Objective To observe the efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal choroidal vasculopathy (PCV). Methods Fourteen patients (14 eyes) of PCV with vitreous hemorrhage diagnosed by routine ophthalmologic examination, A and/or B mode ultrasound, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. The patients included eight males (eight eyes) and six females (six eyes), with the mean age of (58.7plusmn;6.0) years. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were eight eyes received photodynamic therapy (PDT) after surgery. The retinal reattachment, visual acuity, pathological lesion degree and complications were comparatively analyzed. Results Among 14 eyes, six eyes (42.9%) recovered, seven eyes (50.0%) improved, and one eye (7.1%) aggravated. Ten eyes achieved retinal reattachment after surgery, while four eyes developed retinal detachment after the first surgery. The retina remained attached in these three eyes after silicon oil tamponade, C3F8 gas tamponade and scleral buckling, respectively; but one eye maintained silicon oil without special treatment. Thirteen eyes (92.9%) achieved retinal reattachment finally. Five eyes of them occurred hyphema one to seven days after surgery, but hyphema was absorbed and intraocular pressure was stable after douche of anterior chamber and pharmacotherapy. The vision improved with more than two lines in one eyes, improved with one to two lines in one eye, unchanged in 10 eyes, and decreased in two eyes. Of eight eyes who underwent PDT, abnormal vessels regressed in five eyes, abnormal vessels remained in three eyes. Conclusions Vitrectomy can remove cloudy refracting media for PCV with vitreous hemorrhage. The combined treatment of vitrectomy and PDT can improve or stabilize visual function,is an effective therapy for the PCV with vitreous hemorrhage.
ObjectiveTo explore the effects of vitrectomy on neovascular glaucoma combined with vitreous hemorrhage.MethodsSeven eyes of 7 patients with neovascular glaucoma combined with vitreous hemorrhage underwent vitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy. The preoperative visual acuity ranged from light perception to 0.2, and the mean preoperative intraocular pressure was 54 mm Hg (38-64 mm Hg)(1 mm Hg=0.133 kPa). The mean follow-up was 8 months (6-15 months).ResultsThe postoperative visual acuity ranged from light perception to 0.4, and the mean postoperative intraocular pressure was 17 mm Hg (10-30 mm Hg) which was significantly lower than preoperative one (Plt;0.05). The postoperative complications mainly included fibrosis exudates in anterior chamber (7 eyes), intraocular pressure elevation 1-2 weeks after the operation (2 eyes), and postoperative suprachoroidcavity hemorrhage (2 eyes).ConclusionVitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy may be effective procedures for some cases of neovascular glaucoma combined with vitreous hemorrhage.(Chin J Ocul Fundus Dis, 2005,21:148-149)
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
ObjectiveTo conduct an objective record of stroke patient’s retinal diseases by retinal photography, and analyze the incidence of various retinal diseases between different subtypes of stroke.MethodsFrom June to October 2007, the consecutive cases of stroke admitted to the Department of Neurology, West China Hospital of Sichuan University were prospectively registered. Ischemic stroke patients were classified into different subtypes by the Oxfordshire Community Stroke Project criteria, and intracerebral hemorrhage (ICH) patients were classified based on the clinical manifestation and neuroimaging. We collected other clinical data associated with the incidence of stroke. The retinal abnormalities including retinopathy, arteriovenous nicking and arteriolar narrowing were recorded. Multivariate logistic regression was performed to investigate the relationship between retinal abnormalities and stroke.ResultsThis study included 199 patients with ischemic stroke and 95 patients with ICH. Among the patients with ischemic stroke, 43 (21.6%) had retinopathy, 52 (26.1%) presented with arteriovenous nicking, and 43 (21.6%) developed arteriolar narrowing. Among the patients with ICH, retinopathy occurred in 23 (24.2%), arteriovenous nicking occurred in 14 (14.7%), and arteriolar narrowing occurred in 25 (26.3%). In multivariate analysis, retinopathy was independently associated with partial anterior circulation infarct (PACI) (P=0.029) and anterior ICH (P=0.041).ConclusionsRetinopathy is independently associated with PACI and anterior ICH. Further community-based study with large sample should be conducted to confirm the predictive value of retinal diseases on the incidence of anterior stroke.
Objective To investigate the etiological and clinical characteristics of 1298 cases with spontaneous intracerebral hemorrhage. Methods A retrospective analysis was conducted to investigate the epidemiology and clinical characteristics of 1298 patients who suffered from spontaneous intracerebral hemorrhage and were hospitalized in Neurology Dept. of Anhui Provincial Hospital from 2005 to 2009. Results Among 1 298 patients, 822 (63.33%) were male while 476 (36.67%) were female. The constituent ratio of male and female patients was significantly different; the patients mainly suffered from spontaneous intracerebral hemorrhage in winter and spring which was commonly caused by hypertension accounting for 65.87% and was mostly happened on basal ganglia site (n=895, 68.95%). Conclusions The incidence of spontaneous cerebral hemorrhage is related with age, season and hypertension, it is very important to be prevented effectively and to well control the blood pressure.
ObjectiveTo develop a simple and effective subretinal injection pipeline system to enhance the accuracy and precision of subretinal injection volume control. MethodsA retrospective case series study. From May to October 2023, 18 patients (18 eyes) with submacular hemorrhage (SMH) who continuously received modified subretinal injection treatment in Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 10 males and 8 females. The mean age was (60.00±7.41) years. The primary causes included polypoid choroidal vasculopathy (14 cases), retinal macroaneurysm (2 cases), traumatic retinopathy (1 case), and Valsalva retinopathy (1 case). Hemorrhage affected 14 eyes of the fovea centralis. All affected eyes underwent standard three-channel 25G vitrectomy via the flat part of the ciliary body combined with modified subretinal injection of recombinant tissue plasminogen activator. The improved injection system consisted of a 1 ml syringe, a Q-SyteTM connector, a 41G subretinal microinjection needle, a converter and a viscoelastic substance control pipeline. The drug preparation time for subretinal injection (i.e., the time consumed by the system connection step), the injection time, whether bubbles occur during the injection process, and the perioperative complications were recorded and analyzed. ResultsThe preparation time prior to drug injection ranged from 230 to 335 seconds, while the injection completion time varied between 43 and 75 seconds. Both times decreased progressively as operator proficiency improved. Among the treated eyes, five received a target injection dose of 0.05 ml and thirteen received 0.10 ml, with all eyes achieving the preset dose accurately. No subretinal bubbles were observed during the injection procedure. Additionally, no intraoperative complications such as retinal hemorrhage or tear secondary to mechanical trauma at the injection site were recorded. Postoperatively, one eye developed anterior chamber hemorrhage, which resolved following intraocular pressure-lowering treatment. No other postoperative complications, including hemorrhage, rhegmatogenous retinal detachment, or infection, were observed in the remaining eyes. ConclusionThe retinal drug injection system developed in this study has a simple structure, safe and stable operation, can achieve precise drug injection, and effectively avoid the formation of bubbles.
ObjectiveTo assess the effectiveness and safety of continuous lumbar drainage of cerebrospinal fluid for subarachnoid hemorrhage (SAH). MethodsThe Cochrane Library (January 1992 to May 2013), Medline (January 1950 to May 2013), SinoMed (January 1979 to May 2013), CNKI (January 1979 to May 2013), and Wanfang Database (January 1979 to May 2013) were searched for randomized controlled trials (RCTs) on continuous lumbar drainage for SAH. The method of Cochrane systematic review was used to evaluate all the included RCTs. ResultsTwelve RCTs (857 patients) met the inclusion criteria, but the general methodological quality of trials was poor. Only two studies addressed the outcomes about SAH patients' death, vegetative state or disability and other adverse events at the end of the follow-up period (at least 3 months). Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance [RR=0.27, 95%CI (0.12, 0.59), P=0.001]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm: RR=0.20, 95%CI (0.14, 0.30), P<0.000 01; hydrocephalus: RR=0.24, 95%CI (0.13, 0.41), P<0.000 01; cerebral infarction: RR=0.27, 95%CI (0.16, 0.45), P<0.000 01]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid including intracranial infection and intracranial hypotension reaction, while the others did not report the adverse events. ConclusionWith poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidences.
The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
The main magnetic field, generated by the excitation coil of the magnetic induction phase shift technology detection system, is mostly dispersed field with small field strength, and the offset effect needs to be further improved, which makes the detection signal weak and the detection system difficult to achieve quantitative detection, thus the technology is rarely used in vivo experiments and clinical trials. In order to improve problems mentioned above, a new Helmholtz birdcage sensor was designed. Stimulation experiment was carried out to analyze the main magnetic field in aspects of intensity and magnetic distribution, then different bleeding volume and bleeding rates experiments were conducted to compared with traditional sensors. The results showed that magnetic field intensity in detection region was 2.5 times than that of traditional sensors, cancellation effect of the main magnetic field was achieved, the mean value of phase difference of 10 mL rabbit blood was (–3.34 ± 0.21)°, and exponential fitting adjusted R2 between phase difference and bleeding volumes and bleeding rates were both 0.99. The proposed Helmholtz birdcage sensor has a uniform magnetic field with a higher field strength, enable more accurate quantification of hemorrhage and monitored change of bleeding rates, providing significance in magnetic induced technology research for cerebral hemorrhage detection.