DOCSLIB.ORG

A Prospective Study of Biometric Stability After Scleral Buckling Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Prospective Study of Biometric Stability After Scleral Buckling Surgery A Prospective Study of Biometric Stability After Scleral Buckling Surgery CHEE WAI WONG, MARCUS ANG, ANDREW TSAI, VAL PHUA, AND SHU YEN LEE PURPOSE: To assess time to stabilization and factors HE USE OF SCLERAL IMPLANTS IN THE TREATMENT OF associated with changes in biometric parameters after rhegmatogenous retinal detachment (RRD) dates scleral buckling (SB). back to 1937, when Jess reported the use of a gauze T 1 DESIGN: Prospective case series. pad as the scleral implant. Schepens and associates intro- METHODS: Seventeen eyes with primary rhegmatoge- duced the modern scleral buckling (SB) technique in 1957, nous retinal detachment (RRD) that underwent SB at using a permanent implant such as polyethylene and, later, the Singapore National Eye Centre were enrolled. SB soft silicone rubber.1 This well-tolerated technique surgery was performed using an encircling element and increased the anatomic success rate of SB surgery from segmental buckle. Axial length (AL); anterior chamber 40% to 90%. However, the use of a scleral buckle inher- depth (ACD), defined as the distance from the corneal ently changes the anatomy of the eye. Depending on the epithelium to the anterior lens surface; anterior/posterior type of buckling material used, location, and tension of corneal curvature (K); and refraction were measured scleral sutures with the circumferential tightening of the preoperatively and at week 1 and months 1, 3, 6, 9, and buckle, the resultant geometric changes to the globe can 12 postoperatively. Stability of each parameter was cause visually significant changes. These changes include defined as the earliest time point at which there is no alteration of the axial length (AL),2–11 anterior chamber significant difference compared to its value at month 12. depth (ACD, defined as the distance from the corneal 7,9 RESULTS: AL increased (26.09 ± 1.46 to 26.51 ± 1.96, epithelium to the anterior lens surface), and induced P [ .01), ACD decreased (3.84 ± 0.47 to 3.32 ± 0.57, P spherical or astigmatic refractive errors.3,6,8,10,11 < .001), and a myopic shift of 1.04 diopters (95% CI These biometric changes are important, as cataract 0.03–2.05, P [ .04) occurred at month 12. Anterior/ development and/or progression happen commonly after posterior K were not significantly changed from baseline. vitreoretinal procedures. In the Scleral Buckling versus Pri- AL stabilized at month 3 while ACD and spherical equiv- mary Vitrectomy in RRD trial, almost half of all eyes that alent (SE) stabilized at week 1. Cryotherapy was associ- underwent SB developed or had progression of cataract ated with greater increase in AL (P [ .001) and after a mean follow-up duration of 387.6 6 180.6 days.12 myopic shift (P [ .02). More extensive segmental buck- In another recent study by Feng and Adelman,13 38% of ling was associated with greater increase in AL eyes developed cataracts after SB, of which 5.7% required (P [ .009) and myopic shift (P [ .03). extraction at a mean of 11 months after surgery. Nuclear CONCLUSIONS: Our study suggests that patients sclerosis and posterior subcapsular opacities were the requiring cataract surgery after SB should have biometry most common cataracts after SB.13 In a meta-analysis performed no earlier than 3 months post SB surgery, and done by Lv and associates, cataract formation post scleral intraocular lens power calculation with a fourth- buckle surgery was seen in 23.6% compared with 53.1% generation formula. A greater increase in AL and myopic in eyes that have undergone trans–pars plana vitrectomy shift was associated with cryotherapy and more extensive (TPPV) for primary RRD.14 segmental buckling. (Am J Ophthalmol 2016;165: However, there remains considerable uncertainty 47–53. Ó 2016 Elsevier Inc. All rights reserved.) regarding the optimal timing of biometric assessment and, thereafter, cataract surgery post RRD repair by SB. Some studies have shown changes in axial length and ante- rior chamber depth that continue beyond 12 months, while 2–9 Supplemental Material available at AJO.com. others have shown stabilization within 3 months. Accepted for publication Feb 19, 2016. Moreover, various parameters may be altered From Singapore National Eye Centre (C.W.W., M.A., A.T., V.P., differentially, which makes it difficult to predict how and S.Y.L.), Singapore Eye Research Institute (C.W.W., M.A., A.T., S.Y.L.), Duke-NUS, Department of Ophthalmology and Visual Sciences in which direction the overall refractive power of a post- (M.A., S.Y.L.), Singapore; and Moorfields Eye Hospital, NHS Trust, SB eye will change. Moreover, the effect of SB on posterior London, United Kingdom (M.A.). corneal astigmatism, increasingly recognized as an impor- Inquiries to Adjunct Assoc Prof Shu Yen Lee, Singapore National Eye 15 Centre, 11 Third Hospital Ave, Singapore 168751; e-mail: lee.shu.yen@ tant contributor to the total astigmatism of the eye, is snec.com.sg currently unknown. It is also unknown how other surgical 0002-9394/$36.00 Ó 2016 ELSEVIER INC.ALL RIGHTS RESERVED. 47 http://dx.doi.org/10.1016/j.ajo.2016.02.023 factors, such as the use of cryotherapy, gas tamponade, and 12, adjusting for multiple comparisons with Bonferroni extent of buckling, may influence changes in ocular correction. Stability of each parameter was defined as the biometry. earliest time point at which there was no significant differ- As patients with RRD repaired by SB tend to be younger, ence with its value at month 12. economically active patients,16 accurate biometry is impor- A linear mixed-effects model multivariate analysis was tant to achieve good outcomes should they require cataract conducted to account for repeated measurements and loss surgery subsequently. Thus, we conducted a prospective of some follow-up data. Variance-covariance/correlation longitudinal study to assess the biometric changes after structures such as compound symmetry and independent SB surgery and the influence of surgical factors on biomet- and autoregressive structures were used to estimate the ric changes. model fit based on Hurvich and Tsai’s criterion (AICc) and using the smaller-the-better information criterion. This model was used to analyze the multivariate relation- ship of biometric parameters with clock hours of scleral METHODS buckling, cryotherapy, and endotamponade, adjusting for age and sex. Significance was defined as P < .05. IN THIS PROSPECTIVE STUDY, WE INCLUDED CONSECUTIVE cases with primary RRD requiring SB surgery without vitrectomy, at the Singapore National Eye Centre, be- tween May 2012 and March 2013. The study was performed RESULTS with prospective approval from the Singhealth Institu- tional Review Board and in accordance with the Declara- TABLE 1 SHOWS THE BASELINE DEMOGRAPHICS AND CLIN- tion of Helsinki. Written informed consent was obtained ical characteristics of our study cohort. The mean age was from all participants. All scleral buckling procedures were 47.0 6 13.9 years and 62.5% of subjects were male. Most performed by 4 senior vitreoretinal surgeons using the eyes were phakic with no lens opacity (64.7%) preopera- same surgical technique, briefly: encirclage with silicone tively, while none of the study eyes had proliferative bands (reference number 240; MIRA Inc, Uxbridge, Mas- vitreoretinopathy. The most commonly used segmental sachusetts, USA) and segmental silicone tires. The encir- buckle was the 277 (13 eyes, 76.5%), followed by the cling band was fixed 10–12 mm posterior to the limbus 276 (3 eyes, 17.6%). The vast majority of eyes underwent with a 5.0 nylon suture. External drainage of subretinal drainage of subretinal fluid (94.1%). Gas tamponade was fluid was performed where possible. Retinopexy with performed with either air (41.2%) or sulfur hexafluoride cryotherapy intraoperatively and endotamponade with (47.1%). Intraoperative cryotherapy was the preferred injection of air or an expansile gas were additional proce- method of sealing retinal breaks (70.6%). Primary dures performed at the surgeon’s discretion. Postopera- anatomic success was achieved in 100% of patients. tively, all patients routinely used Tobradex eye drops 4 Three eyes with pre-existing cataract had significant times daily and atropine sulfate 1% 3 times daily for progression of the cataract (17.6%), but none of these 2–4 weeks. The following SB surgery–related variables eyes underwent cataract surgery within the duration of were collected: type and extent of segmental silicone tire, the study. whether subretinal fluid drainage was performed, whether The mean values of biometric parameters at each time cryotherapy or postoperative laser retinopexy was point are shown in Table 2. SB surgery resulted in performed, and the use of endotamponade. significantly longer AL (26.09 6 1.46 mm vs We performed a full clinical evaluation and all measure- 26.51 6 1.96 mm, P ¼ .01) and vitreous length (VL) ments were made pre- and postoperatively at 1 week and at (22.25 6 1.66 mm vs 23.26 6 0.28 mm, P ¼ .001), as 3, 6, 9, and 12 months, specifically: axial length measure- well as shallower ACD (3.84 6 0.47 mm vs ments by IOLMaster (Carl Zeiss Meditec, Jena, Germany; 3.32 6 0.57 mm, P < .001) at 12 months after surgery, software version 5.4), ACD in the horizontal meridian compared to preoperative values. Overall manifest using anterior segment optical coherence tomography astigmatism increased initially at week 1 (ASOCT; Visante; Carl Zeiss Meditec, Jena, Germany; (cylinder: À1.56 6 1.05 diopters [D]) but decreased back software version 3.0),17 automated refraction, automated to preoperative levels at month 12 (À0.81 6 0.28 D). keratometry (Topcon KR 8800 Auto-kerato- Both anterior and posterior cornea astigmatism increased refractometer; Topcon Corporation, Tokyo, Japan), and post SB to a maximum of 2.01 6 1.13 D (baseline corneal topography with the Pentacam (Oculus GmbH, 1.26 6 0.67 D) and 0.40 6 0.26 D (baseline 0.24 6 0.20 Wetzlar, Germany; software version 1.17).
Load more

Recommended publications
  • Interactions Between Biomaterials and the Sclera: Implications on Myopia
    Interactions between Biomaterials and the Sclera: Implications on Myopia Progression by James Su A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Vision Science in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Christine F. Wildsoet, Chair Professor Kevin E. Healy Professor Xiaohua Gong Fall 2009 Interactions between Biomaterials and the Sclera: Implications on Myopia Progression © 2009 by James Su University of California, Berkeley Abstract Interactions between Biomaterials and the Sclera: Implications on Myopia Progression by James Su Doctor of Philosophy in Vision Science University of California, Berkeley Professor Christine F. Wildsoet, Chair Myopia prevalence has steadily climbed worldwide in recent decades with the most dramatic impact in East Asian countries. Treatments such as eyeglasses, contact lenses, and laser surgery for the refractive error are widely available, but none cures the underlying cause. In progressive high myopia, invasive surgical procedures using a scleral buckle for mechanical support are performed since the patient is at risk of becoming blind. The treatment outcome is highly dependent on the surgeon’s skills and the patient’s myopia progression rate, with limited choices in buckling materials. This dissertation, in four main studies, represents efforts made to control high myopia progression through the exploration and development of biomaterials that influence scleral growth. First, mRNA expression levels of the chick scleral matrix metalloproteinases, tissue- inhibitor of matrix metalloproteinases, and transforming growth factor-beta 2 were assessed for temporal and defocus power effects. The first study elucidated the roles that these factors play in scleral growth regulation and suggested potential motifs that can be incorporated in future biomaterials design.
    [Show full text]
  • Refractive Changes After Scleral Buckling Surgery
    Refractive changes after scleral buckling surgery Alterações refracionais após retinopexia com explante escleral João Jorge Nassaralla Junior1 ABSTRACT Belquiz Rodriguez do Amaral Nassaralla2 Purpose: A prospective study was conducted to compare the refractive changes after three different types of scleral buckling surgery. Methods: A total of 100 eyes of 100 patients were divided into three groups according to the type of performed buckling procedure: Group 1, encircling scleral buckling (42 patients); Group 2, encircling with vitrectomy (30 patients); Group 3, encircling with additional segmental buckling (28 patients). Refractive examinations were performed before and at 1, 3 and 6 months after surgery. Results: Changes in spherical equivalent and axial length were significant in all 3 groups. The amount of induced astigmatism was more significant in Group 3. No statistically significant difference was found in the amount of surgically induced changes between Groups 1 and 2, at any postoperative period. Conclusions: All three types of scleral buckling surgery were found to produce refractive changes. A correlation exists between additional segments and extent of refractive changes. Keywords: Retinal detachment/surgery; Scleral buckling/adverse effects; Refraction/ ocular; Biometry INTRODUCTION During the past several years, our Retina Service and others(1) have continued to use primarily solid implants with encircling bands. Only occa- sionally episcleral silicone rubber sponges are utilized. Changes in refrac- tion are frequent after retinal detachment surgery. The surgical technique used appears to influence these changes. Hyperopia(2) and hyperopic astig- matism may occur presumably by shortening the anteroposterior axis of the globe after scleral resections(1). Scleral buckling procedures employing an encircling band generally are expected to produce an increase in myopia and myopic astigmatism(1,3).
    [Show full text]
  • Anesthesia Management of Ophthalmic Surgery in Geriatric Patients
    Anesthesia Management of Ophthalmic Surgery in Geriatric Patients Zhuang T. Fang, M.D., MSPH Clinical Professor Associate Director, the Jules Stein Eye Institute Operating Rooms Department of Anesthesiology and Perioperative Medicine David Geffen School of Medicine at UCLA 1. Overview of Ophthalmic Surgery and Anesthesia Ophthalmic surgery is currently the most common procedure among the elderly population in the United States, primarily performed in ambulatory surgical centers. The outcome of ophthalmic surgery is usually good because the eye disorders requiring surgery are generally not life threatening. In fact, cataract surgery can improve an elderly patient’s vision dramatically leading to improvement in their quality of life and prevention of injury due to falls. There have been significant changes in many of the ophthalmic procedures, especially cataract and retinal procedures. Revolutionary improvements of the technology making these procedures easier and taking less time to perform have rendered them safer with fewer complications from the anesthesiology standpoint. Ophthalmic surgery consists of cataract, glaucoma, and retinal surgery, including vitrectomy (20, 23, 25, or 27 gauge) and scleral buckle for not only retinal detachment, but also for diabetic retinopathy, epiretinal membrane and macular hole surgery, and radioactive plaque implantation for choroidal melanoma. Other procedures include strabismus repair, corneal transplantation, and plastic surgery, including blepharoplasty (ptosis repair), dacryocystorhinostomy (DCR)
    [Show full text]
  • Retinal Occlusion As an Advanced Complication of Sickle Cell Disease Mohammed S Alkhaibari* Ministry of Health, Tabuk, Saudi Arabia
    New Frontiers in Ophthalmology Review Article ISSN: 2397-2092 Retinal occlusion as an advanced complication of sickle cell disease Mohammed S Alkhaibari* Ministry of Health, Tabuk, Saudi Arabia Abstract Retinopathy is a one of the major clinical manifestation of Hemoglobinopathy. It is acquired secondary to another retinal disorder. Retinopathy especially retinal occlusions are painless loss of monocular vision it’s from a vascular disorder. Ocular stroke caused by embolism in a retinal artery, that may emboli travel to distal branches of the retinal artery, causing loss of other section in the visual field. The manifestations of Sickle cell disease ocular manifestations came due to vascular occlusion, which may exist in the conjunctiva, iris, retina, and choroid. Because the ocular changes produced by SCD could be shown in other diseases, it’s important to except other occlusions’ causes, which have included central retinal vein occlusion, Eales disease, and retinopathy secondary to other chronic disorders. Other ocular changes cause that includes polycythemia vera, familial exudative vitreoretinopathy, talc and cornstarch emboli, and uveitis. Diagnosis of hemoglobenopathies is performed exclusively through Hb electrophoresis. The treatments and their results vary from one condition to the other. Introduction by valine, while in HbC it is replaced by lysine. The diagnosis of hemoglobinopathies is performed exclusively through hemoglobin Sickle-cell anaemia is a hereditary condition (SS or SC haemoglobin) electrophoresis [4]. The sickling test cannot be used for this purpose common in African people. Owing to occlusion of small vessels at the because it is nonspecific [5]. retinal periphery and ischemia, fibro-vascular proliferation occurs. Localized chorio-retinal scars are also characteristic of the condition.
    [Show full text]
  • Managing a Case of Buckle Intrusion with Recurrent Vitreous Haemorrhage: a Case Report Sharan Shetty1 and Muna Bhende2
    Case Report Managing a case of buckle intrusion with recurrent vitreous haemorrhage: a case report Sharan Shetty1 and Muna Bhende2 1Fellow, Introduction preferred in view of high chance of intraoperative Sri Bhagwan Mahavir Scleral buckling (SB) with silicone implants is an globe rupture. However, patient did not undergo Vitreoretinal Services, effective method to reattach the retina. Silicone the surgery and reported back to us after 3 Sankara Nethralaya, Chennai, India implants used for SB in retinal detachment months. Anterior migration of the scleral buckle surgery have been associated with various compli- was noted this visit. Patient was taken up for cations which include buckle infection, granuloma scleral buckle removal along with trimming the 2Senior Consultant & Deputy formation, extrusion of the implant through the encirclage over the segmental buckle element. Director, conjunctiva, double vision and restriction of An external approach was planned for buckle Sri Bhagwan Mahavir ocular motility. Intrusion of the implant through removal. A standby scleral graft was made Vitreoretinal Services, the sclera may develop due to progressive scleral available to patch any visible scleral defect. The Sankara Nethralaya, 1 Chennai, India thinning. conjunctiva and the tenons were dissected of Intrusion is defined as erosion, followed by the scleral buckle in the supero-temporal quad- protrusion of the scleral implant into the vitreous rant. The two anchor sutures were cut and Correspondence: cavity. The intruding material may either be the removed. The buckle element was cut at the Muna Bhende, material implanted on the sclera or the sutures. centre and gentle expressed out. The encirclage Deputy Director and Senior Intrusion of the buckle through the sclera into the over the buckle was trimmed and edges were Consultant, fi Sri Bhagwan Mahavir subretinal space is particularly dif cult to manage repositioned into the sub-tenons space.
    [Show full text]
  • SURGICAL APPROACH to SICKLE CELL RETINOPATHY RETINA PEARLS RETINA Recommendations for Successful Surgery in These Challenging Cases
    SURGICAL APPROACH TO SICKLE CELL RETINOPATHY RETINA PEARLS RETINA Recommendations for successful surgery in these challenging cases. BY CINDY X. CAI, MD, AND ADRIENNE W. SCOTT, MD Sickle cell disease (SCD), AVOIDING SURGERY first described by James In our anecdotal experience, intravitreal injection with an Herrick in 1910, is the most anti-VEGF agent may be useful in facilitating the involution common inherited blood of sea-fan neovascularization and clearing vitreous hemor- disorder in the United rhage, potentially avoiding the need for surgery. It is known States and worldwide.1,2 It is that SCD leads to peripheral retinal ischemia that can be eas- caused by the inheritance of ily seen on ultrawide-field fluorescein angiography (Figure 1). abnormal beta globin alleles The peripheral ischemia leads to the release of proangiogenic carrying the sickle mutation on the hemoglobin gene. The factors such as VEGF and formation of the characteristic mutations most frequently associated with ophthalmic sea-fan neovascular complexes. Therefore, there is a biologic changes are HbSS and HbSC disease, two of the most com- rationale for intravitreal injection of anti-VEGF agents such mon types of SCD.3 as bevacizumab (Avastin, Genentech) for the regression of The ophthalmic manifestations of SCD range from sickle neovascularization.11-13 Other authors have reported nonproliferative to proliferative changes, but the major this as well in case reports.12,14 Similar success has also been sight-threatening complication in SCD is proliferative reported with ranibizumab (Lucentis, Genentech).15 sickle cell retinopathy (PSR).4 Large-scale population- based studies indicate that the prevalence of PSR is as high as 32% in HbSC and 6% in HbSS.5 More specifically, symptomatically decreased vision typically occurs only in the last two stages of PSR—Goldberg stage IV (pres- ence of vitreous hemorrhage) and Goldberg stage V AT A GLANCE 6,7 (presence of retinal detachment).
    [Show full text]
  • Sickle Cell Retinopathy. a Focused Review
    Graefe's Archive for Clinical and Experimental Ophthalmology https://doi.org/10.1007/s00417-019-04294-2 REVIEW ARTICLE Sickle cell retinopathy. A focused review Maram E. A. Abdalla Elsayed1 & Marco Mura 2 & Hassan Al Dhibi2 & Silvana Schellini3 & Rizwan Malik4 & Igor Kozak5 & Patrik Schatz2,6 Received: 11 December 2018 /Revised: 23 February 2019 /Accepted: 10 March 2019 # The Author(s) 2019 Abstract Purpose To provide a focused review of sickle cell retinopathy in the light of recent advances in the pathogenesis, multimodal retinal imaging, management of the condition, and migration trends, which may lead to increased prevalence of the condition in the Western world. Methods Non-systematic focused literature review. Results Sickle retinopathy results from aggregation of abnormal hemoglobin in the red blood cells in the retinal microcirculation, leading to reduced deformability of the red blood cells, stagnant blood flow in the retinal precapillary arterioles, thrombosis, and ischemia. This may be precipitated by hypoxia, acidosis, and hyperosmolarity. Sickle retinopathy may result in sight threatening complications, such as paracentral middle maculopathy or sequelae of proliferative retinopathy, such as vitreous hemorrhage and retinal detachment. New imaging modalities, such as wide-field imaging and optical coherence tomography angiography, have revealed the microstructural features of sickle retinopathy, enabling earlier diagnosis. The vascular growth factor ANGPTL-4 has recently been identified as a potential mediator of progression to proliferative retinopathy and may represent a possible thera- peutic target. Laser therapy should be considered for proliferative retinopathy in order to prevent visual loss; however, the evidence is not very strong. With recent development of wide-field imaging, targeted laser to ischemic retina may prove to be beneficial.
    [Show full text]
  • Atypical Indication of Scleral Buckling in Primary Rhegmatogenous
    per m Ex i en & ta l l a O ic p in l h Journal of Clinical & Experimental t C h f a o l m l a o Rusnak et al., J Clin Exp Opthamol 2018, 9:4 n l o r g u o y Ophthalmology J DOI: 10.4172/2155-9570.1000736 ISSN: 2155-9570 Case Report Open Access Atypical Indication of Scleral Buckling in Primary Rhegmatogenous Retinal Detachment Stepan Rusnak*, Lenka Hecova and Zdenek Kasl Department of Ophthalmology, University Hospital in Pilsen, Czech Republic *Corresponding author: Stepan Rusnak, Department of Ophthalmology, University Hospital in Pilsen, Czech Republic, Tel: +420603448650; E-mail: [email protected] Received date: July 24, 2018; Accepted date: August 27, 2018; Published date: August 31, 2018 Copyright: ©2018 Rusnak S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract An optimal surgical solution for primary rhegmatogenous retinal detachment (RRD) is the subject of discussion. There are certain surgical methods available such as scleral buckling, pars plana vitrectomy (PPV), pneumatic rhetinopexy and combinations of these. Scleral buckling is considered to be the first-choice of surgical techniques in uncomplicated phakic primary rhegmatogenous retinal detachment cases, especially in young patients with clear optic medias with absent or mild proliferative vitreoretinopathy. After a reliable evaluation of a complex preoperational finding, scleral buckling can be efficient option in some atypical indications as well. Also, using scleral buckling, some primary PPV risks can be avoided as well.
    [Show full text]
  • Combined Rhegmatogenous and Traction Detachment Associated with Vasoproliferative Tumor Secondary to Sickle Cell Retinopathy
    American Journal of Ophthalmology Case Reports 4 (2016) 4e6 Contents lists available at ScienceDirect American Journal of Ophthalmology Case Reports journal homepage: http://www.ajocasereports.com/ Case report Combined rhegmatogenous and traction detachment associated with vasoproliferative tumor secondary to sickle cell retinopathy * Qiancheng Wang a, Shelley Day b, c, Peter A. Nixon b, c, Robert W. Wong b, c, a University of North Carolina, Chapel Hill, NC, USA b Austin Retina Associates, Austin, TX, USA c Department of Surgery, Texas A&M Health Science Center, Bryan, TX, USA article info abstract Article history: Purpose: To report the surgical management of a combined rhegmatogenous and traction retinal Received 22 January 2016 detachment associated with a vasoproliferative tumor secondary to sickle cell retinopathy. Received in revised form Observations: A 29 year old man from Ghana presented with unilateral vision loss, ischemic retina and 16 June 2016 sea fan neovascularization in both eyes and a retinal detachment nearby a vasoproliferative tumor (VPT) Accepted 30 June 2016 in the left eye. Hemoglobin electrophoresis led to the diagnosis of sickle cell disease. The patient un- Available online 4 July 2016 derwent vitrectomy with scleral buckle surgery, resection of the tumor, and removal of subretinal membranes in the left eye. Laser photocoagulation was targeted to areas of ischemic retina in both eyes. Keywords: fi Vascular endothelial growth factor Conclusions: and Importance: To our knowledge, this is the rst report of a combined rhegmatogenous Sickle cell SC disease and traction retinal detachment associated with a VPT in sickle cell retinopathy managed by modern Retinal angioma vitrectomy techniques.
    [Show full text]
  • Diagnosis and Treatment of Hemoglobinopathy and Retinopathy of Sickle Cells
    International Journal of Research Studies in Medical and Health Sciences Volume 3, Issue 11, 2018, PP 20-23 ISSN : 2456-6373 Diagnosis and Treatment of Hemoglobinopathy and Retinopathy of Sickle Cells Luis E. Abad1, Cruz Ruiz Gali Mauro2, Buy Rodrigo Andres2, BuyRubén Exequiel2 1 Directorat Of talmoAbad, Clínicade Ojos, Río Gallegos, Santa Cruz, Patagonia Argentina. 2Resident of Ophthalmology, Of talmoAbad, Clínica de Ojos, Río Gallegos, Santa Cruz, Patagonia Argentina. *Corresponding Author: Dist. Prof. Dr. Luis Emilio Abad, Directorat Of talmoAbad, Clínicade Ojos, Río Gallegos, Santa Cruz, Patagonia Argentina INTRODUCTION Stage 2: Peripheral arteriovenous anastomoses begin to appear as existing We can consider sickle hemoglobinopathiesare dilated capillary channels. After vascular due the presence of one or several abnormal occlusion, the peripheral retina appears for hemoglobins with abnormal red blood cell the most part avascular and with no capillary formation under conditions of hypoxia and perfusion. acidosis. Stage 3: Presents the beginning of The deformed red cells are rigid, being able to neovascularization from the anastomoses. In obstruct the small blood vessels and cause the beginning, the new vessels remain flat in hypoxia. the retina and show a fan-shaped In a normal erythrocyte, hemoglobin. Which is configuration (neovascularization in "sea composed of four alpha chains and two beta fan", this name resembles a marine chains. At the position of glutamic acid in the invertebrate). beta chain is precisely where we can find a point of mutation. If it was replaced by the lysine, we Stage 4: It is characterized by the presence of will have the formation of a hemoglobin. If we vitreous hemorrhage of variable degree.
    [Show full text]
  • Scleral Buckling Versus Vitrectomy for Primary Rhegmatogenous Retinal Detachment Aditya Maitray1, V Jaya Prakash2 and Dhanashree Ratra3
    Major Review Scleral buckling versus vitrectomy for primary rhegmatogenous retinal detachment Aditya Maitray1, V Jaya Prakash2 and Dhanashree Ratra3 1Fellow, Introduction include increased postoperative morbidity like Sri Bhagwan Mahavir Retinal detachment (RD) surgery is the most pain and periorbital oedema, drainage-related Vitreoretinal Services, common retinal surgery performed. RD can be complications like vitreoretinal incarceration, sub- Sankara Nethralaya, Chennai, India repaired either by scleral buckling (SB) or pars retinal haemorrhage and choroidal detachment, plana vitrectomy (PPV). Pneumoretinopexy, laser diplopia due to muscle restriction, chorioretinal delimitation or observation can be done in circulatory disturbances, refractive changes (typic- 2Associate consultant, selected cases. The decision to perform SB or ally axial myopia), epiretinal membrane forma- Consultant, vitrectomy depends on various factors, including tion, buckle intrusion, extrusion and infection. Sri Bhagwan Mahavir age of the patient, duration and extent of RD, Subretinal fluid may take time to absorb in case Vitreoretinal Services, presence of proliferative vitreoretinopathy (PVR) of non-drainage procedure delaying anatomical Sankara Nethralaya, fi Chennai, India changes, the number, location and size of retinal recovery and resulting in poorer nal visual breaks and the lens status. Other factors which outcomes. influence the decision are availability of operating 3Senior Consultant, room equipment or staff, various patient factors Sri Bhagwan Mahavir Pars plana vitrectomy (especially expected compliance with positioning The major advantage of PPV over SB is the Vitreoretinal Services, after surgery) and surgeon preference.1 Until Sankara Nethralaya, improved internal search for breaks with micro- about a decade ago, SB was the preferred proced- Chennai, India scopic visualization of peripheral fundus by scleral ure, but there is a general trend towards vitrec- indentation and internal illumination.
    [Show full text]
  • Chapter 1: Eye History and Physical
    Chapter 1: Eye history and physical A thorough eye exam is important! Not only is the eye the most important organ in the body (of course!), but many common systemic diseases show ocular involvement. In fact, some conditions, like diabetes, may be first detected with the eye exam. To help organize your eye exam, I’ve made a sample ophthalmology note on the facing page. Our clinic notes are difficult to interpret as our physical exam is long, specific, and requires many abbreviations to fit on a single page. Basically, it’s a combination of a neurology and a dermatology note. Here’s a rundown of the basic ophthalmology note’s components. History of Present Illness: As with all other specialties, a detailed ocular history is crucial to diagnosis. You should explore every complaint with the “basic questions” — when did it start, what’s it like, is there anything that makes it better or worse, are you taking any medications for relieve, etc. Specific HPI review of systems should also include: • Floaters and flashing lights: These are the classic symptoms of a retinal detachment and retinal tears so ask EVERY patient about these symptoms. Most patients complain of some floaters – see if they’re actually new or have worsened recently. • Transient vision loss: Think of migraine vessel spasm in the young and micro-emboli in the elderly. Curtains of darkness might indicate an ischemic event or a retinal detachment, so explore these symptoms in detail. • Blurry vision: Is the vision always blurry? Does it worsen when reading or watching TV (people blink less when watching TV and develop dry eyes).
    [Show full text]