Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment

Denwattana, A; Prakhunhungsit, Supalert; Thoongsuwan, Somanus; Rodanant, Nuttawut; Phasukkijwatana, Nopasak

doi:10.1038/eye.2017.262

Cited by 21 publications

(31 citation statements)

References 19 publications

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“…Postoperative follow-up showed the retina was well attached without any visible retinal tear or hole. Even this case was not inclued in the single operation success list, this result is still comparable to those reports with preoperative steroids, that is from 51% to 81.8% [2,3,5,8,[13][14][15] ].…”

Section: Discussionsupporting

confidence: 81%

“…Literature search showed that most of these studies mainly evaluated the effects of preoperative administration of steroids between different routes: systemic or periocular or intravitreal administration. But only two of these studies compared the effects of preoperative steroids to steroids-sparing treatment, and they showed contradict results [2,5] Study conducted by Denwattana et al [5] disclosed that preoperative steroid treatment can significantly improved CD before vitrectomy, but seemed not to improve the single-operation retinal reattachment rate or visual acuity at 3 months when compared to no steroid treatment in RRD/CD patients. It seems that although preoperative steroids can help controlling inflammation, it may be not as so important as we once thought.…”

Section: Discussionmentioning

confidence: 99%

“…However, Denwattana et al [5]revealed that although preoperative steroid significantly improved CD before vitrectomy, but seemed not to improve the single-operation retinal reattachment rate or visual acuity at 3 months when compared to no steroid treatment in RRD/CD patients. Some studies demonstrated that combined lensectomy or lens extraction can improve anatomical reattachment rates in patients with RRD/CD [3,6,7].…”

Section: Introductionmentioning

confidence: 98%

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Phacovitrectomy without preoperative steroids for rhegmatogenous retinal detachment with associated choroidal detachment

Gui¹,

Ai²,

Huang³

2018

Preprint

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Background: To report the anatomical and visual outcomes of combined phacoemulsification and micro-invasive pars plana vitrectomy (phacovitrectomy) without preoperative administration of steroids in the treatment of combined retinal detachments associated choroidal detachment(RRD/CD). Methods: Medical records of patients who were diagnosed as RRD/CD without past ocular trauma and surgical history were retrieved and analyzed. All the patients were treated with phacovitrectomy plus silicone oil (SO) tamponade without preoperative steroids. Patients were followed up at least 3 months postoperatively. The mean follow-up time were 10.3±10.1 months. Results: Seventeen patients (17 eyes), 8 women and 9 men, met the including criteria with mean age of 60.4±8.4 years. None of these eyes had intraocular lens implanted and none had combined scleral procedures in the primary surgical intervention. Preoperative B ultrasound showed that choroidal detachment was severe in 10 eyes (58.8%), moderate in 2 eyes (11.8%) and mild in 5 eyes(29.4%). Fifteen eyes(82.4%) had retina reattached after single operation. Of these 15 eyes, 14 eyes had SO removed, 8 of them had intraocular lens implanted, 2 eye had epimacular membrane peeling at the time of SO removing and one eye was refilled with SO. Two patients had retinal redetached within a month after primary surgical repair due to proliferation and would not willing to take re-operation. Fifteen eyes had postoperative visual acuity improved, 10 eyes had postoperative visual acuity equal or great than 0.1(20/200). The mean IOP at final visit was 15.7±4.2 mmHg, ranging from 10 to 28 mmHg. Conclusions: Phacovitrectomy without preorerative steroids can achieve a satisfied single-operation anatomic and functional outcome. Free of preoperative steroid intervention will not only reduce the time waiting for surgery but also avoid the complications associated with systemic or local administration of steroids.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Phacovitrectomy without preoperative steroids for rhegmatogenous retinal detachment with associated choroidal detachment

Gui¹,

Ai²,

Huang³

2018

Preprint

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“…Their main characteristics and results are shown in Table 1. Four had a prospective design but only two of these were randomized; the other three of the seven studies were retrospective [27][28][29][30][31][32]. Our systematic review found that CCS are widely used preoperatively in addition to surgery to treat patients affected by RRD associated with choroidal detachment (CD) [27][28][29][30][31][32].…”

Section: Preoperative Usementioning

confidence: 99%

Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment

Bonfiglio

Reibaldi

Macchi

et al. 2020

JCM

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The treatment for rhegmatogenous retinal detachment (RRD) is surgery, including pars plana vitrectomy (PPV) and scleral buckling (SB). Despite surgical advances, degeneration of the photoreceptors and post-operative complications, such as proliferative vitreoretinopathy (PVR), often occurs as the result of inflammation, preventing complete visual recovery or causing RRD recurrence. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs and the surgery itself induces an inflammatory response. This comprehensive review focuses on the use of different formulations of corticosteroids (CCS), as an adjunctive treatment to surgery, either PPV or SB, for RRD repair. The purpose was to review the efficacy and safety of CCS in improving functional and anatomical outcomes and in preventing postoperative complications. This review is organized according to the timing of CCS administration: preoperative, intraoperative, and postoperative. The evidence reviewed supported the role of the pre-operative use of CCS in the treatment of combined RRD and choroidal detachment (CD), reducing CD height. No solid consensus exists on intraoperative and postoperative use of CCS to treat and prevent postoperative complications. However, a large randomized clinical trial including more than 200 eyes suggested that oral prednisone after surgery decreases the rate of postoperative grade B PVR.

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“…Anatomically, it makes the insertion and placement of trocar cannulas for pars plana vitrectomy (PPV) time-consuming and technically challenging. Various adjuvant techniques have been proposed to solve these problems, including the administration of steroids, sclerotomy to create passive drainage of the SCF, increasing IOP with an intravitreal injection of balanced saline solution (BSS), and penetration with a longer trocar (6 mm) [ 7 – 13 ]. The theoretical risks include the side effects of the drug and iatrogenic trauma of the transparent lens, which might consequently increase surgical difficulty and worsen patient prognosis.…”

Section: Introductionmentioning

confidence: 99%

Systemic Approach to Prevent Inadvertent Perfusion in Eyes with Extensive Choroidal Detachment, Suprachoroidal Fluid, and Hypotony During Pars Plana Vitrectomy

et al. 2018

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IntroductionRhegmatogenous retinal detachment (RRD) with extensive choroidal detachment (CD), suprachoroidal fluid (SCF), and lower intraocular pressure (IOP) markedly increase the difficulty of pars plana vitrectomy (PPV) because it makes the insertion and placement of the trocar cannulas for PPV time-consuming and technically challenging. In this study, we developed a systemic approach that avoids the risks of sclerotomy or using a longer trocar to help in the safe placement of the trocar cannulas in order to prevent inadvertent fluid/air perfusion during PPV in RRD eyes with extensive CD, SCF, and hypotony.MethodsThis is a prospective case series study. Consecutive patients diagnosed with RRD with extensive CD, SCF, and hypotony were recruited. The main steps included injecting transconjunctival intravitreal fluid to increase IOP and enable the passive egress of SCF into the subconjunctival space, creating and broadening the inner opening for the trocar cannulas, transillumination with an endoillumination light pipe, and indentation of the infusion cannula to create maximum visual exposure of the inner segment and help peripheral shaving around the infusion tip. Main outcomes: the success rate of the infusion placement into the vitreous cavity, surgical duration, intra- and postoperative complications, and functional and anatomical outcomes.ResultsThirty-eight patients (38 eyes) were included. The first-time success rate of cannula placement into the vitreous cavity was 100%, with a mean surgical duration of 8.5 ± 1.8 min. No intra- or postoperative complications related to the approach were observed. Significant vision improvement was noted in 68.4% (26/38) of the patients at the final follow-up. The primary and final retinal reattachment rates were 94.7% (36/38) and 100% (38/38), respectively.ConclusionThis systemic approach is a feasible option to ensure the safe placement of trocar cannulas and prevent inadvertent perfusion during small-gauge PPV in RRD eyes with extensive CD, SCF, and hypotony, without the need for a draining sclerotomy, a longer trocar, or a sharp clearing of the cannula tip.

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Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment

Cited by 21 publications

References 19 publications

Phacovitrectomy without preoperative steroids for rhegmatogenous retinal detachment with associated choroidal detachment

Phacovitrectomy without preoperative steroids for rhegmatogenous retinal detachment with associated choroidal detachment

Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment

Systemic Approach to Prevent Inadvertent Perfusion in Eyes with Extensive Choroidal Detachment, Suprachoroidal Fluid, and Hypotony During Pars Plana Vitrectomy

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