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Purpose: To evaluate real‐world evidence for young Japanese patients with rhegmatogenous retinal detachment (RRD) by retrospectively examining surgical procedures and clinical outcomes in the Japan Clinical Retina Study group. Methods: This was a multicentre retrospective study of the medical records of 562 young patients (384 males and 178 females; mean age: 33.0 ± 11.8 years) who had been diagnosed with RRD and who underwent surgical procedures in participating centres during the period between April 2013 and August 2016. Results: The selected surgeries were scleral buckling (SB) for 295 eyes (49.7%) and pars plana vitrectomy (PPV) for 262 eyes (44.1%). Between the two surgical procedures, there was no significant difference in the primary anatomical reattachment rate (PARR, SB = 92.2%, PPV = 93.9%); improvements in vision were noted in both groups. The incidences of proliferative vitreoretinopathy and cataract formation within 1 year of PPV were 2.3% (p = 0.0047) and 6.5% (p = 0.0005), whereas they were 0% and 1.0% in the SB group, respectively. Conclusion: Scleral buckling (SB) and PPV were chosen with almost equal frequency for young patients with RRD. Clinical outcomes for SB and PPV exhibited a similar PARR. The incidence of cataract formation after PPV may constitute an important limitation of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS‐OCT) and in vivo confocal microscopy (IVCM). Methods: Twenty RRD eyes were consecutively enrolled. AS‐OCT was performed at RRD diagnosis (RRD‐D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD‐D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra‐scleral hypo‐reflective spaces area (MIHSA) at AS‐OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra‐ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. Results: Rhegmatogenous retinal detachment‐ diagnosis (RRD‐D) overall‐mean intra‐scleral hypo‐reflective spaces (MISHA), ‐MMD and ‐MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall‐, AQ‐ and UQ‐MISHA further increased (p < 0.05), whereas overall‐MMD and ‐MMA did not change. At all follow‐up, AQ and UQ parameters did not show significant differences between them. RRD‐D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week‐1, month‐1 and ‐6 IOP was significantly lower than RRD‐D (p < 0.05). Rhegmatogenous retinal detachment‐ diagnosis (RRD‐D), 1‐ and 6‐month overall and AQ‐MISHA and AQ‐MMD negatively correlated with IOP (p < 0.05). Conclusion: Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of pars plana vitrectomy with silicone oil tamponade in the management of retinal detachment associated with giant retinal tears. Methods: We reviewed 45 eyes of 42 patients with primary retinal detachment associated with giant retinal tears over 10 years at a tertiary referral centre. Patients underwent 23‐gauge vitrectomy without adjuvant scleral buckling by a single surgeon and had follow‐up at least 6 months after silicone oil removal. Results: Mean follow‐up was 37 ± 35 months. Seven eyes (16%) had grade C proliferative vitreoretinopathy, and 16 (36%) had a giant retinal tear ≥180° at baseline. The primary reattachment rate was 84%, and the overall final anatomical success rate was 98%. The mean Snellen visual acuity equivalent at the final visit was 20/58. Final visual acuity ≥20/40 was achieved in 64%. The mean duration of silicone oil tamponade was 10.5 ± 4 weeks. By the final visit, silicone oil had been removed from 44 eyes (98%). Conclusion: The high rates of anatomical and functional success support management of giant retinal tears‐associated retinal detachment with vitrectomy without adjuvant scleral buckling. Removal of silicone oil at the earliest possible time helps to avoid complications such as keratopathy, glaucoma and visual loss without apparent reason. [ABSTRACT FROM AUTHOR]

Purpose In this retrospective study we evaluated the anatomic outcomes of scleral buckling (SB) versus re-vitrectomy for the treatment of recurrent inferior retinal detachment ( RD) in silicone oil (SiO) tamponade eyes after primary vitrectomy. Methods There were 103 patients (103 eyes) enrolled in this study. All patients had recurrent inferior RD in the SiO-filled eyes within 6 months after the primary vitrectomy, and were treated by either SB or re-vitrectomy. Patients were divided into two groups based on different surgical procedures: the SB group (49 eyes) and the re-vitrectomy group (54 eyes). Anatomic reattachment of the retina was measured after reoperation. Based on different retinal proliferation states in different postoperative periods after primary vitrectomy, we also compared the anatomic outcomes of the two surgical procedures in two specific postoperative periods, early period (≤1 month) and late period (1-6 months). Results The SB and re-vitrectomy groups exhibited similar retinal reattachment rate (65.3% versus 72.2%, p = 0.449) after reoperation. In the re-vitrectomy group, the retinal reattachment rate was similar in the early period and the late period (70.8% versus 73.3%, p = 0.839). However, the retinal reattachment rate was significantly higher in the early period than that of the late period (80.8% versus 47.8%, p = 0.016) in the SB group. In the early surgery groups, the retinal reattachment rate was similar in the SB group compared to the re-vitrectomy group (80.8% versus 70.8%, p = 0.411). While in the late surgery groups, retinal reattachment rate was trended higher in the re-vitrectomy group compared to the SB group (73.3% versus 47.8%, p = 0.058). Conclusion For recurrent inferior RD in SO-filled eyes, SB surgery provides similar therapeutic effectiveness with satisfactory anatomic outcomes compared to the re-vitrectomy. For eyes with recurrent inferior RD in the early period (≤1 month) after primary vitrectomy, SB surgery may be a better choice since it causes less complication; while in the late period (1-6 months) after primary vitrectomy, re-vitrectomy may be recommended, especially for the eyes with severe anterior proliferative vitreoretinopathy and retinal foreshortening. [ABSTRACT FROM AUTHOR]

Purpose To report the results and complications of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using 25-gauge chandelier endoillumination. Methods A total of 61 patients (61 eyes) with RRD were treated with scleral buckling. For the sclera buckling procedure, a 25-gauge chandelier was inserted through the pars plana for intra-ocular illumination, and retinal tears were identified and treated with episcleral cryotherapy under surgical microscope. On postoperative days 1, 3 and 7, the intra-ocular pressure was measured by a non-contact tonometer. On postoperative months 1 and 3, ultrasound biomicroscopy was used to examine the pars plana incision. Results In the surgical procedure, there was no lenticular or retinal damage due to the chandelier insertion. There was no conjunctival bleb formation at pars plana incision and no incidence of endophthalmitis after surgery. The mean intra-ocular pressure was 15.74 ± 2.98, 15.83 ± 2.76 and 16.14 ± 2.52 mmHg on postoperative days 1, 3 and 7, respectively. The one-time retinal reattachment rate was 93.4%. No visible vitreous incarceration was found in the incision of the pars plana. Conclusion There was no complication found due to the chandelier insertion in early postoperative period. Chandelier endoillumination is a feasible method for retinal visualization under surgical microscope during scleral buckling. [ABSTRACT FROM AUTHOR]

. Purpose: The 'Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study' (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes. Methods: Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods. Results: In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p < 0.0001), break extension > 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229). Conclusion: Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate the anatomical success rate of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and to evaluate the differences in outcome between patients suffering macula-off retinal detachment and those without a macular involvement. Methods: As a retrospective interventional case series, Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) is one of the largest ever established of retinal detachment patients and their outcome after buckling surgery, with 4325 patients who underwent surgery between 1980 and 2001. In 53.94% ( n = 2134) of 3956 patients with nontraumatic retinal detachment, the macula was involved. The main outcome measure was the achievement of dry anatomical attachment of the retina. Results: The success rate in patients with macula-off retinal detachment is 80.46% and thus 7.78% lower (p < 0.01) than that in those patients with their macula intact whose success rate amounted to 88.24%. The overall success rate of all 4325 MUSTARD patients was 83.98%. Conclusions: Scleral buckling is an established and mostly successful method for the treatment of retinal detachment. As our case series has demonstrated, even eyes with macula-off can be treated successfully by this procedure, thereby avoiding the complications of primary vitrectomy. [ABSTRACT FROM AUTHOR]

. Purpose: To identify risk factors that may lead to reoperations following primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). Methods: Analysis of the association between distinct parameters and the necessity for reoperations in the 'Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study' (SPR Study) using an Andersen-Gill-mean intensity model. Results: The risk for recurrent reoperations is significantly reduced by primary vitrectomy (PV) compared to scleral buckling (SB) in pseudophakic eyes (p = 0.0009) and increased after PV compared to SB in phakic eyes (p < 0.0001). Additional significant risk factors were in the pseudophakic group preoperative deterioration of visual acuity (p = 0.0226), YAG capsulotomy (p = 0.0043), large breaks (p = 0.0290), number of affected quadrants (p = 0.0387), retinal incarceration during surgery (p = 0.0115), number of breaks (p < 0.0001) and symptomatic visual field defect (p = 0.0463). In the phakic group, associated risk factors were low intraocular pressure (p = 0.0013) and persistent intraoperative detachment at the buckle (p = 0.0184). Conclusion: Reoperations are used as an indicator for the quality and efficacy of surgical techniques. Using a refined multivariate survival model, distinct factors were identified and associated with one or more reoperations after PV or SB in RRD surgery. This information should be useful in the decision process regarding the surgical approach. [ABSTRACT FROM AUTHOR]

Purpose: The preoperative and intraoperative clinical variables associated with redetachment and/or a poor visual outcome following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) have mainly been studied after a short follow-up. This study aimed to analyse long-term effects by following patients for at least 6 months. Methods: In a retrospective survey we evaluated the data of 436 eyes that underwent SB surgery. Postoperative data were collected at 3-month intervals. Results: After a mean follow-up period of 51 months, anatomic reattachment was achieved in 76% after one SB procedure, with a final reattachment rate of 97% after additional vitreoretinal procedures. In total, 104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up, 32 eyes (7%) and 20 eyes (5%), respectively, developed redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. A cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent RRD. Conclusion: Conventional SB surgery is a reliable procedure in a selected group of eyes with primary RRD. However, in eyes with a retinal tear with a cumulative size of more than three disc diameters, a primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 months, a longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after SB surgery. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence of cystoid macular oedema (CME) diagnosed by spectral domain optical coherence tomography (SD‐OCT) after primary rhegmatogenous retinal detachment (RRD) surgery. Methods: From April 2016 to October 2017, 150 eyes of 150 patients presenting with primary RRD were included consecutively in this prospective single‐centre study. Patients with the following characteristics were excluded: previous vitreoretinal surgery, combined cataract surgery, preoperatively presentation with any intraocular or systemic inflammatory condition, visible macular oedema or epiretinal membrane (ERM) on funduscopy. SD‐OCT (Spectralis, Heidelberg Engineering) was conducted 3 and 6 weeks after surgery. Results: One hundred and twenty‐eight of the 150 patients completed the study, of whom 107 (age: 61.7 ± 11.5 years, mean ± SD) showed successful retinal attachment during follow‐up visits. The most frequent operation method was scleral buckling (54.2%), followed by vitrectomy (25.2%) and the combination of both techniques (20.6%). Postoperative SD‐OCT revealed CME, neurosensory detachment and ERM in 18.7, 31.8 and 32.7% of all cases, respectively. The risk of postoperative CME was significantly elevated in patients with ERM (42.9 versus 6.9%, p < 0.001). In addition, patients with initial detachment of the macula had more postoperative CME (26.5 versus 11.1%, p = 0.044). BCVA improvement was significantly lower in patients with CME compared to patients without 6 weeks after surgery for macula‐on RRD. Conclusions: This prospective study confirmed that postoperative CME is a frequent complication after RRD surgery; we identified ERM and macula‐off RRD as potential risk factors. As CME potentially delays visual recovery, postoperative follow‐ups should include SD‐OCT. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 67-year-old woman diagnosed with rhegmatogenous retinal detachment (RD) on the right eye with full-thickness macular hole (MH). Ophthalmic examination and optical coherence tomography (OCT) were conducted to confirm the diagnosis. Recommendations on the treatment of rhegmatogenous RD with concomitant MH are summarized.

A letter to the editor is presented on scleral buckling in rhegmatogenous retinal detachment.

Purpose To describe the modifications produced in the anterior segment of the eye after placing an encircling scleral buckling (SB) in terms of corneal morphology, biomechanics and intraocular pressure. Methods A prospective study of 15 eyes with rhegmatogenous retinal detachment who underwent pars plana vitrectomy combined with a scleral buckle (PPV/SB), and 12 eyes with vitreous hemorrhage treated with PPV alone. We measured preoperatively and 1‐month after surgery the corneal biomechanical properties using the Ocular Response Analyzer (ORA), including corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (IOPg), and corneal compensated IOP (IOPcc). Moreover, we defined the corneal morphology by 4 parameters provided by the topographer Orbscan IIz: mean corneal power (dioptres), standard deviation, thinnest point (µm), and anterior chamber depth (ACD) (mm). Results Mean CH values were significantly diminished following PPV/SB (p=0.003). We found no significant changes in CRF. IOPg and IOPcc mean values were significantly increased only in the PPV/SB group (p=0.019 and p=0.010, respectively) but not in PPV group (p=0.715 and p=0.273, respectively). In PPV/SB group, IOPcc mean values were significantly higher than IOPg before (p=0.001) and after surgery (p=0.003), but not in the other group. None of the morphological parameters were modified after surgery in any of the two study groups (p>0.05) Conclusion Anterior segment morphology was not modified after placing a SB. Corneal biomechanical properties showed a reduction in CH, probably due to a vascular constriction and reduction of the eye compliance. PPV might be considered a less invasive approach for the repair of noncomplex retinal detachments than PPV/SB. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether choroidal thickness (CT) is associated with persistent subretinal fluid (pSRF) after simple primary rhegmatogenous retinal detachment (RRD) repair. Methods: This single‐centre, retrospective, observational study included patients who underwent RRD repair with at least 12‐month follow‐up. Preoperative and postoperative parameters were evaluated for association with pSRF. CT measurements were obtained at the central 1 mm area on enhanced depth imaging (EDI) OCT scans, using a semiautomatic method. Multiple logistic regression analyses were assessed to determine predictive factors for pSRF. Results: Overall, 100 eyes of 100 patients, mean age of 59.9 ± 12.6 years were included. pSRF was found in 21.0% of eyes and resolved over time in 85.7% of eyes at 12 months. In the pSRF group both RRD and fellow eyes showed lower mean choroidal and RPE thickness values as compared to those without pSRF (p < 0.05). A significant correlation was found between pSRF occurrence and choroidal thinning (p = 0.02). After multiple regression analyses, macula‐off RRD (p = 0.005) and scleral buckling (SB) technique (p = 0.001) were retained as final predictors for pSRF. In macula‐off SB eyes, detachment duration was the only factor associated with pSRF (p = 0.046). There were no significant differences in best‐corrected visual acuity outcomes between the pSRF and the no‐pSRF eyes. Conclusions: Patients with pSRF showed lower choroidal and RPE thickness as compared to those without pSRF. CT did not turn out to be a final predictor for pSRF, as this was mainly associated with macular involvement, surgical technique and detachment duration. [ABSTRACT FROM AUTHOR]

Purpose: To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011–2013. Method: All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011–2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal. Results: In total, 918 primary retinal detachments were recorded during the 3‐year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re‐detachment during the 6‐month follow‐up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re‐detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure – alone or in combination – showed superior outcome as primary surgical approach. Conclusions: There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage–injection–pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). Methods: This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. Results: The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage–injection–pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. Conclusion: Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB. [ABSTRACT FROM AUTHOR]

. Purpose: To compare the anatomic success between repair of rhegmatogenous retinal detachment (RRD) with superior breaks and repair of RRD with inferior breaks, by performing primary vitrectomy and using similar techniques and the same gas. Methods: Eighty-two consecutive eyes of 80 patients with RRD were included in this retrospective comparative study. The eyes were divided into two groups according to the location of the breaks: superior ( n = 62) and inferior ( n = 20). All the patients underwent a standard, 3-port, 20-gauge pars plana vitrectomy with 20% sulphur hexafluoride gas tamponade performed by the same surgeon. The main outcome measured was the primary anatomic reattachment at 3 months after surgery. Results: The primary anatomic success rate in the inferior group was significantly lower than that in the superior group (80% versus 98%, p = 0.012). In the inferior group, the primary anatomic success rate in patients whose symptoms lasted for more than 2 weeks was significantly lower than that in others (5/9 versus 11/11, p = 0.026). Multivariate logistic regression analysis identified inferior break as the only independent risk factor for redetachment (odds ratio, 11.88; p = 0.034). Conclusion: The anatomic success of primary vitrectomy for RRD with inferior breaks is lower than that for RRD with superior breaks. In particular, the duration of symptoms longer than 2 weeks is associated with a worse outcome in patients who had RRD with inferior breaks. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the functional and anatomical outcomes of primary rhegmatogenous retinal detachment (RRD) repair in young adults. Methods: A retrospective, comparative case series study. Patients between the ages of 18 and 40 years who underwent surgical repair of primary RRD between the years 2006 and 2013 were included. Patients were divided into three groups according to the surgical technique used: scleral buckle (SB), pars plana vitrectomy (PPV) or combined surgery (SB‐PPV). Results: Ninety eyes (90 patients) were included. The mean age (SD) was 31.5 ± 5.1 years (range 22–40). Sixty‐seven patients underwent SB, 10 had PPV and 13 had SB‐PPV. Anatomical success rates were similar between the three groups (87%, 90% and 85% for SB, PPV and SB‐PPV groups, respectively; p‐value = 0.9). Mean (SD) preoperative LogMAR visual acuity (VA) was 0.46 ± 0.6, 1.73 ± 1.1, 1.1 ± 1.1 for SB, PPV and SB‐PPV groups, respectively (p < 0.0001). The VA improved at last follow‐up to 0.23 ± 0.4, 0.7 ± 1.5 and 1.09 ± 1.08 in SB, PPV and SB‐PPV groups, respectively (p < 0.0001). Macula‐off was diagnosed in 19.4% of SB, 80% of PPV and 53.9% of SB‐PPV groups (p < 0.0001). In the SB group one phakic patient (1.5%) needed cataract extraction, while following PPV, all phakic eyes (100%) underwent cataract extraction eventually (p‐value < 0.0001). Conclusions: The study emphasizes the efficacy of SB as a primary procedure for the repair of retinal detachment in young adults in terms of anatomical and functional success. Furthermore, preservation of the lens as a result of using SB rather than PPV when possible is of great importance in this age group. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres. Methods: In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re‐detachment and/or serious postoperative complication would be reported back. Results: The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis. Conclusion: Our hypothesis that data in the surgical department's medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals. [ABSTRACT FROM AUTHOR]

Purpose: To compare, in a larger study population, the outcomes of strabismus surgery in patients who either had the scleral explant (EX) retained or removed after surgery for retinal detachment. Methods: A comparative retrospective study includes data from 2 centres. Surgical outcome, motor success, sensory success, the number of secondary operations for strabismus and complications were compared between the two groups. Motor success was defined as horizontal deviation of ≤6 prism diopters (PD) and vertical deviation of ≤6PD. Sensory success was defined as no diplopia without use of prism. Results: Forty‐seven patients were included in the study; 70% had retained the EX and 74% had vertical strabismus. Horizontally, the final alignment was equal between the 2 groups, 4 PD vs.5 PD in the EX removed group. The patients with retained EX were referred with a significant lower mean vertical deviation and had a significant lower post‐operative mean vertical deviation of 2 PD vs. 3 PD in the EX‐removed group. The rates of motor success (76% vs. 71%) and sensory success (79% vs. 93%) did not differ significantly between the EX‐retained and EX‐removed groups. No patients underwent more than 2 operations. Two complications occurred in the EX‐retained group: a subconjunctival cyst and an exposed EX. In the EX‐removed group, 2 patients with retinal re‐detachment were found in the follow‐up period. Conclusion: Good surgical outcomes including high motor and sensory success were obtained regardless of the presence of the EX. Retinal re‐detachment was observed in two patients with previously removed EX. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate treatment effects of intravitreal gas for macular hole with localized retinal detachment (RD) in highly myopic eyes and to examine how the vitreomacular relationship and other factors may influence treatment outcomes. Twenty highly myopic patients with macular holes and localized posterior RD, treated initially with intravitreal injection of CF, were prospectively studied. Recurrent disease was treated with repeated gas injection or vitrectomy according to the extent of detachment. Length of follow-up was ≥ 12 months. Vitreomacular conditions were determined before and within 2 months after gas injection by standard optical coherence tomography. Demographics, refractive errors, axial length, the extent of chorioretinal (CR) atrophy and visual acuity were recorded. The success rate after primary gas injection was 70%. The remaining 30% of patients achieved anatomic success after further treatment, including vitrectomy with gas or silicone oil tamponade and/or scleral buckling. All cases achieved anatomic success after a mean of 1.4 surgeries. Univariate analysis showed that the patterns of the posterior vitreoretinal relationship did not differ significantly between those successfully treated with gas only (group 1) and those requiring vitrectomy (group 2) (p = 1.000). Logistic regression showed no statistically significant differences in any characteristics between groups 1 and 2. Intravitreal gas tamponade alone may achieve anatomic success in more than two-thirds of highly myopic patients with macular holes and localized RD. Patients with different clinical characteristics and vitreoretinal relationships seem to have similar opportunities to achieve reattachment through this relatively non-invasive surgery. [ABSTRACT FROM AUTHOR]

Purpose To examine the incidence of retinal detachments and to evaluate patient profiles and surgical characteristics. Methods Retrospective review of patients operated for primary retinal detachment ( RD) and redetachment between 2010 and 2012 at the Department of Ophthalmology, Odense University Hospital, Denmark. We included all RD such as rhegmatogenous retinal detachment ( RRD), tractional retinal detachment ( TRD) and exudative retinal detachment (ERD). Results In total, 779 RD surgeries were performed: 83.7% ( n = 652) primary operations and 16.3% ( n = 127) reoperation. For primary operation, pars plana vitrectomy ( PPV), scleral buckling and combined operations were performed in 95.1% ( n = 620), 4.6% ( n = 30) and 0.3% ( n = 2) respectively. Over time there was less use of silicone oil and greater use of gas tamponade (p = <0.001), less simultaneous cataract operations (p = <0.001), less use of cryotherapy (p = 0.045) and more use of peeling procedures (p = <0.001) in primary operations. The annual incidence of surgery for primary RD was 22.0 [95% confidence interval ( CI) 20.4-23.8] per 100 000 inhabitants aged >15 years. Retinal detachment (RD) was more common in males than females (1.8:1), and mean age at presentation was 61.8 years (standard deviations ± 12.3). The annual incidence for RRD and TRD operation was 20.72 (95% CI 19.11-22.43) and 1.25 (95% CI 0.9-1.7) per 100 000 inhabitants >15 years. Conclusion This study presents the first overall incidence for RD in Denmark. The highest incidence of RRD was among males aged 60 to 79 years, whereas TRD was among females at same age. Pars plana vitrectomy (PPV) was the preferred surgical technique, and during 2012 all RD patients were treated with PPV, independent of lens status and age. [ABSTRACT FROM AUTHOR]

Surgical approaches for rhegmatogenous retinal detachment (RRD) have evolved rapidly in the past century. This has resulted in an increase in the anatomical success rate from zero per cent in the beginning of the 1900s to now almost 100 per cent. Rhegmatogenous retinal detachment is regarded as an acute eye disease that needs immediate treatment. With the increasing number of cataract surgeries and an increased elderly population, the numbers of RRD occurrences are increasing. The aim of this thesis is to create knowledge on how treatment and care of RRD patients can be optimized. In the first paper, data on the incidence of RRD in Denmark are presented based on data from a nation register the National Patient Registry ( NPR). It was discovered that the incidence of RRD in Denmark is similar to previous reported numbers and that the incidence has been increasing due to increasing numbers of cataract surgeries and an increased elderly population. Using data from the NPR, we estimated that the risk of a RRD occurring on the fellow eye is 100 times larger than on the first eye and that middle aged men have the highest risk. Having an increase in the incidence of RRD we need to ensure that the patients are also treated in the most optimal way. To ensure this, an indicator is needed to monitor the quality at the different centres. This indicator presented in the second paper is based in the occurrence of redetachment. We define a detachment to be caused by poor surgery if the retina detaches within one year after initial surgery with pneumatic retinopexy, scleral buckling and VTX with gas, and one and a half years after surgery with VTX with oil. Also lack of oil removal within the first year is a failed operation. It is widely accepted that RRD is an acute disease but when should surgery be performed to attain the most optimal result? In the third paper, we evaluated the progression of posterior RRD with an optical coherence tomography to make an objective assessment of the movement. We found that the risk of a macula on RRD progressing to affect the fovea is small if the patient is postured appropriately. We found that the movement of the RRD is dynamic but the detachments will ultimately approach the fovea. Having an opportunity to postpone surgery without risking the outcome for the patient allows a more optimal surgery. The results of this thesis can be used by all health care systems to establish optimal conditions in the treatment of RRD. [ABSTRACT FROM AUTHOR]

Purpose To compare pars plana vitrectomy and 360° endolaser therapy with pars plana vitrectomy and an encircling scleral buckle for the treatment of primary rhegmatogenous retinal detachments in a randomized pilot study including 60 patients. Methods Main outcome measures were single-surgery anatomic success rate and final best-corrected visual acuity at 6 months follow-up. Cofactors analysed were complication rates, patients' comfort, refractive outcome and macula status assessed using a spectral-domain optical coherence tomography. Results With differences between both treatment groups regarding type of the retinal detachment, localization of retinal tears (p = 0.0085) and the choice of the intraocular tamponade (p < 0.0202), there were no significant differences between the single-surgery anatomic success rate (93.33% both groups, p = 1.0) and the visual acuity at final follow-up (≤0.3 logMAR [logarithm of minimum angle of resolution] in 66.67% in the endolaser group versus 40.0% in the scleral buckle group, p = 0.0514). Questionnaire responses showed lower levels of patients' discomfort in the endolaser group. A significant difference between both groups was found in the refractive error change after surgery (−0.20 ± 0.51 dioptres in the endolaser group versus −0.88 ± 0.88 dioptres in the scleral buckle group, p = 0.0003). Conclusion Primary vitrectomy combined with 360° endolaser therapy seems to be as effective as vitrectomy combined with an encircling scleral buckle in patients with rhegmatogenous retinal detachment, with possible benefits of an improved patients' comfort and a more stable refractive status after surgery. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate vitrectomy in conjunction with the use of perfluorocarbon, cerclage, laser retinopexy, lens removal and silicone oil as surgical treatment of proliferative vitreoretinopathy associated with retinal detachment. Methods: Sixty-two eyes of 62 patients were treated for complicated retinal detachment following failed prior scleral buckling. Outcome measures were; retinal reattachment rate 6 months after silicone oil removal, status of the retina, visual acuity (VA), duration of silicone tamponade and frequency of reoperations. Results: The final reattachment rate was 95%. Reoperations had to be performed in 25% of patients. Eighty-one per cent of these patients received one and 19% two or more operations following silicone oil implantation. The mean time to reoperation was 1.8 ± 1.4 months. Silicone oil was removed after 5.6 ± 4.1 months following the last vitreoretinal procedure in 90%, respectively, 95% with attached retina. Five per cent experienced retinal detachment after silicone oil removal. At the end of follow-up, the mean VA was 0.13 ± 0.26 Snellen. Seventy per cent of patients achieved a vision of 20/200 or better (mean 0.25 ± 0.27). Conclusion: Our study demonstrates good final outcomes when a rigorous surgical approach was used. Furthermore, this standard procedure reduces the need for reoperations and consequently improves the functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: To report the surgical outcomes of pars plana vitrectomy (PPV) with inferior retinotomy without the need for scleral buckling in primary inferior rhegmatogenous retinal detachment (RRD) with inferior retinal breaks and Proliferative vitreoretinopathy (PVR) grades B or C. Methods: Retrospective, consecutive series, single‐center study of patients that underwent PPV with inferior retinotomy for primary inferior RRD with inferior retinal breaks (4:00 to 8:00 clock hours) and PVR grades B or C. Data were obtained from patients' medical records from October 2014 to November 2020. The primary outcomes of the study were retinal reattachment and visual acuity improvement. Data collected before and after surgery was compared between groups using chi‐square analysis and paired samples t‐test. The resulting p‐values significance level was set at p = 0.05. Results: Thirty‐two patients (32 eyes) met the inclusion criteria. PVR in stage B was present in 19 patients and stage C in 13 patients. Macula‐off RRD was diagnosed in 25 patients while the other 7 patients had RRD with the macula attached. Regarding primary outcomes, 31 out of 32 (97%) patients achieved retinal reattachment with no differences between PVR groups (p = 0.406). The best‐corrected visual acuity (BCVA) improved significantly in eyes with macula‐off RRD at presentation (p < 0.001). Although macula‐attached RRD eyes had higher final BCVA, its improvement was not statistically significant (p = 0.370). Besides one retinal redetachment, no other significant complications were reported after surgery. Conclusions: Inferior retinal breaks are associated with surgical failure following PPV for inferior RRD repair, especially if advanced PVR is present. Our results suggest that, in these less common and more challenging cases, PPV with an inferior retinotomy is associated with very favorable anatomic and visual outcomes. [ABSTRACT FROM AUTHOR]

Purpose To report anatomical and functional outcome of 20-gauge versus 25-gauge primary pars plana vitrectomy for management of complex rhegmatogenous retinal detachment in pseudophakic eyes. Methods Prospective single-centre randomized comparative pilot trial. Fifty patients with retinal detachment ( RD) not complicated by proliferative vitreoretinopathy grade B or C, who cannot be treated with a single meridional sponge, were randomized (1:1) from November 2006 to January 2010 to either 20-gauge or 25-gauge vitrectomy as first surgical intervention and followed up over a 12-month period, evaluating change in best-corrected visual acuity, anatomical success and intraocular pressure dysregulation. Results Mean visual acuity improved by 0.88 ( SD 0.67) from 1.22 log MAR ( SD 0.63) to 0.34 log MAR ( SD 0.31) in the 20-gauge group and by 0.53 ( SD 0.91) from 0.86 log MAR ( SD 0.73) to 0.34 log MAR ( SD 0.46) in the 25-gauge group. Final anatomical success rate was 100% and primary success rate was 69% at 6 months of follow-up. In the 20-gauge group, the retina was attached after one single procedure in 18 eyes (72%) and in 21 eyes (84%) of the 25-gauge group. Two patients in the 25-gauge group had hypotony at the first postoperative day which normalized within 6 weeks. Conclusion In our series, transconjunctival sutureless 25-gauge and 20-gauge vitrectomy showed comparable results in pseudophakic RD not suitable for single sponge surgery with respect to visual outcome and retinal reattachment. Postoperative hypotony does not seem to be a significant problem of transconjunctival sutureless vitrectomy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to describe vitreoretinal surgery activity and vitreoretinal surgeons in private or public practice in metropolitan France over the year 2016 to anticipate surgical training needs. Methods: Patients aged ≥20 years who had undergone vitreoretinal surgery, alone or combined with cataract surgery were included using the French National Healthcare system database. For surgery performed by ophthalmologists carrying out ≥50 procedures during the year, the incidence per 100 000 of population ≥ 20 years of age, the number and mean age of surgeons and the number of surgeons aged >55 years were calculated. Results: Overall, 57 947 posterior segment surgical procedures were included, 40% in the public sector and 49% in the private sector for private surgeons and/or public centres performing ≥50 procedures/year. The remaining 11% of procedures were from private surgeons and/or public centres performing <50 procedures/year. The analysis included 356 surgeons with a mean age of 41 ± 10 years (39% female) in the public sector and 47 ± 10 years (14% female) in the private sector. The majority of urgent surgery was for retinal detachment (n = 30 290 [52% of total surgical procedures]). Scheduled surgery involved surgery for macular holes and epiretinal membranes (n = 16 454 [28% of total surgical procedures]). Combined vitrectomy‐phacoemulsification surgery (n = 10 120) represented 17% of all vitreoretinal surgery. University regions with the fewest surgeons and regions with surgeons >55 years of age were identified, to anticipate the training need for new surgeons. Conclusion: This study demonstrated disparities in the geographic distribution of vitreoretinal surgery in France and identified regions that need increased training capacities to ensure a sufficient number of surgeons. [ABSTRACT FROM AUTHOR]

An introduction is presented with topics including impact of time spent outdoors on reducing myopia risk, greater retinal nerve fiber loss in patients with neuromyelitis spectrum optic neuritis, and use of chandelier endoillumination in scleral buckling procedures for retinal detachment.

Purpose: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). Methods: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. Results: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. Conclusions: The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity. [ABSTRACT FROM AUTHOR]

Purpose: To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB). Materials and methods: We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional‐hazard regression model was used to analyse risk factors for PRD and PRB. Results: Sixty‐five thousand six hundred and sixty‐two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow‐up (median 7.1 years, range 0–21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy. Conclusions: Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present a new surgical technique to remove vitreous cortex remnants. Methods: Non‐consecutive retrospective interventional case series. Results: When the posterior vitreous is split, its outermost layer may remain attached to the retina, developing vitreoschisis‐induced vitreous cortex remnants (VCR). Their role in macular pathology etiopathogenesis has been well documented; however, recently, it has been proposed that VCR also play a crucial role in proliferative vitreoretinopathy and consequent retinal redetachment. The prevalence of VCR is underestimated because triamcinolone acetonide is not routinely used for vitreous staining. Vitreous cortex remnants (VCR) removal is challenging, and several surgical techniques have been proposed. However, they require sclerotomy enlargement, material that may not be readily available, and manual fashioning. Alternatively, a diamond‐dusted membrane scraper (DDMS), already widely used in macular pathology treatment, can follow the contour of the retina, as it is a silicone tube, and remove VCR with its abrasive tip. A DDMS may also be introduced in the vitreous cavity through a standard trocar. Finally, the use of a DDMS provides predictable feedback, making the learning curve short. In this case series, 34 eyes affected by primary rhegmatogenous retinal detachment were enrolled. The retinal redetachment rate was 2.9% at six months of follow‐up, below the average literature value of 21%. No adverse events were reported. Conclusion: A DDMS can be suitable for use in VCR removal, although further studies are warranted to understand the indications and extent of this surgical technique for improving the management of rhegmatogenous retinal detachment. [ABSTRACT FROM AUTHOR]

Purpose: To report the long‐term outcomes of large diameter epiretinal lyophilized amniotic membranes (lAMs) in recurrent or persistent macular holes (MHs) with or without rhegmatogenous retinal detachment (RRD), in a prospective interventional case series. Methods: Ten eyes of 10 patients underwent pars plana vitrectomy for MH‐associated RRD (n = 5) or persistent MH without RRD (n = 5), in a university Hospital. A 3 or 4 mm diameter disc of lAM, stained with 0.06% trypan blue, was inserted with a catheter through a sclerotomy and positioned over the MH. Gas or silicone‐oil tamponade was used. At 1 year, the main outcome was anatomic success defined as complete MH closure. Secondary outcomes were best corrected visual acuity (BCVA) recovery, changes in ellipsoid zone (EZ) and external limiting membrane (ELM) defects, complications. Mean follow‐up was 13.8 ± 2.9 months (range, 12–18). Results: Mean baseline data were minimum and maximum diameters, respectively, 945 ± 330 and 1507 ± 717 μm; axial length 26.58 ± 3.38 mm; and number of prior surgeries 1.4 ± 0.96. At 1 year, anatomic success was achieved in eight eyes (80%), and two had reduced diameter of MH. All RRDs were reattached without recurrence. Mean logMAR BCVA improved from 1.92 ± 0.58 to 1.17 ± 0.57 (p < 0.001), with nine eyes (90%) achieving ≥0.3 logMAR improvement. Mean EZ and ELM defects decreased (p = 0.004, p = 0.003, respectively). Postoperative complications were RRD (n = 1) reattached by subsequent surgery, lAM slightly retracted under silicone (n = 1), foveal atrophy after early lAM displacement (n = 1). Conclusion: A 1‐year follow‐up highlighted that epiretinal large discs of blue‐stained lAM can help safely close refractory MHs, and provide satisfactory visual recovery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate different baseline characteristics, clinical indications, repeat retinopexy rate, and 6‐month detachment rate of primary laser retinopexy across different ethnicities. Method: Retrospective, single‐centre, consecutive comparative study, looking at all patients who had primary laser retinopexy between January 2017 and 2020. Multivariate Cox survival [reporting hazard ratio (HR)] and binary logistic regression (reporting odds ratio) analyses were performed to investigate differences between ethnicities with age, gender, operator level (vitreoretinal or general ophthalmologist) and high myopia status (≤−6.0 Dioptres) as covariates. Results: We report on 812 patients in three ethnicities: Black [69 (8.5%)], South Asian [SA, 156 (19.2%)] and White [587 (72.3%)] with overall 6‐month detachment rate of 31 (3.8%). Rate for subsequent retinopexies was Black: 12 (17.4%), SA: 15 (9.6%) and White: 131 (22.3%), p = 0.002. Multivariate Cox survival regression analysis found no difference in detachment rate between ethnicities. South Asian (SA) had lower repeat retinopexy rate than White patients [HR, 0.40 (95% confidence interval [CI], 0.22–0.71, p = 0.002)]. Multivariate binary logistic regression found that Black and SA patients compared with White, have the following: (i) higher proportion of round holes relative to horseshoe tears [OR, 2.31 (95% CI, 1.19–4.49, p = 0.014) and OR, 2.06 (95% CI, 1.25–3.40), p = 0.004, respectively] and (ii) higher proportion of high myopia [OR, 2.99 (95% CI, 1.20–7.46, p = 0.019) and OR, 2.35 (95% CI, 1.11–4.96), p = 0.025, respectively]. Ethnic minorities were younger than White patients: SA [43, interquartile range (IQR), 28–61], Black (49, IQR, 35–57) and White (61, IQR, 54–67 years, p < 0.001) and had more indirect and 360 retinopexy compared with slit lamp (p < 0.001). Conclusion: We demonstrate a significant difference in baseline characteristics, retinal tear morphology and treatment course between the ethnic groups. Further studies are necessary to investigate the genetic and biological differences that may influence these variations and may help to allow for more targeted health care. [ABSTRACT FROM AUTHOR]

Background/Aims: To identify differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates (SSSR) for repair of rhegmatogenous retinal detachments (RRDs). Methods: This study is a sub‐analysis of subjects who underwent RRD repair in the Primary Retinal Detachment Outcomes (PRO) study, a multi‐institutional, retrospective comparative interventional study. The PRO study examined consecutive primary RRD surgeries from January 1, 2015 through December 31, 2015. The primary outcome was variations in surgical approach to different types of RRDs with secondary analyses of pre and intraoperative metrics for surgeons with SSSR > 90% compared to those <80% who performed at least 40 operations during the study period. Results: A total of 689 surgeries were included in the analysis. The mean SSSR was 94% for the higher tier and 75% for the lower tier (p < 0.0001). Surgeons with >90% SSSR were more likely to have graduated fellowship more recently (p = 0.0025), use less perfluorocarbon liquid (p < 0.0001), perform less 360 degree laser retinopexy (p < 0.0001), and perform a higher percentage of primary buckles and combined PPV/SB (p < 0.0001). For pseudophakic eyes there was no difference between PPV and PPV/SB use (p = 0.6211). Conclusion: Surgeons with high SSSR typically performed SB as well as combination PPV/SB for more RRDs. Similar numbers of PPV and PPV/SB were performed for pseudophakic eyes, suggesting that the difference in SSSR between the two groups may be related to a combination of preoperative and intraoperative decisions as well as differences in technique. [ABSTRACT FROM AUTHOR]

Purpose: To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula‐off rhegmatogenous retinal detachment (RD). Methods: Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral‐domain optical coherence tomography (SD‐OCT) macular images at 1, 3, 6 and 12 months after surgery. Results: Over the follow‐up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD‐OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001). Conclusion: Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD‐OCT lesions after macula‐off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the effectiveness of laser speckle flowgraphy (LSFG) in determining the effects of rhegmatogenous retinal detachment (RRD) on ocular circulation.

Purpose: To evaluate the macular microvascularity with optical coherence tomography angiography (OCTA) in rhegmatogenous retinal detachment (RRD) which were successfully treated with pneumatic retinopexy (PR). Methods: Thirty eyes of thirty patients who were treated with PR (12 eyes with macula‐off RRD and 18 eyes with macula‐on RRD) were included in this prospective study. OCTA was used to evaluate the macular perfusion changes postoperatively at 1 and 3 months. The fellow eyes (30 eyes) were used as control for comparison. Parafoveal retinal thickness (RT) and best‐corrected visual acuity (BCVA) were evaluated. Results: Vessel density (VD) in SCP, DCP and choriocapillaris plexus (CCP) flow area was significantly lower in the macula‐off group one month after the PR (p < 0.001). In the macula‐off group, VD in SCP, DCP and CCP flow area significantly increased at months 3 (p < 0.001, p < 0.001, p = 0.009). The inner RT, RT and FAZ decreased three months after PR (p < 0.001, p = 0.001, <0.001). The FAZ was significantly larger in the macula‐off group at third months after PR (p < 0.001). The inner RT was higher in the macula‐off group at third month (p = 0.012). There was no significant difference between the groups in means of final VD, CCP flow area and RT. There was also a negative correlation between the final BCVA (logMAR) and FAZ at month 3 (r = 0.776, p = 0.003). Conclusion: Optical coherence tomography angiography evaluation of macular capillary plexuses may be useful for predicting vascular structural changes in patients undergoing PR. [ABSTRACT FROM AUTHOR]

Silicone oil (SO) has been used as a long‐term tamponade agent in the treatment of complicated vitreoretinal diseases for about half a century, during which time many advances in surgical techniques and technologies have been made. This review summarizes the chemical and physical properties of SO, its indications and complications, including particularly emulsification. The mechanisms and risk factors for emulsification are discussed, as well as novel strategies for its effective removal. Finally, the review focuses on new improved formulations of SO, including research into slow‐release pharmacological agents within SO and provides an overview of alternatives to SO for the purpose of long‐term tamponade that are being developed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the use of a 25-gauge needle in fixation of encircling silicone band.

Purpose: Retinoschisis (RS), rhegmatogenous retinal detachment (RRD) and combined RS retinal detachment (RSRD) may resemble clinically and pose a diagnostic challenge. This study investigates the role of the fundus autofluorescence (AF) in differentiating RS, RRD and RSRD. Methods: Fundus AF changes of 34 eyes diagnosed with RRD, 30 eyes with RS and 12 eyes with RSRD were retrospectively analysed. Ultra‐widefield AF (UW‐AF) image intensities obtained with the Optomap 200Tx were interpreted as hypo‐, hyper‐ and isoautofluorescent or a mixed pattern with hypo‐ and hyperautofluorescence over and at the posterior margin (PM) of RRD, RS and RSRD. Results: All RS eyes revealed isoautofluorescence over the area of RS, and nine eyes (30%) showed hypoautofluorescent PM. Among RRD, acute (≤2 weeks) and chronic (>2 weeks) RRD demonstrated distinct AF characteristics. Sixty‐two per cent of RRD eyes had acute RRD. From those, 16 eyes (76%) demonstrated hypoautofluorescence over the detached area and 19 (90%) eyes with hyperautofluorescent PM. Sixty‐two per cent of chronic RRD eyes demonstrated isoautofluorecence over the detached area. Eight RSRD eyes (67%) revealed hyperautofluorescence in the detached area. The positive predictive value (PPV) for hypoautofluorescence over the area of subretinal fluid (SRF) in RRD was 95%. The PPV for hyperautofluorescence over the area of SRF in RSRD was 100% and for isoautofluorescence for schitic area in RSRD and RS was 76%. Conclusion: The UW‐AF can be a useful non‐invasive adjuvant tool to distinguish between RRD, RS and RSRD. Hypo‐ or hyperautofluorescence over the area of interest and hyperautofluorescent PM indicates the presence of SRF. [ABSTRACT FROM AUTHOR]

The historical literature on the treatment of rhegmatogenous retinal detachment (RRD) was reviewed from 1911 to the present, focusing on the role of intravitreal air and gas. The history of the pneumatic retinopexy (PnR) technique is described from its original roots to the current day procedure. The treatment of RRD has evolved tremendously over the past century. The introduction of intravitreal gas as a tamponade to reattach the retina was critical in the development of modern day PnR. Although PnR is not a new technique, relatively recent randomized trials have demonstrated the numerous advantages of this procedure compared to pars plana vitrectomy (PPV) and scleral buckle. From a historical perspective, PnR has its origin in 1911 when Ohm performed intravitreal air injection after external subretinal fluid drainage in an attempt to treat RRD. The evolution of the procedure was driven by the introduction and experience with inert expansile intravitreal gas injections, and several great surgeons made critical contributions to the development of the procedure. There is substantial controversy pertaining to the original description of PnR in the literature. Credit has generally been given to Hilton and Grizzard from the United States, although Alfredo Dominguez from Spain published the first description of the procedure and he went to great lengths in an attempt to be rightfully recognized for this. The first randomized trial in retinal detachment repair was led by Dr. Paul Tornambe, comparing PnR to scleral buckle and an additional randomized trial was subsequently carried out demonstrating functional advantages of PnR compared to PPV. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the morphological and functional reconstruction of the macular fovea after autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment (MHRD) in highly myopic eyes. Methods: Ten consecutive cases of recurrent MHRD with high myopia were retrospectively reviewed. All eyes underwent pars plana vitrectomy combined with autologous neurosensory retinal transplantation and were followed up for at least 3 months after silicone oil extraction. The main outcomes were whether or not the retina was reattached and the macular hole (MH) was closed, morphological changes in the retinal graft, best‐corrected visual acuity (BCVA), the sensitivity threshold and blood flow signal in the macula. Results: At the one month postoperative visit, there was an obvious boundary between the graft and the surrounding retinal tissue, and some retinal structural layers could be seen in the graft on optical coherence tomography scans. At the final follow‐up, eight eyes (80%) showed retinal reattachment and closure of the MH. Optical coherence tomography revealed blurring of the boundary between the graft and surrounding retinal tissue and that the retinal structure in the graft was disordered. The MH was not closed in two eyes (20%), in one case because of partial displacement of the graft and in the other because of incomplete coverage of the MH as a result of a smaller graft. The post‐BCVA was significantly better than the pre‐BCVA (1.32 ± 0.33 versus 2.01 ± 0.29 logMAR; p = 0.000, paired t‐test). Conclusion: Autologous neurosensory retinal transplantation can be an effective treatment for recurrent MHRD in highly myopic eyes. 'Fusion' between the neurosensory retinal graft and the original retinal tissue may be the mechanism involved in the closure of the MH and reconstruction of the macular fovea. [ABSTRACT FROM AUTHOR]

Purpose: To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery. Methods: E‐case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded. Results: A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non‐AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7–2.2], p = 0.54). Conclusion: No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the long‐term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. Methods: Thirty‐five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta‐analysis of Pathologic Myopia (META‐PM) Study Group. The best‐corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time–course changes in BCVA and complications. Results: The mean patient age was 61.0 ± 11.4 years. The follow‐up was 45.2 ± 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 ± 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow‐up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1–3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1–3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and pre‐existing disease of glaucoma (p = 0.006). Conclusions: A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3‐year follow‐up period. [ABSTRACT FROM AUTHOR]

The article reports on a clinical trial which evaluates the effects of oral colchicine on the prevention of proliferative vitreoretinopathy (PVR) in eyes undergoing scleral buckling (SB). It states that the subjects of the study were patients with rhegmatogenous retinal detachment undergoing SB. The findings of the study reveal that oral colchicine had no significant effect on the prevention of retinal redetachment due to PVR.

Purpose: To study the development over time of the age‐ and sex‐standardized incidence of rhegmatogenous retinal detachment (RRD) in Denmark. Methods: Registry study, based on the Danish National Patient Registry data. End‐point: Individuals undergoing the first surgery for RRD. Results: During 2000–2016 we identified 11 769 individuals with a primary RRD surgery in either eye. The age‐ and sex‐standardized incidence rate of RRD increased by more than 50% during the study period. We found a significant increase in this incidence rate for both men and women older than 50 years, and in men, but not in women, younger than 50 years (p < 0.001). However, the increase of primary RRD surgery during the study period was most pronounced in men aged 50 years or older, where the rate of increase was 1.7 ± 0.1 cases per 100 000 person‐years per year (p < 10−11). Conclusion: The incidence of RRD is increasing, and this increase is primarily driven by men aged 50 years or older. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the postoperative foveal avascular zone (FAZ) area, superficial vessel density (SVD) and deep vessel density (DVD) and their correlation with functional (best‐corrected visual acuity, BCVA) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair. Method: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas tamponade and a minimum 12 months follow‐up, were re‐examined. Foveal avascular zone (FAZ) area, SVD, DVD and FMT were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye. Results: Fifty‐six patients with macula‐on and 37 with macula‐off RRD were included in the study. In both groups, no difference in FMT and FAZ area was found compared to fellow eyes. In macula‐on RRD eyes, a lower parafoveal DVD (p = 0.001) was detected; FAZ area was related to FMT (p = 0.025), and the postoperative BCVA was correlated with parafoveal DVD (p = 0.010) and FAZ area (p = 0.003). In macula‐off RRD eyes, lower parafoveal SDV (p = 0.012), and foveal and parafoveal DVD (p = 0.012 and p < 0.001, respectively) were observed. BCVA was related to FAZ area (p = 0.012), foveal SVD (p = 0.005) and parafoveal DVD (p = 0.010). Conclusion: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to FAZ area and vessel density. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of the human amniotic membrane (hAM) to treat (HMMH) associated with retinal detachment (RD). Material and Methods: Ten eyes of 10 patients with recurrent HMMH and RD, who had already undergone one or more pars plana vitrectomy (PPV), underwent a PPV with an hAM plug implanted in the macular hole. The initial five patients enrolled were tamponaded with (SO) while the subsequent five patients with 10% octafluoropropane (C3F8). Silicon oil was removed in all five patients 2 months later. No statistical differences were reported between the two groups. Results: Final retinal reattachment was achieved in all the patients. BCVA improved from 1.73 logMAR to 0.94 logMAR after 6 months. No adverse events were registered during follow‐up. Conclusion: An hAM plug is an efficient substrate to manage HMMH associated with RD resulting in encouraging visual acuity recovery. [ABSTRACT FROM AUTHOR]