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Objective:To evaluate the efficacy of scleral buckling in the treatment of retinal detachment (RD) secondary to familial exudative vitreoretinopathy (FEVR).Methods:An observational case series study was conducted.A total of 37 patients (42 eyes) of RD secondary to FEVR who were treated with scleral buckling in Beijing Tongren Hospital from July 2010 to March 2021 were enrolled.There were 30 males (35 eyes) and 7 females (7 eyes), with an average age of (15.21±5.42) years old.Scleral buckling under general anesthesia was performed in all patients.There were 22 eyes with rhegmatogenous RD (RRD), of which 21 eyes were treated with local external compression combined with cerclage, and 1 eye was treated with radial spinal compression.There were 13 eyes with tractive RD (TRD), of which 12 eyes were treated with local external compression combined with cerclage and subretinal fluid drainage, and 1 eye was treated with scleral buckling combined with vitrectomy.There were 7 eyes with RRD combined with TRD, of which 4 eyes were treated with local external compression combined with cerclage and subretinal fluid drainage, and 3 eyes were treated with scleral buckling combined with vitrectomy.The average follow-up time was (30.61±10.50) months.The main outcomes were best corrected visual acuity (BCVA) of the operated eye converted to the logarithm of the minimum angle of resolution, retinal reattachment rate, and incidence of complications.The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2018-056-GZ[2022]-07). Written informed consent was obtained from each subject or their guardians before entering the cohort.Results:The average BCVA was 0.83±0.50 at last follow-up after surgery which was better than 1.10±0.39 before surgery, and the difference was statistically significant ( t=6.639, P<0.001). There were 39 eyes with retinal reattachment and 3 eyes without retinal reattachment.The reattachment rate was 95.45%(21/22) in RRD, 84.62%(11/13) in TRD, and 100%(7/7) in RRD combined with TRD.No serious complication occurred in any patients during postoperative follow-up. Conclusions:On the premise of optimized surgical strategy based on the indications of RD secondary to FEVR, scleral buckling has a high retinal reattachment rate in the treatment of RD secondary to FEVR.
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@#AIM: To compare the efficacy of air versus silicone oil tamponade for management of rhegmatogenous retinal detachment(RRD)following 25G pars plana vitrectomy(PPV).<p>METHODS: A prospective, randomized comparative study. 146 eyes from 146 patients who underwent 25G transconjunctival sutureless vitrectomy to repair rhegmatogenous retinal detachment were performed. Totally 60 eyes used air tamponade but 86 eyes used silicone oil tamponade. The follow-up time ranged from 6-12mo. The best corrected visual acuity(LogMAR), intraocular pressure, retinal reattachment rate, intraoperative and postoperative complications were compared.<p>RESULTS: One month after surgery, the mean BCVA was 0.45±0.5 in the air tamponade group and 0.78±0.65 in the silicone oil tamponade group, it were both evidently improved in comparison with before surgery, what's more, air tamponade had significantly better BCVA than those in the silicone oil tamponade(both <i>P</i><0.05). 3mo after surgery, the reattachment rate of patients in air group was lower than that of silicone oil group(93.3% <i>vs</i> 97.7%), but had no significant differences between the two groups. 6mo after surgery, the anatomical success rate were 100% in both groups. The main intraoperative complication was iatrgenic retinal breaks in 10 eyes(6.8%). The main postoperative complication was high intraocular pressure, the intraocular pressure 1wk after surgery in the silicone oil tamponade group was evidently higher than that air tamponade group(<i>P</i><0.001). No serious complication such as endophthalmitis and choroidal hemorrhage were observed in both groups.<p>CONCLUSION: For the simple early RRD, air tamponade had equivalent reattachment rate to silicone oil tamponade after 25G PPV. In the early postoperative, the visual acuity of air group was better comparing with silicone oil group, and was lower incidence of high intraocular pressure.
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@#AIM:To study the clinical efficacy of phase Ⅱ minimally invasive vitreous surgery in different stages in treatment of open ocular trauma with retinal detachment.<p>METHODS: A retrospective analysis was performed on 41 patients(41 eyes)with open eye trauma combined with retinal detachment from December 2013 to June 2018 in the Ophthalmology Department of Xiaolan People's Hospital of Zhongshan. According to the opportunity of phase Ⅱ vitrectomy, 41 eyes were divided into two groups: 24 eyes in the early group(6d after injury)and 17 eyes in the conventional group(7-14d after injury). Postoperative follow-up with 6mo as the time point, the retinal reattachment rate, TPVR incidence, visual acuity and complications were compared between the two groups.<p>RESULTS: The retinal reduction rate was 92% in the early group and 76% in the conventional group, and the difference was not statistically significant, there was no statistical difference(<i>P</i>=0.692)in retinal reduction rate between the two groups. The incidence of TPVR in the early group was lower than that in the conventional group(<i>P</i>=0.014). The improvement of postoperative visual acuity in early group was better than the conventional group(<i>U</i>=119.5,<i> P</i>=0.0018). There was no significant difference in complications between the two groups.<p>CONCLUSION: Open ocular trauma patients with retinal detachment have better prognosis after phase Ⅱ vitrectomy within 6d after injury than 7-14d.
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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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PURPOSE: Strabismus can occur after retinal reattachment surgery with scleral buckling (SB). We performed surgical treatment of a large-angle esotropia after SB without buckle removal and achieved good surgical outcome. CASE SUMMARY: A 21-year-male revisited our clinic for surgical treatment of esotropia. He had cicatricial retinopathy of prematurity in the right eye, and retinal detachment developed when he was 4 years old. Retinal reattachment surgery was performed with a 360-degree encircling band, a radial buckle at the 8 o'clock position, and a circumferential buckle ranging from the 7 to 11 o'clock position. He was not available for follow-up 2 years after surgery due to a change of residence, but exhibited a 5 prism diopters (PD) esotropia at the last visit. He demonstrated 55 PD esotropia of the right eye in the primary position with limited abduction. Surgery was performed without buckle removal, as recommended by a retinal specialist. Under general anesthesia, a forced duction test revealed a restriction of the medial rectus of the right eye. Exploration showed extensive adhesions around both the medial and lateral rectus with the buckle. Careful adhesiolysis and dissection were performed. A 8-mm resection of the lateral rectus and a 6-mm recession of the medial rectus were performed. The patient demonstrated favorable ocular alignment, and the limited abduction of the right eye improved after surgery. CONCLUSIONS: We report a case of surgical treatment of a large-angle esotropia after SB without buckle removal. This case can be helpful for surgeons planning the treatment of strabismus in patients who had undergone SB.
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Humans , Anesthesia, General , Esotropia , Follow-Up Studies , Retinal Detachment , Retinaldehyde , Retinopathy of Prematurity , Scleral Buckling , Specialization , Strabismus , SurgeonsABSTRACT
·AIM:To investigate the efficacy and safety of minimally invasive vitrectomy with 23G and 25G+ in the treatment of rhegmatogenous retinal detachment.·METHODS:From August 2015 to August 2016, 130 cases of rhegmatogenous retinal detachment patients were chosen as the research object. According to the random number table method, 130 patients were divided into experimental group and control group, 65 cases in each group. The experimental group received 25G+ minimally invasive vitrectomy, the control group was given 23G minimally invasive vitrectomy. The operation time, complication rate, retinal reattachment, visual acuity, intraocular pressure and postoperative complications were compared between the two groups.·RESULTS:The operative time was 69 ± 11min in control group and 66±12min in the experimental group (P>0. 05). The experimental group had 3 cases of iatrogenic retinal breaks, intraoperative complication rate was 4. 6%, the control group of 5 cases of iatrogenic retinal breaks during the operation, the complication rate was 7. 7% (P>0. 05). The experimental group disposable retinal reattachment rate was 96. 9%, the final reduction rate was 90. 8%; the control group disposable retinal reattachment rate was 93. 9%, the final reduction rate was 87. 7%, those differences between the experimental group and the control group were no significant (P>0. 05). At the end of the follow-up visual acuity of experimental group was logMAR 0. 241 ± 0. 062, control group 0. 253 ± 0. 057,significantly different compared with before treatment ( P<0. 05), while not different between the two groups (P>0. 05). intraocular pressure of the two groups were not significantly different before and after surgery (P>0. 05). The complication rate was 44. 6% after operation in the experimental group, the complication rate was 63. 1% in control group (P<0. 05).·CONCLUSION:The 25G+ minimally invasive vitrectomy in the treatment of rhegmatogenous retinal detachment is safe and effective, less operative trauma, rapid postoperative recovery, less postoperative complications compared with 23G vitrectomy.
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@#AIM: To compare the effect of pars plana vitrectomy(PPV)combined with internal limiting membrane peeling(ILMP)for macular hole retinal detachment(MHRD).<p>METHODS: Totally 78 patients with MHRD from December 2013 to December 2015 in our hospital were randomly divided into control group(39 patients 43 eyes)and experimental group(39 patients 40 eyes). The control group was treated with PPV, experimental group with PPV combined with ILMP. We observed the therapeutic effect and recorded the occurrence of postoperative complications. After 6mo follow-up, the vision improvement of the two groups were compared as the average of the best corrected visual acuity(BCVA)before and at 3, 6mo after surgery. <p>RESULTS: The reattachment rate of experimental group was 92%(37/40)with significant difference compared with control group(<i>χ</i><sup>2</sup>=6.882, <i>P</i>=0.009). The improvement of visual acuity in the experimental group was better than that in the control group(<i>χ</i><sup>2</sup>=14.216, <i>P</i><0.001). The postoperative BCVA of the experimental group at 3 and 6mo was significantly higher than that of the control group(<i>t</i>=7.119, <i>P</i><0.001; <i>t</i>=10.573, <i>P</i><0.001). There were less patients with the situation of increased intraocular pressure and visual field defect(<i>χ</i><sup>2</sup>=11.323, <i>P</i>=0.001; <i>χ</i><sup>2</sup>=8.573, <i>P</i>=0.003). The lens opacity occurrence rate had not significantly changed(<i>χ</i><sup>2</sup>=1.835, <i>P</i>=0.176).<p>CONCLUSION: MHRD patients treated with PPV combined with ILMP recovered better and the incidence of complications was lower. It can improve the patient's retinal restoration effect more.
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Objective To explore the design and application of the multifunctional treatment beds on patients′ position compliance and comfort after intraocular retinal reattachment surgery. Methods Eighty-six patients needing special position nursing after intraocular retinal reattachment surgery were randomly divided into experiment and control groups. The former received the special multifunction treatment beds while normal ward beds were used for the control patients . The position compliance , comfort and the complications were observed one month after surgery. Result The position compliance and the degree of comfort in the experiment group were significantly better than those in the control group and the complication rate was significantly lower than that of the control group (all P<0.05). Conclusion The special multifunction treatment beds can be effective in increasing the patients compliance in positions and compliance as well as reducing postoperative complications and increasing the operation success rate.
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A retrospective study was performed in 180 eyes (173 patients) with rhegmatogenous retinal detachment which underwent primary scleral buckling operations. One hundred and sixteen patients (67.1 %) were men. The most common age group was the seventh decade (34 patients, 19.6%). Moderate- to high- degree myopia were the most numerous (65 eyes, 38.0%) as the associated ocular findings and the peripheral retinal degenerations were next (44 eyes. 257%). One hundred and fifty eyes had retinal breaks preoperatively, 129 eyes (76.8%) had breaks distributed in the superior and/or inferior temporal quadrants, 84 eyes (56.0%) had breaks located in the equator and 82 eyes (54.7%) had atrophic holes. Among 180 eyes studied, 141 eyes (78.3%) achieved retinal reattachment by primary scleral buckling operations. Preoperative and/or postoperative proliferative vitreoretinopathy as causes of failure were presented in 18 eyes. Ten eyes had intraocular hemorrhage as intraoperative complications and the other 10 eyes developed cataract as postoperative ones. Fourty-seven eyes (33.3%) had corrected visual acuity below 0.1 in spite of successful retinal reattachment and 23 eyes had macular degenerations as the most common causes of poor vision.