Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

Risk factors of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese patients

AIM： To comprehensively analyze the risk factors of rhegmatogenous retinal detachment （RRD） associated with choroidal detachment （CD）. METHODS： A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B -scan ultrasonography, and ultrasound biomicroscope （UBM）. Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD）. Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS： There were 52 eyes （19.62%） with CD. Pseudophakia was more commonly seen in RRDCD （21.15% ys6.10%, P=0.002）. Intraocular pressure （lOP） was lower （8.60 ±3.62 ys 12.96 ±3.55, P 〈0.001）, best - corrected visual acuity was worse [3.00 （2.00 to 3.00） vs 1.92 （1.22 to 3.00）, P=-0.001], and refractive error was more myopic [-4 （-9 to -2） vs -2 （-6 to 0）, P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment （P=0.007）. In RRDCD, 34.62% of eyes presented with multiple holes （P=0.044） and 25.00% with macular holes （P=0.012）, compared with 20.66% and 14.08% in R RD. High myopia （P=0.039）, low lOP （P=0.017）, and larger extent of retinal detachment （P〈0.001） were significant and independent risk factors for developing CD. - CONCLUSION： For CD in RRD, related factors include BCVA, lOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low lOP are significant and independent risk factors.

Primary Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

Purpose: To evaluate the role and the anatomic and visual results of primary pars plana vitrectomy(PPV) in treating cases with rhegmatogenous retinal detachment associated with choroidal detachment. Methods:All patients were divided into 2 groups. Each group included 23 consecutive eyes with rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C. In the study group, controlled removal of vitreous traction was achieved by primary vitrectomy and augmented by scleral buckling if needed. The breaks were treated by focused endolaser coagulation. Postoperative tamponade was done by SF6 or C3F8 gas. In the control group, all patients underwent regular scleral buckling procedure. The cases were followed up for 6 to 12 months. Results: In the study group, retinal reattachment could be achieved in 21 cases (91.30%) after the first operation and in all cases after the second procedure. No occurrence of choroidal detachment occurred after the first procedure. Retinal reattachment rate and visual results tended to be better compared with conventional surgical techniques in the control group. Conclusion: Primary vitrectomy represents a safe, effective method in the management of rhegmatogenous retinal detachment associated with choroidal detachment.

Changes in axial length after vitrectomy for rhegmatogenous retinal detachment combined with choroidal detachment

AIM:To report the postoperative axial length(AL)changes in rhegmatogenous retinal detachment combined with choroidal detachment(RRD-CD)patients.METHODS:The medical records of 97 consecutive patients from January 2015 to December 2018 were reviewed.Patients included were divided into RRD-CD and RRD only groups.All patients had received AL measurements before pars plana vitrectomy(PPV)and before silicone oil removal(SOR).The changes in AL of the two groups were compared.In addition,the potential factors related to AL changes were analyzed.RESULTS:AL elongation after PPV was 1.01 mm[interquartile range(IQR):0.37,1.79;P=0.02]in the RRD-CD group,which was greater than in RRD only group(0.15 mm,IQR:0.04,0.41;P<0.001).AL increased 0.06 mm per 1 mm Hg intraocular pressure changes in the RRD-CD group(R2=0.11,P=0.03).RRD-CD patient was 11.42 times(3.54-46.80)more likely to experience post-PPV AL elongation of more than 1 mm[P<0.001,Akaike information criterion(AIC)=92.33,area under the curve(AUC)=0.839].CONCLUSION:RRD-CD patients are very likely to have a postoperative elongation of AL.The primary intraoclular lens implantation using presurgery AL data may cause a significant refractive error in RRD-CD patients who underwent PPV.

The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis

AIM: To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment.METHODS: This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients' medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed.RESULTS: After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT in creased with fluid in Tenon's capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61 ±55.61 μm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT.CONCLUSION: PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

A modified method for suprachoroidal fluid drainage in kissing choroidal detachment

●AIM:To introduce a new method for suprachoroidal fluid drainage before 23-gauge pars plana vitrectomy.●METHODS:A 15o side-port blade was firstly used to create a sclerotomy into the suprachoroidal space for initial drainage.A 30-guage needle was then applied to inject balanced saline solution through the existing sclerotomy for further drainage.After most of the suprachoroidal fluid was drained,standard 3-port 23-guage pars plana vitrectomy was performed.●RESULTS:We have succeeded in using this technique to treat five patients with retinal detachment and kissing choroidal detachment(KCD).The choroidal detachment was visibly recessed in all cases after drainage with no intraoperative complications.After removal of silicon oil at 3 mo follow-up,all patients obtained a reattached retina.No postoperative complications such as hypotony and endophthalmitis occurred.●CONCLUSION:The new technique is efficient and safe for suprachoroidal fluid drainage for patients with rhegmatogenous retinal detachment.In future,further larger series are needed to attest to its safety and efficacy.

Spontaneous exudative retinal detachment in a patient with sturge-weber syndrome after taking arginine, a supplement for erectile dysfunction

Background:Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas.These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments.There is no definitive treatment for these types of retinal detachments,but radiotherapy,photodynamic therapy,oral propranolol,pegaptinib and bevacizumab have been used.Case presentation:A 26-year-old male with Sturge-Weber Syndrome developed an exudative retinal detachment that occurred immediately after taking a supplement containing arginine.The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 ml solution.Resolution of the retinal detachment was seen after 4 treatments over a six-month period.Conclusions:Arginine and other medications that cause a release of nitric oxide may lead to intravascular leakage and exudative retinal detachments in patients who have a choroidal hemangioma.

孔源性视网膜脱离玻璃体切割术后发生高眼压的相关分析

目的:探讨孔源性视网膜脱离(RRD)行玻璃体切割术(PPV)后发生高眼压的比例、特点及危险因素。方法:本研究系回顾性队列研究。纳入2021年1月—2023年6月因RRD于我院行PPV的患者523例,术后眼压≥25mmHg即定义为术后发生高眼压。采用t检验、χ^(2)检验、回归分析、Kaplan-Meier生存曲线分析相关危险因素及特点。结果:RRD行PPV术后1个月内发生高眼压的比例为56.6%,术后高眼压与低龄、玻璃体腔填充硅油、合并脉络膜脱离相关(P<0.05)。术后随访至3个月,Kaplan-Meier生存曲线图分析结果显示,玻璃体填充硅油与填充全氟丙烷相比有差异,单纯孔源性视网膜脱离与脉络膜脱离型视网膜脱离相比有统计学差异(P<0.05)。结论:RRD行PPV术后1个月内高眼压发生率为56.6%,低龄、玻璃体腔填充硅油、合并脉络膜脱离是术后高眼压的危险因素。填充硅油、合并脉络膜脱离者术后发生高眼压速率更快,这类患者术后应更加重视监测眼压。

视网膜下抽液联合玻璃体内注射康柏西普和气体治疗息肉样脉络膜血管病变并发浆液性视网膜色素上皮脱离的疗效和安全性

目的探讨视网膜下抽液联合玻璃体内注射康柏西普和气体治疗息肉样脉络膜血管病变(PCV)并发浆液性视网膜色素上皮脱离(sPED)的疗效和安全性。方法选取2019年7月至2021年2月于潍坊眼科医院行视网膜下抽液联合玻璃体内注射康柏西普和气体治疗的PCV并发sPED患者共13例(13眼),所有患眼术前接受过至少3次(每月1次)的玻璃体内抗血管内皮生长因子(VEGF)(雷珠单抗)注射治疗,且治疗无效。检测术前和术后1周、1个月、3个月、6个月患者的最佳矫正视力(BCVA)、中央视网膜厚度(CRT)、黄斑中心凹PED高度及宽度变化,记录术中及术后并发症发生情况。结果术后1周患眼BCVA较术前好转,差异有统计学意义(Z=-3.237,P=0.001);术后1周、1个月、3个月、6个月患眼CRT均较术前变薄,差异均有统计学意义(Z=-3.180、-3.180、-3.110、-3.180,P=0.001、0.001、0.002、0.001);术后1周、1个月、3个月、6个月患眼PED高度和宽度均较术前下降,差异均有统计学意义(均为P<0.05)。术前13眼平均接受过(4.15±1.40)次玻璃体内注药(雷珠单抗)治疗,治疗时间为(5.92±3.95)个月(相当于每6周注射1次)。术后随访6个月内13眼平均接受了(2.31±1.97)次玻璃体内重复注射(康柏西普)治疗(相当于每10周注射1次)。偏相关分析结果显示,术后6个月时患眼BCVA提高量与CRT的降低量呈弱正相关(r=0.416,P=0.203);术后6个月时患眼BCVA提高量与PED高度和宽度的变化量无明显相关性(r=0.218、0.209,P=0.520、0.538)。术后1个月时,9眼出现PED复发或不同程度的视网膜神经上皮下积液,后期配合玻璃体内重复注射康柏西普治疗,PED均改善。术后6个月时,3眼黄斑中心凹下PED完全消失,视网膜解剖完全复位,1眼黄斑区视网膜仍存在活动性渗出。13眼术后随访期间均未出现全身及严重眼部并发症。结论视网膜下抽液联合玻璃体内注射康柏西普和气体治疗PCV并发sPED能够安全有效地降低患者CRT和改善PED,减少PED长期存在对视网膜的损害,但对术后6个月时患者BCVA的提高无明显帮助。

后Tenon囊下注射曲安奈德联合玻璃体切割术在脉络膜脱离型视网膜脱离中的应用

背景曲安奈德具有抗光作用，脉络膜脱离型视网膜脱离（RD/CD）术前玻璃体腔内注射TA可减轻炎症反应，改善手术效果，但由于术前眼压低，玻璃体腔注射易引起并发症。关于后Tenon囊下注射TA在RD/CD中的有效性和安全性尚未见报道。目的探讨后Tenon囊下注射TA治疗RD/CD的疗效及安全性。方法采用回顾性研究方法，收集于2010年5月至2014年6月在温州医科大学附属眼视光医院首诊为RD/CD且接受手术的患者22例22眼的病历资料，患眼均于玻璃体切割术前5 d行后Tenon囊下注射TA混悬液40 mg（0.4 ml），注药后观察葡萄膜的炎性反应。使用Goldmann眼压计和B型超声仪观察注药前及注药后5 d患眼眼压、脉络膜脱离高度及脱离范围的变化，同时监测血压及血糖的变化，并于注药5 d后行玻璃体切割术，所有患者术后随访3个月以上。结果行TA的后Tenon囊下注射的22眼葡萄膜炎症状均不同程度减轻；注药前患眼平均眼压为（5.4±2.9）mmHg（1 mmHg＝0.133 kPa），注射TA后5 d患眼平均眼压为（8.2±4.3） mmHg，眼压上升2.8 mmHg，差异有统计学意义（t＝3.430，P〈0.01）。注药前患眼平均脉络膜脱离高度为5.2（3.1，6.6）mm，注药后5 d平均脉络膜脱离高度为0.9（0，3.8）mm，脉络膜脱离高度显著降低，差异有统计学意义（Z＝－4.198，P〈0.01）。注药前患眼平均脉络膜脱离范围为12（10，12）个点位，注药后5 d平均脉络膜脱离范围为3（0，6）个点位，脱离范围显著下降，差异有统计学意义（Z＝－4.124，P〈0.01）。患者注药前后血糖、血压变化的差异均无统计学意义（均P〉0.05）。术眼术前、术后1个月和3个月LogMAR视力分别为2.14±0.46、1.29±0.57和1.17±0.55，术后视力较术前明显好转，总体比较差异有统计学意义（F＝22.060，P〈0.001）。视网膜复位率为95.5%。7眼术后出现高眼压，其中5眼使用局部降眼压药物治疗后恢复，2眼药物取出后眼压恢复正常。结论RD/CD术前行TA后Tenon囊下注射能减轻术眼葡萄膜炎反应，升高眼压及降低脉络膜脱离，对血糖、血压影响小。

曲安奈德玻璃体内注射联合23G微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效分析

目的探讨曲安奈德玻璃体内注射联合23G微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效。方法 2012年1月至2013年1月在我院就诊的28例脉络膜脱离型视网膜脱离患者,经过术前短期糖皮质激素治疗后,行23G微创玻璃体切割术治疗,术中联合玻璃体内注射曲安奈德4 mg,术后随访6~12个月,观察术后视力恢复、视网膜复位和并发症发生情况。结果一次手术视网膜解剖复位率为89.3%,再次术后视网膜解剖复位率100.0%。术前Log MAR视力为1.98±0.50,术后Log MAR视力为1.17±0.40,差异有统计学意义（t=8.371,P〈0.05）。末次随访眼压（16.2±3.7）mm Hg（1k Pa=7.5 mm Hg）,与术前眼压（6.4±2.3）mm Hg相比,差异有统计学意义（t=17.613,P〈0.05）。术后有15例出现一过性高眼压,3例白内障加重,1例发生后发性白内障,5例术后少量结膜下出血。结论 23G微创玻璃体切割术联合术中曲安奈德玻璃体内注射治疗脉络膜脱离型视网膜脱离是安全有效的。

脉络膜脱离型视网膜脱离的临床研究

目的分析脉络膜脱离型视网膜脱离的临床特点。方法连续选择具有典型临床症状的脉络膜脱离型视网膜脱离患者61例61眼,与同期行玻璃体切割手术的非脉络膜脱离型孔源性视网膜脱离患者52例53眼进行对比研究,观察二者眼部体征及手术复位率等情况,并分析脉络膜脱离型视网膜脱离的好发因素。结果脉络膜脱离型视网膜脱离患者的眼前节反应重,眼压低(平均4mmHg),与一般孔源性视网膜脱离患者相比差异有统计学意义(P<0.01);采用玻璃体切割手术,前者的一次性手术复位率为65.51%,后者为88.68%,二者差异有统计学意义;脉络膜脱离型视网膜脱离组中年龄50岁以上及屈光度-6D以上的患者占总例数的50%以上,27.87%的患者合并有黄斑裂孔。结论脉络膜脱离伴视网膜脱离具有严重的葡萄膜炎和低眼压症状,老年人和高度近视者好发,多合并有黄斑裂孔,其手术复位率显著低于一般孔源性视网膜脱离者。

玻璃体切除术治疗合并脉络膜脱离的孔源性视网膜脱离18例

目的:探讨玻璃体切除术治疗孔源性视网膜脱离并发脉络膜脱离的方法和疗效。方法:18例18眼并发脉络膜脱离的孔源性视网膜脱离,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访2～6(平均3.3)mo。结果:在18眼中13眼(72%)术后视网膜复位,大部分视力均有不同程度的提高;5眼视网膜未复位,其中3眼经再手术后复位,2眼眼球萎缩,未再手术。手术并发症主要有术后葡萄膜炎、玻璃体积血、术后高眼压等。结论:及时的玻璃体手术治疗合并脉络膜脱离的孔源性视网膜脱离,大多数视网膜能够获得复位,部分恢复视功能。

玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离

目的:探讨玻璃体切除联术合巩膜外环扎治疗脉络膜脱离型视网膜脱离的临床疗效。方法:回顾性分析2014-01/2018-02在我院行玻璃体切除术联合巩膜外环扎治疗的脉络膜脱离型视网膜脱离患者19例19眼,术后3~12mo行玻璃体腔硅油取出术。观察患者术后视网膜复位率、眼压、视力恢复及并发症情况。结果:本组患者术后视网膜均复位,术后3mo患眼玻璃体腔硅油填充状态下眼压(16.09±3.58mmHg)、硅油取出术后6mo眼压(14.69±3.10mmHg)均高于术前(6.78±1.90mmHg)(均 P <0.05)。硅油取出术后6mo,15眼患者视力较术前提高。术后无低眼压及眼球萎缩等并发症发生。结论:玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离是相对安全有效的,视网膜复位率高,术后并发症少,再次手术率低。

伴脉络膜脱离的孔源性视网膜脱离的研究进展

伴脉络膜脱离孔源性视网膜脱离是一种特殊类型的孔源性视网膜脱离,具有原因不明和自发的特性。就其发生、表现和治疗存在很多的争议,在此结合文献讨论相关问题,希望增进对疾病的了解。

脉络膜脱离型视网膜脱离术前玻璃体腔注射曲安奈德的临床疗效

目的:探讨术前玻璃体腔注射曲安奈德对微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的临床疗效。方法:选择我院2015-01/2016-06临床确诊的脉络膜脱离型视网膜脱离患者23例23眼,入院后先行玻璃体腔内注射曲安奈德4~5d后行23G玻璃体切割和硅油填充术。观察手术前后视力、眼压情况,以及术后视网膜复位率和并发症情况。随诊6~9mo。结果:曲安奈德注射后前房反应均减轻,眼压升高,由入院眼压4.02±1.47mmH g升高到术前13.69±4.68mmH g,术后升高到17.72±5.88mmH g,入院时眼压与术前和术后比较,差异均有统计学意义(P<0.05)。患者术后末次随访视力较术前均有所改善,视力术后≥0.3者9眼(39%),术后≥0.05者18眼(78%)。术后1wk,1、3mo和末次随访矫正视力与术前比较,差异均有统计学意义(P<0.05)。视网膜复位情况:手术后2wk有23眼(100%)全视网膜在位,一次视网膜解剖复位率87%,二次视网膜解剖复位率100%。术后1mo时3眼出现下方视网膜局限性脱离,经二次手术巩膜外垫压后视网膜复位。无眼内出血、医源性视网膜裂孔、眼内感染、晶状体损伤等并发症。术后一过性高眼压7眼,均出现在术后12~14d,减少局部激素滴眼液使用和点用降眼压滴眼液后,眼压控制在正常范围。结论:术前玻璃体腔注射曲安奈德进行预手术处理,能够提高微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效,降低手术难度,提高视力,避免了全身使用激素的副作用。

伴脉络膜脱离的原发性孔源性视网膜脱离术前局部和全身应用皮质类固醇激素效果比较

目的比较伴脉络膜脱离的原发性孔源性视网膜脱离玻璃体手术前局部和全身应用皮质类固醇激素治疗的手术成功率和视功能改变。方法连续观察38例38眼原发性孔源性视网膜脱离伴脉络膜脱离并行玻璃体手术治疗患者。其中局部应用激素组(A组)11例,术前应用醋酸强的松龙眼液点眼每小时1次,用药(4.91±1.51)d;全身激素治疗组(B组)27例,术前地塞米松静脉滴注15mg,3d后剂量递减,术前用药(5.67±1.88)d。结果一次手术视网膜脱离复位率A组为54.5%,B组为63.0%;再次手术成功率A组为80.0%,B组为100%。A组70%患者术后视力提高,20%视力保持不变,B组68%患者术后视力提高,24%视力保持不变。初次手术后视网膜脱离复发的15例患者中,14例系因玻璃体视网膜增殖形成所致。结论伴脉络膜脱离的原发性孔源性视网膜脱离玻璃体手术前局部激素治疗组的手术成功率趋势上低于全身激素治疗组。两组的最终视功能改善结果无差异。术后视网膜脱离复发的主要原因系玻璃体视网膜增殖所致。

视网膜脱离成功复位1年以上患眼低视力与黄斑区脉络膜厚度的关系

目的使用深部增强成像频域光学相干断层扫描(enhanced depth imaging spectral domain optical coherence tomography,EDI SD-OCT)观察孔源性视网膜脱离成功复位1 a以上低视力患眼黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),分析其与低视力的关系。方法将南昌爱尔眼科医院2010年1月到2014年3月孔源性视网膜脱离成功复位术后1 a以上最佳矫正视力(best corrected visual acuity,BCVA)<0.3的患者72例(72眼)纳入研究。行双眼BCVA及EDI SD-OCT扫描SFCT检查。分析患眼与对侧健眼术后末次随访的BCVA与SFCT的相关性。结果患眼术后末次随访SD-OCT检查显示,72眼中,黄斑中心凹正常者3眼(4.2%);外层视网膜微结构异常者69眼(95.8%)。患眼术后末次随访BCVA,转换为5分记录视力为3.59±0.51,同期健眼为4.94±0.11;患眼术后末次随访SFCT为(164.47±62.95)μm,对侧健眼SFCT为(235.47±42.40)μm;患眼与对侧健眼术后末次随访BCVA、SFCT差异均有统计学意义(均为P<0.05)。患眼术后末次随访BCVA与SFCT有相关性(P<0.05)。患眼黄斑区外层视网膜微结构异常眼与正常眼的BCVA、SFCT差异均无统计学意义(均为P>0.05)。结论孔源性视网膜脱离成功复位术后1 a以上低视力眼的SFCT薄,且与BCVA存在相关性;其视力的恢复可能要晚于EDI SD-OCT下观察到的外层视网膜微结构的恢复。

改良穿刺放液在23G玻璃体切除治疗脉络膜脱离型视网膜脱离中的疗效

目的:观察巩膜全层切开、原位穿刺放液术在微创玻璃体切除术治疗脉络膜脱离型视网膜脱离中的安全性和临床疗效。方法:临床病例回顾性分析。纳入2015-04/2017-04江苏省人民医院眼科住院治疗的脉络膜脱离型视网膜脱离患者20例20眼,所有患者均接受改良巩膜穿刺放液联合23G微创玻璃体切割术治疗。观察术中穿刺放液的成功率,手术前后视力、眼压变化情况,以及手术后视网膜复位率等情况。结果:所有手术均一次顺利放出脉络膜上腔液体。患者术后视力较术前视力提高,差异有统计学意义(P<0.01)。术前眼压7.00±2.05mmHg,术后3mo时平均眼压为15.38±2.66mmHg,两者比较差异有统计学意义(P<0.01)。初次手术视网膜复位率为90%(18/20),最终视网膜复位率为95%(19/20)。结论:改良巩膜穿刺放液在微创玻璃体切割术治疗脉络膜脱离型孔源性视网膜脱离中可简化手术操作,降低手术难度,减少术中并发症的发生。

玻璃体切除联合Conbercept玻璃体腔注射治疗PCV并发玻璃体积血

目的:探讨息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)并发玻璃体积血的患者行玻璃体切除术联合康柏西普(Conbercept)玻璃体腔注射的临床疗效。方法:回顾性筛选2014-02/2015-07我院收治的11例11眼首诊为玻璃体积血的患者,其中男7例,女4例;年龄65~79(平均69.5±9.0)岁,术前视力:光感者1眼,手动者7眼,眼前/指数者3眼,11眼均给予玻璃体切除术及C3F8填充并联合超声乳化白内障摘除及人工晶状体(IOL)植入术。术前有3例患者行FFA及ICGA造影检查确诊为PCV,其余8例患者于玻璃体切除术后1mo时行FFA及ICGA造影检查确诊为PCV。于玻璃体切除术后1mo对11例患者明确诊断后,即行首次康柏西普玻璃体腔注射,注射剂量为0.5mg(0.05mL),连续3次,间隔1mo,此后根据随访情况,当病情加重或复发时追加一次注射治疗。所有患者于首次康柏西普玻璃体腔注射后随访12mo。本研究观察玻璃体切除术前、术后1mo,和首次康柏西普注射后1、2、3、4、5、6、9、12mo的眼底、B超、最佳矫正视力(best corrected visual acuity,BCVA)、光学相干断层扫描(optical coherence tomography,OCT)等情况,对此四项指标进行临床疗效观察。结果:随访至康柏西普注射后12mo时,眼底检查显示11眼患者视网膜深层及浅层出血完全吸收,其中5眼患者仍可见视网膜下橘红色病灶;B超显示11眼患者视网膜下积血完全吸收;11眼患者的BCVA均较术前明显提高,其中有3眼患者诉存在不同程度的视物变形等情况;OCT显示黄斑中心视网膜厚度明显下降,其中有6眼患者仍存在浆液性视网膜色素上皮脱离。结论:玻璃体切除术为PCV并发玻璃体积血患者的明确诊断及后续治疗创造了条件;玻璃体切除术后联合康柏西普玻璃体腔注射治疗,能快速促进视网膜出血及渗出的吸收,减轻视网膜的水肿,促使息肉状病灶的消退,有效地提高患者的预后视力。