The management of retinal detachment complicating degenerative retinoschisis

We repaired six retinal detachments complicating degenerative retinoschisis by using simultaneous external subretinal fluid drainage and intraocular gas injection without a scleral buckle or vitrectomy. The outer wall breaks were 30 to 135 degrees in size, and in three cases, extended close to the arcade vessels. We achieved retinal reattachment and collapse of the schisis cavity at surgery in all six cases. In one case, the retina redetached postoperatively, but it was repaired with a scleral buckle and gas injection. This technique simplified the management of retinal detachments complicating degenerative retinoschisis, particularly those with large or posterior outer-layer breaks.     

Scleral buckle for progressive symptomatic retinal detachment complicating retinoschisis versus primary rhegmatogenous retinal detachment

Objective: To compare the functional and anatomic outcomes of encircling scleral buckle placement for the repair of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR) with outer-layer breaks (OLBs) posterior to the equator versus primary rhegmatogenous retinal detachment (RRD).Design: Retrospective comparative case series.Participants: Thirty-seven patients with PSRDCR with OLBs posterior to the equator (group A) and 703 patients with primary RRD (group B).Methods: All eyes were treated with an encircling scleral silicone band (style 240). External drainage of subretinal and retinoschisis cavity fluid and cryopexy or laser photocoagulation around the tears and the OLBs were performed in all eyes. Best-corrected visual acuity at 6 months postoperatively and final retinal reattachment rate were analyzed.Results: There was no statistically significant difference between the 2 groups in terms of patient age, gender, percentage of retinal detachments that were macula-off (p = 0.241), and preoperative best-corrected Snellen visual acuity (p = 0.927). Best-corrected Snellen visual acuity at 6 months postoperatively was ≤ 20/100 in 35% of eyes, 20/100-20/50 in 14% of eyes, and ≥ 20/40 in 51% of eyes in group A versus ≤ 20/100 in 37% of eyes, 20/100-20/50 in 33% of eyes, and ≥20/40 in 30% of eyes in group B (p = 0.12); the final retinal reattachment rate was 97% in group A versus 98% in group B (p = 0.77).Conclusions: Placement of an encircling scleral buckle may be an effective method to manage both PSRDCR with OLBs posterior to the equator and primary RRDs. The procedure is associated with comparable visual acuity and anatomic outcomes for both types of retinal detachment.     

显微镜直视下视网膜脱离术

目的探讨显微镜直视下视网膜脱离手术的可能性。方法对裂孔性视网膜脱离患者36例36只眼,预置硅胶块和/或环扎带后,在手术显微镜直视下经巩膜电凝排出视网膜下液、视网膜冷凝、最后顶起硅胶填压块检查裂孔是否封闭。术后观察视力恢复及网膜复位情况。结果视网膜完全复位35眼,再次外路手术复位1眼。视力提高32眼,不变2眼,下降2眼,矫正视力在0.3以上33眼。除电凝外排液穿透视网膜和引起视网膜下出血1例外,其它病例排液顺利。所有病例在显微镜直视下冷凝反应均清晰可见,并且轻度屈光间质混浊不影响观察冷凝反应和裂孔定位。结论显微镜下行视网膜脱离手术具有简单、方便、清晰、可靠等优点。     

Gas tamponade and macular grid laser photocoagulation in the management of recurrent retinal detachment

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes. PATIENTS AND METHODS: Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied. RESULTS: Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients. CONCLUSION: Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.     

巩膜外垫压术处置视网膜激光光凝术治疗局限性孔源性视网膜脱离效果不佳病例的临床观察

目的 观察巩膜外垫压术对激光光凝效果不佳局限性孔源性视网膜脱离（RRD）患者的临床疗效。设计回顾性病例系列。研究对象2017年1月至2021年1月空军军医大学西京医院眼科就诊的既往视网膜激光光凝术治疗局限性RRD效果不佳患者19例（19眼）。方法所有患者均行巩膜外垫压术治疗,术后补充视网膜激光光凝。随访6个月～2年,观察治疗效果。主要指标术后视网膜复位情况、视力及并发症情况。结果19眼中,垫压术后视网膜完全复位17眼（89.5%）;2眼（10.5%）垫压嵴明确,但嵴上局部视网膜下存在积液,2周内视网膜下液完全吸收。2个月后2眼增生性玻璃体视网膜病变发生致视网膜脱离复发,均为首次激光后1周内行垫压术并术后2次补充激光光凝患者,行玻璃体切割硅油填充术后复位,后硅油取出稳定。末次随访时,视网膜复位19眼（100%）,其中经一次巩膜外垫压稳定17眼（89.5%）。17眼（89.5%）视力无明显变化;2眼（10.5%）视力下降。结论巩膜外垫压术处置视网膜激光光凝术治疗局限性RRD效果不佳患者远期疗效肯定。局限性RRD不恰当使用激光光凝非但无效,还会有一些负面影响,视网膜激光光凝斑密集、重复激光、...     

Modified external needle drainage procedure for rhegmatogenous retinal detachment

PURPOSE: To describe the results of a modified external needle subretinal fluid drainage technique to treat eyes with a rhegmatogenous retinal detachment. METHODS: One hundred eighty-seven consecutive patients with a rhegmatogenous retinal detachment who underwent scleral buckle and modified external needle drainage at Duke Eye Center or Vistar Eye Associates were included in this study. Subretinal fluid was drained by a technique whereby the intraocular pressure was raised to a supranormal level by tightening an encircling scleral buckle and then the subretinal space was entered by a needle introduced externally while the retina was directly viewed with an indirect ophthalmoscope. Subretinal fluid drainage success rate, one-operation reattachment rate, final retinal reattachment rate, intraoperative and postoperative complication rates, and final visual acuity were the main outcome measures. RESULTS: Subretinal fluid was successfully drained in all eyes. The one-operation reattachment rate was 91%, and the final reattachment rate was 98%. Intraoperatively, 15% of eyes required corneal debridement to obtain an adequate view for safe subretinal fluid drainage. Subretinal hemorrhage of no more than one clock hour occurred in 4.2% of eyes. A total of 2.6% of eyes developed an epiretinal membrane postoperatively that required a vitrectomy to improve the visual acuity. The postoperative visual acuity, 0.54 by logMAR (20/69 by Snellen), was significantly better than the preoperative visual acuity, 1.1 logMAR (20/250 by Snellen) (P < 0.0001). CONCLUSIONS: The modified external needle drainage technique is a flexible, effective method to drain subretinal fluid in eyes with a rhegmatogenous retinal detachment. The retinal reattachment rate and complication rate compare favorably to alternative subretinal fluid drainage techniques.     

Optical coherence tomography of bleb-like subretinal lesions after retinal reattachment surgery.

PURPOSE: To report the optical coherence tomographic characteristics of persistent bleb-like subretinal lesions after retinal reattachment surgery, including scleral buckling and cryopexy. METHODS: Case reports. RESULTS: In two eyes of two patients yellow to yellowish-orange bleb-like lesions were found in the posterior pole after retinal reattachment surgery. The common aspects of the surgery were scleral buckling procedures and cryopexy. There were subretinal precipitates in some of the lesions. The lesions showed no associated leakage during fluorescein or indocyanine green angiography. Optical coherence tomography demonstrated that the bleb-like lesions were tiny retinal detachments. CONCLUSION: Optical coherence tomography examination of bleb-like subretinal lesions showed that they were actually retinal detachments. Our patients and previously reported patients developed these lesions after scleral buckling and cryopexy. These lesions may represent persistent retinal detachment because of the presence of protein in the subretinal fluid.     

Laser pneumatic retinopexy for repair of recurrent retinal detachment after failed scleral buckle--ten years experience

BACKGROUND: Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years. PATIENTS AND METHODS: We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months follow-up. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina. RESULTS: In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy. CONCLUSION: We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone.     

Lincoff temporary balloon buckle in retinal detachment surgery

PURPOSE: To assess the long-term anatomical and functional results of balloon buckle surgery for rhegmatogenous retinal detachment. PATIENTS AND METHODS: Twenty-five selected detachments with a single break or a group of breaks close together were treated with a temporary parabulbar balloon. Adhesion was obtained with transconjunctival cryopexy and argon laser photocoagulation. Retinal detachment was associated with the following risk factors: myopia (15 eyes), aphakia (2 eyes), blunt trauma (1 eye). Twenty-three eyes had a detached macula. The balloon was withdrawn after one week. The patients were kept under observation for at least six months (mean 44.7 months). RESULTS: Initial retinal attachment was achieved in 29 eyes. After the balloon was removed redetachment occurred in two eyes; thus, complete attachment was attained in 27 eyes. Causes of failure were: undetected break (2 eyes), inadequate buckle (4 eyes), proliferative vitreoretinopathy (2 eyes). Conventional scleral buckling and subretinal fluid drainage was done in all failed cases. Vitrectomy and silicone oil were employed in one patient, and finally retinal attachment was achieved in all patients. CONCLUSIONS: Temporary balloon buckling is a simple and curative technique for a selected group of patients with retinal detachments.     

Therapeutic ultrasound in the treatment of retinal detachment: clinical observations and light and electron microscopy

Osmotically-induced retinal detachments were created in rabbit eyes and treated with therapeutic ultrasound. Control eyes showed spontaneous retinal reattachment after ten days (range, 8-10 days), while eyes treated with therapeutic ultrasound showed retinal reattachment in a shorter time (average, 4.5 days). Light and electron microscopy demonstrates at least three major differences in the ultrasound-treated eyes compared to the controls. These findings are evidence of an earlier retinal reattachment, a stronger chorioretinal adhesion, less damage and faster repair in the ultrasound-treated retina than in the control retina. This method of producing chorioretinal adhesions may have applications in certain types of retinal detachments where choroidal thickness or vitreous opacity preclude conventional cryopexy, diathermy or photocoagulation techniques.     

23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离

目的：观察23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离的疗效,探讨其可行性。

方法：选取我院2017-02/2018-02被确诊为孔源性视网膜脱离且视网膜下液较多、呈球形脱离外观的患者21例21眼,在行巩膜扣带术中引流视网膜下积液前于睫状体扁平部预置23G后节灌注,术中对裂孔未作凝固处理,术后裂孔周围行激光光凝治疗。术后随访观察3～10mo,观察视网膜复位和并发症情况。

结果：所有患者手术过程顺利,术中均引流出视网膜下液并未见脉络膜出血和视网膜嵌顿; 术后第1d视网膜完全复位者18眼; 术后2～3d残留视网膜下液吸收完毕者2眼,视网膜脱离未复位者1眼,经再次外加压块调位术后视网膜复位,术后视网膜脱离复发者1眼,经玻璃体手术后视网膜复位。术中有视网膜下出血者1眼,出血范围<1PD,3mo后吸收,未见眼压异常、眼前段缺血和其他严重并发症。

结论：在球形视网膜脱离的巩膜扣带术中引流视网膜下积液前预置灌注,可有效维持术中眼内压平稳,减少因引流视网膜下积液时眼压过快下降导致的爆发性脉络膜上腔出血和术后发生脉络膜脱离的可能性,同时术中视网膜基本趋于平伏,裂孔定位相对准确,可提高手术成功率。     

Vitrectomy techniques in late-stage Coats'-like exudative retinal detachment

Retinal telangiectasia is the hallmark of Coats' disease. In the late stages, leakage from these abnormal vessels can result in a total, bullous exudative retinal detachment with cholesterol-laden subretinal fluid. Secondary angle-closure glaucoma may result in a blind and painful eye which may require enucleation or evisceration. Surgical reattachment of the retina and destruction of the retinal telangiectasia may preserve these eyes. We have found that vitrectomy, internal drainage of subretinal fluid and cholesterol, direct treatment of the retinal telangiectasia with intraocular diathermy and intravitreal gas or silicone oil injection are effective surgical techniques for salvaging these severely damaged eyes.     

孔源性視網膜脱離自動復位的臨床觀察

目的探討孔源性視網膜脱離自動復位的機理和長期療效.方法對孔源性視網膜脱離患者雙眼包扎卧床休息,促使視網膜下液吸收.對12例視網膜自動復位者,行激光光凝對閉視網膜裂孔.結果 12例孔源性視網膜脱離患者視網膜完全復位,光凝裂孔對閉良好,無并發症發生.結論雙眼包扎卧床休息可以减輕玻璃體對視網膜的牽拉,促使視網膜下液吸收,可能使部分患者視網膜自動復位,并通過激光光凝治愈.     

多波长氪激光配合中药在局限性孔源性视网膜脱离的应用

目的:观察多波长氪激光配合中药治疗局限性孔源性视网膜脱离。方法:回顾性分析85例108眼局限性孔源性视网膜脱离,经过多波长氪激光及中药治疗,并随访0.5a。结果:本组108眼中,治愈101眼(93.5%),无效7眼(6.5%)。治愈眼均为光凝1次后,视网膜脱离范围局限,视网膜下积液逐渐吸收后再予补充1～2次光凝,病情稳定后常规0.5a复查,均未复发。无效眼均采用冷凝联合巩膜外垫压手术治愈,术后在视网膜变性区周围补充光凝,108患眼均配合中药治疗。结论:波长氪激光配合中药治疗局限性孔源性视网膜脱离,疗效可靠。     

Anatomical retinal reattachment after scleral buckling with and without retinopexy: a pilot study

Purpose: To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. Methods: This randomized clinical trial was performed on 55 patients. Twenty‐two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s). Results: In the non‐retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34–48 months of follow‐up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35–56 months of follow‐up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically. Conclusion: With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.     

Reattachment of retina and retinoschisis in pit-macular syndrome by surgically-induced vitreous detachment and gas tamponade

The origin of the subretinal fluid in pit-macular syndrome is unknown. Using optical coherence tomography, the authors observed that an optic disk pit is not a true pit but a cystic cavity covered with a superficial layer of the optic disk in a patient with retinal detachment and retinoschisis. The cyst was connected to the intraretinal space of the retina, which was split in several layers, or the retinoschisis in the papillomacular area. Vitrectomy and gas tamponade were performed to treat the patient. During surgically-induced vitreous detachment, strong vitreoretinal attachment at the disk margin and the fovea was observed. After surgery, the cystic space at the optic disk disappeared and the retinal detachment and retinoschisis reattached. Vitreous traction may play a role to introduce the fluid from the optic cyst to the subretinal space through the superficially split retina.     

Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment

The authors report nine cases of endodrainage retinotomy site complications that occurred after vitreous surgery for complicated retinal detachments (RDs). Postoperative subretinal neovascularization developed in four eyes at the retinotomy drainage site. In two eyes, postoperative proliferation at a posteriorly placed endodrainage site created traction macular detachments. Redetachment due to retinotomy opening caused by postoperative drainage site proliferation developed in three eyes. The retinas of all nine eyes were eventually reattached, and vision improved from the preoperative level. These complications are related to retinal pigment epithelium and/or Bruch's membrane damage during internal subretinal fluid drainage and retinotomy endolaser photocoagulation. Careful evaluation of extrusion instruments, drainage techniques, retinotomy placement, and subsequent endolaser treatment is necessary to minimize these complications.     

Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole

PURPOSE: To determine the effectiveness of scleral buckling with a macular plombe in eyes with myopic macular retinoschisis and retinal detachment without a macular hole. DESIGN: A prospective, consecutive interventional case series. METHODS: Setting: Clinical practice at university hospitals. Patient Population: Six eyes of five consecutive patients with myopic macular retinoschisis and retinal detachment without a macular hole. Intervention Procedure: Scleral buckling with a macular plombe. Main Outcome Measures: The best-corrected visual acuity (BCVA), ophthalmoscopic appearance of fundus, and optical coherence tomographic images were recorded preoperatively, and at two weeks, at one, three, and six months, and then every three months thereafter. RESULTS: The mean retinal thickness was reduced significantly by the macular plombe (P < .05). The BCVA was improved by 2 lines or more in four eyes (66%), and remained within 2 lines of the preoperative BCVA in two eyes (34%). The complications were subretinal hemorrhage without choroidal neovascularization in one eye, and a progression of choroidal neovascularization with subretinal hemorrhage, which caused a transient visual impairment in one eye. CONCLUSIONS: We recommend that macular scleral buckling with a macular plombe be considered for eyes with myopic macular retinoschisis and retinal detachment without a macular hole.     

Vitreous changes after treatment of retinopathy of prematurity

PURPOSE: To investigate the vitreous findings in patients with cicatricial retinopathy of prematurity (ROP) who underwent retinal cryopexy and/or photocoagulation during the acute phase of the disease. METHODS: Vitreous findings were evaluated in 15 patients (29 eyes) with cicatricial ROP by slit-lamp biomicroscopy and indirect ophthalmoscopy. RESULTS: The ocular examination revealed that all eyes had extensive vitreous liquefaction that affected a large segment of the vitreous. A great deal of fibrillar condensation of the vitreous was present in membrane-like vitreous fibers that traversed the vitreous cavity to the periphery of the degenerating retina. These vitreous changes were most marked in the areas in which retinal cryopexy and/or photocoagulation had been performed. Despite advanced liquefaction, the posterior cortical vitreous was not separated from the retina in any eyes. CONCLUSION: In eyes with ROP that underwent retinal cryopexy and/or photocoagulation during the acute phase of the disease, the vitreous was abnormal, which may contribute to vitreoretinal traction that eventually leads to retinal breaks and detachment.     

Chronic macular detachment following pneumatic retinopexy

In a consecutive series of 73 retinal detachments managed with pneumatic retinopexy, three (4.1%) of 73 eyes sustained chronic detachment of the posterior retina involving the macula even though all retinal breaks were closed. This shallow subretinal fluid persisted for 12 to 21 months but reabsorbed spontaneously. Two cases presented with a detached macula, one of which had pre-existing macular degeneration. The other case presented with an attached macula but it became detached immediately after pneumatic retinopexy. The visual acuities in the two patients who did not have macular pathology before the development of retinal detachment were 20/50 and 20/40 even with persistent subretinal fluid under the macula. In both cases the visual acuity improved to 20/30 after resolution of the subretinal fluid. Patients with a longstanding component to the retinal detachment and small retinal breaks may be at risk of developing chronic macular detachment following pneumatic retinopexy. Pockets of subretinal fluid can persist following scleral buckling, with or without drainage of subretinal fluid. However, it is unknown whether scleral buckling has a lower incidence of this complication than pneumatic retinopexy.