Q-switched neodymium YAG laser vitreolysis in the therapy of posterior segment disease

We describe our experience of ten cases of posterior segment vitreolysis, using the short-pulse neodymium YAG (Yittrium Aluminium Garnate) laser. Eight patients had proliferative diabetic retinopathy, one patient had had an intraocular foreign body removed and one patient had had uveitis. Of the ten, five patients had macular traction retinal detachments, three patients had progressive traction retinal detachments threatening the macula and two patients had recurrent vitreous haemorrhages from mechanical traction on areas of fibrovascular proliferation. Eight of the patients were successfully treated. One macular retinal detachment failed to flatten and a tear was found which may have been iatrogenic. In one patient with a traction retinal detachment significant traction was relieved but the detachment failed to flatten completely. We discuss the indications, techniques, difficulties and complications. Our experience suggests that this technique has an important role in the treatment of selected patients, sparing patients conventional vitrectomy, or making possible the treatment of those for whom vitrectomy has been contraindicated or refused. Anterior defocussing of the YAG would be a useful modification of current laser systems and improved aiming systems desirable for the future.     

孔源性视网膜脱离眼黄斑区光相干断层扫描 特征与视力预后的关系

目的观察孔源性视网膜脱离患者黄斑区组织形态学改变与手术后视力预后的关系。方法对39例孔源性视网膜脱离患者39只眼进行光相干层扫描（OCT）检查，根据OCT显示的黄斑区神经上皮层形态，分为神经上皮水肿（水肿组）、神经上皮层间分离（分离组）、神经上皮囊样变性（囊样变组）3组，对3组之间视网膜脱离时间、手术前后视力以及OCT检测的黄斑区神经上皮层厚度进行相关指数的秩和及多重比较检验。结果3组患者手术前视力比较，其差异均无统计学意义(P＞0.05)；手术后视力、视网膜脱离时间及神经上皮层厚度三方面的差异均有统计学意义(P＜0.05)。分离组与囊样变组患者在视网膜脱离时间及神经上皮层厚度方面比较，其差异有统计学意义(P＜0.05)，而手术后视力差异无统计学意义(P＞0.05)。结论视网膜脱离患者的视网膜脱离时间、手术后视力均与OCT检测的神经上皮层厚度有相关关系。视网膜脱离时间越长，脱离的黄斑区视网膜神经上皮层厚度增加，视网膜组织形态学改变越明显，手术后视力愈差。(中华眼底病杂志,2005,21:83-85)     

Retinal detachment in the mentally retarded

PURPOSE: To report the clinical features and surgical outcomes of retinal detachment in mentally retarded patients. METHODS: Retrospective review of records of mentally retarded patients who had retinal reattachment surgery at the authors' institutions between February 1994 and February 2000. There were 8 patients with 13 surgically treated eyes. Demographic and clinical data were abstracted from the patients' medical records. RESULTS: The retina of 12/13 (92%) eyes remained reattached after a follow-up ranging from 9 to 78 months. In 6 eyes of the 4 patients whose visual acuity (VA) could be determined, VA improved in 5 eyes of 3 patients. In the remaining 4 patients whose VA could not be determined, improved behavioral patterns suggesting a successful surgical outcome were observed in 3 patients with bilateral retinal detachment, although in one of these patients only unilateral retinal reattachment was achieved. The findings in the eyes in this study agree with the findings in reports on patients with traumatic retinal detachment. CONCLUSIONS: The retinal reattachment rate is fair in the mentally retarded compared with the rate in other segments of the population. Ophthalmological examinations should be provided regularly for mentally retarded persons to keep open the possibility for early sight-improving surgery.     

Factors affecting visual recovery after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study

ObjectiveTo identify risk factors affecting visual outcomes in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery.DesignA prospective study, using online databases, of visual outcomes for 2074 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment.Main outcome measureThe probability of achieving a post-operative visual acuity (VA) of ≤0.30 LogMAR (Snellen 6/12 or better).ResultsMale patients accounted for 64.9% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.41 LogMAR post-operatively. A post-operative VA of ≤0.30 LogMAR was achieved for 1012 (48.8%) eyes and the factors affecting this were the patient age and gender, pre-operative VA, duration of central vision loss, PVR grade, lens status, total RD and the presence of any ocular co-pathology where the model area under the receiver operator curve was 71.6%.ConclusionsFrom the identified risk factors that decrease the probability of achieving a post-operative visual acuity of ≤0.30 LogMAR, the most important modifiable risk factor was the duration of central vision loss. Recent macula-off retinal detachments should be repaired within 72 h of the loss of central vision.Subject terms: Outcomes research, Retinal diseases     

Long-term visual results of vitreous surgery in diabetic eye disease

Long-term visual results in the first 124 consecutively vitrectomized eyes of 105 diabetic patients in our department were evaluated. The indications for vitrectomy were unresorbable vitreous haemorrhage (77 eyes, 62%) (group A), central traction retinal detachment (21 eyes, 17%) (group B), and a combination of both (26 eyes, 21%) (group C). Initially visual acuity (VA) improved at least by one category in 83 eyes (67%). The latest postoperative VA after the mean follow-up of 3.7 +/- 0.2 years was greater than = 0.3 in 36 eyes (29%), 0.1-0.25 in 15 eyes (12%), 0.05-0.08 in 9 eyes (7%), counting fingers (CF) 1-less than 3 m in 13 eyes (11%), and less than CF 1 m in 51 eyes (41%). The latest VA of 0.3 or better was significantly more common in group A (40%) than in group B (10%) or group C (12%) (P = 0.0087 and 0.0076, respectively). The most common causes of visual failure (VA less than C F 1m) were neovascular glaucoma and/or retinal detachment. At the latest follow-up visit 50% of the patients had VA of 0.3 or better, 16% were in the low-vision category, and 34% were blind (VA less than 0.05).     

Therapeutic options for capillary papillary hemangiomas

PURPOSE: To describe the results and therapeutic complications of treatment of papillary capillary hemangiomas over the last 13 years. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five cases of unilateral capillary papillary hemangiomas were reviewed. Three patients had von Hippel-Lindau disease, and two had no associated familial or systemic disease. METHODS: Two patients were treated with argon green laser, one patient received argon green and diode photocoagulation, and two patients underwent argon green photocoagulation and diode transpupillary thermotherapy (TTT); two eyes also underwent vitreoretinal surgery. Follow-up ranged from 1 to 13 years. MAIN OUTCOME MEASURES: The presence of exudative retinal detachment associated with the activity of the hemangioma and the visual acuity were the two main parameters. RESULTS: Prompt argon green laser treatment was the most effective therapy; -II was ineffective. Vitreoretinal surgery, transscleral drainage, and argon endolaser photocoagulation in one case resolved bullous retinal detachment secondary to tumor exudation. Pretreatment visual acuity (VA) levels ranged from 20/25 to counting fingers; posttreatment VA levels ranged from 20/25 to light perception. CONCLUSIONS: If left untreated, papillary hemangiomas may evolve to exudative retinal detachment and marked VA decreases. Although we have not established an ideal therapy, we recommend appropriate treatment on diagnosis. Close follow-up and multiple treatments with argon laser are likely the best therapeutic course.     

Vitrectomy for retinal detachment associated with acute retinal necrosis

Six patients with retinal detachment associated with the acute retinal necrosis syndrome were treated by the combination of vitrectomy, gas injection, and laser photocoagulation. The retinas were successfully reattached in each patient with one operation. Five of the patients achieved a visual acuity of 20/200 or better, and three had a visual acuity of 20/40 or better.     

The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments.

PURPOSE: To present a current series that determined the effect of duration of macular detachment (DMD) and patient age on postscleral buckle (SB) visual acuity (VA) and anatomic results. DESIGN: Retrospective, noncomparative, observational case series. PARTICIPANTS: Ninety-four consecutive patients (94 eyes) with primary, uncomplicated, macula-off retinal detachments, a preoperative VA of 20/200 or worse, and a precise history of when macular function was lost. INTERVENTION: Standard explant scleral buckle technique performed by multiple surgeons. MAIN OUTCOME MEASURES: Visual acuity, anatomic reattachment, and proliferative vitreoretinopathy. RESULTS: Visual acuity after SB of 20/40 or better was seen in 71% of eyes with a DMD of 10 days or fewer, 27% of eyes with a DMD of 11 days to 6 weeks, and 14% of eyes with a DMD of more than 6 weeks. Eyes achieved a mean VA after SB of 20/41 after a DMD of 10 days or fewer, 20/121 after a DMD of 11 days to 6 weeks, and 20/178 after a DMD of more than 6 weeks. No decrease in VA was seen within the 1- to 10-day period or the 11 days to 6 week period of DMD. Patients 60 years of age or less achieved a mean VA after SB of 20/47 compared with 20/81 for patients between 61 to 75 years of age and 20 of 96 in patients more than 76 years of age. Duration of macular detachment and patient age had no statistically significant effect on final anatomic reattachment after SB, reoperation rate, or proliferative vitreoretinopathy. CONCLUSIONS: Eyes with primary, uncomplicated, macula-off retinal detachment repaired with SB achieve excellent postoperative VA if repaired within the first 10 days of macular detachment. These results are better than the VA in eyes repaired after 11 days to 6 weeks and more than 6 weeks of macular detachment. Patients 60 years of age and younger obtained better postoperative VA than older patients. Duration of macular detachment and patient age did not significantly effect anatomic outcomes.     

Acute retinal necrosis: a case series with clinical features and treatment outcomes

Purpose:  To determine clinical features, viral aetiology and treatment outcomes of eyes with acute retinal necrosis (ARN).
Methods:  Retrospective, interventional, non-comparative case series.
Results:  Twenty-two patients (23 eyes) were identified between 1996 and 2007. Varicella zoster virus was the causative agent in 12 patients (nine confirmed by polymerase chain reaction), herpes simplex virus type 1 in six (five polymerase chain reaction-confirmed) and unknown in three patients. Five patients had documented herpes zoster infection in the month prior to the onset of ARN. Twelve patients (55%) had identifiable (clinical or subclinical) immune dysfunction. At 6 months, 3 out of 15 eyes (20%) maintained vision 6/12 or better and 7 (47%) were 6/60 or worse. Median final VA was 6/60. Nine eyes developed retinal detachment and two-thirds of these had received prior barrier laser. Poor prognostic factors for severe visual loss by univariate analysis were male gender ( P  = 0.019), and the development of retinal detachment ( P  = 0.05). Delay between onset of symptoms and diagnosis was associated with moderate visual loss ( P  = 0.018). Barrier laser did not reduce the risk of retinal detachment.
Conclusions:  Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome.     

Sheathotomy in complicated cases of branch retinal vein occlusion

Purpose: To report the clinical experience and results of using a microsurgical technique to decompress the arteriovenous connection in complicated branch retinal vein occlusion (BRVO) combined with haemorrhage, oedema and ischaemia. Methods: We carried out a retrospective, non‐randomized, interventional case study of the surgical sheathotomy decompression procedure. We enrolled 12 patients (seven women, five men; median age 64 years) with BRVO and decreased visual acuity (VA) caused by haemorrhage, oedema and ischaemia. The mean duration of thrombosis was 7 months (2–15 months). The patients were examined for pre‐ and postoperative best corrected VA (BCVA), intraocular pressure (IOP) and fundus photography. Ten patients were examined with fluorescein angiography and eight with ocular coherence tomography (OCT). Postoperative progression of cataract was recorded, as were other complications. The mean follow‐up time was 20 months (8–39 months). Results: Best corrected VA had improved in nine patients, was unchanged in one patient and had deteriorated in two patients at the last follow‐up. Noted complications were venous haemorrhage at surgery in five patients, retinal detachment in one patient and progression of cataract in four patients. Conclusions: Microsurgical treatment with sheathotomy of BRVO is a technically feasible procedure with few complications. Postoperative increased reperfusion could explain the resolution of macular haemorrhage, oedema and ischaemia, and may improve visual function in patients with this common vascular eye disease.     

Vitrectomy with silicone oil infusion in severe diabetic retinopathy

AIMS: To determine the results of pars plana vitrectomy (PPV) and silicone oil infusion (SOI) in severe proliferative diabetic retinopathy (PDR). METHODS: The records of 23 eyes (21 patients: 12 males, nine females) with PDR who had undergone PPV and SOI were reviewed retrospectively. RESULTS: Average follow up was 5.4 months (range 1-25). Surgical indications were tractional retinal detachment (TRD) (17.4%), traction-rhegmatogenous retinal detachment (TRRD) (8.7%), TRD with vitreous haemorrhage (VH) (48%), TRD with neovascular glaucoma (NVG) (8.6%), TRD with fibrinoid syndrome (FS) (17.3%). With one operation, the retinal reattachment rate was 17/23 (74%). Among these 23 eyes, 11 (48%) had previously failed vitrectomy, and the retina was attached in 8/11 (73%) with a single procedure. With additional surgery employing PPV and SOI, the final reattachment rate was 20/23 (87%). The only cases with intraocular pressure <5 mm Hg had retinal detachment. Postoperative visual acuity (VA) improved in 10 eyes (44%), was unchanged in three (12%), and decreased in 10 eyes (44%). CONCLUSION: SO tamponade is useful in severely diseased eyes with PDR, even in the presence of rubeosis iridis (RI) and NVG, FS, or in cases with previously failed vitrectomy, especially in the presence of RI.     

Fellow eye of patients with retinal detachment associated with macular hole and bilateral high myopia

PURPOSE: To estimate the risk of retinal detachment in the fellow eye of patients with bilateral high myopia who had retinal detachment associated with macular hole (MH-RD) in one eye. METHODS: The present study examined retrospectively 56 patients with bilateral high myopia who had MH-RD. To determine the incidence of involvement of the fellow eye, patients who completed a follow up of 12 months or longer were eligible for the current study. RESULTS: Of 56 patients with MH-RD due to high myopia, 54 had unilateral detachment at presentation and two had bilateral detachment. Of the 54 highly myopic fellow eyes without retinal detachment at presentation, 37 eyes underwent 12 or more months of documented follow up. Mean follow up after initial surgery to the primary eye was 6.5 +/- 4.9 years. During follow up, a macular hole without retinal detachment was noted in one (2.7%) of these 37 eyes. Three other eyes (8.1%) had MH-RD at 1, 2 and 7 years, respectively, after the initial surgery to the primary eye. At the final visit, 12 eyes (32%) had visual acuity of > or =6/9, whereas 12 eyes (32%) had visual acuity of < or =6/60. CONCLUSIONS: When patients with bilateral high myopia have MH-RD in one eye, they would be expected to be at increased risk of retinal detachment in the fellow eye.     

首选玻璃体切除术治疗简单孔源性视网膜脱离的临床观察

目的回顾总结首选玻璃体切割术治疗简单裂孔源性视网膜脱离的临床疗效。方法选择26例（26只眼）简单裂孔源性视网膜脱离，裂孔均位于上方，增生性玻璃体视网膜病变（PVR）C1级或以下。均采用标准闭合式玻璃体切割术，巩膜外冷凝裂孔，眼内注入C3F8填充，均无外加压。随访2—16个月，平均9个月，记录视网膜复位情况、末次最佳矫正视力及并发症。结果全部病例均一次复位成功（复位率100％），末次最佳矫正视力均有不同程度的提高，在0．2～0．3者9只眼（34．6％），0．3～1．0者17只眼（65．4％），视网膜裂孔冷凝不足8只眼（30．8％），补充激光光凝，1只眼（3．8％）术后1个月出现后囊下型白内障，12只眼（46．2％）一过性高眼压，经局部使用降眼压药物，1周后眼压正常，未出现其它并发症。结论在经济条件允许时，对于上方裂孔的简单孔源性视网膜脱离．可采用玻璃体切割术作为首选方式。     

Subjective decrease of visual acuity after photodynamic therapy: documentation by optical coherence tomography and its correlation with visual acuity

CASE REPORT: A 68-year-old patient complained of decreased visual acuity (VA) two days after photodynamic therapy (PDT) had been performed. VA decreased from the pre-operative value of 0.4 to 0.1 on the second postoperative day. With additional + 1.75 diopters, VA was 0.32. Optical coherence tomography (OCT) disclosed a subneuroretinal fluid accumulation causing a serous retinal detachment 600 microm in height. One week postoperatively, neither decreased vision nor retinal elevation were noted. DISCUSSION: The temporary subjective decreased VA could be predominantly reduced by adequate refraction. OCT and VA measurements excluded ischemia of the neuroretina or the choroid as a causative factor.     

Surgical repair of retinal detachment secondary to cytomegalovirus retinitis

BACKGROUND AND OBJECTIVE: This study was conducted to determine preoperative predictors of postoperative visual acuity in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and retinal detachment. PATIENTS AND METHODS: The study design was a retrospective chart review of 38 eyes in 33 patients with AIDS and CMV retinitis who had retinal reattachment surgery by pars plana vitrectomy with the use of silicone oil tamponade. Factors considered included: preoperative visual acuity, macular attachment status and CMV activity at the time of surgery, and length of time from diagnosis of retinal detachment to surgical repair. RESULTS: Retinal reattachment was achieved in 37 of 38 eyes. Mean interval from surgery to best corrected visual acuity (VA) was 9 weeks. The mean best corrected post-op VA was 20/70. Approximately half of the patients died within 7 months of the surgery. There was good correlation between preoperative VA and best attained postoperative VA (Spearman's: r = 0.5139, P = 0.001). The interval from retinal detachment to surgery, and best attained postoperative VA did not correlate (Spearman's: r = 0.2339, P=0.158). The lack of macular CMV retinitis correlated well with postoperative VA (P = 0.0066, Wilcoxon rank-sum test). CONCLUSIONS: Preoperative visual acuity and macular attachment status correlates with better postoperative visual acuity results, whereas early surgical repair of retinal detachment does not.     

Retinal detachment in Marfan syndrome

PURPOSE: To report postsurgical findings in patients with Marfan syndrome and retinal detachment (RD). METHODS: The authors identified and retrospectively reviewed the charts of one cohort of 12 patients (15 eyes) with Marfan syndrome and RD who were operated on at the Wilmer Institute and a second cohort of 16 such patients (24 eyes) who were operated several years earlier and elsewhere. RESULTS: First cohort--Final visual acuity (VA) was 20/80 or better and the retina was flat in all five phakic eyes (100%). The RD occurred after the eye had undergone lens removal in 10 eyes, 6 of which (60%) had a final VA of 20/80 or better, and 9 of which (90%) had a final VA of 5/200 or better (P = 0.20). Second cohort--The final VA was 20/80 or better and the retina was flat in 6 of the 7 phakic eyes (86%). Among 17 aphakic or pseudophakic eyes, only 5 (29%) had a flat retina and VA of 20/80 or better, whereas 12 (71%) had no light perception (P = 0.03). CONCLUSIONS: The results of RD operations done in the past in Marfan patients were worse when the eye was aphakic. In most cases operated more recently, the prognosis for successful RD repair was good regardless of whether the eye was phakic.     

Vitrectomy for non-ischaemic macular oedema in retinal vein occlusion

PURPOSE: To evaluate the effect of vitrectomy in eyes with non-ischaemic macular oedema secondary to hemi and central retinal vein occlusion. METHODS: This retrospective study analysed the outcome of eight patients with non-ischaemic macular oedema without posterior vitreous detachment. Six patients had a central retinal vein occlusion and two had a hemi retinal vein occlusion. A standard three-port vitrectomy was performed in all patients. Retinal mapping by optical coherence tomography and visual acuity (VA) testing were performed before vitrectomy and at 1, 2 and 12 months postoperatively. RESULTS: At the 1-month follow-up there was a statistically significant reduction in retinal thickness (Wilcoxon; p = 0.04) that persisted at 2 months (Wilcoxon; p = 0.04). However, at 12 months there was no difference compared with baseline. LogMAR VA was significantly improved at 1 month (Wilcoxon p = 0.04), but at 2 and 12 months there was no difference compared with baseline. CONCLUSIONS: Vitrectomy in hemi and central retinal vein occlusion has the potential to reduce macular oedema and improve VA in the early postoperative phase but does not seem to improve the longterm outcome of the disease.     

Retinal detachment following laser in situ keratomileusis

OBJECTIVE: To report the clinical characteristics, surgical management and outcome of retinal detachment following laser in situ keratomileusis (LASIK) in myopic patients. PATIENTS AND METHODS: Retrospective review of 10 eyes of 10 myopic patients with retinal detachment who had previously undergone LASIK surgery were analyzed. Included in the study were 7 males and 3 females, aged 22 to 68 years (35.2+/-2.8). RESULTS: Mean spherical equivalent refraction was -10.51+/-3.90 D (ranging from -6.37 D to -17.00 D) before surgery. The time interval between the LASIK procedure and the development of retinal detachment varied from two months to nine months (5.2 +/- 2.78 months). The number of retinal breaks was one in 7 patients, two in 2 patients and three in 1 patient. The type of retinal breaks included 7 patients with horse shoe tears, 1 patient with a retinal hole, 1 patient with a giant retinal tear, and 1 patient with retinal dialysis. Retinal breaks were located anterior to the equator in 9 patients and posterior to the equator in 1 patient. Retinal reattachment was achieved with one operation in 8 eyes (80%) and the remaining 2 eyes required a second surgery for the reattachment of the retina. CONCLUSION: This study suggests the possible association between retinal detachment and LASIK procedure in patients with myopia. Clinicians should be aware of retinal pathology predisposing to retinal detachment in patients undergoing LASIK.     

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

AIM: To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS: Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS: A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION: The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.     

Recurrent retinal detachment more than 1 year after reattachment

PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.