Ophthalmic laser microendoscope endophotocoagulation.

PURPOSE: The purpose of this article is to describe the function of the ophthalmic laser microendoscope as it pertains to endophotocoagulation in the management of vitreoretinal disease. METHODS: Fifty-four consecutive vitrectomies with endophotocoagulation were performed using the ophthalmic laser microendoscope instead of endoillumination and endophotocoagulation probes. Intraoperative and postoperative efficacy and complications were evaluated. RESULTS: The ophthalmic laser microendoscope was used to illuminate and view the retina and to deliver diode laser energy in the management of posterior retinal breaks, proliferative retinopathies, and proliferative vitreoretinopathy. The technique of endophotocoagulation was similar to that used routinely in vitreoretinal surgery. The photocoagulation lesions that were created were identical to those delivered by standard endophotocoagulation probes. Intraoperative complications were few, consisting of transient mild retinal or choroidal hemorrhages. Severe postoperative complications related to endophotocoagulation or to use of the ophthalmic laser microendoscope were not observed. CONCLUSION: The ophthalmic laser microendoscope appears to be a safe and effective method of delivering diode laser energy to the retina while simultaneously providing illumination, video recording, and a clear endoscopic view despite anterior segment conditions that might otherwise preclude adequate visualization and treatment. Fewer instrument insertions/removals were required for endophotocoagulation. Post-treatment search for peripheral iatrogenic retinal breaks was accomplished by endoscopy.     

玻璃体手术治疗视网膜静脉周围炎并发症的疗效

目的 观察视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离行玻璃体切割术的疗效及并发症。 方法 回顾性分析1989～2001年行玻璃体切割术治疗合并玻璃体积血和(或)牵引性视网膜脱离的视网膜静脉周围炎患者69例的临床和随访资料。随访时间为手术后6个月～12年，平均随访时间45个月。 结果 (1)手术后视力较手术前显著提高。(2)11只眼有手术中并发症，占14.3%，其中医源性裂孔7只眼，手术中出血3只眼，晶状体损伤1只眼。(3)手术后1个月内20只眼有并发症，占260%，其中玻璃体再积血14只眼，一过性高眼压6只眼，视网膜脱离5只眼，前房出血2只眼，前房机化膜形成1只眼。(4)远期并发症主要为白内障(9只眼)及黄斑病变(6只眼)。 结论 玻璃体切割术联合眼内激光光凝、剥膜等是治疗视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离的有效手段。 (中华眼底病杂志, 2002, 18: 215-217)     

玻璃体切割手术116例临床分析

目的 通过评价玻璃体切割对玻璃体积血及复杂性视网膜脱离的手术效果,分析产生手术并发症的原因。方法1995-06/2000-06行玻璃体切割术116例(118眼)进行回顾性分析。结果 视力提高者76.4％;术前存在视网膜脱离者,术后视网膜脱离复发31.7％;术前无视网膜脱离者,术后发生视网膜脱离14.5％。结论 术前存在PVR是术后出现视网膜脱离的重要危险因素,合理选择手术适应症,结束手术前仔细检查可能存在的视网膜医源性损伤和潜在病灶,防止玻璃体嵌塞,能有效减少并发症。     

医源性眼部损伤临床分析

目的 探讨医院内医源性眼部损伤的原因与防护措施.方法 回顾性分析26例（41眼）医源性眼部损伤,分析其一般情况、眼损伤分类、损伤原因及处理方法及结果.结果 医源性眼部损伤26例（41眼）,年龄6～68岁,单眼伤者11例,双眼伤者15例,左右眼例数相近.眼损伤原因主要是护理缺陷、手术并发症、麻醉并发症3个方面.大部分是轻度损伤,经过对症治疗,获得痊愈.重度损伤3例（3眼）.泪道损伤者,试行泪道探通,探通失败,则行泪囊鼻腔吻合手术治疗.伴有视力严重损害者,尽快查明原因,进行针对性药物治疗或手术治疗,仍有部分病例,疗效不佳.结论 避免或减轻损伤的关键在于预防,一旦出现,应积极请专科会诊,以协助治疗.     

Complications associated with vortex vein damage in scleral buckling surgery for rhegmatogenous retinal detachment.

PURPOSE: To further understand postoperative complications after vortex vein damage during scleral buckling surgery. METHODS: The records of 34 patients (34 eyes) with vortex vein damage during scleral buckling surgery for rhegmatogenous retinal detachment were reviewed and compared with the records of 410 eyes undergoing similar surgery without vortex vein damage. RESULTS: Postoperative complications were noted in 16 eyes (47%) of the damaged vortex vein group. The incidence of choroidal detachment, vitreous opacities, intraocular pressure elevation, and vitreous hemorrhage were 27%, 18%, 9%, and 6%, respectively, with a higher incidence than in the group without vortex vein damage. Other complications included development of epiretinal membrane (9%), subretinal hemorrhage (3%), and anterior segment ischemia (3%). Serous choroidal detachment occurred in the early postoperative days and subsided within 3 weeks. Vitreous opacification became marked in the later periods and continued for 2 months or longer. The incidence of postoperative choroidal detachment in the vortex vein damage group was related to the patient's age (P = .002) and the cutting of the vortex veins (P = .048), but was not related to preoperative conditions of retinal detachment or the number of vortex veins damaged. All the eyes except one achieved retinal reattachment after initial surgery. CONCLUSIONS: Choroidal detachment and vitreous opacity are common after scleral buckling surgery with vortex vein damage. Although intervention of the vortex veins during scleral buckling surgery is acceptable when performing otherwise difficult to achieve ample scleral indentation, it should be minimized to avoid increased incidence of postoperative complications.     

Updating on intraoperative light-induced retinal injury

We are presenting the state of knowledge concerning intraoperative light-induced retinal injury, considered to be a combination of photic retinopathy and retinal photocoagulation. It may arise from retinal light exposure to the operating microscope or to the fiberoptic endoilluminator. Ultraviolet and short-wavelength visible light are more dangerous than longer wavelength light. Many risk factors may facilitate the onset of this iatrogenic disease following surgery. Many aspects of the retinal damage are still poorly understood. Many mild light-induced retinal injuries probably remain undiagnosed in routine postoperative examination. Current appropriate light filters are not the definitive solution. Appropriate precautions should be taken during both anterior segment and vitreoretinal surgery.     

Common Errors in the Use of the Operating Microscope*

The operating microscope enables accurate surgery with minimal surgical trauma and the prevention of complications due to poor wound closure. Despite these advantages, only 30% of ophthalmic surgeons in developed countries are using the operating microscope. The main reason is adjustment difficulty. Three common errors associated with this are: first, high magnification; second, changing techniques; third, lack of practice. Based on these common errors, three main principles in the use of the operating microscopes are recommended as guidelines for surgeons who are adjusting to the operating microscope. Ophthalmic surgery under the microscope improves the quality of conventional anterior segment surgery and should be available to all ophthalmic surgeons. To achieve this, microscopes and microinstruments should be kept simple and inexpensive.     

视网膜脱离手术后黄斑皱褶及其手术治疗

目的：探讨视网膜脱离复位手术后黄斑皱褶的发生原因、手术治疗和预防措施。方法：分析总结了３１例网脱复位术后发生黄斑皱褶的特点,并进行玻璃手术治疗。应用视网膜钩、铲、眼内镊子、笛形针等器械将黄斑前膜剥离,使皱褶松开。结果：黄斑皱褶产生的主要因素包括：大的马蹄形裂孔、冷凝过度、术中眼内出血、术后裂孔后缘皱襞和不恰当的眼底激光治疗等。通过玻璃体手术,３１例黄斑皱褶被被完全松解并恢复正常黄斑形态,未见严重并     

增殖性糖尿病视网膜病变玻璃体手术并发症分析

目的:探讨糖尿病视网膜病变玻璃体手术并发症及防治。方法:82眼增殖性糖尿病视网膜病变行玻璃体手术治疗,并随访3~24mo,对其术中和术后并发症进行回顾性分析。结果:术后视力较术前不同程度的提高者62眼(72%),但部分患眼出现不同情况的并发症,包括高眼压、玻璃体出血、并发性白内障、医源性视网膜损伤等。结论:糖尿病视网膜病变进行玻璃体手术能挽救大多数眼球并恢复一定的有用视力,但对手术并发症应重视并积极预防治疗,以提高玻璃体手术的效果。     

Sensitivity to retinal light damage and surgical blood oxygen levels

Increased oxygen levels decrease the threshold for photochemical retinal damage. We measured arterial oxygen levels in a group of ophthalmic surgical patients. As expected, levels exceeded unanesthetized measurements by one to two times. Based on experimental data, this could decrease the threshold for light-induced retinal damage during ophthalmic surgery by 40% to 50%. While the clinical implications of light-induced retinal damage in surgical eye patients are unclear, it is prudent to take steps to minimize light exposure during surgery.     

眼科手术后斜视和复视的临床分析

目的　探讨眼科手术后继发性斜视的发生机制和防治方法。方法　检查 79例不同眼科手术后发生继发性斜视患者的眼位、眼球运动、复视及预后情况 ,并进行牵拉试验。对部分患者行斜视矫正术 ,术中观察眼部受累组织的情况。结果　在全部患者中 ,视网膜脱离术后患者占 38 0 %(30 / 79) ,白内障摘除手术后患者占 31 7% (2 5 / 79) ,眼眶手术后患者占 13 9% (11/ 79) ,其他为青光眼、翼状胬肉及上睑下垂术后患者。视网膜脱离手术和白内障摘除手术后部分继发性斜视症状持续时间 >6个月的患者 ,受累肌纤维化并 (或 )与结膜、巩膜及外加压物广泛粘连 ,牵拉试验呈阳性 ;眼眶手术后患者眼球主要表现为牵制性运动障碍 ;翼状胬肉切除术后患者内直肌及其周围组织损伤明显 ;抗青光眼手术后患者继发性斜视症状于术后 2～ 14d自行缓解。结论　内眼和外眼手术均可导致继发性斜视的发生 ;斜视的发生机制主要包括眼肌损伤、限制及机械压迫 3个因素。眼科手术医师应高度重视 ,积极采取针对性预防和治疗措施。     

Photic maculopathy after extracapsular cataract surgery. A prospective study.

Photic retinal injuries have been described after surgical exposure to the intense illumination systems of operating microscopes. The overall incidence of such injuries has been postulated at less than 10%. The authors prospectively studied 43 consecutive patients to determine the incidence of photic macular injuries during cataract surgery. Patients underwent complete ophthalmic examinations, fundus photography, and oral fluorography before and after surgery. Photic macular injuries developed in 12 of 43 eyes (28%) as a result of intraocular surgery. This incidence is much higher than previous estimates. The association with possible risk factors, cystoid macular edema, and the effect of these injuries on final visual acuity are discussed.     

Vitreous loss during cataract surgery: prevention and optimal management

Vitreous loss during cataract surgery is associated with a poor visual outcome. Experienced surgeons and those performing a high volume of cataract operations have lower rates of vitreous loss. Risk stratification systems, which allow prediction of intraoperative complications from preoperative criteria exist, so that less experienced surgeons can avoid higher risk cases. The management of vitreous loss includes counselling patients before surgery of the potential risks and complications. When vitreous loss occurs, it is important for the surgeon to avoid actions [corrected] which increase the chance of disaster for the eye. These include phacoemulsification in the presence of vitreous and attempts to recover dropped lens fragments from the posterior segment without vitrectomy. There are advantages in performing an anterior vitrectomy by the pars plana route rather than through the anterior chamber and this approach is facilitated by sutureless 23-gauge instruments. Dislocation of lens nuclear fragments into the vitreous is associated with a high incidence of retinal detachment as well as secondary glaucoma and cystoid macular oedema. Early involvement of a retinal surgeon in the management of these eyes is recommended.     

球周麻醉在眼科手术中的应用

在球周麻醉下成功施行眼科手术33例,其中老年性白内障23例,青光眼4例,裂源性网脱6例。用计分法主观评价三种手术球周麻醉的效果,结果表明以白内障囊外摘除术(显微)的麻醉效果最为满意。球周麻醉具有球后麻醉和眼轮匝肌麻醉的双重效果,它不但可以替代球后麻醉,还可免除面神经阻滞麻醉。由于麻药仅注射在眼球周围,不达球后,故能避免球后麻醉所引起的球后出血及突发性黑蒙等严重并发症。     

Major orbital complications of endoscopic sinus surgery

BACKGROUND: The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS: A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS: All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION: Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.     

From vitreous loss to vitrectomy

The author presents a simple surgical device enabling ophthalmic surgeons to manage vitreous loss in cataract surgery or perforating injuries in a safer and simpler way and with less postoperative complications. The instrument set-up has the following specifications: perfectly cutting vitrectomy microinstrument, mechanical device for repeated use of the cutting edge of the trephine. The instrument set is ready for use in less than 1 min. The same instrument device can be used for several other purposes in anterior and posterior segment surgery, especially for delicate problems in pars plana vitrectomy.     

Fibrin glue in ophthalmology

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.     

Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade: a multicenter, randomized, non-inferiority trial

AIM: To evaluate the efficacy and safety of perfluoro-n-octane (PFO) for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy (PPV) in management of retinal detachment. METHODS: This multicenter, prospective, randomized, double-masked, parallel-controlled, non-inferiority trial was conducted in three ophthalmology clinical centers in China. Patients with retinal detachment, who were eligible for PPV were consecutively enrolled. Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, and dilated fundus examination were performed preoperatively and at 1, 7±1, 28±3d postoperatively. The primary outcome was complete retinal reattachment rate at postoperative day one. The non-inferiority margin was set at 9.8%. The secondary outcomes included intraoperative retinal reattachment rate, and mean changes in IOP and BCVA from baseline to 1, 7±1, 28±3d postoperatively, respectively. Safety analyses were presented for all randomly assigned participates in this study. RESULTS: Totally 124 eligible patients completed the study between Mar. 14, 2016 and Jun. 7, 2017. Sixty of them were randomly assigned to the PFO for ophthalmic surgery group, and 64 were assigned to the F-Octane group. Baseline characteristics were comparable between the two groups. Both groups achieved 100% retinal reattachment at postoperative day one (difference 0, 95%CI: -6.21% to 5.75%, P=1). The pre-defined noninferiority criterion was met. No significant difference was observed in intraoperative retinal reattachment rate (difference 1.77%, P=0.61), mean changes in IOP (difference 0.36, -0.09, 2.22 mm Hg at 1, 7±1, 28±3d postoperatively, with all P>0.05) and BCVA (difference 0.04, -0.02, 0.06 logMAR at 1, 7±1, 28±3d postoperatively, all P>0.05) between the two groups. No apparent adverse events related to the utilization of PFO were reported. CONCLUSION: In patients with retinal detachment undergoing PPV, PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade, and both are safe and well-tolerated.     

Are Ophthalmic Surgeons Aware that Starch Powdered Surgical Gloves are a Risk Factor in Ocular Surgery?

Purpose: To assess the level of awareness among UK ophthalmic surgeons of the potential risks from starch powdered surgical gloves during ophthalmic surgery and to show by electron microscopy that starch granule contamination can occur during ophthalmic surgery. Setting: A sample (N = 46) of UK ophthalmologists from the North of England, UK. Methods: Type of glove usage and awareness of the possible risks from starch powdered surgical gloves were assessed by means of a questionnaire sent to ophthalmic surgeons in the North of England. The surface of a polymethylmethacrylate (PMMA) intraocular lens (IOL) handled with a starch powdered surgical glove was examined by electron microscopy for evidence of starch contamination. Results: Of the sampled ophthalmic surgeons (46), 89.1% considered it important to use starch free surgical gloves and the 84.8% already did so. Starch granule contamination was seen by electron microscopy on the surface of a PMMA IOL which had been handled with starch powdered surgical gloves. Conclusions: Although there has been sporadic attention in the ophthalmic literature to the risks associated with starch powdered surgical gloves in ophthalmology, up to 15% of UK ophthalmic surgeons may still be using starch powdered gloves. The authors show that starch powder contamination of ophthalmic materials can actually occur and remind ophthalmologists that this has been reported in the literature as a possible cause of sterile intra and extraocular inflammation. This revised version was published online in July 2006 with corrections to the Cover Date.     

Ophthalmic viscosurgical devices

PURPOSE OF REVIEW: The indications for ophthalmic viscosurgical devices have expanded with the introduction of newly developed ophthalmic viscosurgical devices. The characteristics of different ophthalmic viscosurgical devices and their specific uses in anterior segment surgery and possible problems are discussed. RECENT FINDINGS: Ophthalmic viscosurgical devices were first introduced to maintain space in the eye during the implantation of intraocular lenses. With the development of different types of ophthalmic viscosurgical devices, additional indications have been discussed. To protect the corneal endothelium, the ability of ophthalmic viscosurgical devices to be retained during phacoemulsification was compared. To enlarge and stabilize the size of the pupil, specific ophthalmic viscosurgical devices are used in patients with small pupils or intraoperative floppy iris syndrome. On the other hand, complications associated with the use of ophthalmic viscosurgical devices and their prevention have been discussed. Postoperative elevations of intraocular pressure have been reported and complete removal of the ophthalmic viscosurgical device at the end of surgery is the key factor to avoiding these elevations. Wound burns during phacoemulsification may occur and creating a fluid space around the phacoemulsification tip is necessary to avoid them. SUMMARY: The rheologic characteristics of the different types of ophthalmic viscosurgical device should be considered, and the appropriate use of ophthalmic viscosurgical devices in specific cases would improve the surgical outcomes.