Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle

●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Clinical and Therapeutic Aspects of Pediatric Rhegmatogenous Retinal Detachment on Senegalese Black Population

Background: Rhegmatogenous retinal detachment in children is particular by its severity and challenging treatment. Purpose: To describe the clinical and therapeutic characteristics of pediatric rhegmatogenous retinal detachment. Method: We retrospectively included files of pediatric patients (aged 0 to 15 years), clinically diagnosed with rhematogenous retinal detachment (RRD) between January 2015 and June 2019. The ophthalmological examination was as complete as the age of the patients allowed and a pediatric examination was systematically performed in all children. The data has been processed with Excel 2016 software. Results: 16 eyes of 11 patients were included. The hospital frequency of RRD was 3.37%, with a sex ratio of 1.75 and a mean age of 11.9 years. The average consultation time was 2 months. Contusive eye trauma was reported in 31.25% and myopia in 18.75%. The visual acuity ranged from no light perception to 20/400. The RRD was total in 81.25% and retinal lesions were found in 43.75%, including 25% atrophic holes and tears with lattice degeneration, 12.5% temporal retinal dialysis and one giant tear. Stage B of Proliferative vitreoretinopathy was found in 18.75% and stage C in 56.25%. Scleral buckling was performed in 37.5% and 23G pars plana vitrectomy with silicone oil in 18.75%. The mean duration of follow-up was 24.6 months with anatomical success in 77.7% correlated with functional recovery in 55.5%. The RRD was persistent in one case and a recurrent RRD under silicone was observed in one eye. Two children underwent cataract surgery secondary to vitrectomy, and one case of ocular hypertonia under silicone was noted. Conclusion: Pediatric rhegmatogenous retinal detachment is a severe disease, with essentially traumatic etiology in older children. Delayed diagnosis is a factor in poor prognosis.

Clinical and Therapeutic Aspects of Pediatric Rhegmatogenous Retinal Detachment on Senegalese Black Population

Background: Rhegmatogenous retinal detachment in children is particular by its severity and challenging treatment. Purpose: To describe the clinical and therapeutic characteristics of pediatric rhegmatogenous retinal detachment. Method: We retrospectively included files of pediatric patients (aged 0 to 15 years), clinically diagnosed with rhematogenous retinal detachment (RRD) between January 2015 and June 2019. The ophthalmological examination was as complete as the age of the patients allowed and a pediatric examination was systematically performed in all children. The data has been processed with Excel 2016 software. Results: 16 eyes of 11 patients were included. The hospital frequency of RRD was 3.37%, with a sex ratio of 1.75 and a mean age of 11.9 years. The average consultation time was 2 months. Contusive eye trauma was reported in 31.25% and myopia in 18.75%. The visual acuity ranged from no light perception to 20/400. The RRD was total in 81.25% and retinal lesions were found in 43.75%, including 25% atrophic holes and tears with lattice degeneration, 12.5% temporal retinal dialysis and one giant tear. Stage B of Proliferative vitreoretinopathy was found in 18.75% and stage C in 56.25%. Scleral buckling was performed in 37.5% and 23G pars plana vitrectomy with silicone oil in 18.75%. The mean duration of follow-up was 24.6 months with anatomical success in 77.7% correlated with functional recovery in 55.5%. The RRD was persistent in one case and a recurrent RRD under silicone was observed in one eye. Two children underwent cataract surgery secondary to vitrectomy, and one case of ocular hypertonia under silicone was noted. Conclusion: Pediatric rhegmatogenous retinal detachment is a severe disease, with essentially traumatic etiology in older children. Delayed diagnosis is a factor in poor prognosis.

Comparison of persistent submacular fluid in different preoperative macular status after vitrectomy for rhegmatogenous retinal detachment

AIM： To compare the incidence of persistent submacular fluid（SMF） and visual outcome after pars plana vitrectomy（PPV） for rhegmatogenous retinal detachment（RRD） in different preoperative macular status according to optical coherence tomography（OCT）.METHODS： A non-randomized, retrospective review was performed for patients who underwent successful PPV for RRD. OCT exams were taken preoperatively and 1 mo after surgery, until SMF disappeared. According to the preoperative macular status on OCT, patients were divided into two groups： macula-off RRD（Group A） and maculaon RRD（Group B）. In Group A, there were two subgroups： macula partly detached（Group A1） and macula totally detached（Group A2）. The main outcome measures were the presence of SMF on OCT 1 mo after surgery, and the preoperative and postoperative best corrected visual acuities（BCVA）, among the different groups and depending on the presence or absence of persistent SMF.RESULTS： A total of 139 eyes of 139 patients were included in the study. Persistent SMF at 1 mo after surgery was 15.8%（22/139）, all occurring in Group A（22/101）; Group B had no SMF at 1 mo after surgery（0/38, P=0.002）. The incidence of persistent SMF at 1 mo after surgery in Group A1 was 50%（14/28）, and in Group A2 was 11.0%（8/73, P〈0.001）. Significant differences were shown between the presence and absence of persistent SMF on foveolaoff RRD, the preoperative BCVA, the 1 mo postoperative BCVA, and the degree of the BCVA improvement from 1 mo postoperatively to the final follow-up（P〈0.05）. However, there were no significant differences in the final BCVA（P〉0.05）.CONCLUSION： Persistent SMF after PPV for retinal detachment is associated with preoperative macular status. Macula-uninvolving RRD shows no persistent SMF after PPV. Macular partly detached RRD has a higher incidence of SMF than macula totally detached RRD after PPV. The persistence of SMF may be responsible for the delayed visual recovery, whereas there were no significant differences in the final visual acuity.

Risk factors of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese patients

AIM： To comprehensively analyze the risk factors of rhegmatogenous retinal detachment （RRD） associated with choroidal detachment （CD）. METHODS： A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B -scan ultrasonography, and ultrasound biomicroscope （UBM）. Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD）. Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS： There were 52 eyes （19.62%） with CD. Pseudophakia was more commonly seen in RRDCD （21.15% ys6.10%, P=0.002）. Intraocular pressure （lOP） was lower （8.60 ±3.62 ys 12.96 ±3.55, P 〈0.001）, best - corrected visual acuity was worse [3.00 （2.00 to 3.00） vs 1.92 （1.22 to 3.00）, P=-0.001], and refractive error was more myopic [-4 （-9 to -2） vs -2 （-6 to 0）, P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment （P=0.007）. In RRDCD, 34.62% of eyes presented with multiple holes （P=0.044） and 25.00% with macular holes （P=0.012）, compared with 20.66% and 14.08% in R RD. High myopia （P=0.039）, low lOP （P=0.017）, and larger extent of retinal detachment （P〈0.001） were significant and independent risk factors for developing CD. - CONCLUSION： For CD in RRD, related factors include BCVA, lOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low lOP are significant and independent risk factors.

Surgical outcomes in inferior recurrences of rhegmatogenous retinal detachment

AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment

AIM:To provide a detailed description of the natural history of persistent subretinal fluid(SRF)after successful repair of rhegmatogenous retinal detachment(RRD)and its association with visual outcome.METHODS:This was a prospective long-term follow-up for eyes undergoing scleral buckling(SB)surgery for maculaoff RRD.Examinations were carried out preoperatively and postoperatively at 1,3,6,9 and 12 mo,until persistent SRF had completely resolved.One month postoperatively,optical coherence tomography(OCT)was used to classify SRF into three patterns:bleb-like loculated(BL),shallow-diffused(SD),and multiple blebs(MB).Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance.Patients were divided into two groups depending on the presence or absence of persistent SRF.RESULTS:A total of 59 patients(59 eyes)were included.There were no statistical differences between two groups at baseline,except for the proportion of patients with high myopia and a younger age.One month after surgery,OCT detected persistent SRF in 49 eyes(83.1%).The 3 morphological patterns of SRF were observed in 27 eyes(55.1%)with BL,13 eyes(26.5%)with SD,and 9 eyes(18.4%)with MB.The mean time for complete absorption differed significantly across the three SRF patterns(F=8.097,P=0.001),which was 8.8±6.1,20.1±12.1,and 16.7±10.2 mo in BL,SD,and MB,respectively.In 9 of the 13 eyes with SD,the pattern transformed into MB type.In cases involving MB,the size and number of blebs decreased gradually until they had been completely absorbed.Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone(49.0%vs 10%,P=0.034).The final best-corrected visual acuity of two groups was 0.37±0.11(with SRF)vs 0.34±0.12(without SRF)logMAR(P=0.499),respectively.CONCLUSION:High preoperative myopia and younger age are associated with persistent SRF.BL is the most commonly observed pattern with the shortest duration and gradually disappeared.Most cases involving SD SRF transform into MB type during resolution.The size and number of the MBs decrease gradually until they were completely absorbed.The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.

Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM： To report the results of rhegmatogenous retinal detachment（RRD） repair after pars plana vitrectomy（PPV） without operative use of heavy liquid, and utilizing air tamponade in selected cases.METHODS： RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5 d.RESULTS： Totally 36 eyes of 36 patients（24 males, 66.7%） aged 53.8±10.9 y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes（29, 80.6%） had retinal detachment involving more than one quadrant. Twenty-two（61.1%） eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8 mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4%（34/36）. Six（16.7%） eyes had intraocular pressure higher than 25 mm Hg. The visual acuity（logMAR） improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively（P〈0.001）. CONCLUSION： The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.

Comparison of Densiron 68 and 1 000 cSt silicone oil in the management of rhegmatogenous retinal detachment with inferior breaks

AIM:To compare success rates and complications of Densiron 68 and 1000cSt silicone oil (SO) in the management of rhegmatogenous retinal detachment (RRD) with inferior breaks (IBs). METHODS:Totally 61 eyes of 61 consecutive patients with RRD with IBs were assigned to pars plana vitrectomy (PPV) with Densiron (n =31) or PPV with SO (n=30) in order of presentation. SO and Densiron removal was performed 3 months after initial surgery. Follow up visits were terminated 6 months after SO removal. ·RESULTS:With a single operation, the Densiron group showed 84% and SO 74% reattachment. With further surgery, both groups showed 90% reattachment. Complications such as cataract, raised intraocular pressure (IOP), inflammatory reaction, macular epiretinal membranes, and emulsification of SO were seen in both groups. CONCLUSION:Densiron and SO are found to have similar success rates and complications.

High frequency of latent Chlamydia trachomatis infection in patients with rhegmatogenous retinal detachment

AIM： To determine the frequency of detection of ocular and extraocular Chlamydia trachomatis （CT） infection in non -high myopes with rhegmatogenous retinal detachment （RRD）. METHODS： This was a single-center, nonrandomized, prospective, case-control study. One hundred and four patients were divided into a study group with RRD （n= 63） and a control group with traumatic retinal detachment （n=41）. Samples of subretinal fluid （SFR）, conjunctival, urethral/cervical swabs, and blood were collected. The frequency of detection of CT infection in SRF samples was determined by polymerase chain reaction （PCR）, direct fluorescence assay （DFA） and cell culture, whereas that in conjunctival swabs was determined by PCR and DFA, and those in urethral/cervical swabs and blood were determined by DFA. Yates Chi-square test （with Bonferroni correction） and two-tailed Student＇s t-test were used for statistical analysis. RESULTS： SRF CT infection was detected more frequently in the study group （50.8%-71.4%） than in the control group （9.8%-12.2%） by all the methods used （P〈 0.01）. The frequency of detection of conjunctival CT infection by DFA was higher in the RRD patients compared with the controls （81.0% vs 24.4%, P=0.004）. The PCR detected conjunctival CT infection more often in the study group than in the controls （46.0% vs89.8%, P= 0.007）. The DFA detected CT in blood specimens almost as frequently as in urogenital specimens, for the RRD patients （61.2% vs 63.5%） and the controls （7.3% vs 9.8%）. CONCLUSION： CT infection is detected with high frequency in non-high myopes with RRD.

Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.

Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange

AIM:To observe the efficacy and safety of pars plana vitrectomy(PPV)with eye position guided fluid-air exchange(FAX)and air to mponade in the treatment of rhegmatogenous retinal detachment(RRD).METHODS:RRD patients without severe proliferative vitreoretinopathy(PVR)C1 or more were enrolled.All patients underwent PPV combining with air tamponade.During operation,the primary retinal break(s)were placed at lower site and subretinal fluid was aspirated through the break(s)at the same time when eye position guided FAX was proceeding.Sufficient laser spots were made to seal the retinal break(s)after FAX,and filtered air was left in vitreous cavity as to mponade agent finally.The main outcomes were primary and final success rates,best corrected visual acuity(BCVA),and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.RESULTS:A total of 37 eyes(20 males and 17 females)with a follow-up time of≥6 mo were included.The range of RRD was 5.6±1.8 h,and the number of retinal breaks was 1.9±1.2.The breaks located at inferior quadrants(between 3:00 and 9:00)in 5 cases(13.5%),and both superior and inferior breaks were found in 3 cases(8.1%).A total of 25 cases(67.6%)with macular detached involvement,9 cases(24.3%)with intraocular lens,and 8 patients(21.6%)were treated with phacoemulsification and intraocular lens implantation together.The success rate of primary retinal reattachment was 100%(37/37).At 6 mo postoperatively,BCVA(logMAR)was increased from 1.13±1.07 to 0.23±0.15(P<0.001).Phacoemulsification combined with intraocular lens implantation was performed in 2 patients(5.4%),and one of them underwent macular epiretinal membrane peeling in addition(2.7%).Furthermore,high intraocular pressure was found in 4 cases(10.8%).CONCLUSION:PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD,and it has the advantages of short postoperative prone time and fewer operative complications.

Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification for rhegmatogenous retinal detachment repair

AIM: To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment(RRD) repair.METHODS: This was a retrospective, consecutive,noncomparative, interventional case series of 30 eyes of30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications.RESULTS: Primary reattachment was achieved in 27eyes(90.0%). The reasons for redetachment(3 eyes, 10%)were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy,respectively. The logarithm of the minimum angle of resolution visual acuity(mean±SD) improved from 0.76±0.74 preoperatively to 0. 21 ± 0. 37 6 months’ postoperatively(P 【0.0001). Postoperative hypotony was not detected,but 1 eye( 3. 3 %) had increased intraocular pressure(30 mm Hg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes(10.0%).· CONCLUSION: Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation.

Nomogram for predicting non-proliferative vitreoretinopathy probability after vitrectomy in eyes with rhegmatogenous retinal detachment

AIM:To identify the risk factors for postoperative proliferative vitreoretinopathy(PVR)in patients with primary rhegmatogenous retinal detachment(RRD)and develop a nomogram for predicting postoperative PVR-free probability.METHODS:A total of 741 patients(741 eyes)diagnosed with primary RRD who underwent first surgery in the same hospital were retrospectively reviewed and randomly assigned with 521 to the training set and 220 to the validation set.Univariate and multivariate logistic regression analyses were performed in the training cohort to determine risk factors to construct a nomogram for predicting the 3-,4-,5-,and 6-month postoperative PVR-free probabilities.Nomogram performance was estimated by the concordance index(C-index),calibration plot,and the area receiver operating characteristic(ROC)curve.RESULTS:A nomogram was constructed based on the preoperative PVR,silicone oil tamponade time(SOTT),photocoagulation energy(PE),retinal tear size(RTS),and hypertension.In the training set,the C-index of the nomogram was 0.896,0.936,0.961,and 0.972 at 3,4,5,and 6mo,respectively.The C-index values in the validation set were 0.860,0.936,0.951,and 0.965 at 3,4,5,and 6mo,respectively.Decision-curve analysis indicated that only the 4-,5-,and 6-month nomograms had significant net benefits over a large threshold probabilities interval.CONCLUSION:Preoperative PVR,SOTT,PE,RTS,and hypertension are significant risk factors for postoperative PVR formation in patients with primary RRD.The proposed nomogram can effectively predict the 4-,5-,and 6-month PVR-free probabilities after surgery and assist in making clinical decisions during follow-up.

Comparison of scleral buckling using wide-angle viewing systems and indirect ophthalmoscope for rhegmatogenous retinal detachment

AIM：To compare the effects of scleral buckling using wide-angle viewing systems（WAVS） with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment.METHODS：The study was a retrospective analyses of the medical records of 94 eyes（94 patients） with rhegmatogenous retinal detachment.Among them,47 eyes underwent scleral buckling using WAVS with endoiiluminator（Group W）,and 47 eyes underwent scleral buckling using indirect ophthalmoscope（Group I）.Surgical durations,primary success rate,best-corrected visual acuities（BCVA）,delayed subretinal fluid absorptions and surgical complications were compared between the two groups.RESULTS：At baseline,there were no statistical differences between the two groups in patient＇s age（P=0.997）,gender（P=0.853）,symptom duration（P=0.216）,BCVA（P=0.389）,refractive error（P=0.167）,intraocular pressure（P=0.595）,the number of retinal breaks（P=0.832）,the extent of retinal detachment（P =0.246）,subretinal demarcation line（P=0.801）,and macular detachment（P=0.811）.The follow-up period was 12 mo.The surgical durations in Group W（with or without encircling buckling） were significant shorter than those in Group I（P〈0.001 respectively）.The primary success rate was94.27%in Group W,which was similar to that in Group I（92.38%,P=0.931）.The BCVA in Group W was better than that in Group I（P〈0.001） at 1-month follow-up visit.However,there were no significant differences between the two groups at 3-month（P=0.221）,6-month（P =0.674）,and 12-month（P=0.363） follow-up visits respectively.Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month（P=0.045） follow-up visit,but there were no significant differences between the two groups at 3-month（P=0.111）,6-month（P =1.000） and 12-month follow-up visits respectively.CONCLUSION：Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment

Missed retinal breaks in rhegmatogenous retinal detachment

AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.

Pars Plana Vitrectomy versus Combined Scleral Buckling—Pars Plana Vitrectomy for Phakic Rhegmatogenous Retinal Detachment with Inferior Breaks

Aims: To compare the results of pars plana vitrectomy (PPV) and combined scleral buckling—PPV (SB/PPV) in phakic rhegmatogenous retinal detachments with inferior breaks. Methods: Randomized, prospective, clinical controlled trial of forty consecutive phakic eyes with primary rhegmatogenous retinal detachment, associated with inferior breaks and not complicated by proliferative vitreoretinopathy ≥grade C, to either PPV (group 1) or combined SB/PPV (group 2). Results: At 6 months follow up the primary reattachment rate was 100% (20/20 cases) in group 2 and 70% (14/20 cases) in the group 1, the difference being statistically significant (p = 0.027). The best corrected visual acuity improved significantly from a preoperative mean of 1.65 ± 1.13 (Range: 0.6 to 3) to a mean of 0.45 ± 0.11 (Range: 0.3 to 0.6) in the group 2 and in the group 1 improved from a preoperative mean of 2.34 ± 0.92 (Range: 0.48 to 3) to a mean of 0.668 ± 0.20 (Range: 0.48 to 1), the difference between the two groups being statistically significant (p = 0.001). Conclusion: Anatomical and functional success rates are significantly better with the use of a scleral explant during PPV for uncomplicated forms of phakic rhegmatogenous retinal detachments with inferior breaks.

Risk factors related to chronic rhegmatogenous retinal detachment

AIM: To evaluate the clinical factors related to chronic rhegmatogenous retinal detachment (RRD). METHODS: A retrospective case-control study. A total of 103 consecutive patients (103 eyes) with primary RRD were studied to evaluate the clinical factors related to chronic RRD. RESULTS: Chi-square test was used to sift out the following associated factors with chronic RRD: younger patients(P=0.0028), better preoperative best corrected visual acuity (BCVA, P=0.0316), atrophic retinal break (P<0.0001), inferior retinal break (P<0.0001), smaller break (P=0.0005); then the independent risk factors related to chronic RRD was determined by stepwise logistic regression analysis as following: atrophic retinal break (odds ratio (OR)=7.997, P=0.007), inferior retinal break (OR=14.127, P<0.0001) and better preoperative BCVA (OR=1.636 P<0.0722). CONCLUSION: Atrophic retinal break, inferior retinal break and better preoperative BCVA are the independent risk factors related to chronic RRD.

Incidence of rhegmatogenous retinal detachments is increasing in Wenzhou,China

AIM:To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments(RRDs)in the Wenzhou area in 2015 to 2019.METHODS:All newly developed RRD cases among residents of the Wenzhou area,from January 2015 to December 2019,were retrospectively retrieved from hospital records.Annual population data were extracted from the Wenzhou Statistical Yearbook.RESULTS:There were 3629 eligible cases.The average incidence of RRD was 7.79 cases per 100000 population(95%confidence interval,7.24-8.34),and the incidences were 7.99 and 7.56 for males and females,respectively.The annual incidence increased gradually from 7.26 cases per 100000 in 2015 to 10.00 cases per 100000 in 2019,with an overall increase of 37.74%.The highest rate of increase occurred in the age group from 60 to 69 years.Of 2750 eyes with axial length(AL)data,1675(60.91%)had an AL greater than 24 mm.CONCLUSION:A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.