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Acta Ophthalmologica Dec 2019To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment...
Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study.
PURPOSE
To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM).
METHODS
Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated.
RESULTS
Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall-, AQ- and UQ-MISHA further increased (p < 0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p < 0.05). Rhegmatogenous retinal detachment- diagnosis (RRD-D), 1- and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p < 0.05).
CONCLUSION
Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.
Topics: Anterior Eye Segment; Aqueous Humor; Case-Control Studies; Conjunctiva; Female; Follow-Up Studies; Humans; Intraocular Pressure; Male; Microscopy, Confocal; Middle Aged; Preoperative Period; Prospective Studies; Retinal Detachment; Sclera; Scleral Buckling; Tomography, Optical Coherence; Visual Acuity
PubMed: 31125179
DOI: 10.1111/aos.14148 -
Eye (London, England) Dec 2018To evaluate anatomic and functional outcomes of patients treated with pars plana vitrectomy (PPV) with scleral buckling versus PPV with inferior retinectomy for... (Comparative Study)
Comparative Study
PURPOSE
To evaluate anatomic and functional outcomes of patients treated with pars plana vitrectomy (PPV) with scleral buckling versus PPV with inferior retinectomy for treatment of cases of primary rhegmatogenous retinal detachment (RRD) associated with proliferative vitreoretinopathy (PVR) and inferior retinal breaks.
METHODS
Retrospective, comparative, interventional, single-center study. Fifty-one eyes of fifty-one patients with primary RRD associated with inferior breaks and PVR grade C1 or more were reviewed over 3 years. Twenty-one eyes underwent PPV with encircling band 360° and thirty eyes underwent PPV with primary inferior retinectomy. The primary outcome was final anatomic success. Secondary outcomes included change in visual acuity, primary anatomical success, the mean number of operations, and incidence of postoperative complications.
RESULTS
Primary anatomical success of 85.7% was achieved in buckle group compared to 83.3% in retinectomy group (p = 0.82). Mean duration of follow-up and mean number of operations was 9.8 ± 2.26 and 9.97 ± 2.44 months; 1.24 ± 0.62 and 1.3 ± 0.75 in buckle group and retinectomy group, respectively, achieving final anatomical success of 95.2% for the buckle group and 90% for the retinectomy group with no statistical significant difference (p = 0.49). Although visual acuity (logMAR) was better in the buckle group in the 1st month, it became nearly equal thereafter during the follow-up period (p = 0.5).
CONCLUSION
Similar anatomical and functional outcomes were achieved by combining PPV with scleral buckle or inferior retinectomy for treatment of primary RRD with PVR and inferior breaks.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Retina; Retinal Detachment; Retinal Perforations; Retrospective Studies; Scleral Buckling; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative
PubMed: 30116008
DOI: 10.1038/s41433-018-0194-0 -
Scientific Reports Oct 2023This study investigates patient's clinical characteristics and management outcomes of PCR-positive Acute Retinal Necrosis (ARN). The patient's clinical characteristics...
This study investigates patient's clinical characteristics and management outcomes of PCR-positive Acute Retinal Necrosis (ARN). The patient's clinical characteristics of the disease, and therapeutic approaches were assessed. Data from the medical records of 40 eyes of 40 patients were analyzed. The mean ± standard deviation (SD) of the age of the patients was 47.8 ± 14.1 years (16-84 years old). The median follow-up time was 160 days, with a range of 120-370 days. The mean ± SD of patients' primary and final BCVA was 1.24 ± 0.78 and 1.08 ± 0.86 LogMAR, respectively. The final BCVA increased significantly after the treatment in the last follow-up period in patients who did not undergo PPV (p = 0.029). Although, vision changes were not statistically significant in patients who underwent PPV (p = 0.549). 75% of our patients had a positive aqueous PCR for VZV, and the second most common causative agents were CMV and HSV (10% for each). Besides, rhegmatogenous retinal detachment (RRD) occurred in 25% of our patients. Our analysis showed that the presenting visual acuity and RRD occurrence are the significant prognostic factors for final blindness in ARN.
Topics: Humans; Adult; Middle Aged; Adolescent; Young Adult; Aged; Aged, 80 and over; Retinal Necrosis Syndrome, Acute; Retinal Detachment; Scleral Buckling; Vitrectomy; Eye; Retrospective Studies
PubMed: 37805622
DOI: 10.1038/s41598-023-44310-4 -
Chang Gung Medical Journal Jan 2002To evaluate the safety and efficacy of sub-Tenon anesthesia for segmental scleral buckling.
BACKGROUND
To evaluate the safety and efficacy of sub-Tenon anesthesia for segmental scleral buckling.
METHODS
Thirty-two patients diagnosed with rhegmatogenous retinal detachment were treated with segmental scleral buckling under sub-Tenon anesthesia. After topical anesthesia, a buttonhole was made through the conjuntiva and Tenon's capsule 4 mm posterior to the limbus. Four milliliters of anesthetic solution was then delivered into the posterior sub-Tenon space using a blunt cannula. The buckling procedure was done immediately after the completion of anesthesia. We evaluated akinesia and recorded the pain with a visual analogue scale after surgery.
RESULTS
There were no anesthesia related complications. Twenty-two patients (69%) reported no pain during surgery. Nine patients (28%) felt pain during surgery. However, the pain was tolerable and the surgeries were finished smoothly with or without a supplemental anesthetic solution. One patient (3%) experienced uncomfortable pain and needed an additional retrobulbar block. Five patients (16%) retained complete eye movement 5 min after anesthesia, and only 4 patients (13%) experienced total akinesia. At the end of the surgery, 16 patients (50%) had total akinesia and 2 patients (6%) retained complete eye movement.
CONCLUSIONS
Sub-Tenon anesthesia is efficient and safe in segmental scleral buckling. It can prevent the complications of peribulbar or retrobulbar anesthesia and is a good alternative to both methods of anesthesia, especially in highly myopic eyes.
Topics: Adolescent; Adult; Anesthesia, Local; Female; Humans; Male; Middle Aged; Pain, Postoperative; Scleral Buckling
PubMed: 11926582
DOI: No ID Found -
Eye (London, England) Sep 2011We conducted a study to investigate: (1) deviations caused by retinal detachment (RD) repair; (2) correlation between visual acuity and the number of surgeries to...
PURPOSE
We conducted a study to investigate: (1) deviations caused by retinal detachment (RD) repair; (2) correlation between visual acuity and the number of surgeries to deviation size; and (3) differences between deviations following scleral buckling (SB) and pars plana vitrectomy (PPV).
METHODS
A retrospective analysis of patients with persistent binocular diplopia following RD repair. Magnitude of manifest deviation (∣dev∣) in the primary position (PP) and position of greatest deviation (maxDev) was calculated. LogMAR acuity and number of previous vitreoretinal procedures were correlated to ∣dev∣ in both PP and maxDev. Manifest ∣dev∣ were compared between SB and PPV groups.
RESULTS
Twenty-five patients were identified. The median ∣dev∣ was 7 prism diopters (PD) in PP and 17 PD in maxDev. We found no association between number of surgeries or VA with ∣dev∣ in either the PP (r=-0.18 and r=0.08) or maxDev (r=-0.26 and r=-0.05). Twelve patients underwent PPV: median ∣dev∣ in PP 6 PD and maxDev 9 PD. In the SB group: median ∣dev∣ in PP 8 PD and in maxDev 22 PD. ∣dev∣ in PP showed no significant differences between PPV and SB (U=63, P=0.41); however, ∣dev∣ in maxDev, showed that SB have significantly greater deviations (U=36.0, P=0.02).
CONCLUSION
We report the largest cohort of patients with symptomatic ocular motility defects following PPV. We show no association between VA or number of procedures to strabismus magnitude. Ocular deviations in maxDev are significantly greater after SB procedures.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Diplopia; Female; Humans; Male; Middle Aged; Retinal Detachment; Retrospective Studies; Scleral Buckling; Strabismus; Visual Acuity; Vitrectomy; Young Adult
PubMed: 21701526
DOI: 10.1038/eye.2011.152 -
Indian Journal of Ophthalmology Oct 2022The study was conducted to determine the ocular pulse amplitude (OPA) changes, measured with a dynamic contour tonometer (DCT), after surgical retinal detachment repair.
PURPOSE
The study was conducted to determine the ocular pulse amplitude (OPA) changes, measured with a dynamic contour tonometer (DCT), after surgical retinal detachment repair.
METHODS
This was a prospective and comparative study. Thirty patients (30 eyes) who had undergone uncomplicated unilateral scleral buckling and encircling procedures for quadrant or half-retinal rhegmatogenous retinal detachment were referred for DCT one day before the surgery was performed, on the 1, 7, and 30 postoperative day. Methods of descriptive (arithmetical mean, standard deviation) and analytical statistics (analysis of variance) were used to analyze the data and evaluate the significance of the difference. A value of P less than 0.05 was considered statistically significant. The data were evaluated for normality with the single-sample Kolmogorov-Smirnov test.
RESULTS
OPA values decreased significantly after scleral buckling procedures (p < 0.0001), but regained near to preoperative values one month after the surgery.
CONCLUSION
OPA tends to decrease after retinal detachment surgery. Restoring patients' vision with scleral buckling and encircling procedures gives early changes in blood supply to the choroid and ocular nerve, and since OPA is an indirect parameter of choroidal vascularization, measuring these values can help make an insight into ocular hemodynamics.
Topics: Choroid; Humans; Prospective Studies; Retina; Retinal Detachment; Scleral Buckling
PubMed: 36190055
DOI: 10.4103/ijo.IJO_374_22 -
Photodiagnosis and Photodynamic Therapy Dec 2023To evaluate anterior segment parameter changes following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) using the Pentacam Scheimpflug system.
PURPOSE
To evaluate anterior segment parameter changes following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) using the Pentacam Scheimpflug system.
METHODS
Twenty-eight phakic eyes of 28 patients who underwent SB surgery for RDD were included. The anterior chamber volume (ACV), central anterior chamber depth (CACD), mean anterior chamber angle (ACA) and ACA in a specific position (buckle quadrant), and central corneal thickness (CCT) were evaluated preoperatively and at 1 day, 1 week, and 1 and 3 months postoperatively by an anterior Pentacam Scheimpflug method.
RESULTS
The ACV parameters were significantly decreased compared with preoperative levels at 1 day after SB surgery (P = 0.0004), but had no significant differences at 1 week, and 1 and 3 months (P > 0.05). The mean intraocular pressure (IOP) at 1 day was significantly higher than the preoperative level, but no subsequent significant difference was noted between the preoperative IOP and that at 1 week and 1 and 3 months postoperatively (P > 0.05). The CCT at 1 day after surgery increased significantly (P = 0.0122) and subsequently returned to the normal level postoperatively at 1 week and remained stable until 3 months (P > 0.05). The degree of postoperative ACA displayed different changes in the different quadrants and there was a significant increase in the ACA of the buckle quadrants at 1 day (P < 0.0001), 1 week (P = 0.02), and 1 month (P = 0.0266) after surgery, returning to the normal level at 3 months.
CONCLUSIONS
The changes of anterior chamber parameters after SB can be demonstrated by Pentacam both objectively and quantitatively. The ACV and CCT changes were mild and resumed their preoperative parameters after 1 week, while the increase of the ACA at the buckle quadrant returned to normal after 3 months. SB surgeries without encircling or conducted with radial buckling might decrease anterior chamber change.
Topics: Humans; Scleral Buckling; Photochemotherapy; Photosensitizing Agents; Anterior Chamber; Retinal Detachment
PubMed: 37935344
DOI: 10.1016/j.pdpdt.2023.103881 -
Acta Ophthalmologica Scandinavica Jun 2005To conduct a randomized prospective clinical trial to compare primary vitrectomy without scleral buckling versus conventional scleral buckling surgery in pseudophakic... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
PURPOSE
To conduct a randomized prospective clinical trial to compare primary vitrectomy without scleral buckling versus conventional scleral buckling surgery in pseudophakic primary retinal detachment (PPRD) in terms of anatomic attachment rate, functional outcome and complications.
METHODS
Fifty consecutive eyes of 50 patients with PPRD were randomized into two groups, with 25 patients in each of group 1 (scleral buckling group) and group 2 (pars plana vitrectomy without buckling group) in a hospital setting and followed up at 1 week, 2 weeks, 6 weeks and 6 months.
RESULTS
A primary reattachment rate of 76% (19 retinas) was obtained in group 1, while a reattachment rate of 84% (21 retinas) was achieved in group 2. The final anatomic reattachment rate was 100% in both groups. The causes of failure in group 1 were proliferative vitreoretinopathy in five eyes and open break/missed break in one eye. The causes of failure in group 2 were missed break/open break in three eyes and proliferative vitreoretinopathy in one eye. Best corrected visual acuity (BCVA) at 2 weeks was better in group 1, while the final BCVA at end of 6 months was two lines better in group 2. The mean change in refractive error was -- 1.38 D in group 1 and -- 0.85 D in group 2.
CONCLUSIONS
Pars plana vitrectomy without buckling provides an effective treatment for PPRD and results in better longterm visual and anatomic outcomes than conventional scleral buckling.
Topics: Adult; Aged; Female; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Prospective Studies; Pseudophakia; Refractive Errors; Retinal Detachment; Scleral Buckling; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 15948779
DOI: 10.1111/j.1600-0420.2005.00461.x -
Acta Ophthalmologica Dec 2021To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults. (Comparative Study)
Comparative Study Observational Study
PURPOSE
To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults.
METHODS
A retrospective, comparative case series study. Patients between the ages of 18 and 40 years who underwent surgical repair of primary RRD between the years 2006 and 2013 were included. Patients were divided into three groups according to the surgical technique used: scleral buckle (SB), pars plana vitrectomy (PPV) or combined surgery (SB-PPV).
RESULTS
Ninety eyes (90 patients) were included. The mean age (SD) was 31.5 ± 5.1 years (range 22-40). Sixty-seven patients underwent SB, 10 had PPV and 13 had SB-PPV. Anatomical success rates were similar between the three groups (87%, 90% and 85% for SB, PPV and SB-PPV groups, respectively; p-value = 0.9). Mean (SD) preoperative LogMAR visual acuity (VA) was 0.46 ± 0.6, 1.73 ± 1.1, 1.1 ± 1.1 for SB, PPV and SB-PPV groups, respectively (p < 0.0001). The VA improved at last follow-up to 0.23 ± 0.4, 0.7 ± 1.5 and 1.09 ± 1.08 in SB, PPV and SB-PPV groups, respectively (p < 0.0001). Macula-off was diagnosed in 19.4% of SB, 80% of PPV and 53.9% of SB-PPV groups (p < 0.0001). In the SB group one phakic patient (1.5%) needed cataract extraction, while following PPV, all phakic eyes (100%) underwent cataract extraction eventually (p-value < 0.0001).
CONCLUSIONS
The study emphasizes the efficacy of SB as a primary procedure for the repair of retinal detachment in young adults in terms of anatomical and functional success. Furthermore, preservation of the lens as a result of using SB rather than PPV when possible is of great importance in this age group.
Topics: Adolescent; Adult; Female; Follow-Up Studies; Humans; Macula Lutea; Male; Retinal Detachment; Retrospective Studies; Scleral Buckling; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Young Adult
PubMed: 33538410
DOI: 10.1111/aos.14783 -
Ophthalmology Apr 2014To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.
OBJECTIVE
To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.
DESIGN
A Markov model of cost-effectiveness and utility.
PARTICIPANTS
There were no participants.
METHODS
Published clinical trials (index studies) of pneumatic retinopexy (PR), scleral buckling (SB), pars plana vitrectomy (PPV), and laser prophylaxis were used to quantitate surgical management and visual benefits. Markov analysis, with data from the Center of Medicare and Medicaid Services, was used to calculate the adjusted costs of primary repair by each modality in a hospital-based and ambulatory surgery center (ASC) setting.
MAIN OUTCOME MEASURES
Lines of visual acuity (VA) saved, cost of therapy, adjusted cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY) saved.
RESULTS
In the facility, hospital surgery setting, weighted cost for PR ranged from $3726 to $5901 depending on estimated success rate of primary repair. Weighted cost was $6770 for SB, $7940 for PPV, and $1955 for laser prophylaxis. The dollars per line saved ranged from $217 to $1346 depending on the procedure. Dollars per line-year saved ranged from $11 to $67. Dollars per QALY saved ranged from $362 to $2243. In the nonfacility, ASC surgery setting, weighted cost for PR ranged from $1961 to $3565 depending on the success rate of primary repair. The weighted costs for SB, PPV, and laser prophylaxis were $4873, $5793, and $1255, respectively. Dollars per line saved ranged from $139 to $982. The dollars per line-year saved ranged from $7 to $49, and the dollars per QALY saved ranged from $232 to $1637.
CONCLUSIONS
Treatment and prevention of RD are extremely cost-effective when compared with other treatment of other retinal diseases regardless of treatment modality. Retinal detachment treatment costs did not vary widely, suggesting that providers can tailor patient treatments solely on the basis of optimizing anticipated results because there were no overriding differences in financial impact.
Topics: Cost-Benefit Analysis; Cryosurgery; Health Care Costs; Humans; Laser Therapy; Markov Chains; Middle Aged; Quality-Adjusted Life Years; Retinal Detachment; Scleral Buckling; Visual Acuity; Vitrectomy
PubMed: 24411577
DOI: 10.1016/j.ophtha.2013.11.003