Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults.

BACKGROUND: Scleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes. METHODS: Retrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal-Wallis tests for numeric covariates between age groups. RESULTS: Eyes were stratified by age: 15-24 (group 1, n = 10), 25-34 (group 2, n = 14), and 35-45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p < 0.001). CONCLUSION: While the final reattachment rates were excellent in all groups, the higher rates of proliferative vitreoretinopathy and lower single surgery success rate in younger patients may suggest that primary pars plana vitrectomy may not be the optimal repair method in these age groups.

FUNDUS AUTOFLUORESCENCE PREDICTING GROWTH OF A CHOROIDAL OSTEOMA IN A 13-YEAR-OLD GIRL.

PURPOSE: To describe multimodal imaging findings, including fundus autofluorescence, in a patient with a growing choroidal osteoma. METHODS: Case report. RESULTS: A 13-year-old girl presented with an asymptomatic lesion in the superonasal macula of her left eye. Vision was correctable to 20/20 in both eyes, and the only significant finding on examination was the yellow flat lesion in the left macula. It measured 0.8-disk areas in size. Ocular coherence tomography showed a space occupying lesion in the choroid that had horizontal hyper-reflective lines consistent with cancellous bone. Re-examination in a year showed enlargement. Fundus autofluorescence showed no abnormalities in either eye. Ultrasonography showed a hyper-reflective lesion with associated shadowing that was consistent with a choroidal osteoma. CONCLUSION: Normal fundus autofluorescence was seen in this young girl with a growing choroidal osteoma. Fundus autofluorescence is a proxy for the health of the retinal pigment epithelium. Normal retinal pigment epithelium is the only factor found to be predictive of future growth of a choroidal osteoma. This noninvasive test may prove useful as a guide to determine frequency of examinations especially in younger patients who might be prone to more rapid growth.

Bilateral pulmonary emboli following macular hole surgery with postoperative prone positioning.

PURPOSE: To report a rare case of bilateral pulmonary emboli following pars plana vitrectomy with postoperative prone positioning. OBSERVATIONS: A 60 year-old female presented with a fourmonth history of unilateral distorted vision. Ocular coherence tomography revealed a full thickness macular hole. Two weeks later, the patient underwent a 23-gauge pars plana vitrectomy with internal limiting membrane peeling and 12% perfluoropropane gas tamponade. Postoperatively, she completed two weeks of prone positioning. Five days later, she presented with a two day history of abdominal pain and shortness of breath. Computed tomography angiography revealed bilateral pulmonary emboli. The patient received six months of anticoagulation to prevent further thromboembolic events. CONCLUSIONS: Life threatening blood clots can form due to prolonged immobilization from prone positioning. Patients should be educated to perform light exercise postoperatively to prevent complications of blood stasis.

Saturday Night Retinopathy: Characterization of a Rare Ophthalmic Condition.

A 48-year-old, black female with a history of heroin and daily alcohol abuse presented to the emergency room in a lethargic state with severe right eye pain and vision loss. She had been unconscious for 10 hours prior to presentation. On exam she was found to have no light perception vision, severe retinal edema, and complete ophthalmoplegia of the right eye. Imaging and clinical course confirmed the diagnosis of Saturday Night Retinopathy--only the second documented case to be published.

Valsalva-Like Retinopathy Secondary to Pancytopenia following Induction of Etoposide and Ifosfamide.

Etoposide and ifosfamide are chemotherapeutic agents used frequently in the treatment of sarcomas and hematologic malignancies. Ocular side effects are rarely reported. We describe a case of a patient on etoposide and ifosfamide who presented with unilateral vision loss, anemia, and thrombocytopenia. The patient was found to have a large subinternal limiting membrane hemorrhage in the right eye that is thought to be related to his anemia and thrombocytopenia. The hemorrhage resolved spontaneously after 10 days. This case illustrates how bone marrow suppression by chemotherapeutic agents may indirectly contribute to retinal hemorrhages resulting in at least transient vision loss.

Surgical treatment of an exudative retinal detachment associated with a giant retinal pigment epithelial tear.

After cataract surgery, a 69-year-old man presented with hypotony and choroidal effusion followed by retinal pigment epithelium tear and exudative detachment of the retina. Vitrectomy with fluid-air exchange successfully led to reattachment of all layers.To the authors' knowledge, this is the first reported case of successful surgical management of exudative detachment secondary to retinal pigment epithelium tears.

Surgical technique for removal of a capsular tension ring from the vitreous cavity.

PURPOSE: To describe a surgical technique for removing a posteriorly dislocated capsular tension ring (CTR). METHODS: Retrospective interventional case report. CASE REPORT: A 68-year-old African American man underwent cataract surgery. Early in the procedure, a CTR was placed at the equator of the lens capsule. Subsequently, the posterior capsule ruptured. The CTR was left in place, and an intraocular lens was placed in the sulcus. On postoperative Day 6, the CTR subluxated into the vitreous cavity and was removed without complication by pars plana vitrectomy, using the CTR inserter. CONCLUSION: The technique of using the CTR inserter to remove the CTR from the vitreous cavity appears to be safe and effective.

Does postoperative near visual acuity predict macular hole closure?

To determine whether prone postoperative near visual acuity following macular hole surgery can be used as a reliable indicator of successful hole closure, data from 21 patients undergoing macular hole surgery were collected. Seventeen of the 18 patients with hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than preoperative visual acuity, yielding 94% sensitivity, 0% specificity, 85% positive predictive value, and 0% negative predictive value. Fourteen of the 18 patients with macular hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than 20/40, yielding 78% sensitivity, 0% specificity, 82% positive predictive value, and 0% negative predictive value. Although postoperative near visual acuity can predict macular hole closure with 94% sensitivity, the test is not clinically useful to predict hole closure because of the high surgical success rate of macular hole surgery. The test could be useful in encouraging patients to maintain head prone positioning and alleviate patient anxiety.

Comparison of a digital retinal imaging system and seven-field stereo color fundus photography to detect diabetic retinopathy in the primary care environment.

BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician regularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologist was evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 11 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on "no retinopathy" versus "any retinopathy" was excellent (Kappa = 0.96). Agreement based on "microaneurysms or less retinopathy" versus "retinal hemorrhages or worse retinopathy" was very good (Kappa = 0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.

Intraocular irrigating solutions. A clinical study of BSS Plus and dextrose bicarbonate fortified BSS as an infusate during pars plana vitrectomy.

PURPOSE: To compare the effect of Balanced Salt Solution Plus (BSS Plus, Alcon Laboratories, Fort Worth, Texas, USA) and fortified regular BSS on the cornea and lens, when used for continuous irrigation in pars plana vitrectomy (PPV) surgery. METHODS: Prospective, investigator masked, randomised study. Forty patients were randomly assigned to undergo PPV using BSS Plus (n=20) or fortified BSS (n=20) [regular BSS, fortified with 10.5 cc. of dextrose in water (D5W) and 13.1 cc. of 8.4% sodium bicarbonate]. Intraoperative features of the corneal epithelium, postoperative changes in the corneal endothelial cell denstiy (ECD) at 3 months, and clarity of the lens during surgery and postoperatively were evaluated. RESULTS: Intraoperative epithelial changes were similar in both groups with 7 (35%) of the cases having the epithelium removed in the BSS Plus group and 8 (40%) in the BSS fortified group (P=0.23). The mean differences in ECD (3 months versus preoperative) in the operated eyes when adjusted for changes in the control eye showed no difference with the type of BSS (P=0.98). Intraoperative lens changes were more significant (P=0.018) in the BSS fortified group. Postoperative lens status at 3 months was similar for both groups. Though there was a trend towards worse postoperative nuclear sclerosis change in the BSS fortified group, it was not significant (P=0.160). CONCLUSION: Standard BSS fortified with dextrose and bicarbonate is an efficacious infusion fluid during pars plana vitrectomy. Both solutions showed comparable effects on postoperative corneal endothelial cell density and corneal epithelial changes intraoperatively. BSS fortified has more lenticular changes intraoperatively than BSS Plus although no lens had to be removed in either group. The study implications are important since BSS fortified is significantly less expensive than BSS Plus.