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International Journal of Ophthalmology 2023To report outcomes of endoscopy-assisted vitrectomy (EAV) in patients with chronic hypotony following severe ocular trauma or vitrectomy.
AIM
To report outcomes of endoscopy-assisted vitrectomy (EAV) in patients with chronic hypotony following severe ocular trauma or vitrectomy.
METHODS
This was a retrospective, noncomparative case series. Ciliary bodies were evaluated using ultrasound biomicroscopy pre-operatively and direct visualisation intraoperatively. All selected individuals (seven patients/seven eyes) underwent EAV. Removal of ciliary membrane and traction, gas/silicone oil tamponade (GT/SOT), and scleral buckling (SB) were performed in selected eyes. Outcome measurements mainly included intraocular pressure (IOP) and best-corrected visual acuity (BCVA).
RESULTS
Seven eyes from 7 male aphakic patients with a mean age of 45 (range, 20-68)y were included in this study; the average follow-up time was 12 (9-15)mo. GT was performed in 2 eyes; membrane peeling (MP) and SOT in 2 eyes; and MP, SOT, and SB in 3 eyes. The mean pre- and post-operative IOP were 4.5 (range, 4.0±0.11 to 4.8±0.2) mm Hg and 9.9 (range, 5.6±0.17 to 12.1±0.2) mm Hg at 52wk (12mo), respectively. BCVA improved in six eyes; one eye still showed light perception, and no bulbi phthisis was observed.
CONCLUSION
Endoscopy offers improved judgment and recognition and has an improved prognosis for chronic hypotony. Therefore, endoscopy can be an effective and promising operative technique for chronic traumatic hypotony management.
PubMed: 37332557
DOI: 10.18240/ijo.2023.06.18 -
Indian Journal of Ophthalmology Jun 2023To assess changes in surgical decisions and outcomes of rhegmatogenous retinal detachment (RRD) during the COVID-19 pandemic at a tertiary center in Taiwan.
PURPOSE
To assess changes in surgical decisions and outcomes of rhegmatogenous retinal detachment (RRD) during the COVID-19 pandemic at a tertiary center in Taiwan.
METHODS
Patients undergoing pars plana vitrectomy (PPV) or scleral buckling (SB) for primary RRD during Taiwan's first wave of domestic COVID-19 cases surge between May and July 2021 (COVID cohort, n = 100) were compared to controls in the closest pre-COVID year, 2019 (pre-COVID cohort, n = 121).
RESULTS
The COVID cohort had significantly worse RRD presentation, received more PPV (alone or combined with SB (PPV + SB)) and less SB alone, and had comparable single-surgery anatomic success (SSAS) rates. In patients who underwent PPV, more underwent PPV + SB instead of PPV alone. The decision to combine SB in PPV surgery was significantly affected by the COVID pandemic (odds ratio [OR], 3.1860 [95% confidence interval (CI), 1.1487-8.8361]). However, a shorter duration of symptoms before the first presentation (0.9857 [95% CI, 0.9720-0.9997]) was the only factor related to SSAS, whereas the surgical method had no association. The SSAS rate remained close to or over 90% in patients with a duration of symptoms before surgery ≤4 weeks but dropped to 83.3% in patients with duration >4 weeks.
CONCLUSION
During the COVID-19 pandemic, worse RRD presentations led to a shift in preference for PPV over SB alone as the primary surgery. The pandemic affected surgeons' decision to combine SB during PPV. Nevertheless, SSAS was only associated with the duration of symptoms but not with surgical methods.
Topics: Humans; Retinal Detachment; Pandemics; Taiwan; Tertiary Care Centers; Treatment Outcome; Visual Acuity; Retrospective Studies; COVID-19; Scleral Buckling; Vitrectomy
PubMed: 37322678
DOI: 10.4103/IJO.IJO_2513_22 -
Indian Journal of Ophthalmology Jun 2023To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD).
PURPOSE
To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD).
METHODS
A retrospective analysis of eyes with ERD that underwent vitrectomy.
RESULTS
Twelve eyes (10 patients) with ERD, non-responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt-Koyanagi-Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re-surgery. The mean follow-up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best-corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline.
CONCLUSION
Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Retinal Detachment; Retrospective Studies; Uveomeningoencephalitic Syndrome; Scleral Buckling; Retina; Vitrectomy; Treatment Outcome
PubMed: 37322677
DOI: 10.4103/IJO.IJO_2575_22 -
BMJ Open Ophthalmology Nov 2022To simulate pars plana vitrectomy in porcine eyes ex-vivo using intraoperative devices and to evaluate viability of retinal cells.
PURPOSE
To simulate pars plana vitrectomy in porcine eyes ex-vivo using intraoperative devices and to evaluate viability of retinal cells.
METHODS
25 enucleated porcine eyes were divided in following groups Group A) No surgery control: Group B) Sham surgery; Group C) Cytotoxic control; Group D) Surgery with residues; Group E) Surgery with minimal residues. The retina was extracted from each eye bulb and the cell viability was determined by MTT assay. The in vitro cytotoxicity of each used compounds was tested on ARPE-19 cells.
RESULTS
No cytotoxicity was detected in retinal samples in groups A, B and E. Samples from eye bulbs that had undergone surgery with minimal removal of residues (group D) and cytotoxic controls (group C) showed high retinal cytotoxicity. The simulation of vitrectomy indicated that the combined use of compounds does not affect retinal cells viability if all the compounds are properly removed, whereas the cytotoxicity detected in group D may suggest that the presence and accumulation of the residues of the compounds used intraoperatively could negatively impact retinal viability.
CONCLUSIONS
The present study demonstrate the crucial role of an optimal removal of the intraoperative devices used in eye surgery to ensure safety to the patient.
Topics: Animals; Swine; Retinal Detachment; Retina; Scleral Buckling; Vitrectomy
PubMed: 37282696
DOI: 10.1136/bmjophth-2022-EEBA.25 -
Indian Journal of Ophthalmology May 2023The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due...
PURPOSE
The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention.
METHODS
It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection.
RESULTS
In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery.
CONCLUSION
The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.
Topics: Male; Humans; Retinal Detachment; Retrospective Studies; Visual Acuity; Vitrectomy; Vasculitis; Hospitals; Treatment Outcome; Scleral Buckling
PubMed: 37203078
DOI: 10.4103/ijo.IJO_2157_22 -
BMC Ophthalmology May 2023To evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling. (Observational Study)
Observational Study
BACKGROUND
To evaluate the feasibility of and identify problems in treating complex rhegmatogenous retinal detachment using foldable capsular buckle scleral buckling.
METHODS
This prospective clinical study enrolled five patients with complex rhegmatogenous retinal detachment treated with foldable capsular buckle scleral buckling at the 988th Hospital of People's Liberation Army Joint Logistic Force, China. During the 24-week follow-up period, the patients underwent measurements of their best-corrected visual acuity, slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Additionally, B-ultrasound and fundus photography of the patients' retinal reattachments helped evaluate the treatment's post-surgery efficacy. We determined the safety of foldable capsular buckle scleral buckling based on infection, eye pain, diplopia, elevated intraocular pressure, and other postoperative severe complications.
RESULTS
All five patients' complex rhegmatogenous retinal detachments were successfully treated and evaluated via B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in four patients 24 weeks after surgery, while the remaining patients developed diplopia after surgery. No other complications were observed.
CONCLUSION
This pilot study preliminarily determined that foldable capsular buckle scleral buckling is feasible for efficient and safe treatment of complex rhegmatogenous retinal detachment. These results support this surgery as a potential and novel alternative to current extraocular procedures for treating complex rhegmatogenous retinal detachment.
TRIAL REGISTRATION
The prospective observational clinical study protocol was approved by the Institutional Review Board and Ethics Committee and registered at the clinical research center in the 988th Hospital of People's Liberation Army Joint Logistic Force, China (9,882,019,000).
Topics: Humans; Retinal Detachment; Scleral Buckling; Pilot Projects; Diplopia; Prospective Studies; Vitrectomy; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 37142972
DOI: 10.1186/s12886-023-02913-5 -
Eye (London, England) Jun 2023To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD).
INTRODUCTION
To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD).
METHODS
A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery.
RESULTS
There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. CF tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10-25%), and 10.1% are at high risk (>25%) of failure.
CONCLUSIONS
Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.
Topics: Humans; Male; Middle Aged; Female; Retinal Detachment; Vitrectomy; Cohort Studies; Retrospective Studies; Scleral Buckling; Silicone Oils; United Kingdom; Treatment Outcome
PubMed: 37100934
DOI: 10.1038/s41433-023-02388-0 -
International Journal of Retina and... Mar 2023Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that can be treated with various surgical approaches. The role of scleral buckling remains... (Review)
Review
BACKGROUND
Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that can be treated with various surgical approaches. The role of scleral buckling remains controversial because of its potential long-term deleterious effects on choroidal vascular perfusion and the limited knowledge of this entity.
METHODS
A total of 135 eyes were retrospectively selected, including 115 with surgically resolved RRD and 20 healthy control eyes. Of the surgically treated eyes, 64 underwent vitrectomy alone, while 51 underwent scleral buckling combined with vitrectomy. Best-corrected visual acuity (BCVA) was evaluated along with the choroidal vascularity index (CVI) as a metric for the state of the choroidal vasculature. BCVA was compared before and after surgery, and the postoperative BCVA was analyzed with the CVI using correlation and multivariate regression analyses.
RESULTS
The preoperative BCVA of the RRD eyes was significantly worse than that of the control eyes, and significantly improved after surgery. However, the long-term postsurgical BCVA was still inferior to that of the control eyes. No significant differences in visual function were found between the two surgical groups. The average CVI was 57.35% in the control eyes, 63.76% in the eyes that underwent vitrectomy, and 53.37% in buckled eyes. The differences in CVI were significant among the three groups. Among the surgical patients, negative Pearson's correlations were found between CVI and postoperative BCVA (expressed in logMAR). A multivariate linear regression model containing four parameters revealed that CVI was the only variable with a significant influence on postoperative BCVA, while the length of time with a detached macula did not have an effect.
CONCLUSIONS
RRD surgery drastically restored vision, but the effect of RRD lingered, as postsurgical visual acuity remained inferior to that of the control eyes. The CVI varied between the treatment groups, likely due to both disease pathology and the impact of the surgery. The correlation between CVI and BCVA indicates the important role that the choroidal vasculature plays in visual function.
PubMed: 36991519
DOI: 10.1186/s40942-023-00454-z -
Medicina (Kaunas, Lithuania) Feb 2023: When scleral buckling is performed using a #240 encircling band anterior to the equator for rhegmatogenous retinal detachment, buckle migration may occur anteriorly,...
: When scleral buckling is performed using a #240 encircling band anterior to the equator for rhegmatogenous retinal detachment, buckle migration may occur anteriorly, eroding the rectus muscle. There are few cases of buckle migration occurring simultaneously with buckle infection. Notably, most previous reports included inadequate data on the pathophysiology of buckle migration and did not include the Hess test and perioperative images. : A 36-year-old man with a history of atopic dermatitis underwent scleral buckling for rhegmatogenous retinal detachment of the left eye with #287 and #240 encircling bands at Kagoshima University Hospital. Four years later, he developed discharge, redness, and diplopia of the left eye. He was then referred to our hospital because buckle infection was suspected. The buckle was partially visible on the lower nasal side. Optical coherence tomography of the anterior chamber revealed the buckle to be on the nasal side and overlying the medial rectus muscle. Buckle migration and infection in the left eye was diagnosed, and early buckle removal was recommended. Two weeks later, on the day before surgery, conjunctival melting progressed in the nasal and inferior areas, and the buckle was exposed to a greater extent. In the surgical video at the initial surgery, the silicone band was confirmed to pass under the four rectus muscles, specifically the inferior and medial rectus muscles. At the beginning of the second surgery, we confirmed that the buckles were over the inferior and medial rectus muscles. As far as could be observed after buckle removal, the inferior and medial rectus muscles were not present at the normal location. Postoperatively, ocular pain and discharge quickly resolved. The subjective symptoms of diplopia also improved, and the postoperative Hess chart showed an improved ocular movement in the upward and lateral directions. : Buckle migration is a rare postoperative complication of scleral buckling; however, patients at risk of buckle migration, such as those with encircling scleral buckle anterior to the eyeball, should be monitored with caution. If a buckle infection develops, buckle migration may occur within a short period, and early buckle removal should be considered.
Topics: Adult; Humans; Male; Diplopia; Eye Movements; Postoperative Complications; Retinal Detachment; Scleral Buckling
PubMed: 36984450
DOI: 10.3390/medicina59030449 -
Journal of Clinical Medicine Mar 2023At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime,...
Effect of Changes in Surgical Strategies for the Treatment of Primary Rhegmatogenous Retinal Detachment on Functional and Anatomical Outcomes: A Retrospective Analysis of 812 Cases from the Years 2004 to 2012.
BACKGROUND
At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime, nighttime) for the treatment of primary rhegmatogenous retinal detachment (RRD) changed continuously in the years 2004 to 2012. This study aims to evaluate changes in surgical strategies over time including their impact on functional and anatomical outcomes.
METHODS
Retrospective evaluation of patients operated on primary RRD between the years 2004 and 2012. Baseline demographic data, month 3 best-corrected visual acuity (BCVA), surgical method, single success surgery, surgical timing, and intraoperative complications were analyzed.
RESULTS
Overall, 812 eyes of 812 patients with a mean (±SD) age of 58.1 ± 13.3 years were included. A total of 413 (51%) patients presented with macula-on and 359 (44%) with macula-off RRD. Month 3 BCVA increased over time, both in macula-on or macula-off groups ( < 0.001). The rate of complete retinal reattachment 3 months postoperatively increased significantly from 65% in 2004 to 83% in 2012 in both groups. Scleral buckling surgeries decreased continuously from 95% to 16% with an appropriate increase in vitrectomies as well as a decrease in surgeries during nighttime (68% in 2004, 6% in 2012) with equal or better visual and functional outcomes.
CONCLUSION
Our data showed that improving functional and single-success surgery outcomes in patients operated on for primary RRD. In the years 2004 to 2012, surgical techniques shifted from scleral buckling to primary vitrectomy and were increasingly scheduled during the daytime.
PubMed: 36983279
DOI: 10.3390/jcm12062278