Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented...Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented with inferior break r etinal detachments was carried out. An inferior break was defined as a horseshoe tear present between 4 and 8 o’clock. Patients were analysed in two groups; gr oup A consisted of 41 patients who underwent a vitrectomy and gas, group B consi sted of 45 patients who underwent a vitrectomy, gas, and scleral buckle. The fea tures of the retinal detachment, peroperative and postoperative complications, a nd outcomes of treatment were recorded for each patient. Results: The primary an atomical success rate at 3 months was 89%in group A versus 73%in group B (P= 0 .11). There was no statistical difference in the complication rate between the t wo groups (P=0.819). The most common cause of treatment failure was proliferativ e vitreoretinopathy, 20%(n=9) in group B compared with 5%(n=2) in group A and this reached statistical significance (P=0.0159). There was a higher rate o f epiretinal membrane development in group B (P=0.000 4). The final attachment r ate was not statistically different between the two groups, 95%(39) in group A and 93%(42) in group B (P=1.0). Conclusion: Vitrectomy and gas without the appl ication of a scleral buckle may be used to safely treat inferior break retinal d etachments. It may be used as an alternative to vitrectomy, gas, and buckle whic h has an increased risk of choroidal haemorrhage, requires a longer operating ti me, and has all the associated complications of a scleral buckle.展开更多
To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospect...To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospective, randomized, placebocontrolled clinical trial. Three tertiary- referral teaching hospital vitreoretinal surgical units. One hundred fifty- seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5- fluorouracil (200 μ g/ml) and LMWH (5 IU/ml) in Hartmann’ s solution for 1 hour. The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56% , treatment group; 51% , placebo group; P=0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P=0.068). A perioperative infusion of combined 5- fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.展开更多
文摘Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented with inferior break r etinal detachments was carried out. An inferior break was defined as a horseshoe tear present between 4 and 8 o’clock. Patients were analysed in two groups; gr oup A consisted of 41 patients who underwent a vitrectomy and gas, group B consi sted of 45 patients who underwent a vitrectomy, gas, and scleral buckle. The fea tures of the retinal detachment, peroperative and postoperative complications, a nd outcomes of treatment were recorded for each patient. Results: The primary an atomical success rate at 3 months was 89%in group A versus 73%in group B (P= 0 .11). There was no statistical difference in the complication rate between the t wo groups (P=0.819). The most common cause of treatment failure was proliferativ e vitreoretinopathy, 20%(n=9) in group B compared with 5%(n=2) in group A and this reached statistical significance (P=0.0159). There was a higher rate o f epiretinal membrane development in group B (P=0.000 4). The final attachment r ate was not statistically different between the two groups, 95%(39) in group A and 93%(42) in group B (P=1.0). Conclusion: Vitrectomy and gas without the appl ication of a scleral buckle may be used to safely treat inferior break retinal d etachments. It may be used as an alternative to vitrectomy, gas, and buckle whic h has an increased risk of choroidal haemorrhage, requires a longer operating ti me, and has all the associated complications of a scleral buckle.
文摘To determine the efficacy of a combination of 5- fluorouracil and low- molecular- weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). Double- masked, prospective, randomized, placebocontrolled clinical trial. Three tertiary- referral teaching hospital vitreoretinal surgical units. One hundred fifty- seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5- fluorouracil (200 μ g/ml) and LMWH (5 IU/ml) in Hartmann’ s solution for 1 hour. The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56% , treatment group; 51% , placebo group; P=0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P=0.068). A perioperative infusion of combined 5- fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.
