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Retina (Philadelphia, Pa.) Feb 2022The causes of floaters include posterior vitreous detachment and fundus hemorrhage, both of which are risk factors for retinal tears. We observed the vitreous of...
PURPOSE
The causes of floaters include posterior vitreous detachment and fundus hemorrhage, both of which are risk factors for retinal tears. We observed the vitreous of patients with floaters using swept source optical coherence tomography.
METHODS
Fundus examination was performed, and the vitreous was observed using swept source optical coherence tomography in 202 eyes of 202 patients with floaters. Patients with uveitis, diabetic retinopathy, and other fundus diseases were excluded.
RESULTS
Swept source optical coherence tomography revealed posterior vitreous detachment in 145 of 202 eyes (71.8%) and dot reflex like stardust in the vitreous in 42 of 202 eyes (20.8%). Posterior vitreous detachment occurred in 35 of 42 eyes (83.3%) and 110 of 160 eyes (68.8%) in the stardust (+) and stardust (-) groups, respectively; a significant difference was observed (P <0.001). In the stardust (+) group, 11 of 42 eyes (26.2%) had retinal tears with posterior vitreous detachment and 21 of 42 eyes (50.0%) had fundus hemorrhage. Three of 160 eyes (1.9%) and 4 of 160 eyes (2.5%) in the stardust (-) group had retinal tears with posterior vitreous detachment and fundus hemorrhage, respectively. Both tears and fundus hemorrhage were more frequent in the stardust (+) group than in the stardust (-) group (P <0.001).
CONCLUSION
The stardust sign on swept source optical coherence tomography indicates the risk of retinal tear.
Topics: Adult; Aged; Aged, 80 and over; Female; Fundus Oculi; Humans; Male; Middle Aged; Prospective Studies; Retinal Perforations; Tomography, Optical Coherence; Vitreous Body; Vitreous Detachment; Young Adult
PubMed: 35050930
DOI: 10.1097/IAE.0000000000003317 -
Indian Journal of Ophthalmology Mar 2022To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS).
PURPOSE
To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS).
METHODS
The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed.
RESULTS
Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases.
CONCLUSION
JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.
Topics: Air Movements; Humans; Iatrogenic Disease; Retinal Detachment; Retinal Perforations; Vitrectomy; Vitreoretinal Surgery
PubMed: 35225540
DOI: 10.4103/ijo.IJO_1918_21 -
Ophthalmology. Retina Jun 2020To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not...
PURPOSE
To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy.
DESIGN
Retrospective, nonconsecutive, noncomparative, multicenter case series.
PARTICIPANTS
Three hundred sixty-three eyes of 186 patients.
METHODS
Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings.
MAIN OUTCOME MEASURES
Rate of RDs and factors conferring a higher risk of RDs.
RESULTS
The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009).
CONCLUSIONS
Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.
Topics: Adolescent; Adult; Aged; Child; Disease Progression; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Retina; Retinal Detachment; Retinal Perforations; Retinopathy of Prematurity; Retrospective Studies; Time Factors; Visual Acuity; Young Adult
PubMed: 32059986
DOI: 10.1016/j.oret.2019.12.015 -
Indian Journal of Ophthalmology Jun 2022To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients...
PURPOSE
To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients with idiopathic full-thickness macular hole (FTMH).
METHODS
In this prospective study, pre and post-operative optical coherence tomography (OCT) scans of 36 eyes with idiopathic FTMH were analyzed. Hole indices and microstructural changes of all retinal layers such as ellipsoid zone (EZ), external limiting membrane (ELM) integrity, outer and inner retinal defects, and cystoid resolution were studied on follow-up visits.
RESULTS
Out of 36 eyes, type-1 closure was achieved in 23 eyes (65.7%) and type-2 closure in 11 eyes (31.42%), one eye showed persistent hole, and one eye was lost to follow-up. The mean minimum diameter of hole (P = 0.026), mean MHI (P = 0.001), DHI (P = 0.158), THI (P = 0.001), and HFF (P < 0.001) showed statistical significance with the type of hole closure. Postoperatively, eyes with intact ELM and EZ had better BCVA at the final visit. The BCVA was better by logMAR 0.73 ± 0.38 (P < 0.001) in patients with absent outer retinal defects. There was a significant difference in BCVA of 0.52 ± 0.35 at 1 month and 0.64 ± 0.34 at 6 months in eyes without inner retinal defects (P < 0.001). At 6 months, cystoid resolution was observed in 28 (80%) eyes. BCVA was significantly better at 1 month (P < 0.001) and at 6 months (P = 0.001) in eyes with no DONFL.
CONCLUSION
Macular hole indices determine the closure type. Postoperative regeneration of outer retinal layers and resolution of retinal defects significantly influence the final visual outcomes. ELM recovery is seen as a prerequisite for EZ regeneration with no new IRD after a period of 3 months.
Topics: Humans; Prospective Studies; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 35647986
DOI: 10.4103/ijo.IJO_192_22 -
Retina (Philadelphia, Pa.) Aug 2022To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana... (Review)
Review
PURPOSE
To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique.
METHODS
Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported.
RESULTS
The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent).
CONCLUSION
Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.
Topics: Basement Membrane; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35439799
DOI: 10.1097/IAE.0000000000003509 -
Acta Ophthalmologica May 2022To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB).
PURPOSE
To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB).
MATERIALS AND METHODS
We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional-hazard regression model was used to analyse risk factors for PRD and PRB.
RESULTS
Sixty-five thousand six hundred and sixty-two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow-up (median 7.1 years, range 0-21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy.
CONCLUSIONS
Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.
Topics: Aged; Humans; Male; Myopia; Postoperative Complications; Pseudophakia; Retinal Detachment; Retinal Perforations; Retrospective Studies; Risk Factors; Vitrectomy
PubMed: 34258879
DOI: 10.1111/aos.14974 -
Acta Ophthalmologica Feb 2022The historical literature on the treatment of rhegmatogenous retinal detachment (RRD) was reviewed from 1911 to the present, focusing on the role of intravitreal air and... (Review)
Review
The historical literature on the treatment of rhegmatogenous retinal detachment (RRD) was reviewed from 1911 to the present, focusing on the role of intravitreal air and gas. The history of the pneumatic retinopexy (PnR) technique is described from its original roots to the current day procedure. The treatment of RRD has evolved tremendously over the past century. The introduction of intravitreal gas as a tamponade to reattach the retina was critical in the development of modern day PnR. Although PnR is not a new technique, relatively recent randomized trials have demonstrated the numerous advantages of this procedure compared to pars plana vitrectomy (PPV) and scleral buckle. From a historical perspective, PnR has its origin in 1911 when Ohm performed intravitreal air injection after external subretinal fluid drainage in an attempt to treat RRD. The evolution of the procedure was driven by the introduction and experience with inert expansile intravitreal gas injections, and several great surgeons made critical contributions to the development of the procedure. There is substantial controversy pertaining to the original description of PnR in the literature. Credit has generally been given to Hilton and Grizzard from the United States, although Alfredo Dominguez from Spain published the first description of the procedure and he went to great lengths in an attempt to be rightfully recognized for this. The first randomized trial in retinal detachment repair was led by Dr. Paul Tornambe, comparing PnR to scleral buckle and an additional randomized trial was subsequently carried out demonstrating functional advantages of PnR compared to PPV.
Topics: History, 20th Century; Humans; Retinal Detachment; Retinal Perforations; Vitrectomy
PubMed: 33855814
DOI: 10.1111/aos.14876 -
Retina (Philadelphia, Pa.) Apr 2021This article aims to review current evidence on the development, diagnosis, and management of retinal pigment epithelium (RPE) tear during anti-vascular endothelial... (Review)
Review
PURPOSE
This article aims to review current evidence on the development, diagnosis, and management of retinal pigment epithelium (RPE) tear during anti-vascular endothelial growth factor (VEGF) therapy.
METHODS
Literature searches were performed using MEDLINE/PubMed databases (cut-off date: August 2019).
RESULTS
Three key recommendations were made based on existing literature and clinical experience: 1) Multimodal imaging with color fundus photography, optical coherence tomography, near-infrared reflectance imaging, fundus autofluorescence imaging, optical coherence tomography-angiography, and/or fluorescein angiography are recommended to diagnose RPE tear and assess risk factors. Retinal pigment epithelium tears can be graded by size and foveal involvement. 2) Patients at high risk of developing RPE tear should be monitored after each anti-VEGF injection. If risk factors worsen, it is not yet definitively known whether anti-VEGF administration should be more frequent, or alternatively stopped in such patients. Prospective research into high-risk characteristics is needed. 3) After RPE tear develops, anti-VEGF treatment should be continued in patients with active disease (as indicated by presence of intraretinal or subretinal fluid), although cessation of therapy should be considered in eyes with multilobular tears.
CONCLUSION
Although evidence to support the assumption that anti-VEGF treatment contributes to development of RPE tear is not definitive, some data suggest this link.
Topics: Angiogenesis Inhibitors; Choroidal Neovascularization; Humans; Intravitreal Injections; Multimodal Imaging; Retinal Perforations; Retinal Pigment Epithelium; Risk Factors; Vascular Endothelial Growth Factor A; Wet Macular Degeneration
PubMed: 33346626
DOI: 10.1097/IAE.0000000000003083 -
Scientific Reports Dec 2021Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT)...
Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.
Topics: Adult; Aged; Diabetic Retinopathy; Epiretinal Membrane; Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence
PubMed: 34903770
DOI: 10.1038/s41598-021-03239-2 -
Turkish Journal of Ophthalmology Sep 2019To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole.
OBJECTIVES
To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole.
MATERIALS AND METHODS
The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskişehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated.
RESULTS
Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient.
CONCLUSION
This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Prevalence; Retinal Degeneration; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitreous Body
PubMed: 31486608
DOI: 10.4274/tjo.galenos.2019.06706