Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade:a multicenter,randomized,non-inferiority trial

AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This multicenter,prospective,randomized,double-masked,parallel-controlled,non-inferiority trial was conducted in three ophthalmology clinical centers in China.Patients with retinal detachment,who were eligible for PPV were consecutively enrolled.Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio.Best-corrected visual acuity(BCVA),intraocular pressure(IOP)measurement,and dilated fundus examination were performed preoperatively and at 1,7±1,28±3d postoperatively.The primary outcome was complete retinal reattachment rate at postoperative day one.The non-inferiority margin was set at 9.8%.The secondary outcomes included intraoperative retinal reattachment rate,and mean changes in IOP and BCVA from baseline to 1,7±1,28±3d postoperatively,respectively.Safety analyses were presented for all randomly assigned participates in this study.RESULTS:Totally 124 eligible patients completed the study between Mar.14,2016 and Jun.7,2017.Sixty of them were randomly assigned to the PFO for ophthalmic surgery group,and 64 were assigned to the F-Octane group.Baseline characteristics were comparable between the two groups.Both groups achieved 100%retinal reattachment at postoperative day one(difference 0,95%CI:-6.21%to 5.75%,P=1).The pre-defined noninferiority criterion was met.No significant difference was observed in intraoperative retinal reattachment rate(difference 1.77%,P=0.61),mean changes in IOP(difference 0.36,-0.09,2.22 mm Hg at 1,7±1,28±3d postoperatively,with all P>0.05)and BCVA(difference 0.04,-0.02,0.06 logMAR at 1,7±1,28±3d postoperatively,all P>0.05)between the two groups.No apparent adverse events related to the utilization of PFO were reported.CONCLUSION:In patients with retinal detachment undergoing PPV,PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade,and both are safe and well-tolerated.

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Background: Cataract surgery is the most frequently performed surgery worldwide. Posterior capsule rupture (PCR) remains one of the most common complications of cataract surgery and a major risk factor for poor visual outcomes. Cataract surgeries complicated by PCR and vitreous loss are managed with anterior vitrectomy at the time of surgery. However, the situation can be further complicated by dropping lens particles into the vitreous cavity necessitating a secondary pars plana vitrectomy (PPV). Purpose: To compare the visual outcomes and risk of rhegmatogenous retinal detachment (RRD) between eyes that required anterior vitrectomy (AV) alone for the management of vitreous loss and eyes that required AV and subsequent PPV for the management of dropped nuclear lens fragments (DNLF) following cataract surgery complicated by PCR in a tertiary care teaching hospital in Saudi Arabia. Methods: Medical records of patients in whom PCR occurred during phacoemulsification cataract surgery requiring AV or subsequent PPV for DNLF were retrospectively reviewed over a 6-year period from January 2016 to December 2021. Results: PCR occurred in 183 (2.3%) of 7757 consecutive eyes that underwent phacoemulsification cataract surgery during the study period. Seven eyes were excluded from analysis for missing data or short follow-up. Of the 176 eyes, 147 eyes (83.5%) were managed with AV alone, and the remaining 29 eyes (16.5%) underwent a secondary PPV for DNLF. After excluding eyes with pre-existing ocular pathology, final best-corrected visual acuity (BCVA) was similar in both groups with a mean of 0.32 logMAR (P = 0.99). Two of 147 eyes (1.4%) in the AV group developed RRD with poor final BCVA whereas none of the eyes in DNLF group developed RRD. Conclusion: The risk of RRD is lower in eyes that required PPV for DNLF than in eyes that were managed with AV alone following PCR during cataract surgery. The poor visual outcomes in eyes that suffered RRD underscore the importance of postoperative retinal examination and early detection of retinal breaks.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

Rhegmatogenous Retinal Detachment in One-Eyed Patients: Therapeutic and Prognostic Challenges

Background: Retinal detachment is a major ophthalmologic emergency. The rhegmatogenous form is the most common and its management is exclusively surgical as soon as possible. This urgency becomes major and absolute when it occurs in a particular monocular vision. Purpose: To analyze the clinical forms of rhegmatogenous retinal detachment (RRD), the results and the complications of their management in monophthalmic patients. Methodology: This was a retrospective and analytical study from June 2007 to December 2019. We included all patients who received a consultation for rhegmatogenous retinal detachment. All patients were seen by at least two posterior segment specialists and all were operated on by the same surgeon. Results: 57 files (57 eyes) were collected with an average age of 44.71 years and a sex ratio of 7.14. The average consultation time is 40.80 days. Patients complained of decreased visual acuity in 96.49% of cases. We had myopia in 49.12% of cases and 91.23% of patients were phakic. Retinal holes were found in 31.58% of our patients and giant tears in 17.54%. The mean retinal detachment extension was 2.52 quadrants and the macula was raised in 32 cases. The average time taken to take charge was 10 days. Detachment surgery was performed in 42 patients with 100% anatomical recovery. Conclusion: Retinal detachment in one-eyed patient is a major ophthalmic emergency. Its management must not suffer from any delay. Post-operative outcomes are relatively similar between the internal and external pathways. In one-eyed patient, silicone can be left alone in the absence of complications.

Risk Factors for Postoperative Retinal Detachment Following Cataract Surgery

Purpose: To determine the relation between patients’ age and degree of myopia on the risk of postoperative retinal detachment following cataract surgery. Setting: University-based cataract referral practice. Patients and methods: This is a retrospective study. The chart of all patients in the practice of 1 surgeon (K.M.M) who had cataract surgery by the Kelman phacoemulsification technique between 1991 and 2010, were reviewed to identify patients (those who had retinal detachment) was associated with 4-control who didn’t detach but had surgery around the same time. Result: Forty-three cases of retinal detachment were identified, the mean age at time of cataract surgery for the RD cases was 57.3 ± 14.7 years (range: 4 to 96 years) and for the control was 69.8 ± 12.9 years (range: 9 to 75 years), p Conclusion: The study shows that risk of retinal detachment and the degree of myopia is linear up to 12.00 diopters of myopia then starting to decline, and the risk of retinal detachment is the highest in age group between 50 to 59 years.

Advances in the treatment of rhegmatogenous retinal detachment

The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.

Anatomical and functional outcomes after Densiron 68 heavy silicone oil tamponade for complicated retinal detachment in Chinese eyes

AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.

Surgical treatment for 42 patients with traumatic annular ciliochoroidal detachment

AIM: To analyze the clinical features of traumatic annular ciliochoroidal detachment (CCD) with ultrasound biomicroscopy (UBM) images, to investigate the surgical outcomes of ciliary body suturing and the prognostic factors. METHODS: Forty-two patients with traumatic annular CCD who had undergone ciliary body suturing were enrolled for complete ocular examinations, including visual acuity (VA), slitlamp microscopy, tonometer, indirect ophthalscopy and UBM. Comparisons of clinical features were performed among baseline and follow-ups, and the morphologic alterations on UBM images were analyzed between pre- and post-surgery. RESULTS: The mean intraocular pressure (IOP) was 5.54mmHg, and the median VA was 0.1 in traumatic eyes at baseline. The pre-surgical morphological features on UBM images consisted of supraciliochoroidal effusion (33.33%), multilayer splits (40.48%) and CCD with cyclodialysis cleft (26.19%). After surgery, the median VA was 0.4 at the final follow-up. IOPs were significantly increased, which the mean final IOP was to 10.36mmHg(P< 0.01). UBM images displayed complete reattachment in 40.48% of patients, partial reattachment in 50.00% of patients and 360-degree detachment in 9.52% of patients. Analyzing the prognostic factors, the significant factors were duration, VA at baseline, ocular laterality (P<0.01), gender, age and the presence of hypotonous maculopathy (P<0.05). CONCLUSION: Ciliary body suturing is the optimized procedure for traumatic annular CCD. UBM is a useful equipment for diagnosis and monitoring post-surgical morphological changes. The periodical detection of TOP and UBM is necessary for the observation of surgical outcomes.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Clinical Evaluation of Traumatic Ciliochoroidal Detachment with Surgical Treatment

Purpose: To determine the clinical features of traumatic ciliochoroidal detachment(CCD), and to evaluate the surgical outcomes.Methods: We retrospectively reviewed the records of 37 consecutive patients with traumatic CCD who underwent surgical procedures,.including ciliary body suturing,.transscleral cyclophotocoagulation,.and cyclocryopexy..A complete ocular examination was performed at pre-surgery and at periodical post-surgery follow-ups. We compared visual acuity(VA),intraocular pressure.(IOP),.and morphologic changes with UBM among the different surgical procedures at the presurgery and periodical follow-ups.Results:.The mean IOP was 6.62 mmHg, and the median VA was 20 / 200 at baseline..The mean final IOP was 11.03mmHg,.and the final median VA improved to 20 / 50..IOPs were significantly different in post-surgery compared with those at baseline(P=0.000) among the ciliary body suturing,cyclophotocoagulation, and cyclocryopexy groups. However,no significant differences were noted at each follow-up among the 3 groups(P>0.05). The post-surgical morphological figures consisted of complete reattachment, partial reattachment,and the complete detachment. Cyclocryopexy(71.4%), suturing(68.4%), and cyclophotocoagulation(63.6%) produced similar surgical outcomes of the complete reattachment based on UBM images.Conclusion:Prompt treatment and periodic follow-ups are necessary after traumatic CCD, based on accurate dimensions and configuration by UBM. The appropriate choice of surgical procedures is pivotal for an optimal outcome.

改良巩膜扣带手术与玻璃体切割术在孔源性视网膜脱离治疗中的效果比较

目的比较改良巩膜扣带手术(RSB)与玻璃体切割术(PPV)在孔源性视网膜脱离治疗中的效果。方法回顾性分析,收集信阳职业技术学院附属医院在2020年6月至2022年6月收治的93例孔源性视网膜脱离患者的临床资料,根据手术方式将入选患者分为观察组(RSB治疗,47例)和对照组(PPV治疗,46例)。两组患者均完成6个月的随访,比较两组患者术后视网膜复位情况,术前、术后1周、术后3个月、术后6个月最佳矫正视力(BCVA)以及术后并发症发生情况。结果观察组初次手术视网膜复位成功率低于对照组,但差异无统计学意义(χ^(2)=0.156,P=0.693)。两组术前、术后6个月BCVA比较,差异无统计学意义(P>0.05);两组术后1周、术后3个月、术后6个月BCVA均较术前逐渐降低,且观察组术后1周、术后3个月BCVA比对照组低,组间、时点、组间时点交互作用有统计学意义(P<0.05)。观察组并发症总发生率较对照组低,差异有统计学意义(P<0.05)。结论RSB与PPV均可有效复位孔源性视网膜脱离患者的视网膜,促进患者视力改善。但与PPV相比,孔源性视网膜脱离患者RSB术后早期视力恢复较快,术后并发症发生率较低。

脉络膜脱离1例

61岁男性,因“左眼前黑影遮挡伴视力下降近2周”就诊。患者4年前、2年前和1年前分别行左眼小梁切除术,右眼穿透性角膜移植术和右眼白内障超声乳化+人工晶状体(IOL)植入术。半年前因左眼颗粒状角膜营养不良,于我院行左眼深板层角膜移植术,手术顺利,术后规律复诊。左眼角膜移植术后3个月和4个月,分别行左眼部分角膜缝线拆除,左眼白内障超声乳化+人工晶体植入术。左眼角膜移植术后半年,再次行左眼角膜缝线拆除。此次拆线术后2周至门诊复诊,主诉“左眼前黑影遮挡伴视力下降近2周”,查体如下。裸眼视力:左眼CF/10 cm;眼压:左眼5 mmHg。左眼角膜植片透明,位置良好,前房清,瞳孔圆,光反射存在,IOL明。眼底:左眼脉络膜广泛脱离,未查见裂孔及出血。B超查及脉络膜脱离回声。经扩瞳、局部及全身抗炎治疗5天后,脉络膜脱离仍未见明显好转,遂决定行左眼玻璃体切除+脉络膜脱离复位术。术中可放出大量微黄色脉络膜上腔液体,复位脉络膜,未见视网膜裂孔,术毕气体填充,术后患者脉络膜复位良好,视力逐渐提高。追问病史,患者第2次角膜拆线过程中,痛感非常明显,术中高度紧张,存在用力屏气过程。讨论体会:患者角膜拆线时的Valsava动作很有可能是该例脉络膜脱离发生的原因,要详细了解病情,做好术前沟通、加强人文关怀,术中充分麻醉,密切关注患者术中情况,做好患教工作,术后尽早随访,以便及时发现特殊并发症。

心理干预对复杂性视网膜脱离修复手术患者术中配合程度的影响分析

目的探究复杂性视网膜脱离修复手术患者使用心理干预的作用。方法选取2022年1月至2023年5月宁德师范学院附属宁德市医院收治的复杂性视网膜脱离修复手术患者60例,以随机数字表法作为分组依据,均30例。对照组行常规护理,试验组行心理干预联合常规护理。对比两组负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、血压及心率、生活质量水平[36项简明健康状况调查问卷(SF-36)]、术中配合程度。结果干预后,试验组心理状态、生活质量均优于对照组,心率及血压低于对照组(均P<0.05)。试验组术中配合程度96.67%高于对照组73.33%(P<0.05)。结论予以复杂性视网膜脱离修复手术患者心理干预,有助于减少患者负性情绪,降低血压及心率,提高术中配合程度、生活质量水平。

多元护理联合个体化健康宣教在陈旧性视网膜脱离手术患者中的应用效果

目的探讨多元护理联合个体化健康宣教在陈旧性视网膜脱离手术患者中的应用效果。方法选取2021年5月至2022年6月河南省周口市眼科医院收治的92例陈旧性视网膜脱离手术患者,以随机数字表法分成干预组(n=46,多元护理联合个体化健康宣教)与对照组(n=46,常规护理),比较两组疾病知晓情况、生活质量、负性情绪及并发症。结果干预后两组视网膜脱离术后知识调查问卷评分高于干预前,且干预组高于对照组;干预后两组贝克焦虑量表(BAI)、贝克抑郁量表第2版(BDI-Ⅱ)评分低于干预前,且干预组低于对照组;干预后两组生活质量综合评定问卷(GQOL-74)评分高于干预前,且干预组评分高于对照组;干预组并发症发生率(4.35%)低于对照组(19.57%),差异有统计学意义(P<0.05)。结论多元护理联合个体化健康宣教干预应用于陈旧性视网膜脱离手术患者中,能够提高患者对疾病的知晓率,改善负性情绪,提高生活质量,减少并发症发生。

断指再植术治疗手指末节完全离断伤的临床效果及美学效果

目的探讨分析断指再植术治疗手指末节完全离断伤的临床效果及美学效果。方法选取郑州市骨科医院手外科和显微骨科在2022年1月至2024年1月收治的手指末节完全离断伤患者98例,均接受断指再植术治疗,观察其疗效及美学效果。结果患者术后断指成活率为94.90%;断指功能恢复优良率为84.69%;并发症发生率为5.10%。术后患者再植指甲长度为(14.29±2.61)mm,两点辨别觉为(7.41±0.16)mm,远端指间活动度为(61.83±3.94)°。术后3个月患者生活质量测定表评分均较术前明显提高(P<0.05)。患者对断指再植术后美观度非常满意67例,一般满意25例,不满意6例,满意度为93.88%。结论断指再植术治疗手指末节完全离断伤效果确切,能有效改善患者手指功能,提高其生活质量,且患者的美观满意度高。

家族性渗出性玻璃体视网膜病变相关视网膜脱离的手术治疗及进展

家族性渗出性玻璃体视网膜病变(FEVR)是一种遗传性视网膜血管疾病,最典型的临床特征是周边无血管区,病情进展可导致视网膜脱离,晚期可继发白内障、青光眼、角膜混浊甚至眼球萎缩,是亚洲儿童、青少年视网膜脱离的主要原因之一。FEVR相关视网膜脱离主要通过手术治疗,包括玻璃体切除术、巩膜扣带术,有时联合视网膜光凝术、抗血管内皮生长因子(VEGF)治疗等。手术方式选择有赖于详细的术前、术中评估,包括患眼分型、分期、纤维增殖情况和眼前段并发症等,不同分期患眼解剖及视功能预后大不相同。孔源性视网膜脱离成年患者的手术复位率较为理想,而牵拉性视网膜脱离儿童患者手术复位率相对较低。低龄、晚期患者手术难度大、预后不良,手术治疗策略存在争议。本文就FEVR相关视网膜脱离的手术治疗效果与进展进行综述。

智能移动健康宣教系统在视网膜脱离日间手术病人围术期的应用

目的:探索智能移动健康宣教系统在视网膜脱离日间手术病人围术期中的应用效果。方法:选取2020年7月—2021年12月因视网膜脱离于首都医科大学附属北京同仁医院眼科日间手术中心接受玻璃体切割联合硅油填充术的160例病人,按入院时间分为对照组和观察组各80例。对照组按照眼科日间病房医护一体化优质护理的要求,对病人进行术前评估、术前健康宣教、手术、出院指导及电话随访,观察组在对照组的基础上应用智能移动健康宣教系统为病人提供全程延续护理。比较两组术后并发症、健康知识知晓程度、焦虑情绪及护理满意度。结果:观察组术后3个月角膜水肿、高眼压、白内障和视网膜复脱并发症发生率低于对照组;对手术相关知识、术前健康知识及术后健康知识知晓情况优于对照组;术后3个月焦虑自评量表评分低于对照组;满意度高于对照组,差异均有统计学意义(P<0.05)。结论:智能移动健康宣教系统能够减少视网膜脱离日间手术病人术后并发症,提高疾病相关知识掌握程度,减轻病人焦虑情绪,提高病人满意度。

最小量外路手术与玻璃体切割术治疗孔源性视网膜脱离的对比研究

目的:对比最小量外路手术与玻璃体切割伴硅油填充术在治疗孔源性视网膜脱离(Rhegmatogenous retinal detachment,RRD)中的疗效。方法:选择2011年1月至2016年12月于赣南医学院第一附属医院眼科就诊的518例RRD(黄斑裂孔除外)患者为研究对象。其中,258例行最小量外路手术(外路组);260例行玻璃体切割伴硅油填充术(玻璃体切割组)。术后随访6个月,比较两组视网膜复位率、最佳矫正视力以及并发症情况。结果:首次手术视网膜复位成功率在外路组及玻璃体切割组分别为96.90%和93.46%,差异无统计学意义(P>0.05)。外路组术后1、3、6月视力提高4行患者比率分别为37.60%、43.41%、48.84%,提高2~4行的患者比率分别为:41.08%、44.57%、46.51%,提高不足2行患者的比率分别为:21.32%、12.02%、4.65%;玻璃体切割组术后1、3、6月视力提高4行的患者比率分别为15.77%、19.23%、21.54%,提高2~4行的患者比率分别为:31.54%、36.15%、37.31%,提高不足2行或视力下降的患者比率分别为:52.69%、44.62%、41.15%,1、3、6个月外路组手术患者视力改善幅度均较玻璃体切割组大,差异有统计学意义(P<0.05)。外路组和玻璃体切割组术后高眼压的发生率分别为1.94%、26.15%,白内障发生率分别为0%、89.23%,外路组白内障和高眼压发生率均小于玻璃体切割组,差异有统计学意义(P<0.05)。结论:虽然最小量外路手术与玻璃体切割术伴硅油填充术治疗孔源性视网膜脱离的首次手术视网膜复位成功率无明显差异,但最小量外路手术患者术后视力收益较好,并发症更少。

Persistent subretinal fluid after successful scleral buckle surgery for macula-off retinal detachment

Background After successful scleral buckle and cryotherapy for macular-off retinal detachment （RD）, some patients have poor visual acuity without any clinically detected macular change, and the unsatisfactory postoperative visual acuity is difficult to explain. The purpose of this study was to determine the characteristics of subretinal fluid （SRF） after successful scleral buckle surgery for macula-off RD. Methods Twenty-eight eyes from 28 patients were included in this study. The patients underwent scleral buckle surgery combined with cryopexy for macular-off RD. After surgery, all eyes underwent thorough ophthalmologic examinations including slit-lamp biomicroscopy, best-corrected visual acuity （BCVA） test, and binocular indirect ophthalmoscopy. The BCVA prior to the operation, duration of RD, the duration of postoperative retinal reattachment, BCVA when SRF was observed, period required for the SRF to become undetectable, and the BCVA at the final follow-up were included in the clinical data for this study. Optical coherence tomography （OCT） and B-ultrasonography were used to confirm SRF, and fluorescein angiography （FFA） was carried out in several patients. BCVA when SRF was observed and BCVA at the final follow-up were evaluated using a paired t test. Correlations between BCVA before the operation and duration of RD and BCVA at the final follow-up were analyzed using the Pearson correlation test. The type of SRF under OCT and BCVA at the final follow-up were compared using one-way analysis of variance （ANOVA）. Results Postoperative retinal reattachment was achieved in 1.0-7.0 days （average, （2.7±.2.1） days）. After retinal reattachment, SRF was detected in all eyes by OCT 2 weeks postoperative, while B ultrasonography found no changes. The mean IogMAR BCVA was 0.35±0.27 at the time of the detection of SRF. The period for SRF to become undetectable ranged from 2.0 to 11.0 months （average, （6.3±2.3） months）. The time of follow-up ranged from 24.0 to 36.0 months （average, （28.9±3.4） months）. The mean IogMAR BCVA improved to 0.30±0.23 at the final follow-up, which was significantly different from the mean IogMAR BCVA at the time of SRF detection （paired t-test, t=3.82, P 〈0.05）. Postoperative OCT images were classified into three categories. FFA was carried out in 10 eyes and revealed no leakage or strain in the lesions. BCVA before the operation was significantly correlated with BCVA at the final follow-up （r=0.56, P 〈0.05）. No significant correlation was observed between BCVA at the final follow-up and duration of RD （r=0.23, P=0.22）. One-way analysis of variance （ANOVA） showed no significant difference between the type of SRF under OCT and BCVA at the final follow-up （F=0.21, P=0.81）. Conclusions The presence of persistent SRF after successful scleral buckle surgery for macular-off rhegmatogenous RD may influence the BCVA or anatomic attachment. SRF was detected in all eyes by OCT at 2 weeks after the operation Residual detachment persisted for almost a year after surgery in certain patients. Fluorescein angiography revealed no leakage or strain in the lesions.