Increased glutamate levels in the vitreous of patients with retinal detachment

Experimental models have implicated glutamate in the irreversible damage to retinal cells following retinal detachment. In this retrospective study we investigated a possible role for glutamate and other amino acid neurotransmitters during clinical rhegmatogenous retinal detachment (RRD). Undiluted vitreous samples were obtained from 176 patients undergoing pars plana vitrectomy. The study group consisted of 114 patients (114 eyes) with a rhegmatogenous retinal detachment. Controls included 52 eyes with an idiopathic macular hole or idiopathic epiretinal membrane and 10 eyes with a traction retinal detachment due to proliferative diabetic retinopathy. Vitreous concentrations of glutamate, gamma-aminobutyric acid (GABA), taurine, glycine, and aspartate were determined by high-pressure liquid chromatography (HPLC). Multivariate analysis was used to examine a possible association between amino acid neurotransmitter levels and several clinical variables including visual acuity. The mean vitreous concentration of glutamate in eyes with a rhegmatogenous retinal detachment (16.6 +/- 5.6 microM) was significantly higher as compared to the controls (13.1 +/- 5.2 microM) (P = 0.001). Taurine levels were also increased in RRD, whereas no significant difference could be observed in glycine, aspartate and GABA levels when comparing RRD with controls. A correlation was found between increased vitreous glutamate and a lower pre-operative visual acuity. No association was, however, observed between post-operative visual acuity and the level of any of the five amino acid neurotransmitters. RRD was associated with a significantly increased vitreous glutamate concentration. Using visual acuity as a functional parameter in this study, we could not demonstrate a correlation between vitreous glutamate, or any of the other tested amino acid neurotransmitters and visual outcome.     

Local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for rhegmatogenous retinal detachment with vitreous traction

AIM: To demonstrate combined local dry vitrectomy and segmental scleral buckling for the treatment of partial rhegmatogenous retinal detachment (RRD) with local vitreous traction in patients at high-risk for proliferative vitreoretinopathy (PVR). METHODS: Seven eyes of 7 patients were retrospectively studied, including 3 retinal dialysis and 4 retinal detachment (RD) (3 eyes with peripheral retinal hole and 1 eye with giant tear). All patients exhibited partial RD and local vitreous traction. Combined local dry vitrectomy without conventional infusion and segmental scleral buckling was performed. Viscoelastic fluid was injected into the vitreous cavity if needed. Demographic information, preoperative and post-operative complications, and outcomes were recorded. RESULTS: The mean age of the patients at presentation was 22.43±14.28y. All seven patients obtained retinal reattachment after a single surgical intervention. Post-operative visual acuities were improved in all patients. None of them developed complications, except for temporary mildly increased intraocular pressure in 2 cases. CONCLUSION: Combined local dry vitrectomy and segmental scleral buckling and viscoelastic tamponade if needed are effective for patients of RRD with local vitreous traction. The technique avoids many complications associated with regular surgery and was minimally invasive to both the external and internal eye.     

Rhegmatogenous retinal detachment associated with primary congenital glaucoma

Background The development of rhegmatogenous retinal detachments (RRDs) in eyes with a history of congenital glaucoma (CG) is very rare. We present the characteristics and surgical outcomes of three cases with a RRD who had CG and had undergone surgery many years earlier. Cases Three men, ages 14, 43, and 48 years of age, each with a history of surgery for primary CG, presented with a RRD. All of the eyes were highly myopic. The retinal tears were located at the equator in all cases. The degree of RRD were superior half, total, and total (proliferative vitreoretinopathy). Observations Vitrectomy was performed and the retinas were reattached in all cases. However, the visual acuity in all cases remained poor. Conclusions Our findings indicate that a posterior vitreous detachment due to advanced vitreous liquefaction in the highly myopic eyes may have been the cause of the RRD. We recommend periodic fundus examinations in patients with CG, because while the RRD in patients with CG can be reattached the functional recovery may not be good.     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.     

Vitreous intercellular adhesion molecule 1 in uveitis complicated by retinal detachment

AIMS—The vitreous levels of soluble intercellular adhesion molecule 1 (sICAM-1) were investigated in uveitic eyes undergoing vitrectomy for retinal detachment (RD) or other complications, and the presence of this molecule was related to disease activity and vitreous levels of the cytokine tumour necrosis factor α (TNFα), known to upregulate ICAM-1 expression on various cells.
METHODS—Vitreous and serum samples from 23 patients with either active or quiescent uveitis undergoing retinal surgery were examined for the levels of immunoreactive sICAM-1 and TNFα by ELISA methods, and for the presence of biologically active TNFα. Vitreous from non-uveitic eyes with rhegmatogenous retinal detachment (RRD), macular holes or cadaveric eyes were used as controls.
RESULTS—As a whole, vitreous from uveitic eyes complicated or uncomplicated by RRD contained significantly higher levels of sICAM-1 than vitreous from non-uveitic eyes with RRD alone (p < 0.0005), eyes with macular holes (p< 0.0001), or normal cadaveric vitreous (p < 0.0001). The proportion of vitreous containing >20 ng/ml sICAM-1 (> four times the normal values) was significantly higher in eyes with uveitis complicated by RRD than in those eyes without RRD (Fisher's test, p= 0.02), and although levels of sICAM-1 were higher in eyes with active uveitis than in those with quiet disease (p < 0.02), this could not be dissociated from the increase caused by RRD. There was a relation between the vitreous levels of sICAM-1 and those of immunoreactive TNFα (Spearman's correlation coefficient; r = 0.601, p = 0.006), but not between the vitreous levels of sICAM-1 and those of biologically active TNFα.
CONCLUSION—Increased vitreous sICAM-1 levels and the association of this molecule with the presence of immunoreactive TNFα in uveitic eyes confirm the operation of cytokine mediated vascular reactions at the blood-retinal barrier during the development of this condition. The persistence of high vitreous levels of sICAM-1 in eyes with uveitis complicated by RRD despite previous immunosuppression may indicate a low rate of clearance of inflammatory molecules from the vitreous cavity and an exacerbation of the existing inflammatory process by the retinal detachment itself.

Keywords: vitreous; retinal detachment; ICAM-1; TNFα; uveitis     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者192例195眼,术中直视下定位、冷凝视网膜裂孔。131眼行巩膜表面节段性外加压,其中37眼联合环扎术;另64眼单纯行环扎术。145眼进行了视网膜下液引流术;16眼在手术结束时行玻璃体腔气体充填。结果:单次手术视网膜解剖复位185眼,首次手术复位率94.9%。术后视力较术前显著提高,且差异有统计学意义(P<0.05)。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

Choroidal detachment associated with rhegmatogenous retinal detachment and aqueous flare]

The aqueous protein level (APL) in eyes of rhegmatogenous retinal detachment (RRD) combined with or without choroidal detachment (CD) was investigated using a laser flare-cell meter. The APL in eyes of RRD with CD was 70 times higher than in eyes of simple RRD. The APL increased suddenly with the appearance of CD and decreased rapidly in accordance with the disappearance of CD. The longer the CD continued, the higher the APL remained preoperatively as well as postoperatively. The APL in eyes of RRD with CD was still twice as high as in eyes of simple RRD 6 months after successful retinal reattachment. This marked and prolonged intraocular inflammation in eyes of RRD with CD might result in a poorer visual outcome. The extremely high APL might be caused by reflux of suprachoroidal protein through the uveoscleral route and/or venous protein through the trabecular meshwork due to ocular hypotony and possibly by diffusion of protein via posterior chamber and vitreous cavity due to the breakdown of the blood-ocular barrier.     

超声诊断视网膜裂孔伴视网膜脱离

目的 探讨超声诊断视网膜裂孔伴视网膜脱离的方法。方法 选取1999年11月～2000年7月眼科超声检查视网膜脱离伴明确裂孔的连续临床病例48眼,每眼均经过各个方位的超声探测。结果 当连续性脱离视网膜光带中有明显中断,且断端间距大于1mm时,可诊断为视网膜裂孔。马蹄形裂孔中18眼在孔前缘有玻璃体牵引,4眼PVD刚好至后缘,8眼在前后缘均有牵孔;黄斑裂孔中6眼在黄斑处有玻璃体牵引,6眼有完全PVD。巨大裂孔中2眼无明显PVD,大量皮质在裂孔中;1眼后缘有明显牵引。结论 应用超声可以诊断部分视网膜裂孔,视网膜裂孔周围多有玻璃体牵引,手术时应特别注意对此部位的处理,超声诊断对于视网膜脱离术前检查有帮助和补充的作用。     

Increased levels of soluble syndecan-1 in the subretinal fluid and the vitreous of eyes with rhegmatogenous retinal detachment

PURPOSE: To investigate whether rhegmatogenous retinal detachment (RRD) alters intraocular soluble syndecan-1 levels. METHODS: In all, 39 samples of subretinal fluid (SRF) and 10 samples of vitreous fluid from RRD patients were collected. Using ELISA, soluble syndecan-1 levels were detected, and potential correlations between syndecan-1 levels with clinical parameters were analyzed. RESULTS: Soluble syndecan-1 in the vitreous fluid (2.577+/-0.578 ng/ml) and in the SRF (1.499+/-0.184 ng/ml) from eyes with RRD enhanced significantly compared to that of the controls (0.224+/-0.095 ng/ml) (p<0.0001 and p=0.006). An increase in the syndecan-1 concentrations in SRF samples correlated with a longer duration of retinal detachment (r=0.716, p<0.0001) and a younger age (r= -0.341, p=0.017). CONCLUSIONS: RRD was found to be associated with a significant increase of soluble syndecan-1 in the vitreous fluid and SRF. In SRF, an enhanced soluble syndecan-1 concentration correlated positively with the duration of retinal detachment and inversely with the age of patients.     

Visual and anatomical outcomes after silicone oil removal in patients with complex retinal detachment

To evaluate outcomes of temporary silicone oil (SO) tamponade in patients with complex retinal detachment. A retrospective study of 184 eyes of 177 consecutive patients who underwent SO removal (SOR) by one surgeon between 2000 and 2010. Indications for the use of SO were proliferative vitreoretinopathy (56 eyes), difficult rhegmatogenous retinal detachment (RRD) (58 eyes), diabetic traction retinal detachment (DTRD) (29 eyes), RRD due to macular hole in highly myopic eyes (16 eyes), giant retinal tears (13 eyes), and RRD after penetrating trauma (12 eyes). All eyes underwent prophylactic 360° laser retinopexy and encircling buckle at the time of primary surgery. The mean duration of SO tamponade was 47 weeks, with a mean follow-up of 66.9 weeks after SOR. Anatomical success after SOR was achieved in 96.73 %. Final visual outcome of ≥20/200 was significantly higher in eyes with RRD compared to eyes with DTRD. Young age (≤16 years), performance of pars plana lensectomy at primary procedure and presence of pseudophakia at last follow-up were factors associated with good visual outcome in eyes with RRD. Factors predicting attached retina at last follow-up were older age (>16 years), normal intraocular pressure (IOP) at initial presentation and no relaxing retinotomy performed during the primary procedure in eyes with RRD. Complications were cataract (100 %) in phakic eyes, increased IOP (15.7 %), keratopathy (3.8 %), and hypotony (2.1 %). The low redetachment rate after SOR in the present study might be due to prophylactic 360° retinopexy and use of encircling buckles at time of primary retinal reattachment.     

玻璃体后脱离及其所致周边视网膜裂孔的早期治疗

目的 探讨玻璃体后脱离(PVD)所致周边视网膜裂孔早期诊治对其预后的影响.方法 对25例25只眼由PVD所致周边视网膜裂孔作一临床分析.所有病例均行三面镜检查周边眼底,+90D前置镜观察眼球运动时玻璃体的状态.采用多波长激光或冷凝治疗周边视网膜裂孔,巩膜外加压与扣带治疗孔源性视网膜脱离(RRD).结果 7例(7只眼)PVD年龄高于50岁,18例(18只眼)因高度近视所致者年龄在50岁以下.18例中、青年人周边视网膜裂孔应用多波长激光光凝,6例老年人用巩膜冷凝术,唯1例老人并发RRD应用巩膜外加压及扣带术治疗,所有治疗患眼都获得了较好的视力预后.结论 由PVD患者引起的周边视网膜裂孔发生率随年龄增长或近视屈光度而增加,预防性治疗是安全、有效和必需的.     

Silicone oil in the surgical treatment of endophthalmitis associated with retinal detachment

Purpose: To investigate the useof silicone oil in thepatients who had undergone vitrectomy for the treatment of endophthalmitis associated with retinal detachment.Methods: Six consecutive cases of endophthalmitis associated with retinal detachment were included in the study. The mean age of the 4 males and 2 females was 47.25 ± 23.76 years. Endophthalmitis associated with retinal detachment occurred following perforating injuries in 4 eyes, pneumatic retinopexy in 1 eye and cataract surgery complicated with vitreous loss in 1 eye. Preoperative visual acuity was light perception-only in all eyes. Red reflex was absent in all eyes. All the patients underwent vitreous tapping,encirclement, vitrectomy ,liquid-gasexchange, endolaser photocoagulation and silicone oil injection. Results: Mean follow-up time was 14.3 ± 7.20 months. The microorganisms that were isolated from the vitreous aspiration were Staphylococcus epidermidis in 3 cases, Staphylococcus aureus in 1 case. Remaining cases were culture negative. Retinal breaks could be found in 4 eyes. Inflammation subsided significantly at 5 days in all cases. Final retinal reattachment and treatment of endophthalmitis was achieved in 5 eyes at the end of follow-up . Final visual acuity was 20/40 in 1 case, counting finger in 4 cases and no light perception in 1 case. The postoperative complications were optic atrophy in 1 eye, epiretinal membrane in 2 eyes and phitisis bulbi in 1 eye.Conclusion: Silicone oil, a retinal tamponading agent that has antimicrobial activity, may have benefical effect in the surgical treatment of endophthalmitis associated with retinal detachment.     

微创玻璃体切除联合无菌空气填充治疗玻璃体视网膜手术后孔源性视网膜脱离

目的:观察微创玻璃体切除联合空气填充治疗玻璃体视网膜手术后上方裂孔源性视网膜脱离的有效性及安全性。方法:回顾分析2017-11/2019-10在我院收治的,经历过一次或多次玻璃体视网膜手术后发生的由上方裂孔(3∶00~9∶00水平线以上)引起且未合并严重增殖性玻璃体视网膜病变(PVR)的(PVR-C级以下)孔源性视网膜脱离患者,施行经平坦部入路玻璃体切除术,充分切除残留玻璃体后,行气液交换复位视网膜,确保裂孔周围视网膜下液充分排出后激光封闭视网膜裂孔,使用无菌空气行玻璃体腔填充。术后患者严格俯卧位24h。主要观察指标为视网膜初始及最终复位成功率,最佳矫正视力(BCVA),次要观察指标为并发白内障及高眼压比率。结果:共纳入符合标准且术后随访时间≥6mo患者31例31眼,脱位范围6.7±3.8个钟点位,裂孔数1.2±0.7个,脱离累及黄斑23眼(74%),人工晶状体18眼(58%),联合白内障超声乳化人工晶状体植入者6眼(19%)。入组患者Ⅰ期视网膜复位成功率87%(27/31),最终视网膜复位成功率100%(31/31),发生一过性眼压升高者5眼(16%)。术后6mo时BCVA(LogMAR)由术前2.17±1.27改善至0.53±0.25(P<0.001)。结论:对于具有玻璃体视网膜手术史的不合并严重PVR的上方裂孔源性视网膜脱离患者,采用玻璃体切除术联合空气填充,可取得较高的视网膜复位成功率,且具有术后俯卧时间短,并发症少等优点。     

玻璃体后脱离及其所致周边视网膜裂孔的早期治疗

目的 探讨玻璃体后脱离(PVD)所致周边视网膜裂孔早期诊治对其预后的影响.方法 对25例25只眼由PVD所致周边视网膜裂孔作一临床分析.所有病例均行三面镜检查周边眼底,+90D前置镜观察眼球运动时玻璃体的状态.采用多波长激光或冷凝治疗周边视网膜裂孔,巩膜外加压与扣带治疗孔源性视网膜脱离(RRD).结果 7例(7只眼)PVD年龄高于50岁,18例(18只眼)因高度近视所致者年龄在50岁以下.18例中、青年人周边视网膜裂孔应用多波长激光光凝,6例老年人用巩膜冷凝术,唯1例老人并发RRD应用巩膜外加压及扣带术治疗,所有治疗患眼都获得了较好的视力预后.结论 由PVD患者引起的周边视网膜裂孔发生率随年龄增长或近视屈光度而增加,预防性治疗是安全、有效和必需的.

Abstract：

Objective To investigate the effect of early diagnosis and treatment on the prognosis of peripheral retinal breaks caused by posterior vitreous detachment(PVD). Methods Twenty-five cases(25 eyes)with peripheral retinal breaks caused by PVD were analyzed. The vitreous conditions of 25 eyes were examined biomicroscopically with a +90D present lens(slitlamp indirect ophthalmoscope)and a Goldman three mirror contact lens. Peripheral retinal breaks were treated with laser photocoagulation or scleral cryotherapy,and rhegmatogenous retinal detachment(RRD)with explant and scleral buckling surgery. Results Seven cases(7 eyes)with PVD were related with age over 50 years old and 18 cases(18 eyes)due to their higher myopia with lower than 50 years old. Peripheral retinal breaks in 18 patients of juniority were treated by laser photocoagulation and in 6 senile patients by scleral cryotherapy. Only one senile patient complicated with RRD was treated by explant and scleral buckling surgery. All treated eyes received favorable visual prognosis on them. Conclusions The prevalence of peripheral retinal breaks caused by patient with PVD increase with patient's age and degree of myopia. Preventive treatment is safe, effective and necessary.     

Characteristics of rhegmatogenous retinal detachment in pseudophakic and phakic eyes

AimsTo investigate whether pseudophakic and phakic rhegmatogenous retinal detachment (RRD) patterns differ.MethodsRetrospective review of electronic database of patients, aged 50 years or over, presenting to our vitreoretinal service. Data included baseline characteristics, digital drawings, and outcomes. Retinal drawings were analysed in a masked fashion for site, size, and number of retinal breaks. Comparisons were made between the following groups and subgroups: pseudophakic eyes, phakic eyes, phakic eyes with cataract, and phakic eyes without cataract.ResultsOf 500 eyes included, 146 were pseudophakic; 177 of the phakic eyes had cataract. The following were significant by univariate analysis: pseudophakic patients were older than phakic patients in general, but the same age as patients with cataract; in the pseudophakic group, there were lower proportions of females and of patients presenting with vitreous haemorrhage or with large or superotemporal breaks; higher proportions of pseudophakic eyes had small breaks and inferonasal breaks. Some differences remained significant when comparing pseudophakia eyes with cataract. Multivariate analysis comparing pseudophakia with phakia confirmed a lower chance in pseudophakia of large breaks, vitreous haemorrhage and superotemporal breaks, but higher chance of detached inferior breaks. Some variables were age dependent.ConclusionDifferences were found between pseudophakic and phakic RRD patterns. These suggest special pathogenetic mechanisms in pseudophakic retinal detachment, which could help explain increased incidences of RRD after cataract surgery.     

Decreased levels of cGMP in vitreous and subretinal fluid from eyes with retinal detachment

BACKGROUND: Cyclic guanosine monophosphate (cGMP) is produced in different retinal cells, including photoreceptor cells, wherein cGMP mediates photo-transduction. CGMP is degraded by phosphodiesterases (PDE). The aim was to investigate whether retinal detachment alters intraocular cGMP levels in human eyes. METHODS: cGMP and PDE were determined in vitreous fluid from 50 eyes with a retinal detachment (group I) and in 20 control samples (group II) of vitreous fluid from eyes without retinal detachment. Group III consisted of subretinal fluid samples from 70 eyes with retinal detachment. RESULTS: cGMP in vitreous fluid from eyes with retinal detachment (6.5 (SD 1.7) nM) was decreased compared to controls (67.1 (10.0) nM) (p<0.0001). In subretinal fluid, the mean level of cGMP was 2.4 (0.2) nM. No PDE could be detected in any of the intraocular fluid samples of patients nor controls. A decrease in the mean level of cGMP in subretinal fluid of eyes with retinal detachment correlated with a longer duration of detachment (r = -0.45, p = 0.007). CONCLUSIONS: Retinal detachment was found to be associated with a decrease in vitreous cGMP concentration. In subretinal fluid, a low cGMP level correlated inversely with the duration of the detachment.     

微创折叠球囊巩膜外加压治疗孔源性视网膜脱离的临床研究

目的:探讨微创折叠球囊巩膜外加压治疗孔源性视网膜脱离(RRD)的临床效果。方法:回顾性研究。收集2023-05/07于我院采用折叠球囊行微创巩膜外加压术连续治疗的RRD患者11例11眼,术中均采用结膜下麻醉、不做肌肉牵拉线、不做术中视网膜裂孔定位,不做视网膜冷冻和视网膜下放液、不做球囊巩膜固定缝线,观察手术最佳矫正视力(BCVA)、眼压和术后并发症。结果:纳入11眼中视网膜成功复位10眼(91%),1眼(9%)术后视网膜再脱离,因多发视网膜裂孔行玻璃体切除联合硅油填充术。成功行球囊顶压手术的10眼中球囊顶压一次成功4眼(40%),球囊顶压后行玻璃体注气1眼(10%),球囊顶压后再次调位3眼(30%),球囊顶压后再次调位及玻璃体腔注气2眼(20%);5眼(50%)术后4-12 wk行球囊取出,视网膜脱离无复发;术前平均最佳矫正视力(LogMAR)为1.30±1.10,术后4 wk为0.37±0.39(P<0.01);术前平均眼压11.51±3.37 mmHg,术后4 wk为13.72±2.57 mmHg(P>0.05)。所有患者术后均未发生严重并发症。结论:微创折叠球囊巩膜外...     

Experimental traction retinal detachment in the cat

We developed a reproducible model of traction retinal detachment (TRD) in the cat eye by creating a serous retinal detachment and then injecting 2.5 × 10⁵ kitten dermal fibroblasts into the vitreous cavity at the site of a retinal wound. Serous detachments were produced by exposing an area of retina to focused light after intravenous injection of rose bengal (a photosensitizing dye). TRD developed rapidly within the first 2 weeks after fibroblast injection, accompanied by the formation of vitreoretinal strands and, to a lesser degree, epiretinal and/or subretinal proliferation. Histopathology demonstrated fibroblasts within the vitreous or along the posterior hyaloid face. Focal deposits of fibroblasts were occasionally found on the inner surface of the retina and/or in the subretinal space. Fibroblast proliferation was confirmed by uptake of radiolabeled thymidine. Deposition of collagen was noted at as early as 3 days after fibroblast injection. Neovascularization was not observed. Control eyes that did not receive fibroblasts showed resolution of serous detachment without retinal traction. In all eyes, retinal degeneration and thinning were seen in the area of previous photodynamic treatment. In this model of TRD, anteroposterior traction (due to vitreous strands) predominates, as is observed in experimental posterior penetrating ocular injury induced by intravitreal blood injection, which also results in vitreous strand formation. Our model, however, enables clinical assessment of TRD in the cat without the media opacification produced by vitreous blood. Offprint requests to: D.L. HatchellSupported by VA medical research funds, NIH research grant EY02903, core grant EY05722, the Helena Rubinstein Foundation, New York, and Research to Prevent Blindness, Inc., New York. Dr. D.L. Hatchell is a Research to Prevent Blindness, Inc., Senior Scientific Investigator. The authors have no commercial or proprietary interest in the chemicals, drugs, or devices used in this study     

Subretinal fluid drainage via original retinal breaks for rhegmatogenous retinal detachment

Objective

To evaluate the outcome of vitrectomy using only original retinal breaks for subretinal fluid (SRF) drainage during the repair of primary rhegmatogenous retinal detachment (RRD).

Design

A retrospective consecutive interventional case series.

Participants

A consecutive series of 112 eyes of 112 patients.

Methods

Patients underwent 23-gauge vitrectomy without the use of posterior retinotomy and perfluorocarbon liquids for uncomplicated primary RRD at Osaka City University Hospital between September 2007 and March 2011. Exclusion criteria included eyes with giant retinal tears, grade C2 or worse proliferative vitreoretinopathy (PVR), ocular trauma, and the presence of other vitreoretinal diseases.

Results

Single-operation success rate was 92.9%, whereas final anatomical success rate was 100%. Median visual acuity improved significantly from the preoperative logMAR of 0.51 ± 0.78 to the postoperative logMAR of 0.03 ± 0.26 (p < 0.01). No significant differences were observed for the single-operation success rate between the 62 eyes (95.2%) in which some SRF remained at the end of the operation and the rest of the 50 eyes (90.0%, p = 1.000) in which the SRF had been completely aspirated. Complications included transient intraocular pressure rise (12 eyes, 10.7%), epiretinal membrane (5 eyes, 4.5%), and PVR (1 eye, 0.9%). Ocular hypotony and endophthalmitis were not observed.

Conclusions

Uncomplicated primary RRD can be successfully repaired by performing vitrectomy using only the original retinal breaks for SRF drainage. In addition, successful outcomes are not dependent on achieving complete reattachment of the retina throughout the fundus.     

孔源性视网膜脱离手术前黄斑改变的光学相干断层扫描检查

目的　观察孔源性视网膜脱离手术前黄斑改变的光学相干断层扫描图像的特征。方法　用光学相干断层扫描检测 6 2例 6 2眼孔源性视网膜脱离患者的双眼手术前黄斑形态改变。以通过黄斑中心凹的 6mm长度和等角度间隔的四线扫描为基础 ,并根据个体情况作改变扫描线长度和角度的附加扫描。结果　孔源性视网膜脱离术前的光学相干断层扫描图像 ,根据黄斑改变分为 3类 :( 1)黄斑附着 2 9眼 ,表现为神经感觉层脱离未波及黄斑 ;( 2 )黄斑部分脱离 5眼 ,包括神经感觉层囊样水肿 2眼 ,伴玻璃体粘连 3眼 ;( 3)黄斑完全脱离2 8眼 ,包括神经感觉层水肿呈网状 18眼 ,视网膜劈裂 3眼 ,黄斑裂孔 5眼 ,以及伴视网膜前膜 2眼。结论　光学相干断层扫描能详细提供孔源性视网膜脱离术前的黄斑形态改变特征 ,这非常有助于对黄斑病变的检查和视力预后评估。