Surgical decisions and outcomes of rhegmatogenous retinal detachment during the coronavirus disease 2019 pandemic: Data from a tertiary referral center in Taiwan

Purpose: To assess changes in surgical decisions and outcomes of rhegmatogenous retinal detachment (RRD) during the COVID?19 pandemic at a tertiary center in Taiwan. Methods: Patients undergoing pars plana vitrectomy (PPV) or scleral buckling (SB) for primary RRD during Taiwan’s first wave of domestic COVID?19 cases surge between May and July 2021 (COVID cohort, n = 100) were compared to controls in the closest pre?COVID year, 2019 (pre?COVID cohort, n = 121). Results: The COVID cohort had significantly worse RRD presentation, received more PPV (alone or combined with SB (PPV + SB)) and less SB alone, and had comparable single?surgery anatomic success (SSAS) rates. In patients who underwent PPV, more underwent PPV + SB instead of PPV alone. The decision to combine SB in PPV surgery was significantly affected by the COVID pandemic (odds ratio [OR], 3.1860 [95% confidence interval (CI), 1.1487–8.8361]). However, a shorter duration of symptoms before the first presentation (0.9857 [95% CI, 0.9720–0.9997]) was the only factor related to SSAS, whereas the surgical method had no association. The SSAS rate remained close to or over 90% in patients with a duration of symptoms before surgery ?4 weeks but dropped to 83.3% in patients with duration >4 weeks. Conclusion: During the COVID?19 pandemic, worse RRD presentations led to a shift in preference for PPV over SB alone as the primary surgery. The pandemic affected surgeons’ decision to combine SB during PPV. Nevertheless, SSAS was only associated with the duration of symptoms but not with surgical methods.

Newer indices for predicting macular hole closure in idiopathic macular holes: A retrospective, comparative study

Purpose: To study the utility and predictive ability of newer macular hole (MH) indices for closure following surgery. Methods: In this retrospective study, pre- and post-operative optical coherence tomography images of 49 eyes with idiopathic full-thickness MH were reviewed and analysed. Various quantitative parameters of MH like maximum outer diameter (OD), minimum diameter between edges, height, nasal and temporal arm lengths, macular hole angle were noted. Indices including hole form factor, Macular Hole Index, (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI) were calculated. Newer area indices like macular hole area index (MAI), cystoid space area index (MCSAI) and tissue area index (MTAI) were calculated using Image J (Ver. 1.51). Receiver operating characteristic (ROC) curves and cut-off values were derived for indices predicting type 1 or type 2 closure. Stepwise regression analysis and binary logistic regression analysis were carried out to predict the chances of hole closure. Results: ROC curve analysis showed indices like MHI, THI and MCSAI were capable of successfully predicting type 1 closure while OD, DHI and MAI predicted type 2 closure. On stepwise regression analysis, MAI was identified as the most important index in predicting the type of hole closure. Using the binary logistic regression analysis, the predictive ability of the model to identify success or failure following MH surgery was 89.7% and 80% respectively. Conclusion: MAI measurement could be used as a single important index in predicting hole closure in idiopathic MH. Further research is required to study this area index in detail.

Clinical Evaluation of Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical characteristics of pseudophakic retinal detachment(RD) as RD is the most common sight-threatening complication after cataract surgery. METHODS: We analysed retrospectively the clinical characteristics of 22 pseudophakic RD patiens(23 eyes) which had been operated from January 1993 to December 1997 and followed for 6 months or longer at the Gyeongsang National University Hospital. RESULTS: The average age of the patients was sixty-three and male predominated 19 eyes(82.6%). According as types of IOL implantation included 14 eyes with posterior chamber IOL, 7 eyes with sclera-fixated IOL, 2 eyes with anterior chamber IOL, and 16 eyes(70%) occurred the posterior casule rupture. The interval between IOL implantation and the development of RD was 9.6 months on average and 78% of eyes developed RD within 1 year. In eyes with sclera-fixated IOL, the interval was shorter than others, In cases with ruptured posterior capsule, RD occurred earlier than those with intact posterior capsule. Retinal breaks were principally located in the upper quadrants in 12 eyes(63%) and horseshoe tear was most commmonly encountered. RD involving 3 or more quadrants was observed in 12 eyes(51%) of patients, and macular detachment in 18 eyes(78%). Anatomic success achieved in 83%. The most common cause of the failure was the development of proliferative vitreoretinopathy. Visual results in eyes with ultimate anatomic success of RD repair improved 0.5 or more in 80% if the macula was not involved and in 14.2% if the macula was involved. CONCLUSION: We thought that thorough fundus examination is neccessary during the follow-up of pseudophakic eye with posterior capsule rupture and sclera-fixated IOL after cataract surgery.

Assessment of Idiopathic Macular Hole Surgery by Heidelberg Retina Tomograph

For the evaluation of preoperative and postoperative factors effecting the results of vitrectomy as a treatment of full thickness macular hole, we estimated the three dimensional morphology of macular hole using the HRT [Heidelberg retina tomography]and investigated every patient's history and operation method. Pars plana vitrectomy, epiretinal and internal limiting membrane removal, and C3F8 injection were performed in 19 patients[19 eyes]with full thickness macular holes. Anatomic success was seen in 12 eyes[63.2%]and was statistically related with preoperative hole area, volume and depth. Functional success was seen in 6 eyes[31.6%]and was significantly related with preoperative hole volume and depth, marginal detachment area and volume, hole diameter and hole area. In addition, anatomic success was statistically related with internal limiting membrane removal[p<0.01], stage and preoperative visual acuity [p<0.05]. Functional success was significantly related with preoperative visual acuity, internal limiting membrane removal[p<0.01], stage and duration of the disease[p<0.05]. We conclude that preoperative HRT is a useful method in deciding the operative indications and also in predicting the outcomes.

A Clinical Study on Rhegmatogenous Retinal Detachment

We reviewed charts of patients on the clinical characteristics and factors which affect the prognosis of surgical results in the 77 patients(77 eyes) who were diagnosed with rhegmatogenous retinal detachment and operated on and followed for at least 3 months postoperatively at Korea University Guro hospital. We evaluated the characteristics of rhegmatogenous retinal detachment in Korea by comparing with other reports on retinal detachment as well. The factors associated with anatomic success were the duration of retinal detachment and the prescence of proliferative vitreoretinopathy. High success rate was achieved when the duration was less than 1 month and there was no proliferative vitreoretinopathy. The factors associated with functional success included the duration of retinal detachment, proliferative vitreoretinopathy, preoperative refractive error and the degree of retinal detachment(P<0.05).

Rhegmatogenous Retinal Detachment with Spared Macula

We determined the ultimate anatomic success and visual outcome for rhegmatogenous retinal detachment with spared macula, and compared the preoperative findings and success rate with those involving the macula in the 445 eyes treated with scleral buckling for rhegmatogenous retinal detachment and the causes of decrease in visual acuity after operation were evaluated. Seventy-seven (67%) of the 115 eyes with rhegmatogenous retinal detachment with spared macula and 28 (8%) of the 330 eyes with that involving the macula had preoperative visual acuity of 0.3 or better. In comparision to the findings of the eyes with retinal detachment involving the macula, in the eyes with rhegmatogenous retinal detachment with spared macula the extent of retinal detachment was less, the retinal break was located more anteriorly, the demarcation line was less frequently noted, and the incidences of high myopia and lattice degeneration were higher. Postoperatively all 115 eyes with spared macula were anatomically reattached, 99 eyes (86%) had visual acuity of 0.3 or better and success rates were significantly better in comparison to those involving the macula (p<.05). Seventeen eyes had a significant decrease in visual acuity postoperatively, the causes included macular detachment after failure of the first operation, macular pucker, progression of cataract, etc.