Surgical Approaches in Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis Comparing Vitrectomy vs. Vitrectomy Combined with Scleral Buckling, Lens-Sparing vs. Phako Procedures

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. .

Pars Plana Vitrectomy versus Combined Scleral Buckling—Pars Plana Vitrectomy for Phakic Rhegmatogenous Retinal Detachment with Inferior Breaks

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.

Local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for rhegmatogenous retinal detachment with vitreous traction

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.

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oilfilled eyes

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.

Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle

●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.

Ratio of Primary Episcleral Buckling Surgery versus Primary Vitrectomy for Rhegmatogenous Retinal Detachment

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.

Comparison of scleral buckling using wide-angle viewing systems and indirect ophthalmoscope for rhegmatogenous retinal detachment

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

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

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.

Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling

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.

Surgical outcomes in inferior recurrences of rhegmatogenous retinal detachment

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.

Paediatric retinal detachment:aetiology,characteristics and outcomes

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.

Rhegmatogenous Retinal Detachment in Pierre Robin Anomaly—A Suspicion for Stickler Syndrome: Case Report

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.

A New Microsurgical Technique to Correct Retinal Detachment

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.

Comparison of pre-and post-operational multifocal electroretinograms of retinal detachment

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

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。

微创折叠球囊巩膜外加压治疗孔源性视网膜脱离的临床研究

目的:探讨微创折叠球囊巩膜外加压治疗孔源性视网膜脱离(RRD)的临床效果。方法:回顾性研究。收集2023-05/07于我院采用折叠球囊行微创巩膜外加压术连续治疗的RRD患者11例11眼,术中均采用结膜下麻醉、不做肌肉牵拉线、不做术中视网膜裂孔定位,不做视网膜冷冻和视网膜下放液、不做球囊巩膜固定缝线,观察手术最佳矫正视力(BCVA)、眼压和术后并发症。结果:纳入11眼中视网膜成功复位10眼(91%),1眼(9%)术后视网膜再脱离,因多发视网膜裂孔行玻璃体切除联合硅油填充术。成功行球囊顶压手术的10眼中球囊顶压一次成功4眼(40%),球囊顶压后行玻璃体注气1眼(10%),球囊顶压后再次调位3眼(30%),球囊顶压后再次调位及玻璃体腔注气2眼(20%);5眼(50%)术后4-12 wk行球囊取出,视网膜脱离无复发;术前平均最佳矫正视力(LogMAR)为1.30±1.10,术后4 wk为0.37±0.39(P<0.01);术前平均眼压11.51±3.37 mmHg,术后4 wk为13.72±2.57 mmHg(P>0.05)。所有患者术后均未发生严重并发症。结论:微创折叠球囊巩膜外加压手术创伤小、操作简单、节省时间、并发症少,是治疗RRD的有效方法。

上方球形视网膜脱离术中行玻璃体内BSS注入与术毕空气充填效果比较

目的:观察巩膜外放液后术中行玻璃体内平衡盐溶液(BSS)注入适当升高眼压,再行巩膜外垫压(SB)治疗原发性上方球形视网膜脱离(SBRD)的效果,并与常规术式(无任何玻璃体内填充)及术毕玻璃体内注入消毒空气的效果进行比较。方法:回顾性病例对照研究。2018-01/2022-12因SBRD在西京医院眼科行SB治疗的72例73眼患者被纳入研究。所有患者术中均行巩膜外放液。根据放液后是否行玻璃体注射升高眼压和注射物不同,患者被分为三组:常规手术组不做任何玻璃体内注射24例24眼、术毕注入消毒空气组(空气组)23例23眼,以及术中注入BSS组(BSS组)25例26眼。所有患者至少随访至视网膜下液完全吸收。比较各组平均手术时间、术后早期眼压、视网膜复位、视网膜下液吸收、视力(LogMAR)和主要并发症等差异。结果:所有患者均顺利完成手术。常规手术组、空气组和BSS组平均手术时间分别为63.17±13.22、61.65±15.55、57.30±11.70 min,三组间无差别(F=0.825,P=0.443)。术后1 d,常规手术组、空气组和BSS组平均眼压分别为13.69±2.69、16.40±2.86、18.35±2.88 mmHg,空气组和BSS组平均眼压高于常规手术组(F=17.18,P<0.001)。三组中单次手术的视网膜复位率分别为88%、96%和100%。术后1 d,常规手术组、空气组和BSS组平均BCVA分别为0.71±0.42、0.59±0.44、0.91±0.50,均较术前提高(均P<0.05),而三组间无差别(F=3.046,P>0.05)。手术后,常规手术组和空气组分别有1眼出现视网膜下出血,空气组1眼出现新裂孔而导致局限性视网膜脱离。结论:针对SBRD患者SB术中放液后出现的低眼压,采取BSS玻璃体内注射适当升高眼压再完成手术,可提高手术成功率,减少术后并发症。这种方法对经选择的SBRD患者是安全和有效的。

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的:探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。方法:回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出;巩膜扣带术中外加压块采用外加压复合体;术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。结果:术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。结论:改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。

玻璃体切割联合节段性巩膜扣带术治疗下方孔源性视网膜脱离的疗效观察

目的探讨采用玻璃体切割(PPV)联合节段性巩膜扣带术(SSB)治疗下方孔源性视网膜脱离(RRD)的临床效果。方法回顾性收集2020年10月至2022年4月于郑州大学第一附属医院眼二科收治的下方RRD患者87例87眼,其中45例(45眼)接受PPV-SSB治疗为PPV-SSB组,42例(42眼)仅接受PPV治疗为PPV组,比较两组患者单次手术视网膜解剖复位成功率、术后最佳矫正视力及并发症情况。结果PPV-SSB组患者单次手术视网膜解剖复位成功率95.56%(43/45),而PPV组为80.95%(34/42),两组相比差异有统计学意义(P=0.033)。术后3个月及6个月,PPV-SSB组与PPV组患者间BCVA相比差异均有统计学意义(P=0.010、0.004)。PPV-SSB组与PPV组患者术后晶状体混浊发生率分别为28.89%(13/45)、54.76%(23/42),两组相比差异有统计学意义(P=0.018),余少数并发症发生率两组患者之间相比差异均无统计学意义(均为P>0.05)。结论PPV-SSB治疗下方RRD具有较高的视网膜复位率、良好的视力效果和较少并发症。

巩膜扣带术治疗家族性渗出性玻璃体视网膜病变继发视网膜脱离效果分析

目的分析巩膜扣带术治疗家族性渗出性玻璃体视网膜病变(FEVR)继发视网膜脱离(RD)的效果。方法采用系列病例观察研究,纳入2010年7月至2021年3月于北京同仁医院采用巩膜扣带术治疗的FEVR继发RD患者共37例42眼,其中男30例35眼,女7例7眼;平均年龄(15.21±5.42)岁。全身麻醉下行巩膜扣带术,孔源性RD患者22眼,术中封闭裂孔,其中21眼采用局部外加压联合环扎,1眼采用放射脊加压;牵拉性RD患者13眼,术中解除牵拉,其中12眼采用局部外加压联合环扎并放视网膜下液,1眼采用巩膜扣带术联合玻璃体手术;牵拉合并孔源性RD患者7眼,术中在封闭裂孔的基础上同时解除牵拉,其中4眼采用局部外加压联合环扎并放视网膜下液,3眼采用巩膜扣带术联合玻璃体切割手术。平均随访时间(30.61±10.50)个月。主要观察指标包括术眼最佳矫正视力(BCVA)、视网膜复位情况及并发症发生情况。结果术后末次随访时平均LogMAR BCVA为0.83±0.50,优于术前的1.10±0.39,差异有统计学意义(t=6.639,P<0.001)。一次性视网膜复位39眼,未复位3眼,其中孔源性RD复位率95.45%(21/22),牵拉性RD复位率84.62%(11/13),牵拉合并孔源性RD复位率100%(7/7)。所有患者术后随访期间均未出现严重并发症。结论根据FEVR继发RD的病情选择合适的手术策略,可有效提高巩膜扣带术的治疗成功率。