Suprachoroidal bleeding: review and description of eight cases

INTRODUCTION: Suprachoroidal hemorrhage (SCH) is a dramatic complication of intraocular surgery that can result in total loss of vision. METHODS: The records of eight cases of SCH during cataract surgery were reviewed. Six of eight patients were treated by combined radial sclerotomies for suprachoroidal drainage and vitrectomy. Risk factors, therapeutic strategies, and functional and anatomical results were analyzed. RESULTS: The incidence of SCH was 0.45%. Preoperative visual acuity of all eyes suffering from SCH was limited to the perception of light. Postoperatively, six patients showed an increase in visual acuity greater than 0.1; one patient achieved 0.5. Ocular and general risk factors (ocular hypotony, myopia, Valsalva-type maneuvers, intraoperative systemic hypertension) and surgery complications were analyzed. CONCLUSIONS: In spite of using state-of-the-art surgical techniques, the prognosis of SCH remains serious, with a poorer outcome associated with increasing complications due to hemorrhage. Secondary treatment combining radial sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.     

玻璃体切除联合巩膜切开引流术治疗驱逐性脉络膜上腔出血的疗效

目的探讨应用玻璃体显微手术联合巩膜切开引流术作为Ⅱ期手术方式治疗脉络膜上腔出血的疗效。方法回顾分析2004年3月-2008年9月我院收治的驱逐性脉络膜上腔出血患者11例,常规行检眼镜,眼B超检查确诊,记录视力和病因。所有病例均于出血后2周左右采用玻璃体切除联合巩膜切开引流术。结果11例均成功引流脉络膜上腔积血,视网膜复位,随访6-18个月,视力均有改善。结论及时关闭切口,控制眼压,适时选择手术,行玻璃体切除联合巩膜切开引流术是二期处理驱逐性脉络膜上腔出血的最有效方法。     

A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage

The authors describe a new surgical approach used in six consecutive patients referred to us between August 1986 and August 1988 with massive suprachoroidal hemorrhage (MSCH) during or after cataract extraction (4 patients), glaucoma filtering surgery (1 patient), or scleral buckling (1 patient). All patients had large hemorrhagic choroidal detachments with five eyes showing "kissing" detachments. Secondary surgery was delayed 7 to 25 days (mean, 14 days) to allow liquefaction of the blood clot and reduce intraocular inflammation. All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid infusion line pressure, followed by pars plana anterior and posterior vitrectomy in five of six eyes. Additionally, two eyes underwent secondary lens implantation during surgery and 6 months later, respectively. Mean follow-up was 10 months. Visual acuity improved in all eyes from a preoperative range of light perception-hand motions to hand motions-20/40. Advantages and disadvantages of this aggressive surgical approach in the management of MSCH are discussed.     

Massive suprachoroidal hemorrhage: secondary treatment and outcome

PURPOSE: Massive suprachoroidal expulsive hemorrhage (SCH) is a dramatic and devastating intraocular complication of intraocular surgery and trauma that can result in total loss of vision. The aim of our study was to present the results of secondary surgical treatment of eyes following massive SCH. PATIENTS AND METHODS: We treated 10 patients suffering from massive SCH by combined radial sclerotomies for suprachoroidal drainage and vitrectomy with use of perfluorocarbon and instillation of silicone oil. We analyzed the clinical characteristics, visual acuity and anatomical status before and after secondary treatment. RESULTS: Visual acuity of all eyes suffering from SCH was light perception. Postoperatively five patients with SCH showed either no improvement of function or visual acuity of counting fingers. An increase in visual acuity to maximal 0.1 was seen in four eyes; one patient achieved 0.6. With a minimum of 6 months' follow-up, four eyes developed hypotony, two eyes became phthisical, and in two eyes recurrent traction retinal detachment occurred. CONCLUSIONS: Secondary treatment by combined suprachoroidal drainage by sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.     

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

PURPOSE: To assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery. METHODS: The medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients' demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded. RESULTS: The mean follow-up period of the patients was 12.3 months (range, 3-47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery. CONCLUSION: Immediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.     

冷超声乳化联合玻璃体切除术治疗白内障合并眼后节病变临床疗效观察

目的:探讨冷超声乳化联合玻璃体切除术的临床应用疗效。方法:对98例106眼白内障合并眼后节病变的患者进行冷超声乳化联合玻璃体切除手术。术后观察视力、人工晶状体植入率和手术并发症。结果:术后1wk;3mo绝大多数患者的视力均有不同程度提高,人工晶状体植入率为75.5%,术后可出现继发性青光眼、后发性白内障、葡萄膜炎、玻璃体再出血及视网膜脱离等不良并发症。结论:冷超声乳化联合玻璃体切除术是治疗白内障合并眼后节病变的有效治疗手段,他可替代超声粉碎技术进行晶状体摘除。     

Management of retained intravitreal lens fragments after phacoemulsification surgery

PURPOSE: To evaluate the clinical features of eyes with retained intravitreal lens fragments after phacoemulsification surgery and to assess the guidelines of management and the visual outcome after vitrectomy. METHODS: Twenty-five consecutive patients referred to our institute for retained intravitreal lens fragments after phacoemulsification cataract surgery were evaluated retrospectively over a 7-year period. RESULTS: The clinical features of retained lens fragments included deceased visual acuity of 6/60 or worse (68%), uveitis (60%), glaucoma (48%), corneal edema (44%) and retinal detachment in 2 patients (8%). There were 24 patients who underwent pars plana vitrectomy; 1 patient was managed with medical therapy. After vitrectomy, 17 eyes (71%) showed visual improvement, and final visual acuity was 6/12 or better in 13 eyes (54%). The causes of poor final visual outcome of 6/60 or worse included retinal detachment and cystoid macular edema. The time interval between vitrectomy and phacoemulsification was within 4 weeks in 17 patients (71%), ranging from on the same day to 97 days. There was only a trend of better visual outcome in early vitrectomy patients (within 1 week). There was no statistical difference between the initial intraocular lens status and final visual acuity. CONCLUSION: Vitectomy with removal of retained intravitreal lens fragments is beneficial for patients with persistent uveitis and glaucoma after phacoemulsification. In the majority of patients, visual improvement was achieved after vitrectomy. However, poor visual outcome may occur secondary to retinal detachment and cystoid macular edema.     

晶状体超声乳化摘除联合前段玻璃体切割治疗恶性青光眼

目的：评价超声乳化摘除晶状体联合前段玻璃体切割治疗恶性青光眼的疗效，并对具体操作手法作一介绍。方法：对23例青光眼术后恶性青光眼患者行联合手术，回顾分析其临床资料。结果：全部病例术后前房形成，其中20例眼压控制良好，1例需加用抗青光眼药物治疗，2例再行阀门管植入术以控制眼压。22例视功能得到不同程度的改善。结论：超声乳化摘除晶状体联合前段玻璃体切割是治疗恶性青光眼的有效手段。     

内眼手术术中及术后暴发性脉络膜上腔出血的原因、处理和预后

目的　分析与评价内眼手术及术中术后暴发性脉络膜上腔出血的原因、处理和预后。方法　选取暴发性脉络膜上腔出血患者１１例,术前５例合并高度近视,４例合并高眼压,２例有既往内眼手术史,２例患者发生二次出血。出血后采取保守或于出血后１０～１６ｄ（平均１２．１ｄ）手术治疗。手术方法包括单纯后巩膜脉络膜上腔积血穿刺放液术,或联合玻璃体切割及硅油填充术。结果　１１例患者中有７例发生于术中,４例发生在术后１～３ｄ,约占同期我科内眼手术的０．１５％（１１／７２０４）。１１例患者中,２例保守治疗,４例行单纯后巩膜脉络膜上腔积血穿刺放液术,１例行玻璃体切割及后巩膜脉络膜上腔积血穿刺放液术,另外４例行玻璃体切割硅油填充及后巩膜脉络膜上腔积血穿刺放液术。平均随访８．２个月,术后７例患者视力改善,１例无变化,３例恶化。结论　术前高眼压、高度近视及既往内眼手术史是暴发性脉络膜上腔出血的高危因素。通过术中迅速关闭切口,术后采取保守治疗,择机行后巩膜脉络膜上腔积血穿刺放液术,视网膜脱离时联合玻璃体切割术,可保留患者部分视力。     

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.     

Surgical management of suprachoroidal haemorrhages induced by cataract surgery--case series

Purpose: Suprachoroidal hemorrhage (SCH) is a rare complication occurring during surgery (early SCH) or 3-5 days after operation as a delayed suprachoroidal hemorrhage. It occurs more often in patients who have complicated cataract surgery with vitreous loss or lens dislocation. The purpose of this study was to present surgical treatment of 7 patients with suprachoroidal hemorrhage due to cataract surgery. Material and methods: Mean age of patients was 72,4 years old. There were 3 female and 4 male. Six patients were operated using phacoemulsification, one patient- using ECCE. In 3 cases the vitreous loss and lens dislocation occurred during operation. Results: Suprachoroidal drainage was performed in 4 patients. In 3 patients suprachoroidal drainage was followed by vitrectomy. In this group in 2 patients injection of silicone oil was done. Anterior infusion line was used in all cases. Drainage sclerotomies were created in the quadrants of the involved SCH, confirmed by ultrasonography. In all treated patients reattachment of the choroid was obtained. The visual acuity improved significantly (final v. a. was between 0. 02 and 0. 5). Conclusions: According to our observation, the implementation of the suprachoroidal drainage combined with vitrectomy might improve the prognosis and facilitate the achievement of functional vision.     

恶性青光眼手术治疗远期疗效探讨

目的 探讨恶性青光眼手术治疗的远期效果。方法 回顾性分析1999年7月至2002年12月在我院手术治疗的恶性青光眼患者17例(17眼)手术方式、术后视力、眼压情况。结果 17例患者(17眼)中，12眼单纯行超声乳化白内障吸除联合后房型人工晶体植入，其中6眼于术后0．5月～10个月病情复发，经分别或联合行激光后囊切开、玻璃体前界膜切开、前部玻璃体切除。甚至房水引流管植入、睫状体光凝术后才得以缓解。5眼行超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入，未见病情复发。患者的视力较术前提高，眼压得到控制。结论 单纯超声乳化吸除白内障联合后房型人工晶体植入对早期或药物治疗能部分缓解的恶性青光眼有效；对弥漫性房角关闭、周边虹膜前粘连的顽固病例，超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入为较佳选择。     

外伤性晶状体脱位的联合手术治疗

目的：评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位或半脱位的临床疗效。方法：对1993年10月－2000年5月连续收治的外伤性晶状体脱位或半脱位36例作回顾性研究。所有患眼根据病情均采用不同的术式去除脱位晶状体,包括角巩缘切口圈套娩出、睫状体扁平部切口行晶状体切除或超声晶状体粉碎,同时切割玻璃体,并应用小梁切除、阀门管植入术、玻璃体视网膜手术联合治疗因晶状体脱位引起的并发症,17例I期植入前房或后房型人工晶状体。结果：所有患眼成功的去除晶状体,91．7％患眼视力有不同程度提高,52．3％患眼视力≥0．3,继发青光眼患者术后眼压获得控制,6例视网膜脱离全部复位。结论：各种手术方法联合应用治疗外伤性晶状体脱位及其所致并发症,视力增进效果明显。阀门管植入术是治疗严重眼外伤顽固性青光眼的有效手术方法。     

新生血管性青光眼联合治疗疗效分析

目的：观察抗血管内皮生长因子( vascular endothelial growth factor,VEGF)药物玻璃体腔内注射及全视网膜光凝( panretinal photocoagulation,PRP)后联合滤过手术治疗新生血管性青光眼的疗效。方法：对21例23眼患者中屈光介质透明者行抗 VEGF药物玻璃体腔内注射及PRP后新生血管消退后行复合式小梁切除术,屈光介质混浊患者行白内障或玻璃体切除术及全视网膜光凝联合复合式小梁切除术,随访3mo,对治疗前后眼压情况进行比较。结果：患者1例1眼视力提高显著,其余患者视力稳定或略有提高,所有患者虹膜新生血管均有不同程度消退。治疗前后眼压比较有统计学差异(P<0.01),所有患者均未出现术中术后严重并发症。结论：抗VEGF药物玻璃体腔内注射及PRP清除虹膜新生血管后联合滤过手术可以较快、较好地控制眼压,可有效治疗新生血管性青光眼。     

Penetrating keratoplasty and anterior segment reconstruction for severe ocular trauma.

The authors reviewed 39 consecutive cases of severe ocular trauma that had undergone penetrating keratoplasty plus anterior segment reconstruction and evaluated visual outcome, graft survival, and secondary complications. Postoperatively, 49% of eyes achieved visual acuity of 20/100 or better compared with 10% before surgery, and 72% improved at least 2 Snellen lines. With a mean follow-up of 23 months, 31 (80%) initial keratoplasties remained clear, and all 4 subsequently re-grafted corneas maintained clarity, for an overall keratoplasty success rate of 90%. Elevated intraocular pressure occurred postoperatively in 18 eyes (46%), and, among these, 10 of 13 eyes (77%) had preoperative glaucoma, whereas 8 of 26 (31%) did not (P less than or equal to 0.015). Preoperative anterior synechiae could be anatomically corrected at surgery in 80% of cases (24 of 30 eyes). In 7 cases with persistent synechiae, 6 (86%) were associated with glaucoma (P less than or equal to 0.025). Retinal detachment occurred in one case. Thus, despite major trauma and a high prevalence of glaucoma, both the visual restoration and anatomic reconstruction achieved were satisfactory and without severe complications.     

玻璃体切割联合白内障手术治疗增生性糖尿病视网膜病变

目的观察玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术及硅油填充术治疗增生性糖尿病视网膜病变的疗效。方法将63例(67眼)增生性糖尿病视网膜病变患者进行玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等,术后随访3～18个月观察治疗效果。结果单纯玻璃体视网膜手术23眼,联合晶状体超声乳化人工晶状体植入术25眼,术中注入硅油37眼。术后矫正视力不同程度改善52眼,11眼不变,4眼下降。术中眼内出血5眼;术后玻璃体积血2眼,视网膜上出血2眼,一过性高眼压14眼,继发性青光眼2眼,白内障加重或形成13眼,后发性白内障形成6眼。结论玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等治疗增生性糖尿病视网膜病变安全有效,联合手术可避免再次行白内障手术,减少视网膜脱离、白内障、继发性青光眼等并发症的发生率。     

玻璃体切除联合白内障摘出人工晶状体植入术

目的探讨玻璃体切除联合白内障摘出及人工晶状体植入术的临床效果。方法对16例(17眼)玻璃体视网膜疾病伴有明显的白内障者实施了此联合手术。先行常规白内障囊外摘出术或晶状体超声乳化术,再行标准三通道闭合式玻璃体切除术,最后植入人工晶状体。结果术后随访2月～3年,平均13月。16眼术后视力均有不同程度提高,1眼增生性糖尿病性视网膜病变术后2月因继发新生血管性青光眼,行广泛视网膜冷凝后视力下降。术后早期16例(17眼)均有不同程度的角膜后弹力层皱褶,术后7～10d消失。2例(2眼)术后有一过性眼压升高。1例(1眼)术后2月发生新生血管性青光眼。3例(3眼)术后后囊浑浊,未影响视力。结论此联合手术的临床效果良好,具有一定的优点,但应严格掌握适应证,并要求有熟练的手术技巧。     

Pars plana vitrectomy for epiretinal membrane associated with sarcoidosis

PURPOSE: To examine retrospectively the visual outcomes in patients undergoing vitrectomy for epiretinal membranes secondary to sarcoid uveitis. METHODS: Eleven consecutive patients (11 eyes) with epiretinal membrane and uveitis associated with sarcoidosis underwent pars plana vitrectomy. RESULTS: Nine eyes (82%) gained two or more lines of Snellen visual acuity at 1-12 months after surgery. However, 4 of these 9 eyes lost two or more lines of Snellen visual acuity by the final visit. Overall, 5 eyes (45%) had attained at least two Snellen lines of visual acuity improvement, 5 eyes (45%) were unchanged, and 1 eye (10%) had worsened by two lines at the final visit. Nine eyes (81%) achieved visual acuity of 20/40 or better by the final visit. Slit-lamp biomicroscopy and fluorescein angiography showed that cystoid macular edema had resolved in 4 of 7 eyes postoperatively; vitritis improved in all cases. Postoperative complications included cataract formation, glaucoma, and membrane recurrence. Subsequent surgeries consisted of cataract extraction in 2 eyes and membrane peeling in 1 eye. CONCLUSIONS: Pars plana vitrectomy appears to have a beneficial effect on restoring vision in eyes with epiretinal membrane and uveitis associated with sarcoidosis, but final visual acuity was limited by the development of cataract and membrane recurrence.     

复杂眼外伤伴睫状体离断的手术疗效

目的 观察复杂眼外伤致睫状体离断并伴有眼前后节损伤患者的手术治疗效果.方法 B型超声及超声生物显微镜(UBM)检查确诊存在不同程度睫状体离断伴眼前后节损伤,需行玻璃体切割手术治疗的复杂眼外伤患者55例55只眼纳入本研究.其中,眼球钝挫伤35例,眼球破裂伤20例.视力无光感～0.15,不能矫正.眼压1～10 mm Hg(1 mm Hg=0.133 kPa),睫状体离断范围1～12个钟点.所有患者均行经扁平部玻璃体切割联合睫状体离断复位术.对于睫状体离断范围≤3个钟点者,冷冻封闭睫状体离断口;睫状体离断范围＞3个钟点者,缝合离断的睫状体与相应巩膜.手术后就外伤愈合、视力、眼压、眼内出血、睫状体以及视网膜的复位情况进行随访.结果 手术后1个月,UBM检查显示,54例患者睫状体复位良好,1例患者前房角镜检查仍见针尖大小离断口,第2次手术缝合后复位成功.手术后3个月,55例患者眼外伤愈合良好,视力无光感～0.15,最佳矫正视力为0.8.视网膜在位,睫状体复位良好.52例患者眼压恢复至正常范围,另外3例眼压仍低于10 mm Hg.3例发生继发性青光眼,手术后15 d行抗青光眼手术,眼压得以控制.结论 经扁平部玻璃体切割联合睫状体冷冻或缝合复位手术治疗复杂眼外伤致睫状体离断并伴有眼前后节损伤患者安全有效,避免了分期手术的痛苦,手术后眼压恢复良好,部分患者恢复了有用的视力.     

Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases

PURPOSE: To compare effectiveness and outcomes of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy system for patients with clinically significant cataract and vitreoretinal diseases. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: Clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy was performed in the study group (15 eyes). Patients in the control group (15 eyes) had combined surgery with clear corneal phacoemulsification and the existing 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, and intraoperative and postoperative complications. The additional outcome measurements in both groups were duration of the surgical procedures, time to return to preoperative corneal clarity, time to achieve stable vision, and subjective ocular irritation postoperatively. RESULTS: Postoperatively, BCVA improved in 12 eyes (80%) in the study group and in 11 eyes (73.3%) in the control group. Mean operative time for opening and closing the sclerotomy was significantly greater in the control group than in the study group. Time to return to preoperative corneal clarity and time to achieve stable vision showed no significant difference between the groups. Compared with the control group, postoperative ocular irritation in patients in the study group was considerably reduced. CONCLUSIONS: Combined sutureless surgery needed shorter setup time for sclerotomy and caused less postoperative ocular irritation than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with cataract and vitreoretinal diseases.