The results from this small pilot study are encouraging, although larger, controlled trials are needed to assess the optimal dose of BTX-A, its long-term efficacy and safety, and the role of multiple injections.
Aim To establish the likelihood of, and risk factors associated with, progression of 'macula-on' retinal detachment. Methods A multi-centre prospective observational study of patients with acute retinal detachment, not involving the fovea, was conducted over a 6-month period. Data collected included duration of symptoms, visual acuity, presence of posterior vitreous detachment, retinal drawings and subretinal fluid (SRF) distance from the fovea at a minimum of two time points. Results A total of 82 data sets from 15 institutions were analysed. Of 82 cases 11 (13%) demonstrated progression of fluid. Mean progression in those cases which progressed was 2.3 disc diameters (dd) and the average rate of progression was 1.80 dd/day. Binary regression analysis failed to reveal any statistically significant risk factors for progression. Multiple regression analyses were made to identify risk factors. With distance of SRF from fovea at operation as a function, distance of SRF at presentation was the only statistically significant risk factor. In all, 26% of patients underwent surgery out-ofhours. A total of 83% patients achieved a 6-week best-corrected vision of 6/9 or better. Conclusion Most retinal detachments in this study did not progress within the first few days. The distance of SRF from the fovea at presentation was the only statistically significant risk factor for progression to foveal detachment.
Results In a total of 10 eyes (77%) the first procedure produced anatomical success. Two eyes required a further procedure to achieve retinal reattachment, producing a final anatomical success rate of 92%. Patients with rhegmatogenous retinal detachment are occasionally found to have concurrent choroidal detachment (CD). These patients often present in an atypical way with pronounced uveitis, posterior synechiae, hypotony, deepened anterior chamber and pain. Patients with blue irides often have an apparent change in iris appearance, the affected eye taking a greenish tinge due to a highly proteinaceous aqueous. Retinal detachment may not be diagnosed if the view of the posterior segment is poor. From the point of view of surgical intervention, the presence of spontaneous CD is an important finding. Cases have in the past been associated with a poor prognosis when treated by 'conventional' (Le.
Materials and methodsA retrospective review was carried out of the case notes of 13 consecutive patients who presented to one surgeon (G.R.K.) with rhegmatogenous retinal detachment combined with CD (RDCD), all of whom were treated with PPV and silicone oil. Patients presented between March 1993 and August 1999. The diagnosis of RDCD was based on clinical examination, supplemented by ultrasonography in cases where CD was suspected, but not definitively visualised, on ophthalmoscopy. Patients with RDCD presenting with a history in the affected eye of previous retinal detachment surgery, intraocular surgery (apart from cataract extraction) or trauma would have been excluded (in fact there were none). Two patients had grade B PVR at presentation. In 2 patients the RD did not involve the macula. Twelve patients had at least one flap tear. Most patients had several breaks (up to 10 in a single patient) including at least one flap tear. In 1 patient only one atrophic hole was identified (it is unknown whether the vitreous was detached pre-operatively in this case). No patient had a giant retinal tear or retinal dialysis. In 4 patients CDs were present in all four quadrants and in the remainder in between one and three quadrants.All patients were operated on by or under the care of one vitreoretinal surgeon (G.R.K.). The following basic operative technique was employed in all patients (Fig. 1)
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