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Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment.

ABSTRACT: Purpose: To describe a bimanual technique, "tug of war" for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).

Methods: We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped.

Results: Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3-8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04).

Conclusion: The 'tug of war' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.

SUBMITTER: Shroff D

PROVIDER: S-EPMC7727933 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment.

Shroff Daraius D Saha Indranil I Bhatia Gagan G Dutta Ranjan R Gupta Charu C Shroff Cyrus M CM

Indian journal of ophthalmology 20201001 10

<h4>Purpose</h4>To describe a bimanual technique, "tug of war" for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).<h4>Methods</h4>We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circ ...[more]

PMID: 32971629

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Project description:PurposeTo compare baseline levels of exploratory biomarkers in the vitreous fluid of patients with primary retinal detachment who subsequently develop proliferative vitreoretinopathy (PVR) versus those who do not.MethodsIn this exploratory case-control study, we evaluated the baseline protein biomarker levels from a biobank containing the vitreous fluid of patients who had undergone primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Undiluted samples were collected at the time of PPV and stored at -80°C. Samples from 13 patients who developed PVR within 6 months (PVR group) and 13 age- and gender-matched controls who did not develop PVR (control group) were included. Protein abundance levels were evaluated using a proximity extension assay, and a confirmatory enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of vimentin.ResultsBaseline vimentin (Normalized Protein eXpression [NPX], 8.6 vs. 6.4, P < 0.0001) and heme oxygenase 1 (NPX 8.9 vs. 7.0, P < 0.001) levels were found to be elevated in vitreous fluid of patients who subsequently developed PVR compared to those who did not. Confirmatory analysis using ELISA demonstrated mean vimentin concentrations of 7254 vs. 2727 ng/mL in the PVR versus control groups (P = 0.0152). The odds ratio for developing PVR was 14 (confidence interval, 1.4-168; P = 0.03), assuming a baseline vimentin threshold of 7500 ng/mL.ConclusionsVimentin is an intermediate filament protein expressed by retinal glial cells, and our data combined with prior evidence suggest that it may serve as an early vitreous biomarker for subsequent PVR formation and reactive gliosis. Furthermore, we found, for the first time, elevated baseline levels of heme oxygenase 1, a measurable indicator of oxidative stress.Translational relevanceOur positive findings could impact clinical care for retinal detachment patients by facilitating risk stratification for targeted interventions or closer monitoring in those at the highest risk of developing PVR.

Project description:Background:Recurrent retinal detachment (RD) is still a widespread event despite the therapeutic options available. Proliferative vitreoretinopoathy (PVR) is one of the main causes of redetachment. Little is known about the use of endoscopy-assisted vitrectomy (E-PPV) in complex recurrent RD with PVR. The purpose of this study was to identify the potential advantages of E-PPV in complex RD with PVR compared with pars plana vitrectomy (PPV) alone. Methods:Single-center, retrospective, observational, descriptive study. The medical records of 293 patients were reviewed. Patients who underwent PPV for complex rhegmatogenous RD and associated PVR between 2009 and 2017 were included. Patients with diabetic tractional RD, trauma, uveitis or detachment postendophthalmitis were excluded. After 2013, an endoscopic visualization system was used in a nonrandomized fashion at the surgeon's discretion. Outcome measures (reattachment rate, number of surgeries, lens status, PVR stage, intraocular pressure, phthisis rate) were compared between the E-PPV and PPV-only groups with independent samples t-tests (continuous variables) and Fisher's exact test (categorical variables), as well as time-adjusted analyses. Postoperative time to retinal redetachment was assessed with Kaplan-Meier survival analysis. Results:One hundred one eyes from 100 patients met the inclusion criteria. The mean participant age was 63.3 years old (95% CI 60.4-66.1 years), without a significant difference between groups. E-PPV was performed in 36.6% (n?=?37) of eyes, and 63.4% (n?=?64) underwent PPV only. The mean follow-up was significantly longer in the PPV-only group (31.9 vs. 21.1 months; p?=?0.021). Upon adjustment for follow-up duration, the mean number of surgeries was significantly lower in the PPV-only group (2.6 vs. 4.3 number of surgeries; p?<?0.001) than in the E-PPV group. A significantly higher risk for redetachment was observed in the PPV-only group (HR [95% CI] 4.1 [1.4-11.8]) than in the E-PPV group (p?=?0.037). The evolution to phthisis was 7% (n?=?4) in the PPV-only group and 2.7% (n?=?1) in the E-PPV group (p?>?0.05). Conclusions:Compared to PPV alone, endoscopy-assisted vitrectomy seems to be advantageous in achieving better reattachment rates in complex RD with advanced PVR. Endoscopic visualization allows a thorough examination and extensive anterior PVR and vitreous base dissection.

Project description:BackgroundTo compare the safety and efficacy of Ab-externo subretinal bands removal in comparison with the classical Ab-interno approach during pars plana vitrectomy for primary rhegmatogenous retinal detachment.MethodsSubjects aged 28-62 years with primary RRD complicated by proliferative vitreoretinopathy (PVR) with subretinal bands interfering with retinal flattening were treated by pars plana vitrectomy (PPV) and silicone oil injection. Subretinal bands were removed using the classical AB interno approach through one or more retinotomies in ten patients (group A) and using AB externo approach in twenty cases (group B). Post-operative follow-up visits occurred at 1 day, 1 week, 1 month, and 3 months, after surgery. The main outcomes were assessment of subretinal bands removal efficacy, documentation of complications, anatomical reattachment rate, and postoperative best-corrected visual acuity (BCVA).ResultsThere was no statistically significant difference between both groups regarding patients' age, gender, lens status, and the onset of retinal detachment. Seventy percent of both groups presented with inferior retinal detachment while ten percent presented with temporal detachments and twenty percent had a total retinal detachment. Both groups had a statistically significant improvement in postoperative visual acuity in comparison with preoperative visual acuity (P = 0.005 for group A and P = < 0.001 for group B). There was no statistically significant difference between both groups regarding preoperative (P = 0.928) and postoperative (P = 0.185) visual acuity. A higher incidence of complications was reported in group A (40%) in comparison with group B (30%) but this difference was not statistically significant (P = 0.69). More Epimacular membranes were seen postoperatively in group A (30%) in comparison with group B (20%) but again this difference was not statistically significant (P = 0.657). Subretinal hemorrhage was seen in ten percent of cases in both groups. Intraocular pressure was measured in every follow-up of all patients in both groups, no statistically significant difference was found between both groups.ConclusionsBoth techniques are effective and safe to remove subretinal bands with similar outcomes.

Dataset Information

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment.

Publications

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment.

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