The effect of cryotherapy on proliferative vitreoretinopathy (PVR)

Safety and efficacy of cryopexy during pars Plana vitrectomy in rhegmatogenous retinal detachment

PURPOSE

To evaluate efficacy and safety of intraoperative cryoretinopexy in cases of rhegmatogenous retinal detachment (RRD).

METHODS

In this retrospective, interventional case series, we review the medical records of 85 consecutive cases of RRD treated with pars plana vitrectomy and gas tamponade, without the use of perfluorocarbon liquids. Baseline best-corrected visual acuity, intraocular pressure, number and location of retinal breaks, location and extension of retinal detachment, duration of symptoms, macula status, presence, and grade of proliferative vitreoretinopathy (PVR) were registered. Follow-up visits were at 1 day, 15 days, 1 month and 3 months. Anatomical and functional outcomes and any adverse event were recorded.

RESULTS

Primary anatomical success was obtained in 82/85 patients (96%). During the postoperative period, PVR was observed in 4/85 cases (4.7%), 3 of whom developed recurrence of retinal detachment. 7/85 (8.2%) patients developed ocular hypertension. We built a model of logistic regression including age, sex, lens status, macula status, number of quadrants involved, number of ruptures and duration of symptoms. None of the variables considered was found to be a predictor of postoperative PVR development. Symptom's duration (β = 0.429; 95% CI = 0.009-0.023; P < 0.001) and preoperative BCVA (β = 0.273; 95% CI = 0.034-0.184; P = 0.005) were predictors for final BCVA.

CONCLUSION

These findings emphasize the safety and efficacy of the use of intraoperative cryotherapy, associated with PPV and gas tamponade, for the management of uncomplicated RRDs.

Rhegmatogenous retinal detachment surgery: A review

Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management.

EXTRAMACULAR FIBROSIS IN COATS' DISEASE

PURPOSE

To determine the rate, risk factors, and outcome of extramacular fibrosis in Coats' disease.

METHODS

Consecutive cases from a single center were retrospectively reviewed. Clinical characteristics and treatments were analyzed by comparative, multivariate, and survival approaches.

RESULTS

Among 69 patients with Coats' disease, 28 (40.6%) showed evidence of extramacular fibrosis (mean follow-up: 58.2 months). Mean time of fibrosis onset was 17.4 months. Extent of retinal exudation and rate of exudative retinal detachment at baseline were significantly higher in eyes that developed extramacular fibrosis compared with those that did not (P < 0.001). Similarly, these parameters showed significant differences using multivariate (P < 0.05) and survival analysis (P < 0.001). Extension of telangiectasia, number of cryotherapy, or laser sessions, and treatment by anti-vascular endothelial growth factor were not associated with extramacular fibrosis. Final visual acuity was worse in patients with extramacular fibrosis (P < 0.001). The rates of tractional retinal detachment and macular fibrosis were higher in patients with extramacular fibrosis (39%.0 vs. 0% and 60.7% vs. 19.5%, respectively, P < 0.001).

CONCLUSION

Extramacular fibrosis led to a worse visual prognosis and was associated with the extension of retinal exudation and the presence of exudative retinal detachment at diagnosis. Treatment should target a quick resolution of exudation to limit its development.

Macular epiretinal membrane formation and treated retinal breaks

PURPOSE

We sought to determine the incidence of macular epiretinal membrane formation in eyes treated for retinal breaks after three different modalities of treatment: laser photocoagulation, cryotherapy, or both.

METHODS

We reviewed the charts of 262 consecutive patients with a diagnosis of retinal tears and included 205 patients who had more than six months of follow-up.

RESULTS

One hundred ninety-five patients were treated. One hundred seventy of these patients had retinal breaks in one eye and 25 patients had breaks in both eyes, for a total of 220 treated eyes. Cryopexy was applied in 125 eyes, laser retinopexy in 73 eyes, and both modalities in 22 eyes. Macular epiretinal membranes developed in a total of 26 eyes: 12 in the cryopexy group, ten in the laser-treated group, and four in the dual modality group. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation between the different treatment modalities. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation in the presence or absence of vitreous hemorrhage or in the type of precedent retinal break.

CONCLUSIONS

After treatment of retinal breaks with laser photocoagulation and cryotherapy, no statistically significant difference in the incidence of macular epiretinal membrane formation was demonstrated.