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Swaminathan VB, Salabati M, Israilevich R, Cehelyk E, Mahmoudzadeh R, Uhr JH, Spirn MJ, Klufas MA, Garg SJ, Hsu J. Outcomes following repair of early-onset versus delayed-onset rhegmatogenous retinal detachments after acute posterior vitreous detachment. Br J Ophthalmol 2024; 108:552-557. [PMID: 36918274 DOI: 10.1136/bjo-2022-322530] [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: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
AIM To report anatomical and functional outcomes after surgical repair of acute-onset vs delayed-onset rhegmatogenous retinal detachments (RDs) following acute posterior vitreous detachment (PVD). METHODS A retrospective, comparative interventional cohort study where patients presenting to a single-centre retina practice between October 2015 and March 2020 with delayed RDs (diagnosed ≥42 days after initial presentation of acute PVD) were compared with a 2:1 age-matched and gender-matched acute RD cohort (PVD and RD at initial presentation). The primary outcome was the final attachment rate and single surgery anatomic success (SSAS) at 3 months after RD repair. RESULTS A total of 210 eyes were analysed-70 in the delayed RD group and 140 in the acute RD group. SSAS was 58/70 (82.9%) for the delayed RD group and 112/140 (80%) for the acute RD group (p=0.71). At the time of RD diagnosis, mean (SD) logarithm of minimum angle of resolution visual acuity (VA) was 0.51 (0.70) (Snellen, 20/65) in the delayed RD group vs 1.04 (0.92) (Snellen, 20/219) in the acute RD group (p<0.001). Mean VA was better at 1 and 3 months post-repair in the delayed RD group (p=0.005 and 0.041, respectively) but similar by 6 months, 12 months and at the final visit post-repair (p=0.48, 0.27, and 0.23, respectively). CONCLUSIONS Delayed-onset RDs occurring ≥6 weeks after initial presentation to a retina specialist with an acute PVD generally had better VA at the time of RD diagnosis and faster post-surgical visual recovery compared with acute-onset RDs diagnosed at the initial presentation. No significant difference in anatomic outcomes was seen between the two groups.
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Affiliation(s)
| | - Mirataollah Salabati
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Rachel Israilevich
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eli Cehelyk
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Joshua H Uhr
- University of Miami Health System, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Marc J Spirn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Michael A Klufas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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Ferro Desideri L, Artemiev D, Zandi S, Zinkernagel MS, Anguita R. Proliferative vitreoretinopathy: an update on the current and emerging treatment options. Graefes Arch Clin Exp Ophthalmol 2024; 262:679-687. [PMID: 37843566 PMCID: PMC10907475 DOI: 10.1007/s00417-023-06264-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Proliferative vitreoretinopathy (PVR) remains the main cause of failure in retinal detachment (RD) surgery and a demanding challenge for vitreoretinal surgeons. Despite the large improvements in surgical techniques and a better understanding of PVR pathogenesis in the last years, satisfactory anatomical and visual outcomes have not been provided yet. For this reason, several different adjunctive pharmacological agents have been investigated in combination with surgery. In this review, we analyze the current and emerging adjunctive treatment options for the management of PVR and we discuss their possible clinical application and beneficial role in this subgroup of patients.
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Affiliation(s)
- Lorenzo Ferro Desideri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland.
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland.
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Dmitri Artemiev
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland
| | - Souska Zandi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rodrigo Anguita
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008, Bern, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Anguita R, Makuloluwa A, Bhalla M, Katta M, Sagoo MS, Charteris DG. Rhegmatogenous retinal detachment in choroidal melanoma: clinical features and surgical outcomes. Eye (Lond) 2024; 38:494-498. [PMID: 37596400 PMCID: PMC10858248 DOI: 10.1038/s41433-023-02709-3] [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: 04/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE To describe the clinical features, prognostic factors, safety and rate of success of surgery and visual outcomes in patients with rhegmatogenous retinal detachment (RRD) and choroidal melanoma (CM). METHODS A retrospective, observational case-series of 21 patients with rhegmatogenous retinal detachment or combined tractional-rhegmatogenous retinal detachment in patients with choroidal melanoma over a period of 20 years. RESULTS Nineteen patients were included in the final analysis. The mean elevation of CM was 4.0 mm and the mean largest diameter was 11.0 mm. RRD occurred after the CM treatment in 14 eyes at a mean interval of 44.2 months. The RRD was macula-on RRD in 6 eyes, there was posterior vitreous detachment (PVD) in 15 and PVR in 7 eyes. BCVA at presentation was 0.71 logMAR and final was 1.5 logMAR (p = 0.01). The primary surgical success rate was 59%. No intraocular or extraocular tumour dissemination occurred. Mean follow-up was 66 months. CONCLUSION RRD in patients with CM is uncommon but requires multidisciplinary management. Anatomical results are favourable but visual outcomes are poor due to a combination of factors related to melanoma treatment, macular retinal detachment and PVR. Vitrectomy as a surgical intervention for RRD in treated CM appears to be safe in terms tumour dissemination.
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Affiliation(s)
- Rodrigo Anguita
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK.
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK.
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland.
| | - Achini Makuloluwa
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Minak Bhalla
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Mohamed Katta
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, EC1V 2PD, UK
| | - David G Charteris
- Vitreoretinal Unit, Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, EC1V 2PD, UK
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Anguita R, Makuloluwa A, Sim SY, Flores-Sanchez B, Roth J, Charteris DG. LATE RECURRENCE OF RETINAL DETACHMENT: Incidence, Clinical Features, and Surgical Outcomes. Retina 2024; 44:83-87. [PMID: 37671784 DOI: 10.1097/iae.0000000000003924] [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: 09/07/2023]
Abstract
PURPOSE To describe and evaluate demographics, clinical features, prognostic factors, rate of success of surgery, incidence, and visual outcomes in patients with a late recurrence of rhegmatogenous retinal detachment over a 10-year period at a large tertiary referral eye center. METHODS A retrospective, observational case series of patients with late recurrence of retinal detachment, defined as redetachment after at least six months of total reattachment in non-proliferative vitreoretinopathy (PVR) rhegmatogenous retinal detachment, after pars plana vitrectomy (PPV) surgery with gas tamponade. RESULTS Thirty-nine patients had a late recurrence of rhegmatogenous retinal detachment of 16,396 rhegmatogenous retinal detachment operations. The mean of time between the first retinal detachment (RD) surgery and redetachment was 122.7 (SD 115) weeks. On presentation with late recurrence, 72% of eyes were pseudophakic and 64% were macula-off. In 28 eyes, small breaks were found. Thirty-eight percent had established PVR (PVR-C in 80%). Ninety-five percent underwent PPV. Gas was used in 61%. The initial secondary success rate was 64%. Initial best-corrected visual acuity was 1.32 logarithm of the minimum angle of resolution (logMAR) (6/120) and final was 0.8 logMAR (6/38; P value 0.002). CONCLUSION Late recurrence of retinal detachment is rare. It is characterized by small retinal breaks that may be difficult to visualize. Although cases can be treated with favorable anatomical results, visual outcomes are often less good and the success rate is lower.
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Affiliation(s)
- Rodrigo Anguita
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Achini Makuloluwa
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Sing Yue Sim
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Blanca Flores-Sanchez
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
| | - Janice Roth
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - David G Charteris
- Department of Vitreoretinal Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom ; and
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Ferro Desideri L, Zandi S, Zinkernagel MS, Anguita R. Challenges in proliferative vitreoretinopathy: is biological therapy a solution? Expert Opin Biol Ther 2023; 23:937-939. [PMID: 37581430 DOI: 10.1080/14712598.2023.2248881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Lorenzo Ferro Desideri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Souska Zandi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rodrigo Anguita
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Vitreoretinal department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Milner DC, Le C, Marin AI, Smith JM, Manoharan N. Outcomes of chronic macula-off retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2023; 261:709-714. [PMID: 36289075 PMCID: PMC9607701 DOI: 10.1007/s00417-022-05876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There have been disparate outcomes in the few studies that have looked at anatomic success and visual acuity (VA) in chronic retinal rhegmatogenous detachment (RRD) repair. Chronic retinal detachments (RD) without a posterior vitreous detachment (PVD) occur in young myopes often secondary to an atrophic hole. These patients are often asymptomatic, and studies report good surgical anatomic results. However, chronic RD with a PVD is symptomatic but presents late due to patient compliance. This paper aims to evaluate this lesser-studied chronic macula-off RD with PVD. METHODS After obtaining Institutional Review Board (IRB) approval, patients who had undergone surgical intervention for all diagnosis codes of RD were identified in the Denver Health Medical Center database. Medical records were reviewed, and patients found to have open-globe injuries, tractional RD due to proliferative diabetic retinopathy, macula-on detachments, and RD due to previous ocular surgery were excluded. Similarly, patients without PVD were also excluded. A total of 37 patients with PVD-type chronic macula-off RD were thus identified and preoperative characteristics, surgical intervention, and complications were analyzed. RESULTS The average patient age was 53.8 years. The length of RRD duration ranged from 30 to 365 days (mean 136.7 days). Twenty-six (70.3% patients had proliferative vitreoretinopathy (PVR) grade C or greater. Initial anatomic success-defined as re-attachment after one surgery-was 54.1%. The final attachment was 94.6%. Fifteen of 37 (40.5%) of the patients had issues with drop adherence, positioning, or missing post-operative appointments. CONCLUSION Chronic macula-off RD with a PVD should be identified as it is associated with much lower rates of initial re-attachment. Socioeconomic factors likely are the driving factor for patients with PVD-type chronic macula-off RD to present late, struggle with positioning, and have difficulty with follow-up and drop compliance. These extended periods without treatment then lead to high rates of PVR and poor initial anatomic success. However, repair of PVD-type chronic macula-off RD should still be pursued as final anatomic success is high.
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Affiliation(s)
- Dallin C Milner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Christopher Le
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA
| | - Alejandro I Marin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jesse M Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA. .,Denver and Health Sciences Center, University of Colorado, Denver, CO, USA. .,Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
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Anguita R, Ting MYL, Makuloluwa A, Charteris DG. Causal factors for late presentation of retinal detachment. Eye (Lond) 2023; 37:185-186. [PMID: 35614341 PMCID: PMC9130971 DOI: 10.1038/s41433-022-02109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Rodrigo Anguita
- Vitreoretinal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Magdalene Yin Lin Ting
- grid.436474.60000 0000 9168 0080Vitreoretinal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Achini Makuloluwa
- grid.436474.60000 0000 9168 0080Vitreoretinal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David G. Charteris
- grid.436474.60000 0000 9168 0080Vitreoretinal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Anguita R, Charteris D. Could real-world data replace evidence from clinical trials in surgical retinal conditions? Br J Ophthalmol 2022; 106:1037-1038. [PMID: 35580995 DOI: 10.1136/bjophthalmol-2022-321759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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