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Central retinal artery occlusion during vitrectomy: Immediate retinal revascularization following induction of posterior vitreous detachment.

ABSTRACT: Purpose:To describe a patient with acute central retinal artery occlusion (CRAO) during vitrectomy surgery and the possible role of vitrectomy in acute CRAO management. Observations:An 84-year-old man presented with broad vitreomacular traction and epiretinal membrane in the right eye. Preoperative assessment clearly showed normal retinal vasculature. On starting vitrectomy, complete CRAO with marked segmentation of all retinal vessels was noted. Vitrectomy was performed in the usual manner and once the posterior hyaloid detached from the disc, immediate complete revascularization of the retinal vessels was noted. The patient had a complete visual recovery. Conclusions and importance:Immediate vitrectomy with induction of posterior vitreous detachment may have a role in selected cases of acute CRAO, particularly if performed within a short window.

SUBMITTER: Ellabban AA

PROVIDER: S-EPMC5786868 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Central retinal artery occlusion during vitrectomy: Immediate retinal revascularization following induction of posterior vitreous detachment.

Ellabban Abdallah A AA Patil Ajay D AD Costen Mark T MT Babar Atiq R AR

American journal of ophthalmology case reports 20180105

<h4>Purpose</h4>To describe a patient with acute central retinal artery occlusion (CRAO) during vitrectomy surgery and the possible role of vitrectomy in acute CRAO management.<h4>Observations</h4>An 84-year-old man presented with broad vitreomacular traction and epiretinal membrane in the right eye. Preoperative assessment clearly showed normal retinal vasculature. On starting vitrectomy, complete CRAO with marked segmentation of all retinal vessels was noted. Vitrectomy was performed in the us ...[more]

PMID: 29468216

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Project description:IntroductionRetinal detachment is a sight-threatening emergency, with more than half of those affected suffering permanent visual impairment. A diagnostic test to identify eyes at risk before vision is threatened would enable exploration of prophylactic treatment. This report presents the use of irregularities in retinal shape, quantified from optical coherence tomography (OCT) images, as a biomarker for retinal detachment.MethodsOCT images were taken from posterior and mid-peripheral retina of 264 individuals [97 after a posterior vitreous detachment (PVD), 99 after vitrectomy for retinal detachment and 68 after laser for a retinal tear]. Diagnoses were taken from history, examination and OCT. Retinal irregularity was quantified in the frequency domain, and the distribution of irregularity across the regions of the eye was explored to identify features exhibiting the greatest difference between retinal detachment and PVD eyes. Two of these features plus axial length were used to train a quadratic discriminant analysis classifier. Classifier performance was assessed by its sensitivity and specificity in identifying retinal detachment eyes and visualised with a receiver operating characteristic (ROC) curve.ResultsValidation set specificity was 84% (44/52 PVD eyes correctly labelled) and sensitivity 35% (23/64 retinal detachment eyes identified, p = 0.02). Area under the ROC curve was 0.75 (95% confidence intervals 0.58-0.85). Retinal detachment eyes were significantly more irregular than PVD eyes in the superior retina (0.70 mm versus 0.49 mm, p < 0.05) and supero-temporal retina (1.12 mm versus 0.80 mm, p < 0.05). Lower sensitivity (16/68, 24%) was seen for eyes with a retinal tear without detachment, that were intermediate in size between retinal detachment and PVD eyes. Axial length on its own was a poor classifier. Neither irregularity nor classification were affected by surgery for retinal detachment or the development of PVD.ConclusionsThe classifier identified 1/3 of retinal detachment eyes in this sample. In future work, these features can be evaluated as a test for retinal detachment prior to PVD.

Project description:PurposeTo investigate the incidence, seasonal variation, and differences among age, sex, and race for rhegmatogenous retinal detachment (RRD) repair, retinal break (RB) treatment, and posterior vitreous detachment (PVD) in the Intelligent Research in Sight (IRIS) Registry.DesignRetrospective database study.ParticipantsPatients in the IRIS Registry who underwent RRD repair, RB treatment, or cataract surgery (CS) based on Current Procedural Terminology codes and PVD diagnosis based on International Classification of Diseases, Ninth and Tenth Revision, codes.MethodsDaily incidence rates were defined as the ratio of patients who underwent RRD repair or RB treatment and patients with a diagnosis of PVD to the total number of patients followed on a given day within the IRIS Registry. The CS group was included as a comparison for seasonal variation. Rates were stratified by decade of life, sex, and race.Main outcome measuresTime series trends for incidence rates of RRD, RB, and PVD.ResultsA total of 7 115 774 patients received a diagnosis of incident PVD, 237 646 patients underwent RRD repair, and 359 022 patients underwent RB treatment. Also included were 5 940 448 patients who underwent CS. The mean daily incidence for RRD repair, RB treatment, PVD diagnosis, and CS were 0.46 per 100 000 patients, 0.70 per 100 000 patients, 13.90 per 100 000 patients, and 11.80 per 100 000 patients, respectively. Men showed higher incidence of RRD repair and RB treatment than women, whereas women showed higher incidence of PVD diagnosis. Rhegmatogenous retinal detachment incidence was higher in White people compared with other races. Seasonal decreases in PVD, RB treatment, RRD repair, and CS corresponded to national holidays, with larger decreases in winter months. Kaplan-Meier estimates showed that RRD repair and RB treatment typically occurred within 60 days of PVD diagnosis.ConclusionsWithin the IRIS Registry, the highest incidence of RRD was in the 6th and 7th decade of life. There was a higher incidence of RRD repair and RB treatment in men compared with women. The seasonal variation associated with national holidays was less pronounced for RRD repair and RB treatment.

Dataset Information

Central retinal artery occlusion during vitrectomy: Immediate retinal revascularization following induction of posterior vitreous detachment.

Publications

Central retinal artery occlusion during vitrectomy: Immediate retinal revascularization following induction of posterior vitreous detachment.

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