0219323 抑郁、视力、伴发病和残疾与年龄相关的黄斑退行性变有关/Brody B L//JAm Acad Ophthalmol.-2001,108(10).-1893～1900 北大图0219324 未手术黄斑裂孔的长期随访/Casuso A L//J Am Acad Ophthalmol.-2001,108(6).-1150～1155
Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng P...Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.展开更多
患者男,72岁。因颜面部及四肢水肿5个月,双眼视物模糊3 d到河南省立眼科医院就诊。既往糖尿病史12年,胰岛素治疗,随机血糖12.8 mmol/L;糖尿病肾病半年;高血压史5年,血压控制差,波动在170~180/100~110 mm Hg(1 mm Hg=0.133 kPa)之间;低...患者男,72岁。因颜面部及四肢水肿5个月,双眼视物模糊3 d到河南省立眼科医院就诊。既往糖尿病史12年,胰岛素治疗,随机血糖12.8 mmol/L;糖尿病肾病半年;高血压史5年,血压控制差,波动在170~180/100~110 mm Hg(1 mm Hg=0.133 kPa)之间;低蛋白血症半年。肝功能检测,总蛋白38.9 mmol/L,白蛋白19.0 mmol/L。尿常规检测,尿蛋白(+++),尿糖(++)。24 h尿蛋白定量检测,尿蛋白4.54 g/L,24 h尿蛋白7.72 g/24 h。眼部检查:右眼视力眼前数指,左眼视力0.1。右眼、左眼眼压分别为18.0、16.2 mm Hg。展开更多
Background: Unexplained sudden visual loss after removal of silicone oil from the eye has recently been described. We report the occurrence and features of unexplained central scotoma developing with silicone oil in s...Background: Unexplained sudden visual loss after removal of silicone oil from the eye has recently been described. We report the occurrence and features of unexplained central scotoma developing with silicone oil in situ in the vitreous cavity. Methods: A retrospective case series of five patients (from two centres)-who reported a central scotoma commencing during silicone oil tamponade was studied. All patients had vitrectomy for macula-on retinal detachment, with ultra-purified silicone oil tamponade (four out of five had giant retinal tear). Investigations included visual acuity, intraocular pressure, optical coherence tomography, fluorescein angiography, visual fields and electrophysiology. Results: All patients reported a central scotoma that appeared during oil tamponade. Visual acuity fell by a mean of 0.93 LogMAR units after onset of the scotoma. After cataract extraction and oil removal, vision remained reduced by a mean of 0.8 units. The mean duration of oil in the eye was 2.7months when the scotoma was noted by the patient. Investigations were performed after removal of oil. Fluorescein angiography (FFA) was performed in two cases and optical coherence tomography (OCT) in five patients. No abnormality was demonstrated. Electrophysiology was performed in five patients with pattern electroretinography suggestive of macular dysfunction in four patients. Conclusion: This is the first case series describing central scotoma as sociated with silicone oil in situ. Electrophysiology indicated macular dysfunction in most cases. We suggest that early removal of oil in cases with good visual potential should be considered to avoid this sightthreatening complication.展开更多
文摘0219323 抑郁、视力、伴发病和残疾与年龄相关的黄斑退行性变有关/Brody B L//JAm Acad Ophthalmol.-2001,108(10).-1893～1900 北大图0219324 未手术黄斑裂孔的长期随访/Casuso A L//J Am Acad Ophthalmol.-2001,108(6).-1150～1155
文摘Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.
文摘Background: Unexplained sudden visual loss after removal of silicone oil from the eye has recently been described. We report the occurrence and features of unexplained central scotoma developing with silicone oil in situ in the vitreous cavity. Methods: A retrospective case series of five patients (from two centres)-who reported a central scotoma commencing during silicone oil tamponade was studied. All patients had vitrectomy for macula-on retinal detachment, with ultra-purified silicone oil tamponade (four out of five had giant retinal tear). Investigations included visual acuity, intraocular pressure, optical coherence tomography, fluorescein angiography, visual fields and electrophysiology. Results: All patients reported a central scotoma that appeared during oil tamponade. Visual acuity fell by a mean of 0.93 LogMAR units after onset of the scotoma. After cataract extraction and oil removal, vision remained reduced by a mean of 0.8 units. The mean duration of oil in the eye was 2.7months when the scotoma was noted by the patient. Investigations were performed after removal of oil. Fluorescein angiography (FFA) was performed in two cases and optical coherence tomography (OCT) in five patients. No abnormality was demonstrated. Electrophysiology was performed in five patients with pattern electroretinography suggestive of macular dysfunction in four patients. Conclusion: This is the first case series describing central scotoma as sociated with silicone oil in situ. Electrophysiology indicated macular dysfunction in most cases. We suggest that early removal of oil in cases with good visual potential should be considered to avoid this sightthreatening complication.
