Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

PURPOSE: To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS: This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS: One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS: Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

Is There a Link Between Vitreous Cortex Remnants and Anatomic Outcome of Vitrectomy for Primary Rhegmatogenous Retinal Detachment?

Purpose: To study the anatomic outcome of leaving vitreous cortex remnants (VCR) during pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). Methods: The study comprised patients with RRD who had PPV by a single surgeon between January 2019 and December 2020 and followed for 6 months. After intravitreal injection of triamcinolone acetonide, the topographic pattern of VCR at the periphery (p) and macula (m) was divided into 2 types by extent: complete or 4 quadrants (pVCR4Q), and between 2 and 4 quadrants ≥2 quadrants (pVCR>2Q), or by location >1 inferior retinal quadrant (pVCR>1InfQ), and at the macula (mVCR). Anatomical failure or retinal re-detachment within 6 months after surgery was the primary outcome measures. The occurrence of grade C proliferative vitreoretinopathy (PVR) and epiretinal membrane (ERM) were used as secondary outcome indicators. Results: A 6-month prospective follow-up was performed on 103 patients. pVCR4Q was detected in 31 eyes, pVCR>2Q in 40 eyes, pVCR>1InfQ in 40 eyes and mVCR in 54 eyes. Recurrent RRD developed in 9 (8.7%) eyes, PVR grade C in 6 (5.8%) eyes and ERM in 11 (10.7%) eyes. According to multivariate regression analysis, the existence of any type of VCR did not correlate with anatomical failure, PVR or ERM. Conclusion: The initial success rate of PPV and the growth of PVR or ERM do not appear to be impacted by keeping VCR.

Associations in corticocapsular adhesions.

OBJECTIVES: To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE). METHODS: Prospective, single surgeon, multi-year study of consecutive patients undergoing PCE was performed. At the conclusion of each procedure, the surgeon recorded the CCA and perceived surgeon stress score. Patient variables included gender, age, diabetes mellitus, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, and intraocular lens power. RESULTS: During the 10-year study, 1097 eyes underwent surgery and CCA was diagnosed intraoperatively in 41 eyes. On multi-variable analysis, the following patient characteristics were associated with intraoperative CCA: diabetes mellitus (p = 0.002), age >80 years (p = 0.002), presence of posterior capsular cataract (p = 0.046), severe nuclear sclerosis (p = 0.004), and absence of pseudo-exfoliation (p = 0.043). CONCLUSION: Diabetes mellitus, advanced age and posterior subcapsular cataract are associated with CCA necessitating generous repetitive hydrodissection.

Perceived Surgeon Stress During No-Sedation Topical Phacoemulsification.

PURPOSE: To determine the patient-related factors that contribute to surgeon stress during phacoemulsification cataract extraction (PCE) performed under unassisted topical anesthesia. METHODS: This is a prospective study of perceived surgeon stress during phacoemulsification by a single surgeon of consecutive patients undergoing PCE. At the conclusion of each procedure, the surgeon recorded the perceived stress according to the following three indices: surgeon score, qualitative score (yes or no), and total score (sum of itemized causes of stress). Patient variables included in the analysis included gender, age, diabetes mellitus, morbid obesity, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, intraocular lens power, and initial visual acuity. RESULTS: During the 10-year study, 1097 eyes underwent surgery. The following patient variables were seen frequently: floppy iris syndrome (92), pseudo-exfoliation (72), and morbid obesity (36). Surgeon identified stress was reported after 250 procedures. On multivariable analysis, the following patient characteristics were associated with surgeon stress: age >80 years; morbid obesity; floppy iris syndrome; severe nuclear sclerosis; and poor baseline distance corrected visual acuity. CONCLUSION: Several ocular and systemic patient-related characteristics contribute to surgeon stress during PCE.