Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Incidence and onset time of epiretinal membranes after two retinopexy techniques.

OBJECTIVE: To compare the incidence and onset time of epiretinal membranes after two surgical techniques to treat retinal detachment (retinopexy). METHOD: Non-experimental, retrospective, longitudinal and comparative study in patients treated of primary rhegmatogenous retinal detachment either with cryotherapy and scleral buckle (group 1) or vitrectomy techniques (group 2), without an epiretinal membrane at the moment of surgery. We compared the incidence of postoperative epiretinal membrane between groups, the median onset time (Mann-Whitney's U) and the proportions of eyes without an epiretinal membrane along time with a survival analysis (log-rank). RESULTS: 112 eyes in group 1, 48 in group 2; the incidence of epiretinal membrane was 23.2% in group 1 and 20.8% in group 2 (p = 0.8). The median time of onset was 12 weeks in group 1 (interquartile rank 8.75-16) and 18 in group 2 (12.5-22, p = 0.02). The log-rank test showed no differences of incidence along the follow-up between groups (p = 0.6). CONCLUSIONS: Epiretinal membranes appear early after retinopexy, before in eyes treated with crio-retinopexy. Although their incidence does not differ between groups, detecting them could start two months after a scleral buckle and three after a vitrectomy procedure.

OBJETIVO: Comparar la incidencia y el tiempo en que aparecen las membranas epirretinianas después de dos técnicas quirúrgicas para tratar el desprendimiento de retina (retinopexia). MÉTODO: Estudio observacional, retrospectivo, longitudinal y comparativo en pacientes operados por desprendimiento regmatógeno primario de retina sin una membrana epirretiniana al momento de la cirugía, divididos en grupos: operados mediante criorretinopexia/cerclaje escleral (grupo 1) o vitrectomía (grupo 2). Se compararon entre grupos la incidencia de membrana epirretiniana, la mediana del tiempo de aparición (U de Mann-Whitney) y las proporciones de ojos sin membrana epirretiniana temporalmente mediante un análisis de sobrevida (log-rank). RESULTADOS: En 112 ojos en el grupo 1 y 48 ojos en el grupo 2, la incidencia de membrana epirretiniana fue del 23.2% en el grupo 1 y del 20.8% en el grupo 2 (p = 0.8). La mediana del tiempo de aparición fue de 12 semanas en el grupo 1 (rango intercuartílico [RIC]: 8.75-16) y de 18 semanas en el grupo 2 (RIC: 12.5-22; p = 0.02). La prueba de log-rank no mostró diferencias en la incidencia durante el seguimiento (p = 0.6). CONCLUSIONES: Las membranas epirretinianas se presentan tempranamente después de una retinopexia, antes en ojos operados mediante criorretinopexia. De acuerdo con la incidencia observada, su búsqueda podría empezar 2 meses después de un cerclaje y 3 meses después de una vitrectomía.

The development of epiretinal membrane following rhegmatogenous retinal detachment repair: incidence, risk factors, and outcomes.

PURPOSE: To investigate the incidence, risk factors, and visual outcomes of epiretinal membrane development following rhegmatogenous retinal detachment repair. METHODS: This was a retrospective study of 309 eyes that underwent initial surgery for primary uncomplicated rhegmatogenous retinal detachment. Examinations were conducted preoperatively and then postoperatively at 1, 3, 6, and 12 months. The study patients were categorized into two groups depending on the presence or absence of the epiretinal membrane. RESULTS: The incidence of postoperative epiretinal membrane was 28.5%; 42.7% of these patients had severe epiretinal membrane development and therefore underwent the epiretinal membrane removal. Logistic regression analyses revealed that giant retinal tears (OR: 2.66; 95% CI: 1.045-6.792, p=0.040) and horseshoe tears (OR: 0.534; 95% CI: 0.295-0.967, p=0.039) were the significant predictors of postoperative epiretinal membrane. Triamcinolone acetonide staining was significantly associated with the prevention of epiretinal membrane (p=0.022). A total of 34 patients showed a better or an equal final best-corrected visual acuity; of which 4 eyes were evaluated at the final follow-up visit and exhibited a reduced best-corrected visual acuity. CONCLUSION: Our analysis demonstrated that horseshoe tears and giant retinal tears represent the risk factors for the postoperative epiretinal membrane. Triamcinolone acetonide staining had a significant preventive effect on the postoperative epiretinal membrane. Furthermore, a second round of pars plana vitrectomy, including membrane removal, led to a significant improvement in the final best-corrected visual acuity as per the last follow-up examination, albeit the recovery was limited.

Association of retinal detachment with age 50 years or younger at onset in patients with acute retinal necrosis.

BACKGROUND: Due to the guarded prognosis of acute retinal necrosis (ARN), it is relevant to develop a strategy to early categorize those patients in a higher risk of worse outcomes. The purpose of this study is to describe clinical features and predictive factors for retinal detachment (RD) in patients with ARN. METHODS: Retrospective observational case series of 34 adult patients (38 eyes) with ARN examined between January 2005 and July 2015 in the National Eye Institute (Bethesda, USA), the Department of Ophthalmology, University of Chile (Santiago, Chile), and APEC (CDMX, Mexico). RESULTS: A total of 16 males and 18 females with a mean age at presentation of 44.5 ± 16.8 years were included. Twenty-seven patients (79.4%) received intravenous acyclovir as first-line treatment, and 7 patients received either oral antiviral (4 patients) or oral plus intravitreal antiviral (3 patients). All subjects were treated with prednisone, with a mean initial dose of 57.7 ± 16.3 mg per day. Seventeen patients (50.0%) developed retinal detachment. An association of retinal detachment with age at onset was observed (p = 0.04), with patients younger than 50 years presenting a higher risk (OR = 14.86, p = 0.0009). Additionally, patients in this higher risk group had more inflammation in both anterior chamber and vitreous (p = 0.04 and 0.03, respectively). No other predictive factor for retinal detachment was found in the present study. CONCLUSIONS: RD represents an important complication in patients with ARN. Younger patients may be at higher risk of this complication, possibly secondary to the presence of a higher level of inflammation.

ASSOCIATION STUDY BETWEEN POLYMORPHISMS OF THE p53 AND LYMPHOTOXIN ALPHA (LTA) GENES AND THE RISK OF PROLIFERATIVE VITREORETINOPATHY/RETINAL DETACHMENT IN A MEXICAN POPULATION.

PURPOSE: To report the results of an association study between single-nucleotide polymorphisms of the p53 and LTA genes and the risk of proliferative vitreoretinopathy (PVR)/retinal detachment (RD) in a Mexican cohort. METHODS: A total of 380 unrelated subjects were studied, including 98 patients with primary rhegmatogenous RD without PVR, 82 patients with PVR after RD surgery, and 200 healthy, ethnically matched subjects. Genotyping of single-nucleotide polymorphisms rs1042522 (p53 gene) and rs2229094 (LTA gene) was performed by direct nucleotide sequencing. Allele frequencies, genotype frequencies, and Hardy-Weinberg equilibrium were assessed with HaploView software. RESULTS: No significant differences in the allelic distributions of the previously identified risk C allele for LTA rs2229094 were observed between RD subjects and controls (odds ratio [95% confidence interval] = 0.8 [0.5-1.2]; P = 0.3). Conversely, the C allele for rs1042522 in p53 was positively associated with an increased risk for RD (odds ratio [95% confidence interval] = 1.4 [1.01-1.9]; P = 0.04). No significant differences were observed when the subgroup of 82 RD + PVR subjects was compared with the subgroup of 98 patients with RD. CONCLUSION: The C allele for rs1042522 in p53 was genetically associated with a higher risk for RD but not for PVR in this cohort. This is the first association study attempting replication of PVR-associated risk alleles in a nonwhite population.

Retinal diseases in a reference center from a Western Amazon capital city / Doenças retinianas em um centro de referência de capital estadual na Amazônia Ocidental

ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.

RESUMO Objetivo Descrever as doenças de retina encontradas em pacientes que aguardavam tratamento para doenças retinianas em um hospital terciário de Rio Branco, Acre, Brasil. Métodos Foi realizado um exame oftalmológico compreendendo biomicroscopia com lâmpada de fenda, mapeamento de retina e ultrassonografia ocular. Os pacientes foram classificados de acordo com o status fácico e a doença retiniana que acometia o olho de maior gravidade. Resultados Foram atendidos 138 pacientes. A média de idade foi de 51,3 anos. A distribuição de diabetes foi de 35,3% e de hipertensão arterial foi de 45,5%. Catarata esteve presente em pelo menos um dos olhos em 23,2%. Tiveram o exame da retina possibilitado 129 pacientes. As principais doenças retinianas detectadas foram descolamento de retina regmatogênico (n=23; 17,8%) e retinopatia diabética (n=32; 24,8%). Dos 40 pacientes avaliados em função do diabetes, 13 (32,5%) apresentavam retinopatia ausente ou estágios iniciais de retinopatia e necessitavam apenas de acompanhamento. Conclusão A principal doença retiniana foi a retinopatia diabética, uma causa de cegueira evitável que pode ser acompanhada à distância, nos estágios iniciais, por meio de estratégias de telemedicina. A telemedicina pode ser uma importante ferramenta no acompanhamento de doenças retinianas em localidades remotas no Brasil.

Retinal diseases in a reference center from a Western Amazon capital city.

OBJECTIVE: To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. METHODS: Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. RESULTS: A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. CONCLUSION: Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.

[Impact of follow-up loss over visual deficiency in open-globe ocular trauma]. / Impacto de la pérdida de seguimiento sobre la deficiencia visual en trauma ocular con globo abierto.

INTRODUCTION: Open-globe ocular trauma causes visual deficiency; calculating the magnitude of the latter often misses the estimation in patients without follow-up. AIM: to identify the modification of the postoperative proportion of visual deficiency in open-globe ocular trauma, which would introduce considering the proportion estimated in patients without follow-up. METHODS: Non-interventional, retrospective, longitudinal, analytical study. Visual outcome in eyes with open-globe trauma, with and without follow-up, was calculated using the Ocular Trauma Score. The observed postoperative proportion of visual deficiency was identified in eyes with follow-up; in eyes without follow-up, the postoperative proportion of visual deficiency was estimated using an analysis of scenarios: best (Ocular Trauma Score), mean (that of eyes with follow-up) and worst (last observation/no visual improvement). The estimated proportion of visual deficiency was added to that observed in eyes with follow-up, and the resulting proportion was compared with that expected in the sample, using the Ocular Trauma Score (χ(2)). RESULTS: 104 eyes, 70 without follow-up and 34 without it. In eyes with follow-up the expected proportion of visual deficiency was 58.6%, and the observed one was 71.4% (p = 0.1); the estimated proportion of visual deficiency in eyes without follow-up was 76.5%. The resulting postoperative proportion of visual deficiency in the sample would be 73.1%, which would overcome that expected by the Ocular Trauma Score (59.6%, p = 0.04). CONCLUSIONS: In open-globe ocular trauma, the efficacy of surgery to reduce the proportion of visual deficiency would decrease with regard to the standard expected by the Ocular Trauma Score, if the deficiency estimated in eyes without follow-up were considered.

Prevalence of macular anatomic abnormalities in high myopia.

BACKGROUND AND OBJECTIVE: Macular anatomic abnormalities in high myopia are more frequent in the presence of posterior staphyloma. The objective was to determine the prevalence of foveoschisis, foveal detachment, vascular traction, epiretinal membrane (ERM), and macular hole (MH) in eyes with high myopia by spectral-domain optical coherence tomography. PATIENTS AND METHODS: Prospective, observational study. Eyes with myopia greater than 8 diopters (D) were included. Results were analyzed using chi-square and Student's t tests. RESULTS: The study included 116 eyes of 72 patients. Mean spherical equivalent: -15.04 ± 5.33 D. Mean axial length: 28.88 ± 2.31 mm. Foveoschisis was observed in 17 eyes (14.65%), vascular traction in 17 (14.65%), ERM in 13 (11.2%), lamellar MH in two (1.72%), and posterior staphyloma in 41 (35.34%). Presence of foveoschisis, vascular traction, and ERM was more frequent in eyes with posterior staphyloma (P = .0001). CONCLUSION: Macular anatomic abnormalities were observed in 22.41% of eyes with high myopia and in 53.65% of eyes with posterior staphyloma.

Retinal detachment in association with pre-eclampsia, eclampsia, and HELLP syndrome.

OBJECTIVE: To review case reports of retinal detachment in women with pre-eclampsia/eclampsia. METHODS: Medline was searched for case reports of retinal detachment associated with pre-eclampsia/eclampsia. Articles written in English, Spanish, or Portuguese and published between 1990 and 2010 were reviewed. RESULTS: A total of 28 cases of retinal detachment were identified; 15 were associated with severe pre-eclampsia (3 of these probably had hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome), 9 with HELLP syndrome, 2 with eclampsia, and 2 with both HELLP syndrome and eclampsia. The majority (60%) of women were nulliparous, 4 had abruptio placentae, and cesarean delivery was performed in 76%. Retinal detachment was bilateral in 89% and associated with delivery of the fetus in 96%; 69% were diagnosed postpartum. Within 2-12 weeks postpartum, all patients had complete recovery of vision with clinical management. CONCLUSION: Retinal detachment in pre-eclampsia/eclampsia might be associated with HELLP syndrome, indicating that microangiophatic hemolysis might have a role in the pathophysiology of retinal detachment. Its occurrence might not be correlated with the severity of pre-eclampsia because pre-eclampsia is a constellation of signs and symptoms (persistent vasospasms with hemolysis and hypoalbuminemia) rather than simply being hypertension.

Humphrey visual fields and optical coherence tomography findings in patients with the Axenfeld-Rieger syndrome: a case series.

INTRODUCTION: Axenfeld-Rieger syndrome is characterized by clinical characteristics including: ocular, craniofacial, dental, umbilical, and other systemic abnormalities. Previous studies have reported that the Axenfeld-Rieger syndrome (ARS) occurs in one out of 200,000 patients. PURPOSE: To study patients with the ARS in a sub-urban community in Puerto Rico. PATIENTS AND METHODS: We conducted a non-concurrent study of 17,800 patients. Of these, 57 patients had the syndrome. Every patient had a comprehensive ophthalmology evaluation. RESULTS: A frequency of 320 per 100,000 was found in the studied population. Using Humphrey's visual field analyzer, we found a mean deviation of less than -2.00 dB in 56.4 and 60.5 percent of the right and left eye respectively. OCT evaluation of the optic nerve rim showed glaucomatous changes in 29.2 and 41.7 percent of the right and left eyes respectively. OCT evaluation of the retinal nerve fiber layer showed glaucomatous changes in 20.8 and 16.7 percent of the right and left eyes respectively. CONCLUSION: The frequency of patients with the syndrome in Puerto Rico is higher than in other populations reported in the literature. Also, the percent of patients with glaucoma is higher than previously reported. A relationship between hemochromatosis and ARS has not been previously described. Further studies will elucidate the genetics of Axenfeld-Rieger syndrome in Puerto Rico.

[Epidemiology and regional differences of diabetic retinopathy in Pernambuco, Brazil]. / Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil.

PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 +/- 12.0 years; mean duration of diabetes 8.1 +/- 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2%) patients had diabetic retinophathy, while in group II, 89 (39.4%) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.

Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil / Epidemiology and regional differences of diabetic retinopathy in Pernambuco, Brazil

OBJETIVOS: Avaliar os dados de freqüência e estadiamento da retinopatia diabética em Pernambuco, Brasil, comparando a região metropolitana com cidades do interior do estado. MÉTODOS: Os prontuários de 2.223 pacientes diabéticos (1.568 mulheres e 655 homens; idade média de 58,4 ± 12,0 anos; duração média do diabetes de 8,1 ± 6,3 anos), que fizeram parte de um programa de triagem para retinopatia diabética na Fundação Altino Ventura entre os meses de junho de 2004 e junho de 2005, foram revistos quanto à presença de retinopatia. Os pacientes foram divididos em dois grupos quanto à origem: grupo I, pacientes residentes em Recife e região metropolitana; grupo II, pacientes residentes no interior do estado de Pernambuco. RESULTADOS: No grupo I, 477 (24,2 por cento) pacientes apresentavam retinopatia diabética ao passo que no grupo II, 89 (39,4 por cento) pacientes (p<0,0001). A freqüência de retinopatia diabética proliferativa, edema macular, hemorragia vítrea e descolamento tracional de retina foi maior entre os pacientes do grupo II com significância estatística (p<0,05). CONCLUSÕES: Pacientes oriundos do interior do estado de Pernambuco apresentam maior prevalência de retinopatia diabética bem como de formas avançadas da doença em relação aos pacientes da região metropolitana quando atendidos na Campanha de Diabetes. Medidas de implantação de telemedicina ou descentralização das unidades são sugeridas para melhorar a qualidade da triagem de diabéticos residentes no interior do estado.

PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 ± 12.0 years; mean duration of diabetes 8.1 ± 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2 percent) patients had diabetic retinophathy, while in group II, 89 (39.4 percent) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.

Demand incidence of retinal detachment in Brazil.

AIM: To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil. METHODS: A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0). RESULTS: There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100,000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100,000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100,000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments. CONCLUSIONS: This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.

Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery.

PURPOSE: To determine the prevalence of and risk factors for proliferatative vitreoretinopathy (PVR) in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. DESIGN: Observational case series. METHODS: Prospective study. SETTING: A private vitreoretinal clinic in Caracas, Venezuela. STUDY POPULATION: 119 eyes of 119 patients who presented with rhegmatogenous retinal detachment but no previous vitreoretinal surgery between 1995 and 1998. OBSERVATION PROCEDURES: Data from detailed preoperative and postoperative examinations of each eye were recorded prospectively and entered into an electronic database. MAIN OUTCOME MEASURES: Prevalence of PVR of any type and severe PVR, preoperative risk factors for PVR of any type and severe PVR, effect of PVR and retinal detachment duration on initial and final visual acuity, and surgical complexity. RESULTS: The prevalence of PVR of any type was 52.9% and of severe PVR was 26.9%. The mean retinal detachment duration (+/-SD) was 58.4 (+/-129.1) days, and the mean time from initial examination to surgical treatment (+/-SD) was 24.3 (81.2) days. By univariable analysis, long retinal detachment duration, poor initial visual acuity, and large retinal detachment extent were significantly associated with PVR prevalence and severity. The presence of vitreous hemorrhage was significantly associated with PVR prevalence, and cataract was significantly associated with PVR severity. By multivariable analysis, long retinal detachment duration and large retinal detachment extent were simultaneous risk factors for PVR prevalence, while long retinal detachment, large retinal detachment extent, and poor initial visual acuity were simultaneous risk factors for PVR severity. Eyes with longer retinal detachment duration, PVR of any type, and severe PVR had worse initial and final visual acuities than eyes with shorter retinal detachment duration or those without PVR, respectively. Eyes with PVR had more complex surgery than those without PVR. CONCLUSIONS: PVR occurred very frequently in this population and was associated with more complex surgery and worse visual outcomes than among eyes without PVR. We have identified preventable risk factors associated with PVR that suggest a specific and significant need for better access to ophthalmologic care and patient education in this group of patients.

Incidencia del desprendimiento de retina en operados de catarata, 1990-1997 / Incidence of retina detachment in patients operated on of cataract, 1990-1997

Se presenta el estudio realizado en pacientes operados de catarata, en el Centro de Microcirugía Ocular en Serie (CMOS) en el período comprendido entre 1990 y 1997, con la técnica de extracción extracapsular del cristalino (incisión amplia) que después presentaron desprendimiento de retina (DR). De un total de 17 762 pacientes operados de catarata solo 42 de ellos presentaron DR, lo que representó una tasa de 2,4 por cada mil operados (tasa muy baja). Se analizaron diferentes variables que pudieran estar incidiendo en la aparición de esta entidad, entre ellas: edad, sexo, antecedentes de enfermedades oculares, antecedentes de enfermedades sistémicas, complicaciones transquirúrgicas, complicaciones posquirúrgicas y capsulotomía posterior; el atrapamiento de Lente Intraocular (LIO) fue la complicación posquirúrgica que mayor tasa presentó, seguida de los antecedentes de enfermedades sistémicas y la salida de vítreo(AU)

Rhegmatogenous retinal detachment in myopic eyes after laser in situ keratomileusis. Frequency, characteristics, and mechanism.

PURPOSE: To report the characteristics and frequency of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for the correction of myopia in a large case series. SETTING: Private practices, Caracas, Venezuela. METHODS: Five refractive surgeons and 31 739 myopic eyes that had surgical correction of a mean myopia of -6.01 diopters (D) (range -0.75 to -29.00 D) participated in this study. Laser in situ keratomileusis was performed in all eyes. Patients were followed for a mean of 36 months (range 6 to 48 months). The clinical charts of patients who developed RRD after LASIK were reviewed. RESULTS: Twenty eyes (17 patients) developed RRD after LASIK. Rhegmatogenous retinal detachments occurred a mean of 13.9 months (range 1 to 36 months) after LASIK. The mean pre-LASIK myopia in eyes that developed an RRD was -7.02 D (range -1.50 to -16.00 D). Most RRDs and retinal breaks occurred in the temporal quadrants (71.4%). Rhegmatogenous retinal detachments were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The frequency of RRD after LASIK was 0.06%. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for the correction of myopia is infrequent. If managed promptly, RRD will result in good vision. Before LASIK is performed, patients should have a thorough dilated indirect fundoscopy with scleral depression and treatment of any retinal lesion predisposing to the development of an RRD.