Rhegmatogenous retinal detachment in children 16 years of age or younger.

PURPOSE: To study the anatomical and visual outcomes and prognostic factors that may predict the outcomes of rhegmatogenous retinal detachment (RRD) in children. METHODS: A retrospective chart review was performed for patients 16 years of age or younger who underwent retinal reattachment surgery for RRD at the King Abdulaziz University Hospital from 1996 to 2005 and the King Khalid Eye Specialist Hospital from 2002 to 2006, Riyadh, Saudi Arabia. Good visual outcome was defined as ≥20/200. The association between two categorical variables was evaluated with the Chi-squared test or the exact test, as appropriate. Predictors for RRD and good final visual acuity were identified by conducting stepwise logistic regression analysis. P < 0.05 was statistically significant. RESULTS: The study population comprised 148 patients (166 eyes). There were 104 (70%) males and 44 (30%) females. Mean age at presentation was 8.33 ± 3.26 years (range 1.5-16 years). The retina was reattached after one surgical procedure in 106 (63.8%) eyes and reattached in 130 (78.3%) eyes after multiple surgeries. Factors predicting recurrence after the first surgery were myopia (P = 0.028), proliferative vitreoretinopathy (PVR) at presentation (P = 0.024), and total retinal detachment (P = 0.032). Good final visual outcome was achieved in 60 (44.4%) eyes. Predictors of good visual acuity were: good visual acuity at presentation (P < 0.001); absence of PVR at presentation (P < 0.001); one quadrant of retinal detachment (P = 0.0024); macula on (P = 0.0107); absence of primary repair of a ruptured globe (P = 0.0059); no pars plana vitrectomy (PPV) (P = 0.0123); clear phakic lens at follow-up (P < 0.001); absence of postoperative complications (P < 0.001); absence of recurrence of RRD (P < 0.001); and absence of epiretinal membrane (P = 0.0088). Logistic regression analysis indicated that recurrence of RRD was associated with myopia and previous congenital cataract surgery; good final visual outcome was associated with macula on detachment and poor visual outcome was associated with recurrence of RRD and occurrence of postoperative complications and previous repair of a ruptured globe. CONCLUSION: RRD in children is usually associated with a predisposing factor, a high rate of PVR, and total retinal detachment. Despite late diagnosis and the presence of PVR, favorable anatomical and visual outcomes can be achieved.

Anesthesia for pars plana vitrectomy with insulin needle, is it possible?

Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compare the efficacy of using 12.5 mm to 25 mm standard needle length in performing single injection peribulbar block for retinal surgery. Peribulbar block was performed in 120 patients using either standard 25 mm or 12.5 mm 30 G needle (insulin needle). While applying digital pressure around the needle hub, 8-10 mL of local anesthetic are injected. Ocular movement was assessed at 5 and 10 min using simple akinesia score (0-8). If after 10 min score was >1, supplementary injection was given. Visual analogue scale (0-10) was used at the end of the procedure to assess surgeons' satisfaction and patients' intraoperative pain. No differences in akinesia score at 5 & 10 min (P = 0.34 and 0.36, resp.). Initial volume injected was comparable between groups (P = 0.31), however total volume of local anesthesia and supplementary injections were significantly higher in 12.5 mm group (P = 0.03 and 0.01, resp.). No difference as regard surgeons' satisfaction and patients' intraoperative pain (P = 1.0 and 0.18, resp.). Peribulbar block with 12.5 mm needle together with digital compression is a suitable alternative to the standard block with 25 mm needle length for retinal surgery.

Macular hole in Behçet's disease.

OBJECTIVE: To investigate the clinical features, prevalence, role of surgical intervention and the visual prognosis of macular holes (MH) in patients with Behcet's disease (BD). MATERIALS AND METHODS: Retrospective study of patients with BD and MH from January 1998 to November 2008. RESULTS: Out of 159 patients, 21 eyes of 17 patients were identified with MH. The mean age was 38.59 (range 23-61) years and the mean follow-up period was 5.1 years (range 13-164 months). The prevalence of MH was 7%. Visual acuity (VA) at the time of presentation ranged from 20/70 to hand-motion. Optical coherence tomography (OCT) findings revealed intraretinal cysts at the edge of the MH. The mean size of MH was 983.6 um; 52% had elevated edges, 43% had flat edges and only one eye (5%) was closed postoperatively. Fluorescein angiography (FA) was consistent with macular ischemia in 76% of the cases. Human leukocyte antigen (HLA) B51 association was found in 14 of the 15 patients investigated. Six patients (out of 17) underwent pars plana vitrectomy. The final VA on their last follow-up ranged from 20/70 to 2/200. Surgical intervention for MH did not result in any visual improvement as compared to non-operated eyes. One patient lost vision completely due to elevated intraocular pressure post vitrectomy and silicon oil tamponade. CONCLUSIONS: MH in patients with BD may lead to significant visual disability. Surgical intervention does not seem to have any potential beneficial effect on the VA, probably due to significant macular ischemia and sequelae from the ocular inflammation.

Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses.

OBJECTIVE: To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy (PPV) to manage dislocated intraocular lenses (IOLs). PATIENTS AND METHODS: A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded. RESULTS: Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85 years (mean 52.6). The range of follow-up was 3 to 108 months (mean ± SD 19.4 ± 17.4 months). The final visual acuity was 20/50 or better in 52 (55.3%) eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic (P = 0.0092). There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome (20/200 or better) in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in (90.0%) of eyes with good vision (20/200 or better) compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 (9.6%), glaucoma in 9 (9.6%), bullous keratopathy in 8 (8.5%), retinal detachments in 6 (6.4%) eyes, and relapsing uveitis in 2 (2%). CONCLUSION: In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies.

Helicoid subretinal fibrosis associated with a novel recessive NR2E3 mutation p.S44X.

OBJECTIVES: To describe a unique pattern of helicoid subretinal fibrosis associated with a novel recessive NR2E3 mutation and to highlight how examination of the proband's affected relative allowed appropriate genetic testing. DESIGN: Interventional family study (ophthalmic examination and candidate gene testing). RESULTS: The proband (mother), who complained of poor vision since early childhood, had bilateral helicoid subretinal fibrosis mostly involving the macula. Two children were symptomatic; one had ophthalmic findings similar to her mother while the second had macular retinoschisis, retinal pigment epithelium changes, and refractive accommodative esotropia. The father and third child were asymptomatic and had unremarkable ophthalmic examination findings. Based on the findings in the second symptomatic child, NR2E3 analysis was performed, which revealed homozygosity for a novel mutation, p.S44X, in all 3 affected individuals and heterozygosity for the mutation in both asymptomatic individuals. CONCLUSION: Helicoid subretinal fibrosis is another potential phenotypic manifestation of recessive NR2E3 mutation. CLINICAL RELEVANCE: Examination of affected relatives can be helpful in guiding molecular genetic testing for hereditary eye disease when the proband's diagnosis is unclear.

Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies.

PURPOSE: To determine the risk factors and visual outcome of endophthalmitis associated with traumatic intraocular foreign body (IOFB) removal and its allied management. METHODS: A retrospective review was conducted of patients with penetrating eye trauma and retained IOFB with associated endophthalmitis managed at King Khaled Eye Specialist Hospital over a 22 year period (1983 to 2004). RESULTS: There were 589 eyes of 565 patients (90.3% male; 9.7% female) which sustained ocular trauma and had retained IOFB that required management. Forty-four eyes (7.5%) developed clinical evidence of endophthalmitis at some point after trauma. From these 44 eyes, initial presenting visual acuity (VA) of 20/200 or better was recorded in 8 eyes (18.1%) and the remaining 36 eyes (81.9%) had VA ranging from 20/400 to light perception. Eleven eyes (25%) underwent IOFB removal and repair within 24 hours after trauma while 33 eyes (75%) had similar procedures done 24 hours or more after trauma. Thirty-one eyes (70%) underwent primary pars plana vitrectomy (PPV) at the time of removal of posteriorly located IOFBs. Definite positive cultures were obtained from 17 eyes (38.6%). Over a mean follow-up of 24.8 months, 21 eyes (47.7%) had improved VA, 6 eyes (13.6%) maintained presenting VA while 17 eyes (38.7%) had deterioration of their VA, including 10 eyes (22.7%) that were left with no light perception (NLP) vision. After the treatment of endophthalmitis, 20 eyes (45.4%) had VA of 20/200 or better at their last follow-up. Four eyes (12.9%) from the vitrectomy group (31 eyes) and 5 eyes (45.4%) from non-vitrectomy (11 eyes) group had final VA of NLP. Predictive factors for the good visual outcome included good initial presenting VA, early surgical intervention to remove IOFB (within 24 hours), and PPV. Predictors of poor visual outcome included IOFB removal 48 hours or later, posterior location and no PPV for the posteriorly located IOFB. CONCLUSIONS: Delayed removal of IOFB following trauma may result in a significant increase in the development of clinical endophthalmitis. Other risk factors for poor visual outcome may include poor initial presenting VA, posterior location of IOFB and no vitrectomy at the time of IOFB removal.

Incidence of sclerotomy-related retinal breaks.

PURPOSE: To estimate the incidence of sclerotomy-related retinal breaks (SRRBs) and identify possible associated risk factors. METHODS: Medical records of patients who underwent pars plana vitrectomy (PPV) from January 1994 to January 1999 at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, were reviewed. The diagnosis, procedure, and possible associated risk factors were documented, in addition to the presence of SRRBs and time of discovery. RESULTS: Of the 441 eyes, 3.1% developed early SRRBs, while 2.9% of 350 eyes developed late SRRBs. Most of the eyes that developed SRRBs were phakic, and penetrating trauma was found statistically to increase the risk of SRRBs. CONCLUSIONS: SRRBs are an uncommon complication of PPV. Early detection and proper management can prevent serious sequelae of such complications.