Analysis of Ganglion Cell-Inner Plexiform Layer Thickness after Internal Limiting Membrane Peeling

PURPOSE: To evaluate the ganglion cell-inner plexiform layer (GCIPL) thickness after internal limiting membrane (ILM) peeling with or without intravitreal gas injection (IVGI) or surgical induction of posterior vitreous detachment (PVD). METHODS: Eighty patients who were diagnosed with epiretinal membrane (ERM) or macular hole and who received surgical intervention were retrospectively reviewed. Forty patients were treated with ILM peeling and forty patients were treated with ERM removal, but not with ILM peeling. The patients were categorized according to ILM peeling, IVGI, and surgical induction of PVD. The GCIPL thickness was measured using optical coherence tomography, and the average and sectorial thickness of GCIPL were compared. RESULTS: The GCIPL thickness in the ILM peeling group significantly decreased (-13.80 ± 22.63 µm; p < 0.001), but was not significantly different in the ERM removal without ILM peeling group, compared with the preoperative GCIPL thickness (+1.21 ± 22.53 µm; p = 0.546). The difference was statistically significant between the two groups (p = 0.038). In the ILM peeling group, GCIPL thickness was not significantly different in the IVGI group (-17.41 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.109) and was significantly decreased in the surgical induction of the PVD group (-23.06 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.020). On sectorial analysis, reduction of the temporal GCIPL thickness was the largest and was significantly different compared with the nasal GCIPL thickness in ILM peeling group (-19.73 ± 28.55 µm vs. -7.42 ± 19.90 µm; p = 0.005). CONCLUSIONS: ILM peeling and surgical induction of PVD may damage ganglion cells. Therefore, gentle ILM peeling and surgical induction of PVD may be needed to minimize ganglion cell damage, especially when ILM peeling is performed in glaucomatous patients.

Treatment of primary rhegmatogenous retinaldetachment with cryopexy in combination with intravitravitreal injection of expending gas / 实用医学杂志

Objective To demonstrate the visual results and complications of an cryopexy in combination with intravitreal injection of expending gas in the therapy of primary rhegmatogenous retinaldetachment (RRD). Methods Thirty-two cases (32 eyes) were retrospectively reviewed in this study. The RRD diagnosis was confirmed by best corrected visual acuity,slit-lamp microscope,indirected ophthalmoscope and Goldman three-mirror contact lens. All patients had undergone cryopexy with intravitreal gas injection and assisted by correct body position. Patients were followed for 6 to 24 months. Post-operative BCVA,final anatomical outcome, complications and failed cases were analyzed. Results The reattachment rate of cryopexy with intravitreal gas injection was 81%(26/32 eyes). Four eyes required additional scleral buckling. Two eyes needed additional vitrectomy with intravitreal injection of expending gas (SF6).Final retinal reattachment was achieved in all 32 subjects (100%). Postoperative BCVA was significantly improved (P < 0.01). Conclusion Cryopexy with intravitreal gas injection is a simple,less trauma, lower cost and effective surgery for primary rhegmatogenous retinaldetachment.

Treatment of Hypotony Maculopathy Caused by Silicone Oil Removal With Gas Tamponade

PURPOSE: To report a case of hypotony maculopathy after silicon oil removal treated by intravitreal gas injection. CASE SUMMARY: A 35-year-old women presented with decreased visual acuity of the right eye for two weeks. Retinal detachment with peripheral retinal tears was observed in the patient's right eye. Pars plana vitrectomy including lensectomy, endolaser photo-coagulation and silicone oil injection was performed. Silicone oil removal was performed to improve patient's visual acuity two months after the operation. After the silicone oil removal, visual acuity was decreased to hand motion, and intraocular pressure was decreased below 3 mmHg while observing chorioretinal folding in fundus for two months. Intraviteal C3F8 gas injections were performed three times in the two months after silicone oil removal. After three gas injections, gradual reduction of chorioretinal folding was observed. Visual acuity was improved to 0.2 and IOP was maintained at 8 to 10 mmHg for 18 months after the last gas injection. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method for treating hypotony retinopathy after silicon oil removal.

Treatment of Hypotony Retinopathy with Cyclodialysis Cleft by Intravitreal Gas Injection

PURPOSE: We report a case of post-traumatic hypotony retinopathy with cyclodialysis cleft treated by intravitreal gas injection. METHODS: A 38-year-old man presented with decreased visual acuity after blunt trauma to the left eye. Visual acuity of the left eye was 0.06 and intraocular pressure was 1 mmHg. No external wound was found. The anterior chamber showed a microscopic hyphema and, upon funduscopic examination, mild macular edema and striae were seen. The cyclodialysis was identified using gonioscopy. We treated the patient with intravitreal gas (perfluoropropane, C3F8) injection under topical anesthesia and tracked the outcome of this treatment. RESULTS: On the first postoperative day, intraocular pressure fell to the normal range. After 7 days the visual acuity improved to 1.0. During a follow-up period of 10 months, intraocular pressure and visual acuity remained in their normal range. CONCLUSIONS: Intravitreal gas injection offers a safe and effective method of treating hypotony retinopathy with cyclodialysis cleft.

Effect of Intravitreal Gas Injection in Retinal Detachment Assiciated with Macular Hole: Long Term Follow-up

In 11(64.7%) of 17 eyes treated by intravitreal gas injection, the retinas were successfully attached during follow-up period that ranged from 12 to 39 months. Group I(detachment limited to the perimaculararea) patients need more frequent gas injection than group II(detachment extending to equator), but success rate of group I(83.3%) is higher than group II(66.7%). Group III(detachment with peripheral retinal break) patients are not successful by gas injection only. In the succesful eyes, macular holes are not visible, but "window defects" are present on FAG. The relative scotomas improve. Recurrent detachment cases(31.3%) are associated with posterior staphyloma, peripheral retinal break and trauma. Time of late recurrences ranged from 4 to 13 months postoperatively(mean: 7 months).

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Treatment of Retinal Detachment with Macular Hole: Paracentesis, Subretinal Fluid Drainage and Intravitreal Gas Injection

Six patients with macular hole and retinal detachment and no visible vitreoretinal connection examined by slitlamp and 3-mirror contact lens were treated by two methods. In two patients with relatively localized retinal detachment in central fundus, 0.7ml or more of pure SF6 gas was injected into vitreous cavity by 27 gauge needle after paracentesis was done because of keeping the large space of gas injection as preventmg the increase of lOP. In the remained 4 patients, 1.2ml or more of pure SF6 gas was injected into vitreous cavity after the subretinal fluid was released externally, and then paracentesis was done because of preventing the increase of lOP. After operation, all patients were placed in prone position for 6 hours or more in a day. In 5 of 6 patients, the retina remained attached duing more than 6 months. Even if 2 with posterior staphyloma in 6 patients were treated with two or more operations, 1 patient was failed. Although visual improvement at 6 months after operation was limited due to macular degeneration, the visual acuity were above 0.05 in 3 patients. This operation is simple and safe and not damaged en macula. This procedure is good surgical method in patients with retinal detachment wirh macular hole but without other breaks or visible vitreous adhesion or posterior staphyloma.

Treatment of Retinal Detachment With Macular Hole: drainage of subretinal fluid and intravitreal gas injection

Four cases of retinal detachment with macular hole and no posterior vitreoretinal connections were treated successfully by draining subretinal fluid externally, injecting sulfur hexafluoride gas into the vitreous cavity, and then keeping the patient in a prone position. And in all four cases, the retina remained attached during follow-up periods of 6 months or longer. This approach is simple, easy, and safe. Moreover, it brings good functional success because the macula is preserved. This approach must be the treatment of choice in retinal detachments with macular hole but without other breaks or vitreous adhesion.