Characteristics of patients with complete visual acuity recovery after vitrectomy for macula-off retinal detachment.

PURPOSE: The purpose of this study is to investigate potential factors predicting complete recovery of visual acuity following surgery for macula off retinal detachment (RD). PATIENTS AND METHODS: Retrospective review of patients operated for macula-off RD at Jules-Gonin Eye Hospital between January 2015 and December 2016. The study included patients with visual acuity recovery of 0 LogMAR. A control group of 83 patients with comparable baseline characteristics but partial recovery of visual acuity after vitrectomy for macula-off RD was used for statistical comparison analysis. RESULTS: Seventy-four patients, 46 males (62%) and 28 females (38%), were included. Mean age was 65 years (standard deviation: 12). Median follow-up was 6 months (interquartile range: 3). Fifty patients (68%) were pseudophakic. Median pre-op best-corrected visual acuity (BCVA) was 2 LogMAR (interquartile range: 1.22). Forty-three of the patients (58%) had preoperative BCVA equivalent of count fingers or less. The majority of the patients (91%) had up to 3-day duration of macular detachment (MD) before surgery. In comparison only 18% of the group of patients with partial recovery of visual acuity after vitrectomy for macula-off RD had been operated within 3 days of MD (p < 0.0001). In 63% of the 40 cases in whom an optical coherence tomography (OCT) of the fovea could be interpreted, OCT image showed a retained foveal depression of the detached retina, whereas only 35% of the 46 control eyes with adequate OCT imaging showed a retained foveal depression (p = 0.01). CONCLUSIONS: In our study, patients had significantly better chances of complete visual acuity recovery when operated within 3 days of MD in comparison to more delayed surgery. Additionally, preservation of the foveal depression of the detached retina appeared to be a common characteristic among patients demonstrating complete visual recovery.

Iris Clip Lens Implantation with Novel Approach for Aphakia After Previous Filtration Surgery.

Purpose To present a novel and simplified surgical technique of Artisan lens implantation for intraocular lens luxation and aphakia in glaucoma patients with previous superior filtration surgery. Methods Analysis of 12 patients with a history of previous superior filtration surgery for glaucoma, who underwent artisan lens implantation. To allow lens manipulation and implantation without alteration of the filtration bleb, the main sclerocorneal incision was performed laterally and the Artisan lens was held in place for enclavation of the iris stroma via a superior corneal incision without disturbing the filtration bleb. Results Mean pre-operative visual acuity was 0.54 ± 0.85 LogMAR, and intraocular pressure (IOP) was 15.8 ± 7.7 mmHg. At the end of follow-up (11.6 ± 8.1 months), visual acuity had improved to 0.32 ± 0.57 LogMAR and intraocular pressure was 14.7 ± 5.4 mmHg. No disturbance of the filtration bleb was observed. Conclusions Artisan lens implantation can be performed successfully via a combined lateral and superior approach despite the presence of a filtration bleb at the 12 o'clock position.

Vitrectomy with Fovea-Sparing Internal Limiting Membrane Peeling for Myopic Foveoschisis.

Background Myopic foveoschisis is a rare form of a tractional maculopathy, which occurs in patients with elevated axial length. The contraction of the posterior hyaloid exerts tangential traction on the retinal surface with a subsequent continuous splitting of the retinal layers. Internal limiting membrane (ILM) peeling has been advocated in foveoschisis, but it has been associated with post-operative macular hole formation. We report on a modified surgical technique, which spares the fovea and may reduce the risk for macular hole formation. Methods Retrospective analysis of 6 patients with myopic foveoschisis. The mean age was 53.8 ± 12.9 years (4M, 2F) and mean myopia was - 18.3 ± 6.5 Dpt. After a 23 g pars plana vitrectomy, the ILM was peeled on the entire macular surface, except in the foveal region lest the thin foveal structures be damaged. All patients received a gas tamponnade with 23 % SF6 and maintained a face down position for 5 days. Results Mean best-corrected pre-operative visual acuity was 0.87 ± 0.56 logMAR, which increased to 0.60 ± 0.40 logMAR at the end of follow-up. The retinal thickness, as measured by optical coherence tomography, decreased from 799 ± 352 micrometers to 318 ± 60 micrometers at the end of follow-up 7.8 ± 5.7 months. No case developed a macular hole. Conclusions Vitrectomy with fovea sparing ILM peeling is a promising surgical technique, which results in an improved foveal anatomy and retinal function. Due to the sparing of the fovea, this surgical technique may reduce the risk of macular hole formation in the post-operative period.

Intraocular Dexamethasone Implant as Adjunct to Silicone Oil Tamponade for Proliferative Vitreoretinopathy.

Background Proliferative vitreoretinopathy (PVR) occurs in 10 % of patients with retinal detachment and is characterized by excessive epi-, sub- or intraretinal contraction. Corticosteroids have been shown to counter this contraction. Patients and Methods Retrospective review of 5 patients (3 females, 2 males) with recurrent retinal detachment with stage C PVR. The mean age was 61.2 ± 20.5 years and myopia > - 5.0 dioptres was present in 3 eyes. Patients were treated with 23 g vitrectomy, retinectomy and endolaser, dexamethasone (Ozurdex®) injection under perfluorocarbone and 5500 cs silicone oil tamponade. Results After a total follow-up of 8.8 ± 6.4 months with silicone oil tamponade, the Ozurdex® implant was localised in the macula in 1 case, and in 4 cases behind the iris with a completely attached retina. Preoperative intraocular pressure was 11.0 ± 4.0 mmHg, which remained stable at 7.8 ± 3.5 mmHg at the end of the final follow-up. No localised adverse effects were observed of the implant on the retina or the iris. Conclusions The dexamethasone implant Ozurdex® is well tolerated in conjunction with silicone oil tamponade in eyes with retinal detachment and PVR. The implant may be a potential candidate for the prevention of PVR.

Long-Term Functional and Anatomical Outcome of Radial Optic Neurotomy for Central Retinal Vein Occlusion.

BACKGROUND: Without treatment, the natural history of central retinal vein occlusion (CRVO) can result in severe loss of vision. MATERIAL AND METHODS: This was a retrospective study of 10 eyes with CRVO treated with pars plana vitrectomy (PPV), combined with radial optic neurotomy. The patients completed a minimum of 5 years follow-up. RESULTS: Median age at the time of surgery was 67 ± 14 years. Median follow-up was 79 ± 9 months. Ischaemic changes were present in 4 patients pre-operatively. Baseline median logMAR BCVA was 2.00 ± 0.76 and improved significantly to a median of 0.35 ± 0.54 (p < 0.0001, two tailed t test) at 5 years follow-up. The baseline median central macular thickness (CMT) was 645 ± 108 µm and improved significantly, to a median of 203 ± 72 µm (p < 0.0001, two tailed t test). One of the patients developed neovascular complications during the follow-up period. CONCLUSIONS: Our results compare very favorably with the natural history of CRVO. All patients demonstrated a trend to improved visual acuity, while only one of the patients developed neovascular complications. These results provide information on the potential long-term effect of PPV in patients with CRVO and may help to reassess the place of the surgical management of CRVO in patients who do not respond to medical treatment.

Incidence and Surgical Management of Simultaneous Bilateral Retinal Detachment.

BACKGROUND: Simultaneous bilateral retinal detachment (RD) is very rare and its incidence has not been very well characterised. MATERIAL AND METHODS: Retrospective review of RD cases treated at the Jules Gonin Eye Hospital between 1999 and 2010. RESULTS: Over the 11 year period, 10 patients (20 eyes) with simultaneous bilateral RD were identified (average incidence among RD= 0.9 %). Mean age: 46.4 ± 17.6 years, with a M : F Ratio of 6 : 4. Pseudophakia was present in 10 eyes and myopia ≥-5.0 dioptres in 11 eyes. Visual symptoms were unilateral in 7 patients, bilateral in 2 patients and absent in one patient. RD was macula-on in 15 eyes and macula-off in 5 eyes. Atrophic holes were present in 11 eyes, U-tears in 6 eyes and a combination in 3 eyes. Primary surgery consisted of buckle surgery (11 eyes), vitrectomy (6 eyes) and combines technique (3 eyes). The final anatomical success rate was 100 %. Mean follow-up time was 22.7 ± 4.95 months. CONCLUSION: The incidence of bilateral simultaneous RD appears to be very low and surgical success rates are excellent. Bilateral pre-operative dilated fundoscopy is mandatory, as the majority of patients have unilateral symptoms.

Pseudophakic Retinal Detachment Surgery by 23 G Vitrectomy using Slit-Lamp and Non-Contact 90 D Lens.

BACKGROUND: The purpose of this study is to report the anatomic and functional results of primary 23 G vitrectomy using slit-lamp and non-contact 90 D lens for the treatment of pseudophakic rhegmatogenous retinal detachment. PATIENTS AND METHODS: Pseudophakic eyes were operated by 23 G vitrectomy using slit-lamp and non-contact 90 D lens, internal subretinal fluid drainage, cryopexy and internal gas tamponade. The preoperative and postoperative characteristics were analysed. Main outcome measures were anatomic success rates after initial surgical intervention and after reoperation for primary failures, visual outcome at the last follow-up visit, and complications. RESULTS: 46 pseudophakic eyes were included in this retrospective study (October 2013- January 2014). In 40 cases, sulfur hexafluoride 23% gastamponade was used, silicone oil in 6 cases (13%). The retina was reattached successfully after a single surgery in 44 eyes (96%). Recurrence of retinal detachment occurred in 2 eyes. Final anatomic reattachment was obtained in 100% after a second operation. Silicone oil was removed in all eyes. Visual acuity improved significantly from logMAR 0 (IQR 0-0.9) to logMAR 0 (IQR 0-0.2) (p<0.005). CONCLUSIONS: Primary 23 G vitrectomy using slit-lamp and non contact 90 D lens for the treatment of pseudophakic rhegmatogenous retinal detachment provides a high anatomic and functional success rate and is associated with few complications.