ObjectiveTo investigate the therapeutic effects of scleral buckling operations on treating longstanding retinal detachment with subretinal proliferation.MethodsThe clinical data of 36 patients (40 eyes) with long-standing retinal detachment with subretinal proliferation who had undergone scleral buckling operation were retrospectively analyzed, and the clinical features, therapeutic methods and curative effects were summarized.ResultsThe diagnosis of long-standing retinal detachment mainly based on the examination of ocular fundus. The features of the affected eyes were: flat retinal detachment, thin and transparent retina, and formation of subretinal cords. In 40 eyes undergone scleral encircling and buclking, 36 (90%) had one-off successful operation, and the visual acuities over 0.05 were found in 77.5% of the whole eyes.ConclusionsScleral encircling and buckling procedures can be used to treat long-standing retinal detachment with subretinal proliferation with fairish cured rate. (Chin J Ocul Fundus Dis, 2005,21:150-152)
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 clinical therapeutic effect of v itrectomy with closed triple incisions on stage 4 or 5 retinopathy of prematurity (ROP). Methods The clinical data of 32 eyes of 26 infants with stage 4 or 5 ROP who un derwent vitrectomy with closed triple incisions from Jan. 2003 to Jan. 2007 were retrospectively analyzed. The 26 infants included 18 males and 8 females, with the gestational age of 27－35 weeks (average 29.4 weeks) and the birth weight of 960－2200 g (average 1434.6 g). The age at the operation was 50-705 days with t he average of 158.3 days. In these 32 eyes, stage 5 ROP was in 13, stage 4 ROP was in 19 (stage 4A in 10 and 4B in 9) in which 11 eyes underwent indirectophthal m oscope photocoagulation because of threshold and type 1 prethreshold ROP and 1 eye underwent cryotherapy again with the disease developing into stage 4 or 5. T he entrance of vitrectomy was closed triple incisions. The lens were saved in 11 eyes and removed in 21 eyes. The followup duration was 2-24 months and the c ondition of retinal reattachment was observed. Results The procedures of operative therapies on 26 affected infants ran smooth. In the 19 eyes at stage 4 ROP, the retina reattached completely in 10 at stage 4A (100%), in which macular traction at optic disc was in 3, remained proliferative membran e in front of the optic disc, in front of the nasal retina and at the peripheral area of the temporal side was found in 4, few vitreous hemorrhage after the ope ration was in 1 which was absorbed 2 weeks later, and cataract after the operati on was in 1; in 9 eyes at stage 4B, retina reattached completely in 6 (66.7%), m acular traction at optic disc was in 1, and retina remained detached in 3 with v itreous hemorrhage after the operation including 2 eyes with anterior chamber he morrhage. In 13 eyes at stage 5, retinal reattached completely in 3 (23.1%) in w hich scars in the peripheral retina, thin retinal vessels and pale optic disc wa s found in 2 and retinal rumple at the temporal side was found in 1; retina reat tached mostly in 1 eye (7.7%) with retinal proliferative membrane and slight re t inal detachment at the nasal side; retina remained detached in 7 eyes. Conclusion Vitrectomy with closed triple incisions for stage 4 ROP may lead the retina l reattachment effectively, but the therapeutic effect is not good on the infant s with stage 5 ROP.
Objective To observe the therapeutic effect of scleral buckling procedure on old retinal detachment. Methods The clinical data of 42 patients (46 eyes), including 24 males (27 eyes) and 18 females (19 eyes), with old retinal detachment treated by scleral buckling procedure in our department were retrospectively reviewed. The duration of the disease ranged from 1 month to 2 years. All the patients were with rhegmatogenous retinal detachment and combined with mainly predominantly-subretinal proliferative vitreoretinopathy (PVR) (stage C), including stage C1 of PVR in 16 eyes (34.8%), stage C2 in 19 eyes (41.3%), and stage C3 in 11 eyes (23.9%). Scleral buckling was performed on 13 eyes (28.3%) and cerclage combined buckling on 33 eyes (71.7%). Sterile air was injected into 36 eyes (78.3%) during the operation, and C 3F 8 was introvitreal injected into 7 eyes (15.2%) after the operation. Results The follow-up duration was from 6 months to 1 year (mean 7.3 months). Retina was completely reattached in 31 eyes (67.4%), and was alleviated obviously in 12 eyes (26.1%). The subretinal fluid increased after the operation with un-reattached retina and vitrectomy was performed in 2 eyes. One eye underwent vitrectomy due to the development of PVR. After the first operation, the curative ratio of retinal detachment was 67.4%, and effective ratio (cure and alleviation) was 93.5%. The visual acuity improved in 28 eyes (60.9%), kept no change in 11 eyes (23.9%), and decreased in 7 eyes (15.2%). Conclusion Reattachment of retina and improvement of visual acuity can be achieved in some degree in some patients with old retinal detachment who undergo simple scleral buckling procedure without vitrectomy. (Chin J Ocul Fundus Dis, 2006, 22: 35-38)
ObjectiveTo observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment (RRD) complicated with macular hole (MH).MethodsA retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females (13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ2=0.324) between the two groups were not statistically significant (P＞0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure.ResultsAt the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ. In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ. There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ2=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038).ConclusionVitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.
Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P＜0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective.