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

Iatrogene Netzhautdefekte nach intravitrealer operativer Medikamenteneingabe

Hintergrund Intravitreale operative Medikamenteneingaben (IVOM) stellen einen der häufigsten Eingriffe in der Medizin dar. Das Risikoprofil ist gering. Neben intraokularen Drucksteigerungen zählen insbesondere erregerbedingte Endophthalmitiden, Glaskörperblutungen und rhegmatogene Netzhautablösungen zu den gängigen Komplikationen. Darüber hinaus wurden auch einzelne Fälle von Linsenverletzungen sowie peripheren Netzhautdefekten und Makulaforamina in Assoziation mit vitreoretinalen Traktionen beschrieben. In der hier vorliegenden Fallserie berichten wir über scharfe iatrogene Netzhaut- bzw. Makulaverletzungen. Methoden Multizentrische Fallsammlung von IVOM-Patienten mit iatrogenen Netzhautdefekten, retrospektiv über den Zeitraum 2016 bis 2023. Ergebnisse Es konnten 9 Fälle (72 Jahre ± 8,1, 3 Augen pseudophak) mit einem iatrogenen retinalen Trauma nach IVOM zur Therapie einer neovaskulären altersbedingten Makuladegeneration (nAMD) dokumentiert werden. Während in 6 Fällen scharfe Verletzungen innerhalb der Makula vorlagen, waren die Läsionen in den anderen Fällen extramakulär lokalisiert. Schlussfolgerungen Iatrogene Netzhaut- und Makulaverletzungen sind seltene Komplikationen im Rahmen der IVOM und bei sachgemäßer Durchführung insbesondere mit Blick auf die Kanülenverwendung und die Wahl des Limbusabstands vermeidbar

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 Flüssigkeit 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 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

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