Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment / Fatores de risco para falha de tratamento após vitrectomia primária sem retinopexia com introflexão escleral

ABSTRACT Objective To assess pre-operative conditions that could influence primary anatomical success rate in a cohort of patients with rhegmatogenous retinal detachments (RRD) treated with primary vitrectomy and no scleral buckling. Methods A retrospective analysis was performed in a group of patients that underwent primary pars plana vitrectomy with gas tamponade and without scleral buckling for RRD between 2014 and 2019, with a minimum follow-up of 4 months. Results 305 eyes of 301 patients were included; 59.01% eyes were phakic, 39.01% were pseudophakic and 1.96% aphakic. 13.11% of patients had proliferative vitreoretinopathy grade B and 3.28% proliferative vitreoretinopathy grade C at the time of diagnosis while 83.61% had proliferative vitreoretinopathy grade 0 or A. 53.1% had superior breaks, 15.4% inferior breaks and 31.5% a combination of both. Primary success rate was obtained in 90.82% of eyes (95%CI 87.58-94.06). 9.18% of eyes (95%CI 5.94-12.42) re-detached. In 3.27% the cause of re-detachment was proliferative vitreoretinopathy, and in the remaining 5.90% because of a new or a missed break, the leakage of a previously treated break, or an area of shallow peripheral detachment with no detectable break. Of 181 phakic eyes, 10.49% re-detached, whereas in over 126 aphakic or pseudophakic eyes 7.75% re-detached (p=0.42). 16.39% eyes of the entire cohort had preoperative grade B or C proliferative vitreoretinopathy, whereas 32.14% of re-detached eyes had preoperative grade B or C proliferative vitreoretinopathy (95%CI 17.29-46.99; p=0.02). Th eyes that re-detached after the first surgery had a mean of 2.5 (95%CI 1.86-3.13) retinal tears, against a mean of 1.87 (95%CI 1.73-2.00) retinal tears of those that did not re-detach after the first surgery (p=0.02). Conclusion We found location of breaks and lens status to be independent factors not related to a lower single operation success rate, whereas the number or size of breaks and preoperative proliferative vitreoretinopathy stages B or C were independent factors related to a higher likelihood of re-detachment.

RESUMO Objetivo Avaliar condições pré-operatórias que poderiam influenciar a taxa de sucesso anatômico primário em uma coorte de pacientes com descolamento de retina regmatogênico tratada com vitrectomia primária e sem introflexão escleral. Métodos Foi realizada uma análise retrospectiva em um grupo de pacientes submetidos a vitrectomia primária pars plana com tamponamento gasoso e sem introflexão escleral por desprendimento de retina regmatogênico entre os anos 2014 e 2019, com monitoramento mínimo de 4 meses. Resultados Foram incluídos 305 olhos de 301 pacientes; 59,01% dos olhos eram fáquicos, 39,01% eram pseudofáquicos, e 1,96% era afáquico; 13,11% dos pacientes tinham vitreorretinopatia proliferativa grau B, e 3,28%, vitreorretinopatia proliferativa grau C no momento do diagnóstico, enquanto 83,61% tinham vitreorretinopatia proliferativa grau 0 ou A; 53,1% tinham rasgaduras superiores; 15,4%, rasgaduras inferiores e 31,5%, uma combinação de ambas. A taxa de sucesso primário foi obtida em 90,82% dos olhos (IC95% 87,58-94,06); 9,18% dos olhos (IC95% 5,94-12,42) se redestacaram. Em 3,27%, a causa do redescolamento foi vitreorretinopatia proliferativa e, nos 5,90% restantes, por causa de uma ruptura nova ou perdida, o vazamento de uma ruptura previamente tratada, ou uma área de descolamento periférico superficial sem ruptura detectável. Dos 181 olhos fáticos, 10,49% redestacaram-se, enquanto em mais de 126 olhos afáquicos ou pseudofáquicos 7,75% redestacaram-se (p=0,42); 16,39% dos olhos de toda a coorte tinham vitreorretinopatia proliferativa pré-operatória grau B ou C, enquanto 32,14% dos olhos redescolados tinham vitreorretinopatia proliferativa pré-operatória grau B ou C (IC95% 17,29-46,99) (p=0,02). Os olhos que se redescolaram após a primeira cirurgia tiveram média de 2,5 (IC95% 1,86-3,13) lágrimas retinianas, contra uma média de 1,87 (IC95% 1,73-2,00) lágrima retiniana daqueles que não se redestacaram após a primeira cirurgia. (p=0,02). Conclusão A localização das rasgaduras e o status da lente são fatores independentes não relacionados a uma menor taxa de sucesso da operação, enquanto o número ou o tamanho das rasgaduras e estágios vitreorretinopatia proliferativa pré-operatórios B ou C foram fatores independentes relacionados a uma maior probabilidade de redescolamento.

Glaucoma e óleo de silicone / Glaucoma and silicone oils

RESUMO O óleo de silicone é um importante tampão utilizado na retinopexia cirúrgica de casos graves de descolamento de retina. O aumento da pressão intraocular e o desenvolvimento de glaucoma secundário são frequentes complicações da sua utilização. A depender do período de aparecimento, diversos mecanismos justificam a ocorrência de tais complicações. Compreender os fatores de riscos e a patogênese do aumento da pressão intraocular associada a aplicação de óleo de silicone em cirurgia retiniana ajuda a orientar o tratamento adequado para cada paciente. O objetivo deste artigo é revisar a literatura sobre a patogenia, a incidência, os fatores de risco e o tratamento desta condição clínica.

ABSTRACT Silicone oil has been an important intraocular tamponade in retinopexy in cases of complicated retinal detachment surgery. The increase of intraocular pressure and development of secondary glaucoma are a known complication of its use. A variety of mechanisms have been proposed for the pathogenesis, depending on the onset. This article aims to review the literature about pathogenesis, the incidence and risk factors, as well as the treatment of this pathology.

Subfoveal perfluorocarbon liquid removal by peeling of internal limiting membrane, without retinotomy / Remoção de perfluorocarbono líquido subfoveal, sem retinotomia, através do peeling da membrana limitante interna

ABSTRACT Perfluorocarbon liquid has been widely used during vitreoretinal operations. Subretinal retention is a rare intraoperative complication, but even small quantities can damage the macular structure and function, and no standard treatment has been established. We encountered a 43-year-old woman who presented a retained subfoveal bubble after a vitreoretinal operation due to primary rhegmatogenous retinal detachment. Herein, we describe the procedure we used to remove the perfluorocarbon liquid without retinotomy using internal limiting membrane peeling.

RESUMO O perfluorocarbono líquido tem sido amplamente durante cirurgias vitreorretinianas. A retenção subretiniana, é uma complicação intraoperatória rara, mas mesmo pequenas quantidades podem danificar a estrutura e função macular, e nenhum tratamento padrão foi estabelecido. Encontramos uma mulher de 43 anos que apresentou bolha subfoveal retida após uma cirurgia vitreorretiniana devido a descolamento de retina regmatogênico. Aqui, descrevemos o procedimento que usamos para remover o líquido perfluorocarbono sem retinotomia usando peeling da membrana limitante interna.

Vitrectomía pars plana asociada a banda de silicona comparada con vitrectomía pars plana para desprendimiento de retina pseudofáquico y afáquico / Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment

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.

Inverted internal limiting membrane flap for the management of optic disc pit maculopathy / Técnica do flap invertido da membrana limitante interna para o manejo da maculopatia causada pela fosseta do disco óptico

ABSTRACT Optic disc pit is a rare congenital anomaly that can cause serous macular detachment. It has no universally accepted single treatment. Recently, several investigators have performed new procedures to directly seal the pit. Herein, we report a case showing a promising method for optic pit maculopathy surgical treatment. We created an inverted internal limiting membrane flap and fold it over the pit to promote barrier in order to stop further fluid accumulation. Gradual absorption of subretinal fluid was observed over 12 months of follow-up. Optical coherence tomography can demonstrate internal limiting membrane folded over the pit and progressive subretinal fluid resolution. This technique resulted in a satisfactory anatomic outcome with good functional improvement in the best-corrected visual acuity.

RESUMO A fosseta do disco óptico é uma rara anomalia con gênita que pode causar descolamento de retina seroso na mácula. Não há um tratamento cirúrgico padrão universalmente aceito. Recentemente, cirurgiões têm realizado procedimentos novos que visam selar o buraco diretamente. Esse caso clínico mostra um método promissor para o tratamento cirúrgico da maculopatia causada pela fosseta do disco. Optamos por criar um flap invertido com a membrana limitante interna, dobrando-o sobre a fosseta para promover uma barreira, impedindo o acúmulo de fluido. A absorção gradual do líquido subretiniano foi observada ao longo de 12 meses de acompanhamento. Imagens de tomografia de coerência óptica podem demonstrar a membrana limitante interna dobrada sobre a fosseta e a resolução progressiva do fluido subretiniano. Esta técnica resultou em um resultado anatômico satisfatório com boa melhora funcional na acuidade visual.

Resultados postquirúrgicos en pacientes con desprendimiento de retina regmatógeno asociado a agujero macular concomitante / Postsurgical results in patients with rhegmatogenous retinal detachment associated with concurrent macular hole

Introducción: el desprendimiento de retina regmatógeno (DRR) y agujero macular concomitante (AM) es una asociación poco frecuente, se reporta alrededor del 1-1,7%. Objetivo: presentar los resultados anatómicos y funcionales obtenidos en 11 casos intervenidos por DRR asociado a AM. Diseño del estudio: estudio observacional descriptivo retrospectivo. Método: estudio retrospectivo. Se registraron 11 pacientes con estas características entre 2010-2018. Se realizó vitrectomía con calibre 23 G, cerclaje escleral, remoción de membrana limitante interna (MLI), endofotocoagulación, lensectomía en los pacientes fáquicos y tamponaje con aceite de silicón o gas. Se evaluaron las siguientes variables: edad, sexo, agudeza visual (AV) al diagnóstico, tiempo de evolución del DRR, número de desgarros, grado de proliferación vitreoretiniana (PVR), si requirió retinectomía, tiempo de tamponaje con aceite de silicón, AV posterior a la extracción de aceite con colocación de lente intraocular y si se obtuvo el cierre del AM. El análisis estadístico descriptivo consistió en las variables cualitativas en frecuencias absolutas y relativas, mientras que en las cuantitativas medidas de tendencia central tipo promedio con rango mínimo y máximo. Resultados: los pacientes presentaban una edad promedio de 63 años (rango 53-74) con agudeza visual (AV) preoperatoria entre proyección luminosa y cuenta dedos. Diez pacientes presentaban mácula desprendida; el número de desgarros fueron de 1 a 2. El grado de PVR al diagnóstico: 2 grado B; 3 grado C2; 2 grado D1; 4 casos sin PVR. En 2 pacientes con PVR C3 y D1 se realizó retinectomía en 180°. En el 82% de los casos se logró la reaplicación de la retina en la primera cirugía, 100% en la segunda y en el 64% se constató el cierre completo del AM. La AV final fue entre 20/200 a 20/50, donde las mejores AV se asocian a casos con intervención precoz y sin PVR. Conclusión: Se encontró una tasa de reaplicación de la retina similar a O'Driscoll et al. donde alcanza el 78%, aunque solo 31% de su serie logra el cierre completo del AM utilizando gas SF6 como tamponaje sin pelaje de la MLI. En este estudio la tasa de cierre del AM es mayor alcanzando el 64% con pelaje de la MLI y una tasa de éxito anatómico con reaplicación de la retina en el 82% en la primera intervención.

Background: rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) is a rare association, reported around 1-1,7%. Objective: to report anatomical and functional postoperative results in 11 patients with RD associated with MH. Study design: observational retrospective descriptive study. Method: this is a retrospective study. Eleven patients were registered with RRD and MH between 2010-2018. A 23G vitrectomy, scleral buckling, internal limiting membrane (ILM) peeling, laser photocoagulation, lensectomy in phakic patients and tamponade with silicone oil or gas were performed. The following variables were evaluated: age, sex, visual acuity (VA) at diagnosis, time of evolution of RRD, number of retinal tears, degree of vitreoretinal proliferation (VRP), if retinectomy is required, tamponade time with silicone oil, VA after extraction of silicon oil and scleral fixation of intraocular lens and if closure of the MH was obtained. The descriptive statistical analysis consisted of qualitative variables in absolute and relative frequencies; in the quantitative variables were applied measures of central tendency like average with minimum and maximum range. Results: the patients had an average age of 63 years (range 53-74) with preoperative visual acuity (VA) between luminous projection and counting fingers. Ten patients had detached macula; the number of retinal tears were 1 to 2. The degree VRP at diagnosis: 2 grade B; 3 grade C2; 2 grade D1; 4 cases without VRP. In 2 patients with VRP C3 and D1, a 180° retinectomy was performed. In 82% of the cases, the reapplication of the retina was achieved in the first surgery, 100% in the second and in 64% the complete closure of the MH was confi rmed. The final VA was from 20/200 to 20/50, where the best visual outcomes are associated with early intervention and without VPR. Conclusion: this study found a retinal reapplication rate similar to O'Driscoll et al. where it reaches 78%, although only 31% of this report achieves the complete closure of the MH using SF6 gas as tamponade without ILM peeling. In this study, the closure rate of the MH is greater reaching 64% with ILM peeling and an anatomical success rate with retinal reapplication in 82% in the first intervention.

Retinitis necrotizante aguda. A propósito de un caso / Acute necrotizing retinitis. Case report

RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.

ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.

Surgical outcomes of rhegmatogenous retinal detachment associated with ocular toxoplasmosis / Resultados cirúrgicos do descolamento regmatogênico de retina associado à toxoplasmose ocular

ABSTRACT Purpose: To evaluate the anatomical and functional outcomes of surgical treatment of retinal detachment secondary to ocular toxoplasmosis. Methods: A retrospective analysis of data from patients who had undergone vitreoretinal surgery for retinal detachment secondary to ocular toxoplasmosis was conducted. The parameters that were analyzed include surgical procedures, anatomical outcomes, visual acuity, and postoperative complications. Results: This study included 22 patients, of which 13 were female (59.1%). The mean age was 28.5 years (SD ± 14.5, range 12-78 years) and the follow-up period varied from 1 to 163 months (mean 64 months). The mean baseline best-corrected visual acuity (BCVA) was 2.0 logMAR (SD ± 1.0). A total of 31 surgeries were performed, and the retina was reattached in 15 patients (68.2%) immediately after the first surgery and in 20 patients (90.9%) at a later point. The mean postoperative BCVA improved to 1.3 logMAR (SD ± 0.9) (p<0.05). Nineteen patients (86.4%) underwent cataract surgery with intraocular lens implant, and 12 patients (60.0%) underwent silicone oil removal. Five patients (22.7%) exhibited elevated intraocular pressure, and 1 patient (4.5%) developed hypotonia. Conclusion: Surgical treatment of retinal detachment secondary to ocular toxoplasmosis resulted in considerable anatomical and functional improvement. Although PPV with silicone oil injection demonstrated the best outcomes, it is not reasonable to conclude that this is the best surgical approach given the small number of patients included in this study.

RESUMO Objetivo: Avaliar os resultados anatômicos e funcionais após o tratamento do descolamento de retina secundário à toxoplasmose ocular. Métodos: Análise retrospectiva de dados de um banco de dados validado, que incluiu registros de pacientes submetidos à cirurgia vitreorretiniana para descolamento de retina secundário a toxoplasmose ocular. Foram analisados procedimentos cirúrgicos, sucesso anatômico, acuidade visual e complicações pós-operatórias. Resultados: Foram avaliados 22 olhos de 22 pacientes. Treze eram do sexo feminino (59,1%) e a idade média era de 28,5 anos (DP ± 14,5, intervalo de 12 a 78 anos). O período de acompanhamento variou de 1 a 163 meses (média de 64 meses). A melhor acuidade visual corrigida (BCVA) foi 2,0 logMAR (SD ± 1,0). Em geral, entre retinopexia (RSB) e vitrectomia pars plana (PPV) utilizando injeção de óleo de gás ou de silicone (SO), realizaram-se 31 cirurgias. A retina foi considerada colada em 15 olhos (68,2%) na primeira cirurgia e em 20 olhos (90,9%) ao final do estudo. A BCVA pós-operatória média melhorou para 1,3 logMAR (SD ± 0,9) (p<0,05). Dezenove olhos (86,4%) foram submetidos à cirurgia de catarata com implante de lente intraocular e 12 olhos (60,0%) tiveram remoção de óleo de silicone. Cinco olhos (22,7%) desenvolveram pressão intraocu­lar elevada e 1 (4,5%) desenvolveu hipotonia. Conclusão: A abordagem cirúrgica no descolamento de retina secundária a toxoplasmose ocular permitiu importante melhora anatômica e funcional. Embora a PPV com injeção de óleo de silicone tenha demonstrado melhores resultados, não é viável afirmar que é a melhor técnica cirúrgica, devido ao pequeno número e às particularidades dos olhos tratados.

Surgical management of retinal fold after 23-Gauge pars plana vitrectomy retinopexy / Manejamento cirúrgico de dobra de retina após retinopexia com vitrectomia via pars plana de 23-Gauge

Abstract The authors report a case of retinal fold after retinal detachment repair performed using 23-gauge pars plana vitrectomy technic (PPV). The fundus photography and optical coherence tomography (OCT) showed a posterior retinal fold with the retina periphery attached. The patient's best corrected visual acuity (BCVA) was 20/200 with severe metamorphopsia. A 25-gauge PPV, subretinal balanced saline solution (BSS) injection using a 25-39-gauge cannula, and gas-fluid exchange were performed. The patient's BCVA improved significantly after treatment. The retinal fold observed is not a frequent complication and can be managed with PPV, subretinal BSS injection and fluid-air exchange.

Resumo Os autores relatam um caso de dobra retiniana após a cirurgia de reparação de descolamento de retina realizada com vitrectomia via pars plana de 23 gauge (VVPP). A retinografia e a tomografia de coerência óptica (OCT) mostraram uma dobra posterior da retina com a periferia da retina colada. A melhor acuidade visual corrigida do paciente foi de 20/200 e severa metamorfopsia. Foi realizada uma VVPP de 25G, injeção subretiniana de solução salina balanceada (BSS) utilizando uma cânula de calibre 25-39 e troca de fluido-gasosa. A melhor acuidade visual corrigida do paciente melhorou significativamente após o tratamento. A dobra retiniana não é uma complicação freqüente e pode ser tratada com VVPP, realização de injeção subretiniana de BSS e troca fluido-gasosa.

¿Retinopexia neumática o implante de silicona para pacientes con desprendimiento regmatógeno de retina? / Scleral buckle versus pneumatic retinopexy for rhegmatogenous retinal detachments

Resumen INTRODUCCIÓN: l desprendimiento de retina de tipo regmatógeno es aquel causado por un desgarro o ruptura de la retina, y es causa frecuente de pérdida de visión. Dentro del manejo quirúrgico existen varias opciones, entre ellas el implante de silicona o cirugía convencional y la retinopexia neumática. A pesar de que la mayoría de los profesionales prefiere el uso de implante de silicona, la retinopexia neumática es un procedimiento más simple, de menor costo y sigue siendo considerada como alternativa en algunos casos de desprendimiento de retina regmatógeno, sin embargo hay poca evidencia que compare ambas intervenciones. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos 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 tres revisiones sistemáticas que en conjunto incluyeron seis estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que el resultado anatómico podría ser mejor con el uso de implante de silicona en términos de re-aplicación de la retina y del riesgo de recurrencia del desprendimiento, pero la retinopexia neumática podría disminuir la incidencia de efectos adversos quirúrgicos oculares.

Abstract INTRODUCTION: Rhegmatogenous retinal detachment is caused by a tear in the retina and is a frequent cause of vision loss. Its treatment is mainly surgical and the following alternatives can be identified: scleral buckling or classic surgery, pneumatic retinopexy and vitrectomy. Between the first two options, most professionals prefer scleral buckling over pneumatic retinopexy, but the latter is a simpler, cheaper and lower-risk procedure, so it is still considered as an option for selected patients. However, there is little evidence comparing both interventions. METHODS: To answer this question we used 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 three systematic reviews including six studies overall, of which three were randomized trials. We concluded the anatomic result might be better with scleral buckling in terms of retinal reattachment and risk of recurrence, but the risk of ocular adverse events might be lower with pneumatic retinopexy.

Maculopatia viteliforme polimorfa exudativa aguda: um relato de caso / Acute exsudative polymorphous vitelliform maculopathy: a case report

Resumo A maculopatia viteliforme polimorfa exsudativa aguda é um distúrbio retiniano extremamente raro, que tem sido considerado como uma forma de retinopatia paraneoplásica, encontrada em pacientes com um tumor primário subjacente. Os sintomas de maculopatia viteliforme polimorfa exsudativa aguda incluem dor de cabeça precedente seguida de perda aguda da visão. O fundo de olho de um paciente com essa condição demonstra geralmente depósitos bilaterais, branco-amarelados na região macular. O relato de uma doença rara e que tem uma forte associação com neoplasia oculta é de extrema relevância, pois ajuda a conhecer melhor a sua historia natural, possíveis complicações e prognóstico.

Abstract Acute exudative polymorphous vitelliform maculopathy is an extremely rare retinal disorder, that has been considered as a form of paraneoplasic retinopathy, found in patients with a underlying primary tumor. Symptoms of acute exudative polymorphous vitelliform maculopathy include preceding headache followed by acute onset of vision loss. The fundus of a patient with this condition typically demonstrates bilateral, subretinal white-yellow deposits in the macular region. The report of a rare disease which has a strong association with underlying neoplasia is extremely relevant whereas it helps better comprehend its genuine history, possible complicacy and prognosis.

Cirugía del desprendimiento de retina en el Departamento de Oftalmología de la Hamad Medical Corporation en Doha, Qatar / Retinal detachment surgery in the Ophthalmological Department of the Hamad Medical Corporation in Doha, Qatar

Objetivo: describir las características relacionadas con el desprendimiento de retina regmatógeno de los pacientes atendidos en el Servicio de Oftalmología de la Hamad Medical Corporation en Doha, Qatar. Métodos: se realizó un estudio descriptivo, retrospectivo de series de casos retrospectivas no comparativo de todos los pacientes (114) quienes experimentaron la reparación de desprendimiento de retina regmatógeno por 2 años (entre enero del año 2011 y diciembre 2012) en el Departamento de Oftalmología de la Hamad Medical Corporation. La demografía de los pacientes, el resultado visual, las complicaciones y las tasas de fracaso fueron identificados y registrados. Resultados: la replicación de la retina sucedió en el 95,3 por ciento de los pacientes y la mejor agudeza visual posoperatoria corregida de 6/36 a 6/6 fue alcanzada en el 59,7 por ciento. Los probables factores de riesgo fueron el desprendimiento de retina en paciente miope en el 39,4 por ciento; el desprendimiento de retina posoperatorio en el 14,9 por ciento y el desprendimiento de retina traumático en el 22,8 por ciento. El desprendimiento por la degeneración retiniana periférica fue de 9,6 por ciento y la causa no visible se registró en el 13,2 por ciento. Conclusiones: el estudio ha revelado un resultado alentador para la reparación de desprendimiento de retina en el Departamento de Oftalmología de la Hamad Medical Corporation en Doha Qatar(AU)

Objective: to describe the characteristics related to the rhegmatogenous retinal detachment in patients seen at the ophthalmological service of Hamad Medical Corporation in Doha, Qatar. Methods: a retrospective, descriptive, non-comparative case-series study was conducted in 114 patients who underwent the repair of the rhegmatogenous retinal detachment during two years (January 2011 to December 2012) at the ophthalmological department of Hamad Medical Corporation. Patient's demographic information, visual outcomes, complications and rates of failure were identified and registered. Results: retinal replication occurred in 95.3 percent of patients and postoperative best corrected visual acuity from 6/36 to 6/6 was reached in 59.7 percent of cases. The probable risk factors were retinal detachment in myopic patient in 39.4 percent; postoperative retinal detachment in 14.9 percent and traumatic retinal detachment in 22.8 percent of cases. Detachment caused by peripheral retinal degeneration was 9.6 percent and the invisible cause was recorded in 13.2 percent of patients. Conclusions: the study has revealed encouraging results for the retinal detachment repair in the ophthalmological department of Hamad Medical Corporation in Doha, Qatar(AU)

Comparison of effect of silicon oil on central corneal thickness and corneal endothelial-cell density

Objective: To compare the mean changes in central corneal thickness [CCT] and corneal endothelial-cell density [CED] after removal of silicon oil [ROSO] using anterior [limbal] versus posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Study Design: Randomized controlled trial

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Sixty eyes of 60 aphakic patients who underwent removal of silicon oil from December 2014 to August 2015 in AFIO after successful retinal re-attachment surgery were analysed. Thirty eyes underwent removal of silicon oil through anterior [limbal] approach [groupl] and 30 eyes through posterior [pars plana] approach [group-2]. Pre-operative central corneal thickness and corneal endothelial-cell density was measured and compared with central corneal thickness and corneal endothelial-cell density measurements 3 months after removal of silicon oil

Results: Mean age of study population was 49.93 +/- 5.18 years. Both groups were age and sex matched [p=0.694 and p=0.80 respectively]. In group 1, mean change in CCT was 1.80 +/- 6.58 micro meters [jum] and mean change in CED was 196.30 +/- 33.78 cells per millimetres square [mm[2]], while in group 2, mean change in CCT was 1.63 +/- 8.96 microm and mean change in CED was 60.20 +/- 39.75 cells/mm2 after 3 months of ROSO. Mean change in CCT between two groups was not statistically significant [p=0.935], however, mean change in CED between two groups was statistically significant [p<0.001]

Conclusion: Removal of silicon oil through anterior [limbal] approach causes significant reduction in CED, as compared to posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Resultados anatómicos y funcionales de la cirugía convencional en pacientes con desprendimiento primario de retina / Anatomical and functional results of the conventional surgery in patients with primary retinal detachment

Se realizó un estudio observacional, descriptivo y prospectivo de 23 pacientes con desprendimiento primario de retina, intervenidos quirúrgicamente en el Hospital General "Dr. Juan Bruno Zayas Alfonso" desde enero hasta diciembre de 2012, a fin de describir los resultados anatómicos y funcionales de la cirugía convencional, para lo cual se utilizaron variables de interés para la investigación. Entre los hallazgos principales predominaron: el sexo masculino (73,9 %), los desprendimientos parciales con desgarros temporales superiores (73,9%), la miopía elevada como antecedente patológico personal (39,1 %), el ojo derecho como el más afectado (60,9 %), la rotura en herradura (30,4 %), fundamentalmente en los cuadrantes superiores, y las técnicas combinadas (91,3 %), por citar algunos. Con la aplicación de dichas técnicas se logró la reaplicación de la mayoría de los casos. El éxito anatómico logrado no fue siempre sinónimo de éxito funcional, aunque lo primero es condición obligada para lo segundo.

An observational, descriptive and prospective study of 23 patients with primary detached retina, undergoing surgery in "Dr. Juan Bruno Zayas Alfonso" General Hospital was carried out from January to December, 2012, in order to describe the anatomical and functional results of the conventional surgery, for which variables of interest for the investigation were used. Among the main findings, the male sex (73.9%), the partial detachment with superior temporary lacerations (73.9%), the high myopia as personal pathological history (39.1%), the right eye as the most affected (60.9%), the horseshoe rupture(30.4%), fundamentally in the superior quadrants, and the combined techniques (91.3%), to mention some, prevailed. With the use of these techniques the new implementation was achieved in most of the cases. The anatomical success achieved was not always synonym of functional success, although the first thing is was necessary for the second one.

A Case of Sympathetic Ophthalmia after 23-Gauge Transconjunctival Sutureless Vitrectomy

No abstract available.

A Case of Sympathetic Ophthalmia after 23-Gauge Transconjunctival Sutureless Vitrectomy

No abstract available.

Autoinjerto limboconjuntival con membrana amniótica en la insuficiencia límbica total unilateral / Limbal-conjunctival autograft with amniotic membrane to treat total unilateral limbal stem cell deficiency

Se presentan tres ojos de tres pacientes con insuficiencia límbica total por quemadura alcalina grave (n= 2), con enfermedad de Coats y antecedentes de cirugía de desprendimiento de retina (n= 1). Los casos uno y dos tenían una evolución de las quemaduras de 2 años y 8 meses respectivamente, y el caso tres de 8 meses. A todos los pacientes se les realizó la misma técnica quirúrgica: peritomía a 360º, extirpación de la membrana corneal fibrovascular, autoinjerto limboconjuntival (donante del ojo homólogo sano) y la implantación de membrana amniótica. El caso 1, con agudeza visual corregida preoperatoria de percepción de luz y sentido cromático en el ojo derecho, alcanzó a los 12 meses una agudeza visual corregida de 0,3 y a los 13 años, con +1,50-0,50 x 90º, una visión de 0,9. El caso 2, con agudeza visual preoperatoria de bultos a 20 centímetros, logró a los dos años una agudeza visual de 0,6; y el caso 3, con visión preoperatoria de percepción de luz, alcanzó una visión de 0,05 (20/500). En todos los casos el autoinjerto limbo-conjuntival del ojo homólogo sano con implantación de membrana amniótica constituyó una excelente alternativa para la mejoría visual y la rehabilitación laboral de los dos primeros pacientes. En el caso uno se logró un resultado extraordinario. El caso 3 logró una reepitelización corneal total y una evidente mejoría de la transparencia corneal, pero por la enfermedad de base la agudeza visual solo mejoró discretamente.

Three eyes of three patients with grave alkali burns (n-2) and with Coats disease after retinal detachment surgery (n-1). All of the cases presented a total limbal stem cells deficiency. Cases 1 and 2 had an burning evolution of 2 years and 8 months respectively, and the case 3 an evolution of 8 months before surgery. All patients underwent the same operation: Peritomy 360º, keratectomy of corneal fibrovascular membrane, limbo-conjuntival autograft from the healthy fellow eye and implantation of amniotic membrane. Case number 1 with preoperatory visual acuity of light perception and projection improved to 0,3 his visual acuity after 12 months and with +1,50-0,50 x 90 a visual acuity 0,9 after 12 years. Case 2 with preoperatory visual acuity of counter finger at 20 centimeters improved his visual acuity 0,6 after two years, and case 3 with preoperatory visual acuity of light perception improved to 0,05 (20/500). In all cases, limbal-conjunctival autograft of the healthy fellow eye with amniotic membrane transplantation resulted an excellent option for improving visual acuity and laborer rehabilitation in cases 1 and 2 (achieving case 1 excellent visual acuity). Case 3 had a total corneal epithelization and an evident improvement in corneal transparency, but visual acuity had a little improvement due to base disease.

Resultados funcionales y anatómicos de la cirugía del desprendimiento de retina recurrente por vitreorretinopatía proliferativa / Functional and anatomical results of the recurrent retinal detachment surgery caused by proliferative vitreoretinopathy

OBJETIVOS: evaluar los resultados funcionales y anatómicos de la cirugía de desprendimiento de retina recurrente por vitreorretinopatía proliferativa. MÉTODOS: estudio observacional descriptivo retrospectivo en una serie de casos de 17 ojos diagnosticados de desprendimiento de retina recurrente por vitreorretinopatía proliferativa, que fueron intervenidos en el período comprendido entre enero 2010 y diciembre 2011. Los pacientes fueron seguidos hasta un mínimo de tres meses posteriores a la última intervención. Los resultados funcionales se evaluaron con la agudeza visual mejor corregida y los anatómicos a través del grado de readaptación retiniana y macular. RESULTADOS: fueron realizadas un total de 25 reintervenciones, rango 13. Se realizaron retinotomía/retinectomía en el 52 % de las cirugías, la mayoría con una extensión menor de 180º (84,6 %). El taponador que con mayor frecuencia se utilizó fue el aceite de silicona (23,92 %). La media de la agudeza visual mejor corregida posoperatoria fue de 1,28 logMAR, que mejoró en el 58,8 % de los ojos y fue inferior a 1,5 logMAR en el 90 % de ellos. El éxito de readaptación retiniana fue del 82,3 % (14 ojos). La readaptación macular se consiguió en el 100 % de los ojos. CONCLUSIONES: el tratamiento quirúrgico del desprendimiento de retina recurrente por proliferación vítreorretinal requiere la realización de diferentes opciones quirúrgicas para que resulte en reaplicación retiniana final y mejoría de la visión en los casos de alta complejidad.

OBJECTIVE: to assess the functional and anatomical results of surgery for recurrent retinal detachment caused by proliferative vitreoretinopathy. METHODS: retrospective, observational and descriptive study of a case series of 17 eyes diagnosed with recurrent retinal detachment caused by proliferative vitreo retinopathy were operated on in the period of January 2010 through December 2011. The patients were followed up for at least 3 months after the last surgery. Functional outcomes were assessed with best corrected visual acuity and the anatomical ones through the retinal and macular reattachment. RESULTS: a total of 25 reoperations were performed, a range of 1 to 3. Retinotomy and retinectomy were performed in 52 % of surgeries, most of them with an area less than 180° (84,6 %). The most frequently used tamponade was silicone oil (23,92 %). The mean postoperative best corrected visual acuity was 1,28 logMAR, improving in 58,8 % of eyes and being lower than 1,5 logMAR in 90 % of them. The retinal reattachment succeeded in 82,3 % (14 eyes). Macular reattachment occurred in 100 % of eyes. CONCLUSIONS: surgical treatment of the recurrent retinal detachment caused by vitreoretinal proliferation requires different surgical options to achieve the final retinal reattachment and visual improvement in highly complex cases.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Macular Hole Formation in Rhegmatogenous Retinal Detachment after Scleral Buckling

PURPOSE: To describe early macular hole (MH) development in rhegmatogenous retinal detachment (RRD) after scleral buckling (SB) based on optical coherence tomography (OCT) findings. METHODS: The medical records and spectral domain OCT images of patients in whom MH developed after RRD repair were evaluated retrospectively. RESULTS: A postoperative MH was detected in five eyes that underwent SB during a 6-year period. All had fovea-off RRD without MH at the time of surgery. OCT showed partial loss of the inner retina with a preserved photoreceptor layer in early postoperative days. On average, 7 days (range,5 to 8 days) after surgery, outer retinal tissues disappeared, resulting in the full-thickness MH. CONCLUSIONS: Serial OCT findings revealed that partial-thickness lamellar holes progressed to full-thickness MHs, which were formed by the degeneration of the outer retina in eyes with preceding loss of the glial cone in the fovea.