The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.
ObjectiveTo invesitigate the relationship between the macular histomorphological changes and the prognosis of the visual acuity (VA) in eyes with rhegmatogenous retinal detachment (RRD).MethodsOptical coherence tomography (OCT) was performed on 39 patients (39 eyes) with rhegmatogenous retinal detachment. According to the macular neurepithelial configuration displayed by OCT, the patients were divided into 3 groups: neurepithelial edema group, neurepithelial detachment group, and neurepithelial cystoid degeneration group. The time of retinal detachment, pre- and post-operative VA, and macular neurepithelial thickness OCT images were observed and analyzed statistically.ResultsThere was no difference of pre-operative VA among the three groups (P＞0.05). Significant differences of post-operative VA, time of retinal detachment, and neurepithelial thickness were found (P＜0.05). The differences of time of retinal detachment and neurepithelial thickness between neurepithelial degeneration group and cystoid degeneration group were significant (P＜0.05) except the postoperative VA (P＞0.05).ConclusionsThe time of retinal detachment and post-operative VA in patients with retinal detachment relate to the neurepithelial thickness detected by OCT. When the duration of retinal detachment becomes longer, the macular neurepithelium becomes thicker, the histomorphological changes increase, and the post-operative VA decreases. (Chin J Ocul Fundus Dis, 2005,21:83-85)
Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma. Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study. All the patients were examined for corrected visual acuity (CVA), slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography (OCT) and intraocular pressure examination. The average axial length was (29.1plusmn;1.8) mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The average logMAR CVA was 1.93plusmn;0.37. All the patients were treated with PPV and triamcinolone acetonide or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was (6.2plusmn;1.6) months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34plusmn;0.48 after surgery, which significantly improved compared to that before surgery (t=39.38, P＜0.01). The CVA after surgery was independent of axial length (r=0.142, P＞0.05), choroid atrophy (t=0.23, -0.165,P＞0.05) and macular hole closure (t=0.12, -0.005, P＞0.05). The retina reattached in 79 eyes (92.9%) and recurrence of retinal detachment occurred in six eyes (7.1%). Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment, proliferative vitroretinopathy, axial length, choroid atrophy and ILMP (OR=1.428, 5.039, 0.815, 2.578, 0.432; P＞0.05). Of these 85 eyes, macular hole closed in ten eyes (11.8%), macular hole did not close in 75 eyes (88.2%). There were 24 eyes (28.2%) experienced high intraocular pressure during the first 2 weeks after surgery, all of them were under control with drugs. There were 12 eyes (14.1%) presented with high intraocular pressure before the silicone oil removal, all of them were under control only by silicone oil removal. Conclusion For the treatment of MHRD with posterior staphyloma, PPV combined with ERMP and (or) ILMP and silicone oil tamponade show a high retinal reattachment rate.
Objective To compare the outcome of C3F8 versus silicone oil intraocular tamponade after pars plana vitrectomy (PPV) for the treatment of severe highly myopic macular hole retinal detachment (MHRD). Methods Thirty-two highly myopic MHRD patients (32 eyes) with extreme long axial lengths (ge;29.0 mm), quot;severequot; retina pigment epithelium (RPE) and chorioretinal atrophy, and posterior staphyloma who underwent PPV, were enrolled in this study. The patients were divided into two groups according to different intraocular tamponade agents: C3F8 (group A, 15 eyes) and silicone oil (group B, 17 eyes). The patients with retinal re-detachment after surgery received PPV again. The differences of sex (P=1.000), age (t=0.444, P=0.660), best-corrected visual acuity (t=0.084, P=0.934), diopter (t=0.449, P=0.978), lens state (P=1.000), time of the symptoms (t=0.375, P=0.710) and degree of retinal detachment (chi;2=0.014, P=0.907) between group A and B were not statistically significant. The anatomic reattachment of the retina, macular hole closure, and vision acuity were observed at one week, one, three, six and 12 months after surgery. Results The rates of retinal reattachment and macular hole closure were 60.00% and 13.33 % in group A, 82.35% and 29.41% in group B in the first time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.243, 0.402). The rates of retinal reattachment and macular hole closure were 86.67% and 20.00% in group A, 94.12% and 29.41% in group B in the second time of surgery. There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.589, 0.691). Twelve months after surgery, the vision acuity improved in five eyes, unchanged in seven eyes , and decreased in three eyes in group A; the vision acuity improved in seven eyes , unchanged in eight eyes , and decreased in two eyes in group B. The differences of vision result was not statistically significant between two groups (chi;2=0.209, P=0.647). Conclusion The rates of retinal reattachment and macular hole closure with silicone oil tamponade was higher than that with C3F8 tamponade in eyes with severe highly myopic MHRD, but the differences are not statistically significant.
Purpose To explore the characteristics of eyes after congenital cataract surgery and to evaluate the methods of different retinal detachment surgery in those eyes． Method We retrospeetively reviewed the cli ncal data of 44 eyes with rhegmatogenous retinal detachment (RRD) after congenital cataract surgery,and compared the surgical results between scleral buckling and vitrectomy in those eyes．The mean interval between the congenital cataract surgery and RRD of the affectde eyes was 14．8 years and most of the techniques of cataract surgery was irrigation-aspiration and capsulotomy was performed in nearly all eyes． The mean axis length in 16 eyes was （26.8plusmn;1.90） mm． Results The success rate was 80．3% in scleral buckling and 85．7% in vitrectomy． Conclusion There is a long interval between congenital cataract surgery and RD．The pupil of these eyes is often small and immobile,causing diffculty in visualizing the peripheral retina ,decreasing the success rate of scleral buckling operation．Vitrectomy is an ideal chocie for such eyes． (Chin J Ocul Fundus Dis，2000，16：71-138)
ObjectiveTo evaluate the efficacy and impacts of air tamponadein treating rhegmatogenous retinal detachments (RRD) including inferior breaks after 25G pars plana vitrectomy (PPV).MethodsA prospective non-randomized study. From November 2016 to December 2018, 110 RRD patients receiving PPV in the Ophthalmology Department of Affiliated Hospital of Nantong University were included in the study. All the patients choose the operation mode voluntarily after fully understand the condition and operation mode. There were 90 eyes in the air filling group and 20 eyes in the silicone oil filling group. There was no difference of age (t=－0.082), sex ratio (χ2=1.538), left or right eye (χ2=0.839), average course of disease (Z=－0.276), intraocular pressure (t=3.669), axial length (t=0.765), grade of proliferative vitreous retinopathy (Z=－2.101), high myopia (χ2=0.013), lens state (χ2=1.275), logMAR BCVA (t=－0.681), the scope of retinal detachment (t=0.970), the site (χ2=0.108) and numbers (t=0.158) of the retinal holes, whether involving macula (χ2=1.791) between the two groups (P＞0.05). At 1, 3, and 6 months after surgery, the first retinal reduction rate, BCVA increase rate, visual recovery rate, intraocular pressure, fovea retinal thickness (CFT), ellipsoid and cross sectional area, and the occurrence of postoperative complications in the two groups were observed and compared. Independent sample t test and Chi-squared test, Mann-Whitney U test, and ANOVA were used for data comparision.ResultsAfter the first operation, retinal reattachmnents were achieved in 87 eyes (96.6%) in the air group and 19 eyes (95.0%) in the silicone oil group (χ2=0.130, P＞0.05). In the air group and the silicone oil group, there were 7 and 2 eyes with subretinal holes, whose retinal reattachmnents were achieved. At 6 months after surgery, logMAR BCVA of the eyes in the air group and the silicone oil group were 0.23±0.23 and 0.37±0.23, respectively. All of them were higher than that before operation (t=－2.410, P＜0.001). BCVA in the air group was superior to that in the silicone oil group (P＜0.05). The increase rate of BCVA of the eyes in the air group and the silicone oil group were 0.69±0.28 and 0.48±0.30 logMAR units, respectively (t=－3.225, P＜0.05). The CFT of the eyes in the air group and the silicone oil group were 226.87±42.30 μm and 234.83±36.10 μm, respectively (t=－0.448, P=0.657). In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively. In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively.ConclusionsAir filling combined with PPV can effectively treat RRD, which is suitable for both superior and inferior holes. The visual acuity recovered well and the complication is less. The time of retinal detachment (especially the time of macular detachment) is an important factor affecting the prognosis.
ObjectiveTo analyze the clinical efficacy of scleral buckling surgery for rhegmatogenous retinal detachment (RRD) of 376 patients.MethodsA retrospective analysis was performed about 376 patients (391 eyes) who underwent scleral buckling surgery in Chengdu Aidi Eye Hospital from January 2018 to December 2019. There were 214 males (224 eyes) and 162 females (167 eyes). There were 15 binocular cases and 361 monocular cases. The average age was 37.16±16.36 years. The average course of disease was 3 months. There were 1 to more than 10 retina holes for all patients. Retinal breaks occur in all quadrants and at ora serrata. The preoperative average BCVA was 0.27 and the postoperative average BCVA was 0.41. Retinal detachment ranges was observed in 268 eyes in 1 quadrant, 97 eyes in 2-3 quadrants, 26 eyes in total, and 231 eyes with macular involvement. There were 376 eyes treated with scleral buckling, 9 eyes treated with scleral buckling combined with scleral encircling, 6 eyes treated with scleral encircling. The average follow-up time was 5 months. Postoperative follow-up was conducted to observe retinal reduction, BCVA, complications and patient compliance.ResultsAfter the first operation, retinal reattachmnents were successfully achieved in 375 eyes (95.91%); 16 eyes (4.09%) failed in retinal reattachmnents. Eight eyes were treated with scleral buckling again, 5 eyes were treated with vitrectomy silicone oil filling, and 3 eyes were treated with air injection. After the second operation, retinal reattachmnents were ultimately achieved in 16 eyes (100.00%). The average BCVA after operation was 0.15. Postoperative intraocular pressure increased by 45 eyes (11.51%). The intraocular pressure increased from the next day to 3 days after operation. The intraocular pressure was completely controlled 1-3 days after the treatment of topical medication and 20% mannitol. Vitreous and subretinal hemorrhage in 1 eye caused by drainage of the subscleral liquid. There was?no cases withpostoperative?infection.ConclusionThe retinal reattachment rate is 95.91% in 376 patients with RRD treated by scleral buckling surgery, and the visual acuity has significantly improved.
Objective To investigate the causes of visual loss and failure of treatment after intraocular silicone oil removal. Methods Retrospective clinical analysis of the causes of loss of visual acuity of 15 eyes after silicone oil removal in patients with complicated retinal detachment which were successfully treated with vitreous and retinal microsurgery. Results Among the 15 eyes,retina failed to reattach in 11 eyes,secondary glaucoma occurred in 2 eyes and corneal opacity appeared in another two eyes.All of them were resulted in total loss of vision. Conclusion Retinal redetachment was the leading cause of final visual loss in the failing 15 cases(15 eyes) after intraocular silicone oil removal,and secondary glaucoma and corneal decompensation may also be the causes of visual loss. (Chin J Ocul Fundus Dis, 1999, 15: 230-231)
Objective To observe surgical outcomes and influencing factors of retinal detachment (RD) after phacoemulsification cataract extraction and intraocular lens (IOL) implantation. Methods The clinical data of 38 patients who underwent retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. All patients diagnosed via visual acuity, slit-lamp microscopy, direct or indirect ophthalmoscopy, A or Bscan ultrasonography and optical coherence tomography (OCT). There were 21 males (21 eyes) and 17 female (18 eyes). The age was from 42 to 83 years, with the mean of (57.4±11.2) years. There were nine patients (10 eyes) with simple macular hole RD (MHRD). Vitrectomy or scleral buckling or combined vitrectomy and scleral surgery were implemented according to RD range, the hole location and size, proliferative vitreoretinopathy (PVR) grading; simple MHRD eyes were treated posterior scleral reinforcement surgery. The followup was ranged from 3 to 12 months, with a mean of (11.9±6.8) months. Results The retina was reattached successfully through one operation in 36 eyes (92.3%), two eyes failed because of a relapse after surgery, and one eye finally succeeded by the third times of surgery. There were two eyes (5.1%) with improved vision, one eye (2.6%) with stable vision, and 36 eyes (92.3%) with decreased vision. Conclusion The ratio of the reattachment by one operation for RD after phacoemulsification cataract extraction and intraocular lens implantation is high, but the final visual prognosis remains poorly.
Objective To observe the therapeutic effect of poly tetrahydrofurfuryl co-lactic acid(copolymer C4) as the biodegradable vitreous substitutes on rhegmatogenous retinal detachment.Methods Vitreoretinal surgery with copolymer C4 tamponades was performed on 32 pigmented rabbits (64eyes) with rhegmatogenous retinal detachment. The rate of reattached retina and the post operative cornplications were observed.Results Three months after the operation, reattached retina was found in 96. 4%, glaucoma in 5.5%, cataract in 10.9%, and copolymer emulsion in 10.2% of all the eyes.Conclusion copolymer C4 may withstand the retinal tear effectively for 3 months, and can be a valuable vitreous substitutes. (Chin J Ocul Fundus Dis，2004，20：27-28)