孔源性视网膜脱离对侧眼无症状视网膜裂孔的预防性治疗

目的:探讨孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝的疗效。方法:用三面镜和间接眼底镜观察孔源性视网膜脱离患者的对侧眼,对917例无症状视网膜裂孔进行预防性激光光凝术,记录其年龄、性别、屈光状态、晶状体的状态、对侧眼玻璃体状态、裂孔的类型和位置、预防性治疗的方法;术后随诊时间6mo～5a;记录术后视网膜和玻璃体的情况,视网膜新裂孔或视网膜脱离形成的例数,形成的时间和新裂孔发生时玻璃体的状态、新发生裂孔的类型和位置、治疗的方法。结果:孔源性视网膜脱离对侧眼裂孔发生的危险因素与年龄、性别、近视、部分玻璃体后脱离(posterior vitreous de-tachment,PVD)高度相关,裂孔以变性萎缩孔多见,马蹄孔次之;裂孔常发生的位置依次是颞上、颞下、鼻上、鼻下象限。术后发现对侧眼视网膜新裂孔或视网膜脱离形成共21例(2.3%),形成的时间平均为21.6mo(7d～3a),平均年龄41.3岁,15例(71.4%)为男性,全部为近视眼,其中16例(76.2%)高度近视(大于6.00D),全部为有透明晶状体眼,病变类型:15例(71.4%)为变性萎缩孔,6例(28.6%)为马蹄孔伴随广泛视网膜格子样变性(变性区大于6个钟点),术前部分PVD2例(9.5%),无明显的色素颗粒。新裂孔或视网膜脱离形成后,部分PVD伴色素颗粒18例(85.7%),全部均为马蹄形裂孔,马蹄孔伴后缘卷边2例(9.5%),9例(42.9%)新裂孔形成的位置位于激光光凝区的边缘,12例(57.1%)位于正常或未治疗的视网膜上,发展为视网膜脱离18例(85.7%),累及黄斑6例(28.6%),16例行视网膜裂孔冷凝联合巩膜环扎和外加压术,2例行玻璃体切除联合惰性气体填充术;单纯视网膜裂孔3例(14.3%),再次行氩激光光凝术,术后平均随访6mo。结论:孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝疗效好;中青年高度近视不伴随PVD是对侧眼无症状视网膜裂孔光凝术后发生视网膜裂孔或视网膜脱离的高危因素;预防性激光治疗与玻璃体后脱离牵拉新裂孔形成有密切相关。     

对侧眼无症状视网膜裂孔预防性激光光凝术后失败原因分析

目的探讨孔源性视网膜脱离患者的对侧眼无症状视网膜新裂孔行预防性激光光凝术后发生视网膜裂孔或视网膜脱离的原因。方法对21例孔源性视网膜脱离同时行对侧眼无症状视网膜裂孔预防性激光光凝术后发生视网膜裂孔或视网膜脱离的患者,记录其年龄、性别、屈光状态、晶状体状态、对侧眼预防性治疗的病变类型和治疗的方法、预防性激光光凝术到视网膜裂孔或视网膜脱离形成的时间和玻璃体状态、新发生裂孔的类型和位置、治疗的方法。结果平均年龄41.3岁,15例(71.4%)为男性,全部为近视眼,其中16例(76.2%)高度近视(大于6.0D),全部为有透明晶状体眼,对侧眼预防性治疗的病变类型:15例(71.4%)为变性萎缩孔,6例(28.6%)为马蹄孔伴随广泛视网膜格子样变性(变性区大于6个钟点),全部病例均行视网膜裂孔孔周氩激光光凝术,视网膜裂孔或视网膜脱离形成的时间平均为21.6个月,术前部分玻璃体后脱离(PVD)2例(9.5%),无明显的色素颗粒,新裂孔或视网膜脱离形成后,部分PVD伴色素颗粒18例(85.7%),全部均为马蹄形裂孔,马蹄孔伴后缘卷边2例(9.5%),9例(42.8%)新裂孔形成的位置位于激光光凝区的边缘,12例(57.2%)位于正常或未治疗的视网膜上,发展为视网膜脱离18例(85.7%),累及黄斑6例(28.6%),16例行视网膜裂孔冷凝联合巩膜环扎和外加压术,2例行玻璃体切除联合惰性气体填充术;单纯视网膜裂孔3例(14.3%),再次行氩激光光凝术,术后平均随访6个月。结论中青年高度近视不伴随PVD是对侧眼无症状视网膜裂孔光凝术后发生视网膜裂孔或视网膜脱离的高危因素;预防性激光治疗与玻璃体后脱离牵拉新裂孔形成有密切相关。     

Visual and anatomical outcomes after silicone oil removal in patients with complex retinal detachment

To evaluate outcomes of temporary silicone oil (SO) tamponade in patients with complex retinal detachment. A retrospective study of 184 eyes of 177 consecutive patients who underwent SO removal (SOR) by one surgeon between 2000 and 2010. Indications for the use of SO were proliferative vitreoretinopathy (56 eyes), difficult rhegmatogenous retinal detachment (RRD) (58 eyes), diabetic traction retinal detachment (DTRD) (29 eyes), RRD due to macular hole in highly myopic eyes (16 eyes), giant retinal tears (13 eyes), and RRD after penetrating trauma (12 eyes). All eyes underwent prophylactic 360° laser retinopexy and encircling buckle at the time of primary surgery. The mean duration of SO tamponade was 47 weeks, with a mean follow-up of 66.9 weeks after SOR. Anatomical success after SOR was achieved in 96.73 %. Final visual outcome of ≥20/200 was significantly higher in eyes with RRD compared to eyes with DTRD. Young age (≤16 years), performance of pars plana lensectomy at primary procedure and presence of pseudophakia at last follow-up were factors associated with good visual outcome in eyes with RRD. Factors predicting attached retina at last follow-up were older age (>16 years), normal intraocular pressure (IOP) at initial presentation and no relaxing retinotomy performed during the primary procedure in eyes with RRD. Complications were cataract (100 %) in phakic eyes, increased IOP (15.7 %), keratopathy (3.8 %), and hypotony (2.1 %). The low redetachment rate after SOR in the present study might be due to prophylactic 360° retinopexy and use of encircling buckles at time of primary retinal reattachment.     

Posterior vitreous detachment after neodymium:YAG laser posterior capsulotomy

PURPOSE: To determine whether retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy is due to a greater incidence of posterior vitreous detachment (PVD) than in controls and whether vitreous status at the time of capsulotomy is useful in predicting the risk for RD. SETTING: Teaching hospital ophthalmology service. METHODS: Patients having Nd:YAG laser posterior capsulotomy after uneventful cataract surgery (treatment group) were prospectively studied. Fellow eyes that had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation but no Nd:YAG capsulotomy (no-laser group) formed 1 control group, and eyes that had no cataract surgery (phakic group) formed a second control group. The treatment group comprised 322 eyes; the no-laser group, 97; and the phakic group, 142. Dilated fundus and vitreous examinations were performed at baseline (before Nd:YAG capsulotomy) and 12 months postoperatively. RESULTS: At baseline, the prevalence of PVD was similar in the treatment and no-laser groups (61.8% and 63.9%, respectively; P=.2014) but was significantly lower in the phakic group (50.7%; P=.0151). There was no significant difference among the groups in the development of PVD in eyes with attached vitreous at baseline (17.9%, treatment group; 11.4%, no-laser group; 17.1%, phakic group) (P=.6588). CONCLUSIONS: The prevalence of PVD was significantly higher in eyes after ECCE and IOL implantation than in phakic eyes independent of Nd:YAG laser posterior capsulotomy. Capsulotomy was not associated with a significantly higher incidence of new PVD; therefore, the presence or absence of PVD at the time of capsulotomy is not helpful in assessing the risk for RD in the first year after laser treatment.     

Success of retinal surgery comparing phakic and pseudophakic eyes with reference to preoperative findings and the kind of lens implant]

We analyzed retrospectively 597 eyes over a minimum follow-up of 6 months and compared the results of pseudophakic eyes with phakic eyes. The repair of pseudophakic retinal detachment is more difficult than the surgery in aphakic retinal detachment. Pseudophakic retinal detachment had a more advanced retinal detachment and PVR-stages at the time of diagnosis. Localisation of the tear was more complicated and the surgery was more invasive than in phakic eyes. In 61.2% the repair was for pseudophakic eyes with posterior chamber lens 78%, with anterior chamber lens 81.8% and for iris-fixated IOL's 75%. Compared to this, the anatomic reattachment rate in phakic eyes was 94.8%. The pseudophakic group had less favorable visual results.     

Results and complications of pneumatic retinopexy

Fifty-one patients with primary rhegmatogenous retinal detachment (RD) were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 63%. Of the 34 phakic eyes, 25 (74%) were reattached; of the 17 aphakic or pseudophakic eyes, seven (41%) were reattached (P less than 0.05). Postoperative complications included the development of new tears (22%), inadequate closure of the original tear, shifting and delayed absorption of subretinal fluid, and opening of previously closed tears. Pneumatic retinopexy is a valuable new technique; however, careful patient selection and postoperative management is required.     

Success and complications of pneumatic retinopexy

Fifty-eight consecutive patients with rhegmatogenous retinal detachment were treated by pneumatic retinopexy using intravitreal perfluoropropane gas. Reattachment was achieved in 29 of 35 eyes (83%) having single retinal breaks (up to 45 degrees in extent), including dialyses (up to 60 degrees), and groups of breaks within one clock hour. The cumulative reattachment rate was 37 of 58 eyes (64%), including eyes with detachments with multiple breaks 30 to 120 degrees apart and vitreous hemorrhage as well as aphakic and pseudophakic eyes. Pneumatic retinopexy was successful in 18 of 22 (82%) myopic eyes (-3 to -11 diopters). Virtually all complications developed in the inferior retinal quadrants, and included preretinal vitreous condensations or membranes in 27 of 58 eyes (47%), new retinal breaks in seven eyes (12%), and rhegmatogenous or tractional detachments in previously attached areas in 14 eyes (24%). Postoperative proliferative vitreoretinopathy occurred in six eyes (10%) and macular pucker in two (3%).     

Posterior extension of retinal break following pneumatic retinopexy

A patient underwent pneumatic retinopexy for partial rhegmatogenous retinal detachment sparing the macula. After reattachment of the retina, a radial, posterior extension of the retinal break developed, causing recurrent retinal detachment. Later, the patient underwent pars plana vitrectomy twice and attained reattachment of the retina. At last follow-up, his visual acuity was 20/30. This report highlights the importance of preoperative assessment of the vitreoretinal relationship in eyes undergoing pneumatic retinopexy.     

Analysis of risk factors for the outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes

BACKGROUND: To compare the preoperative risk profiles of phakic and pseudophakic eyes with primary retinal detachment and to assess their impact on the outcome of primary reattachment surgery. PATIENTS AND METHODS: 220 consecutive patients with primary retinal detachment, 165 phakic and 55 pseudophakic eyes were operated with scleral buckling alone or additional vitrectomy and followed up for 6 months. Pre-, intra- and postoperative risk factors were recorded and their impact on anatomical outcome after primary surgery in phakic and pseudophakic eyes was then compared in a multivariate regression analysis. RESULTS: The cumulative probability of anatomical success 6 months after surgery was similar in phakic (88.5 %) and pseudophakic eyes (86.3 %; log rank = 0.340). The most important risk factor for a different surgical outcome between phakic and pseudophakic eyes was the size of retinal detachment (p = 0.035). In phakic eyes the size of retinal detachment had no significant impact on surgical outcome (1 vs. 4 quadrants; log rank = 0.135); whereas in pseudophakic eyes a significant impairment on surgical outcome was found (1 vs. 4 quadrants; log rank < 0.001). The relative risk for failure of primary surgery due to retinal detachment of at least 3 quadrants was in phakic eyes 1.22 (CI: 0.71 - 1.70), in pseudophakic ones 1.81 (CI: 0.88 - 2.59). CONCLUSIONS: The outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes is similar for retinal detachments up to 3 quadrants. In retinal detachments of more than 9 clock times, the size of retinal detachment impairs the surgical outcome in pseudophakic eyes more than in phakic ones. The combination of extraocular surgery with vitrectomy in pseudophakic eyes with retinal detachment of more than 9 clock times contributes to a better outcome.     

Results of pneumatic retinopexy with air.

Although scleral buckling yields good results in retinal reattachment surgery, we search for less laborious methods which could give the same high cure rate. Fifty-one consecutive patients with phakic, rhegmatogenous retinal detachment and breaks within 60 degrees of the upper retinal quadrants were treated by retino-cryopexy, drainage of subretinal fluid (under an operating microscope), and intravitreal injection of air (0.8 to 2.0 ml). Follow-up examinations (after 6 to 12 months) disclosed retinal reattachment in 44 of 51 eyes (86%). Cases with macular detachment showed good visual recovery, and 15 of 23 eyes (65%) achieved 0.5 (20/40) or more in visual acuity. Postoperatively, new retinal breaks occurred in 6%, proliferative vitreoretinopathy in 2%, and macular pucker also in 2%. Pneumatic retinopexy with air is an easy procedure, it is associated with few complications, and enables rapid postoperative recovery.     

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

ObjectiveTo report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes.DesignNonrandomized, prospective, comparative clinical trial.ParticipantsTwo hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol.InterventionPatients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months.Main outcome measuresReattachment of the retina and visual outcome were compared to previously published studies.ResultsOf 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was −0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes.ConclusionPrimary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.     

玻璃体切割手术相关医源性视网膜裂孔的临床观察

目的分析玻璃体切割手术过程中医源性视网膜裂孔(iatrogenic retinal breaks,氉IRB)的发生率、危险因素及预防措施。方法回顾分析129例133眼玻璃体手术病例,记录眼别、术前诊断、玻璃体后脱离状态、晶状体状态,分析术中IRB的数目、分布及预防措施。结果 133眼中12眼术中出现13个IRB,总体发生率为9.0%。其中,黄斑裂孔或黄斑前膜33眼中3眼(9.1%)出现IRB,增生性糖尿病视网膜病变52眼中6眼(11.5%)出现IRB,玻璃体积血40眼中3眼(7.5%)出现IRB。8眼(6.0%)出现巩膜切口相关IRB,5眼(3.8%)出现其他区域IRB,其中1眼同时存在巩膜切口相关IRB及其他区域IRB。术中制作玻璃体后脱离组的IRB发生率(12.3%)高于术前存在玻璃体后脱离组(6.6%),但差异无统计学意义(P=0.256);有晶状体组的IRB发生率(10.5%)高于术中联合超声乳化组(4.5%)及人工晶状体或无晶状体组(8.0%),但差异均无统计学意义(均为P>0.05)。术后发生视网膜脱离4眼(3.0%),所有视网膜脱离眼经二次手术后视网膜均达到解剖复位。结论各种疾病行玻璃体切割手术均有发生IRB的可能,没有证据表明术中制作玻璃体后脱离及晶状体状态与IRB的发生具有明显相关性。为避免IRB可能引起的玻璃体术后视网膜脱离,术中仔细排查与处理是非常重要的。     

Efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion

 Purpose: To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion. Methods: A total of 21 patients (21 eyes) with choroidal avulsion, secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study. Preoperative findings included 3 to 7.5 mmHg (averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception. Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days (averagely 9.41±2.7 days) after the trauma. The postoperative follow-up lasted for 3 to 9 months (averagely 5.5±1.5 months). Results: The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area. Retinal proliferation/detachment, incarceration and/or partial retinal loss were also observed. Intraoperatively, the retina was separated and released, and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area. The suture fixation on the ciliary body was also introduced in some of the patients. At one month posteoperatively, a complete choroidal reattachment was achieved in 16 eyes (16/21, 76.19%) and partial reattachment in the remaining 5 eyes. At the end of follow-up, partial choroidal redetachment was observed in 4 of 16 eyes (25%), resulting in complete reattachment in 12 eyes (12/21, 57.1％) and partial reattachment in 9 eyes (9/21, 33.34％). The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery (Chi-square test, P<0.05), while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively (Chi-square test, P>0.05). Conclusion: Transscleral suture fixation serves as a reliable technique, particularly improving the choroidal reattachment rate in the choroidal avulsion.     

Skleraeindellende Ablatiochirurgie und pneumatische Retinopexie

For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.     

Late recurrences more than 1 year after primary successful surgery for rhegmatogenous retinal detachment

BACKGROUND: Recurrent retinal detachment following initial successful surgery usually occurs in the early postoperative course. Redetachment after 1 or more years of complete retinal reattachment is a rare event. The present study investigates the frequency and causes of late recurrences. PATIENTS/MATERIAL AND METHODS: A consecutive series of 2,232 eyes that presented with rhegmatogenous retinal detachment (RD) were treated between January 1994 and December 2006. Among them were 30 cases (30 eyes) presenting with late recurrent RD (1.34 %). We compared the clinical characteristics of initial and late recurrent RD. RESULTS: Over the 13-year period, 54.5 % of rhegmatogenous RD cases were treated with scleral buckling, 42.5 % using vitrectomy techniques and 2.55 % with pneumatic retinopexy. Late recurrent RD occurred 1.1 - 10.4 years (average 3.8, SD 2.56) after initially successful surgery. Previous surgery included scleral buckling in 24 eyes (80 %), vitrectomy in 5 eyes (16.7 %) and pneumatic retinopexy in another eye (3.3 %). At the time of initial treatment, primary reattachment rate was 93.3 % and final 100 %. At the time of late redetachment, the anatomic situation appeared more complex. Accordingly, most eyes were treated by vitrectomy (73.3 %), and only 23.3 % using buckling techniques. Furthermore, the numbers of reoperations to achieve reattachment increased from 6.6 % to 23.3 %. Major causes for late failures were vitreous base traction leading to new or reopened breaks and PVR. Three eyes showed these complications immediately after complicated anterior segment surgery. Comparing visual outcomes after initial (preop logMAR 0.57 +/- 0.7 and postop 0.38 +/- 0.43) and late (preop logMAR 0.87 +/- 0.71 and postop 0.66 +/- 0.5) RD, functional prognosis is worse when redetachment occurs. Nonetheless, in 50 % of eyes useful vision (>or= 20 / 50) was retained by repeat surgery. CONCLUSIONS: Recurrent retinal detachment that presents after more than 1 year of complete reattachment occurs in 1.34 % of cases according to the present study. We found a higher rate after scleral buckling compared to vitrectomy. The most important reasons for late failures are vitreous base traction and periretinal proliferations that clinically appear as new or reopened tears or as PVR. Recurrences show a more difficult retinal situation and require more extensive surgical interventions. Based on the anatomic and functional success rates, repeat surgical procedures are worth considering.     

急诊充气性视网膜固定联合气体下激光光凝术治疗视网膜脱离

目的: 探讨充气性视网膜固定术联合气体下激光光凝急诊治疗视网膜脱离的临床疗效、治疗适应证、并发症处理及操作技巧。方法: 分析2011-09/2012-06在我科住院治疗的,PVR级别低于C级、裂孔位于上方6个钟点位的单纯孔源性视网膜脱离患者45例45眼,行充气性视网膜固定术,术后24～48h行气体下裂孔激光光凝术。观察视网膜复位率、最佳矫正视力和并发症。结果: 平均随访10mo。一次手术成功率40眼(88.9%)。术后视网膜下小气泡2眼(4.4%),视网膜下液吸收延迟3眼(6.7%)。新发视网膜裂孔5眼(11.1%),发展为牵拉性视网膜脱离2眼(4.4%),白内障加重1眼(2.2%)。结论: 充气性视网膜固定术联合气下光凝术适用于上方6个钟点位视网膜裂孔和PVR低于C级的病例。与玻璃体视网膜手术或巩膜扣带术相比,该术式能在发现孔源性视网膜脱离后迅速进行视网膜裂孔封闭,治疗环境及医疗设备要求相对宽松,手术技巧难度较低,治疗费用低。其缺点是一次手术成功率较低,术后需要精确的体位控制和密切随访。     

Laser pneumatic retinopexy for repair of recurrent retinal detachment after failed scleral buckle--ten years experience

BACKGROUND: Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years. PATIENTS AND METHODS: We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months follow-up. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina. RESULTS: In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy. CONCLUSION: We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone.     

玻璃体手术治疗继发于视网膜分支静脉阻塞的视网膜脱离

目的 探讨继发于视网膜分支静脉阻塞（BRVO）的视网膜脱离（RD）的临床特点和玻璃体手术的治疗效果。方法 回顾分析45例（45眼）继发于BRVO的RD的临床特点、治疗方法和预后。结果 45眼RD患者术前和术中检查发现，合并视网膜裂孔25眼，完全玻璃体后脱离（PVD）16眼。44眼均完成玻璃体手术，术后随访6—84个月。视力提高28眼（63．64％），稳定11眼（25．00％），下降5眼（11．36％）。手术后视力与手术前视力比较，差别有显著统计学意义（χ^2=4．04，P〈0．01）；完全PVD组与无或仅部分PVD组的手术后视力比较，差别有显著统计学意义（χ^2=2．97，P〈0．01）。第1次手术后视网膜成功复位39／45眼（88．64％），最终视网膜成功复位44／45眼（97．78％）。结论 继发于BRVO的RD有其独特的临床表现。玻璃体手术能有效地治疗继发于BRVO的RD，术后绝大多数患者视力改善，视网膜成功复位。     

Reattachment of Rhegmatogenous Retinal Detachment via Fibrin Tissue Adhesive

PurposeTo manage reattachment of rhegmatogenous retinal detachment using tissue adhesive (fibrin glue) in five patients.MethodsFive eyes of five patients with rhegmatogenous retinal detachment were treated with 23-gauge pars plana vitrectomy and the application of fibrin glue (Tisseel Lyo) into the break under air without laser photocoagulation or cryopexy.ResultsThe median age of patients was 64 (range, 46–82) years, and the median duration of symptoms was 15 (range, 7–60) days. Three eyes had inferior and two had superior rhegmatogenous retinal detachments. Successful retinal reattachment was achieved in all cases and maintained during the followıng 10 to 24 months. The median best-corrected visual acuity improved from 2 / 100 preoperatively to a Snellen visual acuity of 20 / 50 by 6 months postoperatively. No postoperative complications were detected during the follow-up period.ConclusionsExcellent adhesive effects of fibrin glue with respect to sealing retinal tears with no side effects were seen in our study. With further prospective studies, this technique could be an alternative method to conventional retinopexy.     

Reoperations and visual results after failed pneumatic retinopexy

A single pneumatic retinopexy (PR) procedure failed to achieve permanent retinal reattachment in 23 (23%) of 101 cases of simple primary retinal detachment (RD). In 12 (16%) of 76 cases that were phakic or had an intact posterior capsule, a single PR failed compared with 11 (44%) of 25 cases without an intact posterior capsule. A total of 27 reoperations including eight repeat PRs (5 of which were successful) was required to achieve permanent retinal reattachment. Comparison of the final visual acuity and change from preoperative to final visual acuity between the initially failed and the successful cases demonstrated that initial failure of PR does not adversely affect the visual outcome. In all cases, the retina remained reattached at latest follow-up.