OBJECTIVE: The aim of this study was to prospectively evaluate the changes in macular and optic disc microvascular structures in patients who underwent silicone oil (SO) removal.
METHODS: A total of 28 patients scheduled for unilateral SO removal were included in the study. Their fellow eyes served as controls. Optical coherence tomography angiography (OCTA) of the retina (6.0 mm) and disc (4.5 mm) was performed one day before SO removal, and then at 1 week and 1, 3, 6, and 12 months postoperatively. All analyses were conducted using the R programming language, with a p-value <0.05 considered statistically significant.
RESULTS: After silicone oil removal, statistically significant changes were observed in the flow in the outer retina and radial peripapillary capillary (RPC) density for small and all vessels inside the disc. Statistically significant differences between the intervention and control groups were noted in vessel density in both the superficial and deep capillary plexuses and RPC density for small and all vessels.
CONCLUSIONS: Changes in macular vessel density and radial peripapillary capillary density were observed after SO removal. The latter changes appear to improve after the first postoperative month and continue until the first postoperative year. Notably, these changes were significant between the first postoperative week and 6 and 12 postoperative months (p = 0.0263 and p = 0.021, respectively). Best corrected visual acuity (BCVA) is likely associated with these parameters, indicating that improvement may be observed even one year following SO removal.

Macular edema (ME) is a major cause of reduced vision following intraocular surgery. Although the pathophysiology of ME is not completely understood, inflammatory mediators play a key role. The incidence of ME following pars plana vitrectomy with silicone oil tamponade varies between 13% and 27%. ME usually resolves spontaneously following silicone oil removal, but treatment may be required for resistant cases. In this review, the mechanisms of ME formation after pars plana vitrectomy, its incidence, and its possible therapeutic approaches are discussed.

OBJECTIVE: To evaluate the safety and efficacy of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) and complete drainage of subretinal fluid.
METHODS: For this retrospective study, we reviewed the medical charts of 273 patients (275 eyes) who consecutively underwent PPV, subretinal fluid drainage and filtered air tamponade to treat primary RRD between 2018 and 2022. As primary outcome we evaluated the anatomical success considered as retinal reattachment after single surgery. As secondary outcomes: final mean best corrected distance visual acuity (BCDVA), complications, and mean intraocular pressure (IOP) trends.
RESULTS: The anatomical success was reached by 262 (95.6%) of cases. Mean BCDVA improved from 0.73 LogMAR at baseline, to 0.21 LogMAR at the end of follow-up. As complications we recorded: 5 cases of clinically relevant macular pucker, 1 full thickness macular hole, and 1 PFO bubble under the retina. The mean IOP remained on normal values during the overall follow-up period.

UNASSIGNED: The objectiove of the study is to evaluate and compare the outcomes of pars plana vitrectomy (PPV) and PPV combined with scleral buckle (SB) in vitrectomised cases with recurrent retinal detachment (RD) and to analyze the effects of adding SB to the procedure.
UNASSIGNED: Patients with recurrent RD due to grade C proliferative vitreoretinopathy (PVR) were included in this retrospective comparative case series. Patients who underwent re-PPV with or without SB were included and two groups (re-PPV; re-PPV+SB) were compared in terms of anatomical and functional success.
UNASSIGNED: Sixty-five cases were included in the study: 32 underwent re-PPV and 33 underwent re-PPV+SB procedures. Reattachment was achieved in 59.4% of the re-PPV group versus 81.8% of the re-PPV+SB group (p=0.047). Although preoperative BCVA was worse in the re-PPV+SB group (p=0.005), postoperative BCVA at the last visit was similar in both groups (p=0.065).
UNASSIGNED: In the treatment of recurrent RD with grade C PVR, combining the SB procedure with PPV contributes to anatomical and functional outcomes.

Background The emulsification of silicone oil is a significant concern for those with rhegmatogenous retinal detachment (RRD) following surgery. The aim of the study was to assess the frequency of emulsification in the patients who underwent primary vitrectomy and were administered 5000 cs silicone oil. Methodology The Layton Rahmatullah Benevolent Trust in Lahore conducted an ophthalmology study from January 2022 to March 2023. The patients who had primary vitrectomy for RRD with silicone oil tamponade were included regardless of age or gender. Those on anti-inflammatory or steroid medications prior to surgery were excluded. Retinal attachment was examined 8-12 weeks post operation to assess silicone oil removal eligibility. Emulsification occurrence was reported. Data on emulsification time, visual acuity (pre- and post-removal), mean intraocular pressure (IOP), and clinical outcomes were collected and analyzed using the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). The results were graphically presented with mean, standard deviations, frequencies, and proportions. Results A total of 158 patients underwent silicone oil removal after undergoing primary vitrectomy for RRD with silicone oil. The mean age of the patients was 45.90 ± 17.8 years. The mean preoperative intraocular pressure (IOP) among the patients was 16.28 ± 2.97 mmHg. Post removal of silicone oil, the IOP was reduced to 12.66 ± 3.02 mmHg. In 11 out of 158 cases (6.9%) of RRD, emulsification had occurred with silicone oil 5000 cs. We found that out of 11 cases of emulsification, eight (72.73%) were 40 years or older in age. Seven (63.64%) patients had tamponade duration of 10 weeks or longer. However, the difference was not statistically significant. Conclusion In conclusion, our study found that the incidence of emulsification of 5000 cs silicone oil in the patients who underwent primary vitrectomy for the treatment of RRD was 6.9%. We observed that emulsification was more frequent in patients aged 40 years or older and those with a tamponade duration of 10 weeks or longer, although the difference was not statistically significant. Further investigation with bigger sample sizes and extended follow-up periods is required to verify our findings and explore potential factors that could lead to emulsification in this group of patients.

OBJECTIVE:  To investigate the incidence and the risk factors for conjunctival pigmentation at the sclerotomy sites following valved and non-valved cannula pars plana vitrectomy (PPV) performed by different surgical techniques.
METHODS:  This is a prospective observational study which included 70 eyes of 70 patients who underwent PPV for rhegmatogenous retinal detachment with follow-up visits at 1, 3, 6, 12, and 24 months. Twenty-eight eyes were operated using 25G non-valved cannulas (Group A), 22 eyes using 25G non-valved cannulas (Group B), and 20 eyes using 25G valved cannulas (Group C). The evaluated clinical parameters include the surgical technique, the patients\' age, the number of retinal tears, the tamponade agent, the presence of residual sub-retinal fluid (SRF), and the duration of postoperative posturing.
RESULTS:  Group A was associated with significant conjunctival pigmentation at up to 6 months after PPV. Sulfur hexafluoride (SF6) gas tamponade was associated with less conjunctival pigmentation at 3 months follow-up visit [odds ratio, OR 0.09 (95% confidence interval, CI 0.01; 0.67)], whereas the presence of residual SRF was a significant risk factor for postoperative pigmentation at 1-year follow-up visit [OR 5.89 (95% CI 1.84; 23.12)]. The area of measured pigmentation was also positively correlated to the number of retinal tears at all follow-up visits over 2 years. Six patients presented with conjunctival pigmentation at 2 years follow-up visit.
CONCLUSIONS:  New vitrectomy techniques with valved cannulas prevent the postoperative appearance of conjunctival pigmentation. The number of retinal tears, the presence of SRF, and the use of long-standing tamponade agents were the most significant predisposing factors. The post-vitrectomy conjunctival pigmentation gradually reduces over time.

UNASSIGNED: To determine the treatment patterns and outcomes of pediatric retinal detachments (RDs) associated with hereditary vitreoretinopathies.
UNASSIGNED: Retrospective cohort analysis using IRIS® Registry (Intelligent Research in Sight) database.
UNASSIGNED: Patients < 18 years old with a rhegmatogenous RD and a systemic disorder associated with vitreoretinal degeneration (e.g., Stickler syndrome) or other malformation of the vitreous from 2013-2019.
UNASSIGNED: Cases were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9, ICD-10) diagnostic codes from the IRIS® Registry cohort. Other hereditary vitreoretinopathies that are not encoded by specific ICD code(s) were captured by text search. Nonspecific vitreous abnormality ICD codes were also included. Exclusion criteria included traumatic retinal detachments using ICD codes for ocular trauma and serous or exudative retinal detachment. Surgical procedures were identified using Current Procedural Terminology (CPT) codes for repair of retinal detachment. Baseline demographic information collected included age, gender, race/ethnicity, geographic region of the provider location, and health insurance status.
UNASSIGNED: Main outcomes measured in this study were average time to first surgery, number of eyes presenting with bilateral detachments, and choice of initial surgical procedure.
UNASSIGNED: A total of 2115 eyes of 1722 patients were identified (mean age, 10.4 years; 58% male). The median time to first surgery was 7 days (interquartile range, 40 days). One thousand four hundred seven eyes of 1134 patients had ≥ 1 year of follow-up, with 506 eyes (36%) developing a fellow eye RD. Thirty-three percent of patients presenting with bilateral detachments, and 349 eyes had initial RD surgery within 1 year of the index date documented by CPT code. Fellow eye detachment occurred a mean of 32 days after initial presentation. The mean number of surgeries per eye within 1 year was 1.68. Best-corrected visual acuity did not improve from a baseline 20/54 to 20/62. The initial procedure was most commonly complex RD repair (n = 176), followed by scleral buckle (n = 102), pars plana vitrectomy (n = 89), laser (n = 59), cryotherapy (n = 5), and pneumatic retinopexy (n = 5). There were 51 new diagnoses of glaucoma and 37 new diagnoses of aphakia within 1 year after the surgical procedure.
UNASSIGNED: IRIS Registry data provide insight into rare pediatric vitreoretinopathy-associated RDs, which have a high rate of reoperation and fellow eye involvement.
UNASSIGNED: Proprietary or commercial disclosure may be found after the references.

OBJECTIVE: To develop and evaluate an automated deep learning model to predict the anatomical outcome of rhegmatogenous retinal detachment (RRD) surgery.
METHODS: Six thousand six hundred and sixty-one digital images of RRD treated by vitrectomy and internal tamponade were collected from the British and Eire Association of Vitreoretinal Surgeons database. Each image was classified as a primary surgical success or a primary surgical failure. The synthetic minority over-sampling technique was used to address class imbalance. We adopted the state-of-the-art deep convolutional neural network architecture Inception v3 to train, validate, and test deep learning models to predict the anatomical outcome of RRD surgery. The area under the curve (AUC), sensitivity, and specificity for predicting the outcome of RRD surgery was calculated for the best predictive deep learning model.
RESULTS: The deep learning model was able to predict the anatomical outcome of RRD surgery with an AUC of 0.94, with a corresponding sensitivity of 73.3% and a specificity of 96%.
CONCLUSIONS: A deep learning model is capable of accurately predicting the anatomical outcome of RRD surgery. This fully automated model has potential application in surgical care of patients with RRD.

OBJECTIVE: To analyze the correlation between lens status, age, and sex in the epidemiology and success rates of rhegmatogenous retinal detachment (RRD) surgery.
METHODS: The files of all consecutive patients undergoing vitreoretinal surgery for uncomplicated RRD between Jan 2005 und Dec 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment occurring within 3 months after surgery.
RESULTS: 5502 eyes with uncomplicated primary RRD were included. Mean age of the patients was 61.1 years (± 13.6 SD). In the age group over 40 years, a male predominance was found. The percentage of pseudophakic RRD increased from 25 to 40% during the 15 years observation period. In the age group 50 to 69 years, patients with pseudophakic detachments were male in 786 out of 1079 cases (72.9%). In the same age group, 1285 of 2110 (60.9%) patients with phakic RRD were male. Overall, primary success rate after one procedure was 91.2% (5018 of 5502). In the phakic eyes, the primary success rate was higher in those eyes that underwent combined phacovitrectomy (93.0%), compared to those without simultaneous cataract surgery (88.7%; p = 0.002).
CONCLUSIONS: The ratio of male and female patients with RRD varies between age groups. The proportion of pseudophakic RRD has increased within 15 years. The male predominance in RRD is stronger in pseudophakic than in phakic eyes. In phakic eyes with RRD, a combined phacovitrectomy yielded better anatomical results.

Introduction This study aims to evaluate the primary anatomical success and visual outcomes of 25-gauge pars plana vitrectomy (25g PPV) in patients with rhegmatogenous retinal detachment (RRD) in Pakistan. Design This is a five-year retrospective, interventional cohort study conducted at tertiary care hospitals in Pakistan from October 2013 to October 2018. Methods This is a retrospective, interventional cohort study of 418 consecutive patients with RRD who underwent 25g PPV. All surgeries were performed by two experienced surgeons at tertiary care hospitals in Pakistan. Consecutive patients who underwent 25g PPV surgery as the treatment for RRD from October 2013 to October 2018 were included. We excluded patients who had a history of previous retinal surgery or did not complete the 4-8 weeks of primary outcome visit. We used the Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corporation, Armonk, NY, USA) for statistical analysis. A p-value of <0.05 was considered significant. Results We identified 452 patients through the coding system of our hospitals who underwent 25g PPV surgery for RRD during the study period. A total of 441 patient files were reviewed for the study, of which 418 patients met the criteria for final analysis. The mean age was 49 ± 15.8 years. There was a higher number of males (n = 284, 67.9%). In our study, 186 (44.4%) patients were phakic at the time of presentation. The macula was detached in 361 (86.4%) patients. At the primary outcome visit (4-8 weeks of follow-up), the primary anatomical success rate was 89.47%. The most common cause of failure was proliferative vitreoretinopathy (PVR) (n = 20), followed by missed breaks (n = 5). Conclusions The surgical outcomes of RRD with 25g PPV surgery in our study were similar to the outcomes reported in the developed world. We propose a prospective multicenter national study to prospectively evaluate the risk factors for RRD surgical failure in the Pakistani population.