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
BACKGROUND AND OBJECTIVE: To evaluate the management of a series of eyes with magnetic intravitreal foreign bodies. PATIENTS AND METHODS: This retrospective r eview examined consecutive cases of ocular injury associat...BACKGROUND AND OBJECTIVE: To evaluate the management of a series of eyes with magnetic intravitreal foreign bodies. PATIENTS AND METHODS: This retrospective r eview examined consecutive cases of ocular injury associated with intraocular fo reign bodies; 71 eyes included had a single metallic intraocular foreign body (< 5 mm) located in the vitreous cavity removed by external magnet or intraocular forceps. Variables included preoperative and postoperative visual acuity, retina l break formation, retinal detachment, presence of an afferent pupillary defect, intraocular pressure, entrance site, foreign body size, method of extraction, a nd time between occurrence and surgical extraction. RESULTS: Factors predictive of good visual outcome (visual acuity >20/200) were: shortest interval between t rauma and foreign body extraction, preoperative visual acuity of 20/200 or bette r, and absence of afferent pupillary defect. CONCLUSIONS: In this nonrandomized study, good visual results could be obtained in eyes undergoing prompt foreign b ody removal, especially those with good preoperative visual acuity and no affere nt pupillary defect.展开更多
BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METH...BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P=.02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.展开更多
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 AND OBJECTIVE: To evaluate the management of a series of eyes with magnetic intravitreal foreign bodies. PATIENTS AND METHODS: This retrospective r eview examined consecutive cases of ocular injury associated with intraocular fo reign bodies; 71 eyes included had a single metallic intraocular foreign body (< 5 mm) located in the vitreous cavity removed by external magnet or intraocular forceps. Variables included preoperative and postoperative visual acuity, retina l break formation, retinal detachment, presence of an afferent pupillary defect, intraocular pressure, entrance site, foreign body size, method of extraction, a nd time between occurrence and surgical extraction. RESULTS: Factors predictive of good visual outcome (visual acuity >20/200) were: shortest interval between t rauma and foreign body extraction, preoperative visual acuity of 20/200 or bette r, and absence of afferent pupillary defect. CONCLUSIONS: In this nonrandomized study, good visual results could be obtained in eyes undergoing prompt foreign b ody removal, especially those with good preoperative visual acuity and no affere nt pupillary defect.
文摘BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P=.02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.
