Prediction of visual recovery after scleral buckling of macula-off retinal detachments.

Patients with rhegmatogenous retinal detachments involving the fovea have visual loss that may not be recoverable despite anatomically successful surgery. Few guidelines exist to predict ultimate visual outcome with any certainty. We found that despite macular detachment, a device commonly used to predict visual acuity in cataractous eyes, the Potential Acuity Meter (Mentor O & O, Inc., Norwell, Massachusetts), provided acuity measurements even when Snellen visual acuity levels were poor or unmeasurable. In a study of 50 consecutive patients with clear media, we investigated a possible correlation between postoperative Snellen visual acuity with the preoperative Potential Acuity Meter results. We found that actual visual improvement correlated well with potential visual improvement as determined by Potential Acuity Meter measurements (R = .92). Preoperative assessment of patients with this device was a better predictor of final visual outcome than preoperative Snellen visual acuity, the extent of retinal detachment, or the duration of the retinal detachment by history.     

Influence of persistent submacular fluid on visual outcome after successful scleral buckle surgery for macula-off retinal detachment

PURPOSE: To determine the influences of the extent and duration of persistent submacular fluid on final visual outcome after successful scleral buckle surgery for acute macula-off rhegmatogenous retinal detachment (RD). DESIGN: Prospective observational case series. METHODS: Forty-four consecutive patients (44 eyes) who underwent successful scleral buckle surgery for macula-off rhegmatogenous RD were enrolled patients underwent thorough ophthalmologic tests including best-corrected visual acuity (BCVA) assessments and optical coherence tomography (OCT) at one, three, six, nine, and 12 months postoperatively, until at least six months after the disappearance of subretinal fluid (SRF). Patients with persistent submacular fluid one month after surgery were assigned to group A and those without submacular fluid, to group B. In group A, patients whose submacular fluid disappeared before six months were assigned to group A1; the others, to group A2. The natural course of persistent SRF and associations between the extent and duration of SRF and postoperative BCVA were investigated. RESULTS: Twenty-three eyes (52.3%) were in group A and 21 eyes (47.7%) in group B. Twelve eyes (52.2%) were in group A1 and 11 eyes (47.8%) in group A2. SRF disappeared within 12 months after surgery without reoperation in all patients. No significant differences in final visual acuity (VA) were found among groups A, B, A1, and A2. Final VA was not found to be associated with SRF extent or duration. CONCLUSIONS: The presence and extent of submacular fluid after successful scleral buckle surgery for acute macula-off rhegmatogenous RD did not influence final VA or anatomic attachment.     

Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery

PURPOSE: To investigate the time course of foveal reattachment after successful surgery for macula-off retinal detachments. DESIGN: Prospective comparative nonrandomized interventional trial. PARTICIPANTS: Thirty-three patients (16 female and 17 male, 65+/-3 years old) with a spontaneous rhegmatogenous retinal detachment with peripheral breaks and a shallow elevation of the fovea. INTERVENTION: Nine patients were treated with episcleral buckle, cryotherapy, and, in selected cases, external drainage of subretinal fluid. Twenty-four patients were treated with vitrectomy, cryotherapy, and either complete (n = 8), or partial (n = 16) fluid-gas exchange. Patients with complete fluid-gas exchange were kept first in a prone position for 6 hours to help evacuation of subretinal fluid and, afterwards, on their side. Patients with partial fluid-gas exchange were kept in a supine position with the head elevated for 12 hours, allowing spontaneous absorption of submacular fluid. Patients were examined at 1, 6, and 10 to 12 months after surgery with a complete ophthalmic examination as well as optical coherence tomography (OCT). Mean follow-up was 10.0+/-0.5 months. MAIN OUTCOME MEASURE: Foveal attachment was determined clinically and by OCT. RESULTS: Postoperative OCT examination 1 month after buckle surgery (n = 9) showed a small subclinical area of subfoveal fluid in 67% of patients (n = 6). Fluid was still present in 45% of cases (n = 4) at 6 months and in 11% of cases (n = 1) even at 12 months. Optical coherence tomography examination 1 month after vitrectomy showed a completely attached fovea with no subfoveal fluid in all cases (n = 24). CONCLUSIONS: Complete foveal reattachment after macula-off retinal detachment occurs without delay after vitrectomy, whereas subfoveal fluid may persist subclinically for several months in patients operated with a buckle.     

Visual recovery after scleral buckling surgery in macula-off rhegmatogenous retinal detachment

PURPOSE: The primary goal of this study was to investigate the functional results after scleral buckling (SB) surgery in macula-off rhegmatogenous retinal detachment (RRD), with more or less than 7 days' duration of macular detachment (DMD). The secondary outcome measure was to determine the long-term functional results in these two groups 5 years after SB surgery. METHODS: The retrospective studies included 96 eyes of 96 patients with primary, uncomplicated, macula-off RRD. Two studies, one with a short-term follow-up and one with a long-term follow-up, were performed, and in both studies the eyes were divided into two groups according to the DMD. In study I, 96 patients were divided into DMD or=4 days and 7 days (n = 11). Additional preoperative predictive factors including DMD, preoperative visual acuity (VA) and patients' age at the time of the RRD were correlated with the postoperative VA. RESULTS: In study I, the mean final VA was significantly better (0.45) after a DMD of less than or equal to 7 days, compared to patients with a DMD of more than 7 days (0.22; Student's t test, p = 0.02). VA >or=0.4 was achieved in 68% with a subacute DMD compared to 52% in patients with prolonged DMD (chi(2) test, p < 0.001). However, the postoperative VA (0.48 +/- 0.09) in eyes with DMD of 1-3 days was similar (0.42 +/- 0.07) to eyes with DMD of 4-7 days (Student's t test, p = 0.455). We divided the 96 patients into 2 groups according to a preoperative VA. Eyes with a preoperative VA 0.1 (n = 34; Student's t test, p < 0.001). Patients 75 years of age or younger were more likely to achieve a VA of 0.4 or better after SB surgery than older patients (more than 75 years; chi(2) test, p = 0.008). In study II, VA improved (by a mean of 1.60 +/- 0.02 lines) during the follow-up period from 0.32 +/- 0.08 at the 3-month follow-up to 0.46 +/- 0.10 at the 5-year follow-up. Eyes with a subacute DMD had a significantly better VA than eyes with a prolonged DMD (Student's t test, p = 0.004). Patients aged 75 years or less were more likely to achieve a VA of 0.4 or better than patients older than 75 (chi(2) test, p = 0.003). CONCLUSION: The time point of SB surgery has no statistical impact on the final visual recovery in patients with an acute primary macular-off RRD of less than or equal to 7 days. A delay of SB surgery within this time frame does not contribute to an impaired final visual outcome. There was no evidence, that primary macula-off RRDs are emergencies, which cannot wait for a systemic evaluation of the RRD and surgical treatment at the next available scheduled day. A preoperative VA of more than 0.1 and patients' age under 60 years at presentation had an additional prognostic value on the final outcome. Surgeons should be aware that visual function after reattachment may continue to improve over a long period. This study provides useful guidelines for the clinical management of macula-off RRD and the assessment of potential visual recovery in patients after successful SB surgery.     

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     

Predictors for recovery of macular function after surgery for primary macula-off rhegmatogenous retinal detachment

To determine predictors of best-corrected postoperative visual acuity (VA) in patients who underwent surgical intervention for macula-off rhegmatogenous re     

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.     

孔源性视网膜脱离伴黄斑脱离巩膜扣带术后影响视力的因素分析

背景巩膜扣带术是治疗孔源性视网膜脱离（RRD）的主流手术之一,近年来随着手术技巧的改进,视网膜的复位率逐渐提高,术后视功能的恢复仍是备受关注的问题。目的分析RRD伴黄斑脱离患者巩膜扣带术后影响视力的因素。方法对116例116眼行巩膜扣带术的RRD伴黄斑脱离患者的临床资料和随访资料进行回顾性分析,按不同年龄、病程的长短、术前视力及视网膜裂孔情况、视网膜裂孔的位置与数目、视网膜脱离的范围及隆起度、手术过程中是否放液、玻璃体腔是否注气等分别分组后进行∥检验,并将确定的统计量与术后视力进行Logistic多因素线性回归分析,分析年龄、术前视力、病程、屈光度等多种因素与术后视力预后的关联情况。结果χ^2检验结果表明,不同的术前视力、病程长短对术后视力预后的影响差异均有统计学意义（P=0．002,P=0．009）;Logistic多因素回归分析发现,术前视力是影响术后视力恢复的独立危险因素（P=0．009）,术前视力与术后视力预后有线性相关关系（r=0．400,P=0．000）,术前视力≥0．05的患者术后视力恢复至0．4的可能性是术前视力〈0．05患者的3倍（OR=2．992）。本组患者病程≤7d、术前视力〉0．05者行巩膜扣带术后视力预后较好。结论RRD伴黄斑脱离患者行巩膜扣带术后影响视力恢复的主要因素为术前视力和病程,提示RRD伴黄斑脱离时应在7d内早期手术,最晚不宜超过10d,以免影响视功能的恢复。     

累及黄斑视网膜脱离术后解剖学改变和功能恢复情况

目的： OCT观察累及黄斑视网膜脱离行巩膜外加压术后5a黄斑情况。分析脱离时间及术后5a黄斑OCT及视功能的相关性。

方法：回顾性分析47例47眼,累及黄斑视网膜脱离行巩膜外加压术后5a OCT, 视功能及脱离时间,并行统计学分析。

结果：视网膜脱离时间<7d的黄斑厚度(226SymbolqB@88μm)较脱离时间>7d黄斑厚度(209SymbolqB@76μm)厚, 但无统计学意义。而术后复位的黄斑厚度和视力呈正相关(Pearson correlation test, R=1,P=0.01)。脱离时间<7d组视力(0.53)明显好于脱离时间>7d组视力(0.25),明显统计学差异(t-test, P=0.008)。5例(10%)患者发现黄斑区结构异常,包括4例IS/OS层断裂,同时伴有外界膜的断裂(8.5%),且术后5a平均视力(0.15)低于两组的平均视力。

结论：脱离时间的长短严重影响视功能的恢复、术后黄斑的厚度及黄斑结构的改变。累计黄斑视网膜脱离手术尽可能在脱离时间<7d内完成。对于视力恢复较差者,建议行OCT检查。     

视网膜脱离手术后的黄斑改变

目的研究较复杂的孔源性视网膜脱离患者玻璃体手术或巩膜外手术后的黄斑改变,进一步探讨视网膜脱离术后视功能的恢复。方法回顾性分析孔源性视网膜脱离患者146例152眼手术后的黄斑改变,所有患者术前视力均≥0.1,PVR分级B级,裂孔多、分布广或马蹄形裂孔边缘玻璃体牵引明显的,初次发生的伴黄斑脱离的RRD,随访至少3个月。152眼中行巩膜外手术90眼为A组,行玻璃体手术62眼为B组。结果A、B二组术后视力均显著提高(P<0.01),组间无显著性差异(P>0.05)。黄斑形态学改变中,A组表面膜发生率20.0%,较B组8.0%有显著差异(P<0.05),色素紊乱、水肿、渗出、视网膜下膜发生率组间均无显著性差异(P>0.054)。视觉不适中B组视物变形、眼前闪光、眼球疼痛三个指标明显低于A组(P<0.05),小视、色视、复视三个指标稍低于A组(P>0.05)。结论玻璃体手术对黄斑部的影响较小,视觉不适明显改善,对术后视功能的恢复更有利,但易并发白内障。     

孔源性视网膜脱离巩膜扣带术后持续性视网膜下液的研究进展

孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)巩膜扣带术(scleral buckle,SB)后部分患者会出现视网膜下积液延迟吸收的情况,黄斑区受累者可能对视功能的影响更显著。本文就近年来RRD术后持续性视网膜下液(persistent subretinal fluid,PSF)的流行病学、检查方法、致病因素及发病机制、治疗及预防等方面的研究进展进行综述。     

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.     

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.     

Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment

PURPOSE: To compare the anatomic and visual outcomes achieved by scleral buckling and primary vitrectomy for the repair of macula-off rhegmatogenous retinal detachment. METHODS: The records were reviewed for a consecutive series of 167 patients (167 eyes) who were initially treated with scleral buckling or pars plana vitrectomy for primary macula-off retinal detachment. Patients were treated between January 1993 and December 1996. After adjustments for preoperative characteristics, data from 102 cases (55 scleral buckle cases and 47 primary vitrectomy cases) were used for the final comparison. There had been a minimum follow-up period of 24 months. RESULTS: No significant differences in single-procedure reattachment incidence (91%), final success incidence (100%) and incidence of postoperative proliferative vitreoretinopathy development (4%) were observed between the two treatment groups. Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment were the three best predictors of postoperative visual recovery in both groups. Favorable overall visual recovery was obtained postoperatively, with no significant differences between the two groups throughout the follow-up period. However, in the eyes with poor preoperative visual acuity (<0.1), ocular hypotony (intraocular pressure <7 mm Hg), or prolonged macular detachment (more than 7 days), visual recovery in the primary vitrectomy group was significantly better (P <.05) than in the scleral buckle group from the first postoperative month. CONCLUSION: Both procedures achieved favorable anatomic and visual outcomes in the majority of patients with primary macula-off retinal detachment. Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment.     

Sutureless scleral buckle in the management of rhegmatogenous retinal detachment

Purpose:To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD).Design:Retrospective interventional case series.Results:Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.Conclusion:Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.