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Rohowetz LJ, Jabbehdari S, Smiddy WE, Berrocal AM, Townsend JH, Chang JS, Yannuzzi N, Sridhar J, Haddock LJ, Fortun JA, Flynn HW. Retinal Detachment Associated with Retinal Dialysis: Clinical Features and Outcomes of Surgery in a 10-Year Study. Ophthalmol Retina 2023; 7:857-861. [PMID: 37379884 PMCID: PMC10592222 DOI: 10.1016/j.oret.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To report the surgical approaches and outcomes in patients undergoing surgery for retinal detachment associated with retinal dialysis. DESIGN Retrospective, consecutive case series. SUBJECTS All patients who underwent surgery for retinal detachment secondary to retinal dialysis between January 1, 2012, and January 1, 2022. METHODS Retrospective consecutive case series. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), single-operation success rate. RESULTS The study cohort included 60 eyes of 58 patients with a mean age of 26.4 (standard deviation, 13.0) years. Males comprised 49 (84.5%) patients. Known trauma occurred in 35 (61.4%) cases. Initial surgical management included scleral buckling (SB) in 49 (81.7%) eyes and combined SB and pars plana vitrectomy (PPV) in 11 (18.3%) eyes. Preoperative BCVA correlated with BCVA at last follow-up visit (r = 0.66; P < 0.001). At last visit, the SB group had a mean logarithm of the minimum angle of resolution BCVA of 0.36 (20/46) and a single-operation success rate of 76.9% at 6 months, whereas the SB/PPV group had a mean logarithm of the minimum angle of resolution BCVA of 1.08 (20/238) and single-operation success rate of 77.8% (P = 0.04 and P = 0.96, respectively). Six eyes in the SB/PPV group received silicone oil tamponade. In eyes with at least 1 year of follow-up, 4 (14.8%) in the SB group and 6 (100%) in the SB/PPV group developed a visually significant cataract requiring cataract surgery (P < 0.001). CONCLUSIONS Retinal detachment associated with retinal dialysis is typically associated with trauma and more often occurs in young male patients. The current study confirms that SB without PPV is an effective initial treatment strategy for most patients with retinal dialysis and has a low rate of cataract formation. 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)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Luis J Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florid.
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Bonnar J, Tan CH, McCullough P, Wright DM, Williamson T, Lois N. Scleral Buckle, Vitrectomy, or Combined Surgery for Inferior Break Retinal Detachment: Systematic Review and Meta-Analysis. Ophthalmol Retina 2023; 7:837-847. [PMID: 37187441 DOI: 10.1016/j.oret.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
TOPIC To compare outcomes of scleral buckle (SB), pars plana vitrectomy (PPV), and combined PPV-SB to treat rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs). CLINICAL RELEVANCE Rhegmatogenous retinal detachments with IRBs are not uncommon; their management is challenging with higher risk of failure. There is no consensus about their treatment, specifically whether SB, PPV, or PPV-SB should be performed. METHODS Systematic review and meta-analysis. Randomized controlled trials, case-control, and prospective/retrospective series (if n > 50) in English were eligible. Medline, Embase, and Cochrane databases were searched up to January 23, 2023. Standard systematic review methods were followed. The following outcomes at 3 (± 1) and 12 (± 3) months were evaluated: number of eyes with retinal reattachment after ≥ 1 surgeries, change in best-corrected visual acuity from preoperative to postoperative levels, and number of eyes with improvement of > 10 and > 15 ETDRS letters after surgery. Authors of eligible studies were asked for individual participant data (IPD) and IPD meta-analysis was undertaken. Risk of bias was assessed using National Institutes of Health study quality assessment tools. This study was registered prospectively in PROSPERO (CRD42019145626). RESULTS A total of 542 studies were identified: 15 were eligible and included and 60% were retrospective. Individual participant data was obtained from 8 studies (1017 eyes). Given that only 26 patients had received SB alone, these data were not considered in the analysis. There was no evidence for differences between treatment groups (PPV versus PPV-SB) in the probability of having a flat retina at 3 or 12 months postoperatively after 1 (P = 0.067; odds ratio [OR], 0.47; P = 0.408; OR 2.55; respectively) or > 1 (OR, 0.54; P = 0.21; OR, 0.89; P = 0.926; respectively) surgery. Pars plana vitrectomy-SB showed less improvement in vision postoperatively at 3 months (estimate, 0.18; 95% confidence interval, 0.01-0.35; P = 0.044), but this difference was no longer observed at 12 months (estimate, -0.07; 95% confidence interval, -0.27, 0.13; P = 0.479). CONCLUSION Available evidence suggests a lack of benefit of adding SB to PPV to treat RRDs with IRBs. Evidence, however, comes mainly from retrospective series and, thus, despite the large number of eyes included, should be interpreted with caution. Further research is needed. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jonathan Bonnar
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Chin Han Tan
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Philip McCullough
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - David M Wright
- Center for Public Health, Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland.
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Cohen S, Shiuey EJ, Zur D, Rachmiel R, Kurtz S, Mezad-Koursh D, Waisbourd M. Ocular injury from foam dart (Nerf) blasters: a case series. Eur J Pediatr 2023; 182:1099-1103. [PMID: 36575309 DOI: 10.1007/s00431-022-04782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
To report clinical outcomes following ocular injury from foam dart (nerf) blasters - a spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity. These guns gained popularity in recent years among children and adolescents. Eleven patients with ocular injuries from foam dart blasters were included in this retrospective, single-center study. Visual acuity (VA), intraocular pressure (IOP), and anterior segment, glaucoma-related, and vitreoretinal complications were recorded at each visit. The average age at presentation was 13.4 years and 82% were male. Mean initial VA was 6/12 (range 6/6 - 1/18); On initial examination, nine patients (82%) had hyphema, three (27%) had corneal abrasions, three (27%) had vitreous hemorrhage, and two (18%) had traumatic mydriasis. Four patients (36%) experienced glaucoma-related complications, including three (27%) with angle recession and three (27%) with increased IOP. Three patients (27%) were diagnosed with posterior segment injuries, including three (27%) with commotio retinae and one (9%) with severe retinal photoreceptor damage. No patients required surgical intervention. CONCLUSION Foam dart blasters can cause severe blunt ocular trauma and permanent visual loss, illustrating the need for eye protection when handling these toys. WHAT IS KNOWN • Foam dart blasters, a blanket term for spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity, have gained popularity in recent years among pediatric populations, with an increase in associated ocular injuries. • To date, scattered case reporting provides insufficient insight into the full clinical spectrum of injury and prognosis of foam dart blasters related ocular injury. WHAT IS NEW • This case series characterizes the myriad foam dart blasters injuries that may afflict the eye, most of which are self-limiting, but some of which may result in poor visual outcomes and lifelong disability in pediatric patients. • We strongly recommend that all users wear eye protection while using foam dart blasters.
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Affiliation(s)
- Shai Cohen
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Dinah Zur
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Rony Rachmiel
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Shimon Kurtz
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Michael Waisbourd
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
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Mahmoudzadeh R, Huang D, Salabati M, Awh K, Garg S, Hsu J, Ho A, Regillo C. Clinical Characteristics and Management Outcomes of Rhegmatogenous Retinal Detachments Due to Retinal Dialysis. JOURNAL OF VITREORETINAL DISEASES 2021; 5:405-411. [PMID: 37008705 PMCID: PMC9976130 DOI: 10.1177/24741264211024127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This work assesses the clinical characteristics and outcomes of various treatment methods in managing rhegmatogenous retinal detachments secondary to retinal dialysis. METHODS In this retrospective, consecutive case series, patients presenting to a tertiary referral vitreoretinal service from 2015 to 2020 were chosen. The primary outcome measure was the single-surgery anatomic success (SSAS) rate in the first 90 days after surgery and overall SSAS rate until the last visit. RESULTS Eighty-six eyes of 84 patients were included. Mean (SD) age was 30 (14.8) years (range, 7-71 years). Fifty-nine (70%) patients were men and 55 eyes (64%) had a history of trauma. Dialysis occurred in the inferotemporal quadrant in 50 eyes (58%) of the entire cohort and 25 of 55 eyes (45%) with prior trauma. Fifty-one eyes (59.3%) were managed by scleral buckle (SB), 25 eyes (29.2%) with laser retinopexy, and 10 eyes (11.6%) with pars plana vitrectomy (PPV). The SSAS rate in the first 90 days after surgery was 94.1% (81 of 86 eyes), including 90.1% of eyes with SB, 100% of eyes with laser retinopexy, and 100% of eyes with PPV (P = .07). The overall SSAS rate, however, was 89.5% (77 of 86) eyes, including 90.1% of eyes with SB, 84% of eyes with laser retinopexy, and 100% of eyes with PPV (P = .4). Final attachment rate was 100% in the entire cohort. CONCLUSIONS With careful consideration of underlying pathology, all 3 treatment modalities can provide high rates of anatomic and functional success.
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Affiliation(s)
- Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Denis Huang
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katherine Awh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sunir Garg
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen Ho
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carl Regillo
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Yap J, Cole R, Guest SJ. Pars Plana Vitrectomy With or Without Circumferential Scleral Buckling for Primary Repair of Retinal Detachments Secondary to Retinal Dialysis. Asia Pac J Ophthalmol (Phila) 2020; 9:435-439. [PMID: 32694346 DOI: 10.1097/apo.0000000000000309] [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: 10/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the anatomical and functional outcomes after pars plana vitrectomy with or without circumferential scleral buckling, in patients with retinal detachment secondary to retinal dialysis. DESIGN Case series. METHODS A retrospective consecutive case series involving 30 eyes of 30 patients with retinal detachments secondary to retinal dialysis was completed. All 30 patients underwent primary pars plana vitrectomy, with the addition of a circumferential scleral buckle in 24 patients. The main outcome measure was the primary reattachment rate at 6 months after a single surgery. RESULTS Primary anatomical success was achieved in 90% of patients. The final anatomical success rate was 93%, with 4 of 30 eyes still having silicone oil in situ. The main indication for vitrectomy surgery was an inadequate fundal view for scleral buckle surgery alone. The macula was detached in 50% of patients and proliferative vitreoretinopathy grade C was found in 23% of cases. The mean preoperative visual acuity was 20/814 (range 20/20-light perception) and the mean postoperative visual acuity was 20/258 (range 20/20-hand movements). CONCLUSIONS Good final anatomical success rates can be achieved with pars plans vitrectomy, plus or minus circumferential buckling, in patients with retinal detachments secondary to retinal dialysis.
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Affiliation(s)
- Joel Yap
- Green Lane Hospital Ophthalmology Department, Auckland, New Zealand
| | - Rebecca Cole
- Green Lane Hospital Ophthalmology Dept, Auckland, New Zealand
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Kumar P, Hoover DL, Lambert SR. Partial scleral buckle removal during strabismus surgery after retinal detachment repair. J AAPOS 2019; 23:16.e1-16.e4. [PMID: 30625364 DOI: 10.1016/j.jaapos.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/03/2018] [Accepted: 08/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe outcomes after partial scleral buckle removal at the time of strabismus surgery. METHODS The medical records of consecutive patients with symptomatic diplopia who underwent strabismus surgery after scleral buckling by two surgeons were reviewed retrospectively. All patients underwent forced duction testing and had a segment of the scleral buckle removed intraoperatively. Pre- and postoperative ocular motility and alignment were compared. The outcome was considered successful if residual horizontal deviation was ≤8Δ, vertical deviation ≤2Δ, and cyclotropia <5°. RESULTS A total of 12 patients (mean age, 51 years; range, 14-71 years) with a mean horizontal deviation of 16Δ (range, 2Δ-40Δ) and mean vertical deviation of 10Δ (range, 2Δ-20Δ) were included. Three patients underwent 2 strabismus surgeries. All patients underwent intraoperative removal of a segment of the scleral buckle near a muscle being advanced or recessed at the time of surgery. An adjustable suture technique was used in 13 of 15 surgeries (86%). Orthotropia was achieved in 7 patients (58%); surgical success, in 11 (92%). Subjective resolution of diplopia was achieved in all patients, in 2 with the aid of prisms. Mean follow-up was 12.4 months (range, 1-75). No patient had retinal redetachment. CONCLUSIONS In this case series, removal of a segment of the scleral buckle facilitated advancement or recession of a rectus muscle and was associated with good outcomes without retinal redetachment.
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Affiliation(s)
- Priyanka Kumar
- Department of Ophthalmology, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | - Darren L Hoover
- Everett & Hurite Ophthalmic Association, Pittsburgh, Pennsylvania
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
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7
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Uzel MM, Citirik M, İlhan Ç, Tekin K. The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value. Int Ophthalmol 2018; 39:2089-2095. [DOI: 10.1007/s10792-018-1045-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
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8
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TENON CAPSULE-VITREOUS CAVITY FISTULA AFTER HYDROGEL SCLERAL BUCKLE REMOVAL. Retin Cases Brief Rep 2018; 14:360-363. [PMID: 29485478 DOI: 10.1097/icb.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a rare case of vitreous cavity-Tenon capsule fistula formation after removal of a symptomatic hydrogel scleral buckle. METHODS Case report. RESULTS A 43-year-old man presented with chronic headache and involuntary gaze deviation for over 1 year after hydrogel scleral buckle surgery 25 years prior. After removal of the scleral buckle, the patient developed a fluid-filled inflation of the buckle capsule, surrounding a previously noted area of severe scleral thinning. Ocular ultrasonography suggested a fistulous connection between the vitreous cavity and the sub-Tenon space in the area of scleral thinning. There was resolution of diplopia and headache postoperatively, with stability of the fluid collection on clinical examination. Because of high risk of further surgery and resolution of the patient's symptoms, conservative management was elected. CONCLUSION This is the first report, to the best of our knowledge, of Tenon capsule-vitreous cavity fistula formation after scleral buckle explantation. Because of innate ability to expand, as well as tendency to become friable, hydrogel buckles have a higher risk of requiring removal and of complications from explantation, respectively. Our patient experienced relief of symptoms, without complication from the fistula, and was successfully managed conservatively.
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9
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Hodgetts DJ. Nonsurgical Management of Diplopia After Retinal Surgery. ACTA ACUST UNITED AC 2017; 62:38-43. [DOI: 10.3368/aoj.62.1.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David J. Hodgetts
- Department of Ophthalmology, Albany Medical College, Albany, New York
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10
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Abstract
PURPOSE To present and analyze the anatomical and functional outcomes for scleral buckling (SB) in a group of patients with rhegmatogenous retinal detachment without posterior vitreous detachment. METHODS A total of 244 patients underwent SB from 2005 through 2014 by a single surgeon (A.W.E.). Forty patients (45 eyes) were identified as fulfilling the criteria of presenting with a rhegmatogenous retinal detachment without posterior vitreous detachment. Visual outcomes, preoperative retinal findings, and the SB technique were analyzed. The main outcome measure was the primary reattachment rate at 6 months after single surgery. RESULTS The mean age was 29 years (range 11-51 years). The mean follow-up period was 20 months. The mean refractive error was -5.16 diopters. Subretinal fluid drainage was performed in 17 eyes (37.8%). The anatomical success rate after single SB surgery at 6 months was 91.1%. The only factor that had statistically significant correlation with primary anatomical failure was development of subretinal hemorrhage during the drainage procedure (P = 0.03). CONCLUSION Despite an increasing trend toward primary vitrectomy for rhegmatogenous retinal detachment, an indication for SB is in younger patients without a preexisting posterior vitreous detachment. We showed a 91.1% success rate with a primary SB and 100% with a second surgery.
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Kim WJ, Jeong A, Kim MM. A Case of Surgical Treatment of Large-angle Esotropia after Scleral Buckling without Buckle Removal. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.3.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Areum Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung Mi Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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12
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Scleral buckling in phakic uncomplicated primary rhegmatogenous retinal detachment: long-term outcomes. Eur J Ophthalmol 2016; 27:220-225. [PMID: 28106235 PMCID: PMC6379801 DOI: 10.5301/ejo.5000914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Purpose Scleral buckling (SB) is a surgical technique that has been used successfully
to treat retinal detachments for the last 6 decades. The aim of this study
was to report the long-term anatomical and functional outcomes of SB surgery
in phakic patients with uncomplicated primary rhegmatogenous retinal
detachment (PRRD). This article also outlines the benefits of SB compared to
pars plana vitrectomy, such as reducing the risk of developing cataract,
high intraocular pressure, and glaucoma, in addition to reducing surgical
cost. Methods We retrospectively reviewed the clinical notes of 90 phakic eyes with PRRD
treated with SB surgery that had a minimum of 5 years follow-up.
Preoperative and postoperative characteristics were recorded. Main outcome
measures were reattachment rate, best-corrected visual acuity (BCVA)
improvement, and complications. Results A total of 90 eyes (88 patients) with phakic PRRD repaired through SB surgery
were included. Mean age was 49.2 ± 14.6 years (range 20-80). Primary and
final anatomic success was 96.7% and 100%, respectively. Mean preoperative
BCVA was 0.3 ± 0.31 logMAR (6/12) and mean postoperative BCVA 0.1 ± 0.2
logMAR (p<0.001) (6/7.5). There were no cataract or primary open-angle
glaucoma cases after 1 year of follow-up. Mean follow-up was 8.5 ± 2.6 years
(range 5-13). Conclusions We report a high single operation success rate over time in phakic PRRD,
repaired through SB surgery. Functional and anatomical success was
maintained throughout the follow-up without complications. Therefore, the
authors recommend the use of this technique in selected cases in order to
reduce morbidity and the incidence of reoperations.
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13
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Timing and Outcomes of Vitreoretinal Surgery after Traumatic Retinal Detachment. J Ophthalmol 2016; 2016:4978973. [PMID: 27999681 PMCID: PMC5141321 DOI: 10.1155/2016/4978973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Traumatic retinal detachments are a significant cause of morbidity. There are currently no evidence-based guidelines on the appropriate time to perform vitreoretinal surgery to repair a traumatic retinal detachment. Early intervention, within seven days of the inciting trauma, may decrease proliferative vitreoretinopathy and postoperative endophthalmitis. Later intervention may yield a reduced risk of inflammation and hemorrhage, particularly in cases of concomitant open globe injuries. This article reviews the literature on the management of retinal detachments associated with ocular trauma from the years 2006 to 2016. Particular focus was placed on the timing of surgery, concomitant open globe injury, anatomical success rates, visual acuity, and complication rates. In this review, anatomical success was not significantly related to timing of intervention when compared between early and delayed intervention in eyes with and without concomitant open globe injuries. Visual acuities postoperatively varied widely despite timing of intervention due to the large variation in mechanism and extent of ocular injuries. Proliferative vitreoretinopathy was a common complication. Preliminary data indicate that endophthalmitis rates may be lower when early vitreoretinal surgery is performed. There is insufficient data to conclude whether early or delayed surgery leads to improved outcomes, highlighting the need for further research in this domain.
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Moisseiev E, Fogel M, Fabian ID, Barak A, Moisseiev J, Alhalel A. Outcomes of Scleral Buckle Removal: Experience from the Last Decade. Curr Eye Res 2016; 42:766-770. [DOI: 10.1080/02713683.2016.1245423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elad Moisseiev
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Fogel
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ido Didi Fabian
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adiel Barak
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Moisseiev
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Alhalel
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Shankar V, Lim LT, Ah-Kee EY, Hammer H. Outcome of rhegmatogenous retinal detachment repair by scleral buckling: The experience of a tertiary referral center in Scotland. Oman J Ophthalmol 2014; 7:130-4. [PMID: 25378877 PMCID: PMC4220399 DOI: 10.4103/0974-620x.142595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The primary aim of this study is to report the outcome of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling (SB) surgery. Methods: This is a retrospective noncomparative case series study of all patients who underwent RRD repair by primary SB between March 2008 and February 2009. Patient demographics, visual outcome, complications, and failure rates were identified and recorded. Results: A total of 65 patients underwent RRD repair by SB, with a mean age of 44.44 years. Results showed that the primary outcome (primary anatomical success following index surgery) was 90.77%, while the secondary outcome (anatomical success following repeat surgery) was 98.46%. Conclusion: The study showed a high-success rate of SB in phakic eyes both in terms of postoperative best-corrected visual acuity and complication rates. We recommend the continued use of this technique in selected cases of RRD.
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Affiliation(s)
- Vikas Shankar
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Lik Thai Lim
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | | | - Harold Hammer
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
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Chang JH, Hutchinson AK, Zhang M, Lambert SR. Strabismus surgery outcomes after scleral buckling procedures for retinal reattachment. Strabismus 2014; 21:235-41. [PMID: 24299332 DOI: 10.3109/09273972.2013.851260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the outcomes of strabismus surgery in patients with a prior history of a scleral buckling procedure for retinal reattachment. METHODS We reviewed the medical records of 18 patients who underwent strabismus surgery following a scleral buckling procedure and investigated the effect of multiple variables on postoperative alignment after strabismus surgery including gender, age, surgeon, number of strabismus surgeries, adjustable suture use, previous pars plana vitrectomy, preoperative best-corrected visual acuity, and scleral buckle removal. Outcomes were considered successful if there was ≤ 10 prism diopters (PD) residual horizontal and/or ≤ 4 PD residual vertical deviations. Statistical analyses were performed using Fisher's exact test, Mann-Whitney test, and nominal logistic regression. RESULTS Success using our criteria of motor alignment was achieved in 6 of 18 eyes (33%). A higher rate of success was found in the scleral buckle removal group (success with buckle removal, 62.5%; success without buckle removal, 10.0%; p = 0.04). Nominal logistic regression analysis showed scleral buckle removal was the most significant factor associated with successful surgical alignment (p = 0.03; odds ratio = 16.67). Although the success rate was higher in the adjustable suture group (50% in adjustable group vs 14.3% in non-adjustable group: Fisher's exact test, p = 0.30), this difference was not statistically significant. No retinal redetachments occurred after scleral buckle removal. CONCLUSIONS These results suggest that scleral buckles can be safely removed in selected patients with strabismus following retinal reattachment surgery and scleral buckle removal may improve ocular alignment following strabismus surgery.
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Affiliation(s)
- Jee Ho Chang
- Department of Ophthalmology, Emory University School of Medicine , Atlanta , GA , and
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Goto T, Nakagomi T, Iijima H. A comparison of the anatomic successes of primary vitrectomy for rhegmatogenous retinal detachment with superior and inferior breaks. Acta Ophthalmol 2013; 91:552-6. [PMID: 22691313 DOI: 10.1111/j.1755-3768.2012.02455.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the anatomic success between repair of rhegmatogenous retinal detachment (RRD) with superior breaks and repair of RRD with inferior breaks, by performing primary vitrectomy and using similar techniques and the same gas. METHODS Eighty-two consecutive eyes of 80 patients with RRD were included in this retrospective comparative study. The eyes were divided into two groups according to the location of the breaks: superior (n = 62) and inferior (n = 20). All the patients underwent a standard, 3-port, 20-gauge pars plana vitrectomy with 20% sulphur hexafluoride gas tamponade performed by the same surgeon. The main outcome measured was the primary anatomic reattachment at 3 months after surgery. RESULTS The primary anatomic success rate in the inferior group was significantly lower than that in the superior group (80% versus 98%, p = 0.012). In the inferior group, the primary anatomic success rate in patients whose symptoms lasted for more than 2 weeks was significantly lower than that in others (5/9 versus 11/11, p = 0.026). Multivariate logistic regression analysis identified inferior break as the only independent risk factor for redetachment (odds ratio, 11.88; p = 0.034). CONCLUSION The anatomic success of primary vitrectomy for RRD with inferior breaks is lower than that for RRD with superior breaks. In particular, the duration of symptoms longer than 2 weeks is associated with a worse outcome in patients who had RRD with inferior breaks.
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Affiliation(s)
- Teruhiko Goto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan.
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Scleral buckle removal: indications and outcomes. Surv Ophthalmol 2012; 57:253-63. [PMID: 22516538 DOI: 10.1016/j.survophthal.2011.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/26/2011] [Accepted: 11/03/2011] [Indexed: 11/20/2022]
Abstract
Primary scleral buckling has been an effective means to reattach the retina for over 50 years. After surgery, complications may arise that require scleral buckle (SB) removal. The most common indications for SB removal are extrusion, infection, and pain. I review the pertinent literature in an effort to develop guidelines for when to remove a SB.
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Wong V, Kasbekar S, Young J, Stappler T, Marsh IB, Durnian JM. The effect of scleral exoplant removal on strabismus following retinal detachment repair. J AAPOS 2011; 15:331-3. [PMID: 21907112 DOI: 10.1016/j.jaapos.2011.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/10/2011] [Accepted: 03/11/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Scleral buckling for retinal detachment is a well-reported cause of secondary strabismus. We analyzed the effects on motility of removal of the exoplant alone to determine whether this is warranted as a separate step in the surgical management of these patients. METHODS A retrospective case series of patients who underwent scleral exoplant removal due to symptomatic strabismus development following retinal detachment repair from 2007 to 2009 was conducted. Manifest horizontal and vertical deviations were treated as vectors of a single combined deviation (|dev|). Pre- and postoperative manifest |dev| in the primary position (|dev|(pp)) and in the gaze position of maximal deviation (|dev|(max)) were analyzed. RESULTS Five patients were identified, all with symptomatic, binocular diplopia in the primary position prior to exoplant removal. Median |dev|(pp) prior to exoplant removal was 21(Δ) and following removal was 21(Δ) (P = 0.81). The median |dev|(max) prior to exoplant removal was 33(Δ) and following removal, 22(Δ) (P = 0.82). Median follow-up was 8 months. There were no cases of retinal redetachment following the exoplant removal. No patient reported any subjective improvement of their diplopia. All 5 patients went on to have strabismus surgery as a separate procedure. CONCLUSIONS Median primary position deviation was unchanged by scleral buckle removal, and Exoplant removal has minimal long-term benefit on the strabismus following scleral buckling procedures.
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Affiliation(s)
- Vicki Wong
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
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