Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

合并脉络膜脱离的孔源性视网膜脱离临床特点及手术疗效分析

目的:分析合并脉络膜脱离的裂孔性视网膜脱离的临床特点及手术治疗效果。方法:合并脉络膜脱离的裂孔性视网膜脱离患者64例64眼,26例行巩膜扣带术,38例行玻璃体视网膜手术,术中均不行巩膜外冷凝,观察眼部表现及手术复位率等情况,分析合并脉络膜脱离的裂孔性视网膜脱离临床特点。结果:本组病例>-6.00D高度近视占总病例数的41%。64例合并脉络膜脱离的孔源性视网膜脱离均有葡萄膜炎反应,眼压2.00～8.00mmHg;26例行巩膜扣带术,19例视网膜复位,复位率73%,行玻璃体视网膜手术38例,32例视网膜复位,一次手术复位率84%。结论:合并脉络膜脱离的孔源性视网膜脱离高度近视眼、人工晶状体眼及无晶状体眼多发,视网膜光凝替代术中巩膜外冷凝可能提高视网膜复位率及减少术后复发率。     

伴脉络膜脱离的孔源性视网膜脱离复位术

目的 探讨伴脉络膜脱离孔源性视网膜脱离的手术方法。方法 术前不用糖皮质激素治疗。以低眼压，视网膜下液少为手术时机不放液手术。结果 手术一次性复位率91.66%，裂孔封闭后炎症消退，玻璃体改善，眼压回升，视力提高。结论 术前不同糖皮质激素治疗。有利于不放液手术和术中顶压找孔，缩短了术前等待的时间。     

实验性视网膜脱离复位后的视网膜细胞超微结构观察

目的 研究视网膜脱离复位后视网膜超微结构改变,以探讨视功能恢复障碍的机制。方法 12只灰兔通过在视网膜下注射透明酸钠的方法建立视网膜脱离模型。用透射电镜观察术后1,2,3,4周的视网膜。结果 视网膜复位早期光感受器外节段缺失、断裂。内节、视细胞核、双极细胞、神经节细胞均可见胞浆水肿,线粒体肿胀和嵴断裂。复位3周后,视网膜细胞结构基本正常,但仍有部分外节变短,神经纤维空洞存在。结论 视网膜复位后不仅光感受器,而且视网膜其他细胞和神经纤维均有不可逆的改变,这些改变导致视功能恢复不良。     

Simultaneous choroidal melanoma and rhegmatogenous retinal detachment

A case is reported of a 30-year-old man who presented with the unusual combination of a unilateral inferonasal choroidal melanoma and an unassociated rhegmatogenous retinal detachment attributable to a large horseshoe tear in the superotemporal quadrant. Over 20 cases of simultaneous occurrence of these two phenomena have now been reported but this patient appears to be the youngest. The reports of this uncommon association are reviewed.     

Massive Exudative Retinal and Choroidal Detachments Following Scleral Buckling Surgery

Three aphakic male patients underwent successful scleral buckling surgery for unilateral rhegmatogenous retinal detachment. Within a two-week postoperative period, each developed severe ocular pain with massive exudative retinal and choroidal detachments resembling recurrent rhegmatogenous or traction retinal detachment or implant infection. Systemic prednisone therapy resulted in prompt resolution of ocular pain and reabsorption of subretinal and suprachoroidal fluid. It is important to recognize this uncommon postoperative syndrome so that proper medical therapy may be initiated and unnecessary additional retinal or vitreous surgery can be avoided.     

异种巩膜作加压材料治疗视网膜脱离

采用异种（猪）巩膜作加压材料治疗35例（35只眼）视网膜脱离，术后近期全部视网膜复位。随访中有5例复发，其中4例第2次手术，再复位2例，治愈率91.4%.经3年以上随访，术后均无明显免疫排斥反应、加压物排出、暴露及感染发生。猪巩膜具有人巩膜相似的优良特性，可代替异体（人）巩膜应用于眼科临床。 （中华眼底病杂志，1994，10：207-209）     

伴脉络膜脱离的孔源性视网膜脱离的研究进展

伴脉络膜脱离孔源性视网膜脱离是一种特殊类型的孔源性视网膜脱离,具有原因不明和自发的特性。就其发生、表现和治疗存在很多的争议,在此结合文献讨论相关问题,希望增进对疾病的了解。     

Temporal occurrence of retinal detachments after cataract surgery

Purpose: To characterize the temporal occurrence of retinal detachments (RD) after cataract surgery. Methods: In this retrospective, consecutive case series, we reviewed the charts of 798 pseudophakic patients with primary rhegmatogenous RD that underwent surgery between 1999 and 2009, at the Center of Ophthalmology, University of Cologne, Germany. Results: Twenty‐five percent of all pseudophakic RDs occurred within 1 year after cataract surgery, 50% within 3.2 years and 90% within 9.9 years. Risk was increased for at least 11 years. The time interval was significantly shorter in vitrectomized eyes (2.49 versus 4.31 years, p = 0.016). Women showed a statistical trend towards longer time intervals (4.72 versus 3.93 years, p = 0.052), whereas myopic patients and different age groups showed no significant difference. Conclusions: After cataract surgery, the risk for RD was highest in the beginning and decreased continuously over time. However, the risk was increased for at least 11 years. Therefore, most studies have underestimated the incidence of RD after cataract surgery.     

老年视网膜脱离临床研究

目的　探讨老年视网膜脱离的易患因素及临床特点。方法　对４２例６５ａ以上的视网膜脱离患者进行眼底镜、三面镜等检查,记录其屈光状态、玻璃体后脱离、视网膜裂孔特点,并和网脱总体人群比较。结果　４２ 只眼中高度近视占７３．８％ ,存在玻璃体后脱离者占７６．２％ ,马蹄形裂孔与黄斑裂孔各占裂孔总数的６０．３％ 和２４．１％ ．结论　高度近视及玻璃体后脱离是导致老年视网膜脱离的主要原因;老年视网膜脱离中马蹄孔及黄斑孔所占比例较高。     

正视眼孔源性视网膜脱离临床特点分析

目的 对正视眼孔源性视网膜脱离临床特点进行分析。方法 上海市第一人民医院2000年11月至2002年10月期间住院治疗的正视眼孔源性视网膜脱离患者的临床资料进行统计及分析。结果 正视眼孔源性视网膜脱离占视网膜脱离患者总数的16．3％，双眼发病为1．1％。发病年龄6岁～81岁，平均52．9岁，51岁～70岁年龄段患者最多，随年龄增加发病人数逐渐增加。有外伤史和无晶体眼及人工晶体眼共68眼，占总数的18．5％。平均视网膜脱离时间为2．56m。视网膜裂孔以马蹄孔最多见，颞上象限为裂孔最多见的部位。无玻璃体后脱离157眼，有玻璃体后脱离210眼。≤50岁组眼外伤和男性比例明显高于50岁以上年龄组（P〈0．001），50岁以上年龄组玻璃体后脱离的发生率明显≤50岁组（P〈O．001）。结论 正视眼孔源性视网膜脱离多见于50岁以上年龄患者，双眼发病较少。视网膜脱离的发生可能与玻璃体和视网膜老化有关。     

Retinal dialysis

Retinal dialysis is a disinsertion of the sensory retina at the ora serrata. Dialysis may result from ocular trauma or occur as a spontaneous non-traumatic event. Dialyses are often asymptomatic and associated with a slowly progressing secondary retinal detachment. They show a predilection for the inferotemporal retinal quadrant. Retinal dialysis is the major cause of retinal detachment in children and young adults. Two cases of spontaneous retinal dialysis are presented. These cases represent extremes of the age spectrum for this condition.     

Hypotony Maculopathy in a Patient with HLA-B27-associated Uveitis

Purpose: To describe a patient with HLA-B27-associated anterior uveitis who developed hypotony maculopathy. Methods: Visual acuity, biomicroscopic slit-lamp examination, and fluorescein angiogram. Results: Following an episode of acute anterior nongranulomatous HLA-B27-associated uveitis, the patient developed decreased vision, choroidal folds, optic disc edema, and a serous exudative detachment characteristic of hypotony maculopathy. The intraocular pressure was noted to be 4 mmHg. Following therapy with topical 1% prednisolone acetate and 5% homatropine, both the intraocular pressure and retinal anatomy normalized. Conclusions: Hypotony maculopathy may be seen in patients with HLA-B27-associated uveitis and should be considered as a cause of vision loss in patients with this condition.     

玻璃体切除术治疗合并脉络膜脱离的孔源性视网膜脱离18例

目的：探讨玻璃体切除术治疗孔源性视网膜脱离并发脉络膜脱离的方法和疗效。方法：18例18眼并发脉络膜脱离的孔源性视网膜脱离,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访2～6(平均3．3)mo。结果：在18眼中13眼(72％)术后视网膜复位,大部分视力均有不同程度的提高;5眼视网膜未复位,其中3眼经再手术后复位,2眼眼球萎缩,未再手术。手术并发症主要有术后葡萄膜炎、玻璃体积血、术后高眼压等。结论：及时的玻璃体手术治疗合并脉络膜脱离的孔源性视网膜脱离,大多数视网膜能够获得复位,部分恢复视功能。     

Screening and prophylaxis of retinal degenerations prior to refractive surgery

The need and demand for surgical correction of refractive errors, particularly myopia, has been increasing. Degenerations involving the peripheral retina are common in myopes and can result in a rhegmatogenous retinal detachment. There are no clear guidelines for retinal screening and management of asymptomatic retinal degenerations prior to refractive surgery or for follow-up of these patients. This article aims to provide a set of guidelines for the management of retinal degenerations in eyes undergoing refractive surgeries.     

黄斑裂孔性视网膜脱离的手术治疗进展

黄斑裂孔性视网膜脱离是危害视力最大的疾病之一。随着高度近视人群的增加,近年来黄斑裂孔性视网膜脱离的手术治疗受到越来越多的关注。本文就玻璃体腔气体填充术、玻璃体切除术、硅油填充术、黄斑裂孔周边激光光凝术、黄斑扣带术、巩膜扣带术、巩膜环扎术、视网膜前膜和内界膜剥除术、内界膜填塞术、内界膜覆盖术等应用于黄斑裂孔性视网膜脱离的方式进行综述,着重探讨其疗效和特点。     

Proliferative vitreoretinopathy and chemotherapeutic agents

Proliferative vitreoretinopathy (PVR) is a disease process that occurs in eyes with rhegmatogenous retinal detachments and accounts for the majority of failures following retinal detachment surgery. PVR involves the uncontrolled proliferation of non-neoplastic cells capable of forming membranes, which may occur on either surface of the retina or along the detached surface of the vitreous gel. Contraction of these membranes creates tractional forces that can distort or detach the retina. Various surgical procedures have been used to repair retinal detachments associated with PVR. The results have not been encouraging in many instances. Recent efforts have been directed toward the chemical inhibition of cellular proliferation in PVR. The majority of drugs used in these studies have been antineoplastic agents that affect various phases in the cycle of cell growth.     

Missed retinal breaks in rhegmatogenous retinal detachment

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 and 191 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 being 1.91 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.     

视网膜分支静脉阻塞伴视网膜脱离16例的手术治疗

目的：分析视网膜分支静脉阻塞伴视网膜脱离患的手术治疗效果及影响因素。方法：回顾性分析视网膜分支静脉阻塞伴视网膜脱离患16例16眼的手术治疗效果及影响因素，随访6～18mo，观察视力、眼底及视网膜复位情况。结果：视网膜分支静脉阻塞以颞侧分支静脉为主；视网膜裂孔为圆形及马蹄形，均位于牵引点附近，沿血管分布。随访结束后，所有患视网膜均复位，14眼(88％)视力明显改善，2眼(12％)视力保持不变。视力预后与视网膜裂孔种类、玻璃体后脱离、视网膜新生血管及黄斑部是否脱离密切相关。结论：及时进行视网膜脱离复位及激光光凝术是治疗视网膜分支静脉阻塞伴视网膜脱离的有效方法。