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Sothivannan A, Eshtiaghi A, Dhoot AS, Popovic MM, Garg SJ, Kertes PJ, Muni RH. Impact of the Time to Surgery on Visual Outcomes for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis. Am J Ophthalmol 2022; 244:19-29. [PMID: 35932819 DOI: 10.1016/j.ajo.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine the relationship between time from symptom onset or presentation to repair and visual outcomes for macula-on and macula-off rhegmatogenous retinal detachment (RRD). DESIGN Meta-analysis. METHODS We searched MEDLINE, EMBASE, and Cochrane Library for randomized controlled trials and observational studies comparing best-corrected visual acuity (BCVA) based on time to RRD repair. Study identifiers, baseline characteristics, intervention characteristics, and visual outcomes were extracted. We conducted a random effects meta-analysis. Sensitivity analyses included leave-1-out and influence analyses. Primary outcomes included mean difference (MD) in final BCVA, MD between preoperative and final BCVA (∆BCVA), and relative risk of final BCVA <0.4 logMAR for macula-off RRD repair in 0-3 vs 4-7 days and macula-on RRD repair in 0-24 vs >24 hours. Secondary outcomes assessed other time points. RESULTS Twenty observational studies reported on 1929 patients. Macula-off RRD repair in 0-3 days from symptom onset was superior to 4-7 days for final BCVA (MD -0.06 [95% CI -0.09, -0.03], P < .001) but was not different for ∆BCVA (P > .05). Macula-on repair in 0-24 hours from presentation was superior to >24 hours for final BCVA (MD -0.02 [95% CI -0.03, -0.01], P < .05) but was not different for ∆BCVA (P > .05). CONCLUSIONS Macula-off RRD repair in 0-3 days from symptom onset may have better final BCVA compared to repair in 4-7 days. Macula-on RRD repair in 0-24 hours of presentation may have better final BCVA compared to repair in >24 hours. These results were supported by moderate- and low-quality evidence, respectively, and may have been influenced by differences in baseline BCVA.
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Affiliation(s)
- Amirthan Sothivannan
- From the Michael G. DeGroote Faculty of Medicine, McMaster University (A.S.), Hamilton, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto (A.E., A.S.D.), Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto (A.E., A.S.D.), Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada
| | - Sunir J Garg
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre (P.J.K.), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada; Department of Ophthalmology, St Michael's Hospital/Unity Health Toronto (R.H.M.), Toronto, Ontario, Canada.
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Muni RH, Lee WW, Bansal A, Ramachandran A, Hillier RJ. A paradigm shift in retinal detachment repair: The concept of integrity. Prog Retin Eye Res 2022; 91:101079. [DOI: 10.1016/j.preteyeres.2022.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
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Israilevich RN, Starr MR, Mahmoudzadeh R, Salabati M, Swaminathan V, Huang D, Kuriyan AE, Yonekawa Y, Garg SJ, Mehta S, Regillo CD, Hsu J. Factors Associated With Good Visual Acuity Outcomes After Retinectomy in Eyes With Proliferative Vitreoretinopathy. Am J Ophthalmol 2022; 240:143-148. [PMID: 35288070 DOI: 10.1016/j.ajo.2022.02.028] [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: 12/06/2021] [Revised: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate factors associated with good visual acuity (VA) following repair of rhegmatogenous retinal detachments (RD) with proliferative vitreoretinopathy (PVR) undergoing retinectomy. DESIGN Interventional, retrospective, case-control study. METHODS This single-institution study evaluated patients who underwent retinectomy during repair of RD with PVR from January 1, 2015 to December 31, 2019. A good VA cohort was identified based on a final VA ≥20/70. A 2:1 age-matched and gender-matched poor VA cohort with VA <20/70 was subsequently identified. Metrics compared between the two cohorts included time from primary and recurrent RD diagnosis to surgery, lens status, initial RD size, macula involvement, PVR grade, and size of retinectomy. RESULTS A total of 5355 eyes were diagnosed with primary RD during the study period, of which 345 had PVR and underwent retinectomy. The good VA cohort included 62 eyes with a mean final logMAR VA of 0.32 [Snellen 20/42], while the poor VA cohort included 119 eyes with a mean final logMAR VA of 1.54 [Snellen 20/693; P < .0001]. On multivariate analysis, smaller initial RD size (P = .0090), fewer surgeries (P = .0002), shorter time between recurrent RD diagnosis and subsequent surgeries (P = .0006), better preoperative VA (P = .0276), and pseudophakia at final visit (P = .0049) remained significant predictors of good vision. CONCLUSION Eyes undergoing retinectomy during repair of RD with PVR can achieve good VA outcomes. The primary modifiable factor associated with better VA was shorter delay between redetachment diagnosis and surgery, particularly in the absence of silicone oil tamponade.
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Affiliation(s)
- Rachel N Israilevich
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Matthew R Starr
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Raziyeh Mahmoudzadeh
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Mirataollah Salabati
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Vishal Swaminathan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Denis Huang
- UC Davis Eye Center, Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, CA, USA
| | - Ajay E Kuriyan
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Yoshihiro Yonekawa
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Sunir J Garg
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Sonia Mehta
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Carl D Regillo
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H)
| | - Jason Hsu
- From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H).
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Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Dated October 2020. Ophthalmologe 2021; 118:132-134. [PMID: 34232367 DOI: 10.1007/s00347-021-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
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Stellungnahme von DOG, RG und BVA zur zeitlichen Planung der Versorgung einer rhegmatogenen Amotio retinae. Klin Monbl Augenheilkd 2021; 238:314-316. [PMID: 33784791 DOI: 10.1055/a-1364-4747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
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Lee CS, Shaver K, Yun SH, Kim D, Wen S, Ghorayeb G. Comparison of the visual outcome between macula-on and macula-off rhegmatogenous retinal detachment based on the duration of macular detachment. BMJ Open Ophthalmol 2021; 6:e000615. [PMID: 33782654 PMCID: PMC7957123 DOI: 10.1136/bmjophth-2020-000615] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/21/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the visual outcomes between macula-on and macula-off primary rhegmatogenous retinal detachment (RRD) based on the duration of macular detachment (DMD). Methods and Analysis Retrospective study including 96 eyes with RRD (34 macula-on and 62 macula-off) repaired between June 2012 and March 2020. The final visual acuity (VA) was compared after the patients were divided by the status of the macula and their DMD. Results The mean final VA of patients with macula-on RRD (group A) was logarithm of the minimum angle of resolution (logMAR) 0.04±0.07, which was not statistically different from that of individuals with macula-off RRD with DMD ≤3 days (group B; logMAR 0.05±0.06) (p=0.79). There were statistically significant differences in the final VA between group A and patients with macula-off RRD with DMD of 4–7 days (group C; logMAR 0.15±0.15) (p=0.017) as well as between group A and those with macula-off RRD with DMD ≥8 days (group D; logMAR 0.36±0.29) (p<0.001). There was no significant difference in the final VA between group B and C (p=0.33). Conclusion The mean final VA of patients with macula-on RRD was comparable to that of the macula-off patients with DMD ≤3 days. Our findings suggest that if macula-on RRD could not be immediately repaired, a repair within 72 hours may result in similar outcomes, even if the macula detaches within that time frame. However, once the macula detaches, we do not observe statistically significant differences in outcome for repairs done within 7 days.
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Affiliation(s)
- Chang Sup Lee
- Ophthalmology, West Virginia University, Morgantown, West Virginia, USA
| | - Karl Shaver
- Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Samuel Huisok Yun
- Ophthalmology, West Virginia University, Morgantown, West Virginia, USA
| | - Daniel Kim
- Ophthalmology, West Virginia University, Morgantown, West Virginia, USA
| | - Sijin Wen
- Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Ghassan Ghorayeb
- Ophthalmology, West Virginia University, Morgantown, West Virginia, USA
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[Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Situation October 2020]. Ophthalmologe 2021; 118:235-238. [PMID: 33459809 DOI: 10.1007/s00347-020-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
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9
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ROCK inhibition reduces morphological and functional damage to rod synapses after retinal injury. Sci Rep 2021; 11:692. [PMID: 33436892 PMCID: PMC7804129 DOI: 10.1038/s41598-020-80267-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/16/2020] [Indexed: 01/29/2023] Open
Abstract
Retinal detachment (RD) causes damage, including disjunction, of the rod photoreceptor-bipolar synapse, which disrupts vision and may contribute to the poor visual recovery observed after retinal reattachment surgery. We created a model of iatrogenic RD in adult female pigs to study damage to the rod-bipolar synapse after injury and the ability of a highly specific Rho-kinase (ROCK) inhibitor to preserve synaptic structure and function. This model mimics procedures used in humans when viral vectors or cells are injected subretinally for treatment of retinal disease. Synaptic disjunction by retraction of rod spherules, quantified by image analysis of confocal sections, was present 2 h after detachment and remained 2 days later even though the retina had spontaneously reattached by then. Moreover, spherule retraction occurred in attached retina 1-2 cms from detached retina. Synaptic damage was significantly reduced by ROCK inhibition in detached retina whether injected subretinally or intravitreally. Dark-adapted full-field electroretinograms were recorded in reattached retinas to assess rod-specific function. Reduction in synaptic injury correlated with increases in rod-driven responses in drug-treated eyes. Thus, ROCK inhibition helps prevent synaptic damage and improves functional outcomes after retinal injury and may be a useful adjunctive treatment in iatrogenic RD and other retinal degenerative diseases.
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Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greven MA, Leng T, Silva RA, Leung LSB, Karth PA, Moshfeghi DM, Sanislo SR, Schachar IH. Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment. Br J Ophthalmol 2018; 103:1503-1506. [PMID: 30504489 DOI: 10.1136/bjophthalmol-2018-313191] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/02/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine if final visual acuity (VA) is affected by duration of macular detachment (DMD) within the first week of macula-off retinal detachment (RD). METHODS This is a retrospective study of eyes that underwent repair within 7 days with vitrectomy or vitrectomy with scleral buckle for macula-off RD at Stanford University Hospital between 1 May 2007 and 1 May 2017. A generalised linear model was constructed using DMD, postoperative lens status, preoperative VA, patient age and surgeon as the independent variables and the final VA as the dependent variable. The main outcome measure was the final VA. RESULTS Seventy-nine eyes met the entry criteria. Group 1 included 52 eyes with RD repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD. The average final VA in group 1 eyes was logarithm of the minimum angle of resolution (logMAR) 0.21 (Snellen 20/33) and in group 2 eyes was logMAR 0.54 (Snellen 20/69). In group 1 and group 2 eyes, preoperative VA (p=0.017and p=0.007), DMD (p=0.004 and p=0.041) and final lens status (p<0.0001 and p<0.001) predicted postoperative VA. Post-hoc analysis showed significant differences in final VA between detachments of 1day vs 3 days (p=0.0009). CONCLUSION DMD affects the final VA even among patients whose DMD is <3 days. Based on these results, interventions that shorten DMD, including those occurring within the first 3days, may result in improved long-term VA outcomes.
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Affiliation(s)
- Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Theodore Leng
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ruwan Amila Silva
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Loh-Shan Bryan Leung
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Darius M Moshfeghi
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Steven R Sanislo
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ira H Schachar
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Brown GC, Brown MM, Stein JD, Smiddy WE, Brown GC, Brown MM, Geiger L, Lieske HB, Lieske PA, Sharma S, Smiddy WE, Stein JD, Stevens W. Vision-Related Quality of Life Associated with Unilateral and Bilateral Ocular Conditions. Ophthalmology 2018; 125:965-971. [DOI: 10.1016/j.ophtha.2017.12.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
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Wang J, Zarbin M, Sugino I, Whitehead I, Townes-Anderson E. RhoA Signaling and Synaptic Damage Occur Within Hours in a Live Pig Model of CNS Injury, Retinal Detachment. Invest Ophthalmol Vis Sci 2017; 57:3892-906. [PMID: 27472075 PMCID: PMC4974026 DOI: 10.1167/iovs.16-19447] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The RhoA pathway is activated after retinal injury. However, the time of onset and consequences of activation are unknown in vivo. Based on in vitro studies we focused on a period 2 hours after retinal detachment, in pig, an animal whose retina is holangiotic and contains cones. METHODS Under anesthesia, retinal detachments were created by subretinal injection of a balanced salt solution. Two hours later, animals were sacrificed and enucleated for GTPase activity assays and quantitative Western blot and confocal microscopy analyses. RESULTS RhoA activity with detachment was increased 1.5-fold compared to that in normal eyes or in eyes that had undergone vitrectomy only. Increased phosphorylation of myosin light chain, a RhoA effector, also occurred. By 2 hours, rod cells had retracted their terminals toward their cell bodies, disrupting the photoreceptor-to-bipolar synapse and producing significant numbers of spherules with SV2 immunolabel in the outer nuclear layer of the retina. In eyes with detachment, distant retina that remained attached also showed significant increases in RhoA activity and synaptic disjunction. Increases in RAC1 activity and glial fibrillary acidic protein (GFAP) were not specific for detachment, and sprouting of bipolar dendrites, reported for longer detachments, was not seen. The RhoA kinase inhibitor Y27632 significantly reduced axonal retraction by rod cells. CONCLUSIONS Activation of the RhoA pathway occurs quickly after injury and promotes synaptic damage that can be controlled by RhoA kinase inhibition. We suggest that retinal detachment joins the list of central nervous system injuries, such as stroke and spinal cord injury, that should be considered for rapid therapeutic intervention.
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Affiliation(s)
- Jianfeng Wang
- Department of Pharmacology Physiology, and Neuroscience, New Jersey Medical School-Rutgers Biomedical Health Sciences, Rutgers University, Newark, New Jersey, United States
| | - Marco Zarbin
- Institute of Ophthalmology and Visual Science, New Jersey Medical School-Rutgers Biomedical Health Sciences, Rutgers University, Newark, New Jersey, United States
| | - Ilene Sugino
- Institute of Ophthalmology and Visual Science, New Jersey Medical School-Rutgers Biomedical Health Sciences, Rutgers University, Newark, New Jersey, United States
| | - Ian Whitehead
- Department of Microbiology, Biochemistry, and Medical Genetics, New Jersey Medical School-Rutgers Biomedical Health Sciences, Rutgers University, Newark, New Jersey, United States
| | - Ellen Townes-Anderson
- Department of Pharmacology Physiology, and Neuroscience, New Jersey Medical School-Rutgers Biomedical Health Sciences, Rutgers University, Newark, New Jersey, United States
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Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature. Retina 2015; 34:1917-25. [PMID: 25121930 DOI: 10.1097/iae.0000000000000296] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To systematically review the influence of the lag time between macula-off retinal detachment and surgical intervention on postoperative visual acuity as main outcome measure. METHODS Systematic review and meta-analysis of articles published from 1995 to October 2013 of patients with macula-off retinal detachment and treated with scleral buckling or pars plana vitrectomy. Eligible data were pooled in a meta-analysis, analyzing the odds ratio between different durations of ≤ 3, ≤ 4, ≤ 7, and ≤ 10 days, comparing a final visual acuity of ≤ 0.4 logMAR with >0.4 logMAR, using a random-effects model. Last, the number needed to treat was calculated. RESULTS Fourteen articles were eligible, of which 9 studies contained data that were suitable for meta-analysis. Patients who were operated with scleral buckling (n = 602) within 3 days since macular detachment had a statistically significant better chance of reaching a final visual acuity of 0.4 logMAR or better compared with a longer duration of macular detachment, with an odds ratio for ≤ 3 days versus 4 days to 7 days of 2.86 (95% confidence interval, 1.37-5.99) and an odds ratio for ≤ 3 days versus >3 days of 3.09 (95% confidence interval, 1.56-6.12), and with a number needed to treat of 4. For pars plana vitrectomy, the limited amount of data precluded a meta-analysis with substantial results. CONCLUSION This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome.
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Lei L, Li T, Ding X, Ma W, Zhu X, Atik A, Hu Y, Tang S. Gas tamponade combined with laser photocoagulation therapy for congenital optic disc pit maculopathy. Eye (Lond) 2014; 29:106-14. [PMID: 25323852 DOI: 10.1038/eye.2014.245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/15/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the long-term clinical efficacy and safety of gas tamponade combined with laser photocoagulation for optic disc pit maculopathy. METHODS Seven consecutive patients with unilateral maculopathy associated with optic disc pit and one patient with bilateral optic disc pit maculopathy were given octafluoropropane (C3F8) tamponade combined with focal laser photocoagulation treatment. Patients were followed up for 21-62 months after treatment. Main outcomes were determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA). RESULTS Treatment with C3F8 tamponade followed by laser photocoagulation in ODP maculopathy patients resulted in resolution of sub-retinal and/or intra-retinal fluid in six out of eight patients. The remaining two patients had significant reduction in fluid, as determined by OCT, and funduscopy, as well as an improvement in anatomical architecture. Visual acuity improved obviously in seven eyes and remained stable in two eyes. Central visual field loss after photocoagulation was not clinically appreciable by visual field examination. No post-operative complications of maculopathy occurred during the follow-up period. CONCLUSIONS Although repeated treatment was needed in some patients, C3F8 tamponade combined with laser photocoagulation is still a simple, effective, minimally invasive, and economic therapy for optic disc pit maculopathy.
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Affiliation(s)
- L Lei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - T Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - X Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - W Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - X Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - A Atik
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Y Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - S Tang
- 1] State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China [2] Aier School of Ophthalmology, Central South University, Changsha, China
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Thelen U, Amler S, Osada N, Gerding H. Outcome of surgery after macula-off retinal detachment - results from MUSTARD, one of the largest databases on buckling surgery in Europe. Acta Ophthalmol 2012; 90:481-6. [PMID: 20529077 DOI: 10.1111/j.1755-3768.2010.01939.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the anatomical success rate of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and to evaluate the differences in outcome between patients suffering macula-off retinal detachment and those without a macular involvement. METHODS As a retrospective interventional case series, Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) is one of the largest ever established of retinal detachment patients and their outcome after buckling surgery, with 4325 patients who underwent surgery between 1980 and 2001. In 53.94% (n = 2134) of 3956 patients with nontraumatic retinal detachment, the macula was involved. The main outcome measure was the achievement of dry anatomical attachment of the retina. RESULTS The success rate in patients with macula-off retinal detachment is 80.46% and thus 7.78% lower (p < 0.01) than that in those patients with their macula intact whose success rate amounted to 88.24%. The overall success rate of all 4325 MUSTARD patients was 83.98%. CONCLUSIONS Scleral buckling is an established and mostly successful method for the treatment of retinal detachment. As our case series has demonstrated, even eyes with macula-off can be treated successfully by this procedure, thereby avoiding the complications of primary vitrectomy.
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Affiliation(s)
- Ulrich Thelen
- Germany Eye Hospital University of Münster, Münster, Germany.
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Koch KR, Hermann MM, Kirchhof B, Fauser S. Success rates of retinal detachment surgery: routine versus emergency setting. Graefes Arch Clin Exp Ophthalmol 2012; 250:1731-6. [PMID: 22476575 DOI: 10.1007/s00417-012-2007-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 03/06/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Surgery for rhegmatogenous retinal detachment (RRD) should usually be performed as soon as possible. However, a risk of operating in an emergency setting has to be considered against the risk of delaying it. METHODS In a retrospective, interventional, non-comparative clinical case series we reviewed the charts of all patients who underwent surgery for primary noncomplex RRD between February 1999 and July 2009. The primary anatomical success (PAS) of RRD surgery was the primary outcome measure, which was defined as permanent reattachment of the retina after a single surgical procedure. All cases were classified as (I) surgical cases, which were performed as emergency procedures the night of the patient's admission to the hospital (emergency setting), and as (II) those cases, which were operated in a routine setting during daytime (routine setting). Visual acuity was documented 2 and 6 months after surgery RESULTS 1810 cases of primary noncomplex RRD were analysed. PAS rates were 88.0 % in the routine setting and 87.3 % in the emergency setting (p = 0.67). While expert surgeons' PAS rates did not differ between routine and emergency, non-experts achieved inferior anatomical results, when performing surgery in the emergency setting (81.6 % vs. 88.3 %; p = 0.02). There was no difference between expert (87.7 %) and non-expert surgeons (88.6 %) in the routine setting (p = 0.75). There was no statistically significant difference in visual acuity. CONCLUSIONS Prompt RRD surgery in an emergency setting did not improve the anatomical outcome and was worse if performed by non-expert surgeons. The possibility to schedule surgery may improve delivery of care without compromising the outcome. Although we did not see a significant functional difference, there was a trend for better visual acuity for experts and routine setting. If one decides that prompt surgery is necessary, it should only be done by an experienced vitreoretinal surgeon.
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Affiliation(s)
- Konrad R Koch
- Center of Ophthalmology, Department of Vitreo-Retinal Surgery, University of Cologne, 50924, Cologne, Germany
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