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Purpose: This work assesses the clinical characteristics and outcomes of various treatment methods in managing rhegmatogenous retinal detachments secondary to retinal dialysis. Methods: In this retrospective, consecutive case series, patients presenting to a tertiary referral vitreoretinal service from 2015 to 2020 were chosen. The primary outcome measure was the single-surgery anatomic success (SSAS) rate in the first 90 days after surgery and overall SSAS rate until the last visit. Results: Eighty-six eyes of 84 patients were included. Mean (SD) age was 30 (14.8) years (range, 7-71 years). Fifty-nine (70%) patients were men and 55 eyes (64%) had a history of trauma. Dialysis occurred in the inferotemporal quadrant in 50 eyes (58%) of the entire cohort and 25 of 55 eyes (45%) with prior trauma. Fifty-one eyes (59.3%) were managed by scleral buckle (SB), 25 eyes (29.2%) with laser retinopexy, and 10 eyes (11.6%) with pars plana vitrectomy (PPV). The SSAS rate in the first 90 days after surgery was 94.1% (81 of 86 eyes), including 90.1% of eyes with SB, 100% of eyes with laser retinopexy, and 100% of eyes with PPV ( P = .07). The overall SSAS rate, however, was 89.5% (77 of 86) eyes, including 90.1% of eyes with SB, 84% of eyes with laser retinopexy, and 100% of eyes with PPV ( P = .4). Final attachment rate was 100% in the entire cohort. Conclusions: With careful consideration of underlying pathology, all 3 treatment modalities can provide high rates of anatomic and functional success.

Neurofibromatosis type 1 (NF1) is a phacomatosis known to be associated with several developmental abnormalities in multiple organ systems including the eyes. NF1 can present with varying ophthalmic manifestations, including Lisch nodules, retinal astrocytic hamartomas, capillary hemangiomas, plexiform neurofibromas, and choroidal nodules. We present 2 cases of NF1 with presentations that may represent underreported retinal abnormalities occurring in NF1. Case 1 presents a patient who developed spontaneous peripheral retinal dialysis with subsequent retinal detachment; case 2 discusses a patient with multiple pigmented choroidal lesions bilaterally.

Till the start of the twentieth century, rhegmatogenous retinal detachment (RRD) was considered an untreatable disease. Then, Jules Gonin single-handedly changed the landscape of RRD surgery forever. Currently, RD surgery is one of the most commonly performed retinal surgeries. The most commonly practiced surgical approaches for its treatment are scleral buckling (SB) and pars plana vitrectomy.

Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris. The visual prognosis may be extremely poor when involving the macular area or in cases with major comorbidities. On funduscopic examination the rupture appears as a whitish/yellowish curvilinear or crescent-shaped lesion with forked or tapered endings. Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography can provide a detailed assessment of the extent of damage and the onset of complications. Although there is no treatment for choroidal rupture per se, associated complications such as angle-recession glaucoma, retinal detachment, or exudative choroidal neovascularization might need therapeutic interventions. We describe the pathophysiology of choroidal rupture, the recent multimodal imaging findings, and the available treatment options for the management of complications.

Scleral buckling has been successful method of treating rhegmatogenous retinal detachment for 70 years now. In the world of ubiquitous pars plana vitrectomy what has changed was indications and selection of patients for whom scleral buckling is still the first choice procedure. It seems that in young age patients cases scleral buckling should be considered in retinal detachment with holes located in adjacent quadrants and post traumatic retinal dialysis particularly.

Traumatic retinal injuries are commonly encountered in most retinal subspecialty clinics. Retinal dialysis, detachment and other complications consequent to blunt trauma are often thought to be due to equatorial expansion of the globe following an antero-posterior compressive force. However, stretching of the globe along the primary anatomical equator may not hold true for the adjusted globe position as a consequence of the protective Bell's phenomenon which gets activated before impact. The upward and outward rolling of the globe likely creates a new equator, with the compressive forces acting along this new plane, thereby leading to stretching along the ocular coats closer to the retinal periphery. Additionally, the coup and countercoup mechanisms with increased vulnerability of temporal sclera predisposes to retinal complications more commonly along the temporal and the nasal retina. Further, retinal complications involving other quadrants can also be explained through understanding of the Bell's phenomenon.

The pattern of retinal features in patients with retinal detachment caused by retinal dialyses is poorly described. The association with trauma has also been inconsistently reported. The authors aim to analyze patient and retinal characteristics in such cases and identify the proportion where trauma is likely causative mechanism.Retrospective case series.Sixty-three eyes from 63 patients with retinal detachment secondary to retinal dialysis.Population was selected from consecutive patients presenting to a single surgeon at a tertiary referral vitreoretinal service (2001-2010).Sixty-three patients were identified (4.4% incidence rate). The cohort had a mean age of 32 years with a male preponderance (67%). Seventy-one percent had a single break, 21% had 2 breaks, and 8% had 3 to 7 breaks. Six percent of eyes had dialyses smaller than 0.5 disc diameters. Eighty-one percent of eyes had inferotemporal dialyses, but other quadrants also were involved in 25%, or exclusively in 17.5%. The primary success rate for surgery was 92% (94% final success). The presence of proliferative vitreoretinopathy (PVR) was rare (4 cases) but was a significant factor in failure of retinal reattachment (p0.001). Twenty-two percent were regarded as traumatic (93% male; p0.05). Other variables were similar between traumatic and nontraumatic eyes.Most retinal dialyses are located inferotemporally; however, multiple dialyses, small dialyses, and dialyses that involve multiple quadrants may be seen. In patients with evidence of direct globe injury, no difference in the pattern of retinal presentation of the dialyses was observed. Although surgical success rates are high, patients with PVR had poor response to surgery.

A healthy 22-year-old man presented with decreased vision OD for 1 month. There was no history of trauma. Best-corrected visual acuity (BCVA) was 20/400 OD and 20/20 OS. Anterior segment OU was normal. Dilated fundus examination OD (figure 1A) showed large inferotemporal retinal dialysis (black arrows), an intraretinal macrocyst at its edge (blue arrowheads) and rhegmatogenous retinal detachment (RRD) reaching up to the fovea. Yellowish-white vitreous opacities were noted in the inferior fundus …

Purpose: Retinal dialysis is a frequent cause of retinal detachment in infants and young adults. The authors report long-term results obtained with conventional detachment surgery in a large consecutive series. Methods: Fifty-two eyes of 50 patients with retinal detachment due to dialysis underwent a segmental buckling procedure between January 1990 and December 1998. Patient characteristics and surgical results at 1 year of follow-up were evaluated. In 2007, 40 eyes from these groups were reexamined for long-term results (follow-up: 9 to 17 years; median: 13.4 years). Results: The mean age of the patients was 12.8 years (range = 6 to 28 years). Preferred locations of the dialyses were inferotemporal (72%) and superonasal (16%). The macula was detached in 82%. At 1 year of follow-up, the retina was completely reattached after one surgical procedure in 87% and after two procedures in 97%. Long-term follow-up of 40 of 52 eyes revealed no retinal redetachment, but additional surgeries had been performed. Visual acuity improved in 70% of the eyes, but only 40% reattained reading vision due to the high rate of macula-off retinal detachment preoperatively. Conclusion: Scleral buckling for retinal detachment due to dialysis yields good results, even in the long term, and remains the treatment of choice for these usually young patients despite the increasing popularity of primary vitrectomy.

Posterior segment injury involves the vitreous, retina, choroid, and posterior sclera during ocular injury. The nature of industrial and sports-related trauma frequently causes posterior segment injury, 14 which can manifest in a variety of ways. The diverse spectrum of posterior injuries includes a foveal scar from photic exposure, an intraocular foreign body from hammering, intraocular injection of hydraulic fluid from high-pressure lines, chronic retinal detachment due to an unrecognized retinal dialysis, and complete globe disorganization caused by a golf ball injury. It is well recognized and accepted that almost all sport- and work-related ocular injuries can be prevented by the use of appropriate protective eye gear. 39,48 Despite this knowledge, these injuries continue to be the one of the leading causes of visual loss, especially in the younger age group. The visual prognosis after ocular trauma depends on a number of factors. 15 A large proportion of eyes with severe and irreversible visual loss due to trauma almost always exhibit posterior segment injuries. These injuries lead to vitreoretinal complications that may occur immediately, days, weeks, or even years after the initial trauma. 12 Recent advances in microsurgical techniques, as well as an improved understanding of the pathophysiology of these vitreoretinal complications, may minimize the visual loss, even in the more severely affected eyes. Therefore, although prevention remains the ultimate goal, the diagnosis and management of posterior segment injuries are important factors in reducing the magnitude of visual loss in injured eyes.

Proliferative vitreoretinopathy (PVR) is a severe complication of retinal detachment, which can be treated surgically by relaxing retinectomy. In this study, we describe patients with severe inferior retinal folding after this surgical intervention (SIRF). A retrospective review of the electronic patient records of 254 patients who received relaxing retinectomies was performed to identify patients with SIRF. Five patients (1.97% of those with retinectomy) were identified with SIRF, mean age, 51.4 years; mean follow-up, 36 months. Three patients had rhegmatogenous retinal detachment (RRD) with PVR, one had a dropped nucleus with RRD and PVR and one with giant retinal dialysis from ocular trauma. SIRF was noted from a mean 4.2 months after the retinectomy. All involved the macula and visions were hand movements or perception of light. SIRF is an uncommon but devastating complication of relaxing retinectomy with a poor visual outcome. This is the first description of this condition that we are aware of.

Retinal dialysis is a disinsertion of the retina at the ora serrata which commonly leads to retinal detachment. Patients are often asymptomatic until the retinal detachment involves the macula. Management involves surgical reattachment of the retina, often with a scleral buckling procedure. The primary eye care practitioner must be aware of the possible symptoms, clinical features, and potential post-operative complications of retinal dialysis surgery. A case is presented of a patient diagnosed with bilateral retinal dialyses.

A variety of airbag-associated ocular injuries have been reported in children sitting in the front passenger seat during automobile collisions. These injuries range from corneal abrasions to traumatic hyphema with secondary glaucoma and cataract. We report the case of a 5-year-old boy who experienced retinal dialysis and detachment associated with airbag deployment. The patient recovered 20/20 visual acuity after cryopexy and placement of a radial sponge.

Background: Three cases of Fuchs' heterochromic uveitis (FHU) are described, 2 with peripheral retinal breaks and 1 with retinal dialysis. Methods: Argon laser photocoagulation was applied around the breaks and the dialysis. Results: The retinal breaks and dialysis were succssfully photocoagulated. Interpretation: Thorough inspection of the fundus, including the peripheral retina, is important in patients with FHU to exclude a retinal break or a dialysis.

A 35-year-old man presented with traumatic iritis, angle-recession glaucoma, and a retinal dialysis secondary to blunt trauma from a Taser gun in the right eye and a unique electrical cataract in the left eye. Taser guns, which can also function as stun guns, can lead to electrical cataract formation. Given the increasing use of Taser guns by law enforcement and citizens, blunt mechanical and electrical sequelae of Taser gun injuries should be recognized.

Purpose To investigate anatomic success after surgery for chronic retinal detachment. Design Retrospective, case series review. Methods The surgical outcomes of reattachment surgery for 36 eyes of 35 patients with chronic retinal detachments are reported and are compared with the outcomes for 129 fresh retinal detachments. Results After exclusion of retinal detachments secondary to retinal dialysis and of cases with proliferative vitreoretinopathy (PVR), success after a single procedure was seen in eight of 14 (57.1%) chronic retinal detachments, and this compares with 92 of 107 (86.0%) fresh retinal detachments (P = .0161). Conclusions Chronicity of retinal detachment at presentation is an important and poor prognostic indicator for reattachment surgery.

The purpose of this paper is to describe a traumatic retinal detachment occurring as a result of CrossFit training using an elastic exercise band. The patient sustained an ocular injury from an elastic band during CrossFit training, resulting in a giant retinal dialysis and retinal detachment, which were successfully repaired. Trainers and athletes need to be aware of the potential for ocular injury from elastic exercise bands and take appropriate precautions.

It remains controversial whether there is a significant genetic contribution to the pathogenesis of idiopathic giant retinal tears or retinal dialysis. In contrast, the underlying molecular genetic basis of several inherited vitreoretinal dystrophies is now well established, with also an increasing recognition of genetic factors in the development of myopia. We describe asymptomatic female monozygotic twins who were identified as having identical retinal holes. These cases represent the first evidence to our knowledge of a potential role of inherited factors in the causation of idiopathic peripheral retinal holes. This observation raises the need to examine the twin of any patient presenting with a retinal break(s).

A 13-year old boy was hit in the right eye by a coin that was thrown at him. He presented to the accident and emergency (A&E) department with an oblique corneal abrasion, microscopic hyphaema, iris-ciliary body dialysis, commotio retinae with retinal haemorrhages and a large retinal dialysis. The limited amount of available data in the medical literature suggests that eye injuries as a result of coin throwing are serious and should always be referred to an ophthalmologist for evaluation.

An increasing variety of air bag-associated ocular injuries have been reported, ranging from chemical keratitis to retinal tears and orbital fractures. 1-4 We recently treated a patient who experienced a traumatic iritis, vitreous hemorrhage, and retinal dialysis with retinal detachment following a blow to the eye from an air bag. Report of a Case. A 31-year-old woman with a previously unremarkable ocular history was the driver in a motor vehicle that was involved in a frontal collision. She was wearing a passive three-point restraint and was aware of the impending collision. She remembered the explosive inflation of the air bag and did not recall striking her head on any portion of the vehicle. Immediately following the collision, she noted decreased visual acuity in her left eye and mild erythema of the left side of her face. Ophthalmologic examination 2 days later revealed mild photophobia and a visual acuity of 20/20

This new edition is divided into four sections: "Preoperative Exam"; "Instrumentation"; "Surgical Techniques"; and "Types of Retinal Detachment: Clinical Characteristics and Surgical Management." The book is well written, with good organization and appropriate illustrations. The figures and drawings are in black and white, but are nicely produced, plentiful, and instructive. In this book, Bonnet shares her extensive experience in the management of retinal detachment. The book is up to date and well referenced and has a lucid, informative, and easy-to-read style. Unfortunately, the text is complete with all the biases that a single viewpoint often implies. For example, Bonnet repeatedly affirms that "permanent retinal reattachment can be achieved in 100% of eyes," when she describes certain types of detachments such as retinal detachment with retinal dialysis. Such assurance detracts from other experience that the author shares. The main element of this book is the use of microsurgical techniques for retinal

One hundred three cases of retinal dialysis from the files of the Eye Pathology Laboratory at the Wilmer Ophthalmological Institute from the years 1968 to 1981 were reviewed histopathologically. The major etiological mechanisms are illustrated and their pertinent features discussed. Although most of these cases were clearly related to trauma, several were of idiopathic origin and two of those were bilateral. A possible role for lattice degeneration in retinal dialysis is demonstrated. The literature dealing with the clinical, experimental, and histopathologic features of retinal dialysis is reviewed.

Idiopathic retinal dialyses accounted for 1.8% of 1,789 eyes with rhegmatogenous retinal detachments diagnosed in two institutions over the 6-year period from 1972 through 1977. These detachments characteristically occur in the inferotemporal quadrant of young adult eyes and often are associated with demarcation lines, retinal cysts, peripheral microcystoid degeneration, and yellow-white vitreous opacities. This study provides additional evidence that a distinct type of retinal detachment secondary to nontraumatic retinal dialyses exists. The authors believe that these dialyses probably are secondary to a developmental abnormality of the inferotemporal periphery of the retina and vitreous base. Trauma may precipitate these dialyses but is not the primary cause.

Retinal detachments occurred in six eyes of five patients suffering with atopic dermatitis. Retinal detachments occurred before cataract surgery in all but one eye. In each eye, a retinal dialysis was the cause of retinal detachment. Detachment of ciliary epithelium was present in five eyes and pars plana cysts were found in one eye. Retinal dialysis was one of the commonest features of retinal detachment associated with atopic dermatitis.

To the Editor. —In the AugustArchives(1981;99:1371-1374), Ross concluded after examining 50 patients who underwent retinal dialysis that all retinal dialyses probably result from trauma and that genetic weakness of the retina at the ora serrata is not an important factor. In his analysis of inferotemporal dialyses, the author stated that in 15 of 36 dialyses (34 patients), the history was either forgotten or denied for social reasons. Although the number of dialyses in the remaining retinal quadrants came to 13, only one patient in this category denied a history of trauma. In support of a nonhereditary cause of inferotemporal dialyses, Ross also stated that there was no family history of dialysis in any of these 34 patients, but he does not mention if siblings or other relatives of these patients were examined by indirect ophthalmoscopy and peripheral scleral depression. Verdaguer et al1examined the families of 30

Retinal dialyses have been observed in chronic pars planitis as a result of cyclitic membrane contraction1 in retinal detachment following penetrating ocular wounds2,3 and after pars plana vitrectomy. Most cases, however, occur either after ocular contusion or as a primary disease in young individuals. In this chapter we shall only consider traumatic and idiopathic dialyses.

• A lens nucleus dislocated through a retinal dialysis into the subretinal space was managed by successful reattachment of the retina over the lens. Subsequent slow resorption of the lens material resulted in good visual acuity.

Retinal detachments due solely to atrophic round holes in lattice degeneration are in many respects distinct from retinal detachments associated with tractional horseshoe retinal tears. In most cases, those retinal detachments develop in eyes that have neither significant vitreous degeneration nor posterior vitreous detachment. As a consequence, the detachment has a very low progression and shares most of the clinical characteristics of retinal detachments associated with nontraumatic retinal dialysis. The risk of postoperative proliferative vitreoretinopathy is virtually nil. The surgical prognosis for retinal reattachment is excellent.

• The fundus in 63 eyes of 32 karyotyped patients with mongolism (Down syndrome) was examined by indirect ophthalmoscopy. Common features included a rosy disc associated with a greater than normal number of retinal blood vessels, a generalized attenuation of fundus pigmentation regardless of iris coloration, peripapillary and patchy peripheral areas of pigment epithelial atrophy, and choroidal vascular "sclerosis." These findings are believed to be suggestive but not pathognomonic of mongolism. Eleven eyes of six additional patients were found to have retinal detachment. Eight of these were due to a retinal dialysis and only two could be surgically reattached. Trauma was thought to be an important predisposing factor. Several suggestions for prevention and early diagnosis of this complication are briefly presented.

THE surgical repair of retinal detachment associated with a small retinal dialysis is accomplished with a high rate of success by most retinal surgeons,1,2regardless of the specific technique employed. In contrast, detachments associated with giant dialyses have been corrected with less success, especially if the posterior edges are rolled, and in some instances attempted repair has not even been tried.1In this report, a technique is described which permitted a giant dialysis and tear with rolled edge to be successfully reattached. Report of a Case A 25-year-old male student was seen because of acute right eye pain and blurred vision. This developed immediately after he was struck in the eye by a finger while playing football. His past medical history revealed several minor shrapnel injuries to the left arm and knee, reattachment of a severed left thumb, and treatment for malaria; all occurring while he was in

To the Editor. —Dr. Brockhurst has raised an important question concerning whether vitreous is or is not attached to the posterior edge of a retinal dialysis. He believes that if this occurs, it must be a "medical curiosity." We would disagree. First, it would seem relevant to note that multiple areas of attachment of formed vitreous to retina at or posterior to the equator have been described in normal, untraumatized eyes by Grignolo. 1 Irvine 2 has shown "sucker feet" of formed vitreous attached to the posterior retina, and, very recently, Spencer and Foos 3 have reviewed the paravascular vitreoretinal attachments which may occur at or posterior to the equator. More to the point, Cibis 4 has described attachment of the vitreous to the posterior edge of retinal tears, and his illustrations are quite clear. Duke-Elder 5 has shown formed vitreous adherent to the posterior edge of a dialysis. In