The Incidence of Rhegmatogenous Retinal Detachment in The Netherlands

To estimate the incidence and characteristics of rhegmatogenous retinal detachment (RRD) in The Netherlands in 2009.Retrospective, observational case series.All patients with RRD in the Dutch population in 2009.By reviewing surgical logs, cases of primary RRD repair in 2009 were identified. Exclusion criteria included RRD before 2009 and exudative, tractional, or traumatic retinal detachments. Patient demographics, date of surgery, and lens status were documented. Incidence of RRD and 95% confidence intervals (CIs) were calculated based on the Poisson distribution. Age distribution, male-to-female ratio, and proportion of RRD patients with prior cataract extraction (CE) were determined. A Student t test was used to examine differences in the incidence of RRD between groups.Annual RRD incidence in the population and per gender-adjusted age category and proportion of RRD patients with prior CE.The annual RRD incidence was 18.2 per 100 000 people (95% CI, 11.4-18.8), with a peak incidence of 52.5 per 100 000 people (95% CI, 29.4-56.8) between 55 and 59 years of age. The Bilateral RRD rate was 1.67%. Macula-off presentation occurred in 54.5% of all RRD patients. Prior CE was noted in 33.5% of RRD eyes. The male-to-female ratio was 1.3:1, and RRD incidence was statistically significantly more frequent in males (

Glucose metabolism status is associated with changes in macular thickness

Design: Cross-sectional population-based cohort study. Purpose: Macular thinning may be an early sign of diabetic retinopathy. We therefore evaluated to what extent macular thickness differed between individuals with prediabetes (preDM2) and individuals with type 2 diabetes (DM2) without cysts compared with individuals with a normal glucose metabolism (NGM). Methods: Using SD-OCT we measured macular thickness in five ETDRS subfields in 2385 participants (mean age 59 ± 8 years, 50% men, 1397 NGM, 357 preDM2, 631 DM2). Results: After adjustment for age, sex, and spherical equivalent, individuals with preDM2 showed a significant decrease in pericentral superior macular thickness compared with individuals with NGM (-3.34 ± 1.28 µm, P<0.01). In individuals with DM2 without cysts, the four pericentral quadrants were significantly thinner compared with individuals with NGM (range: -5.42 ± 1.04 µm to -5.91 ± 1.03 µm, P<0.001). There was a significant linear trend of pericentral macular thinning with severity of glucose metabolism status (P<0.001). Conclusions: This study demonstrates that the pericentral macular thickness decreases with worsening of glucose metabolism. This may reflect early neurodegenerative changes

Scleral buckling surgery after macula-off retinal detachment: worse visual outcome after more than 6 days

PURPOSE: To determine the effect of duration of macular detachment (DMD) on visual acuity (VA) in patients with macula-off rhegmatogenous retinal detachment (RD). DESIGN: Retrospective observational case series. PARTICIPANTS: Two hundred two consecutive patients (202 eyes) with primary uncomplicated macula-off RD, preoperative VA of 10/100 or worse, a precise history of when macular function was lost, successful reattachment surgery, and a minimal follow-up of 3 months. INTERVENTION: All RDs were repaired with a primary scleral buckling procedure performed by 3 vitreoretinal surgeons. MAIN OUTCOME MEASURE: Visual acuity (best corrected and 3, 6, and 12 months postoperatively). RESULTS: Considering all eyes, the cumulative mean of the best-corrected postoperative VA (logarithm of the minimum angle of resolution [logMAR]) as a function of DMD shows a rapid worsening when DMD exceeds 6 days. Eyes were divided into 3 groups, corresponding to the DMD intervals immediate (within 10 days), delayed (11 days-6 weeks), and late (>6 weeks). Mean postoperative VAs (in logMAR) were 0.35+/-0.31 (between 20/40 and 20/50 Snellen equivalent) in eyes with DMD up to 10 days, 0.48+/-0.26 (20/60 Snellen equivalent) in the delayed group, and 0.86+/-0.30 (8/60 Snellen equivalent) in eyes with DMD longer than 6 weeks. CONCLUSIONS: The cumulative mean of the best-corrected postoperative VA (logMAR) as a function of DMD shows a rapid worsening when DMD exceeds 6 days. Our results indicate that the scleral buckling procedure should be done preferably within a 7-day DMD

Incidence of redetachment 6 months after scleral buckling surgery

PURPOSE: The preoperative and intraoperative clinical variables associated with redetachment and/or a poor visual outcome following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) have mainly been studied after a short follow-up. This study aimed to analyse long-term effects by following patients for at least 6 months. METHODS: In a retrospective survey we evaluated the data of 436 eyes that underwent SB surgery. Postoperative data were collected at 3-month intervals. RESULTS: After a mean follow-up period of 51 months, anatomic reattachment was achieved in 76% after one SB procedure, with a final reattachment rate of 97% after additional vitreoretinal procedures. In total, 104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up, 32 eyes (7%) and 20 eyes (5%), respectively, developed redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. A cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent RRD. CONCLUSION: Conventional SB surgery is a reliable procedure in a selected group of eyes with primary RRD. However, in eyes with a retinal tear with a cumulative size of more than three disc diameters, a primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 months, a longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after SB surgery

Macular thinning in prediabetes or type 2 diabetes without diabetic retinopathy: the Maastricht Study

Purpose: To assess macular thinning in individuals with prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DR) compared with individuals with normal glucose metabolism (NGM). Methods: Using spectral domain optical coherence tomography (SD-OCT), we measured macular thickness in six subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1838 participants from The Maastricht Study, a population-based cohort study (mean age 59 ± 8 years, 49% men, 1087 NGM, 279 prediabetes, 472 DM2 w/o DR). Multivariable linear regression was used to assess the association between macular thickness and glucose metabolism status. Results: After adjustment for age, sex and spherical equivalent, individuals with prediabetes showed a significant decrease in pericentral superior macular thickness [β = −2.14 μm (95% confidence interval (CI): −4.24 to −0.03), p < 0.05] compared with individuals with NGM. In individuals with DM2 w/o DR, the fovea [β = −4.05 μm (95% CI: −6.30 to −1.79), p < 0.001] and the four pericentral quadrants (range: β = −4.64 to −5.29 μm, p < 0.001) were significantly thinner compared with individuals with NGM. There was a significant linear trend of macular thinning with severity of glucose metabolism status in five subfields (p < 0.001). Conclusion: Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle

Macular thinning in prediabetes or type 2 diabetes without diabetic retinopathy:the Maastricht Study

\u3cp\u3ePurpose: To assess macular thinning in individuals with prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DR) compared with individuals with normal glucose metabolism (NGM). Methods: Using spectral domain optical coherence tomography (SD-OCT), we measured macular thickness in six subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1838 participants from The Maastricht Study, a population-based cohort study (mean age 59 ± 8 years, 49% men, 1087 NGM, 279 prediabetes, 472 DM2 w/o DR). Multivariable linear regression was used to assess the association between macular thickness and glucose metabolism status. Results: After adjustment for age, sex and spherical equivalent, individuals with prediabetes showed a significant decrease in pericentral superior macular thickness [β = −2.14 μm (95% confidence interval (CI): −4.24 to −0.03), p &lt; 0.05] compared with individuals with NGM. In individuals with DM2 w/o DR, the fovea [β = −4.05 μm (95% CI: −6.30 to −1.79), p &lt; 0.001] and the four pericentral quadrants (range: β = −4.64 to −5.29 μm, p &lt; 0.001) were significantly thinner compared with individuals with NGM. There was a significant linear trend of macular thinning with severity of glucose metabolism status in five subfields (p &lt; 0.001). Conclusion: Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle.\u3c/p\u3

Prevalence of optical coherence tomography detected vitreomacular interface disorders:The Maastricht Study

Purpose To calculate the prevalence of all vitreomacular interface (VMI) disorders and stratify according to age, sex and (pre)diabetes status. Methods The presence of VMI disorders was assessed in 2660 participants aged between 40 and 75 years from The Maastricht Study who had a gradable macular spectral‐domain optical coherence tomography (SD‐OCT) volume scan in at least one eye [mean 59.7 ± 8.2 years, 50.2% men, 1531 normal glucose metabolism (NGM), 401 prediabetes, 728 type 2 diabetes (DM2, oversampled)]. A stratified and multivariable logistic regression analysis was used. Results The prevalence of the different VMI disorders for individuals with NGM, prediabetes and DM2 was, respectively, 5.7%, 6% and 6.7% for epiretinal membranes; 6%, 9.6% and 6.8% for vitreomacular traction; 1.1%, 0.7% and 0.3% for lamellar macular holes; 0.1%, 0% and 0% for pseudoholes; 1.1%, 1.9% and 5.5% for macular cysts. None of the participants was diagnosed with a macular hole. The prevalence of epiretinal membranes, vitreomacular traction and macular cysts was higher with age (p < 0.001). Vitreomacular traction and lamellar macular holes were more frequent in women (p < 0.01). DM2 is positively associated [OR = 3.9 (95% CI 2.11–7.22, p < 0.001)] with macular cysts and negatively associated with lamellar macular holes [OR = 0.2 (95% CI 0.04–0.9, p = 0.036)] after adjustment for age and sex. The calculated prevalence of VMI disorders was 15.9%. Conclusions The calculated prevalence of VMI disorders in individuals aged between 40 and 75 years is 15.9%. The prevalence depends on age, sex and glucose metabolism status for several types of VMI disorders