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.     

孔源性视网膜脱离伴脉络膜脱离的手术治疗

目的探讨不同的手术方式对伴脉络膜脱离(脉脱)的孔源性视网膜脱离病例的预后影响.方法139例140眼中Ⅱ级膜57眼(40.7%),ⅡA级膜62眼(44.3%).ⅢB级膜21眼(15.0%).64眼行环扎加压手术(scleralbucklingsurgery,SB),76眼行闭合式玻璃体切除手术(closedvirteoussurgery.CV).结果术后随访时间均大于3月,最长达2年,平均3.7月,一次手术复位109眼(77.9%),最终复位率89.3%(125/140).Ⅱ级膜中SB、CV一次手术复位率分别为82.1%、94.4%(P＞0.05),其中裂孔大小合计＞3PD的SB、CV一次手术复位率分别为58.3%、92.3%(P＜0.05);ⅢA级膜中SB、CV一次手术复位率分别为64.0%、86.4%(P＜0.05);ⅢB级膜均采用CV手术,一次手术复位率57.1%.结论对于膜形成不严重的Ⅱ级膜行SB手术比较合适,但裂孔合计＞3PD的宜行CV手术,对于ⅢA级膜及以上的行CV手术更合适.     

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。     

关于脉络膜脱离型视网膜脱离的研究进展

脉络膜脱离型视网膜脱离是一种复杂的伴有睫状体、脉络膜脱离的孔源性视网膜脱离的特殊类型。本病起病急,发展迅速,以严重的葡萄膜炎和低眼压为主要临床表现,如治疗不及时,可迅速导致玻璃体和视网膜周围增生,故预后较差。目前对其发病原因、发病机制和治疗尚未有一个明确的定论,国内外研究主要集中在其治疗方面,我们对其相关发病原因、发病机制和治疗进展进行综述,以期进一步了解脉络膜脱离型视网膜脱离,为临床工作提供依据。     

Schisis-like rhegmatogenous retinal detachment associated with choroidal colobomas

Background: The breaks that cause retinal detachments in colobomatous eyes are often hidden within the lesion and difficult to find. Method: To elucidate the pathoanatomy and possible pathomechanism of such detachments, histological sections of eight choroidal colobomas were reviewed. Results: Sections of the margin showed central continuation of the inner neuroblastic layer (the intercalary membrane) and eversion and separation of the outer neuroblastic layer. The opposite direction of continuity of the neuroblastic layers created a schisis-like configuration between the intercalary membrane and the everted outer retina. The zone of duplication was a point of retinal adhesion, but also a locus minoris resistentiae due to vitreous attachments and variable glial support at the margin. Conclusion: The subset of coloboma-associated retinal detachments requires both a central break in the inner layer and a break in the outer layer at the margin of the coloboma. The inner layer break may be precipated by retinovascular ischemia or scleral stretching; that in the outer layer may be caused by vitreous traction on the margin of the coloboma or extension of the formerly isolated detachment through the outer marginal zone of decreased glial support.Presented at the Annual Meeting of the Retina Society, San Francisco, California, 20 October 1993     

玻璃体切除术前应用糖皮质激素治疗脉络膜脱离型视网膜脱离的效果分析

目的 研究术前糖皮质激素的不同应用途径对孔源性视网膜脱离伴有脉络膜脱离玻璃体切除术后解剖复位的影响。设计 回顾性病例系列。研究对象 北京同仁医院就诊的伴有脉络膜脱离的孔源性视网膜脱离患者155例（155眼）。方法 根据术前糖皮质激素使用情况分为4个组：未应用糖皮质激素（A组）43眼;口服糖皮质激素（B组）42眼;球旁注射糖皮质激素组（C组）32眼;玻璃体注射曲安奈德组（D组）38眼。所有患者均为首次行玻璃体切除手术。观察术后6个月视网膜解剖复位的情况。主要指标 首次玻璃体切除术后视网膜复位情况。结果 首次玻璃体切除术后,A组视网膜复位27眼,手术治愈率62.79%;B组视网膜复位37眼,手术治愈率88.10%;C组视网膜复位29眼,手术治愈率90.63%;D组视网膜复位34眼,手术治愈率89.47%。A组术后视网膜复位率与其他组比较均有统计学意义（P均<0.05）;B、C、D三组间比较无明显统计学意义（P>0.05）。结论 对于伴有脉络膜脱离的孔源性视网膜脱离,术前应用糖皮质激素可以提高术后视网膜复位率;口服、球旁和玻璃体注射不同糖皮质激素应用方式,对于玻璃体切除术后视网膜复位率无明显差异,可根据患者全身及局部情况进行选择。     

曲安奈德玻璃体腔内注射辅助治疗脉络膜脱离型视网膜脱离

目的:评价玻璃体手术前1d玻璃体腔内注射曲安奈德治疗脉络膜脱离型视网膜脱离的疗效和安全性。方法:对28例(28眼)脉络膜脱离型视网膜脱离患者于玻璃体手术前1d玻璃体腔注射曲安奈德混悬液0.1mL(4mg)。手术方式为巩膜环扎联合玻璃体切除,术后C3F8或硅油充填。24眼随访6～17(平均8.9)mo。结果:28眼注射曲安奈德后葡萄膜炎症减轻。24眼单次手术视网膜解剖复位率87.5%(21/24)。结论:在玻璃体手术治疗脉络膜脱离型视网膜脱离前1d玻璃体注射曲安奈德使手术难度降低,提高了视网膜复位率。     

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。     

合并脉络膜脱离的孔源性视网膜脱离患者的手术疗效分析

目的 探讨合并脉络膜脱离的孔源性视网膜脱离患者的手术疗效及其影响手术疗效的因素。方法 回顾1996年1月至1998年8月间,本院收治的188例（188只眼）合并脉络膜脱离的孔源性视网膜脱离患者的临床资料,分析患者术前增生性玻璃体视网膜病变（proliferative vitreoretinopathy,PVR）的分级、手术方式、术前糖皮质激素治疗等因素与手术疗效的关系。结果 本组患者手术治愈率为83．0％,低于一般视网膜脱离的治愈率;PVR的A－B组手术治愈率为89．6％,C1－C3级为84．1％,D1－D3级为69．0％;PVR的C1－C3级中,行玻璃体切除术者的手术治愈率高于行巩膜扣带术者;术前糖皮质激素使用者比未使用者手术治愈率高;糖皮质激素使用时间的长短与手术治愈率无关;巩膜扣带术者中,放液与不放液与手术治愈率无关。结论 合并脉络膜脱离的视网膜脱离患者,其视网膜脱离程度严重,PVR发展快,术前应及时给予糖皮质激素治疗,但不能延误手术时机。对PVR的A－B级、脉络膜程度不严重的患者可行巩膜扣带术,尽量不放视网膜下液、不注气;对PVR的C级患者行玻璃体切除术是解决严重脉络膜脱离的有效方法,对脉络膜脱离程度较轻的患者也可行巩膜扣带术;PVR的D级患者应行玻璃体切除术。     

Macular hole as a risk factor of choroidal detachment in rhegmatogenous retinal detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.     

Bilateral rhegmatogenous retinal detachment associated with unilateral choroidal melanoma

A patient with bilateral rhegmatogenous retinal detachment associated with a unilateral choroidal melanoma is presented. It appears that there is no causative relationship between these two findings in this case. The clinician should be advised that these two phenomena are not as rare as was once thought, and an index of suspicion should be maintained whenever one is evaluating a patient with retinal detachment.     

曲安奈德联合手术治疗脉络膜脱离型视网膜脱离

目的:探讨后Tenon囊注射曲安奈德联合手术治疗脉络膜脱离型视网膜脱离的治疗效果。方法:回顾性分析18例18眼伴有脉络膜脱离的视网膜脱离患者的临床资料,观察术前后Tenon囊注射曲安奈德后眼前段炎症反应、玻璃体混浊程度以及脉络膜脱离变化情况,手术方式的选择和PVR的程度与手术效果的关系。结果:所有18例患者后Tenon囊注射曲安奈德后5～7d眼前段炎症反应15例视网膜完全复位,明显减轻,玻璃体混浊以及脉络膜脱离好转,随访3～12mo,1例未复位,2例复发,最终手术成功率为83%。眼压和视力均有明显的提高。结论:伴有脉络膜脱离的孔源性视网膜脱离较一般的视网膜脱离手术的成功率低,术前后Tenons囊注射曲安奈德可迅速减轻眼前段炎症反应,脉络膜脱离吸收,明显提高脉络膜脱离型视网膜脱离的手术成功率。     

Management of uncomplicated primary retinal rhegmatogenous detachment

International Ophthalmology - The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). This was a...     

Scleral buckling with chandelier illumination system in rhegmatogenous retinal detachment surgery: a large case series

AIM: To evaluate advantages of chandelier illumination system during scleral buckling (SB) procedures for rhegmatogenous retinal detachment (RRD) surgery. METHODS: In this comparative, retrospective study, 72 eyes of 72 patients undergoing SB for RRD at Minerva Hospital (Santa Maria Capua Vetere, Italy), divided in 2 groups of 36 eyes each were collected. In one group (A) eyes underwent SB with chandelier, in the other one (B) eyes underwent SB without using chandelier illumination system. Every eye of both groups was checked before surgery and at 1, 3, 7, 14, 30, 90 and 180d follow up. Parameters such as additional procedures, best spectacles visual acuity (BSVA; measured with Snellen Lines as decimal fraction), surgical time and retinal breaks recurrences had been analyzed before and after surgery and statistical comparison have been run between two groups. RESULTS: A significant (P<0.01) improvement in BSVA was observed at 6mo follow up in both groups; comparing groups A and B, no significant clinical differences was found in recurrences rate whereas mean surgical time in group A was statistically lower than the group B ones. CONCLUSION: According to results observed, even if they need to be confirmed in further studies with larger population, chandelier illumination system could be considered a valuable tool for SB surgery in eyes affected by RRD.     

玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离

目的：探讨玻璃体切除联术合巩膜外环扎治疗脉络膜脱离型视网膜脱离的临床疗效。

方法：回顾性分析2014-01/2018-02在我院行玻璃体切除术联合巩膜外环扎治疗的脉络膜脱离型视网膜脱离患者19例19眼,术后3～12mo行玻璃体腔硅油取出术。观察患者术后视网膜复位率、眼压、视力恢复及并发症情况。

结果：本组患者术后视网膜均复位,术后3mo患眼玻璃体腔硅油填充状态下眼压(16.09±3.58mmHg)、硅油取出术后6mo眼压(14.69±3.10mmHg)均高于术前(6.78±1.90mmHg)(均P<0.05)。硅油取出术后6mo,15眼患者视力较术前提高。术后无低眼压及眼球萎缩等并发症发生。

结论：玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离是相对安全有效的,视网膜复位率高,术后并发症少,再次手术率低。     

Primary vitrectomy for the management of rhegmatogenous retinal detachment associated with choroidal detachment

PURPOSE: To evaluate the role and the results of primary vitrectomy in treating cases with coexisting rhegmatogenous retinal detachment and choroidal detachment. METHODS: Eleven consecutive eyes with coexisting rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C were included. Release of traction on the breaks was achieved by vitrectomy and augmented by episcleral buckle if needed. Perfluorocarbon liquids were used to drain the subretinal fluid through the vitrectomy sclerotomies. The breaks were treated by endolaser under perfluorocarbon liquids. Postoperative tamponade was done by C3F8 gas or silicone oil. Cases were followed up for at least 3 months. RESULTS: Retinal reattachment could be achieved and maintained in all cases by one or more surgeries. No recurrence of choroidal detachment has occurred. In each case, choroidal detachment was drained through the sclerotomies and retinal detachment was repaired. CONCLUSION: Primary vitrectomy represents an effective line in the management of rhegmatogenous retinal detachment with coexisting choroidal detachment in phakic or nonphakic eyes. Summary: Primary vitrectomy is recommended for the management of choroidal detachment associated with retinal detachment.     

脉络膜脱离型视网膜脱离外路显微手术的效果

目的 探讨脉络膜脱离型视网膜脱离外路显微手术的临床效果.方法 回顾性病例系列研究,脉络膜脱离型视网膜脱离22例(22眼).在手术显微镜直视下先预置环扎带,再完成环扎、硅压预置缝线,放视网膜下液或前房穿刺放房水,视网膜冷凝、垫压,核实裂孔、扎紧环扎带和眼内注入膨胀气体,定期观察手术效果.结果 术后随访3～12个月.一次手术视网膜复位18例,手术成功率81.82％,其余4例需二次行玻璃体切除术;术后最佳矫正视力≥0.4者3例,0.06～0.3者6例,手动～0.05者13例,与术前相比差异具有统计学意义(x2=6.49,P＜0.05);无严重并发症发生.结论 脉络膜脱离型视网膜脱离外路显微手术具有操作方便、观察直观、并发症少等优点.     

吊顶灯照明行巩膜扣带术治疗孔源性视网膜脱离

目的：评估治疗孔源性视网膜脱离(RRD)的巩膜扣带术中使用吊顶灯照明系统的优势。

方法：在这一对照、回顾性研究中,72例72眼于密涅瓦医院接受巩膜扣带术治疗的RRD患者分为两组。A组在吊顶灯照明下行巩膜扣带术,B组进行常规巩膜扣带术。两组均于术前、术后1、3、7、14、30、90和180d进行随访。指标包括其它手术操作、最佳框架眼镜矫正视力(BSVA)、手术时间、视网膜裂孔再次出现进行了分析和比较。

结果：术后6mo,两组BSVA均较术前显著改善(P<0.01)。两组再次出现视网膜裂孔的比例未见明显差异,但A组手术时间较B组明显缩短。

结论：通过我们观察得出结果,使用巩膜扣带术治疗RRD时,吊顶灯照明系统是一个有价值的工具,即使这些结果需要在更大人群中进一步研究证明。     

Risk factors of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese patients

AIM: To comprehensively analyze the risk factors of rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD). METHODS: A total of 265 eyes of 265 consecutive cases of RRD were retrospectively analyzed. All patients had systemic and ophthalmologic examination. CD was diagnosed by indirect ophthalmoscopy, B-scan ultrasonography, and ultrasound biomicroscope (UBM). Each parameter was compared between patients of RRD and rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). Logistic regression analysis was used to determine the independent risk factors of CD. RESULTS: There were 52 eyes (19.62%) with CD. Pseudophakia was more commonly seen in RRDCD (21.15% vs 6.10%, P=0.002). Intraocular pressure (IOP) was lower (8.60±3.62 vs 12.96±3.55, P<0.001), best-corrected visual acuity was worse [3.00 (2.00 to 3.00) vs 1.92 (1.22 to 3.00), P=0.001], and refractive error was more myopic [-4 (-9 to -2) vs -2 (-6 to 0), P=0.007] in RRDCD. Eyes with RRDCD had larger extent of retinal detachment (P=0.007). In RRDCD, 34.62% of eyes presented with multiple holes (P=0.044) and 25.00% with macular holes (P=0.012), compared with 20.66% and 14.08% in RRD. High myopia (P=0.039), low IOP (P=0.017), and larger extent of retinal detachment (P<0.001) were significant and independent risk factors for developing CD. CONCLUSION: For CD in RRD, related factors include BCVA, IOP, lens status, refractive error, extent of retinal detachment, number of holes, and macular hole. Larger extent of retinal detachment, high myopia, and low IOP are significant and independent risk factors.     

裂孔源性视网膜脱离的最小量巩膜外加压手术

目的探讨原发性裂孔源性视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离22例(22眼),在直视下行球结膜环形剪开、四直肌预置牵引线,在间接检眼镜下行视网膜裂孔精确定位及中度冷凝,巩膜缝线固定外加压块,所有外加压均采用修剪后的小硅胶海绵块,只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～6月。结果所有患者手术过程顺利,无一例术中并发症,手术损伤小;手术后眼底检查外加压精确地顶压裂孔,视网膜完全复位20眼,2眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位;手术后视力提高者18眼,不变2眼,下降2眼。结论最小量的外加压手术的优点是精确、可靠、创伤小,能避免传统巩膜扣带手术的一些并发症,手术成功率高。