Characteristics of retinal detachment associated with atopic dermatitis

Abstract

Background To examine the characteristics of rhegmatous retinal detachment (RRD) associated with atopic dermatitis. Method Medical records of 2257 patients who underwent RD surgery at this clinic between 2008 and 2018 were retrospectively reviewed. Among them, 61 patients who were diagnosed as AD were assigned into the experimental group and 100 patients who did not have AD were randomly selected and assigned into the control group. Demographics, characteristics of detachment, initial operative method, and prognosis after surgery were investigated as main outcomes. Additionally, in pseudophakic RD patients, the period between the cataract surgery and onset of RD was measured. Result Postoperative VA and prognosis were significantly worse and bilateral involvement of RD was more common in the atopy group than in the control group. (P value = 0.005, 0.001 each) Characteristics of retinal breaks were different between the two groups. Additionally, the risk of developing RD within 1 year after cataract surgery was significantly higher in pseudophakic patients of the atopic group than in the control group. (P value = 0.013) However, there was no significant difference in mean preoperative VA or refractive index between the two groups. Conclusion Our results show that in atopic patients, RD occurs at a young age with different characteristics compared to non-atopic patients. Atopic RD has a poor visual prognosis. Thus, it requires careful management. Furthermore, the risk of developing RD within 1 year after cataract surgery is higher in atopic patients. Therefore, it is important to perform regular and extensive check-up after cataract surgery for atopic patients.

Surgical Outcomes of Vitrectomy for Primary Treatment of Rhegmatogenous Retinal Detachment in Patients with Atopic Dermatitis

“…There is no significant difference between scleral buckling and PPV in the primary success rate, final visual acuity, and final anatomical success in the treatment of rhegmatogenous RD [ 14 ]. RD in patients with AD often involves both eyes and occurs in younger patients, compared to other RD patients without AD [ 10 , 13 ]. The rate of retinal reattachment after primary surgery in AD patients was 72% to 75% in studies before the 2000s, which was lower than the success rate of rhegmatogenous RD in patients without AD [ 15 , 16 ].…”

“…Surgical treatment is required for rhegmatogenous RD, and scleral buckling has been the gold standard for treatment, especially in young patients with phakic eyes, while pars plana vitrectomy (PPV) is increasingly being replaced with technical developments. Although there are no additional guidelines for RD surgery in patients with AD, there is a tendency for more frequent use of PPV combined with encircling or segmental buckling to treat rhegmatogenous RD [ 12 , 13 ]. This study aimed to investigate the surgical outcomes of PPV for rhegmatogenous RD in patients with AD in recent years.…”

Visual outcomes after management of bilateral cataract and retinal detachment in atopic dermatitis

“…Several mechanisms have been proposed to explain the pathogenesis of RRD in AD. Early theories suggested a role of retinal edema and retinal vascular changes within the peripheral retina, leading to RRD [7,9]. Coles and Laval proposed the "shock organ" theory [7], according to which the shared mesodermal components of the skin, vitreous, and crystalline lens confer similar susceptibility to the pathogenic inflammatory processes that underline atopy, ultimately leading to RRD and cataract.…”

“…Later, Balyeat proposed a correlation between AD and RRD [7]. Current evidence regarding this association has mostly been derived from case reports and small observational studies [8][9][10][11][12][13].…”

“…A possible mechanism of RRD in these patients is trauma caused by repeatedly rubbing the eyes to relieve itching. In addition, ocular inflammation present in AD, which leads to an abnormal immune reaction, can cause RRD [8][9][10][11][12][13]; cataract surgery can cause RRD [14,15]. The incidence of AD-associated RRD is 0.5-11% [11].…”