ObjectiveTo investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment. MethodsRetrospective case series study. Eleven eyes of 11 patients with bullous retinal detachment diagnosed in Department of Ophthalmology, Peking University People's Hospital from July 2015 to September 2021 were enrolled. There were 10 males and 1 female, with the mean age of (39.27±6.81) years. All patients had monocular bullous retinal detachment, with mean duration ranged from 3 months to 14 years. The basic information and medical history of all patients were collected. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan ultrasonography. BCVA was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The clinical data and imaging features of BCVA, OCT, FFA and ICGA were retrospectively analyzed and summarized. ResultsThe mean logMAR BCVA of the 11 eyes was 0.91±0.45. Nine patients had bilateral disease, but bullous retinal detachment occurred in only 1 eye, and CSC manifestations were present in the contralateral eye. Six patients had received systemic or topical hormone therapy prior to onset. Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes. OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes, and a few granular hyperreflective substances in the neuroretina in 6 eyes. Neuroretina cystoid degeneration was observed in 6 eyes, adhesion between the detached neuroretina and retinal pigment epithelial (RPE) was observed in 6 eyes, RPE tear was observed in 6 eyes, and different forms of retinal pigment epithelial detachment (PED) were observed in 6 eyes. FFA showed multiple fluorescence leakage spots in 10 eyes, and the average number of fluorescence leakage spots in all eyes was 3.82±2.44. There were multiple diffuse RPE lesions in 9 eyes. The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes. B-scan ultrasonography examination of all affected eyes showed retinal detachment. Retinal reattachment can be achieved at (2.0±1.0) months after photodynamic therapy (PDT), while SRF can be completely absorbed at (2.36±0.81) months. The mean logMAR BCVA can be improved to 0.50±0.33, and no recurrence was found in the follow-up period up to 6 months. ConclusionsBullous retinal detachment is often associated with the use of hormones, while yellow-white material in the subretina and hyperreflective material in the OCT are common. It is characterized by neuroretina cystoid degeneration in the macular area, adhesion between the neuroretina and RPE, RPE tear and PED, with multiple fluorescence leakage spots and diffuse RPE lesions. PDT is an effective treatment for bullous retinal detachment.
Vitrectomy and silicone oil injection were performed for treatment of 43 patients with complicated retinal detachment (RD, n=21 ) or subsequent atrophia bulbi (AB, n=22). Retinal reattachment was achieved in 14 (66.7%) of 21 patients with RD, including 11 with idiopathic proliferative vitreoretinopathy (PVR),6 with traumatic PVR, 3 with congenital uveal coloboma or Marfan syndrome. The visual acuity was better than 0.05 in 7(50%) of successful cases,and better than 0.02 in 11 (78.6%).Only 6(27.3%) patients had retina reattached with visual improvement in 22 cases of AB, including 13 of traumatic PVR,8 of idiopathic PVR.However,the intraoccular pressure was stable and shrinkage of the globe was controlled in 21 (95.5%) of 22 patients with AB.The results indicate that silicone off injection following vitrectomy may provide advanced severe PVR with a chance of successful treatment. （Chin J Ocul Fundus Dis,1994,10:4-6）
We reviewed 44 eyes of pseudophakic(PC-IOL)retinal detackment in which 12 eyes had their posterior lenticular capsules broken,7 of them during the operation and 5 after postoperative YAG laser eapsulotomy.Eleven of the 12 eyes (91.7%) had their retinal detached within 1 year after cataract extraction associated with Intraocular lens implantation,and 18 eyes in 32 eyes(56.3%) with intact po6terior lenticular capsules had their retinae detached within 1 year.The difference between the above conditions was statistically significant (Plt;0.05), Thirty-six of 44 eyes(81.8%) had their detached retinae reattaehed after surgical treatmint. And we found that advanced proliferative vitroretinopethy and failure of detection of retinal breaks played important role for failure of surgical treatment in this series. （Chin J Ocul Fundus Dis,1994,10:74-76）
Objective To analyze the surgical feasibility, operative key points and visual function recovery of scleral buckling in patients with rhegmatogenous retinal detachment (RRD) with large or giant retinal hole. Methods RRD patients with large or giant retinal hole who underwent scleral buckling in Chengdu Aidi Eye Hospital between January 1, 2019 and December 31, 2020 were retrospectively selected. The general data, complications and postoperative recovery of the patients were observed. Results A total of 344 inpatients (351 eyes) underwent scleral buckling with RRD, including 43 patients (43 eyes) with retinal detachment of large or giant hole. Among the 43 patients, there were 30 males (30 eyes) and 13 females (13 eyes); 42 cases were successfully operated and got retinal reattachment, and 1 failed. One week later, the patient underwent vitrectomy combined with silicone oil tamponade, and got retinal reattachment. No serious complications occurred in the patients after operation. The visual acuity of most patients improved after surgery. ConclusionsScleral buckling is still an effective method to treat RRD. It is still suitable for more patients as long as they are carefully checked before operation and the operators master the key points of operation. At the same time, more patients’ vitreous bodies can be preserved, and the normal structure and intraocular environment of the eyeball can be maintained.
Morning glory syndrome (MGS) is a congenital optic disc anomaly. The characteristic ophthalmoscopic findings consist of a generally enlarged, funnel-shaped and excavated optic disc, surrounded by an elevated annulus of chorioretinal pigment disturbance, with a central glial tuft, multiple narrow branches of retina vessels radiating from the disc. There are peripheral non-perfusion retinal areas in most cases. The pathogenesis of MGS remains unclear. MGS might be associated with many ocular and systemic abnormalities, involving facial, central nervous, cerebrovascular and endocrine systems. Persistent hyperplastic primary vitreous and retinal detachments (RD) are the most common ocular complications of MGS. The mechanism RD in MGS is unclear. Vitrectomy with long-acting gas or silicone tamponade and photocoagulation around the breaks or the enlarged disc might be efficient for rhegmatogenous RD of MGS. Early diagnosis is crucial for recognition and treatment of the ocular and systemic complications, and maintenance of the visual function.
ObjectiveTo observe the expression levels of related cytokines in the vitreous humor of eyes with rhegmatogenous retinal detachment (RRD) associated with lattice degeneration (LD). MethodsA clinical observational study. From May 2022 to February 2023, 43 patients of 43 eyes diagnosed with RRD, with or without accompanying LD, who underwent their first pars plana vitrectomy (PPV) at Zhongda Hospital Southeast University and The Affiliated Eye Hospital of Nanjing Medical University were included in the study. The patients were divided into two groups: RRD with LD (LD group), consisting of 27 patients with 27 eyes, and RRD without LD (Non-LD group), consisting of 16 patients with 16 eyes. Additionally, 6 patients (6 eyes) with idiopathic macular holes and 4 patients (4 eyes) with idiopathic epiretinal membranes during the same period were selected as the control group. Before initiating PPV and without intraocular perfusion, a 0.5 ml sample of undiluted vitreous fluid from the central portion was excised and aspirated. The concentrations of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1 alpha (MIP)-1α, MIP-1β, interferon-γ- inducible protein 10 (IP-10), interleukin-6 (IL-6), IL-8, macrophage migration inhibitory factor (MIF), tumor necrosis factor-alpha-α, interferon-γ, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1, platelet endothelial cell adhesion molecule 1 (PECAM-1), placental growth factor (PLGF) and vascular endothelial growth factor (VEGF) in the vitreous fluid were quantitatively measured using the Luminex high-throughput multiplex assay technology. The comparison of cytokine expression levels between groups was performed using the Kruskal-Wallis rank sum test, with significance levels for post-hoc pairwise comparisons adjusted by DSCF methods. ResultsThe eyes of the patients in the LD group, Non-LD group, and control group showed statistically significant differences (P＜0.05) in the concentrations of IL-6 (H=14.400), IL-8 (H=13.610), MCP-1 (H=12.050), VEGF (H=9.920), MIP-1α (H=6.620), IP-10 (H=7.780), MIF (H=12.920), PECAM-1 (H=9.990), ICAM-1 (H=8.070), and PLGF (H=16.850). Upon pairwise comparison between groups, the vitreous fluid concentrations of IL-6, IL-8, and PLGF in the LD group were found to be significantly higher than those in the Non-LD group (P＜0.05). ConclusionThe expression levels of IL-6, IL-8, and PLGF are elevated in the vitreous fluid of eyes with RRD accompanied by LD.
ObjectiveTo compare the efficacy of internal limiting membrane (ILM) flip coverage with ILM multilayer tamponade in the treatment of highly myopic macular hole-associated retinal detachment (MHRD). MethodsA retrospective clinical study. From November 2019 to June 2022, 53 cases and 53 eyes of MHRD patients who were examined and diagnosed at the Eye Centre of Renmin Hospital of Wuhan University were included in the study. Among them, 21 cases and 21 eyes were male and 32 cases and 32 eyes were female. The age was (55.28±11.40) years. The patients were categorized into two groups: the ILM coverage group (from November 2019 to September 2020) and the ILM multilayer tamponade group (from October 2020 to June 2022) based on their surgical procedures. The ILM coverage group comprised of 11 cases involving 11 eyes, while the ILM multilayer tamponade group comprised of 42 cases involving 42 eyes. Best-corrected visual acuity (BCVA) and optical coherence tomography were conducted. BCVA was measured using standardized international visual acuity charts and transformed to logarithmic minimum angle of resolution (logMAR) visual acuity for statistical analysis. The affected eyes were all treated with standard transciliary flattening three-channel 23-gauge vitrectomy. The inverted ILM flap technique was combined with flap coverage in the inverted group, while the ILM multilayer tamponade group used circular ILM stripping to preserve the ILM in the macular area and ILM flap around the macular hole with multilayer ILM tamponade. Postoperative follow-up was carried out for a minimum of 6 months. Relevant examinations were conducted during the follow-up using the same equipment and methods as those used before surgery. The BCVA, as well as the closure of macular hole, resurfacing of the retina, and development of macular hyperplasia, were observed. ResultsIn the ILM-covered group, the macular hole was closed in 7 out of 11 eyes after 1 week of surgery. At 1 month after surgery, the macular hole was closed in all treated eyes. At 6 months after surgery, the macular hole was closed in 9 eyes, while 2 eyes were reopened. In 42 eyes from the ILM-multilayer tamponade group, the macular hole closed after surgery in 41 eyes. At 6 months postoperatively, best corrected visual acuity (BCVA) of eyes in ILM-covered and ILM-multilayer tamponade groups was 0.91±0.29 and 1.05±0.39, respectively, with no statistically significant difference between the two groups (t=1.140, P=0.260). The BCVA of the eyes in both groups showed a significant improvement compared to the preoperative period with a statistically significant difference (t=8.490, 13.840; P＜0.000 1); 6 months after surgery, 10 out of 11 eyes in the ILM coverage group had a restored retina with no detectable macular hyperplasia; 42 eyes in the ILM multilayer tamponade group had a restored retina, but 19 of these eyes had detectable macular hyperplasia. ConclusionsEither ILM flap coverage or ILM multilayer tamponade contributes to high myopic MHRD closure and improved visual acuity. Compared to ILM flap coverage, ILM multilayer tamponade results in higher and earlier rates of macular hole closure and lower rates of macular hole reopening. However, ILM multilayer tamponade may lead to a higher proportion of macular hyperplasia formation without affecting visual acuity recovery at 6 months after surgery.
ObjectiveTo examine the postoperative morphological changes in outer retinal wave-like changes (ORC) in eyes with rhegmatogenous retinal detachment (RRD). MethodsA retrospective clinical study. From March 2020 to March 2024, 64 eyes of 64 RRD patients diagnosed at The Second Affiliated Hospital of Zunyi Medical University were included. The cohort included 39 males (39 eyes) and 25 females (25 eyes), with a mean age of (45.3±15.7) years and a mean retinal detachment duration of (16.6±13.5) days. Macular involvement was observed in 51 eyes. Scleral buckling surgery (SB), pars plana vitrectomy (PPV), and SB+PPV were performed in 17, 44, and 3 eyes respectively. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography examinations were performed in all affected eyes. BCVA examination was performed using the standard logarithmic visual acuity chart, and the visual acuity was converted to logarithm of the minimum angle of resolution (logMAR) during statistics. Combined with the ORC situation before the operation, the morphological repositioning of outer retinal folds (ORF) after the operation was classified into types Ⅰ, Ⅱ and Ⅲ. One week and one and three months after the operation, relevant examinations were performed using the same equipment and methods as before the operation. The structural characteristics of ORC and the morphology of ORF after surgery were observed. The comparison between groups was conducted using the independent sample t test or the Mann-Whitney U test. ResultsAmong the 64 eyes, preoperative ORC was present in 46 eyes (71.9%, 46/64) and absent in 18 eyes (28.1%, 18/64). The 18 eyes without ORC had retinal detachment durations of either ≤4 days or ≥42 days. Postoperatively, ORF was observed in 51 eyes (79.7%, 51/64) and absent in 13 eyes (20.3%, 13/64). Among the 51 eyes with macular holes involved, 24 eyes (47.1%, 24/51) had ORF after the operation and 27 eyes (52.9%, 27/51) had no ORF. Among the 46 and 18 eyes with and without ORC, the ORF after surgery was 28 (60.9%, 28/46) and 1 (5.6%, 1/18) eyes, respectively. There was a statistically significant difference in the reduction rate of ORF after surgery between eyes with and without ORC (χ2=15.974, P＜0.001). Among the 46 eyes with ORC, the proportions of ORF to types Ⅰ, Ⅱ and Ⅲ after surgery were 24 (52.2%, 24/46), 20 (43.5%, 20/46), and 2 (4.3%, 2/46) eyes, respectively. There was no statistically significant difference in the incidence of ORF after different surgical methods in eyes with ORC (P＞0.05). One week and one month after the surgery, the logMAR BCVA of the affected eyes with and without ORF was 0.97±0.47, 0.69±0.34 and 0.85±0.32, 0.54±0.21, respectively. The BCVA of those without ORF was better than that of those with ORF, but the differences were not statistically significant (t=0.237, 0.408; P＞0.05). ConclusionsThe occurrence of ORC in RRD eyes has a certain relationship with the time of retinal detachment. For RRD eyes with ORC before the operation, the repositioning morphology after the operation is more likely to show changes in ORF. The transformation from ORC to ORF after ORC surgery has no correlation with the surgical method.
ObjectiveTo observe the effect of scleral buckling surgery (SB) in the treatment of rhegmatogenous retinal detachment (RRD) with subretinal hyperplasia (SRP). MethodsA retrospective case study. From January 2016 to December 2018, 31 patients with old RRD with SRP who were treated with SB in Department of Ophthalmology, Central Theater Command General Hospital were included in the study. There were 18 males with 20 eyes and 13 females with 15 eyes. Age was (26.5±8.7) years. The course of disease was (12.6±10.3) months. The best corrected visual acuity (BCVA) test was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of recording. Retinal detachment ranges ≤2, ＞2-＜3, ≥3 quadrants were 10 (28.6%, 10/35), 20 (57.1%, 20/35), and 5 (14.3%, 5/35) eyes, respectively. All affected eyes were treated with SB. Among them, 22 eyes (63.0%, 22/35) underwent local Scleral buckling, 11 eyes (31.4%, 11/35) underwent combined encircling buckle, and 2 eyes (5.7%, 2/35) underwent encircling buckle alone. Subretinal fluid drainage was performed in 33 eyes (94.3%, 33/35). The mean follow-up time was 18.2 months. Relevant examinations were performed with the same equipment and methods before operation to observe BCVA and retinal reattachment. Paired sample t test was used to compare logMAR BCVA before and after operation. ResultsAt the last follow-up, retinal reattachment occurred in 32 eyes (91.4%, 32/35) of 35 eyes. The retina did not reset in 3 eyes (8.6%, 3/35). logMAR BCVA of affected eye was 0.67±0.29 (finger counting-1.0). The difference of logMAR BCVA before and after operation was statistically significant (t=5.133, P=0.036). In 35 eyes, visual acuity improved, stabilized and decreased in 19 (54.3%, 19/35), 13 (37.1%, 13/35) and 3 (8.6%, 3/35) eyes, respectively. Ten months after surgery, the silicone tape was exposed and infected 1 eye. After the silicone tape was removed, the infection subsided and the retina was in place. There were no intraocular hemorrhage, vitreoretinal impaction, endophthalmitis and other complications during and after operation. ConclusionSB treatment of RRD with SRP can achieve good retinal reposition and improve visual acuity to some extent.
Human amnion (hAM), as a biomaterial, has made significant progress in the field of ophthalmology, particularly in the treatment of retinal diseases. hAM possesses biological properties such as promoting tissue repair, inhibiting inflammation and neovascularization, and reducing fibrosis, which have led to its promising clinical outcomes in treating macular holes, retinal detachment, proliferative vitreoretinopathy, optic disc depression-related macular detachment, and age-related macular degeneration. The application of hAM can improve surgical success rates and promote vision recovery, with no significant rejection reactions observed due to its low immunogenicity. Nevertheless, the use of hAM still faces challenges in optimizing preparation and storage techniques, enhancing therapeutic efficacy, and reducing the risk of infectious disease transmission. Future research should focus on addressing these issues to further promote the application of hAM in retinal disease treatment and enhance its effectiveness.