Risk factors and prognosis of pediatric rhegmatogenous retinal detachment in Egypt: a university hospital based study.

AIM: To study and compare the predisposing factors and clinical features of pediatric, adult, and elderly rhegmatogenous retinal detachment (RRD). METHODS: This is an observational analytic cross-sectional study in which patients with RRD admitted for surgery during 6mo period were divided into 3 age groups: pediatric (<18y), adult (18-60y), and elderly (>60y). Patients' demographic data, clinical features, RRD predisposing factors/features including myopia (axial length ≥26.5 mm), aphakia/pseudophakia, blunt trauma, peripheral retinal degenerations, history of RRD in the fellow eye, and surgical interventions/findings were recorded and analyzed. RESULTS: Totally 142 patients (142 eyes) were studied: 26 (18.31%) pediatrics, 86 (60.56%) adults, and 30 (21.13%) elderly. Elderly patients had a significantly higher intraocular pressures and cataracts compared to the other 2 groups (P=0.04). The RRD extent was larger in pediatric group (mostly 4 quadrants) compared to adults and elderly (mostly 2 quadrants), but it was not statistically insignificant (P=0.242). There were not statistically significantly differences in proliferative vitreoretinopathy (PVR) rate, posterior vitreous detachment (PVD) rate, number, site, shape, and size of breaks in three groups. All three groups had macular detachment in all eyes. Myopia and peripheral retinal degenerations were found to be more significant in adults (P=0.049, P=0.035, respectively), while blunt trauma was higher but insignificant in pediatric eyes (P=0.052). Pars plana vitrectomy (PPV) with silicone oil as a tamponade was the most used surgery in all groups. CONCLUSION: There are no significant difference in PVR rate in pediatric eyes but a significant higher rate of total RRD. Blunt trauma is more frequent in pediatrics eyes while myopia and/or peripheral retinal degenerations are more frequent in older ages. The rate of PPV as a choice for surgery is similar among all age groups.

Efficacy of non-fovea-sparing ILM peeling for symptomatic myopic foveoschisis with and without macular hole.

AIM: To study anatomical and visual outcomes of pars plana vitrectomy (PPV) with non-fovea-sparing (entire) internal limiting membrane (ILM) peeling in eyes with myopic foveoschisis (MF). METHODS: Prospective interventional case series of eyes undergoing PPV with entire ILM peeling for symptomatic MF. MAIN OUTCOME MEASURES: Preoperative spectral domain optical coherence tomography (SD-OCT) epiretinal membrane, anomalous posterior vitreous detachment, vitreoschisis and postoperative changes in SD-OCT central foveal thickness (CFT), ellipsoid zone defect, foveal detachment (FD), macular hole (MH) diameter (if present) and best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR). RESULTS: This study included 21 eyes (21 patients) with mean age 60.4±13.1, 15 females (71.4%). All patients achieved complete postoperative reattachment by SD-OCT (no FD) 6 months post vitrectomy, with no iatrogenic intraoperative or postoperative MH, and with significant improvement in final BCVA from 1.6±0.30 to1.0±0.2 logMAR, and in CFT from 918.2±311.4 to182.3±33.1 µm. Patients were subdivided into subgroup A: 11 eyes without MH; and subgroup B: 10 eyes with MH, the latter had significant improvement in MH diameter (p=0.005). Preoperative BCVA was a significant risk factor for visual gain, while preoperative FD and CFT were significant for CFT change. CONCLUSION: Vitrectomy with non-fovea-sparing (entire) ILM peeling resulted in a significant functional and anatomical improvement in eyes with MF with/without MH with no reported complications. Results are comparable to fovea-sparing ILM peeling.

Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT.

PURPOSE: To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD). METHODS: In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour]. RESULTS: All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05). CONCLUSION: Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.

Why Poor Vision Despite an Attached Retina following Primary Vitrectomy in Egyptian Patients?

OBJECTIVE: To correlate findings on spectral domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) following primary vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: In this prospective, interventional, non-randomized case series, 71 eyes with RRD of intermediate severity underwent primary vitrectomy followed by SD-OCT one month later. Main outcome measures were inner segment/outer segment (IS/OS) junction line and external limiting membrane (ELM) disruption. RESULTS: All patients achieved reattachment with mean BCVA of 0.77 ± 0.36 logMAR. There was statistically significant correlation between each length of IS/OS and ELM defect on the one hand, and BCVA on the other hand. CONCLUSION: The extent of IS/OS and ELM disruption explains the poor visual outcome in successful RD surgery with an otherwise normal foveal contour.