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AIM:To investigate the clinical efficacy of minimally invasive foldable capsular buckle(FCB)scleral buckling in treating rhegmatogenous retinal detachment(RRD).METHOD: This retrospective study enrolled 11 patients(11 eyes)with RRD treated with minimally invasive FCB scleral buckling at the Hainan Traditional Chinese Medicine Hospital from May to July 2023. The surgeries were performed without subconjunctival anesthesia, extraocular muscle pulling, intraocular positioning, retinal cryotherapy or drainage of subretinal fluid, or FCB suture fixation. Furthermore, the best corrected visual acuity(BCVA), intraocular pressure and complications were observed.RESULTS: Minimally invasive FCB scleral buckling was performed on 11 eyes, with successful retinal reattachment in 10 eyes(91%), and the remaining 1 eye(9%)had postoperative retinal re-detachment and underwent vitrectomy with silicone oil filling for multiple retinal tears. One-time successful surgery was in 4 eyes(40%), gas injection in vitreous body after the surgery was performed in 1 eye(10%), FCB position adjustment after the surgery was performed in 3 eyes(30%), gas injection in vitreous body and FCB position adjustment after the surgery were performed in 2 eyes(20%); and FCB was removed 4-12 wk after the surgery in 5 eyes(50%), without retinal redetachment. The average BCVA(LogMAR)of the 10 eyes improved from 1.30±1.10 before surgery to 0.37±0.39 at 4 wk after surgery(P<0.01); the average preoperative intraocular pressure was 11.51±3.37 mmHg and 13.72±2.57 mmHg at 4wk after surgery(P>0.05). No serious complications occurred.CONCLUSION:Minimally invasive FCB scleral buckling effectively treats RRD with minimal injury, simple operation, time-saving, and fewer complications.
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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.
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Purpose: To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). Methods: A retrospective analysis of eyes with ERD that underwent vitrectomy. Results: Twelve eyes (10 patients) with ERD, non?responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt–Koyanagi–Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re?surgery. The mean follow?up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best?corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline. Conclusion: Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.
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Purpose: We report clinical characteristics, risk factors, treatment outcomes, and prognostic predictors of post?vitrectomy secondary macular holes (MHs). Methods: This was a retrospective observational case series from November 2014 to December 2020. Eyes that developed secondary MH, two weeks and beyond after primary vitrectomy for non?MH indications, were enrolled. Pre? and intraoperative records were screened to exclude pre?existence of MH. Eyes with multiple vitreoretinal surgeries prior to MH detection and tractional myopic maculopathy were excluded. Results: A total of 29 eyes of 29 patients with a mean age of 52 years developed secondary MH post?vitrectomy. The most common indications for primary vitrectomy were rhegmatogenous retinal detachment (RRD, 48.2%) and tractional retinal detachment (TRD, 24.1%). Time to MH detection after primary vitrectomy was 91.5 ± 117.6 days. The mean minimum hole diameter was 530 ± 298 microns. Epi?retinal membrane and cystoid degeneration was noted in 6 (20.7%) and 12 (41.3%) eyes, respectively (p = 0.088). The mean time from MH detection to MH repair was 34 ± 42 days. The surgical intervention included internal limiting membrane peeling with tamponade in 25 eyes. Overall, 80% showed anatomic hole closure, 90.9% versus 57.1% in the RRD and TRD (p = 0.092), respectively. The mean best?corrected visual acuity (BCVA) at the final visit was 0.71 logarithm of the minimum angle of resolution. Thirteen eyes (52%) had a BCVA of 20/100 or better. Minimal hole diameter (p = 0.029) only predicted final visual acuity. The interval between MH diagnosis and repair did not affect hole closure significantly (p = 0.064). Conclusion: Secondary MH post?vitrectomy closed successfully with limited visual improvement and trails behind idiopathic MH.
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AIM: To compare the effectiveness and complications of treating rhegmatogenous retinal detachment(RRD)with foldable capsule body(FCB)and scleral buckling(SB).METHODS: The clinical data of 81 patients(82 eyes)with RRD who underwent surgery at our hospital from March 2019 to April 2022 were retrospectively analyzed. The differences in retinal reattachment rate, best-corrected visual acuity, the absorption of subretinal fluid, postoperative discomfort and incidence of complications between the two treatments were compared.RESULTS: The retinal reattachment rate was 96% in the FCB group and 92% in the SB group, with no significant difference between the two groups(P>0.05). The best corrected visual acuity of the affected macular eyes was different in the both groups(P<0.01). Both groups effectively promoted the absorption of subretinal fluid. The operation time of FCB group was 16.50(12.75, 25.00)min, while it was 38.00(36.25, 41.75)min in the SB group(P<0.001). Patients in the FCB group also had significantly lower eyelid swelling and pain symptoms than those in the SB group(P<0.001). The visual analogue scale(VAS)score at 1d after operation was 1.00(0.00, 2.00)in the FCB group and 3.00(2.00, 3.00)in the SB group(P<0.001).CONCLUSION: FCB is a safe and effective surgical method to treat RRD that can alleviate patient's pain. Furthermore, FCB has a significantly shorter operation time and milder postoperative adverse reactions than SB.
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Purpose: To evaluate the efficacy and safety of hybrid 26?gauge needle drainage in scleral buckling for rhegmatogenous retinal detachment (RRD). Methods: In this retrospective study, we included patients who underwent scleral buckling surgery along with subretinal fluid (SRF) drainage using the ‘Hybrid 26G needle drainage technique’. Pre?operative assessment included the best corrected visual acuity (BCVA), lens status, and extent of retinal detachment. Intra?operative surgical details such as the height of retinal detachment, number of attempts required to drain the fluid, amount of fluid drained, adequacy of break buckle relationship, and any intra?operative or post?operative complications were noted. Post?operatively, the final visual outcome and retina status were assessed at 3 months of follow?up. Results: A total of 10 eyes with primary RRD and proliferative vitreoretinopathy C1 or less were included. Pre?operatively, the mean BCVA was 2.43 ± 1.01 logMAR units, which improved significantly to 0.679 ± 0.45 logMAR units (p value < 0.05) at 3 months of follow?up. Regarding the extent of RRD, five eyes (50%) had a total detachment, two eyes (20%) had a sub?total detachment, and three eyes (30%) had an inferior detachment. Four eyes had shallow detachment, four had a moderate detachment, and two eyes had bullous detachment. Complete drainage of SRF (>75%) was achieved in five patients, and a partial but adequate drainage (50–75%) was achieved in the rest of the five patients. In none of the patients, inadequate or dry tap was encountered. No intra?operative complications were encountered. The retina was attached in eight out of ten eyes at 1 week and at a 1?month follow?up period. Two patients required pars plana vitrectomy for persistent SRF. The retina was attached in all the patients at 3 months of follow?up. Conclusion: The ‘Hybrid needle drainage’ technique is a safe and effective technique for SRF drainage in scleral buckling surgery
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AIM:To evaluate the macular microstructural changes in patients with rhegmatogenous retinal detachment(RRD)after silicone oil tamponade by spectral-domain optical coherence tomography(SD-OCT).METHODS:From November 2019 to July 2021, 27 patients with 27 eyes in RRD who underwent vitrectomy combined with silicone oil tamponade in Cangzhou Aier Eye Hospital were enrolled in this study as the observation group, other 30 healthy volunteers with 30 eyes were included in the control group. The best corrected visual acuity(BCVA)of patients before and after operation were observed, and quantified evaluation of the postoperative macular microstructural changes were performed by SD-OCT.RESULTS: The BCVA(LogMAR)of the observation group at 1wk and 3mo after operation(0.61±0.23, 0.69±0.34)were improved compared with those before operation(1.43±0.77)(all P<0.01). The cube volume and average cube thickness in the macular area at 3mo after operation in the observation group were lower than those at 1wk and 1mo after operation in the control group(all P<0.05). There were no differences in the average ganglion cell-inner plexiform layer(GCIPL)thickness, minimum GCIPL thickness, average macular retinal nerve fiber layer(mRNFL)thickness and minimum mRNFL thickness at 1wk, 1 and 3mo after operation in the observation group, but all decreased compared with the control group(all P<0.01). There were 9 eyes with subretinal fluid(SRF)in the observation group during postoperative follow-up, SRF had a tendency to be gradually absorbed, but 1 eye had a secondary macular hole; 3 eyes had ellipsoid zone disruption, which had a tendency to be gradually repaired; 2 eyes had submacular perfluorocarbon liquid; 2 eyes had macular edema.CONCLUSION: SD-OCT can show the microstructure and morphological changes very well in macular area in patients with RRD after silicone oil tamponade, and has important clinical value for the preoperative and postoperative follow-up evaluation of RRD.
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AIM: To observe the changes of the morphology and structure of macula, blood flow density of macula and optic disc, as well as retinal nerve fiber layer thickness by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in patients with rhegmatogenous retinal detachment(RRD)under went sclera buckling(SB). METHODS: As a cross-sectional case-controlled study, 25 patients(25 eyes)were diagnosed with RRD in the department of ophthalmology, Ganzhou People's Hospital from July 2014 to March 2021. The differences in the vascular density(VD)of superficial vessel cluster(SVC), the VD of deep vessel cluster(DVC)of macula, the SVC-VD of optic disc, retinal nerve fiber layer(RNFL), central macular thickness(CMT), subfoveal choroidal thickness(SFCT)and outer structure of macula between the affected eyes and healthy eyes at the last post-operative follow-up were compared, and the correlation indicators affecting best corrected visual acuity(BCVA, LogMAR)of the affected eyes at the last follow-up were analyzed. RESULTS: There were no statistically significant in SVC-VD and DVC-VD of macula, SVC-VD of optic disc, RNFL, CMT, SFCT between the affected eyes and healthy eyes at the last post-operative follow-up(all P>0.05); At the last follow-up visit, the comparison of macular outer structure on OCT between the affected eyes and the healthy eyes showed that the light band integrity of the external limiting membrane(ELM), myoid zone(MZ), ellipsoid zone(EZ)and outer segment of photoreceptor(OS)had no statistically significant difference(all P>0.05), while the light band integrity of interdigitation zone(IZ)had significant difference(P=0.014); The difference of BCVA(LogMAR)between the affected eyes and the healthy eyes at the last follow-up was statistically significant(P=0.002). There was significant correlation between BCVA(LogMAR)of affected eyes at the last post-operative follow-up and the presence or absence of macular involvement, the correlated with SVC-VD of optic disc, the integrity of the light bands of ELM, MZ, EZ, OS and IZ on the outer structure of macula, it was positively correlated with the presence or absence of macular involvement(rs=0.401, P=0.047)and it was negatively correlated with SVC-VD of optic disc, the integrity of the light bands of ELM, MZ, EZ, OS and IZ on the outer structure of macula(all P<0.05).CONCLUSION: The OCT and OCTA can be used to observe fundus changes after SB surgery for RRD to obtain long-term follow-up information related to vision prognosis, and visual prognosis depends on the recovery of retinal outer structure, and the integrity of IZ structure is more important for visual recovery; The SVC-VD of optic disc is correlated with visual prognosis, and whether it was correlated with intraocular pressure require further observation and verification with postoperative continuous data.
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@#AIM: To observe the efficacy and safety of pars plana vitrectomy(PPV)combined with air tamponade in the treatment of rhegmatogenous retinal detachment(RRD), which caused by superior break(s)following previous vitreoretinal surgery.<p>METHODS: Retrospective analysis of the inpatients in our hospital from November 2017 to October 2019. Patients with RRD caused by superior break(s)who had underwent previous vitreoretinal surgeries and the proliferative vitreoretinopathy less than PVR-C1 were enrolled. For treatment, patients underwent PPV combined with air tamponade. During the operation, the residual vitreous cortex was fully removed, and the subretinal fluid was aspirated from retinal break(s)as much as possible. Make sure the subretinal fluid around the hole was fully drained. Then firmly laser spots were accomplished to seal the retinal break(s). Finally, filtered air was left in the vitreous cavity as tamponade agent. The patients were informed to keep a prone position for 24h postoperation. The primary outcomes were primary and final success rates, best corrected visual acuity(BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.<p>RESULTS: Totally 31 patients(31 eyes)with follow-up time more than 6mo were included. The range of retinal detachment was 6.7±3.8h, and the number of retinal breaks was 1.2±0.7. There are 23 eyes(74%)with macular detachment and 18 eyes(58%)with intraocular lens. 6 eyes(19%)were treated with phacoemulsification and intraocular lens implantation together. The rate of primary retinal reattachment in enrolled patients was 87%(27/31), and the final reattachment rate was 100%(31/31). At the 6mo of postoperatively, the BCVA(LogMAR)increased from 2.17±1.27 to 0.53±0.25(<i>P</i><0.001). Furthermore, 5 eyes(16%)developed transient ocular hypertension.<p>CONCLUSION: PPV with air tamponade can achieve a high success reattachment rate in the management of RRD following previous vitreoretinal surgery. It has the advantages of short postoperative prone time and fewer complications.
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@#AIM: To investigate the correlation between macular mierostructure changes and visual outcomes after scleral buckling for macular-off primary rhegmatogenous retinal detachment(RRD)by three-dimensional optical coherence tomography(3D-OCT).<p>METHODS: Retrospective case review, the clinical data of scleral buckling in 30 eyes of 30 cases of RRD involving macular area were analyzed retrospectively. The changes of ellipsoid zone(EZ), external 1imiting membrane(ELM), subretinal fluid(SRF)and central retinal thickness(CRT)were observed and the relationship between them and best corrected visual acuity(BCVA)was analyzed by 3D-OCT at 2d, 2wk, 1, 3 and 6mo after operation.<p>RESULTS: Postoperative SRFH and CRT showed a descended trend. Postoperative BCVA showed an ascendant trend. Multiple comparisons: there were significant difference in each groups except SRFH(2wk <i>vs</i> 1mo, <i>P</i>>0.05), CRT(2d <i>vs</i> 2wk, <i>P</i>>0.05), BCVA(2d <i>vs</i> preoperation, 2wk <i>vs</i> preoperation, <i>P</i>>0.05). There are four forms of EZ and ELM::9 eyes, intact ELM and EZ(EZ+ELM+); B: 7 eyes, intact ELM with disrupted EZ:(EZ-ELM+); AC: 6 eyes, intact EZ with disrupted ELM:(EZ+ELM-); D: 8 eyes, disrupted ELM and EZ:(EZ-ELM-), the BCVA of the above four types are 0.15±0.04, 0.50±0.06, 0.54±0.05 and 0.59±0.09, there were significant difference in each groups except(C <i>vs</i> B, <i>P></i>0.05)and(C <i>vs</i> D, <i>P</i>>0.05). The incidence of SRF was 87% 2d after operation, 46.6% patients had persistent SRF at 6mo after operation. Postoperative CRT was positively correlated with postoperative SRFH.<p>CONCLUSION: After scleral buckling, the macular microstructure showed dynamic changes. The effect of SRF may be manifested as BCVA delayed recovery. With the slow absorption of SRF, CRT decreased and BCVA increased. The intact ELM or EZ shows better vision, but the disrupted ELM means worse vision.
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@#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).
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@#Rhegmatogenous retinal detachment(RRD)is the separation of the retinal nerve sensory layer and the pigment epithelium layer caused by retinal tears. It is a kind of ophthalmic emergency. If it is not treated in time, the blinding rate is close to 100%. Surgery is an important way to treat RRD. With the deepening of disease awareness and the improvement of retinal reattachment techniques, RRD reattachment has achieved a higher anatomical success rate, but in clinical, the postoperative visual experience of patients is still not ideal. This article mainly summarizes the influencing factors of RRD visual function prognosis and provides guidance for clinical treatment.
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@#AIM: To investigate subfoveal subretinal fluid thickness(SFT)and subfoveal choroidal thickness(CT)after scleral buckling surgery(SBS)for macula-off rhegmatogenous retinal detachment(RRD).<p>METHODS: Retrospective observational case series. Twenty-three patients with macula-off RRD underwent successful SBS combined with cryotherapy. Patients with recurrent retinal detachment and proliferative preretinal membranes were excluded. Optical coherence tomography(OCT)was used to measure subfoveal SFT and subfoveal CT. The OCT images were then evaluated preoperatively and postoperatively at 1wk, 1, 3, 6, and 12mo. Best-corrected visual acuity(BCVA)was measured preoperatively and postoperatively.<p>RESULTS: All of the patients had subretinal fluid 1wk after operation. Subfoveal SFT gradually reduced over time. The subfoveal CT was thicker 1wk postoperatively and gradually decreased subsequently. The BCVA(mean±SD, LogMAR)was 0.60±0.35, which was a statistically significant change from the preoperative BCVA(<i>t</i>=6.35, <i>P</i><0.01).<p>CONCLUSION: The subretinal fluid was gradually absorbed with time, and the subfoveal CT gradually decreased after the early thickening. The SBS rapidly improved the visual acuity of the patients after the early postoperative period.
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@#AIM: To evaluate the outcome of scleral buckling(SB)in patients with rhegmatogenous retinal detachment(RRD)with subretinal proliferation. <p>METHODS: This was a retrospective clinical analysis research. Patients with RRD associated with subretinal proliferation who visited the Beijing Tongren Hospital were included in this study. From October 2016 to January 2020. There were 54 patients, including 36 males and 18 females, with the average age of 24.92±11.99 years. The retinal detachment range <1, 1-2 and >2 quadrants were 12, 25 and 17 eyes, respectively. The macula was involved in 47 eyes. Subretinal proliferation range <1, 1-2 and >2 quadrants were 26, 23 and 5 eyes, respectively. The average Logarithm of the minimum angle of resolution(LogMAR)best corrected visual acuity(BCVA)was 1.21±0.77, all patients were treated with SB under general anesthesia and the anatomical retinal reattachment, visual acuity and complications were observed.<p>RESULTS: The retina was reattached in 52 eyes(96%), and 2 eyes(4%)needed pars plana vitrectomy for retinal redetachment. The mean follow wp was 19.17±11.15mo. The BCVA improved from 1.21±0.77 LogMAR before surgery to 0.61±0.40 LogMAR after surgery(<i>P</i><0.01). No serious complications occurred. <p>CONCLUSION: Under the circumstance of correct selection of indications, SB was highly successful in eyes with RRD associated with subretinal proliferation.
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Objetivo: Describir el comportamiento de la hipertensión ocular asociada al desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo de corte longitudinal retrospectivo de una serie de casos atendidos en la consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período comprendido de mayo del año 2016 a diciembre de 2019. Se estudiaron 7 ojos de 7 pacientes. Se utilizaron las siguientes variables: edad, sexo, antecedentes patológicos oculares, tiempo de evolución de la disminución de la visión, tensión ocular, tipo de rotura retinal, cirugía de retina realizada y tratamiento antihipertensivo ocular. Resultados: Predominó el sexo masculino, con un promedio de edad de 27,2 años. La mayoría de los pacientes tuvieron rotura retinal en el cuadrante nasal superior y todos en extrema periferia. Todos los pacientes tuvieron la presión intraocular antes de la cirugía por encima de 30 mmHg. A todos se le indicó tratamiento hipotensor tópico y se les realizó cirugía convencional. Con diferentes fluctuaciones de la presión intraocular posterior a la cirugía, todos los pacientes normalizaron la tensión ocular y mantuvieron la retina aplicada. Conclusiones: El diagnóstico correcto de este síndrome puede ofrecer dificultad porque los signos de una condición pueden enmascarar los de otra. El reconocimiento de la entidad puede ser más fácil si el oftalmólogo tiene en mente que estas entidades pueden aparecer juntas. De esta forma, se hace un diagnóstico y un tratamiento certero que evite la discapacidad visual por esta causa(AU)
Objective: Describe the behavior of ocular hypertension associated to rhegmatogenous retinal detachment. Methods: An observational retrospective longitudinal descriptive study was conducted of 7 eyes of 7 patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to December 2019. The variables considered were age, sex, ocular pathological antecedents, time of evolution of vision reduction, ocular tension, type of retinal tear, retinal surgery performed and ocular hypertension treatment. Results: A predominance was found of the male sex, with a mean age of 27.2 years. Most of the patients had retinal tear in the upper nasal quadrant, and all in the extreme periphery. In all cases, intraocular pressure was above 30 mmHg before surgery. All patients were indicated topical hypotensive treatment and underwent conventional surgery. With different intraocular pressure fluctuations after surgery, all patients normalized their ocular tension and retained the retina applied. Conclusions: Correct diagnosis of this syndrome may be difficult to achieve, since the signs of one condition may mask those of another. Identification may be easier if the ophthalmologist bears in mind that these diseases may occur together. An accurate diagnosis may thus be made and an effective treatment indicated which will prevent visual disability due to this cause(AU)
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Humans , Male , Adult , Retinal Perforations , Retinal Detachment/diagnosis , Ocular Hypertension/etiology , Intraocular Pressure/drug effects , Antihypertensive Agents/therapeutic use , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Observational Studies as TopicABSTRACT
INTRODUCCIÓN: La cirugía de cataratas es un factor de riesgo para el desprendimiento de retina regmatógeno. Dentro de las técnicas utilizadas para su reparación, se encuentran la vitrectomía pars plana y la banda de silicona. La combinación de ambas técnicas ha sido propuesta en pacientes con desprendimiento de retina previamente operados de cataratas (pseudofáquicos o afáquicos), pero su efectividad no está clara. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. A partir de éste, concluimos que la combinación de vitrectomía pars plana y banda de silicona podría resultar en poca o nula diferencia en la reaplicación retinal primaria, en la reaplicación retinal final y en la agudeza visual, pero la certeza de la evidencia es baja. Respecto a las complicaciones, no es posible establecer con claridad si la combinación de ambas técnicas aumenta la frecuencia de vitreorretinopatía proliferativa o si disminuye el desarrollo de glaucoma, debido a que la certeza de la evidencia fue evaluada como muy baja.
INTRODUCTION: Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.
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Humans , Scleral Buckling/methods , Vitrectomy/methods , Retinal Detachment/surgery , Retinal Detachment/etiology , Cataract Extraction/adverse effects , Randomized Controlled Trials as Topic , Databases, FactualABSTRACT
RESUMEN Objetivos: Determinar los factores epidemiológicos, sistémicos y oculares del desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo transversal de los casos nuevos con desprendimiento de la retina regmatogéno que requirieron cirugía y se presentaron de forma consecutiva en la Consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde mayo del año 2016 hasta mayo de 2017. Se estudiaron las variables demográficas y los antecedentes patológicos sistémicos y oculares. Los resultados se expresaron en frecuencias absolutas y relativas (variables cualitativas) y se calculó la media y la desviación estándar en las cuantitativas. Resultados: En el período estudiado se atendieron 237 casos nuevos de desprendimiento de la retina regmatogéno que requirieron cirugía. La edad media de estos fue de 57,79 años (desviación estándar 11,98). Prevaleció el sexo masculino (62 por ciento). La mayor cantidad de casos provenía de las provincias occidentales, fundamentalmente de La Habana (43,9 por ciento) y los primeros síntomas se presentaron en los meses primaverales (48,1 por ciento). La hipertensión arterial se reportó en el 54,4 por ciento. Entre los antecedentes oculares predominó la cirugía de catarata (65,8 por ciento), seguida de la degeneración reticular en la retina periférica (36,3 por ciento). Conclusiones: El desprendimiento de la retina regmatógeno se presenta en edades avanzadas y la cirugía de catarata es un antecedente frecuente en estos casos(AU)
ABSTRACT Objectives: Determine the epidemiological, systemic and ocular factors of rhegmatogenous retinal detachment. Methods: A cross-sectional observational descriptive study was conducted of the new cases of rhegmatogenous retinal detachment requiring surgery and presenting consecutively at the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to May 2017. Analysis was performed of demographic variables and systemic and ocular pathological antecedents. Results were expressed as absolute and relative frequencies (qualitative variables), whereas quantitative variables underwent mean and standard deviation estimation. Results: During the study period, 237 new cases were seen of rhegmatogenous retinal detachment requiring surgery. Mean age was 57.79 years (standard deviation 11.98). The male sex prevailed (62 percent). Most cases were from the western provinces, mainly Havana (43.9 percent), and the first symptoms appeared in the spring months (48.1 percent). Hypertension was reported in 54.4 percent of the cases. The prevailing ocular antecedents included cataract surgery (65.8 percent), followed by lattice degeneration in the peripheral retina (36.3 percent). Conclusions: Rhegmatogenous retinal detachment presents in advanced ages. Cataract surgery is a common antecedent in these cases(AU)
Subject(s)
Humans , Male , Middle Aged , Scleral Buckling/methods , Retinal Detachment/diagnosis , Epidemiologic Factors , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as TopicABSTRACT
@#AIM: To compare the efficacy of air versus silicone oil tamponade for management of rhegmatogenous retinal detachment(RRD)following 25G pars plana vitrectomy(PPV).<p>METHODS: A prospective, randomized comparative study. 146 eyes from 146 patients who underwent 25G transconjunctival sutureless vitrectomy to repair rhegmatogenous retinal detachment were performed. Totally 60 eyes used air tamponade but 86 eyes used silicone oil tamponade. The follow-up time ranged from 6-12mo. The best corrected visual acuity(LogMAR), intraocular pressure, retinal reattachment rate, intraoperative and postoperative complications were compared.<p>RESULTS: One month after surgery, the mean BCVA was 0.45±0.5 in the air tamponade group and 0.78±0.65 in the silicone oil tamponade group, it were both evidently improved in comparison with before surgery, what's more, air tamponade had significantly better BCVA than those in the silicone oil tamponade(both <i>P</i><0.05). 3mo after surgery, the reattachment rate of patients in air group was lower than that of silicone oil group(93.3% <i>vs</i> 97.7%), but had no significant differences between the two groups. 6mo after surgery, the anatomical success rate were 100% in both groups. The main intraoperative complication was iatrgenic retinal breaks in 10 eyes(6.8%). The main postoperative complication was high intraocular pressure, the intraocular pressure 1wk after surgery in the silicone oil tamponade group was evidently higher than that air tamponade group(<i>P</i><0.001). No serious complication such as endophthalmitis and choroidal hemorrhage were observed in both groups.<p>CONCLUSION: For the simple early RRD, air tamponade had equivalent reattachment rate to silicone oil tamponade after 25G PPV. In the early postoperative, the visual acuity of air group was better comparing with silicone oil group, and was lower incidence of high intraocular pressure.
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@#AIM: To compare the postoperative outcomes after segmental scleral buckling(SSB)surgery with minimal <i>in situ</i> conjunctival incision(MCI)and conventional limbal conjunctival incision(LCI). <p>METHODS: Prospective randomized controlled study. Eighty eyes of 80 patients with rhegmatogenous retinal detachment(RRD)who received SSB surgeries in our hospital from August 2016 to November 2018 were recruited. They were randomly divided into two groups. Patients in control group were performed with conventional LCI, while patients in observation group received MCI. The length of the surgery, the retinal reattachment rate and the visual analogue scale(VAS)for evaluating the pain on the first postoperative day, questionnaire scoring method for evaluating the postoperative comfort level(including foreign body sensation and tearing)on the first, seventh, fourteenth, and thirtieth days were recorded. <p>RESULTS: The difference of surgery time between the control group and the observation group was statistically significant(<i>t</i>=2.057, <i>P</i><0.05). There was no significance in retinal reattachment rate between two groups. At the first day after surgery, the postoperative pain of the observation group was significantly lower than the control group(<i>P</i><0.05). At the first and seventh day after surgery, the observation group had higher postoperative comfort questionnaire score than the control group(<i>P</i><0.01), however, at the fourteenth and thirtieth day after surgery, the score was similar between the two groups(<i>P</i>>0.05). <p>CONCLUSION: Using MCI in SSB operation could shorten the operation time and significantly reduced postoperative pain and discomfort level.
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@#AIM: To observe the efficacy and safety of 25-gauge vitrectomy combined with air tamponade for rhegmatogenous retinal detachment. <p>METHODS: The clinical data of 30 eyes with primary rhegmatogenous retinal detachment(RRD)from 30 patients who received vitrectomy with intraocular air tamponade in Zunyi First People's Hospital from August 2017 to December 2018 were retrospectively analyzed. The best corrected visual acuity(BCVA)(LogMAR), intraocular pressure were evamined before surgery, 1wk and 1mo after surgery, while the retinal reattachment rate, intraoperative and postoperative complications were recorded.<p>RESULTS: The mean BCVA was significant different among before surgery, 1wk and 1mo after surgery(<i>F</i>=3.74, <i>P</i>=0.047), and the BCVA at 1wk and 1mo after surgery was evidently improved in comparison with before surgery(0.64±0.36 <i>vs </i>0.87±0.71; 0.37±0.22 <i>vs</i> 0.87±0.71). The mean IOP was(13.61±3.57),(15.74±4.84)and(14.05±2.88)mmHg before surgery, 1wk and 1mo after surgery, showing no significant difference in IOP before and after operation(<i>F</i>=4.13, <i>P</i>=0.051). The retinal reattachment rate of retinal hiatus was 97%(29/30)1wk after operation. Postoperative OCT monitored 1 eye of persistent subomental effusion, which was absorbed 3mo after operation.<p>CONCLUSION: Vitrectomy combined with air tamponade is effective in the treatment of rhegmatogenous retinal detachment. It can improve visual quality, reduce complications related to silicone oil and reduce the economic burden of patients.