Simultaneous, bilateral rhegmatogenous retinal detachment

PURPOSE: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment. METHODS: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998. RESULTS: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100,000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from -3 to -9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period. CONCLUSION: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.     

Bilateral rhegmatogenous retinal detachment

During a 4-year period, 1978-1981, 34 patients with bilateral rhegmatogenous retinal detachment were operated on at the University Eye Hospital in Helsinki. The incidence of bilaterality in the entire detachment population was 10%, in the aphakic group it was 16%. In 24 cases (71%) the interval from the first to the second eye detachment was less than 5 years, 6 patients (18%) had bilateral detachment simultaneously. The mean age of the patients when the first eye was affected (46 years, range 6-73) was significantly younger than the mean age of those with unilateral detachment (58 years, range 6-83) (P less than 0.001). Previous eye diseases were significantly (P less than 0.01) more common in patients with bilateral than in those with unilateral detachment, but the incidences of myopia, aphakia and lattice degeneration of the retina did not differ significantly between these groups. At least one of these predisposing factors was found in 85% and two or more of them in 53% of bilateral detachments. The retina was re-attached in 80% of the 44 eyes operated on during the study period. Of the 24 eyes operated on earlier, 71% were blind (visual acuity CF 1 m or worse). The latest visual acuities in both eyes or in the better eye for all patients were: greater than or equal to 0.5 in 38%, 0.4-0.2 in 35%, 0.1-CF2 m in 12%, and less than or equal to CF1 m in 15%.     

Asymptomatic rhegmatogenous retinal detachment

The vast majority of patients with rhegmatogenous retinal detachments present with either acute or chronic symptoms. In these cases repair of the retinal detachment is almost always recommended to either improve vision or prevent further visual loss. In a small subgroup, rhegmatogenous retinal detachments were detected as incidental findings in asymptomatic patients. Such asymptomatic detachments are often caused by atrophic holes in lattice degeneration and are more commonly located in the inferior quadrants. Demarcation lines are often present. Asymptomatic retinal detachments also occur in a younger age group of patients when compared with symptomatic rhegmatogenous retinal detachments. The management of eyes with an asymptomatic retinal detachment is controversial. The risk of complications during surgical repair must be weighed against the chance that the retinal detachment will progress. Recently published clinical data suggest that the risk of progression of asymptomatic rhegmatogenous retinal detachments is small. Consequently, observation can be considered as a reasonable management option in reliable patients until progression is documented or symptoms occur. Patient education geared toward instruction on self-monitoring of the visual field and a review of the risks and benefits of retinal detachment repair versus observation are important in patients with asymptomatic retinal detachment.     

Juvenile rhegmatogenous retinal detachment

PURPOSE: To review the clinical features, evaluate visual, and anatomical outcomes and potential complications following surgery for rhegmatogenous retinal detachment (RRD) in juveniles. METHODS: Retrospective, consecutive case series of children and young adults (birth through 18 years) who underwent surgerys for RRD between February 1999 and January 2002. RESULTS: The authors reviewed a consecutive series of 111 eyes of 105 juveniles [86 (77.47%) eyes belonged to male and 25 (22.52%) to female subjects] operated for RRD. The mean age of patients was 13.62 years. Bilateral retinal detachment was present in 12 (10.8%); 51 (46%) patients had some form of bilateral ocular pathology at initial presentation. The two most common aetiologies were non-penetrating trauma (45.04%) and myopia (41.44%). Decreased vision was the most frequent symptom. The mean duration of symptoms was 165.36 days. The commonest retinal break was a retinal hole (34.23%). Late diagnosis was common, evidenced by high frequency of macular detachment (97.29%) and proliferative vitreoretinopathy (PVR) (45.94%) at initial presentation. The most commonly performed primary surgery was scleral buckle (61.26%). The average postoperative follow-up after the first procedure was 10 months (range 8-19 months). Final retinal reattachment was accomplished in 78.37% (87/111) with a mean of 1.29 surgeries per eye. Improvement, no change and decline in vision was seen in 50 (48%), 32 (31%) and 22 (21%) eyes respectively. CONCLUSION: Non-penetrating injury and myopia were the most common cause for RRD in juveniles. Fellow eyes commonly had vision-threatening abnormalities. Final anatomical and visual recovery rates were encouraging despite late initial presentation and high rates of macular detachment, and PVR at initial presentation.     

Pediatric rhegmatogenous retinal detachment

PURPOSE: To review the clinical features and surgical and visual outcomes of pediatric rhegmatogenous retinal detachment (RRD) as seen in a tertiary referral center. METHODS: Retrospective case series spanning 6 years from January 1, 1991 to January 1, 1997. Exclusionary criteria were trauma disrupting the globe and acute retinopathy of prematurity. RESULTS: The authors reviewed a series of 29 eyes in 27 pediatric patients (birth to 18 years of age) with RRD. Seventy percent of the patients were male. The mean patient age was 9.6 years. Bilateral RRD was present in 22% of patients; 89% of patients had some form of bilateral ocular pathology at initial presentation. The two most common etiologies (34% each) were myopia and eyes that had undergone surgery for another ocular disorder with subsequent development of RRD. The most common presentation was decreased vision, with a mean duration of 52 days. At presentation, 75% of the affected eyes and 48% of the fellow eyes had visual acuity worse than 20/800. The most common type of retinal break was a horseshoe tear. Late diagnosis was a common problem, evidenced by the frequency of macular detachment (79%) and proliferative vitreoretinopathy (45%) at initial presentation. The most common primary repair was a scleral buckle. Anatomic reattachment was ultimately accomplished in 72% of cases with a mean of 2.2 surgeries per eye. Average postoperative follow-up time was 21.4 months (range 4 to 61 months). At final follow-up, 41% of the affected eyes had visual acuity 20/800 or better. Thirty-eight percent of the affected eyes had a final visual acuity better than or equal to the fellow eye. CONCLUSION: In this series, pediatric RRD occurred most commonly in association with myopia (Stickler's syndrome and adolescent retinopathy of prematurity) and prior intraocular surgery. Most eyes were anatomically reattached after multiple surgeries. Forty-one percent of eyes retained vision of 20/800 or better. Preserving vision in children with RRD is of great importance, particularly given the 89% frequency of vision-threatening abnormalities in fellow eyes.     

Missed retinal breaks in rhegmatogenous retinal detachment

AIM: To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). METHODS: Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. RESULTS: Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. CONCLUSION: Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.     

Incidence and epidemiological characteristics of rhegmatogenous retinal detachment in Beijing, China

OBJECTIVE: To estimate the incidence and epidemiologic characteristics of rhegmatogenous retinal detachment (RRD) in Beijing, China. DESIGN: Prospective population-based incidence study. PARTICIPANTS: The population of Beijing and its nearby suburbs (N = 6 589 000). MAIN OUTCOME MEASURE: Incident RRD. RESULTS: A total of 526 patients with RRD were newly diagnosed between October 1999 and September 2000. The annual incidence was 7.98/100 000 people (95% confidence interval = 7.30-8.67). People aged 60 to 69 had the highest incidence (22.15/100 000). Incidences of 3 subtypes of RRD were 0.93/100 000 for related to blunt trauma, 0.80/100 000 for aphakic and pseudophakic, and 6.25/100 000 for nontraumatic phakic retinal detachment. A significantly higher incidence was found in males for traumatic detachment, but not for the other 2 subtypes of RRD. High myopia (> or = -6 diopters) was more prevalent in bilateral RRD (57.1%) than in the unilaterally affected patients (32.4%). CONCLUSIONS: The incidence of RRD in Beijing is comparable to most of the reports from the developed countries. It is estimated that there are 9000 to 10 000 new cases of RRD in China each year. As 60% to 70% of the RRD patients live in small towns or remote farming areas with limited access to qualified retina-vitreous surgeons, care for these patients presents a great challenge in China.     

儿童孔源性视网膜脱离的病因及临床特点分析

目的探讨儿童孔源性视网膜脱离的病因及临床特点。设计回顾性、非对照病例研究。研究对象99例12岁以下孔源性视网膜脱离的患者。方法回顾性总结2002年6月至2006年3月在北京同仁眼科中心接受手术治疗的12岁以下孔源性视网膜脱离患者共99例119眼,记录患者就诊原因、裂孔形状和视网膜脱离特点,对儿童孔源性视网膜脱离的病因及临床特点进行分析。主要指标病史、患眼屈光度、视网膜脱离的形态和特点。结果27例27眼有眼部钝挫伤史。26例37眼屈光度数>-4.0D,13例14眼有既往白内障手术史,5例7眼伴先天性脉络膜缺损,还有29例34眼原因不明。患者就诊时60眼(50.4%)视网膜全脱离,66眼(55.5%)发生C级以上增生性玻璃体视网膜病变。结论近视和眼部顿挫伤是儿童孔源性视网膜脱离发生的主要危险因素,患儿就诊时视网膜脱离范围常较大、且多伴有较严重的增生性玻璃体视网膜病变,故应加强对具有危险因素患儿的随访观察。     

Characteristics of rhegmatogenous retinal detachment

Characteristics of rhegmatogenous retinal detachment and its predisposing factors were studied in a consecutive series of 342 patients operated on for retinal detachment (RD) at the University Eye Hospital in Helsinki in 1978-1981. On these, 234 were pre-operatively examined and operated on by the senior author. The mean age of the patients was 52.8 +/- 1.0 (range 5.7 to 83.0) years, 49.1% were males, 50.9% females. Bilateral RD occurred in 9.9%, and another 4.7% had been treated for retinal breaks in the fellow eye. Of the main predisposing factors, myopia (greater than or equal to -1.0 D) was found in 50.6% of the phakic eyes, 23.0% of the eyes were aphakic, and lattice degeneration was found in 15.1% and trauma in 11.9% of the whole series. In the nontraumatic phakic group, lattice degeneration was present in 31.3%. In the aphakic group, 25.9% had underlying myopia and 8.1% showed lattice degeneration. The relative importance of these factors varied with age. Total RD was found in 60 eyes (17.0%), most commonly in aphakic eyes (32.1%). Macula was detached in 56.5%. Two or more retinal breaks were found in 40.9%. The type of breaks varied with age and refraction. Oral dialysis was common before the age of 20 in non-myopic phakic eyes. Between 20 and 39 years, tears and holes were equally common, and after 40 years of age tears predominated. Tears outnumbered holes both in nonmyopic and myopic eyes, most round holes were found in myopic eyes. In 11.6% of the eyes no sure retinal breaks were detected. Relation of retinal breaks to peripheral retinal degenerations was studied.     

Post-operative outcome in rhegmatogenous retinal detachment

Anatomic and visual results of retinal detachment surgery were analyzed in 352 consecutive eyes operated on for rhegmatogenous type of retinal detachment in 1978-1981 at the University Eye Hospital in Helsinki. From 1978-79 to 1980-81, both the re-attachment rate and the visual results improved significantly (P less than 0.05). In the latter period, the retina was re-attached in 87% and partially re-attached in 2%. In the same period, a good visual acuity (VA greater than or equal to 0.5) was achieved in 39%, reasonable (VA 0.4-0.15) in 28%, and an ambulatory vision (VA 0.1-CF2m) in 16%, whereas 18% of the eyes became blind (VA CF1m or worse). A favourable outcome was related to good pre-operative visual acuity, short duration and limited extent of detachment as well as sparing of the macula. Among factors which predicted an unfavourable outcome were aphakia, failure to detect retinal breaks, signs of proliferative vitreoretinopathy, multiple operations and old age. Poor outcome was more common after encircling as compared with localized procedures, but the success rate of the various types of operations was not comparable because encircling procedures were selected for more severe cases.     

Interventions in pseudophakic rhegmatogenous retinal detachment

With refinement of vitrectomy techniques over the past 30 years, the treatment of rhegmatogenous retinal detachment (RRD) has transitioned from the almost exclusive use of extraocular techniques to the present time in which intraocular interventions are available and, in some practices, enjoy almost exclusive use for primary repair of RRD. Except for those situations in which a retinal detachment is associated with obvious immediate complications related to the cataract surgery, the considerations for the treatment of pseudophakic RRD are quite similar to those of phakic RRD. The current options are: use of an extraocular buckling device, vitrectomy-related procedures, intraocular gas injection with associated retinopexy, and combinations of these. Disagreement on the ideal intervention for pseudophakic retinal detachment is not uncommon and particularly so in those RRDs which lie somewhere in the spectrum between complex and simple. As is so often the case in the surgical treatment of disease, there may not be one ideal technique for a particular type of RRD; but knowledge of alternatives logically increases the likelihood of a successful result. The goal of this paper is to outline the clinical factors shown to be of importance in deciding which technique will have the greatest chance at not only achieving retinal re-attachment but also in optimizing long-term vision.     

Interventions in pseudophakic rhegmatogenous retinal detachment

With refinement of vitrectomy techniques over the past 30 years, the treatment of rhegmatogenous retinal detachment (RRD) has transitioned from the almost exclusive use of extraocular techniques to the present time in which intraocular interventions are available and, in some practices, enjoy almost exclusive use for primary repair of RRD. Except for those situations in which a retinal detachment is associated with obvious immediate complications related to the cataract surgery, the considerations for the treatment of pseudophakic RRD are quite similar to those of phakic RRD. The current options are: use of an extraocular buckling device, vitrectomy-related procedures, intraocular gas injection with associated retinopexy, and combinations of these. Disagreement on the ideal intervention for pseudophakic retinal detachment is not uncommon and particularly so in those RRDs which lie somewhere in the spectrum between complex and simple. As is so often the case in the surgical treatment of disease, there may not be one ideal technique for a particular type of RRD; but knowledge of alternatives logically increases the likelihood of a successful result. The goal of this paper is to outline the clinical factors shown to be of importance in deciding which technique will have the greatest chance at not only achieving retinal re-attachment but also in optimizing long-term vision.     

Pediatric rhegmatogenous retinal detachment in taiwan

PURPOSE: To describe the clinical features and surgical outcomes in a series of pediatric patients with rhegmatogenous retinal detachments in Taiwan. METHODS: Retrospective study of pediatric patients (age 1 to 15 years) with rhegmatogenous retinal detachment dated between January 1995 and December 2004. Patients with perforating ocular trauma were excluded. Patients were divided into four groups according to the predisposing factors: Group 1, those with congenital or developmental anomalies; Group 2, those with trauma history; Group 3, those with myopia greater than -3 D but excluding patients in Groups 1 and 2; and Group 4, the others with miscellaneous etiologies. Patients' age, sex, medical history, ocular history, type of detachment, macular status, refractive status, previous visual acuity, number and type of surgeries performed, postoperative retinal status, and current visual acuity were recorded. RESULTS: Thirty-five eyes of 32 patients were included in this study. The median age was 13 years, and 75% of patients were boys. There were 17 eyes (49%) in Group 1, 8 in Group 2 (23%), 8 in Group 3 (23%), and 2 in Group 4 (6%). Bilateral retinal detachment was present in 7 patients (22%). In Group 1, familial exudative vitreoretinopathy was present in 7 eyes; retinopathy of prematurity was noted in 5 eyes; Marfan's syndrome was present in 3 eyes; mental and growth retardation was present in 2 eyes. Macula sparing retinal detachment was found in 3 eyes. Retinal attachment was achieved in 28/35 eyes. Visual recovery was modest. CONCLUSION: Congenital or developmental anomalies, myopia, and trauma were the most common risk factors for pediatric rhegmatogenous retinal detachment in Taiwan. Regular follow-up for children at risk of developing rhegmatogenous retinal detachment is necessary for early detection.     

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.     

Finding the retinal break in rhegmatogenous retinal detachment

The development of subretinal fluid is governed by a limited number of anatomical factors and gravity. As a result, rhegmatogenous retinal detachments form in a predictable manner around the retinal break of their origin. The shape of the detachments points to the position of the break. The purpose of this review is to describe the characterstic contours of subretinal fluid in rhegmatogenous retinal detachments, and to highlight some rules and methodology which can help in the detection of the retinal break in phakic, psuedophakic and recurrent retinal detachments.     

Persistent foveal retinal detachment after successful rhegmatogenous retinal detachment surgery

PURPOSE: To describe the tomographic features of the neurosensory retina after successful rhegmatogenous retinal detachment surgery. DESIGN: Cohort study. METHODS: We prospectively examined cross-sectional retinal images using optical coherence tomography (OCT) in 15 eyes of 15 consecutive patients (mean age, 46 years) who underwent scleral buckling surgery for treatment of rhegmatogenous retinal detachment. The retinas appeared reattached upon binocular stereoscopic indirect ophthalmoscopy. All eyes were examined at 1, 3, 6, and 12 months postoperatively. The time from onset of subjective symptoms of retinal detachment to retinal surgery ranged from 4 to 66 days (mean, 14 days). The postoperative OCT findings and best-corrected visual acuity were statistically analyzed using the Mann-Whitney U test. RESULTS: The detached retinas appeared attached on ophthalmoscopy in all eyes 1 month postoperatively. OCT showed residual retinal detachment in four eyes (27%) at the fovea and in three eyes (20%) at the fovea and adjacent area. The remaining eight retinas (53%) were attached when examined tomographically. In six of the seven eyes with residual foveal detachment by OCT, the retinas reattached spontaneously up to 12 months postoperatively. The postoperative best-corrected visual acuity improved gradually during 12 postoperative months in all 15 eyes. A substantial increase in visual acuity occurred when the fovea reattached in the six eyes with residual detachment. CONCLUSIONS: Foveal retinal detachment may persist after successful retinal detachment surgery in eyes in which the fovea appeared to be attached on ophthalmoscopy. The residual foveal detachment may explain, in part, the delayed visual acuity improvement after successful scleral buckling.     

北京市城区及近郊区孔源性视网膜脱离发病情况调查

目的：调查北京市城区及近郊区孔源性视网膜脱离（retinal detachment,RD）发病情况及分布特点。方法：由35所北京市有条件诊断和治疗孔源性RD的各级医院及北京大学保健流行病学研究室组成的协作组,采用前瞻性设计的新发患者登记方法收集病例资料,对北京市城区和近郊区1999年10月至2000年9月间在其医院初诊的孔源性RD患者（包括门诊和住院患者）进行调查。以1999年12月国家统计局分布的人口资料数据为基数,对孔源性RD的年发病率、年龄、性别、季节分布特征及屈光状态等进行分析。结果：北京市城区和近郊区1999年10月至2000年9月孔源性RD年发病率为7．98／10万[95％可信区间（confidence interval,CI)：7．3－8．7]。其中外伤眼孔源性RD年发病率为0．93／10万（95％CI：0．7－1．2）,无晶状体或人工晶状体眼孔源性RD患者年发病率为0．80／10万（95％CI：0．6－1．0）,无外伤史有晶状体眼孔源性RD患者发病率为6．25／10万（95％CI：5．7－6．9）。外伤眼孔源性RD年发病率,男性为1．55／10万（95％CI：1．1－2．0）,女性为0．30／10万（95％CI：0．1－0．5）,男性高于女性。各年龄段孔源性RD患者发病率不同,其发病率高峰分别为20－29岁和60－69岁。无季节性差异（0．8＜P＜0．9）。无眼别差异（P＞0．05）。约5．82％为双眼孔源性RD,其中高度近视所占比例高于单眼孔源性RD（χ^2=5.73,0.01＜P＜0．02）。结论：北京市城区和近郊区1999年10月至2000年9月孔源性RD年发病率为7．98／10万（95％CI:7．3－8．7％）。     

Molecular genetics of rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) most commonly occurs as a spontaneous event resulting from posterior vitreous detachment, typically between the ages of 40-70 yrs. It is also a feature in some inherited disorders, most commonly Stickler syndrome. The relationship between these inherited disorders and the spontaneous cases is unclear. Here in particular we review Stickler syndrome, and discuss the differential diagnosis of Stickler, Wagner and Marshall syndromes. Other rare inherited disorders associated with RRD are also briefly reviewed.