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@#AIM: To observe the efficacy and safety of pars plana vitrectomy(PPV)combined with air tamponade in the treatment of rhegmatogenous retinal detachment(RRD), which caused by superior break(s)following previous vitreoretinal surgery.<p>METHODS: Retrospective analysis of the inpatients in our hospital from November 2017 to October 2019. Patients with RRD caused by superior break(s)who had underwent previous vitreoretinal surgeries and the proliferative vitreoretinopathy less than PVR-C1 were enrolled. For treatment, patients underwent PPV combined with air tamponade. During the operation, the residual vitreous cortex was fully removed, and the subretinal fluid was aspirated from retinal break(s)as much as possible. Make sure the subretinal fluid around the hole was fully drained. Then firmly laser spots were accomplished to seal the retinal break(s). Finally, filtered air was left in the vitreous cavity as tamponade agent. The patients were informed to keep a prone position for 24h postoperation. The primary outcomes were primary and final success rates, best corrected visual acuity(BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.<p>RESULTS: Totally 31 patients(31 eyes)with follow-up time more than 6mo were included. The range of retinal detachment was 6.7±3.8h, and the number of retinal breaks was 1.2±0.7. There are 23 eyes(74%)with macular detachment and 18 eyes(58%)with intraocular lens. 6 eyes(19%)were treated with phacoemulsification and intraocular lens implantation together. The rate of primary retinal reattachment in enrolled patients was 87%(27/31), and the final reattachment rate was 100%(31/31). At the 6mo of postoperatively, the BCVA(LogMAR)increased from 2.17±1.27 to 0.53±0.25(<i>P</i><0.001). Furthermore, 5 eyes(16%)developed transient ocular hypertension.<p>CONCLUSION: PPV with air tamponade can achieve a high success reattachment rate in the management of RRD following previous vitreoretinal surgery. It has the advantages of short postoperative prone time and fewer complications.
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@#AIM: To explore the safety and efficacy of air tamponade in the closure of large idiopathic macular holes(IMHs).<p>METHODS: A retrospective study. Nine eyes of eight patients with large IMH were admitted to our hospital from June 2017 to may 2018. Mean macular hole(MH)minimum diameter >700 μm and mean MH basal diameter >1 300 μm. All the patients were underwent 25G phacovitrectomy, internal limiting membrane flaptuck, and sterilized air tamponade in the vitreous cavity. With a mean follow up of 12mo, the best-corrected visual acuity(BCVA)and macular hole closure were compared before and after operation.<p>RESULTS: At the last follow up, all the patients obtained MH closure. The SD-OCT showed that the postoperative MH closure rate was 100%(9/9). Postoperative BCVA improved significantly compared with the preoperative(0.83±0.26 <i>vs</i> 1.27±0.28), the difference was statistically significant(<i>P</i>=0.007). No complications occurred during and after the operation.<p>CONCLUSION: Sterilized air tamponade might provide a safe and efficient effect on the closure of large IMHs.
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@#AIM: To observe the efficacy and safety of 25-gauge vitrectomy combined with air tamponade for rhegmatogenous retinal detachment. <p>METHODS: The clinical data of 30 eyes with primary rhegmatogenous retinal detachment(RRD)from 30 patients who received vitrectomy with intraocular air tamponade in Zunyi First People's Hospital from August 2017 to December 2018 were retrospectively analyzed. The best corrected visual acuity(BCVA)(LogMAR), intraocular pressure were evamined before surgery, 1wk and 1mo after surgery, while the retinal reattachment rate, intraoperative and postoperative complications were recorded.<p>RESULTS: The mean BCVA was significant different among before surgery, 1wk and 1mo after surgery(<i>F</i>=3.74, <i>P</i>=0.047), and the BCVA at 1wk and 1mo after surgery was evidently improved in comparison with before surgery(0.64±0.36 <i>vs </i>0.87±0.71; 0.37±0.22 <i>vs</i> 0.87±0.71). The mean IOP was(13.61±3.57),(15.74±4.84)and(14.05±2.88)mmHg before surgery, 1wk and 1mo after surgery, showing no significant difference in IOP before and after operation(<i>F</i>=4.13, <i>P</i>=0.051). The retinal reattachment rate of retinal hiatus was 97%(29/30)1wk after operation. Postoperative OCT monitored 1 eye of persistent subomental effusion, which was absorbed 3mo after operation.<p>CONCLUSION: Vitrectomy combined with air tamponade is effective in the treatment of rhegmatogenous retinal detachment. It can improve visual quality, reduce complications related to silicone oil and reduce the economic burden of patients.
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@#AIM: To analyze the treatment of retinal arterial macroaneurysm(RAM)and its efficacy. <p>METHODS:A total of 26 diagnoses of retinal arterial microaneurysm made in the Fourth People's Hospital of Shenyang between June 2016 and June 2018 were reviewed. Various treatment strategies for different types, and complications, of RAM were utilized, with the clinical, anatomical, and functional outcomes being analyzed retrospectively. <p>RESULTS: Visual prognosis and its efficacy were due to the scope and location of exudation or heamorrhage, disease duration and treatments employed. Hemorrhagic RAM, edema or hemorrhage affecting the macular region and long disease duration associated with poor prognosis. Vitrectomy with subretinal air tamponade had strong functional and anatomical effects on submacular haemorrhages within 3wk. <p>CONCLUSION: A suitable, individually adapted treatment of retinal arterial macroaneurysm should be chosen to achieve better prognosis.
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@#AIM: To compare the clinical efficacy and safty of 25G and 27G pars planavitrectomy(PPV)in the treatment of rhegmatogenous retinal detachment(RRD)with air tamponade.<p>METHODS: Sixty-three cases(63 eyes)with RRD underwent 27G or 25G PPV from May 2016 to June 2018 were retrospectively reviewed. Thirty-three eyes(33 eyes)for 25G vitrectomy and 30 eyes underwent 27G vitrectomy. The main outcome measurements of the study included the best corrected visual acuity(BCVA, LogMAR), intraocular pressure, surgicaltime, retinal reattachment rate, intraoperative and postoperative complications.<p>RESULTS: There were no significant differences in baseline demographic between the two groups(<i>P</i>>0.05). The BCVA was increased significantly in both groups(all <i>P</i><0.01), but there was no significant difference in terms of visual improvement between the two groups(<i>P</i>>0.05). The mean surgical time in the 25G group was(44.13±5.9)min, which was no significant difference than that of 27G group(46.07±6.1)min(<i>t</i>=0.028, <i>P</i>=0.412). The retinal reattachment rate after a single operation was 91% and 93% for 25G and 27G group respectively(χSymbolr@@=0.015, <i>P</i>=0.902). There was no significant difference about hypotony(<6mmHg, 1mmHg=0.133kPa)between the 25G group(15%)and the 27G group(10%),(χSymbolr@@=0.376, <i>P</i>=0.540). No serious complication such as choroidal detachment and endophthalmitis was observed in both groups.<p>CONCLUSION: This study finds no significant differences in the surgical time, the rate of reattachment of retina, improvement of BCVA and complications between the 25G or 27G vitrectomy for rhegmatogenous retinal detachment with air tamponade. 27G vitrectomy with air tamponade seems to be a safe, economical and effective surgery for RRD.
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·AIM:To compare the effectiveness of inverted internal limiting membrane flap ( ILMF) coverage combined with sterile air tamponade or C3F8-filled surgery for idiopathic macular hole (IMH). ·METHODS: In this retrospective study, 165 patients (175 eyes) who underwent pars plana vitrectomy ( PPV) combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air (Group A) and C3F8-filled (Group B) groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity ( BCVA ), macular hole closure rate, and major postoperative complications were analyzed. · RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively ( P< 0. 05 ). There was no significant difference between the two groups 1mo postoperatively, but the average BCVA in Group A was better than that in Group B at 3mo, to a level of statistical significance ( P<0. 05). The closure rate of macular hole was 97. 5% in Group A and 96. 8% in Group B, a statistically non-significant difference. There were no statistically significant differences in defect diameters of the inner and outer junctions between the two groups at 1 and 3mo postoperatively(P<0. 05), but significant differences compared to before surgery in both groups (P<0. 05). The rate of IOP elevation was 9. 5% in Group B, and zero ( 0 ) in Group A; this difference was statistically significant (P<0. 05). ·CONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C3F8-filling, sterile air tamponade can avoid IOP elevation; it may replace C3F8-filling in PPV for IMH.
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Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD).Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery,1 week and 3 months after surgery.The operative duration,sclerotomy sites,retinal reattachment rate,intraoperative and postoperative complications were recorded.Results The mean duration of vitreous removal was (15.3 ± 3.6) minutes,and the mean duration of operation was (34.5 ± 4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100％.The mean BCVA was significantly different among before surgery,1 week and 3 months after surgery (F =64.12,P＜0.01),and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs.1.01 ±0.40;0.68±0.30 vs.1.01 ±0.40) (both at P＜0.05).The mean IOP was (14.69±3.66),(17.37±2.32) and (16.69±2.45) mmHg (1 mmHg =0.133 kPa) before surgery,1 week and 3 months after surgery,showing a significant difference among them (F=14.82,P＜0.01),and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P＜0.05).The complications included intraoperative iatrogenic retinal breaks in 2 eyes,postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable.Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach.
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·AIM: To compare the treatment efficacy of vitrectomy with macular epiretinal membrane ( MEM ) peeling combined with or without air tamponade for idiopathic macular epiretinal membranes( IMEM) .·METHODS: Forty-two cases of IMEM patients ( 46 eyes ) associated with cataract were randomly divided into two groups. Twenty-five eyes of 23 cases in Group A were performed with vitrectomy with macular epiretinal membrane peeling combined with air tamponade. The other 21 eyes of 19 cases in Group B only underwent vitrectomy and macular epiretinal membrane peeling ( without air tamponade ) . The visual acuity and central macular thickness ( CMT ) were compared between the two groups before and after the surgery. The intraoperative and postoperative complications were also observed in both groups in the mean time.· RESULTS: There was no statistical significant difference between two groups in age, visual acuity and CMT before operation (P>0. 05). By 1wk, 3 and 6mo follow-up after operation, mean visual acuity improved significantly; mean CMT decreased obviously in both groups after the operation and the difference was statistically significant (P<0. 05). But for mean visual acuity and CMT, there were not statistically significant difference between two groups postoperatively at the same time(P>0. 05),there was no correlation between postoperative mean visual acuity and CMT in the two groups. No serious complications occurred during and after operation.· CONCLUSION: Vitrectomy with macular epiretinal membrane peeling can be a safe and effective treatment for IMEM, meanwhile air tamponade in vitreous cavity does not reveal more advantages in the treatment.
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AIM: To evaluate the anatomic and visual outcomes of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic macular hole (IMH).METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study.All patients underwent 25-gauge pars plana vitrectomy (PPV) combined with phacoemulsification and air tamponade.Best corrected visual acuity (BCVA, logMAR), perimetry and multifocal electroretinography (mfERG) were conducted before and after the operation.Anatomical changes were evaluated with optical coherence tomography (OCT).RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy.The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively (P<0.001).In the visual field of central 10°, the average mean deviation (MD) decreased from-3.59±1.83 dB preoperatively to-2.51±1.36 dB postoperatively (P<0.001) and the average pattern standard deviation (PSD) decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively (P=0.001).The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly (P<0.05).The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA (P<0.001, P=0.001, respectively).CONCLUSION: The 25-gauge PPV and air tamponade with 1 day prone positioning produce favorable anatomic and functional outcomes.
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AIM: To compare the efficacy of vitrectomy combined with internal limiting membrane peeling and C3F8 or sterile air tamponade for idiopathic macular hole (IMH).METHODS: In this research, 51 cases of IMH with holes diameter ≤600μm were accepted from the same doctor of department of Ophthalmology in Luoyang Central Hospital from January 2011 to January 2016.All the patients were under taken vitrectomy combined with internal limiting membrane peeling and gas tamponade.All the study subjects were divided into two groups (Group A and Group B).The Group A were tamponaded with perfluoropropane(C3F8)(27 eyes), while the Group B were tamponaded with sterile air (24 eyes).The closure rate and morphology of macular hole, the time of prone position, the best corrected visual acuity(BCVA), the improvement of metamorphopsia and the process of cataract were compared and statically analyzed in these two groups.While the closure rate was compared among ≤200μm, >200-400μm and >400-600μm groups.Postoperative followup time was 1wk, 1, 3mo and half a year.RESULTS: The difference of two groups was no statistically significant in all interval according to holes diameter (P>0.05).The difference of two groups was no statistically significant in morphology of macular hole form(P>0.05).The time of prone position in Group B was significantly shorter than that in Group A, and the difference was statistically significant(P0.05).The metamorphopsia of postoperative was improved than preoperative in two groups while there was not statistically significant between the two groups in the BCVA of postoperative(P>0.05).Cataract progress rate was reduced in the Group B than the Group A, but the difference was not statistically significant(P>0.05).CONCLUSION: This study shows that sterile air tamponade can obtain same closure rate, morphology of macular hole and the improvement of metamorphopsia and visual function in holes diameter ≤600μm when reducing the time of prone position and the risk of systemic diseases induced by prone position after operation.
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PURPOSE: In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after receiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole. METHODS: This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I assumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared between the 2 groups 6 months postoperatively. RESULTS: The preoperative mean macular hole size was 456.2 +/- 164.1 microm in Group I and 411.2 +/- 105.7 microm in Group II and the differences between the 2 groups were not statistically significant (p = 0.647). At 6 months after surgery, the macular hole closure rate was 93% in Group I and 100% in Group II (p = 0.571) and the BCVA (log MAR) was 0.82 +/- 0.29 preoperatively and 0.92 +/- 0.35 postoperatively in Group I and 0.71 +/- 0.39 and 0.97 +/- 0.33 in Group II, respectively. The differences between the 2 groups (p = 0.09, p = 0.058) were not statistically significant (p = 0.809, p = 0.267). CONCLUSIONS: There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in patients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.
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Humans , Membranes , Retinal Perforations , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To evaluate the surgical outcomes of primary 23-gauge (23G) transconjunctival sutureless vitrectomy (TSV) with air tamponade in patients with idiopathic simple rhegmatogenous retinal detachment (RRD). METHODS: A chart review of 38 eyes with idiopathic simple RRD which underwent primary 23G TSV with air tamponade and without prone positioning by a single vitreoretinal surgeon was retrospectively performed. All cases were followed up for a minimum of 3 months after the operation. RESULTS: The primary anatomical success rate was 94.7% (36/38 eyes). Preoperative mean logMAR (Snellen) best corrected visual acuity (BCVA) was 0.81 +/- 0.13 and improved to 0.63 +/- 0.37 and 0.48 +/- 0.37 at postoperative 1 week and 3 months (p < 0.05), respectively. The mean 21.35% amount of air bubble remained in the vitreous cavity at postoperative 1 week and the residual air bubble was completely absorbed at postoperative 2 weeks. Complications were sclerotomy site leakage (1 eye), cataract (3 eyes), vitreous hemorrhage (1 eye), epiretinal membrane (2 eyes) and increased intraocular pressure (3 eyes). CONCLUSIONS: The use of 23G TSV with air tamponade in cases with idiopathic simple RRD may be an effective and safe surgical technique.