Macula off retinal detachments. How long can they wait before it is too late?

PURPOSE: To determine the association between the duration of macula off detachment and the visual outcome following corrective surgery. METHODS: Retrospective review of the medical records of patients who underwent surgery for macula off detachment over a 5 year period (April 1994- March 1999). RESULTS: There were 104 patients in the study. Patients with macula off detachments wait a mean of 2.6 weeks (+/-0.3 SE mean) before presentation and 1.8 weeks (+/-0.2 SE of mean) thereafter before surgery. The mean duration of detachment prior to surgical repair was 4.2 weeks (+/-0.3 SE mean). 78% of patients achieved a postoperative improvement in visual acuity. 36.5% achieved functional visual success of 6/12 at 3 months, which increased to 51% at final discharge. There was no significant difference in visual outcomes for patient undergoing internal vs external procedures (p=0.188). The preoperative visual acuity was the most significant predictor of post operative visual acuity (p<0.0005). Less than 40% of macula off detachments of > or =6 weeks duration will achieve a vision of 6/12 or better compared with 68.2% of patients with macula off detachments of < or =1 week. CONCLUSIONS: The best mean postoperative vision (LogMAR 0.35) was seen in patients with detachment of <1 week duration. Patients <60 years are more likely to achieve visual improvement despite the duration of the detachment. Macula off detachments of >6 weeks duration have a significantly poor postoperative visual prognosis. Awareness of this visual prognosis can assist in planning the timing of surgery to ensure an acceptable result.     

Prognosis of pseudophakic retinal detachment

PURPOSE: To compare preoperative and postoperative findings in phakic and pseudophakic patients operated on for rhegmatogenous retinal detachment (RD). SETTING: Herlev University Hospital, Copenhagen, Denmark. METHODS: This retrospective review comprised 120 pseudophakic patients and 280 phakic patients who had RD surgery during a 4-year period. An identical scleral buckling procedure was used for primary surgery in both groups. Cataract surgery had been performed using extracapsular cataract extraction (ECCE) in most eyes; phacoemulsification was used in 67.5% of the pseudophakic eyes. The mean follow-up was 13.5 months. RESULTS: Pseudophakic patients with RDs presented with significantly worse preoperative visual acuity than phakic patients due to a higher frequency of total RDs and macula-off RDs. Retinal breaks were found significantly less frequently and reoperations were performed with a higher frequency in pseudophakic patients than in phakic patients. At 6 months, no differences between pseudophakic and phakic patients were found. The overall anatomic reattachment rate was 94% and 96% in the 2 groups, and the visual outcome was also identical, with a visual acuity better than 0.4 in about 60% of patients. CONCLUSIONS: Pseudophakic patients presented with more extended RDs and with the macula detached more frequently. Retinal breaks were found less frequently. Despite these findings, the anatomic and visual prognosis of pseudophakic detachments was identical to that of phakic detachments.     

Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole

AIM: To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. METHODS: All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and chi(2) tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. RESULTS: Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) CONCLUSIONS: A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial effect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis     

Combined scleral buckle and vitrectomy as a primary surgery for pseudophakic and aphakic retinal detachments

AIM: To determine whether a combined scleral buckle and pars plana vitrectomy, as a primary surgery, owns any advantage over a single scleral buckling in pseudophakic and aphakic retinal detachments. · METHODS: Thirty consecutive pseudophakic/aphakic retinal detachments were included in this retrospective study. Each patient underwent combined scleral buckle and pars plana vitrectomy, and was followed up for 3 to 14 months. Patients were examined with respect to anatomic reattachment, visual acuity improvement, and surgical complications. · RESULTS: All eyes were anatomically reattached after the first operation. All patients had an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure. · CONCLUSION: A combined surgery for primary pseudophakic/ aphakic retinal detachments offers significant benefits to scleral buckling alone. The improved success rate is contributing to the function of vitrectomy, which improves peripheral visibility and reduces the occurrence of proliferative vitreoretinopathy (PVR).     

巩膜外硅压联合玻璃体切割术治疗人工晶状体或无晶状体眼视网膜脱离

目的:探讨在治疗人工晶状体或无晶状体眼视网膜脱离中巩膜硅压联合玻璃体切割术比单纯巩膜硅压手术的优越性。方法:回顾性分析30例我院联合手术治疗的人工晶状体或无晶状体眼视网膜脱离患者的临床资料。各位患者均采用巩膜外硅压联合玻璃体切割手术修复脱离的视网膜,术后随诊3～14mo,对手术后的解剖复位、视力提高情况以及并发症进行考察。结果:所有患者(30眼)均1次手术复位成功并有不同程度的视力提高,没有发现任何玻璃体切割手术的并发症。结论:在治疗人工晶状体或无晶状体眼视网膜脱离中,巩膜外硅压联合玻璃体切割术比单纯巩膜硅压手术有明显的优越性,其成功率的提高与玻璃体切割术提高周边视网膜的可见度,以及减少PVR的发生相关。     

Pneumatic buckle for the repair of primary rhegmatogenous retinal detachment

OBJECTIVES: This prospective study examines the effectiveness of the pneumatic buckle procedure (nondrainage scleral buckle with pneumatic retinopexy) for repair of primary rhegmatogenous retinal detachments. METHODS: We studied 58 consecutive patients with primary rhegmatogenous retinal detachments who underwent a pneumatic buckle with air or SF6. The procedures were performed at 2 centers. Retinal reattachment and visual acuity were examined. RESULTS: The single operation reattachment rate for patients undergoing a pneumatic buckle procedure was 95%. Eighty eight percent of patients with macula-on detachment had unchanged or improved final visual acuity. Sixty seven percent of patients with macula-off detachments had a final visual acuity between 20/20 and 20/50. Twenty nine percent had final visual acuity between 20/60 and 20/200. Two patients developed a new retinal hole postoperatively. CONCLUSION: Pneumatic buckle is an effective technique for repair of primary rhegmatogenous retinal detachments caused by breaks in the superior 8 o'clock segment. This technique avoids the complications associated with the drainage portion of the traditional scleral buckle operation and results in a high rate of retinal reattachment and stable or improved visual acuity. The rate of new retinal hole formation in this study is much lower than those reported for pneumatic retinopexy.     

Combined scleral buckle and pars plana vitrectomy as a primary procedure for pseudophakic retinal detachments.

BACKGROUND AND OBJECTIVE: Pseudophakic and aphakic retinal detachments are associated with a lower percentage of successful primary repair with standard scleral buckling surgery, than phakic retinal detachments. The objective of this study was to determine whether a combined scleral buckle and vitrectomy, as a primary procedure, offers any advantage over conventional scleral buckling in primary pseudophakic and aphakic retinal detachments, without proliferative vitreoretinopathy. MATERIALS AND METHODS: This was a prospective, non-randomized clinical study. Ninety-four consecutive pseudophakic and aphakic retinal detachments were included in the study. All patients were operated upon by the same surgeon. Each patient underwent a combined scleral buckle and pars plana vitrectomy with perfluorocarbon injection and air-fluid exchange. Each patient was followed by the operating surgeon for a minimum of 6 months. Patients were followed with respect to anatomic reattachment, visual acuity improvement, and surgical complications. RESULTS: All eyes were anatomically reattached after a single operation. All demonstrated an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure. CONCLUSIONS: We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments.     

Prognosis of primary rhegmatogenous retinal detachments. 1. Associations between clinical detachment characteristics, subretinal fluid butyrylcholinesterase and visual outcome following scleral buckling procedures.

Thirty-five patients with primary rhegmatogenous retinal detachments were followed for at least 6 months after scleral buckling procedures with subretinal fluid (SRF) drainage, in order to define factors influencing anatomic and visual outcome. Thirty-two cases were surgically reattached; three were not. Among the reattached cases, final visual acuity was poorer in patients with: older age; longer standing, more extensive detachments; detachment of the macula (with or without the development of a visible macular lesion); macular lesions; and higher SRF butyrylcholinesterase activity. These factors were themselves interrelated. Follow-up duration was only weakly related to final acuity, probably because of the long post-surgical follow-up. Phakic/aphakic status bore little relationship to final acuity. The type or timing relative to drainage of inflammation producing treatment was not related to final acuity.     

Intravitreous tissue plasminogen activator injection and pneumatic displacement in the management of submacular hemorrhage complicating scleral buckling procedures

PURPOSE: To evaluate the efficacy of recombinant tissue plasminogen activator (rTPA) and sulfur hexafluoride (SF6) in displacing submacular hemorrhage in patients who had scleral buckling procedures complicated by the development of submacular hemorrhage. Final visual acuity and complications of the procedures were evaluated. METHODS: Sequential intravitreal injections of 50 microg rTPA in 0.1 mL and 0.4 cc SF6 were performed in eight patients who showed submacular hemorrhage 1 day after a scleral buckling procedure. The fundus was checked daily for 3 days after the injection of TPA and gas, and then was followed every week for 1 month and then every 2 months. Patients were observed for at least 6 months. Visual acuity and the status of complications were evaluated. RESULTS: Submacular hemorrhage was totally or partially displaced extramacularly in all patients on the day after rTPA and SF6 injection. Vitreous hemorrhage was present in all patients. The retina was attached in all patients and no recurrent retinal detachment was noted. Visual acuity was improved at 6 months after treatment in all seven of the patients with macula-off retinal detachments compared to the preoperative visual acuity. The last patient who had a macula-sparing retinal detachment had decreased vision (20/25) at 6 months compared to preoperatively. CONCLUSIONS: Recombinant tissue plasminogen activator and SF6 injection is an easy procedure that is less complicated than and as effective as internal drainage in patients with submacular hemorrhage developing as a complication of scleral buckling procedures.     

Demarcation laser therapy in the management of macular-sparing persistent subretinal fluid after scleral buckling procedures

Background Persistent or recurrent macular-sparing subretinal fluid (SRF) can sometimes occur following scleral buckling procedures. Observation and reoperation have been used in the management of such cases. Demarcation laser therapy (DLT) has been used to treat macular-sparing retinal detachments in the context of cytomegalovirus retinitis and as primary treatment for selected rhegmatogenous retinal detachments. There are, however, scarce data in the literature regarding its use following primary scleral buckling procedures. The current study explores the use of DLT under the latter circumstances.Methods The medical records of all consecutive patients with persistent SRF sparing the macula following primary rhegmatogenous retinal detachment repair using a scleral buckling procedure were retrospectively reviewed. Only those patients in whom the breaks were localised to the area of indentation and, thus, seemed to be well supported by the buckle were included. Demographics, clinical characteristics of the retinal detachment prior to scleral buckling, extension of the residual SRF observed postoperatively, details of the laser procedure, anatomical and functional outcomes and complications were evaluated.Results Seven patients, all females, with a mean age of 47.9 years (range: 20–81) were included in the study. The retinal detachments were superior (n=3), inferior (n=3) and subtotal, affecting both superior and inferior retina (n=1). Scleral buckling procedures were used to treat the retinal detachments in all cases. Following demarcation laser therapy, the area of SRF remained stable in two patients, and flattened in four. In one patient, extension of SRF occurred requiring further surgery.Conclusions Demarcation laser therapy appears to be a reasonable option in the management of patients with persistent or recurrent SRF sparing the macula following scleral buckling surgery.The authors do not have any proprietary interests in the products or methods utilised in this study     

Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling

PURPOSE: To report presenting characteristics as well as anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling. METHODS: Review of 28 eyes of 27 patients with an asymptomatic clinical retinal detachment-defined as a rhegmatogenous retinal detachment with subretinal fluid extending more than 2 disk diameters posterior to the equator-which were repaired by scleral buckling from January 1989 through December 1996 with follow-up of 6 months or longer. RESULTS: With a single scleral buckling procedure, anatomic reattachment of the retina occurred in all eyes; one eye redetached 14 months after the initial surgery secondary to a new retinal break and was successfully reattached. All eyes had best-corrected presenting and final visual acuity of 20/50 or better. Final best-corrected Snellen visual acuity was within 1 line of best-corrected presenting visual acuity in 82% of eyes; three eyes improved more than 1 line of Snellen visual acuity and two eyes lost more than 1 line. CONCLUSION: Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment after scleral buckling surgery are excellent. Strong consideration should be given to repair of these detachments.     

Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery

PURPOSE: To investigate whether the method of retinopexy influences the visual recovery rate and the breakdown of the blood-ocular barrier after conventional retinal detachment surgery. METHODS: Forty-eight patients (48 eyes) with primary rhegmatogenous retinal detachment entered into the study. All eyes were phakic, had an attached macula, and were scheduled for conventional scleral buckling surgery. Patients were randomly assigned to have either laser or cryotherapy for retinopexy. All visual acuity and flare measurements were performed by a masked observer. The interventional procedure was cryopexy at the time of scleral buckling surgery or postoperative (4 weeks) laser photocoagulation. Visual acuity testing with ETDRS chart and aqueous flare measurement with laser flare photometry were performed by a masked observer at standard intervals: preoperatively and 1 day, 7 days, 4 weeks, and 10 weeks postoperatively. Analysis of covariance by multiple linear regression was used for statistical evaluation. RESULTS: Postoperative flare values from patients receiving cryotherapy were significantly higher at each measurement point in time (P < or =.001). The visual recovery was slower in the patients receiving cryotherapy (1 week, P =.003; 4 weeks, P =.03; 10 weeks, P =.081). CONCLUSION: Laser flare photometry proved sufficiently sensitive to quantify an increase in aqueous flare after limited external retinal cryotherapy. Postoperative flare, as a measure of blood-ocular barrier breakdown, was significantly higher and visual recovery slower in the cryotherapy group. Visual acuity after 10 weeks was not significantly different between both groups.     

Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.     

巩膜扣带术与玻璃体切割术治疗累及黄斑的孔源性视网膜脱离后对黄斑结构改变及视力预后的影响

背景 视网膜脱离患者在成功完成视网膜复位手术后并不能很快恢复视力,其原因目前尚不十分清楚. 目的 比较累及黄斑的孔源性视网膜脱离患者巩膜扣带术和玻璃体切割术后黄斑椭圆体区完整性、黄斑区视网膜神经上皮层下积液的发生率及留存时间,探讨黄斑区视网膜神经上皮层下积液存留对视力预后的影响.方法 回顾性分析2010年1月至2013年1月于北京大学人民医院眼科确诊的孔源性视网膜脱离患者66例66眼的病例资料,按手术方式分为巩膜扣带术组和玻璃体切割术组,记录2个组患者病程、屈光状态、最佳矫正视力LogMAR、有无合并症等,观察黄斑区神经上皮下积液存留时间及黄斑椭圆体区完整性,计算2个组在术后1个月时黄斑区神经上皮下积液的发生率. 结果 术前巩膜扣带术组及玻璃体切割术组间年龄、性别、病程、屈光度及LogMAR视力差异均无统计学意义(均P＞0.05).巩膜扣带术组视网膜下积液平均存留(96±60)d,玻璃体切割术组为(21±6)d,差异有统计学意义(t=7.966,P=0.000).术后1个月时,巩膜扣带术组黄斑区神经上皮下积液发生率为78.6％,大于玻璃体切割术组的12.5％,差异有统计学意义(x2=26.891,P=0.000),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异有统计学意义(t=3.185,P=0.003);术后6个月时,巩膜扣带术组与玻璃体切割术组LogMAR视力比较,差异无统计学意义(t=1.876,P--0.065),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异无统计学意义(t=1.755,P=0.087).视网膜神经上皮下积液吸收后,2个组内黄斑椭圆体区连续患者与椭圆体区缺失患者LogMAR视力比较,差异均有统计学意义(巩膜扣带术组:t=2.555,P=0.015;玻璃体切割术组:t=4.005,P=0.001). 结论 椭圆体区受损程度与视网膜脱离时间有关,而椭圆体区的完整性明显影响患者的视力预后.对于累及黄斑的孔源性视网膜脱离患者,玻璃体切割术后视网膜神经上皮下积液吸收较巩膜扣带术快;视网膜神经上皮下积液的存留延缓视力的恢复,手术方式对最终的视力恢复影响不大.     

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.     

Sclerally fixated intraocular lens implant associated with vitrectomy: a study of 50 cases

INTRODUCTION: We present a retrospective study of 50 cases of scleral fixation of intraocular lenses (IOLs) associated with vitrectomy. MATERIALS AND METHODS: From January 1996 to June 2001, 50 consecutive patients who underwent surgery with insertion of a sclerally fixated intraocular lens implant associated with vitrectomy were studied. Indications included luxated lenses due to ocular contusion, cataract surgery complicated by capsular rupture and luxated nucleus or implant into the vitreous, and replacement of anterior chamber lenses. The implant was sutured 2 mm behind the limbus into the scleral sulcus with 10.0 Prolene. Vitrectomy was performed to treat pre-existing maculopathy, remove the lens or lens fragments luxated into the vitreous or to remove a luxated implant, and to provide for complete retinal examination during the operation. RESULTS: With a mean follow-up of 30 months, the mean postoperative visual acuity was 20/30. For 95% of cases, final visual acuity was improved compared to preoperative visual acuity. No postoperative complications due to the implant were encountered. There were four cases of cystoid macular edema and two cases of retinal detachment. DISCUSSION: Despite the macula edema and retinal detachments, there was no loss of visual acuity compared to the preoperative state. There were eight cases of raised intraocular pressure; seven were controlled medically and one after hemi-cyclocryo-therapy. CONCLUSIONS: Scleral fixation of an IOL is a reliable means of correcting aphakia in the absence of capsular support and may be associated with a vitrectomy with very little risk.     

Retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE: To analyze the incidence and characteristics of retinal detachment in myopic patients treated by laser-assisted in situ keratomileusis. METHODS: We retrospectively studied the retinal detachments observed in 1,554 consecutive eyes (878 patients) undergoing laser-assisted in situ keratomileusis for the correction of myopia (follow-up, 30.34+/-10.27 months; range, 16 to 54). Mean patient age was 33.09+/-8.6 years (range, 20 to 60). Before treatment with laser-assisted in situ keratomileusis, all patients had a comprehensive examination, and detected lesions predisposing to retinal detachment were treated before performing the laser-assisted in situ keratomileusis procedure. RESULTS: Retinal detachment occurred in four (0.25%) of 1,554 eyes of four (0.45%) of 878 patients. All four patients who developed retinal detachment in one eye were women. Degree of preoperative myopia was -13.52+/-3.38 diopters (range, -8.00 to -27.50). The time interval between refractive surgery and retinal detachment was 11.25+/-8.53 months (range, 2 to 19 months). In all cases retinal detachment was spontaneous. In all eyes the retina was reattached successfully at the first retinal detachment surgery. Mean best-corrected visual acuity after laser-assisted in situ keratomileusis and before retinal detachment development was 20/43 (range, 20/50 to 20/30). After retinal detachment repair, best-corrected visual acuity was 20/45 (range, 20/50 to 20/32). Differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .21, paired Student t test). A myopic shift was induced in three eyes that had retinal detachment repaired by scleral buckling, from -0.58+/-0.72 diopter (range, +0.25 to -1.00) before retinal detachment and -2.25+/-1.14 diopters (range, -1.00 to -3.25) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: Laser-assisted in situ keratomileusis for correction of myopia is followed by a low incidence of retinal detachment. Conventional scleral buckling surgery was successful in most cases and did not cause significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after scleral buckling in these patients.     

Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively

PURPOSE: To present the postoperative optical coherence tomography (OCT) findings of the macula in rhegmatogenous retinal detachment with spared macula preoperatively. METHODS: Eleven of 46 patients who underwent surgery for rhegmatogenous retinal detachment had an uninvolved macula preoperatively. Scleral buckling without intravitreous gas injection was the operation used in all eyes. All 11 patients were examined before and after treatment with slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and OCT. RESULTS: In 3 of the 11 patients with rhegmatogenous retinal detachment and uninvolved macula preoperatively, fluid was identified with OCT in the macula after successful treatment. OCT showed that the fluid gradually diminished and finally disappeared 5 to 7 months after the scleral buckling procedure. The fluid in the macula became visible with slit-lamp biomicroscopy in only one of the three patients. CONCLUSION: Subretinal fluid in a preoperatively uninvolved macula can be found after successful treatment of rhegmatogenous retinal detachment. If the fluid is located in the fovea, the visual acuity decreases and does not reach the preoperative levels. OCT identifies the presence of fluid and contributes to the study of the fluid's evolution.     

Tomographic image and visual recovery of acute macula-off rhegmatogenous retinal detachment

Purpose To observe the macula of acute rhegmatogenous retinal detachment involving the macula with optical coherence tomography (OCT) after scleral buckling and to study the relation between pre- and postoperative visual acuity and the OCT image.Methods Prospective study of 15 eyes of 15 patients with macula-off rhegmatogenous retinal detachment. We selected cases with preoperative visual acuity worse than 0.5 to analyze the improvement in postoperative visual acuity. The time period between macula-off retinal detachment and surgery was less than 1 week.Results Indirect ophthalmoscopy indicated that all retinal detachments were reattached at 2 weeks postoperatively. Accumulation of subretinal fluid at the fovea was observed in nine (60%) cases with OCT. In four of these nine eyes, the accumulation of subretinal fluid persisted up to 6 months after the operation. The presence of residual subretinal fluid did not influence visual recovery during the 6 months postsurgical follow-up.Conclusions OCT revealed postoperative residual subretinal fluid at the macula in some acute macula-off retinal detachment cases. Residual subretinal fluid did not influence the recovery of visual acuity for at least 6 months after surgery.Presented at the 26th Congress of the Ophthalmic Surgery of Japan, Kyoto, Japan, 31 January 2003None of the authors have a proprietary interest in any material related to this research     

Outcome of diabetic vitrectomy in Latino population

PURPOSE: Evaluation of visual acuity and anatomic outcome in Latino patients undergoing vitrectomy for proliferative diabetic retinopathy, using silicone oil or gas tamponade. METHODS: Retrospective review of 57 vitrectomies, 42 in Latino patients, performed by a single surgeon over a 3-year period. RESULTS: Seventy-four percent of vitrectomies were on patients of Latino descent. Sixty-three percent of eyes had traction retinal detachments involving the macula. Overall, 29% in the Latino group received silicone oil tamponade, while the remainder received gas tamponade. In the gas treatment group, 16% developed rhegmatogenous detachments, while no rhegmatogenous detachments occurred in oil-treated eyes. This difference was not statistically significant. Follow-up ranged from 1 to 4 years (median, 1 year). The change from pre- to postsurgery visual acuity was calculated for both gas and oil treated groups, showing no statistically significant difference. Pre- and postsurgery visual acuity median was hand motions for both. CONCLUSION: There was no statistically significant difference in final anatomic outcome or visual outcome in Latino eyes undergoing surgery for severe proliferative diabetic retinopathy. Silicone oil and gas tamponade appeared to work equally well in this population.