Natural history of asymptomatic clinical
retinal detachments.Am
J Ophthalmol. 2005
May;139(5):777-9.
PURPOSE: To
determine the natural history of asymptomatic, clinical
rhegmatogenous retinal detachment. DESIGN: Single observer,
prospective, consecutive, observational case series. METHODS:
Consecutive patients were included who were referred to the
author's clinical practice with rhegmatogenous retinal
detachment extending greater than two disk-diameters posterior
to the equator. Patients whose eye had an intraocular procedure
within the past year or who had a history of symptomatic retinal
detachment in the fellow eye were excluded. Eighteen eyes of 16
patients were followed for an average of 46 months. The main
outcome measure was progression of asymptomatic retinal
detachment to symptomatic retinal detachment. RESULTS: None of
the 18 asymptomatic, clinical, rhegmatogenous retinal
detachments became symptomatic. The posterior margin of one
retinal detachment slightly progressed 4 months into the study
and then stabilized for 4 years and remained asymptomatic.
CONCLUSIONS: Asymptomatic, clinical, rhegmatogenous retinal
detachments can probably be safely observed for many years.
Analysis
of symptoms associated with rhegmatogenous retinal detachments.Clin
Experiment Ophthalmol. 2004
Dec;32(6):603-6.
AIM: The
symptoms associated with rhegmatogenous retinal detachments are
variable and can be associated with other vitreoretinal and
neuro-ophthalmic entities. The present study sought to determine
the frequency and type of symptoms associated with
rhegmatogenous retinal detachment (RRD), and analyse any
relationships with the premorbid state. METHODS: An
observational case series was undertaken. A patient
questionnaire together with clinical data was collected for
patients presenting with RRD. RESULTS: The data on 141 patients
presenting with RRD were evaluated prospectively. More than 90%
of patients reported a variety of symptoms including visual
loss, floaters and flashes. The speed of visual loss was not
associated with the extent of retinal break. Rather
unexpectedly, patients with a history of retinal pathology were
not any more likely to be symptomatic either in their presenting
or fellow eye. The absence of symptoms was not associated with
age, high myopia or previous cataract surgery. CONCLUSION: Both
patients and physicians need to be aware of the importance of
the symptoms associated with RRD.
Diabetic
tractional retinal detachment.
Klin Monatsbl Augenheilkd.
2002 Apr;219(4):186-90.
Diabetic
tractional retinal detachment is a severe complication in
diabetic retinopathy. The decision for a surgical intervention
has to consider the spontaneous course of the disease,
intraoperative and postoperative complications and the expected
functional results. An extramacular tractional detachment can
remain stable for a long time and can be observed as long as the
centre of the macula is not threatened. Traction to the macula
can cause oedema and reduced vision, even if the macula itself
is not detached. In these cases vitreous surgery can improve
vision. Retinal breaks due to tractional membranes can cause a
traction-rhegmatogenous retinal detachment which is usually
rapidly progressive and requires early surgery. For cases with
tractional detachment of the macula there is no alternative to
surgery. In cases with long-standing and complete tractional
detachment with severe retinal ischaemia the functional
prognosis even after anatomically successful surgery is poor and
it may be better not to operate.
Late
recurrent retinal detachment after scleral buckling.J
Fr Ophtalmol. 2006 Nov;29(9):991-3.
PURPOSE:
To analyze the physiopathologic mechanism, therapeutic
modalities, and prognosis of late recurrent retinal detachment.
METHODS: A retrospective study was conducted on late recurrent
retinal detachment operated with episcleral surgery over a
15-year period. Ten patients were included in this study.
RESULTS: Late recurrent retinal detachments occurred in 0.39% of
all retinal detachments repaired by episcleral surgery over 15
years. Redetachment occurred 3-7 years after surgery, with
etiologies including new retinal breaks (seven cases), reopening
of old breaks (three cases), and removal of scleral explant (one
case). Proliferative vitreoretinopathy (PVR) grade B was seen in
three cases, grade C in six cases, and grade D in one case.
After reoperation, the retina was reattached in nine cases.
Three eyes were treated with scleral buckle, the others
underwent vitreoretinal surgery. Failure occurred in one patient
who had a very high level of vitreoretinal proliferation.
CONCLUSION: Late recurrent retinal detachments are rare and
vitreous base traction seems to be an important factor, although
the associated PVR was probably a secondary factor. Treatment
depends on PVR, with vitreoretinal surgery necessary in some
cases. They usually have a good prognosis.
Bilateral exudative retinal detachment as the first sign of
relapsing acute myelogenous leukaemia.Clin
Experiment Ophthalmol. 2006;34(6):623-5.
Bilateral
exudative retinal detachment is rarely seen as an ocular
manifestation of acute myelogenous leukaemia. Herein, a case is
described where a trans-scleral choroidal biopsy was used to
diagnose relapsing acute myelogenous leukaemia when the rest of
her systemic work-up was negative.
Concentration of neuron-specific enolase and S100 protein in the
subretinal fluid of rhegmatogenous retinal detachment.Graefes
Arch Clin Exp Ophthalmol. 2005 Nov;
243(11):1167-74. Epub 2005 May 20.
BACKGROUND: Neuron-specific enolase and S100 protein are markers
of neuronal lysis. To assess the neuronal suffering in
rhegmatogenous retinal detachment we quantified neuron-specific
enolase and S100 protein in the subretinal fluid. METHODS: The
puncture was performed in the sclera with a Merseture 5/0 round
needle, and the fluid was collected with a glass capillary tube.
Twelve subretinal fluid samples were obtained from 12 eyes with
rhegmatogenous retinal detachment undergoing retinal detachment
surgery. Vitreous from ten eyes with macular hole or epimacular
membrane served as negative control group, and vitreous
collected during cornea procurement from ten deceased patients
served as positive control group. RESULTS: The mean
concentration of neuron-specific enolase (in nanogrammes per
millilitre) was 602 in the subretinal fluid of rhegmatogenous
retinal detachment, 10.2 in the serum of these patients, 2.9 in
the vitreous of the negative control group, and 364 in the
positive control group. The mean concentration of S100 protein
(in nanogrammes per millilitre) was 104 in the subretinal fluid
of rhegmatogenous retinal detachment, <0.1 in the serum of these
patients and in the vitreous of the control negative group, and
11.18 in the positive control group. CONCLUSION: Neuron-specific
enolase (NSE) and S100 are known to be good markers of brain
stress and, thus, are good markers of retinal stress.
Bilateral exudative retinal detachments as the presenting
features of idiopathic orbital inflammation.Clin
Experiment Ophthalmol. 2005 Dec;33(6):671-4.
Idiopathic
orbital inflammation, also known as orbital pseudotumour, is a
term describing a spectrum of idiopathic, non-neoplastic,
non-infectious, space-occupying orbital lesion without
identifiable local or systemic cause. This disease occurs mainly
in young adults and typically presents with acute proptosis,
chemosis and limited extraocular movement. Herein an unusual
case of idiopathic orbital inflammation presenting with
bilateral exudative retinal detachment in a 9-year-old girl is
described. It demonstrates that prompt diagnosis and
corticosteroid treatment can yield good clinical response and
significant visual recovery.
Rhegmatogenous retinal detachment in children and youth--chosen
epidemiological features.Klin
Oczna. 2004;106(3 Suppl):453-5.
PURPOSE:
To assess chosen epidemiological features (risk factors) of
rhegmatogenous retinal detachment in young patients. MATERIAL
AND METHODS: Retrospective evaluation of patients aged up to 18
years with rhegmatogenous retinal: detachment hospitalized in
the Department of Ophthalmology, University of Medical Sciences
of Bydgoszcz--in the period between 1993-2003. Studied group
comprised 37 patients aged from 2 to 18 years. Excluded were the
patients with retinopathy of prematurity. RESULTS: Mean age in
the group studied was 12.6 (SD=3.6) years, over 80% were male.
In 88.9% at least one risk factor was found--the most common of
which was history of trauma (52.7%). Myopia was diagnosed in
27.7% of cases, in 8.3% patients cataract surgery had been
performed prior to retinal detachment. In 8.3% of patients in
group studied revealed congenital structural abnormalities. One
patient (2.8%) had toxocariasis. Bilateral retinal detachment
occurred also in one patient. The macula was detached in 75% and
total retinal detachment was present in 38.8% of cases.
CONCLUSIONS: The most common risk factor in the group studied
was history of nonsurgical trauma. Prevalence of macular
detachment was noted.
Traction
retinal detachment, optic atrophy, apallic syndrome after
shaking trauma in an infant.Ophthalmologe.
2002 Apr;99(4):295-8.
INTRODUCTION: Ophthalmological examinations are important in
children with suspected shaken baby and/or battered child
syndrome. Retinal and epiretinal haemorrhages can indicate
non-accidental injuries. We observed a case of extensive retinal
hemorrhages, edema of the optic disc followed by development of
optic atrophy, neovascularisation and tractional retinal
detachment over the course of months. CASE REPORT: A 6-week-old
infant with no history of systemic disease or trauma was
admitted to the children's hospital because of a disorder of
consciousness, respiratory insufficiency, taut fontanel and
dilated pupils with sluggish reaction to light. A subdural
haematoma was diagnosed. Ophthalmological examination showed no
signs of trauma in the anterior segment. Ophthalmoscopy revealed
extensive retinal haemorrhages and swollen optic nerve heads.
During the next months optic atrophy, subretinal fibrosis at the
posterior pole, neovascularisation at the optic disc and non-rhegmatogenous
retinal detachment developed. The child is in a persistent
vegetative state. DISCUSSION: Non-accidental injuries can cause
direct trauma and indirect traumatic sequelae. Retinal
haemorrhages, especially in conjunction with unexplained trauma
or changes of consciousness should arouse suspicion of shaken
baby syndrome. The ophthalmologist should emphasize this and
strongly recommend further investigation if not previously
undertaken.
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