Tractional Retinal Detachment Follow-up

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 30, 2012
 

Further Inpatient Care

  • Most vitreoretinal procedures currently are performed in an ambulatory setting.
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Further Outpatient Care

  • Certain eyes that undergo vitreoretinal surgery have an intraocular gas bubble to serve as internal tamponade. Depending on the gas used and the location of the breaks, the surgeon instructs the patient to maintain a certain head position for a limited time.
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Inpatient & Outpatient Medications

  • Postoperative medications usually include a topical corticosteroid, a topical cycloplegic, and a topical antibiotic. The intraocular pressure is monitored and controlled accordingly.
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Deterrence/Prevention

  • PVR
    • Extensive cryotherapy, cryotherapy over bare RPE, and scleral depression after cryotherapy should be avoided because this will disperse RPE cells into the vitreous cavity. Cryotherapy also causes breakdown of the blood-ocular barrier, allowing serum (containing various growth factors believed to be stimulatory to the formation of PVR) to enter the eye.
    • A double-masked, prospective, randomized, placebo-controlled clinical trial reported that adjuvant therapy with 5-fluorouracil and low molecular weight heparin does not improve anatomical and visual success rates in retinal detachments with preexisting PVR. Furthermore, it is associated with worse visual outcomes in cases with macula-sparing retinal detachment.
  • PDR: Patients with diabetes should be monitored closely and treated with aggressive panretinal photocoagulation when indicated.
  • ROP: Screening protocols should be monitored, and patients should be treated with laser or cryotherapy as indicated.
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Complications

  • Retinal redetachment
  • Vitreous hemorrhage
  • Phthisis bulbi
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Prognosis

  • Visual prognosis depends on the underlying cause of TRD.
    • Anatomical success rates for retinal reattachment surgery for PVR are anywhere from 75-90% of eyes. However, visual results are poor, since only about 40-50% obtain a visual acuity of 20/400 or better.
    • The results after ROP surgery are very poor but better than the natural history (no light perception).
    • For PDR, series by Rice et al, Thompson et al, and Williams et al report 70-80% of eyes attain 5/200 or better visual acuity with 40% achieving 20/100 or better.[11, 12, 13]
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Patient Education

  • Patients with diabetes must be aware that a fully dilated eye examination by a competent ophthalmologist should be performed at least once a year. Depending on the presence and degree of retinopathy, the patient may need to be seen on a more frequent basis.
  • Patients should be educated about the importance of good glycemic, hypertensive, and lipemic control.
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Contributor Information and Disclosures
Author

Lihteh Wu, MD  Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Pan-American Association of Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD  Retina Fellow, St Michael's Hospital, University of Toronto, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Patient with a central retinal vein occlusion complicated by neovascularization at the disc with subsequent tractional retinal detachment.
This patient underwent a scleral buckle for a rhegmatogenous retinal detachment. Now, the patient presents with proliferative vitreoretinopathy with a membrane tenting up and detaching the retina.
A patient with proliferative diabetic retinopathy complicated by a tractional retinal detachment over the supertemporal arcade.
 
 
 
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