Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment

Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD. Methods: We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning. Results: A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less. Conclusion: PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.

Options for management of intra ocular tumors.

The management of intra ocular tumors has undergone a sea change from the era of enucleation or external beam radiation. With the advent of new chemotherapy protocols, globe and vision salvage have become possible in a majority of cases of retinoblastoma. This article is an overview of the various modalities available for the management of intra ocular tumors and their indications. Chemotherapy has been covered elsewhere in this series of articles on ocular oncology. Photocoagulation and cryopexy are easily administered modalities of treatment for small tumors and totally within the ophthalmologist’s domain. Slightly larger tumors are treatable with brachytherapy. The susceptibility of the tumors to chemotherapy and radiation decide the choice of treatment and the dosage. Management of intra ocular tumors very often needs a multidisciplinary approach including ophthalmologist, oncologist, radiation physicist, and radiotherapist.

Treatment of primary rhegmatogenous retinaldetachment with cryopexy in combination with intravitravitreal injection of expending gas / 实用医学杂志

Objective To demonstrate the visual results and complications of an cryopexy in combination with intravitreal injection of expending gas in the therapy of primary rhegmatogenous retinaldetachment (RRD). Methods Thirty-two cases (32 eyes) were retrospectively reviewed in this study. The RRD diagnosis was confirmed by best corrected visual acuity,slit-lamp microscope,indirected ophthalmoscope and Goldman three-mirror contact lens. All patients had undergone cryopexy with intravitreal gas injection and assisted by correct body position. Patients were followed for 6 to 24 months. Post-operative BCVA,final anatomical outcome, complications and failed cases were analyzed. Results The reattachment rate of cryopexy with intravitreal gas injection was 81%(26/32 eyes). Four eyes required additional scleral buckling. Two eyes needed additional vitrectomy with intravitreal injection of expending gas (SF6).Final retinal reattachment was achieved in all 32 subjects (100%). Postoperative BCVA was significantly improved (P < 0.01). Conclusion Cryopexy with intravitreal gas injection is a simple,less trauma, lower cost and effective surgery for primary rhegmatogenous retinaldetachment.

Comparison of Results of Cryopexy and Laser Indirect Ophthalmoscopy in Rhegmatogenous Retinal Detachment

PURPOSE: To compare the efficacy and safety of intraoperative laser indirect ophthalmoscopy and cryopexy for rhegmatogenous retinal detachment through the use. METHODS: We retrospectively analyze the clinical results of 60 patients (61 eyes) with rhegmatogenous retinal detachment. All eyes had an attached macula and were scheduled for conventional scleral buckling surgery with cryopexy (25 eyes) or laser indirect ophthalmoscopy (36 eyes) from March 2001 to August 2007. The visual acuities of the two groups at the first postoperative day, 1 week, 1 month, and 3 months were compared. Retinal reattachment, macular pucker, cystoid macular edema, and proliferative vitreoretinopathy were confirmed 3 months after surgery. RESULTS: The visual recovery was faster in patients who received laser indirect ophthalmoscopy (1 day, P=0.044; 1 week, P=0.017). During the follow-up period, anatomical failure in the laser indirect ophthalmoscopy group did not develop, but there were two anatomical failures in the cryopexy group. In addition, 1 PVR was detected in the cryopexy group. However, neither group exhibited macular pucker or cystoid macular edema. Postoperative additional laser photocoagulation was performed on 7 eyes (19.4%) in thelaser indirect ophthalmoscopy group and 2 eyes (4.0%) in the cryopexy group. CONCLUSIONS: Although intraoperative laser indirect ophthalmoscopy causes less chorioretinal scar formation than cryopexy, it has a higher anatomical success rate and allows for faster visual recovery.

A Case of Retinal Detachment Surgery in Albinism Patient

PURPOSE: To report a case of retinal detachment surgery in a patient with oculocutaneous albinism. CASE SUMMARY: A 44-year-old man visited our clinic complaining of decreased visual acuity in his left eye. His best corrected visual acuity was hand movement in his left eye, and rhegmatogenous retinal detachment involving the macula at the superior temporal site was found. We performed pars plana vitrectomy and attempted to reattach the retina using endolaser photocoagulation; however, the laser burn was not made, and we failed to reattach the retina. At that point, we carried out cryopexy around the retinal tear, and injected silicone oil into the vitreous cavity. Ten months after surgery, his best corrected visual acuity was 0.06, and there was no recurrent retinal detachment or proliferative vitreoretinopathy. CONCLUSIONS: In patients with albinism with melanin deficiency, cryopexy is more useful than laser photocoagulation for retinal detachment surgery.

The Clinical Analysis of the Acute Posterior Vitreous Detachment-related Retinal Tears

PURPOSE: To evaluate the clinical characteristics of patients who were previously treated for acute posterior vitreous detachment-related retinal tears. METHODS: A retrospective chart review of patients who were treated for retinal tears with symptoms of acute posterior vitreous detachment between January 2000 and December 2005 was performed. RESULTS: The mean age at diagnosis was 51.62+/-12.29 years, and the mean follow-up period was 16.13+/-9.87 months. A barrier laser photocoagulation and cryopexy was performed to treat initial retinal tears. The outcomes of treatment for initial retinal tears were favorable. During the follow-up period, the incidence of new retinal tears was 10.3% (8 eyes/77 eyes), and the onset of new retinal tears occurred within a mean of 11.87+/-5.96 months after treatment for initial retinal tears. Only 2 patients who had new retinal tears complained of symptoms such as increased floaters and photopsia. A barrier laser photocoagulation was performed to treat new retinal tears. The outcomes of treatment for new retinal tears were successful. CONCLUSIONS: The outcomes of treatment with a barrier laser photocoagulation and cryopexy for acute posterior vitreous detachment-related retinal tear were good. In addition, new retinal tears were almost asymptomatic and developed within 15 months after the treatment for initial retinal tears.

The Effects of Cryotherapy in Pars Planitis

Pars planitis is characterized by an inferior vitreous opacification with vitreous exudation and organization. Although it has been called a benign process. it may lead to recurrent exacerba tions and remissions with many ocular complications. The response to corticosteroid treatment is seemingly good. However, many ocular complications such as posterior subcapsular cataract. vitreous opacity and cystoid macular edema were developed. This study was undertaken to evaluate the effectiveness of cryopexy on severe cases not responding to corticosteroid therapy. We reviewed a consecutive series of 9 eyes in the nine patients with pars planitis that had been treated with cryopexy and followed for a meridian of 23 months. In majority of cases, the inflammatory cells were not visible in anterior chamber and no increase of inflammatory cells in the anterior viterous after 2 months except 2 cases who were recurred on the other sides of the same eye. The improvement of visual acuity was rather good without significant side effects.

The Effect of the Prophylactic Cryopexy in the Experimental Penetrating Ocular Injury with Retinal Laceration

Retinal detachment was studied in a rabbit model of penetrating ocular injuries with retinal laceration. In experimental group, to study its effect on the prevention of retinal detachment, cryopexy was performed at the site of penetrating ocular injury. No retinal detachment was found when the injury was made in 3 mm radial incision from corneoscleral limbus. When the injury was extended to the equator of the globe, namely 6 mm radial incision from corneoscleral limbus, the incidence of retinal detachment was 35%. But when the incision was made circumferentially 6 mm through the retina near ora serrata ie, 3 mm from the limbus, the incidence was 65%. The higher incidence of retinal detachment following injuries located at the ora serrata is probably due to the involvement of the vitreous base. However, there was no significant difference in the incidence of retinal detachment between control and experimental groups. And the cryotherapy can release viable retinal pigment epithelial cells into the vitreous cavity which can cause proliferative vitreoretinopathy. Therefore, the cryotherapy should be limited in posterior penetraring ocular injuries. The histopathologic examination of proliferative vitreoretinopathy in rabbit eyes with posterior penetrating ocular injuries revealed Muller cells, fibroblast and retinal pigment epithelial cells as main cellular components. Through this experiment, cryopexy was proved to be little effect in prevention of retinal detachment in rabbit eyes with perforating eye injuries.