Reattachment of retina and retinoschisis in pit-macular syndrome by surgically-induced vitreous detachment and gas tamponade

The origin of the subretinal fluid in pit-macular syndrome is unknown. Using optical coherence tomography, the authors observed that an optic disk pit is not a true pit but a cystic cavity covered with a superficial layer of the optic disk in a patient with retinal detachment and retinoschisis. The cyst was connected to the intraretinal space of the retina, which was split in several layers, or the retinoschisis in the papillomacular area. Vitrectomy and gas tamponade were performed to treat the patient. During surgically-induced vitreous detachment, strong vitreoretinal attachment at the disk margin and the fovea was observed. After surgery, the cystic space at the optic disk disappeared and the retinal detachment and retinoschisis reattached. Vitreous traction may play a role to introduce the fluid from the optic cyst to the subretinal space through the superficially split retina.     

Extraction of subfoveal liquid perfluorocarbon

PURPOSE/METHODS: Perfluorocarbon liquids (PFCL) are synthetic and transparent compounds with a high specific gravity which are very useful for vitreoretinal surgery. Subretinal injection of PFCL can occur during vitreoretinal surgery. A case report is presented of a patient with retained subretinal perfluoro-N-octane following retinal detachment repair for an ocular penetrating injury. RESULTS/CONCLUSION: Perfluoro-N-octane was retained in the subfoveal space for ten postoperative days and was removed thereafter. Based on our experience, residual PFCL droplets in the subretinal space for ten days after retinal detachment surgery allow a good anatomical and visual outcome, after two years follow-up.     

Risk factors for retention of subretinal perfluorocarbon liquid in vitreoretinal surgery

PURPOSE: To analyze factors that may lead to inadvertent subretinal retention of perfluorocarbon liquid (PFCL) after vitreoretinal surgery and compare surgical outcomes and complications associated with these events. DESIGN: Consecutive retrospective study. METHODS: The authors retrospectively reviewed the charts of 72 vitreoretinal surgeries using intraoperative PFCL and its removal through fluid-air exchange and subsequent tamponade. Indications for surgery included trauma, retinal detachment, giant retinal tear, and submacular hemorrhage. Most interventions studied had significant amounts of proliferative vitreoretinopathy and were required after failed or complicated previous vitreoretinal surgery. MAIN OUTCOME MEASURES: Analysis was focused on the occurrence of subretinal retention of PFCL during different surgical procedures and techniques, indications, anatomic and visual results, and complications. RESULTS: At the last follow-up, the retina was completely attached in 97% of eyes treated with PFCL after 1 or 2 vitrectomies. Subretinal PFCL was found in 8 (11.1%) eyes. There was no statistical difference in the retention rate for perfluorodecalin and perfluoro-n-octane. The factor most significantly associated with subretinal retention of PFCL was the presence and large size of a peripheral retinotomy. All cases of subretinal PFCL had a retinotomy of 120 degrees or larger. The average retinotomy size in these cases was 259 degrees . Subretinal PFCL was found in 40% of eyes with a 360 degrees retinotomy. Small and medium-sized retinal breaks were not associated with PFCL retention. Another surgical procedure that correlated significantly with subretinal PFCL was lack of saline rinse during fluid-air exchange. Only 1 of the 23 eyes that were rinsed had subretinal PFCL, although many had large retinotomies. CONCLUSION: Subretinal PFCL retention is most likely to occur in eyes with large peripheral retinotomies, especially if 360 degrees . Saline rinse seems to be useful in the prevention of subretinal PFCL. The presence of subretinal PFCL does not seem to affect visual and anatomic success when located outside the macula, at least during an intermediate period of follow-up.     

Natural history of sub-retinal triamcinolone acetonide deposition after triamcinolone-assisted vitrectomy

Purpose To describe the natural course of subretinal triamcinolone acetonide (TA) deposition after a TA-assisted vitrectomy for retinal detachment. Methods Observational case series. Results TA deposition was observed between the neurosensory retina and retinal pigment epithelium in the macular area at the conclusion of vitreoretinal surgery in three patients with retinal detachment. On follow up, TA granules gradually decreased over the next 2 weeks and resolved completely by 3 weeks. Two months after the operation, the retina was observed to be successfully attached and no ophthalmoscopic or functional damage was observed. Conclusion As no apparent clinically detectable adverse effect was found in the three cases that demonstrated subretinal deposition of TA we opine that active surgical maneuvers to remove the same are not warranted during surgery.     

The effect of intraoperative retinal manipulation on the underlying retinal pigment epithelium: an experimental study

PURPOSE: Retinal pigment epithelial changes described after vitreoretinal surgery may result from localized compression injury caused by intentional or inadvertent contact with vitreoretinal instruments. The authors evaluated these changes resulting from manipulation of the retina without frank retinal injury. METHODS: One eye each of six pigmented rabbits underwent surgery during which the inner retinal surface was touched at several points with a 20-gauge silicone-tipped subretinal fluid cannula without causing a retinal break or subretinal hemorrhage. The rabbits were followed-up with indirect ophthalmoscopy, fundus photography, and fluorescein angiography, and were killed at 1 hour, 1 week, or 2 weeks. Light microscopy was used for histopathologic evaluation. RESULTS: On fluorescein angiography, diffuse leakage noted at the injury sites significantly decreased by the fourth day and almost completely disappeared by the second week. Disruption of photoreceptor outer segments and retinal pigment epithelium in the early specimens, and irregular pigmentation, proliferation, and migration of the retinal pigment epithelium at 1 and 2 weeks were the prominent features on histopathologic examination. CONCLUSIONS: Intraoperative manipulation of the attached retina may cause significant pigment epithelium displacement and proliferation and varying degrees of disorganization of normal retinal architecture in the absence of clinically evident retinal breaks and subretinal hemorrhages.     

伴视网膜嵌顿的外作性视网膜脱离的手术治疗

目的 探讨伴视网膜嵌顿的外伤性视网膜脱离的玻璃体手术方法及疗效。方法 应用玻璃体切除、膜剥离、松解性多膜切开、眼内激光眼内充填订,部分病便结合巩膜外加压术治疗伴视网嵌顿的外伤性视网膜脱离１３例（１３只眼）。结果 １３只眼术后视网膜均复位,３个月至３年随访期间,１０例视网膜保持平复;３例视网离复发,其中１例经再次手术使视网膜复位;解剖学复位结果为１１／１３,术后和随访时间视力有不同程度提高。结论 外     

视网膜下膜的处理

目的：探讨视网膜下膜的处理原则及方法。方法：回顾性分析62例视网膜脱离伴视网膜下膜病例的治疗情况。结果：取出视网膜下膜20例（32．3％）,术后视网膜复位18例,占90％。未取下膜42例（67．7％）,术后视网膜复位39例,占90．5％。结论：多数视网膜下膜不影响视网膜复位不需手术处理。     

硅油填充术后视网膜再脱离的分析与处理

目的探讨硅油填充术后视网膜再脱离的特点及处理方式。设计回顾性病例系列。研究对象55例(55眼)硅油填充术后视网膜再脱离患者。方法分析硅油填充术后视网膜再脱离患眼的临床表现,并分别采取硅油取出联合玻璃体视网膜手术、硅油下视网膜复位手术及单纯巩膜扣带术复位治疗,术后随访3个月。主要指标视网膜再脱离临床表现、视网膜复位情况及视力。结果硅油填充术后视网膜再脱离的特点为下方脱离为主,范围常小于2个象限,多伴有再增生及裂孔。50眼再次行手术治疗,39眼行硅油取出联合玻璃体视网膜手术,9眼行硅油下视网膜复位手术,2眼行单纯巩膜扣带术。随访期间,完全复位41眼(78％),部分复位7眼,未复位2眼。结论硅油填充术后视网膜再脱离较为复杂,需根据视网膜再脱离的特点,针对性地选择手术方法。     

Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery

PURPOSE: To report the clinical characteristics of, discuss the surgical options for, and analyze the factors affecting the anatomic and visual outcome of intraocular cysticercosis. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Forty-five eyes of 44 Indian patients with posterior segment intraocular cysticercosis. METHODS: The charts of 45 eyes, in which intraocular cysticercosis was removed by vitreoretinal surgery (either transscleral or transvitreal), were reviewed. MAIN OUTCOME MEASURES: These included the postoperative retinal status and the best-corrected Snellen visual acuity. RESULTS: Intraocular cysticercosis was present in the vitreous cavity of 27 eyes (60%) and in the subretinal space of 18 eyes (40%). Anterior segment inflammation was seen in 13 eyes (28.8%) and vitreous inflammation in 38 eyes (84.4%). Retinal detachment was observed in 22 eyes (48.8%), with proliferative vitreoretinopathy in 13 eyes (59.09%). Subretinal cysts anterior to the equator (4 eyes) were removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts (41 eyes) were removed transvitreally. The mean follow-up was 10.5 months. At the last follow-up, the retina was attached in 39 eyes (86.6%); visual acuity of >/=5/200 was achieved in 67.5%. CONCLUSIONS: Current vitreoretinal surgical techniques enable removal of intraocular cysticercosis in all cases, with reattachment of the retina in 86.6% and recovery of ambulatory vision in approximately 67% of cases.     

Transscleral drainage of subretinal/suprachoroidal silicone oil

Silicone oil migration into the subretinal space following vitreoretinal surgery may occur in complex cases of retinal detachment with proliferative vitreoretinopathy. This complication prevents achievement of the primary goal (ie, to attach the retina) and fails to provide the internal tamponade, leading to a permanent decrease in visual acuity. Successful and complete removal of the subretinal oil is a challenge. Internal drainage as described earlier in the literature advocates a large relaxing retinotomy. The authors describe two similar cases, one with retinal detachment secondary to type II iridochoroidal coloboma wherein the oil had passed into the subretinal space and the other with diabetes mellitus and retinal detachment with oil in the suprachoroidal space. In both cases, silicone oil was removed successfully through a transscleral approach. The transscleral approach for removal of subretinal/suprachoroidal oil appears to be relatively safe, less time-consuming, and effective.     

Inadvertent perforation of the globe during regional anaesthesia

Purpose: This retrospective study was undertaken to review the clinical signs and management of patients with perforating eye injuries associated with regional anaesthesia for ophthalmic surgery.
Methods: Fifteen consecutive patients presenting with inadvertent perforation of the globe were evaluated. Eleven required vitreoretinal surgery. The indications were retinal detachment (six eyes), vitreous haemorrhage (four) and an epiretinal membrane (one eye).
Results: Those eyes with retinal detachments generally had a poor functional outcome in spite of the retinae being attached in five of the six eyes. The operative findings of those eyes with vitreous haemorrhage but attached retina demonstrated varying retinal tear configurations.
Conclusions: Eyes with perforating injuries following intraorbital anaesthesia are at risk of developing a retinal detachment. In those eyes presenting with dense vitreous but attached retina, consideration of vitrectomy and laser photocoagulation is advised.     

26例玻璃体手术后视网膜脱离原因分析

目的：探讨玻璃体手术中及术后可能导致视网膜脱离的各种原因，以便 有效提高手术成功率。方法：回顾性分析26例玻璃体手术后视网膜脱离病例。通过再次玻璃体手术观察新破孔的位置、大小及其比邻关系，结合前次手术的有关资料，确定前次手术失败的原因。结果：26例玻璃体手术后视网膜再脱离直接原因（再网脱原因）：发生增殖性玻璃体视网膜病变（PVR）15例；术中遗漏视网膜裂孔（遗漏裂孔）3例；巩膜切口玻璃体嵌顿（玻璃体嵌顿）5例；下方视网膜裂孔硅油充填不足（硅油不足01例；视网膜裂孔缘翻卷（孔缘翻卷）1例；视网膜Ar激光光凝形成视网膜孔（激光孔）1例。结论：PVR是玻璃体手术失败的主要原因。巩膜切口玻璃体嵌顿导致的玻璃体手术失败而引起术者的关注。     

Vitreous surgery with trypan blue staining of membranes in PVR retinal detachment surgery

BACKGROUND: In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. PATIENTS AND METHODS: We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. RESULTS: After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. CONCLUSIONS: Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.     

二次玻璃体手术治疗复杂眼外伤

目的探讨二次玻璃体视网膜手术治疗复杂性外伤性视网膜脱离的疗效并分析首次手术失败的原因。方法分析复杂眼外伤26眼在玻璃体视网膜手术后因出现视网膜前膜或视网膜脱离,在术后7d～6月分别再次行玻璃体视网膜手术等2次以上手术,并对第2次手术原因进行分析。结果术后增生性玻璃体视网膜病变复发、视网膜裂孔封闭不良、首次手术玻璃体切除不彻底是第1次玻璃体手术失败的主要原因。第2次手术后26眼中视网膜完全解剖复位23眼,2眼因局限性视网脱离分别再行玻璃体切除联合巩膜环扎或视网膜切开术,另1眼失败,复位率88.46%。术后视力提高者20眼（76.92%）,术后视力与手术前比较,差异有统计学意义（U=-3.397,P〈0.001）。结论彻底清除PVR增生组织、恢复视网膜活动度、选择合适封孔方式及眼内填充物,方能够复位视网膜,并恢复部分视力。     

急性视网膜坏死综合征视网膜脱离的手术治疗

目的 探讨急性视网膜坏死综合征视网膜脱离的手术治疗的方法和效果。方法 回顾性分析1985-2002年6月收治的52例71眼急性视网膜坏死综合征中33例41眼视网膜脱离的患者。结果 接受普通外路视网膜脱离手术治疗13眼中8眼视网膜复位，手术成功率61％；接受玻璃体视网膜手术治疗10眼全部视网膜复位，手术成功率100％。结论 视网膜脱离手术，特别是玻璃体视网膜手术，可有效地使急性视网膜坏死综合征视网膜脱离复位。     

复杂性视网膜脱离术中视网膜切开技术的应用及疗效观察

目的观察复杂性视网膜脱离眼术中应用视网膜切开技术的临床疗效。方法23例伴有严重增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)的视网膜脱离眼,经常规玻璃体手术不能使视网膜复位,选择视网膜缩短僵硬处切开松解,或掀起切开的视网膜清除其下增生膜,再予眼内激光光凝、硅油填充。视网膜切开范围30～360°平均为132°。结果术毕23例均取得视网膜解剖复位,15例于术后3．0～11．0个月（平均5．6个月）取出硅油。所有病例随访6个月以上,17例视网膜完全复位 (4例未取硅油) ,占74.0%,视力 0. 02及 其以上者 11例,占48.0%, 2例取硅油后复发视网膜脱离;未取硅油者中 3例下方视网膜增生 伴浅脱离,1例因白内障而眼底情况不明。主要并发症为眼内增生(26.0%)和低眼压(13.0%) 。 结论复杂性视网膜脱离玻璃体手术中应用视网膜切开技术能取得一定的疗效。(中华眼底病杂志,2001,17:87-89)     

外伤性视网膜脱离的玻璃体手术治疗

目的:评价外伤性视网膜脱离的玻璃体手术治疗方法及疗效。方法:对24例(24眼)外伤性视网膜脱离患者行常规经平坦部玻璃体切除、膜剥离、松解性视网膜切开、眼内激光、硅油或长效气体眼内填充等治疗,部分病例联合巩膜扣带术;随访3～24mo,观察疗效。结果:24眼术后视网膜均复位,视力均有不同程度的提高,随访期间,19例视网膜保持平复,5例复发视网膜脱离,其中3例经再手术视网膜复位,另2例因眼球萎缩未再手术。结论:外伤性视网膜脱离多伴有浓密的玻璃体积血、视网膜嵌塞及严重的增殖性玻璃体视网膜病变(prolifera-tivevitreoretinopathy,PVR),通过适时的玻璃体手术能获得比较满意的治疗效果。     

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.     

视网膜厚度分析仪(RTA)在眼底病的初步应用

目的：用视网膜厚度分析仪（retinal thickness analyzer,RTA）定量化检查视网膜厚度，了解常见眼底病视网膜厚度的定量变化。方法：采用扫描式RTA观察正常眼及26例（46只眼）各种眼底病变者，产生视网膜的系列光学切面像。得到视网膜地形图和厚度值。结果：各种眼底病变在RTA上的形态改变为：糖尿病性黄斑水肿眼：视网膜厚度图显示有视网膜厚度增加和中心凹凹陷消失，中心性浆液性脉络膜视网膜病变；玻璃体视网膜界面抬高，浆液性浅脱离；黄斑裂孔；视网膜内界面的中断，可见孔周的视网膜下液和局部脱离，近视眼；视网膜的萎缩性改变；黄斑前膜；视网膜神经上皮前的膜状物伸进玻璃体内，上述图形都伴有量化数据分析。结论：RTA显示的视网膜地形图和厚度图可提高对眼底疾病特别是黄斑疾病的诊断能力。     

Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy

PURPOSE: To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. METHODS: A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. RESULTS: The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. CONCLUSIONS: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.