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.

Epidemiología del desprendimiento de la retina regmatógeno / Epidemiology of rhegmatogenous retinal detachment

RESUMEN Objetivos: Determinar los factores epidemiológicos, sistémicos y oculares del desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo transversal de los casos nuevos con desprendimiento de la retina regmatogéno que requirieron cirugía y se presentaron de forma consecutiva en la Consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde mayo del año 2016 hasta mayo de 2017. Se estudiaron las variables demográficas y los antecedentes patológicos sistémicos y oculares. Los resultados se expresaron en frecuencias absolutas y relativas (variables cualitativas) y se calculó la media y la desviación estándar en las cuantitativas. Resultados: En el período estudiado se atendieron 237 casos nuevos de desprendimiento de la retina regmatogéno que requirieron cirugía. La edad media de estos fue de 57,79 años (desviación estándar 11,98). Prevaleció el sexo masculino (62 por ciento). La mayor cantidad de casos provenía de las provincias occidentales, fundamentalmente de La Habana (43,9 por ciento) y los primeros síntomas se presentaron en los meses primaverales (48,1 por ciento). La hipertensión arterial se reportó en el 54,4 por ciento. Entre los antecedentes oculares predominó la cirugía de catarata (65,8 por ciento), seguida de la degeneración reticular en la retina periférica (36,3 por ciento). Conclusiones: El desprendimiento de la retina regmatógeno se presenta en edades avanzadas y la cirugía de catarata es un antecedente frecuente en estos casos(AU)

ABSTRACT Objectives: Determine the epidemiological, systemic and ocular factors of rhegmatogenous retinal detachment. Methods: A cross-sectional observational descriptive study was conducted of the new cases of rhegmatogenous retinal detachment requiring surgery and presenting consecutively at the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to May 2017. Analysis was performed of demographic variables and systemic and ocular pathological antecedents. Results were expressed as absolute and relative frequencies (qualitative variables), whereas quantitative variables underwent mean and standard deviation estimation. Results: During the study period, 237 new cases were seen of rhegmatogenous retinal detachment requiring surgery. Mean age was 57.79 years (standard deviation 11.98). The male sex prevailed (62 percent). Most cases were from the western provinces, mainly Havana (43.9 percent), and the first symptoms appeared in the spring months (48.1 percent). Hypertension was reported in 54.4 percent of the cases. The prevailing ocular antecedents included cataract surgery (65.8 percent), followed by lattice degeneration in the peripheral retina (36.3 percent). Conclusions: Rhegmatogenous retinal detachment presents in advanced ages. Cataract surgery is a common antecedent in these cases(AU)

¿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.

Ultrasonography-guided scleral buckle retinopexy and cryotherapy: case report / Retinopexia com "buckle" escleral e crioterapia guiada por ultrassom: relato de caso

If the ocular media are clear, indirect binocular ophthalmoscopy allows retinal detachment and retinal tear identification and treatment under direct visualization. However, if opacities are present preventing direct fundus examination, ultrasonography becomes the most important tool for evaluating the posterior segment. In addition, ultrasonography can be useful in retinal tear treatment by guiding cryotherapy. In this article we describe a rhegmatogenous retinal detachment treatment technique applied to a patient with corneal opacity. Cryopexy and circumferential and radial buckle positioning were guided by ultrasonography, resulting in retinal attachment during the 6-month follow-up period.

Quando os meios oculares são transparentes, oftalmoscopia binocular indireta permite a identificação de descolamento de retina e roturas, bem como seu tratamento sob visibilização direta. Porém, em olhos que apresentam opacidades de meios impedindo o exame oftalmoscópico, a ultrassonografia constitui o exame mais importante do segmento posterior do olho. Além disso, o tratamento de roturas retinianas também pode ser auxiliado pelo uso desse equipamento, orientando a crioterapia. Neste trabalho será apresentada técnica de tratamento de descolamento de retina regmatogênico, no qual a criopexia e o posicionamento dos "buckles" episclerais circunferencial e radial foram guiados pelo ultrassom em paciente com leucoma corneano. O tratamento resultou em aplicação retiniana durante o seguimento em seis meses.

Lens-sparing Vitrectomy for Stage 4 and Stage 5 Retinopathy of Prematurity

PURPOSE: To describe the results of lens-sparing vitrectomy for the correction of retinal detachment associated with retinopathy of prematurity (ROP) and its associated complications. METHODS: Seventeen patients who underwent a lens-sparing vitrectomy for stage 4 and stage 5 ROP with plus disease at Seoul National University Children's Hospital between 1999 and 2003 were enrolled in this study. The patients who had bilateral retinal detachment of ROP underwent a lens-sparing vitrectomy in one eye and a scleral buckling surgery or lensectomy-vitrectomy in the other eye. The patients who had a retinal detachment in one eye and a regressed ROP in the other eye underwent unilateral lens-sparing vitrectomies. A review of their preoperative clinical findings (including the status of retinal detachment and plus disease), post-operative results, and any complications encountered was performed. RESULTS: In 17 patients, the postoperative success rate of lens-sparing vitrectomy was 58.8%. However, lens-sparing vitrectomy as a treatment for stage 5 ROP (25.0%) produced more negative post-operative results than it did when used to treat either those for stage 4a (75,0%) or 4b (66.7%) ROP. Among the 10 eyes in which the retina was attached, form vision was shown in six eyes, light could be followed by three eyes, and no light perception was present in one eye. Intra- and post-operative complications included retinal break formation, cataracts, vitreous hemorrhages, and glaucoma in patients with stages 4b and stage 5 ROP. CONCLUSIONS: Lens-sparing vitrectomy resulted in encouraging surgical outcomes in the correction of retinal detachment of ROP, especially in stage 4 patients. Therefore, a lens-sparing vitrectomy for stage 4 ROP patient may be beneficial, although it is still associated with some intra- and post-operative complications.

Surgical outcomes in rhegmatogenous retinal detachment at Srinagarind Hospital.

OBJECTIVES: To evaluate the surgical outcome for patients with rhegmatogenous retinal detachment and to find out the factors influencing the anatomic reattachment and visual results. MATERIAL AND METHOD: Retrospective review of the medical records of patients for the following details: age, sex, time to diagnosis, time to surgery, phakic status, types, numbers and locations of the retinal breaks, macular status, presence of proliferative vitreoretinopathy (PVR), types of surgical procedures, anatomic reattachment and visual improvement. RESULTS: Two hundred and twelve patients were surgically treated by pneumatic retinopexy, scleral buckling, pars plana vitrectomy or combined procedures. Initial anatomic reattachment was found in 157 cases (74.06%) and final reattachment in 193 cases (91.04%). Several factors including age, phakic status, number of the retinal breaks, macular detachment, PVR and types of surgical procedures have been identified to have a correlation with the anatomic success rate. Types of surgical procedures and time to surgery within 8 weeks of detachment have also been demonstrated to have a correlation with final visual improvement. However, only types of surgical procedures had statistically significant difference. Pneumatic retinopexy had a lower anatomic reattachment rate, but obtained a higher visual improvement than did other surgical procedures. Moreover, after repeated pneumatic retinopexy or further surgical procedures, the final anatomic success rate improved from 65.52% to 92.24%. CONCLUSION: Surgical outcomes for rhegmatogenous retinal detachment are comparable to other studies. Types of surgical procedures had a significant correlation with anatomic reattachment and final visual improvement.

Modified needle drainage. A safe and efficient technique of subretinal fluid drainage in scleral buckling procedure.

PURPOSE: To compare modified needle drainage (MND) with conventional drainage (CD) of subretinal fluid (SRF) as described by Schepens in surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective randomised clinical trial of 80 patients undergoing scleral buckling with subretinal fluid drainage for primary rhegmatogenous retinal detachment. In 40 patients modified needle drainage of subretinal fluid (SRF) was done using a perpendicular trans-scleral entry with a 26-gauge needle and the appearance of SRF in the hub of needle as end point. In 40 patients conventional drainage was done as described by Schepens using a diathermy needle. Adequacy of SRF drainage, intraoperative complications, anatomical and functional outcome were noted. RESULTS: 100% adequate drainage was achieved in all cases. The complication rate was 32.5% (n=13) in the CD group and 15% (n=6) in the MND group. In the CD group, 17.5% (n=7) patients had subretinal haemorrhage and in 2 eyes it was clinically significant. In the MND group 15% (n=6) of cases had subretinal haemorrhage and in one patient it was clinically significant. In the CD group, more serious SRF drainage complications were observed; these were absent in the MND group. CONCLUSION: Modified needle drainage is a safe and effective procedure for SRF drainage. In comparison with CD, MND is technically easy, less cumbersome and requires no special equipment.

Finding the retinal break in rhegmatogenous retinal detachment.

The development of subretinal fluid is governed by a limited number of anatomical factors and gravity. As a result, rhegmatogenous retinal detachments form in a predictable manner around the retinal break of their origin. The shape of the detachments points to the position of the break. The purpose of this review is to describe the characterstic contours of subretinal fluid in rhegmatogenous retinal detachments, and to highlight some rules and methodology which can help in the detection of the retinal break in phakic, psuedophakic and recurrent retinal detachments.

Pseudophakia retinal detachment

Study the outcome of pseudophakic retinal detachment surgery. Setting: Retina service, Ophthalmology department, Salmaniya Medical Centre, Bahrain. Subjects and Design: Review of medical records of all patients who presented to our unit between July 1987 and June 1995. A total of 14 cases of pseudophakic retinal detachments were analysed. Simple technique of episcleral buckling was found to be adequate to repair the detachment in 85.7% of cases. Single procedure was successful in 78.6% of patients. 64.3% of the cases regained 6/18 or better vision after surgery. Conclusions: Overall outcome of this small series of patients was comparable to the reports in the literature. Patients should be made aware of the risk of postoperative retinal detachment and its warning signals. The number of patients of this disease is likely to increase in the future and upgrading of existing facilities is suggested

Selection of surgical technique for retinal detachment with coloboma of the choroid.

Four eyes with rhegmatogenous retinal detachment and coloboma of the choroid were managed by conventional scleral buckling (one eye); scleral buckling combined with lensectomy, vitrectomy, and fluid-air exchange (two eyes); and vitrectomy, silicone oil injection without scleral buckling (one eye). Retinal break was seen within the coloboma in two eyes, at the periphery in one eye, and, both in the coloboma and periphery in one eye. At a follow-up of 15 months, the retina was found attached in all the patients. The success of these surgical procedures could be attributed to careful preoperative/intraoperative fundus examination and individualised surgical planning.

Bulbar conjunctival granuloma following scleral buckling

A 36-year-old man developed the now rare bulbar conjuctiva granuloma nearly two years after scleral bukling procedure in his right eye. [Pakistan Journal of Ophthalmology 10:6, 17, January, 1994.]