Modified external needle drainage procedure for rhegmatogenous retinal detachment

PURPOSE: To describe the results of a modified external needle subretinal fluid drainage technique to treat eyes with a rhegmatogenous retinal detachment. METHODS: One hundred eighty-seven consecutive patients with a rhegmatogenous retinal detachment who underwent scleral buckle and modified external needle drainage at Duke Eye Center or Vistar Eye Associates were included in this study. Subretinal fluid was drained by a technique whereby the intraocular pressure was raised to a supranormal level by tightening an encircling scleral buckle and then the subretinal space was entered by a needle introduced externally while the retina was directly viewed with an indirect ophthalmoscope. Subretinal fluid drainage success rate, one-operation reattachment rate, final retinal reattachment rate, intraoperative and postoperative complication rates, and final visual acuity were the main outcome measures. RESULTS: Subretinal fluid was successfully drained in all eyes. The one-operation reattachment rate was 91%, and the final reattachment rate was 98%. Intraoperatively, 15% of eyes required corneal debridement to obtain an adequate view for safe subretinal fluid drainage. Subretinal hemorrhage of no more than one clock hour occurred in 4.2% of eyes. A total of 2.6% of eyes developed an epiretinal membrane postoperatively that required a vitrectomy to improve the visual acuity. The postoperative visual acuity, 0.54 by logMAR (20/69 by Snellen), was significantly better than the preoperative visual acuity, 1.1 logMAR (20/250 by Snellen) (P < 0.0001). CONCLUSIONS: The modified external needle drainage technique is a flexible, effective method to drain subretinal fluid in eyes with a rhegmatogenous retinal detachment. The retinal reattachment rate and complication rate compare favorably to alternative subretinal fluid drainage techniques.     

激光脉络膜切开视网膜下放液的临床观察

目的 探讨激光脉络膜切开与冷针穿刺脉络膜视网膜下放液的安全性及效果。 方法 孔源性视网膜脱离需行巩膜扣带术的病例70例74只眼，随机分为两组，A组34例36只眼采用冷针穿刺脉络膜放液，B组36例38只眼采用半导体激光眼内激光探头光凝脉络膜放液，比较两种方法的效果及并发症发生情况。 结果 两种放液方法均获成功，冷针穿刺脉络膜放液发生视网膜下出血3例、1例视网膜嵌塞、视网膜穿孔，而激光脉络膜切开放液组未发生明显的并发症。 结论 半导体激光脉络膜切开视网膜下放液可以降低并发症发生率，适用于任何需视网膜下放液的病例，尤其在视网膜下液不多的病例。 (中华眼底病杂志,1998,14:202-203)     

Subretinal bevacizumab detection after intravitreous injection in rabbits

PURPOSE: To evaluate subretinal detection of bevacizumab 2 hours after intravitreous injection of 1.25 mg in rabbit eyes. METHODS: Anterior chamber paracentesis using a 30-gauge needle was performed in nine female Dutch-belted rabbits by removal of 0.05 mL of aqueous humor. Transscleral retinal detachment was performed with a modified 25-gauge infusion cannula connected to a bottle of physiologic saline solution (PSS). The animals were divided into experimental group 1, with intravitreous injection of 0.05 mL of (1.25 mg) with a 30-gauge needle (n = 6) and the control group 2, with intravitreous injection of 0.05 mL of PSS with a 30-gauge needle (n = 3). Two hours after the intravitreous bevacizumab or PSS injection, subretinal fluid was aspirated and immunoassayed to measure the level of bevacizumab. The rabbits were killed by intravenous pentobarbital injection. The eyes were enucleated and fixed in 10% formaldehyde. The pars plana site at which the transscleral cannula was introduced was analyzed by light microscopy, to exclude iatrogenic retinal tears. Eyes with accidental retinal tears were excluded. RESULTS: Subretinal bevacizumab molecules were detected in the six eyes that received an intravitreous bevacizumab injection. No subretinal bevacizumab was detected in the control eyes. Light microscopy showed no evidence of retinal tears or holes in any rabbits used for the bevacizumab detection and control group. CONCLUSIONS: Bevacizumab molecules were detected in the subretinal space after intravitreous injection of 1.25 mg of bevacizumab, possibly as the result of diffusion through the retina in a rabbit model.     

改良穿刺放液在外路法视网膜脱离复位术中的应用

目的 探讨外路法视网膜脱离复位手术中改良穿刺放视网膜下液的临床有效性及安全性.设计回顾性病例系列.研究对象2006年1月至2009年9月收住南京医科大学第一附属医院眼科的329例孔源性视网膜脱离的患者.方法 手术显微镜下予巩膜环扎和（或）巩膜外加压术,术中均联合改良穿刺法放出视网膜下液,即穿刺点选在角巩膜缘后11 mm的直肌两侧,避开涡状静脉和视网膜裂孔,采用25 G 5/8-in针头（1ml BD针头,新加坡Becton Dickinson Medical（S）Pte Ltd.）垂直巩膜穿刺放出视网膜下液,穿刺深度不超过针头斜面.收集术前、术后及手术数据并进行分析.主要指标改良穿刺放液的成功率及并发症的发生率.结果 329例外路法视网膜脱离复位手术,327例（99.4%）引流出视网膜下液,2例未引流出视网膜下液.改良穿刺放液的并发症有视网膜下出血2例（0.6%）,出血范围小于2PD,穿刺点正对视网膜裂孔处1例（0.3%）,导致玻璃体自巩膜穿刺口脱出.结论 改良穿刺放液法是外路法视网膜脱离复位术中引流视网膜下液的一种安全、有效的方法.     

Suture needle drainage of subretinal fluid.

A simple technique is described for the transcleral drainage of subretinal fluid during retinal detachment repair. In a prospective study of 94 consecutive suture needle drainage procedures subretinal fluid was successfully drained in 91 cases. There were six 'significant' subretinal haemorrhages associated with the procedure, but none was subfoveal in location or directly compromised the surgical outcome. In no case was retinal incarceration or retinotomy observed.     

Modified needle drainage. A safe and efficient technique of subretinal fluid drainage in scleral buckling procedure

PURPOSE: To compare modified needle drainage (MND) with conventional drainage (CD) of subretinal fluid (SRF) as described by Schepens in surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective randomised clinical trial of 80 patients undergoing scleral buckling with subretinal fluid drainage for primary rhegmatogenous retinal detachment. In 40 patients modified needle drainage of subretinal fluid (SRF) was done using a perpendicular trans-scleral entry with a 26-gauge needle and the appearance of SRF in the hub of needle as end point. In 40 patients conventional drainage was done as described by Schepens using a diathermy needle. Adequacy of SRF drainage, intraoperative complications, anatomical and functional outcome were noted. RESULTS: 100% adequate drainage was achieved in all cases. The complication rate was 32.5% (n=13) in the CD group and 15% (n=6) in the MND group. In the CD group, 17.5% (n=7) patients had subretinal haemorrhage and in 2 eyes it was clinically significant. In the MND group 15% (n=6) of cases had subretinal haemorrhage and in one patient it was clinically significant. In the CD group, more serious SRF drainage complications were observed; these were absent in the MND group. CONCLUSION: Modified needle drainage is a safe and effective procedure for SRF drainage. In comparison with CD, MND is technically easy, less cumbersome and requires no special equipment.     

环扎加压放液与不放液治疗视网膜脱离的体会

目的评价环扎加压放液与不放液治疗视网膜脱离的临床疗效。方法随机分为A组（不放液）与B组（放液）进行手术。结果A组30例手术成功28例（93.3％）;B组30例成功27例（90％）。复位的55眼视力均有提高。两组疗效无显著性差异（P＞0．05）。结论环扎加压不放液治疗视网膜脱离与放液比较具有手术难度小、时间短、并发症少等优点,且疗效可靠,但对周边超过90°的巨大裂孔、黄斑后极部裂孔不适应该术式。     

两种不同放液方法在环扎加压术中使用的比较

目的 比较2种不同的放液方法在环扎加压术中使用后对于手术成功率以及手术并发症的影响。方法 回顾性分析同一手术者在2002年1月至2003年3月间所进行的80眼环扎加压手术，其中38眼为使用巩膜切开法冷针放液(2002年1月～10月)，42眼为冷针直接穿刺放液(2002年11月～2003年3月)，比较不同的放液方法对于手术成功率和手术中并发症出现的比率的影响。结果 两种不同的手术方法，手术成功率和并发症出现率差异无显著性。结论 冷针直接穿刺放液法是一种安全有效的放出视网膜下液(SRF)的方法。     

External argon laser drainage of subretinal fluid using the endolaser probe

The results of 200 consecutive scleral buckling procedures in which the argon endolaser probe was used to create a choroidotomy for drainage of subretinal fluid are reported. This technique was used in any case requiring drainage and was specifically employed in cases in which needle drainage was contraindicated because the detachment was shallow. The argon laser was set at 0.2 seconds, 1.25 watts, and was used with the endolaser probe held adjacent to, but not touching, the choroid. Drainage was successfully accomplished in 98% of cases. Rates of subretinal hemorrhage, retinal incarceration, and perforation related to laser drainage were 5.5%, 2.5%, and 1%, respectively. No large or submacular subretinal hemorrhages occurred. This technique appears to be particularly promising for drainage of shallow retinal detachments.     

缝针巩膜穿刺放液法在视网膜脱离手术中的应用

目的:探讨缝针巩膜穿刺放液法在视网膜脱离术中应用的有效性和安全性。方法:选取64例孔源性视网膜脱离患者,均采用外路视网膜脱离手术。分为A,B两组,A组采用巩膜切开放液法,B组采用缝针巩膜放液法。比较手术的成功率和并发症。结果:两组手术均获成功,成功率和并发症无显著性差异(P>0.05)。结论:缝针巩膜放液法是一种有效、安全的放液方法。     

Design features and surgical use of a cannulated extrusion needle

A cannulated extrusion needle was designed as a modification of the standard 20-gauge extrusion by including an inner 24-gauge flexible cannula that can be extended up to 18 mm beyond the metal tip. Indications for use of the instrument are reviewed along with selected case histories demonstrating its use. The instrument is used primarily for internal subretinal fluid drainage in eyes with complex retinal detachments caused by proliferative vitreoretinopathy. The flexible cannula is guided into the subretinal space through an open peripheral retinal break and the subretinal fluid is evacuated during a simultaneous fluid/air exchange. The positive pressure of the automated air pump creates a pressure gradient sufficient to achieve passive egress of subretinal fluid through the cannula. Active suction is avoided because of the risk of posterior retinal incarceration into the cannula tip. In addition, the cannula can be used to remove hemorrhage, gas, or silicone oil in the subretinal space.Presented at the XVIth Meeting of the Club Jules Gonin, Bruges, 4–8 September 1988Supported in part by the Helena Rubinstein Foundation, New York, and in part by the Veteran's Administration Medical Center, Miami, Florida, USA; the authors have no commercial or financial interest in the cannulated extrusion needle     

Endoscopy-guided subretinal fluid drainage in vitrectomy for retinal detachment

PURPOSE: To study the usefulness of endoscopy-guided subretinal fluid drainage in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). PARTICIPANTS/METHODS: A prospective non-comparative study of a small number of RRD cases. The study involved examining 10 eyes of 10 patients with RRD that received PPV. Two eyes had hazy corneas, which hindered the observation by surgical microscopy. Fluid-gas exchange was performed and then subretinal fluid was drained through a primary retinal break guided by an endoscope. No drainage retinotomy was made. Each clinical feature was studied and the surgical outcome and complications were evaluated. RESULTS: All eyes had retinal reattachment by a single operation. No serious complication related to surgery was experienced. CONCLUSIONS: Endoscopy-guided subretinal fluid drainage is the safe and effective procedure in PPV for RRD.     

视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物治疗重度渗出性视网膜脱离Coats病的临床疗效

目的 研究视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物雷珠单抗治疗重度渗出性视网膜脱离Coats病的效果.方法 选取2013年4月至2017年1月在北京同仁医院眼科中心确诊为3B期Coats病的患者13例13眼纳入研究.13例患者中,视力为无光感1例,光感～数指7例,0.01 ～0.1者2例,因年幼无法配合检查3例.巩膜外放液选取位置在视网膜脱离较高的位置,在显微镜观察下缓慢放出视网膜下液,所有患眼放液后于角膜缘后3.5 mm睫状体平坦部行玻璃体内注射抗血管内皮生长因子药物雷珠单抗0.5 mg(0.05 mL).随访期观察患者的视力、眼压、裂隙灯、间接检眼镜及彩色眼底像.分析异常血管变化,视网膜下液及渗出的吸收情况,视网膜复位及并发症发生情况.结果 13例患者中3例进行了2次的视网膜下液引流,10例进行了1次的视网膜下液引流;联合两次玻璃体内注射雷珠单抗的有6例,联合三次注射的4例,三次以上3例.所有患者的视网膜下液吸收或者大部分吸收后,进行了视网膜冷冻或激光治疗,单纯激光治疗的有5例,单纯视网膜冷冻治疗的3例,激光联合冷冻治疗的5例.13例患者中,视力提高的2例,无变化的8例,因年幼无法配合检查3例.在随访中,8例视网膜完全复位,未观察到与视网膜下液引流和眼内注药手术操作相关的并发症,如眼内炎、视网膜裂孔、玻璃体积血等.结论 视网膜下液引流联合玻璃体内注射雷珠单抗是一种有效治疗重度3B期Coats病的方法.     

Pneumatic retinopexy with drainage of subretinal fluid

Thirty bullous retinal detachments were treated with pneumatic retinopexy and drainage of subretinal fluid. Patient selection criteria were similar to pneumatic retinopexy. All the eyes were reattached after the first operation. In three (10%) eyes new breaks with retinal detachment developed within two months after the initial operation and were treated with scleral buckling. One of these three eyes developed proliferative vitreoretinopathy grade D3 two months after scleral buckling. Twenty-nine (96.7%) out of thirty eyes were eventually reattached. The follow-up period was at least nine months. Visual acuity was maintained or improved in 29 (96.7%) eyes. Complications developing due to subretinal fluid like extension of detachment, persistence of subretinal fluid, subretinal gas, reopened retinal breaks were not encountered. By applying cryotherapy to a reattached retina after drainage of subretinal fluid, retinal pigment epithelial dispersion is decreased and the so-called steamroller technique is avoided. Drainage of subretinal fluid did not prevent a good success rate and did not result in additional complications.     

巩膜扣带术不放液治疗陈旧性原发视网膜脱离

目的:观察分析巩膜扣带术不放液治疗陈旧性视网膜脱离的临床效果。方法:回顾分析我科46例(46眼)陈旧性视网膜脱离患者经巩膜扣带术不放液进行治疗。病例资料,男39例,女7例。年龄9~18岁15例,18~35岁20例,35岁以上11例。提供病史2mo~2a。视网膜下方2个象限浅脱离35眼占76%,其视网膜小圆孔、多筛孔36眼占78%,所有患者脱离的视网膜下均伴有黄色机化条索,46眼均行外路手术不放视网膜下液,采用单纯巩膜外加压16眼(35%),环扎联合加压30眼(65%)。结果:随访1~12mo,46眼中有44眼1次手术达到视网膜解剖复位(96%),术后矫正视力0.1以上36眼。结论:巩膜扣带术不放液治疗好发于青少年陈旧性视网膜脱离,简单有效。     

Symptomatic retinoschisis-detachment involving the macula

We treated three patients (four eyes) in whom posteriorly situated retinoschisis-detachments became symptomatic because of elevation of a limited area of full-thickness retina at the macula adjacent to these lesions. Laser photocoagulation alone was successful in achieving long-term macular reattachment in one eye but failed in both eyes of a bilaterally affected patient. In this patient, retinal cryopexy, external drainage of subretinal and retinoschisis cavity fluid, and intravitreal air injection attained long-term macular reattachment and retinoschisis cavity collapse in both eyes. In the third patient, cryopexy, drainage of subretinal and retinoschisis cavity fluid, and scleral buckling failed to reattach the retina. Subsequent laser photocoagulation induced reabsorption of subretinal fluid but without retinoschisis cavity collapse. Alternative management strategies for these unusual cases include retinal cryopexy alone and vitrectomy techniques.     

External argon laser choroidotomy for subretinal fluid drainage

Purpose: To evaluate the efficacy and safety of external argon laser choroidotomy for drainage of subretinal fluid (SRF) during scleral buckling procedures for the repair of rhegmatogenous retinal detachments. Methods: Fifty eyes of 50 consecutive patients presenting to a hospital-based retinal outpatient clinic with rhegmatogenous detachments underwent choroidotomy with argon endolaser for SRF drainage. The laser parameters used were 0.5 s duration and 0.8 W power. The primary outcome measures were successful drainage of SRF and incidence of complications. The drainage was considered successful if it was sufficient to complete the planned scleral buckling procedure. The extent of subretinal haemorrhage was graded. Results: The mean age of patients was 55 years (range 16–80 years). Successful drainage of SRF was obtained in 47 eyes (94%). The complications observed at the drainage site included subretinal haemorrhage of less than I disc diameter in six eyes (12%) and retinal perforation in one eye (2%). Conclusion: External argon laser choroidotomy appears to be an effective method of draining SRF in rhegmatogenous retinal detachments.     

不放液巩膜外加压术治疗陈旧性视网膜脱离

目的:探讨不放液巩膜外加压术治疗陈旧性视网膜脱离的临床疗效。方法:回顾性分析不放液单纯巩膜外加压术治疗32例32眼陈旧性视网膜脱离的临床病例资料,观察术后最佳矫正视力、手术并发症和视网膜复位情况。结果:术后随访6～12(平均9.2)mo,最佳矫正视力>0.1者17例17眼,2例2眼术后短期内眼压升高,首次手术解剖复位30例30眼,成功率94%。2例2眼术后视网膜下增殖继续发展,行玻璃体切除术后视网膜复位。结论:不放液巩膜外加压术对视网膜下增殖不严重的陈旧性视网膜脱离简单有效。     

脉络膜脱离孔源性视网膜脱离术中不放液观察

目的 观察视网膜裂孔冷凝，巩膜环扎外加压手术不放液治疗脉络膜脱离型孔源性视网膜脱离的疗效。方法 对28眼脉络膜脱离型孔源性视网膜脱离进行裂孔冷凝，巩膜环扎，外加压，术中不引流视网膜下液，对其治疗结果进行分析。结果 28眼中一次成功25眼，视网膜下液在1～2天吸收为13眼，3天～1周内吸收为12眼，术后均有不同程度的视力提高。结论 在成功封闭裂孔后，脉脱型孔源性视网膜脱离视网膜下液可自行吸收，手术成功率高，可有效减少放液所带来的并发症。     

球形孔源性视网膜脱离的手术探讨

目的：探讨球形孔源性视网膜脱离的手术方法选择与手术预后,方法：回顾性分析1999年在我院手术的球形视网膜脱离患者161例161眼资料。最终手术采用环扎加压不放液53眼,环扎加压放液75眼,玻璃体手术33眼,平均随访3个月。结果：出院时手术复位159眼,复位率98．8％,随访期间复发2眼,最终手术成功157眼,成功率97．5％,术后视力有明显提高,结论：球形孔源性视网膜脱离由于其发病急,就诊快,只要手术方法选择适当,大部分还是可以取得成功,对于膜形成严重,裂孔多,大,靠后,或再手术病例,采用玻璃体手术,其术后解剖复位率和视功能恢复还是相当满意的。