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To describe the case of a 12-year-old woman with vitreoretinal manifestations of Type 3 Gaucher disease.A retrospective case report including multimodal imaging and histologic examination of the vitreous.A 12-year-old woman with a history of Gaucher disease Type 3 was referred to the ophthalmology service for evaluation of vitreous deposits in both eyes. Funduscopic examination was notable for white vitreous opacities in both eyes. Ultra-widefield fluorescein angiography demonstrated areas of blockage associated with the deposits and focal areas of leakage. Optical coherence tomography angiography showed shadow artifact without intrinsic flow at these sites. Three years after presentation, she developed a right hemorrhagic posterior vitreous detachment, requiring pars plana vitrectomy with scleral buckle. A vitreous sample was sent to pathology, which demonstrated Gaucher cells.Gaucher disease is a rare metabolic condition caused by an autosomal recessive deficiency of glucocerebrosidase. To the best of our knowledge, this is the first report of hemorrhagic posterior vitreous detachment in Type 3 Gaucher disease, including ultra-widefield imaging, optical coherence tomography angiography, and histopathology.

Purpose To report a case of Coccidioides immitis endophthalmitis with severe vision loss and a return to excellent vision following aggressive intervention. Methods Case report. Results A 41-year-old male with a history of solid organ transplantation who complained of floaters and decreased vision in the setting of disseminated Coccidioides infection was found to have presumed coccidioidal endophthalmitis with visual acuities (VA) of 20/20 in the right eye and 20/200 in the left eye. The patient was managed with intravenous amphotericin B, oral voriconazole, and intravitreal injections of amphotericin B and voriconazole in the left eye every three days. Five weeks after presentation, VA remained 20/20 in the right eye and improved to 20/40 in the left eye. The patient was transitioned to twice weekly intravitreal injections and oral voriconazole upon hospital discharge. One week later, vision in the left eye decreased to 20/500 with worsening vitritis, prompting vitrectomy. Vision in the left eye subsequently improved to 20/30. Five weeks later, the patient developed a macula-on inferior rhegmatogenous retinal detachment in the left eye and underwent a second vitrectomy, with scleral buckle, laser, and gas injection. Vision in the left eye returned to 20/25. In total, the patient received 22 amphotericin B and 17 voriconazole intravitreal injections in the left eye with two vitrectomies. Vision in the right eye remained 20/20 throughout his treatment course. At four months after presentation, the patient remained on oral voriconazole with no evidence of active intraocular infection on exam. Conclusions Aggressive medical and surgical management can be successful in ocular conservation and restoration of vision in coccidioidal endophthalmitis. Very mild disease may be conservatively monitored and managed with systemic antifungal therapy alone. In severe disease, early diagnosis and prompt and aggressive use of systemic and intravitreal antifungals may spare panophthalmitis and preserve vision.

PURPOSE To describe the safety and efficacy of rhegmatogenous retinal detachment (RRD) repair with external drainage of subretinal fluid using a 28-gauge External Drainage and Depression device (Vortex Surgical, Chesterfield, MO). METHODS Retrospective review of patients who underwent primary rhegmatogenous retinal detachment repair with scleral buckle, pars plana vitrectomy, or scleral buckle/pars plana vitrectomy using the drainage device from August 2018 through March 2020, performed by four surgeons at two vitreoretinal practices. RESULTS Eighty-three eyes of 83 patients were included. At presentation, 28% had proliferative vitreoretinopathy. Surgery included 65% scleral buckle/pars plana vitrectomy, 33% pars plana vitrectomy, and 2% scleral buckle. There were no cases of retinal incarceration and two subretinal hemorrhages at the drainage site (both < 2 DD), 2 cases of recurrent RD with proliferative vitreoretinopathy (1 had proliferative vitreoretinopathy at presentation), and 6 (10%) new epiretinal membranes (3 were mild). There were no other complications. Mean follow-up was 274 days. Single operation success rate for those with ≥ 6-month follow-up was 97% (57/59). CONCLUSION External drainage of subretinal fluid during rhegmatogenous retinal detachment repair demonstrated a favorable safety profile with a high single operation success rate. Further study of the role of external drainage in rhegmatogenous retinal detachment repair is warranted.

BACKGROUND/PURPOSE To determinate the efficacy of the human amniotic membrane plugs with sulfur hexafluoride versus human amniotic membrane plug with air as endotamponade to treat macular holes that failed to close after vitrectomy plus internal limiting membrane peeling. Multimodal imaging was focused to evaluate preoperative features and postoperative changes. METHODS Prospective interventional comparative study. Twenty eyes of 20 patients affected with macular hole that failed to close were divided into 2 groups: 10 eyes received an amniotic membrane plug with 20% sulfur hexafluoride tamponade and 10 eyes received an amniotic membrane plug with air tamponade. All eyes were studied using multimodal advanced diagnostic tools, such as spectral-domain optical coherence tomography, optical coherence tomography angiography, microperimetry, and adaptive optics to investigate the postoperative results. RESULTS In both groups, all macular holes were found successfully closed after 12 months. Mean preoperative best-corrected visual acuity was 20/400 in the SF6 group and 20/250 in air group. Final mean best-corrected visual acuity was 20/63 in both groups. The superficial capillary plexus, studied using optical coherence tomography angiography, showed a statistically significant difference between the treated and the fellow eyes. Adaptive optics images revealed the presence of a photoreceptor cell mosaic in the area of the amniotic membrane plug. CONCLUSION The human amniotic membrane combined with air endotamponade demonstrated its effectiveness to seal macular holes that failed to close after vitrectomy plus internal limiting membrane peeling. Advanced multimodal diagnostic imaging helped us to better understand the modifications associated with the use of the amniotic membrane in these cases.

Introduction Rhegmatogenous retinal detachments with inferior retinal breaks are believed to have a higher risk of recurrent rhegmatogenous retinal detachment. This study compared anatomic and visual outcomes between primary pars plana vitrectomy (PPV) and combination PPV with scleral buckle (PPV/SB) for rhegmatogenous retinal detachments with inferior retinal breaks. Methods This is an analysis of the Primary Retinal Detachment Outcomes study, a multi-institutional cohort study of consecutive primary rhegmatogenous retinal detachment surgeries from January 1, 2015, through December 31, 2015. The primary outcome was single-surgery success rate. Only eyes with inferior retinal breaks (one break in the detached retina between five and seven o'clock) were included. Results There were 238 eyes that met the inclusion criteria, 95 (40%) of which underwent primary PPV and 163 (60%) that underwent combined PPV/SB. The single-surgery success rate was 76.8% for PPV and 87.4% for PPV/SB (P = 0.0355). This remained significant on multivariate analysis (P = 0.01). Subgroup analysis showed that a superior single-surgery success rate of PPV/SB was especially noted in phakic eyes (85.2% vs. 68.6%; P = 0.0464). Conclusion Retinal detachment with inferior retinal breaks had a higher single-surgery success rate if treated with PPV/SB compared with PPV alone, particularly in phakic eyes.

Background/purpose To describe a case of a rare, late scleral buckle-related complication, which was masquerading as ocular inflammation. Methods Case report. Results A 63-year-old woman with ocular history significant for cataract extraction with intraocular lens placement and retinal detachment repaired through pars plana vitrectomy and scleral buckle presents with anterior chamber inflammation and debris in the left eye. Uveitis workup was negative for any associated systemic disease. Anterior chamber washout and biopsy were nondiagnostic. At postoperative Month 1, she had recurrent anterior chamber debris and new debris noted in the vitreous cavity. A pars plana vitrectomy was performed, and during intraoperative scleral depression, copious strands of whitish material were expressed into the vitreous cavity. The scleral buckle was removed with additional whitish material noted within the encapsulated area. Papanicolaou stain of the material demonstrated a mixture of epithelial cells, histiocytes, lymphocytes, plasma cells, and neutrophils consistent with an epithelial cyst. Conclusion Epithelial inclusion cysts are a rare complication of scleral buckle placement. These cysts are lined by a nonkeratinized, stratified squamous epithelium with or without goblet cells and most commonly occur after ocular trauma, inflammation, or surgical procedures. To the best of our knowledge, this is the first reported case of erosion of an epithelial inclusion cyst into the vitreous cavity.

Purpose To compare outcomes in dense vitreous hemorrhage versus mild vitreous hemorrhage due to nontraumatic posterior vitreous detachment. Methods We compared 315 eyes, divided into 2 patient groups, one with dense and the other with mild vitreous hemorrhage. The main outcome measures were final mean best-corrected visual acuity, number of retinal tears, number of retinal detachments, and the number of pars plana vitrectomy and/or scleral buckle surgeries. Results In 33.4% of the patients, posterior vitreous detachment without complications was found. Retinal breaks after posterior vitreous detachment were found in 59% of the eyes. Rhegmatogenous retinal detachment was principally treated with pars plana vitrectomy and scleral buckle. In nonvisible fundus hemorrhage group, 44.4% of the patients underwent vitrectomy. In visible fundus hemorrhage group, 9.52% of the patients underwent pars plana vitrectomy. The mean final visual acuity was 20/25, without significant difference between groups (P = 0.064). Conclusion Acute, spontaneous, nontraumatic posterior vitreous separation with vitreous hemorrhage is associated with a high incidence of retinal complications. Close follow-up is necessary. We did not find significant differences in final visual acuity neither between the two groups nor among the treatments.

PURPOSE To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. RESULTS Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). CONCLUSION Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.

PURPOSE: To present the distribution of time to retinal redetachment in eyes undergoing retinal detachment surgery, using a method for adjusting time to outcome in eyes with silicone oil or heavy liquid tamponade ("oil-filled eyes"). METHODS: Data from two Australian centers were used. Adjusted time to outcome was measured from the date of tamponade removal in oil-filled eyes, unless failure was diagnosed with tamponade in situ. RESULTS: 188/1257 failures were identified (15.0%). Using unadjusted time to outcome, failures in oil-filled eyes occurred later than non-oil-filled eyes (median time to failure 57 vs. 28 days, P < 0.001). After adjustment, the distribution of time to failure was similar for oil-filled and non-oil-filled eyes (median 25 vs. 28 days, P = 0.68). Larger detachments, eyes with ≥Grade B proliferative vitreoretinopathy and eyes receiving surgery for recurrent detachments were more likely to fail, but the time to failure was similar regardless of risk. CONCLUSION: Adjustment of time to outcome resulted in a similar distribution of time to failure in oil-filled and non-oil filled eyes and was similar in low- and high-risk eyes. The use of adjusted time to outcome will support consistent collection and interpretation of outcomes across different jurisdictions where time to oil removal may vary.

To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment repair.Cost-utility analysis using data from the Primary Retinal Detachment Outcomes Study. The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year for treatment of moderately complex rhegmatogenous retinal detachment with SB, PPV, or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ambulatory surgery center settings.Total costs (2020 US dollars) for repair of a moderately complex rhegmatogenous retinal detachment in hospital (ambulatory surgery center) settings were $5,975 ($3,774) for the SB group, $8,125 ($5,082) for the PPV group, and $7,551 ($4,713) for the PPV/SB group. The estimated lifetime quality-adjusted life years gained were 5.4, 4.7, and 4.7 in the SB, PPV, and PPV/SB groups, respectively. The cost per quality-adjusted life year for hospital and ambulatory surgery center settings was $1,106 a ($699) for the SB group, $1729 ($1,081) for the PPV group, and $1,607 ($1,003) for the PPV/SB group.Scleral buckle, PPV, and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex rhegmatogenous retinal detachment, with slightly better results for SB, compared with current willingness to pay standards.

Purpose To understand the epidemiology of retinopathy of prematurity (ROP) requiring treatment in Taiwan from 2002 to 2011. Methods This retrospective cross-sectional study enrolled 11,180 premature patients with a length of stay >28 days who survived during hospitalization. The incidence of the first ROP treatment was analyzed. Results Among ROP patients (n = 4,096), 6.5% (n = 265) received treatment. The most frequently performed treatment was laser administration (n = 199), followed by intravitreal anti-vascular endothelial growth factor (VEGF) injection (n = 38), scleral buckle or pars plana vitrectomy (n = 14), and cryotherapy (n = 14). The incidence of ROP requiring treatment increased during the study period, as did the use of intravitreal anti-VEGF injection. Shifts in the treatment modality from cryotherapy and scleral buckle/pars plana vitrectomy to laser treatment after 2003 and from laser treatment to intravitreal anti-VEGF injection after 2010 were observed. Conclusion In Taiwan, the incidence of the use of intravitreal anti-VEGF injection for treating ROP increased between 2002 and 2011. Laser treatment was less frequently used than intravitreal anti-VEGF injection in 2011.

PURPOSE To elucidate the clinical characteristics and surgical outcome of consecutive patients with bilateral simultaneous retinal detachment who reported to a tertiary eye care institution over a period of 10 years. METHODS Retrospective interventional consecutive study of 168 eyes of 84 patients with bilateral simultaneous retinal detachment, observed by indirect ophthalmoscopy at the initial examination was performed. Demographic and clinical characteristics were collected before and after surgery. Patients with attached retina at final follow-up were considered to have anatomical success and those with two or more lines improvement in visual acuity were considered to have functional success. RESULTS Most cases (90% in the better eye and 82.1% in the worse eye) were managed by scleral buckling procedure. With scleral buckle, anatomical success was seen in 99% and functional success was seen in 87% of the cases. Pars plana vitrectomy was performed in remaining cases with anatomical success in 83% and functional success in 78% of cases. Eyes with partial retinal detachment, without macular involvement, and eyes in which additional surgeries were not performed had significantly better anatomical and functional results. CONCLUSION Early sequential surgery gives good anatomical and functional outcomes. Surgical outcomes were better with scleral buckling than pars plana vitrectomy.

Purpose To determine predictive factors of proliferative vitreoretinopathy (PVR) formation after uncomplicated primary retinal detachment repair. Methods Retrospective, single-center, case-control study of 74 consecutive patients with (37 eyes) and without (37 eyes) PVR formation after undergoing uncomplicated primary surgery for retinal detachment repair. Logistic regression was used to assess factors associated with PVR formation. Results Retinal detachment involving the macula was 4.2 times (adjusted odds ratio; 95% confidence interval, 1.4-12.9; P = 0.0119) more likely to have PVR formation compared with those without. Patients who were current or former smokers were 3.6 times (adjusted odds ratio; 95% confidence interval, 1.1-11.7; P = 0.0352) more likely to have PVR formation compared with nonsmokers. Compared with 25-gauge (g) vitrectomy, larger gauge vitrectomy (20 g or 23 g) was 3.6 times (adjusted odds ratio; 95% confidence interval, 1.2-11.3; P = 0.0276) more likely to have PVR formation. Duration of retinal detachment symptoms, high myopia, lens status, lattice degeneration, location of retinal break, number of retinal breaks, and surgical technique (e.g., scleral buckle with or without vitrectomy versus vitrectomy alone) were not found to be predictive of PVR formation. Conclusion Cigarette smoking and macular involvement are significant risk factors predictive of PVR formation after uncomplicated primary retinal detachment repair.

Purpose To describe a case of scleral buckling in a patient with severe (Type III) osteogenesis imperfecta. Methods Single interventional case report of a 37-year-old woman, with clinically diagnosed osteogenesis imperfecta Type III, presenting with an inferior retinal detachment of the right eye. The patient was promptly treated with scleral buckling. Results Long-term follow-up has shown a good clinical outcome, with no recurrence of the retinal detachment. Eighteen months postsurgery, an ischemic branch retinal vein obstruction has developed in the right eye, complicated by macular edema. The patient was treated successfully with bevacizumab injections, with restoration of visual acuity to 20/25. Conclusion Scleral buckle may provide a good surgical option in selected patients with osteogenesis imperfecta, yielding excellent anatomical and functional results.

Purpose To present a rare presentation of pyogenic granuloma arising almost 4 decades after a scleral buckle for retinal detachment. Method We describe the clinical presentation, diagnostic workup, and management of a suspicious conjunctival lesion in an immunocompromised patient. We report the histopathological findings and the postoperative outcome. Results A 58-year-old man with human immunodeficiency virus presented for evaluation of a possible malignant conjunctival lesion in the left eye. The patient reported that the lesion had appeared 1.5 months before presentation with significant growth over the past month. The patient denied any trauma to the eye other than an ocular history of retinal detachment repair with scleral buckle 37 years earlier. Clinical examination revealed a pink, fleshy, mobile, and lobulated conjunctival lesion measuring 7 mm by 10 mm, emanating from the superior-nasal bulbar quadrant. A high-resolution optical coherence tomography revealed highly cellular infiltrate and hyperreflective mass with significant posterior shadowing. Further exploration of the lesion revealed a white, stringy, cauliflower-like material on the underside of the lesion. Surgical excision and pathology subsequently confirmed a diagnosis of pyogenic granuloma with remnants of silk suture. Conclusions A diagnosis of pyogenic granuloma secondary to retained silk sutures should be considered in patients with a history of intraocular surgery irrespective of other risk factors and length of time since procedure.

Purpose: To describe the case of a young boy affected by a rhegmatogenous retinal redetachment in whom the use of peripheral optical coherence tomography led the vitreoretinal surgeon to treat the patient with an additional surgery instead of a “watchful waiting” strategy. Methods: A 13-year-old boy was referred to the Vitreoretinal Department of the study institution affected by a macula-off rhegmatogenous retinal redetachment in his right eye secondary to a second blunt trauma. Three months before, he was treated with episcleral surgery and cryopexy as a result of a first traumatic rhegmatogenous retinal detachment. Once presented to the study Department for a second opinion, a complete ophthalmic examination and optical coherence tomographic scans of the peripheral retina were performed. Results: Preoperative best-corrected visual acuity was 20/63 (Snellen equivalent). Because the tomographic images clearly showed that the edges of the causative retinal break were not attached to the previous encircling buckle, a second episcleral surgery was performed. Postoperative peripheral optical coherence tomographic B-scans immediately revealed the effective indenting effect of the new scleral buckle, showing a complete reattachment of retinal break's edges. Despite some residual subretinal fluid, best-corrected visual acuity increased to 20/32 after 6 months of the surgery, and no retinal redetachment was observed. Conclusion: Pre- and postoperative peripheral optical coherence tomography may help the vitreoretinal surgeon to better evaluate the status of the adhesion between the outer retina and the retinal pigment epithelium after episcleral surgery, especially at the level of the retinal tears causing the retinal detachment. This observation could ultimately influence the surgical decision whether to treat if the suspect buckle's malpositioning is also detected on these images.

Rationale: We report a new scleral buckling technique using a 27-gauge endoilluminator and a wide-field viewing system to overcome the limitations of conventional indirect ophthalmoscope-methods and “chandelier-assisted” surgery. Patient concerns: A 26-year-old female patient visited the local clinic for floaters and lower visual field defects in her left eye that had occurred 5 days prior. Diagnoses: On fundus examination, upper retinal detachment without macular involvement and an atrophic hole was observed in her left eye. Interventions: Under general anesthesia and after perilimbal conjunctival incision, extraocular muscle isolation, and traction with black silk, a 27-gauge trocar-cannula was inserted 90° away from the retinal break, 4 mm away from the limbus. Under wide-field viewing using a contact lens, the fundus was observed through a surgical microscope. Retinal break was evaluated and cryopexy was performed with careful movement of the endoilluminator, paying attention to damage to the lens. The surgeon could accurately and freely control the direction of the illumination tip to obtain a brighter view of the region of interest. Outcomes: There were no complications associated with trocar cannula incision or the illuminator. The retina was successfully reattached. Lessons: Twenty seven gauge endoilluminator-assisted scleral buckling is an easy and safe procedure and provides better control over and free adjustment of the light direction, thus overcoming the limitations of chandelier-assisted surgery.

Purpose To evaluate rhegmatogenous retinal detachment (RRD) in eyes with retinoblastoma after intraarterial chemotherapy (IAC). Design Retrospective case series. Methods Chart review. Main outcome measure Development of RRD in the IAC era. Results Of 167 eyes in 157 consecutive patients, mean patient age at diagnosis of retinoblastoma was 19 months. Intraarterial chemotherapy was primary (75/167, 45%) or secondary (92/167, 55%). There were 10 eyes (10/167, 6%) that developed RRD after IAC. The RRD was mostly related to rapid tumor regression with atrophic retinal hole, occurring within one month (n = 8) or 12 months (n = 2) of IAC. Rhegmatogenous retinal detachment was found after primary (6/75, 8%) or secondary (4/92, 4%) IAC. Of primary cases, RRD was found in Group D (1/38 [3%], P = 0.1075) or Group E (5/30 [17%], P = 0.0348). For primary IAC (n = 75 eyes), RRD was found in endophytic (5/22 [23%], P = 0.0073), exophytic (0/29 [0%], P = 0.0760), or combined endophytic/exophytic pattern (1/24 [4%], P = 0.6575). A comparison of eyes with RRD (n = 10) versus without RRD (n = 157) found significant differences including greater mean age at presentation (38 vs. 18 months, P = 0.0522), greater 4-quadrant vitreous seeding (5/10, 50% vs. 27/157, 17%, P = 0.0236), and absence of subretinal fluid (3/10, 30% vs. 102/157, 65%, P = 0.0236). The cause of RRD was tumor regression-related atrophic retinal hole(s) in 7 (7/10, 70%) (unifocal [1/10, 10%] or multifocal [6/10, 60%] holes), cryotherapy-induced single atrophic hole in 2 (2/10, 20%), and single flap-tear from posterior vitreous detachment in one (1/10, 10%). In 4 (4/10, 40%) eyes with RRD, proliferative vitreoretinopathy was noted. The RRD was not related to intravitreal injection in any case, as in primary IAC no case had previous injection and in secondary IAC the injections were performed many months previously. Primary RRD repair involved pars plana vitrectomy in three, scleral buckle without drainage in one, laser barricade in one, and observation in five eyes. After 24 months mean follow-up, the retina showed complete reattachment (3/10, 30%), partial reattachment (2/10, 20%), and persistent detachment in all observed eyes (5/10, 50%). Enucleation was necessary for tumor recurrence (4/10, 40%) or neovascular glaucoma (1/10, 10%). There were no tumor-related metastases or death. Conclusion After IAC for retinoblastoma, RRD occurs in 6%, mostly in advanced eyes with extensive endophytic tumor and generally from atrophic retinal hole after rapid tumor regression.

Purpose To describe the treatment and natural history of a patient with complicated congenital retinoschisis. Methods A retrospective case report. A 10-month-old boy with congenital retinoschisis presented with tractional retinal detachments and foveal schisis in both eyes. Results On presentation, vision was decreased in both eyes with presumed amblyopia of the left eye. Funduscopic examination revealed bilateral foveal schisis and tractional retinal detachment involving the macula. Follow-up examination revealed superior retinal dragging and peripheral ischemia on fluorescein angiogram in both eyes. Nine months after presentation, combined rhegmatogenous and tractional retinal detachment developed in the right eye and was treated by scleral buckle. After vitrectomy for nonclearing vitreous hemorrhage in the left eye, a combined rhegmatogenous and tractional retinal detachment developed. Vitrectomy and lensectomy with silicone oil was performed. At 6 years of follow-up, both retinas were attached and foveal schisis had resolved. Conclusion Sight threatening complications of congenital retinoschisis include retinal detachment and vitreous hemorrhage. Vitrectomy and/or scleral buckling may prevent progression of vision loss and promote resolution of schisis.

To present and analyze the anatomical and functional outcomes for scleral buckling (SB) in a group of patients with rhegmatogenous retinal detachment without posterior vitreous detachment.A total of 244 patients underwent SB from 2005 through 2014 by a single surgeon (A.W.E.). Forty patients (45 eyes) were identified as fulfilling the criteria of presenting with a rhegmatogenous retinal detachment without posterior vitreous detachment. Visual outcomes, preoperative retinal findings, and the SB technique were analyzed. The main outcome measure was the primary reattachment rate at 6 months after single surgery.The mean age was 29 years (range 11-51 years). The mean follow-up period was 20 months. The mean refractive error was -5.16 diopters. Subretinal fluid drainage was performed in 17 eyes (37.8%). The anatomical success rate after single SB surgery at 6 months was 91.1%. The only factor that had statistically significant correlation with primary anatomical failure was development of subretinal hemorrhage during the drainage procedure (P = 0.03).Despite an increasing trend toward primary vitrectomy for rhegmatogenous retinal detachment, an indication for SB is in younger patients without a preexisting posterior vitreous detachment. We showed a 91.1% success rate with a primary SB and 100% with a second surgery.

PURPOSE To evaluate eyes with preexisting scleral buckles (SBs) that underwent placement of a 250 mm Baerveldt glaucoma drainage device (GDD). PATIENTS AND METHODS Records of all patients with a preexisting SB who underwent 250 mm Baerveldt GDD placement at the Kellogg Eye Center between January 1, 2005 and September 30, 2012 were reviewed. Outcome measures included visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications prescribed. RESULTS Seventeen eyes of 17 patients were analyzed. Mean follow-up was 23.9 months. Twelve eyes (70.6%) achieved successful control of IOP (

Purpose To evaluate the use of subtenon amikacin injection for the treatment of Nocardia asteroides orbital cellulitis in a patient with a history of scleral buckle surgery. Methods Case report. Results A 79-year-old diabetic woman presented with an 8-month history of diplopia, discharge, and swelling around her left eye. She had a scleral buckle surgery in this eye about 15 years ago. Examination of the left eye showed a visual acuity of 20/80, swollen and ptotic upper eyelid, chemotic conjunctiva, and limited extraocular motility. Magnetic resonance imaging showed an abscess under the scleral buckle. The scleral buckle was removed, and the abscess under the scleral buckle was drained. N. asteroides grew on the culture. Despite 4 months of the systemic trimethoprim/sulfamethoxazole and the topical fortified amikacin therapy, her infection worsened. After 5 monthly subtenon amikacin injections, the infection regressed dramatically, and her vision improved to 20/70. She used the systemic trimethoprim/sulfamethoxazole for 10 more months. After a 1-year follow-up, her external examination was normal, except for the left upper eyelid ptosis. Conclusion Subtenon amikacin injection can be added to the regimen for N. asteroides orbital cellulitis, of which surgical drainage, systemic and topical antibiotic therapies are not enough to control infection.

A 45-year-old man was originally referred for management of spontaneous subluxation of the inferior haptic of a 3-piece intraocular lens (IOL) into the anterior chamber of the right eye (). He had a significant past ocular history of laser-assisted laser in situ keratomileusis (LASIK) in both eyes, pars plana vitrectomy/scleral buckle for retinal detachment repair in the right eye, and pseudophakia in both eyes. The corrected distance visual acuity was 20/200 in the right eye and 20/20 in the left eye. Of note, he had severe iridodonesis, a 2+ pigmented cell in the anterior chamber without significant pseudophacodonesis and the posterior capsule was intact with striae. The referring physician attempted a refixation surgery that failed, and the patient was ultimately left aphakic.Next, a secondary 3-piece posterior chamber (PC) IOL (CT Lucia 602, Carl Zeiss Meditec AG) was fixated with the Yamane flanged intrascleral haptic fixation technique (ISHF). A surgical peripheral iridotomy (PI) was made with the vitrector to avoid pupillary capture postoperatively.On postoperative day 1 the patient had a well-centered PC IOL and uncorrected distance visual acuity (UCVA) of 20/30. However, on postoperative day 14 the patient complained of decreased vision as the UCVA dropped to 20/100 and pupillary capture of the optic was noted. In addition, there was a 3+ pigmented cell in the anterior chamber, pigment dusting on the anterior surface of the PC IOL, and an intraocular pressure (IOP) of 32 mm Hg ().What additional testing would you consider? How would you manage this patient's problem?

PURPOSE To describe the role of multiplanar reconstruction and three-dimensional volume-rendered imaging in the assessment of silicon-based scleral buckle (SB)-related complications. METHODS Five eyes of five patients with SB-related complications where the history, surgical notes, and clinical examination proved inconclusive were included. Unenhanced axial orbital computed tomography images of all patients were acquired parallel to orbitomeatal line, and images were reviewed in orthogonal planes. The volume rendition of the imaged volume was evaluated in various tilts, with special reference to the spatial relationship of the band-buckle to the globe and bony orbit. All patients underwent imaging-assisted SB removal. RESULTS Imaging assisted in in vivo localization of the obscure band or buckle in all five eyes. Band was seen as hyperdense structure encircling whole of the globe, whereas buckle was seen as segmental, broad, hyperdense structure with scleral indentation. Presence of SB was identified in three patients, and globe integrity was shown in the other two. Abnormal anterior displacement of band and buckle was demonstrated in three cases on volume-rendered imaging in relation to lateral orbital rim. Focal exuberant soft-tissue proliferation around the buckle was present in all patients, suggesting chronic inflammation and infection. Successful removal of band and buckle could be achieved, and all patients were relieved of their preoperative complaints. No complication occurred during intraoperative and postoperative period. CONCLUSION Use of multiplanar reconstruction and three-dimensional volume-rendered computed tomography imaging played a pivotal role in surgical success.

Purpose: To compare pars plana vitrectomy (PPV) with PPV combined with scleral buckle (PPV/SB) in the treatment of primary, noncomplex rhegmatogenous retinal detachment in an academic setting. Methods: Retrospective review of 74 consecutive cases that underwent either PPV or PPV/SB for primary rhegmatogenous retinal detachment at New York Presbyterian Hospital, Weill Cornell Medical College. Fifty-two eyes underwent PPV alone while 22 eyes had PPV combined with SB. All eyes had a minimum of 2 months of follow-up. The main outcome measure was single surgery anatomical success. Results: Patients in the PPV/SB group were less likely to be phakic (P = 0.05) and more likely to have an inferior retinal break (P = 0.001) when compared with the PPV group. Between groups, there was no difference in eyes with peripheral retinal lattice degeneration (P = 0.929), multiple breaks (P = 0.801), breaks seen preoperatively (P = 0.095), or those presenting with the macula off retinal detachment (P = 0.548). The majority of patients in both groups underwent small-gauge surgery (23 G or 25 G) (P = 0.65). Attachment of the retina was obtained in 100% of the patients in both groups at most recent follow-up. Single surgery anatomical success was similar between groups (83% PPV vs. 86% PPV/SB; P = 0.695). Mean best-corrected Snellen visual acuity improved in both groups (P = 0.75), with a final best-corrected Snellen visual acuity of 0.418 logMAR in the PPV group and 0.479 logMAR in the PPV/SB group (P = 0.61). When comparing PPV with PPV/SB, no difference in single surgery anatomical success existed after evaluating eyes with inferior breaks (P = 0.68), pseudophakia (P = 0.75), or when small-gauge surgery was performed (P = 0.76). Conclusion: We did not find significant differences in single surgery anatomical success, final anatomical success, or change in visual acuity when comparing PPV with PPV/SB in the repair of primary noncomplex rhegmatogenous retinal detachment in an academic setting where vitreoretinal fellows participate in key aspects of all cases.

To study the microbiological spectrum and in vitro susceptibility of bacterial isolates from explanted scleral buckles and to correlate clinical presentation to the causative agent.Medical records of patients who underwent buckle explantation from July 2007 to May 2012 were reviewed retrospectively. Clinical features and microbiological profile were noted and correlated.Twenty of 24 buckles (83.33%) from 24 patients grew 21 isolates. Isolates included 6 acid-fast bacilli (28.57%; atypical mycobacteria = 5, Nocardia asteroides = 1), 5 gram-positive bacilli (23.8%; Corynebacterium spp. = 4, Bacillus sp. = 1), 4 gram-positive cocci (19.0%; Staphylococcus spp. = 4), 2 gram-negative bacilli (9.5%; Pseudomonas aeruginosa = 2), and 4 fungi (19.0%; Aspergillus spp. = 3, Paecilomyces sp. = 1). Acid-fast bacilli and gram-negative bacilli were sensitive to amikacin and gram-positive bacilli and gram-positive cocci to vancomycin. Buckle exposure within 2 years of primary surgery tended to be noninfective (P = 0.06). Fungal or mycobacterial infections were more symptomatic than those with Corynebacterium species. Results of microscopic examination of conjunctival swab in 5 of 7 eyes (71.4%) were consistent with culture of conjunctival swab and explanted buckles.Clinical features and microscopic examination of conjunctival swab may give a lead toward the causative organism in suspected buckle infections. Based on these leads, vancomycin and amikacin may be used as the initial empirical therapy.

Purpose To determine the long-term risk of developing glaucoma after an encircling scleral buckle procedure. Methods Retrospective case series of patients with at least 10 years of follow-up who underwent successful, unilateral retinal detachment repair by encircling scleral buckle. The main outcome measure was the proportion of eyes that developed perimetric glaucoma of buckled compared with fellow eyes. Results Sixty-eight patients with an average postoperative follow-up of 21 years were included. Perimetric glaucoma developed in 13% (9 patients), and an additional 22% (15 patients) had preperimetric glaucoma or were glaucoma suspects. Perimetric glaucoma was present in 2.9% of patients in the buckled eye only, 8.8% in the fellow eye only (P = 0.27), and 1.3% in both eyes. There was no increased prevalence of ocular antihypertensive use in buckled (5.9%) compared with fellow eyes (11.8%, P = 0.36). Conclusion Our study showed no evidence of increased risk for developing glaucoma after repair of retinal detachment in eyes that underwent an encircling scleral buckling technique compared with fellow eyes with follow-up of at least 10 years.

To evaluate the efficacy, safety, and biodegradation of chitosan-gelatin scleral buckles in rabbit eyes.Segmental scleral buckling was performed on the left eye of each rabbit. There were 40 rabbits in chitosan-gelatin group and 20 rabbits in silicone sponge group. B-scan ocular ultrasonography was used to evaluate buckling effect. Retinal function after implantation was evaluated by electroretinograms. Tissue reaction and biocompatibility was examined by histology. Scanning electron microscope was used to analyze structural changes after episcleral implantation. Degradation of chitosan-gelatin was assessed by mass loss.Indentation of both implants decreased over time. However, the indentation created by chitosan-gelatin implant was lower than the silicone sponge one. Extrusion of implant was found in 20% eyes of silicone sponge group. Electroretinography revealed no detectable difference in retinal function between the two groups. Partially degraded chitosan-gelatin, newly formed capillaries, loose connective tissue, and some cell infiltration were found in chitosan-gelatin; however, only a slight cell infiltration was found in silicone sponge. Over a 9-month observation period, degradation rate of the chitosan-gelatin was about 36%.Chitosan-gelatin polymer was used effectively and safely as an implant for scleral buckling in a rabbit and showed good biodegradation.

To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal.A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present).Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD.Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.

Purpose: To report the efficacy of 23-gauge (G) pars plana vitrectomy with silicone oil injection in rhegmatogenous retinal detachment. Methods: Retrospective chart review of consecutive patients with retinal detachment who underwent pars plana vitrectomy by one of two surgeons using distinct and consistent methods. All patients undergoing 23-G pars plana vitrectomy did not have scleral buckling, whereas all patients undergoing surgery by 20-G pars plana vitrectomy had additional 240-band encircling scleral buckle. All patients received silicone oil tamponade. Patients with proliferative vitreoretinopathy Grade D, previous retinal detachment surgery, and penetrating eye injury were excluded. The main outcome measure was the final anatomical reattachment rate. The secondary outcome measures were the improvement in visual acuity and recurrence rate of retinal detachment after primary surgery. Results: Eighteen patients in the 23-G group and 21 patients in the 20-G group were analyzed. The mean age of the patients was 48.05 ± 10.37 years and 42.57 ± 17.84 years in the 23-G and 20-G groups, respectively. The mean follow-up duration was 5.9 months (range, 2–12 months) and 6.2 months (range, 4–9 months) in the 23-G and 20-G groups, respectively. The primary reattachment rate was 83.3% (95% confidence interval, 66.11%–100%) in the 23-G group and 86.8% (95% confidence interval, 67.81%–100%); P = 1.00) in 20-G group. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.30 ± 0.57 (Snellen equivalent 20/400) in the 23-G group and 1.27 ± 0.70 (Snellen equivalent 20/400) in the 20-G group (P = 0.80). The mean logarithm of the minimum angle of resolution visual acuity at 1 month after the surgery was 0.66 ± 0.25 (Snellen equivalent 20/100) in the 23-G group and 0.77 ± 0.50 (Snellen equivalent 20/120; P = 0.46) in the 20-G group. The visual acuity at the last visit was 0.80 ± 0.52 (20/125) versus 0.65 ± 0.44 (20/100) in the 23-G and 20-G, respectively (P = 0.32). Conclusion: Silicone oil injection with 23-G system is possible and is associated with favorable anatomical success in cases of rhegmatogenous retinal detachment.

Purpose The purpose of this study was to report the clinical characteristics and surgical outcome of familial exudative vitreoretinopathy-associated rhegmatogenous retinal detachment. Methods Retrospective interventional case series of patients with familial exudative vitreoretinopathy-associated rhegmatogenous retinal detachment. All cases had preoperative and postoperative clinical evaluations. Eyes were divided into three groups: no, moderate, and severe foveal dragging according to the status of fovea. Scleral buckling procedures or vitrectomy was performed to attach the retina. Results Twenty-four eyes in 22 patients were included in this study. The male to female ratio was 18:4. The average age was 16.42 ± 5.48 years. There were 14, 5, and 5 eyes in the no, moderate, and severe foveal dragging groups, respectively. Proliferative vitreoretinopathy was present in only one eye in the severe foveal dragging group. In the subgroup of eyes without foveal dragging, neither proliferative vitreoretinopathy, posterior located breaks, nor giant tears were noted. All eyes needed only scleral buckle to reattach the retina. In the subgroup with moderate foveal dragging, posterior located break was noted in one eye, which was the only eye in this group that needed vitrectomy besides scleral buckle to attach the retina. In eyes with severe foveal dragging, Stage D proliferative vitreoretinopathy was noted in one eye and posterior located break in one eye. Encircling buckle and vitrectomy were necessary in all eyes. The average number of operation is 1.1, 1.2, and 2.4 for each of the three groups, respectively. Final visual acuity improved in 23 of 24 eyes. Final retinal attachment was obtained in 95.8% of eyes (23 of 24). Conclusion Male predominance and juvenile onset are the main characteristics in familial exudative vitreoretinopathy-associated rhegmatogenous retinal detachment. Surgical success rates are comparable to rhegmatogenous retinal detachment unassociated with familial exudative vitreoretinopathy in cases without severe foveal dragging and are worse in the group with severe foveal dragging.

Purpose: To investigate the benefit of intravitreal bevacizumab as supplemental or primary treatment for retinopathy of prematurity. Methods: The files of nine consecutive infants treated with intravitreal bevacizumab for bilateral severe posterior retinopathy of prematurity were reviewed. Results: Gestational age was 24 weeks to 27 weeks, and birth weight was 660 g to 1,131 g. Indications for treatment were retinopathy of prematurity progression from Stage 3 to 4A or 2 to 3 with extraretinal neovascularization despite laser treatment; active neovascular Stage 4A disease after laser and cryo-treatment; anterior segment neovascularization and bleeding after laser treatment; and aggressive posterior disease with tunica vasculosa lentis and vitreous haze, which prevented laser treatment. One patient (two eyes) underwent lens-sparing vitrectomy after bevacizumab treatment; one eye acquired macular fold. One patient underwent bilateral scleral buckle. Bevacizumab treatment was associated with subsidence of the active vascular component in all eyes. Anatomical results were favorable in 17 eyes. There were no local or systemic complications. Conclusion: Intravitreal bevacizumab may serve as a supplemental therapeutic agent for severe laser-refractory retinopathy of prematurity or as monotherapy when media opacities preclude diode laser photocoagulation or the patient is too sick for lengthy laser treatment.

To assess the frequency and results of cataract surgery with concurrent vitrectomy due to zonule weakness in eyes with pseudoexfoliation (PXF).Private practice, Boston, Massachusetts, USA.This retrospective nonrandomized study assessed consecutive eyes with PXF having cataract surgery. High risk was defined as preoperative phacodonesis, iridodonesis, or lens subluxation (subgroup 1); preoperative anterior chamber depth or angle-depth asymmetry between eyes confirmed by slitlamp biomicroscopy or gonioscopy, respectively (subgroup 2); or complicated cataract extraction related to zonule weakness in the fellow eye (subgroup 3). Exclusion criteria were previous vitrectomy, scleral buckle, or trabeculectomy surgery and combined cataract-glaucoma surgery. A comparative analysis of outcome parameters was performed.Of the 1059 eyes evaluated, 38 had vitrectomy. Concurrent vitrectomy was required in 19 (15.6%) of 122 high-risk eyes and 19 (2.0%) of 937 non-high-risk eyes (P.00001). The need for concurrent vitrectomy was greatest in subgroup 3 (72.7%) and subgroup 1 (42.9%). There was no statistically significant difference between the vitrectomy group and the no-vitrectomy group in the mean improvement in logMAR corrected distance visual acuity (CDVA) (P = .38) or mean change in intraocular pressure (IOP) (mean decrease 2.6 mm Hg +/- 1.5 [SD] and 1.6 +/- 0.5 mm Hg, respectively) (P = .47).Despite the need for vitrectomy and the attendant increased demands in postoperative care, both the vitrectomy group and no-vitrectomy group had improved logMAR CDVA and IOP.No author has a financial or proprietary interest in any material or method mentioned.

Purpose To describe two patients with peripheral Coats disease-like tumor reaction years after surgical repair for rhegmatogenous retinal detachment. Methods Retrospective review of two clinical cases. Results Patient 1 presented with visual deterioration caused by a retinal angiomatous tumor and lipid exudates originating from telangiectatic vessels on the scleral buckle 8 years after vitrectomy and encircling band surgery for a giant retinal tear. In Patient 2, a vascularized retinal mass was detected during vitrectomy for a vitreous hemorrhage 24 years after scleral buckling procedures. Both patients were highly myopic and had no history of scleral perforation or angiomatous proliferation before surgery. They underwent vitrectomy and removal of the vascularized tumor. Histologic examination revealed wide lacunae filled with erythrocytes, connective tissue strands with inflammatory cells, and capillaries that showed thickened multilamellar basement membranes. Conclusion Secondary Coats disease-like tumor reaction may occur as a late complication years after successful retinal detachment surgery and may be caused by a chronic ischemic and inflammatory stimulus induced by prominent buckling elements in highly myopic eyes.

To determine the cause of the progressive glaucomatous visual field defects in three patients after an encircling scleral buckle for a rhegmatogenous retinal detachment (RRD).Scanning laser Doppler flowmetry and visual field tests were performed on three cases with unilateral progressive visual field defect after an encircling scleral buckling for a RRD. Similar measurements were made after the buckle was removed.After implanting the scleral buckle, the intraocular pressure was normal and chamber angle was open. The blood flow in the neuroretinal rim of the optic disk was lower than that in the healthy fellow eye. After removing the buckle, the blood flow improved to normal levels and a further worsening of the visual field was not detected.These results suggest that an encircling scleral buckle may impair choroidal circulation and lead to visual field defects similar to eyes with normal tension glaucoma.

PURPOSE We describe surgical outcomes in a single-surgeon, consecutive series of patients who received scleral buckle placement for primary retinal detachment using a modified external needle drainage technique. METHODS Eighty-two eyes of 80 patients with primary retinal detachment underwent scleral buckle placement with modified external needle drainage. Preoperative, postoperative, and surgical data were collected. Regression analysis was used to evaluate the association between preoperative clinical data and number of surgeries. RESULTS The retinal detachment most commonly involved 41% to 50% of the retina. Seventy-six eyes (92.7%) were repaired after 1 surgical procedure, 98.8%, after 2 procedures, and 100%, after 3 procedures. No preoperative clinical variables were found to be significantly correlated with the number of surgeries performed. Vision improved an average of 0.3 logarithm of the minimal angle of resolution or 3 lines of vision (P < 0.001). One eye (1.2%) developed a localized subretinal hemorrhage at the drainage site that resolved spontaneously. CONCLUSIONS The modified external needle drainage technique used during scleral buckle placement appears to be safe and effective in patients with primary retinal detachment.

Purpose The historical extrusion/explantation rate of silicone sponge scleral buckle exoplants is 3.5 to 24.4%. This contrasts with the published 0.6 to 1.2% explantation rate of solid silicone elements. Previously reported silicone sponge exoplants studies were noncircumferential (quadrantic or multiple). This study was undertaken to assess the long-term stability of 360 degrees circumferentially placed 3 x 5 mm silicone sponge exoplants. Methods Interventional case series of 840 consecutive circumferentially placed 3 x 5 mm silicone sponge exoplants. A retrospective review of operative reports and patient charts was performed. Results A total of 552 patients had documented follow-up over 1 year. Median follow-up was 32.8 months. Six patients underwent removal of the scleral buckling element (two for diplopia, one acute postoperative infection, and three for extrusion). Median time to removal was 7.3 months. Extenuating circumstances contributed to two of the three extrusions. Of the entire series, fewer than 1% of patients required removal of the silicone sponge implant. Excluding patients with less than 1 year of documented follow-up, the long-term infection/extrusion rate was 0.7%. Conclusions Circumferentially placed silicone scleral buckling sponge elements are very stable and are well tolerated. The explantation/extrusion rate is comparable to published solid silicone element series.

To compare the anatomical and functional outcome of scleral buckle (SB) surgery with that of pars plana vitrectomy (PPV) alone in the treatment of primary rhegmatogenous pseudophakic retinal detachment (RD).In this prospective, randomized clinical trial, 150 eyes of 150 patients with pseudophakic RD and proliferative vitreoretinopathy (PVR) stage B or less were randomized to SB surgery (75 eyes) or primary PPV (75 eyes). SB surgery involved break localization, cryotherapy, placement of a circumferential 240 style 2.5-mm solid silicone band, combined with a local buckle when indicated, and transscleral drainage of subretinal fluid. PPV included extensive vitreous removal, perfluoro-n-octane injection or endodrainage of subretinal fluid to flatten the retina, cryopexy treatment of breaks, and fluid/air exchange with injection of 20% SF6. Postoperative follow-up was 1 year. Break diagnosis, operating time, intraoperative and postoperative complications, retinal reattachment rate for single as well as multiple surgeries, axial length changes, and best-corrected visual acuity at 1 year after surgery were the main outcome measures.The number of eyes that were diagnosed with additional breaks inter-operatively was higher in the PPV group (P=0.004, chi test). Mean operating time was significantly less (P=0.0001, t-test) in the PPV group. With a single surgery, the retina was reattached in 62 eyes (83%) in the SB surgery group and in 71 eyes (94%) in the PPV group (P=0.037, Fisher exact test). With subsequent surgeries, final anatomical reattachment was achieved in 71 cases in the SB surgery group and in 74 cases in the PPV group (P=0.37, Fisher exact test). Mean axial length change at 1 year was 0.95 mm in the SB surgery group and 0.1 mm in the PPV group (P=0.0001, t-test). Mean final best-corrected visual acuity (logMAR) was 0.40 in the SB surgery group and 0.33 in the PPV group (P=0.26, t-test).Primary PPV offers potential advantages over SB surgery in the treatment of pseudophakic RD, including less operating time, accurate diagnosis of breaks, higher reattachment rate with a single surgery, and no postoperative axial length changes. Retinal reattachment rate with multiple surgeries and final visual acuity at 1 year were similar for SB surgery and PPV.

PURPOSE To evaluate the incidence and effect on visual acuity of complicating factors such as retinal tears (RTs) and rhegmatogenous retinal detachment (RRD) in eyes with posteriorly dislocated lens fragments after cataract extraction. METHODS Retrospective consecutive series of patients presenting at a referral vitreoretinal practice with posteriorly dislocated lens material after cataract extraction over a period of 8 years. The presence of RT, RRD, endophthalmitis, and choroidal hemorrhage was noted, and their effect on visual outcome was studied. RESULTS A total of 307 eyes with posteriorly dislocated lens material after cataract extraction were identified. Fifty-eight eyes (19%) were managed medically (Group I), whereas the other 249 eyes (81%) underwent pars plana vitrectomy for removal of the lens material (Group II). Indications for surgical management included uncontrolled inflammation, elevated intraocular pressure, and large lens fragments. No eyes in Group I developed RT or RRD. Of the 249 Group II eyes, 13 (5%) were found to have RT, and 25 (10%) developed RRD. In Group II, choroidal hemorrhage and endophthalmitis were noted in 12 (5%) and 4 (2%) eyes, respectively. Fifty-one (88%) of 58 eyes in Group I and 138 (55%) of 249 eyes in Group II achieved a final visual acuity of 20/40 or better. Seven (54%) of the 13 eyes with RT and 9 (36%) of the 25 eyes with RRD achieved a final visual acuity of 20/40 or better. In the RRD group, 9 (56%) of the 16 macula-on eyes achieved a final visual acuity of 20/40 or better, whereas none of the 9 macula-off eyes had a final visual acuity of 20/40 or better. None of the 4 eyes with endophthalmitis and only 1 (8%) of the 12 eyes with choroidal hemorrhage had a final visual acuity of 20/40 or better. Five (62%) of eight eyes with retinal detachment treated with pneumatic retinopexy needed further treatment with scleral buckle to achieve anatomical reattachment. CONCLUSION A good visual outcome (20/40 or better) is possible in eyes with posteriorly dislocated lens fragments after cataract extraction, even when retinal tears or macula-on retinal detachment is present. The presence of a macula-off retinal detachment, however, has a significant adverse effect on the visual outcome. Pneumatic retinopexy is not associated with retinal reattachment in many cases and is not preferred.

Purpose To report an unusual case of dizygotic twins, in whom one neonate developed acute retinal necrosis from herpes simplex virus (HSV) type 2. Methods Retrospective chart review. Results A 29-week-old premature infant from in vitro fertilization donor egg with negative maternal and fetal history for HSV-1 and HSV-2 developed vesiculopapular rash upon birth. Fundus examination revealed vitritis with retinal hemorrhages, suggestive of retinitis; the twin, however, had a normal funduscopic examination. A presumptive diagnosis of HSV infection was made, and the patient was started on intravenous acyclovir. Polymerase chain reaction of the anterior chamber fluid was positive for HSV-2; serology of both mother and child was HSV-2 IgG(+), IgM(-). Acute retinal necrosis was managed with 360° of bilateral peripheral laser cerclage. A subsequent rhegmatogenous retinal detachment in one eye was successfully treated with a scleral buckle. Retinal reattachment, macular pigmentary disturbances, and mild optic atrophy were noted at 6 months of follow-up. Conclusion The authors report a case of isolated congenital acute retinal necrosis in an otherwise healthy neonate, and product of a dichorionic, diamniotic in vitro fertilization pregnancy. Clinicians should consider possible HSV transmission from in vitro fertilization donor egg in the differential diagnosis, despite the negative fetal and maternal histories for HSV infection.

PURPOSE To investigate long-term complications of hydrogel buckles used in scleral buckling surgery for retinal detachment. METHODS Clinical records of 31 patients who underwent scleral buckle removal between April 1998 and April 2001 were reviewed. Removed buckles were examined by scanning electron microscopy (SEM). RESULTS Nineteen patients were men and 12 were women, with a mean age of 43 years. Initial scleral buckling surgery using hydrogel buckles had been performed between February 1988 and October 1995. Patients presented at a mean of 8.5 years postoperatively with complaints of symptoms such as foreign body sensation and diplopia, prompting buckle removal. Buckles from 28 eyes, left in place for 5.8 years or more, were discolored, friable, and swollen. Buckles from three eyes, left in place for 5.5 years or less, appeared grossly unaltered. One eye with buckle swelling associated with a large retinal cyst underwent buckle removal and vitrectomy. SEM of deteriorated buckles showed distortion of micropores when compared to grossly unaltered buckles and unused controls. CONCLUSIONS Severe deterioration of hydrogel buckles may occur when they are left in place for 5 years or longer and may cause adverse symptoms and rarely intraocular complications. This deterioration is associated with changes in the microstructural architecture of the hydrogel material.

PURPOSE To report the anatomic and visual results of retinal detachment in patients with Marfan syndrome in an Asian population. METHOD A retrospective review of all patients with Marfan syndrome and retinal detachment operated on by a single surgeon was conducted. RESULTS Thirteen eyes of 12 patients were reviewed. Eleven patients were males, with an average age of 24.6 years. Three eyes had a history of trauma. Ten eyes were successfully treated with scleral buckle and encircling band. Three eyes were also treated with vitrectomy, scleral buckle, and encircling band. One hundred percent success was achieved with only one surgery. Best-corrected visual acuity of at least 20/40 was achieved in 7 of 12 eyes (58.3%). Eight of 12 eyes (66.7%) had at least two lines of improvement on the Snellen chart after 6 months. CONCLUSIONS With appropriate surgical intervention, an excellent anatomic reattachment rate and good visual outcome can be achieved in Marfan syndrome patients with retinal detachment regardless of their lens status.

PURPOSE To evaluate the efficacy of preemptive analgesia in surgical repair of retinal detachment (RD) using scleral buckle and cryopexy under general anesthesia. METHODS Thirty patients who were scheduled for rhegmatogenous RD surgical repair using scleral buckle and cryopexy and who were American Society of Anesthesiologists physical status I, II, or III were included in this study. The patients were randomly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in Group 2, sub-Tenon anesthesia was given as preemptive analgesia after induction anesthesia and before start of surgery. Both groups were statistically comparable as regards patient age and weight and duration of anesthesia and surgery. RESULTS The incidences of intraoperative oculocardiac reflex and postoperative vomiting were significantly lower in Group 2 compared with Group 1 (P < 0.001 and 0.0113, respectively). The time of first postoperative analgesic dose was significantly shorter in Group 1 (46.67 +/- 18.84 minutes) compared with Group 2 (162.67 +/- 29.391 minutes) (P < 0.001). The total analgesic consumption per 24 hours was significantly higher in Group 1 compared with Group 2 (P < 0.001). The time of discharge from the hospital was significantly shorter in Group 2 (8.8 +/- 2.704 hours) compared with Group 1 (12.4 +/- 3.481 hours) (P = 0.0018). CONCLUSION The use of sub-Tenon block as preemptive analgesia after induction of general anesthesia and before the start of rhegmatogenous RD surgical repair was effective in reducing postoperative pain and analgesic requirements compared with an unblocked group. The use of sub-Tenon block was also effective in reducing intraoperative incidence of oculocardiac reflex and postoperative incidence of vomiting.

Purpose To describe traction retinal detachment as a complication of posterior dislocation of Descemet stripping automated endothelial keratoplasty (DSAEK) graft. Methods Vitrectomy surgery was performed in 3 eyes that developed posterior dislocation of DSAEK graft. Intraoperatively, the corneal tissue was found to be adherent to the retina. In 2 cases, a retinal detachment with proliferative vitreoretinopathy (PVR) was already present and the donor DSAEK flap was found to be fused with the retina. In 1 case, the retina was attached at the time of surgery but PVR subsequently developed despite near total removal of the graft, requiring an additional procedure to achieve retinal reattachment. Results Corneal tissue removal with a vitreous cutter was attempted in all cases. Residual tissue that had fused with the retina was left in place. Retinal reattachment was achieved with silicone oil injection in 2 cases and scleral buckle alone in 1 case. Conclusions Posterior segment dislocation of a DSAEK flap and its adherence to the retina may cause PVR and traction retinal detachment. Early removal is warranted when dislocation occurs.

Purpose This report describes the results of a prospective trial to evaluate the efficacy of pars plana vitrectomy (PPV) in conjunction with perfluoro-n-octane (PFO) as initial treatment of pseudophakic retinal detachment (RD) with no breaks diagnosed preoperatively. Methods Fourteen consecutive eyes presenting with pseudophakic RD in which retinal breaks could not be identified preoperatively underwent primary PPV, internal microsurgical identification of the retinal breaks with endoillumination and noncontact wide angle viewing system, PFO retinal reattachment, transscleral cryopexy or endolaser treatment of breaks, PFO-air exchange, and final injection of 20% sulfur hexafluoride. In five eyes, a scleral buckle was also used. Mean follow-up period was 18 months. Results In 13 of the 14 eyes in which no breaks had been identified preoperatively, breaks were diagnosed during surgery. Perfluoro-n-octane retinal attachment facilitated accurate microscopic treatment of retinal breaks. The retina was reattached with a single operation in all eyes. Eleven eyes had final visual acuity of 20/60 or better. Complications were minimal. Conclusions Pars plana vitrectomy in conjunction with PFO expression of subretinal fluid is effective in the initial treatment of pseudophakic RD with no preoperative diagnosis of retinal breaks.

PURPOSE To analyze visual and anatomic results following surgical repair of cytomegalovirus (CMV)-related retinal detachment (RD) without silicone oil permanent tamponade. METHODS We analyzed five consecutive patients (six eyes) with acquired immunodeficiency syndrome and CMV-related RD that were repaired with pars plana vitrectomy with peeling of the posterior hyaloid, laser photocoagulation, encircling scleral buckle, and intraocular gas tamponade. RESULTS Preoperative vision ranged from 20/40 to hand motion. Total retinal reattachment was achieved in five of six eyes (83%). Macular reattachment was achieved in all eyes. Mean postoperative visual acuity was 20/40 (range 20/30-20/60). Mean postoperative follow-up was 12 months (range 7-19 months). All patients in this series presented with low preoperative CD4+ T-lymphocyte counts (mean, 24 cells per microL) and received highly active antiretroviral therapy. One retina (Patient 1) redetached 7 months after initial repair and was successfully reattached without using silicone oil. Postoperatively, visual acuity remains 20/30, and total retinal reattachment has been maintained for 16 months. CONCLUSION Good anatomic and visual success can be achieved and maintained in CMV-related RD without the use of silicone oil.

PURPOSE To report a case of retinal degeneration associated with long-standing submacular fluid. METHODS Observational case report. RESULTS A 64-year-old African American woman with hand motion vision was found to have a macula-involving rhegmatogenous retinal detachment (RRD). Following an otherwise successful repair by pneumatic retinopexy, a small puddle of subretinal fluid persisted in the macula, limiting her vision to 20/70 at 1 month's time. Refusing further intervention, she experienced visual decline to 20/200 2 months postoperatively due to retinal degeneration seen as progressive retinal thinning and irregularity of the outer neurosensory retina on optical coherence tomography. CONCLUSION Although the literature suggests that submacular fluid following RRD repair by scleral buckle does not affect visual acuity, persistent submacular fluid may result in progressive retinal degeneration with concomitant vision loss as early as 2 months following repair.

Concussions, or mild traumatic brain injuries (mTBI), are on the forefront of sports medicine. There is a spectrum of symptoms associated with mTBI; some of which include blurriness, double vision, and light sensitivity. Further evaluation for nonconcussion-related causes is warranted if vision changes do not improve concurrently with other symptoms. Keeping in mind other less obvious injuries, including retinal detachment, is important when performing an initial evaluation or follow-up of an mTBI. Language: en