Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

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.

Changes in axial length after vitrectomy for rhegmatogenous retinal detachment combined with choroidal detachment

AIM:To report the postoperative axial length(AL)changes in rhegmatogenous retinal detachment combined with choroidal detachment(RRD-CD)patients.METHODS:The medical records of 97 consecutive patients from January 2015 to December 2018 were reviewed.Patients included were divided into RRD-CD and RRD only groups.All patients had received AL measurements before pars plana vitrectomy(PPV)and before silicone oil removal(SOR).The changes in AL of the two groups were compared.In addition,the potential factors related to AL changes were analyzed.RESULTS:AL elongation after PPV was 1.01 mm[interquartile range(IQR):0.37,1.79;P=0.02]in the RRD-CD group,which was greater than in RRD only group(0.15 mm,IQR:0.04,0.41;P<0.001).AL increased 0.06 mm per 1 mm Hg intraocular pressure changes in the RRD-CD group(R2=0.11,P=0.03).RRD-CD patient was 11.42 times(3.54-46.80)more likely to experience post-PPV AL elongation of more than 1 mm[P<0.001,Akaike information criterion(AIC)=92.33,area under the curve(AUC)=0.839].CONCLUSION:RRD-CD patients are very likely to have a postoperative elongation of AL.The primary intraoclular lens implantation using presurgery AL data may cause a significant refractive error in RRD-CD patients who underwent PPV.

Primary Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

Purpose: To evaluate the role and the anatomic and visual results of primary pars plana vitrectomy(PPV) in treating cases with rhegmatogenous retinal detachment associated with choroidal detachment. Methods:All patients were divided into 2 groups. Each group included 23 consecutive eyes with rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C. In the study group, controlled removal of vitreous traction was achieved by primary vitrectomy and augmented by scleral buckling if needed. The breaks were treated by focused endolaser coagulation. Postoperative tamponade was done by SF6 or C3F8 gas. In the control group, all patients underwent regular scleral buckling procedure. The cases were followed up for 6 to 12 months. Results: In the study group, retinal reattachment could be achieved in 21 cases (91.30%) after the first operation and in all cases after the second procedure. No occurrence of choroidal detachment occurred after the first procedure. Retinal reattachment rate and visual results tended to be better compared with conventional surgical techniques in the control group. Conclusion: Primary vitrectomy represents a safe, effective method in the management of rhegmatogenous retinal detachment associated with choroidal detachment.

Treatment of diffuse choroidal haemangioma using photodynamic therapy

Dear Editor,I am Dr.Khay Wei Poh from Department of Ophthalmology,Hospital Kuala Lumpur,Malaysia.I write to share a case of diffuse choroidal haemangioma in a child with SturgerWeber syndrome who showed resolution of exudative retinal