Necrosis retinal aguda. Dos casos clínicos / Acute retinal necrosis. A report of two clinical cases

La necrosis retinal aguda es una afección grave que amenaza la visión. Es frecuente en adultos, tanto inmunocompetentes como inmunocomprometidos. Se presentan dos pacientes, uno de 38 años, con antecedentes de salud anterior que acude a consulta con síntomas y signos de necrosis retinal aguda en el ojo izquierdo, la que fue diagnosticada luego; y otro de 48 años de edad con antecedentes de infección por herpes zóster, tres meses antes de los síntomas oculares, que concluyó con igual diagnóstico. No existió evolución satisfactoria, a pesar del tratamiento adecuado, lo que demostró que independientemente de datos estadísticos y estudios realizados que demuestran lo infrecuente de esta enfermedad, se diagnosticaron dos casos en el periodo de un año, dato que nos exhorta al estudio y práctica de alternativas diagnósticas y terapéuticas para minimizar las consecuencias devastadoras de esta afección.

Acute retinal necrosis is a serious vision-threatening condition. It is common in both immunocompetent and immunocompromised adults. We present two male patients; one aged 38 years, with a previous health history who comes to consultation with symptoms and signs of acute retinal necrosis in his left eye, which was later diagnosed; and another one aged 48 years with a history of herpes zoster infection three months before the ocular symptoms, which concluded with the same diagnosis. Regardless of the statistical data and research carried out on this rare disease, there was no satisfactory evolution despite adequate treatment. Two cases were diagnosed in a period of one year, data that urges us to study and practice diagnostic and therapeutic alternatives to minimize the devastating consequences of this condition.

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.

Manejo del desprendimiento de retina regmatógeno / Management of rhegmatogenous retinal detachment

1. INTRODUCCIÓN El desprendimiento de retina es un problema visual grave que puede ocurrir a cualquier edad, aunque suele darse en individuos de edad media o en personas de la tercera edad. La incidencia es relativamente baja considerando que las estima-ciones varían según zonas geográficas; y, se han reportado datos de entre 6,3 y 17,9 por 100 000 habitantes. Otras características im-portantes a considerar son la degeneración en encaje de 45,75% y la miopía de 47,28% que influyen en la presentación del desprendi-miento de retina. Al mismo tiempo que la edad, los cambios vítreos retinianos y la presencia de pseudofaquia1,2. Además, de los factores oculares relacionados también influyen, el seguimiento inadecuado de los factores de riesgo y el difícil acceso a médicos especialistas que se traduce en retraso en el diagnóstico certero y tratamiento tardío que implica deterioro del pronóstico visual cuando el área macular está incluida en el área desprendida con pobres resultados en adultos jóvenes y en edad productiva.El tratamiento evitará el deterioro o pérdida irreversible de la visión. El pronóstico con tratamiento quirúrgico es bueno si el des-prendimiento no incluye a la mácula.

1. INTRODUCTIONRetinal Detachment is a serious visual problem that can occur at any age, although it usually occurs in middle-aged or elderly in-dividuals. The incidence is relatively low considering that estimates vary ac-cording to geographical areas; and, data have been reported be-tween 6,3 and 17,9 per 100 000 inhabitants. Other important cha-racteristics to consider are socket degeneration of 45,75% and myopia of 47,28% that influence the presentation of retinal deta-chment, as well as age, vitreoretinal changes and the presence of pseudophakia1,2.In addition to the related ocular factors, inadequate follow-up of risk factors and difficult access to medical specialists also play a role, resulting in delayed accurate diagnosis and late treatment that implies deterioration of the visual prognosis when the macular area is included in the detached area with poor results in young adults and those of productive age.Treatment will prevent irreversible deterioration or loss of vision. The prognosis with surgical treatment is good if the detachment does not include the macula.

Identación escleral y retinopexia neumática / Scleral buckling and neumatic retinopexy

Objetivo: Determinar los resultados de la técnica quirúrgica de identación escleral y la de retinopexia neumática en el desprendimiento regmatógeno de retina. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en pacientes operados con la técnica de identación escleral y la de retinopexia neumática en el Centro Oftalmológico de Villa Clara entre junio de 2019 y diciembre de 2020. Resultados: Los hombres fueron los más afectados y la edad media fue de 57,5 años. En el 72,7 por ciento la rotura causante del desprendimiento fueron los desgarros en herradura. La media del tiempo de evolución de la enfermedad fue de 7,2 días y el 77,3 por ciento de los ojos presentaba mácula desprendida al momento del diagnóstico. El 68,2 por ciento tuvo una agudeza visual mejor corregida preoperatoria < 20/200. Los pacientes con mácula desprendida preoperatoria alcanzaron como media una agudeza visual final de 0,4 ± 0,3 (desviación estándar). En el 86,4 y el 77,3 por ciento de los ojos se lograron buenos resultados anatómicos y funcionales finales. Las membranas epirretinales se presentaron como complicación posoperatoria en ambas técnicas quirúrgicas y el líquido subretinal residual solo en la retinopexia neumática. Conclusiones: El desprendimiento regmatógeno de retina se presenta con pobre agudeza visual preoperatoria. Con ambas técnicas quirúrgicas, en pacientes con ninguna o mínima vitreorretinopatía proliferativa, se logran buenos resultados anatómicos y funcionales.

Objective: Determine the results of the surgical technique of scleral buckling and neumatic retinopexy in rhegmatogenous retinal detachment. Methods: A prospective longitudinal descriptive study was conduced of patients undergoing scleral buckling and neumatic retinopexy at Villa Clara Ophthalmology Center from June 2019 to December 2020. Results: Male gender prevailed; mean age was 57.5 years. In 72.7 percent of the cases the retinal break causing the detachment was a U-shaped tear. Mean time of evolution of the disease was 7.2 days, and 77.3 percent of the eyes had a detached macula at diagnosis. In 68.2 percent preoperative best corrected visual acuity was <20/200. Patients with a preoperative detached macula achieved a mean final visual acuity of 0.4 ± 0.3 (standard deviation). Good final anatomical and functional results were obtained in 86.4 percent and 77.3 percent of the eyes. Epiretinal membranes were a postoperative complication in both surgical techniques, whereas residual subretinal fluid was a complication only in neumatic retinopexy. Conclusions: Rhegmatogenous retinal detachment presents with poor preoperative visual acuity. Both surgical techniques obtain good anatomical and functional results in patients with minimum or no proliferative vitreoretinopathy(AU)

Clinical Features of Primary Rhegmatogenous Retinal Detachment According to Initial Intraocular Pressure

PURPOSE: To determine the correlations of intraocular pressure (IOP) with risk factors in rhegmatogenous retinal detachment (RRD) patients. METHODS: A total of 113 eyes in 113 consecutive patients with RRD were enrolled in this study. IOP was measured using applanation tonometry at the initial visit. Based on the difference in IOP between the affected and unaffected eyes, the subjects were divided into two groups: group 1 (IOP difference ≤ 2 mmHg) and group 2 (IOP difference > 2 mmHg). Correlations between the IOP and RRD morphology, visual acuity (VA), best-corrected VA (BCVA), retinal break size and location, range of retinal detachment, macular involvement, and proliferative vitreoretinopathy were analyzed. RESULTS: The IOP at the initial visit was 12.88 ± 3.2 mmHg in the affected eyes and 14.27 ± 2.5 mmHg in the unaffected eyes. The IOP difference between the affected and unaffected eyes was −1.40 ± 2.82 mmHg. The BCVA and range of retinal detachment showed statistically significant differences between groups 1 and 2. CONCLUSIONS: In patients with RRD, the IOP difference compared to the unaffected eye was correlated with the extent of area of retinal detachment and decreased BCVA.

Ruptura del globo ocular / Rupture of the eyeball

Los traumatismos oculares representan la principal causa de pérdida de la agudeza visual en individuos jóvenes y se sitúa entre las causas de ceguera en el mundo. Pueden tener un efecto devastador sobre el globo ocular; es el tipo de traumatismo más severo en esta zona, con un pobre pronóstico visual para el paciente. Constituye un accidente grave, que en muchas ocasiones conlleva a la enucleación. Se presentan tres pacientes con rotura del globo ocular, con la conducta terapéutica, seguimiento y resultados visuales en cada caso, para mostrar a la comunidad médica, la complejidad y particularidades de este traumatismo(AU)

Ocular traumatisms represent the principal cause of loss of vision in young people and they are among the causes of blindness in the world. Trauma can result in a wide spectrum of tissue lesions of the globe and it can has devastating effect on the eyeball, since it is the most severe type of trauma in this area, with a poor visual prognosis for the patient. It is a serious accident, which often leads to nucleation as result of a bruised intense trauma. This is the report of three patients with rupture of the ocular globe with the therapeutic behavior, follow-up and visual results in each case, to show the medical community, the complexity and particularities of this traumatism(AU)

Comparative transcriptomic analysis reveals adriamycin-induced apoptosis via p53 signaling pathway in retinal pigment epithelial cells / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#This paper applied a transcriptomic approach to investigate the mechanisms of adriamycin (ADR) in treating proliferative vitreoretinopathy (PVR) using ARPE-19 cells.@*METHODS@#The growth inhibitory effects of ADR on ARPE-19 cells were assessed by sulforhodamine B (SRB) assay and propidium iodide (PI) staining using flow cytometry. The differentially expressed genes between ADR-treated ARPE-19 cells and normal ARPE-19 cells and the signaling pathways involved were investigated by microarray analysis. Mitochondrial function was detected by JC-1 staining using flow cytometry and the Bcl-2/Bax protein family. The phosphorylated histone H2AX (γ-H2AX), phosphorylated checkpoint kinase 1 (p-CHK1), and phosphorylated checkpoint kinase 2 (p-CHK2) were assessed to detect DNA damage and repair.@*RESULTS@#ADR could significantly inhibit ARPE-19 cell proliferation and induce caspase-dependent apoptosis in vitro. In total, 4479 differentially expressed genes were found, and gene ontology items and the p53 signaling pathway were enriched. A protein-protein interaction analysis indicated that the TP53 protein molecules regulated by ADR were related to DNA damage and oxidative stress. ADR reduced mitochondrial membrane potential and the Bcl-2/Bax ratio. p53-knockdown restored the activation of c-caspase-3 activity induced by ADR by regulating Bax expression, and it inhibited ADR-induced ARPE-19 cell apoptosis. Finally, the levels of the γ-H2AX, p-CHK1, and p-CHK2 proteins were up-regulated after ADR exposure.@*CONCLUSIONS@#The mechanism of ARPE-19 cell death induced by ADR may be caspase-dependent apoptosis, and it may be regulated by the p53-dependent mitochondrial dysfunction, activating the p53 signaling pathway through DNA damage.

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

PURPOSE: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. RESULTS: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). CONCLUSIONS: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Scleral Buckling Using a Non-contact Wide-Angle Viewing System with a 25-Gauge Chandelier Endoilluminator

PURPOSE: To report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator. METHODS: Retrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination. RESULTS: The patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached. CONCLUSIONS: Scleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.

Comparison of the Recurrence of RRD in PPV Combined Cataract Surgery with PPV Alone, and Risk Factors in PPV Combined Cataract Surgery

PURPOSE: To compare the recurrence percentage and risk factors of recurrence in rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) by in two groups of patients according to combined cataract surgery. METHODS: The recurrence percentage of RRD and risk factors after PPV over 20 years, performed by a single surgeon from January 1997 to September 2016, were retrospectively evaluated by classification into two groups according to combined cataract surgery. The risk factors were the patients' factors (age and sex), duration of disease, preoperative visual analyses, posterior capsular tears (PCR) during cataract surgery, the tamponade used, retinal detachment ranges, macular status, number and position of retinal tears, proliferative vitreoretinopathy (PVR) grade, and vitreous opacity. A total of 158 cases were included in the study. RESULTS: The recurrence percentage of RRD was not associated with combined cataract surgery. In the combined cataract surgery group, PCR (p = 0.020), inferior retinal tears (p = 0.037), and PVR above grade B (p = 0.037) were associated with the recurrence of RRD using univariate logistic regression analyses, but PCR (odds ratio 1.880, p = 0.021) was the only significant risk factor for RRD using multivariate logistic regression analyses. CONCLUSIONS: Cataract surgery can be performed at any time, but there should be consideration of the recurrence of RRD if there was PCR during combined cataract surgery.

Clinical Features and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment according to Age

PURPOSE: To investigate the clinical features and surgical outcomes of rhegmatogenous retinal detachment (RRD) requiring surgery according to age. METHODS: Medical records of patients who underwent surgery for primary RRD between January 2008 and March 2016 were reviewed retrospectively. Patients were classified into two groups according to age at diagnosis: the under-40 group and the over-40 group. The two groups were compared in terms of demographic features, ocular manifestation, operating methods, primary anatomical success rate, and visual outcome. RESULTS: One hundred and forty-four eyes from 144 patients were included. Mean subject age was 48.6 ± 16.9 years old. The under-40 group involved 42 eyes from 42 patients, and the over-40 group included 102 eyes from 102 patients. Symptom duration was shorter in the under-40 group compared to the over-40 group (7.6 ± 10.7 days vs. 14.5 ± 24.4 days; p = 0.029). Proliferative vitreoretinopathy (PVR) occurred more frequently in the under-40 group (40.0% vs. 17.4%, p = 0.007) than in the over-40 group. The anatomical success rate of primary surgery was significantly different between the two groups; 78.6% in the under-40 group and 91.2% in the over-40 group (p = 0.038). Preoperative PVR increased the rate of anatomical failure (40.0% vs. 6.2%, p < 0.001). The visual outcomes were not significantly different between the two groups. CONCLUSIONS: RRD is combined with PVR more frequently in young patients than in old patients, which increases the failure rate of primary re-attachment surgery.

Development of medical treatment for eye injuries in the mainland of China over the past decade / 中华创伤杂志(英文版)

In the article, the development of medical treatment for eye injuries in the mainland of China was reviewed. According to the data provided in Eye Injury Vitrectomy Study (EIVS), 27% of 72 eyes with no light perception (NLP) gained recovery in term of antomy and visual function. Vitrectomy initiated at more than 4 weeks after open eye injury is an independent risk factor for developing PVR. Prognosis of anatomy and visual function of the injured eye with PVR is markedly worse than that without PVR. Serious injuries of ciliary body, choroid and retina are three key parts of the eye with NLP. The concept that the treatment of the eye injury gradually focus on the whole globe is embodied. The data from 13575 in patients with traumatic eyes in 14 hospitals revealed that the rate of immediate enucleation was remarkable reduced with comparison of 20 years ago.

Trauma of the globe: State of art in global and in China / 中华创伤杂志(英文版)

Current states of traumatic eye injury are reviewed in terms of epidemiology in the developing countries and developed countries, causes of the trauma, eye injury types, traumatic eye injury diagnostic methods and treatments. Trauma-caused vision-threatening conditions such as open global injury, traumatic optic neuropathy and proliferative vitreoretinopathy are particularly discussed. Also the most updated clinic research in China as Eye Injury Vitrectomy Study is discussed. At the end, the current achievements and research in traumatic eye injury in the world are summerized.

Anatomical success in patients after retinectomy for complex retinal detachment

To evaluate the efficacy of primary and redo retinectomy in eyes with complex retinal detachment. Quasi-experimental study. Armed Forces Institute of Ophthalmology Rawalpindi from Jan 2012 to June 2013. Fifty eight eyes [patients] underwent relaxing retinectomies for complex retinal detachment with proliferative vitreoretinopathy or intrinsic retinal shortening. Operative technique included pars plana vitrectomy, proliferative vitreoretinopathy management, use of intraoperative perfluorocarbon liquid, retinectomy, endolaser and intraocular temponade. The main outcome was anatomic success, defined as complete retinal reattachment at four months follow up. Eighteen eyes out of the same primary group underwent second retinectomy because of anatomical failure. Mean age of study population was 53.78 +/- 15.11 years, 56.9% of patients were male[s]. Anatomic success rate after 1[st] retinectomy was achieved in 68.96% [40 eyes out of 58]. In eighteen eyes that underwent 2[nd] retinectomy, anatomic success rate was 72.22% [13 eyes out of 18]. Overall success rate was 91.3% [53 eyes out of 58] in our study. Relaxing retinectomies for retinal shortening can improve the anatomical success rate in patients with complex RD

Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

PURPOSE: To report the outcomes of relaxing retinectomy for retinal detachment in patients with proliferative vitreoretinopathy (PVR). METHODS: Sixty-four cases of relaxing retinectomy for PVR with a minimum follow-up of 6 months were retrospectively reviewed. The outcomes included achievement of complete retinal reattachment, PVR recurrence, the mean number of additional operations, visual acuity and incidence of postoperative complications. We analyzed the influence of intraoperative factors including lens status, retinectomy extent, additional scleral buckling, and tamponade agent on primary retinal reattachment. RESULTS: Complete retinal reattachment was achieved in 47 eyes (74.3%) without an additional surgery. PVR recurred in 19 eyes (29.7%) and an additional operation was performed in 17 eyes (26.6%). Fifty-seven (89.1%) eyes showed complete retinal reattachment and 40 eyes (62.5%) had visual acuity of 0.02 or more at the final follow-up visit. Hypotony was the major complication and developed in 10 eyes (15.6%). Eyes undergoing smaller ( or = 180degrees) retinectomy or gas tamponade (p = 0.043 and 0.013, respectively). CONCLUSIONS: Relaxing retinectomy is a useful technique for retinal detachment with PVR, but risk of recurrent proliferation or hypotony should be considered.

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

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

An association between subclinical familial exudative vitreoretinopathy and rod-cone dystrophy / Associação entre vitreorretinopatia exsudativa familiar subclínica e distrofia de cones e bastonetes

A 21-year-old Caucasian man presented with a complaint of nyctalopia. Visual acuity in both eyes was 20/20 and anterior segment biomicroscopy results were unremarkable. Fundoscopy revealed peripheral avascular zones, minimal peripheral retinal exudation from the retinal vessels, peripheral retinal telangiectasias and anastomosis in both eyes, and retinal vascular dragging toward the temporal periphery in both eyes. Full field electroretinography showed that rod responses were almost absent and that cone responses were reduced. Macular optical coherence tomography showed normal structure in both eyes. Vascular changes were attributed to a subclinical form of familial exudative vitreoretinopathy. This was an interesting case due to the association of familial exudative vitreoretinopathy with rod-cone dystrophy.

Um homem caucasiano de 21 anos foi avaliado com queixa de nictalopia. A acuidade visual era 20/20 em ambos os olhos. Biomicroscopia do segmento anterior era normal. A fundoscopia revelava zonas avasculares periféricas, exsudação mínima dos vasos retinianos periféricos da retina, telangiectasias da retina periférica com anastomoses em ambos os olhos e deslocamento vascular da retina em direção a periferia temporal em ambos os olhos. O eletrorretinograma (ERG) de campo total apresentava respostas de bastonetes praticamente indetectáveis e redução das respostas de cones. A tomografia de coerência óptica (OCT) macular mostrava estrutura normal em AO. As alterações vasculares foram atribuídas à forma subclínica da vitreorretinopatia exsudativa familiar. Este é um caso interessante com a associação de vitreoretinopatia exsudativa familiar e distrofia de cones e bastonetes (RCD).

Analgesia preemptiva com nepafenaco 0, 1% na fotocoagulação da retina / Preemptive analgesia of nepafenac 0. 1% in retinal photocoagulation

Objetivo: Avaliar o efeito preemptivo com nepafenaco 0,1% em pacientes submetidos à fotocoagulação da retina para tratamento da retinopatia diabética proliferativa. Métodos: Trinta pacientes foram submetidos à fotocoagulação com laser de argônio em ambos os olhos. O olho contralateral de cada paciente foi o controle. O nepafenaco e o placebo foram utilizados 30 minutos antes da aplicação do laser. Ambos os olhos foram fotocoagulados no mesmo dia. A intensidade da dor foi avaliada por meio da escala analógica visual e da escala descritiva de dor. Resultados: A análise da interação instilação versus nepafenaco mostrou que os pacientes do grupo placebo apresentaram níveis de dor semelhantes em ambos os olhos, e os do grupo nepafenaco apresentaram redução importante do nível de dor no olho em que foi instilado a suspensão de 0,1% quando comparado ao olho contralateral que recebeu placebo (p=0,023). Conclusão: Este estudo sugere que a suspensão de 0,1% de nepafenaco foi útil na analgesia preemptiva de pacientes submetidos à fotocoagulação de retina quando comparada ao placebo. .

Objective: To evaluate the preemptive effect of nepafenac 0,1% in patients undergoing retinal photocoagulation for the treatment of proliferative diabetic retinopathy Methods: Thirty patients underwent argon laser photocoagulation in both eyes. The contralateral eye of each patient was the control. The nepafenac and placebo were used 30 minutes before the application of the laser. Both eyes were photocoagulated in the same day. Pain intensity was assessed by visual analog scale and descriptive pain scale Results: The analysis of the interaction instillation versus nepafenac showed that patients in the placebo group had similar levels of pain in both eyes, and the nepafenac group had significant reduction in pain in the eye that was instilled suspension of 0,1% when compared to the contralateral eye which received placebo (p = 0.023). Conclusion: This study suggests that a suspension of 0,1% nepafenac helpful for preemptive analgesia in patients undergoing retinal photocoagulation compared to placebo. .

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.

Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

PURPOSE: To investigate the risk factors and the factors affecting surgical and visual outcomes of rhegmatogenous retinal detachment in patients under 40 years of age. METHODS: This retrospective study included 88 patients (96 eyes) diagnosed with rhegmatogenous retinal detachment that were followed up for more than 3 months postoperatively. Patients were categorized into 3 groups according to age. The etiologic risk factors and the primary anatomical and functional success rates were analyzed. Preoperative factors that could affect postoperative visual acuity and primary anatomical outcome, such as subretinal strands and proliferative vitreoretinopathy (grade C or worse), were analyzed. RESULTS: Myopia more severe than -4.0 diopters was the most common predisposing factor in all 3 groups. Anatomical success rates and functional success rates were not significantly different among the groups. Prevalence of macular detachment and proliferative vitreoretinopathy were highest in group 1. The presence of subretinal strands was highest in group 2 and proliferative vitreoretinopathy was highest in group 1. Patients with preoperative subretinal strands showed a lower primary anatomical success rate in group 1 and poor postoperative visual acuity in groups 1 and 2. Patients with proliferative vitreoretinopathy had poor postoperative visual acuity however there was no significant difference in primary anatomical success rate among the groups. CONCLUSIONS: Proliferative vitreoretinopathy did not affect the anatomical success rate but did affect visual outcome in rhegmatogenous retinal detachment in patients under age 40. Subretinal strands contributed to a lower anatomical success rate and poorer visual outcome in such patients that were under age 18.