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Eye (London, England) May 2022
Topics: Humans; Laser Coagulation; Lasers; Retinal Detachment; Retinal Diseases; Retinal Perforations
PubMed: 34117387
DOI: 10.1038/s41433-021-01590-2 -
Medicine Dec 2021Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis...
RATIONALE
Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis occurred, and CM occurred later in the left eye with 2 retinal detachments, which is very rare.
PATIENT CONCERNS
A 62-year-old man complained of a sudden decrease in visual acuity consisting of a small shadow in front of his left eye with a sensation of covered vision after 1 cycle of systemic chemotherapy and radiotherapy for resected esophageal cancer with brain metastasis. Fundus examination revealed exudative retinal detachment without retinal tears. CM with exudative retinal detachment was also considered. The patient refused further treatment. After the second cycle of chemotherapy, there were no significant changes in the retina and visual acuity improved. However, after craniocerebral surgery for brain metastasis, the visual acuity decreased again and showed 3 choroidal masses with macular involvement and retinal detachment but without retinal tears.
DIAGNOSIS
The final diagnosis was CM with retinal detachment.
INTERVENTIONS
The patient was advised to undergo enucleation of the left eye during the second retinal detachment, but he refused.
OUTCOMES
Two months after the second retinal detachment, the patient died of systemic metastases.
LESSONS
It is important to consider CM when the first retinal detachment and known cancer are diagnosed. At present, it is necessary to develop a standardised treatment plan as well as a multidisciplinary approach to early diagnosis, combined treatment, and timely intervention for such cases.
Topics: Brain Neoplasms; Choroid Neoplasms; Combined Modality Therapy; Esophageal Neoplasms; Fatal Outcome; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations
PubMed: 34941041
DOI: 10.1097/MD.0000000000028009 -
BMC Ophthalmology Jul 2020Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this...
BACKGROUND
Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this study, we investigate the clinical characteristics, risk factors, and prognosis of total RRD.
METHODS
A retrospective chart review was performed on cases of 44 total RRD and an age- and sex-matched 88 partial RRD. Two groups were compared for clinical characteristics, risk factors, and prognosis.
RESULTS
The prevalence of total RRD in all cases of retinal detachment was 4.4%. Pseudophakic eye, ocular trauma, and proliferative vitreoretinopathy (PVR) were significantly associated with a risk of total RRD (P = .002, P = .003, and P < .001, respectively). In the total RRD group, retinal breaks were located in both superior and inferior parts of the retina, and macular holes and giant retinal tears were frequently found. The best-corrected visual acuity (log MAR) before surgery and final best-corrected visual acuity after surgery were 2.23 ± 0.45 and 1.88 ± 0.96, which was significantly poorer than in the partial RRD group (P < .001). The success rate after primary surgery was 75.0% in the total RRD group, which was significantly lower than partial RRD group (P < .001). Old age, pseudophakic eye, and macular hole as the type of retinal break were highly associated with low success rate. (P = .010, P = .0500, and P = .002).
CONCLUSIONS
Patients with total RRD had higher recurrence rate and poorer visual outcome after surgery than patients with focal RRD. Old age, pseudophakic eye, and presence of macular hole were important risk factors for recurrence after total RRD repair. Additional surgical procedures should be considered to combine with vitrectomy to achieve better surgical outcomes in these patients.
Topics: Case-Control Studies; Humans; Prognosis; Retinal Detachment; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 32660545
DOI: 10.1186/s12886-020-01560-4 -
BMC Ophthalmology Mar 2024Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM.
METHODS
To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1.
RESULTS
Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group.
CONCLUSION
Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Humans; Fovea Centralis; Macular Degeneration; Myopia, Degenerative; Retinal Detachment; Retinal Perforations
PubMed: 38443856
DOI: 10.1186/s12886-024-03374-0 -
Korean Journal of Ophthalmology : KJO Jun 2021To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.
PURPOSE
To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.
METHODS
The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis.
RESULTS
Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD.
CONCLUSIONS
Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.
Topics: Humans; Retinal Hemorrhage; Retinal Perforations; Retrospective Studies; Rosaniline Dyes; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 34120419
DOI: 10.3341/kjo.2020.0124 -
Asia-Pacific Journal of Ophthalmology... Jan 2021Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with... (Review)
Review
Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with success rates and limitations of different surgical techniques are reported.The pathogenesis, the definition and the management were clarified in a recent study(cit). The MTM Staging System (MSS) table summarizes all the stages of MTM offering insights on the pathogenesis and natural evolution of the disease.Guidelines of management of MTM were therefore proposed, but customized for each stage.Initial stages 1a and 2a, which define maculoschisis in the inner or inner-outer or only outer layers of the retina, should be observed. Stages 3a and 4a, defining macular detachment with and without associated schisis, should be treated with a macular buckle (MB).Stage 1b, which is a lamellar macular hole in a myopic eye, should be treated with pars plana vitrectomy (PPV) only in symptomatic cases. Stages 2b, 3b, and 4b should be treated with a MB and PPV should be added in a second step only if the presence of a lamellar macular hole requires intervention to improve visual function.Stage 1c, which is a full thickness macular hole in a myopic eye, should be treated with PPV. Stages 2c, 3c and 4c should be treated with a combination of simultaneous MB + PPV to treat both the retinal pattern of schisis or detachment and the full thickness macular hole.
Topics: Humans; Macular Degeneration; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity; Vitrectomy
PubMed: 33481391
DOI: 10.1097/APO.0000000000000347 -
Acta Ophthalmologica Dec 2020To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole...
PURPOSE
To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes.
METHODS
Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best-corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula.
RESULTS
At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow-up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post-BCVA was significantly better than the pre-BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t-test).
CONCLUSION
Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea.
Topics: Adult; Aged; Endotamponade; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myopia, Degenerative; Refraction, Ocular; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Transplantation, Autologous; Visual Acuity; Vitrectomy
PubMed: 32323479
DOI: 10.1111/aos.14442 -
Indian Journal of Ophthalmology Apr 2022Diabetic membranes are always a challenge for a surgeon because of sticky nature and chances of iatrogenic break while removing.
BACKGROUND
Diabetic membranes are always a challenge for a surgeon because of sticky nature and chances of iatrogenic break while removing.
PURPOSE
To demonstrate a safe reverse swiss roll technique to dissect diabetic vitreous membranes.
SYNPOSIS
Approaches and techniques for membrane dissection are segmentation, delamination and en-bloc dissection using various types of instruments and illumination. With vitreous cutte, picks and scissors, surgical steps are traditionallu performed by using classic lift and shave technique. After identifying the plane, tissue is lifted and then cut, which puts the retina at risk of break because of traction and active suction. Such a threat can be reduced by placing the cutter above the membrane thereby having the membrane itseld acting as a protective cushion to the retina. Port here, unlike lift and shave technique, doesn't face the edge of membrane but is exactly 180 degree opposite and membrane curls into port because of suction. Also, hemostasis is maintained by continuous aspiration and cutting as the instrument is moved side to side, retracting from the edge.
HIGHLIGHTS
Reverse swiss roll technique is safer compared to lift and shave because of the safety cushion of the membrane between the port and the retina. There is inherently less chances of retinal break because the active suction from the port is directed away from the retina. The technique also minimises traction and localised pull on the atrophic macula.
VIDEO LINK
https://youtu.be/WNnSsP69ZLw.
Topics: Diabetes Mellitus; Humans; Retinal Perforations; Switzerland; Vitrectomy; Vitreous Body
PubMed: 35326086
DOI: 10.4103/ijo.IJO_631_22 -
Ophthalmic Surgery, Lasers & Imaging... Jan 2022To report the impact of prophylactic laser retinopexy in the prevention of retinal detachments (RDs) in patients with Stickler syndrome.
BACKGROUND AND OBJECTIVE
To report the impact of prophylactic laser retinopexy in the prevention of retinal detachments (RDs) in patients with Stickler syndrome.
PATIENTS AND METHODS
This was a retrospective, comparative case series of patients with Stickler syndrome from the year 2000 to 2019. We compared the rate of RDs between individuals who did and did not receive prophylactic laser therapy. In patients with an RD, we compared the rate of RD in the fellow eye with and without prophylactic laser treatment.
RESULTS
A total of 95 eyes were identified. Fifty-four percent of the overall population was female. The RD rate was 26.7% among eyes without previous prophylactic laser retinopexy and 4.6% among eyes with previous prophylactic laser retinopexy. A Cox proportional model revealed that laser prophylaxis treatment had a statistically significant effect on the risk of RD or retinal tear during the 25-year survival period from birth ( = .034). Eyes receiving treatment were 70% less likely to experience RD or retinal tear (hazard ratio, 0.297; 95% CI, 0.097 to 0.913).
CONCLUSIONS
This study's results suggest a potential role for prophylactic laser retinopexy in the prevention of rhegmatogenous RD among patients with a clinical diagnosis of Stickler syndrome. .
Topics: Arthritis; Connective Tissue Diseases; Eye Diseases, Hereditary; Female; Hearing Loss, Sensorineural; Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies
PubMed: 34982001
DOI: 10.3928/23258160-20211213-02 -
Eye (London, England) Apr 2021To investigate the safety and efficacy of the use of navigated retinal laser as a delivery method of laser retinopexy in the treatment of symptomatic retinal tears. (Observational Study)
Observational Study
PURPOSE
To investigate the safety and efficacy of the use of navigated retinal laser as a delivery method of laser retinopexy in the treatment of symptomatic retinal tears.
METHODS
We conducted a retrospective observational study of 69 patients presenting to a district general hospital in the United Kingdom with a diagnosis of symptomatic retinal tear who underwent retinopexy using a navigated retinal laser (Navilas 577s). Patients were followed up at two weeks or later to assess the efficacy and safety of the use of navigated retinal laser for retinopexy treatment.
RESULTS
In total, 72 retinal tears in 69 patients were identified in our cohort. Of these cases, 70 (97.2%) retinal tears were treated with retinopexy using a navigated laser with a median treatment time 200 seconds. Two retinal tears could not be imaged on the navigated laser system and so underwent cryopexy. In 67/70 (95.7%) of retinal tears, one session of laser treatment using the navigated laser system was sufficient for primary management. The remaining three tears required a second session. No retinal tears treated with navigated laser treatment progressed to retinal detachment. There were no other complications seen with the use of this laser.
CONCLUSIONS
The use of navigated retinal laser as a method of laser retinopexy for the treatment of retinal tears shows comparable safety and efficacy with other studies using traditional retinal laser systems.
Topics: Humans; Lasers; Retina; Retinal Detachment; Retinal Perforations; United Kingdom
PubMed: 32587386
DOI: 10.1038/s41433-020-1050-6