Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual fu...Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual function.The incidence of metamorphopsia remains the most common postoperative complaint,from 24% to 88.6%.Currently,the risk factors of metamorphopsia are categorized into macular involvement,retinal shift,outer retinal folds,subretinal fluid,secondary epiretinal membrane,outer retinal layer damage,and surgical approach.The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial.The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts.Most treatments cannot progress beyond the management of negative visual sensations,through methods such as occlusion therapy and aniseikonia-correcting spectacles.The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair.Additional research concerning metamorphopsia treatment,further upgrades of auxiliary inspection methods,and more accurate microstructural assessments are needed to address this common complication.展开更多
AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case seri...AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.展开更多
AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for ...AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD.METHODS:A total of 694 patients(694 eyes)diagnosed with RRD in the emergency surgery(the median duration of RRD was 5d)group were included from the Department of Ophthalmic Emergency,and 692 patients(eyes)in the routine inpatient surgery group(the median duration was 15d)were selected randomly from the Ocular Fundus Department.Demographics,refractive status,macular status,lens status,extent of retinal detachment,number of retinal breaks,duration of symptoms before surgery,and the incidence of RRDCD were compared.A logistic regression analysis was used to determine potential risk factors for RRDCD.RESULTS:Compared to the routine inpatient surgery group,the emergency surgery group had a significant less median time to surgery(P<0.001)and a decreased proportion of RRDCD(2.88%vs 10.84%,P<0.001).Logistic regression analysis revealed that a prolonged duration of RRD[OR 3.51,95%confidence interval(CI)1.98-6.23],pseudophakia/aphakia status[OR 2.74,95%CI(1.50-4.98)],multiple retinal breaks[OR 1.67,95%CI(1.03-2.70)],and a substantial extent of RRD[OR 11.58,95%CI(7.12-18.84)]were independent risk factors for RRDCD.CONCLUSION:Emergency surgical pattern of RRD demonstrates a lower incidence of RRDCD.The adoption of an expedited surgical approach has the potential to reduce the duration of RRD,possibly correlating with a decreased risk of RRDCD development.展开更多
AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary ...AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.展开更多
AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve under...AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve understanding of this adverse outcome.METHODS:Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed.Postoperative blindness was defined according to the World Health Organization(WHO)criteria for legal blindness.Potential risk factors included demographic characteristics,preoperative clinical features,and surgical variables.Univariable and multivariable logistic regression analyses were performed to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for each risk factor.RESULTS:A total of 532 patients were included in the cohort,of whom 62(12.0%;28 males,34 females)developed postoperative blindness at the final follow-up.Among these 62 patients,30 had high myopia and 32 did not.The mean age of participants was 49.0±16.4y,with 275 subjects(52%)being male and 133 patients(25%)having the condition in the right eye.In the multivariable model for all patients,the following factors were associated with an increased risk of postoperative blindness:higher preoperative logarithm of the minimum angle of resolution visual acuity(logMAR VA;OR=1.09 per 0.1 logMAR unit increase,95%CI 1.03-1.15);inferior or superior retinal breaks(OR=2.42,95%CI 1.12-5.24);and macular holes or superior retinal breaks(OR=8.46,95%CI 3.45-20.75).In the subgroup of patients with high myopia,risk factors for postoperative blindness included:pseudophakia/aphakia versus phakia(OR=6.33,95%CI 1.41-28.31);macular holes or superior retinal breaks(OR=15.15,95%CI 3.07-74.85);and proliferative vitreoretinopathy(PVR;OR=21.41,95%CI 2.14-214.57).In the subgroup of patients without high myopia,increased risk of postoperative blindness was associated with:higher preoperative logMAR VA(OR=1.11 per 0.1 logMAR unit increase,95%CI 1.04-1.18);and inferior or superior retinal breaks(OR=2.90,95%CI 1.19-7.06).CONCLUSION:Using a large real-world clinical database,we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia.These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.展开更多
Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),...Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).展开更多
AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total ...AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total of 22 participants(22 eyes)with high myopia[axial length(AL)≥26.5 mm]and MHRD who underwent PSC combined with intravitreal C_(3)F_(8)injection,with at least 6mo of follow-up were retrospectively recruited.Outcome measures included best-corrected visual acuity(BCVA),AL,optical coherence tomography(OCT)findings,and adverse events.Retinal recovery was categorized as type Ⅰ(macular hole bridging with retinal reattachment)or type Ⅱ(reattachment without hole bridging).RESULTS:The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo.Complete retinal reattachment was observed in 11 eyes(50%)at postoperative day 1,19 eyes(86.3%)at week 1,and all 22 eyes at month 1.Ten eyes(45.5%)achieved type Ⅰ recovery and 12 eyes(54.5%)achieved type Ⅱ.Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery(P<0.001),and AL was significantly reduced compared to baseline(29.07±2.05 vs 30.8±2.2 mm;P<0.001).No serious complications were reported.CONCLUSION:PSC combined with intravitreal C_(3)F_(8)injection is a safe and effective treatment for MHRD in highly myopic eyes,especially for retinal detachment limited within the vascular arcade.展开更多
AIM:To evaluate the surgical outcomes of the perfluorocarbon liquid(PFCL)-assisted inverted multilayer internal limiting membrane(ILM)flaps covering technique in macular hole retinal detachment(MHRD)in high myopia wit...AIM:To evaluate the surgical outcomes of the perfluorocarbon liquid(PFCL)-assisted inverted multilayer internal limiting membrane(ILM)flaps covering technique in macular hole retinal detachment(MHRD)in high myopia with axial length(AL)≥30 mm.METHODS:In this retrospective,interventional,consecutive comparative study,44 MHRD eyes were divided into two groups:the PFCL-assisted inverted multilayer ILM flaps covering technique group(Group 1,21 eyes)and the ILM peeling group(Group 2,23 eyes).The follow-up period was>12mo.Postoperative outcomes,including retinal reattachment,macular hole(MH)closure,and bestcorrected visual acuity(BCVA),were assessed.Statistical analysis using the Mann–Whitney U test and Fisher’s exact test was conducted to compare differences between groups.RESULTS:There were no statistically significant differences in baseline preoperative clinical characteristics,including age,sex,AL,diopters,duration of symptom,lens status,posterior staphyloma presence and extent of RD.Retinal reattachment rates were higher in Group 1(90.5%)than in Group 2(82.6%),without statistical significance(P=0.667).MH closure rates were significantly higher in Group 1(85.7%)than in Group 2(17.4%;P<0.001).The Group-1 BCVA(logMAR)improved significantly from 2.13±0.91 preoperatively to 1.21±0.66 postoperatively(P=0.026).The Group 2 BCVA improved significantly from 1.91±0.53 preoperatively to 1.19±0.41 postoperatively(P=0.032).However,there were no significant differences in visual-acuity improvement between groups(P=0.460).CONCLUSION:This technique offers a more effective approach for improving MH closure rates and postoperative visual function in MHRD with AL≥30 mm in high myopia.展开更多
AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This mul...AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This multicenter,prospective,randomized,double-masked,parallel-controlled,non-inferiority trial was conducted in three ophthalmology clinical centers in China.Patients with retinal detachment,who were eligible for PPV were consecutively enrolled.Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio.Best-corrected visual acuity(BCVA),intraocular pressure(IOP)measurement,and dilated fundus examination were performed preoperatively and at 1,7±1,28±3d postoperatively.The primary outcome was complete retinal reattachment rate at postoperative day one.The non-inferiority margin was set at 9.8%.The secondary outcomes included intraoperative retinal reattachment rate,and mean changes in IOP and BCVA from baseline to 1,7±1,28±3d postoperatively,respectively.Safety analyses were presented for all randomly assigned participates in this study.RESULTS:Totally 124 eligible patients completed the study between Mar.14,2016 and Jun.7,2017.Sixty of them were randomly assigned to the PFO for ophthalmic surgery group,and 64 were assigned to the F-Octane group.Baseline characteristics were comparable between the two groups.Both groups achieved 100%retinal reattachment at postoperative day one(difference 0,95%CI:-6.21%to 5.75%,P=1).The pre-defined noninferiority criterion was met.No significant difference was observed in intraoperative retinal reattachment rate(difference 1.77%,P=0.61),mean changes in IOP(difference 0.36,-0.09,2.22 mm Hg at 1,7±1,28±3d postoperatively,with all P>0.05)and BCVA(difference 0.04,-0.02,0.06 logMAR at 1,7±1,28±3d postoperatively,all P>0.05)between the two groups.No apparent adverse events related to the utilization of PFO were reported.CONCLUSION:In patients with retinal detachment undergoing PPV,PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade,and both are safe and well-tolerated.展开更多
AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.MET...AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.展开更多
●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation...●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.展开更多
AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who receiv...AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.展开更多
AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients wh...AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.展开更多
AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients under...AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.展开更多
This study aimed to conduct finite element(FE)analysis matched with an in vitro experiment to analyze traumatic retinal detachments(TrRD)resulting from blunt trauma and provide stress and strain thresholds to predict ...This study aimed to conduct finite element(FE)analysis matched with an in vitro experiment to analyze traumatic retinal detachments(TrRD)resulting from blunt trauma and provide stress and strain thresholds to predict the occurrence of TrRD.The in vitro experiment was performed on forty-eight porcine eyes using a pendulum device.We examined dynamic mechanical responses at four energy levels.A FE model,based on experimental results and published data,was used to simulate TrRD.Fifty-one additional eyes underwent immediate pathological examination following blunt impact.A dynamic variation of velocities was observed post-impact,displaying an approximate cosine oscillation-attenuation profile.Energy absorption increased as the initial energy and differed significantly at four energy levels(p<0.001).FE simulation showed a peak strain of 0.462 in the anterior vitreous body and a peak stress of 1.408 MPa at the cornea at the high-energy level.During the energy transfer,the stress was initially observed in retinal region along the impact direction at the separation.TrRD were observed in injured eyes,where a few detachments were detected in control eyes.Correlations were performed between the proportion of pathological outcomes and FE results.In conclusion,this study suggests that stress contributes to the development of retinal detachment,providing an indicator to distinguish the occurrence of TrRD.展开更多
Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even fo...Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in adulthood.Moreover,the anatomical success,when achieved,is frequently not related to a functional recover.Postsurgical adverse events,refractive errors and amblyopia may additionally undermine the final outcome.Up to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal detachment.In this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were considered.The available literature from the last decades were reviewed and summarized.Epidemiology,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.展开更多
AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A re...AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.展开更多
AIM： To comprehensively analyze the risk factors of rhegmatogenous retinal detachment （RRD） associated with choroidal detachment （CD）. METHODS： A total of 265 eyes of 265 consecutive cases of RRD were retrospec...AIM： To comprehensively analyze the risk factors of rhegmatogenous retinal detachment （RRD） associated with choroidal detachment （CD）. METHODS： A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B -scan ultrasonography, and ultrasound biomicroscope （UBM）. Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD）. Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS： There were 52 eyes （19.62%） with CD. Pseudophakia was more commonly seen in RRDCD （21.15% ys6.10%, P=0.002）. Intraocular pressure （lOP） was lower （8.60 ±3.62 ys 12.96 ±3.55, P 〈0.001）, best - corrected visual acuity was worse [3.00 （2.00 to 3.00） vs 1.92 （1.22 to 3.00）, P=-0.001], and refractive error was more myopic [-4 （-9 to -2） vs -2 （-6 to 0）, P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment （P=0.007）. In RRDCD, 34.62% of eyes presented with multiple holes （P=0.044） and 25.00% with macular holes （P=0.012）, compared with 20.66% and 14.08% in R RD. High myopia （P=0.039）, low lOP （P=0.017）, and larger extent of retinal detachment （P〈0.001） were significant and independent risk factors for developing CD. - CONCLUSION： For CD in RRD, related factors include BCVA, lOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low lOP are significant and independent risk factors.展开更多
AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (P...AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR). METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR >= C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed. RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000). CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be dosed successfully without additional sclera! buckling.展开更多
AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included ...AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.展开更多
文摘Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual function.The incidence of metamorphopsia remains the most common postoperative complaint,from 24% to 88.6%.Currently,the risk factors of metamorphopsia are categorized into macular involvement,retinal shift,outer retinal folds,subretinal fluid,secondary epiretinal membrane,outer retinal layer damage,and surgical approach.The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial.The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts.Most treatments cannot progress beyond the management of negative visual sensations,through methods such as occlusion therapy and aniseikonia-correcting spectacles.The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair.Additional research concerning metamorphopsia treatment,further upgrades of auxiliary inspection methods,and more accurate microstructural assessments are needed to address this common complication.
文摘AIM:To report the refractive and surgical outcomes of scleral buckling(SB)with or without pars plana vitrectomy(PPV)in patients with pseudophakic rhegmatogenous retinal detachment(PRRD).METHODS:A consecutive case series of patients with pseudophakia who underwent retinal detachment(RD)surgery was enrolled.The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases,according to preoperative findings.Eyes with anterior chamber intraocular lens,proliferative vitreoretinopathy anterior to equator,previous invasive glaucoma surgery,severe degenerative myopia or macular hole,and<6mo follow-up were excluded from outcomes analysis.The primary clinical outcome measures were the single surgery anatomic success(SSAS)and final surgery anatomic success(FSAS)rates.Secondary outcome measures were postoperative visual acuity and refractive error.RESULTS:A total of 81 consecutive patients(81 eyes)were enrolled for analysis,comprising 66(81%)men and 15(19%)women with a mean age of 58y(range,33-86y)and the mean final follow-up period was 21.0±19.6mo.A total of 62 PRRDs(n=62;76.5%)were repaired with an initial SB,and 19 PRRDs(n=19;23.5%)were repaired with a combined SB-PPV.The SSAS and FSAS rates were 92.6%(75/81)and 100%(81/81),respectively.All initial failures had retinal reattachment after the secondary PPV.The mean final postoperative best-corrected visual acuity(BCVA)was 0.42±0.33 logMAR(visual acuity 20/55)and final mean refractive error was-1.48±1.40 diopters.The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate(P<0.05)preoperatively.SSAS was 56/62(90.3%)and 19/19(100%),and the mean postoperative refractive error was-1.30±1.32 D and-1.53±1.38 D for the patients in the SB and SB-PPV groups,respectively.There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups.The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group(median,20/40)than in the SB-PPV group(median 20/50).In the SB group,patients with macula-on had better visual acuity postoperatively than patients with macula-off(P=0.000).CONCLUSION:The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.
基金Supported by the Medical Scientific Research Foundation of Guangdong Province,China(No.C2022060).
文摘AIM:To compare the proportion of rhegmatogenous retinal detachment(RRD)associated with choroidal detachment(RRDCD)in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD.METHODS:A total of 694 patients(694 eyes)diagnosed with RRD in the emergency surgery(the median duration of RRD was 5d)group were included from the Department of Ophthalmic Emergency,and 692 patients(eyes)in the routine inpatient surgery group(the median duration was 15d)were selected randomly from the Ocular Fundus Department.Demographics,refractive status,macular status,lens status,extent of retinal detachment,number of retinal breaks,duration of symptoms before surgery,and the incidence of RRDCD were compared.A logistic regression analysis was used to determine potential risk factors for RRDCD.RESULTS:Compared to the routine inpatient surgery group,the emergency surgery group had a significant less median time to surgery(P<0.001)and a decreased proportion of RRDCD(2.88%vs 10.84%,P<0.001).Logistic regression analysis revealed that a prolonged duration of RRD[OR 3.51,95%confidence interval(CI)1.98-6.23],pseudophakia/aphakia status[OR 2.74,95%CI(1.50-4.98)],multiple retinal breaks[OR 1.67,95%CI(1.03-2.70)],and a substantial extent of RRD[OR 11.58,95%CI(7.12-18.84)]were independent risk factors for RRDCD.CONCLUSION:Emergency surgical pattern of RRD demonstrates a lower incidence of RRDCD.The adoption of an expedited surgical approach has the potential to reduce the duration of RRD,possibly correlating with a decreased risk of RRDCD development.
基金Supported by the Shenzhen Science and Technology Program(No.JCYJ20220818103207015)the SanMing Project of Medicine in Shenzhen(No.SZSM202311012).
文摘AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.
文摘AIM:To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment(RRD)at their first presentation to a tertiary center,using a large clinical database to improve understanding of this adverse outcome.METHODS:Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed.Postoperative blindness was defined according to the World Health Organization(WHO)criteria for legal blindness.Potential risk factors included demographic characteristics,preoperative clinical features,and surgical variables.Univariable and multivariable logistic regression analyses were performed to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for each risk factor.RESULTS:A total of 532 patients were included in the cohort,of whom 62(12.0%;28 males,34 females)developed postoperative blindness at the final follow-up.Among these 62 patients,30 had high myopia and 32 did not.The mean age of participants was 49.0±16.4y,with 275 subjects(52%)being male and 133 patients(25%)having the condition in the right eye.In the multivariable model for all patients,the following factors were associated with an increased risk of postoperative blindness:higher preoperative logarithm of the minimum angle of resolution visual acuity(logMAR VA;OR=1.09 per 0.1 logMAR unit increase,95%CI 1.03-1.15);inferior or superior retinal breaks(OR=2.42,95%CI 1.12-5.24);and macular holes or superior retinal breaks(OR=8.46,95%CI 3.45-20.75).In the subgroup of patients with high myopia,risk factors for postoperative blindness included:pseudophakia/aphakia versus phakia(OR=6.33,95%CI 1.41-28.31);macular holes or superior retinal breaks(OR=15.15,95%CI 3.07-74.85);and proliferative vitreoretinopathy(PVR;OR=21.41,95%CI 2.14-214.57).In the subgroup of patients without high myopia,increased risk of postoperative blindness was associated with:higher preoperative logMAR VA(OR=1.11 per 0.1 logMAR unit increase,95%CI 1.04-1.18);and inferior or superior retinal breaks(OR=2.90,95%CI 1.19-7.06).CONCLUSION:Using a large real-world clinical database,we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia.These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.
文摘Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).
文摘AIM:To evaluate the efficacy and safety of combining posterior scleral contraction(PSC)with intravitreal perfluoropropane(C_(3)F_(8))injection in high myopia with macular hole retinal detachment(MHRD).METHODS:A total of 22 participants(22 eyes)with high myopia[axial length(AL)≥26.5 mm]and MHRD who underwent PSC combined with intravitreal C_(3)F_(8)injection,with at least 6mo of follow-up were retrospectively recruited.Outcome measures included best-corrected visual acuity(BCVA),AL,optical coherence tomography(OCT)findings,and adverse events.Retinal recovery was categorized as type Ⅰ(macular hole bridging with retinal reattachment)or type Ⅱ(reattachment without hole bridging).RESULTS:The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo.Complete retinal reattachment was observed in 11 eyes(50%)at postoperative day 1,19 eyes(86.3%)at week 1,and all 22 eyes at month 1.Ten eyes(45.5%)achieved type Ⅰ recovery and 12 eyes(54.5%)achieved type Ⅱ.Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery(P<0.001),and AL was significantly reduced compared to baseline(29.07±2.05 vs 30.8±2.2 mm;P<0.001).No serious complications were reported.CONCLUSION:PSC combined with intravitreal C_(3)F_(8)injection is a safe and effective treatment for MHRD in highly myopic eyes,especially for retinal detachment limited within the vascular arcade.
基金Supported by Research Incubation Fund of Xi’an People’s Hospital(Xi’an Fourth Hospital)(No.FZ-58).
文摘AIM:To evaluate the surgical outcomes of the perfluorocarbon liquid(PFCL)-assisted inverted multilayer internal limiting membrane(ILM)flaps covering technique in macular hole retinal detachment(MHRD)in high myopia with axial length(AL)≥30 mm.METHODS:In this retrospective,interventional,consecutive comparative study,44 MHRD eyes were divided into two groups:the PFCL-assisted inverted multilayer ILM flaps covering technique group(Group 1,21 eyes)and the ILM peeling group(Group 2,23 eyes).The follow-up period was>12mo.Postoperative outcomes,including retinal reattachment,macular hole(MH)closure,and bestcorrected visual acuity(BCVA),were assessed.Statistical analysis using the Mann–Whitney U test and Fisher’s exact test was conducted to compare differences between groups.RESULTS:There were no statistically significant differences in baseline preoperative clinical characteristics,including age,sex,AL,diopters,duration of symptom,lens status,posterior staphyloma presence and extent of RD.Retinal reattachment rates were higher in Group 1(90.5%)than in Group 2(82.6%),without statistical significance(P=0.667).MH closure rates were significantly higher in Group 1(85.7%)than in Group 2(17.4%;P<0.001).The Group-1 BCVA(logMAR)improved significantly from 2.13±0.91 preoperatively to 1.21±0.66 postoperatively(P=0.026).The Group 2 BCVA improved significantly from 1.91±0.53 preoperatively to 1.19±0.41 postoperatively(P=0.032).However,there were no significant differences in visual-acuity improvement between groups(P=0.460).CONCLUSION:This technique offers a more effective approach for improving MH closure rates and postoperative visual function in MHRD with AL≥30 mm in high myopia.
基金Supported by the Program of Shanghai Academic/Technology Research Leader(No.21XD1402700)the Clinical Research Plan of Shenkang Hospital Development Center of Shanghai(No.SHDC2022CRD001).
文摘AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This multicenter,prospective,randomized,double-masked,parallel-controlled,non-inferiority trial was conducted in three ophthalmology clinical centers in China.Patients with retinal detachment,who were eligible for PPV were consecutively enrolled.Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio.Best-corrected visual acuity(BCVA),intraocular pressure(IOP)measurement,and dilated fundus examination were performed preoperatively and at 1,7±1,28±3d postoperatively.The primary outcome was complete retinal reattachment rate at postoperative day one.The non-inferiority margin was set at 9.8%.The secondary outcomes included intraoperative retinal reattachment rate,and mean changes in IOP and BCVA from baseline to 1,7±1,28±3d postoperatively,respectively.Safety analyses were presented for all randomly assigned participates in this study.RESULTS:Totally 124 eligible patients completed the study between Mar.14,2016 and Jun.7,2017.Sixty of them were randomly assigned to the PFO for ophthalmic surgery group,and 64 were assigned to the F-Octane group.Baseline characteristics were comparable between the two groups.Both groups achieved 100%retinal reattachment at postoperative day one(difference 0,95%CI:-6.21%to 5.75%,P=1).The pre-defined noninferiority criterion was met.No significant difference was observed in intraoperative retinal reattachment rate(difference 1.77%,P=0.61),mean changes in IOP(difference 0.36,-0.09,2.22 mm Hg at 1,7±1,28±3d postoperatively,with all P>0.05)and BCVA(difference 0.04,-0.02,0.06 logMAR at 1,7±1,28±3d postoperatively,all P>0.05)between the two groups.No apparent adverse events related to the utilization of PFO were reported.CONCLUSION:In patients with retinal detachment undergoing PPV,PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade,and both are safe and well-tolerated.
基金Supported by National Natural Science Foundation of China(No.81700884)Scientific Research Foundation of National Health and Health Commission(No.WKJ-ZJ-2037)+1 种基金Zhejiang Public Welfare Technology Application Project(No.LGF21H120005)Science and Technology Project of Wenzhou(No.Y20190649).
文摘AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.
基金Supported by Xuzhou Health Outstanding Talents Project(No.XWJC001)Critical Special Project for Social Development of Xuzhou(No.KC21153)+1 种基金Science and Technology Innovation Project of Xuzhou Municipal Health Commission(No.XWKYHT20230039)Applied Basic Research Project of Xuzhou(No.KC23016).
文摘●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.
基金Supported by the Fundamental Research Funds of the State Key Laboratory of Ophthalmology(No.303060202400201203).
文摘AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.
文摘AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.
文摘AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
基金supported by the National Nature Science Foundation of China(Grant Nos.11972066,U20A20390,and 11827803)the support of Open Fund of State Key Laboratory of Virtual Reality Technology and Systems。
文摘This study aimed to conduct finite element(FE)analysis matched with an in vitro experiment to analyze traumatic retinal detachments(TrRD)resulting from blunt trauma and provide stress and strain thresholds to predict the occurrence of TrRD.The in vitro experiment was performed on forty-eight porcine eyes using a pendulum device.We examined dynamic mechanical responses at four energy levels.A FE model,based on experimental results and published data,was used to simulate TrRD.Fifty-one additional eyes underwent immediate pathological examination following blunt impact.A dynamic variation of velocities was observed post-impact,displaying an approximate cosine oscillation-attenuation profile.Energy absorption increased as the initial energy and differed significantly at four energy levels(p<0.001).FE simulation showed a peak strain of 0.462 in the anterior vitreous body and a peak stress of 1.408 MPa at the cornea at the high-energy level.During the energy transfer,the stress was initially observed in retinal region along the impact direction at the separation.TrRD were observed in injured eyes,where a few detachments were detected in control eyes.Correlations were performed between the proportion of pathological outcomes and FE results.In conclusion,this study suggests that stress contributes to the development of retinal detachment,providing an indicator to distinguish the occurrence of TrRD.
文摘Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in adulthood.Moreover,the anatomical success,when achieved,is frequently not related to a functional recover.Postsurgical adverse events,refractive errors and amblyopia may additionally undermine the final outcome.Up to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal detachment.In this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were considered.The available literature from the last decades were reviewed and summarized.Epidemiology,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.
文摘AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). · METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three -port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow -up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure (IOP) were recorded and analyzed. ·RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow -up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.·CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.
文摘AIM： To comprehensively analyze the risk factors of rhegmatogenous retinal detachment （RRD） associated with choroidal detachment （CD）. METHODS： A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B -scan ultrasonography, and ultrasound biomicroscope （UBM）. Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD）. Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS： There were 52 eyes （19.62%） with CD. Pseudophakia was more commonly seen in RRDCD （21.15% ys6.10%, P=0.002）. Intraocular pressure （lOP） was lower （8.60 ±3.62 ys 12.96 ±3.55, P 〈0.001）, best - corrected visual acuity was worse [3.00 （2.00 to 3.00） vs 1.92 （1.22 to 3.00）, P=-0.001], and refractive error was more myopic [-4 （-9 to -2） vs -2 （-6 to 0）, P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment （P=0.007）. In RRDCD, 34.62% of eyes presented with multiple holes （P=0.044） and 25.00% with macular holes （P=0.012）, compared with 20.66% and 14.08% in R RD. High myopia （P=0.039）, low lOP （P=0.017）, and larger extent of retinal detachment （P〈0.001） were significant and independent risk factors for developing CD. - CONCLUSION： For CD in RRD, related factors include BCVA, lOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low lOP are significant and independent risk factors.
基金supported by the Health Bureau of Zhejiang Province, China (No.20100580)
文摘AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR). METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR >= C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed. RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000). CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be dosed successfully without additional sclera! buckling.
文摘AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.
