Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks

Internal Limiting Membrane Flaps for Coexistent Macular Hole and Retinal Detachment in Eyes with Proliferative Diabetic Retinopathy

Purpose

To evaluate logical surgical approaches to closing macular holes in eyes with proliferative diabetic retinopathy with retinal detachment.

Methods

Retrospective, interventional case series.

Results

10 eyes in 10 patients were included in this study. The inverted internal limiting membrane (ILM) flap technique was used in 2 eyes, while inverted ILM insertion was used in 5 eyes, and free ILM flaps in 3 eyes. Closed macular holes and retinal reattachment were observed in all eyes. Best corrected visual acuity improved from 1.33 ± 0.39 preoperatively to 1.02 ± 0.36 postoperatively (p=0.03).

Conclusion

Various surgical approaches utilized in managing macular holes may effectively close macular holes and reattach retinas. This trial is registered with NCT 03618498.

Retinal detachment in East Africa

PURPOSE

To report the causes of retinal detachment in an African setting and the outcome after surgery.

DESIGN

Noncomparative interventional case series.

PARTICIPANTS

A total of 361 eyes in 345 patients.

METHODS

Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression.

MAIN OUTCOME MEASURES

Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation.

RESULTS

The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up.

CONCLUSIONS

Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.

The results of surgery on macular holes associated with rhegmatogenous retinal detachment

PURPOSE

Macular holes can occur as a secondary phenomenon with or after otherwise successful repair of uncomplicated macula-off rhegmatogenous retinal detachments with peripheral breaks. The purpose of this study was to evaluate the anatomical and visual outcomes of vitrectomy surgery to close the macular holes in these situations.

METHODS

A retrospective record review was completed for patients with a retinal detachment with peripheral breaks and a macular hole or those patients developing macular holes within 2 weeks of successful primary external buckling surgery for macula-off retinal detachment. In those patients with a concurrent macular hole and retinal detachment, a primary vitrectomy was carried out to close the macular hole and reattach the retina. In those patients who developed a macular hole after successful primary external buckling surgery, a secondary vitrectomy was then carried out to close the macular hole.

RESULTS

The authors reviewed the records of 10 patients. All had a preoperative visual acuity of 20/400 or worse. After surgery, one patient achieved a best-corrected visual acuity of 20/40; six patients achieved a best-corrected visual acuity of 20/80; and three patients achieved a best-corrected visual acuity of 20/120.

CONCLUSION

These results suggest that macular hole surgery is worthwhile for these patients and can provide satisfactory results in terms of visual improvement.

Retinal detachment in developing countries

Treatment of retinal detachment has been a low priority in developing countries. It is thought to be less common in India and Africa than in Europe and N America. The aetiology and presentation of retinal detachment in the Third World are affected by genetic and environmental factors. In general, patients are more likely to present late, and complex detachments are relatively more common. Despite these problems, the results of surgery are encouraging, with more than 80% final anatomical success, and over 60% of re-attached retinas obtaining vision of 6/60 or better. The management of retinal detachment in developing countries can be improved by strengthening training programmes and by developing and equipping centres to carry out retinal surgery.

Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes. An assessment of outcome and the status of the macular hole

PURPOSE

To establish the effectiveness of vitrectomy and gas tamponade for treating retinal detachments due to peripheral retinal breaks with an associated macular hole and to discover the status of the macular hole at long-term follow-up.

METHODS

Twenty-three consecutive patients with combined peripheral break and macular hole retinal detachments were treated by pars plana vitrectomy. The main outcome measures were reattachment of the retina and status of the macular hole.

RESULTS

Seventy-eight percent of the operations were successful in reattaching the retina initially, improving to 87% after two patients had another operation. Three patients declined further surgery. Long-term follow-up of macular hole status was possible in 16 cases. Closure rate was 31%.

CONCLUSION

Pars plana vitrectomy with gas tamponade is an effective method of treating this form of retinal detachment. Some macular holes close after this surgery.