AIM:To investigate the effects of shortening the duration of silicone oil tamponade on retinal structure and function in patients undergoing silicone oil removal(SOR)after surgery for primary rhegmatogenous retinal de...AIM:To investigate the effects of shortening the duration of silicone oil tamponade on retinal structure and function in patients undergoing silicone oil removal(SOR)after surgery for primary rhegmatogenous retinal detachment(RRD).METHODS:A total of 58 eligible patients were enrolled and randomly assigned to two groups based on tamponade duration:the short-term group(30-45d)and the conventional group(≥90d).Comprehensive evaluations were performed before and after SOR,including slitlamp examination,best-corrected visual acuity(BCVA)measurement,intraocular pressure(IOP)testing,optical coherence tomography(OCT),optical coherence tomography angiography(OCTA),microperimetry,electroretinography(ERG),and visual evoked potential(VEP)assessment.RESULTS:A total of 33 patients(23 males and 10 females;33 eyes)were enrolled in the short-term SO tamponade group with mean age of 52.45±9.35y,and 25 patients(15 males and 10 females;25 eyes)were enrolled in the conventional SO tamponade group with mean age of 50.80±12.06y.Compared with the conventional group,the short-term silicone oil tamponade group had a significantly lower incidence of silicone oil emulsification and cataract progression,with no significant difference in retinal reattachment success rate.Structurally,short-term tamponade was associated with increased thickness of the retinal ganglion cell layer(RGCL)in the nasal and superior macular regions and improved recovery of superficial retinal vascular density in these areas.Functionally,the shortterm group showed better BCVA and retinal sensitivity both before and 1mo after SOR;additionally,the P100 amplitude in VEP tests was significantly increased in this group.CONCLUSION:Shortening the duration of silicone oil tamponade effectively reduces damage to retinal structure and function without compromising the success rate of retinal reattachment in patients with primary RRD.展开更多
Rhegmatogenous retinal detachment(RRD)is a serious ocular condition marked by the separation of the neuroretina from the retinal pigment epithelium(RPE).The pathogenesis of RRD involves intricate molecular and cellula...Rhegmatogenous retinal detachment(RRD)is a serious ocular condition marked by the separation of the neuroretina from the retinal pigment epithelium(RPE).The pathogenesis of RRD involves intricate molecular and cellular mechanisms,including inflammation,cell migration,and the activation of proliferative signaling pathways.One of the most challenging complications of RRD is proliferative vitreoretinopathy(PVR),which refers to the proliferation and contraction of fibrocellular membranes on the retinal surface and in the vitreous cavity.PVR is a major cause of surgical failure in RRD,as it can lead to recurrent retinal detachment and severe vision loss.However,the pathogenesis of PVR is not yet fully understood,and the treatment options are quite limited.Recent advances in analytical techniques have offered valuable insights into the molecular alterations present in the subretinal fluid(SRF)of patients with RRD.This review seeks to consolidate the current knowledge regarding the SRF profile in RRD and PVR,emphasizing potential biomarkers and therapeutic targets.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
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 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
The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retin...The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.展开更多
AIM： To compare the incidence of persistent submacular fluid（SMF） and visual outcome after pars plana vitrectomy（PPV） for rhegmatogenous retinal detachment（RRD） in different preoperative macular status accordin...AIM： To compare the incidence of persistent submacular fluid（SMF） and visual outcome after pars plana vitrectomy（PPV） for rhegmatogenous retinal detachment（RRD） in different preoperative macular status according to optical coherence tomography（OCT）.METHODS： A non-randomized, retrospective review was performed for patients who underwent successful PPV for RRD. OCT exams were taken preoperatively and 1 mo after surgery, until SMF disappeared. According to the preoperative macular status on OCT, patients were divided into two groups： macula-off RRD（Group A） and maculaon RRD（Group B）. In Group A, there were two subgroups： macula partly detached（Group A1） and macula totally detached（Group A2）. The main outcome measures were the presence of SMF on OCT 1 mo after surgery, and the preoperative and postoperative best corrected visual acuities（BCVA）, among the different groups and depending on the presence or absence of persistent SMF.RESULTS： A total of 139 eyes of 139 patients were included in the study. Persistent SMF at 1 mo after surgery was 15.8%（22/139）, all occurring in Group A（22/101）; Group B had no SMF at 1 mo after surgery（0/38, P=0.002）. The incidence of persistent SMF at 1 mo after surgery in Group A1 was 50%（14/28）, and in Group A2 was 11.0%（8/73, P〈0.001）. Significant differences were shown between the presence and absence of persistent SMF on foveolaoff RRD, the preoperative BCVA, the 1 mo postoperative BCVA, and the degree of the BCVA improvement from 1 mo postoperatively to the final follow-up（P〈0.05）. However, there were no significant differences in the final BCVA（P〉0.05）.CONCLUSION： Persistent SMF after PPV for retinal detachment is associated with preoperative macular status. Macula-uninvolving RRD shows no persistent SMF after PPV. Macular partly detached RRD has a higher incidence of SMF than macula totally detached RRD after PPV. The persistence of SMF may be responsible for the delayed visual recovery, whereas there were no significant differences in the final visual acuity.展开更多
AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 fema...AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.展开更多
AIM:To provide a detailed description of the natural history of persistent subretinal fluid(SRF)after successful repair of rhegmatogenous retinal detachment(RRD)and its association with visual outcome.METHODS:This was...AIM:To provide a detailed description of the natural history of persistent subretinal fluid(SRF)after successful repair of rhegmatogenous retinal detachment(RRD)and its association with visual outcome.METHODS:This was a prospective long-term follow-up for eyes undergoing scleral buckling(SB)surgery for maculaoff RRD.Examinations were carried out preoperatively and postoperatively at 1,3,6,9 and 12 mo,until persistent SRF had completely resolved.One month postoperatively,optical coherence tomography(OCT)was used to classify SRF into three patterns:bleb-like loculated(BL),shallow-diffused(SD),and multiple blebs(MB).Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance.Patients were divided into two groups depending on the presence or absence of persistent SRF.RESULTS:A total of 59 patients(59 eyes)were included.There were no statistical differences between two groups at baseline,except for the proportion of patients with high myopia and a younger age.One month after surgery,OCT detected persistent SRF in 49 eyes(83.1%).The 3 morphological patterns of SRF were observed in 27 eyes(55.1%)with BL,13 eyes(26.5%)with SD,and 9 eyes(18.4%)with MB.The mean time for complete absorption differed significantly across the three SRF patterns(F=8.097,P=0.001),which was 8.8±6.1,20.1±12.1,and 16.7±10.2 mo in BL,SD,and MB,respectively.In 9 of the 13 eyes with SD,the pattern transformed into MB type.In cases involving MB,the size and number of blebs decreased gradually until they had been completely absorbed.Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone(49.0%vs 10%,P=0.034).The final best-corrected visual acuity of two groups was 0.37±0.11(with SRF)vs 0.34±0.12(without SRF)logMAR(P=0.499),respectively.CONCLUSION:High preoperative myopia and younger age are associated with persistent SRF.BL is the most commonly observed pattern with the shortest duration and gradually disappeared.Most cases involving SD SRF transform into MB type during resolution.The size and number of the MBs decrease gradually until they were completely absorbed.The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.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 describe the clinical characters of rhegmatogenous retinal detachment(RRD) associated with massive spontaneous suprachoroidal hemorrhage(SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy....AIM:To describe the clinical characters of rhegmatogenous retinal detachment(RRD) associated with massive spontaneous suprachoroidal hemorrhage(SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy.METHODS:A retrospective review of 6 cases(6 eyes)of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage,phacoemulsification(PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported.RESULTS:In the 6 affected eyes of 6 patients(3 men and 3 women; mean age, 53.83y; range 34-61y),preoperative visual acuity ranged from faint light perception(LP) to counting finger(CF). The average interventional duration from visual decreased to surgery was 12.8 d(range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm(range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes.Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo(Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5eyes(83.33%) and no change in 1 eye(16.67%). Ocular hypertension ocurred in 1 eye(16.67%), which wassuccessfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy(PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively.CONCLUSION:RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.展开更多
Dopamine and its receptors have been widely studied in the neurological conditions and in the retina. In this study, we evaluated the possible role of dopamine in rhegmatogenous retinal detachment(RRD) by comparing th...Dopamine and its receptors have been widely studied in the neurological conditions and in the retina. In this study, we evaluated the possible role of dopamine in rhegmatogenous retinal detachment(RRD) by comparing the amount of 3,4-dihydroxyphenylacetic acid(DOPAC), a surrogate index of retinal dopamin levels, in the vitreous sample of patients affected by RRD with those affected by macular pucker and vitre ous hemorrhage. Our results showed that significantly higher levels of DOPAC were found in the vitreou sample of patients affected by RRD compared with those affected by vitreous hemorrhage and macula pucker(P = 0.002). Specifically, no trace of the substance was found in vitreous hemorrhage and macula pucker samples. A slightly significant positive correlation was found among DOPAC and post-operativ best corrected visual acuity(r = 0.470, P = 0.049). No correlation was found between DOPAC and the day elapsed between diagnosis and surgery(P = 0.317). For the first time our findings suggest that DOPAC i released in RRD, but not in other retinal diseases such as vitreous hemorrhage and macular pucker. More over, we showed a correlation between visual acuity outcome and the amount of DOPAC in the vitreous This might have a potential, although still unknown, implication in the pathogenesis of the disease and/o in the associated photoreceptors loss. This study was approved by the Ethics Committee of Rome Tor Ver gata University Hospital(R.S.92.10) on September 24, 2010.展开更多
AIM： To report the results of rhegmatogenous retinal detachment（RRD） repair after pars plana vitrectomy（PPV） without operative use of heavy liquid, and utilizing air tamponade in selected cases.METHODS： RRD pati...AIM： To report the results of rhegmatogenous retinal detachment（RRD） repair after pars plana vitrectomy（PPV） without operative use of heavy liquid, and utilizing air tamponade in selected cases.METHODS： RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5 d.RESULTS： Totally 36 eyes of 36 patients（24 males, 66.7%） aged 53.8±10.9 y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes（29, 80.6%） had retinal detachment involving more than one quadrant. Twenty-two（61.1%） eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8 mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4%（34/36）. Six（16.7%） eyes had intraocular pressure higher than 25 mm Hg. The visual acuity（logMAR） improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively（P〈0.001）. CONCLUSION： The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.展开更多
AIM:To observe the efficacy and safety of pars plana vitrectomy(PPV)with eye position guided fluid-air exchange(FAX)and air to mponade in the treatment of rhegmatogenous retinal detachment(RRD).METHODS:RRD patients wi...AIM:To observe the efficacy and safety of pars plana vitrectomy(PPV)with eye position guided fluid-air exchange(FAX)and air to mponade in the treatment of rhegmatogenous retinal detachment(RRD).METHODS:RRD patients without severe proliferative vitreoretinopathy(PVR)C1 or more were enrolled.All patients underwent PPV combining with air tamponade.During operation,the primary retinal break(s)were placed at lower site and subretinal fluid was aspirated through the break(s)at the same time when eye position guided FAX was proceeding.Sufficient laser spots were made to seal the retinal break(s)after FAX,and filtered air was left in vitreous cavity as to mponade agent finally.The main outcomes were primary and final success rates,best corrected visual acuity(BCVA),and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.RESULTS:A total of 37 eyes(20 males and 17 females)with a follow-up time of≥6 mo were included.The range of RRD was 5.6±1.8 h,and the number of retinal breaks was 1.9±1.2.The breaks located at inferior quadrants(between 3:00 and 9:00)in 5 cases(13.5%),and both superior and inferior breaks were found in 3 cases(8.1%).A total of 25 cases(67.6%)with macular detached involvement,9 cases(24.3%)with intraocular lens,and 8 patients(21.6%)were treated with phacoemulsification and intraocular lens implantation together.The success rate of primary retinal reattachment was 100%(37/37).At 6 mo postoperatively,BCVA(logMAR)was increased from 1.13±1.07 to 0.23±0.15(P<0.001).Phacoemulsification combined with intraocular lens implantation was performed in 2 patients(5.4%),and one of them underwent macular epiretinal membrane peeling in addition(2.7%).Furthermore,high intraocular pressure was found in 4 cases(10.8%).CONCLUSION:PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD,and it has the advantages of short postoperative prone time and fewer operative complications.展开更多
AIM： To determine the frequency of detection of ocular and extraocular Chlamydia trachomatis （CT） infection in non -high myopes with rhegmatogenous retinal detachment （RRD）. METHODS： This was a single-center, n...AIM： To determine the frequency of detection of ocular and extraocular Chlamydia trachomatis （CT） infection in non -high myopes with rhegmatogenous retinal detachment （RRD）. METHODS： This was a single-center, nonrandomized, prospective, case-control study. One hundred and four patients were divided into a study group with RRD （n= 63） and a control group with traumatic retinal detachment （n=41）. Samples of subretinal fluid （SFR）, conjunctival, urethral/cervical swabs, and blood were collected. The frequency of detection of CT infection in SRF samples was determined by polymerase chain reaction （PCR）, direct fluorescence assay （DFA） and cell culture, whereas that in conjunctival swabs was determined by PCR and DFA, and those in urethral/cervical swabs and blood were determined by DFA. Yates Chi-square test （with Bonferroni correction） and two-tailed Student＇s t-test were used for statistical analysis. RESULTS： SRF CT infection was detected more frequently in the study group （50.8%-71.4%） than in the control group （9.8%-12.2%） by all the methods used （P〈 0.01）. The frequency of detection of conjunctival CT infection by DFA was higher in the RRD patients compared with the controls （81.0% vs 24.4%, P=0.004）. The PCR detected conjunctival CT infection more often in the study group than in the controls （46.0% vs89.8%, P= 0.007）. The DFA detected CT in blood specimens almost as frequently as in urogenital specimens, for the RRD patients （61.2% vs 63.5%） and the controls （7.3% vs 9.8%）. CONCLUSION： CT infection is detected with high frequency in non-high myopes with RRD.展开更多
AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomize...AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.展开更多
AIM:To evaluate macular microvasculature changes in eyes after pars plana vitrectomy(PPV)and intraocular silicone oil(SO)tamponade for macula-off rhegmatogenous retinal detachment(RRD)using optical coherence tomograph...AIM:To evaluate macular microvasculature changes in eyes after pars plana vitrectomy(PPV)and intraocular silicone oil(SO)tamponade for macula-off rhegmatogenous retinal detachment(RRD)using optical coherence tomography angiography(OCTA).METHODS:Totally 19 eyes(19 patients)with maculaoff RRD who underwent PPV and intraocular SO tamponade were retrospectively reviewed.The parafoveal superficial capillary plexus(SCP)vessel density(VD),deep capillary plexus(DCP)VD,choriocapillaris plexus(CCP)VD,and foveal macular thickness were evaluated using OCTA throughout 16 wk postoperatively.The values of healthy fellow eyes were used as control.RESULTS:The parafoveal SCP,DCP,and CCP VDs were significant increased over time in RRD eyes during the 12 wk postoperatively,then decreased at 16 wk postoperatively(all P<0.01).The ratios of RRD eyes and fellow healthy eyes(r/f ratios)of the SCP and DCP VDs were lower than those of the CCP VD postoperatively(all P<0.05).There were not significant differences in the r/f ratios between SCP and DCP VDs postoperatively(all P>0.05).CONCLUSION:The parafoveal SCP,DCP,and CCP VDs gradually recover over time after PPV surgery with SO tamponade.Long-time SO tamponade might decrease postoperative macular VDs.Compared to parafoveal CCP VD,the parafoveal SCP and DCP VDs were more vulnerable in RRD eyes postoperatively.展开更多
AIM:To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments(RRDs)in the Wenzhou area in 2015 to 2019.METHODS:All newly developed RRD cases among residents of the Wenzhou area,fr...AIM:To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments(RRDs)in the Wenzhou area in 2015 to 2019.METHODS:All newly developed RRD cases among residents of the Wenzhou area,from January 2015 to December 2019,were retrospectively retrieved from hospital records.Annual population data were extracted from the Wenzhou Statistical Yearbook.RESULTS:There were 3629 eligible cases.The average incidence of RRD was 7.79 cases per 100000 population(95%confidence interval,7.24-8.34),and the incidences were 7.99 and 7.56 for males and females,respectively.The annual incidence increased gradually from 7.26 cases per 100000 in 2015 to 10.00 cases per 100000 in 2019,with an overall increase of 37.74%.The highest rate of increase occurred in the age group from 60 to 69 years.Of 2750 eyes with axial length(AL)data,1675(60.91%)had an AL greater than 24 mm.CONCLUSION:A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.展开更多
AIM:To identify the risk factors for postoperative proliferative vitreoretinopathy(PVR)in patients with primary rhegmatogenous retinal detachment(RRD)and develop a nomogram for predicting postoperative PVR-free probab...AIM:To identify the risk factors for postoperative proliferative vitreoretinopathy(PVR)in patients with primary rhegmatogenous retinal detachment(RRD)and develop a nomogram for predicting postoperative PVR-free probability.METHODS:A total of 741 patients(741 eyes)diagnosed with primary RRD who underwent first surgery in the same hospital were retrospectively reviewed and randomly assigned with 521 to the training set and 220 to the validation set.Univariate and multivariate logistic regression analyses were performed in the training cohort to determine risk factors to construct a nomogram for predicting the 3-,4-,5-,and 6-month postoperative PVR-free probabilities.Nomogram performance was estimated by the concordance index(C-index),calibration plot,and the area receiver operating characteristic(ROC)curve.RESULTS:A nomogram was constructed based on the preoperative PVR,silicone oil tamponade time(SOTT),photocoagulation energy(PE),retinal tear size(RTS),and hypertension.In the training set,the C-index of the nomogram was 0.896,0.936,0.961,and 0.972 at 3,4,5,and 6mo,respectively.The C-index values in the validation set were 0.860,0.936,0.951,and 0.965 at 3,4,5,and 6mo,respectively.Decision-curve analysis indicated that only the 4-,5-,and 6-month nomograms had significant net benefits over a large threshold probabilities interval.CONCLUSION:Preoperative PVR,SOTT,PE,RTS,and hypertension are significant risk factors for postoperative PVR formation in patients with primary RRD.The proposed nomogram can effectively predict the 4-,5-,and 6-month PVR-free probabilities after surgery and assist in making clinical decisions during follow-up.展开更多
基金Supported by the Key Science&Technology Project of Guangzhou(No.202103000045)the National Natural Science Foundation of China(No.82070972,No.82271093).
文摘AIM:To investigate the effects of shortening the duration of silicone oil tamponade on retinal structure and function in patients undergoing silicone oil removal(SOR)after surgery for primary rhegmatogenous retinal detachment(RRD).METHODS:A total of 58 eligible patients were enrolled and randomly assigned to two groups based on tamponade duration:the short-term group(30-45d)and the conventional group(≥90d).Comprehensive evaluations were performed before and after SOR,including slitlamp examination,best-corrected visual acuity(BCVA)measurement,intraocular pressure(IOP)testing,optical coherence tomography(OCT),optical coherence tomography angiography(OCTA),microperimetry,electroretinography(ERG),and visual evoked potential(VEP)assessment.RESULTS:A total of 33 patients(23 males and 10 females;33 eyes)were enrolled in the short-term SO tamponade group with mean age of 52.45±9.35y,and 25 patients(15 males and 10 females;25 eyes)were enrolled in the conventional SO tamponade group with mean age of 50.80±12.06y.Compared with the conventional group,the short-term silicone oil tamponade group had a significantly lower incidence of silicone oil emulsification and cataract progression,with no significant difference in retinal reattachment success rate.Structurally,short-term tamponade was associated with increased thickness of the retinal ganglion cell layer(RGCL)in the nasal and superior macular regions and improved recovery of superficial retinal vascular density in these areas.Functionally,the shortterm group showed better BCVA and retinal sensitivity both before and 1mo after SOR;additionally,the P100 amplitude in VEP tests was significantly increased in this group.CONCLUSION:Shortening the duration of silicone oil tamponade effectively reduces damage to retinal structure and function without compromising the success rate of retinal reattachment in patients with primary RRD.
文摘Rhegmatogenous retinal detachment(RRD)is a serious ocular condition marked by the separation of the neuroretina from the retinal pigment epithelium(RPE).The pathogenesis of RRD involves intricate molecular and cellular mechanisms,including inflammation,cell migration,and the activation of proliferative signaling pathways.One of the most challenging complications of RRD is proliferative vitreoretinopathy(PVR),which refers to the proliferation and contraction of fibrocellular membranes on the retinal surface and in the vitreous cavity.PVR is a major cause of surgical failure in RRD,as it can lead to recurrent retinal detachment and severe vision loss.However,the pathogenesis of PVR is not yet fully understood,and the treatment options are quite limited.Recent advances in analytical techniques have offered valuable insights into the molecular alterations present in the subretinal fluid(SRF)of patients with RRD.This review seeks to consolidate the current knowledge regarding the SRF profile in RRD and PVR,emphasizing potential biomarkers and therapeutic targets.
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.
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.
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The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.
基金Supported by the Platform Key Project of Medical Scientific Research Foundation of Zhejiang Province (No.2016ZDA016)
文摘AIM： To compare the incidence of persistent submacular fluid（SMF） and visual outcome after pars plana vitrectomy（PPV） for rhegmatogenous retinal detachment（RRD） in different preoperative macular status according to optical coherence tomography（OCT）.METHODS： A non-randomized, retrospective review was performed for patients who underwent successful PPV for RRD. OCT exams were taken preoperatively and 1 mo after surgery, until SMF disappeared. According to the preoperative macular status on OCT, patients were divided into two groups： macula-off RRD（Group A） and maculaon RRD（Group B）. In Group A, there were two subgroups： macula partly detached（Group A1） and macula totally detached（Group A2）. The main outcome measures were the presence of SMF on OCT 1 mo after surgery, and the preoperative and postoperative best corrected visual acuities（BCVA）, among the different groups and depending on the presence or absence of persistent SMF.RESULTS： A total of 139 eyes of 139 patients were included in the study. Persistent SMF at 1 mo after surgery was 15.8%（22/139）, all occurring in Group A（22/101）; Group B had no SMF at 1 mo after surgery（0/38, P=0.002）. The incidence of persistent SMF at 1 mo after surgery in Group A1 was 50%（14/28）, and in Group A2 was 11.0%（8/73, P〈0.001）. Significant differences were shown between the presence and absence of persistent SMF on foveolaoff RRD, the preoperative BCVA, the 1 mo postoperative BCVA, and the degree of the BCVA improvement from 1 mo postoperatively to the final follow-up（P〈0.05）. However, there were no significant differences in the final BCVA（P〉0.05）.CONCLUSION： Persistent SMF after PPV for retinal detachment is associated with preoperative macular status. Macula-uninvolving RRD shows no persistent SMF after PPV. Macular partly detached RRD has a higher incidence of SMF than macula totally detached RRD after PPV. The persistence of SMF may be responsible for the delayed visual recovery, whereas there were no significant differences in the final visual acuity.
文摘AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.
文摘AIM:To provide a detailed description of the natural history of persistent subretinal fluid(SRF)after successful repair of rhegmatogenous retinal detachment(RRD)and its association with visual outcome.METHODS:This was a prospective long-term follow-up for eyes undergoing scleral buckling(SB)surgery for maculaoff RRD.Examinations were carried out preoperatively and postoperatively at 1,3,6,9 and 12 mo,until persistent SRF had completely resolved.One month postoperatively,optical coherence tomography(OCT)was used to classify SRF into three patterns:bleb-like loculated(BL),shallow-diffused(SD),and multiple blebs(MB).Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance.Patients were divided into two groups depending on the presence or absence of persistent SRF.RESULTS:A total of 59 patients(59 eyes)were included.There were no statistical differences between two groups at baseline,except for the proportion of patients with high myopia and a younger age.One month after surgery,OCT detected persistent SRF in 49 eyes(83.1%).The 3 morphological patterns of SRF were observed in 27 eyes(55.1%)with BL,13 eyes(26.5%)with SD,and 9 eyes(18.4%)with MB.The mean time for complete absorption differed significantly across the three SRF patterns(F=8.097,P=0.001),which was 8.8±6.1,20.1±12.1,and 16.7±10.2 mo in BL,SD,and MB,respectively.In 9 of the 13 eyes with SD,the pattern transformed into MB type.In cases involving MB,the size and number of blebs decreased gradually until they had been completely absorbed.Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone(49.0%vs 10%,P=0.034).The final best-corrected visual acuity of two groups was 0.37±0.11(with SRF)vs 0.34±0.12(without SRF)logMAR(P=0.499),respectively.CONCLUSION:High preoperative myopia and younger age are associated with persistent SRF.BL is the most commonly observed pattern with the shortest duration and gradually disappeared.Most cases involving SD SRF transform into MB type during resolution.The size and number of the MBs decrease gradually until they were completely absorbed.The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.
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 describe the clinical characters of rhegmatogenous retinal detachment(RRD) associated with massive spontaneous suprachoroidal hemorrhage(SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy.METHODS:A retrospective review of 6 cases(6 eyes)of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage,phacoemulsification(PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported.RESULTS:In the 6 affected eyes of 6 patients(3 men and 3 women; mean age, 53.83y; range 34-61y),preoperative visual acuity ranged from faint light perception(LP) to counting finger(CF). The average interventional duration from visual decreased to surgery was 12.8 d(range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm(range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes.Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo(Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5eyes(83.33%) and no change in 1 eye(16.67%). Ocular hypertension ocurred in 1 eye(16.67%), which wassuccessfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy(PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively.CONCLUSION:RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.
文摘Dopamine and its receptors have been widely studied in the neurological conditions and in the retina. In this study, we evaluated the possible role of dopamine in rhegmatogenous retinal detachment(RRD) by comparing the amount of 3,4-dihydroxyphenylacetic acid(DOPAC), a surrogate index of retinal dopamin levels, in the vitreous sample of patients affected by RRD with those affected by macular pucker and vitre ous hemorrhage. Our results showed that significantly higher levels of DOPAC were found in the vitreou sample of patients affected by RRD compared with those affected by vitreous hemorrhage and macula pucker(P = 0.002). Specifically, no trace of the substance was found in vitreous hemorrhage and macula pucker samples. A slightly significant positive correlation was found among DOPAC and post-operativ best corrected visual acuity(r = 0.470, P = 0.049). No correlation was found between DOPAC and the day elapsed between diagnosis and surgery(P = 0.317). For the first time our findings suggest that DOPAC i released in RRD, but not in other retinal diseases such as vitreous hemorrhage and macular pucker. More over, we showed a correlation between visual acuity outcome and the amount of DOPAC in the vitreous This might have a potential, although still unknown, implication in the pathogenesis of the disease and/o in the associated photoreceptors loss. This study was approved by the Ethics Committee of Rome Tor Ver gata University Hospital(R.S.92.10) on September 24, 2010.
基金Supported by the Innovation Research Project of the Eye Hospital of Wenzhou Medical University (No. YNCX201308)
文摘AIM： To report the results of rhegmatogenous retinal detachment（RRD） repair after pars plana vitrectomy（PPV） without operative use of heavy liquid, and utilizing air tamponade in selected cases.METHODS： RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5 d.RESULTS： Totally 36 eyes of 36 patients（24 males, 66.7%） aged 53.8±10.9 y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes（29, 80.6%） had retinal detachment involving more than one quadrant. Twenty-two（61.1%） eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8 mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4%（34/36）. Six（16.7%） eyes had intraocular pressure higher than 25 mm Hg. The visual acuity（logMAR） improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively（P〈0.001）. CONCLUSION： The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.
基金Supported by the Natural Science Basic Research Project of Shaanxi Province(No.2019JM-578)。
文摘AIM:To observe the efficacy and safety of pars plana vitrectomy(PPV)with eye position guided fluid-air exchange(FAX)and air to mponade in the treatment of rhegmatogenous retinal detachment(RRD).METHODS:RRD patients without severe proliferative vitreoretinopathy(PVR)C1 or more were enrolled.All patients underwent PPV combining with air tamponade.During operation,the primary retinal break(s)were placed at lower site and subretinal fluid was aspirated through the break(s)at the same time when eye position guided FAX was proceeding.Sufficient laser spots were made to seal the retinal break(s)after FAX,and filtered air was left in vitreous cavity as to mponade agent finally.The main outcomes were primary and final success rates,best corrected visual acuity(BCVA),and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.RESULTS:A total of 37 eyes(20 males and 17 females)with a follow-up time of≥6 mo were included.The range of RRD was 5.6±1.8 h,and the number of retinal breaks was 1.9±1.2.The breaks located at inferior quadrants(between 3:00 and 9:00)in 5 cases(13.5%),and both superior and inferior breaks were found in 3 cases(8.1%).A total of 25 cases(67.6%)with macular detached involvement,9 cases(24.3%)with intraocular lens,and 8 patients(21.6%)were treated with phacoemulsification and intraocular lens implantation together.The success rate of primary retinal reattachment was 100%(37/37).At 6 mo postoperatively,BCVA(logMAR)was increased from 1.13±1.07 to 0.23±0.15(P<0.001).Phacoemulsification combined with intraocular lens implantation was performed in 2 patients(5.4%),and one of them underwent macular epiretinal membrane peeling in addition(2.7%).Furthermore,high intraocular pressure was found in 4 cases(10.8%).CONCLUSION:PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD,and it has the advantages of short postoperative prone time and fewer operative complications.
文摘AIM： To determine the frequency of detection of ocular and extraocular Chlamydia trachomatis （CT） infection in non -high myopes with rhegmatogenous retinal detachment （RRD）. METHODS： This was a single-center, nonrandomized, prospective, case-control study. One hundred and four patients were divided into a study group with RRD （n= 63） and a control group with traumatic retinal detachment （n=41）. Samples of subretinal fluid （SFR）, conjunctival, urethral/cervical swabs, and blood were collected. The frequency of detection of CT infection in SRF samples was determined by polymerase chain reaction （PCR）, direct fluorescence assay （DFA） and cell culture, whereas that in conjunctival swabs was determined by PCR and DFA, and those in urethral/cervical swabs and blood were determined by DFA. Yates Chi-square test （with Bonferroni correction） and two-tailed Student＇s t-test were used for statistical analysis. RESULTS： SRF CT infection was detected more frequently in the study group （50.8%-71.4%） than in the control group （9.8%-12.2%） by all the methods used （P〈 0.01）. The frequency of detection of conjunctival CT infection by DFA was higher in the RRD patients compared with the controls （81.0% vs 24.4%, P=0.004）. The PCR detected conjunctival CT infection more often in the study group than in the controls （46.0% vs89.8%, P= 0.007）. The DFA detected CT in blood specimens almost as frequently as in urogenital specimens, for the RRD patients （61.2% vs 63.5%） and the controls （7.3% vs 9.8%）. CONCLUSION： CT infection is detected with high frequency in non-high myopes with RRD.
文摘AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.
文摘AIM:To evaluate macular microvasculature changes in eyes after pars plana vitrectomy(PPV)and intraocular silicone oil(SO)tamponade for macula-off rhegmatogenous retinal detachment(RRD)using optical coherence tomography angiography(OCTA).METHODS:Totally 19 eyes(19 patients)with maculaoff RRD who underwent PPV and intraocular SO tamponade were retrospectively reviewed.The parafoveal superficial capillary plexus(SCP)vessel density(VD),deep capillary plexus(DCP)VD,choriocapillaris plexus(CCP)VD,and foveal macular thickness were evaluated using OCTA throughout 16 wk postoperatively.The values of healthy fellow eyes were used as control.RESULTS:The parafoveal SCP,DCP,and CCP VDs were significant increased over time in RRD eyes during the 12 wk postoperatively,then decreased at 16 wk postoperatively(all P<0.01).The ratios of RRD eyes and fellow healthy eyes(r/f ratios)of the SCP and DCP VDs were lower than those of the CCP VD postoperatively(all P<0.05).There were not significant differences in the r/f ratios between SCP and DCP VDs postoperatively(all P>0.05).CONCLUSION:The parafoveal SCP,DCP,and CCP VDs gradually recover over time after PPV surgery with SO tamponade.Long-time SO tamponade might decrease postoperative macular VDs.Compared to parafoveal CCP VD,the parafoveal SCP and DCP VDs were more vulnerable in RRD eyes postoperatively.
基金Supported by Zhejiang Provincial Highlevel Health Talents Training Project(No.CZ-RC2022010)Wenzhou Basic Medical and Health Technology Project(No.Y20220779)。
文摘AIM:To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments(RRDs)in the Wenzhou area in 2015 to 2019.METHODS:All newly developed RRD cases among residents of the Wenzhou area,from January 2015 to December 2019,were retrospectively retrieved from hospital records.Annual population data were extracted from the Wenzhou Statistical Yearbook.RESULTS:There were 3629 eligible cases.The average incidence of RRD was 7.79 cases per 100000 population(95%confidence interval,7.24-8.34),and the incidences were 7.99 and 7.56 for males and females,respectively.The annual incidence increased gradually from 7.26 cases per 100000 in 2015 to 10.00 cases per 100000 in 2019,with an overall increase of 37.74%.The highest rate of increase occurred in the age group from 60 to 69 years.Of 2750 eyes with axial length(AL)data,1675(60.91%)had an AL greater than 24 mm.CONCLUSION:A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.
文摘AIM:To identify the risk factors for postoperative proliferative vitreoretinopathy(PVR)in patients with primary rhegmatogenous retinal detachment(RRD)and develop a nomogram for predicting postoperative PVR-free probability.METHODS:A total of 741 patients(741 eyes)diagnosed with primary RRD who underwent first surgery in the same hospital were retrospectively reviewed and randomly assigned with 521 to the training set and 220 to the validation set.Univariate and multivariate logistic regression analyses were performed in the training cohort to determine risk factors to construct a nomogram for predicting the 3-,4-,5-,and 6-month postoperative PVR-free probabilities.Nomogram performance was estimated by the concordance index(C-index),calibration plot,and the area receiver operating characteristic(ROC)curve.RESULTS:A nomogram was constructed based on the preoperative PVR,silicone oil tamponade time(SOTT),photocoagulation energy(PE),retinal tear size(RTS),and hypertension.In the training set,the C-index of the nomogram was 0.896,0.936,0.961,and 0.972 at 3,4,5,and 6mo,respectively.The C-index values in the validation set were 0.860,0.936,0.951,and 0.965 at 3,4,5,and 6mo,respectively.Decision-curve analysis indicated that only the 4-,5-,and 6-month nomograms had significant net benefits over a large threshold probabilities interval.CONCLUSION:Preoperative PVR,SOTT,PE,RTS,and hypertension are significant risk factors for postoperative PVR formation in patients with primary RRD.The proposed nomogram can effectively predict the 4-,5-,and 6-month PVR-free probabilities after surgery and assist in making clinical decisions during follow-up.
