¿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.

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)

Extrusion of hydrogel exoplant into upper eyelid 16 years after a scleral buckle procedure.

Sixteen years after scleral buckle surgery with a hydrogel episcleral exoplant, a 43-year-old woman presented with progressive binocular diplopia, ptosis, and an expanding mass in her upper eyelid. She underwent surgical removal of the hydrogel exoplant through an anterior approach. The exoplant proved to be friable, fragmented, and encapsulated in a fibrous tissue; the exoplant was removed in its entirety. Postoperatively, the eyelid mass resolved, while her diplopia and ptosis improved slightly.

Preserved scleral patch graft for unexpected extreme scleral thinning found at the scleral buckling procedure: A case report.

Pre-existing scleral pathology is an important risk factor for globe rupture during scleral buckling procedures. We report here, the surgical management of an unexpected scleral pathology found at the scleral buckling procedure in a retinal detachment patient. A 77-year-old white female with retinal detachment underwent a scleral buckling procedure. The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively. An alcohol-preserved donor sclera graft was used. The second surgery for definitive retinal alignment was performed two weeks later. The presented case of an unexpected scleral pathology in a retinal detachment patient was managed with a combination of scleral grafting and pars plana vitrectomy, without any major complications. The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory. A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

Complications of conventional sclera buckling occurring during and after treatment of rhegmatogenous retinal detachment

To identify and determine the frequency of the intra-operative and early postoperative compkicaitons of Cinventional Scieral Buckling [CSB] ans the primary surgical intervention in patients with Phegmatogenous Retinal Detachment [RRD]. A quasi-interventional study. Khyber Institute of Ophthalmic Medicl Sciences [KIOMS], Postgraduate Medical Institute [PGMI], Hayatabad Medical Complex [HMC], Peshawar, from April 2005 to June 2006. Fifty consecutive patients who underwent CSB and fulfilled the inclusion criteria, were included in the study. Operative details and any intra-operative complications were noted. The patients underwent another detailed clinical examination and pain assessment on the first postoperative day. All the patients were followed-up minimum for 3 months. Postoperative complications were identified and recorded. The data was analyzed on SPSS 120 for measures of central tendency and dispersion. There were 36 males and 14 female subjects. Mean age was 37.18 +/- 20.145 years. Encirclement [56%] was the most frequently used CSB technique, sixteen [32%] patients had at least one intra-operative complication. Intra-operative complications were iatrogenic sclera break [2%], accidental Sub Retinal Fluid [SRF] drainage [8%], choroidal haemorrhage [2%], subretinal haemorrhage [14%], retinal incarceration [2%], vitreous haemorrhage [6%], raised [4%] or very low [2%], intra-operative IOP and hyphema [2%]. Postoperative complications included systemic complications [24%], choroidal detachment [8%], vitreous haemorrahge [16%], raised IOP [22%], angle closure [2%] and explants exposure [6%]. Mean refractive change in spherical equivalent was -1.478 +/- 0.698 D. final re-attachment rate was [82%] and final BCVA of > 6/60 was achieved in 62% of the subjects in the treated eyes. CSB is a safe and effective option for treating uncomplicated RRD, but it is associated with certain complications. Sub-retinal bleed was the most common intra-operative complication. Raised IOP was most the common early postoperative complication followed by choroidal detachment

Pyogenic granuloma after retinal detachment surgery with scleral buckle: case report / Granuloma piogênico após cirurgia de descolamento de retina com introflexão escleral: relato de caso

The authors relate an uncommon case of pyogenic granuloma restricted to tarsal conjunctiva post retinopexy with scleral buckle.

Os autores relatam um caso de granuloma piogênico subconjuntival pós retinopexia com introflexão escleral. É uma complicação pós-cirúrgica incomum neste tipo de procedimento.

Anatomical and visual outcomes of three different scleral buckling techniques

To compare the anatomical and visual outcomes of three different scleral buckling techniques and to explore the effect of cryotherapy and subretinal fluid drainage [SRFD] on outcomes of surgery. This retrospective study was performed on 111 eyes of 109 patients undergoing scleral buckling for rhegmatogenous retinal detachments [RRDs] by a single surgeon. Pre-, intra- and postoperative data were retrieved from hospital records. Buckles were radial in 27 [24.3%], circumferential [segmental] in 16 [14.4%] and encircling in 68 [61.3%] eyes. Anatomical and visual results were comparable with all three buckling techniques. Application of cryotherapy, the spot number, and SRFD did not affect anatomical and visual results. The only preoperative factor associated with poorer anatomical results was the presence of multiple retinal breaks [P=0.006]. The following preoperative factors affected visual outcomes on univariate analysis: extent of retinal detachment [r=0.417, P=0.011] and relative afferent pupillary defect [r=0.423, P=0.02]. Preoperative macular status [attached vs detached] also had a significant effect on visual outcomes [P < 0.001]. Based on multivariate analysis however, only preoperative macular status was significantly correlated with visual results [P=0.022]. Silicone sponges placed for non-encircling surgery were removed due to ocular dysmotility in 4 [3.6%] eyes, cosmetic reasons in 3 [2.7%] cases and extrusion in 2 [1.8%] eyes. One encircling tire was also removed due to extrusion. Surgical technique and performing cryotherapy or SRFD do not seem to influence the anatomical and visual outcomes of scleral buckling. Postoperative complications seem to be more prevalent with non-encircling techniques

Vitrectomy with and without scleral buckling for retinal detachment

PURPOSE: To compare the surgical results of vitrectomy with and without scleral buckling for rhegmatogenous retinal detachment (RD). METHODS: Fifty-one patients with rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) at different stages were submitted to pars plana vitrectomy as the primary surgery, 23 patients (45.09 percent) with scleral buckle (group I) and 28 (54.90 percent) without scleral buckle (group II). Visual acuity, anterior segment complications, intraocular pressure, strabismus and retina reattachment rate were evaluated in both groups. RESULTS: The anatomical success and postoperative complications were similar in both groups. Retinal reattachment was achieved in 20 of 23 eyes (87 percent) of group I and in 24 of 28 eyes (85.7 percent) of group II after the initial surgery (p=1.000). Elevated intraocular pressure was noted in 2 eyes (8.7 percent) of group I and 1 eye (3.6 percent) of group II (p=0.583). Corneal abnormalities were seen in 3 eyes (13 percent) of group I and 2 eyes (7.19 percent) of the group II (p=0.647). Visual acuity improved from a preoperative median of 20/200 to a median of 20/100 in group 1 and from 20/400 to 20/100 in group 2; the difference between the two groups was statistically significant (p<0.05). The mean follow-up period was 10 months, ranging from 6 to 18 months. CONCLUSIONS: Both surgical procedures had similar reattachment rates. Intra- and postoperative complications were similar considering both procedures. Visual acuity improved significantly in group 2 (vitrectomy without scleral buckling).

OBJETIVOS: Comparar os resultados cirúrgicos da vitrectomia com e sem "buckle" escleral para descolamento da retina regmatogênico (DR). MÉTODOS: Cinqüenta e um pacientes com descolamento da retina regmatogênico com proliferação vitreorretiniana (PVR) em diferentes estádios foram submetidos a vitrectomia pars plana como cirurgia primária; 23 pacientes (45,09 por cento) com buckle escleral (grupo 1) e 28 pacientes (54,90 por cento) sem "buckle" escleral (grupo 2). Acuidade visual, complicações do segmento anterior, pressão intra-ocular, estrabismo e razão do redescolamento da retina foram avaliados em ambos os grupos. RESULTADOS: O sucesso anatômico e complicações pós-operatórias foram semelhantes em ambos os grupos. A reaplicação da retina foi obtida em 20 dos 23 olhos (87 por cento) no grupo 1 e em 24 dos 28 olhos (85,7 por cento) no grupo 2 após a cirurgia inicial (p=1,000). Aumento da pressão intra-ocular foi notada em 2 olhos (8,7 por cento) no grupo 1 e em 1 olho (3,6 por cento) no grupo 2 (p=0,583). Anormalidades na córnea foram vistas em 3 olhos (13 por cento) no grupo 1 e em 2 olhos (7,19 por cento) no grupo 2 (p=0,647). A acuidade visual melhorou de uma média pré-operatória de 20/200 para uma média de 20/100 no grupo 1 e de 20/400 para 20/100 no grupo 2, com diferença estatisticamente significativa entre os grupos (p<0,05). O período médio de seguimento foi de 10 meses, variando entre 6 e 18 meses. CONCLUSÕES: Ambos procedimentos cirúrgicos tiveram razão semelhante de reaplicação da retina. Complicações intra- e pós-operatória foram semelhantes em ambos os procedimentos. A acuidade visual melhorou significativamente no grupo 2 (vitrectomia sem "buckle" escleral).

Diplopia and Periorbital Mass Associated with Miragel Buckling Explant

A 28-year-old female presented with a palpable mass lesion on the superonasal aspect of her right globe and she had a progressive diplopia. She had a scleral encircling surgery with a Miragel explant (MIRA, Waltham, Mass, USA) for the tractional retinal detachment associated with pars planitis 9 years previously. On examination, she revealed restricted eye movements of her right eye. The magnetic resonance imaging documented a swelling of the Miragel explant that mimicked a periorbital mass lesion. The Miragel explant was removed and fragmentation of the explant was found intraoperatively. The removed Miragel explant was examined by a scanning electron microscopy, and this demonstrated a disintergrated and swollen structural composition of the Miragel explant. Postoperatively, her extraocular movement was almost restored and the retina remained well attached. Alterations in the structural composition of the Miragel explant results in an excessive swelling that causes a restriction of the extraocular movement, and this can mimick a periorbital mass lesion.

Uveítis simpática: complicaciones de la cirugía del segmento posterior / Sympathetic uveitis: complications of the posterior segmentsurgery

La oftalmía simpática es una uveítis difusa bilateral granulomatosa, secundaria a un traumatismo ocular penetrante accidental o quirúrgico. Se considera de origen inmunológico. La forma de presentación clínica posterior es rara. Evoluciona con recurrencias. Requiere del tratamiento corticoesteroidaly/o inmunosupresor. Su histopatología muestra infiltración linfocitaria y de células epiteloideas uveal difusa con diversas otras respuestas histológicas agregadas. Se presenta un caso clínico en una mujer miope de 47 años, portadora de desprendimiento de retina, intervenida con cirugía vitreo-retinal que, un año y medio más tarde, hace una oftalmía simpática, cuyo estudio histopátologico confirmóla sospecha clínica