Visual and surgical outcomes of retinal detachment following macular hole repair

OBJECTIVE: To characterize 20 cases of retinal detachment (RD) following surgical repair of macular holes. METHODS: Retrospective review of 20 eyes in 16 patients (4 patients [25%] had bilateral macular hole repairs with subsequent RD) who developed RD in the same eye in which surgical repair of a macular hole had been performed. RESULTS: Twenty detachments in 16 patients were reviewed. The average duration between macular hole repair and presentation of RD was 5.5 weeks. The inferior retina was involved more frequently than the superior retina. A total of 76% of all breaks were located inferiorly. Ten of the 20 eyes were asymptomatic at the time the detachment was diagnosed. Of the 20 eyes, 19 underwent surgical repair, all with anatomic reattachment. At final follow-up, the macular hole was closed in all 20 eyes, and 60% of the patients had final visual acuity improved by 2 lines or more over that before their macular hole repair. CONCLUSION: Retinal detachment is a complication of macular hole surgery. These detachments tend to occur within the first 2 months of follow-up, and have a high success rate of anatomic reattachment with surgery. The occurrence of RD does not preclude improved final visual acuity.     

视网膜分支静脉阻塞合并视网膜脱离的临床分析

目的 分析视网膜分支静脉阻塞(BRVO)合并视网膜脱离(RD)的临床特征及有效的治疗方法.方法 收集2004年11月至2007年10月治疗的有完整随访观察资料的18例(18只眼)BRVO合并RD的病例,采用常规三通道闭合式玻璃体切割手术,其中6例联合白内障超声乳化吸出术,合并黄斑裂孔的患眼行内界膜剥离,术后1、2周,1、2、3、6月随访,平均随访4.8月,观察患者的视力、眼底、眼压、玻璃体后脱离,术中术后并发症、及术后视网膜复位等情况.结果 全部病例于术中均发现裂孔,单个孔、多发孔各9例,孔源性视网膜脱离17例,牵引性视网膜脱离1例,黄斑孔5例,黄斑孔中合并黄斑囊样水肿1例,合并黄斑前膜2例.18例中发现纤维血管膜生长的15例,玻璃体不完全性后脱离粘连牵拉视网膜的12例,黄斑水肿6例,其中合并黄斑前膜2例.BRVO发生于颞上的6例,鼻上6例,上半侧3例,颞下2例,颢上合并颞下1例.18例中术后视力提高12例,视力稳定3例,视力下降3例,术后最佳矫正视力HM3例、0.1-0.39例、0.3以上6例.一次手术视网膜复位的16例,2例于硅油取出时发现局限性视网膜脱离,再次填充C3F8后视网膜复位.结论 视网膜分支静脉阻塞合并视网膜脱离的临床表现较复杂,术前眼底情况不明确,视网膜裂孔及多发性裂孔的发生率较高,多数病例玻璃体后脱离不完全粘连牵拉视网膜,且合并纤维血管膜的增生,玻璃体手术或联合手术是适合的治疗方法,可取得较好的临床疗效.     

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.     

The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment

PURPOSE: To evaluate the anatomic and functional outcome of vitreoretinal surgery in eyes with pathologic myopia and macular hole and to determine if surgery improves visual acuity. METHODS: Twenty-four consecutive highly myopic eyes with full-thickness macular hole without posterior retinal detachment were treated by vitrectomy. Posterior hyaloid dissection, removal of epiretinal and internal limiting membranes (ILM) if thickened, instillation of platelet concentrate, and flushing with 25% sulfur hexafluoride were performed. RESULTS: Patients' refractive error ranged between -8.0 and -17.5 diopters, and axial length ranged from 27.1 to 31.4 mm. Two epimacular membranes and 10 macular ILM were removed. Ten patients also underwent phacoemulsification and intraocular lens implantation at the same procedure. Mean preoperative best-corrected visual acuity was 20/200. Successful anatomic macular hole closure occurred 6 months postoperatively in 100% of eyes after one (21 eyes, 87.5%) or two surgeries (3 eyes, 12.5%). Visual acuity improved three or more lines in 83.3% of patients. Mean postoperative visual acuity was 20/70. No retinal detachment was observed during the follow-up period, which ranged from 12 to 45 months. CONCLUSION: Our results suggest that vitreoretinal surgery may effectively manage myopic macular holes, thus improving anatomic and visual outcomes. By closing the hole, vitreoretinal surgery may decrease the risk of posterior retinal detachment in highly myopic eyes.     

Efficacy of internal limiting membrane removal for retinal detachments resulting from a myopic macular hole

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) or epiretinal membrane removal during pars plana vitrectomy for a retinal detachment resulting from a macular hole in myopic eyes. METHODS: A retrospective study was conducted in a single institution. Twenty-six highly myopic eyes with a retinal detachment resulting from a macular hole were studied. During pars plana vitrectomy, ILM peeling (ILM-peeled group) was performed on 13 eyes, and the ILM was not removed (ILM-preserved group) in 12 eyes. Main outcome measures were anatomic reattachment, optical coherence tomography-determined macular hole closure, and visual acuity. Follow-up periods were longer than 12 months in all cases. RESULTS: The anatomic reattachment rate after the initial surgery was significantly higher in the ILM-peeled group (92.3%) than in the ILM-preserved group (50%). The macular holes of 8 (72.7%) of the 11 ILM-peeled and reattached eyes and 2 (50%) of the 4 ILM-preserved and reattached eyes were successfully closed by the initial surgery. No significant difference was found in the postoperative visual acuity and the improvement of visual acuity between the ILM-peeled group and the ILM-preserved group. There was also no significant difference of the postoperative visual acuity and improvement of the visual acuity between the two groups in cases with an initial anatomic success. CONCLUSION: These results indicate that removal of the ILM contributes to a successful reattachment and is an effective treatment for macular hole and retinal detachment in highly myopic eyes. The authors suggest that the higher success rate after ILM peeling resulted from the release of the traction of the prefoveal vitreous and the epiretinal membrane over the detached retina.     

巩膜外路手术联合术后眼底激光治疗孔源性视网膜脱离

目的讨论巩膜外路手术联合术后眼底激光治疗单纯孔缘性视网膜脱离的临床疗效。方法对591例592眼单纯性视网膜脱离病人行巩膜外路手术，包括：巩膜外加压、放液或不放液，部分病人联合环扎或玻璃体腔注C，R气体，术后氩激光或532激光治疗视网膜裂孔。结果视力提高414眼，不变166眼，下降12眼。视网膜复位情况：完全复位561眼（成功率95％），部分复位24眼，未复位7眼。接受一次手术558眼，接受二次手术（包括玻璃体手术）29眼，接受三次手术1眼，7例7眼病人自动放弃。视网膜复位不良手术失败的原因依次为：玻璃体出血、脉络膜脱离型网脱、马蹄形视网膜裂孔伴牵引、黄斑裂孔、锯齿缘离断，以上均与PVR关系密切。结论选择适当病例，巩膜外路手术联合术后激光治疗孔源性视网膜脱离是一种安全、可行、简便、易操作、效果良好的方法。     

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments

PURPOSE: To investigate the incidence and outcomes of retinal detachment (RD) associated with retained lens fragments removed by pars plana vitrectomy (PPV). DESIGN: Retrospective, noncomparative, interventional consecutive case series. PARTICIPANTS: All patients who underwent PPV for retained lens material after cataract surgery at Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. METHODS: Demographic and clinical data were extracted from patients' medical records. MAIN OUTCOME MEASURES: Incidence of retinal detachment, reattachment rate, and visual acuity outcome. RESULTS: RD occurred in 44 of 343 (12.8%) patients, including 25 (7.3%) before or during PPV and 19 (5.5%) after PPV. The RD was macula-on in 22 of 44 (50%) patients and macula-off in 22 of 44 (50%) patients. The RD was associated with a giant retinal tear in 7 of 44 (15.9%) patients, limited suprachoroidal hemorrhage in 3 of 44 (6.8%) patients, and endophthalmitis in 4 of 44 (9.1%) patients. Retinal reattachment was achieved in 40 of 44 (90.9%) patients; 14 of 44 (31.8%) patients underwent one or more additional procedures for recurrent detachment. Final visual acuity in the patients in this series was >/=20/40 in 8 of 44 (18%), 20/50 to 20/100 in 13 of 44 (30%), 20/200 to 5/200 in 13 of 44 (30%), and <5/200 in 10 of 44 (23%). In the 36 patients with vision less than 20/40, the primary causes of decreased vision were attributed to prior history of RD in 8 of 36 (22.2%), corneal edema in 7 of 36 (19.4%), cystoid macular edema in 5 of 36 (13.9%), persistent retinal detachment in 4/36 (11.1%), preexisting primary open-angle glaucoma in 4 of 36 (11.1%), age-related macular degeneration in 3 of 36 (8.3%), epiretinal membrane in 2 of 36 (5.5%), macular hole in 1 of 36 (2.7%), optic atrophy in 1 of 36 (2.7%), and irregular astigmatism in 1 of 36 (2.7%) patients. CONCLUSIONS: RD is a frequent complication in eyes undergoing PPV for removal of retained lens fragments. Despite favorable retinal reattachment rates, visual acuity outcomes are often poor in these eyes and are associated with other comorbidities such as corneal edema and cystoid macular edema. Poor initial visual acuity and the presence of a retinal tear at the time of PPV were associated with a higher rate of RD after PPV.     

Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes

PURPOSE: Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN: Retrospective, nonrandomized, comparative study. PATIENTS: Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS: Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS: The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS: The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.     

Surgical management of traumatic macular hole-related retinal detachment

PURPOSE: To investigate the clinical characteristics and surgical outcome of traumatic macular hole-related retinal detachment. DESIGN: Retrospective, interventional case series. METHODS: Eight eyes of eight patients with traumatic macular hole-related retinal detachment underwent vitrectomy combined with gas tamponade, either initially or subsequently. Anatomic re-attachment of the retina, closure of traumatic macular hole, and visual outcome were measured. RESULTS: Successful retinal re-attachment was achieved in seven eyes (87.5%), and the macular hole was successfully closed in all eyes (100%). Improved vision after the surgery was noted in five eyes (62.5%), whereas three eyes (37.5%) displayed no change. CONCLUSIONS: Vitrectomy combined with gas tamponade appears to give an effective anatomic re-attachment rate for traumatic macular hole-related retinal detachment. The presence of peripheral retinal breaks, vitreous hemorrhage, or the extent of retinal detachment has no discernible significant influence on closure rate of macular hole and retinal re-attachment rate.     

Gas tamponade and macular grid laser photocoagulation in the management of recurrent retinal detachment

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes. PATIENTS AND METHODS: Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied. RESULTS: Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients. CONCLUSION: Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.     

Vitrectomy for diabetic traction retinal detachment using the multiport illumination system

OBJECTIVE: To examine the visual and anatomic results of bimanual vitrectomy surgery with the multiport illumination system (MIS) in eyes with advanced diabetic traction retinal detachment. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-seven consecutive eyes in 62 patients having vitrectomy with the MIS. METHODS: During surgery, the vitreous, the posterior hyaloid membrane, and fibrovascular proliferative tissue were removed by using bimanual dissection made possible by the MIS. MAIN OUTCOME MEASURES: Retinal reattachment rate, visual function, and postoperative complications were compared with previously published series of vitrectomy for diabetic traction retinal detachment. RESULTS: With a minimum of 6 months of follow-up, complete retinal reattachment was achieved in 62 eyes (93%), and macular attachment was achieved in all 67 eyes. Vision was stabilized or improved in 51 eyes (72%), and 5/200 vision was achieved in 47 eyes (70%). No unique complications, such as incision-related retinal tears, occurred. CONCLUSION: MIS allows bimanual surgery during vitrectomy for diabetic traction retinal detachment, with good visual and anatomic results.     

Macular hole surgery in conjunction with endolaser photocoagulation

PURPOSE: To determine whether endolaser photocoagulation to the retinal pigment epithelium at the base of a macular hole increases the anatomic success rate of surgery. METHODS: In a prospective consecutive clinical trial, eight eyes of seven patients with idiopathic macular hole underwent vitrectomy with posterior cortical vitreous removal and peeling of visible epiretinal membrane when present. A single shot of argon endolaser photocoagulation was applied to the retinal pigment epithelium at the center of the macular hole with a duration of 0.05 to 0.2 seconds and an intensity of 50 to 200 mW. After fluid-gas exchange was performed with 14% perfluoropropane gas, patients maintained face-down positioning for 2 weeks. RESULTS: One eye with stage 2 macular hole, six eyes with stage 3 macular hole, and one eye with stage 4 macular hole were included. All eight eyes had a closed macular hole (100% anatomic success rate) at final examination 6 to 12 months after surgery. Best-corrected visual acuity improved 3 or more lines on the Early Treatment Diabetic Retinopathy Study visual acuity chart in all eyes. Four (50%) of the eight eyes had a final visual acuity of 20/40 or better. CONCLUSIONS: Endolaser photocoagulation may be a useful adjunct to macular hole surgery but requires further investigation and long-term evaluation.     

Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的 探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。 方法 高度近视黄斑裂孔视网膜脱离患者35例38只眼，11例12只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；24例26只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作6个月以上的随访(平均随访时间21．7个月)。 结果 非光凝组5只眼黄斑裂孔性视网膜脱离复发，占41．7%，术后0．1以上视力6只眼，占50.0%；光凝组2只眼黄斑裂孔复发，占7.7%，1只眼因周边新裂孔形成而复发视网膜脱离，术后有13只眼视力在0.1以上，占50.0%。统计学检验两组黄斑裂孔复发率概率P=0.024,视网膜脱离复发率概率P=0.0487。两组患者术后视力无显著差异。 结论 玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。 (中华眼底病杂志,1998,14:199-201)     

Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation.

PURPOSE: To determine the long-term anatomic and functional results of temporary silicone oil tamponade coupled with laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in eyes with myopia higher than -10.0 diopters (D). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eleven patients (9 female, 2 male; average age, 57+/-3 years) with spontaneous retinal detachment due to macular hole. All patients had a myopia higher than -10.0 D and had no proliferative vitreoretinopathy and no history of trauma. The average myopia amounted to -17.7+/-1.1 D, and in eight cases, a large posterior staphyloma was present. Follow-up was 69+/-17 months. INTERVENTION: Patients underwent pars plana vitrectomy, temporary silicone oil tamponade, and laser photocoagulation of the macular hole rim. Silicone oil removal was performed after 2.8+/-0.8 months. MAIN OUTCOME MEASURES: Anatomic attachment of the retina was determined and visual acuity was measured. RESULTS: Final successful retinal attachment at the end of follow-up was achieved in ten eyes (91 %). Average logarithm of the minimum angle of resolution (logMAR) visual acuity increased from 1.39+/-0.12 before surgery to 1.18+/-0.13 after surgery (P < 0.05, Student's t test for paired data). This corresponds to a mean increase of measured Snellen equivalents from 0.06+/-0.03 to 1.11+/-0.04. Intraocular pressures remained stable with 13.9+/-1.8 millimeters of mercury (mmHg) before surgery and 16.6+/-1.6 mmHg at the end of follow-up (P > 0.05). CONCLUSIONS: Primary vitrectomy with temporary silicone oil tamponade and laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in highly myopic eyes appears to provide a good long-term anatomic success and acceptable functional results.     

Incidence of retinal detachment after macular surgery: a retrospective study of 634 cases

AIMS: To evaluate the rate of retinal detachment after macular surgery. METHODS: A retrospective non-randomised study of 634 macular surgery procedures was undertaken in two academic centres. Idiopathic macular hole (IMH) surgery (n = 272) and epiretinal membrane (ERM) surgery (n = 362) were performed between 2000 and 2003. We noted the anatomical and functional results of these procedures and we studied serious complications excluding cataract. RESULTS: Minimum follow up was 1 year. No retinal detachment (RD) occurred in patients presenting with an intraoperative or preoperative successfully treated retinal break (RB). The rate of RD occurring after IMH surgery was higher than after the ERM surgical procedure (6.6% vs 2.5%, p = 0.02). The rate of RD was higher in patients presenting with stage 2 and 3 IMH than with stage 4 IMH. However, lens status as well as preoperatively treated RD did not influence the rate of RD after macular surgery. CONCLUSION: Retinal detachment remains the most common serious complication of macular surgery. Surgical detachment of the posterior vitreous face and associated peripheral retina anomaly seem to increase the rate of this complication. Careful examination of the peripheral retina is a key issue in preventing retinal detachment occurring after macular surgery.     

Retinal detachment in East Africa

PURPOSE: To report the causes of retinal detachment in an African setting and the outcome after surgery. DESIGN: Noncomparative interventional case series. PARTICIPANTS: A total of 361 eyes in 345 patients. METHODS: Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression. MAIN OUTCOME MEASURES: Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation. RESULTS: The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up. CONCLUSIONS: Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.     

高度近视眼黄斑裂孔性视网膜脱离手术疗效的临床分析

目的 探讨高度近视眼黄斑裂孔性视网膜脱离手术治疗的临床疗效。 方法 回顾分析149例高度近视眼黄斑裂孔性视网膜脱离患者的临床资料，将其是否伴有玻璃体后脱离（posterior vitreous detachment,PVD）分两组比较手术方式及视网膜解剖复位率和视力变化。 结果 视网膜解剖复位：两组用玻璃体手术治疗的复位率为77.9% ，非玻璃体手术为2 5.9%（P＜0.001）；不完全PVD组用玻璃体手术治疗复位率为75.5%，非玻璃体手术治疗为15.0%（P＜0.001）；用非玻璃体手术治疗完全PVD组复位率为57.1%，不完全PVD组为 15.0%（P=0.05）。视力进步：完全PVD组为68.6%，不完全PVD组为57.0%（P＞0.05）。 结论 高度近视眼黄斑裂孔性视网膜脱离应用巩膜外手术联合玻璃体切割、眼内气体填充和手术后激光光凝封闭黄斑裂孔可提高视网膜复位率。 （中华眼底病杂志，2003，19：8-10）     

Exudative retinal detachment in macular hole surgery using platelet concentrates – a case report

INTRODUCTION: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. CASE REPORT: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. CONCLUSION: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.     

A simple way to prevent indocyanine green from entering the subretinal space during vitrectomy for retinal detachment due to myopic macular hole

PURPOSE: To present a safe and simple method of preventing indocyanine green (ICG) from entering the subretinal space in patients undergoing vitrectomy for retinal detachment caused by myopic macular hole. PATIENTS AND METHODS: Four consecutive highly myopic eyes (three phakic, one pseudophakic) with retinal detachment due to myopic macular hole were operated on by pars plana vitrectomy. The ICG-assisted peeling of the internal limiting membrane was performed after temporarily closing the macular hole by means of a small bubble of perfluorocarbon liquid (PFCL) in order to prevent ICG from entering the subretinal space. RESULTS: Retinal reattachment was successful in all patients, and anatomic closure of the macular hole occurred during the follow-up period (range 3 to 10 months). CONCLUSIONS: A small bubble of PFCL prevents ICG dye from entering the subretinal space during vitrectomy for retinal detachment due to macular hole in highly myopic eyes.