Traumatic Retinal Detachment in Patients with Self-Injurious Behavior: An International Multicenter Study.

PURPOSE: To describe the clinical characteristics, surgical outcomes, and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) resulting from self-injurious behavior (SIB). DESIGN: International, multicenter, retrospective, interventional case series. PARTICIPANTS: Patients with SIB from 23 centers with RRD in at least 1 eye. METHODS: Clinical histories, preoperative assessment, surgical details, postoperative management, behavioral intervention, and follow-up examination findings were reviewed. MAIN OUTCOME MEASURES: The rate of single-surgery anatomic success (SSAS) was the primary outcome. Other outcomes included new RRD in formerly attached eyes, final retinal reattachment, and final visual acuity. RESULTS: One hundred seven eyes with RRDs were included from 78 patients. Fifty-four percent of patients had bilateral RRD or phthisis bulbi in the fellow eye at final follow-up. The most common systemic diagnoses were autism spectrum disorder (35.9%) and trisomy 21 (21.8%) and the most common behavior was face hitting (74.4%). The average follow-up time was 3.3 ± 2.8 years, and surgical outcomes for operable eyes were restricted to patients with at least 3 months of follow-up (81 eyes). Primary initial surgeries were vitrectomy alone (33.3%), primary scleral buckle (SB; 26.9%), and vitrectomy with SB (39.7%), and 5 prophylactic SBs were placed. Twenty-three eyes (21.5%) with RRDs were inoperable. The SSAS was 23.1% without tamponade (37.2% if including silicone oil), and final reattachment was attained in 80% (36.3% without silicone oil tamponade). Funnel-configured RRD (P = 0.006) and the presence of grade C proliferative vitreoretinopathy (P = 0.002) correlated with re-detachment. The use of an SB predicted the final attachment rate during the initial surgery (P = 0.005) or at any surgery (P = 0.008. These associations held if restricting to 64 patients with ≥12 months followup. Anatomic reattachment correlated with better visual acuity (P < 0.001). CONCLUSIONS: RRD resulting from SIB poses therapeutic challenges because of limited patient cooperation, bilateral involvement, chronicity, and ongoing trauma in vulnerable and neglected patients. The surgical success rates were some of the lowest in the modern retinal detachment literature. The use of an SB may result in better outcomes, and visual function can be restored in some patients.

Elimination of a False-Negative Result With the M-CHARTS Metamorphopsia Assessment Tool Achieved Through Sampling Oblique Axes.

Standard implementation of the M-CHARTS metamorphopsia tool presents patients with only vertical and horizontal lines, potentially overlooking distortions not occurring within those precise meridians. The authors propose rotating the M-CHARTS testing booklet about the central fixation point until maximal distortion is perceived, after which sequential M-CHARTS testing can take place along that same axis. In a symptomatic patient with residual parafoveal fluid cysts after release of vitreomacular traction, M-CHARTS testing yielded standard testing scores of 0 (false-negative); upon rotating the reference test line, a score of 0.3 was measured at the 30° meridian. The authors believe this modification of the original methodology is more sensitive and more accurately reflects the severity of a patient's distortions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:734-736.].

Digital Nullification of Visual Distortion to Quantify Metamorphopsia: A Pilot Study.

BACKGROUND AND OBJECTIVE: To evaluate a novel digital method of metamorphopsia quantification in patients with symptomatic visual distortion as determined by M-CHARTS. PATIENTS AND METHODS: In this institutional review board-approved, prospective, cross-sectional observational study, subjects were presented with an objectively straight dotted line that bisects a central fixation point. The subjects digitally altered the line's contour until it appeared straight. Calculation of the area between the original objectively straight line presented to the subject and their newly manipulated line was performed to determine the manipulated area under the curve (M-AUC). RESULTS: Sixty-two percent of test targets were fully or significantly straightened by affected subjects. M-AUC was significantly correlated with M-CHARTS scores in both the horizontal (P < .001) and vertical (P = .05) orientations. CONCLUSIONS: The deformation of an objectively straight line by a subject with metamorphopsia may be a viable way of both quantifying and spatially characterizing visual distortions. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:11-20.].