Elsevier

Ophthalmology

Volume 105, Issue 5, 1 May 1998, Pages 804-809
Ophthalmology

Surgical management of retinal detachments related to coloboma of the choroid1,

Presented in part at the Symposium on “A Tribute to Dr. Relja Zivojnovic,” Antwerp, November, 1996.
https://doi.org/10.1016/S0161-6420(98)95018-7Get rights and content

Abstract

Objective

This study aimed to develop a rationale for the management of retinal detachments related to choroidal coloboma and to study the outcome of their management.

Design

The study design was a retrospective study.

Participants

A total of 85 eyes of 81 patients with retinal detachments related to coloboma of the choroid participated.

Intervention

All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil (80 eyes) or perfluropropane gas (5 eyes). Behavior of the retina on fluid-air exchange was used to guide the further steps of surgery. Endolaser was performed along the coloboma border. Silicone oil was removed in 80% of eyes. The main outcome measures were retinal reattachment and visual recovery.

Results

Recurrent retinal detachment occurred in 16.3% of silicone oil-filled eyes and 60% of gas-filled eyes. After silicone oil removal, 15.6% of eyes had recurrent retinal detachment. After a mean follow-up of 13.4 months, 81.2% of eyes had attached retina and 69.4% recovered equal to or better than 10/200 visual acuity.

Conclusion

Retinal detachment secondary to coloboma of choroid is treated best by pars plana vitrectomy along with silicone oil tamponade. Gas tamponade has limited indications. Clinical evaluation of the extent of retinal detachment within the colobomatous area and the behavior of the retina on fluid-air exchange help the authors understand the pathogenesis of the retinal detachment and plan a rational therapy.

Section snippets

Materials and methods

This is a retrospective study of 85 eyes of 81 patients (58 males and 23 females) who presented to us between January 1987 and May 1996. All patients had retinal detachments related to coloboma of the fundus. The retinal detachments were attributed to the coloboma if there was extension of the detachment within the border of the coloboma. A break in the intercalary membrane often was identifiable preoperatively or intraoperatively. Four patients were operated on in both eyes for a similar

Results

Of the 85 eyes that were operated on, 5 had gas tamponade and 80 had silicone oil tamponade. Recurrent retinal detachments occurred in a total of 16 eyes: 3 of 5 eyes with gas tamponade and 13 of 80 eyes with silicone oil tamponade. The recurrence was caused by PVR in 13 eyes (15.3%), new retinal break outside the coloboma in 1 eye (1.2%), and leak from the break in the coloboma due to inadequate chorioretinal adhesion around the coloboma in 2 eyes (2.4%). Revision surgery involved membrane

Discussion

Retinal detachments caused by coloboma of the fundus are relatively rare. The treatment of these patients had been difficult with external scleral buckling techniques as evidenced by the reported poor results.3 This is because of the difficulty in identifying and closing the causative retinal breaks. To develop a rational approach for the treatment of these patients, one has to understand the pathogenesis clearly. Hermann Schubert,11 describing the histopathology of the colobomatous border in

References (11)

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Supported by Vision Research Foundation, Chennai, India.

1

The authors have no proprietary interest in any of the materials used in this study.

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