Pediatric rhegmatogenous retinal detachment

PURPOSE: To review the clinical features and surgical and visual outcomes of pediatric rhegmatogenous retinal detachment (RRD) as seen in a tertiary referral center. METHODS: Retrospective case series spanning 6 years from January 1, 1991 to January 1, 1997. Exclusionary criteria were trauma disrupting the globe and acute retinopathy of prematurity. RESULTS: The authors reviewed a series of 29 eyes in 27 pediatric patients (birth to 18 years of age) with RRD. Seventy percent of the patients were male. The mean patient age was 9.6 years. Bilateral RRD was present in 22% of patients; 89% of patients had some form of bilateral ocular pathology at initial presentation. The two most common etiologies (34% each) were myopia and eyes that had undergone surgery for another ocular disorder with subsequent development of RRD. The most common presentation was decreased vision, with a mean duration of 52 days. At presentation, 75% of the affected eyes and 48% of the fellow eyes had visual acuity worse than 20/800. The most common type of retinal break was a horseshoe tear. Late diagnosis was a common problem, evidenced by the frequency of macular detachment (79%) and proliferative vitreoretinopathy (45%) at initial presentation. The most common primary repair was a scleral buckle. Anatomic reattachment was ultimately accomplished in 72% of cases with a mean of 2.2 surgeries per eye. Average postoperative follow-up time was 21.4 months (range 4 to 61 months). At final follow-up, 41% of the affected eyes had visual acuity 20/800 or better. Thirty-eight percent of the affected eyes had a final visual acuity better than or equal to the fellow eye. CONCLUSION: In this series, pediatric RRD occurred most commonly in association with myopia (Stickler's syndrome and adolescent retinopathy of prematurity) and prior intraocular surgery. Most eyes were anatomically reattached after multiple surgeries. Forty-one percent of eyes retained vision of 20/800 or better. Preserving vision in children with RRD is of great importance, particularly given the 89% frequency of vision-threatening abnormalities in fellow eyes.     

Characteristics and surgical outcomes of paediatric retinal detachment

PURPOSE: To report the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the paediatric population. METHODS: A retrospective review of children (aged 0-15 years) who underwent primary surgical repair for RRD at the Hiroshima University Hospital between 1988 and 2001. RESULTS: In all 53 eyes of 49 patients were identified; paediatric RRD accounted for 3.1% of 1779 eyes with RRD operated on during this period. The causes of RRD included blunt trauma (27%), myopia (25%), idiopathic (20%), familial exudative vitreoretinopathy (13%), and others. Among 55 eyes, 12 (22%) already had proliferative vitreoretinopathy (PVR) of grade C or D preoperatively. The median initial visual acuity (VA) was 0.3. Retinal reattachment was achieved with a single operation in 78%. Final retinal reattachment was achieved in 87%. Retinal reattachment rates with and without PVR were 42% and 100%, respectively (P<0.01). Median final VA was 0.7. Final VA was > or =0.1 in 73% and > or =0.5 in 53%; four eyes had a final VA of no light perception. The presence of preoperative PVR (P=0.03) and the initial VA (P<0.0001) significantly affected final VA. CONCLUSIONS: Paediatric RRD is characterised by a delay in diagnosis, as evidenced by the high rate of PVR at presentation. Retinal reattachment was adversely affected by the presence of PVR. Final VA correlated with the initial VA and was significantly affected by preoperative PVR. Early diagnosis may improve the visual prognosis of paediatric retinal detachment.     

影响孔源性视网膜脱离术后视力的因素分析

目的:探讨孔源性视网膜脱离(rhegmatogenous retinalde-tachment,RRD)术后视力的恢复情况及其影响因素。方法:回顾性分析我院眼科2002-01/2007-10期间,以孔源性视网膜脱离为第一诊断并经手术治疗视网膜复位成功的病历资料,共99例102眼。其中采用巩膜外路手术81眼、玻璃体联合视网膜手术21眼。观察RRD患者的发病年龄、视网膜脱离范围、视网膜脱离时间、增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)程度、黄斑状态、屈光状态、裂孔位置、手术前后视力、术后裂孔封闭及视网膜复位情况,用卡方检验对不同年龄、视网膜脱离范围、视网膜脱离时间、PVR分级、黄斑状态及屈光状态的患者术后视力变化情况进行分析,根据结果选择差异有统计学意义的因素进行Spearman等级相关检验。结果:视网膜复位术后视力提高53眼(52.0%),视力不变33眼(32.3%),视力下降16眼(15.7%)。不同PVR分级、黄斑状态、视网膜脱离范围、视网膜脱离时间及年龄的术后视力恢复情况有显著差别(P<0.05),不同屈光状态的术后视力恢复情况无明显差别。对上述因素进行Spearman等级相关检验,发现上述术前因素与术后视力关联程度从大到小为:PVR分级(rs=-0.521,P=0.000)、黄斑是否脱离(rs=-0.446,P=0.000)、视网膜脱离时间(rs=-0.423,P=0.000)、视网膜脱离范围(rs=-0.411,P=0.000)、患者年龄(rs=-0.267,P=0.007)。结论:RRD患者的术后视力恢复与术前PVR分级、黄斑状态、视网膜脱离时间、视网膜脱离范围、年龄有关,其中术前PVR分级、黄斑状态、视网膜脱离时间对术后视力的恢复影响最为显著。     

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.     

Visual and anatomical outcomes after silicone oil removal in patients with complex retinal detachment

To evaluate outcomes of temporary silicone oil (SO) tamponade in patients with complex retinal detachment. A retrospective study of 184 eyes of 177 consecutive patients who underwent SO removal (SOR) by one surgeon between 2000 and 2010. Indications for the use of SO were proliferative vitreoretinopathy (56 eyes), difficult rhegmatogenous retinal detachment (RRD) (58 eyes), diabetic traction retinal detachment (DTRD) (29 eyes), RRD due to macular hole in highly myopic eyes (16 eyes), giant retinal tears (13 eyes), and RRD after penetrating trauma (12 eyes). All eyes underwent prophylactic 360° laser retinopexy and encircling buckle at the time of primary surgery. The mean duration of SO tamponade was 47 weeks, with a mean follow-up of 66.9 weeks after SOR. Anatomical success after SOR was achieved in 96.73 %. Final visual outcome of ≥20/200 was significantly higher in eyes with RRD compared to eyes with DTRD. Young age (≤16 years), performance of pars plana lensectomy at primary procedure and presence of pseudophakia at last follow-up were factors associated with good visual outcome in eyes with RRD. Factors predicting attached retina at last follow-up were older age (>16 years), normal intraocular pressure (IOP) at initial presentation and no relaxing retinotomy performed during the primary procedure in eyes with RRD. Complications were cataract (100 %) in phakic eyes, increased IOP (15.7 %), keratopathy (3.8 %), and hypotony (2.1 %). The low redetachment rate after SOR in the present study might be due to prophylactic 360° retinopexy and use of encircling buckles at time of primary retinal reattachment.     

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens

AIM: To investigate the clinical characteristics, treatment methods and outcomes of rhegmatogenous retinal detachment (RRD) in highly myopic eyes with implantable collamer lens (ICL). METHODS: High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed. Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient. RESULTS: A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included. The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo (range, 1-60mo). At the initial visit for RRD, giant retinal tear (GRT), horseshoe tear, simple round hole, and horseshoe tear combined with round hole were detected in 3, 3, 2, and 1 eye(s), respectively, with macula-off in eyes. Eight patients received surgical treatment, and one patient was treated by retinal laser photocoagulation alone. The ICL was preserved in 7 eyes. At the last follow-up, the mean best corrected visual acuity (BCVA) improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR (P=0.035), and no case of recurrent retinal detachment was found. CONCLUSION: The morphological presentation of retinal breaks is diverse in this study. The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data, companied with acceptable visual and anatomical outcomes.     

Pediatric rhegmatogenous retinal detachment: clinical features and surgical outcomes

OBJECTIVE: To describe the characteristics of and surgical outcomes for primary pediatric rhegmatogenous retinal detachment (RRD) and to evaluate whether specific characteristics impact anatomical outcomes after surgical intervention. METHODS: Data for consecutive patients (18 years of age or younger) with RRD who required surgery over a 5-year period were studied retrospectively. Patients with recurrent retinal detachment or active retinopathy of prematurity were excluded. RESULTS: Forty-six eyes of 45 patients (median age, 9 years) were included. Ninety-eight percent of the patients had at least 1 predisposing factor, including prior surgery (61%), trauma (43%), developmental abnormality (35%), and myopia (17%). Retinal reattachment was attained in 78% of eyes. Younger age (P = 0.019), worse initial vision (P = 0.008), greater extent of retinal detachment (P = 0.007), and presence of proliferative vitreoretinopathy (grade C or worse) (P = 0.008) were associated with worse anatomical outcomes. Vision improved after surgery in 56% of patients, but overall visual results were modest. Thirty-seven percent of patients had vision-threatening lesions in the other eye, and 18% had a history of retinal detachment in the fellow eye. CONCLUSIONS: Pediatric RRD is often associated with a predisposing factor. Favorable anatomical and visual outcomes are possible, and lesions in the fellow eye are common.     

Rhegmatogenous retinal detachment in myopic eyes after laser in situ keratomileusis. Frequency, characteristics, and mechanism

PURPOSE: To report the characteristics and frequency of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for the correction of myopia in a large case series. SETTING: Private practices, Caracas, Venezuela. METHODS: Five refractive surgeons and 31 739 myopic eyes that had surgical correction of a mean myopia of -6.01 diopters (D) (range -0.75 to -29.00 D) participated in this study. Laser in situ keratomileusis was performed in all eyes. Patients were followed for a mean of 36 months (range 6 to 48 months). The clinical charts of patients who developed RRD after LASIK were reviewed. RESULTS: Twenty eyes (17 patients) developed RRD after LASIK. Rhegmatogenous retinal detachments occurred a mean of 13.9 months (range 1 to 36 months) after LASIK. The mean pre-LASIK myopia in eyes that developed an RRD was -7.02 D (range -1.50 to -16.00 D). Most RRDs and retinal breaks occurred in the temporal quadrants (71.4%). Rhegmatogenous retinal detachments were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The frequency of RRD after LASIK was 0.06%. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for the correction of myopia is infrequent. If managed promptly, RRD will result in good vision. Before LASIK is performed, patients should have a thorough dilated indirect fundoscopy with scleral depression and treatment of any retinal lesion predisposing to the development of an RRD.     

最小量巩膜外手术治疗近视性原发性视网膜脱离临床观察

目的:探讨最小量巩膜外手术治疗PVRC2以下近视性原发性视网膜脱离(孔源性视网膜脱离)患者的治疗效果。方法:原发性视网膜脱离PVRC2以下的近视眼患者32例32眼,入院后1wk内,采用配戴小孔镜和体位治疗,裂孔周围堤坝式激光光凝。剩余视网膜下液不能吸收者行最小量巩膜外手术治疗。结果:本组病例经体位治疗网膜脱离范围缩小,再通过手术治疗,经过2～6mo随诊,无严重并发症发生,矫正视力、眼压均有显著提高,视网膜解剖复位。结论:最小量巩膜外手术是PVRC2以下的近视性原发性视网膜脱离患者的有效治疗方法。     

Retinal detachment after silicone oil removal

PURPOSE: To evaluate the causes of retinal detachment after silicone oil removal, to define possible risk factors and the anatomical and functional prognosis of this complication. METHODS: 112 eyes that underwent silicone oil removal were included. The group of eyes with retinal detachment after oil removal (18/112 eyes, 16.1%) was compared with the group with no postoperative retinal detachment. RESULTS: The most common cause for retinal detachment after oil removal was anterior PVR (77.8%). Initial PVR detachment, advanced PVR stages, anterior PVR, more preceding operations, aphakia/pseudophakia, myopia and shorter duration of the oil tamponade were significantly more represented in the group of eyes with retinal detachment after oil removal. The prognosis of retinal detachment after oil removal is poor. CONCLUSION: Some criteria could be regarded as risk factors for retinal detachment after silicone oil removal. Improvement of the results should be possible by considering these factors and by control of reproliferations.     

Macular hole as a risk factor of choroidal detachment in rhegmatogenous retinal detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.     

Silicone oil tamponade in 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies. METHODS: Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months. RESULTS: Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision. CONCLUSION: Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.     

The fellow eye of patients with rhegmatogenous retinal detachment

OBJECTIVE: To determine how often the fellow eyes of patients with rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy (PVR) harbor vision-threatening conditions at presentation and during follow-up. DESIGN: Retrospective, observational case series. PARTICIPANTS: Two hundred forty-eight patients with RRD without PVR were studied. INTERVENTION: The authors observed the fellow eye of patients with RRD for vision-threatening pathology. MAIN OUTCOME MEASURE: Detection of vision-threatening pathology in the fellow eye of patients with RRD without PVR. RESULTS: Two hundred forty-eight patients were observed for an average of 5.2 years. One hundred fifty-seven vision-threatening events or diagnoses occurred in the fellow eye, including pre-existing and newly diagnosed conditions, 97 (62%) of which were rhegmatogenous in nature. Fifty-six patients (23%) had retinal detachments in their fellow eye, including those with a history of RRD repair (28 eyes), those presenting with bilateral RRD (4 eyes), and those developing new RRD during follow-up (24 eyes). In addition, 1 patient developed recurrent retinal detachment in the fellow eye during follow-up. Retinal tears were diagnosed and treated with laser retinopexy or cryotherapy in 30 (12%) fellow eyes (4 before the initial examination, 7 upon initial examination, and 19 on follow-up). Lattice degeneration was present in 27 (11%) fellow eyes. CONCLUSIONS: Patients who develop RRD are at considerable risk for developing vision-threatening events, particularly rhegmatogenous events, in the fellow eye.     

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment in Taiwan

PURPOSE: To evaluate the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the pediatric population. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: A review of patients under 18 years who underwent primary retinal detachment surgery at National Taiwan University Hospital from 1989 to 2003 was conducted. RESULTS: Included in the study were 152 eyes of 146 patients (mean age of 13.1 years). Male patients comprised 69.9% of the sample. Bilateral RRD was present in 4.1%. Etiologies included myopia >4 diopters (37.5%), trauma (32.9%), developmental anomaly (11.8%), previous surgery (5.9%), previous uveitis (3.9%), atopic dermatitis (2.6%), and unknown (5.3%). Macular detachment was found in 73.0%. The most common primary treatment was scleral buckling (61.2%). Single-operation reattachment was accomplished in 58.5% of patients and eventual reattachment in 78.3% of patients occurring in a mean of 1.5 (SD = 0.9) operations. Average postoperative follow-up time was 48.3 months. Visual improvement occurred in 42.8%, remained the same in 32.2%, and worsened in 19.1%. In the logistic regression model, statistically significant risk factors for poor surgical outcome were nonmyopic RRD (P = .026), macular involvement (P = .01), and presence of proliferative vitreoretinopathy (P = .07). CONCLUSIONS: Myopia >4 diopters was the most common etiology in retinal detachment in our sample, followed by trauma. Myopia (> -4.0 diopters) may be more common than previously reported. Most eyes (78.3%) were anatomically reattached after multiple surgeries. Retinal detachment not associated with myopia is a newly identified predictor for poor surgical outcomes.     

巩膜扣带术后影响视网膜复位和视力恢复的相关因素分析

目的 分析孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)行巩膜扣带术后影响视网膜复位和视力恢复的相关因素,为临床治疗提供参考.方法 回顾性临床研究,选择2012年1月至2016年1月我院收治的初发RRD患者行巩膜扣带术治疗者148例148眼,观察术后视网膜解剖复位率、最佳矫正视力(best-corrected visual acuity,BCVA)及并发症,并对可能影响术后视网膜复住和视力恢复的相关因素进行Logistic回归分析.结果 检眼镜和眼底照相检查示首次手术视网膜复位率为91.9％,最终复位率为97.3％;频域光学相干断层扫描(spectral-domainoptical coherence tomography,SD-OCT)检查视网膜首次复位率为60.1％,最终复位率为80.4％.单因素Logistic回归分析结果表明:多发视网膜裂孔和C1级增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)对视网膜复位率有显著影响(均为P＜0.05);单因素Logistic回归分析结果显示:术前BCVA、病程长短、视网膜脱离范围、黄斑累及与否对术后BCVA恢复均有明显影响(均为P＜0.05),而年龄、术前屈光状态、PVR分级、术中是否实施视网膜下放液、玻璃体内注气、联合巩膜外加压、术后视网膜下液对术后BCVA的恢复均无明显影响(均为P＞0.05);多因素Logistic回归分析结果显示:术前BCVA是影响术后BCVA的独立危险因素(P＜0.05).结论 巩膜扣带术治疗RRD效果良好,但多发视网膜裂孔和C1级PVR会增加手术失败风险;术前视力、病程长短、视网膜脱离范围、黄斑状态均影响巩膜扣带术后视力的恢复,而术前视力是关键因素,提示RRD患者应早发现、早治疗,尽可能保护术前视力.     

影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

目的 探讨巩膜扣带术(scleral buckling,SB)治疗孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效以及影响视网膜解剖复位和视力恢复的相关危险因素.方法 回顾性分析2005年1月至2008年12月行sB的RRD患者72例(72只眼).术后随访6-30月,平均(13.96±8.28)月,观察术后视网膜解剖复位率、最佳矫正视力(best corrected visual acuity,BCVA)及并发症.Logistic回归用于分析影响视网膜解剖复位和视力恢复的相关危险因素.结果 在眼底镜和B超检测下视网膜首次复位率为90.28%,最终复位率为97.22%;而光学相干断层扫描(optical coherence tomography,OCT)检测下的视网膜首次复位率为59.72%,最终复位率为77.78%.术后BCVAI>0.3者为62.5%.C1级PVR和多发性裂孔对视网膜复位率有显著影响(P=0.0183、0.0181 ).术前视力、黄斑脱离与否、黄斑脱离时间及PVR的程度对术后视力恢复的影响有统计学意义(P=0.0235、0.0124、0.0325、0.0357). 术后出现葡萄膜炎占13.89%,视物变形占9.72%,增殖性玻璃体视网膜病变(proliferative vitreous retinopathy,PVR)进展占6.94%,黄斑皱褶占6.94%,高眼压占4.17%,复视占2.78%.术后前房深度、眼轴长度、屈光度和散光度的变化较术前差异有统计学意义(P=0.0260、<0.0001、0.0005、0.0018).结论 SB治疗RRD有良好的疗效,但C1级PVR和多发性裂孔会显著增加手术失败的风险.术前视力、黄斑脱离状态和脱离时间及PVR的程度是影响术后视力恢复的重要因素;同时,该手术可导致术后前房深度变浅、眼轴延长、屈光度和散光度向负值偏移.     

Anatomical and functional outcome of surgery of primary rhegmatogenous retinal detachment in high myopic eyes

PURPOSE: To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. METHODS: We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. RESULTS: Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. CONCLUSIONS: The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.     

高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的相关因素分析

目的 探讨高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的相关危险因素,总结其临床特点及治疗方法.方法 连续收集合并脉络膜脱离的高度近视黄斑裂孔性视网膜脱离的病例10例(A组),并以同一时期不伴脉络膜脱离的高度近视黄斑裂孔性视网膜脱离病例12例为对照(B组),对比两组发病年龄、病程、术前屈光度、眼轴、眼压、视网膜脱离范围以及术后视网膜复位、视功能恢复等情况.结果 A组发病年龄大、近视度数高、眼压低、视网膜脱离范围大,与B组相比差异有统计学意义(P<0.05),其中眼压差异显著(P<0.01);两组的一次玻璃体切割手术视网膜复位率相近,A组为80%,B组为83%,但A组术后视力≥0.02的比例低(P=0.048).结论 高度近视黄斑裂孑L性视网膜脱离一旦合并脉络膜脱离常伴有年龄大、病程长、近视度数高、视网膜脱离广泛和显著低眼压等特点.适时采用玻璃体切割合并硅油填充术可达到与不合并脉络膜脱离组相近的视网膜复位率,但视力预后仍较差.     

微创玻璃体切割术治疗高度近视性黄斑裂孔视网膜脱离的疗效

目的：观察微创玻璃体切割联合内界膜剥除术治疗高度近视性黄斑裂孔视网膜脱离(macular hole retinal detachment,MHRD)的临床效果。

方法：回顾性非随机临床研究。纳入2011-01/2016-12我院高度近视MHRD患者26例26眼,所有患者均行标准三通道经睫状体平坦部23G微创玻璃体切割联合内界膜剥除术。术后定期进行最佳矫正视力(best corrected visual acuity,BCVA)、眼压、裂隙灯眼前节和眼底检查,并用光学相干断层扫描(optical coherence tomography,OCT)检查黄斑裂孔解剖情况。以发病年龄、裂孔Gass分期、发病天数、裂孔闭合形态(W、V、U型)、初始视力5项作为自变量进行Logistic回归分析,探讨影响术后BCVA的因素。

结果：高度近视MHRD术后黄斑裂孔(macular hole,MH)闭合率为58%。依据OCT图像,将高度近视MHRD术后OCT闭合形态分为3类：U型(3眼),相对正常的中心凹形状; V型(4眼),黄斑中心凹较陡; W型(8眼),黄斑中心凹处神经上皮缺损,但裂孔缘未翘起,无囊腔形成。多因素Logistic回归分析结果表明,术后预后视力提高与裂孔闭合OCT形态和初始视力相关(P<0.05),术后U型裂孔闭合视力提高是W型的6.9倍。

结论：微创玻璃体切割联合内界膜剥除术是治疗高度近视MHRD的有效方式。高度近视MHRD术后视力提高与黄斑裂孔愈合的OCT形态和初始视力相关。     

Rhegmatogenous retinal detachment after LASIK for myopia of up to –10 diopters: 10 years of follow-up

Background

The aim of this work was to characterize rhegmatogenous retinal detachment (RRD) in over 22,000 eyes after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ –10.00 diopters (D), its characteristics, and its frequency at 10?years of follow-up.

Methods

This is a retrospective single-center interventional non-comparative case series. A total of 22,296 myopic eyes that underwent surgical correction of myopia ≤ –10.00 D were included. LASIK for the correction of myopia was performed in all eyes. Patients were followed for 10?years after LASIK. The clinical charts of patients that developed rhegmatogenous retinal detachment (RRD) after LASIK were reviewed.

Results

A total of 11,594 (52%) eyes came back for follow-up after LASIK at 10?years. Twenty-two eyes (19 patients) developed a RRD after LASIK at 10?years. Rhegmatogenous retinal detachments occurred between 1?month and 10?years (mean: 31.6?±?39.3?months) after LASIK. Eyes that developed a RRD had from –1.50 to –9.75 D of myopia (mean: –4.81?±?2.2 D) before LASIK. The frequency of RRD after LASIK determined in our study was 0.05% (11/22,296) at 1?year, 0.15% (18/11,371) at 5?years, and 0.19% (22/11,594) at 10?years.

Conclusions

Rhegmatogenous retinal detachment after LASIK for the correction of myopia ≤ –10.00 D is infrequent. The risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. We recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of a RRD before LASIK surgery should be performed.