VITRECTOMY RESULTS FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH CONCOMITANT MACULAR HOLE IN NONMYOPIC PATIENTS.

PURPOSE: To report on results of pars plana vitrectomy with ILM peeling in patients with rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) and to assess for preoperative associated conditions related to this type of RRD. METHODS: Patients undergoing surgical repair for RRD between 2014 and 2021 were reviewed, and subjects with concomitant, non-causal, macular hole were identified. We studied post-operative macular status, retinal reattachment rate and visual acuity. RESULTS: Over 532 eyes operated on for RRD, 11 (2.06%) had a concurrent non-causal macular hole. Preoperative PVR B or superior was recorded in 86 eyes (16.6%) of the entire cohort and in 6 eyes (54.54 %) with RRD and concomitant MH (p=0.00001). Severe hypotony with choroidal detachment was present in 15 eyes (2.81%) of the entire cohort and in 3 eyes (27.27%) with RRD and concomitant MH (p=<0.00001). CONCLUSIONS: RRD with concomitant MH is an infrequent association. Retinal reattachment and anatomical hole closure can be achieved in most of cases but despite this fact, functional recovery is usually not good. Preoperative PVR is a more frequent finding in this group of patients, as well as severe hypotony with choroidal detachment.

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.

Steam roller maneuver in pneumatic retinopexy. Does it work?

OBJECTIVE: To identify the efficacy and safety of the steam-roller maneuver, in patients treated with pneumatic retinopexy. METHOD: Experimental, prospective, comparative, longitudinal study in patients with retinal detachment, treated with pneumatic retinopexy. Patients were assigned to one of two groups: without steam roller maneuver (group 1) or with it (group 2). The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events were compared between groups (chi squared); preoperative and postoperative visual acuity in logMAR was compared within groups (Wilcoxon's t). RESULTS: 40 eyes were evaluated (mean age 55.9 ± 13.3 years); 15 were assigned to group 1, 25 to group 2. The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events did not differ between groups (p > 0.05). At the end of follow up, visual acuity improved in both groups; however, it only improved in group 2, in eyes with single intervention anatomical success (mean log MAR before surgery 1.72 ± 1.64; after surgery 0.61 ± 0.61; p = 0.008). CONCLUSIONS: The steam roller maneuver is efficient for improving visual acuity in patients with pneumatic retinopexy, who achieve single intervention anatomical success; furthermore, the maneuver does not impair prognosis in eyes that require reintervention.

OBJETIVO: Determinar la eficacia y la seguridad de la maniobra steam roller en pacientes tratados con retinopexia neumática. MÉTODO: estudio experimental, prospectivo, comparativo y longitudinal en pacientes con desprendimiento de retina primario, tratados mediante retinopexia neumática. Los sujetos se asignaron a uno de dos grupos: sin maniobra de steam roller (grupo 1) o con ella (grupo 2). Se compararon entre grupos las proporciones de éxito anatómico con una sola intervención, mejoría visual, éxito anatómico con reintervención y eventos adversos (prueba de ji al cuadrado). Se comparó en cada grupo la agudeza visual preoperatoria con la posoperatoria (prueba t de Wilcoxon). RESULTADOS: 40 ojos (edad 55.9 ± 13.3 años); 15 se asignaron al grupo 1 y 25 al grupo 2. Las proporciones de éxito anatómico con una sola intervención, mejoría visual, éxito anatómico con reintervención y eventos adversos no difirieron entre grupos (p > 0.05). La agudeza visual mejoró en ambos grupos, pero en los ojos que presentaron éxito con una sola intervención solo mejoró en el grupo 2 (promedio logMAR preoperatorio 1.72 ± 1.64; postoperatorio 0.61 ± 0.61; p = 0.008). CONCLUSIONES: La maniobra steam roller es eficaz para mejorar la agudeza visual en pacientes con retinopexia neumática, que alcanzan éxito anatómico con una sola intervención, y no deteriora el pronóstico en quienes requieren reintervención.

Recurrent vitreous hemorrhage secondary to retinal vessel avulsion.

Spontaneous vitreous hemorrhage is a rare entity, present in 7 out of 100,000 inhabitants. It is associated with different pathologies; however, it is rarely reported to be caused by retinal vessel avulsion syndrome. In the present manuscript, we report a case of avulsion of retinal vessels associated with recurrent vitreous hemorrhage managed, at first, by photocoagulation, but due to the several recurrence of bleeding, the patient went into surgical management.

SUPRACHOROIDAL BUCKLING FOR THE MANAGEMENT OF RHEGMATOGENOUS RETINAL DETACHMENTS SECONDARY TO PERIPHERAL RETINAL BREAKS.

PURPOSE: To evaluate functional and anatomical outcomes of eyes undergoing suprachoroidal buckling for the management of peripheral retinal breaks in rhegmatogenous retinal detachment. METHODS: Retrospective cohort study of 41 eyes of 41 patients undergoing suprachoroidal buckling for the management of rhegmatogenous retinal detachment secondary to single or multiple retinal breaks. Suprachoroidal indentation was achieved through the introduction of filler material using a 23-gauge (23-G) olive-tipped, suprachoroidal cannula. This allowed for the creation of a suprachoroidal dome and chorio-retinal apposition. Healon5 (Abbott Medical Optics) was used as filler material in all eyes. Combined 25-G vitrectomy was performed in 5 eyes. Cryopexy and laserpexy were used in 37 and 4 eyes, respectively. RESULTS: Mean visual acuity gain was the primary outcome measure. Final retinal reattachment rate, single-surgery reattachment rate, and complications were secondary outcome measures. Mean best-corrected distance visual acuity improved from 20/1,100 to 20/42. Single surgery reattachment rate was 92.7% (38/41 eyes). Final retinal reattachment was achieved in all 41 eyes (100%). There was no statistically significant difference in visual acuity gain or anatomical reattachment in terms of retinal break quadrant or extent. No major complications were observed. Two localized suprachoroidal hemorrhages occurred at the entry site for the cannula. These resolved without further intervention. CONCLUSION: Suprachoroidal buckling using a specially designed cannula is a safe and effective procedure for the management of rhegmatogenous retinal detachment secondary to peripheral retinal breaks.

[Bilateral spontaneously reattached rhegmatogenous retinal detachment. Case report and differential diagnosis with pigmentary retinopathies]. / Desprendimiento bilateral de retina regmatógeno con resolución espontánea. Informe de un caso y diagnóstico diferencial con retinopatías pigmentarias.

BACKGROUND: A dark pigmentation of the ocular fundus presents in degenerative diseases such as retinitis pigmentosa; this disease must be distinguished from others whose evolution is not progressive, in order to estimate the functional prognosis of the patient. OBJECTIVE: To analyze the features which distinguish spontaneously reattached retinal detachment from other causes of ocular fundus pigmentation, in order to be able to identify it even in bilateral cases. CLINICAL CASE: A case of a female with chronic visual loss is presented, who was referred for evaluation with the diagnosis of a pigmented retinopathy. Clinical exploration discarded causes as retinitis pigmentosa, retinal inflammatory diseases or trauma. Based on the clinical features, on the topography of pigmentation and in the information provided by electroretinography, a bilateral spontaneous reattachment of rhegmatogenous retinal detachment was diagnosed made. Clinical features of this entity are discussed, as well as the diagnostic approach to distinguish it from other pigment retinopathies. CONCLUSION: Clinical features of spontaneously reattached retinal detachment allow the explorer to distinguish it from other causes of bilateral pigmentation, despite presenting bilaterally. Since the prognosis of the attached retina is better than that of a degenerative disease, the correct diagnosis makes rehabilitation easier.

Antecedentes: la pigmentación oscura en el fondo del ojo aparece en enfermedades degenerativas, como la retinosis pigmentaria; para poder estimar el pronóstico funcional del paciente esta afección debe distinguirse de otras de evolución no progresiva. En el desprendimiento de retina regmatógeno con resolución espontánea puede existir pigmentación oscura, pero es infrecuente que sea bilateral. Objetivo: analizar las características que distinguen al desprendimiento de la retina con resolución espontánea de otras causas de pigmentación en el fondo del ojo, para poder identificarlo también en casos bilaterales. Caso clínico: paciente femenina con baja visual crónica, referida para evaluación por una retinopatía pigmentaria bilateral. En la exploración clínica se descartaron causas como: retinosis pigmentaria, enfermedades inflamatorias de la retina y traumatismo. Por las características clínicas, la localización de la pigmentación y la información del electrorretinograma se integró el diagnóstico de desprendimiento de la retina regmatógeno, con resolución espontánea bilateral. Se discuten las características clínicas de esta enfermedad y el abordaje diagnóstico para distinguirlo de otras retinopatía pigmentarias. Conclusiones: las características clínicas del desprendimiento de retina con resolución espontánea permiten diferenciarlo de otras causas de pigmentación retiniana, aunque la presentación sea bilateral. El pronóstico de la retina no desprendida es mejor que en una enfermedad degenerativa, por lo que el diagnóstico correcto facilita la rehabilitación.

[Perfluoroctane liquid as a short-term vitreous-retinal tamponade in the postoperative period in patients with retinal detachment due to giant tears]. / Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante.

PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90 masculine to 210 masculine were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80%) after a mean follow-up of 16.2 +/- 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10%) case, and there was no attachment of the retina in two (20%) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50%) cases. CONCLUSION: Good results (80%) and improvement of the visual acuity (50%) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante / Perfluoroctane liquid as a short-term vitreous-retinal tamponade in the postoperative period in patients with retinal detachment due to giant tears

OBJETIVOS: Relatar os resultados de vitrectomia via pars plana com utilização de perfluocarbono líquido (Perfluoroctano-Ophtalmos®), como tamponante vítreo-retiniano de curta duração, no pós-operatório de portadores de descolamento de retina, por ruptura gigante. MÉTODOS: Estudaram-se dez desses pacientes. Todos os casos eram complicados por vitreorretinopatia proliferativa grau B ou pior com rupturas que variavam em extensão de 90° a 210°. O perfluorocarbono líquido foi introduzido, por via pars plana, com o volume necessário para ultrapassar o limite posterior da ruptura, permanecendo no pós-operatório por cinco dias, estando os pacientes em decúbito dorsal. Após esse período submetiam-se a segunda intervenção para troca do perfluorocarbono líquido para gás ou óleo de silicone. RESULTADOS: Após período de acompanhamento médio de 16,2 ± 12,4 meses (2 a 43 meses), 80 por cento das retinas estavam aplicadas, sendo necessária a repetição desta técnica em 1 caso (10 por cento) caso e em 2 casos (20 por cento) não houve reaplicação da retina por vitreorretinopatia avançada. Houve melhora da acuidade visual em 5 casos (50 por cento). CONCLUSÃO: Observaram-se bons resultados quanto à aplicação da retina (80 por cento) e melhora da acuidade visual (50 por cento) quando do uso do perfluorocarbono líquido como tamponante vitreorretiniano de curta duração no pós-operatório de cirurgias de descolamento de retina por rupturas gigantes.

PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90° to 210° were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80 percent) after a mean follow-up of 16.2 ± 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10 percent) case, and there was no attachment of the retina in two (20 percent) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50 percent) cases. CONCLUSION: Good results (80 percent) and improvement of the visual acuity (50 percent) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Spontaneous separation in idiopathic vitreomacular traction syndrome associated with contralateral full-thickness macular hole.

PURPOSE: Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular retinal pigment epithelial detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients. METHODS: This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the tractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated. RESULTS: Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity. CONCLUSIONS: Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.

Retinal detachment in myopic eyes after laser in situ keratomileusis.

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.

Surgical management of complications associated with X-linked retinoschisis.

OBJECTIVE: To evaluate the role of surgical intervention in cases with severe, vision-threatening complications of X-linked retinoschisis. DESIGN: A retrospective survey of consecutive patients with X-linked retinoschisis who underwent surgery at our institution during a 16-year period. SETTING: A tertiary-care eye hospital. PATIENTS: Six eyes of four patients were identified. The mean age of the patients at the time of the first surgical procedure was 4.9 years (range, 18 months to 9 years). INTERVENTION: Scleral buckling procedure or pars plana vitrectomy. MAIN OUTCOME MEASURE: Surgical indications and long-term anatomic and visual outcome. RESULTS: Patients were initially operated on for rhegmatogenous retinal detachment (three eyes), exudative retinal detachment (one eye), and vitreous hemorrhage (two eyes). The surgical approach was scleral buckling for retinal detachment and vitrectomy for vitreous hemorrhage or proliferative vitreoretinopathy. Anatomic success and ambulatory vision (20/400 or better) was achieved in five of the six eyes with a mean follow-up of 3.8 years (range, 1 to 6 1/2 years). An average of 1.8 procedures per eye were performed. Two of the four eyes approached by primary scleral buckling eventually required vitrectomy. Proliferative vitreoretinopathy with retinal detachment was the major reason for reoperation. CONCLUSIONS: Surgery for X-linked retinoschisis-associated retinal detachment and vitreous hemorrhage can yield favorable anatomic and functional results. Multiple operations and the use of advanced vitreoretinal techniques to manage proliferative vitreoretinopathy-related complications, however, were necessary for ultimate success in certain cases.

Utilizaçäo do implante de silicone sólido em forma de cunha em cirurgias do descolamento da retina associado à presença de "boca de peixe" / The use of solid silicone implant in wedge shaped in retinal detachment surgeries associated with the presence of the fishmouth phenomenon

Este trabalho descreve a utilizaçäo do implante de silicone sólido em forma de cunha - wedge implant - num grupo de 37 pacientes operados por descolamento regmatogênico da retina, causado por grandes rupturas em ferradura, onde uma complicaçäo transoperatória conhecida como o fenômeno da "boca de peixe" pôde ser suspeitada. Os resultados positivos de reaplicaçäo retiniana alcançado nesta série ficaram na ordem de 86,5% sem que nenhuma complicaçäo trans ou pós-operatoria pudesse ter sido atribuída ao implante utilizado

Descolamento de retina por rotura gigante: tratamento simplificado em casos selecionados / Retinal detachment with giant breaks

Os autores citam técnica e fazem comentários a respeito para o tratamento de casos selecionados de descolamento de retina, provocado por rotura gigante. Enfatizam que, algumas vezes, a rapidez no tratamento é täo importante quanto a utilizaçäo de aparelhagem sofisticada