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      Electroretinographic Changes Following Retinal Reattachment Surgery

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          Abstract

          Purpose

          To explore functional visual recovery after retinal reattachment surgery employing full-field electroretinography (ffERG).

          Methods

          In this case series, scotopic and photopic ffERGs were compared 2 days before, and 1, 3 and 6 months after successful scleral buckling for total rhegmatogenous retinal detachment (RRD). Main outcome measures were changes in ERG a-and b-wave amplitudes postoperatively.

          Results

          Twenty eyes of 20 patients including 14 male and 6 female subjects with mean age of 34.7±8.2 (range, 23 to 50) years were enrolled. Preoperatively, mean a-wave amplitude in the maximal combined response was 27.5±11.7 mV which was increased to 110.7±41.9 (P<0.001), 175.7±53.1 (p<0.001) and 174.6±51.4 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative a-wave amplitude of the cone ERG response was 2.1±0.8 mV, which was increased to 2.2±0.9 (P=0.03), 5.1±1.7 (P<0.001) and 5.3±1.6 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude in the maximal combined response was 97.6±28.9 mV which was increased to 179.2±44.9 (P<0.001), 264.2±56.3 (P<0.001) and 267.8±54.2 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude of the cone ERG response was 2.9±0.9 mV which was increased to 3±0.9 (P=0.32), 9.9±1.9 (P<0.001) and 9.8±1.9 (P<0.001) mV at 1, 3 and 6 months, respectively.

          Conclusion

          After retinal reattachment surgery, photoreceptor and visual function show parallel improvement. The scotopic ERG response recovered faster than the photopic response. Incomplete recovery of ERG parameters indicates that photoreceptor cell damage in retinal detachment is not completely reversible.

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          Most cited references35

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          Limiting photoreceptor death and deconstruction during experimental retinal detachment: the value of oxygen supplementation.

          To assess the role of hypoxia in causing the death and deconstruction of photoreceptors in detached retinas and the effectiveness of supplemental oxygen in limiting such damage. Retinal detachment was induced surgically in the right eye of each of 10 cats. The cats were allowed to survive surgery for 3 days. Two were kept for these 3 days in normoxia (room air, 21% oxygen) and eight in hyperoxia (70% oxygen). The retinas were examined for cell death by use of labels for normal and fragmenting DNA, with antibodies and a cone sheath-specific lectin to demonstrate the status of their inner and outer segments, the synaptic structures of the outer plexiform layer, and the distribution of basic fibroblast growth factor (bFGF) and with in situ hybridization to demonstrate bFGF mRNA. Retinal detachment without oxygen supplementation caused the death of some photoreceptors; the loss of cytochrome oxidase from the inner segments and the collapse of the outer segments of surviving photoreceptors; the loss of synaptophysin profiles from the outer plexiform layer; and the loss of bFGF protein from retinal neurons and neuroglia but not from retinal vessels. Oxygen supplementation (hyperoxia) during detachment mitigated all these changes, reducing photoreceptor death, maintaining the specialized structures of surviving photoreceptors, and stabilizing the bFGF within the retina. In experimental retinal detachment, hypoxia caused by the separation of outer retina from its normal source of nutrients is a factor in inducing the death and deconstruction of photoreceptors as well as in the loss of bFGF from the detached retina. Hyperoxia offered to human patients between diagnosis of retinal detachment and surgery may enhance the function of the reattached retina.
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            Northern New Zealand Rhegmatogenous Retinal Detachment Study: epidemiology and risk factors.

            The incidence of retinal detachment in New Zealand is not currently documented in the literature. This study sought to determine the annual incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors in northern New Zealand. Epidemiological and clinical data were collected for all patients presenting with a RRD in a 12-month interval in a confined geographical area of New Zealand. One hundred and forty-one patients presented between May 1997 and April 1998 with a RRD. Five patients presented with bilateral RRD. The mean age at presentation was 53.9 years and the annual incidence for RRD was 11.8 cases per 100,000 people. RRD was more common in males than in females (1.3:1). Ocular trauma, high myopia and cataract extraction were found to be significant risk factors in the development of RRD. The annual incidence of RRD in northern New Zealand is comparable to values reported for other parts of the world and, consistent with previous studies, the incidence of RRD was found to increase with age, and in association with trauma, high myopia and cataract surgery.
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              Neurite outgrowth from bipolar and horizontal cells after experimental retinal detachment.

              To study the responses of horizontal cells and rod bipolar cells, the second-order neurons in the retina, to the degeneration induced by experimental retinal detachment. Retinas from the eyes of domestic cats were examined 1, 3, 7, and 28 days after detachment using immunocytochemical and electron microscopic analyses. Retinal sections were labeled with antibodies to synaptophysin, calbindin D, and protein kinase C (PKC), proteins that serve as markers for synaptic terminals, horizontal cells, and rod bipolar cells, respectively. Beginning 1 day after detachment, the outer plexiform layer becomes disorganized and synaptophysin-labeled photoreceptor terminals are detected among the cell bodies of photoreceptors in the outer nuclear layer (ONL). At the same time, horizontal and rod bipolar cell processes grow into the ONL. In some cases, these processes contact photoreceptor terminals that have withdrawn deep into the ONL. Double-labeling experiments with antibodies to glial fibrillary acidic protein (Müller cell labeling) and phosphodiesterase gamma (cone labeling) demonstrate that the calbindin D- and PKC-positive neurite outgrowths are not derived from either Müller cells or cone photoreceptors. Horizontal and rod bipolar cell processes lengthen after retinal detachment, perhaps in response to a withdrawal of their presynaptic targets, the photoreceptor synaptic terminals. This apparent attempt to maintain synaptic contact after injury demonstrates a plasticity in the adult retina that may be of importance for the recovery of vision in human patients.
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                Author and article information

                Journal
                J Ophthalmic Vis Res
                J Ophthalmic Vis Res
                JOVR
                Journal of Ophthalmic & Vision Research
                Ophthalmic Research Center
                2008-2010
                2008-322X
                October 2013
                : 8
                : 4
                : 321-329
                Affiliations
                Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Mohsen Azarmina, MD. Department of Ophthalmology, Labbafinejad Medical Center, Boostan 9 St., Pasdaran Ave., Tehran 16666, Iran; Tel: +98 21 2258 5952, Fax: +98 21 2258 0607; e-mail: azarminam@ 123456yahoo.com
                Article
                JOVR-08-321
                3957038
                24653819
                8fd0be21-6592-4b70-b57d-0ee14254566a
                © 2013 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 26 January 2013
                : 17 March 2013
                Categories
                Original Article

                Ophthalmology & Optometry
                retinal detachment,electroretinography,visual function,retinal sensitivity

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