17 research outputs found
Characteristics of Bilateral Retinal Detachment
Introduction: Rhegmatogenous retinal detachment (RD) is
still a sight-threatening and potentially blinding disease,
especially if both eyes are affected. The purpose of this study
is analysing the specific characteristics of bilateral
rhegmatogenous RD.
Methods: The files of all 5,791 consecutive
eyes undergoing vitreoretinal surgery for uncomplicated
RD in a single tertiary retinal centre between
January 2005 and June 2021 were retrospectively reviewed.
Results: A total of 300 patients (600 eyes) had bilateral
retinal detachment. Interval between initial and subsequent
RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years.
Symptoms were reported by the patients for 20 ± 75
(median 5) days before presentation in the initial eye and
12 ± 32 (median 4) days in the subsequent eye. 220 patients
were male (73%), and mean age at initial RD was 55 years.
183 (61%) of the initial RD eyes were phakic. In the initial eye,
more patients had a detached macula, worse visual acuity,
and more quadrants involved. Primary anatomic success
rate was higher in the subsequent eye (90%) compared to
the initial eye (83%). There was no difference in the reattachment
rate of fellow eyes with primary failure in the first
eye (91%) compared to those with primary success in the
first eye (90%). There was a high symmetry between the eyes
in terms of type of retinal break, number of breaks, and
presumed localization of the causative retinal break.
Conclusion: Patients with bilateral RD were more commonly
male and younger than the group of all RD patients. The
proportion of pseudophakia was not different. The majority
of fellow eye RD occurred within 2 years after the RD in the
first eye. Second eye RD was less advanced and had a better
anatomical repair rate. Despite their experience in the first
eye and despite typical symptoms, patients presented only
after a mean of 12 days with RD in the second eye. RD in the
initial and the subsequent eye showed a high symmetry. The
anatomic result in the first eye is not a predictor for the
anatomic result in the subsequent eye
Retinal Vascular Occlusion after COVID-19 Vaccination : More Coincidence than Causal Relationship? Data from a Retrospective Multicentre Study
Background: To investigate whether vaccination against SARS-CoV-2 is associated with
the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data
from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch
retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were
retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined
protocol. The relation to any previous vaccination was documented for the consecutive case series.
Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case–
control study using age- and sex-matched controls from the general population (study participants
from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was
conducted. Results: Four hundred and twenty-one subjects presenting during the index period
(61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO,
fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred
and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given
were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our
case–control analysis integrating population-based data from the GHS yielded no evidence of an
increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with
a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any
association between SARS-CoV-2 vaccination and a higher RVOD risk
Subretinale Lufteingabe zur Behandlung postoperativer Netzhautfalten nach Ablatio
Hintergrund
Faltenbildungen der Netzhaut stellen ein Problem v. a. nach Vitrektomie oder Buckelchirurgie mit Gaseingabe dar. Liegen diese Falten im Makulabereich, wirkt sich das meist erheblich auf das Sehvermögen des Patienten aus. Im Folgenden wird eine Behandlungstechnik solcher Falten beschrieben.
Methode
In einem Zeitraum von Januar 2017 bis Juni 2020 wurden 6 Patienten mit der im Folgenden beschriebenen Behandlungstechnik operiert. Es erfolgte die erneute Abhebung der Netzhaut mittels Balanced Salt Solution (BSS), gefolgt von einer subretinalen Eingabe gefilterter Luft. Das Ausstreichen der Falte erfolgte mithilfe von Perfluorcarbon (PFC). Eine postoperative Drainage der subretinalen Luft und FlĂĽssigkeit erfolgte nicht, die Spontanresorption wurde abgewartet.
Ergebnisse
Bei keinem Patienten kam es zu einer Visusverschlechterung nach erneuter Netzhautabhebung. Eine Verbesserung der Sehschärfe zeigte sich bei 4 von 6 Fällen. Eine Verminderung der Metamorphopsien konnte bei 5 von 6 Patienten erreicht werden, 2 Patienten gaben an, die Metamorphopsien gar nicht mehr wahrzunehmen. Nur 1 Patient berichtete über einen gleichbleibend verzerrten Seheindruck trotz anatomisch glatter zentraler Netzhaut.
Schlussfolgerung
Bei kritischer Indikationsstellung stellt unsere Behandlungstechnik eine sichere und erfolgreiche Vorgehensweise zur Behandlung von Netzhautfalten im Bereich der Makula nach Ablatiooperation dar
Pseudophakes zystoides Makulaödem
Pseudophakic cystoid macular edema (PCME) is still one of the most frequent causes of loss of vision after cataract surgery. Clinical PCME occurs after initial improvement of vision 2-10 weeks after surgery in 1-2% with secondary vision loss and biomicroscopically visible macular cysts. Alterations, which are often not associated with functional limitations, can frequently be seen with angiography and optical coherence tomography (OCT). Inflammation mediators are released due to the surgical trauma in the anterior segment of the eye and diffuse to the capillaries of the macula where they lead to exudation of fluid into the retinal tissue and swelling of the macula. Risk factors for PCME are complicated cataract surgery, diabetes, uveitis, epiretinal gliosis and a status after retinal vein occlusion. In eyes at risk, perioperative prophylaxis with topical nonsteroidal anti-inflammatory drugs should be prescribed. The natural course of PCME is often benign with spontaneous recovery over several months; however, to avoid irreversible loss of vision treatment should be initiated
Thermal Laser Monotherapy for Extrafoveal Polypoidal Choroidal Vasculopathy
INTRODUCTION
Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid. Diagnosis is mainly based on polypoidal aneurysm-like lesions seen in indocyanine green (ICG) angiography. Various therapeutic options have been proposed.
METHODS
Outcomes of 10 cases with extrafoveal PCV and consecutive macular edema treated with thermal laser are reported. Diagnosis of PCV was confirmed by ICG angiography.
RESULTS
Upon successful occlusion of the polyps in 10 eyes after thermal laser treatment demonstrated in ICG angiography, a regression of central foveal edema was seen in optical coherence tomography and color fundus photography. Visual acuity improved from logMAR 0.8 to logMAR 0.3. Follow-up ranged from 4 months to 15 years, with a median of 1 year. Two eyes had a recurrence of exudative maculopathy 5 and 7Â years after laser treatment, respectively.
CONCLUSION
A careful differentiation between various subforms of exudative maculopathy using fluorescein and ICG angiography can identify certain selected patients with extrafoveal PCV, for whom thermal laser monotherapy can be a therapeutic option
Thermal Laser Monotherapy for Extrafoveal Polypoidal Choroidal Vasculopathy
Introduction Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid. Diagnosis is mainly based on polypoidal aneurysm-like lesions seen in indocyanine green (ICG) angiography. Various therapeutic options have been proposed. Methods Outcomes of 10 cases with extrafoveal PCV and consecutive macular edema treated with thermal laser are reported. Diagnosis of PCV was confirmed by ICG angiography. Results Upon successful occlusion of the polyps in 10 eyes after thermal laser treatment demonstrated in ICG angiography, a regression of central foveal edema was seen in optical coherence tomography and color fundus photography. Visual acuity improved from logMAR 0.8 to logMAR 0.3. Follow-up ranged from 4 months to 15 years, with a median of 1 year. Two eyes had a recurrence of exudative maculopathy 5 and 7 years after laser treatment, respectively. Conclusion A careful differentiation between various subforms of exudative maculopathy using fluorescein and ICG angiography can identify certain selected patients with extrafoveal PCV, for whom thermal laser monotherapy can be a therapeutic option
Long-Term Outcome and Complications of IOL-Exchange
Purpose: To describe the long-term outcome after intraocular lens (IOL) exchange for IOL-opacification with a focus on any
occurring complications.
Patients and Methods: Patients with an IOL exchange for opacified IOLs (Lentis LS-502-1) were identified. Medical records and
information from the treating ophthalmologists were reviewed. Visual outcomes and any occurring complications after the IOL
exchange were analyzed.
Results: IOL exchange was performed in 48 eyes of 46 patients and significantly improved best-corrected distance visual acuity from
0.42 ± 0.32 logMar (mean ± SD) in opacified lenses to 0.25 ± 0.28 logMar after IOL exchange. Nine of the 48 eyes (19%) underwent
11 further surgical procedures for complications due to four indications: IOL dislocation (n = 2, 4%), retinal detachment (RD) (n = 6,
12%), epiretinal membrane (n = 2, 4%), and pupillary block (n = 1, 2%). Three eyes (6%) developed a temporarily elevated intraocular
pressure. Temporary postoperative cystoid macular edema was found in 2 eyes (4%).
Conclusion: IOL exchange can restore vision owing to IOL opacification in most cases. Nonetheless, IOL exchange is not an easy or
risk-free procedure. This may lead to sight-threatening complications, even in eyes without predisposing ocular comorbidities
Rhegmatogenous retinal detachment repair—does age, sex, and lens status make a difference?
Purpose
To analyze the correlation between lens status, age, and sex in the epidemiology and success rates of rhegmatogenous retinal detachment (RRD) surgery.
Methods
The files of all consecutive patients undergoing vitreoretinal surgery for uncomplicated RRD between Jan 2005 und Dec 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment occurring within 3 months after surgery.
Results
5502 eyes with uncomplicated primary RRD were included. Mean age of the patients was 61.1 years (± 13.6 SD). In the age group over 40 years, a male predominance was found. The percentage of pseudophakic RRD increased from 25 to 40% during the 15 years observation period. In the age group 50 to 69 years, patients with pseudophakic detachments were male in 786 out of 1079 cases (72.9%). In the same age group, 1285 of 2110 (60.9%) patients with phakic RRD were male. Overall, primary success rate after one procedure was 91.2% (5018 of 5502). In the phakic eyes, the primary success rate was higher in those eyes that underwent combined phacovitrectomy (93.0%), compared to those without simultaneous cataract surgery (88.7%; p = 0.002).
Conclusion
The ratio of male and female patients with RRD varies between age groups. The proportion of pseudophakic RRD has increased within 15 years. The male predominance in RRD is stronger in pseudophakic than in phakic eyes. In phakic eyes with RRD, a combined phacovitrectomy yielded better anatomical results
Unexplained visual loss after primary pars-plana-vitrectomy with silicone oil tamponade in fovea-sparing retinal detachment
Background
To investigate the incidence and clinical characteristics of unexplained visual loss in patients with fovea-sparing rhegmatogenous retinal detachment (RRD) during or after silicone oil (SO) tamponade.
Methods
The medical charts of all patients with macula-on RRDs, who underwent pars-plana-vitrectomy (ppV) with SO tamponade were retrospectively assessed regarding unexplained visual loss (UVL) of ≥ 3 Snellen lines and alterations on optical coherence tomography (OCT) during or after SO tamponade. The clinical data analysed included visual acuity, surgical parameters, OCT images, duration of SO tamponade and the time point of visual decline. Cases with re-detachment or secondary causes of visual loss such as SO emulsification, epiretinal membranes or macular edema were excluded.
Results
Over a 15-year-period, 22 cases with macula-on RRD, which had primarily been treated with ppV and SO tamponade, met the inclusion criteria. In most eyes (n = 20; 91%), the RRD was caused by a giant retinal tear (GRT). In 11 of these 22 cases (50%), best-corrected visual acuity (BCVA) had dropped by at least 3 lines for no apparent reason. In these 11 cases, mean preoperative logMAR BCVA was 0.2 (SD 0.13; range 0-0.5), equal to Snellen’s VA of 0.63, and mean postoperative logMAR BCVA 1.0 (SD 0.24; range 0.5–1.3), equal to Snellen’s VA of 0.10. Visual decline occurred about 12 weeks postoperatively (SD 6.2; range 3–20 ) and comprised 8 lines (SD 2.3; range -11 to -4). SO was removed on average 139 (SD 50.0; range 88–271) days after the first ppV. In 9 cases visual decline occurred while the SO was in-situ. In 2 patients, BCVA decline was noted 2 weeks after SO removal. In all eyes, preoperative central foveal thickness (CFT) was 254 μm (SD 24.2), which decreased to 224 μm (SD 29.6) during SO tamponade and increased to 247 μm (SD 29.2) after SO removal, irrespective of the presence of UVL. The mean follow-up time was 20 months (SD 30.6) after SO removal.
Conclusion
UVL after SO tamponade for macula-on RRD is more frequent than expected. The incidence in our case series was 50%. The mechanism of this phenomenon is still unknown. In general, vitreoretinal surgeons should thoroughly question the need for SO tamponade, inform their patients of possible UVL and remove SO as early as possible.
Trial registration
The study was approved by the local ethics committee on 6th of May 2022 (Ethikkommission der Universität Regensburg, Votum 22-2925-104) and was conducted in accordance with the ethical standards of the Declaration of Helsinki