Risk of Proliferative Vitreoretinopathy in the Second Eye in Adult Patients with Bilateral Retinal Detachment.

PURPOSE: To examine the incidence and risk factors of proliferative vitreoretinopathy (PVR) in the patients who develop rhegmatogenous retinal detachment (RRD) in their fellow eye after having a prior RRD complicated by PVR. DESIGN: Multicenter, retrospective observational study. SUBJECTS: Eyes with retinal detachment and PVR between 2015 and 2023 were identified through the Vestrum Health Database. METHODS: Risk factors for PVR development, specifically documented PVR in the fellow eye, gender, age, lens status, and presenting and final visual acuity (VA), were evaluated. MAIN OUTCOME MEASURES: Odds ratio (OR) for PVR development during 6 months postoperative period. RESULTS: Of 57 264 patients, 11% had PVR in ≥1 eye. Of the 50 989 patients who did not develop PVR after the initial RRD, 4834 developed RRD in the fellow eye. One hundred sixty-six of these patients developed PVR in their second eye for a PVR rate of 3% in the fellow eye. Of the 6275 patients who developed PVR after primary RRD repair, 406 of these patients went on to develop RRD in their fellow eye. Forty-two of these patients developed PVR in their second eye for a PVR rate of 10%. A regression model that also included age, gender, and VA led to an OR of 3.42 (P < 0.001). The OR of PVR development generally decreased with age. Pseudophakic patients had a higher OR for PVR development, 1.48 (P = 0.017). Initial patients with VA 20/40 to 20/80 had an OR of 2.15 (P = 0.003). Patients with VA worse than 20/200 had an OR of 2.89 for PVR development (P < 0.001). CONCLUSIONS: Patients with a history RRD with PVR in 1 eye have approximately 3.5 times higher rate of PVR in their second eye after RRD compared with patients without a history of PVR. This finding potential impacts surgical decisions and use of prophylactic anti-PVR therapy if the patient's second eye has RRD. The final VA in the second eye of patients with a history of PVR is better than for the second eye of patients with no history of PVR, which may indicate surgeons are already taking steps to prevent PVR in the patient's second eye. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Involvement of Sclera in Lattice Retinal Degeneration: An Optical Coherence Tomography Study.

The aim of the study was to evaluate the local status of the sclera in lattice retinal degeneration. Patients with lattice degeneration, snail-track degeneration, or horseshoe retinal breaks were included. One lesion of a single eye in each patient was captured with cross-sectional optical coherence tomography (OCT) along and across the greatest lesion dimension. The maximum height of scleral indentation was measured and compared between different lesion types and between lattice lesions with and without retinal breakage or local detachment. The correlation between the maximum height of the scleral indentation of lattice lesions and the age of the patients was calculated. Seventy-five eyes of 75 patients (44.4 ± 14.7 years; 35 males and 30 females) were included. OCT showed variable local scleral indentation in 52 out of 55 (94.5%) lattice lesions, in five out of nine (55.5%) snail-tack lesions, and in three out of eleven (27.3%) horseshoe breaks. The maximum scleral indentation within lattice lesions, snail-tack lesions, and horseshoe breaks was 227.2 ± 111.3, 22.0 ± 49.2, and 88.5 ± 48.4 µm, respectively (p < 0.001 for snail-tack lesions and horseshoe breaks compared to lattice lesions). Lattice lesions with retinal breaks and/or local retinal detachment had statistically significantly lower scleral indentation than those without (p = 0.01). The height of the scleral indentation of lattice lesions was positively correlated with patient age (r = 0.51, p = 0.03). In conclusion, scleral indentation is one of the hallmarks of lattice retinal degeneration and may be associated with a reduced risk of rhegmatogenous retinal detachment.

Posterior Retinal Breaks Secondary to Closed-Globe Blunt Ocular Trauma.

Purpose: To describe 2 cases of posterior pole retinal tears resulting from closed-globe trauma. Methods: Two cases of retinal breaks in the posterior pole after blunt ocular trauma were evaluated, and the relevant literature was reviewed. Results: Two eyes of 2 patients with posterior pole retinal tears secondary to closed-globe trauma were included. One patient had a pars plana vitrectomy with laser retinopexy and gas tamponade; the final Snellen visual acuity (VA) was 20/200. The second patient was treated with indirect laser retinopexy; the final Snellen VA was counting fingers. Conclusions: The rapid deformation of the globe in response to blunt ocular trauma may create significant tangential stress on the retina, leading to stretch breaks in the posterior pole. Clinicians should follow patients with a closed-globe injury to watch for retinal breaks in the posterior pole, in particular when a hemorrhage or other pathology obscures the view.

Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis.

BACKGROUND: Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT. METHODS: PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). RESULTS: Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%. CONCLUSIONS: The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.

Fundus examination using a wide-angle viewing system and intraocular illumination through the corneal incision during cataract surgery: a case series.

PURPOSE: To report a new technique for fundus examination using a wide-angle viewing system combined with intraocular illumination without accessing the vitreous cavity. STUDY DESIGN: Retrospective case series METHODS: Consecutive patients with atopic dermatitis-related cataracts who underwent standard cataract surgery and the novel fundus examination technique were included. After phacoemulsification, the anterior and posterior chambers were filled with ocular viscoelastic devices. A 27-gauge endo-illumination probe was inserted into the anterior chamber through a corneal incision made for cataract surgery. The fundus examination was performed with a wide-angle viewing system and scleral indentation. If any retinal breaks/detachments were detected, they were treated simultaneously. Finally, an intraocular lens was implanted. RESULTS: Ten patients (13 eyes) were included (mean age 26.8 years; 9 men). Retinal breaks were detected in 5 eyes (38%); 2 of the 5 had rhegmatogenous retinal detachment (RRD) (15%). Intraoperative cryopexy was performed for 3 eyes with retinal breaks, while 2 eyes with RRD underwent a scleral buckling procedure (SBP) during the same surgery. There were no intra- or postoperative complications, including posterior capsule damage. The average surgical time was 22 minutes for cases requiring only fundus examination and about 28 and for eyes with cryopexy and 80 minutes for SBP. CONCLUSION: The described technique may reduce the disadvantages of creating scleral incisions and provide comparable visibility to inserting the illuminator into the vitreous cavity.

Ultra-Widefield-Guided Swept-Source OCT Findings of Peripheral Vitreoretinal Abnormality in Young Myopes.

PURPOSE: To evaluate the ultra-widefield fundus photography (UWF-FP)-guided swept-source OCT (SS-OCT) images of peripheral vitreoretinal abnormality (PVRA) in young asymptomatic myopes. DESIGN: Cross-sectional, single-center study. PARTICIPANTS: A total of 1966 eyes of 983 consecutive patients aged 18 to 42 years with refractive error in the spherical equivalent of < 0 diopters (D) who visited KEYE Eye Center, Seoul, Republic of Korea, for refractive surgery. METHODS: The prevalence of PVRA and their characteristics, including shape, location, presence of pigmentation, membrane, retinal breaks, and detachment, were evaluated. A logistic regression analysis was done to evaluate the risk factors of PVRA and the risk of retinal breaks or detachment among eyes with PVRA. RESULTS: Among 1966 eyes, 317 (16.1%) had PVRA, and 182 (57.4%) and 135 (42.6%) had focal and linear lesions, respectively. The risk of PVRA was increased with axial length of the eyes (odds ratio [OR], 1.238, 95% confidence interval [CI], 1.112-1.379, P < 0.001), corneal astigmatism (OR, 1.320, 95% CI, 1.148-1.519, P < 0.001), presence of discrete margins of different retinal reflectivity (DMDRR; indicating outer retinal disruption from abnormal vitreoretinal traction) (OR, 1.751, 95% CI, 1.334-2.300, P < 0.001), and posterior vitreous detachment (PVD) at the posterior pole of the retina (OR, 1.833, 95% CI, 1.352-2.485, P < 0.001). Among eyes with PVRA, patient age (OR, 1.063, 95% CI, 1.008-1.121, P = 0.025), linear lesions (OR, 15.234, 95% CI, 7.891-29.407, P < 0.001), and multiple lesions (OR, 3.432, 95% CI, 1.780-6.620, P < 0.001) were independently associated with the presence of retinal breaks or detachment. CONCLUSIONS: The follow-up for PVRA among young myopes should be personalized on the basis of their ocular characteristics, including asymmetric ocular expansion (axial length and astigmatism) and vitreoretinal interface status. The treatment plan for PVRA eyes should emphasize the greater risk of retinal breaks and detachment with increasing age and the presence of linear and multiple lesions. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Semi-automated quantification of vitreal hyperreflective foci in SD-OCT and their relevance in patients with peripheral retinal breaks.

BACKGROUND: Retinal breaks (RB) are emergencies that require treatment to prevent progression of rhegmatogenous retinal detachment. Vitreal hyperreflective foci (VHF) representing migration of RPE cell clusters or interphotoreceptor matrix from the RB are potential biomarkers. The aim of this study is to investigate VHF in RB-patients using SD-OCT. METHODS: The retrospective cross-sectional study included RB patients from our Department of Ophthalmology, HSK Wiesbaden who underwent macular SD-OCT (SPECTRALIS®, Heidelberg Engineering, Germany) on both eyes. VHF, defined and quantified as foci that differ markedly in size and reflectivity from the background speckle pattern, were assessed for presence and frequency. The RB-affected eyes were the study group (G1), the partner eyes the control group (G2). RESULTS: 160 consecutive patients with RB were included. Age was 60 ± 10.2 years (52% female). 89.4% of G1 and 87.5% of G2 were phakic (p = 0.73). 94.4% (n = 151) were symptomatic. Symptom duration was 8.0 ± 10.1 days in G1, 94.4% (n = 151) showed VHF versus 5.6% (p < 0.0001) in G2, of which 75% (n = 6) showed asymptomatic lattice degenerations. Detectable VHF showed a strong association of OR = 320 (95% CI, 110-788, p < 0.0001)) with respect to symptomatic RB. Sensitivity and specificity were 94.7% and 94.7%, respectively. CONCLUSIONS: Most eyes with symptomatic RB show vitreal VHF in SD-OCT. Detected VHF are strongly associated with RB, and our semi-automated greyscale reflectivity analysis indicates that VHF likely originate from photoreceptor complexes torn out of the RB area that migrate into the vitreous cavity. The presence of VHF may indicate RB and should lead to a thorough fundus examination in both symptomatic and asymptomatic cases.

Long-term retinal changes after strabismus surgery, suspected signs of past scleral perforations.

Purpose: Scleral perforation during strabismus surgery is considered a rare complication that usually results in no significant consequences. The true rate of such occurrences is difficult to evaluate due to the young age of most patients and the occult nature of most events. This study aimed to evaluate long-term retinal changes under the suture areas in patients post-strabismus surgery as presumed signs indicating past undiscovered scleral perforations. Methods: The study population consisted of patients with a follow-up of at least 10 years post-strabismus surgery at the [redacted for review] Eye Institute and with no known retinal conditions as well as with wide fundus visibility. We performed slit-lamp retinal periphery examinations in search of retinal scars or changes at the suture sites. Results: Seventy-one eyes from 43 patients were examined. The mean age (±standard deviation [SD]) at the time of examination was 27 years (±14), and the mean number of strabismus surgeries per patient was 1.8. Three of the examined eyes showed retinal changes at the suture sites, yielding an overall incidence rate of suspected perforation/penetration of 4.2% per eye and 3.6% per strabismus surgery. These three patients were all asymptomatic. Conclusion: Scleral perforations during strabismus surgeries could remain unnoticed since a comprehensive exam of the retinal periphery is challenging in young children, especially during the postoperative period. While retinal changes caused by inadvertent scleral perforations appear to have no clinical sequelae in a time frame of 10 years, such changes should be noted for future fundoscopic examinations.

Analysis of Posterior Vitreous Detachment and Development of Complications Using a Large Database of Retina Specialists.

PURPOSE: To examine the incidence of complications after posterior vitreous detachment (PVD) through an extended follow-up period and to identify patient-specific factors associated with a greater incidence of complication. DESIGN: Multicenter, retrospective observational study. PARTICIPANTS: Eyes with acute PVDs between 2015 and 2019 were identified through the Vestrum Health database. METHODS: Complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute PVD at presentation and throughout the 6-month follow-up period. MAIN OUTCOME MEASURES: Rate of complications throughout the 6 month follow-up period after PVD and odds of complications by patient-specific factors. RESULTS: A total of 9635 eyes were included. The rate of any complication was 25.0%, isolated vitreous hemorrhage was 13.1%, retinal breaks without detachment was 16.0%, and retinal detachment was 4.2%. The majority of each complication was noted at presentation; however, 8.0% of isolated vitreous hemorrhages, 19.2% of retinal breaks without detachment, and 25.8% of retinal detachments were first noted within the 6-month follow-up period. Men experienced a significantly higher rate of any complication than women (30.0% versus 21.7%, P < 0.001), as well as retinal breaks and retinal detachments at both presentation and within 6-month follow-up. Patients with pseudophakia experienced significantly higher rates of delayed retinal detachment than phakic eyes (odds ratio, 1.85 [1.13, 3.04], P = 0.01). Among eyes with lattice/peripheral retinal degeneration, 44.2% experienced any complication throughout the clinical course. The presence of a retinal break in the fellow eye and retinal detachment in the fellow eye was associated with a significantly increased rate of any complication at any time point (retinal break: P < 0.0001; retinal detachment: P = 0.02), as well as each individual complication within the 6 month follow-up period. Among eyes with vitreous hemorrhage at presentation, 42.0% had a concurrent or delayed retinal break and 10.5% had concurrent or delayed retinal detachments. CONCLUSIONS: A clinically significant proportion of PVD-related complications are detected late, warranting extended follow-up, especially in higher-risk groups such as men, pseudophakic eyes, eyes with lattice/peripheral retinal degeneration, and eyes with a history of retinal breaks or detachment in the fellow eye. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Late Vitreoretinal Complications of Regressed Retinopathy of Prematurity: Retinal Break, Vitreous Hemorrhage, and Retinal Detachment.

PURPOSE: To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment. DESIGN: International, multicenter, noncomparative retrospective case series. PARTICIPANTS: We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP. METHODS: Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared. MAIN OUTCOME MEASURES: Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP. RESULTS: A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P = 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement. CONCLUSIONS: Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.

Microscope-assisted pneumatic retinopexy for the management of primary rhegmatogenous retinal detachment.

PURPOSE: Outcomes of pneumatic retinopexy (PnR) using surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted pneumatic retinopexy) for primary rhegmatogenous retinal detachment (RRD). METHODS: Retrospective study. 43 consecutive eyes with RRD undergoing microscope-assisted PnR surgery (MAPR) were analysed. Inclusion criteria comprehend phakic eyes with single retinal break or a group of breaks in detached retina in the same quadrant above 8- and 4-o'clock meridians. Follow-up was at least 6 months. RESULTS: Of the 43 eyes, a total of 25 (58%) presented preoperatively a single retinal break, 15 (35%) had two retinal breaks in the same quadrant and 3 (7%) presented three or more retinal breaks in the same quadrant. Other retinal breaks not observed preoperatively were discovered intraoperatively in 12 eyes (28%). In 9 (21%) the missed retinal breaks were in the same quadrant as the main diagnosed break(s), while 3 (7%) had missed retinal breaks in a different one. These 3 eyes as no longer adhering to the PnR indication criteria switched intraoperatively to other surgical procedures and were excluded in the reattachment rate results. The total primary reattachment rate with MAPR was achieved in 37 eyes (92.5%). No significant BCVA changes were observed postoperatively. CONCLUSION: MAPR is an effective and safe surgical option, it allows to work with both hands free and provides an adequate visualization of the retina during the procedure minimizing the risk of missed retinal breaks potentially leading to surgical failure.

Demographics and Seasonality of Retinal Detachment, Retinal Breaks, and Posterior Vitreous Detachment from the Intelligent Research in Sight Registry.

Purpose: To investigate the incidence, seasonal variation, and differences among age, sex, and race for rhegmatogenous retinal detachment (RRD) repair, retinal break (RB) treatment, and posterior vitreous detachment (PVD) in the Intelligent Research in Sight (IRIS) Registry. Design: Retrospective database study. Participants: Patients in the IRIS Registry who underwent RRD repair, RB treatment, or cataract surgery (CS) based on Current Procedural Terminology codes and PVD diagnosis based on International Classification of Diseases, Ninth and Tenth Revision, codes. Methods: Daily incidence rates were defined as the ratio of patients who underwent RRD repair or RB treatment and patients with a diagnosis of PVD to the total number of patients followed on a given day within the IRIS Registry. The CS group was included as a comparison for seasonal variation. Rates were stratified by decade of life, sex, and race. Main Outcome Measures: Time series trends for incidence rates of RRD, RB, and PVD. Results: A total of 7 115 774 patients received a diagnosis of incident PVD, 237 646 patients underwent RRD repair, and 359 022 patients underwent RB treatment. Also included were 5 940 448 patients who underwent CS. The mean daily incidence for RRD repair, RB treatment, PVD diagnosis, and CS were 0.46 per 100 000 patients, 0.70 per 100 000 patients, 13.90 per 100 000 patients, and 11.80 per 100 000 patients, respectively. Men showed higher incidence of RRD repair and RB treatment than women, whereas women showed higher incidence of PVD diagnosis. Rhegmatogenous retinal detachment incidence was higher in White people compared with other races. Seasonal decreases in PVD, RB treatment, RRD repair, and CS corresponded to national holidays, with larger decreases in winter months. Kaplan-Meier estimates showed that RRD repair and RB treatment typically occurred within 60 days of PVD diagnosis. Conclusions: Within the IRIS Registry, the highest incidence of RRD was in the 6th and 7th decade of life. There was a higher incidence of RRD repair and RB treatment in men compared with women. The seasonal variation associated with national holidays was less pronounced for RRD repair and RB treatment.

Lincoff's Rule Is Not Followed in Pediatric Rhegmatogenous Retinal Detachments.

PURPOSE: To validate Lincoff's rules (LRs) in cases of rhegmatogenous retinal detachment (RRD) in the pediatric age group and to identify factors in cases LR was not followed. METHOD: This was a retrospective study where 98 pediatric patients with RRD were identified through surgery records. Forty case sheets with complete record of ocular examination and surgical findings were analyzed. Visible or suspected preoperative retinal break identified using the LR and actual intraoperative retinal break noted was recorded. Validity of LR was tested and analysed. RESULT: The median age of the study participants was 11 years ranging from 5 to 18 years. There were 35 (88%) boys and 5 (12%) girls in the study. Myopia was noted in 13 (33%) eyes and in 21 (53%) eyes, there was a history of preexisting ocular trauma. Moderate degree of agreement with a Cohen's kappa 0.41 was noted with regards to LR validity in pediatric RRD. LR was validated in non-myopic eyes (p = 0.022), inferior RD (p < 0.001), and those with anteriorly located retinal breaks (p < 0.001). Other attributes such as history of trauma (p = 0.08), lens status (p = 0.489), macula sparing RRD (p = 0.882), and chronicity of RRD (p = 0.612) did not have a statistically significant association with validity of LR. Multivariate logistic regression analysis identified the presence of anterior retinal break (p = 0.011) and presence of inferior RD (p = 0.022) as the two most important attributes in a RD for agreement of LR. CONCLUSION: LRs fail to accurately identify the exact location of the retinal break due to its posterior location and absence of posterior vitreous detachment in most cases with pediatric RRDs.

Outcomes of 25-gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks.

BACKGROUND: This study was investigated the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRBs) that were repaired by 25-gauge pars plana vitrectomy (PPV) with air tamponade. METHODS: This retrospective review included 81 consecutive patients who had RRD with IRBs and underwent PPV with air tamponade in our hospital from January 2017 to January 2020. The main outcomes were single surgery anatomical success (SSAS) rate, postoperative best-corrected visual acuity (BCVA), and complications. RESULTS: The patient population consisted of 29 women and 52 men (mean age, 52.12 years); the mean follow-up interval was 8.88 months. The mean number of affected quadrants was 1.65 (range, 1-4 quadrants) and the mean number of breaks was 3.25. A single break was present in 20 cases (24.7%); two to 10 breaks were present in 61 (75.3%) cases. The SSAS rate was 91.36% (74/81) and the final anatomical success rate was 96.30% (78/81). More than half of the patients had BCVA < 0.3 logarithm of the minimum angle of resolution at the last follow-up. Axial length and patient age were candidate risk factors for redetachment (axial length, p = 0.03; age, p = 0.002). Postoperative complications included macular epiretinal membrane formation in one patient, lens opacity in three patients, and clinically significant macular edema in one patient. CONCLUSIONS: PPV with air tamponade may be effective for the treatment of primary RRD with IRBs. Extensive preoperative discussion may be necessary for young patients and patients with particularly long axial length.

Is gas/air tamponade essential for eyes with small peripheral retinal breaks without detachment during vitrectomy?

BACKGROUND: To investigate the safety of vitrectomy with laser photocoagulation in eyes with small peripheral retinal breaks without air or gas tamponade. METHODS: Among patients who underwent vitrectomy for various retinal disorders, those with small peripheral retinal breaks treated by laser photocoagulation without air or gas tamponade were included in this study. Their medical records were assessed retrospectively, and we investigated the characteristics of small peripheral retinal breaks and the incidence of postoperative retinal detachment (RD). RESULTS: Thirty-one eyes of 31 patients who presented with small peripheral retinal breaks requiring endolaser photocoagulation during vitrectomy were included in this analysis. There were two cases of iatrogenic retinal breaks that occurred during vitrectomy, while others were preexisting lesions, including retinal tears, atrophic retinal holes, and retinal holes with lattice degeneration. There were no cases of RD during the follow-up period of at least 6 months. CONCLUSIONS: Adequate laser treatment without gas or air tamponade may be sufficient during vitrectomy in cases with small peripheral retinal breaks without concurrent RD, along with complete removal of vitreoretinal traction.

Whitish Outer Retinal Spots in Retinal Detachment: Longitudinal Follow-up, Multimodal Imaging, and Clinical Utility.

PURPOSE: To characterize the poorly understood phenomenon of whitish outer retinal spots that occasionally appear in retinal detachment (RD). DESIGN: Retrospective, consecutive case series. SUBJECTS: Patients with RDs that had ophthalmoscopically visible whitish outer retinal spots. METHODS: All RDs with whitish outer retinal spots identified by one examiner over a 4-year interval were identified, and records were retrospectively reviewed. MAIN OUTCOME MEASURES: Clinical and surgical observations, photography, and OCT. RESULTS: Whitish outer retinal spots were visualized in 51 occurrences of RDs: 45 in rhegmatogenous retinal detachments (RRDs), 5 in tractional RDs, and 1 in exudative RD. In RRDs, the spots usually formed an arcuate band located between the causative retinal break and the attached retina. However, 6 RRDs had spots located between a peripheral gutter of subretinal fluid and attached retina. In 11 eyes, the spots were observed to appear over time or to propagate to areas of detached retina more distal to the break. The spots corresponded to hyperreflective foci in the ellipsoid/interdigitation layers on OCT. The spots were isofluorescent on fluorescein angiography. The average duration of symptoms before surgical repair was 27.7 days. In 7 of 23 eyes surgically repaired by the author, the distribution of the spots assisted in localizing an occult retinal break. The spots sometimes appeared or persisted in areas of residual subretinal fluid but invariably resolved after retinal reattachment. CONCLUSIONS: Whitish outer retinal spots can occur in all types of RD, not just RRDs. Observation of the spots can help date an RD as subacute and should prompt surgery. Because the spots occur in distributions that reflect the path of spread of subretinal fluid, their position can be used to localize causative retinal breaks.

Comparison of surgical outcomes after removal of epiretinal membrane associated with retinal break and idiopathic epiretinal membrane.

PURPOSE: To compare the surgical outcomes of epiretinal membranes (ERMs) associated with retinal break and idiopathic ERMs. METHODS: This retrospective study included patients with an idiopathic ERM or an ERM associated with retinal break, who were followed up for ≥ 6 months after ERM removal. The postoperative functional and anatomical outcomes were compared between the groups. RESULTS: A total of 160 and 38 eyes (198 patients) were in the idiopathic and retinal break groups, respectively. There was no significant difference in the baseline anatomical and functional parameters between the groups. At 6 months after surgery and at the final follow-up, best-corrected visual acuity, central foveal thickness, and ectopic inner foveal layer improved significantly in both groups, but there was no significant difference between the groups. In latter 49.0% of patients, tests for metamorphopsia and aniseikonia were performed. There was a significant improvement in the scores of metamorphopsia (0.40 ± 0.38 to 0.27 ± 0.28; p < 0.001) and aniseikonia (6.07 ± 4.46 to 4.11 ± 3.52; p < 0.001) in the idiopathic group at 6 months after surgery, but not in the retinal break group. The idiopathic group had significantly greater circularity of ERM extent compared to the retinal break group (p = 0.025). CONCLUSION: Visual and anatomical improvements after removal of ERMs associated with retinal break and idiopathic ERMs were comparable. However, metamorphopsia and aniseikonia improved only after removal of idiopathic ERMs.

Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic.

PURPOSE: To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only. METHODS: Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment. RESULTS: Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). CONCLUSIONS: The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.

Analysis of Complications for Epiretinal Membrane and Macular Hole Surgery Performed by Vitreoretinal Fellows and Consultants.

PURPOSE: The aim of this study was to report the intraoperative and postoperative complications of vitrectomy for epiretinal membrane (ERM) and macular hole (MH) performed by retinal fellows under direct faculty supervision compared with experienced faculty members. PATIENTS AND METHODS: A total of 271 eyes that underwent pars plana vitrectomy (PPV) for MH and ERM from January 2014 to December 2019 at King Khaled Eye Specialist Hospital were analyzed. PPV for ERM and MH was performed by vitreoretinal fellows and consultants. RESULTS: The outcome measures assessed were the intraoperative complications rates, such as posterior lens touch, retinal breaks (RBs), retinal detachments, and vitreous hemorrhage. Moreover, the postoperative complications and optical coherence tomography (OCT) changes were assessed upon a minimum follow-up of 6 months. The rate of iatrogenic RB was more common in the ERM than in the MH surgery (15.5% vs 11.2%). Fellows and consultants had a rate of 20.5% of RB during the ERM surgery and 14.6% during MH surgery, respectively. However, these differences were not statistically significant (p = 0.12 for MH and p = 0.236 for ERM). Postoperative OCT analysis revealed an MH closure rate of 72.2%, and complete removal of the ERM was achieved in 88.6% in cases performed by fellows, while consultants achieved 61.8% closure rate of MH, and 83.3% of the patients achieved complete removal of ERM. CONCLUSION: Macular surgery is overall a safe procedure and the complication rates between fellows and consultants are comparable. With proper supervision, vitreoretinal fellows can achieve equally high anatomical outcomes with few complications.

Ultra-Widefield Swept-Source Optical Coherence Tomography Findings of Peripheral Retinal Degenerations and Breaks.

PURPOSE: To investigate whether ultra-widefield (UWF) swept-source optical coherence tomography (SSOCT) system (Silverstone, Nikon Healthcare Japan, Inc, Tokyo, Japan) can obtain OCT images of peripheral retinal degenerations and breaks. METHODS: Thirty-seven eyes of 31 consecutive cases (16 men, 15 women; mean age 51 years) who had peripheral retinal degenerations and underwent a UWF-SSOCT imaging were enrolled. The convenience and usefulness were investigated. RESULTS: In all eyes, OCT images were capable and interpretable without any special techniques. The respective findings on OCT were retinal degeneration in 16 eyes: lattice degeneration in 8 eyes, paving stone degeneration in 4 eyes, and unclassified in 4 eyes, retinal tear in 12 eyes, and retinal hole in 9 eyes. The respective locations of the retinal degenerations or breaks were the posterior pole in 0 eyes, mid-periphery in 23 eyes, and far-periphery in 14 eyes. Fifteen eyes had a rhegmatogenous retinal detachment (RRD), one of which was preoperative and the other 14 eyes were postoperative. A buckle was placed in 8 eyes for RRD repair. Subretinal fluid was observed in 9 of 21 eyes with retinal break or retinal hole. Vitreoretinal traction was observed in 10 of 27 eyes without a history of vitrectomy. Inverted artifacts on OCT images were observed in 20 of 37 eyes, which were not related to the location or axial length, but were supposed to be due to the limited scan depth. CONCLUSION: The UWF-SSOCT system could capture the OCT images of peripheral retinal degenerations and breaks without any special technique.