Scleral buckling with chandelier illumination system in rhegmatogenous retinal detachment surgery: a large case series / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate advantages of chandelier illumination system during scleral buckling(SB)procedures for rhegmatogenous retinal detachment(RRD)surgery. <p>METHODS: In this comparative, retrospective study, data of 72 eyes of 72 patients undergoing SB for RRD at Minerva Hospital(Santa Maria Capua Vetere, Italy), divided in 2 groups of 36 eyes each were collected. In one group(group A)eyes underwent SB with chandelier, in the other one(group B)eyes underwent SB without using chandelier illumination system. Every eye of both groups was checked before surgery and at 1, 3, 7, 14, 30, 90 and 180d follow up. Parameters such as additional procedures, best spectacles visual acuity(BSVA)(measured with Snellen Lines as decimal fraction), surgical time and retinal breaks recurrences had been analyzed before and after surgery and statistical comparison have been run between two groups.<p>RESULTS: A significant(<i>P</i><0.01)improvement in BSVA was observed at 6mo follow up in both groups; comparing groups A and B, no significant clinical differences was found in recurrences rate whereas mean surgical time in group A was statistically lower than the group B ones. <p>CONCLUSION: According to results observed, even if they need to be confirmed in further studies with larger population, chandelier illumination system could be considered a valuable tool for SB surgery in eyes affected by RRD.

A Case of Silicone Band Migration Following an Encircling Procedure

PURPOSE: In the present study, a case of silicone band migration following an encircling procedure was reported. CASE SUMMARY: A seven-year-old male was admitted to our hospital after undergoing primary corneal suture and cataract extraction for traumatic corneal laceration and cataract in the left eye at another hospital. The cornea was well sutured, but due to vitreous bleeding and retinal detachment, we performed vitrectomy and silicone oil injection in combination with scleral buckling. The retina was well attached for 7 months following the procedure but the silicone oil was removed due to uncontrolled intraocular pressure elevation. Ten days later, the patient was readmitted for blurred vision in the left eye and vitreous bleeding as well as superotemporal retinal detachment were observed. During vitrectomy, we could not locate the indentation caused by scleral buckle, therefore extraocular area was closely examined. The scleral fixation sutures were well maintained in all 4 quadrants but the silicone band was not observed within the sutures. The band was located anterior to the fixation sutures and was displaced anterior to the medial rectus muscle insertion. The encircling silicone band was removed. The encircling procedure was again performed with a new silicone band combined with vitrectomy and silicone oil injection. Retinal attachment has been maintained and the silicone band well anchored since the operation. CONCLUSIONS: Anterior migration of the silicone band through the outer layer of the sclera or one or more tendons of recti muscles is a rare but potential complication of scleral buckling. Hence, clinicians must note the possibility of this complication when retinal detachment recurs and the encircling buckle is not observed.

Incidence rate and related factors of intraocular pressure after vitro-retinal surgery for patients with diabetic retinopathy / 局解手术学杂志

Objective To explore the incidence rate and related factors of high intraocular pressure after vitro-retinal surgery for patients with diabetic retinopathy(DRP). Methods The 986 patients(1 326 eyes) with DRP arranged vitro-retinal surgery were studied. The inci-dence rate of intraocular pressure was analyzed between different types,grades,complicated with macular detachment,filled with silicone oil/C3F8,total/supplementary retina photo-coagulation and crystalline lens excision. Results The incidence rate of high intraocular pressure was 27. 8%(368/1 326). The incidence rate of high intraocular pressure of proliferative DRP (34. 0%) was obviously higher than non-pro-liferative DRP (17. 2%)(χ2 =30. 648,P=0. 000),and higher in DRP D grade than B grade(34. 1%,20. 8%)(χ2=8. 834,P=0. 003). The incidence rate of high intraocular pressure of proliferative DRP (34. 0%) was obviously higher in patients complicated with macular de-tachment(30. 4%,22. 7%)(χ2 =8. 834,P=0. 0030). The incidence rate of patients filled with silicone oil/C3F8(39. 1%,24. 0%) (χ2 =28. 088,P=0. 000),total/supplementary retina photo-coagulation(32. 8%,16. 8%) (χ2 =21. 159,P=0. 000),with/without crystal-line lens excision (40. 5%,25. 9%)(χ2=15. 532,P=0. 0001)was different obviously. Conclusion There is a high incidence rate and re-lated factors of high intraocular pressure after vitro-retinal surgery for patients with diabetic retinopathy,and it is related to different DRP types,grades,complicated with macular detachment,filled with silicone oil/C3F8,total/supplementary retina photo-coagulation,crystalline lens excision.

Microperimetría y tomografía de coherencia óptica en operados por cirugía convencional del desprendimiento de retina / Microperimetry and optical coherente tomography in patients operated on by the convencional retinal detachment surgery

Se realizó un estudio descriptivo para determinar la agudeza visual, la microperimetría y la tomografía de coherencia óptica en operados por cirugía convencional de desprendimiento de retina regmatógeno, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer desde octubre de 2006 a marzo de 2007. Se estudiaron 26 pacientes que acudieron con oftalmoscopia y biomicroscopia normal y una evolución entre tres y seis meses. Se obtuvo mejor agudeza visual corregida, fijación, sensibilidad media, morfología y grosores maculares. La agudeza visual media fue de 0,41 y la fijación fue estable en la mayoría de los pacientes, la sensibilidad retiniana promedio fue de 11 decibeles. El hallazgo más frecuente fue el desprendimiento seroso. El grosor macular promedio fue de 246,3 micras. No se encontró relación estadística entre el tiempo de evolución preoperatorio y las características maculares del desprendimiento con respecto a estas pruebas. El estado funcional y anatómico de la retina no estuvo totalmente recobrado y pudiera ser monitorizado gracias a la microperimetría y la tomografía de coherencia óptica.

A descriptive study was made to determine the visual acuity, microperimetry and optical coherence tomography in patients operated on by the conventional rhegmatogenous retinal detachment at Ramon Pando Ferrer Cuban Ophthalmologic Institute from October 2006 to March 2007. Twenty six patients, who had gone to the hospital with normal values in ophthalmoscopy and biomicroscopy and three-six months of disease development. Better corrected visual acuity, fixation, average sensitivity, morphology and macular thickness were obtained after surgery. Average visual acuity was 0,41 and fixation was stable in most of patients; average retinal sensitivity was 11 decibels. The most frequent finding was serum detachment. Average macular thickness was 246,3 micras. There was no statistical relation between preoperative time of disease development and the macular characteristics of detachment in these tests. The functional and anatomic state of the retina was not completely recovered and may be monitored based on microperimtery and optical coherence tomography.

Retinectomy with 360? for severe ocular rupture / 中华眼底病杂志

Objective To investigate the effect of retinectomy 360? for severe ocular rupture and evaluate the related factors associated with prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone Ⅰ in 5 eyes, zone Ⅰ-Ⅱ in 8 eyes,zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes, zone Ⅲ in 7 eyes, zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes and zone Ⅲ in 7 eyes. The presenting visual acuity was in grade 4 (0. 02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360? retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes. Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76. 9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70. 0%) had corrected visual acuity of 0. 02 or more, including 7 (35. 0%) had 0. 05 or more, 3 had 0. 1 or more, and 1 had the best visual acuity of 0. 3. Conclusion Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.

Combined study on the causes of strabismus after the retinal surgery

Extraocular muscle imbalance and diplopia after retina surgery have been previously reported, but the etiology is still controversial. In order to better understand the cause of strabismus after retinal surgery, the authors retrospectively studied 30 patients with persistent strabismus following retinal surgery and combined the result about seven patients of strabismus after retinal surgery in the previous report. Results showed multiple etiologies for the strabismus. Causes of strabismus included fat adherence syndrome (14 patients), non-specific restrictive adhesion (11), displacement of superior oblique tendon (2), scleral explant interfering with ocular motility (1), lost or slipped muscle with adhesion (2), sensory strabismus (2), macular pucker causing ectopic fovea (2), and previous strabismus before the retinal surgery (3). Knowledge of the varieties of abnormalities that can cause strabismus and diplopia will help both the retina and strabismus surgeon prevent and treat strabismus after retinal surgery.

Prevention of complications of vitreo-retinal surgery / 眼科

Vitreo-retinal surgery is one of the effective methods in treating severe vitreoretinopathy.However,there remains great variance in surgical quality,outcomes and success rates among hospitals of different areas in China.This article focuses on how to im- prove in surgical outcomes and success rate as well as to avoid complications of vitreo-retinal surgery.Specific issues are addressed on such as indications and timing of vitreo-retinal surgery,management of pre-operative patients,applications of new appliances and mate- rials,maneuver of surgical techniques and nurturing appropriate habits of surgery.