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Purpose: To describe preoperative anatomical features of Stage 5 retinopathy of prematurity with results of surgery and patient-related and surgery-related factors affecting postoperative success., Methods: Forty eyes of 33 infants who underwent vitrectomy with lensectomy or lens-sparing vitrectomy for Stage 5 retinopathy of prematurity were enrolled. Stage 5 cases were divided into different groups according to their preoperative anatomical features as follows: A: for eyes with ophthalmoscopically observable total retinal detachment; B: for eyes with total leucocoria associated with funnel retinal detachment; and C: for eyes with very shallow anterior chamber and corneal opacity. Only A and B eyes underwent surgery. The effect of the presence of vascular dilation and tortuosity, preoperative treatment status, surgically induced posterior hyaloid detachment, and sparing the lens on anatomical and functional results was evaluated., Results: Thirty-five percentage of the eyes were in Group A and 65% were in Group B. The mean follow-up was 30.6 months (12-68). Anatomical success was 55.5% for Group A and 15.4% for Group B (P: 0.047), and functional success was 33.3% for Group A and 7.7% for Group B at the third year (P: 0.125). The presence of vascular dilation and tortuosity and postoperative vitreous hemorrhage were found to have negative effects; preoperative treatment and surgical induction of posterior hyaloid detachment were found to have positive effects on anatomical and functional results., Conclusion: Surgery for ophthalmoscopically observable retinopathy of prematurity-associated retinal detachment resulted in better anatomical and functional outcomes, and the results are even better in eyes with preoperative treatment, lens-sparing vitrectomy, and surgically induced posterior hyaloid detachment.

Objectives: To assess seasonal variations in the incidence of rhegmatogenous retinal detachment (RRD) in the Eastern Black Sea region of Turkey., Materials and Methods: Patients presenting due to primary RRD to a university hospital operating as a reference clinic in the region between 2011 and 2018 were evaluated retrospectively. Patients' ages, sex, affected eye, and presentation times were recorded. Years were divided into months, quarters, seasons, and half-year periods, and these periods were analyzed in terms of differences in patient numbers., Results: Two hundred eighty-one eyes of 276 patients meeting the study criteria were included. The patients' mean age was 60.2 years, and the male:female ratio was 1.35:1. Right and left eye rates were similar. Detachments were most common (49.4%) in the upper temporal quadrant. Eighty-nine patients (31.6%) had undergone uncomplicated phacoemulsification surgery a mean 2.7 years previously. The mean annual case number was 35.13±5.43, and no statistically significant variation was determined in case numbers by year (p=0.558). Analysis of all years revealed a monthly mean case number of 23.42±4.4, with the highest number of cases, 29 (10.3%), being seen in September and the lowest number, 13 (4.7%), in December. No statistically significant monthly variation was determined (p=0.613). Similarly, no statistically significant variation was observed in case numbers analyzed by quarter, season, or half-year (p>0.05)., Conclusion: The incidence of cases of uncomplicated RRD does not exhibit seasonal variation in our region. We also think that since 31.6% had a history of cataract surgery, patients undergoing phacoemulsification surgery, even if uncomplicated, should be periodically assessed for detachment.

Various eye conditions cause tears in the retinal pigment epithelium (RPE). The most common cause of a RPE tear is vascularized retinal pigment epithelial detachment (PED) in patients with exudative age-related macular degeneration. Although RPE tears can develop spontaneously in vascularized PEDs, most recent cases have been associated with anti-vascular endothelial growth factor (VEGF) injections. The subretinal fluid within the PED applies hydrostatic pressure to the RPE and stretches it. The PED enlarges as the hydrostatic pressure increases. Contraction of the choroidal neovascular membrane adds tractional forces to the RPE monolayer. Especially in larger PEDs, the risk of a RPE tear increases after anti-VEGF therapy owing to increasing contraction of the choroidal neovascular membrane. The risk factors and predictors defined by retinal imaging can contribute to prevention of RPE tears, and modified therapies can be used for patients at most risk; however, there is no proven method for prevention of RPE tears. After tear formation, in the presence of an active choroidal neovascular membrane, anti-VEGF should be repeated until the underlying disease has been suppressed. When the subretinal fluid is present for more than 6 months, the denuded area is covered with thickened fibrotic tissue. We review the literature to describe the classification, epidemiology, mechanisms of development, and repair of RPE tears, diagnosis, risk factors and predictors, prevention, and management., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The purpose of the present study was to evaluate the intraretinal migration of the retinal pigment epithelium (RPE) cells in age-related macular degeneration (AMD) using polarimetry. We evaluated 155 eyes at various AMD stages. Depolarized light images were computed using a polarization-sensitive scanning laser ophthalmoscope (PS-SLO), and the degree of polarization uniformity was calculated using polarization-sensitive optical coherence tomography (OCT). Each polarimetry image was compared with the corresponding autofluorescence (AF) images at 488 nm (SW-AF) and at 787 nm (NIR-AF). Intraretinal RPE migration was defined by the presence of depolarization at intraretinal hyperreflective foci on PS-SLO and PS-OCT images, and by the presence of hyper-AF on both NIR-AF and SW-AF images. RPE migration was detected in 52 of 155 eyes (33.5%) and was observed in drusenoid pigment epithelial detachment (PED) and serous PED with significantly higher frequencies than in other groups (P = 0.015). The volume of the migrated RPE cluster in serous PED was significantly correlated with the volume of the PED (R 2  = 0.26; P = 0.011). Overall, our results showed that intraretinal RPE migrations occurred in various AMD stages, and that they occurred more commonly in eyes with serous and drusenoid PED.

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., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

PurposeTo evaluate the anatomic and functional outcome of pars plana vitrectomy (PPV) combined with scleral buckling (SB) vs retinectomy in treating posterior segment open-globe injuries with retinal incarceration.MethodsPatients (38 eyes) with posterior segment open-globe injuries and retinal incarceration were identified, and they underwent either PPV combined with SB (PPV+SB, n=19) or retinectomy (n=19). The two groups were matched in the following categories: the severity of injury (including wound length), the location of the incarceration site and the presence of retinal detachment. Anatomic reattachment of the retina and best-corrected visual acuity (BCVA) were measured at the time of 12 months after operation.ResultsAt 12 months after operation, the PPV+SB group demonstrated a better anatomic retinal attachment rate (84.2% vs 68.4%, P=0.252) and BCVA (73.7% vs 47.4%, P=0.247) compared with the retinectomy group, however, the differences failed to reach statistical significance. Compared with the PPV+SB group, the rectinectomy group had significantly higher rates of hemorrhage (47.4% vs 15.8%, P=0.036), inflammation (42.1% vs 10.5%, P=0.027), and a lower intraocular pressure (IOP, 9.8±3.1 vs 13.6±4.1 mmHg, P=0.002) after silicone oil (SO) removal.ConclusionsFor patients with posterior segment open-globe injuries and retinal incarceration, PPV and SB treatments resulted in a better anatomic and functional outcome and less post-operation complications compared with the retinectomy.

A variety of different factors may participate in causing an accident or in influencing its course. These have different legal consequences in different areas of insurance. These differences are outlined for the assessment areas, together with the different states of evidence. In particular, it is discussed whether and under which conditions a trauma can indirectly (as a participating factor) either cause, trigger or exacerbate detachment of the retina., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To determine the clinical significance of retinal pigment epithelium (RPE) undulations in the acute stage of Vogt-Koyanagi-Harada disease., Methods: Retinal pigment epithelium undulations were detected and classified into 3 grades: Grade 1, slight; Grade 2, moderate; and Grade 3, severe undulations, in the enhanced depth imaging optical coherence tomographic images. The relationship between the clinical characteristics and the presence of RPE undulations was investigated., Results: Among the 61 eyes of 31 patients with Vogt-Koyanagi-Harada disease, 40 eyes had some degree of RPE undulations (Grade 1 = 12, Grade 2 = 15, and Grade 3 = 13). The patients with RPE undulations in both eyes were significantly older at the onset (P = 0.0002). The eyes with RPE undulations were more likely to develop posterior recurrences (P = 0.032) and have worse vision at 12 months (P = 0.043). Multiple regression analysis revealed that RPE undulations were an independent predictor of posterior recurrences (P = 0.009) and poor visual outcomes (P = 0.035)., Conclusion: Retinal pigment epithelium undulations detected by enhanced depth imaging optical coherence tomographic are relatively frequent occurrences at the acute stage of Vogt-Koyanagi-Harada, and their presence is a predictor of posterior recurrences and poor visual outcomes after high-dose steroid therapy.

Purpose: To evaluate a morphology score for drusenoid pigment epithelial detachment (dPED) regarding predictability of a decline in retinal function beyond best-corrected visual acuity., Methods: Thirteen eyes of 10 patients with dPED due to age-related macular degeneration (AMD) were included (age 72.8 ± 4.2 years). All underwent volume spectral domain optical coherence tomography, fluorescence angiography, and confocal scanning laser ophthalmoscopy infrared imaging as well as multifocal electroretinography and microperimetry. The dPED morphology score suggested consists of five parameters: hyperreflective spots in infrared, lesion diameter, lesion height, presence of vitelliform-like material in the subretinal space or subretinal fluid, and integrity of the ellipsoid zone in spectral domain optical coherence tomography. Subsequently, a score value between 0 and 1 according to the extent of morphologic changes was correlated to foveal multifocal electroretinography and microperimetry measurements., Results: The mean best-corrected visual acuity was 20/40. The mean height and mean diameter of dPED were 312.2 ± 111 μm and 2,535 ± 805 μm. Two dPED showed no hyperreflective spots in confocal scanning laser ophthalmoscopy infrared images, three displayed a moderate stage of hyperreflective spots, and eight had severe hyperreflective spots. Two eyes showed subretinal fluid, and five patients showed vitelliform-like material in the subretinal space. Eight eyes revealed a severe disruption of the ellipsoid zone. Although no correlation was found between dPED morphology score and best-corrected visual acuity, eyes with a dPED morphology score >0.5 revealed distinctly decreased values in functional measurements compared with those with a score ≤0.5., Conclusion: The dPED morphology score aggregates all currently known morphologic changes in dPED and represents a valuable tool for clinical lesion evaluation. Furthermore, it allows for assessing an estimate of functional decline beyond best-corrected visual acuity.

The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To describe morphologic alterations of pigment epithelial detachments (PEDs) associated with neovascular age-related macular degeneration during anti-vascular endothelial growth factor upload therapy with ranibizumab., Methods: Prospective, single-arm interventional study. Primary outcome was the reduction of height of PED during monthly treatment using ranibizumab. Secondary outcomes were factors influencing the regression of PED. Inclusion criteria were presence of PED associated with naive neovascular age-related macular degeneration, visual acuity of >20/200, and height of PED >150 μm on optical coherence tomography. All eyes (n = 54) received 3 injections of ranibizumab in monthly intervals ("upload therapy"). Last review examination was performed 14 weeks after the initial treatment., Results: The mean PED height decreased from 515 μm (SD, 268.3) to 294 μm (SD, 201.9) at Week 14 with the highest degree of regression after the first treatment. A complete resolution of PED was noted in 8 eyes (15%). Using conventional regression model, none of the factors investigated, including height of PED, presence of intraretinal or subretinal fluid, intraretinal cysts, macular volume, retinal thickness, presence of foveal depression, presence of hemorrhage, and visual acuity, had a significant impact on the morphologic response. Using a modified binary logistic regression model ("bootstrapping"), presence of foveal depression (P > 0.033), and retinal thickness (P > 0.004) showed statistical significance., Conclusion: This study on the responses and potential predictive factors associated with vascularized PED during the uploading phase of intravitreal ranibizumab shows a complete resolution of the PED in 15% of the cases.

Purpose: To describe the spectrum of pigment epithelial detachments (PEDs) occurring mainly in age-related macular degeneration and central serous chorioretinopathy and also in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders., Methods: Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories., Results: The clinical presentation, classification, and natural history of PEDs are reviewed as illustrated with multimodal imaging combining traditional and novel imaging techniques, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and spectral domain optical coherence tomography. Most PEDs occur because of pathophysiologic mechanisms taking place below the retinal pigment epithelium that are difficult to identify with conventional imaging modalities. Enhanced depth imaging optical coherence tomography and indocyanine green angiography allow a better analysis of the subretinal pigment epithelium compartment., Conclusion: The differentiation between various kinds of PEDs is essential because each PED type is a distinct entity that has a specific pathogenesis, natural history, prognosis, and optimal treatment strategy.

Purpose: To assess the accuracy of automated classification of pigment epithelial detachments (PED) by using a software algorithm applied to spectral-domain optical coherence tomography (SD-OCT) scans., Methods: HD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) volume scans (512 × 128) were retrospectively collected from 46 eyes of 33 patients with evidence of PED in the setting of age-related macular degeneration (AMD, n = 28) or central serous chorioretinopathy (CSCR, n = 5). In these eyes, 168 PEDs were automatically detected with a system-associated tool (Cirrus HD-OCT RPE Elevation Analysis; Carl Zeiss Meditec). Two independent, certified Doheny Image Reading Center (DIRC) OCT graders classified these PEDs into three categories--serous, drusenoid, or fibrovascular--via inspection of the B-scans. Manual classification results served as the gold standard for comparisons with automated classification. For automated classification, interindividual variation in intensities was normalized in all images. Individual A-scans within the detected PEDs were then automatically classified into one of three categories based on the mean internal intensity and the standard deviation of the internal intensity: mean intensity <30 (serous type); mean intensity ≥30 but <60 or mean intensity ≥30 and SD ≥30 (fibrovascular type); or mean intensity ≥60 and SD < 30 (drusenoid type). Individual PEDs were then automatically classified into the same three categories based on the predominant type of A-scan within the PED. For mixed PEDs (many A-scans of each type), a risk index for neovascularization was computed based on the percentage of fibrovascular A-scans. In addition, a confidence index was computed for each PED based on its mathematical distance from the PED category boundaries., Results: Among the 168 PEDs, the DIRC graders classified 16 as serous, 88 as fibrovascular, and 64 as drusenoid PEDs. The automated algorithm classified 14 as serous, 96 as fibrovascular, and 58 as drusenoid PEDs. The sensitivity and specificity values for automated classification according to type of PED were 88% and 100% for serous, 76% and 64% for fibrovascular, and 58% and 81% for drusenoid, respectively., Conclusions: Automated classification of PEDs using internal reflectivity characteristics appears to be sensitive for detecting serous and fibrovascular PEDs. Automated classification and quantification of PEDs may be a useful tool in future studies for stratifying PEDs according to risk and possibly predicting the risk of advanced AMD.

Retinal pigment epithelial detachment (PED) is an important predictor of vision loss in patients with age-related macular degeneration (AMD). Here we review the historical PEDs subtypes, include recent insights into PED pathogenesis provided by modern imaging modalities, and summarize the current options for treatment.

Purpose: To assess morphologic differences in pigment epithelial detachment (PED) with en face optical coherence tomography in central serous chorioretinopathy (CSC) and age-related macular degeneration (AMD)., Methods: We recruited 30 eyes of 22 patients with PED. Nine eyes had a clinical diagnosis of CSC and 21 had AMD. All patients were assessed with en face optical coherence tomography. Morphologic PED aspects were estimated on C-scans and classified according to shape, inner silhouette, content, wall aspects, wall thickness, and size., Results: Pigment epithelial detachment shape was predominantly circular (88.8%) in CSC and irregular or with multilobular features in AMD (76.2%). The PED inner silhouette had a smooth aspect (88.9%) in CSC and a slightly granular aspect or granular profile in AMD (100%). Clear PED content was the most characteristic feature of CSC (88.9%) but not of AMD. In CSC, PED morphologic wall aspect was uniform or slightly irregular (100%), while in AMD, it was slightly irregular (52.4%) or irregular (47.6%). Pigment epithelial detachment wall thickness and dimensions were larger in AMD than in CSC. Statistically significant differences were observed between CSC and AMD concerning PED inner silhouette, contents, wall aspects, and wall thickness measurements., Conclusion: En face optical coherence tomography scanning is a valuable tool for showing important morphologic differences between CSC and AMD.

Purpose: To observe the complications after heavy silicone oil (HSO) tamponade in complicated retinal detachment., Methods: Thirty-three eyes of 33 patients with complicated retinal detachment were included in this retrospective study. Vitrectomy and HSO tamponade were performed in all patients. Other surgical procedures were performed as necessary. The main outcome measures included retinal reattachment, visual acuity, intraocular pressure, intraocular inflammation, lens opacity, and HSO emulsification., Results: The patients were followed up for 3 months to 24 months (average, 8.1 ± 5.3 months). Retinal reattachment was achieved in 29 eyes (87.9%) with a first surgery and in 33 eyes (100%) with a second surgery. In all 33 eyes, HSO had been removed and the visual acuity was improved. Short-term (within 2 weeks after operations) complications included temporarily increased intraocular pressure and mild inflammation in the anterior chamber. Major long-term complications included cataract (100%) and HSO emulsification (42.4%). Other long-term complications included ocular hypertension (12.1%), retinal detachment and proliferative vitreoretinopathy (12.1%), and low intraocular pressure (9.1%)., Conclusion: Heavy silicone oil tamponade is safe and effective to treat complicated retinal detachment. The most common complications are cataract and HSO emulsification.

Background: To assess prognostic value of the Ocular Trauma Score (OTS) in childhood open-globe injuries., Methods: This retrospective, interventional case series included 61 children with open-globe injuries. Certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories; the likelihood of the final visual acuities in the OTS categories were calculated, and compared with those in the OTS Study., Results: Age ranged from 3 years to 14 years (mean, 8.0 years). Forty-two boys and 19 girls were included. Follow-up ranged from 6 months to 56 months (mean, 18 months). The likelihood of the final visual acuities (no light perception, light perception/hand motion, 1/200-19/200, 20/200-20/50, and > or = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS Study group., Conclusions: OTS calculated at initial examination may provide prognostic information in children with open-globe injuries.

Purpose: To evaluate the birefringence properties of eyes with age-related macular degeneration (AMD). To compare the information from two techniques--scanning laser polarimetry (GDx) and polarization-sensitive spectral-domain optical coherence tomography (OCT)--and investigate how they complement each other., Methods: The authors prospectively examined the eyes of two healthy subjects and 13 patients with exudative AMD. Using scanning laser polarimetry, they computed phase-retardation maps, average reflectance images, and depolarized light images. To obtain polarimetry information with improved axial resolution, they developed a fiber-based, polarization-sensitive, spectral-domain OCT system and measured the phase retardation associated with birefringence in the same eyes., Results: Both GDx and polarization-sensitive spectral-domain optical coherence tomography detected abnormal birefringence at the locus of exudative lesions. Polarization-sensitive, spectral-domain OCT showed that in the old lesions with fibrosis, phase-retardation values were significantly larger than in the new lesions (P = 0.020). Increased scattered light and altered polarization scramble were associated with portions of the lesions., Conclusions: GDx and polarization-sensitive spectral-domain OCT are complementary in probing birefringence properties in exudative AMD. Polarimetry findings in exudative AMD emphasized different features and were related to the progression of the disease, potentially providing a noninvasive tool for microstructure in exudative AMD.

Silicone oil is a valuable surgical tool to treat severe retinal detachment (RD). However, following surgery, remaining RD or the appearance of inferior RD with silicone tamponade is a delicate situation. Anamnesis and careful examination should provide a suitable treatment. Silicon oil removal will be considered after treatment of this residual RD. The endocular approach may be required: dissection of vitreoretinal proliferation, phakoexeresis, or retinectomy, whereas complementary indentation, subretinal fluid puncture, and scleral shortening are external therapeutic methods. One of the frequent causes of these persistent RDs is the presence or the progression of a more or less large and extended anterior vitreoretinal proliferation, which will sometimes require extended silicon oil tamponade. Indeed, after a certain time has elapsed, the existence of a genuine retinal adhesion disease makes a durable reapplication without internal tamponade impossible.

Purpose: To provide a historical perspective on outcomes of surgery for infants with stage 5 retinopathy of prematurity (ROP) as performed by a single surgeon over a 24-year period., Design: Retrospective observational cohort study., Setting: Clinical practice of the Charles Retina Institute., Patients: The 601 infants with stage 5 ROP in at least one eye who were referred for surgery between 1977 and 2001. Charts were reviewed for demographic data and postoperative anatomical and visual acuity outcomes in eyes that underwent surgery., Main Outcome Measures: The postoperative anatomical status of the retina and visual function were assessed after surgery. Anatomical outcome was categorized as success (macula attached), partial success (macula detached), failure (total retinal detachment), or lost eye (opaque cornea, secluded pupil, or phthisis). Visual function was classified as>20/200, 20/200-5/200, hand movement, light perception, or no light perception. Multivariable logistic regression was used to explore relationships between outcomes and baseline characteristics., Results: Only a minority of eyes had prior cryotherapy (15%) or laser photocoagulation (7%) therapy. The mean follow-up was 44 months for the 956 eyes treated surgically. The 608 eyes with available follow-up data were classified as follows: 28% success, 5% partial success, 55% failure, and 11% lost eye. Visual function of light perception or better was achieved in 74% of the 183 eyes with data on visual acuity. Controlling for other baseline factors, early postpartum age at the time of surgery was a statistically significant predictor of failure/lost eye (OR=2.08, 95% CI 1.09-3.97) and no light perception (OR=5.13, 95% CI 1.45-18.14). Surgery for stage 5 ROP on the fellow eye was also a predictor of failure/lost eye (OR=2.38, 95% CI 1.39-4.08)., Conclusions: Surgery resulted in anatomical success for approximately one third of infant eyes with stage 5 ROP, and only a minority of eyes (8 of 183) achieved visual acuity better than 5/200. However, some initially successfully attached retinas redetached. Although this study is limited by follow-up and may represent a group of patients with a more vascularly active disease state due to the low proportion of patients with prior peripheral ablation, this cohort of infants provides results against which future interventions may be compared.

Purpose: To assess the anatomical success rate after three-port lens-sparing vitrectomy (LSV) in stage 5 (total) retinal detachments secondary to retinopathy of prematurity., Methods: In a retrospective, interventional, single-surgeon, consecutive case series, the records of 33 eyes of 21 patients presenting with stage 5 retinal detachment secondary to retinopathy of prematurity who underwent primary three-port LSV from February 1998 to January 2004 were evaluated. Twenty-one eyes (63.6%) had open anteriorly-open posteriorly and 12 (36.4%) had open anteriorly-narrow posteriorly in terms of anatomical configuration. The main outcome measure, retinal reattachment, was reviewed at final follow-up visits, which ranged from 6 months to 48 months (mean, 32 months) after LSV., Results: Fifteen eyes (45.5%) maintained attachment and 18 eyes (54.5%) remained detached at the final visit. Open anteriorly-open posteriorly configuration eyes had a statistically significant higher anatomical success rate than eyes with an open anteriorly-narrow posteriorly configuration (P<0.001)., Conclusions: Three-port LSV may achieve anatomical success in stage 5 retinopathy of prematurity-related detachments. The open anteriorly-open posteriorly configuration portends a better prognosis; thus, surgery should be performed before closure of the posterior retina into a funnel configuration, if possible.

Purpose: To determine the anatomical success rate of lensectomy and vitrectomy with and without intravitreal triamcinolone acetonide (TA) for vascularly active stage 5 tractional retinal detachments due to retinopathy of prematurity (ROP)., Methods: In a retrospective, interventional, single-surgeon, consecutive case series, the records of 21 eyes of 21 patients presenting with stage 5 retinal detachment secondary to ROP who underwent primary pars plicata vitrectomy with lensectomy from February 1998 to January 2004 were evaluated. All eyes were vascularly active at the time of surgery. Eleven eyes underwent the surgical procedure without TA (group 1), and 10 eyes received TA at the end of the procedure (group 2). The main outcome measure, retinal reattachment, was reviewed at the final follow-up visit, which ranged from 6 months to 42 months (mean, 28 months) after surgery., Results: None (0/11) of the eyes in group 1 maintained attachment, while 6 (60%) of 10 eyes in group 2 maintained at least posterior pole reattachment at the final visit. None of the group 2 eyes exhibited plus disease during follow-up. None of the eyes in either group exhibited signs of increased intraocular pressure after surgery. All six eyes that maintained posterior pole reattachment were able to fix and follow light at the last follow-up visit., Conclusions: Vascularly active stage 5 ROP detachments portend a poor progress. The use of TA as a postoperative adjunct may improve the likelihood of retinal reattachment in select cases.

Ocular contusions are common and cause significant morbidity. The mechanism of ocular contusion is a decrease in the length of the anterioposterior axis whereas the transversal axis increases. Epidemiology data shows that young men are most injured in relation with sports, aggression, work, or car or work accidents. Injury to the ocular surface (conjunctiva and cornea) is minor. The iris is very frail, usually leading to hyphema which can progress to glaucoma. A cataract can appear after a contusion but usually years after the trauma. Final visual acuity can be compromised by retinal contusion or retinal detachment (due to a retinal dehiscence or post-traumatic dialysis). The worst outcome is optic neuropathy. The most difficult task is to predict visual acuity after the initial ocular lesion.

Objective: To assess lens clarity after 3-port lens-sparing vitrectomy for stages 4A and 4B tractional retinal detachment secondary to retinopathy of prematurity., Methods: In a retrospective, interventional, consecutive clinical case series, 108 eyes of 102 patients who underwent lens-sparing vitrectomy for stages 4A and 4B tractional retinal detachment from February 1, 1998, through January 31, 2004, were reviewed. All procedures and follow-up examinations were performed by a single surgeon. Lens clarity was assessed at the final follow-up examination., Results: Of the 108 eyes reviewed, 102 (94.4%) maintained clear lenses at the final follow-up examination, which ranged from 6 to 48 months (mean, 32 months) after the procedure. Thirty-two eyes had stage 4A detachments and 76 eyes had stage 4B., Conclusions: Three-port lens-sparing vitrectomy may be performed with relatively low risk of cataract formation during the early postoperative period. Maintenance of a clear crystalline lens during the critical period of visual development may lead to better functional outcomes.

Purpose: To determine whether the observed anatomy of macular holes can be explained by a hydrodynamic model in which fluid flow through the hole is balanced by fluid pumping across the retinal pigment epithelium. We use this model to draw conclusions about the possible role of vitreomacular traction in determining the anatomy of macular holes and their resolution after vitreous surgery., Design: Cross sectional., Methods: Retrospective study in a clinical practice. The study included 42 eyes of 42 patients with a stage 3 or 4 macular hole (Gass classification). We measured the radius of the macular hole and the radius of the surrounding cuff of subretinal fluid from color or red-free fundus photographs and determined the relationship between these two variables., Results: The mean age of the patients was 68.0 +/- 7 years (range, 51 to 80). Twenty-five patients had stage 3 macular holes and 17 patients had stage 4 macular holes. The neurosensory detachment radius was related to the square of the macular hole radius for stage 3 and stage 4 holes, with no significant difference between the stage 3 and stage 4 linear trend lines (P = .999). There was no correlation between patient age and the area of the macular hole (r = 0.0645) or neurosensory detachment plus hole (r = 0.156) over the range of age in this study. However, the area of the doughnut-shaped cuff of subretinal fluid increased with increasing patient age (P = .0493), thus suggesting an age-dependent decline in the pumping ability of the retinal pigment epithelium., Conclusions: Our data are consistent with a hydrodynamic model in which macular hole anatomy is determined by a balance between fluid flow through the hole and fluid outflow across the retinal pigment epithelium. Because stage 3 and stage 4 macular holes exhibit a similar relationship between the size of the macular hole and the size of the cuff of subretinal fluid around the hole, simple relief of vitreomacular traction would not lead to resolution of the subretinal fluid cuff unless it is accompanied by a reduction in hole diameter due to approximation of wound edges.

Purpose: To develop and standardize a universally acceptable new staging system for idiopathic retinal periphlebitis (Eales disease)., Methods: A new staging system was established and standardized based on standard terminology and features. Idiopathic retinal periphlebitis was classified as peripheral and central types. Peripheral disease consisted of four stages. Stage 1 is periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages. Stage 2a denotes capillary nonperfusion and 2b neovascularization elsewhere/of the disc. Stage 3a is classified as fibrovascular proliferation and 3b vitreous hemorrhage. Stage 4a is traction/combined rhegmatogenous retinal detachment whereas 4b is rubeosis iridis, neovascular glaucoma, complicated cataract, and optic atrophy. A total of 253 cases of idiopathic retinal periphlebitis (mean age, 24.7 +/- 4.7 years, all male) presenting at this tertiary care center were classified prospectively according to the new staging system, by two independent observers (interobserver correlation = 0.7)., Results: The new staging system was consistent, simple, and easy to recall. Peripheral and central types of idiopathic retinal periphlebitis were found in 94.07% and 5.93% of cases, respectively. The new staging system also defined the severity of the disease. Vitreous hemorrhage was found to be the commonest presenting feature (51.68%), whereas traction/combined rhegmatogenous detachment was found in 5.88% of cases., Conclusions: The new staging system is useful in classifying and assessing the severity of disease. Management strategy can also be defined according to the stage of the disease. It is designed to promote the use of standard assessment with applications to clinical management and research.

Retinal detachment often is a preventable cause of vision loss. There are three types of retinal detachments: exudative, tractional, and rhegmatogenous. The most common type is rhegmatogenous, which results from retinal breaks caused by vitreoretinal traction. Risk factors for retinal detachment include advancing age, previous cataract surgery, myopia, and trauma. Patients typically will present with symptoms such as light flashes, floaters, peripheral visual field loss, and blurred vision. Early intervention facilitates prevention of retinal detachment after formation of retinal breaks and improves visual outcomes of retinal detachment surgery. Patients with acute onset of flashes or floaters should be referred to an ophthalmologist.

Objective: To estimate the incidence and epidemiologic characteristics of rhegmatogenous retinal detachment (RRD) in Beijing, China., Design: Prospective population-based incidence study., Participants: The population of Beijing and its nearby suburbs (N = 6 589 000)., Main Outcome Measure: Incident RRD., Results: A total of 526 patients with RRD were newly diagnosed between October 1999 and September 2000. The annual incidence was 7.98/100 000 people (95% confidence interval = 7.30-8.67). People aged 60 to 69 had the highest incidence (22.15/100 000). Incidences of 3 subtypes of RRD were 0.93/100 000 for related to blunt trauma, 0.80/100 000 for aphakic and pseudophakic, and 6.25/100 000 for nontraumatic phakic retinal detachment. A significantly higher incidence was found in males for traumatic detachment, but not for the other 2 subtypes of RRD. High myopia (> or = -6 diopters) was more prevalent in bilateral RRD (57.1%) than in the unilaterally affected patients (32.4%)., Conclusions: The incidence of RRD in Beijing is comparable to most of the reports from the developed countries. It is estimated that there are 9000 to 10 000 new cases of RRD in China each year. As 60% to 70% of the RRD patients live in small towns or remote farming areas with limited access to qualified retina-vitreous surgeons, care for these patients presents a great challenge in China.

Background: The subretinal organization (SRO) seen in patients who undergo vitrectomy for stage 5 retinopathy of prematurity has not previously been characterized. We report our observations of SRO and correlate its development with previous laser and cryotreatment for neovascular disease., Methods: We surveyed data from 426 eyes in a retrospective chart review of 263 patients that underwent open-sky vitrectomy for stage 5 retinopathy of prematurity., Results: Of 426 eyes evaluated, 130 eyes received laser, cryo, or a combination of both treatments. In 44 eyes (10.3%), SRO was observed and considered the cause of incomplete retinal attachment. Three forms of SRO were identified: subretinal bands (63.6%), subretinal plaques (15.9%), and diffuse SRO (18.2%). One patient had both a band and a plaque. SRO developed in 24 eyes after cryotreatment, 3 after laser, and 2 after combination cryo and laser treatment. Fewer untreated eyes than cryotreatment eyes developed SRO (15 of 296 eyes, 5.1%; ( P=0.0001). Eyes without laser or cryotreatment had a 5.1% frequency of developing SRO., Conclusion: Subretinal organization, a previously uncharacterized entity in retinopathy of prematurity, was most frequently identified in the form of subretinal band formation. SRO was identified in 10.3% of all stage 5 eyes evaluated, and was associated with incomplete retinal reattachment in all cases.

Background: Accurate documentation and follow-up of pathological findings of the macula require graphical methods for clinical evaluation., Methods: Symbols describing and identifying different findings of the macula were evolved. A pattern for the standardised representation of the macular region -- with size and distribution of different areas -- was also developed., Results: Use of different symbols supported by a standard pattern of the macula as background simplifies documentation of pathological macular findings., Conclusions: Graphical documentation of pathological macular findings allows simple, inexpensive and standardised assessment of such findings.

Background: A pigment epithelial detachment (PED) is an exudative manifestation of late age-related macular degeneration (AMD). Its long-term unfavourable prognosis is influenced by the association of a neovascular membrane. Seemingly identical PEDs in ophthalmoscopy can be further differentiated by fluorescein and indocyanine green angiography. The purpose of this prospective follow-up study was to determine the most reliable angiographic classification to distinguish PEDs in AMD and to evaluate their outcome., Material and Methods: 73 eyes of 68 patients with a PED in AMD were examined with simultaneous angiography with fluorescein and indocyanine green. 34 eyes were additionally scanned by retinatomography. Fluorescein angiographic classification comprises 4 types: 1. early hyperfluorescent type, 2. late hyperfluorescent type, 3. drusen type, 4. irregular fluorescent type. Indocyanine green angiographic classification consists of the following three groups: 1. angiographically no vascularisation, 2. associated choroidal neovascularisation, 3. associated polypoidal choroidal vasculopathy., Results: Both classifications show statistically significant correlation with visual acuity (fluorescein classification: P = 0.0112, ICG-classification: P = 0.0004) and area of the PEDs (fluorescein classification: P = 0.0002, ICG-classification: P < 0.0001). ICG-classification additionally is significantly associated with the volume (P = 0.0008). Both classifications correlate (P = 0.0001). Factors influencing visual acuity are: age (P = 0.0044), associated neovascular membrane (P = 0.0004), area (P < 0.0001), volume (P = 0.0077) and height (P < 0.0001)., Conclusions: PEDs in AMD can best be classified by indocyanine green angiography on the basis of an associated prognostically important neovascular membrane, which can only be further distinguished into choroidal neovascularisation or polypoidal choroidal vasculopathy by indocyanine green angiography. Statistical analysis shows qualitatively and quantitatively more significant results for the indocyanine green angiographic classification.

Purpose: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR)., Design: Retrospective consecutive noncomparative case series., Participants: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment., Methods: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma., Main Outcome Measures: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment., Results: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years)., Conclusions: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.

Unlabelled: To compare the success rate and the visual improvement of different surgical techniques for treating 21 retinal detachments due to macular hole in highly myopic eyes., Methods: Twelve patients were treated by gas tamponade alone, 5 patients underwent vitrectomy with gas tamponade, 4 patients underwent vitrectomy with epiretinal membrane pealing and gas or oil silicone tamponade., Results: Fifty eight % of patients were successfully treated after gas tamponade alone, and 75% after vitrectomy, epiretinal membrane pealing and gas or silicone oil tamponade. After retreatment in 7 patients, the final reattachment rate was 80%. Visual acuity was inchanged in 12 cases, improved to 1/20-1/10 in 8 case and reached 3/10 in 1 case., Conclusion: A therapeutic scheme is suggested according to the type of retinal detachment, macular vitreoretinal traction and pigment epithelium and chorioretinal degeneration condition.

Background: Kroll's classification of proliferative diabetic vitreoretinopathy (PDVR) defines stage A (vitreoretinal proliferations without retinal detachment), stage B (partially detached retina not involving the macula), stage C (partially detached macula) and stage D (completely detached macula). The purpose of this study was to analyse the prognostic value of Kroll's classification in respect of the postoperative results of vitreoretinal surgery based on our group of patients., Patients and Methods: The charts of 563 patients who underwent vitrectomy because of PDVR between 1990 and 1997 were examined retrospectively. Postoperative visual acuity, possible risk factors, frequencies of silicone oil tamponade and revitrectomies were related to the preoperative staging of PDVR. The influence of possible predictive factors on the postoperative visual outcome were evaluated using multivariate logistic regression analysis., Results: After vitreoretinal surgery mean postoperative visual acuity was significantly better in stage A compared to stage C (p < 0.01) or D (p < 0.0001). In 179 out of 563 eyes (31.7 %) revitrectomy (including silicone oil removal) was required and in 51 eyes (9.1 %) more than one revitrectomy was performed. Silicone oil tamponade was used in 22 out of 253 eyes (8.7 %) classified as stage A, in 27 out of 201 eyes (13.4 %) of stage B, in 17 out of 78 eyes (21.8 %) of stage C and in 10 of 31 eyes (32.3 %) of stage D. Postoperative increase of visual acuity of more than 3 lines was significantly less frequent in stage B (p < 0.014), C (p < 0.039) and D (p < 0.001) compared to stage A., Conclusion: Kroll's classification for PDVR has a high prognostic value for the postoperative visual outcome and level of surgical risk management. Thus patients with good prognosis can be identified easily, facilitating the decision for surgery.

A retinal detachment is often traumatic and shocking to patients once they become aware of the condition. Nurses have the unique opportunity to assist these patients in accepting and in coping with this potential serious vision loss through understanding, education, rehabilitation, and ocular safety.

Objective: To evaluate the reproducibility and the prognostic utility of the Retina Society and Silicone Study Classification Systems in eyes after surgery for severe proliferative vitreoretinopathy (PVR)., Design: Subgroup analysis of the Silicone Study--a randomized, multicentered, surgical trial., Setting: Community and university-based ophthalmology clinics., Materials: Three hundred forty eyes with preoperative and intraoperative evaluations using both systems of grading PVR (reproducibility study), and 287 eyes with preoperative and intraoperative evaluations using both systems of grading PVR and with a 24-month follow-up examination (prognosis study)., Interventions: Vitrectomy for PVR with long-acting perfluoropropane gas or silicone oil as the intraocular tamponade., Outcome Measures: Retinal reattachment, visual acuity ( > or = 5/200), intraocular pressure, corneal clarity, and the need for reoperation., Results: The reproducibility of the Silicone Study Classification System was 64% (type of contraction), 77% (number of clock hours), 67% (posterior PVR), 88% anterior and posterior PVR), and 94% (anterior, posterior, and subretinal PVR). The reproducibility of the Retina Society Classification System was 99%. Using the Silicone Study Classification System, location of PVR predicted visual acuity (P=.004, chi 2 test for trend) and hypotony (P=.03, chi 2 test for trend). Using the Retina Society Classification System, the grade of PVR predicted only visual acuity (P=.01, chi 2 test for trend). For eyes with anterior and posterior PVR, there was a decreasing trend in successful visual acuity outcome with increasing severity of PVR (from C-3 to D-3, P=.02, chi 2 test for trend)., Conclusions: Although the classification of PVR using the Silicone Study classification System was not reproducible for the type of contraction or for posterior PVR, identification of the anteroposterior extent of the PVR was prognostic of visual acuity and hypotony at 24 months. The joint knowledge of the location of PVR (using the Silicone Study Classification System) and the tightness of the funnel for retinas with 9 to 12 clock hours involved by fixed folds (using the Retina Society Classification System) has prognostic utility for eyes with anterior and posterior PVR.

Background: The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan., Methods: The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area., Results: From a population of 1 840 000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100 000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment-nontraumatic phakic, aphakic, and blunt trauma--were 9.8, 0.5 and 0.2 per 100 000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes., Conclusion: Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.

Senile macular hole usually affects only one eye. It is caused by tangential contraction of the premacular vitreous cortex, particularly that in the foveolar area. Its early stages produce characteristic biomicroscopic findings. In approximately 50% of cases, spontaneous vitreofoveal separation and recovery of vision occurs. Differentiation between a stage 1 impending hole and a stage 2 hole may be difficult. A stage 2 hole may begin as either a central foveolar dehiscence or as a foveolar tear. In both cases, the holes may be accompanied by a similar appearing prehole opacity (pseudo-operculum in the former, and an operculum in the latter cases) in 75 to 80% of the cases. The visual prognosis is probably better in patients whose hole begin in the center. Histopathological examination of the prehole opacity for evidence of retinal tissue at the time of surgery should provide us with important information concerning the relative frequency of the two types of hole development. Meanwhile, there is accumulating circumstantial evidence to suggest that the majority of macular holes begin as a central dehiscence with little loss of retinal tissue and enlarge as a result of centrifugal displacement and concentration of the retinal receptors around the hole, and that visual improvement following surgery occurs not only because of reattachment of the retina, but also centripetal movement of the retinal receptors. Results of a small randomized study of treatment of stage 1 impending holes, while inconclusive, suggest that surgery is of little benefit. Although uncontrolled pilot studies of surgical treatment of full-thickness holes are encouraging, we must await results of the randomized trials to know its value.

Purpose: To describe the type of breaks that occur in the diaphanous tissue within the coloboma of the choroid and the types of retinal detachment that are associated with these breaks., Methods: This is a retrospective study of 36 eyes of 36 patients with retinal detachments that extended into the choroidal coloboma. Preoperative findings were documented using detailed fundus drawings and color photographs. Intraoperative identification of retinal breaks was possible using high magnification of the operating microscope., Results: Based on the identifiable breaks inside the coloboma and the extent of retinal detachment, these patients were divided into five subgroups. Three distinct types of breaks were identified within the coloboma: (1) breaks at the edge of the detachment inside the coloboma; (2) oval atrophic breaks; and (3) breaks in anatomic macula that was involved in the coloboma. Multiple breaks were common., Conclusions: Retinal detachments that extend into the colobomatous area always are associated with breaks in the diaphanous tissue. Intraoperative identification of these breaks is relatively easy. Commonly, the breaks are seen at the edge of the retinal detachment inside the coloboma or as oval breaks within the detached diaphanous tissue. Macula, if involved in the coloboma, occasionally can harbor a retinal break.

The retinopathy of prematurity is the most important cause of blindness at children and one of the most frequent cause of blindness in the postnatal period. 435 newborn prematures and dismatures, were examined in the first two weeks since they were born. The ophthalmological exam showed vasoconstriction of retinal vessels. The treatment consisted in cryotHerapy with good results. The most up-to-date method is the therapy with argon laser mounted on the indirect ophthalmoscope.

Background: The following questions should be addressed: (1) Is minimal detachment surgery justified in treating detachments with preoperative PVR stage B or C? (2) Can this reattach the retina with stabilization or regression of PVR?, Materials and Methods: 72 PVR detachments stage B or C (38 C1, 11 C2, 1 C3) were treated by cryopexy, segmental buckling (n = 68) or balloon (n = 4) without drainage or vitrectomy. Reoperation (n = 10) was done without cerclage or vitrectomy. The follow-up of patients alive is 11 to 13 1/2 years and of all patients (31 died) x 7 1/2 years., Results: After the primary operation the retina was reattached in 79%, partially in 15% and detached in 6%. An "early" redetachment (< or = 6 months postoperatively) occurred in 8.3%, no redetachment > 6 months to < 9 years and "late" redetachment (9-13 1/2 years postoperatively) in 2.8%. After reoperation (n = 10) the retina was reattached in 85%, partially in 3%, and detached in 12%. 34 eyes had delayed resorption (2 weeks to 18 months) with a residual concave detachment in area of starfolds and tractions, resulting in dry starfolds or their disappearance after months. Postoperatively there were no rubeosis iridis, no secondary glaucoma and no phthisis bulbi. Subsequent macular pucker developed in 12 eyes, which were not treated by vitreoretinal surgery. Six months postoperatively visual acuity was: 26x 20/60-20/25; 16x 20/200-20/100; 30x < or = 20/400 which was not statistically significant different (p = 0.549) after x 7 1/2 years., Conclusion: Primary treatment of a PVR detachment stage B or C1/C2 with cryopexy and segmental buckling and nondrainage seems justified to test for the chance of PVR-regression. The retina was reattached in 8 of 10 patients x 7 1/2 years postoperatively after primary operation without reoperation or vitrectomy and visual acuity was 20/60-20/25 in every third patient, thus implying a lack of late serious complications.

Background: Occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is known to occur with and without an associated serous pigment epithelial detachment (PED). Digital indocyanine green (ICG) videoangiography has been reported to provide enhanced definition of occult CNV., Methods: A total of 244 of 657 (37%) consecutive patients with AMD, with occult CNV and an associated serous PED evident on fluorescein angiographic examination, were further studied with ICG videoangiography., Results: On ICG videoangiographic examination, 9 of the 244 (4%) eyes had no evidence of underlying CNV, or essentially a pure serous PED. Each of the remaining 235 eyes (96%) had evidence of neovascularization and were defined as having a vascularized PED. These eyes were further divided into two groups, depending on the size and delineation of the neovascularization seen. Of the 235 eyes with vascularized PEDs, 89 (38%) had a solitary area of neovascularization that was well delineated, no more than one disc area in size, and defined as focal CNV. The other 146 (62%) eyes had a larger area of neovascularization, with variable delineation, defined as plaque CNV. Based on conventional guidelines, some patients were considered to be potentially eligible for laser photocoagulation treatment., Conclusion: The results of this study suggest that ICG videoangiography may be an important adjunct to the diagnosis, classification, and potential treatment of patients with AMD and occult CNV associated with a serous PED (vascularized PED).

Retinal detachment is a separation of the neurosensory retina from the retinal pigment epithelium. Most retinal detachments are rhegmatogenous, and identification of risk factors and predisposing lesions are important aspects of patient management. Retinal detachment is relatively rare, but can pose a significant threat to vision if there is macular involvement. Prompt diagnosis combined with patient education and appropriate intervention often can avert irrevocable visual impairment. This paper presents an overview of the categories of retinal detachment, discusses the pathogenesis of the various types of detachment, and provides recommendations for primary care of patients with predisposing factors and high-risk characteristics.

To understand the natural history of retinal pigment epithelial (RPE) detachments (PEDs) associated with drusen, we retrospectively reviewed 125 PEDs that had not undergone laser treatment over an average follow-up period of 28 months. We identified six types of RPE detachments: pseudo-vitelliform, confluent drusen, serous, vascular, and hemorrhagic lesions as well as PEDs associated with a retinal vascular abnormality. We correlated the type of detachment with visual acuity and anatomic outcome. The poorest results were obtained for PEDs associated with neovascularization (vascular, hemorrhagic, and retinal vascular abnormality types). Eyes presenting with pseudo-vitelliform lesions or confluent drusen had the best visual prognosis and anatomic results. Obvious subretinal new vessels developed in 16 (34%) of the serous PEDs over an average follow-up period of 25 months. Subretinal neovascularization was rare in the pseudo-vitelliform and confluent drusen groups. The proposed classification system may be useful in predicting the natural course of PEDs.

Nineteen cases with (27 eyes) of bullous retinal detachment, male (24 eyes), female (3 eyes), were reported. The age of onset was from 16 to 46, mean 36.7. All of them underwent fundus fluorescence angiography (FFA). According to the results of FFA, it could be divided into two types of fluorescence angiograph changes were seen: type I, multiple pigmental epithelial damage at posterior pole, it consisted of twelve cases (16 eyes); type II, extensive pigmental epithelial damage at posterior pole, it consisted of seven cases (11 eyes). The treatments consist: medicine; medicine and photocoagulation; combined medicine, transscleral drainage and photocoagulation. Among 27 eyes, 20 had their vision improved after treatment, 4 eyes unchanged and 3 eyes decreased in vision. 22 eyes obtained their retinal reattachment (81.4%). The diagnosis, differential diagnosis, classification and treatment are discussed.

The Retinal Society classification on proliferative vitreoretinopathy of 1983 has been updated to accommodate major progress in understanding of this disease. There are three grades describing increasing severity of the disease. Posterior and anterior location of the proliferations have been emphasized. A more detailed description of posterior and anterior contractions has been made possible by adding contraction types such as focal, diffuse, subretinal, circumferential contraction, and anterior displacement. The extent of the abnormality has been detailed by using clock hours instead of quadrants.

We followed-up without any treatment 17 eyes of 14 highly myopic patients affected by a retinal detachment confined to the posterior pole. The follow-up ranged from 3 to 92 months (mean follow-up: 4 years). The retinal detachment remained unchanged in 12 eyes (70.5%), spontaneously reattached in 3 eyes (17.6%), and progressed to the periphery in 2 eyes (11.7%). At the end of the follow-up period, 68.7% of eyes retained useful visual acuity. From these data we conclude that 1) immediate surgical management is probably unnecessary in a number of myopic eyes with retinal detachment confined to the posterior pole and 2) such detachments likely are traction retinal detachments rather than rhegmatogenous retinal detachments due to a macular hole.

In the first part of this study a description of the different types of ocular trauma is given. This is followed by the pathogeny of retinal detachment after blunt trauma. Then the specific characteristics of the tears and other signs of non-perforation traumatic retinal detachment are discussed. Finally a description is given of the operative technique used in those cases.