Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To inverstingate the effect of perfluorohexyloctane(F6H8)to the retina of rabbit eyes. Methods Fifteen vitrectomized New Zealand white rabbits were injectedF6H8(experiment group,12 rabbits ) and BSS(control group,3 rabbits) into vitreous cavity.Slit-lamp biomicroscopy and indirect ophthalmoscopy were performed pre- and postoperatively in all the eyes.Histopathological examination was done after the rabbits were sacrificed at the end of the study. Results A large clear balb was formed after intravitreal injection of theF6H8 in the vitreous was injected and no retinal detachment and cataract were found.The OPL was edematous and then thinned out in 4th week in experimental group.Degenerating cells was found in inner and outer nuclear layers.Cellular vaculoar degeneration was present in TEM. ConclusionF6H8 in vitreous cavity may cause significant side effects on retina,we could not recommend it to be used as an intraocular temponade.
Objective To study the factors affecting the prognosis of vitrectomy in mechanically injured eyes. Methods One hundred and thirty-Seven eyes undergone vitrectomy were in cluded.Recorded to EPIINFO data base were visual acuity (VA) immediately after injury,type and location of injury,the interval from injury to surgical intervention,retinal detachment,basic surgical maneuvers,proliferative vitreo-retinopathy (PVR),stage of trauma,complications,final VA,and final retinal status.Data were analyzed by SAS. Results We got anatomic success in 107 eyes (75.9%).Final VA of 74 eyes (54.1%) were better than 0.02.Multiple-variable analysis showed that the factors significantly affecting prognosis of vitrectomied eyes of mechanical injury were retinal detachment (RD) before surgery,delay of surgical intervention,complexity of surgical maneuvers,complications after surgery. Conclusions RD before surgery,delayed surgical intervention,complexity of surgery and post vitrectomy complications are the most important factors contributing to the poor prognosis of VA and failure of surgery. (Chin J Ocul Fundus Dis，2000，16：139-212)
Objective To evaluate the efficacy of perioperative management for vitrectomy of patients with severe systemic disease. Methods The clinical data of 21 patients (22 eyes) with severe systemic disease who underwent vitrectomy were retrospectively analyzed. There were 11 patients (12 eyes) with proliferative diabetic retinopathy, 9 patients (9 eyes) with rhegmatogenous retinal detachment, and 1 patient (1 eye) with intraocular lens dislocation. The preoperative visual acuity ranged from hand movement to 0.6. There were 4 patients (5 eyes) with renal insufficiency undergoing renal dialysis, 7 patients (7 eyes) with myocardial infarction or coronary artery stenosis received cardiac bypass surgery or coronary stent implantation, 2 patients (2 eyes) with severe arrhythmia received cardiac pacemaker implantation or radiofrequency catheter ablation, 5 patients (5 eyes) with cerebral infarction, 2 patients (2 eyes) with hemophilia, and 1 patient (1 eye) with aplastic anemia. For patients with cardiac bypass surgery or coronary stent implantation, anticoagulants were switch to low molecular heparin at 7 days before vitrectomy. For patients undergoing renal dialysis, 0.4 ml low molecular heparin was used during renal dialysis at one day before vitrectomy, protamine and heparin were administered after vitrectomy. Prothrombin complex was infused from 1 day before surgery to 5 days after surgery for Hemophilia B patients.6 patients (6 eyes) underwent phacoemulsification, and 1 patient (1 eye) underwent ciliary sulcus fixed intraocular lens implantation. 14 patients (14 eyes) underwent silicone oil tamponade,5 patients (6 eyes) underwent C3F8 tamponade.Results The postoperative visual acuity ranged from light perception to 1.0. The vision increased in 18 patients (19 eyes), unchanged in 2 patients (2 eyes), and decreased in 1 patient (1 eye). The retina attached in all eyes postoperatively. The postoperative complications mainly included mild anterior chamber bleeding in 4 patients (4 eyes), severe anterior chamber bleeding in 1 patient (1 eye), mild retinal hemorrhage in 2 patients (2 eyes), optic disc bleeding in 2 patients (3 eyes), temporary elevation of intraocular pressure in 1 patient (1 eye), and neovascular glaucoma in 1 patient (1 eye). Serum creatinine increased in 1 patient and hypertension in 1 patient within 1 week postoperatively. Conclusions Severe systemic disease is not an absolute contraindication for vitrectomy. Vitrectomy can be successfully performed with better outcomes under the proper perioperative management of systemic disease.
Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists. The surgical success rate reached 95.0% and above for vitrectomy, macular surgeries with ILM peeling, or local/total scleral buckling. However, the postoperative visual function recovery is nowhere near good enough. Specialists must pay more attention to the visual function recovery of those patients. Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time. At present, the postoperative visual acuity for macular hole depends on many factors, such as macular hole closure conditions, surgical procedures, microsurgical invasive ways, skills of membrane peeling, usage of dye staining, and tamponade material choice. It also depends on residual subretinal fluid under macular area for patients received scleral buckling. It is important for us to investigate these factors affecting recovery of macular anatomy and function, and thus develop some drugs to improve the macular function recovery.