Missed retinal breaks in rhegmatogenous retinal detachment

Takkar, Brijesh; Azad, Shorya Vardhan; Shashni, Adarsh; Pujari, Amar; Bhatia, Indrish; Azad, Rajvardhan

doi:10.18240/ijo.2016.11.15

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…Early detection of anterior retinal breaks is crucial because missed retinal breaks are responsible for up to 64% of the cases of failed RRD surgery [ 17 ]. Kornberg et al [ 15 ] also found that UWF imaging may be insufficient for detecting retinal breaks, especially in the far superior and inferior quadrants.…”

Section: Discussionmentioning

confidence: 99%

Non-Mydriatic Ultra-Wide Field Imaging Versus Dilated Fundus Exam and Intraoperative Findings for Assessment of Rhegmatogenous Retinal Detachment

Abadia¹,

Desco

Mataix

et al. 2020

Brain Sciences

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Background: to compare the extent of the detached retina and retinal tears location in rhegmatogenous retinal detachment (RRD) among non-mydriatic ultra-wide field (UWF) imaging, dilated fundus exam (DFE), and intraoperative evaluation. Methods: this retrospective chart review comprised 123 patients undergoing surgery for RRD. A masked retina specialist analyzed the UWF fundus images for RRD area, status of the macula, and presence and location of retinal breaks. The same variables were collected from a database including DFE and intraoperative recordings. Evaluation methods were compared. Results: mean age was 59.8 ± 14.9 years. Best-corrected visual acuity improved from 0.25 ± 0.3 (Snellen) to 0.67 ± 0.3 at 12 months (p = 0.009). The RRD description and assessment of macula status (34.5% macula-on) did not differ between UWF, DFE, and intraoperative examination. The inferior quadrant was involved most frequently (41.5%), followed by the superior (38.9%), temporal (27.8%) and nasal quadrant (14.8%). Intraoperative exam detected 96.7% of retinal tears compared with DFE (73.2%, p = 0.008) and UWF imaging (65%, p=0.003). UWF imaging and DFE did not differ significantly. Conclusion: RRD extent on DFE and UWF images was consistent with intraoperative findings. UWF and DFE detection of peripheral retinal tears was similar, but 25% of retinal breaks were missed until intraoperative evaluation.

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Section: Discussionmentioning

confidence: 99%

Non-Mydriatic Ultra-Wide Field Imaging Versus Dilated Fundus Exam and Intraoperative Findings for Assessment of Rhegmatogenous Retinal Detachment

Abadia¹,

Desco

Mataix

et al. 2020

Brain Sciences

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“…The reason for this could be the presence of PVD in 138 (91%) of the patients, which is understandable given the age of the patients. Takkar et al reported a 50% prevalence of PVD in patients with RRD [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Different Surgical Repair Techniques for Rhegmatogenous Retinal Detachment—A Health Economic Analysis in the Split-Dalmatia County, Croatia

Borjan,

Pleština-Borjan,

Hertzberg

et al. 2024

Healthcare

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Purpose: The goal of this research is to investigate the characteristics and surgical techniques for repairing rhegmatogenous retinal detachment (RRD) and their influence on anatomical and functional success of the treatment with a special emphasis on the economic costs and outcome quality-adjusted life years (QALYs) of the procedures. Methods: This retrospective study analyzed data from 151 patients with RRD treated at the Department of Ophthalmology, Clinical Hospital Centre Split, Croatia, in a 3-year period, using one of three surgical techniques: pneumoretinopexy (PR), scleral buckling (SB) or pars plana vitrectomy (PPV), followed-up for at least 6 months. Demographic, pre- and post-operative ophthalmic exam parameters and surgical technique used were collected accordingly. Statistical analysis of the influence of the studied parameters upon anatomical and functional outcomes was performed, as well as health economic analysis on costs and derived utilities/QALYs of these surgical methods. Results: Of all patients, 130 (86%) were successfully operated on, and 21 patients (14%) required another surgical procedure. No statistically significant differences in the anatomical success between the 3 surgical techniques were found. However, the functional outcome (based on the final best corrected visual acuity (BCVA)) differed significantly. Despite improvement in the final BCVA, BCVA ≥ 0.5 was achieved in only 52 (34.4%) patients. The final BCVA showed significant association with the time elapsed from the onset of RRD to the surgical intervention, pre-operative BCVA, macular- and preoperative lens- status and type of surgery. The estimated diagnosis-related group (DRG) cost for day and inpatient surgery was based upon existing DRG cost for PPV, which for PR and SB was calculated accordingly. Based upon the success of the procedure and visual outcome, the overall calculated QALYs for PR and SB appeared to be similar, while the QALYs were lower for PPV. Conclusions: The success rate of treating RRD mostly depends on performing an early surgical procedure (especially in the case of attached macula), identification of all retina tears and, most importantly, choosing the appropriate surgical technique. Decisions on treatment for RRD should also be based upon cost-effective and QALYs-assessed procedures, especially in countries like Croatia, where limited healthcare resources exist. This study shows PR to be efficient and most cost-effective for RRD repairment in appropriate cases.

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“…IRB is a serious complication of VRS, and missing it can lead to failure of retinal surgery and vision loss. [ 6 ] The typically vulnerable cases include tractional retinal detachment without PVD and macular hole. The frequency of IRBs is close to 10% of the operated cases overall.…”

Section: Discussionmentioning

confidence: 99%

Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

Takkar

Belenje

Agarwal

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS). Methods: The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed. Results: Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases. Conclusion: JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.

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Missed retinal breaks in rhegmatogenous retinal detachment

Cited by 8 publications

References 37 publications

Non-Mydriatic Ultra-Wide Field Imaging Versus Dilated Fundus Exam and Intraoperative Findings for Assessment of Rhegmatogenous Retinal Detachment

Non-Mydriatic Ultra-Wide Field Imaging Versus Dilated Fundus Exam and Intraoperative Findings for Assessment of Rhegmatogenous Retinal Detachment

Outcome of Different Surgical Repair Techniques for Rhegmatogenous Retinal Detachment—A Health Economic Analysis in the Split-Dalmatia County, Croatia

Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

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