Surgical Treatment of Retinal Detachment Associated with Degenerative Retinoschisis

Abstract

Purpose: Although degenerative retinoschisis is almost always asymptomatic, retinal detachment occurs in some patients with outer layer breaks (OLBs). The purpose of this study is to evaluate the different surgical techniques used for the treatment of this condition. Methods: Retrospective interventional case series. The patients underwent either a Scleral-Buckling procedure (SB) or a 3-port pars plana vitrectomy (V). Pre-, intra-, and post-operative data were analyzed for the two groups. Results: Thirty eyes of 30 consecutive patients were included in the analysis. There was a statistically significant difference (0.5?±?0.48 LogMAR units for the SB group, 1.37?±?1.4 LogMAR units for the V group, p?=?0.027) in final BCVA when the two groups were compared, whereas there was no statistically significant difference in the baseline BCVA between the two groups (p?=?0.38). The proportion of cases that were successfully attached with one operation was slightly lower in the V group (62% versus 76%). Conversely, the proportion of cases that were successfully attached with more than one operation was similar in both groups (23% and 24%, respectively). Conclusion: The present study highlights that retinoschisis-associated RD is a demanding situation to treat and remains a challenge for vitreoretinal surgeons. Scleral buckle procedure was found to be successful in eyes that have peripheral OLBs and not extensive RDs, and PPV should be considered for treating symptomatic, rather extensive schisis-RDs, especially in cases with large or posterior outer layer breaks.     

Serous Macular Detachment Associated with Retinal Arterial Macroaneurysm

Purpose

To report optical coherence tomography (OCT) findings of macular edema secondary to retinal arterial macroaneurysms.

Methods

Six eyes with retinal arterial macroaneurysms were retrospectively examined by OCT. All eyes had macular edema without massive macular hemorrhage. Fluorescein angiography was performed in six eyes, and indocyanine green angiography was done in four eyes. Five eyes underwent direct laser photocoagulation to the retinal arterial macroaneurysms. The foveal thickness, height of the serous macular detachment, and visual acuity (VA) were evaluated from the initial examination until the macular edema resolved.

Results

In all six eyes, the macular edema secondary to retinal arterial macroaneurysms comprised a serous macular detachment with retinal swelling. No cystoid macular edema was observed in any eyes. Dye leakage occurred only from the macroaneurysms in all eyes. OCT showed complete resolution of the serous macular detachment and retinal swelling 1 to 4 months after the initial examination. Macular hard exudates developed during absorption of the serous macular detachment in all eyes. VA improved more than two lines in all eyes after the macular edema resolved.

Conclusion

Retinal arterial macroaneurysms may leak extravasated fluid into the subretinal space, which may result in a serous macular detachment.?Jpn J Ophthalmol 2006;50:460–464 © Japanese Ophthalmological Society 2006     

Retinoschisis at Macular Area in Highly Myopic Eye by Optic Coherence Tomography

The macular change in highly myopic eyes has been known for a long time[1,2]. Recently there were papers on macular schisis in these eyes. But the cases were limited[3,4]. So in order to improve our understanding of macular schisis in highly myopic eyes, we did the following study. Methods From June 2002 to December 2003, the highly myopic eyes with macular schisis found by Optic Coherence Tomography at our hospital were included in the study. The including criteria were: high myopia (>6D)…     

Parapapillary Intrachoroidal Cavitation in Glaucoma: Association with Choroidal Microvasculature Dropout

PurposeTo characterize the choroidal microvasculature in glaucomatous eyes with parapapillary intrachoroidal cavitation (PICC) using optical coherence tomography angiography (OCTA) and its association with parapapillary choroidal microvasculature dropout (MvD).MethodsThis study included 47 glaucomatous eyes with PICC, as identified by color fundus photography and optical coherence tomography scanning of the optic nerve head area. Peripapillary choroidal microvasculature was evaluated on en-face OCTA images. Choroidal MvD was defined as a focal sectoral capillary dropout with no visible microvascular network.ResultsPICC was visible as a well-demarcated area with homogeneously reduced vessel density in en-face OCTA images of the choroidal layer. MvD was detected in 42 eyes (89.4%). Although located in the juxtapapillary area adjacent to the PICC, MvD was confined to the area of parapapillary atrophy. MvD observed in OCTA en-face images was distinguished from the area of PICC by the absence of vascular signal. Of the 50 PICCs, 49 (98.0%) had hemifield visual field defects at the location corresponding to the hemispheric location of PICC.ConclusionsPICC was found to have a characteristic microvascular feature in choroidal en-face OCTA images, and to be topographically associated with glaucomatous visual field defect. PICC was frequently accompanied by MvD and was located adjacent to the area of MvD, suggesting that PICC and MvD have similar pathogenesis.     

正常眼和老年黄斑变性眼的局部视网膜电图

以全视野亮背景及４５′视角的红色闪光作刺激，采用带中孔的角膜接触镜电极，记录了局部视网膜电图。测得２２只正常眼的黄斑中心对盲点区的局部ＥＲＧ振幅之比值为３．５４±１．３５，而３１只老年黄斑变性眼的比值是１．３９±０．５４，两者差异显著（Ｐ＜０．０１），两组全视野明适应ＥＲＧ间无意义，表明此法建立的局部ＥＲＧ记录技术对早期老年黄斑变性病人具有一定诊断价值。     

硅油充填术后复发性视网膜脱离的临床研究

目的分析硅油填充术后带油情况下视网膜再脱离常见原因和再次手术的方法.方法54例54眼合并严重增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)的视网膜脱离行硅油填充术后带油视网膜再脱离的病例进行临床回顾研究.结果54眼后段检查:下方视网膜脱离37眼(68.5%),明确视网膜裂孔35眼中22眼见下方裂孔(62.9%),形成视网膜前增殖41眼中22眼位下方(53.7%).51眼再次手术治疗,其中38眼行硅油取出联合玻璃体术式,视网膜复位率92.1%(35/38).7眼行巩膜手术,视网膜复位5眼.结论带油眼视网膜的病理生理改变主要位于下方,大部分病例可通过再次手术获得成功.     

Multilayered Retinoschisis Associated with Optic Disc Pit

Background

Recently, optical coherence tomography (OCT) analysis has contributed greatly to the detection of posterior retinoschisis associated with optic disc pits. We report an unusual case of optic disc pit maculopathy.

Case

A 37-year-old woman with a multilayered structure of posterior retinoschisis associated with a very small, shallow optic disc pit was treated.

Observations

The patient came to our clinic after a few weeks of decreased vision in her right eye. Fundus examination showed a shallow macular detachment with a tiny, shallow pit at the temporal edge of the optic disc. OCT revealed an unusual multilayered structure of retinoschisis connected to the optic disc. We performed vitrectomy with induction of the posterior hyaloid separation and gas tamponade. After vitrectomy, OCT showed a marked fluid resolution in the retinoschisis, and the patient's vision improved rapidly.

Conclusion

The multilayered separation of retinoschisis can be caused by traction of the optic disc with a tiny, shallow pit at the temporal edge of the disc. Jpn J Ophthalmol 2005;49:414–416 © Japanese Ophthalmological Society 2005     

Laser Photocoagulation in Intermediate Uveitis Associated with Retinoschisis

Purpose: To describe cases of pars planitis associated with retinoschisis, in which laser photocoagulation was carried out.

Methods: Retrospective review.

Results: Three pars planitis cases were associated with retinoschisis and underwent laser photocoagulation. All cases were idiopathic. Retinoschisis was located in the inferior retinal quadrants in all cases and all of them were in bullous formation. None of the cases developed retinal detachment.

Conclusion: As well as posterior vitreous detachment, or peripheral retinal tears, retinoschisis may accompany pars planitis. Laser photocoagulation of the pars plana is effective in these cases both as a treatment and to prevent sight-threatening complications like retinal detachment.     

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.       

玻璃体切割治疗黄斑裂孔性视网膜脱离

对２０例２０眼黄斑裂孔性视风膜脱离施行玻璃体切割术并进行１－４个月的随访。一次性手术后视网膜复位者１６眼，占８０％，二次手术后成功者２眼，手术后总愈率为９０％。术后视力均有改善，认为该手术不失为治疗黄斑裂孔性视网膜脱离的良好措施之一。     

Serous Retinal Detachment and Cystoid Macular Edema in a Patient with Wyburn-Mason Syndrome

Abstract

Wyburn-Mason syndrome is a rare phacomatosis characterized by unilateral arteriovenous malformations (AVMs) involving the brain, retina, and (rarely) the skin. The diagnosis is concluded with dilated fundus examination and markedly dilated tortuous vascular loops with arteriovenous communications on fluorescent angiography. We present a 14-year-old male patient with Wyburn-Mason syndrome who developed serous macular neuroretinal detachment, cystoid macular edema (CME), and consequent visual deterioration in the left eye. To the best of our knowledge, this is the first report of a patient with Wyburn-Mason syndrome who developed serous retinal detachment and CME.     

玻璃体切割术治疗视网膜脱离合并脉络膜脱离

目的探讨玻璃体切割术治疗视网膜脱离合并脉络膜脱离的临床疗效及适应证.方法对23例(23眼)视网膜脱离合并脉络膜脱离的患者,术前7 d即开始口服强的松,采用标准平坦部三切口玻璃体切割及眼内填充(C3F8或硅油),酌情联合巩膜扣带术,术后随访6～12个月.结果术中新发现裂孔 5个(21.74%);术后6个月,视网膜完全复位20眼(86.96%),部分复位2眼(8.70%),未复位1眼(4.35%);术后视力有不同程度的提高,其中0.1以上为5眼(21.74%);术后并发症较少,增生性玻璃体视网膜病变(proliferativevitreore tinopathy,PVR)的发生率较低.结论对眼内增殖明显,视网膜裂孔位于大范围脉络膜脱离区或术前未发现裂孔的视网膜脱离合并脉络膜脱离,玻璃体切割术是可以优先考虑的术式.