Giant retinal tear retinal detachment etiologies, surgical outcome, and incidence of recurrent retinal detachment after silicone oil removal.

PURPOSE: The purpose of this study was to evaluate etiologies, management, and outcomes of patients with giant retinal tears (GRTs) undergoing primary surgery at a tertiary referral center. METHODS: This was a retrospective, consecutive case series of 94 patients with at least 3 months follow-up after silicone oil removal (SOR). Fifty-seven eyes (60.6%) underwent vitrectomy, 36 eyes (38.3%) underwent combined vitrectomy with buckling, and 1 eye (1.1%) underwent scleral buckling. Perfluorocarbon liquid (PFCL) heavy liquid to flatten GRT flap intraoperative has been used then PFCL air exchange then air-silicon exchange in all eyes undergoing vitrectomy. Fellow eye was observed for retinal detachment (RD). RESULTS: Idiopathic cause constitutes 47 eyes (50%), in which 25 eyes (26.6%) are myopic and 22 eyes (23.4%) have a history of trauma. Eighty-five eyes (90.4%) achieved anatomic success. Visual acuity at the last follow-up was at least 20/400 in 71 eyes (75.5%) of patients. Recurrent RD after SOR was found in 21 eyes (22.3%), of which 50% had proliferative vitreoretinopathy grade C (PVR-C) or more (P = 0.03) and 20% had GRT size more than 180° (P = 0.04). Pars plana vitrectomy (PPV) alone (P = 0.89) or combined PPV with buckling (P = 0.98) has no significant correlation with recurrent RD. Twenty-one percent of the fellow eye had RD. CONCLUSION: Idiopathic cause constitutes the majority (50%). Patients with GRT who underwent surgery achieved a high anatomic success rate. PVR-C or more and GRT size more than 180° remain the most significant risk factor for recurrent RD after SOR, whereas PPV alone or combined PPV with buckling has no significant correlation with recurrent RD.

RETINAL FINDINGS IN A CASE OF PRESUMED CUTIS MARMORATA TELANGIECTATICA CONGENITA.

PURPOSES: To correlate the clinical picture and fundus fluorescein angiography findings in case of presumed cutis marmorata telangiectatica congenita. METHODS: A 41-year-old woman with presumed cutis marmorata telangiectatica congenita who is a known case of hypothyroidism for the last 6 years and has bilateral peripheral retinal vascular abnormalities, peripheral retinal nonperfusion on fluorescein angiography and bilateral optic disk drusen. RESULT: A patient presented with blurring of vision in both eyes for last 6 months. On examination, livedo reticularis skin lesions in both upper and lower extremities were noted. Best-corrected visual acuity in the right eye was 6/18 and left eye was 6/36. Slit-lamp examination revealed posterior subcapsular cataract in the right eye. Fundus examination showed bilateral optic disk drusen, tortuous blood vessels, and peripheral fan-shaped sclerosed neovascularization. Fundus fluorescein angiography showed peripheral retinal nonperfusion. She underwent peripheral laser photocoagulation of the left eye and cataract surgery in the right eye. After 2 years of follow-up, her best-corrected visual acuity was 6/9 in both eyes. Her fundus examination and fundus fluorescein angiography findings were stable in both eyes. CONCLUSION: Presumed cutis marmorata telangiectatica congenita is a rare cutaneous vascular disorder that can manifest with nonprogressive retinal vascular abnormality and optic disk drusen.

Comparison of clinical outcome between 23-G and 25-G vitrectomy in diabetic patients.

PURPOSE: To compare the clinical outcomes and complications between 23-G and 25-G vitrectomy in patients with diabetic vitreous hemorrhage (VH). MATERIALS AND METHODS: A retrospective comparative study comprising 69 eyes (36 eyes in 23-G group and 33 eyes in 25-G group) of 65 patients who underwent vitrectomy with air tamponade for diabetic vitreous hemorrhage (VH) with at least 6 months of follow-up was conducted. RESULTS: There were no significant differences between the two groups in age, gender, bilaterality, type of diabetes, presence of hypertension, lens status, and previous argon laser photocoagulation state (P > 0.05). Best-corrected visual acuity (BCVA) of both groups at postoperative 1 month logarithm of the minimum angle of resolution (logMAR) (1.06 ± 0.99, 0.90 ± 0.96), 3 months logMAR (1.07 ± 0.93, 0.83 ± 0.85), and 6 months logMAR (1.03 ± 0.89, 0.83 ± 0.85) significantly improved from the preoperative BCVA logMAR (2.03 ± 0.83, 2.15 ± 0.99) for 23-G group, 25-G group, respectively (P < 0.0001). There was no significant difference in BCVA between the two groups preoperatively and at 1, 3, and 6 months postoperatively (P = 0.566, 0.506, 0.333, and 0.445, respectively), incidence of intraoperative wound suturing (21.4%, 15.2%), postoperative hypotony (0.0%, 0.0%), early postoperative VH (POVH) (11.1%, 15.2%), late POVH (5.6%, 0.0%), retinal detachment (2.8%, 6.1%), neovascular glaucoma (92.8%, 9.1%), and endophthalmitis (0.0%, 0.0%) for 23-G group, 25-G group, respectively (P > 0.05). CONCLUSION: 25-G vitrectomy is as effective for PDR as 23-G vitrectomy.

Correlation of spectral domain optical coherence tomography findings in sub-silicone oil foveal depression space and visual outcome in eyes undergoing silicone oil removal.

BACKGROUND/PURPOSE: To describe small hyper-reflective spherical bodies in sub-silicone oil-foveal depression (SSO-FD) space using spectral domain optical coherence tomography (SD-OCT) and its effect on visual outcomes in eyes undergoing silicone oil removal (SOR). METHODS: This was a prospective interventional comparative study comprising 42 eyes undergoing SOR with clear media. All patients underwent detailed clinical examination and SD-OCT scan of fovea pre-operatively and at 30 days and 90 days postoperatively. Patients were divided into Group A (n = 21) and Group B (n = 21) depending on presence or absence, respectively, of small hyper-reflective spherical bodies in the SSO-FD space in preoperative scans. The findings between SD-OCT and best-corrected visual acuity were correlated and analyzed. RESULTS: The mean age of patients was 41.9 years (range, 23-60 years) in Group A and 45.6 years (range, 23-60 years) in Group B. Twenty-one eyes showed small hyper-reflective spherical bodies on SD-OCT imaging. These were thought to represent emulsified silicone oil globules trapped in the potential space created by silicone oil meniscus and foveal pit, which is the SSO-FD space. These bodies were absent in all post SOR scans of Group A and Group B. Group A had significant visual improvement (p = 0.0001) after SOR with clearance of these hyper-reflective bodies as compared to Group B(p = 0.356). CONCLUSION: We conclude that these small hyper-reflective spherical bodies in the SSO-FD space were most likely emulsified silicone oil globules and correlated with significant visual improvement with their clearance after silicone oil removal.

Morphometric analysis of fovea with spectral-domain optical coherence tomography and visual outcome postsurgery for retinal detachment.

PURPOSE: The purpose of this study was to correlate the postoperative best-corrected visual acuity (BCVA) with spectral-domain optical coherence tomography (SD-OCT) findings in fovea involving rhegmatogenous retinal detachment (RRD) surgery. MATERIALS AND METHODS: Thirty eyes with preoperative fovea-involving RRD, who underwent scleral buckling (SB) (6 eyes) and pars plana vitrectomy (PPV) (19 eyes) and combined SB and PPV (5 eyes) were recruited. Patients underwent clinical examination and SD-OCT scan of fovea preoperatively and at 30 days and 90 days postoperatively. The correlations between SD-OCT findings and BCVA were analyzed. RESULTS: Inner segment/outer segment (IS/OS) junction integrity was the indicator of better BCVA at 30 days and 90 days (P = 0.0002 and P = 0.0003, respectively) whereas outer retinal corrugation (ORC) was related to worse BCVA at 30 days and 90 days (P = 0.001). External limiting membrane did not have a co-relation with visual outcome, but cystoid macular edema showed co-relation at 90 days (P = 0.047). All eyes of SB and 3 eyes of PPV had a minimal subfoveal fluid at 30 days follow-up that had no effect on visual acuity. All retinas were attached at final follow-up. CONCLUSION: IS/OS junction integrity and ORC may be important predictors of postoperative visual outcome after anatomically successful RRD surgery.