Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD). Methods The clinical interventional caseseries study included 104 patients (112 eyes) with DTRD, who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas. Among the eyes, there were 6 eyes with iris neovascularization (INV), 1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment. There were no preexisting retinal holes or breaks prior to surgery nor any iatrogenic retinal breaks developed during vitrectomy. Cataract removal combined with intraocular lens implant surgeries were performed on 15 eyes. Followup duration varied from 12 to 65 months (mean: 29 months). Results Subretinal fluid was completely absorbed within 2 months after surgery. In 107 eyes (95.54%), the retina reattached after surgery and remained attached till the end of followup period. Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%), remained unchanged in 14 eyes (12.50%) and got worse in 19 eyes (16.79%). The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes, 66.00% Vs 46 eyes/62 eyes, 74.19%,chi;2=0.89, P=0.344). No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries. Seven (6.25%) eyes showed INV (5 new onset eyes), and none of them developed into NVG. In multivariate logistic regression, factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis ［adjusted odds ratio (OR)=10.2］, low preoperative BCVA (OR=11.1) and low postoperative BCVA (OR=16.7). Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oilor gas tamponade if there are no preoperative or intraoperative retinal breaks, and only using irrigation fluid could access a good longterm prognosis result.
ObjectiveTo compare the effects of different airway humidification methods for patients with artificial airway offline. MethodsOne hundred and fifty-five critically ill patients with artificial airway who did not need mechanical ventilation for more than 72 h, admitted in the Affiliated Hospital to Armed Police Logistics College between January 2012 and December 2012, were recruited in the study.They were randomly divided into 3 groups to receive different airway humidification treatment, ie.MR410 device for group A, MR850 device for group B, AIRVO2 device for group C.PaO2, SpO2, heart rate, and breathing frequency were measured after 72 h.The Airway Scoring System was used for evaluation of sputum viscosity.The time of pulmonary infection control was also recorded. ResultsThere were no significant differences in gender, age, underlying diseases, duration of artificial airway, and APACHEⅡscore among three groups (P > 0.05).There were significant differences in respiratory frequency, PaO2, SpO2, heart rate, sputum viscosity, humidification effect, lung infection control time among three groups (P < 0.05), with group C better than group A and B in above parameters. ConclusionsCompared with MR410 and MR850 humidification devices, AIRVO2 is a more ideal device for airway humidification, and is more suitable for patients with artificial airway offline.
ObjectiveTo compare the clinical effect of C3F8 and air tamponade after vitrectomy for the treatment of idiopathic macular hole (IMH). MethodsA total of 54 eyes of 54 patients with IMH that had undergone 23G pars plana vitrectomy with internal limiting membrane peeling were retrospectively studied. All patients received optical coherence tomography (OCT) examination and the best corrected visual acuity (BCVA). They were divided into 2 groups. 26 eyes in group A were filled with air and 28 eyes in group B were filled with C3F8. In group A, 6 eyes at stage Ⅱ, 20 eyes at stage Ⅲ, the minimum diameter (Dmin) of macular hole in 14 eyes was less than 400 μm,and in the other eyes was larger than 400 μm. In group B, 10 eyes at stage Ⅱ, 18 eyes at stage Ⅲ, the Dmin of macular hole in 15 eyes was less than 400 μm,and in the other eyes was larger than 400 μm. The differences of age, course of the disease, BCVA, fundus diameter, Dmin, height, index, diameter of outer retina diameter (Dord) between the two groups were not significant (P>0.05). The basic data before surgery and the closure rate, BCVA, Dord 1 month after surgery between two groups were compared. ResultsAt 1 month after surgery, the IMH closure rate was 100.0% in group A and 92.9% in group B, the difference between these two groups was not significant (P=0.491).The closure rate of eyes with Dmin<400 μm were both 100.0% in two groups, and the closure rate of eyes with Dmin>400 μm were 100.0% in group A and 84.6% in group B. There was no statistically significant differences between two groups (P=0.480). The mean BCVA of two groups were 0.35±0.22 and 0.33±0.16 respectively. The mean Dord were (782.2±478.0) μm and(792.1±432.7) μm respectively. All cases got better BCVA (t=-7.310,-10.506; P<0.01) and shorter Dord (t=6.704,7.770;P<0.01). But there was no statistically significant differences between groups 1 month after surgery in BCVA and Dord(t=0.381,-0.800; P=0.705, 0.937). ConclusionAir tamponade after vitrectomy has the same efficacy as C3F8 tamponade in the treatment of IMH.
ObjectiveTo compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD). MethodsA retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age (Z=0.804), course of disease (Z=－0.490), eye type (χ2=0.175), logMAR BCVA (Z=－0.895), intraocular pressure (Z=0.178), lens status (χ2=1.090), number of detached clocks (Z=0.301) and macular involvement (χ2=0.219), number of holes (Z=－1.051) and number of lower holes (χ2=0.619) were compared, there was no significant difference (P＞0.05). The gender composition ratio was compared, and the difference was statistically significant (χ2=5.341, P＜0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. ResultsIn the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation (χ2=0.120, P=0.729) and logMAR BCVA (Z=－0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery (χ2=2.320, 0.227; P=0.128, 0.634). ConclusionIt is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.
ObjectiveTo observe the clinical effect of intravitreal injection of tissue plasminogen activator (t-PA), ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV).MethodsThe clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study. The duration of bleeding in the eye was 7 to 28 days, and the mean duration of bleeding was 14.8±5.6 days. All eyes are measured using the Snellen chart best corrected visual acuity (BCVA), logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography. The average logMAR BCVA of eyes was 1.73±0.91; the mean CRT was 620.0±275.8 μm; the average central PED thickness was 720.3±261.9 μm. All eyes receive intravitreal injection of t-PA, ranibizumab and C3F8. The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months, followed by an on-demand treatment plan. Mean follow-up time was 9.9±3.6 months. The changes in BCVA, CRT, central PED thickness and clearance degree of SMH at 6 months after treatment were observed.ResultsOn the 6 months after treatment, the average logMAR BCVA, CRT and central PED thickness of the eyes were respectively 0.42±0.37, 290.2±97.4 μm and 41.6±78.1 μm. Compared with baseline, the after treatment BCVA was significantly increased (F=38.14, P=0.000), but the CRT and central PED were significantly decreased (F=7.48, 75.94; P=0.000, 0.000). Among the 20 eyes, 16 eyes of SMH was completely cleared, accounting for 80%;4 eyes was partially cleared, accounting for 20%. No recurrence and systemic or local complications occurred during follow-up of all eyes.ConclusionIntravitreal injection of t-PA, ranibizumab, and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH, improve vision, reduce CRT and central thickness of PED.