Objective To observe surgical outcomes and influencing factors of retinal detachment (RD) after phacoemulsification cataract extraction and intraocular lens (IOL) implantation. Methods The clinical data of 38 patients who underwent retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. All patients diagnosed via visual acuity, slit-lamp microscopy, direct or indirect ophthalmoscopy, A or Bscan ultrasonography and optical coherence tomography (OCT). There were 21 males (21 eyes) and 17 female (18 eyes). The age was from 42 to 83 years, with the mean of (57.4±11.2) years. There were nine patients (10 eyes) with simple macular hole RD (MHRD). Vitrectomy or scleral buckling or combined vitrectomy and scleral surgery were implemented according to RD range, the hole location and size, proliferative vitreoretinopathy (PVR) grading; simple MHRD eyes were treated posterior scleral reinforcement surgery. The followup was ranged from 3 to 12 months, with a mean of (11.9±6.8) months. Results The retina was reattached successfully through one operation in 36 eyes (92.3%), two eyes failed because of a relapse after surgery, and one eye finally succeeded by the third times of surgery. There were two eyes (5.1%) with improved vision, one eye (2.6%) with stable vision, and 36 eyes (92.3%) with decreased vision. Conclusion The ratio of the reattachment by one operation for RD after phacoemulsification cataract extraction and intraocular lens implantation is high, but the final visual prognosis remains poorly.
Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P＜0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
ObjectiveTo invesitigate the relationship between the macular histomorphological changes and the prognosis of the visual acuity (VA) in eyes with rhegmatogenous retinal detachment (RRD).MethodsOptical coherence tomography (OCT) was performed on 39 patients (39 eyes) with rhegmatogenous retinal detachment. According to the macular neurepithelial configuration displayed by OCT, the patients were divided into 3 groups: neurepithelial edema group, neurepithelial detachment group, and neurepithelial cystoid degeneration group. The time of retinal detachment, pre- and post-operative VA, and macular neurepithelial thickness OCT images were observed and analyzed statistically.ResultsThere was no difference of pre-operative VA among the three groups (P＞0.05). Significant differences of post-operative VA, time of retinal detachment, and neurepithelial thickness were found (P＜0.05). The differences of time of retinal detachment and neurepithelial thickness between neurepithelial degeneration group and cystoid degeneration group were significant (P＜0.05) except the postoperative VA (P＞0.05).ConclusionsThe time of retinal detachment and post-operative VA in patients with retinal detachment relate to the neurepithelial thickness detected by OCT. When the duration of retinal detachment becomes longer, the macular neurepithelium becomes thicker, the histomorphological changes increase, and the post-operative VA decreases. (Chin J Ocul Fundus Dis, 2005,21:83-85)
The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.
Objective To observe the therapeutic effect of scleral buckling procedure on old retinal detachment. Methods The clinical data of 42 patients (46 eyes), including 24 males (27 eyes) and 18 females (19 eyes), with old retinal detachment treated by scleral buckling procedure in our department were retrospectively reviewed. The duration of the disease ranged from 1 month to 2 years. All the patients were with rhegmatogenous retinal detachment and combined with mainly predominantly-subretinal proliferative vitreoretinopathy (PVR) (stage C), including stage C1 of PVR in 16 eyes (34.8%), stage C2 in 19 eyes (41.3%), and stage C3 in 11 eyes (23.9%). Scleral buckling was performed on 13 eyes (28.3%) and cerclage combined buckling on 33 eyes (71.7%). Sterile air was injected into 36 eyes (78.3%) during the operation, and C 3F 8 was introvitreal injected into 7 eyes (15.2%) after the operation. Results The follow-up duration was from 6 months to 1 year (mean 7.3 months). Retina was completely reattached in 31 eyes (67.4%), and was alleviated obviously in 12 eyes (26.1%). The subretinal fluid increased after the operation with un-reattached retina and vitrectomy was performed in 2 eyes. One eye underwent vitrectomy due to the development of PVR. After the first operation, the curative ratio of retinal detachment was 67.4%, and effective ratio (cure and alleviation) was 93.5%. The visual acuity improved in 28 eyes (60.9%), kept no change in 11 eyes (23.9%), and decreased in 7 eyes (15.2%). Conclusion Reattachment of retina and improvement of visual acuity can be achieved in some degree in some patients with old retinal detachment who undergo simple scleral buckling procedure without vitrectomy. (Chin J Ocul Fundus Dis, 2006, 22: 35-38)