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Nielsen BR, Alberti M, Høgild ML, Bek T, Thinggaard BS, Grauslund J, Christensen U, la Cour M. The role of phacoemulsification surgery in the incidence rate of rhegmatogenous retinal detachment. Acta Ophthalmol 2024. [PMID: 38785299 DOI: 10.1111/aos.16723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To investigate changes in the incidence rate of primary rhegmatogenous retinal detachment (RRD) surgery over time and to determine to what extent these changes can be attributed to pseudophakia. METHODS This nationwide cohort study was based on national patient registries. The study population comprised individuals at risk of RRD aged 40 years and above from 2006 to 2021 in Denmark. The primary outcome was RRD incidence, and the exposure was phacoemulsification surgery. A chart review was conducted to validate and examine the lens status of the outcome. RESULTS The crude and age-adjusted incidence rate of RRD in the Danish population increased significantly during the study period. The largest increase in RRD was seen in phakic RRD (phRRD) (65%), whereas pseudophakic RRD (pRRD) accounted for 35% of the total increase. A chart review revealed that 17% of phRRDs were misclassified as pseudophakic, resulting in pRRD accounting for a total of 45% of the increase in RRD. The prevalence of pseudophakia in Denmark grew significantly for all age groups and for both sexes (p = 10-6) from 2006 to 2021, but the 1-year incidence of pRRD in the pseudophakic population was constant throughout the entire period. CONCLUSION The incidence rate of RRD is continuing to increase in Denmark. The increase in phRRD remains undetermined, and while the risk of pRRD seemed to be constant during the study period, 45% of the overall increase in RRD could be attributed to the rise of a growing pseudophakic population.
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Affiliation(s)
- Birgitte Romme Nielsen
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Alberti
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Morten Lyng Høgild
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Benjamin Sommer Thinggaard
- OPEN Data Explorative Data Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Ulrik Christensen
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Chahar A, Sen A, Shukla D, Talwar D. THE ROLE OF INTRAVITREAL METHOTREXATE AS AN ADJUNCT TO LOCAL OR SYSTEMIC CORTICOSTEROIDS IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT AND CHOROIDAL DETACHMENT: A Pilot Study. Retina 2024; 44:774-781. [PMID: 38194672 DOI: 10.1097/iae.0000000000004046] [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: 01/11/2024]
Abstract
PURPOSE To evaluate the role of repeated intravitreal methotrexate as an adjunct to pars plana vitrectomy in the management of rhegmatogenous retinal detachment with choroidal detachment. METHOD The authors compared anatomical and visual outcomes of rhegmatogenous retinal detachment with choroidal detachment eyes that underwent pars plana vitrectomy with (Group B) or without repeated intravitreal methotrexate (Group A). RESULTS The study included 25 eyes of 25 patients, 16 eyes in Group A and nine in Group B. Both groups had similar baseline characteristics. In Group A, successful retinal attachment was achieved in 50% as compared with 89% in Group B; however, the difference was not statistically significant ( P = 0.08). Also, Group B had a significantly greater change in visual acuity from baseline to the last follow-up visit (1.6 + 1.5 logMAR units) compared with Group A (1.18 + 1 logMAR units) ( P = 0.05). There were no significant safety concerns with the use of intravitreal methotrexate. CONCLUSION Repeated intravitreal methotrexate after vitrectomy for rhegmatogenous retinal detachment with choroidal detachment improves outcomes without posing major safety concerns. Nonetheless, further investigation is necessary to establish the optimal intravitreal methotrexate dosage and duration to prevent recurrence effectively.
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Affiliation(s)
- Annu Chahar
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Alok Sen
- Department of Vitreo-Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Dhananjay Shukla
- Department of Retinal and Vitreous, Ratan Jyoti Eye Hospital, Gwalior, India ; and
| | - Dinesh Talwar
- Department of Retina and Vitreous, Indraprastha Apollo Hospital, New Delhi, India
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Salabati M, Massenzio E, Kim J, Awh K, Anderson H, Mahmoudzadeh R, Wakabayashi T, Hsu J, Garg S, Ho AC, Khan MA. Primary Retinal Detachment Repair in Eyes Deemed High Risk for Proliferative Vitreoretinopathy: Surgical Outcomes in 389 Eyes. Ophthalmol Retina 2023; 7:954-958. [PMID: 37453482 DOI: 10.1016/j.oret.2023.07.009] [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: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To evaluate surgical outcomes in eyes with primary rhegmatogenous retinal detachment (RRD) deemed at high risk for postoperative proliferative vitreoretinopathy (PVR). DESIGN Retrospective, consecutive case cohort study. PARTICIPANTS Eyes undergoing primary RRD repair with pars plana vitrectomy (PPV) or combined PPV with scleral buckling (PPV/SB) between January 1, 2016, and December 30, 2017, at Wills Eye Hospital. METHODS Eyes were defined as "high risk" if ≥ 1 of the following risk factors for PVR was present on preoperative examination: preoperative PVR grade A or B, vitreous hemorrhage, RRD involving ≥ 50% of retinal area, presence of ≥ 3 retinal breaks, history of prior cryotherapy, presence of choroidal detachment, or duration of RRD > 2 weeks. Surgical failure was defined as an additional intervention required for the retinal reattachment. MAIN OUTCOMES MEASURES Single surgery attachment success (SSAS) rate 3 months after first surgical intervention for primary RRD. RESULTS Of 2053 reviewed charts, a total of 389 eyes (18.9%) met the definition of high risk and were included in the analysis. Mean patient age was 63.5 years. PPV/SB was performed in 125 (32.1%) eyes and PPV alone in 264 (67.9%) eyes. SSAS rate of the overall cohort was 71.5% at 3 months. SSAS rate was significantly higher in eyes treated with PPV/SB compared with PPV (80.8% vs. 67%, respectively, P = 0.006). On multivariate analysis, use of PPV/SB was the only feature associated with SSAS (odds ratio, 2.04; 95% confidence interval, 1.12-3.69, P = 0.019). CONCLUSION In eyes with primary RRD and risk factors for PVR, overall SSAS was 71.5% after primary repair. In this cohort, use of PPV/SB was associated with a significantly higher SSAS compared with PPV alone. 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)
| | - Erik Massenzio
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Julie Kim
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Katherine Awh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hannah Anderson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Taku Wakabayashi
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir Garg
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - M Ali Khan
- The Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Aylward GW, Williamson TH. Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study. Eye (Lond) 2023; 37:1527-1537. [PMID: 37100934 PMCID: PMC10219959 DOI: 10.1038/s41433-023-02388-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD). METHODS A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery. RESULTS There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C2F6 tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10-25%), and 10.1% are at high risk (>25%) of failure. CONCLUSIONS Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.
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Affiliation(s)
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - D A Laidlaw
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G W Aylward
- Moorfields Eye Hospital City Road, EC1V 2PD, London, UK
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Neuhaus C, Valmaggia C. Postoperative Results in the Treatment of Retinal Detachment with Scleral Buckling Surgery. Klin Monbl Augenheilkd 2023; 240:481-485. [PMID: 37164406 DOI: 10.1055/a-2040-3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The course after scleral buckling surgery is investigated in patients with rhegmatogenous retinal detachment. PATIENTS AND METHODS The Ethics Committee of Eastern Switzerland approved the retrospective single-center study (EKOS19/152, Project ID: 2019-02034). The primary endpoint is the anatomical reattachment of the retina 3 months after surgery. Secondary endpoints are visual acuity and the occurrence of intra- and postoperative complications. The patient files of all patients treated for rhegmatogenous retinal detachment with scleral buckling surgery between January 2005 and December 2014 at the Cantonal Hospital of St. Gallen were included. RESULTS In 165 of 184 patients (89.7%), reattachment of the retina 3 months postoperatively was achieved by single scleral buckling surgery. Treatment of rhegmatogenous retinal detachment improved patients' visual acuity by an average of 4.8 ETDRS letters. Intraoperatively, subretinal hemorrhage occurred in one patient. Postoperatively, interfering buckling material was removed in 24 patients (13.1%). A pars plana vitrectomy was performed in six patients (3.2%) due to epiretinal membrane, in two patients (1.1%) due to a macular hole, and in three patients (1.6%) due to disturbing vitreous opacities. CONCLUSIONS Scleral buckling surgery is an effective and relatively low complication method for the treatment of selected patients with rhegmatogenous retinal detachment.
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Affiliation(s)
- Caroline Neuhaus
- Eye Clinic, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Artificial intelligence using deep learning to predict the anatomical outcome of rhegmatogenous retinal detachment surgery: a pilot study. Graefes Arch Clin Exp Ophthalmol 2023; 261:715-721. [PMID: 36303063 DOI: 10.1007/s00417-022-05884-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To develop and evaluate an automated deep learning model to predict the anatomical outcome of rhegmatogenous retinal detachment (RRD) surgery. METHODS Six thousand six hundred and sixty-one digital images of RRD treated by vitrectomy and internal tamponade were collected from the British and Eire Association of Vitreoretinal Surgeons database. Each image was classified as a primary surgical success or a primary surgical failure. The synthetic minority over-sampling technique was used to address class imbalance. We adopted the state-of-the-art deep convolutional neural network architecture Inception v3 to train, validate, and test deep learning models to predict the anatomical outcome of RRD surgery. The area under the curve (AUC), sensitivity, and specificity for predicting the outcome of RRD surgery was calculated for the best predictive deep learning model. RESULTS The deep learning model was able to predict the anatomical outcome of RRD surgery with an AUC of 0.94, with a corresponding sensitivity of 73.3% and a specificity of 96%. CONCLUSION A deep learning model is capable of accurately predicting the anatomical outcome of RRD surgery. This fully automated model has potential application in surgical care of patients with RRD.
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Long-term visual prognosis and characteristics of recurrent retinal detachment after silicone oil removal. PLoS One 2023; 18:e0265162. [PMID: 36753472 PMCID: PMC9907833 DOI: 10.1371/journal.pone.0265162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 02/25/2022] [Indexed: 02/09/2023] Open
Abstract
PURPOSE Silicone oil (SO) is commonly used for tamponade purposes in retinal detachment (RD) surgery, but the long-term visual prognosis after removal of the oil, and in particular, what is known about the recurrence of RD after SO removal, remains unclear. The purpose of this study is to evaluate the long-term vision prognosis after SO removal, and to understand the frequency and characteristics of RD recurrence. METHODS We retrospectively reviewed the medical charts of 1017 eyes of patients with a diagnosis of RD who had a pars plana vitrectomy with SO tamponade between January 2009 and December 2018. Best-corrected visual acuity (BCVA) was obatained before and after vitrectomy and also at the last visit. After SO removal, the group who showed improvement in visual acuity and the group who did not were compared. The anatomical results were compared between the group in which the retina was detached again after SO removal and the group in which the retina was not detached. To determine whether the duration of SO tamponade affects RD recurrence, further analysis was performed by dividing subgroups according to SO tamponade duration. RD recurrence, visual acuity, SO tamponade period were investigated. RESULTS Mean follow-up period was 56.65 ± 72.02 months. An average SO tamponade period was 6.68 ± 11.39 months. The average logMAR BCVA was 1.75 ± 0.91 before SO injection, 1.60 ± 0.75 before SO removal and 1.29 ± 0.96 after the removal. After SO removal, 926 of the 1017 (91.1%) patients had well attached retina without recurrence. There was no significant difference in visual acuity before SO removal in re-detachment group compared to no re-detachment group, but visual acuity of re-detachment group was worse than no re-detachment group after SO removal (p<0.001). The SO tamponade period in the group with improved vision after SO removal was 5.09 ± 9.87 months, and the period was significantly shorter than the 9.09 ± 13.05 months in the group not showing vision recovery (p = 0.005). The occurrence of corneal opacity was significantly higher in the group with SO over 6 months, than those of the two groups with SO tamponade duration of less than 3 months and between 3 and 6 months (p = 0.038). The longest tamponade group showed the worst final vision after SO removal (p<0.001). CONCLUSION The prognosis for final vision is generally good when performing surgery using SO in RD, but considering the complications that arise after surgery, long-term retention of SO is not recommended and the timing of SO removal should be considered.
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Paulk PB, Eloubeidi D, Johnson M, Swain T, Mason JO, Curcio CA, Crosson JN. Visual outcomes of macula-involving rhegmatogenous retinal detachment in patients with and without age-related macular degeneration. BMC Ophthalmol 2022; 22:471. [PMID: 36474227 PMCID: PMC9724310 DOI: 10.1186/s12886-022-02718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis for patients with macula-off rhegmatogenous retinal detachment (RRD) and concomitant age-related macular degeneration (AMD) is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD. METHODS This was a retrospective chart review of 1149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls), and 29 AMD eyes. The main outcome measure was postoperative visual acuity following pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB in control eyes versus AMD eyes. This was compared using Fisher's exact test. RESULTS There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a worse visual outcome overall (p = 0.0048). A similar percentage of AMD versus non-AMD eyes achieved vision better than 20/40. More patients in the non-AMD group achieved a final visual acuity between 20/40 and 20/200. Of patients with AMD, more had vision worse than 20/200 though 58% maintained functional vision (better than 20/200). Those without AMD had a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023). CONCLUSIONS Though postoperative visual acuity was worse overall in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is likely a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD.
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Affiliation(s)
- P. Barrett Paulk
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA
| | - Dala Eloubeidi
- grid.267153.40000 0000 9552 1255University of South Alabama College of Medicine, 5795 USA Drive North, CSAB 170, Mobile, AL 36688 USA
| | - Mark Johnson
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA
| | - Thomas Swain
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA
| | - John O. Mason
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA ,Retina Consultants of Alabama, 700 18th Street South, Birmingham, AL 35223 USA
| | - Christine A. Curcio
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA
| | - Jason N. Crosson
- grid.265892.20000000106344187Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, 1720 University Boulevard, Birmingham, AL 35223 USA ,Retina Consultants of Alabama, 700 18th Street South, Birmingham, AL 35223 USA
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Guner ME, Guner MK, Cebeci Z, Kır N. Preoperative and Postoperative Factors Affecting Functional Success in Anatomically Successful Retinal Detachment Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:477-485. [PMID: 36220639 DOI: 10.3341/kjo.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery. METHODS Seventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated. RESULTS The mean age was 53.9 ± 17 years (range, 11-85 years). The mean follow-up period was 36.7 ± 16 months (range, 14-72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes. CONCLUSIONS Early intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.
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Affiliation(s)
- Mehmet Eren Guner
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Zafer Cebeci
- Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Nur Kır
- Department of Ophthalmology, Istanbul University, Istanbul, Turkey
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Chidlow G, Chan WO, Wood JPM, Casson RJ. Investigations into photoreceptor energy metabolism during experimental retinal detachment. Front Cell Neurosci 2022; 16:1036834. [PMID: 36467607 PMCID: PMC9716104 DOI: 10.3389/fncel.2022.1036834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 08/27/2023] Open
Abstract
Retinal detachment is a sight-threatening disorder, which occurs when the photoreceptors are separated from their vascular supply. The aim of the present study was to shed light on photoreceptor energy metabolism during experimental detachment in rats. Retinal detachment was induced in the eyes of rats via subretinal injection of sodium hyaluronate. Initially, we investigated whether detachment caused hypoxia within photoreceptors, as evaluated by the exogenous and endogenous biomarkers pimonidazole and HIF-1α, as well as by qPCR analysis of HIF target genes. The results showed no unequivocal staining for pimonidazole or HIF-1α within any detached retina, nor upregulation of HIF target genes, suggesting that any reduction in pO2 is of insufficient magnitude to produce hypoxia-induced covalent protein adducts or HIF-1α stabilisation. Subsequently, we analysed expression of cellular bioenergetic enzymes in photoreceptors during detachment. We documented loss of mitochondrial, and downregulation of glycolytic enzymes during detachment, indicating that photoreceptors have reduced energetic requirements and/or capacity. Given that detachment did not cause widespread hypoxia, but did result in downregulated expression of bioenergetic enzymes, we hypothesised that substrate insufficiency may be critical in terms of pathogenesis, and that boosting metabolic inputs may preserve photoreceptor bioenergetic production and, protect against their degeneration. Thus, we tested whether supplementation with the bioavailable energy substrate pyruvate mitigated rod and cone injury and degeneration. Despite protecting photoreceptors in culture from nutrient deprivation, pyruvate failed to protect against apoptotic death of rods, loss of cone opsins, and loss of inner segment mitochondria, in situ, when evaluated at 3 days after detachment. The regimen was also ineffective against cumulative photoreceptor deconstruction and degeneration when evaluated after 4 weeks. Retinal metabolism, particularly the bioenergetic profiles and pathological responses of the various cellular subtypes still presents a considerable knowledge gap that has important clinical consequences. While our data do not support the use of pyruvate supplementation as a means of protecting detached photoreceptors, they do provide a foundation and motivation for future research in this area.
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Affiliation(s)
- Glyn Chidlow
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia
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Scleral Buckling: History and Current Indications. Int Ophthalmol Clin 2022; 62:17-26. [PMID: 36170218 DOI: 10.1097/iio.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lan C, Chen YH, Chen YJ, Lee JJ, Kuo HK, Wu PC. Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia. Front Public Health 2022; 10:895024. [PMID: 36033821 PMCID: PMC9403186 DOI: 10.3389/fpubh.2022.895024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area. Methods This retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained. Results A total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > -3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was -8.66 ± 0.92 (range: -3.00--12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important. Conclusion In the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.
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Affiliation(s)
- Chieh Lan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Jen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,*Correspondence: Pei-Chang Wu
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Gopal AD, Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE, Yonekawa Y. Predictors of Vision Loss after Surgery for Macula-Sparing Rhegmatogenous Retinal Detachment. Curr Eye Res 2022; 47:1209-1217. [PMID: 35608082 DOI: 10.1080/02713683.2022.2081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine factors associated with loss of good vision (defined as Snellen visual acuity [VA] < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment (RRD) with initial VA ≥20/40. MATERIALS AND METHODS Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40. RESULTS Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 [20/28]) compared to eyes that preserved good vision (mean 0.11 ± 0.10 [20/26]) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 [95% CI 1.44-14.51]; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 [95% CI 2.10-24.90]; p = 0.0017) or PPV/SB (multivariate OR 10.74 [95% CI 3.20-36.11]; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 [95% CI 1.47-50.66]; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 [95% CI 5.39-38.21]; p <0.0001) were more likely to lose good vision. CONCLUSION Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.
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Affiliation(s)
- Anand D Gopal
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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14
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Rasool S, Kaushik M, Chaudhary R, Blachford K, Berry M, Scott RAH, Logan A, Blanch RJ. Visual deterioration in patients with photoreceptor loss after retinal reattachment surgery. Graefes Arch Clin Exp Ophthalmol 2022; 260:2141-2147. [PMID: 35080648 PMCID: PMC9203401 DOI: 10.1007/s00417-021-05519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Assess the relationship between photoreceptor degeneration and visual function after retinal reattachment surgery (RRS) in a prospective cohort. METHODS Patients with rhegmatogenous retinal detachment (RRD) were reviewed before and 6 months after vitreoretinal surgery. Optical coherence tomographical thickness of the outer nuclear layer (ONL), outer retinal segment (ORS), retinal pigmented epithelium to ellipsoid zone (RPE-EZ) and external limiting membrane to EZ (ELM-EZ) were recorded 6 months post-operatively. These were compared to best corrected visual acuity (BCVA) and retinal sensitivity (Humphrey visual field). RESULTS Thirteen macula-off and 8 macula-on RRD patients were included. The mean ONL thickness was higher after macula-on RRD compared to macula-off RRD (97.70 ± 3.62 μm vs. 73.10 ± 4.98 μm). In all RRD eyes, every 1 μm decrease in ONL thickness correlated with a 0.052 dB decrease and in retinal sensitivity and every 1 μm decrease in ORS thickness was associated with a 0.062 dB reduction in retinal sensitivity. ORS, ELM-EZ and RPE-EZ thickness did not correlate with BCVA post-RRS. CONCLUSION There was greater ONL and ORS thinning following macula-off compared to macula-on RRD. Correlations between ONL and ORS thinning with decreased retinal sensitivity may be explained by RRD-induced photoreceptor death.
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Affiliation(s)
- Sana Rasool
- Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Megha Kaushik
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rishika Chaudhary
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,National Institute of Health Research Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Robert A. H. Scott
- Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ann Logan
- Axolotl Consulting Ltd, Droitwich, WR9 0JS Worcestershire UK ,Division of Biomedical Sciences, Warwick Medical School, University of Warwick, CV4 7HL Coventry, UK
| | - Richard J. Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Neuroscience & Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,National Institute of Health Research Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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15
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Angermann R, Huber AL, Hofer M, Nowosielski Y, Egger S, Kralinger MT, Zehetner C. Efficiency benchmarks in the surgical management of primary rhegmatogenous retinal detachment: a monocentric register cohort study of operating room time metrics and influential factors. BMJ Open 2021; 11:e052513. [PMID: 34933861 PMCID: PMC8693097 DOI: 10.1136/bmjopen-2021-052513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the effect of clinical, methodological and logistic factors on operating room (OR) efficiency in the surgical management of primary rhegmatogenous retinal detachment (RRD). DESIGN Monocentric retrospective register cohort study. SETTING Single tertiary centre in the western region of Austria. PARTICIPANTS We audited patients diagnosed with primary RRD who were treated between January 2014 and August 2019. In total, 783 eyes of 776 consecutive patients were included in this study. Various risk factors affecting OR time efficiency and anatomical success after pars plana vitrectomy (PPV) procedures and scleral buckle (SB) surgery were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES OR efficiency was the primary outcome measure. Secondary outcome measures were the primary success rate after PPV procedures and SB surgery. RESULTS PPV was performed in 641 (81.9%) eyes and SB surgery in 142 (18.1%) eyes. Mean surgical times in PPV and SB under retrobulbar anaesthesia (RA) were 74.0 (±32.6) min and 62.1 (±24.6) min (p<0.001), respectively, while under general anaesthesia (GA), these values were 112.0 (±52.0) min and 76.0 (±22.5) min (p<0.001), respectively. A regression analysis revealed the following main risk factors for prolonged OR time for the surgical management of RRD with PPV (all p<0.001): presence of a giant tear (β=24.01; 32%), proliferative vitreoretinopathy (PVR)-C (β=16.43; 22%), surgery postponed for 72 hours after diagnosis (β=21.40; 29%), GA (β=23.64; 32%) or surgery performed by a trainee (β=17.35; 23%). PVR (p=0.022) in PPV cases, after-hours settings (p=0.006) and surgeon experience (p=0.030) in SB cases were independent risk factors for reduced success rates. CONCLUSIONS OR coordinators should consider various independent clinical (giant tear, PVR-C, advanced detachment), methodological (PPV vs SB) and logistic (GA vs RA, after-hours setting and surgeon experience) factors to improve the success rate and surgical management planning of RRD accurately while optimising OR resources and staff efficiency.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
- Department of Ophthalmology, Paracelsus Medical Private University, Salzburg, Austria
| | - Anna Lena Huber
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Markus Hofer
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Stefan Egger
- Department of Ophthalmology, Paracelsus Medical Private University, Salzburg, Austria
| | - Martina T Kralinger
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology, Medizinische Universität Innsbruck, Innsbruck, Austria
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16
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Chidlow G, Chan WO, Wood JPM, Casson RJ. Differential Effects of Experimental Retinal Detachment on S- and M/L-Cones in Rats. Mol Neurobiol 2021; 59:117-136. [PMID: 34633652 DOI: 10.1007/s12035-021-02582-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
Retinal detachment is a vision-threatening condition, which occurs when the neurosensory retina is separated from its blood supply. The main purpose of this study was to examine the effect of experimental retinal detachment in rats on cone photoreceptors. Retinal detachment was induced in the eyes of rats via subretinal injection of sodium hyaluronate. Experimental detachment caused a rapid, sustained loss of short (S)- and medium/long (M/L)-wavelength cone opsins. Importantly, S-opsin+ cones were affected earlier than M/L-opsin+ cones and were affected to a greater extent than M/L-opsin+ cones throughout the duration of detachment. In comparison, to cone opsins, reductions in other cone markers-peanut agglutinin PNA and cone arrestin-were substantially less marked. These data suggest that loss of cone opsins does not reflect cone degeneration and may rather indicate prolonged downregulation of specific proteins in affected cones. This conclusion is supported by the lack of TUNEL+- cone arrestin+ double-labelled cells at the time point of greatest rod photoreceptor cell death, together with the partial recovery of cone arrestin+ cell numbers over time. Analysis of retinas that had naturally re-attached reinforced the deduction that few cones die following detachment, but also highlighted that prolonged detachment leads to deconstruction of cone segments that may not be readily reversible. Survival and functional recovery of cones following surgery for retinal detachment is vital for successful recovery of vision. The data suggest that experimental detachment in rats may offer a useful approach to model the response of S-cones to retinal detachment in humans.
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Affiliation(s)
- Glyn Chidlow
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia.
| | - Weng Onn Chan
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
| | - John P M Wood
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
| | - Robert J Casson
- Ophthalmic Research Laboratories, Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Level 7 Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
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17
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Resch MD, Balogh A, Lászik G, Nagy ZZ, Papp A. Association between retinal vessel density and postoperative time after primary repair of rhegmatogenous retinal detachment. PLoS One 2021; 16:e0258126. [PMID: 34597349 PMCID: PMC8486093 DOI: 10.1371/journal.pone.0258126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023] Open
Abstract
The study aimed at a quantitative evaluation of macular vasculature after primary repair of rhegmatogenous retinal detachment (RRD) in correlation with the elapsed postoperative time. Optical coherence tomography angiography (OCT-A) was performed in 66 eyes of 33 patients in a retrospective case-control study: superficial and deep retinal vessel density (VD) of the whole image, fovea, parafovea, non-flow area, and foveal avascular zone (FAZ) were measured. Data of eyes with RRD were compared to the healthy fellow eyes in 3 groups according to the elapsed time after surgery: RD1: 6–12 months (n = 10), RD2: 1–2 years (n = 10), and RD3: 2–10 years (n = 13). In RD1 VD was significantly lower in the superficial parafoveal, deep parafoveal, and deep whole area compared to the fellow eyes. In RD3 VD was significantly lower in the superficial fovea, parafovea, whole image, and deep fovea, the non-flow area was significantly enlarged. OCT-A demonstrated a significant reduction in the superficial and deep regions of the macular vasculature after the repair of RRD. The deep area is more affected in the early postoperative period and the superficial region and the extent of the non-flow area are more involved after a longer postoperative time.
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Affiliation(s)
- Miklós D. Resch
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Anikó Balogh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Gábor Lászik
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - András Papp
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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18
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Xu D, Belin PJ, Staropoli PC, Yannuzzi NA, Vangipuram G, Chiang A, Shah GK, Townsend JH, Ryan EH, Klufas MA. Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis. Ophthalmol Retina 2021; 5:797-804. [PMID: 33197679 DOI: 10.1016/j.oret.2020.11.002] [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: 07/04/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included. METHODS Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES Single-operation anatomic success between the initial-eye and subsequent-eye RRD. RESULTS Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
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Affiliation(s)
- David Xu
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | | | - Patrick C Staropoli
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Nicolas A Yannuzzi
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Allen Chiang
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | - Justin H Townsend
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Michael A Klufas
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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19
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Cheung N, Lee SY, Wong TY. Will the Myopia Epidemic Lead to a Retinal Detachment Epidemic in the Future? JAMA Ophthalmol 2021; 139:93-94. [PMID: 33237318 DOI: 10.1001/jamaophthalmol.2020.5112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
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20
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Kalloniatis M, Loh CS, Acosta ML, Tomisich G, Zhu Y, Nivison‐smith L, Fletcher EL, Chua J, Sun D, Arunthavasothy N. Retinal amino acid neurochemistry in health and disease. Clin Exp Optom 2021; 96:310-32. [DOI: 10.1111/cxo.12015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/01/2012] [Accepted: 07/17/2012] [Indexed: 12/25/2022] Open
Affiliation(s)
- Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia,
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Chee Seang Loh
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Monica L Acosta
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Guido Tomisich
- Department of Optometry and Vision Science, The University of Melbourne, Parkville, Victoria, Australia,
| | - Yuan Zhu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
| | - Lisa Nivison‐smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia,
| | - Erica L Fletcher
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia,
| | - Jacqueline Chua
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Daniel Sun
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
| | - Niru Arunthavasothy
- Department of Optometry and Vision Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand,
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21
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Chua J, Ke M, Tan B, Gan ATL, Lim LS, Tan GS, Lee SY, Wong E, Schmetterer L, Cheung N. Association of macular and choroidal perfusion with long-term visual outcomes after macula-off rhegmatogenous retinal detachment. Br J Ophthalmol 2021; 106:1258-1263. [PMID: 33827859 DOI: 10.1136/bjophthalmol-2021-318907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/27/2021] [Accepted: 03/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIMS To examine the relationship between macular perfusion, as assessed using optical coherence tomography angiography (OCTA), and long-term visual outcome after surgical repair of macula-off rhegmatogenous retinal detachment (RRD). METHODS A prospective study of 29 patients who had undergone successful surgical repair of macula-off RRD. OCTA imaging was performed at month 3 and repeated at months 6 and 12 after surgery. Associations between OCTA parameters including, foveal avascular zone (FAZ) area, vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris flow deficit features and logMAR best-corrected visual acuity (VA) were assessed using a random intercept hybrid linear mixed model. RESULTS Over the 1-year follow-up, VA improved (0.025 logMAR/ month, 95% CI 0.015 to 0.035) and FAZ area decreased (-0.020 mm2/month, 95% CI -0.032 to -0.007). Better VA after surgery was significantly associated with denser superficial VD (β=0.079, 95% CI 0.026 to 0.131), lower number of choriocapillaris flow deficits (β=-0.087, 95% CI -0.154 to -0.021) and larger average size of choriocapillaris flow deficits (β=0.085, 95% CI 0.022 to 0.147), after adjusting for baseline VA, types of surgery and other factors. CONCLUSIONS OCTA measures of vascular perfusion in the macula may provide new pathophysiological insights and prognostic information related to macula-off RRD.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Mengyuan Ke
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore
| | | | - Laurence S Lim
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Gavin Sw Tan
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Shu Yen Lee
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Edmund Wong
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Leopold Schmetterer
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ning Cheung
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
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22
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Xu D, Uhr J, Patel SN, Pandit RR, Jenkins TL, Khan MA, Ho AC. Sociodemographic Factors Influencing Rhegmatogenous Retinal Detachment Presentation and Outcome. Ophthalmol Retina 2021; 5:337-341. [PMID: 32771613 DOI: 10.1016/j.oret.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The impact of sociodemographic factors on the presentation and outcomes of rhegmatogenous retinal detachment (RRD) in the United States has not been described. We analyzed the impact of these factors on the presenting fovea-on or off status of RRD, single operation anatomic success (SOAS) of repair, and postoperative visual acuity (VA). DESIGN Retrospective, single-center, cohort study. PARTICIPANTS Participants included 4061 patients from Wills Eye Hospital/Mid Atlantic Retina from February 2015 to February 2020. METHODS Sociodemographic factors including age, gender, race, and regional mean household income (MHI) as determined by ZIP code were recorded. The VA at baseline and 12 months post-RRD repair was recorded. Multiple regression analysis was used to evaluate the relationship between sociodemographic factors to fovea-on or off presentation of RRD, SOAS, and 12-month VA. MAIN OUTCOME MEASURES Foveal attachment at presentation of RRD, SOAS, and 12-month VA. RESULTS Older age (odds ratio [OR], 1.34 per decade, 95% confidence interval [CI], 1.27-1.41, P < 0.001), male gender (OR, 1.27, 95% CI, 1.11-1.45, P < 0.001), non-White race (OR, 2.41, 95% CI, 1.92-3.03, P < 0.001), and lower MHI (OR, 0.94 per $10 000, 95% CI, 0.91-0.98, P = 0.005) were independent risk factors for fovea-off presentation of RD. The need for reoperation to repair RRD within 90 days was independently associated with fovea-off presentation (OR, 1.47, 95% CI, 1.24-1.74, P < 0.001) and non-White race (OR, 1.72, 95% CI, 1.27-2.39, P < 0.001). Finally, 12-month postoperative VA was worse in patients who were fovea-off (P < 0.001), older (P = 0.041), male (P = 0.038), and non-White (P = 0.007) but was not related to MHI (P = 0.24). CONCLUSIONS These findings reveal associations between the sociodemographic factors and the presentation and outcomes of RRD. Physicians should be aware that socioeconomic disparities can negatively impact the prognosis of patients with RRD. Further study confirming these findings and efforts to mitigate their effects are warranted and will be of interest to the greater ophthalmology community.
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Affiliation(s)
- David Xu
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | - Joshua Uhr
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Samir N Patel
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ravi R Pandit
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Thomas L Jenkins
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - M Ali Khan
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Allen C Ho
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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Chen D, Yu Y, Zhou Y, Peng B, Wang Y, Hu S, Tian M, Wan S, Gao Y, Wang Y, Yan Y, Wu L, Yao L, Zheng B, Wang Y, Huang Y, Chen X, Yu H, Yang Y. A Deep Learning Model for Screening Multiple Abnormal Findings in Ophthalmic Ultrasonography (With Video). Transl Vis Sci Technol 2021; 10:22. [PMID: 34004002 PMCID: PMC8083108 DOI: 10.1167/tvst.10.4.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose The purpose of this study was to construct a deep learning system for rapidly and accurately screening retinal detachment (RD), vitreous detachment (VD), and vitreous hemorrhage (VH) in ophthalmic ultrasound in real time. Methods We used a deep convolutional neural network to develop a deep learning system to screen multiple abnormal findings in ophthalmic ultrasonography with 3580 images for classification and 941 images for segmentation. Sixty-two videos were used as the test dataset in real time. External data containing 598 images were also used for validation. Another 155 images were collected to compare the performance of the model to experts. In addition, a study was conducted to assess the effect of the model in improving lesions recognition of the trainees. Results The model achieved 0.94, 0.90, 0.92, 0.94, and 0.91 accuracy in recognizing normal, VD, VH, RD, and other lesions. Compared with the ophthalmologists, the modal achieved a 0.73 accuracy in classifying RD, VD, and VH, which has a better performance than most experts (P < 0.05). In the videos, the model had a 0.81 accuracy. With the model assistant, the accuracy of the trainees improved from 0.84 to 0.94. Conclusions The model could serve as a screening tool to rapidly identify patients with RD, VD, and VH. In addition, it also has potential to be a good tool to assist training. Translational Relevance We developed a deep learning model to make the ultrasound work more accurately and efficiently.
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Affiliation(s)
- Di Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yi Yu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yiwen Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Bin Peng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yujing Wang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shan Hu
- School of Resources and Environmental Sciences of Wuhan University, Wuhan, Hubei Province, China
| | - Miao Tian
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shanshan Wan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yuelan Gao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Ying Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yulin Yan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - LiWen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Biqing Zheng
- School of Resources and Environmental Sciences of Wuhan University, Wuhan, Hubei Province, China
| | - Yang Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yuqing Huang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xi Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yanning Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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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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Kurochkin P, Huang N, Petrela R, Rosenberg KI, Brown JS, Oellers P. Pars Plana Vitrectomy Outcomes for Rhegmatogenous Retinal Detachment Qualifying for Pneumatic Retinopexy. Clin Ophthalmol 2021; 15:1207-1214. [PMID: 33776417 PMCID: PMC7989046 DOI: 10.2147/opth.s302413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate real-world outcomes of pars plana vitrectomy (PPV) for eyes with primary rhegmatogenous retinal detachments (RRD) eligible for pneumatic retinopexy (PnR). Methods This was a single center retrospective case series looking at consecutive patients with primary RRDs. A database was created on all patients with a primary RRD from 2010 to 2018 based on billing code 67108. Eyes anatomically eligible for PnR were reviewed for preoperative, intraoperative and postoperative characteristics. The main outcome assessed was single surgery anatomical success (SSAS), final anatomical success (FAS), and postoperative LogMAR vision. Results A total of 720 eyes (age, 62.9 ± 9.1 years; 61.7% were male) met inclusion criteria for PnR and underwent PPV. SSAS was 94.0% and FAS was 99.9%. Preoperative and final LogMAR vision was 0.853 and 0.293 (P<0.001) in eyes with SSAS vs 0.714 and 0.648 (P=0.686) in eyes with primary failure. PVR was the most common etiology of primary surgical failure (n=21, 49%). Patients who failed primary repair had a mean of 1.12 additional surgeries with a median time of 45 days between surgeries. Conclusion A robust single surgery success rate with good visual outcomes was achieved across 8 years and multiple surgeons utilizing PPV to treat primary RRDs in eyes which anatomically qualified for pneumatic retinopexy in a real-world setting.
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Potic J, Bergin C, Giacuzzo C, Konstantinidis L, Daruich A, Wolfensberger TJ. APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE. Retina 2021; 41:653-660. [PMID: 32568989 PMCID: PMC7889283 DOI: 10.1097/iae.0000000000002894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery. METHODS In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]). RESULTS One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41). CONCLUSION The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.
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Affiliation(s)
- Jelena Potic
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
- Eye Trauma and Vitreoretinal Surgery Unit, Clinics for Eye Diseases, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ciara Bergin
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Clarice Giacuzzo
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Lazaros Konstantinidis
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Alejandra Daruich
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Thomas J. Wolfensberger
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
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Yamashita K, Sakakura S, Ofuji Y, Sato M, Nagamoto T, Kubono H, Kawamura M, Suzuki K. Micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachments with posterior vitreous detachments in elderly patients: Preoperative characteristics and surgical outcomes. PLoS One 2021; 16:e0244614. [PMID: 33406140 PMCID: PMC7787454 DOI: 10.1371/journal.pone.0244614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/11/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose To assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group. Methods This retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications. Results Data were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients. Conclusions This study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.
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Affiliation(s)
- Kazuya Yamashita
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
- * E-mail:
| | - Saki Sakakura
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Yoshiko Ofuji
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Maho Sato
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | | | - Hirohisa Kubono
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Mari Kawamura
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
| | - Kotaro Suzuki
- Department of Ophthalmology, Keiyu Hospital, Yokohama, Japan
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Ng H, Vermeer KA, van Meurs JC, La Heij EC. Visual Acuity Inadequately Reflects Vision-Related Quality of Life in Patients After Macula-Off Retinal Detachment Surgery. Invest Ophthalmol Vis Sci 2021; 61:34. [PMID: 32805003 PMCID: PMC7441472 DOI: 10.1167/iovs.61.10.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the impact of postoperative visual function on the vision-related quality of life (VRQoL) in patients after anatomically successful surgery for macula-off rhegmatogenous retinal detachment (RRD) and to propose a classification to grade the extent of macular detachment using preoperative optical coherence tomography (OCT) scans. Methods This prospective study evaluated 48 patients. At 12 months after surgery, visual function assessments were as follows: metamorphopsia (M-CHARTS), aniseikonia (New Aniseikonia Test), best corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS]), low contrast BCVA (10% ETDRS), color vision (Hardy Rand Rittler), and stereopsis (Titmus Fly). VRQoL was assessed by the National Eye Institute Visual Functioning Questionnaire-25 (NEIVFQ-25). Associations between visual function parameters and NEIVFQ-25 scores were evaluated. Preoperative OCT-scans were classified into six stages according to the extent of macular detachment based on an ETDRS-grid: incomplete perifoveal detachment (1), incomplete parafoveal detachment (2), incomplete foveal detachment (3), complete foveal detachment (4), complete parafoveal detachment (5), and complete perifoveal detachment (6). Results General vision and driving were the lowest scoring categories. General vision had the strongest correlation with low contrast BCVA (r = −0.41, P = 0.002), while driving had the strongest correlation with stereopsis (r = −0.39, P = 0.008). All macular detachments were graded stage 3 or beyond. Patients with stage 3 macular detachments had the highest visual function values compared to the other stages. The highest percentage of patients with metamorphopsia, aniseikonia and BCVA>0.1 logMAR was found in stages 5 and 6. Conclusions Macula-off RRD particularly affects general vision and driving. The extent of macular detachment is a potential predictor for visual function and can be graded using the proposed classification.
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Affiliation(s)
- Heijan Ng
- Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
| | | | - Jan C van Meurs
- The Rotterdam Eye Hospital, Vitreoretinal Surgery, Rotterdam, the Netherlands
| | - Ellen C La Heij
- The Rotterdam Eye Hospital, Vitreoretinal Surgery, Rotterdam, the Netherlands
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Deiss M, Kaya C, Pfister IB, Garweg JG. Impact of Vitreal Tamponade on Functional Outcomes in Vitrectomy with ILM Peeling in Primary Macula-Involving Retinal Detachment: A Retrospective Analysis. Clin Ophthalmol 2020; 14:4493-4500. [PMID: 33380783 PMCID: PMC7769588 DOI: 10.2147/opth.s287107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling and failed SF6 gas tamponade requiring silicone oil (SO) in a second procedure with primary SO tamponade in fovea-involving retinal detachment (FiRD). METHODS Retrospective analysis of 82 eyes with retinal detachment and mild, but without advanced proliferative retinopathy (PVR ≥C2) requiring vitrectomy for FiRD. Group 1 comprised 23 eyes that underwent SF6 tamponade resulting in re-detachment requiring revision surgery with secondary SO tamponade. Based on the intraoperative findings, group 2 patients had primarily received SO as vitreal tamponade (n=59). Patients receiving a scleral buckle surgery or with advanced PVR as well as patients with underlying vascular diseases and uveitis were excluded. RESULTS Preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 13.5 ± 19.1 in group 1 and 14.0 ± 18.3 in group 2 (p=0.44). Twelve months after first surgery for FiRD, visual acuity was 49.8 ± 19.8 in group 1 and 51.7 ± 18.7 letters in group 2 (p=0.63). Re-detachment after SO removal requiring revision surgery developed in 17.4 (n=4) and 15.3% (n=9) cases. CONCLUSION Our findings suggest that if retinal traction is completely relieved at the end of surgery, vitrectomy with ILM peeling and SF6 may, if successful, improve the functional outcomes in instances with visual potential, ie, a foveal detachment of short duration despite the presence of a mild to moderate PVR, but with the inherent increased risk of re-detachment requiring further intervention and the use of a SO tamponade. Hence, secondary SO installation during re-vitrectomy after failed primary reattachment surgery results in similar functional outcomes as primary oil filling.
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Affiliation(s)
| | - Cagdas Kaya
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Justus G Garweg
- University of Bern, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zaletel Benda P, Vratanar B, Petrovski G, Gavrić AU, Matović K, Gornik A, Vergot K, Lumi A, Lumi X. Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment. J Clin Med 2020; 9:jcm9103251. [PMID: 33053642 PMCID: PMC7601405 DOI: 10.3390/jcm9103251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. A swept source OCT was used to obtain images at the postoperative visit at least 6 months after PPV. Hierarchical linear regression model was used to evaluate the influence of preoperative factors related to patient, ocular clinical and postoperative OCT macular findings on functional outcomes of PPV for RRD. Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p < 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
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Affiliation(s)
- Polona Zaletel Benda
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Bor Vratanar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway;
| | - Ana Uršula Gavrić
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katja Matović
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Ana Gornik
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katarina Vergot
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Anila Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
- Correspondence: ; Tel.: +38-615-221-900
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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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32
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Balogh A, Milibák T, Szabó V, Nagy ZZ, Resch MD. Position of macula lutea and presence of proliferative vitreoretinopathy affect vitreous cytokine expression in rhegmatogenous retinal detachment. PLoS One 2020; 15:e0234525. [PMID: 32542038 PMCID: PMC7295219 DOI: 10.1371/journal.pone.0234525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
Our purpose was to evaluate the concentrations of vitreous cytokines in patients with rhegmatogenous retinal detachment (RRD). We hypothesized that patients with macula on RRD have lower levels of cytokines compared to patients with macula off RRD and proliferative vitreoretinopathy (PVR). Vitreous fluids were collected during 23G pars plana vitrectomy from 58 eyes of 58 patients. Indication for vitrectomy included macula off and macula on RRD, PVR, and idiopathic epiretinal membrane (ERM). A multiplex chemiluminescent immunoassay was performed to measure the concentrations of 48 cytokines, chemokines, and growth factors. Levels of HGF, IL-6, IL-8, IL-16, IFN-gamma, MCP-1, and MIF were significantly higher in all groups of retinal detachment compared to ERM. Levels of CTACK, eotaxin, G-CSF, IP-10, MIG, SCF, SCGF-beta, SDF-1alpha were significantly higher in PVR compared to macula on RRD and ERM. Levels of IL-1ra, IL-5, IL-9, M-CSF, MIP-1alpha, and TRIAL were significantly higher in PVR compared to macula on RRD. Our results indicate that the position of macula lutea and the presence of PVR significantly influence vitreous cytokine expression. The detected proteins may serve as biomarkers to estimate the possibility of PVR formation and may help to invent personalized therapeutic strategies to slow down or prevent PVR.
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Affiliation(s)
- Anikó Balogh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Tibor Milibák
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Viktória Szabó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Miklós D. Resch
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- * E-mail:
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Risk Factors for Retinal Detachment: A Case-Control Study. J Occup Environ Med 2020; 62:445-451. [PMID: 32510908 DOI: 10.1097/jom.0000000000001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate risk factors for retinal detachment or tear (RD/T), and follow up two studies that found increased risk from work-related heavy lifting. METHODS We conducted a case-control study including 200 cases of RD/T and 415 controls. Participants completed a questionnaire covering general health, vision, and physical exertion. Multiple logistic regression and propensity score matching was used to control confounding and estimate independent effects. RESULTS RD/T risk was increased by one lifting measure: current regular lifting of more than 30 lbs (>13.6 kg). In the population aged less than 65 years, the odds ratio comparing those with/without heavy lifting was 1.81, 95% confidence interval = 1.08 to 3.04. CONCLUSION Occupational heavy lifting may represent a risk factor for RD/T, but further research is needed in populations with frequent heavy physical exertion to more precisely quantify the risk.
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Baba T, Kawasaki R, Yamakiri K, Koto T, Nishitsuka K, Yamamoto S, Sakamoto T. Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV. Br J Ophthalmol 2020; 105:227-232. [DOI: 10.1136/bjophthalmol-2020-315945] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/03/2022]
Abstract
Background/AimTo determine the preoperative ocular factors and surgical methods that led to best-corrected visual acuity (BCVA) after pars plana vitrectomy (PPV) or scleral buckling (SB) for rhegmatogenous retinal detachment (RRD).MethodsThis was a prospective, nationwide, multicentre, observational study. Data from the Japanese Retina and Vitreous Society registry from 2016 to 2017 were used to determine the association between preoperative clinical factors, surgical procedures and postoperative BCVA at 6 months. Japanese individuals >40 years of age were included. Eyes with proliferative vitreoretinopathy were included. The primary outcome was the percentage of eyes that achieved 20/25 vision.ResultsOf the 3219 registered cases, 2192 met the inclusion criteria (344 SB, 1738 PPV, 110 PPV+SB). Cases with preoperative BCVA (≤0 logarithm of the minimum angle of resolution (logMAR) units) had good postoperative BCVA (OR=3.97, CI 2.87 to 5.51). Older age (>70 years), low intraocular pressure (<10 mm Hg), high myopia (<−5 dioptres), multiple retinal breaks (>4), giant retinal tear (>90°), wide retinal detachment (>3 quadrants) and macula-off detachment were associated with less probability of postoperative 20/25 vision (OR=0.39, 0.64, 0.62, 0.60, 0.12, 0.51 and 0.36, respectively). Postoperative BCVA was 0.03±0.23 and 0.10±0.32 logMAR units after SB and PPV, respectively. The percentage of cases that achieved 20/25 vision was not significantly different after PPV or SB if cases that had concurrent cataract surgery were excluded (p=0.251).ConclusionsBetter BCVA in patients with RRD who had undergone PPV was observed. However, if concurrent cataract surgery is not performed, BCVA will be comparable with either PPV or SB.
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Palácios RM, Kayat KV, Morel C, Conrath J, Matonti F, Morin B, Farah ME, Devin F. Clinical Study on the Initial Experiences of French Vitreoretinal Surgeons with Heads-up Surgery. Curr Eye Res 2020; 45:1265-1272. [DOI: 10.1080/02713683.2020.1737136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Renato Menezes Palácios
- From the Department of Ophthalmology-Retina, Federal University of São Paulo , São Paulo, SP, Brazil
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - Kim Vieira Kayat
- From the Department of Ophthalmology-Retina, Federal University of São Paulo , São Paulo, SP, Brazil
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - Christophe Morel
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - John Conrath
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - Frédéric Matonti
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - Bruno Morin
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
| | - Michel Eid Farah
- From the Department of Ophthalmology-Retina, Federal University of São Paulo , São Paulo, SP, Brazil
| | - François Devin
- From the Department of Ophthalmology-Retina, Centre Monticelli Paradis d’Ophtalmologie , Marseille, France
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Mudhar HS. A brief review of the histopathology of proliferative vitreoretinopathy (PVR). Eye (Lond) 2020; 34:246-250. [PMID: 31792351 PMCID: PMC7002513 DOI: 10.1038/s41433-019-0724-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/09/2022] Open
Abstract
Proliferative vitreoretinopathy (PVR) is thought to represent an exaggerated and protracted scarring process following rhegmatogenous retinal detachment (RD) and following RD surgery. Following detachment, a combination of retinal ischaemia, inflammation and cell proliferation lead to the formation of tractional membranes on the epiretinal and subretinal surfaces and to marked gliosis within the retina that leads to retinal shortening. Both of these factors convert a rhegmatogenous RD into a tractional one are a major feature of RD surgery failure. The major cell types that are involved in PVR are retinal pigment epithelium (RPE), glial cells (principally Muller cells) and inflammatory cells (macrophages and lymphocytes). These cells interact with numerous growth factors and cytokines derived from the breakdown of the blood-retinal barrier and from vitreous contact that trigger a cascade of cellular processes, such as epithelial-mesenchymal transition (EMT), cell migration, chemotaxis, proliferation, elaboration of basement membrane and collagen and cellular contraction, that lead to overt retinal pathology. This review covers the histopathology of PVR and touches upon the cellular processes involved in the pathogenesis of PVR.
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Affiliation(s)
- Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathlogy, E-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
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Sella R, Sternfeld A, Budnik I, Axer-Siegel R, Ehrlich R. Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair. Int J Ophthalmol 2019; 12:1872-1877. [PMID: 31850171 DOI: 10.18240/ijo.2019.12.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the rate and possible contributors for post-pars plana vitrectomy (PPV) epiretinal membrane (ERM) in patients treated for rhegmatogenous retinal detachment (RRD). METHODS This prospective, nonrandomized study comprised 47 consecutive patients (47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS ERM developed postoperatively in 23 eyes (48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity (median logMAR 1.9 vs 0.3, respectively; P=0.003) rate of macula-off (69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications (55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81 (P=0.031). CONCLUSION ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.
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Affiliation(s)
- Ruti Sella
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amir Sternfeld
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ivan Budnik
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow 119146, Russia
| | - Ruth Axer-Siegel
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rita Ehrlich
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Carpineto P, Agnifili L, Senatore A, Agbeanda A, Lappa A, Borrelli E, Di Martino G, Oddone F, Mastropasqua R. Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study. Acta Ophthalmol 2019; 97:e1069-e1076. [PMID: 31125179 DOI: 10.1111/aos.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). METHODS Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. RESULTS Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall-, AQ- and UQ-MISHA further increased (p < 0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p < 0.05). Rhegmatogenous retinal detachment- diagnosis (RRD-D), 1- and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p < 0.05). CONCLUSION Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.
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Affiliation(s)
- Paolo Carpineto
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Luca Agnifili
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Alfonso Senatore
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Aharrh‐Gnama Agbeanda
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Andrea Lappa
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Enrico Borrelli
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Giuseppe Di Martino
- School of Hygiene Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
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Li Z, Guo C, Nie D, Lin D, Zhu Y, Chen C, Zhang L, Xu F, Jin C, Zhang X, Xiao H, Zhang K, Zhao L, Yu S, Zhang G, Wang J, Lin H. A deep learning system for identifying lattice degeneration and retinal breaks using ultra-widefield fundus images. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:618. [PMID: 31930019 DOI: 10.21037/atm.2019.11.28] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Lattice degeneration and/or retinal breaks, defined as notable peripheral retinal lesions (NPRLs), are prone to evolving into rhegmatogenous retinal detachment which can cause severe visual loss. However, screening NPRLs is time-consuming and labor-intensive. Therefore, we aimed to develop and evaluate a deep learning (DL) system for automated identifying NPRLs based on ultra-widefield fundus (UWF) images. Methods A total of 5,606 UWF images from 2,566 participants were used to train and verify a DL system. All images were classified by 3 experienced ophthalmologists. The reference standard was determined when an agreement was achieved among all 3 ophthalmologists, or adjudicated by another retinal specialist if disagreements existed. An independent test set of 750 images was applied to verify the performance of 12 DL models trained using 4 different DL algorithms (InceptionResNetV2, InceptionV3, ResNet50, and VGG16) with 3 preprocessing techniques (original, augmented, and histogram-equalized images). Heatmaps were generated to visualize the process of the best DL system in the identification of NPRLs. Results In the test set, the best DL system for identifying NPRLs achieved an area under the curve (AUC) of 0.999 with a sensitivity and specificity of 98.7% and 99.2%, respectively. The best preprocessing method in each algorithm was the application of original image augmentation (average AUC =0.996). The best algorithm in each preprocessing method was InceptionResNetV2 (average AUC =0.996). In the test set, 150 of 154 true-positive cases (97.4%) displayed heatmap visualization in the NPRL regions. Conclusions A DL system has high accuracy in identifying NPRLs based on UWF images. This system may help to prevent the development of rhegmatogenous retinal detachment by early detection of NPRLs.
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Affiliation(s)
- Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Danyao Nie
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Li Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,School of Computer Science and Technology, Xidian University, Xi'an 710071, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Guoming Zhang
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Jiantao Wang
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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Gottlieb M, Holladay D, Peksa GD. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. Acad Emerg Med 2019; 26:931-939. [PMID: 30636351 DOI: 10.1111/acem.13682] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ocular complaints are common presentations to the emergency department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment. METHODS PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO CRD42018097288. There was no funding for this review. RESULTS Eleven studies (n = 844 patients) were identified. Overall, ultrasound was 94.2% (95% confidence interval [CI] = 78.4% to 98.6%) sensitive and 96.3% (95% CI = 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a positive likelihood ratio of 25.2 (95% CI = 8.1 to 78.0) and a negative likelihood ratio of 0.06 (95% CI = 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers. CONCLUSIONS Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment. Future studies should determine the ideal training protocol and the influence of color Doppler and contrast-enhanced ultrasound on diagnostic accuracy.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Dallas Holladay
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
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Poulsen CD, Green A, Grauslund J, Peto T. Long-Term Outcome of Patients Operated with Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment. Ophthalmic Res 2019; 63:25-33. [PMID: 31013505 DOI: 10.1159/000499130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the long-term outcome of patients operated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify potential predictors for poor visual outcome. METHODS Prospective, observational 30-month study of patients operated for primary RRD with PPV. Examinations were performed preoperatively and after months 2, 6, and 30. RESULTS Eighty-four patients (84 eyes) were included and 73 (86.9%) participated at month 30. The macula was attached in 30 (35.7%) patients at primary operation. The majority of patients (n = 59, 80.8%) achieved a good final best corrected visual acuity (BCVA ≤0.3 logMAR, ≥0.5 Snellen) with a better outcome in patients with the macula attached than detached (0.02 vs. 0.17 logMAR, p = 0.007). Variables associated with poor visual outcome were baseline BCVA >0.3 logMAR (p = 0.03), female gender (p = 0.02), silicone oil (p = 0.03), and larger areas of retinal detachment (p = 0.01). In multivariable regression analysis, female gender (OR = 8.5 [95% CI 1.8-39.8]) was the strongest risk factor for poor visual outcome. CONCLUSION The majority of patients operated for primary RRD achieved a reasonable long-term visual outcome. Notably, female gender was associated with poor visual outcome, indicating a need for closer follow-up.
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Affiliation(s)
- Christina D Poulsen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Anders Green
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Poulsen CD, Petersen MP, Green A, Peto T, Grauslund J. Fundus autofluorescence and spectral domain optical coherence tomography as predictors for long-term functional outcome in rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2019; 257:715-723. [DOI: 10.1007/s00417-018-04222-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022] Open
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Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment. J Ophthalmol 2018; 2018:9016302. [PMID: 30538859 PMCID: PMC6260553 DOI: 10.1155/2018/9016302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.
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Abu El-Asrar A, Al-Kwikbi H, Kangave D. Prognostic Factors after Primary Vitrectomy and Perfluorocarbon Liquids for Bullous Rhegmatogenous Retinal Detachment. Eur J Ophthalmol 2018; 19:107-17. [DOI: 10.1177/112067210901900116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To identify prognostic factors for visual acuity and anatomic outcomes associated with bullous rhegmatogenous retinal detachment (RRD) management using primary pars plana vitrectomy, intraoperative perfluorocarbon liquids (PFCLs), and internal gas tamponade. Methods The authors studied a consecutive series of 115 eyes (115 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, and/or posterior breaks in 58 (50.4%) eyes. All eyes underwent vitrectomy, injection of PFCL, and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. The follow-up period ranged from 3 to 60 months (mean 16.6±14.1 months). Results Retinal reattachment was achieved in 92.2% of eyes (106/115) with one operation and in all eyes after a second procedure. PVR was observed in 1 (0.87%) eye and pre-retinal membranes in 3 (2.6%) eyes. Progression of pre-existing cataract and development of new cataract occurred in 45 (58.4%) of the 77 phakic eyes. The presence of inferior retinal breaks was significantly associated with redetachment after the first procedure (p=0.0156). On univariate analysis, better preoperative visual acuity (p<0.001), macular sparing retinal detachment (p<0.001), and fewer quadrants involved by the detachment (p=0.0015) were significant positive prognostic factors for final visual acuity. Logistic regression analysis highlighted that macular sparing retinal detachment and absence of trauma were associated with better final visual acuity. Conclusions Redetachment was associated with the presence of inferior retinal breaks. Visual recovery was dependent on preoperative visual acuity, macular involvement, extent of retinal detachment, and trauma.
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Affiliation(s)
- A.M. Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh - Saudi Arabia
| | - H.F. Al-Kwikbi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh - Saudi Arabia
| | - D. Kangave
- Research Center, College of Medicine, King Saud University, Riyadh - Saudi Arabia
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Jovanović Đ, Jovanović V, Karadžić J. Significance of clinical parameters and treatment methods for prognosis and postoperative outcome of rhegmatogenous retinal detachment. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Park SW, Kwon HJ, Byon IS, Lee JE, Oum BS. Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:328-335. [PMID: 28752694 PMCID: PMC5540988 DOI: 10.3341/kjo.2016.0024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). Methods The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. Results This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). Conclusions Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.
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Affiliation(s)
- Sung Who Park
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
| | - Han Jo Kwon
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Boo Sup Oum
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
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Haugstad M, Moosmayer S, Bragadόttir R. Primary rhegmatogenous retinal detachment - surgical methods and anatomical outcome. Acta Ophthalmol 2017; 95:247-251. [PMID: 27860442 DOI: 10.1111/aos.13295] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/16/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the study was to evaluate the anatomical success of surgical management of primary rhegmatogenous retinal detachment (RRD) and to compare the anatomical outcomes from different surgical techniques. METHODS During 2012, 517 consecutive eyes (514 patients) were operated by 11 surgeons at the Department of Ophthalmology, Oslo University Hospital. Patient records were retrospectively analysed with no exclusions. Main outcome measures were primary and final anatomical success. Primary anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations excluded. Final anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations included. RESULTS Incidence of RRD was 18.6 eyes per 100 000 person-years. The macula was detached in 50.5% of the eyes at baseline. Of 517 operated eyes, 317 (61.3%) underwent pars plana vitrectomy (PPV), 23 (4.5%) pars plana vitrectomy together with a scleral buckle (PPV-SB), 175 (33.9%) scleral buckle (SB) surgery and two (0.4%) pneumatic retinopexy (PR). Primary anatomical success was 89.0% in the PPV group, 87.0% in the PPV-SB group and 85.7% in the SB group. Final anatomical success was 98.1% in the PPV group, 100% in the PPV-SB group and 99.4% in the SB group. Factors which were correlated to the redetachment were detachment of more than 6 clock hours (p = 0.003) and visual acuity (VA) on Snellen chart <0.5 (p = 0.02) at baseline. CONCLUSION This study showed no significant differences in the surgical success rates in the treatment of RRD between pars plana vitrectomy, scleral buckle or the combined procedure of vitrectomy and buckle. Factors which were found to be correlated to the redetachment of the retina were large detachment and low VA.
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Affiliation(s)
- Marta Haugstad
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
| | - Stefan Moosmayer
- Department of Orthopedic Surgery; Martina Hansens Hospital; Sandvika Norway
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Üney GÖ, Acar MA, Ünlü N, Hazirolan D, Yalniz-Akkaya Z, Örnek F. Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery. Can J Ophthalmol 2016; 51:331-335. [PMID: 27769322 DOI: 10.1016/j.jcjo.2016.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 12/25/2015] [Accepted: 02/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases. DESIGN Retrospective series in a tertiary care centre. PARTICIPANTS One hundred and twenty consecutive patients. METHODS The medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed. RESULTS The single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point. CONCLUSIONS Consequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.
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Affiliation(s)
- Güner Ö Üney
- Ministry of Health Ankara Training and Research Hospital Ophthalmology Clinic, Ankara, Turkey.
| | - Mehmet A Acar
- Department of Ophthalmology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Nurten Ünlü
- Ministry of Health Ankara Training and Research Hospital Ophthalmology Clinic, Ankara, Turkey
| | - Dicle Hazirolan
- Ministry of Health Ankara Training and Research Hospital Ophthalmology Clinic, Ankara, Turkey
| | - Zuleyha Yalniz-Akkaya
- Ministry of Health Ankara Training and Research Hospital Ophthalmology Clinic, Ankara, Turkey
| | - Firdevs Örnek
- Ministry of Health Ankara Training and Research Hospital Ophthalmology Clinic, Ankara, Turkey
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Woo MY, Hecht N, Hurley B, Stitt D, Thiruganasambandamoorthy V. Test characteristics of point-of-care ultrasonography for the diagnosis of acute posterior ocular pathology. Can J Ophthalmol 2016; 51:336-341. [DOI: 10.1016/j.jcjo.2016.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 03/02/2016] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
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Fang W, Li JK, Jin XH, Dai YM, Li YM. Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling. Int J Ophthalmol 2016; 9:994-8. [PMID: 27500107 DOI: 10.18240/ijo.2016.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/16/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). METHODS Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. RESULTS Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, P<0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P=0.0250), better baseline BCVA (r=0.7291, P<0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR(2))=0.5316, P<0.0001], shorter symptoms duration (PR(2)=0.0609, P=0.0101), longer follow up duration (PR(2)=0.0278, P=0.0477) and shorter operative duration (PR(2)=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0.0067). CONCLUSION Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.
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Affiliation(s)
- Wei Fang
- Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jiu-Ke Li
- Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao-Hong Jin
- Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yuan-Min Dai
- Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yu-Min Li
- Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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