Choroidal detachment following retinal detachment surgery: an analysis and a new hypothesis to minimize its occurrence in high-risk cases

PURPOSE: To determine factors predisposing to the development of choroidal detachment following conventional retinal detachment surgery, to evaluate its clinical course, and to identify possible measures to reduce its occurrence. METHODS: Analysis of 25 consecutive cases of choroidal detachment following retinal detachment surgery out of a total of 510 cases undertaken at a tertiary care referral eye center over a period of 15 months. RESULTS: The incidence of developing choroidal detachment was 4.9%. The mean age was 61 years (range 28 to 76 years) and there was no sex predilection. Hypertension was present in 16% (n=4). A total of 44% (n=11) of patients had myopia and with respect to the lens status, 44% (n=11) were phakic, 36% (n=9) were pseudophakic, and 20% (n=5) were aphakic. Redetachment of the retina was observed in 12% (n=3) of cases. Elevated intraocular pressure developed in 12% (n=3). In one patient with an anterior chamber intraocular lens and "kissing" choroidal detachment, drainage of the choroidals was undertaken to prevent corneo-lenticular touch and corneal decompensation. In two patients with redetachment, anatomic settlement of the retina was achieved only following vitreoretinal surgery. CONCLUSIONS: The following preoperative and intraoperative factors are associated with a significantly increased risk of choroidal detachment following retinal detachment: higher age, myopia, posteriorly placed explants even if its extent is less, anteriorly placed explants whenever its extent is large, drainage of subretinal fluid, and intraoperative hypotony. Choroidal detachment may also occur in patients with only a radial sponge. Designing a notch intraoperatively in the region of the explants overlying the vortex veins may help to reduce the risk of choroidal detachment following conventional retinal detachment surgery.     

Pseudophakic retinal detachment

Pseudophakic retinal detachment is a rare, but potentially serious, complication of cataract surgery. The incidence of pseudophakic retinal detachment following current surgical techniques of cataract extraction, including extracapsular cataract extraction by nuclear expression and phacoemulsification, is lower than that found after intracapsular cataract extraction. The risk of pseudophakic retinal detachment appears to be increased in myopic patients, in those patients in whom vitreous loss had occurred at the time of cataract surgery, and in patients undergoing Nd:YAG posterior capsulotomy. Most cases present to the clinician when the macula is already detached and the central vision is affected. When evaluating patients with pseudophakic retinal detachment, the fundal view is often impaired by anterior or posterior capsular opacification, reflections related to the intraocular lens, or poor mydriasis. Scleral buckling, pneumatic retinopexy, and primary pars plana vitrectomy, with or without combined scleral buckling, are the surgical techniques used to treat pseudophakic retinal detachment. Anatomical success rates are high after vitreo-retinal surgery for pseudophakic retinal detachment, although a smaller proportion of patients recover good vision following surgery.     

Retinal detachment after perforating eye injuries. III. Analysis of retinal detachment after perforating eye injuries and determination of the characteristics of the retinal detachment after perforating eye injuries

In 1977-1987 the authors operated, using the cryosurgical method post-traumatic retinal detachment in 69 patients. Retinal detachment developed in 37 patients after simple perforation of the eye by a foreign intraocular body. In all patients the perforation penetrated as far as the vitreous space. In patients with retinal detachment the authors investigated the following: the patient's age, refraction, period of retinal detachment, extent of retinal detachment, the state of the macula, the characteristics of the retinal defect (site, size and number), type of retinal detachment and associated adverse factors. In the characteristics of retinal detachment after perforating eye injuries the first place was held by prognostically adverse vitreous traction in 73.9%.     

准分子激光原位角膜磨镶术后视网膜脱离

目的：分析LASIK治疗近视术后发生视网膜脱离的临床特征和处理原则。方法：回顾性分析LASIK术后发生视网膜脱离的3只眼（3例患者）。结果：术前平均屈光度（等值球间，下同）为－9．3D（范围－7．37－－11．50D）。LASIK与网脱发生的间隔时间为0．5－26个月（平均11．8个月）。视网膜裂孔类型和数目：1例为马蹄形，1个；1例为锯齿缘断离；1例为小圆形裂孔，3个，裂孔位置；3例均在赤道部前方，3例通过一次手术后即成功复方。结构：具有视网膜病变的高度近视病在LASIK术后易发生视网膜脱离。     

Hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered patients

This is the first report describing the syndrome of hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered eyes. Four patients had a history of advanced primary open-angle glaucoma treated with multiple medical therapies, including timolol for 11 to 36 months. They then underwent filtration surgery, which failed in two cases. Timolol and/or acetazolamide therapy was instituted 1 to 18 months following surgery. The patients then developed hypotony and ciliochoroidal detachment, which resolved spontaneously after cessation of the pharmacologic aqueous suppressant therapy. In three of the cases, the episode of hypotony and ciliochoroidal detachment recurred after a second challenge with timolol and/or acetazolamide therapy. Inflammation, tumor, wound leakage, retinal detachment and cyclodialysis cleft were excluded. A mechanism of formation of ciliochoroidal detachment in this syndrome is proposed. Long-term timolol therapy followed by filtration surgery and its attendant postoperative hypotony and ciliochoroidal detachment sensitizes the ciliary epithelium. Subsequent pharmacologic aqueous suppressant therapy results in almost total reduction of aqueous production, causing hypotony and ciliochoroidal detachment.     

Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment

AIM: To evaluate the functional outcome after removal of silicone oil (ROSO) in patients undergoing retinectomy for complex retinal detachment. METHODS: We performed a retrospective case note review of patients who underwent ROSO after retinectomy for complex retinal detachment. Patients with less than 6mo follow up and recurrent retinal detachment following ROSO were excluded. RESULTS: Thirty-six patients were included. The mean best corrected visual acuity (BCVA) pre-ROSO was 1.13 logMAR (SD 0.5). The mean BCVA 3mo following ROSO was 1.16 logMAR (SD 0.53), 6mo following ROSO 1.13 (SD 0.63), and 12mo following ROSO 1.18 (SD 0.69). At 12mo after ROSO, the BCVA improved in 38.9% of patients, remained unchanged in 25%, and deteriorated in 36.1%, although there was no statistical significant difference in BCVA after ROSO at 3, 6 and 12mo (P=0.93). The size of retinectomy ranged from 15° to 270° (SD 53) and did not influence the visual outcome (P=0.11). CONCLUSION: There was no statistically significanT difference in BCVA between pre- and post- ROSO following retinectomy for complex retinal detachment. There was no statistical difference in visual outcome related to the size of the retinectomy.     

Small-gauge vitrectomy in traumatic retinal detachment

Purpose: To report the outcome of retinal detachment surgery following trauma treated with small‐gauge vitrectomy. Design: Retrospective chart review. Participants: Adult patients presenting with a retinal detachment following severe trauma between 2007 and 2009 that underwent vitreoretinal surgery with either 25‐ or 23‐gauge vitrectomy. Methods: Data collected included; age, sex, eye, time interval between injury and diagnosis of retinal detachment, anatomical and functional success, complications, and length of follow up. Main Outcome Measures: Anatomical and functional outcome. Results: Nineteen consecutive adult patients with traumatic retinal detachment were included. The mean age was 51.4 ± 19.3 years; 68.5% were male. Thirteen patients (68.4%) presented with visual acuity of hand movement or worse including six patients with light perception only. Five eyes achieved 6/60 vision or better, and three eyes had visual acuity of 6/12 or better. During the period of follow up six eyes experienced a recurrent retinal detachment. Conclusion: Traumatic retinal detachment can be successful managed with small‐gauge vitrectomy.     

Efficiency of laser coagulation in the treatment of rhegmatogenous retinal detachment

A hundred and seventeen (143 eyes) patients with different types of retinal detachment were examined. The patients were treated by laser coagulation on a LAHTA device (Milon). The clinical findings indicated the efficiency of retinal laser coagulation as an independent treatment for retinal rhegmatogenous detachment and indications for laser coagulation were defined in the following types of retinal detachment: subclinical local retinal detachment; fresh mobile retinal detachment (Stages A and B); non-mobile retinal detachment occupying not more than one quadrant, and partially self-circumscribed retinal detachment (Stages B and C1) taking up the lower quadrants. The benefits of this method are noninvasiveness and high functional results, which enables laser coagulation to be regarded as an independent effective treatment for the above types of retinal detachment.     

Rhegmatogenous retinal detachment after rupture of retinal arterial macroaneurysm

PURPOSE: To report two cases of rhegmatogenous retinal detachment following rupture of retinal arterial macroaneurysm. DESIGN: Observational case report. METHODS: Review of clinical records of 75 consecutive eyes (73 patients) with macroaneurysm. RESULTS: Ruptured macroaneurysm was present in 68 of the 75 eyes, and rhegmatogenous retinal detachment developed spontaneously in 2 (2.9%) of the 68 eyes. In the 2 eyes with retinal detachment, there were no predisposing lesions to retinal detachment and the detachment occurred either 2 weeks or 1 month after the rupture of a macroaneurysm. Retinal detachment and posterior vitreous detachment developed simultaneously after bleeding from the macroaneurysm spread into the vitreous in 1 eye. CONCLUSIONS: We report the occurrence of retinal detachment after macroaneurysmal rupture. Detailed fun-dus examination is required to detect retinal detachment in the follow-up of patients with ruptured macroaneurysm.     

Surgery for pre-macular fibrosis

We review 12 consecutive cases of pre-macular fibrosis (PMF) treated by vitreous surgical techniques. The causes of PMF included retinal detachment surgery in four patients, idiopathic in three patients, laser treatment in three patients, pars planitis in one patient and diabetic retinopathy in one patient. The membrane was successfully removed in all the patients. One patient developed a retinal detachment that was repaired successfully. All patients had improved visual acuity (VA) of two Snellen lines or more and six patients achieved VA of 6/12 or better. Patients with PMF following retinal detachment had poorer final VA.     

Tractional detachment of the macula following branch retinal vein occlusion

In two patients, a detachment of the macula occurred following a branch retinal vein occlusion. Vitreoretinal relationships were investigated and documented by biomicroscopic photography. Both eyes showed partial posterior vitreous detachment with dense adhesions to a preretinal membrane at the macula. Vitreous contraction and traction appeared to be responsible for the detachment.     

Late postoperative choroidal detachment

Three eyes of three patients with advanced primary open angle glaucoma developed hypotony and choroidal detachment 2-3 months following technically uncomplicated trabeculectomy, in one patient and facoemulsification in two patients. The two latter patients had undergone trabeculectomy previously. No wound or bleb leakage were found. Patients did not receive any antiglaucoma medications before the detachment. After treatment with topical corticosteroids and cycloplegic eyedrops both patients showed marked clinical improvement within 2-6 weeks. However, one of the patients after phacoemulsification developed recurrent choroidal detachment shortly after application of timolol drops used due to IOP elevation. Detachment resolved spontaneously after discontinuation of timolol.     

Retinal detachment following surgery for congenital cataract: presentation and outcomes

AIMS: To review the current management and outcomes of retinal detachment following cataract surgery in childhood. METHODS: A retrospective review of 59 eyes of 52 patients. RESULTS: In 37% of patients, the fellow eye was blind (<3/60). The macula was detached at presentation in 81% of eyes. The detachment was obscured by residual lens matter, or a miotic pupil in 67% of eyes that had cataract surgery before 1970, but in only 30% of eyes operated after 1970. The retina was reattached with one operation in 59% of eyes, and final reattachment was achieved in 81%. No retina was reattached by scleral buckling alone. Visual outcomes were slightly better in eyes that had retinal detachment repair after 1 January 1998. Nine patients were blind in both eyes at the latest follow-up. CONCLUSIONS: Retinal detachment following childhood cataract surgery remains a serious condition. There has been some improvement in the prognosis due to a combination of advances in childhood cataract surgery as well as to improvements in the management of retinal detachment. Early recognition and prompt surgery, using an internal approach, may prevent blindness in most cases.     

Clinical predictors of retinal detachment after open globe injury

BACKGROUND: A retinal detachment after open globe injury has important prognostic and therapeutic implications. MATERIAL AND METHODS: To determine whether retinal detachment following open globe injury could be predicted by clinical factors, we retrospectively evaluated 52 patients (52 eyes) with open globe injury admitted to our department. The Birmingham Eye Trauma Terminology System was used. Only patients which open eye injuries were evaluated. The results were registered during the 7 days after the accident. RESULTS: In the week after the open globe injury, retinal detachment was present in 40.3 %. 100 % of the patients with previous cataract operation (with IOL) developed a retinal detachment (p < 0.01). Retinal detachment also correlated significantly with visual acuity less than hand movement and retained intraocular foreign bodies. 19 (95 %) of the 20 patients with a visual acuity less than hand movement had retinal detachment versus only 2 (9 %) patients with visual acuity of hand movement or better (p < 0.01). 6 (66.6 %) of the 9 patients with intraocular foreign bodies had retinal detachment compared to 15 (34.8 %) of the 46 patients without intraocular foreign bodies (p=0.01). Logistic regression analysis confirmed this variables as independent predictors of retinal detachment. CONCLUSION: We conclude that previous cataract operation, versus less than hand movement and the presence of intraocular foreign bodies are predictive to retinal detachment.     

Visual results following vitreous loss and primary lens implantation

Implantation of an intraocular lens following vitreous loss at cataract surgery is a controversial decision. To address this issue, we retrospectively identified all cases performed at the University of Minnesota in the last three years that had either a posterior or an anterior chamber lens placed following anterior vitrectomy. Twenty patients had a posterior chamber lens implant; 14 had follow-up longer than six months. All these patients achieved 20/40 or better visual acuity, although one patient had a retinal detachment. Of the six patients with an anterior chamber lens implant, four achieved 20/40 or better acuity and two achieved 20/50 acuity with follow-up of six months; one patient had a retinal detachment. This review demonstrates that with a meticulous anterior vitrectomy, good visual results can be achieved, although the risk of retinal detachment is higher than in uncomplicated cases.     

Does unintentional macular translocation after retinal detachment repair influence visual outcome?

Background: To document the occurrence of postoperative macular translocation after retinal detachment repair and discuss its influence on visual outcome. Design: Retrospective case series in a tertiary care setting. Participants: Five eyes of five patients presenting to our clinic with macula‐off rhegmatogenous retinal detachment. Methods: All patients underwent surgical repair of the retinal detachment, with regular postoperative follow‐up, including macular optical coherence tomography and fundus autofluorescence. Main Outcome Measures: Visual acuity and subjective visual symptoms in patients with anatomically successful retinal detachment repair, in whom inadvertent macular translocation was noted. Results: Our series demonstrates the presence of unintentional macular translocation after retinal detachment repair, detected by fundus autofluorescence imaging. In contrast to previous reports, we document inadvertent macular translocation in one patient after scleral buckling surgery. In each case, the retina was fully reattached postoperatively and no other complications were identified. There was variability in the symptoms and objective visual outcomes after surgery. Conclusions: Inadvertent macular translocation can occur following repair of macula‐off retinal detachment, and may be a significant contributor to poorer visual outcome after retinal detachment, despite objective surgical success.     

Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy

We used sophisticated vitreous surgical techniques in conjunction with silicone oil injection in ten eyes of ten patients with rhegmatogenous retinal detachment complicated by advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. After a minimum follow-up of one year, three patients achieved total retinal reattachment and two patients regained ambulatory vision (5/200 or better). Maintenance of low to normal intraocular pressure was observed in nine of the ten eyes despite some cases of progressive anterior segment neovascularization and retinal detachment. Although treatment was more difficult and less successful than in either retinal detachment with proliferative diabetic retinopathy or proliferative vitreoretinopathy alone, these techniques allowed some success in eyes that otherwise would have a poor prognosis.     

孔源性视网膜脱离术后视功能恢复的影响因素

孔源性视网膜脱离是一种严重的致盲性眼病。随着现代手术技术和眼科设备的进步，术后解剖复位率越来越高，但视功能的恢复却不尽人意。本文主要对影响孔源性视网膜脱离患者视网膜复位术后视功能的因素进行综述，以期为术前评估预后、术中避免损伤、术后维护视功能提供依据。     

巩膜宽带环扎术后屈光状态改变的研究

目的 探讨巩膜宽带环扎术治疗视网膜脱离前后屈光状态及眼球各部分形态和容积的变化.方法 选取我院于2002年7月至2003年12月间行巩膜宽带环扎术并手术成功的孔源性视网膜脱离26例（26只眼）,利用A型超声、角膜地形图等技术,进行前瞻性研究.结果 视网膜脱离巩膜宽带环扎术后眼轴显著延长,前房显著变浅,晶状体明显增厚,而角膜平均屈光力和散光的变化无显著性意义.结论 视网膜脱离巩膜宽带环扎术后可发生眼球形态改变,其屈光状态的改变是诸多因素相互作用的结果.     

Hereditary progressive arthro-ophthalmopathy of Stickler

The ocular histopathologic findings in three patients with the Stickler syndrome from two families included the following: total retinal detachment with marked folding, disorganization of the retina, and a preretinal membrane. The progression of the fundus lesions was followed up in two patients during the course of 30 and 24 years. Many cases variously reported as Wagner's disease, familial retinal detachment, hyaloideoretinopathy with cleft palate, and the Pierre Robin syndrome probably were the Stickler syndrome.