Retinal surface en face optical coherence tomography: a new imaging approach in epiretinal membrane surgery.

PURPOSE: To describe the clinical effectiveness of a new imaging approach: en face spectral domain optical coherence tomography of the retinal surface before and after epiretinal membrane (ERM) and internal limiting membrane peeling. METHODS: Retrospective analysis of preoperative and postoperative en face spectral domain optical coherence tomography images of the inner face of the macula obtained from 20 eyes of 20 patients undergoing vitrectomy with internal limiting membrane peeling for ERM. RESULTS: Preoperatively, en face spectral domain optical coherence tomography imaging of the retinal surface clearly showed plaques surrounded by radiating folds because of ERM. It could also disclose areas possibly devoid of internal limiting membrane secondary to ERM contraction. A rough retinal surface was visible in the peeled area during the first postoperative month. At 3 months, various amounts of dimples were progressively observed in 13 of 15 eyes (87%). In all these cases, they lasted or increased in size and number at the last follow-up examination. Some residual epiretinal tissue was also detected by this technique. CONCLUSION: En face spectral domain optical coherence tomography of the retinal surface is an interesting complement to standard retinal optical coherence tomography section that provides an easy-to-understand global overview of the retinal surface. It can detect and classify tiny progressive morphologic changes in the texture of the retinal surface occurring after internal limiting membrane peeling.

Scleral buckle removal associated with pars plana vitrectomy for recurrent retinal detachment.

PURPOSE: Scleral buckle (SB) removal is rarely performed due to extrusion, infection, or diplopia. We report a series of patients with recurrent retinal detachment (RRD) after primary SB due to new breaks occurring at sites where the presence of a pre-existing SB was judged counterproductive. All patients were treated by means of pars plana vitrectomy (PPV) and SB removal with the sole purpose of achieving a more favorable retinal profile. METHODS: We retrospectively reviewed all patients undergoing PPV and SB removal for RRD due to new breaks occurring at sites hidden by pre-existing exoplants. RESULTS: Mean age was 52 years and VA on presentation was 20/620 and 20/216 at latest visit (p<0.01), 23 months of follow-up. On presentation, 3/11 (27%) had a VA better than 20/400 and 1/11 (9%) better than 20/40. At the end of follow-up, 9/11 (81%) and 3/11 (27%) saw better than 20/400 and 20/40 (p<0.05). At the end of follow-up, 8/11 (72%) had an attached retina, 2/11 (18%) had a partially attached retina, and 1/11 (9%) had a total RD. Explanted buckles included 5 silicone sponges and 6 solid silicone rubber elements. CONCLUSIONS: Although occasionally cumbersome and time-consuming, SB removal may provide a more favorable retinal profile and improve retina-tamponade contact. Larger series are needed to assess if this translates into a significant benefit in the treatment of selected RRD.

Combined pars plana vitrectomy and artificial iris diaphragm implant after globe rupture.

BACKGROUND: Retinal detachment (RD) associated with aniridia due to globe rupture (GR) is an uncommon condition with a severe prognosis. Surgical technique must address anterior and posterior segment issues secondary to the altered compartmentalization and increased risk for corneal toxicity. The purpose of this paper is to report a series of GR patients undergoing combined pars plana vitrectomy (PPV) and artificial iris diaphragm (AID) implant for the repair of RD associated to aniridia. METHODS: The authors retrospectively reviewed 12 consecutive patients operated on by a single surgeon. Surgery consisted of a standard three-port PPV with extensive bimanual dissection of vitreous base and ciliary body membrane and combined AID implant. Office visits included Snellen visual acuity (VA), intraocular pressure measurement, biomicroscopy and indirect ophthalmoscopy. AID prosthesis included aniridic IOLs, Heimann's PMMA and silicone diaphragm. RESULTS: Mean age was 53 years and mean follow-up was 19 months. At the end of follow-up, seven patients gained more than two lines (58.3%), two lost their vision (16.6%) and three were unchanged (25%). Seven patients (58.3%) had a VA better than 20/400 and one (8%) 20/40 vision. Eight patients (66.6%) retained a clear cornea, two (16.6%) had minimal corneal oedema and two (16.6%) corneal decompensation. Implanted prosthesis included two silicone diaphragms, four PMMA diaphragms and six aniridic IOLs. After an average 1.6 operations, the retina was completely attached in six patients (50%), partially attached in four (33.3%) and detached in two (16.6%). CONCLUSION: RD associated to GR carries a guarded prognosis both due to RD complexity and hypotony. The combined repair of RD and aniridia after GR offers the advantage of addressing all issues at one time allowing correct eye compartmentalization and better tamponade effect. Successful anatomical and functional results can be achieved although multiple surgeries are often needed.

Long-term vitreous replacement with perfluorohexyloctane and silicone oil: preliminary reports of a multicentric study.

AIM: To report on the use of a combined intra-ocular tamponade with silicone oil and perfluorohexyloctane (F(6)H(8)) in the treatment of complex retinal detachment. DESIGN: A prospective consecutive interventional case series from seven study centres. PARTICIPANTS: 69 patients presenting a retinal detachment with proliferative vitreoretinopathy (PVR) and retinal breaks of the inferior two quadrants of the fundus. METHOD: Patients were divided into two groups: (1) 28 eyes which had not been operated on before; (2) 41 eyes affected by recurrent retinal detachment that had had unsuccessful previous surgery with silicone oil or gas tamponade. A pars plana vitrectomy, membrane peeling and -- when necessary -- a retinotomy were performed; the vitreous cavity was filled with two thirds of F(6)H(8) and one third of silicone oil 1,000 mPas (double filling, DF). The endotamponade was removed after 30-45 days (median 38) and replaced by balanced salt solution or silicone oil according to the condition of the retina. RESULTS: Retinal reattachment was achieved in 52 out of 69 cases (75%) 6 months after removal of the DF without any endotamponade. CONCLUSION: The DF with F(6)H(8) and silicone oil allows a good endotamponading to the inferior retina and the posterior pole. The DF appeared to be well tolerated. Further studies are necessary to evaluate whether a DF is advantageous in respect to silicone oil filling alone in case of retinal breaks and PVR of the inferior retina.