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 investigate the technique of drain-air, cryotherapy, and explant (DACE) of operation for superior bullous retinal detachment (SBRD).Methods In the DACE procedure, drainage and air or balanced salt soultion (BSS) injection were carried out first, with the intention of flattening the retina before localization of retinal hole, cryotherapy out of choroid and scleral buckling.Results In 42 SBRD eyes, 40 underwent the operation with DACE technique. In 23 eyes injected with BSS instead of air, 5 should be injected air due to no avail for flattening deeply retinal detachment, and 1 needed scleral buckling due to new retinal tear after DACE procedure two weeks. During the follow-up, all retinae attached. Conclusions The DACE technique is very useful and effective in upper ballooned retinal detachment due to single hole or breaks localized in small area between the 10 and 2 o′clock meridiant. BSS instead of air injection can eliminate the difficulty of observation of retinal breaks from the presence of air in some cases. (Chin J Ocul Fundus Dis，2003，19：11-13)
Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)
Objective To observe the effect of amniotic homogenate on closing holes in experimental rhegmatogenous retinal detachment and investigate its mechanism. Methods Forty rabbits were randomly divided into group A, B, C and D with 10 rabbits in each group. Group A and C were the treatment groups, and group B and D were the control groups. All eyes of rabbits underwent pars plana vitrectomy, retinectomy, and fluidair exchange. The surface of the breaks was treated with 01 ml amniotic homogenate in experimental groups and 0.1 ml PBS in control groups. At the end of operation, 20% SF6 was tamponaded and the retina reattaced. The animals were executed 14 (group A and B) and 28 days (group C and D) after the surgery. The tissue sections were observed by light microscope, electron microscope and immunocytochemistry method. Results Fourteen days after the surgery, the retina reattached in 6 eyes in group A (60%) and 2 eyes in group B (20%) （P=0.021）. Twenty-eight days after the surgery, the retina reattached in 8 eyes in group C (80%) and 3 eyes in group D (30%) (P=0.046). The difference of the rate of retinal reattachment among the 4 groups were statistical significant (Plt;0.05). Light postoperative inflammation of ocular anterior segment was observed, which was controlled 3-5 days after treated with topical steroids. The result of light microscopy showed that the eyes in treatment groups had multilayer of fibroblastlike cells around the retinal breaks, adhering to the choroid and retinal pigment epithelial cells. The proliferative cells around the retinal breaks obvious less in control groups than that in the treatment groups, and the retina could not adhere to the choroid. The results of electron microscopy were the same as that of light microscopy. Immunohistochemistry staining of the fibroblastlike cells revealed positve glial fibrillary acidic protein, which suggested that the proliferative cells around the retinal breaks were retinal glial cells. Conclusions Amniotic homogenate helps to seal retinal breaks and promote retinal reattachment by stimulating the proliferation of retinal glial cells around the breaks.
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)
Purpose To evaluate the safety and efficacy of draining subretinal fluid with transchoroidal probing by using the traditional needling and diode endolaser probing. Methods The investigation included 70 consecutive patients(74 eyes) with rhegmatogenous retinal detachment undergoing scleral buckling surgery.Seventy cases were randomly divided into 2 groups,group A 34 cases(36 eyes)with the needle drainage procedure and group B 36 cases(38 eyes) with the diode probe respectively.The safety and efficacy were compared in between the 2 groups. Results No operative failure was found in these 2 groups.In group A,subretinal hemorrhage occurred in 3 eyes,and retinal incarceration,retinal preforation in one eye. No significant complication occurred in group B. Conclusion Diode laser drainage has the advantage in that it may reduce the incidence of operative complication with drainage.This technique might be used in any case requiring drainage of subretinal fluid especially of rhegmat ogenous retinal detachment in cases of shallow retinal detachment. (Chin J Ocul Fundus Dis,1998,14:202-203)
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
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.
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.
ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.