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1.
Chin Med Sci J ; 39(1): 74-78, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38623049

RESUMO

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.


Assuntos
Dermatite Atópica , Edema Macular , Descolamento Retiniano , Vasculite Retiniana , Masculino , Humanos , Adulto Jovem , Adulto , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/cirurgia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/complicações , Vasculite Retiniana/cirurgia , Edema Macular/etiologia , Edema Macular/complicações , Recurvamento da Esclera/efeitos adversos , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 103(13): e37620, 2024 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-38552087

RESUMO

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.


Assuntos
Cistos , Descolamento Retiniano , Retinosquise , Feminino , Humanos , Adulto , Recurvamento da Esclera/métodos , Retinosquise/complicações , Retinosquise/cirurgia , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Retiniana/complicações , Cistos/complicações , Cistos/cirurgia
4.
Nat Rev Dis Primers ; 10(1): 18, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38485969

RESUMO

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.


Assuntos
Descolamento Retiniano , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Qualidade de Vida , Recurvamento da Esclera/efeitos adversos , Vitrectomia/efeitos adversos , Resultado do Tratamento
5.
Int Ophthalmol ; 44(1): 156, 2024 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-38522047

RESUMO

PURPOSE: To compare the surgical results in cases of primary rhegmatogenous retinal detachments between standard scleral buckling (SSB) and scleral buckling with chandelier illumination (SBC) and to analyse the differences in SBC surgical results between an experienced ophthalmologist and inexperienced ophthalmologists. METHODS: Consecutive surgical case series of 155 eyes that underwent scleral buckling were retrospectively reviewed and divided into four groups: SSB performed by an experienced ophthalmologist (n = 54), SBC performed by an experienced ophthalmologist (n = 52), SBC performed by inexperienced ophthalmologists (n = 40) and SSB performed by inexperienced ophthalmologists (n = 9). Then, these four groups were compared. RESULTS: No significant differences were observed between SSB and SBC procedures both performed by the experienced ophthalmologist with regard to demographics, preoperative findings, contents of the surgery, intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SBC performed by the experienced ophthalmologist and SBC performed by the inexperienced ophthalmologists, no significant differences were found regarding intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SSB and SBC procedures both performed by the inexperienced ophthalmologist, a significant difference was found regarding intraoperative complications. CONCLUSION: There were no significant differences in surgical results between SSB and SBC when both were performed by the experienced ophthalmologist. In addition, the surgical results were equal between the experienced ophthalmologist and the inexperienced ophthalmologist as far as SBC was concerned. Learning scleral buckling skills by using SBC is a reasonable course of action for inexperienced ophthalmologists.


Assuntos
Iluminação , Recurvamento da Esclera , Humanos , Estudos Retrospectivos , Retina , Complicações Intraoperatórias , Complicações Pós-Operatórias
6.
BMC Ophthalmol ; 24(1): 97, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38433191

RESUMO

BACKGROUND: Pediatric rhegmatogenous retinal detachments (PRRDs) are complex, rare occurrences and are often related to trauma or congenital abnormalities. Children often do not recognize or report symptoms of retinal detachment. Thus at presentation, PRRD is typically advanced often with macular involvement, proliferative vitreoretinopathy (PVR), chronic duration, and poor visual acuity. Because 5-FU and LMWH are effective in different aspects in the PVR process, it was believed that a syngergistic approach to the prevention of PVR would be advantageous. METHODS: After informed consent, children under 14 years of age with high-risk PRRD underwent pars plana vitrectomy and silicone oil injection with scleral buckle divided into 2 groups in prospective randomized trial. Group A received intraoperative infusion of 5-FU (200 µg/ml) and LMWH (5 IU/ml), group B received infusion of normal saline. Primary outcome was occurrence of recurrent PRRD within 12 weeks, secondary outcomes were occurrence of PVR, best corrected visual acuity (BCVA), number and timing of secondary procedures within 12 weeks. RESULTS: The study included 42 eyes of 41 patients, 21 in group A and 21 in group B, the duration of PRRD ranged from 0.5 to 7 months in group A and 0.25-5 months in group B.The rate of recurrent PRRD was higher in group B 33% compared to 19% in group A (p = 0.292). The mean timing of occurrence of recurrent PRRD was 9.5 ± 5 weeks in group A compared to 2.86 ± 2.41 weeks in group B (p = 0.042), more patients in group B ended up with more advanced PVR (p = 0.038), BCVA was hand movement (HM) only in all cases preoperatively and improved to HM-0.3 Snellen in group A compared to light perception (PL)-0.1Snellen in group B (p = 0.035), there was no difference in any of secondary procedures but with later timing in group A 9.71 ± 3.73 weeks than in group B 4.0 ± 2.83 weeks (p = 0.042). CONCLUSION: This study concluded that the use of the 5-FU and LMWH combination in high risk PRRD resulted in lower rate of postoperative PVR, later recurrence of PRRD and better final BCVA. TRIAL REGISTRATION NUMBER: Registry: clinicaltrials.gov PRS NCT06166914 date of initial release 4/12/2023. Unique Protocol ID: 9,163,209 date 21/10/2021. Retrospectively registered.


Assuntos
Descolamento Retiniano , Humanos , Criança , Descolamento Retiniano/cirurgia , Fluoruracila/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Estudos Prospectivos , Recurvamento da Esclera
7.
Sci Rep ; 14(1): 5249, 2024 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-38438557

RESUMO

To compare the efficacy of scleral buckling with adjuvant pneumatic retinopexy (SB with PR) and scleral buckling (SB) alone for primary rhegmatogenous retinal detachment (RRD). This retrospective and comparative study included patients who underwent SB with PR (n = 88) or SB alone (n = 161) for primary RRD. The primary anatomical success rate for SB with PR was 81.8%, whereas that for SB alone was 80.7% (P = 0.836). Among patients who achieved primary anatomical success, those in the SB with PR group showed postoperative epiretinal membrane (ERM) formation more frequently than those in the SB alone group (11 of 72 [15.3%] vs. 6 of 130 [4.6%]) (P = 0.009). The mean time to subretinal fluid absorption was not significantly different between the SB with PR and SB alone groups (11.2 ± 6.2 vs. 11.4 ± 5.8 months, P = 0.881). In the SB with PR group, retinal detachment involving ≥ three quadrants was a significant risk factor for surgical failure (hazard ratio, 3.04; P = 0.041). Adjuvant pneumatic retinopexy does not provide additional benefit in improving the surgical outcomes of SB for primary RRD repair.


Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Humanos , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Adjuvantes Imunológicos , Adjuvantes Farmacêuticos
8.
Curr Opin Ophthalmol ; 35(3): 217-222, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38364771

RESUMO

PURPOSE OF REVIEW: We describe the history and series results of pneumatic retinopexy (PnR)and provide an analysis of PnR utilization after publication of results of pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial (PIVOT). RECENT FINDINGS: No significant trends were found for average number of services ( P  = 0.153) of PnR after the publication of PIVOT results. SUMMARY: PnR is a rhegmatogenous retinal detachment (RRD) repair technique that was first described in the early 1900 s and has evolved over time to become a modern-day, minimally invasive, underutilized treatment option. Other repair techniques for RRD include scleral buckling and pars plana vitrectomy (PPV), which has been compared to the use of PnR in PIVOT. Results of PIVOT concluded that PnR offered superior visual acuity and noninferiority. PnR is underutilized in the United States even after publication of results of PIVOT deemed it a noninferior treatment. Lack of a significant increase in national utilization of PnR could be associated with multifactorial clinician, systems, and financial reasons in the real-world setting.


Assuntos
Descolamento Retiniano , Humanos , Estados Unidos , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Resultado do Tratamento , Recurvamento da Esclera/métodos , Retina , Estudos Retrospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Cesk Slov Oftalmol ; 80(1): 12-17, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38365577

RESUMO

AIM: The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD). MATERIAL AND METHODS: The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results. RESULTS: In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8. CONCLUSION: In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.


Assuntos
Traumatismos Oculares , Descolamento Retiniano , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Descolamento Retiniano/etiologia , Recurvamento da Esclera/efeitos adversos , Recurvamento da Esclera/métodos , Estudos Retrospectivos , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Retina/cirurgia , Traumatismos Oculares/complicações , Resultado do Tratamento
11.
Int Ophthalmol ; 44(1): 92, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38367129

RESUMO

AIMS: The current study compared a novel technique of scleral indentation using the self-retaining Leyla retractor to the conventional scleral self-indentation with the chandelier light. METHODS: Patients with rhegmatogenous retinal detachment were randomized on a 1:1 basis to either have the (Baha) indentation using a tip of a thimble scleral indenter welded to the support for the Leyla retractor system or to have the conventional scleral indentation while using a 25-gauge chandelier light. A video was recorded for the surgery of all the cases and reviewed by another consultant masked to the type of indentation. The indentation duration (i.e., the time in seconds between the first appearance of a hump due to scleral indentation in the recorded video until its final disappearance) was measured for every case. RESULTS: The current study included 60 eyes of 60 adults with a mean age of 59.6 ± 9.8 years. Thirty-nine of the eyes were phakic and 21 were pseudophakic. The mean indentation time was 618 ± 87 and 696 ± 72 s in (Baha) indentation and conventional indentation groups, respectively. The difference was not statistically significant (p = 38). There was a positive correlation between the vertical palpebral fissure height and the indentation duration for both (Baha) indentation (r = 0.58) and conventional indentation groups (r = 0.42). Readjustment of the chandelier endo-illumination was required in 19 cases (63.3%) in the conventional indentation group. Iatrogenic breaks or accidental crystalline lens touch did not occur in any case. CONCLUSION: The (Baha) technique is effective and safe, especially in patients with a larger palpebral fissure.


Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Adulto , Humanos , Pessoa de Meia-Idade , Idoso , Recurvamento da Esclera/métodos , Vitrectomia/métodos , Resultado do Tratamento , Acuidade Visual , Descolamento Retiniano/cirurgia , Estudos Retrospectivos
12.
BMC Ophthalmol ; 24(1): 63, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38350933

RESUMO

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.


Assuntos
Miopia , Descolamento Retiniano , Perfurações Retinianas , Humanos , Masculino , Feminino , Recurvamento da Esclera/efeitos adversos , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica , Vitrectomia/efeitos adversos , Miopia/cirurgia , Estudos Retrospectivos
13.
Jpn J Ophthalmol ; 68(2): 112-116, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38289510

RESUMO

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.


Assuntos
Extração de Catarata , Catarata , Descolamento Retiniano , Perfurações Retinianas , Masculino , Humanos , Adulto , Perfurações Retinianas/cirurgia , Iluminação , Estudos Retrospectivos , Acuidade Visual , Recurvamento da Esclera , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Complicações Pós-Operatórias , Catarata/complicações , Catarata/diagnóstico , Vitrectomia , Resultado do Tratamento
14.
Am J Ophthalmol ; 261: 28-35, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38219892

RESUMO

PURPOSE: We determined the incidence, etiology, and longitudinal trends of vitreoretinal diseases necessitating pars plana vitrectomy (PPV) in the pediatric and adolescent population. DESIGN: Nationwide, population-based cohort study. METHODS: This study utilized data extracted from the Korean National Health Claims database spanning from 2009 to 2020. All pediatric and adolescent patients (under 20 years of age) who underwent PPV across the Korean population were included. The cumulative incidence of PPV was estimated from 2009 to 2020, with 2009 to 2011 as the washout period. The annual trends of PPV incidence, the proportion of each etiology, and comorbidity were estimated based on sex and specific age groups. RESULTS: In total, 1913 patients, including 83 infants, 746 pediatric patients, and 1084 adolescents, were newly identified as having undergone PPV surgery. The cumulative incidence of PPV surgery per 100,000 individuals was 21.42 (95% CI, 21.41-21.43). The rate of PPV was 2.4 times higher for males than females, and the rate of trauma as a comorbidity was also higher for males than females (13.1% vs 4.8%). Among males aged 5 years and older, the incidence of PPV nearly halved from 2011 to 2020. Among the primary etiologies, ROP had the highest rate (72%) in infants (under 1 year), while RD was most common (63%) in individuals aged 5 to 19 years. Myopia was present in 30.3% of patients, and atopic dermatitis was present in 31.8% of all patients. CONCLUSION: The primary etiologies underlying the need for PPV in the pediatric and adolescent populations vary by sex and age group. The incidence of PPV continues to decline in the adolescent population. Therefore, tailored patient education and age-specific etiological examination are recommended.


Assuntos
Descolamento Retiniano , Masculino , Lactente , Feminino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Estudos de Coortes , Estudos Retrospectivos , Recurvamento da Esclera/efeitos adversos
15.
Retina ; 44(5): 756-763, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38207330

RESUMO

PURPOSE: To evaluate outer retinal recovery on postoperative optical coherence tomography (OCT) based on presenting morphologic stage of rhegmatogenous retinal detachment (RRD). METHODS: Retrospective cohort of consecutive primary fovea-involving RRDs, referred from January 2012 to September 2022. Baseline OCTs were assessed for morphologic stage of RRD. Postoperative OCT scans were graded at 3, 6, and 12 months for external limiting membrane, ellipsoid zone and interdigitation zone discontinuity, epiretinal membrane formation and severity, and residual subfoveal fluid. RESULTS: Three hundred and fifty-one patients were included. Increasing baseline morphologic stage of RRD was significantly associated with external limiting membrane, ellipsoid zone, and interdigitation zone discontinuity at all time points postoperatively ( P < 0.001) and was shown to be an independent predictor of foveal photoreceptor integrity after adjusting for height of detachment, time to surgery, and duration of fovea involvement ( P < 0.001). Earlier stages were associated with residual subfoveal fluid ( P < 0.001). There was no association between the stages of RRD and epiretinal membrane severity. However, late stages presented with earlier development of epiretinal membrane ( P = 0.012). CONCLUSION: Increasing morphologic stage of RRD is associated with delayed recovery of outer retinal bands in the first year and faster development of epiretinal membrane after RRD repair. The results of this study suggest that the stages may serve as a prognostic biomarker for postoperative photoreceptor recovery.


Assuntos
Descolamento Retiniano , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Período Pós-Operatório , Idoso , Seguimentos , Células Fotorreceptoras de Vertebrados/patologia , Fóvea Central/patologia , Recurvamento da Esclera/métodos , Adulto
16.
Retina ; 44(5): 799-809, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38261829

RESUMO

PURPOSE: To investigate the efficacy, safety, and indications for additional pneumatic retinopexy (PR) in patients with persistent retinal detachment after scleral buckling. METHODS: This retrospective study included patients who underwent additional PR after scleral buckling for primary rhegmatogenous retinal detachment (n = 78). We defined "inadequate buckle" as retinal detachment persistence because of low buckle height despite accurate buckle placement and "buckle misplacement" as an uncovered tear because of incorrect buckle placement. RESULTS: The anatomical success rate after additional PR was 52.6%. Development of proliferative vitreoretinopathy Grade B (hazard ratio, 5.73; P < 0.001) and inferior retinal tears (hazard ratio, 2.12; P = 0.040) were significant risk factors for anatomical failure. The most common cause of anatomical failure was proliferative vitreoretinopathy (19 of 37; 51.4%), and epiretinal membrane formation was a common complication after additional PR (22 of 78; 28.2%). The anatomical success rate with additional PR was significantly higher in the inadequate buckle group than in the misplacement group (8 of 9 [88.9%] vs. 1228 [42.9%]; P = 0.023). CONCLUSION: Development of proliferative vitreoretinopathy Grade B and inferior retinal tears were significantly associated with anatomical failure after additional PR. Additional PR may benefit patients with superior retinal tears or low buckle height and those without proliferative vitreoretinopathy.


Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Acuidade Visual , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Descolamento Retiniano/diagnóstico , Recurvamento da Esclera/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Reoperação , Tamponamento Interno/métodos , Perfurações Retinianas/cirurgia , Perfurações Retinianas/etiologia , Perfurações Retinianas/diagnóstico , Complicações Pós-Operatórias , Vitreorretinopatia Proliferativa/cirurgia , Vitreorretinopatia Proliferativa/etiologia , Vitreorretinopatia Proliferativa/diagnóstico
17.
Retina ; 44(5): 928-933, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38285651

RESUMO

PURPOSE: To introduce a surgical technique for temporary scleral buckling of noncomplex rhegmatogenous retinal detachment using a combination of nonabsorbable and absorbable sutures that would induce minimal permanent refractive changes. METHODS: Twenty consecutive patients (20 eyes) with noncomplex rhegmatogenous retinal detachment were prospectively included. Scleral buckling was performed in all eligible subjects, and encircling buckling was added when necessary. The silicone elements were fixed on the sclera with 5-0 nonabsorbable sutures and tightened to form a ridge with 6-0 absorbable sutures. Best-corrected visual acuity, scleral ridge status, axial length, spherical diopter, and cylinder diopter were collected. RESULTS: All patients achieved primary retinal reattachment with significant improvement of best-corrected visual acuity after surgery. Scleral ridge was obvious and in situ at the 1-month follow-up but diminished at the 3-month follow-up. At the 1-month follow-up, axial length increased from 24.78 mm ± 2.14 mm preoperatively to 25.22 mm ± 2.11 mm, and cylinder diopter increased from -1.99 ± 1.03 to -2.95 ± 1.55 (both P < 0.001). At the 3-month follow-up, axial length, spherical diopter, and cylinder diopter decreased significantly compared with the values at the 1-month follow-up (all P < 0.05). No obvious complications were observed during the whole follow-up. Patients who underwent additional encircling buckling exhibited greater changes in axial length and cylinder diopter at the 1-month follow-up (both P < 0.001). CONCLUSION: The modified technique of scleral buckling with/without encircling buckling using both nonabsorbable and absorbable sutures offers a safe and effective option to repair noncomplex rhegmatogenous retinal detachment, which would offer an adequate temporary scleral buckling effect and induce minimal permanent refractive changes.


Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Técnicas de Sutura , Acuidade Visual , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/fisiopatologia , Recurvamento da Esclera/métodos , Feminino , Masculino , Acuidade Visual/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Idoso , Seguimentos , Suturas , Resultado do Tratamento
20.
Retina ; 44(2): 255-260, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37903447

RESUMO

PURPOSE: To report the clinical settings, management, and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment. METHODS: Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan. RESULTS: Overall 303 eyes were included. Mean age was 43.72 ± 20.64 years (median 46). Best-corrected presenting visual acuity was 1.79 ± 0.92 logMAR (median 2.10) (Snellen 20/1,233). Forty-four patients (17.91%) received preoperative steroids. Final visual acuity was 1.33 ± 0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%), whereas favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (odds ratio [OR] 2.76), absence of proliferative vitreoretinopathy worse than Grade A (OR 7.69), use of preoperative steroids (OR 4.50), and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of proliferative vitreoretinopathy worse than Grade A (OR 10.41), and use of preoperative steroids (OR 7.24). CONCLUSION: Administration of preoperative steroids, use of an encircling band during surgery, and pseudophakic status of the eye were found to have better outcomes in rhegmatogenous retinal detachment with concurrent choroidal detachment.


Assuntos
Efusões Coroides , Descolamento Retiniano , Vitreorretinopatia Proliferativa , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Recurvamento da Esclera , Vitreorretinopatia Proliferativa/cirurgia , Estudos Retrospectivos , Vitrectomia , Esteroides , Resultado do Tratamento
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