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Rhegmatogenous Retinal Detachment (rhegmatogenou + retinal_detachment)
Selected AbstractsDiscriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachmentOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2010Jonathan F. B. Goodfellow Abstract Aims:, To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD). Methods: Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms. Results:, A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD (p = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT (p = 0.001, specificity 96%, sensitivity 40%). Conclusions:, Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD. [source] 1251: Diagnosis of adult ophthalmic tumours: role of clinical history, symptoms and signsACTA OPHTHALMOLOGICA, Issue 2010T KIVELÄ Purpose To summarise signs and symptoms useful in diagnosing adult ophthalmic tumours. Methods Personal experience of the author as a member of the European Ophthalmic Oncology Group. Results According to studies from the United Kingdom, Finland and United States, 28-42% of adult patients with intraocular tumours may experience delays because the lesion is either misdiagnosed (e.g. as macular degeneration, naevus, rhegmatogenous retinal detachment) or missed at the initial visit. Of these patients, 72-87% have symptoms attributable to the tumour such as blurred vision, photopsia, floaters, metamorphopsia, and visual field loss. These symptoms can also be caused by many benign conditions (e.g. vitreous detachment) but should not be interpreted as innocent without thorough clinical examination. Signs specific for iris and ciliary body tumours include a tumour mass, sentinel vessels, acquired astigmatism, and cataracts. Choroidal tumours may induce serous retinal detachments, subretinal and vitreous bleedings and, sometimes, lipid exudation. Finally, orange subretinal pigment suggests the diagnosis of a uveal melanoma whereas many drusen point to a long-standing naevus. Conclusion Signs and symptoms of ophthalmic tumours are mostly nonspecific, necessitating an appropriately high level of suspicion and a systematic approach to clinical examination to avoid delayed or missed diagnoses. Earlier diagnosis could be achieved especially if dilated fundus examinations were performed without exception and if all suspicious naevi were referred for a second opinion. [source] 1253: Technique and role of biopsies in intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010BE DAMATO Purpose To discuss the roles of various forms of biopsy of intraocular tumours, to describe the techniques and to highlight the main pitfalls and complications. Methods Intraocular tumours can be sampled by exo- or endo-biopsy. Exo-biopsy can consist of excisional biopsy (e.g., iridocyclectomy), trans-scleral incisional biopsy, or trans-scleral fine-needle aspiration biopsy. Endo-biopsy comprises vitreous biopsy and retinal or choroidal biopsy performed with a fine needle or vitreous cutter. In rare cases, enucleation is the most pragmatic method of establishing the diagnosis, especially if the eye is blind and painful. Results For many years, biopsy was performed mostly for diagnostic purposes the main reasons being to distinguish melanoma from metastasis and lymphoma from various forms of uveitis. Recently, prognostic biopsy has become more popular, the objective being to determine whether or not a uveal melanoma is likely to be life-threatening. Biopsy can profoundly influence the management of an individual patient but requires special expertise both in the operating theatre and in the laboratory. There are many possible complications, which include endophthalmitis, extraocular seeding of tumour, rhegmatogenous retinal detachment, cataract, haemorrhage, inconclusive result, and mis-diagnosis. Conclusion Biopsy of intraocular tumours is invaluable in the management of selected patients, but requires special expertise to ensure that good results are obtained without causing complications. [source] 1231: How to identify retinal tears?ACTA OPHTHALMOLOGICA, Issue 2010JP BERROD Purpose Locating the retinal tear(s) in rhegmatogenous retinal detachment witout PVR is the first step of a successful treatment. The purpose of the course is to present the different techniques and rules to examine the retina in order to detect and locate all the tears. Methods We emphasised the 3 Lincoff's rules that permit concentration of the efforts to a small area of the periphery to identify the breaks. More than one break is present in 50% of eyes. Hence, there is a need to inspect the rest of the fundus including areas of attached retina. Results In the evaluation, one needs to stress the importance of good binocular indirect ophthalmoscopy with scleral depression or direct ophthalmocopy with slitlamp and 3 mirror contact lens. Vitrectomy can be indicated in certain cases of failure to detect breaks. In the presence of severe PVR the surgery would involve thorough cleaning of the entire retina, hence it may not be so important to identify all breaks preoperatively. Conclusion A minimal rate of postoperative failure for rhegmatogenous retinal detachment can only be achieved if a maximal preoperative search for the retinal breaks has been performed. [source] 1233: How to choose the best surgical procedure?ACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Dealing to the localization and sealing retinal breaks, the surgical success rate for the cure of rhegmatogenous retinal detachment greatly changed with the introduction of scleral buckling (SB), intraocular gas injection, and pars plana vitrectomy (PPV). Methods In localized cases, pneumatic retinopexy and scleral buckling surgery (SB) remains the most popular surgical methods. Complicated cases with PVR grade B or C, giant tears, or macular holes are most commonly treated with primary pars plana vitrectomy. A large group of rhegmatogenous RDs with medium severity that comprise about 30% of all primary rhegmatogenous RDs in the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment recruitment study, were treated by SB and PPV. Advances in vitrectomy instrumentation and wideangle imaging systems have increased the popularity of PPV. Results The decision by the surgeon to use scleral buckling rather than PPV depends on a number of factors, including the lens status, size and location of breaks, patient compliance, and individual experience. Initial PPV may be successful for phakic patients. However, the SPR study shows a benefit of SB in phakic eyes with respect to BCVA improvement. Although no difference in BCVA was demonstrated in the pseudophakic trial, PPV was recommend for pseudophakic RD based on a better anatomical outcome. Conclusion There was a significant trend towards more frequently employing primary PPV (with or without SB) for the management of primary RRD. A significant improvement in the primary success rates for RD, were shown for all retinal surgical modalities applied for the treatment of rhegmatogenous retinal detachment. [source] 4235: Vitreoretinal considerations in OOKPACTA OPHTHALMOLOGICA, Issue 2010E HUGHES Purpose To present the difficulties of managing vitreoretinal complications in patients with OOKP and open a discussion about future strategies to prevent and deal with these problems. Methods Retrospective review of cases. Results Vitreo-retinal complications occurred in 14 of 54 patients receiving OOKP surgery. These included vitreous hemorrhage (4 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment (5 patients), endophthalmitis without retinal detachment (1 patient) and intraoperative choroidal hemorrhage (1 patient). Most cases of endophthalmitis presented late and may result from lamina resorption, leak and hypotony. The prognosis of retinal detachment in an eye with OOKP was poor with successful repair in 1 of 3 cases not related to endophthalmitis and 0 of 5 cases with endophthalmitis. Overall, pars plana vitrectomy was performed on 10 occasions (8 patients), of which 2 were endoscopic and 2 utilised a temporary keratoprosthesis. Conclusion There is a relatively high rate of posterior segment problems in OOKP patients and their management is challenging both in assessment (limited view and ultrasound amenability) and surgical approach. Surgical outcomes were poor for these complications. Other concepts in management, including endoscopic vitrectomy at stage I surgery should be considered, which will be discussed. [source] 2123: Transferrin and transthyretin in vitreoretinal surgeryACTA OPHTHALMOLOGICA, Issue 2010C ARNDT Purpose The concentration of transferrin in the vitreous is known to be higher than in plasma or aqueous humor. This has been related to a local synthesis of transferrin by the ciliary body. Increased levels have been found in vitro-retinal proliferation. A relationship between the level of transthyretin and the functional outcome has been previously reported. The purpose of the study was to look for a relation between transferrin and transthyretin. Methods Patients with epiretinal membrane and rhegmatogenous retinal detachment were prospectively enrolled. The vitreous samples were obtained without intraocular infusion. The levels of transferrine and transthyretin (prealbumin) were determined in all cases. Results In the group of patients with retinal detachment (n=18), two groups could be identified: the transferrin levels were either low between 40 and 70 mg/l with low transthyretin (<17,8 mg/l)(n=6) or high (>400 mg/l) with transthyretin levels between 200 and 400 mg/l (n=12). No relationship to any clinical parameters (extension of the detachment, onset of symptoms or degre of vitreo-retinal proliferation) could be demonstrated. In patients with epiretinal membranes (n=6), the transferrin levels <40 mg/l, transthyretin < 17,8 mg/l. Conclusion Increased transferrin seems to correlate with increased transthyretin levels in the vitreous. The clinical signification of this relationship remains to be demonstrated and probably requires a larger patient sample. [source] 4333: How does scleral buckling affect the anterior segment of the eye?ACTA OPHTHALMOLOGICA, Issue 2010FJ ASCASO Purpose To describe the modifications produced in the anterior segment of the eye after placing an encircling scleral buckling (SB) in terms of corneal morphology, biomechanics and intraocular pressure. Methods A prospective study of 15 eyes with rhegmatogenous retinal detachment who underwent pars plana vitrectomy combined with a scleral buckle (PPV/SB), and 12 eyes with vitreous hemorrhage treated with PPV alone. We measured preoperatively and 1-month after surgery the corneal biomechanical properties using the Ocular Response Analyzer (ORA), including corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (IOPg), and corneal compensated IOP (IOPcc). Moreover, we defined the corneal morphology by 4 parameters provided by the topographer Orbscan IIz: mean corneal power (dioptres), standard deviation, thinnest point (µm), and anterior chamber depth (ACD) (mm). Results Mean CH values were significantly diminished following PPV/SB (p=0.003). We found no significant changes in CRF. IOPg and IOPcc mean values were significantly increased only in the PPV/SB group (p=0.019 and p=0.010, respectively) but not in PPV group (p=0.715 and p=0.273, respectively). In PPV/SB group, IOPcc mean values were significantly higher than IOPg before (p=0.001) and after surgery (p=0.003), but not in the other group. None of the morphological parameters were modified after surgery in any of the two study groups (p>0.05) Conclusion Anterior segment morphology was not modified after placing a SB. Corneal biomechanical properties showed a reduction in CH, probably due to a vascular constriction and reduction of the eye compliance. PPV might be considered a less invasive approach for the repair of noncomplex retinal detachments than PPV/SB. [source] Incidence of redetachment 6 months after scleral buckling surgeryACTA OPHTHALMOLOGICA, Issue 2 2010Fleur Goezinne Abstract. Purpose:, The preoperative and intraoperative clinical variables associated with redetachment and/or a poor visual outcome following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) have mainly been studied after a short follow-up. This study aimed to analyse long-term effects by following patients for at least 6 months. Methods:, In a retrospective survey we evaluated the data of 436 eyes that underwent SB surgery. Postoperative data were collected at 3-month intervals. Results:, After a mean follow-up period of 51 months, anatomic reattachment was achieved in 76% after one SB procedure, with a final reattachment rate of 97% after additional vitreoretinal procedures. In total, 104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up, 32 eyes (7%) and 20 eyes (5%), respectively, developed redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. A cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent RRD. Conclusion:, Conventional SB surgery is a reliable procedure in a selected group of eyes with primary RRD. However, in eyes with a retinal tear with a cumulative size of more than three disc diameters, a primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 months, a longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after SB surgery. [source] Insights into the molecular basis of rhegmatogenous retinal detachmentACTA OPHTHALMOLOGICA, Issue 2009PN BISHOP Purpose Factors that determine the likelihood of developing posterior vitreous detachment and subsequent rhegmatogenous retinal detachment (RRD) include (i) the degree of vitreous liquefaction (ii) the strength of post-basal vitreoretinal adhesion and (iii) the topology of the posterior border of the vitreous base. The purpose of these studies was to investigate each of these using a combination of ultrastructural and molecular techniques. Methods Ultrastructural studies of the human vitreous and vitreoretinal interface were performed in combination with various antibodies and cationic dyes. Biochemical studies were performed on extracted vitreous components. Results The resultant data suggest that: (i) vitreous liquefaction is caused by the aggregation of vitreous collagen fibrils and this is due to a loss of type IX collagen proteoglycan from the fibril surfaces; (ii) interactions between heparan sulphate proteoglycans in the inner limiting lamina and components on the surface of cortical vitreous collagen fibrils contribute to postbasal vitreoretinal adhesion; (iii) the posterior border of the vitreous base migrates posteriorly with aging due to the synthesis of new vitreous collagen by the peripheral retina. Conclusion The molecular basis of RRD is starting to be unravelled. Furthering our understanding of the underlying molecular processes may lead to the development of novel therapeutic strategies to treat RRD and other vitreoretinal disorders. [source] Primary vitrectomy in retinal detachment: is scleral buckling still indicated?ACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose The surgical management of rhegmatogenous retinal detachment has evolved due to introduction of primary pars plana vitrectomy (PPV). The choice of primary vitrectomy has grown over recent years even for managment of simple retinal detachment. Methods Review of reports on primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment. Evaluation of optimal indications of vitreectomy for specific types of retinal detachments. Results Comparaison of primary vitrectomy with scleral buckling had failed to demonstrate advantage of this method regarding anatomical and functional results. Vitrectomy avoids some of the complications associated with scleral buckling, such as diplopia, choroidal detachment, perforation of the sclera, abnormalities in the eyelid, but it carries higher risks of several other complications,including cataract formation in phakic eyes, glaucoma and other problems with tamponade, and new retinal breaks. Data from case series and randomized studies suggest that primary detachments in phakic eyes may be treated successfully with scleral buckling or vitrectomy, whereas vitrectomy appears to be preferable for corresponding detachments in pseudophakic eyes. Conclusion The choice of primary PPV in new uncomplicated retinal detachment remains to the surgeon's discretion and skills due to lack of controlled randomized trials covering the large spectrum of the retinal detachment pathology. [source] Surgical experience and outcome of scleral buckling procedures in retinal detachmentACTA OPHTHALMOLOGICA, Issue 2009C ARNDT Purpose The purpose of this study was to evaluate the impact of the surgeons' experience on the anatomical and functional outcome of primary scleral buckling surgery in rhegmatogenous retinal detachment. Methods The charts of patients presenting with a retinal detachment between 2000 end 2006 were analyzed retrospectively. All patients with macular involvement treated with scleral buckling surgery were included. The surgeons were designated according to the "on call" list. Junior surgeons were fellows with less than 2 years of experience, physicians with more than 2 years of experience were defined as senior surgeons. Results Among the 115 included patients, 76 (65,8%) were operated by senior surgeons. The age, duration of symptoms, initial visual acuity, extension of the retinal detachment were similar in both groups. The primary reattachment rate was 87,7% in the senior surgeon group versus 92,1% in the junior surgeon group (p=0,36). In the eyes operated by senior surgeons, the final visual acuity was better than 20/40 in 78,5% versus 63,2% in eyes operated by junior surgeons (p=0,09).However, in phakic eyes with limited retinal detachments, the senior surgeons achieved better functional results (p<0.01). Conclusion The surgical experience, except in some subgroups of patients, did not significantly influence the anatomical or the functional overall outcome of patients undergoing primary scleral buckling surgery in retinal detachment with macular involvement. [source] PaCE: a technique to avoid subretinal fluid drainage in retinal detachment surgeryACTA OPHTHALMOLOGICA, Issue 1 2006Manzar Saeed Abstract. Purpose:,Subretinal fluid (SRF) drainage and thus the potential complications of this procedure during scleral buckling can be avoided by inducing SRF absorption preoperatively. The technique described in this series is named PaCE (Pneumatic Cryo Explant). Methods:,A total of 22 eyes of 22 patients with primary bullous rhegmatogenous retinal detachment (RRD) were included in this prospective non-comparative case trial. All satisfied specific inclusion criteria similar to those used in previous pneumatic retinopexy (PR) studies. Under direct visualization, 0.3 ml C3F8 100% was injected into the vitreous cavity through the pars plana. Postoperative posturing was encouraged. Retinopexy with either cryotherapy or laser was performed, combined with scleral buckling (SB) when the SRF was absorbed. Avoidance of SRF drainage and persistent reattachment of the retina at the end of the 12-month follow-up was considered a successful outcome. A change in vision by one line (logMAR) was considered significant. Results:,Resolution of SRF before retinopexy and the SB procedure was achieved in 20 of 22 eyes (90.9%) and hence SRF drainage was not required. Visual improvement was achieved in 95% of cases. One eye (4.5%) lost vision due to a total RD after gas injection (further surgery was not carried out). Conclusion:,PaCE should be considered in any suitable case of primary RRD where SRF drainage is deemed necessary. The potential complications associated with this procedure are relatively less serious and it does not compromise the viability of subsequent procedures. [source] Fibrinogen and detached retina with or without proliferationACTA OPHTHALMOLOGICA, Issue 6 2000I. P. Theoharis ABSTRACT. Purpose: Fibrinogen is a multifunctional molecule, participating in processes such as wound healing, inflammation and cell proliferation. Therefore a comparative study of plasma fibrinogen levels was performed on patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy after RRD (PVR). Method: Plasma fibrinogen levels were measured preoperatively in three groups of patients; twenty-two (n=22) patients from the ORL department of our hospital, serving as a control group; twenty-eight (n=28) patients with RRD; and twenty (n=20) patients with PVR after RRD. Patients' ages were matched for all three groups; diabetics and patients with cardiovascular disease were excluded. T-Student's test was performed for the comparison of the plasma fibrinogen mean values of the aforementioned groups. Results: Statistically significant (p value: 0.013) elevation of fibrinogen plasma levels was observed in patients with RRD compared to those of the control group. In addition, patients with PVR had significantly higher plasma fibrinogen levels (p value: 0.03) than RRD patients. Conclusion: The results suggest a correlation between fibrinogen plasma levels and the development of RRD and PVR. [source] | ||||||||||