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Vitreoretinal Surgery in Rare Conditions
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Resolution of the detachment following deroofing of the vortex vein and sclerotomy was first reported by Brockhurst. Subsequently, it was noted that partial-thickness sclerectomy alone at the equator brings about a steady resorption. The operative procedure starts with peritomy and bridle of the recti muscles. An area measuring 5 mm × 4 mm is marked over the region of the equator [with the anterior margin about 3 mm from the spiral of Tillaux] in two or more quadrants. Scleral flap is cautiously raised in the demarked area using a surgical blade braker or crescent blade. As the sclera is thickened, sclerectomy may have to be completed in layers so as to ensure an adequate dissection. The end point of dissection is indicated by the appearance of a violaceous hue at the sclera bed [due to the underlying choroidal vasculature]. Care must be taken to avoid penetration into the suprachoroidal or subretinal space. Local application of mitomycin C 0.02% solution [2 minutes using Merocel sponge] on the bed of the dissected sclera [followed by copious irrigation with normal saline] may improve the long-term results. [The scleral flap may be sent for pathological or microscopic studies.] The conjunctiva and tenon are then secured using Vicryl sutures. Resolution of retinal detachment occurs gradually over several weeks to months.
Retinal Tears and Detachments
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Optical coherence tomography (OCT): OCT scans can be useful in delineating the retinal layers to confirm a retinoschisis or to exclude subretinal fluid and hence a retinal detachment. If you are unsure whether the macula is involved in a retinal detachment, then OCT scans of the scans are useful in confirming macular involvement.
The eye
Published in Angus Clarke, Alex Murray, Julian Sampson, Harper's Practical Genetic Counselling, 2019
Retinal detachment is commonly associated with severe myopia, and a significant risk to relatives is only likely when they also have severe myopia. Occasional dominantly inherited families are documented with retinal detachment unrelated to myopia or other ocular disorders. Several other genetic syndromes may be accompanied by retinal detachment, including type II collagen defects such as severe spondyloepiphyseal dysplasia and Stickler syndrome, as well as the related, but distinct, condition known as Wagner retinopathy, all of which are dominantly inherited.
Intermediate Uveitis: A Review
Published in Ocular Immunology and Inflammation, 2023
Andrea York Tiang Teo, Bjorn Kaijun Betzler, Keith Low Qie Hua, Elizabeth Jiahui Chen, Vishali Gupta, Rupesh Agrawal
Retinal detachment has also been observed in IU across both paediatric and adult populations, and is associated with a higher risk for poor visual acuity in adults.54 Retinal detachment in patients with IU may be exudative due to peripheral vascular leakage into the subretinal space,120 or tractional due to fibrotic and tractional pulling by the inflamed vitreous or pars plana gliosis.121 Retinoschisis seen in IU patients has been associated with various vascular disorders, including peripheral neovascularization, telangiectasia, and retinal capillary angiomas.122 Neovascularization is also the usual cause of vitreous hemorrhage, another complication well documented in IU.123 While patients with peripheral retinal elevations (retinoschisis and retinal detachment) usually remain stable in the long-term,121,122 concomitant telangiectatic vessels or vasoproliferative tumors might show increased accumulation of exudate and must be treated.122 Vasoproliferative tumors in IU are believed to be caused by uncontrolled proliferation of fibrous tissue and angiogenesis in the retina secondary to inflammation.124 This tumor may in turn cause multiple complications including CME, retinal detachment, and vitreous hemorrhage, resulting in poor visual outcomes.125
Retinal detachment in a child with Frank-ter Haar syndrome
Published in Ophthalmic Genetics, 2023
Onur Furundaoturan, Mine Esen Baris, Durdugul Ayyıldız Emecen, Elif Demirkilinc Biler
In addition to megalocornea and high astigmatism in the right eye, retinal detachment in the left eye was the major and most serious ophthalmological manifestation in the current case. Retinal detachment is quite rare in children when compared to adults, with only 2% to 6% of all retinal detachments attributed to children. Retinopathy of prematurity, myopia, and trauma are the leading causes of retinal detachment. Interrogation of the family did not reveal any trauma or a predisposing condition for detachment. A history of ophthalmic surgery (especially cataract), hereditary diseases (Marfan syndrome, X-linked juvenile retinoschisis, familial exudative vitreoretinopathy), uveitis, and certain malformations may result in retinal detachment but were ruled out for this patient (15). To the best our knowledge this is the first case of FTHS with retinal detachment. The presence of sensory exotropia in the left eye, in addition to fibrotic membranous changes of the retina, which are suggestive of proliferative vitreoretinopathy, may have promoted chronic retinal detachment. As the VEP test supported a poor prognosis, a decision of no treatment was taken for the patient with the consent of the family. We were unable to rule out avascular peripheral retina by fluorescein angiography in the right eye as the family deferred any further testing under anesthesia, and we continued to monitor this patient in an outpatient setting.
Malpractice Cases Arising From Telephone Based Telemedicine Triage in Ophthalmology
Published in Seminars in Ophthalmology, 2023
Elias H Kahan, Joshua D Shin, Michael E Jansen, Rebecca Hughes Parker, Ravi Parikh
This analysis showed that most medical malpractice lawsuits related to teleophthalmology resulted from delays in evaluation and/or treatment secondary to telephone visits. Although synchronous live audio-visual evaluation and high-resolution images generated through mobile health applications will become more prominent in the coming years, it is unlikely that telephone communication will ever be completely phased out of ophthalmic practice, and these learnings should be leveraged for mitigating future malpractice across all teleophthalmic encounters. Regarding telephone triage in particular, certain steps can be implemented in current practice to avoid the likelihood of malpractice litigation. Based on our findings, certain symptoms that may portend to endophthalmitis or retinal detachment, such as flashes and floaters, especially in the context of previous vitreous hemorrhage, detachment, or retinal repair, should warrant immediate in-person evaluation.