Retinal detachment following neodymium-YAG laser capsulotomy

Five patients developed retinal detachments within one month of undergoing neodymium-YAG laser posterior capsulotomy. In four patients rhegmatogenous retinal detachments developed in association with typical aphakic breaks; in the fifth patient a previously stable extramacular traction detachment extended into the fovea. In all five patients scleral buckling or vitrectomy successfully reattached the retina and visual acuity improved. None of the findings associated with the detachments could be definitely attributed to the YAG laser. These included the lack of structural or positional changes in the vitreous as well as the absence of retinal damage. We were unable to learn the specific settings used for each laser but were told that the minimum energy levels needed to produce a capsulotomy were used.     

Encircling panretinal laser photocoagulation may prevent macular detachment after vitrectomy for proliferative diabetic retinopathy

Macular detachment due to peripheral retinal tears that occur after pars plana vitrectomy for proliferative diabetic retinopathy can result in severe visual loss despite successful retinal reattachment. The authors reviewed the records of three patients who developed peripheral sclerotomy-related rhegmatogenous retinal detachments one to six months after vitrectomy for proliferative diabetic retinopathy, despite the absence of detectable sclerotomyrelated retinal tears by indirect ophthalmoscopy and scleral depression at the conclusion of surgery. All three patients had received standard panretinal laser photocoagulation in a complete encircling pattern either prior to or during the initial vitrectomy. Clinically or echographically, each patient was seen to have a partial or complete annual peripheral sclerotomy-related rhegmatogenous retinal detachment delimited to the equator. In each of these three cases, posterior extension of the peripheral retinal detachment into the macular area was prevented by the most anterior row of the photocoagulation scars. Standard panretinal laser photocoagulation applied in a complete encircling pattern may be useful in the prophylaxis of macular detachment from sclerotomy-related retinal tears that occur after vitrectomy for proliferative diabetic retinopathy.     

VITRECTOMY IN COMPLICATED RETINAL DETACHMENTS

In this paper complicated traction retinal detachments are discussed in relation to aetiology, techniques of treatment and results of treatment. Complicated traction retinal detachments are caused by pathological vitreous membranes or bands and epiretinal membranes. These membranes are found in the following groups of eyes: aphakia with vitreous loss, penetrating trauma, chronic vitreous inflammation and failed retinal detachments. Patients with extramacular traction detachments are not necessarily treated. Patients with diabetic traction retinal detachment are not included in this series. Of 150 consecutive pars plana vitrectomy operations – 34 operations were for complicated traction retinal detachments.     

Surgical treatment of retinal detachment from macular hole

Six cases of retinal detachment from the macular hole were treated by a procedure including closed vitrectomy, air-fluid exchange, and prone positioning of the patient. All of these detachments were of the idiopathic type. Five patients had myopia ranging from –13 to –20 diopters; one was emmetropic. The initial success rate can be considered 100%: in all six cases the retina remained attached during follow-up periods ranging from 4–10 months at least. One later recurrence was not caused by the macular hole. This new technique, which allows permanent releasing of vitreous traction and temporary closure of the hole, shows that idiopathic retinal detachment is caused by vitreous traction.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Retinal complications following YAG laser capsulotomy

Eighteen patients (19 eyes) developed retinal complications following YAG laser capsulotomy. Complications included one retinal flap tear, two macular holes, six eyes with cystoid macular edema, and ten retinal detachments. The retinal complications resulted from opening the capsule and were not a specific complication of the YAG laser.     

The inner diameter of the optic disc pit decreases with pars plana vitrectomy

To report a patient with optic disc pit who showed decreased inner diameter of the optic disc pit along with resolution of recurrent macular detachment after pars plana vitrectomy. Pneumatic retinopexy and peripapillary laser photocoagulation was performed in a 28-year-old female with optic disc pit and serous macular detachment. Two months after the initial therapy, serous macular detachment recurred. Then, pars plana vitrectomy with removal of the posterior hyaloid was performed, and intraocular perfluoro-octane (C3F8) tamponade was used. Fundus photography and ocular coherence tomography were obtained at each visit. The patient was followed up for 1 year. Visual acuity was 20/400 (Snellen) at first presentation, improved to 20/40 at 2 weeks after pneumatic retinopexy and peripapillary laser treatment. Then, 2 months later visual acuity decreased to 20/200, improved to 20/40 at 2 weeks after the vitreoretinal surgery, and stayed stable during the 1-year follow-up. It was also noticed on clinical examinations as well as fundus photographs that the inner diameter of the optic disc pit had decreased significantly. Vitreous traction plays an important role in the formation of serous macular detachments with optic disc pits. In these patients, pars plana vitrectomy and posterior hyaloid removal may be an effective treatment for reduction of the inner diameter of the optic pit and resolution of the serous macular detachments.     

Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis

Seventeen patients with the acquired immune deficiency syndrome and cytomegalovirus retinitis were treated with the antiviral drug ganciclovir (9-[1,3-dihydroxy-2-propoxy-methyl]-guanine, DHPG). Eight eyes of five patients developed rhegmatogenous retinal detachment after initiation of treatment. Multiple breaks in areas of peripheral, healed, atrophic retina accounted for the detachments. All seven eyes that underwent surgery had extensive retinal detachments that were reattached with vitrectomy and silicone oil. Retinotomy and retinal tacks were necessary in two cases that were complicated by severe proliferative vitreoretinopathy. In the fellow eye of one patient, laser treatment was used prophylactically to wall off a peripheral patch of healed retinitis. Endoretinal biopsies and culture were taken in five eyes; evidence of persistent cytomegalovirus was seen in two cases despite concurrent and clinically effective antiviral therapy.     

Acute macular hole and retinal detachment in highly myopic eyes after neodymium:YAG laser capsulotomy

We report 2 cases of acute onset of macular hole and retinal detachment (MHRD) in highly myopic eyes after uneventful neodymium:YAG (Nd:YAG) laser posterior capsulotomy. Case 1 was a 76-year-old highly myopic woman who had decreased vision 4 days after Nd:YAG capsulotomy. Macular hole and retinal detachment were detected, and vitrectomy was performed. Case 2 was a 62-year-old highly myopic woman who reported visual loss 1 week after Nd:YAG capsulotomy. Macular hole and retinal detachment were detected, and vitrectomy was performed and the retina reattached. The developmental mechanisms of MHRD after Nd:YAG capsulotomy are discussed.     

Treatment of pigment epithelial detachments due to age-related macular degeneration with intra-ocular C3F8 injection*

Purpose: To flatten pigment epithelial detachments (PED) cue to age-related macular degeneration in an attempt to visualize the underlying choroidal neovascularization by fluorescein angiography (FA) and reveal a treatment target. Methods: Nine patients with PED received intravitreal gas injections via the pars plana and postured face down. Fluorescein angiograms were obtained before and after gas injection. In two patients, retinal scotopic sensitivity was also measured. Results: Eight patients demonstrated change in the shape and size of the PED following gas injection. Four patients showed a better delineation of underlying structures on FA. Three patients had focal laser treatment to the newly visible choroidal neovascular complex, but this was successful in only one patient with flattening of the PED. Conclusion: Pigment epithelial detachments can be modified by intravitreal gas injection in some patients, but this treatment did not have a major impact on overall outcome or management.     

Treatment of macular hole retinal detachment.

Seven patients with macular hole retinal detachment were treated by intravitreal gas injection with or without release of subretinal fluid. Macular buckling, diathermy, cryopexy, or vitrectomy were not used. The patients were placed prone for eight hours a day until the gas had absorbed. In five of the seven patients the retina became reattached within three days and remained reattached with follow-up periods of three to 22 months (average nine months). It is believed that such detachments are due to vitreoretinal traction and the intravitreal gas bubble relieves this traction. This technique is simple, safe, and does not require costly or sophisticated instruments. It has an added advantage in preserving macular function.     

The 1-year incidence of rhegmatogenous retinal detachment post 23-gauge pars plana vitrectomy

ObjectiveThe purpose of this study was to evaluate the 1-year incidence of retinal tear or retinal detachment following 23-gauge pars plana vitrectomy (PPV) for epiretinal membrane (ERM), macular hole (MH), or vitreomacular traction (VMT).MethodsA retrospective chart review of all patients who underwent 23-gauge PPV for ERM, MH, or VMT between January 1, 2007, and December 31, 2007, was performed. Inclusion criteria included age greater than 50 years and absence of other significant ocular pathology. Exclusion criteria included confounding retinal pathology, laser treatment at the time of surgery, previous laser treatment of the retina, or previous PPV.ResultsA total of 272 eyes of 268 patients were eligible for inclusion: 159 eyes (58%) had the diagnosis of ERM; 108 (40%) had MH; and 5 (2%) had VMT. The average patient age was 70 years. Of the patients, 15 required additional surgery related to persistent macular pathology within 1 year (5 with ERM, 10 with MH). The incidence of retinal detachment after surgery was 1.1% (3 eyes of 3 patients). The mean time duration prior to development of retinal detachment was 159 days (range, 19 to 333 days).ConclusionsThe 1-year incidence of rhegmatogenous retinal detachment post 23-gauge vitrectomy for repair of macular pathology without prophylactic laser of sclerotomy sites is approximately 1%.     

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.     

Surgical Treatment for the Proliferative Retinal Detachment Associated with Macular Hole in the Morning Glory Syndrome

 PURPOSE:To evaluate the efficacy of vitrectomy with peripapillary photocoagulation and silicone oil tamponade for the proliferative retinal detachment associated with macular hole in children with morning glory syndrome.   METHODS:Eight children with morning glory syndrome (mean age 8.0±2.8 years; range 5–13 years) were included; all patients had unilateral eye disease and were initially misdiagnosed as having bilateral squint or amblyopia, with best corrected visual acuity &;lt;6/60. Five patients could not cooperate with the fundus examination and one patient had lens opacities. B ultrasound confirmed that all eight patients had retinal detachment and optic disc dysplasia. All patients underwent standard 3-port pars plana vitrectomy surgery (20G for three cases and 23G for five cases). At surgery, all patients were confirmed to have morning glory syndrome, macular hole, and proliferative retinal detachment; two cases had a funnel-shaped bulge. All the retinal detachments involved the macular area, and macular hole was detected in the abnormal expansion excavation of the optic disk. The epiretinal membrane and subretinal membrane were completely removed during surgery. Combined photocoagulation in the abnormal expansion excavation of the optic disk, and silicone oil tamponade were also performed. RESULTS:All eyes achieved anatomical resolution of retinal detachment. After follow-ups ranging from eight months to four years, the visual function for all patients was improved by postoperative refractive correction associated with vision training. Best corrected visual acuity was 6/600 to 6/30 at the final follow-up, no retinal detachment recurred, and no silicone oil fluid entered the subretinal space. The silicone oil was successfully removed postoperatively after a mean of 1.5 years.   CONCLUSION:Vitrectomy with peripapillary photocoagulation and silicone oil tamponade is effective in treating the proliferative retinal detachment associated with macular hole in children with morning glory syndrome.       

Retrospective study of retinal detachment following neodymium:YAG laser posterior capsulotomy

A retrospective study of 1,000 cases that had Nd:YAG laser posterior capsulotomy after cataract surgery is presented. We analyzed the correlation of the patient's age, axial length of the eye, method of cataract surgery, and laser parameters (exposures, energy, and burst mode) with the incidence of retinal detachment (1.6% overall). The highest risk for retinal detachment (12.3%) was in patients with an axial eye length of 26.1 mm to 28.0 mm. The average age of patients with retinal detachments was 60.6 years, ten years younger than the collective average age. Laser parameters, such as energy, exposures, and burst mode, and the method of cataract surgery (extracapsular or phacoemulsification) did not correlate with the incidence of retinal detachment. After surgical treatment of the 16 retinal detachments, a good postoperative visual acuity (better than 20/40) was achieved in most cases.     

Prophylactic argon laser coagulation for rhegmatogenous retinal detachment in AIDS patients with cytomegalovirus retinitis

· Background: The incidence of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) reaches 20–45%. Despite aggressive medical treatment, rhegmatogenous retinal detachments develop in up to 30% of the affected eyes. Surgical repair is often difficult due to multiple, large and hardly visible retinal holes with vitreal traction. Pars plana vitrectomy with instillation of silicone oil is the procedure of choice, giving limited functional results with anatomical reattachment. · Methods: We performed prophylactic laser coagulation in AIDS patients with medically treated CMV retinitis to prevent a progressive retinal detachment. Twenty-two quiescent CMV lesions in 22 eyes of 20 patients were treated with argon green laser coagulation. Each CMV lesion was completely surrounded with a double or triple row of laser spots (500–600 μm; 0.2 s; gray-white lesions). · Results: The duration of follow-up was 2–24 months. Histopathologic evaluation was possible in two eyes of one patient. Reactivated or smoldering CMV retinitis crossed the laser scars in 11 eyes, making additional laser coagulation necessary. In four eyes retinal holes in the CMV scar tissue led to retinal detachment, which stopped at the laser scar. In three eyes the detachment is still controlled by the laser scar. In one eye, the detachment stopped at the laser scar for 6.5 months and then slowly progressed across it. There were no complications associated with our laser treatment. · Conclusion: Prophylactic argon laser coagulation in quiescent CMV retinitis seems to reduce the rate of progressive retinal detachment with no need for vitrectomy and silicone oil tamponade. Received: 25 January 1997 Revised version received: 20 August 1997 Accepted: 1 October 1997     

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.     

Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes

PURPOSE: Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN: Retrospective, nonrandomized, comparative study. PATIENTS: Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS: Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS: The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS: The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.     

Subretinal, viscoelastic-assisted, endoscope-guided photothermal ablation of choroidal neovascular membranes by Erbium:YAG laser.

BACKGROUND AND OBJECTIVE: The efficacy of endoscope-guided Erbium:YAG laser, assisted by viscoelastic macular detachment, in subretinal ablation of choroidal neovascular membranes (CNVs) is evaluated. PATIENTS AND METHODS: A high-repetition, midinfrared erbium:YAG laser was used subretinally to ablate CNVs in 2 patients. Ablation followed pars plana vitrectomy and macular retinal detachment using a viscoelastic substance, and was guided by a high resolution endoscope. RESULTS: Visual acuity improved from 6/90 to 6/20, six months after treatment in 1 patient, and from finger counting from 1 meter to 6/30, three months after treatment in the other. The membranes showed no angiographic signs of activity postoperatively. However, a zone of stippled hyperfluorescence appeared in both patients, corresponding with the macular detachment area. This gradually diminished in size in both patients. CONCLUSIONS: The surgical procedure was found effective in our preliminary research. The use of viscoelastic substance and endoscope is felt to contribute to the favorable outcome. The cause and significance of the retinal pigment epithelium damage are yet to be determined.     

Bilaterale seröse Abhebung der neurosensorischen Retina und des retinalen Pigmentepithels mit Riss des peripheren Pigmentepithels

HISTORY: A 52-year-old patient with atypical plasmocytoma presented with a bilateral serous detachment of the retina as well as a huge detachment of the pigment epithelium (PE) in the periphery. Shortly thereafter the PE ruptured. In the left eye this led to substantial central macular fibrosis. DIAGNOSIS: The clinically healthy patient showed a nephrotic syndrome; neither typical monoclonality was detectable nor was erythropoiesis or myelopoiesis reduced. THERAPY: To avoid further reduction of VA pars plana vitrectomy (ppV) with silicone oil tamponade and laser coagulation was performed. Clinical findings were reduced significantly and VA was stabilized for 2.5 years. DISCUSSION: PE detachments and serous retinal detachments in patients with nephrotic syndrome are only mentioned in a few cases. However, a peripheral rupture of the PE to this extent seems to be very rare. Early ppV with silicone oil and laser coagulation may prevent further macular fibrosis.     

Evolving techniques in the treatment of macular detachment caused by optic nerve pits

Fourteen patients with macular detachments caused by optic nerve pits were treated for progressive visual loss, cystoid macular changes, or atrophy of the macular retinal pigment epithelium. Photocoagulation of the temporal disc border alone was unsuccessful in two cases but promptly reattached the macula of two patients immobilized after laser surgery. Vitrectomy and gas tamponade improved vision and flattened the macula of three patients over various periods. The detachment recurred in one patient. Prompt and sustained macular reattachment with improved vision was noted after photocoagulation, vitrectomy, and gas tamponade in eight patients, although four required second operations. The prompt reattachment and visual recovery noted in these eight patients surpasses the reported 25% rate of spontaneous resolution.