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)
Thinning and atrophy of sclerotic tissues play an important role in the development of high myopia. High myopic eyes had the thickest sclera at the posterior pole and the thinnest sclera at the equator. Most clinical studies found that scleral thickness was negatively correlative with the axial length. Patients complicated with posterior staphyloma had even thinner sclera, and its height was negatively related with the scleral thickness. At present, the main measurement methods for scleral thickness of high myopic eyes include histological measurement, enhanced depth imaging optical coherence tomography (OCT), and swept-source OCT. Following the development of OCT technique, it gradually becomes feasible to carry out studies on sclera thickness in mildly and moderately myopic populations, which is helpful to illuminate the mechanism of action of sclera on the onset and progression of high myopia.
We demonstrate 35 cases of retinal detachment in which the patients received treatment with xenogeneie (poreine)sclera as pressor material. All the patients improved with retinal replacement after initial operation. There are 5 relapsing cases in which 4 patients were reoperated and the retinas were reattaehed in 2 cases. So far the total curative percentage was 91.4 in this series. After a period of three year follow-up ,none of the patient showed apparent postoperative complication of rejection reaction,discharge,exposure and infection. These findings suggest that porcine sclera has excellent characteristic,similar to human sclera ,and may be used in ophtha[mologic surgery as a substitute of homologous(human)sclera. （Chin J Ocul Fundus Dis,1994,10:207-209）
ObjectiveTo observe the effect of segmental scleral buckling on the treatment of rhegmatogenous retinal detachment (RRD) with multiple retinal breaks. MethodsThis is a retrospective study. Seventeen patients (17 eyes) suffering from RRD with multiple retinal breaks were enrolled in this study. There were 8 eyes with the retinal breaks located in different quadrants and 9 eyes located in different latitudes within the same quadrant. Three were 3 eyes with 2 retinal breaks, 5 eyes with 3 retinal breaks, 9 eyes with more than 3 retinal breaks. The forms of retinal breaks included U-shaped break (4 eyes), tear break (1 eye), degenerative break (3 eyes) or U-shaped breaks combined with degenerative breaks (7 eyes), U-shaped breaks combined with tear breaks (1 eye), tear breaks combined with degenerative breaks (1 eye). The best corrected vision acuity (BCVA) was count finger to 0.8. The segmental scleral buckling was performed in all patients with the reasonable combination of silicon sponges and tires. The mean follow-up was 9.3 months (from 6 to 12 months). The BCVA, retinal attachment and complications were observed in the follow-up. ResultsFifteen eyes were reattached without recurrent of retinal detachment (88.2%). One eye with recurrent retinal detachment after 3 months due to proliferative vitreoretinopathy, and was partly reattached after vitrectomy combined with silicon oil tamponade. Retina remained detached in 2 eyes (11.8%), including 1 eye reattached after combined with gas tamponade, and 1 eye with vitrectomy. Sixteen eyes were completely reattached (94.1%), including 14 eyes were underwent only 1 operation (82.4%). The BCVA were improved more than 2 lines in 9 eyes (52.9%), 1 to 2 lines in 5 eyes (29.4%), and only 3 eyes (17.7%) without improvement. All patients have no serious complications during the operations. ConclusionFor certain patients suffering from RRD with multiple retinal breaks, a reasonable design of segmental scleral buckling can effectively increase the success rate of retinal reattachment (82.4%).
With the surged prevalence of myopia, the pathogenic mechanism underlying myopia has attracted attention. At present, it is generally believed in the flied that the reduced blood perfusion in the choroid is crucial for myopigenesis. Then, in the process of myopigenesis, how are the blurred visual signals transmitted to the choroidal blood vessels through the retina and retinal pigment epithelium, leading to the reduced choroidal blood perfusion. The cellular and molecular mechanisms underpinning this process remain elusive. In recent years, the theory of scleral hypoxia has attracted much attention. Popular signaling molecules in current research include dopamine, epidermal growth factor, retinoic acid, cholinergic molecules and adenosine, etc. These factors are likely to participate in signal transduction in retina and RPE, thus causing changes in choroidal blood flow and affecting the occurrence and development of myopia. Therefore, these signaling factors and their downstream pathways may provide new ideas for the prevention and control of myopia targets.
ObjectiveTo analyze the clinical efficacy of scleral buckling surgery for rhegmatogenous retinal detachment (RRD) of 376 patients.MethodsA retrospective analysis was performed about 376 patients (391 eyes) who underwent scleral buckling surgery in Chengdu Aidi Eye Hospital from January 2018 to December 2019. There were 214 males (224 eyes) and 162 females (167 eyes). There were 15 binocular cases and 361 monocular cases. The average age was 37.16±16.36 years. The average course of disease was 3 months. There were 1 to more than 10 retina holes for all patients. Retinal breaks occur in all quadrants and at ora serrata. The preoperative average BCVA was 0.27 and the postoperative average BCVA was 0.41. Retinal detachment ranges was observed in 268 eyes in 1 quadrant, 97 eyes in 2-3 quadrants, 26 eyes in total, and 231 eyes with macular involvement. There were 376 eyes treated with scleral buckling, 9 eyes treated with scleral buckling combined with scleral encircling, 6 eyes treated with scleral encircling. The average follow-up time was 5 months. Postoperative follow-up was conducted to observe retinal reduction, BCVA, complications and patient compliance.ResultsAfter the first operation, retinal reattachmnents were successfully achieved in 375 eyes (95.91%); 16 eyes (4.09%) failed in retinal reattachmnents. Eight eyes were treated with scleral buckling again, 5 eyes were treated with vitrectomy silicone oil filling, and 3 eyes were treated with air injection. After the second operation, retinal reattachmnents were ultimately achieved in 16 eyes (100.00%). The average BCVA after operation was 0.15. Postoperative intraocular pressure increased by 45 eyes (11.51%). The intraocular pressure increased from the next day to 3 days after operation. The intraocular pressure was completely controlled 1-3 days after the treatment of topical medication and 20% mannitol. Vitreous and subretinal hemorrhage in 1 eye caused by drainage of the subscleral liquid. There was no cases withpostoperative infection.ConclusionThe retinal reattachment rate is 95.91% in 376 patients with RRD treated by scleral buckling surgery, and the visual acuity has significantly improved.
OBJECTlVE:To evaluate the value of inhibiting effect of the verapamil(Ver)on human selcral fibroblast (HSF). METHODS:The rate al inhibition of Ver,5-Fu,heparin(Hep)and dexamethasone(Dex)to cultured HSF was respectively determined by MTT method and enzyme linked immunosorbent assay. In addition,the rate of inhibition of Ver associated with 5-Fu Hep and Dex to cultured HSF was respectively determined. RESULTS:The rate of cellular proliferation of cultured HSF was found to be significantly reduced(Plt;0.05),when the concentration of Ver was 20mg/L,and further reduced when 5-Fu,Hep or Dex was added even in smaller dose (5~10mg/L)of Ver. CONCLUSION: Tbe effect of inhibition of cellular proliferation of 5-Fu, Hep and Dex in eye could be enbenced by Ver. （Chin J Ocul Fundus Dis,1996,12: 98-100）
ObjectiveTo evaluate the correlation between macular microstructure changes and visual outcome before and after scleral buckling for macular-off primary rhegmatogenous retinal detachment (RRD). MethodsA total of 43 eyes in 43 patients with RRD were enrolled in this retrospective study. All patients underwent scleral buckling and the retina was successfully reattached. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were measured for all patients before and at 3 days, 1, 3 and 6 months after surgery. The height of subretinal fluids (SRF), the thickness of retinal neurosensory layer in foveal, and the thickness of outer nuclear layer (ONL) were measured. The microstructure changes of external limiting membrane (ELM), junction line and intermediate line of photoreceptor inner segment/outer segment (IS/OS) were observed. The correlation between morphologic changes in the macular foveal and BCVA on 6 months after surgery were also analyzed. ResultsThe mean preoperative BCVA was 1.18±0.93. The detached retinas had 3 types of SD-OCT images, including normal foveal contour without edema, diffuse edema with ONL cystoids cavities, diffuse edema with ONL cystoids cavities and wave-like ONL. The mean preoperative SRF height was (885.05±493.28) μm. The preoperative mean thickness of retinal neurosensory layer in foveal and ONL in the RRD eyes were thinner than the healthy fellow eyes (t=2.642, 1.895;P < 0.05). The fluids and cystoids cavities were absorbed, retina reattached in all the RRD eyes at 3 days after surgery. SRF had been detected in 100.0%, 93.0%, 77.8%, 46.5% RRD eyes on 3 days, 1 month, 3 months and 6 months after surgery, with heights of (219.00±117.02), (163.51±72.83), (101.27±64.47), (55.69±21.15) μm respectively. There were 3 patterns of residual SRF: diffuse, subfoveal multi-bleb, subfoveal single bleb. Compared with the healthy fellow eyes, there were significant differences in the mean thickness of foveal neurosensory layer (t=-10.658, -8.550, -6.955) and ONL thickness (t=-6.240, -5.424, -3.326, -3.323) at 3 days, 1 month, 3 months and 6 months after surgery(P < 0.05), except for the thickness of foveal neurosensory layer at 6 months after surgery (t=-2.186, P=0.570). The reattached retinas had 4 types of SD-OCT images, including: (1) disrupted ELM, IS/OS line and intermediate line; (2) intact ELM with disrupted IS/OS line and intermediate line; (3) intact ELM and IS/OS line with disrupted intermediate line; (4) intact ELM, IS/OS line and intermediate line. The mean postoperative BCVA at different time points were better than preoperative BCVA (t=-3.12, -4.89, -5.03, -4.53; P < 0.05). The postoperative BCVA of eyes with intact IS/OS was different from that of eyes with disrupted IS/OS at 6 months after surgery (t=2.609, P < 0.05). The preoperative SRF height, thickness of foveal neurosensory layer and ONL were correlated with the BCVA at 6 months after surgery (r=0.817, 0.028, 0.521; P < 0.05). ConclusionsMacular-off RRD eyes had SRF, thinner foveal neurosensory layer and ONL before and after scleral buckling. The disruption of ELM, IS/OS junction line and intermediate line can be seen in most of RRD patients. The thinner foveal neurosensory layer and ONL were correlated with the slow recovery of postoperative BCVA.
Objective To investigate the refractive changes of ocular measurable factors due to scleral buckling surgery. Methods A total of 86 eyes of successful rhegmatogenous retinal detachment with a higher encircling scleral buckle underwent A-scan and keratometer examination before surgery as well as l week,4 and 12 weeks after surgery.The refractive factors included the depth of anterior chamber,thickness of lens,axial length of eye,corneal curvature and refraction of eye were detected pre- and post-operatively. Results Compared with preoperation,the depth of anterior chamber was decreased significantly at the lst,4th and 12th postoperative week(P＜0.05),while no significant change of the axial length of eye was observed.The thickness of lens was increased significantly and the refractive error was myopic shifted at the lst and 4th week after operation(P＜0.05),but no significant change was observed at the 12th postoperative week.Statistically significant difference was also observed in corneal curvature of central axis in the local bucklele;1 quadrant with encircling group between preoperation and the lst and 4th postoperative week. Conclusions With higher encircling scleral buckle,the refractive change after buckling surgery may be caused primarily by the shallowing of anterior chamber and thickening of lens. (Chin J Ocul Fundus Dis, 1999, 15: 227-229)
ObjectiveTo observe the surgical effects of scleral buckling and vitrectomy for familial exudative vitreoretinopathy (FEVR). Methods34 eyes of 27 patients with FEVR who underwent either scleral buckling or vitrectomy were enrolled in this study. There are stage 2B in 2 eyes (5.88%), stage 3B in 7 eyes (20.59%), stage 4A in 1 eye (2.94%), stage 4B in 16 eyes (47.06%), stage 5 in 8 eyes (23.53%). 5 eyes associated with rhegmatogenous retinal detachment. The surgical approaches had been chosen according to the disease stage, severity, extent and morphology of the proliferative membrane. 13 eyes (stage 2B in 2 eyes, 3B in 4 eyes, and 4 in 7 eyes) underwent scleral buckling and 21 eyes (stage 3B in 3 eyes, 4 in 10eyes, and 5 in 8 eyes) underwent vitreoretinal surgery. The main outcome measurement was the anatomic status of the macula, which was recorded as attached, partially attached or remain detached. The mean follow up was (18.00±14.61) months (range 4 to 60 months). ResultsAmong 13 eyes received scleral buckling, the macula was attached in 2 eyes with stage 2B (15.38%), partially attached in 11 eyes (84.62%) including 4 eyes with stage 3B, 1 eye with stage 4A and 6 eyes with stage 4B. Among 21 eyes received vitrectomy, the macula was attached in 8 eyes (38.10%) including 2 eyes with stage 3B, 4 eyes with stage 4 and 2 eyes with stage 5; the macula was partially attached in 9 eyes (42.86%) inducing 4 eyes with stage 4 and 5 eyes with stage 5; the macula remained detached in 4 eyes (19.05%) including 1 eye with stage 3B, 2 eyes with stage 4 and 1 eye with stage 5. ConclusionIf the surgical approaches were chosen based on the stage of FEVR and the severity, extent and morphology of the proliferative membrane, the surgery is effective and beneficial to FEVR patients.