Aim: This study aimed to assess and compare the functional and anatomical results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral buckling (SB), and lens-sparing versus phaco-procedures for treat...Aim: This study aimed to assess and compare the functional and anatomical results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral buckling (SB), and lens-sparing versus phaco-procedures for treating rhegmatogenous retinal detachment. Methods: A comprehensive literature search was performed using the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases to retrieve comparative studies. The main objective was to assess the BCVA, while reattachment rates and ocular adverse events were considered secondary measures. Rev Manager software was used for statistical analysis. Results: The literature search identified 10 articles comprising 1518 eyes, with 682 eyes in the PPV group, 193 eyes in the lens-sparing versus phaco-procedure group, and 643 eyes in the combined PPV and SB surgery group. Quality assessment revealed a low risk of bias in most domains. The meta-analysis results revealed a significant difference in postoperative BCVA between the PPV and PPV combined with SB groups (WMD = −0.17, 95% CI [0.27, 0.07], p = 0.001). The primary reattachment rates were 82.80% for PPV alone and 87.52% for PPV combined with SB (p = 0.34). The final reattachment rates did not differ significantly between PPV and PPV combined with SB (99% vs. 99.8%;RR = 1.00, 95% CI [1.01, 0.99], p = 0.96). PPV alone demonstrated a significantly reduced risk of macular edema compared to PPV combined with scleral buckling (9.9% vs. 23%;p = 0.006). The incidences of macular hole development (p = 0.46), recurrent retinal detachment (p = 0.27), proliferative vitreoretinopathy development (p = 0.48), epiretinal membrane proliferation (p = 0.77), and limited choroidal hemorrhage (p = 0.69) were not significantly different between the two groups. Conclusions: These findings suggest that PPV alone may be a more effective treatment option in terms of visual acuity (VA) improvement, lower risk of macular edema and cataract development. However, there was no significant difference in VA improvement or complication rates between the lens-sparing and phaco-procedure groups. .展开更多
Aims: To compare the results of pars plana vitrectomy (PPV) and combined scleral buckling—PPV (SB/PPV) in phakic rhegmatogenous retinal detachments with inferior breaks. Methods: Randomized, prospective, clinical con...Aims: To compare the results of pars plana vitrectomy (PPV) and combined scleral buckling—PPV (SB/PPV) in phakic rhegmatogenous retinal detachments with inferior breaks. Methods: Randomized, prospective, clinical controlled trial of forty consecutive phakic eyes with primary rhegmatogenous retinal detachment, associated with inferior breaks and not complicated by proliferative vitreoretinopathy ≥grade C, to either PPV (group 1) or combined SB/PPV (group 2). Results: At 6 months follow up the primary reattachment rate was 100% (20/20 cases) in group 2 and 70% (14/20 cases) in the group 1, the difference being statistically significant (p = 0.027). The best corrected visual acuity improved significantly from a preoperative mean of 1.65 ± 1.13 (Range: 0.6 to 3) to a mean of 0.45 ± 0.11 (Range: 0.3 to 0.6) in the group 2 and in the group 1 improved from a preoperative mean of 2.34 ± 0.92 (Range: 0.48 to 3) to a mean of 0.668 ± 0.20 (Range: 0.48 to 1), the difference between the two groups being statistically significant (p = 0.001). Conclusion: Anatomical and functional success rates are significantly better with the use of a scleral explant during PPV for uncomplicated forms of phakic rhegmatogenous retinal detachments with inferior breaks.展开更多
AIM:To demonstrate local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for the treatment of partial rhegmatogenous retinal detachment(RRD)with local vitreous traction in patients a...AIM:To demonstrate local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for the treatment of partial rhegmatogenous retinal detachment(RRD)with local vitreous traction in patients at high-risk for proliferative vitreoretinopathy(PVR).METHODS:Eleven eyes of 11 patients were retrospectively studied,including 5 retinal dialysis and 6 retinal detachment(RD;5 eyes with peripheral retinal hole and I eye with giant tear).All patients exhibited partial RD and local vitreous traction.Combined local dry vitrectomy without conventional infusion and segmental scleral buckling was performed.Viscoelastic fluid was injected into the vitreous cavity if needed Demographic information,preoperative and postoperative complications,and outcomes were recorded.RESULTS:The mean age of the patients at presentation was 26.55±13.52y.All 11 patients obtained retinal reattachment after a single surgical intervention.Postoperative visual acuities were improved or remained stable in all patients.None of them developed complications,except for temporary mildly increased intraocular pressure in 3 cases.CONCLUSION:Combined local dry vitrectomy and segmental scleral buckling are effective for patients of RRD with local vitreous traction.The technique avoids many complications associated with regular surgery and was minimally invasive to both the external and internal eye.展开更多
AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.MET...AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.展开更多
●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation...●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.展开更多
Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical dep...Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department.Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded.Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges(42.9%) formed the largest part,followed by pars plana vitrectomies(35.0%) and encircling bands(22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds(65%).of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%.Conclusion: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.展开更多
AIM:To compare the effects of scleral buckling using wide-angle viewing systems(WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment.METHODS:The study was a retrospe...AIM:To compare the effects of scleral buckling using wide-angle viewing systems(WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment.METHODS:The study was a retrospective analyses of the medical records of 94 eyes(94 patients) with rhegmatogenous retinal detachment.Among them,47 eyes underwent scleral buckling using WAVS with endoiiluminator(Group W),and 47 eyes underwent scleral buckling using indirect ophthalmoscope(Group I).Surgical durations,primary success rate,best-corrected visual acuities(BCVA),delayed subretinal fluid absorptions and surgical complications were compared between the two groups.RESULTS:At baseline,there were no statistical differences between the two groups in patient's age(P=0.997),gender(P=0.853),symptom duration(P=0.216),BCVA(P=0.389),refractive error(P=0.167),intraocular pressure(P=0.595),the number of retinal breaks(P=0.832),the extent of retinal detachment(P =0.246),subretinal demarcation line(P=0.801),and macular detachment(P=0.811).The follow-up period was 12 mo.The surgical durations in Group W(with or without encircling buckling) were significant shorter than those in Group I(P〈0.001 respectively).The primary success rate was94.27%in Group W,which was similar to that in Group I(92.38%,P=0.931).The BCVA in Group W was better than that in Group I(P〈0.001) at 1-month follow-up visit.However,there were no significant differences between the two groups at 3-month(P=0.221),6-month(P =0.674),and 12-month(P=0.363) follow-up visits respectively.Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month(P=0.045) follow-up visit,but there were no significant differences between the two groups at 3-month(P=0.111),6-month(P =1.000) and 12-month follow-up visits respectively.CONCLUSION:Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment展开更多
AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of hi...AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.展开更多
AIM: To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). METHODS: Totally 48 patients (51 eyes) with primary ...AIM: To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). METHODS: Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon twosample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. RESULTS: Baseline BCVA was 0.8313±0.6911 IogMAR and final BCVA was 0.4761 ±0.4956 IogMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r =0.3850, P=0.0053), less detached area (r=0.5489, P〈0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P= 0.0250), better baseline BCVA (r=0.7291, P〈0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR2) = 0.5316, P〈0.0001], shorter symptoms duration (PR2= 0.0609, P=0.0101), longer follow up duration (PR2=0.0278, P =0.0477) and shorter operative duration (PR2=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P= 0.0041] and longer follow up duration (OR=1.144, P= 0.0067). CONCLUSION: Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.展开更多
AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 fema...AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.展开更多
AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment.METHODS: A retrospective review of all those under 16 y who underwent surgical repair for retinal d...AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment.METHODS: A retrospective review of all those under 16 y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded.RESULTS: Twenty-eight eyes of 24 patients, 15(62.5%) of whom were male and 9(37.5%) of whom were female, their mean age being 11.6 y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14(50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11(39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 log MAR with range 0.0-3.0 log MAR. In 22 of 26(84.6%) cases which underwent surgical repair the retina was attached at last follow-up.CONCLUSION: Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.展开更多
Stickler syndrome (SS) is an autosomal dominant inherited genetic disorder that presents with hearing loss, a cleft palate, epiphyseal dysplasia, and degeneration, similar to arthritis and well known to be associated ...Stickler syndrome (SS) is an autosomal dominant inherited genetic disorder that presents with hearing loss, a cleft palate, epiphyseal dysplasia, and degeneration, similar to arthritis and well known to be associated with rhegmato-genous retinal detachments. A particular group of physical features called Pierre Robin sequence is also common in people with stickler syndrome. Pierre Robin sequence includes a cleft palate, glossoptosis, and micrognathia. We describe a case report of a family diagnosed with stickler syndrome presenting with Pierre Robin sequence and share some universal management steps for rhegmatogenous retinal detachment in stickler syndrome. Genetic testing is important to support the diagnosis and conduct screenings of family members.展开更多
Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods : Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD with...Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods : Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy ( ≤C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy. Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in 31 eyes (86%) during the primary surgery and in three eyes after a second surgery (94% total). The best-corrected visual acuity was <0.1 in 6 eyes (16.7%) , 0.1-0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy. Conclusions : This microsurgical procedure to correct RD is simple, convenient, reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.展开更多
s To explore the changes of multifocal electroretinograms (mfERG) before and after retinal detachment surgery and to evaluate its clinical significance Methods Twenty three patients (23 eyes) with rhegmatogenous ...s To explore the changes of multifocal electroretinograms (mfERG) before and after retinal detachment surgery and to evaluate its clinical significance Methods Twenty three patients (23 eyes) with rhegmatogenous retinal detachment underwent mfERG before and after surgery The latencies and average response densities of N 1 wave and P 1 wave of mfERGs in detached areas, attached areas, fovea and the entire tested area were compared before and after surgery Results Preoperatively, the average response densities of N 1 wave and P 1 wave in the detached area were significantly smaller than those in attached areas ( t =3 68, t =4 26, P 【0 01), and the latencies of N 1 wave and P 1 wave in detached areas were significantly longer than those in attached areas ( t =3 07, t =3 89, P 【0 01) Postoperatively, the average response densities of N 1 wave and P 1 wave in detached areas, fovea and the entire tested area increased, and there were significant differences pre and postoperatively ( P 【0 05) However, the latencies of N 1 wave and P 1 wave before and after surgery showed no significant differences ( P 】0 05) Conclusions The mfERG is a useful tool to evaluate the recovery of posterior retinal function after retinal detachment surgery The response density is a more sensitive index than latency to evaluate retinal function of retinal detechment展开更多
文摘Aim: This study aimed to assess and compare the functional and anatomical results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral buckling (SB), and lens-sparing versus phaco-procedures for treating rhegmatogenous retinal detachment. Methods: A comprehensive literature search was performed using the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases to retrieve comparative studies. The main objective was to assess the BCVA, while reattachment rates and ocular adverse events were considered secondary measures. Rev Manager software was used for statistical analysis. Results: The literature search identified 10 articles comprising 1518 eyes, with 682 eyes in the PPV group, 193 eyes in the lens-sparing versus phaco-procedure group, and 643 eyes in the combined PPV and SB surgery group. Quality assessment revealed a low risk of bias in most domains. The meta-analysis results revealed a significant difference in postoperative BCVA between the PPV and PPV combined with SB groups (WMD = −0.17, 95% CI [0.27, 0.07], p = 0.001). The primary reattachment rates were 82.80% for PPV alone and 87.52% for PPV combined with SB (p = 0.34). The final reattachment rates did not differ significantly between PPV and PPV combined with SB (99% vs. 99.8%;RR = 1.00, 95% CI [1.01, 0.99], p = 0.96). PPV alone demonstrated a significantly reduced risk of macular edema compared to PPV combined with scleral buckling (9.9% vs. 23%;p = 0.006). The incidences of macular hole development (p = 0.46), recurrent retinal detachment (p = 0.27), proliferative vitreoretinopathy development (p = 0.48), epiretinal membrane proliferation (p = 0.77), and limited choroidal hemorrhage (p = 0.69) were not significantly different between the two groups. Conclusions: These findings suggest that PPV alone may be a more effective treatment option in terms of visual acuity (VA) improvement, lower risk of macular edema and cataract development. However, there was no significant difference in VA improvement or complication rates between the lens-sparing and phaco-procedure groups. .
文摘Aims: To compare the results of pars plana vitrectomy (PPV) and combined scleral buckling—PPV (SB/PPV) in phakic rhegmatogenous retinal detachments with inferior breaks. Methods: Randomized, prospective, clinical controlled trial of forty consecutive phakic eyes with primary rhegmatogenous retinal detachment, associated with inferior breaks and not complicated by proliferative vitreoretinopathy ≥grade C, to either PPV (group 1) or combined SB/PPV (group 2). Results: At 6 months follow up the primary reattachment rate was 100% (20/20 cases) in group 2 and 70% (14/20 cases) in the group 1, the difference being statistically significant (p = 0.027). The best corrected visual acuity improved significantly from a preoperative mean of 1.65 ± 1.13 (Range: 0.6 to 3) to a mean of 0.45 ± 0.11 (Range: 0.3 to 0.6) in the group 2 and in the group 1 improved from a preoperative mean of 2.34 ± 0.92 (Range: 0.48 to 3) to a mean of 0.668 ± 0.20 (Range: 0.48 to 1), the difference between the two groups being statistically significant (p = 0.001). Conclusion: Anatomical and functional success rates are significantly better with the use of a scleral explant during PPV for uncomplicated forms of phakic rhegmatogenous retinal detachments with inferior breaks.
基金Supported by the National Natural Science Foundation of China(No.81770963,No.81500725,No.81770964)Shanghai Shen Kang Hospital Development Center Program(No.16CR4017A).
文摘AIM:To demonstrate local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for the treatment of partial rhegmatogenous retinal detachment(RRD)with local vitreous traction in patients at high-risk for proliferative vitreoretinopathy(PVR).METHODS:Eleven eyes of 11 patients were retrospectively studied,including 5 retinal dialysis and 6 retinal detachment(RD;5 eyes with peripheral retinal hole and I eye with giant tear).All patients exhibited partial RD and local vitreous traction.Combined local dry vitrectomy without conventional infusion and segmental scleral buckling was performed.Viscoelastic fluid was injected into the vitreous cavity if needed Demographic information,preoperative and postoperative complications,and outcomes were recorded.RESULTS:The mean age of the patients at presentation was 26.55±13.52y.All 11 patients obtained retinal reattachment after a single surgical intervention.Postoperative visual acuities were improved or remained stable in all patients.None of them developed complications,except for temporary mildly increased intraocular pressure in 3 cases.CONCLUSION:Combined local dry vitrectomy and segmental scleral buckling are effective for patients of RRD with local vitreous traction.The technique avoids many complications associated with regular surgery and was minimally invasive to both the external and internal eye.
基金Supported by National Natural Science Foundation of China(No.81700884)Scientific Research Foundation of National Health and Health Commission(No.WKJ-ZJ-2037)+1 种基金Zhejiang Public Welfare Technology Application Project(No.LGF21H120005)Science and Technology Project of Wenzhou(No.Y20190649).
文摘AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.
基金Supported by Xuzhou Health Outstanding Talents Project(No.XWJC001)Critical Special Project for Social Development of Xuzhou(No.KC21153)+1 种基金Science and Technology Innovation Project of Xuzhou Municipal Health Commission(No.XWKYHT20230039)Applied Basic Research Project of Xuzhou(No.KC23016).
文摘●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.
文摘Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department.Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded.Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges(42.9%) formed the largest part,followed by pars plana vitrectomies(35.0%) and encircling bands(22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds(65%).of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%.Conclusion: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.
基金Supported by the Projects of Henan Health and Family Planning Commission(No.2014005)Henan Health Department(No.201304007)Henan Science and Technology Department(No.142102310110)
文摘AIM:To compare the effects of scleral buckling using wide-angle viewing systems(WAVS) with that using indirect ophthalmoscope for the treatment of rhegmatogenous retinal detachment.METHODS:The study was a retrospective analyses of the medical records of 94 eyes(94 patients) with rhegmatogenous retinal detachment.Among them,47 eyes underwent scleral buckling using WAVS with endoiiluminator(Group W),and 47 eyes underwent scleral buckling using indirect ophthalmoscope(Group I).Surgical durations,primary success rate,best-corrected visual acuities(BCVA),delayed subretinal fluid absorptions and surgical complications were compared between the two groups.RESULTS:At baseline,there were no statistical differences between the two groups in patient's age(P=0.997),gender(P=0.853),symptom duration(P=0.216),BCVA(P=0.389),refractive error(P=0.167),intraocular pressure(P=0.595),the number of retinal breaks(P=0.832),the extent of retinal detachment(P =0.246),subretinal demarcation line(P=0.801),and macular detachment(P=0.811).The follow-up period was 12 mo.The surgical durations in Group W(with or without encircling buckling) were significant shorter than those in Group I(P〈0.001 respectively).The primary success rate was94.27%in Group W,which was similar to that in Group I(92.38%,P=0.931).The BCVA in Group W was better than that in Group I(P〈0.001) at 1-month follow-up visit.However,there were no significant differences between the two groups at 3-month(P=0.221),6-month(P =0.674),and 12-month(P=0.363) follow-up visits respectively.Delayed subretinal fluid absorptions were more common in Group I than in Group W at 1-month(P=0.045) follow-up visit,but there were no significant differences between the two groups at 3-month(P=0.111),6-month(P =1.000) and 12-month follow-up visits respectively.CONCLUSION:Scleral buckling using WAVS can be an alternative choose for rhegmatogenous retinal detachment
基金Supported by the Project of Integrated Traditional Chinese and Western Medicine by Tianjin Municipal Health Commission(No.2021067)。
文摘AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.
文摘AIM: To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). METHODS: Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon twosample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. RESULTS: Baseline BCVA was 0.8313±0.6911 IogMAR and final BCVA was 0.4761 ±0.4956 IogMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r =0.3850, P=0.0053), less detached area (r=0.5489, P〈0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P= 0.0250), better baseline BCVA (r=0.7291, P〈0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR2) = 0.5316, P〈0.0001], shorter symptoms duration (PR2= 0.0609, P=0.0101), longer follow up duration (PR2=0.0278, P =0.0477) and shorter operative duration (PR2=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P= 0.0041] and longer follow up duration (OR=1.144, P= 0.0067). CONCLUSION: Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.
文摘AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.
文摘AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment.METHODS: A retrospective review of all those under 16 y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded.RESULTS: Twenty-eight eyes of 24 patients, 15(62.5%) of whom were male and 9(37.5%) of whom were female, their mean age being 11.6 y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14(50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11(39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 log MAR with range 0.0-3.0 log MAR. In 22 of 26(84.6%) cases which underwent surgical repair the retina was attached at last follow-up.CONCLUSION: Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.
文摘Stickler syndrome (SS) is an autosomal dominant inherited genetic disorder that presents with hearing loss, a cleft palate, epiphyseal dysplasia, and degeneration, similar to arthritis and well known to be associated with rhegmato-genous retinal detachments. A particular group of physical features called Pierre Robin sequence is also common in people with stickler syndrome. Pierre Robin sequence includes a cleft palate, glossoptosis, and micrognathia. We describe a case report of a family diagnosed with stickler syndrome presenting with Pierre Robin sequence and share some universal management steps for rhegmatogenous retinal detachment in stickler syndrome. Genetic testing is important to support the diagnosis and conduct screenings of family members.
基金Supported by a grant(A2002219)from the Guangdong Health Department.
文摘Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods : Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy ( ≤C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy. Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in 31 eyes (86%) during the primary surgery and in three eyes after a second surgery (94% total). The best-corrected visual acuity was <0.1 in 6 eyes (16.7%) , 0.1-0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy. Conclusions : This microsurgical procedure to correct RD is simple, convenient, reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.
文摘s To explore the changes of multifocal electroretinograms (mfERG) before and after retinal detachment surgery and to evaluate its clinical significance Methods Twenty three patients (23 eyes) with rhegmatogenous retinal detachment underwent mfERG before and after surgery The latencies and average response densities of N 1 wave and P 1 wave of mfERGs in detached areas, attached areas, fovea and the entire tested area were compared before and after surgery Results Preoperatively, the average response densities of N 1 wave and P 1 wave in the detached area were significantly smaller than those in attached areas ( t =3 68, t =4 26, P 【0 01), and the latencies of N 1 wave and P 1 wave in detached areas were significantly longer than those in attached areas ( t =3 07, t =3 89, P 【0 01) Postoperatively, the average response densities of N 1 wave and P 1 wave in detached areas, fovea and the entire tested area increased, and there were significant differences pre and postoperatively ( P 【0 05) However, the latencies of N 1 wave and P 1 wave before and after surgery showed no significant differences ( P 】0 05) Conclusions The mfERG is a useful tool to evaluate the recovery of posterior retinal function after retinal detachment surgery The response density is a more sensitive index than latency to evaluate retinal function of retinal detechment