AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on ...AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.展开更多
Purpose:To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.Methods:A total of 21 patients.(21 eyes).with choroidal avulsion,secondary to open eye ...Purpose:To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.Methods:A total of 21 patients.(21 eyes).with choroidal avulsion,secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study.Preoperative findings included 3 to 7.5 mmHg(averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception.Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days(averagely 9.41±2.7 days) after the trauma.The postoperative follow-up lasted for 3 to 9 months(averagely 5.5±1.5 months).Results:The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area.Retinal proliferation/detachment,incarceration and/or partial retinal loss were also observed.Intraoperatively,the retina was separated and released,and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area.The suture fixation on the ciliary body was also introduced in some of the patients.At one month posteoperatively,a complete choroidal reattachment was achieved in 16 eyes(16/21,76.19%) and partial reattachment in the remaining 5 eyes.At the end of follow-up,partial choroidal redetachment was observed in 4 of 16 eyes(25%),resulting in complete reattachment in 12 eyes(12/21,57.1%) and partial reattachment in 9 eyes(9/21,33.34%).The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery.(Chi-square test,P<0.05),while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively(Chi-square test,P>0.05).Conclusion:Transscleral suture fixation serves as a reliable technique,particularly improving the choroidal reattachment rate in the choroidal avulsion.展开更多
AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique an...AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.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
文摘AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.
文摘Purpose:To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.Methods:A total of 21 patients.(21 eyes).with choroidal avulsion,secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study.Preoperative findings included 3 to 7.5 mmHg(averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception.Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days(averagely 9.41±2.7 days) after the trauma.The postoperative follow-up lasted for 3 to 9 months(averagely 5.5±1.5 months).Results:The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area.Retinal proliferation/detachment,incarceration and/or partial retinal loss were also observed.Intraoperatively,the retina was separated and released,and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area.The suture fixation on the ciliary body was also introduced in some of the patients.At one month posteoperatively,a complete choroidal reattachment was achieved in 16 eyes(16/21,76.19%) and partial reattachment in the remaining 5 eyes.At the end of follow-up,partial choroidal redetachment was observed in 4 of 16 eyes(25%),resulting in complete reattachment in 12 eyes(12/21,57.1%) and partial reattachment in 9 eyes(9/21,33.34%).The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery.(Chi-square test,P<0.05),while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively(Chi-square test,P>0.05).Conclusion:Transscleral suture fixation serves as a reliable technique,particularly improving the choroidal reattachment rate in the choroidal avulsion.
基金Supported by the National Natural Science Foundation of China(No.81770944,No.81800846)Shanghai Hospital Development Center(No.SHDC2020CR2041B)。
文摘AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.
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.
