Surgical Outcomes of Vitrectomy for Primary Treatment of Rhegmatogenous Retinal Detachment in Patients with Atopic Dermatitis
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Abstract:
To investigate the clinical results of vitrectomy alone as the primary treatment for rhegmatogenous retinal detachment (RD) in patients with atopic dermatitis (AD).The medical records of patients with AD treated for rhegmatogenous retinal detachment (RD) were retrospectively reviewed. We investigated the characteristics of retinal breaks and detachments, applied surgical methods, and results.Twenty eyes of 14 patients with AD who presented with rhegmatogenous RD and treated by vitrectomy were included in this analysis. Sixteen eyes (80%) were treated with vitrectomy, either alone or in combination with cataract surgery, and the retina was successfully attached to 94% of the eyes. There were four cases in which vitrectomy was combined with encircling. Reoperation was needed in half of the eyes that received vitrectomy with encircling, which presented nearly total detachment, severe proliferative vitreoretinopathy, and pseudophakia.Vitrectomy alone, in combination with cataract surgery, may be sufficient to treat rhegmatogenous RD in patients with AD. Additional encircling or buckling should still be considered in complicated cases.Keywords:
Proliferative Vitreoretinopathy
Pseudophakia
A consecutive series of 114 eyes (112 patients) undergoing pars plana vitrectomy for rhegmatogenous retinal detachment not complicated by severe proliferative vitreoretinopathy is presented (follow up 1 to 4 years; mean 19 months). The indications for vitrectomy fell into two main groups: (1) where the retinal view was poor and vitrectomy was required to clear media opacities to allow identification of retinal breaks (n = 62); and (2) where technically difficult breaks existed and vitrectomy with internal tamponade was used to relieve vitreoretinal traction and facilitate retinal break closure (n = 44). In some of these cases the need for scleral buckling was eliminated. A smaller third group (n = 8) existed where the position of the break(s) was uncertain in the presence of an adequate view. The success rate with one procedure was 74% and with further surgery retinal reattachment was achieved in 92%. At 6 months after further surgery, beyond which interval no new failures were encountered, best corrected visual acuity was improved in 92 eyes (81%), unchanged in 14(12%), and worse in eight (7%). We conclude that pars plana vitrectomy is an effective method for treatment of selected cases of rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy.
Proliferative Vitreoretinopathy
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Proliferative Vitreoretinopathy
Silicone oil
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To determine the role of vitrectomy be used in retinal detachment uncomplicated by proliferative vitreoretinopathy (PVR).We studied 54 cases who had undergone vitrectomy for retinal detachment uncomplicated by severe proliferative vitreoretinopathy. The indications for vitrectomy fell into three main groups: 1) retineal detachment of PVR-B (n = 15), 2) Retinal breaks at the posterior of PVR-C1 or C2 (n = 11), 3) retinal view was poor (n = 28).The success rate with one procedure was 74% and with further surgery retinal reattachment was achieved in 96%. After surgery, the visual acuity was improved in 43 eyes (79.6%) unchanged in 9 eyes (16.7%), and worse in 2 eyes (3.7%).Vitrectomy is an effective method for treatment of selected cases of retinal detachment uncomplicated by proliferative vitreoretinopathy.
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Objective:To evaluate the effect of vitrectomy in the proliferative vitreoretinopathy(PVR).Methods:21 cases of PVR(≥Grade-C2) with retinal detachment were treated by vitrectomy and scleral encircling buckling, membrane peeling, retinotomy, and gas or silicon oil tamponade.Results:The retina was reattached in a rate of 78.9% in 2～9 months postoperatively, visual acuity improved significantly in 20 eyes(95.2%). 4 eyes failed because of PVR recurrent.Conclusion:Modern vitrectomy is optimal operation for PVR. The most important technique is membrane peeling and eliminating the traction of vitreous base. PVR recurrent is major cause of failure.
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urpose To investigate apoptosis in vitrectomy specimens of
proliferative vitreoretinopathy. Methods Vitrectomy specimens from 60 cases of different
classes of proliferative vitreoretinopathy were studied by TdTmediated dUTP nick end
labelling(TUNEL)method. Results The characteristic change of apoptosis was observed in all
vitrectomy specimens.The amount of apoptotic nonpigmentary cell is gradually decreasing
along with the development of proliferative vitreoretinopathy,and apoptotic pigmentary cells are
observed. Conclusion There are different kinds of apoptosis cell in vitrectomy specimens of
proliferative vitreoretinopathy.It is suggested that apoptosis might be one of the important
mechanisms of regulating the degree in proliferative vitreoretinopathy.
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Objective To observe the features during the surgery,the surgical techniques,the selection of temponade materials and the clinical efficacy of vitrectomy in the treatment of severe proliferative diabetic vitreoretinopathy(PDVR).Methods A series of PDVR(34 eyes of 34 cases)treated by vitrectomy were retrospectively analyzed.Vitreous removal,membrane peeling,photocoagulation and temponade were carried out during the operations.Results All cases exhibited a kind of incomplete posterior vitreous detachement(PVD)with some dense adherent sites between the proliferative membranes and the surface of retinal disc and big vessels.The adjacent posterior vitreous cortex(PVC)and proliferative membranes were separated carefully step by step,cut into segments and then removed little by little.All the patients were followed up postoperatively for 6～12 months.Anatomical recovery was achieved primarily in 33(33/34,97%)cases.Visual acuity increases in all 34 eyes,26 eyes were above 0 05(26/34,76 5%),which had statistically significant difference compared with that before operation.7 eyes obtained an uncorrected visual acuity up to 0 2～0 7.Conclusions Vitrectomy using specific surgical techniques separating and cutting PVC and proliferative membranes,combined with photocoagulation and different temponade,should be considered as an effective method to save the vision in PDVR patients.
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Objective
To diagnose retinal detachment with International Classification of Diseases-10 (ICD-10) and to analyze the surgical modalities of vitrectomy for the disease.
Methods
The clinical data of 1 648 hospitalized patients with retinal detachment undergoing vitrectomy in our hospital in 2013 were retrospectively analyzed.
Results
The ICD etiological classification showed that primary retinal detachment accounted for 50.18% (827/1 648), tractional retinal detachment accounted for 32.52% (536/1 648), exudative retinal detachment accounted for 0.61%(10/1 648)and other types accounted for 16.69% (275/1 648). The top 5 common etiological diagnoses were simple rhegmatogenous retinal detachment (25.73%, 424/1 648), diabetic tractional retinal detachment (12.62%, 208/1 648), traumatic retinal detachment (12.08%, 199/1 648), other primary retinal detachment (11.23%, 185/1 648) and retinal detachment after intraocular surgery (10.62%, 175/1 648). The top 4 modalities of vitrectomy were combined silicone oil implanting surgery (54.73%, 902/1 648), basic vitrectomy (21.97%, 362/1 648), combined silicone oil and lenticular surgery (14.38%, 237/1 648) and combined lenticular surgery (5.58%, 92/1 648).
Conclusions
Modern vitrectomy is used mainly for the treatment of primary retinal detachment and the treatment of retinal detachment related to diabetes, ocular trauma and intraocular surgeries.The complexity of various retinal detachment diseases requires different surgical modalities of vitrectomy for treatment.
Key words:
Vitrectomy; Retinal detachment; International Classification of Diseases
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Repair of rhegmatogenous retinal detachment is successful in approximately 90% of cases. Assuming all retinal breaks are identified and closed, the most common reason for eventual failure of surgery is the development of proliferative vitreoretinopathy, accounting for the failure of 7% to 10% of primary repairs and an increased proportion of secondary procedures. Recurrent retinal detachment complicated by proliferative vitreoretinopathy is now most frequently treated by pars plana vitrectomy with intraoperative peeling of membranes. During the 1990s, a better understanding of the nature of recurrent retinal detachment due to proliferative vitreoretinopathy has grown concomitantly with more experience using various vitreoretinal techniques to manage these complicated cases. This article reviews the latest developments in vitreous surgery to repair recurrent retinal detachments due to proliferative vitreoretinopathy, focusing on the most recent reports in the literature.
Proliferative Vitreoretinopathy
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