Ultrawide-angle retinal imaging and retinal detachment

PURPOSE: To illustrate the utility of ultrawide-angle fundus imaging in documenting the clinical course of a retinal detachment. DESIGN: Observational case report. METHOD: A 20-year-old man with high myopia and a blind fellow eye noted symptoms of retinal detachment and was imaged with an ultrawide-angle fundus imaging device (Optos P200). Imaging was performed after scleral buckling and before and after additional vitreoretinal surgery. RESULTS: Ultrawide-angle images were useful in delineating the extent of retinal detachment even in the presence of intraocular gas. CONCLUSION: The ability to rapidly image the ocular fundus well anterior to the equator facilitates clinical management and may prove particularly useful in electronic record keeping.     

Avulsed retinal veins without retinal breaks

A localized segment of a retinal vein can be avulsed or torn from the retina by vitreous traction without a concurrent retinal break or tear. Eight eyes in eight patients (five women and three men, 20 to 69 years old) with avulsed retinal veins without retinal breaks showed a wide range of underlying retinal abnormalities, including background diabetic retinopathy, pars planitis, and involutional proliferative retinopathies. Such avulsed retinal veins often cause recurrent vitreous hemorrhage. Despite vitreous hemorrhages in six of the eight eyes, the visual prognoses were excellent in all eyes. An avulsed retinal vein must be considered in the differential diagnosis of those patients with proliferative retinopathies who have vitreous hemorrhage.     

超声诊断视网膜裂孔伴视网膜脱离

目的 探讨超声诊断视网膜裂孔伴视网膜脱离的方法。方法 选取1999年11月～2000年7月眼科超声检查视网膜脱离伴明确裂孔的连续临床病例48眼,每眼均经过各个方位的超声探测。结果 当连续性脱离视网膜光带中有明显中断,且断端间距大于1mm时,可诊断为视网膜裂孔。马蹄形裂孔中18眼在孔前缘有玻璃体牵引,4眼PVD刚好至后缘,8眼在前后缘均有牵孔;黄斑裂孔中6眼在黄斑处有玻璃体牵引,6眼有完全PVD。巨大裂孔中2眼无明显PVD,大量皮质在裂孔中;1眼后缘有明显牵引。结论 应用超声可以诊断部分视网膜裂孔,视网膜裂孔周围多有玻璃体牵引,手术时应特别注意对此部位的处理,超声诊断对于视网膜脱离术前检查有帮助和补充的作用。     

巨大裂孔视网膜脱离手术的探讨

目的探讨玻璃体视网膜手术治疗巨大裂孔视网膜脱离的手术方法和效果。方法巨大裂孔视网膜脱离11例（11眼）。其中10眼行闭合式三通道玻璃体切除联合巩膜扣带术和眼内视网膜光凝,另1眼未做巩膜扣带。6眼手术中采用全氟化碳液（重水）-硅油置换,硅油眼内填充;5眼为气体-液体交换,硅油填充。结果 11眼手术后视网膜均完全复位。随访观察中视网膜复位良好,2眼已取出硅油。但其中1眼取出油后又发生了视网膜脱离,并出现新裂孔,又做了硅油填充术。2眼发生继发性青光眼,2眼发生了并发性白内障,其中1眼已做了白内障手术。未发生全氟化碳液（重水）眼内残留或角膜变性等并发症。结论玻璃体切除术联合巩膜扣带、硅油眼内填充、视网膜激光光凝能有效治疗有巨大裂孔的视网膜脱离。     

Rhegmatogenous retinal detachment with retinal telangiectasia

A 34-year-old man with unilateral retinal telangiectasia developed a bullous retinal detachment. A horseshoe retinal tear was found at 12 o'clock. The detachment resolved with placement of an encircling scleral buckle. The prompt and permanent resolution of subretinal fluid supported our belief that this was a rhegmatogenous retinal detachment.     

视网膜功能影像检查技术在视网膜疾病中的临床应用

新型的视网膜影像学技术能帮助我们更好地理解多种视网膜疾病的发病机制,如糖尿病视网膜病变、老年性黄斑变性、青光眼以及葡萄膜炎等.早期对这些疾病进行监测能够预防进行性视力丧失,同时在发展新型治疗方法上也起着重要的作用.视网膜功能影像检查技术是一种独特的非损伤性的功能性影像学检查技术.与目前临床上广泛使用的视网膜影像检查技术不同的是,视网膜功能影像检查技术不仅能显示视网膜结构上的改变,还能动态监测视网膜的功能状态和评估血流动力学参数,如监测视网膜血液流速、血氧状态等.本文即对这项视网膜功能影像检查技术在各种视网膜疾病中的应用进展作简要综述.     

缺血-再灌注大鼠视网膜TPA变化与视网膜水肿的关系

目的　探讨缺血-再灌注对大鼠视网膜分泌组织型纤溶酶原激活物(TPA)的影响及其与视网膜水肿的关系。方法　采用提高眼压法造成视网膜缺血后,恢复眼压形成血流再灌注。实验分正常对照组、缺血 1h再灌注 1h组、缺血 1h再灌注 2h组、缺血 2h再灌注 1h组和缺血 2h再灌注 2h组。每组各取 10例测试视网膜组织TPA的活性和含水量。结果　缺血-再灌注后,大鼠视网膜组织TPA的活性和含水量随缺血和再灌注时间的延长而升高(P<0 01)。 结论　缺血-再灌注可引起视网膜组织TPA的活性升高和视网膜水肿,是视网膜组织结构和功能损伤的因素之一。     

Missed retinal breaks in rhegmatogenous retinal detachment

AIM: To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). METHODS: Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. RESULTS: Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. CONCLUSION: Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.     

Peripheral retinal degenerations predispose to retinal detachment

Peripheral retinal degenerations are a fascinating chapter of retinal pathology. The authors merely try to classify those peripheral retinal lesions that predispose to RD.     

急性视网膜坏死伴复杂性视网膜脱离的处理

目的:分析急性视网膜坏死(acuteretinalnecrosis,ARN)所致视网膜脱离的临床特征,探讨玻璃体切除手术效果。方法:回顾性分析16例(16眼)因ARN所致复杂性视网膜脱离,5眼为巨大裂孔,9眼为周边多发网状裂孔,2眼视网膜表面见渗出和坏死灶。诊断明确后即予更昔洛韦200～400μg玻璃体腔内注射。患者均接受玻璃体切除手术。病程<2mo者8眼,首次术中5眼充填硅油,3眼充填长效气体。病程>2mo者8眼,首次术中7眼充填硅油,1眼充填长效气体。结果:术后追踪观察16～39mo。病程<2mo者手术成功率100%,10眼(94%)视力增进,6眼视力在0.05以上。病程>2mo者手术成功率88%,5眼(94%)视力增进,3眼视力在0.05以上。结论:ARN可致复杂性视网膜脱离,玻璃体切割加硅油充填术效果肯定,并存的视网膜脉络膜、视神经、血管病变及黄斑疤痕是限制视功能恢复的主要原因,因而早期诊断是提高手术成功率以及改善视力的关键。     

未找到明确裂孔的原发性视网膜脱离的术式选择

目的探讨孔源性视网膜脱离术前找不到裂孔如何选择手术方式。方法回顾分析2001年1月～2004年3月我院收治的屈光间质较透明,瞳孔能散大、PVRC3级以下的原发性视网膜脱离患者,选择巩膜扣带术及玻璃体视网膜手术的术前术后视力及视网膜复位情况。结果54例54眼中,33例行巩膜扣带术,第一次手术解剖复位率有84.8%(29/33眼),21例行玻璃体视网膜手术,第一次手术解剖复位率有90.5%(19/21只眼),两组第一次手术解剖复位率在统计学上无显著性差异(p=0.437)。在巩膜扣带术组和玻璃体视网膜手术组两组术前术后矫正视力无显著性差异(p=0.392)。术后随访(3～27)月,平均8.5月,巩膜扣带术组并发症明显少于玻璃体视网膜手术组。结论对未找到明确裂孔的孔源性视网膜脱离患者,尽可能用损伤最小、操作简单的巩膜扣带术来获得最大成功机会。     

Characteristics of rhegmatogenous retinal detachments secondary to retinal dialyses

Objective

The pattern of retinal features in patients with retinal detachment caused by retinal dialyses is poorly described. The association with trauma has also been inconsistently reported. The authors aim to analyze patient and retinal characteristics in such cases and identify the proportion where trauma is likely causative mechanism.

Design

Retrospective case series.

Participants

Sixty-three eyes from 63 patients with retinal detachment secondary to retinal dialysis.

Methods

Population was selected from consecutive patients presenting to a single surgeon at a tertiary referral vitreoretinal service (2001–2010).

Results

Sixty-three patients were identified (4.4% incidence rate). The cohort had a mean age of 32 years with a male preponderance (67%). Seventy-one percent had a single break, 21% had 2 breaks, and 8% had 3 to 7 breaks. Six percent of eyes had dialyses smaller than 0.5 disc diameters. Eighty-one percent of eyes had inferotemporal dialyses, but other quadrants also were involved in 25%, or exclusively in 17.5%. The primary success rate for surgery was 92% (94% final success). The presence of proliferative vitreoretinopathy (PVR) was rare (4 cases) but was a significant factor in failure of retinal reattachment (p < 0.001). Twenty-two percent were regarded as traumatic (93% male; p < 0.05). Other variables were similar between traumatic and nontraumatic eyes.

Conclusions

Most retinal dialyses are located inferotemporally; however, multiple dialyses, small dialyses, and dialyses that involve multiple quadrants may be seen. In patients with evidence of direct globe injury, no difference in the pattern of retinal presentation of the dialyses was observed. Although surgical success rates are high, patients with PVR had poor response to surgery.