Macula-off retinal detachment--a matter of time?

BACKGROUND: The aim of this study was to determine the influence of the lag time between macular detachment and surgical intervention on post-operative visual acuity gain in patients with rhegmatogenous macula-off retinal detachment. PATIENTS AND METHODS: We retrospectively evaluated the medical records of 62 consecutive patients having undergone scleral buckling surgery for rhegmatogenous macula-off retinal detachment. The correlation of gender, age, refraction, number of retinal breaks, development of cataract during follow-up, pre-operative visual acuity and timing of surgical intervention with final visual acuity and post-operative visual acuity gain were determined. Mean follow-up time was 12.7 months. RESULTS: A correlation with final visual acuity was found for pre-operative visual acuity and lag between the beginning of symptoms and surgical intervention. A correlation with visual acuity gain was found only for timing of surgical procedure. When divided into subgroups operated after 0, 1-3, 4-6, or 7-9 days, respectively, visual recovery was better the earlier the patients underwent surgical repair. Compared to surgery at day 0, statistical significance was found only for patients operated 4 or more days after the occurrence of symptoms. CONCLUSION: The first three days seem to represent a relatively safe period during which surgery for macula-off retinal detachment may be postponed without compromising the patient's visual prognosis.

[Acute peripheral vestibular lesions. Monocular subjective visual vertical and cyclodeviation]. / Akute periphere vestibuläre Läsionen. Monokulare subjektive visuelle Vertikale und Zykloduktionsstellung.

BACKGROUND: A deviation of the subjective visual vertical (svv) is often found in patients with unilateral peripheral vestibular lesions and in most cases the deviation is transitory and easy to compensate. The purpose of the study was to find out if there is a correlation between deviation of the svv and objective cyclodeviation of the retina. PATIENTS AND METHODS: A total of 20 patients (10 females and 10 males aged between 16 and 78 years) with acute vestibular disease were enrolled. Only patients with a binocular deviation of the svv of more than 2 degrees and/or a difference between the monocular deviation of more than 1.5 degrees were included. The svv was examined monocular in a darkened room and after pupil dilatation, fundus photography was performed on each eye. The angle between papilla and macula was measured manually. RESULTS: We found a good qualitative correlation between svv (mean 7.9 degrees) and objective cyclodeviation (mean 10.6 degrees). CONCLUSION: In contrast to the binocular measurement of the svv, we found good correlation between the monocular svv and the objective cyclorotation measured with fundus photography. It is not yet clear which part of the vestibular system is responsible for cyclodeviation. Because of our results we recommend monocular measurement of the svv in clinical examinations.

[Clinical predictors of retinal detachment after open globe injury]. / Klinische Prädikatoren einer Netzhautablösung nach offener Augenverletzung1.

BACKGROUND: A retinal detachment after open globe injury has important prognostic and therapeutic implications. MATERIAL AND METHODS: To determine whether retinal detachment following open globe injury could be predicted by clinical factors, we retrospectively evaluated 52 patients (52 eyes) with open globe injury admitted to our department. The Birmingham Eye Trauma Terminology System was used. Only patients which open eye injuries were evaluated. The results were registered during the 7 days after the accident. RESULTS: In the week after the open globe injury, retinal detachment was present in 40.3 %. 100 % of the patients with previous cataract operation (with IOL) developed a retinal detachment (p < 0.01). Retinal detachment also correlated significantly with visual acuity less than hand movement and retained intraocular foreign bodies. 19 (95 %) of the 20 patients with a visual acuity less than hand movement had retinal detachment versus only 2 (9 %) patients with visual acuity of hand movement or better (p < 0.01). 6 (66.6 %) of the 9 patients with intraocular foreign bodies had retinal detachment compared to 15 (34.8 %) of the 46 patients without intraocular foreign bodies (p=0.01). Logistic regression analysis confirmed this variables as independent predictors of retinal detachment. CONCLUSION: We conclude that previous cataract operation, versus less than hand movement and the presence of intraocular foreign bodies are predictive to retinal detachment.