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 compare the efficacy and safety of laser photocoagulation and intravitreal injection of bevacizumab for stage 3 retinopathy of prematurity (ROP). Methods The study included 38 eyes of 19 infants with stage 3 ROP (18 eyes of 9 infants in zone Ⅰ, 20 eyes of 10 infants in zone Ⅱ). All the patients were examined by indirect ophthalmoscope and photographed by wide-angle digital retinal imaging system (RetCam Ⅱ). The fundus lesions in both eyes were the same. Patients received laser photocoagulation in one eye (laser group) and intravitreal injection of 0.03 ml bevacizumab (25 mg /ml) in the fellow eyes (bevacizumab group) during treatment. Follow-up ranged from 12 to 66 weeks, with an average of 33 weeks. The regression time of neovascular ridges and plus-diseases in two groups were compared. ResultsFor 18 eyes with stage 3 ROP in zone Ⅰ, the regression time of neovascular ridges and plusdiseases were (2.25±0.46) and (2.11±0.60) weeks respectively in bevacizumab group, and both were (3.75±1.75) weeks in laser group. The differences between those two groups were statistically significant (F=18.29，15.56；P＜0.05). For 20 eyes with stage 3 ROP in zone Ⅱ, the regression time of neovascular ridges and plusdiseases were (3.1±1.72) and (2.1±0.56) weeks respectively in bevacizumab group, and were (3.50±1.90) and (2.50±1.35) weeks respectively in laser group. The differences between those two groups were not statistically significant(F=0.38，2.62；P＞0.05). There were more fibrous membrane proliferations on the retinal surface in 8 eyes, including 6 eyes in laser group and 2 eyes in bevacizumab group. There was no treatment-related endophthalmitis, cataract, retinal tears and other complications during the follow-up. ConclusionThe laser photocoagulation and intravitreal injection of bevacizumab were both safe and effective in treating stage 3 ROP.
Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)
Objective To investigate the clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious endophthalmitis. Methods Sixty-two patients (62 eyes) with endophthalmitis, diagnosed by the examinations of the best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscopy, direct and (or) indirect ophthalmoscopy and ocular B-ultrasound. There are 44, 17 and 1 eyes with posttraumatic, postoperative and endogenous infectious endophthalmitis, respectively. The patients were randomly divided into the group A (32 eyes) and B (30 eyes). The former was treated immediately by vitrectomy combined with silicone oil tamponade after diagnosis, while the latter was treated by the same surgery after drug treatment depended on patientsprime;choice. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. 19/62 (30.65%) vitreous samples were positive for culture. The follow-up was ranged from 6 to 26 months. The visual acuity, intraocular pressure and eye retention situation before and after surgery were comparatively analyzed. Results In group A, endophthalmitis was controlled in all eyes after surgery; the visual acuity and intraocular pressure improved significantly after surgery (chi;2=43.72, 6.83; P＜0.05). In group B, endophthalmitis was controlled in 19/30 eyes (63.33%) after surgery; evisceration was performed on 11 eyes (36.67%) because of the atrophy of the eyeball. There was no significant difference of visual acuity before and after surgery. Conclusions Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected endophthalmitis. Performing the surgery immediately after the diagnosis is the key to achieve good effect.
ObjectiveTo observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).MethodsA retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.ResultsThe postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=−11.66, −7.52, −4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,ConclusionsThe macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation.
ObjectiveTo observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.MethodsA prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.ResultsThe foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.ConclusionsPars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.
Objective To evaluate the efficacy of vitrectomy with internal limiting membrane（ILM）peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes.Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from －9.5D to －21.0 D with the mean of －(13.1plusmn;3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3plusmn;2.1) mm. Conventional 20G vitrectomy was performed with ILM peeling and 10% C3F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.6plusmn;51.7),(165.2plusmn;22.6),(159.3plusmn;28.7),(167.7plusmn;17.1),(142.7plusmn;13.8) and (169.1plusmn;19.6) mu;m respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 18 months followup compared with the preoperational result (t=9.21，9.23，9.21，10.67，9.21; Plt;0.05). The foveal thickness had no significant change at each timepoint after surgery.From 4 months after surgery, recurrence of macular retionoschisis was found in 3 eyes (9.1%).Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.
Objective To investigate the effects and complications of the vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment. Methods Seventy-seven eyes of 69 cases undergoing vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment were analyzed retrospectively. Results (1) The postoperative visual acuity was enhanced significantly. (2) Complications during the operation in 11 eyes (14.3%): iatrogenic retinal break in 7 eyes, bleeding in 3 eyes and lens damage in 1 eye. (3) Postoperative complications in 20 eyes (26.0%): rebleeding in 14 eyes, elevated IOP in 6 eyes, retinal detachment in 5 eyes, hyphema in 2 eyes, and exudative membrane in anterior chamber in 1 eye. (4) The main long-term complication was cataract formation (9 eyes) and macular disorder (6 eyes). Conclusion Vitrectomy is an effective method to treat Eales′ disease with vitreous hemorrhage or traction retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 215-217)