Rhegmatogenous retinal detachment masquerading as exudative panuveitis with intense anterior chamber inflammatory reaction.

Purpose:This is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation. We have included clinical features, anterior segment and fundus photography, B-scan ultrasonography, fluorescein angiography, and intraoperative findings. Observations:A 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation. Conclusions:Rhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications

Retinal Detachment: What are the Types and Potential Causes?

Retinal detachment is one of the few ocular emergencies. Depending on the extensiveness of the detachment, and whether it is macula on or macula off, will affect the patient’s visual acuity after treatment. Therefore, it is vital that after experiencing any common retinal detachment symptoms, the patient sees an ophthalmologist immediately. High-risk factors for retinal detachment include aging, ocular trauma, high myopia, and prior eye surgery. Statistically, the cause of a given retinal detachment often determines the specific type of detachment that occurs. There are three forms of retinal detachment, categorized separately based on their anatomical characteristics

Preoperative electrophysiological characterization of patients with primary macula-involving rhegmatogenous retinal detachment

Purpose: To determine 1) which components of retinal function are impaired after rhegmatogenous retinal detachment, 2) which outer retinal pathways (rod- or cone-driven) are more severely affected, and 3) whether there is concomitant inner retinal dysfunction. Methods: We conducted a prospective observational study in a large academic institution. We performed preoperative electroretinography on eight patients to assess outer and inner retinal function. In all cases, a comparison between the eye with the detached retina and the control fellow eye was made. Results: Eyes with a detached retina had significantly lower a-wave and b-wave amplitudes with respect to both rod- and cone-dominated testing parameters (P < 0.05) and reduced 30 Hz flicker responses compared to fellow eyes (P < 0.05); the effect size was similar for all significantly reduced parameters (r~0.6). There were no significant differences between eyes with detached retinas and control fellow eyes with respect to b/a-wave ratios, a-wave latencies, or b-wave latencies. Conclusion: Patients with rhegmatogenous retinal detachment have preoperative outer retinal dysfunction equally affecting both rod- and cone-driven pathways, and they have minimal inner retinal dysfunction

Clinical study of retinal detachment associated with choroidal detachment

AIM: To analyze the clinical characteristics of retinal detachment associated with choroidal detachment and to evaluate the surgical techniques, the efficacy and operation time for treatment.<p>METHODS: We reviewed and analyzed the operative effects of vitreoretinal surgeries in 45 patients(45 eyes)with retinal and choroidal detachment in our hospital from January, 2010 to January, 2012. In these 45 patients, there were 38 patients of rhegmatogenous retinal detachment associated with choroidal detachment, 7 patients of retinal redetachment associated with choroidal detachment. The surgical techniques include scleral encircling operation, epichoroidal space drainage by sclerocentesis intraocular photocoagulation, gas-fluid exchange, perfluoropropane(C₃F₈)or silicone oil intraocular tamponade and vitreoretinal surgery.<p>RESULTS: The drainage of the suprachoroidal space liquid and blood was successful in 45 eyes. Silicone oil tamponade was performed for 39 eyes and C₃F₈ tamponade for 6 eyes. Retinas and choroids were all reattached and retinal holes were closed. Visual acuities were improved, ≥0.1 in 23 eyes.<p>CONCLUSION: The vitreoretinal surgery and external drainage by sclerocentesis and scleral encircling operation is an effective operating method for rhegmatogenous retinal detachment associated with choroidal detachment

Outcomes of retinal detachment surgery at Charlotte Maxeke Johannesburg Academic Hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Ophthalmology. Johannesburg, 2018.Purpose: The aim of this study was to determine the visual acuity and anatomical outcome of retinal detachment repair at Charlotte Maxeke Johannesburg Academic hospital. Methods: Retrospective record review (clinical audit) of outcomes in patients who had retinal surgery (pars plana vitrectomy) for either rhegmatogenous retinal detachment or diabetic retinal detachment (tractional detachment or combined tractional and rhegmatogenous detachment) at Charlotte Maxeke Johannesburg Academic hospital during the period from 1 January 2010 to 31 December 2014. Results: During the specified time period 941 pars plana vitrectomies (including repeat surgery) were performed at the hospital. After exclusion for indications other than retinal detachment repairs and for missing or incomplete records, a total of 164 records of 164 patients were reviewed. The patients were divided into two groups: a rhegmatogenous retinal detachment group (n=99) and a diabetic retinal detachment group (n=65). Rhegmatogenous retinal detachment Ninety nine patients with rhegmatogenous detachment were included in the study, 62% male and 38% female. The mean age (± standard deviation) was 48(±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37 % and 21% of all causes respectively. Sixty three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty three eyes (84%) obtained vision improvement or stabilization and retinal attachment. Forty eyes (40%) had visual acuity improvement, 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% (n=92) of eyes including those that needed a repeat surgery. Diabetic retinal detachment Sixty five patients with diabetic retinal detachment were included in the study. Sixty three percent (n=41) were males and the mean age (± standard deviation) was 54± 12.2 years. Sixty eight percent (n=44) had tractional retinal detachment and 32% (n=21) had a combined tractional and rhegmatogenous retinal detachment. Thirty two percent of patients had detachments associated with vitreous haemorrhage, and 60% had macular involving detachments. Forty six eyes (71%) obtained vision improvement or stabilization and attachment of the retina; 36.9% (n=24) had visual acuity improvement, 33.9% (n=22) retained the same visual acuity and 29.2% (n=19) lost vision. Eighty five percent (n=55) had successful anatomical reattachment of the retina and 15% (n=10) had re-detachments after surgery. Conclusions: This study found that the majority of patients, whose files were reviewed, benefited from surgical intervention for rhegmatogenous and diabetic retinal detachment in terms of stabilisation or improvement of vision. The major limitation of this study is the large number of missing or incomplete records. The results of this study are therefore not generalisable to our retinal detachment patient population.LG201

Ocular toxoplasmosis and retinal detachment: five case reports

BACKGROUND: Ocular toxoplasmosis is a potentially blinding cause of posterior uveitis. Retinal detachment is rare complication of ocular toxoplasmosis. AIM: To report the clinical course and prognosis of retinal breaks and detachments occurring in patients with ocular toxoplasmosis. PATIENTS AND METHODS: This study was a retrospective, non-comparative case series of five patients with ocular toxoplasmosis who had consulted us with retinal detachment. RESULTS: All of the participants had retinal detachment after severe and treatment resistant toxoplasmic retinochoroiditis, leaving one of them with decreased visual acuity to light perception in spite of treatment and final visual acuity was 20/100 or better in four patients. CONCLUSIONS: The functional prognosis for the patients with retinal detachment was poor. Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with severe intraocular inflammation

Transient tractional retinal detachment in an eye with retinitis pigmentosa

We present a case of retinitis pigmentosa with vitreoretinal traction-associated retinal detachment. The retinal detachment was detected in the nasal periphery. No retinal breaks and no active vascular leakage were observed by fundus scopy and fluorescein angiography, respectively. However, 8 months later, the tractional retinal detachment was spontaneously resolved with posterior vitreous detachment

Update on a long-term, prospective study of capsulotomy and retinal detachment rates after cataract surgery

Journal ArticlePURPOSE: To evaluate the retinal detachment risks and neodymium:YAG (Nd:YAG) capsulotomy rates associated with different cataract approaches and intraocular lens (IOL) styles in a long-term,prospective clinical study. SETTING: Clinical practice of 1 ophthalmologist, Fort Collins, Colorado, USA. METHODS: Prospectively studied were surgical approach, date, and complications; IOL type; axial length; patient age and sex; Nd:YAG capsulotomy and date; and retinal detachment and date. RESULTS: Phacoemulsification had a lower risk of retinal detachment than intracapsular cataract extraction (ICCE) (0.4% versus 5.4%; P <.001) and extracapsular cataract extraction (ECCE) (0.4% versus 1.6%; P =. 002). Although retinal detachment was significantly associated with Nd:YAG for ECCE (3.1% versus 1.0%; P =.01), no patient in the phacoemulsification group had a retinal detachment after an Nd:YAG treatment. Retinal detachment was strongly associated with axial length of 24.0 mm and greater (P <.001), age of 60 years or less if axial length was 24.0 mm or greater (for ECCE, P =.001; for phacoemulsification, P =.01) and sex; that is, male (for ECCE, P =. 04; for phacoemulsification, P =.02). Regarding IOL styles the Surgidev B20/20 (P <.001) and AcrySof MA60 (P <.001) had significantly lower Nd:YAG rates, while the Cilco UPB 320 GS had a significantly higher Nd:YAG rate (P <.001). CONCLUSIONS: Cataract surgical approach and IOL style significantly affect Nd:YAG and retinal detachment rates. Being a man, being 60 years or younger, and especially having an axial length of 24.0 mm or greater were associated with detachment. Some Nd:YAG approaches may not put the patient at increased risk for retinal detachment

Effects of Corneal Transplant on Rates of Retinal Detachment

Introduction: Corneal transplant remains the gold standard treatment for irreversible corneal damage. The purpose of this study is to evaluate retinal detachment rates and clinical outcomes after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). We hypothesized that corneal transplants would increase the rate of RD. Methods: This retrospective cohort study utilized corneal transplant data from all surgical visits from PK or EK between April 1, 2012 and August 31, 2018. Individual charts were reviewed from patients who had a subsequent retinal detachment. Incidence of retinal detachment following PK or EK was the main outcome measured. Results: A total of 1,676 PKs and 2,292 EKs were performed for 3,069 patients during the study period. Fifty-four cases of retinal detachment occurred during the study period; forty-two cases occurred after PK and twelve cases occurred after EK. The rate of retinal detachment after EK (11 of 2,292; 0.5%) was significantly lower than that after PK (43 of 1,676; 2.6%) (p = 0.01). Additionally, the odds of developing retinal detachment after PK or EK performed in conjunction with anterior or pars plana vitrectomy were significantly higher than after either PK or EK alone (OR: 8.66; 95% CI: 2.98-25.18; p \u3c 0.001). Discussion: Overall rates of retinal detachment for individuals receiving either PK or EK were low. Rates of retinal detachment were significantly lower for EK compared to PK. These results support our hypothesis and can help patients make informed decisions on their surgical options and associated risks