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@#AIM:The repair of macular structure after 23G vitrectomy was performed in patients with idiopathic macular hole, and the changes of retinal thickness in vision and macular area were analyzed.<p>METHODS: A total of 85 patients(85 eyes)with monocular idiopathic macular hole who underwent elective surgery in our hospital from June 2016 to December 2017 were included in the study, of which 37 were male and 48 were female, with an average age of(64.7±10.1)years. All subjects underwent 23G vitrectomy were observed the closure of macular hole after operation, and the changes of retinal thickness in macular forea were observed preoperatively and postoperatively by optical coherence tomography(OCT). To observe the changes of the best corrected visual acuity(BCVA)in preoperative, 1mo, 3mo and 6mo after operation.<p>RESULTS: All subjects underwent postoperative examinations had good macular hole closure. The average BCVA of 3mo and 6mo after operation were significantly higher than that of preoperative and 1mo after operation(<i>P</i><0.05); the average BCVA in 6mo after operation was significantly higher than the average BCVA of 6mo after operation, with statistically significant differences(<i>t</i>=7.983, <i>P</i>=0.037). The macular central fovea thickness in 1mo after operation was significantly higher than preoperative and 3mo, 6mo after operation(<i>P</i><0.05); The retinal thickness of the macular fovea thickness in 3mo and 6mo after operation were significantly lower than that of preoperative.<p>CONCLUSION:The treatment of idiopathic macular hole with 23G vitrectomy had a high degree of successful closure rate of fracture hole and the visual acuity of patients was obviously improved.
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@#Glucocorticoid as adjunctive drug before and after the surgery for retinal detachment associated with choroidal detachment. It has obvious effects in controlling inflammation and improving choroidal detachment, which creates favorable conditions for the operation. However, the ophthalmologists have different opinions on the effects of postoperative retinal reattachment rate and improvement of visual function. There has been controversy about whether to use hormones before surgery, the time of use and the way they are used. This article will review the relevant knowledge. In order to provide a more accurate and feasible reference for clinical treatment.
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Purpose: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). Methods: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. Results: Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ?5 when circumferential sclerotomies were used. Conclusion: Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.
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·AIM: To discuss the curative effect of extra-panretinal photocoagulation on proliferative diabetic retinopathy (PDR) during vitreous operation. ·METHODS:We conducted a retrospective analysis of 70 diabetic retinopathy patients (70 eyes) who accepted vitreous surgery in our hospital due to vitreous hemorrhage or vitreous retina traction change from March 2011 to March 2013. In follow-up clinics, according to the difference of patient's retinal photo-coagulation range, we divided it into extra - panretinal photocoagulation group (40 patients) and panretinal photocoagulation (30 patients),respectively observed the best corrected visual acuity,intraocular pressure and retinal vessel changes in two groups and made statistical analysis. ·RESULTS:Through comparing the eye condition,visual acuity after 3mo, intraocular pressure between the two groups patients, the difference had no statistical significance (all of the P>0.05). Comparing the incidence of retinal blood vessel leak, posterior pole exudate, and posterior pole bleeding points in two groups patients,the difference had statistically significant (all of the P<0.05). Comparing the incidence of no-perfusion area of retina, prepapillary vascular leak in two groups patients, the difference had statistically significant(P = 0. 04, 0. 02). Comparing the incidence of macular edema in two groups patients after operation,the difference had no statistically significance(P=1.00). Comparing the extinction time of macular edema,the difference had statistically significant (P<0.05), extra-panretinal photocoagulation group was better than panretinal photocoagulation.· CONCLUSION: To cure proliferation diabetic retinopathy, adopting the extra - panretinal photocoagulation has a better curative effect than panretinal photocoagulation on curing no-perfusion area of retina, retinal blood vessel leak, prepapillary vascular leak in operation on vitreous. However, the excessive retinal photocoagulation has a clear damage on retina and choroid. Therefore, in the treatment, while covering the retinopathy as far as possible, it is important to master the laser energy and spot number preventing the complications.
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Background Vitreous amyloidosis is an autosomal dominant hereditary disease,often leads to reduction of visual acuity and affects life quality of patients.Vitrectomy is the main treatment for vitreous amyloidosis,but the analysis of curative efficacy in China is rarely reported.Objective The study was to observe and analyze the efficacy of vitrectomy for vitreous amyloidosis.Methods The clinical data of 11 eyes from 6 patients with vitreous amyloidosis who received vitrectomy from March 2011 to February 2013 in Affiliated Hospital of Guizhou Medical University.The best corrected visual acuity (BCVA),intraocular pressure (IOP),manifestations under the slit lamp microscope,findings of ocular fundus and results of fundus fluorescence angiography (FFA) were observed after surgery.Pathological examination for vitreous samples was carried by Congo red staining.Results Before surgery,the visual acuity was counting fingers for 30 cm in 5 eyes and hand movement for 30 cm in 6 eyes,and the mean IOP was (13.09±2.12)mmHg (1 mmHg=0.133 kPa).Fixed white flocks in vitreous and white membrane on the posterior lens capsule were seen under the slit lamp microscope.The BCVA remained 1.0 in 7 eyes and 0.8 in 4 eyes 1 week,6 months and 2 years after vitrectomy,and the mean IOP was (13.32±2.07),(14.09±2.47),(12.32±1.87)mmHg at 1 week,6 months and 2 years after vitrectomy,respectively.FFA showed a little fluorescein leakage at peripheral retinal vessel in all eyes at 1 week after vitrectomy but the leakage disappeared at 6 months after vitrectomy.The white flocks increased at peripheral retina in 4 eyes at 2 years after vitrectomy,but the BCVA remained the same in the eyes.Pathological examination of vitreous specimens comfirmed the diagnosis of vitreous amyloidosis.Conclusions Vitrectomy is an effective method for the treatment of vitreous amyloidosis,which can effectively improve the visual acuity of patients.Postoperative recurrence of vitreous amyloidosis appear in parts of patients,but the BCVA is unaffected.
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AIM: To explore the relationship between different timing of vitreous surgery and prognosis after the open globe injuries. METHODS:Fifty-eight cases (58 eyes) with open globe injuries were chosen in our hospital from June 2011 to June 2013, and randomly divided into observation group and control group to have vitreous surgery in early phase and normal time respectively. Thirty cases ( 30 eyes ) in the observation group were received vitreous surgery during 3d, and 28 cases (28 eyes) in the control group from one to two weeks. The vitreous surgery of two groups of patients were finished by the author herself. The ocular injury before surgery, the effect of surgery treatment and the incidence of complications after surgery of the two groups of patients were compared. RESULTS: The eye damage situation such as lens rupture, vitreous hemorrhage, retinal detachment and corneal laceration of two groups of patients before surgery were no significant statistical difference ( P >0.05). The postoperative therapeutic effect of observation group was better than the control group (χ2=6. 869, P<0.05 ); the postoperative complications of observation group was obviously lower than the control group (P<0. 05). CONCLUSION: The timing of vitreous surgery of patients with open globe injuries correlate with the prognosis, which prompts that better therapeutic effect can be achieved and the occurrence of complications can be reduced in early vitreous surgery of the patients with open globe injuries.
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Purpose: To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23‑gauge transconjunctival sutureless vitrectomy (TSV). Materials and Methods: In this prospective, non‑comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23‑gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any. Results: All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye. Conclusion: The advantages of 23‑gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.
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ObjectiveTo observe the effects of vitrectomy for persistent fetal vasculature (PFV).Methods The clinical data of 11 patients (14 eyes) with PFV, including posterior PFV (one eye) and combined PFV (13 eyes), were retrospectively analyzed. Vitrectomy was performed for all patients,lensectomy was performed for seven eyes, retinotomy was performed for five eyes, retinotomy and scleral buckling was performed for one eye. Intraoperative and postoperative complications were observed. The follow-up period ranged from eight to 74 months, with the mean of 44 months. The visual acuity (VA) and intraocular pressure before and after surgery were comparatively analyzed. Results There were no intraoperative complications in all the patients. The surgery was performed successfully in 12 eyes (86.0 %)and failed in two eyes (14. 0%). The postoperative VA of five eyes (35.7%) increased, four eyes (28. 6%)didn't change and five eyes (35.7%) decreased. The postoperative intraocular pressure of two eyes (14. 3%) increased, 11 eyes (78. 6%) didn't change and one eye (7. 1%) decreased. There was one eye with persistent hypotension and one eye with recurrent retinal detachment after surgery. Conclusion Vitrectomy can prevent complications and improve visual acuity in some PFV patients.
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Macular pucker describes minute radiating retinal folds and a preretinal membrane in the macular area. Macular pucker can cause reduced central vision and metamorphopsia. In this study, vitreous surgery is used to remove epiretinal membrane in 21 eyes (21 patients) with macular pucker. In order of the decreasing frequency, the causes of macular pucker were uveitis (9 eyes, 429%). trauma (5 eyes). idiopathic (4 eyes), retinal detachment (2 eyes) and retinal vascular disorder (1 eye). The results were as follows: 1. Preoperative visual acuity was 0.2 (40/200) or higher in 6 cases (28.6%). Postoperative visual acuity was 0.2 (40/200) or higher in 16 cases (76.2%). 2. The visual acuity was improved in 18 cases (85.7%) after surgery. 3. The eyes with final visual acuity of 0.1 (20/200) or less had severe preexisting macular damage such as degeneration or edema.
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Edema , Membrana Epirretinal , Membranas , Desprendimiento de Retina , Retinaldehído , Uveítis , Trastornos de la Visión , Agudeza VisualRESUMEN
Intraocular hemorrhage is a major problem during the vitreous surgery, despite of improvements in instrumentation and operative methods. Infusion of thrombin has been reported as an efficacious method of control of intraocular hemorrhage in various vitreous surgery. In this study, 100 U/ml diluted thrombin was injected through the infusion system of Grieshaber manipulator into the vitrous cavity on the bleeding site instead of adding to the infusion solution in 10 cases of vitreous surgery including proliferative diabetic retinopathy, posttraumatic advanced proliferative vitreoretinopathy and giant retinal tear. As the result, all cases of intraocular hemorrhage were controlled within 2 min utes after the injection of thrombin, with the combined use of intraocular diathermy or elevation of intraoclar pressure. The amount of diluted thrombin which was injected in concentration of 100 U/ml, was less than 5ml. The 6 cases of postop erative complication were noted, including 2 cases of vitreous hemorrhage and 4 cases of hypopyon which were controlled within 5 days with topical steroid therapy.