Impact of duration of silicone oil tamponade on foveal and parafoveal thickness in rhegmatogenous retinal detachment: a retrospective cohort study.

PURPOSE: To detect and analyze the influence of the duration of tamponade with silicone oil on the foveal and parafoveal thickness in cases of rhegmatogenous retinal detachment. METHODS: This is a retrospective cohort study of 64 eyes with rhegmatogenous retinal detachment in one eye who underwent pars plana vitrectomy (PPV) with silicone oil injection during the period between January 2019 and December 2021. The patients were divided into 2 groups. Group A with early removal of the silicone oil after 3-4 months and Group B with late removal of the silicone oil (SOR) after 6-8 months. The 2 groups were compared as regards the central foveal (CFT) and parafoveal (PFT) thickness changes from baseline, just before SOR, and after SOR. Changes in best corrected visual acuity (BCVA), relative risk of severe thinning. It was conducted at Kasr Alainy Hospital. RESULTS: 64 eyes were enrolled in the study. Group A included 36 eyes, and group B included 28 eyes. The mean CFT changed insignificantly from 253 ± 52 µm to 252 ± 48 µm after SOR in group A; while it changed significantly from 211 ± 52 µm to 202 ± 46 µm after SOR in group B. The mean PFT decreased insignificantly from 299 ± 39 µm to 297 ± 40 µm in group A, while it decreased significantly from 284 ± 46 µm to 273 ± 44 µm in group B. Lines of improvement of BCVA were 4.11 ± 1.88 in group A, and 2.00 ± 1.24 in group B. Relative risk of severe foveal thinning after SOR was 14.3, and severe parafoveal thinning was 15.43, in group B compared to group A. CONCLUSION: Longer period of silicone oil tamponade may carry a higher risk for severe foveal and parafoveal thinning after silicone oil removal. TRIAL REGISTRATION: The study was registered at clinical trial.gov under the title of (Duration of silicone oil tamponade on foveal and parafoveal thickness in Rhegmatogenous Retinal Detachment) with an ID NCT05817630 at April 2023 "retrospectively registered".

Traumatic terson syndrome with a peculiar mass lesion and tractional retinal detachment: a case report.

BACKGROUND: To report a case with bilateral Terson syndrome presented with a unique mushroom-like mass lesion on the optic disc along with proliferative vitreoretinopathy and tractional retinal detachment. CASE PRESENTATION: A 33-year-old man was injured during a traffic accident and had diffuse brain swelling and intraocular hemorrhage. Poor vision in both eyes was noted after the patient regained consciousness. B-scan ultrasonography showed extensive vitreous opacity with a posterior vitreous detachment and without obvious retinal detachment. Vitrectomy was performed in both eyes five months after the accident. After clearing up the vitreous opacity, a peculiar pigmented mushroom-like mass lesion was noted in the posterior pole and had severe adhesion to the underneath optic disc. Extensive multilayered peripapillary epiretinal membrane was found covering the posterior pole and led to tractional retinal detachment around the macula. The mass was presumed to be an organized vitreous hemorrhage originated from the optic disc. The extensive and adherent epiretinal membrane together with the mass lesion were removed as much as possible and silicon oil was injected for tamponade. However, in the right eye, the retina redetached under silicon oil, whereas in the left eye, his vision improved to 20/100. CONCLUSIONS: Terson syndrome usually has a favorable prognosis but may be complicated by proliferative vitreoretinopathy and tractional retinal detachment. Careful monitoring is warranted and early vitrectomy should be considered in cases suspecting additional pathologies.

Two patients with Knobloch syndrome due to mutation in COL8A1 gene: case report and review of the literature.

BACKGROUND: Knobloch syndrome (KNO, OMIM # 267,750) is a rare ciliopathy group sydrome characterized by a collagen synthesis disorder. It represents an uncommon cause of pediatric retinal detachment. This report presents two cases with different COL18A1 gene mutations, complicated by retinal detachment. CASE PRESENTATION: Both cases exhibited high myopia and various degrees of occipital skull defect. The first case, a female, had bilateral congenital retinal detachment, posterior embryotoxon, and strabismus. The second case, a male, had unilateral congenital retinal detachment and neuromotor developmental delay. The first case, diagnosed in the early months of life, underwent successful retinal reattachment surgery. However, surgery was not performed on the second case, who presented with late-stage unilateral retinal detachment and pre-phthisis. CONCLUSIONS: The report describes two patients with Knobloch syndrome, one of whom responded favorably to surgery for retinal detachment in both eyes. Successful anatomical results were achieved with early surgical interventions. It is essential to recognize the phenotypic and genetic heterogeneity within KNO.

Atopic Dermatitis Associated Retinal Detachment and Retinal Vasculitis: A Case Report.

Atopic dermatitis is usually associated with various ocular complications. We report a 21-year-old Chinese male who presented to our ophthalmology clinic with bilateral retinal detachment and cataracts. The patient had a clear medical history of atopic dermatitis, which had been diagnosed eight years earlier and had been treated with loratadine and pimecrolimus. Cataract surgery was performed for both eyes, combined with scleral buckling for the right eye and pars plana vitrectomy for the left eye. During postoperative follow-up, fundus fluorescein angiography showed retinal vasculitis in both eyes and macular edema in the left eye, which coincided with an exacerbation of atopic dermatitis. Macular edema improved after four months of regular dupilumab treatment in the dermatology department. The ocular condition remained stable three years postoperatively.

Deep Learning-Based Automated Detection of Retinal Breaks and Detachments on Fundus Photography.

Purpose: The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using artificial intelligence (AI). Methods: Optomap UWF images of the database were annotated to four groups by two retina specialists: (1) retinal breaks without detachment, (2) retinal breaks with retinal detachment, (3) retinal detachment without visible retinal breaks, and (4) a combination of groups 1 to 3. The fundus image data set was split into a training set and an independent test set following an 80% to 20% ratio. Image preprocessing methods were applied. An EfficientNet classification model was trained with the training set and evaluated with the test set. Results: A total of 2489 UWF images were included into the dataset, resulting in a training set size of 2008 UWF images and a test set size of 481 images. The classification models achieved an area under the receiver operating characteristic curve (AUC) on the testing set of 0.975 regarding lesion detection, an AUC of 0.972 for retinal detachment and an AUC of 0.913 for retinal breaks. Conclusions: A deep learning system to detect retinal breaks and retinal detachment using UWF images is feasible and has a good specificity. This is relevant for clinical routine as there can be a high rate of missed breaks in clinics. Future clinical studies will be necessary to evaluate the cost-effectiveness of applying such an algorithm as an automated auxiliary tool in a large practices or tertiary referral centers. Translational Relevance: This study demonstrates the relevance of applying AI in diagnosing peripheral retinal breaks in clinical routine in UWF fundus images.

Retinal detachment.

Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.

Retinal giant cyst treated by the scleral buckling procedure: A case report.

INTRODUCTION: Retinal cysts are rare lesions of the fundus that are essentially fluid-filled cavities located or originating in the retina, with a diameter larger than the normal retinal thickness. To date, there have been few case reports of giant retinal cyst hemorrhage with retinoschisis. CASE PRESENTATION: A 32-year-old woman with no other medical history complained of decreased vision for 3 days after a severe cough. The best-corrected visual acuity in the right eye was 0.5. A comprehensive ophthalmological examination including slit-lamp fundoscopy, ultrasound scan of the eye, optical coherence tomography scan, and orbital magnetic resonance imaging was performed. Ophthalmological examination revealed grade III anterior chamber blood cells and grade III vitreous hemorrhage in the right eye and a large herpetic cyst on the nasal side of the retina. The cyst projected into the vitreous, with a large amount of hemorrhage vaguely visible within it. The cyst was clearly visible, and a superficial retinal limiting detachment was observed around it. Ultrasound showed a retinal cyst with retinal detachment in the right eye. Laboratory test results were unremarkable. After 3 months of conservative treatment, the patient's intracystic hemorrhage was significantly absorbed, but the size of the cyst cavity did not show any significant change. Scleral buckling with external compression combined with external drainage of the intracystic fluid was performed, the patient's visual acuity was gradually restored to a normal 1.0 after the operation, and the retina appeared flattened. The patient was finally diagnosed with a giant retinal cyst with retinoschisis in the right eye. The presumed cause was heavy coughing leading to rupture and hemorrhage of the retinal cyst, similar to the mechanism of rupture of an arterial dissection. To the best of our knowledge, this case of retinal cyst rupture and hemorrhage caused by heavy coughing with good recovery after external surgical treatment has never been reported before. CONCLUSIONS: Giant cystic retinal hemorrhage with retinoschisis is very rare. Orbital magnetic resonance imaging and ocular B-scan ultrasound are essential for its diagnosis, and the selection of an appropriate surgical procedure is necessary to maximize the benefit for affected patients.

Incidence of macular displacement after rhegmatogenous retinal detachment surgery using ultra-widefield fundus autofluorescence.

PURPOSE: The incidence of retinal displacement after rhegmatogenous retinal detachment (RRD) surgery is variable and its clinical consequences are unclear. The aim of this study was to assess the incidence and clinical features of retinal displacement after RRD surgery by using ultra-widefield (UWF) imaging. METHODS: Retrospective observational study including all consecutive patients who underwent RRD surgery at the Rothschild Foundation Hospital. Postoperative data included the visual acuity and symptoms of visual impairment. Macular retinal displacement occurrence and its features were assessed and measured by using the autofluorescence images. RESULTS: A total of 123 eyes were included. UWF fundus autofluorescence revealed the presence of macular retinal displacement in 14 (11%) eyes. All displacements were inferior, with a mean angle of 3.8°. Patients with and without macular displacement did not differ in postoperative visual acuity. The retinal detachment extent and preoperative macular involvement were not significantly associated with the occurrence of retinal displacement. CONCLUSION: In this representative cohort of eyes that underwent RRD surgery with systematic screening for postoperative retinal displacement by UWF fundus autofluorescence, 11% of eyes experienced an inferior retinal shift. As in other cohorts, the presence of metamorphopsia was not associated with the occurrence of retinal shift.

Functional and perfusion changes associated with silicone oil tamponade after macula-off rhegmatogenous retinal detachment surgery: an optical coherence tomography angiography/microperimetry study.

PURPOSE: The current study utilizes microperimetry and optical coherence tomography angiography (OCTA) to assess the optic nerve head vasculature, retinal microvasculature, and retinal sensitivity before and after silicone oil (SO) removal. METHODS: This prospective observational case series study involved 30 eyes subjected to silicone oil endotamponade. Microperimetry and OCTA were utilized to assess the vascular density (VD) of the macula and optic nerve head, as well as the retinal sensitivity (RS), of the participants preoperatively and 1 month following SO removal. The correlation between the various parameters of OCTA and microperimetry was evaluated. RESULTS: There was a significant improvement in the postoperative best-corrected visual acuity (BCVA) (p-value < 0.001) and the postoperative total RS, which was 6.38 ± 2.34 dB as compared to a mean preoperative total RS of 5.04 ± 2.06 dB (p-value < 0.001) and showing a significant increase in all rings. However, there was no significant difference in the pre and postoperative macular VD. On the other hand, there was a significant increase in the postoperative VD of the whole disk and the peripapillary capillary plexus, p-values < 0.001 and 0.002, respectively. CONCLUSION: The removal of SO resulted in significant improvements in retinal sensitivity, vision, and optic nerve perfusion. However, no significant change was observed in macular VD. CLINICAL TRIALS: gov Identifier: NCT04928196.

Macular hole following scleral buckling for rhegmatogenous retinal detachment: a case series.

BACKGROUND: Macular hole (MH) development following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) repair is rare. This study presents both full-thickness MH (FTMH) and lamellar MH (LMH) cases following SB for the treatment of RRD. METHODS: Clinical records of patients undergoing SB surgery for treatment of RRD at the Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2016 to December 2021 were reviewed, and cases with postoperative MH were selected. Clinical features and follow-up data were summarised, and possible causes were analysed. RESULTS: Among 483 identified cases (483 eyes), four eyes (three male patients, one female patient) had postoperative MH, with prevalence, mean age, and mean axial length of 0.83%, 43.5 ± 10.66 years, and 29.13 ± 3.80 mm, respectively. All patients did not undergo subretinal fluid (SRF) drainage. The mean time for detecting MH was 26 ± 15.5 days postoperatively. Macula-off RRD with high myopia and FTMH combined with retinal re-detachment were diagnosed in three patients. One patient had macula-on RRD with outer LMH. The average follow-up duration was 7.25 ± 1.5 months. The FTMH closed successfully after reoperation, while the outer LMH closed without intervention. Visual acuity insignificantly improved or slightly decreased in all patients. CONCLUSIONS: Patients with high myopia combined with macula-off RRD might be more susceptible to FTMH, causing MH related retinal detachment. Additionally, LMH following SB was noted in patients with macula-on RRD. Therefore, we should raise awareness of MH following SB for RRD repair.

Fundus examination using a wide-angle viewing system and intraocular illumination through the corneal incision during cataract surgery: a case series.

PURPOSE: To report a new technique for fundus examination using a wide-angle viewing system combined with intraocular illumination without accessing the vitreous cavity. STUDY DESIGN: Retrospective case series METHODS: Consecutive patients with atopic dermatitis-related cataracts who underwent standard cataract surgery and the novel fundus examination technique were included. After phacoemulsification, the anterior and posterior chambers were filled with ocular viscoelastic devices. A 27-gauge endo-illumination probe was inserted into the anterior chamber through a corneal incision made for cataract surgery. The fundus examination was performed with a wide-angle viewing system and scleral indentation. If any retinal breaks/detachments were detected, they were treated simultaneously. Finally, an intraocular lens was implanted. RESULTS: Ten patients (13 eyes) were included (mean age 26.8 years; 9 men). Retinal breaks were detected in 5 eyes (38%); 2 of the 5 had rhegmatogenous retinal detachment (RRD) (15%). Intraoperative cryopexy was performed for 3 eyes with retinal breaks, while 2 eyes with RRD underwent a scleral buckling procedure (SBP) during the same surgery. There were no intra- or postoperative complications, including posterior capsule damage. The average surgical time was 22 minutes for cases requiring only fundus examination and about 28 and for eyes with cryopexy and 80 minutes for SBP. CONCLUSION: The described technique may reduce the disadvantages of creating scleral incisions and provide comparable visibility to inserting the illuminator into the vitreous cavity.

Bilateral Combined Rhegmatogenous and Tractional Retinal Detachments Due to Persistent High-Titer Syphilis.

A 23-year-old man developed bilateral rhegmatogenous retinal detachments secondary to high-titer ocular syphilis. The patient's titer increased four-fold after completing a 14-day course of intravenous penicillin (IVP). He underwent bilateral pars plana vitrectomy with silicone oil fill in both eyes. In this article, the authors propose an updated treatment method for patients with advanced ocular syphilis that includes oral doxycycline for 30 days following 14 days of IVP to optimally minimize the patient's infectious burden. Following surgery and this new treatment regime, this patient's best-corrected visual acuity 10 weeks postoperatively measured 20/50 in the right eye and 20/30 in the left eye. This case highlights a rare but devastating complication of ocular syphilis. We suggest the addition of oral doxycycline to IVP for patients with syphilis titers ≥ 1:256, HIV co-infection, and presence of posterior retinitis. [Ophthalmic Surg Lasers Imaging Retina 2024;55:46-50.].