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Objective To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Design Nonrandomized, multicenter, retrospective study. Participants One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. Methods Reported data included clinical manifestations, the method of repair, and the outcome. Main Outcome Measures Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). Results The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy ( P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone ( P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle ( P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone ( P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle ( P = 7×10 −8 ). Conclusions In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Objective To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs). Design Nonrandomized, multicenter retrospective study. Participants One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs. Methods Reported data included specific clinical findings, the method of repair, and the outcome after intervention. Main Outcome Measures Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate). Results Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle ( P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group ( P = 3×10 –8 ). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles ( P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present ( P = 0.65), but not in cases with a flap tear ( P = 0.034). Conclusions In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Resumen Objetivo Evaluar el cambio medio de la mejor agudeza visual corregida (MAVC) en pacientes con degeneracion macular asociada a la edad exudativa-hemorragica (DMAE-EH) a los 12 meses de tratamiento con ranibizumab. Metodos Estudio observacional, retrospectivo, multicentrico y nacional, en dos grupos de pacientes con DMAE-EH: primer ojo afectado (grupo 1) y segundo ojo afectado (grupo 2), teniendo afectado el primer ojo. Se incluyeron pacientes ≥ 50 anos, diagnosticados de neovascularizacion coroidea subfoveal activa principal o recurrente secundaria a DMAE-EH. Resultados Se incluyo a 184 pacientes (91 en grupo 1 y 93 en grupo 2), edad media ± DE de 75,3 ± 7,5 anos y 53,6% mujeres. La MAVC mostro una mejoria de la AV a los 12 meses de 9,3 ± 18,0 numero de letras en el grupo 1 y 5,1 ± 16,8 numero de letras en el grupo 2 (p Conclusiones La administracion de ranibizumab intravitreo durante un minimo de 12 meses conllevo una mejoria significativa en la MAVC, una disminucion de las lesiones retinianas y una disminucion del grosor retiniano medio inicial en pacientes con NVC principal o secundaria a DMAE-EH, tanto en los pacientes con primer ojo afectado como en los pacientes con segundo ojo afectado, teniendo afectado el primero.

PURPOSE To show how effective photodynamic therapy (PDT) is for papillary hemangioma. PATIENT AND METHODS During follow-up, a papillary hemangioma in a 7-year-old girl increased in size, reducing visual acuity. PDT (verteporfin at a dose of 6 mg/m body surface area and a light dose of 50 J/cm for 83 seconds) with a spot placed directly over the whole papilla was used to treat the tumor. A reduction in exudation and an improvement in visual acuity were achieved after two treatments. DISCUSSION In this case, PDT over a tumor on the optic nerve head allowed preservation of some visual function; this strategy can be considered a therapeutic option for tumors in this location.

Purpose To validate three models for predicting proliferative vitreoretinopathy (PVR) based on the analysis of genotypic data and relevant clinical characteristics. Methods The validation series consisted of data from 546 patients operated on from primary rhegmatogenous retinal detachment (RRD) coming from centres in the Netherlands, Portugal, Spain and the UK. Temporal and geographical validation was performed. The discrimination capability of each model was analysed and compared with the original series, using a receiver operating curve. Then, clinical variables were combined in order to improve the predictive capability. A risk reclassification analysis was performed with and without each one of the variables. Reclassification of patients was compared and models were readjusted in the original series. Readjusted models were further validated. Results One of the models showed good predictability in the temporal sample as well as in the original series (area under the curve (AUC) original=0.7352; AUC temporal=0.6457, 95% CI 50.17 to 78.97). When clinical variables were included, only pre-existent PVR improves the predictability of this model in the validation series (temporal and geographical samples) (AUC original=0.7940 vs AUC temporal=0.7744 and AUC geographical=0.7152). The other models showed acceptable AUC values when clinical variables were included although they were less accurate than in the original series. Conclusions Genetic profiling of patients with RRD can improve the predictability of PVR in addition to the well-known clinical biomarkers. This validated formula could be a new tool in our current clinical practice in order to identify those patients at high risk of developing PVR.

This is an open-access article distributed under the terms of the Creative Commons Attribution License.-- et al., Proliferative vitreoretinopathy (PVR) is still the major cause of failure in retinal detachment (RD) surgery. It is believed that down-regulation in the p53 pathway could be an important key in PVR pathogenesis. The purpose was to evaluate the impact of T309G MDM2 polymorphism (rs2279744) in PVR. Distribution of T309G MDM2 genotypes among European subjects undergoing RD surgery was evaluated. Proportions of genotypes between subsamples from different countries were analyzed. Also, a genetic interaction between rs2279744 in MDM2 and rs1042522 in p53 gene was analyzed. Significant differences were observed comparing MDM2 genotype frequencies at position 309 of intron 1 between cases (GG: 21.6%, TG: 54.5%, TT: 23.8%) and controls (GG: 7.3%, TG: 43.9%, TT: 48.7%). The proportions of genotypes between sub-samples from different countries showed a significant difference. Distribution of GG genotype revealed differences in Spain (35.1-53.0)/(22.6-32.9), Portugal (39.0-74.4)/(21.4-38.9), Netherlands (40.6-66.3)/(25.3-38.8) and UK (37.5-62.4)/(23.3-34.2). The OR of G carriers in the global sample was 5.9 (95% CI: 3.2 to 11.2). The OR of G carriers from Spain and Portugal was 5.4 (95% CI: 2.2-12.7), whereas in the UK and the Netherlands was 7.3 (95% CI: 2.8-19.1). Results indicate that the G allele of rs2279744 is associated with a higher risk of developing PVR in patients undergoing a RD surgery. Further studies are necessary to understand the role of this SNP in the development of PVR., This work was supported by SAF 2007-66394, FIS PI10/00219 and Group of Excellence Grant (GR15) from Junta de Castilla y León.

Purpose. Proliferative vitreoretinopathy (PVR) is still the major cause of failure of retinal detachment (RD) surgery and although the risk for developing this complication is associated with some clinical characteristics, the correlation is far from absolute, raising the possibility of genetic susceptibility. The objective of this study was to analyze the genetic contribution to PVR in patients undergoing RD surgery, the Retina 4 Project. Methods. A candidate gene association study was conducted in 2006 in a Spanish population of 450 patients suffering from primary rhegmatogenous RD. Replication was carried out in a larger population undergoing RD surgery at several European centers among 546 new patients. Single nucleotide polymorphism (SNP) of 30 genes known to be involved with inflammation were analyzed. For replication stage, those genes previously detected as significantly associated with PVR were genotyped. Distribution of allelic and haplotypic frequencies in case and control group were analyzed. Single and haplotypic analysis were assessed. The Rosenberg two-stage method was used to correct for single and multiple analyses. Results. After correction for multiple comparisons, four genes were significantly associated with PVR: SMAD7 (P = 0.004), PIK3CG (P = 0.009), TNF locus (P = 0.0005), and TNFR2 (P = 0.019) In the European sample, replication was observed in SMAD7 (P = 0.047) and the TNF locus (P = 0.044). Conclusions. These results confirm the genetic contribution to PVR and the implication of SMAD7 and TNF locus in the development of PVR. This finding may have implications for understanding the mechanisms of PVR and could provide a potential new therapeutic target for PVR prophylaxis. © 2013 The Association for Research in Vision and Ophthalmology, Inc.