divided into two groups as follows: group A was patients instructed to keep strict postoperative prone positioning for a minimum of 8 days. Group B was patients instructed to keep the prone positioning on the day of the surgery followed by supine positioning for minimum of 7 days from the day after surgery.

RESULT

Sixty-two eyes were enrolled (group A: 32, group B: 30). There was no significant difference in baseline data between two groups. The initial and final anatomical success rates were 93.8% and 100% in group A and 93.3% and 100% in group B, respectively (p = 1, p = 1, respectively). Posterior synechia of the iris occurred in one eye in group A and in two eyes in group B (p = 0.61). Macular pucker and retinal fold did not occur in either group. Preoperative intraocular pressure (IOP; mmHg) was 14.5 ± 2.9 in group A and 14.5 ± 2.6 in group B (p = 0.92). Intraocular pressure (IOP) was not statistically different between the groups during the follow-up period (p = 0.36, p = 0.07, respectively).

CONCLUSION

Supine positioning may be an option as a postoperative positioning after TSV and gas tamponade for the treatment of RRD.

Longitudinal study of macular folds by spectral-domain optical coherence tomography

PURPOSE

To understand the natural history of macular folds using serial spectral-domain optical coherence tomography (SD-OCT).

DESIGN

Prospective case series.

METHOD

Serial OCTs were performed using Topcon 3D OCT. The main outcome measures were: patient demographics; preoperative, perioperative, and postoperative details; serial SD-OCTs; and length of follow-up.

RESULTS

Ten patients who underwent standard 3-port pars plana vitrectomy with gas tamponade to repair rhegmatogenous retinal detachment were included in this study. Mean follow-up was 9.9 months (range 5-17 months). Three types of retinal folds were identified: 1) ripple; 2) taco; 3) displacement. Ripple and taco folds were found to resolve spontaneously. Outer retinal hyperreflective lesions resolved first, followed by flattening of the inner retinal layers. Displacement folds also resolved, but left the macula translocated inferiorly, causing binocular diplopia.

CONCLUSION

Ripple and taco folds could be managed conservatively with good outcomes. However, the optimal treatment of displacement folds requires further research.

Spontaneous resolution of macular fold following retinal reattachment: morphologic features on SD-OCT

Macular fold is an infrequent complication after retinal detachment surgery. In this report, long-term changes of macular fold are demonstrated using spectral-domain optical coherence tomography. Although spontaneous resolution was noted in this study, spectral-domain optical coherence tomography revealed morphologic changes in the photoreceptor layer after resolution of macular fold, hyperreflective photoreceptor outer segment, and distorted Henle's fiber layer, which might be associated with poor visual outcome even after resolution of the fold.

[Reasons for readmission to hospital after vitreoretinal surgery: 5-year retrospective follow-up]

INTRODUCTION

To study the etiologies and occurrence rate of readmissions after vitreoretinal surgery.

PATIENTS AND METHODS

One hundred fifty-three eyes requiring vitreoretinal surgery in 2000 at the Besançon (France) University Hospital were retrospectively studied. The occurrence rate and etiologies of these readmissions and the time between surgery and readmission were analyzed from the patient files.

RESULTS

The main indications for vitreoretinal surgery were retinal detachment, epiretinal membrane surgery, idiopathic macular holes, neovascular retrovascular membranes, and intravitreal hemorrhage. A total of 40.5% of the patients were readmitted. The major causes were redetachment and cataract for retinal detachment surgery and cataract for epiretinal membrane and macular hole surgeries.

CONCLUSION

The results highlight the possibly iatrogenic association between anterior and posterior eye segment surgeries, in agreement with the literature.

Macular translocation for neovascular age-related macular degeneration

BACKGROUND

Macular translocation has been proposed by vitreoretinal surgeons to displace the neuroretinal tissue onto healthy retinal pigment epithelium and choroid when the macula has been invaded by subretinal neovascularisation.

OBJECTIVES

This review aims at assessing the effectiveness of macular translocation for preserving or improving vision in patients with neovascular age-related macular degeneration (AMD).

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Caribbean Literature on Health Sciences (LILACS). There were no language or date restrictions in the search for trials.The electronic databases were last searched on 21 July 2008.

SELECTION CRITERIA

We included randomised or quasi randomised controlled trials comparing macular translocation with any other treatment or observation.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data. The risk ratio (RR) of visual loss and visual gain was estimated at one year after treatment.

MAIN RESULTS

Only one small unblinded study on 50 people compared full macular translocation with photodynamic therapy (PDT) in AMD patients with predominantly classic subfoveal choroidal neovascularisation (CNV). At the last examination, performed in most of the cases after one year, there was no difference in the rate of visual loss of 3 or more lines (translocation versus PDT: RR 0.56, 95% confidence interval (CI) 0.22 to 1.43), as well as in the mean change of contrast sensitivity (1 letter favouring translocation; 95% CI -3.51 to 5.51) and the rate of recurrence of CNV (translocation versus PDT: RR 1.56, 95% CI 0.83 to 2.91). Other outcomes significantly favoured translocation, such as the gain of 3 or more ETDRS lines (RR 21, 95% CI 1.30 to 340.02), the mean change of visual acuity (mean difference (MD) 14.60, 95% CI 5.39 to 23.81) and the mean change of near visual acuity score (MD 17.80, 95% CI 3.98 to 31.62) which is obtained with an algorithm. Serious complications reported after macular translocation were retinal detachment in 6/25 patients and diplopia requiring prismatic correction in 5/25 patients.

AUTHORS' CONCLUSIONS

There is insufficient evidence from randomised controlled trials on the effectiveness of macular translocation, which is also not free of important risks. Furthermore, this technique is difficult to perform and a long surgical training is required. Future studies might include patients with small neovascular lesions that failed to respond to current pharmacological therapies and are willing to accept the risks associated with surgery to try to improve visual acuity.