Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial.

BACKGROUND: Cellophane membranes are an early stage of proliferative vitreoretinopathy (PVR) complicating retinal detachment surgery. Our aim was to assess whether a prolonged administration of systemic corticosteroids would attenuate early stages of PVR such as cellophane membranes. DESIGN: Prospective randomized placebo-controlled double-blind clinical trial. PATIENTS AND METHODS: A total of 220 consecutive eyes (220 patients) were operated for primary rhegmatogenous retinal detachment (RD), mainly by scleral buckling procedures. Patients were randomized into two groups: 110 patients (steroid group) received prednisone for 15 days starting with 100 mg at the day of surgery and being tapered to 12.5 mg. The control group of 110 patients received placebo in a comparable manner. Follow-up examinations were performed at 1, 3 and 6 months postoperatively, and included visual acuity and assessment of retinal findings. RESULTS: Cellophane membranes occurred in 41.8%, 46.9%, and 39.1% in the placebo group and 26.7%, 23.6%, and 19.8% in the steroid group at 1, 3 and 6 months postoperatively (p < 0.05, = 0.0005, and <0.005 respectively). The application of five or more cryocoagulation spots was associated with more cases developing cellophane membranes in the placebo than the steroid group (p < 0.05). A complete reattachment of the retina was achieved in 95% steroid and 89% placebo group eyes, and a reattachment of the macula in 98% of both groups. There was no significant difference of the final visual outcome in both groups. CONCLUSION: Early stages of PVR such as cellophane membranes after retinal detachment surgery can be reduced with corticosteroids in oral doses.

Outcome indicators for vitrectomy in Terson syndrome.

PURPOSE: There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. METHODS: In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. RESULTS: Thirty-seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best-corrected visual acuity (BCVA) at first and last presentation was 0.07 +/- 0.12 and 0.72 +/- 0.31, respectively. Thirty-five eyes (79.5%) achieved a postoperative BCVA of > or = 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of > or = 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 +/- 0.27 compared to 0.66 +/- 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 +/- 0.24 compared to 0.60 +/- 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. CONCLUSION: Ninety-eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.

Analysis of risk factors for the outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes.

BACKGROUND: To compare the preoperative risk profiles of phakic and pseudophakic eyes with primary retinal detachment and to assess their impact on the outcome of primary reattachment surgery. PATIENTS AND METHODS: 220 consecutive patients with primary retinal detachment, 165 phakic and 55 pseudophakic eyes were operated with scleral buckling alone or additional vitrectomy and followed up for 6 months. Pre-, intra- and postoperative risk factors were recorded and their impact on anatomical outcome after primary surgery in phakic and pseudophakic eyes was then compared in a multivariate regression analysis. RESULTS: The cumulative probability of anatomical success 6 months after surgery was similar in phakic (88.5 %) and pseudophakic eyes (86.3 %; log rank = 0.340). The most important risk factor for a different surgical outcome between phakic and pseudophakic eyes was the size of retinal detachment (p = 0.035). In phakic eyes the size of retinal detachment had no significant impact on surgical outcome (1 vs. 4 quadrants; log rank = 0.135); whereas in pseudophakic eyes a significant impairment on surgical outcome was found (1 vs. 4 quadrants; log rank < 0.001). The relative risk for failure of primary surgery due to retinal detachment of at least 3 quadrants was in phakic eyes 1.22 (CI: 0.71 - 1.70), in pseudophakic ones 1.81 (CI: 0.88 - 2.59). CONCLUSIONS: The outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes is similar for retinal detachments up to 3 quadrants. In retinal detachments of more than 9 clock times, the size of retinal detachment impairs the surgical outcome in pseudophakic eyes more than in phakic ones. The combination of extraocular surgery with vitrectomy in pseudophakic eyes with retinal detachment of more than 9 clock times contributes to a better outcome.

Normal-tension glaucoma is associated with sleep apnea syndrome.

INTRODUCTION: In normal-tension glaucoma, optic nerve damage occurs without elevated intraocular pressures, hence vascular and pathogenic mechanisms other than intraocular pressure effects have been postulated. However, the exact cause(s) remain unknown. We have looked for an association between normal-tension glaucoma and sleep apnea syndrome, a disease characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of late cardiovascular and neurological sequelae. METHODS: We performed overnight polysomnography in 16 consecutive Caucasian patients with normal-tension glaucoma. The respiratory disturbance index (RDI) during night sleep was used to diagnose and grade obstructive sleep apnea. Patients with an RDI of 10 or more were diagnosed as having obstructive sleep apnea. RESULTS: We observed the following prevalences of obstructive sleep apnea in normal-tension glaucoma patients: 0% (0 of 2) for the group of patients younger than 45 years, 50% (3 of 6) for the age group 45-64 years, and 63% (5 of 8) for the group older than 64 years. Prevalences in the middle and older age group were significantly higher than in a historic control group (p < 0.025 for both, binomial test). CONCLUSION: Normal-tension glaucoma patients constitute a high-risk population for sleep apnea syndrome. Therefore, they should be screened for sleep apnea syndrome, and, if necessary, be treated to avoid late cardiovascular and neurological sequelae.