Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P＜0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) for refractory glaucoma. MethodsTwenty-eight patients (30 eyes) diagnosed with refractory glaucoma were enrolled in this study. The intraocular pressure was ranged from 28 to 55 mmHg (1 mmHg=0.133 kPa), with the mean of (46.3±10.3) mmHg. There were 24 eyes with initial visual acuity <0.05, 1 eye with 0.05-0.08 initial visual acuity and 5 eyes with ≥0.1 initial visual acuity. The mean number of intraocular pressure-decreased drugs was 4. All the eyes underwent PPV combined with ECP. The cyclophotocoagulation ranged from 90°-360°, with the mean of (232.5±77.6)°. The cyclophotocoagulation was <180° in 4 eyes, 180°-270° in 6 eyes, >270° in 20 eyes. The follow-up ranged from 12 to 20 months, with the mean of 15.2 months. The intraocular pressure, vision and the mean number of intraocular pressure-decreased drugs before and after surgery were comparatively observed. The relationship between cyclophotocoagulation area and postoperative intraocular pressure was analyzed. ResultsAt the final follow-up, the intraocular pressure ranged from 12 to 36 mmHg, with the mean of (18.5±4.4) mmHg, which decreased 49.4% compared with preoperative intraocular pressure (t=15.537, P<0.01). Among 30 eyes, the intraocular pressure was ≤21 mmHg without any intraocular pressure-decreased drugs in 24 eyes (80.0%), 1 eye (3.3%) with ≤21 mmHg who treatment by local intraocular pressure-decreased drugs, lose control of intraocular pressure in 5 eyes (16.7%). The vision was <0.05 in 15 eyes, 0.05-0.08 in 3 eyes and ≥0.1 in 12 eyes. The difference of vision distribution before and after surgery was not significant (χ2=6.197, P>0.05). Compared with preoperative vision, the postoperative vision was improved in 8 eyes (26.7%), stabled in 15 eyes (50.0%), decreased in 7 eyes (23.3%). The mean number of intraocular pressure-decreased drugs was reduced from 4 to 1 (t=8.402, P<0.01).The cyclophotocoagulation area was positive related to postoperative intraocular pressure (r=4.160, P<0.05). There were no ocular and systemic complications during and after surgery except slight inflammation. ConclusionPPV combined with ECP for refractory glaucoma can reduce intraocular pressure, stabilize or improve the visual acuity.
Objective To evaluate the therapeutic effect of vitreo-retinal surgery on oclular siderosis. Methods The clinical data of 22 patinets (22 eyes) with ocular siderosis due to the magnetic foreign body at intraocular postsegment were retrospectively analyzed. The patients aged from 6 to 54 years (average 40 years), including 21 males and 1 femal. The duration of the magnetic foreign body remained in the eye lasted for 1 month to 20 years. The preoperative best corrected visual acuity (BCVA) was ＜0.01 in 15 eyes, 0.01-0.15 in 5 eyes and 0.1-0.2 in 2 eyes. There was Intra-vitreous foreign body in 18 eyes and ocular wall embedded foreign body in 4 eyes; intraocular foreign body (IOFB) combined with cataract in 18 eyes; combined with retinal detachment in 3 eyes; scleral buckling combined with silicon oil filled in 12 eyes and C3F8 filled in 7 eyes. Cataract extraction was performed in 12 eyes, and 2 eyes underwent filtrating surgery. Results The IOFB was successfully removed by one-off surgery in 22 eyes. BCVA increased in 20 eyes (90.9％) and kept unchanged in 2 eyes (9.1%), including＜0.1 in 7 eyes, 0.1-0.4 in 8 eyes, and 0.5-1.0 in 7 eyes. Operative complications involved retinal holes with retinal detachment in 2 eyes and vitreous haemorrhage secondary to enlarge sclera incision in 2 eyes. Postoperative complications included secondary cataract in 4 eyes, retinal detachment due to silicon oil removal 3 months after submacular removal of foreign body in 1 eye, and retinal detachment 7 days after C3F8 filling in 1 eye; the latter two eyes had reattached retina after another silicon oil filling. At the end of the follow-up period, retina reattached in 22 eyes. Conclusion Advanced modern vireoretinal operation is effective on oclular siderosis, which can avoid the release of Fe+ and improve the patientsprime; visual function.
【Abstract】Objective To study the advances in clinical application of shape memory alloy (SMA) in general surgery. Methods The literature in the recent years on the advances of SMA was reviewed. Results At present clinical application of SMA have been developed. Different stents could dilate the benign and malignant stricture of blood vessels, biliary ducts, cola, recta and gastric outlet obstruction. The SMA catheter system was effective for peroral cholangiopancreatoscopy. Novel nitinol basket instrument might be useful for percutaneous cholecystolithotomy. Compression anastomoses was safe and sound in gastrointestinal surgery using a device made of SMA. Nitinol stent could be used in transjugular intrahepatic portosystemic stent shunt (TIPSS) with satisfactory results. Nitinol occlusion devices was superior to stainless steel coils. The Simon nitinol filter represented a new generation of venous interruption devices designed to prevent recurrent pulmonary embolism. Conclusion Clinical application of SMA will be increased by the development of endoscope, laparoscope and interventional technique.
Objective To explore the surgical techniques, efficacy and the management of complicated ocular trauma with anteriorposterior segment complications such as cyclodialysis.Methods Fifty-five patients (55 eyes) with complicated ocular trauma were enrolled in this study. Among them, there were 35 cases with eyeball contusion and 20 cases of eyeball rupture. Preoperative visual acuity was from no light perception to 0.15, intraocular pressure (IOP) ranged from one to 10 mm Hg(1 mm Hg=0.133 kPa）.Cyclodialysis, vitreous hemorrhage or retinal detachment were revealed by B-ultrasound and ultrasound biomicroscopy (UBM). Cyclodialysis clefts ranged from one to 12 clockhours. All patients underwent 3-port pars plana vitrectomy with gas/silicone oil tamponade and ciliary body reattachment by cryotherapy (cyclodialysis cleftsle;three clock-hours) or suture fixation (cyclodialysis clefts＞three clockhours). Healing after surgical trauma, visual acuity, intraocular pressure, intraocular hemorrhage, ciliary body and retinal reattachment were followed up.Results In one month after surgery, UBM showed 54 patients out of 55 patients had good ciliary body reattachment. Gonioscopy revealed cyclodialysis still existed in one patient, and this was cured by a second surgical suture fixation. In three months after surgery, ocular trauma healed in all 55 patients, the visual acuity ranged from no light perception to 0.15, with a best corrected visual acuity of 0.8. The ciliary body and retina had good reattachment. IOP of 52 patients was normal; IOP of three patients was still lower than 10 mm Hg. Three patients had secondary glaucoma which was treated by glaucoma surgery. Conclusions Complicated ocular trauma with cyclodialysis can be treated with vitrectomy and cryotherapy or transscleral sutures. The procedure is safe and effective.
ObjectiveTo investigate the therapeutic effects of scleral buckling operations on treating longstanding retinal detachment with subretinal proliferation.MethodsThe clinical data of 36 patients (40 eyes) with long-standing retinal detachment with subretinal proliferation who had undergone scleral buckling operation were retrospectively analyzed, and the clinical features, therapeutic methods and curative effects were summarized.ResultsThe diagnosis of long-standing retinal detachment mainly based on the examination of ocular fundus. The features of the affected eyes were: flat retinal detachment, thin and transparent retina, and formation of subretinal cords. In 40 eyes undergone scleral encircling and buclking, 36 (90%) had one-off successful operation, and the visual acuities over 0.05 were found in 77.5% of the whole eyes.ConclusionsScleral encircling and buckling procedures can be used to treat long-standing retinal detachment with subretinal proliferation with fairish cured rate. (Chin J Ocul Fundus Dis, 2005,21:150-152)