Ciliochoroidal Detachment Following Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose and Methods: We observed the peripheral choroid, ciliary body, and depth of the anterior chamber by ultrasound biomicroscopy (UBM) in 31 eyes with rhegmatogenous retinal detachment before and after scleral buckling surgery. Scleral encircling was performed in 11 eyes and segmental scleral buckling in 20 eyes.Results: With UBM, ciliochoroidal detachment was detected in all eyes (100%) following scleral encircling and in 8 eyes (40.0%) following segmental scleral buckling. After scleral encircling procedure, the eyes with preoperatively bullous and wide retinal detachment showed a severe ciliochoroidal detachment and edema of the ciliary body. Shallowing of the anterior camber occurred in all 11 eyes (100%) after scleral encircling and in 12 of 20 eyes (60.0%) after segmental scleral buckling. Marked shallowing with closure of the angle and elevated intraocular pressure occurred in 2 eyes.Conclusion: The results showed that careful postoperative examinations for the anterior segments, chamber angle, and intraocular pressure are necessary with slit-lamp examination and applanation tonometry after scleral buckling surgery.     

Macular Hole Formation in Rhegmatogenous Retinal Detachment after Scleral Buckling

Purpose

To describe early macular hole (MH) development in rhegmatogenous retinal detachment (RRD) after scleral buckling (SB) based on optical coherence tomography (OCT) findings.

Methods

The medical records and spectral domain OCT images of patients in whom MH developed after RRD repair were evaluated retrospectively.

Results

A postoperative MH was detected in five eyes that underwent SB during a 6-year period. All had fovea-off RRD without MH at the time of surgery. OCT showed partial loss of the inner retina with a preserved photoreceptor layer in early postoperative days. On average, 7 days (range,5 to 8 days) after surgery, outer retinal tissues disappeared, resulting in the full-thickness MH.

Conclusions

Serial OCT findings revealed that partial-thickness lamellar holes progressed to full-thickness MHs, which were formed by the degeneration of the outer retina in eyes with preceding loss of the glial cone in the fovea.     

视网膜下液体对人视网膜色素上皮细胞生长的刺激作用及其临床特征

研究了28例孔源性视网膜脱离患者视网膜下液对人眼视网膜色素上皮细胞生长的作用。所有标本均可刺激视网膜色素上皮细胞增殖，但存在较大范围的活动性，发现增殖刺激活力与视网膜脱离的增殖性玻璃体视网膜病变程度、视网膜脱离范围和脱离持续时间呈正相关，且与视网膜脱离增殖性玻璃体视网膜病变程度及脱离范围相关性最大（P＜0．01）。结果表明：增殖性玻璃体视网膜病变在C级以上，脱离范围超过2个象限、脱离时间超过4周者，视网膜下液促增殖活力显著增强。     

Ratio of Primary Episcleral Buckling Surgery versus Primary Vitrectomy for Rhegmatogenous Retinal Detachment

 Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department. Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded. Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges (42.9%) formed the largest part, followed by pars plana vitrectomies (35.0%) and encircling bands (22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds (65%) of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%. Conclusions: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.     

Prospective Study Comparing the Effectiveness of Scleral Buckling to Vitreous Surgery for Rhegmatogenous Retinal Detachment

Purpose

To compare the effectiveness of scleral buckling to vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) due to equatorial retinal tears.

Methods

Forty-six patients (46 eyes) ≥50 years of age with RRD due to equatorial retinal tears were studied. One group of 23 patients was selected by the randomized envelope method to be treated by scleral buckling and a second group of 23 to be treated by vitrectomy. The rate of retinal reattachment, the visual acuity, optical coherence tomography findings, and postoperative complications were determined. In addition, a questionnaire was filled out by the patients on their subjective assessment of the surgery and recovery.

Results

The rate of retinal reattachment was identical in the two groups. The postoperative visual acuity, the number of patients with visual acuity ≥0.8 and the mean visual acuity were significantly better in the vitrectomy group (χ-squared and Mann-Whitney U tests, P < 0.05) within 12 months after surgery. At 24 and 36 months, the differences in the visual acuity were not significant. The answers to the questionnaire given by the patients in the vitrectomy group suggested that their surgical experiences and visual recovery were better than those of patients in the scleral buckling group.

Conclusion

In patients ≥50 years of age, vitrectomy was more effective than scleral buckling for obtaining good visual acuity in the short term.?Jpn J Ophthalmol 2007;51:360–367 © Japanese Ophthalmological Society 2007

     

Retinal Blood Flow in the Macular Area Before and After Scleral Buckling Procedures for Rhegmatogenous Retinal Detachment Without Macular Involvement

Purpose To investigate retinal microcirculation changes in patients with rhegmatogenous retinal detachment (RRD).Methods The tissue blood flow in the macular area was measured in 28 patients with RRD without macular involvement by scanning laser Doppler flowmetry before and after scleral buckling procedures. The mean blood flow (MBF) was calculated by the automatic full-field analysis program. The MBF ratios of the affected eye to the fellow eye (a/f ratio) in patients were compared with those of the right eye to the left eye (R/L ratio) in the control subjects.Results The mean preoperative a/f ratio in the patients (0.81 ± 0.11) was lower than the mean R/L ratio in the control subjects (1.02 ± 0.11, P < 0.0001) and correlated with the extent of RRD (P < 0.05). The mean a/f ratio tended to decrease 2 weeks after surgery (0.72 ± 0.09) and recovered to an almost normal level after 1 month (0.96 ± 0.09). The blood-flow change was not influenced by the type of buckling.Conclusions The retinal microcirculation in the macular area was disturbed in RRD patients without macular involvement. It correlated with the extent of the RRD, and subsided 1 month after successful scleral buckling procedures. Jpn J Ophthalmol 2004;48:358–363 © Japanese Ophthalmological Society 2004     

视网膜下液中cAMP,cGMP水平与孔源性视网膜脱离眼内液动态

分别采用蛋白结合法、放射免疫法测定22例孔源性视网膜脱离患者的视网膜下液、外周血中cAMP、cGMP的含量。发现视网膜下液中,cAMP含量高于血浆;cGMP含量低于血浆。提示cAMP含量升高、cGMP含量降低可能抑制了视网膜色素层对视网膜下液的吸收。在行视网膜脱离手术封闭裂孔同时辅以cAMP拮抗剂,是否有利于视网膜下液的吸收,尚需进一步研究。     

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

Purpose

To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD).

Methods

We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT.

Results

The mean duration of macular detachment was 15.5 ± 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 ± 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017).

Conclusions

Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.     

玻璃体视网膜手术联合巩膜扣带术治疗复杂性视网膜脱离

使用玻璃体视网膜手术联合巩膜扣带术的方法，进行复杂性视网膜脱离的治疗，达到提高治愈成功率的目的。（１）进行常规的巩膜扣带术，（２）进行睫状体平部三切口的闭合式玻璃体切除手术，包括膜剥离、气体、硅油眼内填充等技术。随访１－１６月，２９眼中，２２眼达到解剖复位，成功率７５．８％；其中，１５眼行硅油眼内填充，１２眼视网膜复位，成功率８０％，闭合式玻璃体手术的开展，使复杂性视网膜脱离的治疗成为可能，其解剖     

Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)

The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited.In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.     

Recurrence of Retinal Detachment after Scleral Buckle Removal

PurposeTo investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.MethodsIn this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.ResultsForty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).ConclusionsScleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.     

Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

PurposeTo evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment.MethodsThe results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 µm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated.ResultsIn 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324).ConclusionsIn patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.     

累及黄斑的孔源性视网膜脱离手术前后黄斑区光学相干断层扫描与多焦视网膜电图的变化

目的：观察累及黄斑区的孔源性视网膜脱离( RRD)患眼手术前后黄斑区光学相干断层扫描(OCT)与多焦视网膜电图（mfERG）表现的变化。 方法：回顾性研究。选择2013年9月至2014年7月在河南省眼科研究所确诊为累及黄斑的RRD并行巩膜扣带术的患者52例（52眼）,以对侧正常眼作对照。RRD患眼均行巩膜扣带手术治疗。手术前及手术后1周,术后1、3、6个月,进行OCT及mfERG检查,观察RRD患眼黄斑区微结构,以及黄斑区反应振幅密度及潜伏期的变化。采用t检验对术前患眼与正常眼进行比较,采用重复测景方差分析对患眼手术前后黄斑中心凹厚度变化与中央1环的N1、P1波反应密度和潜伏期比较分析;采用Pearson积矩相关分析法分析术后各时问点最佳矫正视力(BCVA)与黄斑中心凹厚度、中央1环的N1、P1波反应密度和潜伏期的相关性。 结果：所有患眼术后均成功复位。术前患眼黄斑中心凹厚度较正常眼明显增厚,为(534+44) μm,差异有统计学意义（t=17.127,P<0.05）,术后1周、1个月、3个月、6个月患者黄斑中心凹厚度,较术前明显降低,差异有统计学意义(P<0.01)。与正常眼相比较,术前患者中央1环Nl波和P1波振幅密度降低（t_N1=17.372、t_p1=23.943,P< 0.05）,潜伏期延长（t_Nl=5.291、t_Pl=7.306,P< 0.05）,差异均有统计学意义,术后1周、术后1、3、6个月中央1环N1波及P1波振幅密度较术前均提高（P<0.01）,潜伏期与术前差异无统计学意义。患者BCVA在术后1、3、6个月与黄斑中心凹厚度呈负相关(r=-0.801、-0.695、-0.643,P<0.05),l与中央1环N1波及P1波振幅密度呈正相关(r_N1=0.702、0.695、0.632,r_p1=0.811、0.713、0.648;P< 0.05),与潜伏期无相关性。 结论：OCT与mfERG可以客观综合观察RRD患者术后黄斑区的形态和功能,评估视网膜脱离后的手术疗效。     

The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Purpose

To investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment.

Methods

We retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded.

Results

Postoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker.

Conclusions

In our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.     

Preoperative and Postoperative Factors Affecting Functional Success in Anatomically Successful Retinal Detachment Surgery

PurposeTo investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery.MethodsSeventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated.ResultsThe mean age was 53.9 ± 17 years (range, 11–85 years). The mean follow-up period was 36.7 ± 16 months (range, 14–72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes.ConclusionsEarly intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.     

Outcomes of Recurrent Retinal Detachment Surgery following Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Aim: To study the anatomical and functional outcomes of recurrent retinal detachment (RD) surgery following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Methods: Retrospective analysis of 133 consecutive cases of recurrent RD. Inclusion criteria: age ≥18 years, recurrent RD following PPV ± encircling band for rhegmatogenous RD. Exclusion criteria: age <18 years, post-endophthalmitis/tractional/exudative/combined RD, post-scleral buckle, primary surgery done at another institute. The final anatomical and functional outcomes, and their association with clinico-surgical factors, were analyzed. Results: Proliferative vitreoretinopathy (PVR) ≥ Grade C in re-detached retina (OR, 2.49; 95% CI, 1.02–6.09; P = 0.045) and need for multiple resurgeries (OR, 6.48; 95% CI, 2.51–16.69; P < 0.0001) were significant risk factors for the final anatomical failure. Eyes with PVR ≥ Grade C (OR, 0.31, 95% CI, 0.12–0.80; P = 0.013) in primary RD, and with multiple breaks (OR, 0.24; 95% CI, 0.06–0.96; P = 0.044) at the time of recurrent RD, were less likely to have final BCVA ≥20/200. The visual acuity at the time of recurrent RD had a moderately positive correlation (r = 0.454, P < 0.001), and the delay in recurrence of RD had a weakly positive correlation (r = 0.214, P = 0.046) with the final BCVA. Conclusions: PVR ≥ Grade C and multiple resurgeries are associated with higher incidence of anatomical failure in recurrent RD surgery. Multiple breaks are associated with a poorer visual outcome, whereas a better baseline visual acuity and delayed recurrence of RD after primary repair are associated with a better visual outcome.