Incidence of posterior vitreous detachment after laser in situ keratomileusis

Background Vitreoretinal complications are rare in laser in situ keratomileusis (LASIK). Increase in intraocular pressure caused by intraoperative suction with subsequent deforming of the ocular globe and excimer laser shock during the ablation have been discussed as possible causes. The purpose of this study was to determine the effect of LASIK on the vitreous body. Patients and methods In a prospective study we performed ocular ultrasonography (B scan) immediately before and 1 week after LASIK procedure in 103 myopic or myopic–astigmatic eyes (53 patients, mean age 36.3 years, 32 women, 21 men). In particular, the prevalence, localization, and extent of posterior vitreous detachment (PVD) were determined. Results The mean spherical equivalent was −4.85 D (range −1.25 to −8.38) and the mean anteroposterior ocular globe length was 25.13 mm (range 23.31–27.65). Ninety-five eyes (92.2%) had no PVD preoperatively. Nine eyes out of this group (seven patients, 9.5%) developed incomplete PVD as assessed 1 week postoperatively. Eight eyes (7.8%) had a partial PVD preoperatively and in only one eye was an extension of vitreous detachment observed after the surgery. None of the preoperatively measured parameters could predict the occurrence of PVD by LASIK. Conclusions LASIK may in rare cases lead to new occurrence of PVD or extension of a previously existing partial PVD. Thomas Kohnen is a consultant for scientific advice to Bausch & Lomb, Inc., but neither author has a financial proprietary in any of the instrumentation or devices used in this study. This paper was presented in part at the German Ophthalmic Society (DOG) 2003 annual meeting, Berlin, with the title “LASIK-induced posterior vitreous detachment.”     

B型超声在急性玻璃体后脱离的诊断应用

目的探讨B型超声在急性玻璃体后脱离（PVD）的诊断价值。方法应用B型超声诊断技术对434例（434只眼）急性PVD患者进行检查、分析,根据PVD的声像图特点分为完全性和不完全性PVD。结果完全性PVD 289只眼（占66.59%）,而不完全性PVD 145只眼（占33.41%）,其中有28只眼合并少量玻璃体出血,仔细寻找发现裂孔19只眼,给予裂孔周边视网膜光凝,术后随访6个月无复发。结论 B型超声检查可以准确地诊断急性PVD,在玻璃体视网膜疾病的病程和预后中起重要的作用。     

Choroidal detachment after vitreous surgery

BACKGROUND AND OBJECTIVE: To study the frequency and clinical features of choroidal detachment (CD) after vitreous surgery, because there have been no reports on this problem. PATIENTS AND METHODS: We studied the clinical features of 14 patients (15 eyes) with CD from a total of 380 patients treated with vitrectomy at the Nagasaki University Hospital from January 1994 to August 1997. RESULTS: The incidence of CD after vitreous surgery was 3.9% (15/380). The reasons for vitrectomy were 6 retinal detachments, 4 proliferative diabetic retinopathies, and 5 others. During vitrectomy, 4 eyes were treated with scleral buckling, 11 with endolaser photocoagulation, and 3 with cryoretinopexy. Retinal detachment as a postoperative complication was seen in 8 patients, and in 5 of them the retina remained detached after the final treatment. CONCLUSIONS: CD may be caused by scleral buckling, panphotocoagulation, or stress on the ciliary body. Some patients with CD have a poor outcome.     

Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study

Japanese Journal of Ophthalmology - To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia....     

Incidence of retinal detachment following Nd:YAG capsulotomy after cataract surgery.

In a retrospective study, we reviewed 218 consecutive Nd:YAG laser posterior capsulotomies performed at the Gimbel Eye Centre between June 1987 and November 1989 for the incidence of retinal detachment (RD) following treatment. Matched controls were found for 198 YAG cases. The median post-surgical follow-up for the YAG cases was 49.5 months; for the controls, 50.0 months. The median time between cataract extraction and YAG laser posterior capsulotomy was 24.8 months. The median follow-up after YAG was 24.2 months. Two of the 198 YAG cases (1.0%) and one of the 198 controls (0.5%) had RD. In the YAG cases, RD occurred 54.8 and 36.5 months after cataract surgery; in the control cases, 51.8 months after cataract surgery. Retinal detachment occurred at 15.0 and 17.0 months after YAG capsulotomy. These rates were lower than those reported in the literature. We feel that the surgical techniques of continuous circular capsulorhexis and in-the-bag IOL placement reduce the risk of RD following Nd:YAG posterior capsulotomy.     

眼科B型超声检查在诊断玻璃体后脱离中的应用

目的:探讨眼科B型超声检查在诊断玻璃体后脱离(posterior vitreous detachment,PVD)中的应用价值。方法:选取2011-09/2012-09来我院进行治疗的PVD患者305例506眼,应用B型超声进行检查和分析。结果:选取506眼中共计179眼(35.4%)为不完全PVD,327眼(64.6%)为完全PVD。其中有61眼(12.1%)出现少量玻璃体出血,经检查26眼(5.1%)为视网膜裂孔,裂孔周边激光光凝治疗后痊愈。结论:眼科B型超声检查可以准确诊断PVD,同时具有无创和快捷等特点,值得在临床上推广。     

先天性白内障术后视网膜脱离

目的 :探讨先天性白内障术后视网膜脱离的特点、治疗效果及其影响因素。方法 :回顾分析 2 7例 2 7只眼先天性白内障术后视网膜脱离的临床资料。结果 :视网膜完全复位 2 0只眼 ,占 74 1% ;限局脱离 4只眼 ,占 14 8% ;完全脱离 3只眼 ,占 11 1%。术后视力 0 0 2以下者 8只眼 ,占 2 9 6% ;0 0 2～ 0 0 4者 6只眼 ,占 2 2 2 % ;0 0 5～ 0 0 9者 7只眼 ,占 2 5 9% ;0 1者 3只眼 ,占 11 1% ;0 2者 3只眼 ,占 11 1%。结论 :先天性白内障术后视网膜脱离经手术治疗可以取得较好的效果。增生性玻璃体视网膜病变 (PVR) ,尤其是前部增生性玻璃体视网膜病变 (aPVR)是影响手术预后的主要原因。     

Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

纤维蛋白溶解酶诱导兔眼玻璃体后脱离

目的 研究纤维蛋白溶解酶分别联合透明质酸酶和气体六氟化硫(SF-6)诱导兔眼玻璃体后脱离（PVD）的效果。 方法 18只健康成年青紫兰兔随机分为A、B、C 3组，每组6只兔。右眼均为实验眼，左眼为对照眼。A、B、C 组实验眼玻璃体腔内分别注射纤溶酶1 U(浓度10 U/ml)、纤溶酶1 U和透明质酸酶20 U(浓度200 U/ml)、纤溶酶1 U和SF6 0.5 ml；对照眼玻璃体腔内注射眼用平衡盐溶液（BSS）0.1ml。注药前后行间接检眼镜、裂隙灯和VOLK+90D前置镜及B型超声和视网膜电图(ERG)检查。最后取所有兔眼行光学显微镜、扫描电子显微镜和透射电子显微镜观察。 结果 扫描电子显微镜观察结果：A组实验眼中有2只眼后极部发生不完全性PVD，发生率为33.3%；B、C两组实验眼中分别各有4只眼发生完全性PVD，发生率为66.7%；B、C两组实验眼出现PVD的阳性发生率与A组比较，差异有统计学意义 (P<0.05)。3组实验眼注药后ERG振幅与手术前及对照眼比较差异均无统计学意义（P>0.05）。光学显微镜和透射电子显微镜观察结果显示，视网膜组织结构无明显异常改变。 结论 纤溶酶联合透明质酸酶或SF6较单独采用纤溶酶更能迅速有效的诱发完全性PVD且对视网膜无明显的毒性作用。 (中华眼底病杂志, 2005, 21: 388-390)     

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.     

Variations of posterior vitreous detachment

AIMS—To identify variations in posterior vitreous detachment (PVD) and establish a clinical classification system for PVD.METHODS—400 consecutive eyes were examined using biomicroscopy and vitreous photography and classified the PVD variations—complete PVD with collapse, complete PVD without collapse, partial PVD with thickened posterior vitreous cortex (TPVC), or partial PVD without TPVC.RESULTS—In each PVD type, the most frequently seen ocular pathologies were as follows: in complete PVD with collapse (186 eyes), age related changes without vitreoretinal diseases (77 eyes, 41.4%) and high myopia (55 eyes, 29.6%); in complete PVD without collapse (39 eyes), uveitis (23 eyes, 59.0%) and central retinal vein occlusion (8 eyes, 20.5%); in partial PVD with TPVC (64 eyes), proliferative diabetic retinopathy (30 eyes, 46.9%); and in partial PVD without TPVC (111 eyes), age related changes without vitreoretinal diseases (62 eyes, 55.9%). This PVD categorisation was significantly associated with the prevalence of each vitreoretinal disease (p<0.0001, χ² test on contingency table).CONCLUSIONS—PVD variations can be classified into four types, which is clinically useful because each type corresponds well to specific vitreoretinal changes.     

玻璃体后脱离的并发症

对有典型玻璃体后脱离症状的１０８例（１２７眼）进行了详细的眼底检查。发现所有受检眼均存在玻璃体后脱离，其中完全性玻璃体后脱离５９只眼，不完全性者６８只眼。并发症包括：视网膜裂孔３０只眼（周边圆孔１６只眼；马蹄形裂孔１４只眼），玻璃体积血７只眼，黄斑出血４只眼，黄斑裂孔４只眼，视网膜出血、黄斑区水肿及玻—网粘连灶各３只眼。文中对玻璃体后脱离及其并发症发生的机制进行了讨论。     

Spontaneous closure of macular hole after posterior vitreous detachment

Macular holes can be treated with surgically-induced vitreous detachment and gas tamponade. The authors report a case of a macular hole that closed spontaneously after the development of posterior vitreous detachment (PVD). Optical coherence tomography (OCT) revealed a small full-thickness macular hole with perifoveal cystic changes in a 25-year-old female with a central scotoma at her initial visit. There was no evidence of PVD. Five months later, PVD was observed and the macular hole disappeared. OCT performed three months later showed macular hole closure and resolution of the perifoveal cystic changes. The physiologic pit was restored in the fovea. OCT is useful to detect and monitor the morphologic changes of a macular hole.