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BMC Ophthalmology Oct 2023Demarcation line in a rhegmatogenous retinal detachment (RD) is a classic finding noted in chronic cases. In this case report, we describe a case of evolution of...
BACKGROUND
Demarcation line in a rhegmatogenous retinal detachment (RD) is a classic finding noted in chronic cases. In this case report, we describe a case of evolution of post-operative demarcation line after pneumatic retinopexy (PnR) in a subtotal rhegmatogenous RD.
CASE DESCRIPTION
A 31-year-old male diagnosed with acute, subtotal, macula-off rhegmatogenous RD in the left eye of 15-day duration underwent PnR on the same day. His presenting visual acuity was 6/48 in the left eye. Transconjunctival cryopexy was performed to the retinal break at the same sitting and 0.5 cc of 100% perfluoroproprane (C3F8) gas was injected in the vitreous cavity and right lateral position was advised to the patient.
RESULT
A pigmentary demarcation line was noted extending the nasal part of the macula along the most dependent part of the detachment on the immediate post-operative day and was more obviously visible on the 2nd and then on the 11th post-operative day. The visual acuity at the last follow-up visit improved to 6/18. Successful reattachment of the retina was noted on the last follow-up visit.
CONCLUSION
Post-operative demarcation lines after RD surgery could develop due to subretinal migration of pigments and along the most-dependent part depending upon post-operative positioning of the patient. Careful post-operative positioning, particularly in macula splitting RDs could be important to avoid pigment accumulation along the foveal area.
Topics: Male; Humans; Adult; Retina; Ophthalmologic Surgical Procedures; Retinal Detachment; Vitreous Body; Retinal Perforations; Retrospective Studies; Vitrectomy
PubMed: 37891492
DOI: 10.1186/s12886-023-03184-w -
Asian Journal of Surgery Jan 2024
Topics: Humans; Retinal Perforations; Amnion; Retrospective Studies
PubMed: 37891112
DOI: 10.1016/j.asjsur.2023.10.066 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Oct 2023The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric...
The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?
BACKGROUND
The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma.
METHODS
In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated.
RESULTS
The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most com-mon CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with ab-normal vitreous density (median 45 [30-69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings.
CONCLUSION
The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.
Topics: Humans; Child; Male; Female; Prognosis; Trauma Severity Indices; Visual Acuity; Retrospective Studies; Eye Injuries; Eye Foreign Bodies; Tomography, X-Ray Computed; Eye Injuries, Penetrating
PubMed: 37889035
DOI: 10.14744/tjtes.2023.72470 -
BMC Ophthalmology Oct 2023Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in...
BACKGROUND
Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in vivo studies. However, the clinical toxic effect of ICG during macular surgery has not been functionally evaluated. In this study, we evaluated functional and structural changes in retinal sensitivity and retinal thickness associated with ICG toxicity using microperimetry before and after ICG-assisted ILM peeling in patients with macular holes.
METHODS
ICG staining was performed only on the macular area below the horizontal line connecting the fovea and optic disc. ILM peeling was performed over the entire macular area inside the vascular arcade. Visual acuity assessment, spectral domain optical coherence tomography, and microperimetry were performed at baseline and one, three, and six months postoperatively. The mean retinal sensitivity of four macular areas was calculated and analyzed.
RESULTS
Eleven eyes were included. Macular holes were successfully closed in all patients. Six months postoperatively, retinal sensitivity improved insignificantly in Area 1 (ICG-/ILM-) and Area 2 (ICG-/ILM+) but decreased in Area 4 (ICG+/ILM-). Three months postoperatively, retinal sensitivity significantly decreased in Area 3 (ICG+/ILM+; 26.63 ± 1.80 vs. 25.52 ± 2.08 dB, p = 0.036). However, the statistical significance of this result was lost six months after the surgery (p = 0.059). The change of Gc-IPL thickness in Area 3 was significantly different compared to Area 2 at post-operative 3- and 6-months (p = 0.01, 0.05).
CONCLUSIONS
Retinal sensitivity decreased three months after ICG-assisted ILM peeling. However, the statistical significance was lost six months after surgery. ICG staining can be performed with caution during macular hole surgery.
Topics: Humans; Indocyanine Green; Retinal Perforations; Retrospective Studies; Coloring Agents; Vitrectomy; Staining and Labeling; Retina; Epiretinal Membrane; Basement Membrane
PubMed: 37875860
DOI: 10.1186/s12886-023-03161-3 -
Arquivos Brasileiros de Oftalmologia 2023This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting...
PURPOSE
This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes.
METHODS
This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery).
RESULTS
This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed.
CONCLUSION
The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible.
Topics: Humans; Aged; Retinal Perforations; Retrospective Studies; Epiretinal Membrane; Visual Acuity; Fovea Centralis; Vitrectomy; Tomography, Optical Coherence; Basement Membrane
PubMed: 37851742
DOI: 10.5935/0004-2749.2022-0252 -
Ophthalmic Surgery, Lasers & Imaging... Oct 2023
Topics: Humans; Retinal Perforations; Vitreous Hemorrhage; Retina; Epiretinal Membrane; Lasers; Vitrectomy; Basement Membrane; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37847162
DOI: 10.3928/23258160-20230919-01 -
Retinal Cases & Brief Reports Jul 2024The purpose of this study was to describe the surgical management of bilateral giant full-thickness macular hole with sudden onset two months after cataract surgery in a... (Observational Study)
Observational Study
PURPOSE
The purpose of this study was to describe the surgical management of bilateral giant full-thickness macular hole with sudden onset two months after cataract surgery in a patient with Alport syndrome.
METHODS
This was an observational, single-case report.
RESULTS
A 54-year-old woman with a history of Alport syndrome presented with severe bilateral visual loss two months after cataract surgery. The diagnosis of bilateral giant full-thickness macular hole was made. We found the absence of the internal limiting membrane and the inability to lift and peel a continuous posterior hyaloid sheet during surgical management with 25-gauge pars plana vitrectomy (left eye). Amniotic membrane grafting followed by gas tamponade were performed for hole closure. The hole remained closed but vision was poorly restored two months after.
CONCLUSION
Cataract surgery in patients with Alport syndrome could promote early development of giant full-thickness macular hole. Collagen defects could underlie internal limiting membrane absence and the inability to properly peel the posterior hyaloid.
Topics: Humans; Retinal Perforations; Nephritis, Hereditary; Female; Middle Aged; Vitrectomy; Amnion; Visual Acuity; Tomography, Optical Coherence; Cataract Extraction
PubMed: 37824682
DOI: 10.1097/ICB.0000000000001428 -
European Journal of Ophthalmology Jan 2024To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a...
PURPOSE
To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient.
METHODS
A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days.
RESULTS
Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up.
CONCLUSIONS
Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.
Topics: Male; Humans; Middle Aged; Retinal Detachment; Retinal Perforations; Amnion; Retrospective Studies; Myopia; Tomography, Optical Coherence; Epiretinal Membrane; Vitrectomy
PubMed: 37820366
DOI: 10.1177/11206721231206717 -
Investigative Ophthalmology & Visual... Oct 2023To describe the pathophysiology of secondary macular hole (MH) in rhegmatogenous retinal detachment (RRD).
PURPOSE
To describe the pathophysiology of secondary macular hole (MH) in rhegmatogenous retinal detachment (RRD).
METHODS
A retrospective cohort of 360 consecutive primary fovea-off RRDs presenting to St. Michael's Hospital, Toronto, from January 2012 to September 2022 were included. Preoperative OCT was assessed for bacillary layer detachment (BALAD) abnormalities. Histological sections of normal eyes were assessed to inform OCT interpretations. Primary outcome measure was the progression of BALAD to full-thickness MH (FTMH).
RESULTS
Of the 360 patients, 22.5% (n = 81) had BALAD abnormalities at presentation. Eight percent (29/360) had associated MH, of which 79.3% (23/29) were a BALAD-lamellar hole and 20.7% (6/29) were FTMH. After reattachment, 62% of MHs persisted (18/29), of which 83% (15/18) had BALAD-lamellar holes that subsequently progressed to FTMH in a mean of 8.1 ± 3.2 days. BALAD-lamellar holes had significantly worse postoperative visual acuity (P < 0.001) when compared with other BALAD abnormalities (58/81) or with the rest of the cohort (279/360). OCT spectrum from BALAD to FTMH includes (1) cleavage planes extending from Henle fiber layer into the BALAD; (2) central outer nuclear layer thinning; (3) Müller cell cone loss with tissue remnants at the foveal walls; (4) retinal tissue operculum close to BALAD-MH; and (5) progressive thinning or degradation of the posterior band of BALAD-lamellar hole leading to FTMH. Histological specimens identified foveal regions of low mechanical stability.
CONCLUSIONS
BALAD plays a crucial role in the pathophysiology of MH in RRDs, which forms owing to sequential changes in four critical areas: RPE-photoreceptor interface, myoid zone, Henle fiber layer, and Müller cell cone with surrounding tissue. Timely management of fovea-off RRD with BALAD may be prudent to avoid the progression to BALAD-lamellar hole, subsequent FTMH, and worse functional outcomes.
Topics: Humans; Retinal Detachment; Retinal Perforations; Retrospective Studies; Firmicutes; Retina
PubMed: 37815508
DOI: 10.1167/iovs.64.13.12 -
Eye (London, England) Mar 2024Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the... (Observational Study)
Observational Study
BACKGROUND
Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care.
METHODS
Prospective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD.
RESULTS
1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than 'PVD-only' eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05).
CONCLUSIONS AND RELEVANCE
This large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination.
Topics: Humans; Retinal Perforations; Vitreous Detachment; Prospective Studies; Retinal Detachment; Referral and Consultation
PubMed: 37798362
DOI: 10.1038/s41433-023-02779-3