Incidence and Factors Influencing Retinal Displacement in Eyes Treated for Rhegmatogenous Retinal Detachment With Vitrectomy and Gas or Silicone Oil

dell’Omo, Roberto; Scupola, Andrea; Viggiano, Davide; Sammarco, Maria Grazia; Turris, Serena De; Romano, Mario R.; Grimaldi, Gabriela; dell’Omo, Ermanno; Costagliola, Ciro

doi:10.1167/iovs.17-21466

Cited by 55 publications

(69 citation statements)

References 25 publications

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“…Patients were placed prone in the operating room immediately after the completion of surgery (i.e., rolled on the operating table to a face-down position) and kept prone for at least 2 h. They were subsequently asked to remain prone for the following 24 h. Of these patients, 41% had evidence of postoperative FAF shift. The groups of Dell'Omo et al [5] and Schawkat et al [6] may have been different to ours in terms of the distribution of causative retinal breaks and both RD extent and distribution.…”

Section: Discussioncontrasting

confidence: 82%

“…Dell'Omo et al [5] retrospectively reported an uncontrolled consecutive series of 97 patients with primary success of vitrectomy and gas repair of macula-involved RD in whom postoperative FAF imaging had been performed. Patients were placed prone in the operating room immediately after the completion of surgery (i.e., rolled on the operating table to a face-down position) and kept prone for at least 2 h. They were subsequently asked to remain prone for the following 24 h. Of these patients, 41% had evidence of postoperative FAF shift.…”

Section: Discussionmentioning

confidence: 99%

“…Unintentional macula displacement or "macula shift" can complicate otherwise anatomically successful repair of macula-involved or macula-uninvolved retinal detachments (RD) [1][2][3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Vitrectomy with standard subtotal volume isovolumetric gas tamponade has been reported to be associated with fundus autofluorescent (FAF) shift rates between 23 and 72% [1][2][3][4][5][6][7][8][9]. Most series contain patients with both maculainvolved and macula-uninvolved RD.…”

Section: Introductionmentioning

confidence: 99%

“…Such posturing clearly has significant implications for ambulatory surgical care. Macula-uninvolved RD can also become macula involved [2,5], even with prophylactic face-down positioning.…”

Section: Introductionmentioning

confidence: 99%

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Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

et al. 2020

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Purpose: Chronically distorted vision is an important adverse outcome in patients with otherwise successfully treated macula-involved retinal detachment (RD). Symptomatic distortion is associated with macular vessel shift on fundus autofluorescence (FAF) imaging. Immediate prone posture has to date been the only mechanism adopted to reduce postoperative FAF shift. The aim of this study was to establish the rates of primary anatomical success and (FAF) macular shift in 67 eyes with macula-involved RD and superior breaks treated with vitrectomy, retinopexy, 0.7-1 mL 100% gas tamponade, and no prone posture. Methods: Singlecenter, retrospective series. Results: Rates of primary anatomical success and fundus autofluorescent imaging macular shift were 89 and 26%, respectively. Conclusion: Vitrectomy with a 0.7-1 mL expanding gas bubble tamponade and no prone posture were associated with an acceptable rate of primary anatomical success. We found the lowest yet reported rate of FAF shift in patients with macula-involved RD. If confirmed, this simple technique modification could improve the visual outcome of RD surgery whilst facilitating postoperative ambulatory care.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Such posturing clearly has significant implications for ambulatory surgical care. Macula-uninvolved RD can also become macula involved [2,5], even with prophylactic face-down positioning.…”

Section: Introductionmentioning

confidence: 99%

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Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

et al. 2020

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Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair

et al. 2020

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IMPORTANCE A lack of consensus exists with regard to the optimal positioning regimen for patients after macula-involving retinal detachment (RD) repair.OBJECTIVE To evaluate the effect of face-down positioning vs support-the-break positioning on retinal displacement and distortion after macula-involving RD repair. DESIGN, SETTING, AND PARTICIPANTSA prospective 6-month single-masked randomized clinical trial was conducted at a multicenter tertiary referral setting from May 16, 2016, to May 1, 2018. Inclusion criteria were fovea-involving rhegmatogenous RD; central visual loss within 14 days; patients undergoing primary vitrectomy and gas surgery, under local anesthetic; patients able to give written informed consent; and 18 years old and older. Analysis was conducted following a modified intention-to-treat principle, with patients experiencing a redetachment or failure to attach the macula being excluded from analysis.INTERVENTIONS Participants were randomized 1:1 to receive face-down positioning or support-the-break positioning for a 24-hour period postoperatively. Positioning compliance was not monitored. MAIN OUTCOMES AND MEASURESThe proportion of patients with retinal displacement on autofluorescence imaging at 6 months postoperatively. Secondary outcomes included proportion of patients with displacement at 2 months; amplitude of displacement at 2 and 6 months; corrected Early Treatment Diabetic Retinopathy Study visual acuity; objective Distortion Scores; and quality of life questionnaire scores at 6 months. RESULTSOf the 262 randomized patients, 239 were analyzed (171 male [71.5%]; mean [SD] age, 60.8 [9.8] years). At 6 months, retinal displacement was detected in 42 of 100 (42%) in the face-down positioning group vs 58 of 103 (56%) in the support-the-break positioning group (odds ratio, 1.77; 95%CI, 1.01-3.11; P = .04). The degree of displacement was lower in the face-down group. Groups were similar in corrected visual acuity (face-down, 74 letters vs support-the-break, 75 letters), objective D Chart Distortion Scores (range: 0, no distortion to 41.6, severe distortion; with face-down at 4.5 vs support-the-break at 4.2), and quality of life scores (face-down 89.3 vs support-the-break 89.0) at 2 and 6 months. Retinal redetachment rate was similar in both groups (face-down group, 12.2% and support-the-break group, 13.7%). Retinal folds were less common in the face-down positioning group vs the support-the-break positioning group (5.3% vs 13.5%, respectively; odds ratio, 2.8; 95% CI, 1.2-7.4; P = .03). Binocular diplopia was more common in the support-the-break group compared with the face-down positioning group (7.6% vs 1.5%, respectively; odds ratio, 5.3; 95% CI, 1.3-24.6; P = .03). Amplitude of displacement was associated with worse visual acuity (r = −0.5; P < .001) and distortion (r = 0.28; P = .008). CONCLUSIONS AND RELEVANCEIn this study, findings suggest that face-down positioning was associated with a reduction in the rate and amplitude of postoperative retinal displacement after macula-involving RD r...

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Retinal Displacement Following Pneumatic Retinopexy vs Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

et al. 2020

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IMPORTANCE Retinal displacement following rhegmatogenous retinal detachment repair may have consequences for visual function. It is important to know whether surgical technique is associated with risk of displacement.OBJECTIVE To compare retinal displacement following rhegmatogenous retinal detachment repair with pneumatic retinopexy (PR) vs pars plana vitrectomy (PPV). INTERVENTIONS OR EXPOSURESFundus autofluorescence images were assessed by graders masked to surgical technique. DESIGN, SETTING, AND PARTICIPANTSA multicenter retrospective consecutive case series in Canada and the UK. A total of 238 patients (238 eyes) with rhegmatogenous retinal detachments treated with PR or PPV who underwent fundus autofluorescence imaging from November 11, 2017, to March 22, 2019, were included. MAIN OUTCOMES AND MEASURESProportion of patients with retinal displacement detected by retinal vessel printings on fundus autofluorescence imaging in PR vs PPV. RESULTSOf the 238 patients included in the study, 144 were men (60.5%) and 94 were women (39.5%); mean (SD) age was 62.0 (11.0) years. Of the 238 eyes included in this study, 114 underwent PR (47.9%) and 124 underwent PPV (52.1%) as the final procedure to achieve reattachment. Median time from surgical procedure to fundus autofluorescence imaging was 3 months (interquartile range, 1-5 months). Baseline characteristics in both groups were similar. The proportion of eyes with retinal vessel printing on fundus autofluorescence was 7.0% for PR (8 of 114) and 44.4% for PPV (55 of 124) (37.4% difference; 95% CI, 27.4%-47.3%; P < .001). Analysis based on the initial procedure found that 42.4% (42 of 99) of the eyes in the PPV group vs 15.1% (21 of 139) of the eyes in the PR group (including 13 PR failures with subsequent PPV) had displacement (27.3% difference; 95% CI, 15.9%-38.7%; P < .001). Among eyes with displacement in the macula, the mean (SD) displacement was 0.137 (0.086) mm (n = 6) for PR vs 0.297 (0.283) mm (n = 52) for PPV (0.160-mm difference; 95% CI, 0.057-0.263 mm; P = .006). Mean postoperative logMAR visual acuity was 0.31 (0.32) (n = 134) (Snellen equivalent 20/40) in eyes that initially underwent PR and 0.56 (0.42) (n = 84) (Snellen equivalent 20/72) in eyes that had PPV (−0.25 difference; 95% CI, −0.14 to −0.35; P < .001). Among eyes with displacement, mean postoperative logMAR visual acuity was 0.42 (0.42) (n = 20) (Snellen equivalent 20/52) in those that initially underwent PR and 0.66 (0.47) (n = 33) (Snellen equivalent 20/91) in those that initially underwent PPV (−0.24 difference; 95% CI, −0.48 to 0.01; P = .07). CONCLUSIONS AND RELEVANCEThese findings suggest that retinal displacement occurs more frequently and is more severe with PPV vs PR when considering the initial and final procedure used to achieve retinal reattachment. Recognizing the importance of anatomic integrity by assessing retinal displacement following reattachment may lead to refinements in vitreoretinal surgery techniques.

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Incidence and Factors Influencing Retinal Displacement in Eyes Treated for Rhegmatogenous Retinal Detachment With Vitrectomy and Gas or Silicone Oil

Cited by 55 publications

References 25 publications

Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair

Retinal Displacement Following Pneumatic Retinopexy vs Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

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