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Purpose: To investigate the incidence, risk factors, and clinical characteristics of unexplained visual loss after macula-on rhegmatogenous retinal detachment (RRD). Methods: Retrospective cohort of patients with primary macula-on rhegmatogenous retinal detachment treated by vitrectomy with gas or silicone oil (SO) tamponade in 2011 and 2012. Outcome was unexplained visual loss (>2 Snellen lines) 2 months after the last vitrectomy. Results: Incidence of unexplained visual loss was 0.7% (1/151) in patients treated by gas and 29.7% (11/37) in patients treated by SO (P 0.001). Visual loss occurred both during SO tamponade and after removal. Cases underwent optical coherence tomography, perimetry, microperimetry, fluorescein angiography, and visual evoked potentials. Patients with unexplained visual loss after SO tamponade showed a small scotoma within the central 2° on microperimetry. Duration of SO tamponade was the only statistically significant factor related to the incidence of unexplained visual loss (P 0.001). Conclusion: Incidence of SO-related visual loss was 30% with duration of tamponade as the only risk factor. This study is the first to apply microperimetry in these patients, which showed a distinct pattern of a small central scotoma. Therefore, microperimetry can be of great value in the diagnostic workup of patients with unexplained visual loss after vitrectomy.

PURPOSE: To evaluate the endothelial cell density changes in eyes with silicone oil tamponade after vitrectomy for complex rhegmatogenous retinal detachment. METHODS: A prospective controlled study with 81 eyes with complex rhegmatogenous retinal detachment undergoing vitrectomy and silicone oil tamponade. Fellow eyes that fulfilled specific inclusion criteria served as controls. Endothelial cell density (in cells per square millimeter), coefficient of variance (standard deviation per mean cell area x 100), percentage of hexagonal cells, and corneal thickness were documented preoperatively and compared with values obtained at 3, 6, and 12 months postoperatively. For the purpose of the study analysis, all study eyes were divided into 5 groups, according to their lens status during the follow-up. RESULTS: High endothelial cell density loss was found in Group 3, (eyes that underwent an additional phacoemulsification procedure) and Group 4 (eyes that underwent lens and/or intraocular lens removal during the follow-up) at 12 months with a mean cell loss of 19% and 39%, respectively (P < 0.001). CONCLUSION: An intact natural or artificial lens-iris diaphragm may provide a protective barrier against corneal endothelial cell damage from long-term silicone oil tamponade.

Objective Myopic patients have an increased risk for the development of a rhegmatogenous retinal detachment (RRD). Currently, myopic patients have the choice to undergo correction of their refractive error by the implantation of a phakic intraocular lens (pIOL). After pIOL implantation, progressive endothelial cell loss may result if the anterior chamber is too shallow. Because scleral buckling (SB) surgery for treatment of an RRD may in itself result in a decreased anterior chamber depth (ACD), this may become an important issue not only for the retinal surgeon who is faced with a patient who has both an RRD and a pIOL, but also for the refractive surgeon who should consider the potential problems of the implantation of pIOL in an eye that has previously undergone SB surgery. The goal of this study was to evaluate how long changes in ACD persist after SB procedures in patients with RRD. Design Prospective case series. Participants Thirty-eight eyes with a primary RRD treated by SB using an encircling element and a radial or segmental buckle; 31 fellow eyes served as controls. Methods Anterior chamber depth (in the horizontal meridian) and axial length were measured preoperatively and at 1 week and 1, 3, 6, 9, and 12 months postoperatively with an anterior optical coherence tomography method and an IOLMaster (Carl Zeiss Meditec, Jena, Germany), respectively. Main Outcome Measures In all 38 eyes, ACD was significantly reduced compared with preoperative levels up to 9 months after SB surgery. Results Anterior chamber depth returned to normal at 1 year after surgery. Axial length was significantly enlarged during the whole follow-up period. No significant differences were found between the use of radial or segmental buckles. Conclusions Anterior chamber depth may remain decreased after SB for a longer time period than previously reported. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.

Aims Treatment delay of progressive vision-threatening conditions should be minimal. In this study, the treatment delay of patients with a rhegmatogenous retinal detachment (RRD) undergoing retinal detachment surgery was quantified, and causes for this delay were evaluated. Materials and methods Consecutive patients (n = 205) presenting with a primary RRD between June 2006 and June 2007 at the tertiary referral center (TRC) were interviewed. Five categories of delay were discerned in the following: 'patient delay,' 'general practitioner's delay,' 'referring ophthalmologist's delay,' 'delay at the TRC' and 'delay before surgery at the TRC'. In addition, overall delay was calculated. Results In total, 186 eyes were included in the analysis. Median overall delay between the patients' first symptoms and RRD surgery was 10 days. Almost 60% of this overall delay time was due to patient delay and the delay of the general practitioner. More than 50% of patients had a delay owing to unawareness of the symptoms. The median patient delay was significantly lower in patients with a vitreous hemorrhage and in patients with a history of a RRD in the fellow eye. Conclusions The major reason for patient delay with a RDD was the patients' unawareness and unfamiliarity with the symptoms of a retinal detachment. Eye (2009) 23, 1393-1399; doi:10.1038/eye.2008.272; published online 12 September 2008

Purpose To determine the effect of duration of macular detachment (DMD) on visual acuity (VA) in patients with macula-off rhegmatogenous retinal detachment (RD). Design Retrospective observational case series. Participants Two hundred two consecutive patients (202 eyes) with primary uncomplicated macula-off RD, preoperative VA of 10/100 or worse, a precise history of when macular function was lost, successful reattachment surgery, and a minimal follow-up of 3 months. Intervention All RDs were repaired with a primary scleral buckling procedure performed by 3 vitreoretinal surgeons. Main Outcome Measure Visual acuity (best corrected and 3, 6, and 12 months postoperatively). Results Considering all eyes, the cumulative mean of the best-corrected postoperative VA (logarithm of the minimum angle of resolution [logMAR]) as a function of DMD shows a rapid worsening when DMD exceeds 6 days. Eyes were divided into 3 groups, corresponding to the DMD intervals immediate (within 10 days), delayed (11 days–6 weeks), and late (>6 weeks). Mean postoperative VAs (in logMAR) were 0.35±0.31 (between 20/40 and 20/50 Snellen equivalent) in eyes with DMD up to 10 days, 0.48±0.26 (20/60 Snellen equivalent) in the delayed group, and 0.86±0.30 (8/60 Snellen equivalent) in eyes with DMD longer than 6 weeks. Conclusions The cumulative mean of the best-corrected postoperative VA (logMAR) as a function of DMD shows a rapid worsening when DMD exceeds 6 days. Our results indicate that the scleral buckling procedure should be done preferably within a 7-day DMD.

Experimental models have implicated glutamate in the irreversible damage to retinal cells following retinal detachment. In this retrospective study we investigated a possible role for glutamate and other amino acid neurotransmitters during clinical rhegmatogenous retinal detachment (RRD). Undiluted vitreous samples were obtained from 176 patients undergoing pars plana vitrectomy. The study group consisted of 114 patients (114 eyes) with a rhegmatogenous retinal detachment. Controls included 52 eyes with an idiopathic macular hole or idiopathic epiretinal membrane and 10 eyes with a traction retinal detachment due to proliferative diabetic retinopathy. Vitreous concentrations of glutamate, gamma-aminobutyric acid (GABA), taurine, glycine, and aspartate were determined by high-pressure liquid chromatography (HPLC). Multivariate analysis was used to examine a possible association between amino acid neurotransmitter levels and several clinical variables including visual acuity. The mean vitreous concentration of glutamate in eyes with a rhegmatogenous retinal detachment (16.6 +/- 5.6 microM) was significantly higher as compared to the controls (13.1 +/- 5.2 microM) (P = 0.001). Taurine levels were also increased in RRD, whereas no significant difference could be observed in glycine, aspartate and GABA levels when comparing RRD with controls. A correlation was found between increased vitreous glutamate and a lower pre-operative visual acuity. No association was, however, observed between post-operative visual acuity and the level of any of the five amino acid neurotransmitters. RRD was associated with a significantly increased vitreous glutamate concentration. Using visual acuity as a functional parameter in this study, we could not demonstrate a correlation between vitreous glutamate, or any of the other tested amino acid neurotransmitters and visual outcome.

PURPOSE. Transforming growth factor (TGF)-beta2 and hepatocyte growth factor (HGF) have been implicated in the pathogenesis of proliferative vitreoretinopathy (PVR) after retinal detachment surgery. The exact role of these factors in the early events, immediately after primary retinal detachment, is not yet known, and determining their roles was therefore the purpose of this study. METHODS. Subretinal fluids were collected prospectively from 144 patients during surgery for scleral buckling. TGF-beta2 and HGF were measured with commercially available ELISA kits. Thirty patients in whom a redetachment caused by postoperative PVR developed, were compared with 114 patients with an uncomplicated retinal detachment. The controls included 18 vitreous samples from patients with macular hole or pucker. Multivariate regression analysis was used to compare the relative roles of growth factors and clinical factors in the development of PVR. RESULTS. The median amount of subretinal TGF-beta2 was approximately two times lower in patients with postoperative PVR (1.9 ng/mL) than in the uncomplicated detachment group (3.3 ng/mL; P = 0.002). TGF-beta2 levels in the PVR-positive group were similar to control vitreous levels (1.8 ng/mL). Subretinal HGF concentrations were not significantly different between the two groups of patients (PVR positive: 8.8 ng/mL; PVR negative: 8.9 ng/mL), but were higher than control vitreous levels (4.6 ng/mL; P = 0.01). Stepwise multivariate logistic regression analysis revealed that of all factors under study, decreased TGF-beta2 content was the exclusive predictor of postoperative PVR (P = 0.01). CONCLUSIONS. High TGF-beta2 levels in subretinal fluid at the time of primary retinal detachment may protect a patient against subsequent development of PVR.

To analyse vitrectomy results in diabetic eyes with retinal traction detachment and to investigate which variables are associated with a worse visual outcome.Forty-four diabetic eyes (33 patients) with central retinal traction detachment were analyzed retrospectively.After a median follow-up of 10 months, median visual acuity significantly improved from 20/800 to 20/160 (P=0.02), despite the fact that the majority of patients had a long-standing macular traction detachment (median 120 days). Twenty-two eyes (50%) achieved a visual acuity of20/200. The retina was finally reattached in 38 eyes (86.3%). Univariate analysis showed that patients with type 2 diabetes, age older than 50 years, preoperative visual acuity20/200, iris neovascularisation and macular detachment of30 days had a significantly worse final visual outcome. After multiple logistic regression analysis, age and iris neovascularisation were the strongest predictors of a worse visual outcome; if both were present, the chance of a obtaining a visual outcome of20/200 was almost 90%.Age and iris neovascularisation were the strongest predictors for a low visual outcome. In a review of vitrectomy studies in eyes with severe diabetic traction detachment in the past 2 decades, we found a trend towards higher anatomic success rates, while visual outcome only slightly improved. The current study confirmed the importance of ophthalmic variables, but also indicates the importance of evaluating systemic variables in larger series in order to predict which eyes may truly benefit from vitrectomy.

To examine the foveal cone photopigment kinetics in two patients with commotio retinae of the posterior pole (Berlin edema).A noninvasive technique, called fundus reflection densitometry, was used to provide a measure of the amount of visual photopigment at the foveal area and the time constant of photopigment regeneration.Strongly impaired foveal cone photopigment kinetics were found in two patients during the acute stage of commotio retinae. Complete recovery occurred within 3 months in both patients.Retinal opacification in Berlin edema is accompanied by a traumatic lesion at the level of the photoreceptor-retinal pigment epithelium (RPE) complex. These results support recent histopathologic data on commotio retinae, which revealed moderate photoreceptor outer segment disruption and retinal pigment epithelium damage. According to our data, such damage might be reversible.

PURPOSE: The possibility of postoperative binocular diplopia is seen as an important drawback of conventional scleral buckling surgery for rhegmatogenous retinal detachment. The goal of this study was to evaluate the occurrence and pattern of binocular diplopia after scleral buckle procedures in patients with rhegmatogenous retinal detachment. METHODS: In a retrospective study of 1,030 patients with primary rhegmatogenous retinal detachment who were treated by scleral buckle surgery between January 2001 and July 2008, the postoperative occurrence of binocular diplopia was retrieved from the medical charts. RESULTS: Secondary strabismus developed in 39 subjects (3.8%) after scleral buckle surgery during a mean follow-up of 6.4 +/- 6.3 months. Twenty-eight patients (2.7%) developed strabismus because of a mechanical restriction of one of the muscles. No association was found between the position of the buckle, that is, the muscle affected, and the incidence of diplopia. A moderate significant association was found when two muscles were affected with a higher incidence of diplopia. This was, however, not found for three or more muscles. In 28 of 39 patients, binocular single vision was restored at the end of the follow-up period. In the majority, this was accomplished with conventional prism treatment. CONCLUSION: Strabismus caused by a restriction of the muscles in scleral buckle surgery was not predictable based upon the buckle position. Patients with a minimal restriction of the muscles after scleral buckle surgery can often be well treated with prisms.

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a major cause of visual loss in developed countries. Proliferative vitreoretinopathy (PVR), an eye-sight threatening complication of RRD surgery, resembles a wound-healing process with inflammation, scar tissue formation, and membrane contraction. This study was performed to determine the possible involvement of a wide range of cytokines in the future development of PVR, and to identify predictors of PVR and visual outcome. METHODOLOGY: A multiplex immunoassay was used for the simultaneous detection of 29 different cytokines in subretinal fluid samples from patients with primary RRD. Of 306 samples that were collected and stored in our BioBank between 2001 and 2008, 21 samples from patients who developed postoperative PVR were compared with 54 age-, sex-, and storage-time-matched RRD control patients who had an uncomplicated postoperative course during the overall follow-up period. FINDINGS: Levels of IL-1α, IL-2, IL-3, IL-6, VEGF, and ICAM-1 were significantly higher (P0.05). Multivariate logistic regression analysis revealed that IL-3 (P = 0.001), IL-6 (P = 0.047), ICAM-1 (P = 0.010), and preoperative visual acuity (P = 0.026) were independent predictors of postoperative PVR. Linear regression analysis showed that ICAM-1 (P = 0.005) and preoperative logMAR visual acuity (P = 0.001) were predictive of final visual outcome after primary RRD repair. CONCLUSIONS/SIGNIFICANCE: Our findings indicate that after RRD onset an exaggerated response of certain cytokines may predispose to PVR. Sampling at a time close to the onset of primary RRD may thus provide clues as to which biological events may initiate the development of PVR and, most importantly, may provide a means for therapeutic control.

PURPOSE:: To investigate the influence of subfoveal fluid and foveal thickness on visual outcome in patients who underwent reattachment surgery for rhegmatogenous retinal detachment (RRD). METHODS:: This prospective study included 53 patients who were undergoing successful scleral buckling surgery for primary RRD. A thorough ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography scanning was performed preoperatively and during all subsequent follow-up visits at 1, 3, 6, 9, 12, and 24 months postoperatively. RESULTS:: Preoperative foveal thickness was significantly higher in the macula-off group (n = 38) compared with the macula-on group (n = 15) (P < 0.0001), whereas postoperative measurements were normal in both the groups. Linear mixed-model analysis revealed that persistent subfoveal fluid (P = 0.0004) was an independent predictor of a worse visual outcome after scleral buckling surgery for primary macula-off RRD, although the effect on visual outcome was small (0.1 logarithm of the minimal angle of resolution units). Moreover, increased preoperative foveal thickness was associated with a worse visual prognosis in macula-off RRD (P = 0.010). CONCLUSION:: Persistent subfoveal fluid and increased preoperative foveal thickness were associated with a worse visual prognosis in macula-off RRD patients, albeit the effect of persistent subfoveal fluid was small and temporary.

PURPOSE. Interleukin (IL)-6, a multifunctional cytokine with regulatory functions in wound healing, and several chemokines have been implicated in the pathogenesis of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD). The exact role of these chemokines, their correlation with IL-6 after primary RRD, and their association with the future development of PVR are not yet known. METHODS. A multiplex immunoassay was used to determine levels of 15 different chemokines and IL-6 in subretinal fluid samples obtained during scleral buckling surgery for primary RRD. Samples from patients with preoperative uveitis, preoperative trauma, or preoperative vitreous hemorrhage were excluded. Patients who developed a redetachment due to postsurgical PVR within 2.5 months (n = 21) were compared with control subjects who had an uncomplicated retinal detachment during the overall follow-up period (n = 54). Control subjects were matched for sex, age, and storage time. RESULTS. Levels of IL-6 (P = 0.001), MIF (P = 0.016), CCL2 (P = 0.041), CCL11 (P = 0.012), CCL17 (P = 0.003), CCL18 (P = 0.007), CCL19 (P

PURPOSE. An increased mRNA expression of genes related to blood coagulation has been demonstrated in an experimental retinal detachment model but has not yet been confirmed in human clinical specimens. Tissue factor (TF), the initiating factor of blood coagulation, may be a determinant of the extent of tissue injury after rhegmatogenous retinal detachment (RRD). This study was conducted to determine whether subretinal fluid and vitreous fluid collected from patients with RRD have a procoagulant effect. METHODS. Calibrated thrombin generation (CAT) was used to investigate the thrombogenic properties of 28 subretinal fluids collected during scleral buckling surgery for RRD. Further, the thrombogenic properties of vitreous fluids from RRD (n 12), macular pucker (n 5), macular hole (n 6), and proliferative diabetic retinopathy (n 5) were compared with the properties of eye bank eyes (n 11), which served as control specimens. The procoagulant activity of TF was determined with Western blot analysis. RESULTS. The addition of subretinal fluid from all RRD patients (28/28, 100%) induced thrombin generation in normal and severely factor (F)XII-deficient plasma. Contrary to the subretinal fluid, the addition of vitreous fluids from various ocular disorders evoked very little thrombin generation in normal and severely FXII-deficient plasma (4/12, 33% RRD; 1/5, 20% macular pucker; 0/6, 0% macular hole; 0/5, 0% proliferative diabetic retinopathy; and 2/11, 18% eye bank eyes). The procoagulant activity in subretinal fluid was almost completely neutralized by antibodies against human TF. The presence of TF in subretinal fluid was confirmed by Western blot. CONCLUSIONS. Subretinal fluid of patients with RRD induces high procoagulant activity, determined by measuring the level of tissue factor. (Invest Ophthalmol Vis Sci. 2010;51: 5234‐5239) DOI:10.1167/iovs.10-5354 T issue factor (TF), a transmembrane glycoprotein, is the major initiating factor of blood coagulation in normal hemostasis in vivo. Upon the complexing of coagulation factor VII and TF, coagulation factor X and IX further activate downstream proteases. 1 Ultimately, this activation generates thrombin, the key enzyme in the conversion of fibrinogen into fibrin. 2 TF is ubiquitous throughout the human body and maintains hemostasis when blood vessels are injured. Therefore, TF is constitutively expressed by subendothelial cells and epithelia, to prevent blood loss into extravascular spaces. 3 In the human eye, TF is mostly expressed in the retinal vessel walls but only faintly in anterior segmental tissue. 4 Recently, it was shown that genes related to blood coagulation were upregulated in an experimental retinal detachment model in the pig. 5 In this study, TF gene expression showed a threefold change in expression level and was considered to be upregulated in detached and peridetached neural retinas and in retinal pigment epithelial (RPE) cells, compared with control retinas. It is postulated that TF may be a critical determinant of the extent of tissue injury mediated by an ongoing inflammatory response. 6 For instance, it was suggested that plasma TF levels reflect endothelial cell injury and/or destruction of TFcontaining cells in patients with diabetes mellitus with retinopathy or nephropathy. 3 Since the blood‐retinal barrier with its TF-containing RPE cells may be damaged during rhegmatogenous retinal detachment (RRD), it is conceivable that TF is released into the subretinal space. Moreover, blood coagulation components may play an essential role in the development of proliferative vitreoretinopathy (PVR) after RRD, as is shown in animal models. 7,8

Purpose To evaluate the six-month results of patients treated with intravitreal prednisolone sodium succinate injections for persistent diabetic macular edema. Design Retrospective, noncontrolled, clinical case series. Methods Nineteen eyes had intravitreal injections with prednisolone sodium succinate. Need for retreatment was based on fluorescein angiographic or optical coherence tomography evidence of persisting macular edema. Results Mean visual acuity at six weeks, three months, and six months after injection was significantly better than the mean preoperative visual acuity ( P = .015, P = .004, and P = .031, respectively). In none of the studied eyes intraocular pressure exceeded 22 mm Hg. No other adverse events, such as endophthalmitis or retinal detachment, occurred. Conclusions In this small pilot study, mean visual acuity improvement was statistically significant up to six months postoperatively. Current results suggest that intravitreal injection of the solution of prednisolone sodium succinate may be a safe and good alternative in eyes with macular edema.

Purpose To investigate whether the peeled internal limiting membrane (ILM) contains cellular retinal cell fragments, and to learn more about their possible origin. Design Experimental study. Methods ILM peeled from ten eyes during vitrectomy by infracyanine green (ICG) was studied immunohistochemically using the markers: GFAP, S-100, and vimentin. Five ILM specimens were from eyes with diabetic macular edema (DME), two from eyes with a macular hole, and three from eyes with persisting macular edema after retinal detachment surgery. Results In eight of the ten ILM specimens, we found GFAP-positive staining, indicating the presence of remnants of footplates from Muller cells or glial cells. Two ILM specimens were positive for S-100, indicating the presence of neural cells or ganglion cells. Conclusions ILM peeled from the retina during vitrectomy using ICG may contain remnants of Muller cell footplates, neural cells, and ganglion cells.

Cyclic guanosine monophosphate (cGMP) is produced in different retinal cells, including photoreceptor cells, wherein cGMP mediates photo-transduction. CGMP is degraded by phosphodiesterases (PDE). The aim was to investigate whether retinal detachment alters intraocular cGMP levels in human eyes.cGMP and PDE were determined in vitreous fluid from 50 eyes with a retinal detachment (group I) and in 20 control samples (group II) of vitreous fluid from eyes without retinal detachment. Group III consisted of subretinal fluid samples from 70 eyes with retinal detachment.cGMP in vitreous fluid from eyes with retinal detachment (6.5 (SD 1.7) nM) was decreased compared to controls (67.1 (10.0) nM) (p0.0001). In subretinal fluid, the mean level of cGMP was 2.4 (0.2) nM. No PDE could be detected in any of the intraocular fluid samples of patients nor controls. A decrease in the mean level of cGMP in subretinal fluid of eyes with retinal detachment correlated with a longer duration of detachment (r = -0.45, p = 0.007).Retinal detachment was found to be associated with a decrease in vitreous cGMP concentration. In subretinal fluid, a low cGMP level correlated inversely with the duration of the detachment.

To investigate the presence of basic fibroblast growth factor (bFGF), glutamine synthetase (GS), and interleukin-6 (IL-6) in vitreous fluid from eyes with retinal detachment complicated by proliferative vitreoretinopathy (PVR).Comparative case series; experimental study.In a prospective study, we measured bFGF, GS, IL-6, and total protein in vitreous fluid samples from 53 eyes from 53 consecutive patients with PVR operated on in our hospital. As controls, vitreous fluid samples from eyes with a macular hole (n = 9) or pucker (n = 11) were used.Laboratory data of the patient group were compared with the control group and correlated with various clinical data, especially with visual recovery and redetachment.For IL-6, bFGF, and total protein we found significantly higher levels in PVR patients' eyes than in control eyes (P =.03, P =.046, and P.0001, respectively). Within the PVR group, no significant correlation was found for IL-6, bFGF, GS, or total protein with the various tested clinical variables.We found increased levels of IL-6, bFGF, and total protein in vitreous fluid from patients' eyes with PVR. Whether the increased levels of IL-6, bFGF, and total protein are the result of an injury-induced upregulation of these proteins as part of a self-protective mechanism of the retina to minimize photoreceptor damage after the mechanical injury induced by retinal detachment is, at present, not known.

AIM: To assess foveal cone photoreceptor function in patients with unexplained loss of central visual acuity. METHODS: Testing of foveal cone photoreceptor function was performed using scanning laser densitometry, colour matching (Rayleigh equation), and pattern electroretinography (ERG). Standard tests included full field ERG, electrooculography, visual evoked potentials, static perimetry, and fluorescein angiography. RESULTS: Decreased foveal cone photopigment density and abnormal pattern ERG were found in three patients. Results of colour matching were not unequivocal. CONCLUSION: Testing of foveal cone photoreceptor function using scanning laser densitometry may determine the location of pathological changes in certain patients with unexplained visual loss.

We compared the results of foveal densitometry with results of other retinal function tests in five asymptomatic subjects with adult-onset diffuse drusen. All results of routine retinal function tests, including visual acuity, Rayleigh equation color matches, multiple static perimetry, electroretinography, and electro-oculography, were normal. All five subjects had decreased foveal cone photopigment density with densitometry, indicating an early dysfunction at the level of the foveal cone photoreceptors. Several functional defects may be responsible for the densitometric results in adult-onset diffuse drusen, including retinal pigment epithelium dysfunction, foveal cone photoreceptor misalignment, and a reduction of the in situ foveal cone photopigment.

Purpose The goal of this study was to identify risk factors for redetachment and/or a worse visual outcome after silicone oil removal (SOR) for complicated retinal detachment. Methods The authors retrospectively analyzed 287 consecutive eyes with SOR between January 1999 and December 2003. Results Anatomic success after SOR was achieved in 81% of the eyes. The overall anatomic success at the end of follow-up was 94%. Postoperative ocular hypertension was found in 8% of the eyes, hypotony in 6% of the eyes, and keratopathy in 29% of the eyes. After SOR 43% of the eyes had an improvement in visual acuity of at least two Snellen lines. After multivariate analysis, male sex, the presence of preoperative rubeosis, and proliferative diabetic retinopathy (PDR) were found to be risk factors for recurrent retinal detachment. Male sex, preoperative visual acuity of Conclusions Retinal detachment after SOR in the current unselected series of eyes occurred in approximately 20%, which is comparable to the Silicone Oil Study reports, published approximately 20 years ago. However, preoperative selection was then made, and less than 50% of the silicone oil-filled eyes had SOR. The higher overall anatomic success in the current study may be due to improved vitreoretinal surgical techniques.