-
Indian Journal of Ophthalmology Oct 2021
Topics: Epiretinal Membrane; Humans; Massage; Retina; Retinal Perforations; Vitrectomy
PubMed: 34571691
DOI: 10.4103/ijo.IJO_794_21 -
Indian Journal of Ophthalmology Oct 2021
Topics: Epiretinal Membrane; Humans; Massage; Retina; Retinal Perforations; Vitrectomy
PubMed: 34571688
DOI: 10.4103/ijo.IJO_827_21 -
BMJ Case Reports Feb 2021A 38-year-old man presented with sudden decreased vision in the right eye 3 years ago due to vitreous haemorrhage. During follow-up, right eye fundus showed evidence...
A 38-year-old man presented with sudden decreased vision in the right eye 3 years ago due to vitreous haemorrhage. During follow-up, right eye fundus showed evidence of vasculitis, non-perfusion areas and neovascularisation elsewhere. Systemic evaluation findings of positive Mantoux test, QuantiFERON Gold test and right apical pleuroparenchymal fibrosis observed on high-resolution CT of the chest were suggestive of postinfection probable tubercular aetiology. He was treated with oral steroids, antitubercular therapy, intravitreal bevacizumab and anterior retinal cryopexy, leading to resolution of vasculitis and vitreous haemorrhage. Later he developed peripheral retinal flap and posterior retinal breaks at 8-month and 11-month follow-up, respectively, which were managed by barrage laser. He maintained a stable visual acuity of 20/20, N6 for the next 2 years. He then presented with sudden decreased vision in the right eye (20/50, N10). Right eye fundus showed posterior pole retinal detachment with lifting of previously barraged posterior retinal breaks. He underwent vitreoretinal surgery with gas tamponade. Recent 1-month postoperative visit showed successful retinal reattachment and visual recovery of 20/20, N6.
Topics: Adult; Humans; Male; Middle Aged; Myopia; Retinal Detachment; Retinal Perforations; Retinal Vasculitis; Visual Acuity; Vitrectomy
PubMed: 33637495
DOI: 10.1136/bcr-2020-239012 -
Irish Journal of Medical Science Oct 2023The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye... (Review)
Review
AIM
The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye emergency department of a tertiary referral hospital (the Mater Misericordiae University Hospital) over a 3-year period. The diagnostic and clinical outcomes of F/F presentations were also analysed.
METHODS
This retrospective study assessed eye casualty attendances between January 2018 and December 2020. Solar irradiation (j/cm) at ground level was retrieved from the records of Met Eireann (Irish National Meteorological Service) via their open access records. A review of electronic patient medical records using the in-house database patient centre was carried out of all patients who attended EED of during the study timeline on the 5 'brightest' and 5 'darkest' days of each year.
RESULTS
Seven hundred forty patient presentations were analysed in total. Overall, 16% (n = 119) of all patients that attended EED during the timeframe of the study presented with F/F. One hundred six patients (89%) presented with floaters, 40 patients (34%) presented with flashing lights/photopsia, and 35 patients (29%) presented with both F/F. More patients presented to EED with F/F on bright days when compared with dark days (74 vs 45, p < 0.05). Eighty-nine percent of all patients with F/F presented with monocular floaters. There were more floater presentations during bright when compared with dark days (70 vs 36, p < 0.05). More patients were diagnosed with PVD on bright days when compared with those diagnosed with PVD on dark days (43vs 15, p < 0.05). More RDs were diagnosed on dark days compared with bright days (7 vs 3, p < 0.05).
CONCLUSION
This study established that F/F presentations were more likely to present during bright days when compared with dark days. The diagnosis of PVD was more common during bright days, and RDs were diagnosed significantly more frequently on dark days. Although incident solar radiation was correlated with greater floaters/PVD presentation, causation is unlikely, and the duration of PVD may have been longer in patients presenting on bright days (i.e. pseudo-sudden symptoms).
Topics: Humans; Retrospective Studies; Vitreous Detachment; Retinal Perforations; Vision Disorders; Emergency Service, Hospital
PubMed: 36658378
DOI: 10.1007/s11845-023-03281-1 -
International Ophthalmology Apr 2021The development of degenerative lamellar macular holes (DLH) is largely unclear. This study was aimed at documenting with spectral-domain optical coherence tomography...
PURPOSE
The development of degenerative lamellar macular holes (DLH) is largely unclear. This study was aimed at documenting with spectral-domain optical coherence tomography the tractional development and morphological alterations of DLH.
METHODS
A retrospective case series of 44 eyes of 44 patients is described.
RESULTS
The development of DLH is preceded for months or years by tractional deformations of the fovea due to the action of contractile epiretinal membranes (ERM) and/or the partially detached posterior hyaloid, or by cystoid macular edema (CME). DLH may develop after a tractional stretching and thickening of the foveal center, from a foveal pseudocyst, after a detachment of the foveola from the retinal pigment epithelium, a disruption of the foveal structure due to CME, and after surgical treatment of tractional lamellar or full-thickness macular holes (FTMH). The foveal configuration of a DLH can be spontaneously reestablished after short transient episodes of CME and a small FTMH. A DLH can evolve to a FTMH by traction of an ERM. Surgical treatment of a DLH may result in an irregular regeneration of the foveal center without photoreceptors.
CONCLUSIONS
Tractional forces play an important role in the development of DLH and in the further evolution to FTMH. It is suggested that a DLH is the result of a retinal wound repair process after a tractional disruption of the Müller cell cone and a degeneration of Henle fibers, to prevent a further increase in the degenerative cavitations.
Topics: Epiretinal Membrane; Follow-Up Studies; Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity
PubMed: 33433772
DOI: 10.1007/s10792-020-01674-0 -
BMC Ophthalmology May 2022We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF), and analysed prognosis with different...
BACKGROUND
We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF), and analysed prognosis with different gas tamponade.
METHODS
Retrospective, non-randomized study. The records of patients with MF treated by vitrectomy, were reviewed. Patients were followed up postoperatively mean 16.74 months, to record changes of Best-corrected visual acuity (BCVA) and central foveal thickness (CFT).
RESULTS
Sixty-two eyes (59 patients) were analysed in total, with mean age of 55.29 ± 10.34 years, 49 females (83.1%). Foveoschisis completely resolved in all eyes at least 6 months post vitrectomy, except for two postoperative full-thickness macular holes (FTMH). Final BCVA improved significantly from 0.69 ± 0.39 to 0.44 ± 0.42 logMAR, and CFT from 502.47 ± 164.78 to 132.67 ± 52.26 μm. Patients were subdivided into three subgroups based on the different endotamponades used (C3F8, C2F6, and air). Baseline BCVA, baseline CFT and foveal detachment (FD) were not significantly different among the three groups. Eyes treated with air tamponade had better visual outcomes than eyes with C3F8 tamponade (P = 0.008). Baseline BCVA and FD were significant risk factors for postoperative BCVA (P < 0.001 and P = 0.013, respectively).
CONCLUSIONS
Vitrectomy with ILM peeling and gas tamponade results in good functional and anatomic outcomes in the treatment of most MF. Good vision and no-FD pre-surgery are related with good visual prognosis. Air tamponade can provide as good visual recovery as expansive gas, and reduce postoperative complications.
Topics: Adult; Aged; Basement Membrane; Female; Humans; Middle Aged; Myopia; Myopia, Degenerative; Retinal Perforations; Retinoschisis; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 35549885
DOI: 10.1186/s12886-022-02376-0 -
Acta Ophthalmologica Jun 2019Flashes and floaters are the hallmark symptoms of a posterior vitreous detachment (PVD) which itself is related to an increased risk of the development of retinal tears,...
Flashes and floaters are the hallmark symptoms of a posterior vitreous detachment (PVD) which itself is related to an increased risk of the development of retinal tears, retinal detachment and vitreous haemorrhage. The aim of this study is to assess the associations between different symptoms related to PVD and the risk of developing retinal tears. A systematic review of articles written in English, using MEDLINE, Embase (via Embase.com) and the Cochrane Controlled Trials Register (1996-2017) was conducted. Search terms included five elements: PVD, retinal tears, retinal detachment, floaters and flashes. Independent extraction of articles was conducted by two authors using predefined data fields, including study quality indicators. Thirteen studies fulfilled the selection criteria. Analysis of pooled data revealed that presence of isolated flashes was associated with the development of retinal tears in 5.3% of symptomatic eyes [mean 2.9 eyes; 95% CI (2.1, 5.7)].Conversely, floaters alone had a stronger association with retinal tears (16.5% of eyes), as compared to flashes. The association to retinal tears was even greater for those patients reporting both flashes and floaters [mean 17.8 eyes (20.0%); 95% CI (17.4, 18.1)]. Retinal and/or vitreous haemorrhage was also associated with the presence and later development of retinal tears [mean 12.5 eyes (30.0%); 95% CI (11.7, 13.9)]. Patients with more than 10 floaters or a cloud in their vision had a high risk of developing retinal tears (OR19.8, p-value 0.032). In the setting of a PVD, the onset of flashes and floaters, and the presence of retinal and/or vitreous haemorrhage are risk factors for the development of retinal tears. The association is greater when both symptoms are present, and even greater when the patient reports more than 10 floaters, a curtain or a cloud and/or there is a positive finding of a vitreous or retinal haemorrhage. This study supports the necessity of an immediate examination of patients presenting with symptoms related to a PVD, and a follow-up examination might be prudent in a subgroup of these patients.
Topics: Fluorescein Angiography; Fundus Oculi; Global Health; Humans; Incidence; Retina; Retinal Perforations; Risk Assessment; Risk Factors; Vitreous Body; Vitreous Detachment
PubMed: 30632695
DOI: 10.1111/aos.14012 -
Ophthalmology. Retina May 2023To investigate the time courses of morphologic changes in the transplanted grafts, including the retinal layer, the ellipsoid zone (EZ) and the visual acuity (VA) after...
PURPOSE
To investigate the time courses of morphologic changes in the transplanted grafts, including the retinal layer, the ellipsoid zone (EZ) and the visual acuity (VA) after autologous retinal transplantation (ART) in patients with primary large macular holes (MHs).
DESIGN
Single-center, retrospective cohort study.
SUBJECTS
The study included 17 eyes of 17 patients who had undergone ART. All patients fulfilled the following criteria: (1) MH was the only disease-causing anatomic abnormality of the macula; (2) they could be followed up for at least 12 months after ART surgery; (3) they had no other systemic disorders; and (4) the MH was > 400 μm in diameter.
METHODS
Data of all patients who underwent assessment of the VA and spectral-domain (SD)-OCT at 1, 3, 6, and 12 months after surgery were analyzed. The morphologic features of the graft and the EZ were measured by SD-OCT.
MAIN OUTCOME MEASURES
Changes in the morphologic features of the graft (graft thickness, overall graft area, graft length, area of outer retina, and EZ) and VA over 1 year after surgery.
RESULTS
Closure of the MH was achieved in all patients. The VA was 0.59 ± 0.27 (logarithm of the minimal angle of resolution units) at 1-year postsurgery compared with 0.84 ± 0.22 before surgery (P < 0.05). The retinal layers gradually became smoothly connected. Although a decrease in graft thickness and overall graft area was observed, the length and area of the outer retina were maintained throughout the follow-up period. The presence of the EZ was observed in 9 patients (52.9%) and our analyses revealed significantly greater improvement of VA in these patients than in those without the EZ (P < 0.05). Moreover, the incidence of macular edema (ME) was higher in the group without the EZ (P = 0.04; chi-square test).
CONCLUSION
Patients showed significant improvements of the VA. Morphologically, the layers were gradually connected to each other, and the outer retina was particularly maintained. Especially, patients in whom an EZ was restored in the graft showed a low prevalence of ME and greater improvement of the VA.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; Retinal Perforations; Retrospective Studies; Retina; Macular Edema; Macula Lutea
PubMed: 36516935
DOI: 10.1016/j.oret.2022.12.004 -
European Journal of Ophthalmology 2008To report the delayed development of idiopathic full-thickness macular hole in eyes with previously documented complete posterior vitreous detachment that were...
PURPOSE
To report the delayed development of idiopathic full-thickness macular hole in eyes with previously documented complete posterior vitreous detachment that were vitrectomized during surgery for rhegmatogenous retinal detachment.
METHODS
Two interventional case reports with serial color fundus photographs and optical coherence tomography scans.
RESULTS
Case 1: A 62-year-old man underwent vitrectomy, cryoretinopexy, and intraocular gas tamponade for rhegmatogenous retinal detachment associated with a complete posterior vitreous detachment. Three years later, he developed a full-thickness macular hole in the same eye. Peeling of the inner limiting membrane and gas tamponade resulted in complete closure of the macular hole with improvement in visual acuity. Case 2: A 70-year-old man presented with a macula-off inferior retinal detachment and counting fingers vision. Vitrectomy, cryoretinopexy to a single tear, and gas tamponade was successful and acuity improved to 6/9. He subsequently developed retinal redetachment associated with a new retinal tear and was treated by further vitrectomy and gas. He developed a full-thickness macular hole in the same eye 2 years later with acuity dropping to 1/60.
CONCLUSIONS
Macular hole formation may occur in the context of vitrectomized eyes. These observations support the hypothesis that anteroposterior vitreomacular traction, while traditionally implicated, is not always essential for the development of macular holes.
Topics: Aged; Cryosurgery; Humans; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Retinal Perforations; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Vitreous Detachment
PubMed: 18988183
DOI: 10.1177/112067210801800631 -
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