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K. Johansson, F. Ghosh; Clinical Characteristics and Glial Changes After Radical Retinectomy for Severe Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5715.
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To investigate clinical features and histopathological changes after retinectomy for severe cases of rhegmatogenous retinal detachment (RRD).
A retrospective study including 7 eyes from 7 patients with recurrent severe RRD. All eyes had previously undergone several surgical procedures for RRD. In 3 eyes, a limited retinectomy had been performed. The total duration of retinal detachment was 2-14 months (median 3). Visual acuity (VA) ranged from hand motion to 0,2 (median 0,02). All eyes displayed severe intraretinal proliferativ vitreoretinal retinopathy (PVR) with subsequent neuroretinal shortening. The surgery included a standard 3-port vitrectomy, peripheral retinectomy 120-240°, laser retinopexy and silicone oil tamponade. Lensectomy was performed at the same time on 4 out of 6 fakic eyes. In addition, a full-thickness neuroretinal specimen was obtained for histopathological examination including hematoxylin and eosin stainining as well as immunohistochemistry against glial fibrillary acidic protein (GFAP).
Silicon oil was removed in 5 eyes, and in all of these a complete retinal reattachment was achieved with a follow-up of 3-13 months. Reattacchment of the central part of retina was seen in 2 eyes although the periferal retina was still detached, and in these eyes a decision to leave the silikonoil was made. Visual acuity was improved or stabilized in 5 eyes. In the neuroretinal specimens, severe degenerative changes were seen. The retinal layers were thin with only a few rows of cells, and no inner or outer segments were found. A massive upregulation of GFAP was found in immunolabeled sections. In 5 eyes, a massive gliotic reaction with subretinal hypertrophy of the Müller cells was also seen.
Radical retinectomy can be used to reattach the retina and preserve a certain degree of visual function in RRD eyes with severe intraretinal PVR. The degenerative and gliotic changes found confirms that long term RRD severely affects retina and its possibility of reattachment or function.
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