松馳性視網膜周邊切開術臨床應用

目的探討更有效治療伴有嚴重增殖性玻璃體視網膜病變(PVR)的難治性視網膜脱離的方法.方法采用玻璃體切除術聯合松弛性周邊視網膜切開與切除,并運用氟碳液展平視網膜和硅油填充.結果出院時19例中18例視網膜復位.視力有不同程度提高,最佳爲0.1.術后三個月以上隨訪者有17例,其中5例爲取硅油后,這5例中1例視網膜全部脱離,1例局部牽拉性視網膜脱離.其余3例視網膜平復視力提高,最佳視力爲0.15.復位率爲60%.結論松弛性周邊視網膜切開與切除術是治療難治性視網膜脱離有效的方法.     

25%全氟丙烷全氣液交换眼眼壓動態觀察

目的探討25%C3F8氣體玻璃體切割術後作爲玻璃體臨時替代物的效果.方法玻璃體切割術後應用25%C3F8氣體作全氣液交换,前瞻性研究術後眼壓動態燮化情况.結果術中控制眼黶正常,術後觀察眼壓變化平穩.球内氣體半衰期爲19天.結論在較復雜玻璃體手術中應用25%C3F8作爲玻璃體臨時替代物是有效和安全的..     

玻切硅油充填後視網膜再脱離的手術處理方法

目的介紹復雜性視網膜脱離經玻切眼内硅油充填後再發生局限性脱離病例的手術處理方法.并對手術適應證、手術要點等進行討論.方法復雜性視網膜脱離、嚴重眼外傷等經睫狀體扁平部三切口閉合式玻璃體切割,眼内硅油填充術後發現仍有視綱膜裂孔伴有局限性脱離的病例,進行硅油下鞏膜脉絡膜切開引流網膜下液,鞏膜外冷凝封孔,局部鞏膜外墊壓處理.對該種術式病例進行回顧性分析.結果5例5眼中,多孔性視網膜脱離PVRC級玻切術後發現1祗裂孔漏封1眼,又出現新裂孔者3眼,原裂孔封閉不牢再漏水者1眼.以上病例均先行激光光凝,試圖封閉裂孔但均失敗,後改為上述方法處理均獲得完全性復位,復位率100%.結論(1)適應癥復雜性視綱膜脱離、眼外傷玻切眼内充填術後至3個月内發現大部分視綱膜復位滿意,但局部有局限性視綱膜未復位或再脱離的病例并非少見.詳細檢查會發現仍有裂孔在起作用.脱離處因有綱膜下積液,激光往往難以奏效.對這種病例的處理各家報道不一,我們采用經鞏膜脉胳膜切開放液、冷凝封孔、局部墊壓的方法,5例均獲得成功.(2)手術要點及注意事項雙目檢眼鏡下,冷凝頭頂壓裂孔定位,Ⅱ級冷凝斑封孔.在有視網膜下液處,避開裂孔一定距離,行鞏膜脉絡膜切開,引流綱膜下液.引流切開後若無液體流出,可改變頭位,使切口位于最低處稍等片刻,不可勉强擠壓.裂孔處置鞏膜外硅塊墊壓.引流後若眼壓過低,可經睫狀體扁平部補充硅油.裂孔有牽拉張口,裂孔過大硅油嵌入裂孔者禁用此法.(3)可行性與并發癥硅油粘度高,表面張力大,在眼内呈球形存留,油泡與視網膜之間似有一層水膜,在硅油量充填不足情况下更明顯.有裂孔時,可有視網膜下液經裂孔與玻璃體腔相通.過有這種情况,硅油取出後肯定會發生視網膜再脱離,導致手術失敗.硅油作為玻璃體的替代物,粘度、表面張力遠遠大于玻璃體.因此,在其頂壓下,切開鞏膜脉絡膜引流視綱膜下液完成標準的鞏膜外墊壓術是完全可行的.網膜下液一經放出,脱離綱膜與色素上皮會即刻靠攏.在外墊壓下,嵴狀隆起會將色素上皮等推壓至視綱膜.該手術最大的風險是硅油進入視綱膜下.我們的病例中無一例發生.放液切口錯開視綱膜裂孔一定距離是必要的.脉絡膜切開放液以電火花擊開為佳,可防止切透淺脱的視網膜.(4)另文中,我們已提出過"玻切眼内充填術後不應無目的放置環扎帶"的觀點,以免騷擾眼表.當玻切手術一日.出現上述情况時,為硅油下鞏膜扣帶術保留一個良好條件.     

自體结膜角膜缘上皮和异體羊膜移植术治疗翼状胬肉的临床研究

目的 觀察自體结膜角膜緣上皮移植術和异體羊膜移植術治療翼狀胬肉的臨床效果。方法 對55例(73只眼)行自體結膜角膜緣上皮移植術,隨訪1-17月,平均8.9月;對35例(46只眼)行异體羊膜移植術,隨訪1-14月,平均7.7月。结果兩組病例中初發性翼狀胬肉均無復發,而復發性翼狀胬肉的復發率分别為10.53％和6.67％,兩者無顯著性差异(P>0.05),但后者術后反應輕、上皮恢復快。结論 自體結膜角膜緣上皮移植術和异體羊膜移植術均是治療翼狀胬肉的良好方法,以后者為佳,治療翼狀胬肉的關鍵在于初發性手術方式的選擇。     

玻璃體切割聯合FLURON填充治療復雜性視網膜脱離9例

目的探討玻璃體切割術聯合FLURON注入治療難治性、復雜性視網膜脱離的方法、療效、并發癥及舆惰性氣體、硅油注入的比較.方法分析9例9眼難治性、復雜性視網膜脱離,其中外傷所致的復雜性視網膜脱離3例;視網膜脱離復位術後再脱2例;巨大裂孔4例.病例中合并黄斑裂孔5例.行三切口經睫狀體平坦部玻璃體切除術、FLURON(F6H8)填充術.術中6例環扎+外墊壓+冷凝,4例行黄斑裂孔邊緣激光光凝或巨大裂孔邊緣激光光凝,2例行内界膜剥出,2例行晶狀體咬切術.結果術後患者視力均優于術前,網膜均平復,有2例出現一過性高眼壓,2例出現白内障(前囊和後囊後混濁).結論玻璃體切割聯合FLURON注入治療難治性、復雜性視網膜脱離有良好的療效,舆惰性氣體、硅油注入比較對下方及後極部的裂孔有更好的療效;更方便的操作;病人更舒適的體位的優勢.但有引起白内障和繼發性青光眼的可能.     

雙目間接檢眼鏡在結合頂壓時的簡捷用法

目的介紹一種雙目間接檢眼鏡的簡捷用法,在視網膜脱離手術中,借助頂壓可以直接觀察到一個直立的正像.方法在手術中借助頂壓不用間接鏡頭,直接用目鏡觀察眼底,目鏡距角膜的距離平均7±1.2cm,并將此用法與雙目間接檢眼鏡的正規用法比較.結果此方法放大倍數高、識别力强、無倒像、有立體感,術中借助頂壓,能發現視網膜皺折間的小裂孔,明顯提高了裂孔的檢出率(提高9%).不但使檢查和冷凝操作更爲簡捷方便,而且由于固定與移動較好的結合,加强了視網膜檢查的連續性.但在屈光間質不清時,光穿透性較差、視野較小.結論這種簡捷用法放大倍數高、識别力强、無到像、有立體感、操作順手.但仍有缺陷.     

自體眼表移植術治瘵翼狀胬肉

目的觀察自體角膜緣(幹細胞)及球結膜的眼表移植衍治瘵翼狀胬肉的瘵效.方法對38例42眼進行期翼狀胬肉采用自體角膜緣及球結膜移植術治瘵.術後隨隨訪5～18個月.結果 41眼移植片Ⅰ期愈合,角膜上皮穩定,無胬肉復發.1眼由于取結膜植片過小,植片皺縮,出現胬肉組織潜在復發可能,占2.38%.結論自體角膜緣及球結膜移植衍治瘵翼狀胬肉是一種安全而有效地阻止胬肉復發的手衍.     

自體角膜緣幹細胞球結膜移植治療翼狀胬肉

目的探討自體角膜緣幹細胞球結膜移植治療翼狀胬肉的療效以及顯微手術技術的有關要點.方法應用自體角膜緣幹細胞球結膜移植治療翼狀胬肉38例52祗眼,其中静止期翼狀胬肉13例22祗眼,活動期25例30祗眼,包括復發性胬肉3例4祗眼,隨訪期最長18個月,最短6個月.結果經過平均11.80個月觀察,祗有1眼胬肉術後復發(占52祗眼的1.92%),其餘病例無復發,角膜上皮穩定、泪膜正常、供區角膜創面正常愈合.結論本術式是目前治療翼狀胬肉最爲安全有效的方法.     

活瓣式小梁切開術治療青光眼的臨床觀察

目的平價活瓣式小梁切開術治療原發性青光眼的遠期療效.方法對48例52眼原發性青光眼施行活瓣式小梁切開術.對術後降眼壓效果及并發癥等進行了觀察.全部病例隨訪37個月～68個月(平均4年).結果近期降眼壓成功率為100%,遠期降眼壓成功率為90.38%.術後無1例發生前房延緩形成.結論該術式安全、并發癥少、可促進前房早日形成,降眼壓效果滿意,是一種較為理想的青光眼滤過性手術.     

硅油注入术后难治性青光眼的经角膜下方小梁切除术治疗

目的探討采用經角膜的下方小梁切除術治療視網膜玻璃體手術聯合硅油注入術後離治性青光眼的療效.方法對27例(27眼)硅油注入術後的難治性青光眼采用經角膜下方小梁切除術進行治療.結果隨訪3個月,所有病例滤過泡均扁平、彌散,在不使用降眼壓藥的情况下,眼壓穩定在21mmHg以下,且無一例過多硅油存留前房.結論該術式不僅降眼壓效果好,而且術後硅油不易溢入前房,解决了長期以來硅油注入術後難治性青光眼難以處理的問題.     

Surgical management of secondary glaucoma after pars plana vitrectomy and silicone oil injection for complex retinal detachment

OBJECTIVE: To evaluate the outcomes of surgical intervention for secondary glaucoma after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Forty-three eyes of 43 patients who underwent incisional surgery for secondary glaucoma after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment over a 9-year period. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), intraoperative and postoperative complications, visual acuity, and the need for further surgical intervention for glaucoma. Success was defined as IOP < or =21 mmHg and > or =5 mmHg with or without medication but without surgical reoperation for glaucoma. RESULTS: Findings associated with elevated IOP included emulsified oil in the anterior chamber (n = 14), pupillary block from silicone oil (n = 13), open-angle glaucoma without silicone oil in the anterior chamber (n = 9), and angle-closure glaucoma without pupillary block (n = 7). The mean (+/- standard deviation) IOP was 41.4 +/- 15.1 mmHg before surgery for glaucoma and 17.2 +/- 10.2 mmHg after an average follow-up of 19.6 months (P < 0.001). Cumulative success was 69%, 60%, 56%, and 48% at 6, 12, 24, and 36-months respectively. In patients who underwent silicone oil removal alone for surgical management of glaucoma (n = 32), 11 of 12 IOP failures (92%) were due to uncontrolled IOP, whereas most IOP failures in the group who underwent silicone oil removal plus glaucoma surgery (n = 8) failed because of hypotony (3 of 4, 75%, P = 0.027). Of three patients who underwent glaucoma surgery alone to control IOP, one failed because of hypotony. There was no significant change in visual function at last follow-up (logarithm of the minimum angle of resolution [logMAR] 2.01) compared with preoperative visual function (logMAR 2.07, P = 0.74). CONCLUSION: Surgical management of secondary glaucoma after silicone oil injection for complex retinal detachment may achieve good IOP control and stabilization of visual function in most patients. Patients who undergo silicone oil removal alone to control IOP are more likely to have persistent elevation of IOP and possibly undergo reoperation for glaucoma, whereas patients who undergo concurrent silicone oil removal and glaucoma surgery are more likely to have hypotony.     

Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments

ObjectiveTo determine the incidence and associations of glaucoma after pars plana vitrectomy (PPV) and silicone oil injection (SOI) for complicated retinal detachments and the response to treatment.DesignRetrospective noncomparative case series.ParticipantsA total of 150 eyes of 150 patients who had completed a minimum of 6 months of follow-up were included in this study. Analysis included clinical records of all consecutive cases of complicated retinal detachment that underwent PPV with SOI between July 1991 and February 1996.InterventionSurgical intervention for vitreoretinal pathology included standard three-port PPV and additional procedures as appropriate for the retinal pathology, and SOI. Procedures for the control of glaucoma were silicone oil removal (SOR), trabeculectomy with mitomycin C, cyclocryotherapy, semiconductor diode laser contact transscleral cyclophotocoagulation (TSCPC) and anterior chamber tube shunt to encircling band (ACTSEB).Main outcome measuresPresence of glaucoma (predefined as intraocular pressure [IOP] ≥ 24 mmHg, which also was ≥10 mmHg over the preoperative level, sustained for ≥6 weeks) and the result of medical and surgical management were the main outcome measures. Demographic, preoperative, intraoperative, and postoperative parameters including the age of the patient, etiology of retinal detachment, refractive status, pre-existing glaucoma, aphakia, diabetes mellitus, presence of silicone oil (SO) in the anterior chamber, emulsification of SO, rubeosis iridis, and anatomic success were evaluated by univariate and multivariate logistic regression analyses to assess their predictive value in the causation of glaucoma and to determine factors prognosticating response to treatment.ResultsThe main indications for PPV+SOI were proliferative vitreoretinopathy (57%; 85 of 150), proliferative diabetic retinopathy (15%; 23 of 150), and trauma (14%; 21 of 150). Glaucoma occurred in 60 eyes (40%) at 14 days median (range, 1 day–18 months). Elevation of IOP could be attributed directly to SO in 42 (70%) eyes. Glaucoma was controlled in 43 (72%) of 60 eyes on treatment (with medicines alone in 30%; SOR and medicines in 25%; trabeculectomy with mitomycin C/ACTSEB/cyclocryotherapy or TSCPC in 17%); 28% (17 of 60) remained refractory. Independent predictive factors for glaucoma on multivariate analysis were rubeosis iridis (odds ratio, 10.76), aphakia (odds ratio, 9.83), diabetes (odds ratio, 6.03), SO in anterior chamber (odds ratio, 4.74), and anatomic failure (negative risk factor; odds ratio, 0.11). Poor prognostic factors for the control of glaucoma were SO emulsification (odds ratio, 15.34) and diabetes (odds ratio, 6.03).ConclusionGlaucoma is a frequent and often a refractory complication of PPV with SOI and has a multifactorial etiology. Aggressive medical and surgical management with SOR, trabeculectomy with mitomycin C, glaucoma shunts, and cyclodestructive procedures shows modest success in controlling IOP.     

Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments.

BACKGROUND: Intravitreal silicone oil injection used for managing complicated retinal detachments can be associated with elevated intraocular pressure (IOP). This study was undertaken to determine the incidence of glaucoma in patients who underwent silicone oil injection, as well as to evaluate the effectiveness of medical and surgical therapy in patients in whom glaucoma developed. METHODS: The postoperative courses of 50 eyes of 47 consecutive patients who underwent pars plana vitrectomy and silicone oil injection for the management of complicated retinal detachments were reviewed retrospectively. The outcomes of patients who underwent silicone oil removal and/or glaucoma surgery also were evaluated. RESULTS: The mean overall postoperative IOP before any glaucoma surgery was 16.7 +/- 9.3 mmHg (range, 0 to 45 mmHg), with a mean follow-up of 16.6 +/- 12.1 months (range, 2 to 51 months). Twenty-four (48%) eyes had postoperative IOPs of at least 25 mmHg and IOP elevations of at least 10 mmHg above the preoperative levels. Twenty-one (42%) eyes underwent complete removal of silicone oil and/or glaucoma surgery to effect IOP control. The IOPs were controlled to 21 mmHg or less (but > 5 mmHg) in 8 of 14 eyes that underwent removal of silicone oil alone, in 3 of 5 eyes that underwent Molteno implantation, and in 1 eye that underwent Nd:YAG transscleral cyclophotocoagulation, but not in 1 eye that underwent a modified Schocket procedure (mean follow-up, 13.5 +/- 11.0 months; range, 0.2 to 33 months). CONCLUSION: Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal, glaucoma implants, or cyclodestructive procedures.     

玻璃体切割手术治疗急性视网膜坏死综合征的长期随访观察

目的 观察玻璃体切割手术(PPV)治疗急性视网膜坏死综合征(ARN)的长期效果.方法 回顾性分析17例ARN患者19只眼接受PPV治疗后随访观察1年及以上的临床资料.所有患者均经临床症状、裂隙灯显微镜以及间接检眼镜检查明确临床诊断.手术前最佳矫正视力(BCVA)无光感～0.1,1只眼为0.1,其中18只眼存在视网膜脱离.19只眼均行常规PPV治疗.19只眼分别接受1～5次手术,平均手术次数2.8次;18只眼接受再次或多次手术,占94.7%.治疗后随访观察12～120个月,平均随访时间44个月.分析首次PPV手术后视网膜复位情况;统计再次或多次手术的主要原因;对比观察治疗前后BCVA、眼压、视网膜以及眼球形态变化.结果 首次PPV手术后第1天17只眼视网膜完全复位.再次或多次手术的主要原因为单纯硅油取出(RSO)、增生性玻璃体视网膜病变(PVR)、低眼压和视网膜脱离.随访期间9只眼BCVA≥0.1,但末次随访时仅4只眼BCVA≥0.1.19只硅油眼的平均眼压12.7 mm Hg(1 mm Hg=0.133 kPa),其中15只眼RSO手术后平均眼压5.1 mm Hg.19只眼PPV手术后均发生了不同程度的PVR.末次随访时8只眼存在不同程度的眼球萎缩.结论 PPV治疗ARN的长期效果较差.     

Ultrasound biomicroscopy after vitrectomy in eyes with normal intraocular pressure and in eyes with chronic hypotony

PURPOSE: To analyze the ultrasound biomicroscopy (UBM) features of eyes with chronic hypotony after pars plana vitrectomy (PPV) and compare them with the UBM features of eyes with normal intraocular pressure (IOP) after PPV. METHODS: This comparative (nonrandomized) interventional study included 64 eyes of 64 patients who underwent PPV. Group 1 included 20 eyes with less complex vitreoretinal diseases (VRD) that presented with normal IOP after PPV. Group 2 included 44 eyes with severe proliferative vitreoretinopathy (PVR) managed with PPV and silicone oil tamponade that presented with complete retina reattachment and chronic ocular hypotony. UBM was performed to study the anterior segment, ciliary body (CB), and peripheral retina. The UBM findings of the two groups were compared. RESULTS: In Group 1, 19/20 eyes presented with no CB alterations detected by UBM. In Group 2, 43/44 eyes presented with CB alterations that included tractional CB detachment (n=16); exudative CB detachment (n=11); tractional CB detachment/CB atrophy (n=7); CB hypotrophy (n=5); tractional CB detachment/exudative CB detachment (n=3); and CB edema (n=1). There was a strong relationship between IOP and CB findings revealed by UBM. CONCLUSIONS: Eyes with hypotony following PPV have CB abnormalities that can be detected by UBM. These CB alterations were not found in eyes with normal IOP after PPV in this series.     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。     

硅油取出全氟丙烷气体充填术后继发性青光眼的原因及处理

目的:探讨硅油取出联合全氟丙烷(C3F8)气体充填术后继发青光眼的原因及处理方法。方法:回顾从2004-01/2008-10我们在治疗复杂的玻璃体视网膜疾病施行玻璃体切割联合硅油充填术后,一部分患者在硅油眼状态下眼底检查发现有新鲜出血灶、增殖膜、黄斑前膜合并有黄斑水肿、硅油眼下新裂孔等,采取硅油取出联合C3F8气体充填术后出现了继发性青光眼。结果:术后随访1wk～3mo,46眼出现继发性青光眼,其中形成白内障5眼(5/46);前房角前粘连2眼(2/46);眼球萎缩1眼(1/46);视神经萎缩3眼(3/46);长期高眼压8眼(8/46);角膜内皮水肿4眼(4/46)。常见的原因是C3F8气体注入过多;浓度过高;无晶状体眼玻璃体腔过度充盈,虹膜膨隆,致广泛周边虹膜前粘连,前房消失;术后体位不正确;眼部炎症反应;残存乳化硅油滴,油气共同影响等导致眼压升高。其中34眼经术中放出部分气体、术后给予消炎、皮质激素、降眼压药物等治疗后眼压恢复正常;2眼经放出部分气体联合前房成形术,治疗后眼压正常;残存有乳化硅油滴4眼,采用SLT激光治疗联合降眼压药物,眼压控制良好。1例放出部分气体后出现眼球萎缩。结论:硅油取出联合C3F8气体充填术后可引起继发性青光眼,经有效的治疗可以取得较满意的结果。     

全氟萘烷在玻璃体视网膜手术中应用的临床分析

目的 探讨全氟萘烷(Perfluorodecalin,PFDL)在睫状体扁平部玻璃体切除术(ParsPlana Vitrectormv,PPV)中的独特作用及在眼内长期残留时对眼组织的影响.方法 回顾分析在PPV中应用PFDL的临床病例239例239只眼,其中裂孔源性视网膜脱离(retinaldetachment,RD)130例,晶状体脱位于玻璃体腔4例,外伤性RD41例,增殖性糖尿病性视网膜病变导致玻璃体出血合并牵拉性RD21例,视网膜静脉栓塞和视网膜静脉周嗣炎导致玻璃体腔出血合并牵拉性RD27例,陈旧性脉络膜出血1例,急性视网膜坏死合并视网膜脱离2例,眼内炎3例,Coats病合并牵拉裂孔性RD1例,眼内填充硅油合并RD9例.采用PPV,膜剥离,PFDL使用,眼内激光,气液交换,惰性气体及硅油眼内填充.探讨防止PFDL眼内残留的方法 ,对黄斑裂孔或后极部裂孔采用"气液交换后置换PFDL法",对巨大裂孔性视网膜脱离采用"PFDL联合部份气液交换法",对360°视网膜切开采用"逐步使用PFDL法".结果 随访12～15个月,212例212只眼获得随访,视网膜复位181例181只眼,有效率85.37%,术后PFDL残留22只眼,随访期间,角膜、前房及视网膜均未见功能及结构上的改变.结论 PFDL可有效地应用于PPV中,提高治疗巨大裂孔性视网膜脱离、外伤性视网膜脱离、眼内填充硅油合并RD等复杂性视网膜脱离的手术成功率,PFDL小滴在眼内长期存留,临床上未观察到明显眼部损害.     

Vitreoretinal surgery in the treatment of neovascular glaucoma

PURPOSE: Neovascular glaucoma develops on a background of ischemic ocular pathologies, such as diabetic eye diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevated intraocular pressure. Since treatment by cyclodestructive therapy or drainage surgery often fails, we have examined intense antiproliferative surgery as a treatment for advanced neovascular glaucoma. PATIENTS AND METHODS: Thirty-two patients with neovascular glaucoma subsequent to central vein occlusion or advanced diabetic retinopathy underwent antiproliferative surgery, which comprised vitrectomy, panretinal laser treatment and direct laser coagulation of the ciliary processes, followed by silicone oil tamponade. Patients were followed for a minimum of 1 year and as long as 3 years. RESULTS: After one week following surgery the intraocular pressure (IOP) was normal, ranging from 8 to 21 mm#Hg, in 52% (15/29 eyes), after 3 months the IOP was normal in 50% (16/32 eyes), after 6 months the IOP was normal in 59% (16/27 eyes) and after 1 year the IOP was normal in 72% (18/25 eyes). Of the 10 eyes that lost all sight after the surgery, 7 eyes had a history of central vein occlusion. Hypotony was observed in 6% (2/32) of the eyes 3 months following surgery; after 6 months hypotony was present in 15% (4/27) of the eyes and after 1 year hypotony was present in 12% (3/25) of the eyes. CONCLUSIONS: The theoretical premise of our surgical intervention (antiproliferative surgery) is based on the assumption that laser treatment interrupts the self enhancing pathway of retinal ischemia, release of proliferative factors and increase in intraocular pressure. The silicone oil endotamponade prevents postoperative complications and supports the rapid regression of rubeosis iridis by separating the anterior from the posterior segment.     

Evaluation of intraocular pressure in the immediate postoperative period after phacoemulsification

PURPOSE: To determine the incidence of hypotony and intraocular pressure (IOP) elevation in the immediate and early postoperative period after temporal posterior limbal phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ambulatory surgical center. METHODS: This prospective analysis comprised 310 eyes that had temporal posterior limbal phacoemulsification with IOL implantation. Surgical parameters included keratome incision of 2.85 mm, incision length of 2.5 mm, peribulbar anesthesia, case-completion IOP of 20 mm Hg, and postoperative lid taping. The IOP measurements were collected preoperatively and 30 minutes and 1 day after surgery. RESULTS: Nineteen eyes (6.1%) had an IOP lower than 5 mm Hg 30 minutes postoperatively in the absence of incision leakage at the paracentesis or keratome sites. Eighteen of the 19 eyes with postoperative hypotony received hydroxypropyl methylcellulose 2% (OcuCoat) and 1 received hypromellose 2% (Cellugel). None of the 23 eyes with an acrylic IOL implanted via a cylindrical lens inserter had an IOP lower than 5 mm Hg postoperatively. Suturing did not significantly affect the incidence of hypotony, and there were no postoperative complications related to hypotony. The mean IOP at 30 minutes was lower than at 1 day in the normal, glaucoma, and glaucoma-suspect groups. Twenty-one normal eyes (8.1%), 5 glaucoma eyes (15.6%), and 1 glaucoma-suspect eye (5%) had an IOP greater than 30 mm Hg 1 day postoperatively. CONCLUSIONS: Postoperative hypotony (IOP <5 mm Hg) occurred in 19 (6.1%) of 310 eyes. At 1 day, IOP higher than 30 mm Hg was more frequent in glaucoma eyes than in normal eyes. Although there were no direct problems related to hypotony at 30 minutes or to elevated IOP (>30 mm Hg) at 1 day, surgeons should be aware of and check for IOP variability (low and high) that can occur in normal, glaucoma, and glaucoma-suspect eyes within the first 24 hours after surgery.