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      Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C 3 F 8) for retinal detachment

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          Abstract

          Purpose:

          To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD).

          Materials and Methods:

          A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C 3F 8) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded.

          Results:

          Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better.

          Conclusions:

          PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C 3F 8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.

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          Most cited references37

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          Vitrectomy: a pars plana approach.

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            Photoreceptor apoptosis in human retinal detachment.

            Although photoreceptor cell apoptosis has been demonstrated in various animal models of retinal detachment (RD), little is known about its occurrence in human RD. We sought to determine whether human photoreceptor cells undergo apoptosis in response to primary and recurrent RD. Prospective, clinical-pathologic, case series. Retinal tissue fragments excised during the course of vitreous surgery for RD and recurrent RD were frozen, cut into 4-mum sections, and analyzed using a TdT-dUTP terminal nick-end labeling assay for cell apoptosis. The onset of patient symptoms was used to estimate the duration of the RD. There were eight patients with primary RD and four patients with recurrent RD enrolled in this study. Duration of RD ranged from 1 to 180 days in the primary RD group, and 2 to 15 days in the recurrent RD group. All retinal tissue specimens had TUNEL-positive cells localized to the outer nuclear layer of the retina, consistent with the localization of photoreceptor cell bodies. TUNEL-positive cells were first identified at 24 hours, peaked by 2 days, and dropped to a low level by 7 days after RD. Recurrent RD induced a greater number of TUNEL-positive cells/mm(2) in the ONL compared with primary RD at corresponding timepoints after the onset of RD. In response to primary and recurrent RD, human photoreceptor cells follow a pattern of apoptosis that is similar to that seen in animal models of RD. This study suggests that photoreceptor cell apoptosis may be one of the causes of reduced vision after RD, especially those that involve the macula. Drugs that inhibit photoreceptor apoptosis may help improve the final visual prognosis of patients with RD.
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              Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases.

              Primary pars plana vitrectomy (PPPV) has gained widespread popularity in the treatment of rhegmatogenous retinal detachments (RRD). However, the surgical procedure is still flawed by a significant rate of anatomical and functional failures. The study was conducted to analyse the risk factors for a dissatisfying postoperative outcome. We carried out a retrospective study of 512 cases of PPPV with a minimum follow-up of 3 months from one institution over a 9-year period. Preoperatively, 24.8% of patients (127 out of 512) were pseudophakic, 16.4% (84 out of 512) highly myopic, 19.9% (102 out of 512) had preoperative proliferative vitreoretinopathy (PVR) and 14.6% (75 out of 512) had vitreous haemorrhage. The follow-up period ranged from 3 to 108 months (median 14.8). Retinal reattachment was achieved with one operation in 70.7% (362 out of 512) and after one or more operations in 97.5% of cases (499 out of 512). The major reasons for redetachments were new retinal breaks, followed by a combination of new breaks and PVR, and PVR without apparent breaks. Postoperative visual acuities of > or =0.1 and > or =0.4 were achieved in 82.8% (424 out of 512) and 48.2% (247 out of 512) respectively. Out of 376 phakic patients at study entry, 66.4% (250 out of 376) underwent cataract surgery either in combination with PPPV or during the postoperative course. Factors that were significantly associated with either anatomical or functional failure included duration of symptoms, low preoperative visual acuity, myopia, amblyopia, hypotony, macular detachment, preoperative PVR, extent of detachment, involvement of inferior quadrants, no detectable breaks, large breaks, breaks posterior to the equator, surgeon, level of surgical training, endocryotherapy, and combined scleral buckling surgery. Primary pars plana vitrectomy is still flawed by a relatively high primary redetachment rate following the initial procedure. The advantages of the technique are a high final reattachment rate and relatively good functional results in a subset of patients with more complicated types of RRD. The risk factors for postoperative failures following PPPV for RRD match to a large extent those following scleral buckling surgery (SBS). Future improvements of the technique will have to focus on modifiable risk factors, such as details of the surgical procedures, surgical training and case selection, to distinguish it from SBS.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                July 2014
                : 62
                : 7
                : 804-808
                Affiliations
                [1 ]Department of Ophthalmology, Rush University Medical Center, Chicago, USA
                [2 ]Department of Ophthalmology, Illinois Retina Associates, Harvey, Illinois, USA
                Author notes
                Correspondence to: Dr. Kourous A. Rezaei, Illinois Retina Associates, 71 West 156 th Street, Suite 400, Harvey, Illinois 60426-4265, USA. E-mail: mail: karezaei@ 123456yahoo.com
                Article
                IJO-62-804
                10.4103/0301-4738.138621
                4152652
                25116775
                8d09f3dd-84cf-4a7b-8964-bba2e09df5ac
                Copyright: © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 June 2013
                : 02 June 2014
                Categories
                Original Article

                Ophthalmology & Optometry
                retinal detachment,vitreous shaving,gas
                Ophthalmology & Optometry
                retinal detachment, vitreous shaving, gas

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