RESUMEN
Rhegmatogenous retinal detachment (RRD) is a severe disease of the visual organ that is one of the leading causes of blindness worldwide. Without surgical treatment, RRD almost always leads to vision loss and blindness. Surgical treatment in the early stages of the disease reduces the risk of blindness. This article analyzes scientific publications reflecting the issues of prognosis and prevention of RRD. Literature analysis showed that there are few prognostic matrices in ophthalmology in general, and specifically related to RRD. Most prognostic matrices for RRD are aimed at preventing its recurrence and predicting the development or progression of peripheral vitreochorioretinal dystrophy in the operated or fellow eye. Building a prognostic matrix for the risk of occurrence and development of such a serious disease as RRD in adults will allow early prediction, enabling surgical treatment in the shortest possible time and positively influencing the functional outcome of treatment.
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Recurrencia , Desprendimiento de Retina , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/diagnóstico , Humanos , Pronóstico , Progresión de la Enfermedad , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
Persistent subretinal fluid (PSF) after scleral bucking of rhegmatogenous retinal detachment may delay recovery and affect the final visual quality, but with no effective treatment. This study firstly investigated the safety and efficacy of 577 nm yellow subthreshold micropulse laser (SML) on PSF after scleral bucking surgery. This double-masked randomized clinical trial was conducted from December 2020 to October 2022 at Chongqing Aier Eye Hospital. Participants with PSF last for 1 month after scleral bucking surgery with break closed and retina reattachment were recruitment. These participants were treated by 577 nm yellow SML or sham treatment. Funduscopy, optical coherence tomography (OCT) volume change, best corrected vision acuity (BCVA) and visual field test were evaluated for six mouths follow-up. A total of 24 participants were randomized into SML group or Sham group equally. Compared with Sham group, the OCT volume within 6 mm of macular fovea was significantly less in SML group 6 months after therapy (P = 0.048). There were no statistically significant differences of OCT volume at 1, 2 and 3 months from baseline between groups. BCVA of ETDRS letters had no statistically significant difference. Pattern Standard Deviation amelioration (P = 0.039) had statistically significance in SML group compared with Sham group. There were no complications in the 2 groups. These preliminary findings suggest that 577 nm yellow SML therapy could accelerate PSF absorption after scleral bucking surgery.Trial registration: Chinese Clinical Trial Registry No. ChiCTR2000037838, 02/09/2020, https://www.chictr.org.cn/showproj.html?proj=51885 .
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Desprendimiento de Retina , Curvatura de la Esclerótica , Líquido Subretiniano , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Femenino , Masculino , Curvatura de la Esclerótica/métodos , Curvatura de la Esclerótica/efectos adversos , Desprendimiento de Retina/cirugía , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodos , Adulto , Resultado del Tratamiento , Método Doble CiegoRESUMEN
OBJECTIVE: To investigate the risk factors and prognostic factors that affect the long-term clinical outcomes of acute retinal necrosis (ARN). METHODS: A retrospective study of patients with ARN who underwent treatment and completed follow-up in our ophthalmology department from 2011 to 2021 was conducted. The incidence and risk factors of retinal detachment (RD) and prognostic factors affecting long-term clinical outcomes, such as late-onset RD and final vision loss (< 20/200), were analyzed. RESULTS: Totally 59 ARN patients (65 eyes) with an average follow-up of 48.9 months were enrolled. During the follow-up period, RD occurred in 34 eyes (52.3%). The risk factors for RD included quadrants of involved retinal necrosis (odds ratio [OR], 4.181; 95% confidence interval [CI], 1.950-10.834) and initial intraocular viral load (OR, 1.721; 95% CI, 1.071-3.083). Early intravitreal antiviral treatment (OR, 1.204; 95% CI, 1.040-1.480) was independently associated with a decreased risk of late-onset RD. The factors independently associated with an increased risk of final vision loss were worse initial visual acuity (OR, 3.895; 95% CI, 1.551-13.662) and late-onset RD (OR, 8.043; 95% CI, 1.380-67.216). In addition, we utilized the fluctuating magnitude of viral load to quantify the extent of its reduction in comparison to its original value following the initial intravitreal antiviral injection (IAI). This ratio was strongly related to initial intraocular IL-8 concentration (Spearman correlation coefficient=-0.741, P = 0.000) and moderately related to the initial degree of aqueous flare (Spearman correlation coefficient=-0.508, P = 0.010). CONCLUSION: RD is a common and severe complication of ARN with multiple risk factors, such as initial retinitis involvement area and initial intraocular viral load. Active local antiviral therapy may reduce the risk of late-onset RD. The antiviral medication should be adjusted according to the inflammatory state. Therefore, timely detection of causative viruses and intensive systemic and local antiviral therapy is crucial for preserving visual function in ARN patients.
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Desprendimiento de Retina , Síndrome de Necrosis Retiniana Aguda , Agudeza Visual , Humanos , Síndrome de Necrosis Retiniana Aguda/diagnóstico , Síndrome de Necrosis Retiniana Aguda/virología , Síndrome de Necrosis Retiniana Aguda/tratamiento farmacológico , Masculino , Factores de Riesgo , Estudios Retrospectivos , Femenino , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/diagnóstico , Agudeza Visual/fisiología , Persona de Mediana Edad , Pronóstico , Adulto , Anciano , Estudios de Seguimiento , Incidencia , Antivirales/uso terapéutico , Infecciones Virales del Ojo/virología , Infecciones Virales del Ojo/diagnóstico , Inyecciones Intravítreas , Adulto JovenRESUMEN
Purpose: The purpose of this study was to compare the clinical efficacy of foldable capsular vitreous body (FCVB) filled with either light or heavy silicone oil and the incidence of complications after their implantation for the treatment of severe ocular trauma and silicone oil-dependent eyes. Methods: FCVB filled with either light (n = 16) or heavy (n = 8) silicone oil was implanted in 24 patients. During the 12-month follow-up period, the intraocular pressure, final best-corrected visual acuity, retinal reattachment condition, position of the FCVB, and complications were assessed. Results: All surgeries were performed without issue. There was no significant difference in preoperative and postoperative best-corrected visual acuity between the two groups. A significant improvement in the intraocular pressure was observed after surgery in both the light silicone oil (P = 0.029) and heavy silicone oil (P = 0.035) groups. None of the patients developed displacement or prolapse of the FCVB. The most common early and late postoperative complications were postoperative hemorrhage (33.3%) and corneal opacification (50%), respectively. Conclusions: FCVB filled with heavy silicone oil can be used as a supplemental therapy for patients who have lost the anterior segment of their eye, have lesions of the inferior retina, or cannot maintain the prone position for various reasons. Translational Relevance: Implantation of FCVB combined with heavy silicone oil compensates for the shortcomings of this with light silicone oil, providing patients with more personalized treatment.
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Aceites de Silicona , Agudeza Visual , Cuerpo Vítreo , Humanos , Aceites de Silicona/uso terapéutico , Aceites de Silicona/efectos adversos , Masculino , Femenino , Adulto , Cuerpo Vítreo/efectos de los fármacos , Persona de Mediana Edad , Agudeza Visual/efectos de los fármacos , Resultado del Tratamiento , Adulto Joven , Vitrectomía/efectos adversos , Vitrectomía/métodos , Presión Intraocular/efectos de los fármacos , Presión Intraocular/fisiología , Desprendimiento de Retina/cirugía , Adolescente , Prótesis e Implantes/efectos adversos , Estudios de Seguimiento , Complicaciones Posoperatorias/etiología , Anciano , Endotaponamiento/métodosRESUMEN
BACKGROUND: This study aimed to compare the regressive effects of aflibercept and faricimab on pigment epithelial detachment (PED) in patients with neovascular age-related macular degeneration. METHODS: In total, 41 eyes of 40 patients diagnosed with type 1 macular neovascularization were retrospectively analyzed using multimodal imaging. Of these, 23 eyes were treated with intravitreal aflibercept injections (IVA group), and 18 eyes were treated with intravitreal faricimab (IVFa group), with 3 consecutive injections administered as loading dose therapy. Before treatment and at 1, 2, and 3 months after the first treatment, the maximum height (MH) and maximum diameter (MD) of the PED were measured using optical coherence tomography in each treatment group. RESULTS: In the IVA group, the MH at baseline (215 ± 177 µm) was reduced to 141 ± 150 (P = 0.06), 119 ± 150 (P < 0.01), and 107 ± 150 µm (P < 0.0001) at 1, 2, and 3 months after treatment, respectively. Similarly, in the IVFa group, the MH decreased from 240 ± 195 µm before treatment to 165 ± 170 µm (P = 0.24), 139 ± 142 µm (P < 0.05), and 117 ± 112 µm (P < 0.01) at 1, 2, and 3 months after treatment, respectively. The reduction at 2 and 3 months was significant in both treatments. The mean changes of MH from baseline were -108 ± 142 µm in the IVA group and -124 ± 112 µm in the IVFa group, with no significant difference (P = 0.21). In both groups, the MD did not regress significantly. CONCLUSIONS: The results suggested that the MH of the PED between the IVA and IVFa groups regressed similarly after each loading therapy.
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Inhibidores de la Angiogénesis , Inyecciones Intravítreas , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Desprendimiento de Retina , Epitelio Pigmentado de la Retina , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Proteínas Recombinantes de Fusión/uso terapéutico , Proteínas Recombinantes de Fusión/administración & dosificación , Masculino , Femenino , Estudios Retrospectivos , Desprendimiento de Retina/tratamiento farmacológico , Desprendimiento de Retina/diagnóstico , Anciano , Tomografía de Coherencia Óptica/métodos , Inhibidores de la Angiogénesis/uso terapéutico , Epitelio Pigmentado de la Retina/patología , Epitelio Pigmentado de la Retina/efectos de los fármacos , Degeneración Macular Húmeda/tratamiento farmacológico , Degeneración Macular Húmeda/diagnóstico , Degeneración Macular Húmeda/fisiopatología , Anciano de 80 o más Años , Persona de Mediana Edad , Angiografía con Fluoresceína , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
Purpose: With the widespread application of silicone oil in vitreoretinal surgery, the purpose of this study was to determine the risk factors of long-term vision loss 12 months post oil removal in retina-detached eyes treated with vitrectomy and silicone oil tamponade. Methods: Of the 592 patients approached, eligible eyes completed the investigation up to 12 months post-oil-removal. Eligible eyes underwent pars-plana vitrectomy following oil tamponade. Oil removal was performed after 3 to 28 months in different individuals, under the condition that the retina has reattached as well as the hemorrhage and inflammation has dissolved. Postoperative best-corrected visual acuity (BCVA), age, sex, and interval between tamponade and removal were recorded, and retinal thickness was determined using optical coherence tomography (OCT). Results: Fifty eyes of 50 participants aged 31 to 83 years were enrolled. BCVA (LogMAR) 12 months post-oil-removal improved in 25 of 40 (62.5%) patients, varying from 0.05 (20/22) to 1.0 (20/200) (mean ± SD = 0.55 ± 0.32). Pre-oil-removal nasal perifoveal retinal nerve fiber layer thickness varied from 16 to 83 µm (38.40 ± 18.50), and was significantly linked with post-oil-removal BCVA (0.5%, 95% confidence interval 0.0%-1.0%; P = 0.046). Conclusions: This study demonstrates the risk factors and prognosis of visual function after long-term regeneration post vitrectomy, oil tamponade, and oil removal, thereby underscoring the need for a complete, dynamic examination of retinal structure via OCT measurement. Related studies should be conducted on a larger scale to facilitate the stratification of late-period vision damage in retina-detached eyes. Translational Relevance: This study developed OCT-based clinical markers for the postoperative visual prognosis of eyes affected by retinal detachment.
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Desprendimiento de Retina , Aceites de Silicona , Tomografía de Coherencia Óptica , Agudeza Visual , Vitrectomía , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Vitrectomía/efectos adversos , Adulto , Anciano de 80 o más Años , Desprendimiento de Retina/cirugía , Aceites de Silicona/administración & dosificación , Aceites de Silicona/farmacología , Fibras Nerviosas/patología , Endotaponamiento/métodos , Factores de Riesgo , Estudios de SeguimientoRESUMEN
Giant retinal tear-associated rhegmatogenous retinal detachment (GRT-RRD) presents a significant surgical challenge. Trauma stands out as one of the risk factors. This retrospective case series aims to assess the outcomes of GRT-RRD patients treated with pars plana vitrectomy (PPV), distinguishing between non-trauma and blunt ocular trauma cases. The medical records and relevant retinal imaging of 60 GRT-RRD patients undergoing PPV and followed with a mean (SD) of 21.2 (13.4) months were reviewed (47 were non-trauma-related and 13 were trauma-related). Both the non-trauma and trauma groups exhibited comparable distribution of proliferative vitreoretinopathy grade (P = 0.067). Following the primary operation, there was no statistically significant difference in the proportion of patients achieving single surgery anatomical success between the non-trauma group (27/47 patients, 57.5%) and the trauma-related group (9/13 patients, 69.2%) (P = 0.534). At the final follow-up, 17 patients remained tamponade with silicone oil. Among the remaining 43 patients, 33/34 patients (97.1%) in the non-trauma group and 9/9 patients (100%) in the non-trauma group (P = 0.661) achieved comparable final surgical anatomical success. Additionally the final vision was comparable between the two trauma categories (Snellen equivalent of 20/125 for the non-trauma group and 20/200 for the trauma group, P = 0.331). In multivariable regression, no significant factors related to primary reattachment rate or final vision were identified. Non-penetrating ocular trauma did not emerge as a significant risk factor for recurrent detachment post-surgery. This study supports that PPV outcomes in GRT-RRD patients are unaffected by the ocular trauma association and reports the effectiveness of PPV in managing these patients.
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Desprendimiento de Retina , Perforaciones de la Retina , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Masculino , Femenino , Persona de Mediana Edad , Vitrectomía/métodos , Estudios Retrospectivos , Perforaciones de la Retina/cirugía , Perforaciones de la Retina/etiología , Resultado del Tratamiento , Adulto , Anciano , Agudeza VisualRESUMEN
PURPOSE: To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy and diabetic retinopathy. METHODS: Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent sickle cell retinopathy and diabetic retinopathy between January 01, 2014, and December 31, 2021. RESULTS: The study included 20 eyes of 14 patients. Indications for surgery included tractional retinal detachment in 12 eyes (60%), combined tractional retinal detachment/rhegmatogenous retinal detachment in 6 eyes (30%), and vitreous hemorrhage in 2 eyes (10%). Pars plana vitrectomy was performed in all eyes. One eye received a scleral buckle at the same time as pars plana vitrectomy. There was no change in mean best-corrected visual acuity at the last follow-up examination (1.5 [20/678]) when compared with mean preoperative best-corrected visual acuity (1.6 [20/762], P = 0.83). Preoperative best-corrected visual acuity correlated with postoperative best-corrected visual acuity at the last follow-up examination in eyes with retinal detachment (r = 0.49, P = 0.04). Single operation anatomic success was achieved in 11 of 17 eyes (65%) with retinal detachment. CONCLUSION: Functional and anatomic outcomes after surgery in eyes with concurrent sickle cell retinopathy and diabetic retinopathy are relatively poor.
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Anemia de Células Falciformes , Retinopatía Diabética , Desprendimiento de Retina , Agudeza Visual , Vitrectomía , Humanos , Estudios Retrospectivos , Retinopatía Diabética/cirugía , Retinopatía Diabética/complicaciones , Retinopatía Diabética/fisiopatología , Retinopatía Diabética/diagnóstico , Masculino , Femenino , Agudeza Visual/fisiología , Anemia de Células Falciformes/complicaciones , Persona de Mediana Edad , Adulto , Vitrectomía/métodos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/etiología , Desprendimiento de Retina/diagnóstico , Resultado del Tratamiento , Estudios de Seguimiento , Adulto Joven , Anciano , Cirugía Vitreorretiniana/métodosRESUMEN
PURPOSE: To evaluate the long-term anatomic and visual outcomes in eyes with sickle cell retinopathy-related retinal detachments (RDs). METHODS: Patients who underwent surgery for sickle cell retinopathy-related RDs at the Wilmer Eye Institute or Wills Eye Hospital between 2008 and 2020 and followed for at least 6 months postoperatively were retrospectively reviewed. The primary outcome was the rate of single-surgery anatomic success and final reattachment. RESULTS: This study included 30 eyes from 28 patients (16 women and 12 men) with tractional RD (n = 13), rhegmatogenous RD (n = 1), and combined tractional RD/rhegmatogenous RD (n = 16). Mean age was 42.1 ± 15.1 years. The mean follow-up duration was 47.8 ± 34.1 months. Twenty-five (83.3%) eyes underwent pars plana vitrectomy and five (16.7%) eyes underwent pars plana vitrectomy with scleral buckling. Single-surgery anatomic success was achieved in 21 (70.0%) eyes at 6 months. Final reattachment was achieved in 28 (93.3%) eyes (22 eyes [73.3%] without tamponade). Recurrence of RDs was significantly associated with male gender (P = 0.041), absence of previous laser (P = 0.032), iatrogenic breaks (P = 0.035), retinectomy (P = 0.034), and silicone oil tamponade (P = 0.024). Overall, the logarithm of the minimum angle of resolution visual acuity improved from 1.53 ± 0.57 (Snellen equivalent, 20/678) to 1.15 ± 1.01 (20/283) at the final visit (P = 0.03); however, eyes with recurrent RD did not achieve significant visual improvement. CONCLUSION: Pars plana vitrectomy to repair sickle cell retinopathy-related RDs was effective in achieving anatomic success and improving vision in most eyes. Single-surgery anatomic success is critical for optimizing visual outcomes.
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Anemia de Células Falciformes , Desprendimiento de Retina , Curvatura de la Esclerótica , Agudeza Visual , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/etiología , Desprendimiento de Retina/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Adulto , Agudeza Visual/fisiología , Vitrectomía/métodos , Anemia de Células Falciformes/complicaciones , Curvatura de la Esclerótica/métodos , Estudios de Seguimiento , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven , Endotaponamiento/métodosRESUMEN
PURPOSE: To report the anatomic outcomes and retinal structure changes from lens-sparing vitrectomy (LSV) for eyes with Stage 3 or 4 familial exudative vitreoretinopathy (FEVR). METHODS: Overall, 133 consecutive eyes of 119 patients with Stage 3 (51 eyes) or 4 (82 eyes) FEVR who underwent LSV between January 2012 and May 2023 were retrospectively reviewed. RESULTS: One hundred twenty-nine eyes (97.0%) achieved traction relief through one LSV operation. The extent of retinal detachment improved in 98 eyes (73.7%), remained stable in 32 eyes (24.1%), and progressed in three eyes (2.3%). At long-term follow-up, 39 (29.3%) and 60 (45.1%) eyes had completely or partially reattached retina, respectively. The median change of venular angle was 3.6° (95% CI, 3.5-10.5; P < 0.001) and -9.9° (95% CI, -15.8 to -4.6; P < 0.001) for temporal and nasal vessels, respectively. The mean disk-fovea distance was 0.3 papillary diameter shorter (95% CI, -0.4 to -0.2; P < 0.001), and the mean temporal venular arcade distance was 0.02 papillary diameter larger (95% CI, -0.16 to 0.21; P = 0.361). CONCLUSION: These results suggest that LSV can relieve vitreoretinal traction and reattach the retina in late-stage FEVR eyes. Improvements in temporal and nasal venular angle and disk-fovea distance reflect positive retinal structure changes for patients.
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Vitreorretinopatías Exudativas Familiares , Agudeza Visual , Vitrectomía , Humanos , Vitrectomía/métodos , Masculino , Vitreorretinopatías Exudativas Familiares/diagnóstico , Vitreorretinopatías Exudativas Familiares/cirugía , Estudios Retrospectivos , Femenino , Niño , Estudios de Seguimiento , Preescolar , Adolescente , Resultado del Tratamiento , Tomografía de Coherencia Óptica/métodos , Cristalino/cirugía , Retina/patología , Retina/diagnóstico por imagen , Retina/cirugía , Adulto , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/diagnóstico , Lactante , Adulto JovenRESUMEN
PURPOSE: To assess the functional outcomes in visual acuity, metamorphopsia, and vision-related quality of life (VR-QOL) and to evaluate prognostic factors after macular buckling (MB) surgery in eyes with high myopia and foveoschisis (FS)-associated macular detachment (MD). METHODS: Thirty-nine eyes of 39 patients with FS-associated MD who underwent MB surgery were enrolled. Measured outcomes comprised best-corrected visual acuity (BCVA), metamorphopsia, VR-QOL, axial length (AL), macular reattachment, and resolution of foveoschisis. In addition, factors affecting final BCVA and metamorphopsia were analyzed. RESULTS: At 12 months postoperatively, 36 eyes (92.31%) achieved macular reattachment, 37 eyes (94.87%) achieved complete resolution of foveoschisis, and metamorphopsia diminished in 31 eyes (79.49%). LogMAR BCVAs at baseline and months 1, 3, 6, and 12 postoperatively were 0.62 ± 0.35 (20/83), 0.65 ± 0.3 (20/89), 0.59 ± 0.31 (20/77), 0.54 ± 0.31 (20/69), and 0.46 ± 0.27 (20/57) (P < 0.001), respectively. Metamorphopsia scores by M-CHARTS were 1.36° ± 0.51°, 1.04° ± 0.51°, 0.74° ± 0.47°, 0.59° ± 0.47°, and 0.13° ± 0.29° (P < 0.001). All Visual Function Questionnaire-25 subscales demonstrated significant improvement postoperatively, with the exception of "general health" (P = 0.08) and "driving" (P = 0.111). Preoperative BCVA was an independent risk factor for postoperative BCVA at month 12 (r = 0.638, P < 0.001), and the preoperative M-score was an independent risk factor for postoperative M-score at month 12 (r = 0.187, P = 0.045). CONCLUSION: MB surgery significantly improved BCVA, metamorphopsia, and VR-QOL in patients with FS-associated MD. Preoperative BCVA and metamorphopsia score were prognostic factors for postoperative BCVA and metamorphopsia score at month 12.
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Miopía Degenerativa , Calidad de Vida , Desprendimiento de Retina , Retinosquisis , Curvatura de la Esclerótica , Trastornos de la Visión , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Masculino , Femenino , Persona de Mediana Edad , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/etiología , Miopía Degenerativa/complicaciones , Miopía Degenerativa/fisiopatología , Miopía Degenerativa/cirugía , Curvatura de la Esclerótica/métodos , Retinosquisis/cirugía , Retinosquisis/fisiopatología , Retinosquisis/diagnóstico , Anciano , Estudios Retrospectivos , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Adulto , Estudios de Seguimiento , Tomografía de Coherencia Óptica/métodos , Resultado del TratamientoRESUMEN
To our knowledge, this is the first report of a patient with both genetically confirmed Kabuki and Marfan syndrome demonstrating a perifoveal macular degeneration in one eye. Progressive loss of the outer retinal layers was captured and demonstrated with spectral-domain optical coherence tomography imaging. Fundus autofluorescence imaging revealed perifoveal hypoautofluorescence. The patient had initially presented with a spontaneously resolved serous-exudative retinal detachment associated with tortuous retinal vasculature and preretinal proliferative vitreoretinopathy in the other eye. Prior to presentation, the patient had an ocular history of bilateral ectopia lentis treated with crystalline lens removal and placement of iris-claw intraocular lenses. [Ophthalmic Surg Lasers Imaging Retina 2024;55:541-544.].
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Degeneración Macular , Síndrome de Marfan , Desprendimiento de Retina , Tomografía de Coherencia Óptica , Humanos , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/etiología , Degeneración Macular/diagnóstico , Degeneración Macular/etiología , Degeneración Macular/complicaciones , Tomografía de Coherencia Óptica/métodos , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/complicaciones , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/etiología , Angiografía con Fluoresceína/métodos , Anomalías Múltiples/diagnóstico , Cara/anomalías , Agudeza Visual , Femenino , Masculino , Fondo de Ojo , Progresión de la EnfermedadRESUMEN
Objectives: To evaluate the characteristics and surgical outcomes of late-onset rhegmatogenous retinal detachment (RRD) associated with regressed retinopathy of prematurity (ROP) and the status of fellow eyes. Materials and Methods: Retrospective review of consecutive cases undergoing surgery for regressed ROP-related RRD and the fellow eyes between 2012-2022. Demographic data, fundus findings, retinal detachment characteristics, surgical procedures, and anatomic and functional outcomes were analyzed. Anatomic success was defined as retinal attachment after silicone oil removal at final follow-up. Results: Fifteen eyes of 14 patients with a history of regressed ROP underwent surgical repair for RRD at a mean age of 12 (range, 3-26) years. Primary surgical intervention yielded a 53% failure rate overall. This rate was 33% for scleral buckling (SB), 100% for pars plana vitrectomy (PPV), and 40% for combined SB-PPV surgery. Eyes with posterior cicatricial changes and/or proliferative vitreoretinopathy (PVR) demonstrated a higher tendency for recurrence. The final anatomic success rate was 73% after a mean number of 2.3 (range, 1-5) surgeries. The chances of restoring useful vision diminished with repeated surgery despite the improvement in anatomic success. In the fellow eyes, peripheral retinal pathologies were universally observed, with posterior cicatricial changes noted in 33%. Conclusion: The study reveals a significant initial failure rate in surgical treatment of cases with late-onset RRD associated with regressed ROP, particularly in eyes with posterior cicatricial changes or PVR, suggesting the need for a combined surgical approach as an initial strategy in such high-risk cases. The consistent presence of retinal abnormalities in fellow eyes calls for proactive monitoring and potential prophylactic intervention.
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Desprendimiento de Retina , Retinopatía de la Prematuridad , Curvatura de la Esclerótica , Agudeza Visual , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/etiología , Desprendimiento de Retina/diagnóstico , Estudios Retrospectivos , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/complicaciones , Retinopatía de la Prematuridad/diagnóstico , Femenino , Masculino , Curvatura de la Esclerótica/métodos , Vitrectomía/métodos , Niño , Preescolar , Adolescente , Estudios de Seguimiento , Adulto , Resultado del Tratamiento , Adulto Joven , Endotaponamiento/métodosRESUMEN
BACKGROUND: In this report, we describe a case of proliferative diabetic retinopathy that developed into exudative changes confusing with central serous chorioretinopathy (CSCR) following extensive endolaser pan retinal photocoagulation. CASE DESCRIPTION: A 49-year-old male patient with diabetic retinopathy in both eyes presented with vitreous hemorrhage and 6/60 visual acuity in his left eye. Optical coherence tomography (OCT) scans at presentation revealed serous PEDs in both eyes. On day 10 after vitreoretinal surgery and complete peripheral endolaser PRP for the left eye, there was serous retinal detachment (SRD) and an increase in PED heights, mimicking CSCR. No additional treatment was considered. At the three-week post-operative visit, OCT scans revealed that the SRD had resolved and the PED heights had decreased without rupture. At the final follow-up visit, 12 weeks after surgery, the SRD had not recurred, and the PEDs had stabilized. Despite no additional ocular therapy for the right eye, the serous PED height had decreased. The choroidal thickness (CT) at the fovea at various points during the follow-up visits revealed a reduction in both eyes. CONCLUSION: This case demonstrated the course of SRD, PED, and CT following extensive PRP. These changes may be associated with intraocular VEGF changes. In the presence of SRD and serous PED, the PED morphology may help differentiate the condition from CSCR. Although caution should be exercised when performing PRP during surgery or as an outpatient procedure, the SRD usually resolves without problem.
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Retinopatía Diabética , Coagulación con Láser , Tomografía de Coherencia Óptica , Humanos , Masculino , Persona de Mediana Edad , Retinopatía Diabética/cirugía , Retinopatía Diabética/diagnóstico , Coagulación con Láser/métodos , Tomografía de Coherencia Óptica/métodos , Angiografía con Fluoresceína/métodos , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/cirugía , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/etiología , Agudeza Visual/fisiología , Coroides/patología , Coroides/diagnóstico por imagenRESUMEN
In the realm of ophthalmic surgeries, silicone oil is often utilized as a tamponade agent for repairing retinal detachments, but it necessitates subsequent removal. This study harnesses the power of machine learning to analyze the macular and optic disc perfusion changes pre and post-silicone oil removal, using Optical Coherence Tomography Angiography (OCTA) data. Building upon the foundational work of prior research, our investigation employs Gaussian Process Regression (GPR) and Long Short-Term Memory (LSTM) networks to create predictive models based on OCTA scans. We conducted a comparative analysis focusing on the flow in the outer retina and vessel density in the deep capillary plexus (superior-hemi and perifovea) to track perfusion changes across different time points. Our findings indicate that while machine learning models predict the flow in the outer retina with reasonable accuracy, predicting the vessel density in the deep capillary plexus (particularly in the superior-hemi and perifovea regions) remains challenging. These results underscore the potential of machine learning to contribute to personalized patient care in ophthalmology, despite the inherent complexities in predicting ocular perfusion changes.
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Aprendizaje Automático , Disco Óptico , Desprendimiento de Retina , Aceites de Silicona , Tomografía de Coherencia Óptica , Humanos , Desprendimiento de Retina/cirugía , Disco Óptico/irrigación sanguínea , Disco Óptico/diagnóstico por imagen , Mácula Lútea/diagnóstico por imagen , Mácula Lútea/irrigación sanguíneaRESUMEN
Purpose: Proliferative retinal changes may occur postsurgery for rhegmatogenous retinal detachment (RRD), possibly preceding recurrent detachment. This study aims to establish the groundwork for an imaging system capable of discerning changes in retinal vessel tortuosity after RRD repair, analyzing widefield optical coherence tomography angiography (WF-OCTA) images. Methods: Eighty-eight eyes of 86 patients with RRD who underwent surgical procedures and had repeated imaging with clear widefield optical coherence tomography (WF-OCT) and WF-OCTA on different postoperative days were enrolled in this retrospective study. We compared WF-OCTA images over time to identify alterations in retinal vessel tortuosity and observed regional changes in retinal morphology. Results: After image processing, changes in retinal vessel tortuosity were detected in 66 quadrants. These changes, attributed to retinal traction from proliferative membranes, were observed in 56 quadrants, among which retinal thickness remained unchanged in seven sectors (12.5%) according to the WF-OCT map. In nine quadrants, changes in retinal vessel tortuosity were attributed to changes in subretinal fluid, aligning with observable variations in retinal thickness. Conclusions: Observation of vessel tortuosity changes using WF-OCTA can help detect early postoperative proliferative changes in eyes with RRD. Translational Relevance: Because WF-OCTA can detect minute vessel tortuosity changes, it can offer a noninvasive alternative for the detection of early postoperative proliferative changes.
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Angiografía con Fluoresceína , Desprendimiento de Retina , Vasos Retinianos , Tomografía de Coherencia Óptica , Humanos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/diagnóstico por imagen , Desprendimiento de Retina/patología , Tomografía de Coherencia Óptica/métodos , Femenino , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Anciano , Angiografía con Fluoresceína/métodos , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Adulto , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Vitrectomía/métodos , Agudeza Visual/fisiología , Periodo Posoperatorio , Curvatura de la Esclerótica/métodosRESUMEN
PURPOSE: To investigate whether intravitreal antiviral injection (IAI) during vitrectomy reduces the postsurgical retinal detachment (RD) rate and improves the visual prognosis of patients with acute retinal necrosis (ARN). METHODS: This retrospective cohort study included ARN patients treated at a tertiary hospital between January 2013 and December 2020. Patients who underwent pars plana vitrectomy (PPV) alone or combined with intraoperative IAI were classified in PPV-only group and PPV + IAI group, respectively. The incidence of postsurgical RD and the best corrected visual acuity (BCVA) between the groups was compared. A multivariate Cox hazard analysis was employed to explore the risk factors of postsurgical RD. A multivariate logistic regression analysis was applied to assess the impact of intraoperative IAI on preventing severe vision loss (SVL). RESULTS: Fifty-seven eyes with ARN with a median follow-up of 18.5 months were included in the study. There was no significant association between intraoperative IAI during vitrectomy and a reduced risk of postsurgical RD (hazard ratio [HR], 2.65; 95% CI, 0.71-9.89) or SVL at the 6-month follow-up visit (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.25-3.35). Better baseline best-corrected visual acuity (BCVA) was identified to associate with a higher risk of postsurgical RD (HR, 0.33; 95% CI, 0.14-0.81) and a lower risk of SVL at 6 months (OR, 2.28; 95% CI, 1.10-4.89). CONCLUSION: We did not observe a significant effect of intraoperative IAI on the anatomic and visual outcomes of ARN patients in this study. Intraoperative IAI may not be a necessary treatment option for ARN patients who receive vitrectomy.
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Antivirales , Inyecciones Intravítreas , Síndrome de Necrosis Retiniana Aguda , Agudeza Visual , Vitrectomía , Humanos , Vitrectomía/métodos , Síndrome de Necrosis Retiniana Aguda/cirugía , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Agudeza Visual/fisiología , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Infecciones Virales del Ojo/cirugía , Anciano , Estudios de Seguimiento , Adulto , Desprendimiento de Retina/cirugíaRESUMEN
PURPOSE: To report the rate of retinal redetachment after silicone oil removal following rhegmatogenous retinal detachment surgery and to determine potential risk factors. METHODS: Retrospective observational case series of 161 eyes who underwent rhegmatogenous retinal detachment surgery and subsequent silicone oil removal. Pre- and intraoperative risk factors were evaluated using univariate and multivariate logistic regression. We also evaluated the effect of tamponade duration on anatomical outcomes. RESULTS: The median tamponade duration was 5.9 [4.3;7.6] months. Seventeen (10.6%) eyes underwent silicone oil removal within 3 months of surgery, with a median delay of 2.3 [2.0;2.8] months. The rate of retinal detachment after silicone oil removal was 14.9%. A history of previous unsuccessful surgery was the only significant risk factor for retinal redetachment after silicone oil removal (OR 4.8, 95%CI [1.5;19.0], p = 0.02). The use of 360° laser retinopexy and concomitant air or gas tamponade during silicone oil removal were not found to affect the redetachment rate. Eyes with silicone oil tamponade ≤ 3 months showed an increased, albeit not significant, risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal (35.3% versus 12.5%, p = 0.06). CONCLUSION: A retinal redetachment occurred in 14.9% of eyes undergoing silicone oil removal following rhegmatogenous retinal detachment surgery. Previous failed surgery was associated with a 4.8-fold increased risk of developing recurrent rhegmatogenous retinal detachment after silicone oil removal. Eyes with silicone oil tamponade ≤ 3 months tended to have a higher redetachment rate. TRIAL REGISTRATION NUMBER: ID NCT05647928 (12th April 2022).