Management of Giant Retinal Tears Without Scleral Buckling

Hoffman, Marc E.; Sorr, Edward M.

doi:10.1097/00006982-198606040-00001

Cited by 43 publications

(16 citation statements)

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“…Furthermore, to better compare the influence of gas versus SO on displacement, direct exchange PFCL/SO was not allowed, so all eyes underwent a fluid/air exchange before receiving the final tamponade. Cases with potential confounders like PVR grade C or worse 15 and GRTs that are known risk factors for retinal slippage 17,18 were deliberately excluded. Similarly, cases with overt ERMs were excluded because the presence of RVPs in eyes with prominent ERMs and a history of RRD could be either caused by a genuine full-thickness displacement of the retina (secondary to RRD) or to a shift involving only the superficial retinal layers (secondary to the traction exerted by the ERM on the inner retina).…”

Section: Discussionmentioning

confidence: 99%

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

dell’Omo

Scupola

Viggiano

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The purpose of this study was to study the incidence and factors influencing retinal displacement in eyes treated for rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV) and gas or silicone oil.METHODS. This was a prospective observational case series. One hundred twenty-five eyes with macula-off RRD from 125 patients underwent 25-gauge PPV at two vitreoretinal institutional practices. Eyes without proliferative vitreoretinopathy (PVR) or PVR grade A were tamponated with sulfur hexafluoride (SF6) gas, whereas eyes with PVR grade B received 1000 centistokes silicone oil (SO). The patients postured face-down immediately after surgery. Blue-fundus autofluorescence (B-FAF) pictures were obtained at each follow-up examination. Main outcome measures were incidence and direction of retinal displacement.RESULTS. Ninety-seven eyes (77.6%) were tamponated with SF6 and 28 eyes (22.4%) with SO. After retinal reattachment, displacement was observed in 44 of 125 (35.2%) eyes (40 eyes in the SF6 group and 4 eyes in the SO group, respectively). The type of tamponade, specifically gas, was the only significant predictor of retinal displacement (P ¼ 0.007). The displacement was downward in 39 (88.6%) eyes (36 tamponated with SF6 and 3 with SO) and upward in 5 (11.4%) eyes (4 tamponated with SF6 and 1 with SO).CONCLUSIONS. Displacement of the retina after repair of macula-off RRD with PPV is observed using either SF6 gas or SO. Downward and upward displacements may occur with both tamponades, but downward dislocation is more common. Of the factors potentially implicated in favoring displacement that were studied, only the type of tamponade, specifically the gas, was significant.Keywords: blue fundus autofluorescence, retinal vessel printings, retinal detachment, pars plana vitrectomy, retinal displacement T here has recently been a trend toward pars plana vitrectomy (PPV) as the preferred method for treatment for rhegmatogenous retinal detachment (RRD). The reasons behind this trend include the advent of outpatient ambulatory surgery and improvements in technology, instrumentation, and viewing systems. [1][2][3][4][5] When PPV is chosen for the treatment of RRD, it is typically accompanied with a postoperative intraocular tamponade agent-most commonly gases or silicone oils (SOs). Many surgeons prefer to use SO for complicated RRD or if postoperative airplane or high elevation travel is planned. However, a recent prospective study has shown that PPV with SO injection is also a safe and efficient surgical approach for treatment of primary uncomplicated RRD. 6 The use of both gas and SO in conjunction with PPV for repair of RRD may be associated with unintentional displacement of the retina. [7][8][9][10][11][12] Blue fundus autofluorescence (B-FAF) elegantly depicts this shift via lines of increased autofluorescence, which closely reflect the caliber and orientation of the adjacent retinal vessels. These lines indicate the original location of the retinal vessels, which have been displaced along with t...

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Section: Discussionmentioning

confidence: 99%

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

dell’Omo

Scupola

Viggiano

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Additionally, buckling can complicate the closure of GRT by causing a gaping of retinal tissue, redundant retinal folds when the buckle is tightened, fish-mouthing and increased tendency of posterior retinal slippage [3,4,6,14]. …”

Section: Discussionmentioning

confidence: 99%

“…While some surgeons consider it a beneficial procedure to help attachment of the retina because it minimizes vitroretinal tractional forces, others consider it a real cause of posterior retinal slippage due to its role in changing ocular contour and scleral shortening relative to retina. Alternatively, some surgeons consider it only in recurrent cases [2,4-8,13,14]. …”

Section: Introductionmentioning

confidence: 99%

The outcome of surgical management for giant retinal tear more than 180°

Dabour

2014

BMC Ophthalmol

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BackgroundTo evaluate the surgical outcome for management of giant retinal tear (GRT) more than 180° by combined pars plana vitrectomy (PPV), encircling scleral buckle, 360° Laser endophotocoagulation, and silicon oil tamponade.MethodsThis was a Prospective, interventional case series study. Twenty four eyes of 23 patients suffering from GRT more than 180° underwent PPV combined with encircling scleral buckle and 360° laser retinopexy of the peripheral retina followed by silicon oil tamponade. All patients were followed up for at least six months.ResultsComplete anatomical success (retinal attachment after silicone oil removal) was achieved in 20 (83.3%) eyes at the end of follow-up, while incomplete anatomical success (retinal redetachment under or after removal of silicon oil) occurred in four (16.7%) eyes. At the end of follow-up period (mean of 13.7 months + 6.5), improvement of best-corrected visual acuity was achieved in 22 (91.7%) eyes. Preoperative best-corrected visual acuity ranged from HM to 0.15 while postoperative visual acuity ranged from HM to 0.9. Retinal slippage did not occur in any case. Additionally, removal of the clear crystalline lens in phakic eyes was not necessary in the primary intervention.ConclusionsGRT more than 180° can be effectively treated with PPV coupled with encircling scleral buckle, 360° laser retinopexy and silicon oil tamponade with no incidence of retinal slippage. In this complex procedure, concurrent encircling buckle the primary intervention may contribute to high chance of success.

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“…Dans ce type de décollement de rétine, la majorité des récidives semblent liées soit à la réouverture d'une corne de la déchirure géante, soit à la formation d'une nouvelle déchirure secondaire à des tractions vitréennes antérieures résiduelles [1,15,22]. Ce mécanisme était à l'origine de 5/7 récidives (3 cas de nouvelles déchirures dont une en arrière des cicatrices laser et 2 cas d'extension ou de réou-verture de la corne de la déchirure géante).…”

Section: Discussionunclassified

“…Dans une série limitée de 6 déchirures géantes sans PVR traitées par vitrectomie-photocoagulation sur 360 • -gaz, le taux de succès anatomique était de 83 % en une intervention et de 100 % en 3 interventions [22]. Dans une autre série de 11 déchirures géantes sans PVR traitées par vitrectomie-photocoagulation sur 360 • -échange PFCL-gaz (6 cas) ou PFCL-huile de silicone (5 cas), le taux de succès anatomique était de 91 % en une intervention et de 100 % en 2 interventions.…”

Section: Endophotocoagulation Laser Sur 360 •unclassified