Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post?traumatic posterior GRT and full?thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21?year?old?male presented with sudden diminution of vision in the right eye (RE) following blunt?trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior?GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid?assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post?operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior?GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.

Clinical analysis of vitreous haemorrhage associated with retinal tears / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the clinical characteristics of vitreous hemorrhage associated with retinal tears, so as to provide suggestions for early intervention and improving the prognosis of patients.<p>METHODS: This was a retrospective study. Totally 105 patients(105 eyes)with vitreous haemorrhage associated with retinal tears treated at our hospital from December 2016 to December 2018 including 54 males and 51 females, of who the clinical characters, therapeutic effcet and prognostic facors were retrospectively analyzed.<p>RESULTS: Among the 105 eyes(151 retinal tears), 82 tears were located in the superotemporal area(54.3%), 28 tears were located in the superonasal area(18.5%), 27 tears were located in the inferior temporal area(17.9%), and 14 tears were located in the inferior nasal area(9.3%). The shape of the retinal tears was mostly horseshoe(77.5%). The diameter of the tear was between 1/8-4 papillary diameter(PD), most commonly is 1 PD. Seventy-six patients(72.4%)had visual acuity better than or equal to their preoperative vision. There was no significant difference in corrected visual acuity pre-and postoperative(<i>P</i>>0.05), and there was no statistically significant improvement in visual acuity between the buckling procedure group and the vitrectomy group(<i>P</i>>0.05).<p>CONCLUSION: Retinal tear is an important cause of vitreous haemorrhage. Retinal tears were mostly located in the superotemporal area with horseshoe shape. A comprehensive understanding of the clinical characteristics of rhegmatogenous vitreous haemorrhage helps to detect tears early and avoid serious complications.Patients had preoperative best corrected visual acuity(BCVA)(LogMAR)less than 1.6 and light perception less than 1 m, have poor postoperative vision, as do patients with retinal detachment involving the macula especially along with proliferative vitreoretinopathy(PVR).

Bilateral Rhegmatogenous Retinal Detachments after Systemic Pazopanib Treatment

PURPOSE: A case of bilateral rhegmatogenous retinal detachment is reported after pazopanib treatment of a patient with breast angiosarcoma. CASE SUMMARY: A 53-year-old female presented with bleeding in a right breast mass prior to an emergency room visit. She was diagnosed with metastatic breast angiosarcoma after a breast mass biopsy. She was treated with paclitaxel and radiation therapy. Systemic pazopanib treatment was added to treat lung metastasis. After 3 weeks, she felt sudden floaters in her right eye. In her fundus examination, there was vitreous hemorrhage, but no retinal detachment was noted. Five weeks later, she visited the clinic for a bilateral temporal visual field defect. A fundus examination showed bilateral retinal detachments with superonasal retinal tears. Both the patient and her family did not want surgery for her systemic condition because of her terminal cancer. CONCLUSIONS: Retinal detachment has been reported as a rare complication after systemic pazopanib treatment, but there has been no previous report in the Republic of Korea, therefore this is the first case of bilateral retinal detachments after systemic pazopanib treatment.

Clinical Characteristics of Intraocular Foreign Bodies According to Entrance Location: Corneal vs. Non-Corneal

PURPOSE: To investigate differences in the clinical features of post-traumatic intraocular foreign bodies (IOFBs) according to their entrance locations, specifically, those penetrating the cornea and those not penetrating the cornea. METHODS: A retrospective chart review was performed of patients with an IOFB from January 2011 to July 2016. The patients were divided into two groups: those in whom the IOFB entered through the cornea (“corneal entrance” group) and those in whom the IOFB did not penetrate the cornea (“non-corneal entrance” group), and compared. Damage to the anterior and posterior capsule, retinal tear, and retinal detachment were analyzed, and differences in surgical techniques including the IOFB extraction route and intraocular lens implantation were recorded. RESULTS: A total of 43 eyes (43 patients) were included, with 33 (76.7%) in the corneal entrance group and 10 (23.3%) in the non-corneal group. The posterior capsule was preserved in 24.2% (eight) of eyes in the corneal group and 80% (eight) of eyes in the non-corneal group. The corneal group had significantly more posterior capsule ruptures but dramatically fewer retinal tears (39.4%) than the non-corneal group (80% retinal tears). CONCLUSIONS: The location of IOFB entrance is a predictable factor of lens capsule and retinal injuries.

Transcleral approach for closing retinal tears using DuraSeal� hydrogel sealant

Purpose: The aim of this study was to evaluate an innovative approach for closing retinal tears using DuraSeal� (DS) hydrogel sealant in a rabbit model. Methods: Retinal detachment with a small tear was performed on 20 New Zealand rabbits. Thereafter, rabbits were divided into two groups; the experimental group received a transscleral injection of 0.1 ml DS into the subretinal space whereas the control group received sham injection of saline. Eyes were clinically evaluated using indirect ophthalmoscopy, retinal function was recorded in ten rabbits by electroretinography and the sealant's toxicity was evaluated histopathologically. Results: We found that the DS hydrogel was easily injected transsclerally into the subretinal space of the detached retinas with no major complications. Retinal reattachment was seen in both groups within 2 weeks with no toxicity to the sensory retina. There were no significant differences in retinal function between groups. Conclusion: Subretinal injection of hydrogel through a transscleral route is easy to perform and may open a new avenue in the treatment of retinal detachment. However, the efficacy of the DS as a tamponade for sealing retinal tear is yet to be definite. Long-term clinical, functional, and toxicological studies are needed to evaluate its full potential for clinical applications.

Current status and progress of surgical management of giant retinal tear / 眼科新进展

Giant retinal tear (GRT) refers to a retinal break extending circumferential for ≥ 3 clock hours (＞90°) of the retinal with trailing edge folding.With the de velopment of technology,success rate of surgical for GRT was increased.Chandelier illumination can help surgeons complete the operation by themselves,and 23 G,25G,27G microsurgical techniques make it easy for the application of surgical instruments and amplify the scope of operation.Meanwhile,endoscope can reduce the impact of refractive media opacity.Administration of preoperative intraocular medicine is helpful for the operation.However,there is no definite findings of whether adjuvant scleral buckling and lens extraction are necessary in the management of GRT as well as how to deal with retinal stiff and flap of GRT.And this article tries to summarize the pathogenesis,surgical methods and pre-and post-operative stuffing of the GRT.

Current status and progress of surgical management of giant retinal tear / 眼科新进展

Giant retinal tear (GRT) refers to a retinal break extending circumferential for ≥ 3 clock hours (＞90°) of the retinal with trailing edge folding.With the de velopment of technology,success rate of surgical for GRT was increased.Chandelier illumination can help surgeons complete the operation by themselves,and 23 G,25G,27G microsurgical techniques make it easy for the application of surgical instruments and amplify the scope of operation.Meanwhile,endoscope can reduce the impact of refractive media opacity.Administration of preoperative intraocular medicine is helpful for the operation.However,there is no definite findings of whether adjuvant scleral buckling and lens extraction are necessary in the management of GRT as well as how to deal with retinal stiff and flap of GRT.And this article tries to summarize the pathogenesis,surgical methods and pre-and post-operative stuffing of the GRT.

Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

PURPOSE: To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid. METHODS: Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intraocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, location and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed. RESULTS: Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular surgery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92). CONCLUSIONS: When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without proliferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.

Analysis of Leading Diseases Causing Epiretinal Membrane and Comparison of Prognosis after Epiretinal Membrane Peeling

PURPOSE: In the present study we analyzed the leading diseases causing epiretinal membrane and compared the prognosis after epiretinal membrane peeling. METHODS: We enrolled 158 (160 eyes) patients diagnosed with epiretinal membrane who underwent epiretinal membrane peeling from January 2005 to January 2014. The medical records including age, underlying ocular disease, and pre-operative symptoms of patients from Chonbuk National University Hospital were analyzed retrospectively. Additionally, we evaluated the changes in central macular thickness and visual acuity after the epiretinal membrane peeling. RESULTS: Idiopathic epiretinal membrane was the most common type of disease (44.4%, 71/160). The causes of secondary epiretinal membrane were diabetic retinopathy (20.6%, 33/160), retinal tear, and retinal hole (18.1%, 29/160). Other causes were post retinal detachment surgery, traumatic epiretinal membrane, retinal vein occlusion and uveitis; 6.9% (11/160), 4.4% (7/160), 3.8% (6/160), and 1.9% (3/160), respectively. The changes in central macular thickness after surgery did not differ significantly between the idiopathic epiretinal membrane and secondary epiretinal membrane patients after adjusting for age (p = 0.958, based on analysis of variance (ANOVA). Additionally, the visual acuity did not differ significantly after the surgery even after adjusting for age (p = 0.118, analysis of covariance [ANCOVA]). CONCLUSIONS: Various ocular diseases can be the leading causes of epiretinal membrane, but the leading disease does not affect the degree of central macular thickness changes after surgery or change the prognosis of post-surgical visual acuity.

Relación entre el desprendimiento de retina, desgarro en herradura y eficacia del tratamiento con fotocoagulación focal láser / Relation between retinal detachment, horse-shoe retinal tears and efficacy of focal laser photocoagulation treatment

El desprendimiento de retina (DR) produce pérdida visual. El desgarro en herradura (DH) es la lesión retiniana mayormente asociada a los desprendimientos de retina y aparece con frecuencia en población. La fotocoagulación focal láser (FCF) de desgarros reduce el riesgo de presentar desprendimiento de retina, por tanto se debería realizar este tratamiento a las lesiones retinianas.

Retinal detachment produces visual loss. Horseshoe retinal tears is directly associated with retinal detachment and it is usually found in general population. Retinal laser photocoagulation signifi cantly reduces the incidence of retinal detachment.

Risk Factors for Retinal Breaks in Patients with Symptom of Floaters

PURPOSE: To identify the risk factors of retinal breaks in patients with symptoms of floaters and to determine the associations between those risk factors and retinal breaks. METHODS: A retrospective chart review of patients who visited with the symptom of vitreous floaters between July 2012 and October 2012 was performed. Patient information, such as age, sex, symptoms (e.g., multiple floaters and flashing), duration of symptoms, refractive error, and complete eye examination were recorded. The patients were divided into 2 groups: the control group had symptoms of floaters with no retinal breaks and the retinal breaks group had symptoms of floaters with retinal breaks. The chi-square test and univariate logistic regression were used for statistical analysis. RESULTS: A total of 1744 eyes were examined in this study, including 1706 eyes in the control group and 38 eyes in the retinal breaks group. Univariate analysis revealed that patients with high myopia and multiple floaters showed increased risk of retinal breaks by 3.4 and 4.4 times, respectively, when compared to patients with a single floater alone. Lattice degeneration and vitreous or retinal hemorrhage increased the risk of retinal breaks by 10.8 and 37.5 times when compared to eyes that did not have lattice degeneration or vitreous or retinal hemorrhage. During the follow-up period after laser photocoagulation, a new retinal tear was found in 2 patients (2/38, 5.3%). CONCLUSIONS: Vitreous or retinal hemorrhage, lattice degeneration, multiple floaters, and high myopia are risk factors of retinal breaks in patients with the symptom of floaters. Therefore, it is important for ophthalmologists to be aware of these risk factors and the patients at risk should be encouraged to attend follow-up examinations.

Comparison between Retinal Tear and Rhegmatogenous Retinal Detachment as the Cause of Dense Vitreous Hemorrhage

PURPOSE: To analyze retinal tears and to compare the clinical outcomes between retinal tear and rhegmatogenous retinal detachment (RRD) as the cause of dense non-diabetic vitreous hemorrhage in patients who underwent vitreoretinal surgery. METHODS: In a retrospective case series, the medical records of patients who presented dense non-diabetic vitreous hemorrhage and who underwent vitreoretinal surgery between January 2005 and June 2009 were reviewed. Among the 134 patients, 27 patients had dense vitreous hemorrhage caused by retinal tears. The first group had retinal tears only and the second group had accompanying RRD. A comparison of clinical features and postoperative prognoses between the two groups was performed. RESULTS: Among the 27 eyes with non-traumatic retinal tear and RRD, 18 were categorized into the retinal tear group and 9 to the RRD group. The demographic findings between the two studied groups exhibited no significant differences except for time between onset of symptoms and diagnosis. However, the time to diagnosis was significantly delayed in the group with RRD (22.67 +/- 37.47 days) compared to the retinal tear group (5.00 +/- 3.41 days) (p = 0.035). The amount of visual improvement was also greater in the retinal tear group than the RRD group (p = 0.002). CONCLUSIONS: Retinal tears are a major cause of non-diabetic vitreous hemorrhage. Vitreous hemorrhage caused by retinal detachment may result in delayed diagnosis and poor visual recovery. Therefore, early examinations in suspicion of RRD and appropriate treatments are needed in non-diabetic vitreous hemorrhage.

Perfluoro-N-octane as Postoperative Vitreous Substitutes in Retinal Detachment: A Case Report

PURPOSE: To report a case of retinal detachment with a giant retinal tear, which was treated with perfluorocarbon liquid as an intraocular substitute. CASE SUMMARY: A 37-year-old woman with a dislocated lens and a giant retinal tear underwent vitrectomy and lensectomy and was instructed to maintain a supine position after the operation. Perfluorocarbon liquid (Perfluoro-N-octane, C8F18) was used as a substitute in the vitreous cavity for 17 days. After 17 days, the perfluorocarbon liquid was removed and intraocular lens scleral fixation was performed. After removal of the perfluorocarbon liquid, the corneal endothelium was stable without other complications (including corneal edema, elevated intraocular pressure, ocular hypotony, macular pucker), and the best corrected visual acuity after intraocular lens scleral fixation was 0.4. CONCLUSIONS: Perfluorocarbon liquid is a useful surgical material in patients with a dislocated lens and retinal detachment with a giant retinal tear who have difficulty maintaining a prone position.

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.

Effect of Cryotherapy on Focal Adhesion Kinase in Retinal Pigment Epithelial Cells

PURPOSE: In the pathogenesis of proliferative vitreoretinopathy (PVR), retinal pigment epithelial (RPE) cells do not undergo apoptosis after separation from the basement membrane. In order to investigate the mechanism by which RPE cells resist apoptosis in PVR, the expression of focal adhesion kinase after cryotherapy was studied. METHODS: After lensectomy and vitrectomy was performed on rabbit eyes, a retinal tear was created. Cryotherapy was applied to the tear site one week after the tear creation. Rabbits were sacrificed at 1, 4 and 7 days after the tear formation and 30 minutes, 1, 4, 7, 9, 21 days after cryotherapy. Eyes were stained with anti-focal adhesion kinase (FAK) antibody. RESULTS: Expression of FAK increased after the tear formation and remained increased until 21days after cryotherapy. CONCLUSIONS: These data show that creation of a retinal tear and cryotherapy increases FAK expression and may contribute to resistance to apoptosis.

Vitrectomy in Severe Giant Retinal Tear

PURPOSE: To determine the results of pars plana vitrectomy (PPV) for the treatment of severe giant retinal tear. METHODS: We analyzed the clinical records of patients who had 150degrees or greater of giant retinal tear and underwent PPV. RESULTS: Of all 10 patients (10 eyes), 7 were male patients and mean age was 29.8 years. Giant retinal tear was idiopathic in 6 eyes and traumatic in 1 eye, and occurred after vitrectomy in 3 eyes. Primary operations were scleral buckle in 1 eye, PPV with intraocular gas injection in 2 eyes and with silicone oil (SO) injection in 7 eyes. In 3 eyes without SO injection, secondary operations were PPV with intraocular gas injection in 1 eye and with SO injection in 2 eyes. In 1 eye with PPV and intraocular gas injection, tertiary operation was PPV with SO injection. Removal of SO was done in all 10 eyes and SO was re-injected due to proliferative vitreoretinopathy in 2 eyes. Visual acuity was counting fingers or worse in 8 eyes before the primary operation and, on the final visit, 0.1 or better in 6 eyes and 0.3 or better in 3 eyes. CONCLUSIONS: These results suggest that PPV with SO injection might be better for the treatment of severe giant retinal tear than with intraocular gas injection.

Application of coherence tomography in the course of idiopathic macular hole / 中华眼底病杂志

Objective To investigate the course of the idiopathic macular hole (IMH) clinically diagnosed as at stage Ⅰ-Ⅳ by optical coherence tomography (OCT), and analyze the relationship between the posterior vitreous detachment (PVD) and the course of IMH. Methods Hadn′t undergone any operation, periodical OCT were performed on 72 eyes of 58 patients with IMH at stage Ⅰ-Ⅳ confirmed by Gass standard and the features of OCT images. Results The longest follow-up period was 43 months (average 13.4 months), and the examine times of OCT on each eye were between twice to 10 times (average 4.7 times). During the follow-up period, 23 eyes were in stage I in which 9 (39.1%) developed to stage II and 2 had recovered normal curve of fovea after PVD; 19 were in stage II in which 13 (68.4%) developed to Ⅲ-Ⅳ and 1 had closed hole after PVD; 11 were in stage III in which 5 (45.5%) developed to stage IV and 1 had partly closed hole 12 months later. The images of OCT showed that the process of macular hole was consistent with the course that vitreous depart from retina from the circumference of fovea till entire posterior detachment.Fifteen affected eyes in this series of patients had undcrygong surgical treatment due to serious progression of IMH in follow-up period. Conclusions There is a close relationship between the formation and development of macular hole and the occurrence of PVD. OCT can show the progress of the macular hole directly and offer an important technique in diagnosis, classification and surgical treatment of IMH.

A Case of Giant Retinal Tear in Atopic Dermatitis

Retinal detachments occuring in atopic dermatitis patients are usually associated with tears of peripheral retina or nonpigmented epithelium of the ciliary body or retinal dialysis. It has been considered relatively rare, however, its clinical reports have been increasing recently. We experienced a case of atopic dermatitis with retinal detachment of right eye caused by giant retinal tear and retinal tear of left eye in 23-year-old male, we could obtain successful result by treating his right eye with scleral buckling procedure and intravitreal gas injeciton.

The effect of cryotherapy on proliferative vitreoretinopathy (PVR)

Cryotherapy is implicated for inducing or aggravating proliferative vitreoretinopathy (PVR) by releasing retinal pigment epithelial (RPE) cells. These are based on the fact that PVR rarely occurs in a non-operated eye, and many of the PVR patients have received cryotherapy during surgery. Nonetheless, eyes with diathermy also developed PVR, and although there have been many experiments, the effect of cryotherapy on inducing PVR has not been proven experimentally in the living eye. We made retinal tears in living rabbit eyes, and applied cryotherapy on one eye of each rabbit. The result was compared histologically with the contralateral noncryothermized control eye. There was no statistically significant difference between the two groups concerning the migration of RPE, and the proliferation of RPE. Although the formation of an epiretinal membrane was more obvious in the cryothermized group, the difference was not statistically significant.

Effect of Cryotherapy on Proliferative Vitreoretinopathy(PVR)

Cryotherapy is blamed for inducing or aggravating PVR, by releasing retinal pigment epithelial(RPE) cells. These are based on the fact that PVR rarely occurs in non-operated eye, and many of PVR patients have received cryotherapy during surgery. Nontheless, in eyes with diathermy also developed PVR, and although there have been many experiments, the effect of cryotherapy on inducing PVR was not proven experimentally in the living eye. We made retinal tears in the living rabbit eyes, and applied cryotherapy on one eye of each rabbit. The result was compared histopathologically with noncryothermized control eye. There was no statistically significant difference between the two groups concerning the migration of RPE, and the proliferation of RPE. Although the formation of epiretinal membrane was more obvious in the cryothermized group, the difference was not statistically significant.