Retinal mobility and retinal detachment surgery.

A series of 200 consecutive retinal detachments was examined prospectively to consider the physical sign of mobility of the detached retina. Retinal mobility was found to be absent in 28 cases, and this immobility is caused by periretinal membrane formation. The importance of retinal mobility when considering the case for non-drainage retinal surgery has been examined with particular emphasis on the tear/buckle relationship at the end of the operation. It was found that there was an excellent prognosis (92% success rate) for cases in which the retina was found to be mobile in the vicinity of the retinal tear, and a high proportion of these cases (71%) can be successfully treated with a non-drainage operation.     

Retinal detachment surgery.

Retinal surgery commences with careful ophthalmoscopy. The surgeon must be familiar with indirect monocular and binocular ophthalmoscopy, but biomicroscopy is most essential. Buckling procedures can be produced by different techniques and should be adapted to the case. Drainage of subretinal fluid is crucial. One should avoid it if possible, but if it has to be done, care has to be taken to avoid complications. The sealing of retinal holes and tears can be performed by diathermy, cryo- and light coagulation. Each technique has its indication and should be available at the time of surgery. Vitreous surgery is still in the experimental stage, but seems to be very promising, although its main use will most probably lie outside the field of retinal detachment.     

Massive retinal gliosis: a late complication of retinal detachment surgery

Purpose Massive retinal gliosis is a rare, benign, intraocular tumor. It develops mostly in long-standing ocular disease such as chronic inflammation, vascular disorders, glaucoma, trauma, or congenital abnormalities. We report on a case of massive retinal gliosis, which developed 17 years following retinal detachment surgery.Methods Case report.Results A 64-year-old woman developed a peripheral fundus tumor 17 years after successful retinal detachment surgery. Follow-up examination demonstrated growth of the mass. The tumor was treated by pars plana vitrectomy and local endoresection. Histopathological study revealed massive reactive gliosis of the retina.Conclusions To our knowledge, this is the first histopathologically proven case of a massive retinal gliosis, which developed after a non-drainage retinal detachment surgery. Endoresection is a therapeutic option in suspected massive retinal gliosis. It provides material for histological diagnosis which obviates unnecessary intervention in a functioning eye.     

Retinal thickening after successful surgery for macula-off retinal detachment

PURPOSE: To study changes in retinal thickness after reattachment of the retina after scleral buckling surgery for rhegmatogenous retinal detachment. METHODS: In this retrospective study, patients were classified into three subgroups according to preoperative macular status. Retinal thickness within 3 mm of the center was measured with optical coherence tomography. RESULTS: Foveal retinal thickness at a mean of 2 years postoperatively was significantly increased in patients with preoperatively detached macula. Additionally retinal thickness in the fovea and postoperative visual acuity was positively correlated. CONCLUSIONS: Successful surgery for macula-off retinal detachment is associated with significant thickening of the neurosensory retina when examined with optical coherence tomography 6 months postoperatively.     

Retinal detachment surgery without cryotherapy.

A series of cases of retinal detachment treated without the application of cryotherapy at the time of surgery has been studied. The omission of cryotherapy while not interfering with retinal reattachment, carries the risk of redetachment at a later date. Macular pucker may still occur in spite of the absence of cryotherapy.     

Retinal circulation in rhegmatogenous retinal detachment demonstrated by videofluorescence angiography and image analysis. I. The condition of retinal circulation before retinal detachment surgery

The retinal circulation in cases of retinal detachment was studied in eight eyes with rhegmatogenous retinal detachment. Retinal mean circulation times of the detachment areas and the non-detachment areas were measured by a system using videofluorescence angiography and image analysis with dye dilution technique. The mean circulation times were 4.05 +/- 1.13 seconds (mean +/- standard deviation) in the non-detachment areas and 6.59 +/- 2.91 seconds in the detachment areas. The difference between the two areas was statistically significant (p less than 0.03). The results demonstrated that the velocity of retinal circulation is slower in retinal detachment area.     

Retinal detachment with retinal dialysis]

A group of 165 eyes operated on account of detachment of the retina comprised 16 eyes with oral dialysis (i.e. 9.7%). Only in 6 eyes of the group there was a positive traumatic case-history. The anatomical results of the operations were favourable (81% amotions cured), the functional results depended on the state of the macula before operation.     

Retinal detachment caused by retinal dialysis

Purpose : To determine the characteristics of patients developing retinal detachment secondary to retinal dialysis in Western Australia and to confirm the clinical impression that these patients had a low rate of proliferative vitreoretinopathy (PVR). Methods : A retrospective analysis of the records of 1601 consecutive patients with rhegmatogenous retinal detachment identified 71 patients in whom the retinal detachment was caused by a retinal dialysis. Results : The majority of these patients were young adults (mean age of 30 years) and the male to female ratio was 1.3: 1. Seventy percent of patients provided a history of significant trauma to the affected eye. Sporting injuries, assault, and motor vehicle injuries together accounted for 72% of identifiable trauma. Examination revealed a dialysis of the inferotemporal quadrant in 75% of cases and despite obvious signs of chronicity of the associated retinal detachment (such as intraretinal macrocysts and demarcation lines) in approximately one-third of the eyes, only 5.6% developed grade C1 PVR either pre- or postoperatively. Conclusion : The present study supports the view that it is the low rate of PVR that explains the good prognosis and high surgical success rate for retinal detachments caused by retinal dialysis. It is postulated that a major reason for the low rate of PVR is that the vitreous base attachment to the posterior margin of a retinal dialysis acts as a significant barrier to the migration of potentially proliferative retinal pigment epithelial cells. This may lead to containment of the responsible proliferative cells within the loculated subretinal space.     

Systemic bevacizumab for retinal angiomatous proliferation associated with retinal pigment epithelial detachment

PURPOSE: To report the off-label use of systemic bevacizumab in a patient with stage 3 retinal angiomatous proliferation (RAP) associated with a vascularized pigmented epithelium detachment (PED). METHODS: Interventional case report. RESULTS: The patient was treated with systemic bevacizumab after obtaining fully informed consent. At 3 months post-treatment, the authors observed an improvement of one line (seven letters) in visual acuity and total regression of the PED on ocular coherence tomography. No adverse effects were observed. CONCLUSIONS: Systemic bevacizumab therapy appears to be safe and effective in the treatment of RAP associated with PED during this short follow-up period of 3 months. The authors recommend a large trial with long-term follow-up to confirm the promising results and evaluate the occurrence of adverse effects associated with systemic bevacizumab.     

视网膜脱离显微镜直视下巩膜外顶压及冷凝术

目的 观察显微镜直视下巩膜外顶压及冷凝术治疗原发性(孔源性)视网膜脱离的效果并评估临床应用的可能性。方法 21眼原发性(孔源性)视网膜脱离应用显做镜直视下巩膜外顶压及冷凝的手术方法。先做巩膜外垫压和／或环扎带的预置缝线，在手术显微镜下切开巩膜和脉络膜引流视网膜下液体，然后用冷凝头顶压巩膜直视下确定裂孔及变性区的部位并冷凝。最后结扎垫压和／或巩膜环扎缝线术后观察视力、眼压、视网膜复位情况。结果 所有病例视网膜完全复位，矫正视力在0．3以上者14眼。结论 显微镜直视下巩膜外顶压并冷凝治疗原发性视网膜脱离手术具有简单、方便、快捷的特点，疗效可靠。     

Diplopia after retinal detachment surgery.

Diplopia following retinal detachment usually responds to simple measures. Fifteen out of 311 cases developed diplopia lasting more than three months after conventional retinal detachment surgery. Binocular single vision was restored in 12 of the 15 cases (80%). The mean follow-up was four years. Diplopia was eliminated stepwise. If prisms were ineffective, our first surgical procedure was removal of the scleral buckle. If the retina was flat, we were prepared to remove the buckle early. When diplopia persisted after buckle removal, we proceeded to strabismus surgery. Our most consistent results followed strabismus surgery on the untreated eye. Prisms alone restored binocular single vision in six patients (40%), one of whom preferred to adopt a compensatory head posture. Removal of the scleral buckle restored binocular single vision in three patients (20%), with the help of a prism in one case and a compensatory head posture in another. Binocular single vision was restored after buckle removal and strabismus surgery in three further patients (20%), one requiring a prism in addition. Binocular single vision was not restored in three patients (20%).