Tractional Retinal Detachment Follow-up

Updated: Mar 11, 2016
  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

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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Further Inpatient Care

Most vitreoretinal procedures currently are performed in an ambulatory setting.

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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

Proliferative vitreoretinopathy

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.

Proliferative diabetic retinopathy

Patients with diabetes should be monitored closely and treated with aggressive panretinal photocoagulation when indicated.

Retinopathy of prematurity

Screening protocols should be monitored, and patients should be treated with laser or cryotherapy as indicated.

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Complications

See the list below:

  • 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. [14, 15, 16]

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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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