Dataset Information

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment.

ABSTRACT:

Background

To determine the incidence and characteristics of the multiple subretinal particles (SRPs) present after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).

Methods

The medical records of 224 eyes of 224 patients that underwent PPV for RRD were reviewed. The presence of SRPs in the subretinal fluid blebs and the presence of subretinal deposits were determined by optical coherence tomography (OCT) and fundus autofluorescence (FAF). The characteristics of the FAF and infrared reflectance (IR) images of a scanning laser ophthalmoscope in eyes with SRPs (SRPs group) were compared to that of eyes without SRPs (control group).

Results

SRPs were observed in 27 eyes (12%), and they were completely resolved in 20 eyes (74%) after 6 months. The incidence of macula-off RRD (85%) and preoperative precipitates (41%) were significantly higher in the SRPs group than that in the control group (64%, P = 0.046; 12%, P = 0.002). The axial length was significantly shorter in the SRPs group than that in the control group (25.04 ± 1.54 mm, 26.00 ± 1.78 mm, P = 0.012). The preoperative and postoperative best-corrected visual acuity were not significantly different between the two groups (P = 0.702, P = 0.337). The subretinal fluid bleb determined by OCT were hyperfluorescent in the FAF images in 24 eyes (89%), and the subretinal deposits were hypofluorescent with solid appearance by OCT other than fluid in 3 eyes (11%). The hypofluorescent subretinal deposits in the FAF images were bright in the IR images in 2 eyes.

Conclusions

The SRPs consist of lipofuscin-related hyperfluorescent subretinal fluid and the subretinal deposits containing bright IR melanin particles of proliferating retinal pigment epithelial cells.

SUBMITTER: Noji S

PROVIDER: S-EPMC10035235 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment.

Noji Sho S Mizuno Masaharu M Inoue Makoto M Koto Takashi T Hirakata Akito A

BMC ophthalmology 20230323 1

<h4>Background</h4>To determine the incidence and characteristics of the multiple subretinal particles (SRPs) present after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).<h4>Methods</h4>The medical records of 224 eyes of 224 patients that underwent PPV for RRD were reviewed. The presence of SRPs in the subretinal fluid blebs and the presence of subretinal deposits were determined by optical coherence tomography (OCT) and fundus autofluorescence (FAF). The characteristic ...[more]

PMID: 36959557

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Project description:BackgroundTo compare the safety and efficacy of Ab-externo subretinal bands removal in comparison with the classical Ab-interno approach during pars plana vitrectomy for primary rhegmatogenous retinal detachment.MethodsSubjects aged 28-62 years with primary RRD complicated by proliferative vitreoretinopathy (PVR) with subretinal bands interfering with retinal flattening were treated by pars plana vitrectomy (PPV) and silicone oil injection. Subretinal bands were removed using the classical AB interno approach through one or more retinotomies in ten patients (group A) and using AB externo approach in twenty cases (group B). Post-operative follow-up visits occurred at 1 day, 1 week, 1 month, and 3 months, after surgery. The main outcomes were assessment of subretinal bands removal efficacy, documentation of complications, anatomical reattachment rate, and postoperative best-corrected visual acuity (BCVA).ResultsThere was no statistically significant difference between both groups regarding patients' age, gender, lens status, and the onset of retinal detachment. Seventy percent of both groups presented with inferior retinal detachment while ten percent presented with temporal detachments and twenty percent had a total retinal detachment. Both groups had a statistically significant improvement in postoperative visual acuity in comparison with preoperative visual acuity (P = 0.005 for group A and P = < 0.001 for group B). There was no statistically significant difference between both groups regarding preoperative (P = 0.928) and postoperative (P = 0.185) visual acuity. A higher incidence of complications was reported in group A (40%) in comparison with group B (30%) but this difference was not statistically significant (P = 0.69). More Epimacular membranes were seen postoperatively in group A (30%) in comparison with group B (20%) but again this difference was not statistically significant (P = 0.657). Subretinal hemorrhage was seen in ten percent of cases in both groups. Intraocular pressure was measured in every follow-up of all patients in both groups, no statistically significant difference was found between both groups.ConclusionsBoth techniques are effective and safe to remove subretinal bands with similar outcomes.

Project description:BackgroundRhegmatogenous retinal detachment (RRD) is a common, potentially blinding ocular pathology that is considered a surgical emergency. Macular involvement has been identified as a major negative prognostic indicator for visual recovery after RRD correction. It is not currently clear whether early intervention improves visual outcomes, and in practice, there are potential disadvantages to performing early surgery for fovea-involving RRD. Such disadvantages include inadequate assessment of coexisting comorbidities, increased rate of complications related to poorly trained staff or tired surgeons, and anesthetic risk.MethodsA single-center, retrospective, cohort study of patients who underwent repair of macula-involving rhegmatogenous retinal detachment at the University of Virginia was performed. Variables collected included patient demographics, ocular history, clinical characteristics, and post-operative complications. Patients were excluded if they had a history of congenital or acquired pathology with an effect on visual function, bilateral or repeat rhegmatogenous detachment, age less than 18 years, follow up duration less than 6 months, or if they were repaired using scleral buckle, pneumatic retinopexy, 25- or 27-gauge pars plana vitrectomy, or any combination of these techniques. A multivariate regression model was used to compare overall outcomes such as post-operative visual acuity, intra-ocular pressure, retina attachment status, and complications among patients of differing timing of surgical repair. These analyses were adjusted for clinical factors known or considered to be associated with worse prognosis in rhegmatogenous retinal detachment.ResultsA total of 104 patients undergoing 23-gauge vitrectomy for repair of macula involving rhegmatogenous retinal detachments were included in this study with mean follow up period 17.9 ± 14.1 months. Early surgical repair (< 48 h) was pursued in 26 patients, moderately delayed surgical repair (3-7 days), was performed in 29 patients and late surgical repair (> 7 days) in 49 patients. Our analysis showed no difference in post-operative visual acuity between patients with detachments undergoing early versus moderately delayed repair of RRD. However, mean visual acuity differed between patients undergoing early versus late repair at 3, 6, and 12 months. No significant difference was observed in post-operative complications between the three surgical timepoints including cataract formation, development of glaucoma and re-detachment rate. Use of 360 laser was found to be protective against re-detachment overall (OR 6.70 95% CI 1.93-23.2).ConclusionsThese findings indicate that a moderate delay of 3-7 days from symptom onset for repair of macula-involving retinal detachment may be a safe approach as there are no differences in terms of visual acuity or post-operative complications compared to early repair within 48 h. Delaying surgery for > 7 days however is not recommended due to the loss of recovery of visual acuity observed in this study. Use of 360 laser may prevent risk of re-detachment after primary repair.

Dataset Information

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment.

Background

Methods

Results

Conclusions

Publications

Characteristics of subretinal particles detected after pars plana vitrectomy for rhegmatogenous retinal detachment.

Similar Datasets

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