Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment（ASPVD） and vitreous hemorrhage was conducted at University Eye Clinic,University Hospital ＂Sveti Duh＂,Zagreb,Croatia.To check ultrasound reliability in detecting retinal tears in patients with ASPVD,transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6 wk period.In 13（17%） patients membranous lesion with ultrasound characteristics of retinal tear was detected.Ophthalmoscopy confirmed the diagnosis in 8/13 patients.In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear.Sensitivity of ultrasound examination was 100%,specificity 92%,positive predictive value 62% and negative predictive value 100%.Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD.Given the high sensitivity and negative predictive value,negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Dear Editor,We were interested to read the paper by Kuzmanovic Elabjer et al.The purpose of the authors was to assess ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment （ASPVD）. They performed transpalpebral ultrasound of the eye and the orbit followed by fundus examination initially and in 6wk period.

Long-Term Postoperative Perfusion Status in Giant Retinal Tears: A Preliminary Case Report

Background: Information on the long-term perfusion status of patients after successful surgery for giant retinal tear (GRT) macula-off rhegmatogenous retinal detachment (RRD) is limited. Purpose: To examine long-term structural, functional, and perfusion outcomes in normal control eyes and eyes treated for different degrees of GRT-associated extensions of RRD. Methods: One emmetropic normal eye (control), one healthy highly myopic eye (control myopic), and three eyes surgically treated for GRT (surgical), were included in the study for a long-term comparison of study outcomes. The surgical eyes were classified based on the degree of GRT-associated RRD extension as follows: one eye with GRT-associated RRD extension ˚one eye with GRT-associated RRD extension between 180˚- 270˚and one eye with GRT-associated RRD extension > 270˚. Structural, functional, and perfusion outcomes were compared with those of the control eyes. Results: All three eyes were phakic and the condition was monocular. The mean age of the patients was 48.67 ± 8.50 years (range, 39 - 55 years). All three eyes had GRT macula-off RRD. The mean preoperative time for GRT surgery was 1.2 weeks. The mean pre- and postoperative best corrected visual acuities (BCVA) were 1.87 logMAR and 0.46 logMAR, respectively. The mean postoperative follow-up period was 19.67 ± 5.69 months. Proliferative vitreoretinopathy resulted in multiple surgeries in one eye (31.5%). Long-term postoperative optical coherence tomography (OCT) showed abnormal retinal thickness, ellipsoid zone disruption, and external limiting membrane line discontinuities in one eye. OCT angiography yielded abnormal perfusion indices in the surgically treated eyes. Conclusions: Our data showed multiple structural alterations in spectral-domain OCT biomarkers. One eye that developed secondary epiretinal membrane (ERM) proliferation showed a significantly improved BCVA after proliferation and internal limiting membrane were removed. Perfusion findings were correlated with the final BCVA. Despite a fully reattached retina without ERM proliferation, GRT-associated RRD has a guarded functional prognosis.

Treatment of early giant retinal tears with domestic perfluorodecalin and perfluoropropane

Objective To explore the methods of lens sparing (without lensectomy), non silicone oil tamponade and no scleral buckling for treatment of early giant retinal tears. Methods Thirteen cases of early retinal detachment of proliferative vitreoretinopathy (PVR) grade C 2 D 1, with giant tear extending from 135°to 270° were chosen. Transscleral cryotherapy was first applied to treat each end of the giant tear up to the oral serrate. And then conventional three port pars plana vitrectomy was performed. Perfluorodecalin liquid was injected to manipulate the flap of the retinal tear. The flap with no cryotherapy before was treated with endolaser or cryotherapy under optimal visual condition, then air fluid was exchanged completely and C 3F 8 was injected properly.Results With a mean follow up of 8.2 months, the retina was reattached completely in 12 eyes. Success rate was 92.3%, and visual acuity improved. Most postoperative complications were slight. The retina failed to reattach only in 1 case with severe vitreous blood. Conclusions In treating early retinal giant tears without severe PVR, the lens sparing, non silicone oil tamponade and no scleral bucking are helpful to simplify operation and to improve the success rate of the retinal surgery and to yield satisfactory outcome of visual acuity. Besides, it can also avoid the initial side effects of silicone oil tamponade and diopter irregularity after lensectomy.

Combined hamartoma of the retina and retinal pigment epithelium:A case report

BACKGROUND Combined hamartoma of the retina and retinal pigment epithelium(CHRRPE)is a rare congenital benign tumor which is commonly monocular.Typical CHRRPE comprises slightly raised lesions at the posterior pole,with proliferation membrane often leading to vascular distortion.In severe cases,macular edema,macular hole,retinal detachment or vitreous hemorrhage may occur.Patients with atypical clinical manifestations are prone to misdiagnosis by inexperienced ophthalmologists.CASE SUMMARY A 33-year-old man reported onset of right eye blurred vision for one week prior.Anterior segment and intraocular pressure were normal in both eyes.Left eye fundus photography was normal.Right eye ophthalmoscopy showed vitreous hemorrhage and off-white raised retinal lesions below the optic disc.Proliferative membranes on the lesion surfaces resulted in superficial retinal detachment and tortuosity and occlusion of peripheral blood vessels.A horseshoe-like tear in the temporal periphery was surrounded by retinal detachment.Optical coherence tomography revealed retinal thickening at the focal site with structural disturbance indicated by high reflectance.Right eye ultrasound showed retinal thickening at the lesion,stretching and uplifting of the proliferative membrane,with moderately patchy echo at the optic disc edge.Cytokines and antibodies were detected in vitreous fluids during the operation to rule out other diseases.Fundus fluorescein angiography(FFA)at postoperative follow-up led to final diagnosis of CHRRPE.CONCLUSION FFA is helpful in diagnosing retinal and retinal pigment epithelial combined hamartoma.In addition,other cytokine and etiological tests facilitate further differential diagnosis to rule out other suspected diseases.