Retinal detachment and prophylaxis in type 1 Stickler syndrome.

PURPOSE: To report the prevalence of retinal detachment (RD) and results of prophylaxis against detachment from a giant retinal tear in a large cohort of patients with type 1 Stickler syndrome. DESIGN: Retrospective study. PARTICIPANTS: Two hundred four type 1 Stickler syndrome patients. METHOD: Pedigrees and individuals with type 1 Stickler syndrome were identified from the vitreous research clinic and divided into 3 groups. Group 1 consisted of patients who received no prophylaxis (control group). Group 2 consisted of patients who had bilateral 360 degrees prophylactic cryotherapy (study group). Group 3 consisted of patients referred with unilateral RD for surgical repair and who underwent prophylaxis in the fellow eye (mixed group). MAIN OUTCOME MEASURES: Retinal status after prophylaxis, with failure of prophylaxis being defined as the development of RD or retinal tears needing further retinopexy. RESULTS: Of 111 patients who had no prophylactic retinopexy (group 1; mean age, 49 years), 73% (81/111) suffered RD and 48% (53/111) were bilateral. Of 62 patients who had bilateral prophylactic cryotherapy (group 2; mean age, 21 years), 8% (5/62) suffered failure of prophylaxis. There were no cases of bilateral detachments. The mean follow-up period was 11.5 years. In 31 patients who had unilateral prophylactic cryotherapy to the fellow eye (group 3; mean age, 36 years), failure occurred in 10% (3/31) of cases with a mean follow-up of 15.5 years. The prevalence of failure of prophylaxis in treated patients was significantly less than prevalence of RD in untreated patients (chi2(1) = 119.2, P<0.001). CONCLUSION: Prophylactic cryotherapy substantially reduces the risk of RD in type 1 Stickler syndrome and, in this series, eliminated the risk of bilateral detachments.

Posterior vitreous detachment after neodymium:YAG laser posterior capsulotomy.

PURPOSE: To determine whether retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy is due to a greater incidence of posterior vitreous detachment (PVD) than in controls and whether vitreous status at the time of capsulotomy is useful in predicting the risk for RD. SETTING: Teaching hospital ophthalmology service. METHODS: Patients having Nd:YAG laser posterior capsulotomy after uneventful cataract surgery (treatment group) were prospectively studied. Fellow eyes that had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation but no Nd:YAG capsulotomy (no-laser group) formed 1 control group, and eyes that had no cataract surgery (phakic group) formed a second control group. The treatment group comprised 322 eyes; the no-laser group, 97; and the phakic group, 142. Dilated fundus and vitreous examinations were performed at baseline (before Nd:YAG capsulotomy) and 12 months postoperatively. RESULTS: At baseline, the prevalence of PVD was similar in the treatment and no-laser groups (61.8% and 63.9%, respectively; P=.2014) but was significantly lower in the phakic group (50.7%; P=.0151). There was no significant difference among the groups in the development of PVD in eyes with attached vitreous at baseline (17.9%, treatment group; 11.4%, no-laser group; 17.1%, phakic group) (P=.6588). CONCLUSIONS: The prevalence of PVD was significantly higher in eyes after ECCE and IOL implantation than in phakic eyes independent of Nd:YAG laser posterior capsulotomy. Capsulotomy was not associated with a significantly higher incidence of new PVD; therefore, the presence or absence of PVD at the time of capsulotomy is not helpful in assessing the risk for RD in the first year after laser treatment.