Objective To investigate the clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious endophthalmitis. Methods Sixty-two patients (62 eyes) with endophthalmitis, diagnosed by the examinations of the best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscopy, direct and (or) indirect ophthalmoscopy and ocular B-ultrasound. There are 44, 17 and 1 eyes with posttraumatic, postoperative and endogenous infectious endophthalmitis, respectively. The patients were randomly divided into the group A (32 eyes) and B (30 eyes). The former was treated immediately by vitrectomy combined with silicone oil tamponade after diagnosis, while the latter was treated by the same surgery after drug treatment depended on patientsprime;choice. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. 19/62 (30.65%) vitreous samples were positive for culture. The follow-up was ranged from 6 to 26 months. The visual acuity, intraocular pressure and eye retention situation before and after surgery were comparatively analyzed. Results In group A, endophthalmitis was controlled in all eyes after surgery; the visual acuity and intraocular pressure improved significantly after surgery (chi;2=43.72, 6.83; P＜0.05). In group B, endophthalmitis was controlled in 19/30 eyes (63.33%) after surgery; evisceration was performed on 11 eyes (36.67%) because of the atrophy of the eyeball. There was no significant difference of visual acuity before and after surgery. Conclusions Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected endophthalmitis. Performing the surgery immediately after the diagnosis is the key to achieve good effect.
Objective To evaluate the efficacy and its affecting factors of silicone oil as an introocular tamponade for copmlicated retinal detachments in children(le;14 years). Methods We analysed retrospectively 34 cases(36 eyes) of complicated retinal detachments in children, who were performed with pars plana vitrectomy combined with silicone oil tamponade from June 1993 to November 1997. Results After 3-21 months of follow-up, the detached retinas in 19 eyes(52.7%) were reattached, in 10 eyes(27.8%) partially reattached and in 6 eyes (16.7%) redetached, 1 eye(2.8) had a media opacity that precluded evaluation of the retina. Postoperative visual acuity was less than 0.05 in 12 eyes(33.3%), and 0.05-0.2 in 20 eyes(55.6%), 2 cases(4 eyes) could not tell their visions(11.1%). Conclusion Silicone oil tamponade is an effctive therapy for complicated retinal detachments in children. The major cause of surgical fai;ure was development of recurrent proliferative vetrioretinopathy. (Chin J Ocul Fundus Dis,1999,15:7-8)
Objective To observe the clinical effect of conventional vitrectomy using transconjunctival sutureless 20 Gauge (20G) trocar. Methods The clinical data of 62 patients (63 eyes) who had undergone vitrectomy were retrospectively analyzed. The patients were divided into 2 groups according to the surgery methods. Group A: conventional vitrectomy using transconjunctival sutureless 20G trocar were performed on 33 cases (34 eyes) including 19 males (20 eyes) and 14 females (14 eyes). The patients aged from 17 to 75 years with the average age of 52.3 years. The average visual acuity was 0.04 and the average intraocular pressure was 18.25 mm Hg (1 mm Hg=0.133 kPa). Included were 13 cases of diabetic retinopathy, 9 cases of vitreous hemorrhage, 2 cases of silicone oil removal and tearing membrane off, 9 cases of complex retinal detachment, and 1 case of tearing epiretinal macular membrane. Group B: 20G conventional incision vitrectomy was performed on 29 cases (29 eyes) including 13 males (13 eyes) and 16 females (16 eyes) aged from 24 to 69 years with the average age of 49.5 years. The average visual acuity was 0.02 and the average intraocular pressure was 17.50 mm Hg. Included were 10 cases of diabetic retinopathy, 8 cases of vitreous hemorrhage, 5 cases of retinal detachment, 2 cases of longstanding retinal detachment performed with vitrectomy and scleral buckling, and 4 cases of silicone oil removal and tearing membrane off and intravitreal injection of expanding gases. Within group A, 21 eyes were treated with intraocular laser photocoagulation, 9 eyes were treated with scleral cryosurgery to block the hole, 3 eyes were treated with intravitreal injection of expanding gases, and 15 eyes were injected with silicone oil. Leakage of incision, incidence of iatrogenic holes and comfort of patients after operation were recorded and analyzed. All data were analyzed by chi;2 test statistical analysis. Results In group A, 31 eyes had a good degree of comfort without incision leakage and did not need special treatment; 3 eyes filled with inert gas needed suppression for 3 to 5 minutes, and had gas spill from the temporal incision, which needed to be sutured once. In group B, all incisions were sutured with 8.0 silk suture without any incision leakage, whileforeign body sensation and irritation was apparent. Difference on the degree of comfort in the two groups was statistically significant (chi;2 =50.56,Plt;0.01). No eyes in group A generated iatrogenic hole, while 2 eyes in group B generated ora serrata slit pores next to the puncture. Compared with each other, there was a significant statistical difference (chi;2=4.15,Plt;0.05). Conclusion Conventional vitrectomy using transconjunctival sutureless 20G trocar made the vitrectomy simpler and quicker and can reduce the incidence of iatrogenic hole significantly.
OBJECTIVE:To investigate the treatment of retinal redetachment after vitrectomy and silicone oil tamponade. METHODS:Investigating retrospectively on the treatment effect of 8 cases of redetachment of retina with proliferative vitreoretinopathy(PVR) in which the retinas had been attached formerly after vetrectomy and silicone oil tamponade operation.The reoperative procedures included pars plana vitrectomy,membranes peeling,retinotomy,inner exchange of the fluid and silicone oil tampnade and subretinal membranes were removed out in 2 eyes. RESULTS:Six eyes had anatomical reattachment postoperatively and another 2 eyes still had inferior shallow retinal detachment.Visual acuity was improved in 6 patients and remained unchange in 2 patients. CONCLUSIONS:The cause of recurrent retinal detachment might be the formation of the proliferative epiretinal and subretinal membranes,and vitrectomy to release the traction of proliferative membranes and full fluid silicone oil exchange should do good to reattachment. （Chin J Ocul Fundus Dis,1996,12: 13-15 ）
ObjectiveTo explore the effects of vitrectomy on neovascular glaucoma combined with vitreous hemorrhage.MethodsSeven eyes of 7 patients with neovascular glaucoma combined with vitreous hemorrhage underwent vitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy. The preoperative visual acuity ranged from light perception to 0.2, and the mean preoperative intraocular pressure was 54 mm Hg (38-64 mm Hg)(1 mm Hg=0.133 kPa). The mean follow-up was 8 months (6-15 months).ResultsThe postoperative visual acuity ranged from light perception to 0.4, and the mean postoperative intraocular pressure was 17 mm Hg (10-30 mm Hg) which was significantly lower than preoperative one (Plt;0.05). The postoperative complications mainly included fibrosis exudates in anterior chamber (7 eyes), intraocular pressure elevation 1-2 weeks after the operation (2 eyes), and postoperative suprachoroidcavity hemorrhage (2 eyes).ConclusionVitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy may be effective procedures for some cases of neovascular glaucoma combined with vitreous hemorrhage.(Chin J Ocul Fundus Dis, 2005,21:148-149)
Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation.
Abstract:Five eyes of acute retinal necrosis(ARN)with multiple retinal breaks and retinal detachment were treated by closed vetrectomy combined with encircling buckle,gas/fluid exchange,nolaser and cryotherapy.After operation,the detached retinas reattached in 4eyes,and among them th visual acuity was 0.2 in 1 eye,and better than 0.05 in 3 eyes.The follow-up duration in 5 eyes was from 6 to18 months and recurrent retinal detachment was found in one eys. （Chin J Ocul Fundus Dis,1996,12: 20-21)
Objective To inverstingate the effect of perfluorohexyloctane(F6H8)to the retina of rabbit eyes. Methods Fifteen vitrectomized New Zealand white rabbits were injectedF6H8(experiment group,12 rabbits ) and BSS(control group,3 rabbits) into vitreous cavity.Slit-lamp biomicroscopy and indirect ophthalmoscopy were performed pre- and postoperatively in all the eyes.Histopathological examination was done after the rabbits were sacrificed at the end of the study. Results A large clear balb was formed after intravitreal injection of theF6H8 in the vitreous was injected and no retinal detachment and cataract were found.The OPL was edematous and then thinned out in 4th week in experimental group.Degenerating cells was found in inner and outer nuclear layers.Cellular vaculoar degeneration was present in TEM. ConclusionF6H8 in vitreous cavity may cause significant side effects on retina,we could not recommend it to be used as an intraocular temponade.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Objective To investigate the effects,safety and indications of local resection of choroidal melanoma with vitreoretinal surgery. Methods Eight patients with choroidal melanoma were treated with surgery.The range of the diameters of tumors was 5～20 mm and of the thickness was 4～12 mm.Retinal detachment was detected in 4 eyes.The local tumors were endoresected in 2 eyes,and managed by partial lamellar sclerouvectomy in 6 eyes.Vitreoretinal surgery,including vitrectomy,using perfluorocarbon liquid,endolaser and gases or silicone oil tamponde were performed in all eyes.Pathologic tests were performed for removed tissues. Results All tumors were resected completely.Among them,7 were histologically identified as choroidal melanomas,five were classified as spindle-cell type,2 as mixed-cell type.The ciliary body was involved in 3 tumors.The other one was choroidal melanocytoma.There was no tumor recurrence and metastasis during follow-up(average 9 .1 months).All eyeballs had no obvious changes in contour.Visual acuities werege;0.1 in 5 eyes. Conclusion In local resection cases of choroidal melanoma the affected eyeballs and their vision are saved,and the accurate diagnosis can also be made from the excisional biopsy. (Chin J Ocul Fundus Dis，2000，16：139-212)