ObjectiveTo create a new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment (RRD), and to evaluate its safety and effectiveness. MethodsA scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination was performed in 6 eyes of 6 patients with RRD, including 2 males and 4 females. The mean age was 51 years old with a range from 23 to 66 years old. Proliferative vitreoretinopathy (PVR) were diagnosed of grade B in all 6 eyes. Duration of retinal detachments until surgery was 5.8 days with a range from 2 to 13 days. The mean preoperative intraocular pressure (IOP) was 12 mmHg with a range from 9 to 15 mmHg (1 mmHg=0.133 kPa). A 23-gauge optic fiber was used to provide an intraocular illumination. Fully examination of the ocular fundus and cryoretinopexy of retinal breaks was performed under a noncontact wide-angle viewing system. Subretinal fluid drainage through the sclerotomy and buckling procedure were performed under the operating microscope. Intravitreal injection of sterile air bubble was performed in 4 eyes. Antibiotic eye drops was applied in all eyes postoperatively, and all the eyes were followed up for at least 6 months. ResultsRetinal reattachment was achieved in all eyes, and the conjunctiva healed well. The best corrected visual acuity (BCVA) increased in all eyes. The mean postoperative IOP was 15 mmHg with a range from 12 to 19 mmHg. No complications were found intra and postoperatively. ConclusionsThis new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for RRD is safe and effective. Advantages such as higher successful rate, less complication, shorter operating time, and less discomfort of patients were showed comparing with the previous scleral buckling surgery using indirect ophthalmoscope.
Objective To summarize the experiences of surgical treatment of sinus venosus atrial septal defect （SVASD）. Methods There were 32 patients of SVASD, all of them were associated with totally or partially right anomalous pulmonary venous connection. There were 25 cases of superior SVASD, 22 cases underwent double-patch procedure, 3 cases underwent Warden procedure. In 7 cases of inferier SVASD, 3 cases of Scimitar syndrome underwent ASD repair by pericardial patch and at the same time the anomalous pulmonary vein was divided and reimplanted to the posterior wall of left atrium, 4 cases of them underwent single-patch ASD repair. Results The surgical results were satisfying and no patient died, 28 patients were in sinus rhythm and echocardiography showed neither obstruction of caval vein and right pulmonary vein nor residual interatrial shunt. Conclusion SVASD mostly associated with right anomalous pulmonary venous connection according to its special anatomic structure. Preserving the function of sinus node and avoiding of obstruction of caval vein should be routinely considered when superior SVASD was repaired. The heart function of Scimitar syndrome should be followed-up for a long time for it usually associated with right lung hypoplasia.
ObjectiveTo evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling. MethodsA total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana three-port vitrectomy (23G PPV). The macular ERM alone was removed in 20 eyes (non-ILM peeling group). Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group). All patients underwent removal of ERM with assistance of triamcinolone acetonide. For patients who underwent ILM peeling, indocyanine green dye was used to stain the ILM. ILM was peeled off up to the marginal of macular vessels arch. The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively. There were no significant differences in gender, age, OD/OS, preoperative best-corrected visual acuity (BCVA), preoperative central macular thickness (CMT), preoperative total macular volume (TMV) and follow-up time between the two groups (P > 0.05). Intraoperative or postoperative complication was recorded during the follow-up period. At the final visit, the differences in BCVA, CMT and TMV between the two groups were analyzed, so did the correlations between BCVA and CMT or TMV in each group at the same time. ResultsThere was no recurrence of an ERM or severe complications, such as retinal detachment and endophthalmitis in either group. The mean BCVA of ILM peeling group and non-ILM peeling group was 0.53±0.27 and 0.54±0.26 respectively at the final visit. Postoperative BCVA improved significantly in both groups with significant difference (t=5.035, 4.964; P < 0.05). The was no difference of postoperative BCVA between two groups (t=0.176, P > 0.05). The mean CMT was (343.55±48.74) μm and (311.70±42.48) μm, and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3. CMT (t=9.508, 8.549) and TMV (t=11.098、15.372) revealed a significant decrease in both groups with significant difference (P < 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203, P < 0.05). No difference was found between the two groups in terms of TMV (t=0.755, P > 0.05). Furthermore, no correlation was observed between postoperative BCVA and CMT (r=0.244, 0.266; P > 0.05) or TMV (r=-0.096, 0.157; P > 0.05). Conclusions23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM. ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling, combined with much thicker postoperative CMT.
ObjectiveTo compare the safety and efficacy of a modified 23G with suturing incision and traditional 23G vitrectomy for silicone oil removal. MethodsA total of 177 patients (180 eyes) who underwent silicon oil removal (the average tamponade period was 4.5 months) were enrolled in this prospective study. The patients included 112 males (113) and 65 female (67). The mean age was (43.8±10.3) years. The corrected vision, indirect ophthalmoscopy, intraocular pressure, B-ultrasound and optical coherence tomography were measured for all patients. All patients had no complete retinal detachment. The patients were randomly divided into modified 23G with suturing incision group (group A, 88 eyes) and traditional 23G vitrectomy (group B, 92 eyes). The differences of sex (χ2=1.596), age, corrected vision (t=0.785), intraocular pressure (t=0.352), primary disease (χ2=1.982) and lens condition (χ2=2.605) were not significant (P>0.05). The operation time, intraocular pressure, silicon oil retention, choroidal detachment, retinal redetachment and endoophthalmitis were recorded at the end of the operation. ResultsThe difference of mean operation time was not significant between group A and B (t=1.950,P>0.05). The differences of mean visual acuity 1 day, 1 week and 3 months after operation were not significant between group A and B (t=0.873, 1.115, 0.141; P>0.05). There was difference of mean intraocular pressure at 1 day after operation (t=2.550,P<0.05), but not at 1 week and 3 months after operation (t=1.451,1.062; P>0.05) between group A and B. There were 25 eyes (28.4%) with intraocular hypotension, 8 eyes (9.1%) with choroidal detachment, 5 eyes (5.7%) with vitreous hemorrhage, 9 eyes (10.2%) with retinal redetachment, and 7 eyes (8.0%) with silicon oil retention in group A. There were 5 eyes (5.4%) with intraocular hypotension, 2 eyes (2.2%) with choroidal detachment, 2 eyes (2.2%) with vitreous hemorrhage, 8 eyes (8.7%) with retinal redetachment, and 1 eye (1.1%) with silicon oil retention in group B. The differences of incidence of intraocular hypotension, choroidal detachment and silicon oil retention were significant (P<0.05). No endoophthalmitis occurred. ConclusionThe safety of modified 23G with suturing incision is better than traditional 23G vitrectomy for silicone oil removal, with decreased incidence of intraocular hypotension, choroidal detachment and silicon oil retention.
ObjectiveTo summarize the clinical research progress of surgical procedures for cubital tunnel syndrome. MethodsThe related literature on surgical procedures for cubital tunnel syndrome was summarized and analyzed. ResultsMultiple surgical procedures have been applied to treat cubital tunnel syndrome, including simple decompression, subcutaneous transposition, submuscular transposition, medial epicondylectomy, intramuscular transposition, and ulnar groove plasty. Each procedure has its own advantages and disadvantages. With the development of minimally invasive surgical technique, endoscope-assisted surgery has been gradually applied to treat cubital tunnel syndrome. ConclusionOptimal surgical procedure remains controversial and individualized treatment decision based on patient's clinical conditions is recommended.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
Vitrectomy is the preferred surgical method for diabetic retinopathy, especially in the stage of proliferative diabetic retinopathy. Vitrectomy for diabetic retinopathy involves all aspects of vitrectomy, which is one of the signs of maturity of retinal surgeons. With the application of minimally invasive vitrectomy and perioperative anti-neovascularization drugs, indications and timing of surgery, perioperative medication, management of vitreous, and whether combined with cataract surgery have changed greatly, and new understanding is needed. Evidence-based clinical research on the timing of diabetic retinopathy surgery and perioperative drug use should be carried out to provide a new theoretical basis for the surgical treatment of diabetic retinopathy.
Objective To observe the related complications of 23G pars plana vitrectomy (PPV). Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study. There were 98 patients (65.3%) with macular diseases, 46 patients (30.7%) with proliferative diabetic retinopathy, four patients (2.7%) with vitreous hemorrhage, one patient (0.7%) with rhegmatogenous retinal detachment, and lens nucleus falling off in cataract surgery in one patient (0.7%). Among 98 patients with macular diseases, 21 patients (21.4%) underwent topical anesthesia, 77 patients (78.6%) underwent retrobulbar anesthesia. DORC "twostep method" was performed in three patients, and Alcon 23G PPV "onestep method" was performed in 147 patients. The operation times ranged from 20 to 100 minutes, with a mean of (51.1±18.9) minutes. The follow-up ranged from three to 12 months. The intraoperative and postoperative complications were observed. Results Intraoperative complications was found in seven patients (4.7%), which included iatrogenic retinal breaks in one patient (0.7%), macular damage in one patient (0.7%), suprachoroidal perfusion in one patient (0.7%), puncture leakage and closure incision in two patients (1.3%), vitreous hemorrhage in one patient (0.7%) and stopper broken off in cannula in one patient (0.7%). Postoperative complications was found in 34 patients (22.7%), which including retinal detachment in one patient (0.7%), vitreous hemorrhage in three patients (2.0%), cataract in three patient (2.0%), intraocular pressure ＜10 mm Hg（1 mm Hg=0.133 kPa） in 20 patient (13.3%), and transient ocular hypertension in seven patients (4.7%). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.
Abstract: Objective To summarize onestage repair of coarctation of the aorta(CoA) with intracardiac malformation in infants. Methods From January 2001 to January 2006, 28 patients with CoA and associated intracardiac malformation underwent onestage repair. There were 18 patients with preductal and another 10 patients with juxtaductal CoA. Six patients were accompanied by diffuse hypoplasia of aortic arch and 22 patients were associated with patent ductus arteriosus (PDA). Associated cardiac malformation included ventricular septal defect in 16 patients, ventricular septal defect and atrial septal defect in 5 patients, atrioventricular canal defect in 3 patients, transposition of great artery and ventricular septal defect in 2 patients and double outlet right ventricle in 2 patients. Left posterolateral thoracotomy combined with median sternotomy were used in 12 patients and single median sternotomy was used in 16 patients. End to end anastomosis of aorta with removal of the coarctated segment were performed in 20 patients, Gore-Tex patch graft aortoplasty were performed in 4 patients and aortoplasty with left subclavain flap were performed in 4 patients. Results There was no death.The lasting time of intubation was 7h to 13d, and intensive care unit (ICU) staying time was 3 to 18d. Four patients received delayed sternal closure in 48 to 72h after surgery because of cardiac dilatation. Three patients received peritoneal dialysis for acute renal failure following cardiac surgery. Three patients received inhalation of nitric oxide for treatment of postoperative pulmonary hypertension. The systolic pressure difference between lower limb and upper limb measured after operation was 10 to 20mmHg in 18 patients.There were no obvious systolic pressure difference between arm and leg in 8 patients.The systolic pressure of upper limb was higher than that of lower limb in 2 patients, and the pressure difference was 15mmHg and 20mmHg. All patients were followed up from 3 to 50 months. They were all survival except one died of severe tricuspid regurgitation, pulmonary infection and respiratory failure 3 months after surgery which diagnosis was transposition of great artery and ventricular septal defect. The results of other 27 patients were satisfactory. Recoarctation occurred in 1 patient with end to end anastomosis and 1 patient with Gore-Texpatch graft aortoplasty. The pressure difference through the measurement of echocardiography was 25mmHg and 28mmHg. No reoperation were undergone. Conclusion CoA with intracardiac malformation can be repaired by single median sternotomy or left posterolateral thoracotomy combined with median sternotomy in onestage. This operative approach is beneficial, not only with shorten period of therapy and less operative cost, but also advantageous for the recovery of cardiac and pulmonary function.
Objective To evaluate the effect of 27G pars plana vitrectomy (PPV) and 25G PPV on idiopathic epiretinal membrane (IMEM). Methods Thirty-eight eyes of 38 patients with IMEM were enrolled into this retrospective and comparative study. Eighteen eyes were treated with 27G PPV (group A), 20 eyes underwent 25G PPV (group B) voluntarily. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp microscope, indirect ophthalmoscopy, fundus color photograph, ocular coherence tomography (OCT) and counting of corneal endothelial cells (CEC) were examined before the surgery. BCVA results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. There was no statistically significant difference between two groups in terms of BCVA, IOP, foveal macular thickness (FMT), the counting of CEC and CEC hexagon rate before the surgery (t=1.627, 0.860, 0.293, 1.238, 0.697;P＞0.05). All operations were performed by the same doctor. Operation time for vitrectomy and peeling membrane was recorded. BCVA, IOP, OCT, FMT, counting of CEC and the improvement of metamorphopsia were observed on 1, 7 days and 1, 3 months after PPV. Results The mean operation time for vitrectomy in group A and B were (6.7±2.8), (10.5±3.3) min, respectively. The mean operation time for vitrectomy in group A was significantly longer than that in group B (t=3.084,P＜0.05). The mean operation time for peeling membrane in group A and B were (10.2±5.2), (11.0±5.9) min, respectively. There was no statistically significant difference between two groups in terms of the time for peeling membrane (t=1.970,P=0.187). On 1, 7 days and 1, 3 months after PPV, the difference of BCVA (t=1.463, 0.683, 0.961, 1.226;P=0.833, 0.509, 0.699, 0.744) and IOP (t=1.314, 1.262, 0.699, 1.116;P=0.763, 0.721, 0.534, 0.712) between two groups were not statistically significant. On 1 day after PPV, there were 2 eyes and 5 eyes with ＜9 mmHg (1 mmHg=0.133 kPa) IOP in group A and B. On 7 days and 1, 3 months after PPV, the difference of FMT between two groups were not statistically significant (t=1.257, 1.368, 1.437;P=0.735, 0.745, 0.869). On 3 months after PPV, the difference of CEC between two groups were statistically significant (t=2.276,P＜0.05); the difference of hexagon rate between two groups were not statistically significant (t=1.473,P=0.889). Conclusion The efficacy of 27G PPV for IMEM appears similar to 25G PPV. But 27G PPV has a shorter operating time for vitrectomy, a more stable IOP and a minimal damage to CEC.