Detachment, retinal

The incidence and severity of ROP both rise with decreasing birthweight and gestational age. Fielder et al. (1992) have shown that the incidence of ROP in infents of < 1700 g birthweight is about 50%, although only 5% had severe disease. Severe ROP results in vitreous haemorrhage from new vessel formation on the immature retina, retinal traction and eventually retinal detachment (Fig. 9.6). In the most severe cases, retinal detachment is complete, resulting in total blindness. Treatment with cryotherapy or laser has halved the incidence of retinal detachment. 

Figure 9.6 Retinal detachment associated with retinopathy of prematurity.

The adverse effects of pilocarpine are caused by the induction of miosis. The contraction of the ciliary muscle causes the lens to displace forward, which can lead to accommodation spasm, myopia, and brow ache. Pupillary constriction can also affect night vision. Pilocarpine should be avoided in patients with severe myopia, as it increases the risk of developing retinal detachment. Systemic effects may occur at higher concentrations and include, nausea, vomiting, diarrhea, and bradycardia. 

Blunt trauma to eye Macular edema Retinal detachment Sudden congestive proptosis (bulging of eye forward) Corneal ulcer Corneal abrasion... 

Retinal or vitreous hemorrhage, retinal detachment, transient or permanent visual loss central retinal vein occlusion... 

Also, we have noted that patients with unilateral cataracts after trauma or retinal detachment repair typically have very similar RRS carotenoid levels in the normal and in the pseudophakic eye. Thus, we have concluded that there is a decline of macular carotenoids that reaches a low steady state just at the time when the incidence and prevalence of AMD begins to rise dramatically. While this age effect has been noticed sometimes also in other studies using clinical populations and different MP detection methods (Sharifzadeh et al. 2006, Nolan et al. 2007), several groups have reported constant, age-independent MP levels. Examples include reflectance-based population studies in which respective average MP optical densities of 0.23 (Delori et al. 2001), 0.33 (Berendschot et al. 2002), and 0.48 (Berendschot and Van Norren 2004) were determined. 

Initial clinical assessment involved some 1200 wet AMD patients. Although both control and product groups continued to experience vision loss, the rate of vision decline experienced by macugen-treated patients was significantly slower than in the case of control patients. The most frequent/potentially serious side effects noted during these trials were endophthalmitis, retinal detachment, eye inflammation/irritation and blurred vision, although rare cases of anaphylaxis have also been reported. Macugen is marketed by Eyetech Pharmaceuticals and Pfizer. 

Three out of 45 galactosemic patients studied by Hsia and Walker (H10) had retinal detachment and one had intraocular hemorrhage. 

Ocular effects Carefully examine the fundus prior to initiating therapy with pilocarpine. An association of ocular pilocarpine use and retinal detachment in patients with preexisting retinal disease has been reported. The systemic blood level that is associated with this finding is not known. 

Retinal detachment Retinal detachment has been observed in subjects with CMV retinitis both before and after initiation of therapy with ganciclovir. Its relationship to therapy is unknown. Patients with CMV retinitis should have frequent ophthalmologic evaluations to monitor the status of their retinitis and to detect any other retinal pathology. 

Adverse reactions occurring in at least 3% of patients include the following Abdominal pain, anemia, diarrhea, graft rejection, headache, hypertension, insomnia, leukopenia, nausea, neutropenia, paresthesia, peripheral neuropathy, pyrexia, retinal detachment, thrombocytopenia, tremors, vomiting. 

Retinal detachment Retinal detachment has been caused by miotics in susceptible individuals, in individuals with pre-existing retinal disease, or in those who are predisposed to retinal tears. 

Ophthalmic-Transient stinging and burning corneal clouding persistent bullous keratopathy retinal detachment transient ciliary and conjunctival injection ciliary spasm with resultant temporary decrease of visual acuity. 

Uses Neovascular wet macular degenoation Action Vascular endothelial growth factor inhibitor Dose 0.5 mg intravitreal inj qmo Caution [C ] Hx thromboembohsm Contra Periocular Infxn Disp Inj SE Endophthalmitis, retinal detachment/hemorrhage, cataract, intraocular inflammation, conjunctival hemorrhage, eye pain, floaters EMS None OD Unlikely, but immediate effect would be vision loss and pain d/t t ocular pressure... 

Fluorinated Molecules in Eye Surgery Experimental and Clinical Benefit of a Heavy Silicone Oil Oxane Hd (Mixture of Silicone Oil and RMN3 Fluorine Olefin) in the Treatment of Retinal Detachment... 

Rhegmatogenous retinal detachment (RD) is defined by fluid accumulation in the subretinal space through retinal tear, inducing separation of the neurosensory retina from the retinal pigmentary epithelium (Fig. 1). 

Fig. 1. Photograph of fundus with a retinal detachment. (See Colour Plate Section at the end of this book.)...

A multicentre, prospective study was conducted in cooperation with three vitroretinal surgery centres (CHU de Rangueil, Hotel Dieu, Paris, CHNO des XV-XX, Paris) in 30 patients operated on between 1998 and 2000, which confirmed the effectiveness and tolerance of the RMN3-5700 cSt silicone oil 12%/88% mixture, with a density of 1.03, in the treatment of retinal detachment, especially inferior and/or posterior dehiscences [8,9], In particular, only one case... 

On the basis of the results, it appears that heavy silicone oil Oxane Hd , the first formulation of this type on the market, as a temporary internal tamponade is equally tolerated as standard silicone oil in the surgical treatment of complex retinal detachment. It does not pose any emulsification or major fragmentation problem, as encountered with other heavier than water products. Its effectiveness on inferior and posterior dehiscence tamponade appears to be very effective to currently available anatomical results. Oxane Hd , moreover, presents in this context a real benefit in the treatment of complex retinal detachment [48]. Retinopexy quality and the absence of residual subretinal fluid in internal tamponade of inferior lesions, extensive inferior retinectomies in particular, may reduce the risk of recurrence of complex retinal detachment by PVR. More extensive studies are now in course to see the limits of Oxane Hd in comparison with new analogues such as Densiron 68 , which has been marketed recently. 

E.W.D. Norton, Edward Jackson Memorial lecture, Intraocula gas in the management of selected retinal detachments, Trans. Am. Acad. Ophthalmol. Olaryngol. 77 (1973) 85-98. 

P.A. Cibis, Vitreoretinal Pathology and Surgery in Retinal Detachment, The CV Mosby Company, St Louis, USA, 1965. 

P.A. Cibis, B. Becker, E. Okun, S. Canaan, The use of liquid silicone in retinal detachment surgery. Arch. Ophthalmol. 68 (1962) 590-599. 

M. Gonvers, Temporary use of silicone oil in the treatment of special cases of retinal detachment, Ophthalmologica 187 (1983) 202-209. 

D. Me Leod, Silicone-oil injection during closed microsurgery for diabetic retinal detachment, Graefes Arch. Clin. Exp. Ophthalmol. 224 (1986) 55-59. 

J.S. Rinkoff, E. de Juan Jr, B.W. Me Cuen, Silicone oil of retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. Am. J. Ophthalmol. 101 (1986) 181-186. 

S. Wolf, V. Schdn, P. Meier, P. Wiedemann, Silicone oil-RMN3 mixture ( heavy silicone oil ) as internal tamponade for complicated retinal detachment, Retina 23 (2003) 335-342. 

V. Pagot-Mathis, X. Benouaich, A. Mathis, I. Rico-Lattes, A. Dumoulin, Management of complicated retinal detachment using a heavy silicon oil as temporary tamponade, J. Fr. Ophthalmol. 29 (2006) 137-145. 

Various diseases of the natural vitreous itself, like opacification, haemorrhage, inflammation, as well as retinal detachment, may require its removal by so-called vitrectomy. 

Primary (idiopathic, rhegmatogeneous) retinal detachment is induced by a retinal tear, followed by penetration of vitreous fluid between the sensoric retina and the pigment epithelium. 

Tractional retinal detachment is the result of the shrinkage of membranes. This is a frequent event in proliferative vitreretinopathy (PVR), which is characterised by the growth of membranes on the outer as well as on the inner side of the detached retina. The shrinkage of these membranes results in further detachments of the retina and additional retinal holes. 

Winter et al. [41] could demonstrate that the intra-operative treatment of retinal detachments with PFCLs, followed by an exchange to intraocular gas, resulted in total coating of the retinal surface with the fatal effect of complete sealing, creating an interruption of essential transretinal exchange processes. Equivalent scenarios have to be taken into consideration in the situation of a completely filled eye or if the droplets of an endotamponade media show a non-spherical shape. 

Chapter 9, Fig. 1. Photograph of fundus with a retinal detachment. 

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