Management of cataract in patients undergoing vitrectomy.

We developed two techniques to combine vitrectomy with cataract extraction. In technique 1, we used the lens fragmenter to break up cataractous lenses with 1+ to 2+ nuclear sclerosis. The vitrophage removed the lens and opaque vitreous body through a single pars plana incision. In technique 2, if the knife did not penetrate the nucleus (in the presence of 3+ or more nuclear sclerosis), we removed the lens through a corneal incision and immediately performed a vitrectomy with a vitrophage through a corneal incision and immediately performed a vitrectomy with a vitrophage through the pars plana. In ten consecutive patients, we used these techniques successfully to remove ca((taractous lenses in patients undergoing vitrectomy for vitreous hemorrhage.     

Life expectancy of diabetic patients undergoing vitreous surgery.

BACKGROUND: Patients with advanced diabetic eye disease are commonly in poor general health. In addition to the ocular status, life expectancy is an important factor in the decision whether and how to perform vitreous surgery. The present study investigates mortality and risk factors for survival in diabetic patients following vitrectomy. METHODS: The follow up of 332 consecutive patients who underwent vitrectomy for complications of diabetic retinopathy between 1990 and 1994 was studied retrospectively. Survival and risk factors for survival were analysed using the Kaplan-Meier life table method and for multivariate analysis the Cox proportional hazard model. RESULTS: The 5 year survival rate was 68%. Absence of heart disease was the most important predicting factor for survival. Fifty per cent of the patients with heart disease had died within 3.5 years. Patients without heart disease had a 5 year survival rate of 90%. Other significant, independent risk factors were age and presence of nephropathy. CONCLUSION: In diabetic patients undergoing vitrectomy the presence of heart disease indicates a poor prognosis for survival. This should be taken into consideration for indications and strategies in cases of vitrectomy.     

玻璃体切割治疗玻璃体积血的临床疗效观察

目的:探讨玻璃体切割治疗玻璃体积血的临床疗效。方法:对72例75眼玻璃体积血患者采用玻璃体切割手术治疗,术中根据具体病情联合单纯白内障摘除或白内障摘除联合人工晶状体植入术、眼内异物取出、膜剥离、水下透热、眼内光凝或/和巩膜外冷凝及眼内注气或硅油充填。结果:选取75眼中外伤性玻璃体积血(穿孔性眼外伤19眼,眼球钝挫伤8眼)27眼,视网膜静脉阻塞15眼,增殖期糖尿病视网膜病变12眼,Eales病9眼,视网膜裂孔合并玻璃体积血9眼,年龄相关性黄斑病变3眼。术后随访6～48(平均18±5.6)mo,75眼中72眼视力有不同程度的提高,>0.05者65眼(87%),>0.2者54眼(72%),>0.5者23眼(31%),术后视力没有提高3眼(4%),术后视力与术前相比差异具有统计学意义(P<0.05)。结论:严重的眼外伤合并玻璃体积血、大量玻璃体积血药物治疗不吸收,反复发生的玻璃体积血和B超检查发现视网膜脱离者应及时行玻璃体切割术以改善和保护视功能。     

玻璃体切割术治疗玻璃体淀粉样变性的疗效分析

背景 玻璃体淀粉样变性属于常染色体显性遗传性眼病,常导致患者视力下降而影响其生活质量,目前其主要治疗方法为玻璃体切割术,但中国对其手术疗效的分析少有报道. 目的 观察并分析玻璃体切割术治疗玻璃体淀粉样变性的疗效.方法 对2011年3月至2013年2月在贵州医科大学附属医院行玻璃体切割术的玻璃体淀粉样变性患者6例11眼的临床资料进行回顾性分析,观察患者术前及术后1周、6个月、2年的最佳矫正视力(BCVA)、眼压、裂隙灯显微镜检查和眼底表现,以及术后1周、6个月术眼荧光素眼底血管造影(FFA)表现.患眼玻璃体切割标本行刚果红染色,观察其病理学表现.结果 术前5眼视力为数指/30 cm,6眼视力为手动/30 cm,眼压为(13.09±2.12)mmHg(1 mmHg=0.133 kPa),裂隙灯显微镜下可见玻璃体内固定的白色絮状混浊物,晶状体后囊有白色膜状物附着.术后1周、6个月及2年,7眼BCVA为1.0,4眼为0.8.术后1周、6个月及2年术眼眼压分别为(13.32±2.07)、(14.09±2.47)和(12.32±1.87) mmHg.术后1周11眼FFA可见周边视网膜血管局部荧光素渗漏,术后6个月FFA检查未见明显异常.2例4眼术后2年可见周边视网膜表面白色淀粉样物质增多,BCVA无明显下降.术眼玻璃体切割标本经刚果红染色证实为淀粉样变性.结论 玻璃体切割术是治疗玻璃体淀粉样变性的有效方法,能有效改善患眼视力.术后远期周边部视网膜可出现复发病灶,但不影响患眼视力.     

Immunocytology of cellular components in vitreous and subretinal fluid from patients with proliferative vitreoretinopathy.

Proliferative vitreoretinopathy accounts for most of failures in retinal detachment surgery. It results from the formation of membranes spreading onto inner and outer surfaces of the detached retina and within the vitreous body, but the nature of the growing cells and the mechanisms of proliferation remain speculative. A cytological study was thus undertaken on 35 specimens of vitreous and subretinal fluid obtained surgically in patients with proliferative vitreoretinopathy. Various types of cells were identified: typical pigment epithelial cells, lightly pigmented and large totally unpigmented macrophage-resembling cells, smaller unpigmented cells and lymphocytes. Immunocytological procedures with 10 different monoclonal antibodies directed against different markers of epithelial and immunocompetent cells showed the epithelial nonmacrophagic origin of the intravitreal and subretinal cells, as most of these cells were positive for cytokeratin but remained negative for macrophage markers. Examination of intravitreal pigment granules, using autofluorescence analysis by epi-illumination and toluidine blue staining, showed two distinct populations of pigmented cells, one containing melanin and the other lipofuscin, suggesting that pigmented cells could originate from the retinal and ciliary pigment epithelia. As concerns lymphocyte identification, only B cells were seen, whereas no T lymphocyte could be found. Fibronectin was found on a minority of cells in 4 vitreous specimens, but cells positive for glial fibrillary acidic protein could not be seen. These results confirm the involvement of pigment epithelial cells and the strong morphological changes they undergo during the course of proliferative vitoretinopathy, but the mechanisms of proliferative phenomena after retinal detachment remain to be determined.     

Persistent hyperplastic primary vitreous. Middle-term results of vitrectomy]

In this study, the authors present a homogeneous series of seven children suffering from persistent hyperplastic primary vitreous, in its complete anterior and posterior form. These children were operated by pars plana lensectomy and vitrectomy. The surgical operation was beneficial in every case: not only were there no complications, but the operation also prevented progression towards neovascular glaucoma, vitreous hemorrhages and phtisis bulbi. In addition, one of the benefits of this technique was esthetic, with the disappearance of leucocoria, the occasional correction of strabismus and the reduction in microphthalmos. Visual recovery can be surprisingly good, in the absence of any associated retinal malformation.     

玻璃体切除术治疗玻璃体积血临床效果分析

目的探讨玻璃体切除术治疗玻璃体积血的临床疗效。方法采用玻璃体切除术治疗的玻璃体积血58例（58眼）。分析玻璃体积血的病因，并观察玻璃体切除术后视力变化和并发症。结果本组主要病因为视网膜静脉阻塞和视网膜静脉周围炎；视力在0．01～0．05者术前为6眼（10．35％），术后1周为35眼（60．35％），随访2～4月的50例中为33眼（66．00％）。术中并发症有医源性裂孔和眼内出血；术后并发症有玻璃体再次积血，视网膜脱离，晶状体浑浊等。结论对药物治疗不能吸收的玻璃体积血施行玻璃体切除术后视力可显著提高，术中术后并发症少。     

玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察

目的 观察玻璃体切割手术治疗息肉状脉络膜血管病变(PCV)引起的玻璃体积血的疗效.方法 伴玻璃体积血的PCV患者14例14只眼纳入研究.男性8例8只眼,女性6例6只眼.平均年龄(58.7±6.0)岁.均行常规眼科检查,以及A/B型超声、荧光索眼底血管造影、吲哚青绿血管造影等检查确诊.行常规玻璃体切割手术,手术中切除玻璃体积血,手术结束时行硅油或C3F8气体填充.手术后行光动力疗法(PDT)治疗8只眼.观察患眼视网膜复位情况、视力改善状况、病变稳定程度以及手术后并发症发生情况.结果 14只眼中,治愈6只眼,占42.9％;好转7只眼,占50.0％;无效或加重1只眼,占7.1％.1次手术后视网膜复位良好10只眼.视网膜复位不良4只眼.其中,再次注入硅油后视网膜复位1只眼;再次C3F8填充后视网膜复位1只眼;下方裂孔1只眼行巩膜外垫压手术后视网膜复位;未行特殊处理1只眼,硅油维持.最终视网膜复位13只眼,占92.9％,手术后1～7 d出现前房积血5只眼,经前房冲洗或药物治疗积血吸收,眼压稳定.视力提高2行以上者1只眼,1～2行者1只眼,不变10只眼,下降2只眼.行PDT治疗的8只眼中,异常血管消退5只眼,未消退3只眼.结论 对于伴玻璃体积血的PCV行玻璃体切割手术清除玻璃体积血,恢复屈光间质透明性,手术后联合PDT治疗,对稳定或提高视功能有一定的疗效.     

Characterization of Toxoplasma gondii-specific T cells recovered from vitreous fluid of patients with ocular toxoplasmosis.

PURPOSE: The mechanisms involved in reactivations of latent ocular Toxoplasma gondii (Tg) infections in immunocompetent patients are poorly understood. In view of the possible role of T cells in the immunopathogenesis of the disease, ocular infiltrating T cells obtained from patients with recurrent ocular toxoplasmosis were characterized phenotypically and functionally. METHODS: Ocular infiltrating T cells were recovered from vitreous fluid (VF) samples of 10 patients with active recurrent ocular toxoplasmosis. Two patients with uveitis of other origins were included as control subjects. T-cell lines (TCLs) were generated by mitogenic stimulation and tested for reactivity to Tg and human retinal protein extracts. The TCLs of three patients were cloned by limiting dilution. Tg-reactive T-cell clones (TCCs) were characterized with respect to their phenotype, T-cell receptor variable (TCR V)-beta gene usage, HLA restriction, and cytokine secretion profile. RESULTS: Reactivity to Tg could be detected only in the TCLs of patients with ocular toxoplasmosis. None of the TCLs showed reactivity to human retinal antigens. All tested intraocular Tg-specific TCCs (n = 23) were CD3+CD4+ and displayed differential TCR Vbeta usage. Twenty-one TCCs were HLA-DR restricted and two TCCs were restricted by HLA-DP. The majority of the intraocular Tg-specific TCCs showed a bias toward a T-helper (Th)0-Th2 cytokine profile. CONCLUSIONS: The data indicate that T cells specific for the triggering microorganism infiltrate the eye of patients with recurrent ocular toxoplasmosis. The functional characteristics of the VF-derived Tg-specific T cells and their presence at the site of inflammation suggest their involvement in the local inflammatory response of ocular toxoplasmosis.     

Characteristics and survival of diabetic patients undergoing vitreous surgery

Characteristics, and the occurrence of other diseases, and complications related to diabetes mellitus of 91 consecutive diabetic patients who underwent vitreous surgery in 1979-1985 were examined. The mean age of the patients was 40 years (median 37, range 19-74), and the mean duration of diabetes 23 years (range 5-44). All, but one, had insulin therapy. Abnormalities in the cardiovascular and/or renal function were found in 89 of the 91 patients (98%). Signs of cardiovascular disease were observed in 58 patients (64%): 42% had elevated blood pressure (greater than or equal to 150/100 mmHg), 46% were on antihypertensive therapy, 14% had a history or signs of ischaemic heart disease, 12% had been digitalized, 7% had a history of cerebral ischaemia, and 8% had had surgery for gangrene of the lower limb. Signs of nephropathy were recorded in 64 patients (70%); 6 of them were on dialysis therapy, and two had received a kidney transplant. Symptoms possibly related to autonomic neuropathy e.g. postural hypotension, urinary tract symptoms, and gastric discomfort were found in 27%. Nine patients (10%) had some kind of thyroid disease, and two of them signs of multiple autoimmune endocrinopathy. The percentage surviving decreased from 96% at one year to 80% after 5 years of follow-up.     

严重外伤性玻璃体积血玻璃体切除疗效观察

目的 探讨严重外伤性玻璃体积血的玻璃体切除手术的效果。方法 对37例（37眼）严重外伤性玻璃体积血不同时期的玻璃体切除术进行回顾性分析。结果 玻璃体积血37例中积血和视网膜粘连者共有13例，这是主要并发症。行单纯玻璃体切除13例，联合手术24例。术后视力下降2眼，占5．40％，无变化3眼，占8．11％，其余32眼较术前不同程度提高，占86．49％。结论 玻璃体切除是治疗严重外伤性玻璃体积血的有效方法，伤后应根据积血和网膜情况尽早手术。     

Early vitrectomy for fundus-obscuring dense vitreous haemorrhage from presumptive retinal tears

Background Published literature on the management of patients with fundus-obscuring dense vitreous haemorrhage due to presumptive retinal tears is sparse and advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified. Methods A retrospective review of all patients who underwent early vitrectomy for vitreous haemorrhage associated with posterior vitreous detachment was carried out. A comparison of initial visual acuity versus final visual acuity after vitrectomy was performed. The number of eyes that were found to have retinal tears and retinal detachment were documented. Initial and final Snellen acuities were used for statistical analysis. Categorical data were analysed using Fisher’s exact test and statistical significance was considered to be p<0.05. Results Sixteen eyes were identified and all these patients presented or were referred soon after the onset of vitreous haemorrhage. Associated ocular pathology (choroidal neovascular membrane, retinal branch vein occlusion, macroaneurysm) was suspected to be the source of the haemorrhage in 4 eyes. Vitrectomy was carried out in 12 eyes soon after presentation (mean time 6.3 days, range 1–28 days). Nineteen retinal breaks were seen in these eyes and 5 eyes had more than two breaks. None of the eyes were found to have proliferative vitreo-retinopathy at the time of surgery. Two eyes needed repeat surgery for new retinal breaks. Excluding the eyes found to have an ocular pathology as the cause of vitreous haemorrhage, the mean visual acuity improved from hand movements to 6/12 (p<0.001). Conclusions Early vitrectomy for spontaneous dense fundus-obscuring vitreous haemorrhage and posterior vitreous detachment is safe. Since the number of patients in this study was small, a prospective randomised controlled study comparing early versus late vitrectomy is needed to see whether early surgery also prevents proliferative vitreoretinopathy formation.     

增生型糖尿病视网膜病变玻璃体切除术后再出血的相关危险因素分析

目的探讨增生型糖尿病视网膜病变（PDR）玻璃体切除术后再出血的相关危险因素,为PDR玻切术后再出血的发生风险评估提供研究基础。方法采用病例对照方法,对130例（135眼）行玻璃体切除的PDR的年龄、糖尿病病程、空腹血糖值（FPG）、收缩压、舒张压、眼压、视网膜灌注压、眼内充填物性质、手术前是否曾行一次或多次视网膜光凝、是否联合晶状体超声乳化吸出术、是否植入人工晶状体等因素进行统计学分析。结果PDR玻璃体切除术后再出血发生的相关危险因素包括高视网膜灌注压、高血糖、糖尿病病程长及高收缩压,玻璃体腔硅油填充可降低术后再出血的风险。结论在糖尿病病程长、血糖及血压控制不理想者应根据术中情况优先考虑应用硅油填充。同时,术后仍应注意血糖及血压的控制,从而尽可能降低术后再出血的发生风险。     

Pars plana vitrectomy relieves the depression in patients with symptomatic vitreous floaters

AIM: To explore the susceptible association between the insulin-like growth factor-1 receptor (IGF1R) single nucleotide polymorphism (SNP) and age-related cataract (ARC), and investigate the underlying mechanisms in human lens epithelial (HLE) cells. METHODS: Totally 1190 unrelated participants, comprising 690 ARC patients and 550 healthy individuals in Han Chinese population were recruited and genotyped for target SNP. The χ2-test was used to detect genotypic distribution between the patient and control groups and the logistic regression was performed to adjust the age and gender. Meanwhile, different biological experimental methods, such as CCK-8 assay, flow cytometry, Q-PCR and Western blot, were used to detect cell viability, cell cycle progression and apoptosis in HLE cells or IGF1R knockdown HLE cells. RESULTS: The rs1546713 in IGF1R gene was identified (P=0.046, OR: 1.606, CI: 1.245, 2.071), which shown a significant relevance with ARC risk under the dominant model. The results demonstrated that IGF1R knockdown inhibited cell proliferation by inducing cell cycle arrested at S phase and promoting apoptosis. Mechanistically, the cell cycle blocked at S phase was linked with the alterations of cyclinA, cyclinB, cyclinE and P21. The pro-apoptosis function of IGF1R may related with stimulating the activation of Caspase-3 and altering the expression levels of apoptotic proteins, including Bcl-2, Bax and Caspase-3. CONCLUSION: This study first report that IGF1R polymorphisms may affect susceptibility to ARCs in Han Chinese population and provide new clues to understanding the pathogenic mechanism of ARCs. Notably, IGF1R is likely a potential target for ARC prevention and treatment.     

Management of persistent hyperplastic primary vitreous by pars plana vitrectomy.

Two children with persistent hyperplastic primary vitreous (PHPV) underwent vitrectomy and lensectomy via the pars plana to remove the fibrovascular stalk. Postoperatively the eyes were quiet, only a slight vitreous haze obscured the fundus view in the immediate postoperative period, and the stumps of the stalks retracted. Early surgical treatment of PHPV may prevent later serious complications.     

玻璃体切割术治疗飞蚊症的疗效及安全性

飞蚊症是眼科的常见病,玻璃体液化和玻璃体后脱离(PVD)是飞蚊症的主要原因.临床上,飞蚊症一直被认为不属于严重的病理性改变而建议患者采取保守治疗方法,但部分患者因飞蚊症严重影响视力而迫切需要解除症状.国外已有利用玻璃体切割术治疗飞蚊症的报道,但手术治疗的利弊尚存在争议,近年来关于玻璃体切割术治疗飞蚊症的安全性也日益引起学者们的关注.目前飞蚊症尚不是玻璃体切割术的手术适应证,因此对玻璃体切割术治疗飞蚊症的病例选择、手术方式、手术并发症及安全性、患者满意度等方面的研究进展进行综述,对于临床工作有其重要意义.     

Sutureless limited vitrectomy for positive vitreous pressure in cataract surgery.

A sutureless transconjunctival pars plana vitrectomy with the 25-gauge transconjunctival vitrectomy system is used to facilitate phacoemulsification in eyes with positive posterior vitreous pressure and shallow anterior chamber. Peribulbar local anesthesia is administered. In eyes with shallow anterior chamber, if an injection of a viscoelastic substance through anterior chamber paracentesis fails to deepen the anterior chamber, a limited pars plana vitrectomy is performed to remove a small amount of retro-lental vitreous (approximately 0.2 to 0.3 cc) with a 25-gauge high-speed cutter. Phacoemulsification is subsequently performed. The limited pars plana vitrectomy reduces the chances of intraoperative vitreous loss and suprachoroidal hemorrhage. It also increases the anterior chamber depth, facilitates intraoperative steps such as pupil stretching and capsulorhexis, and results in a phacoemulsification procedure that is less complex and safer.     

Pars plana vitrectomy in vitreous haemorrhage due to Eales' disease.

Repeated vitreous haemorrhage is a common occurrence in Eales disease. 25 eyes of unresolving vitreous haemorrhage were subjected to pars plana vitrectomy. 18 eyes improved to 1/60 or better. Vitreous rebleed was the commonest problem encountered. We discuss our experience, complications and limitations.     

Nature of subretinal fluid in patients undergoing vitrectomy for macular hole: a cytopathological and optical coherence tomography study

Background: Outer retinal defects (ORDs) may occur after surgical closure of full thickness macular holes (FTMH) and be associated with delayed visual recovery. This may be due to the nature of the subretinal fluid (SRF) cuff and/or the loss of retinal elements. Methods: Vitrectomy with internal limiting membrane (ILM) peel was performed for FTMH. After fluid‐air exchange, SRF was either aspirated from the hole (group 1) or left in situ (group 2). The SRF specimens obtained were examined by light microscopy and correlated with optical coherence tomography (OCT). Results: In group 1, cellular material was found in 6 out of 12 cases. Photoreceptors were seen in 3 and macrophages in 3 cases. Nine of 12 holes closed and ORDs were seen in 3 of these. In group 2, 7 out of 8 holes closed, with 4 having ORD. There was no difference in visual acuity (LogMAR) for closed holes at 3 months between groups 1 (0.61, range 0.3–1) and 2 (0.51, range 0.3–0.78) nor between patients with ORD (0.57, range 0.3–1.0) or without ORD (0.57, range 0.3–1.0). Conclusions: SRF from FTMH may contain macrophages and photoreceptors. Such photoreceptor loss may contribute to reduced retinal function. ORDs occur commonly in spite of fluid aspiration, but their presence is still compatible with good vision. Aspiration of SRF did not appear to confer added benefit in this series.