马凡综合征合并视网膜脱离的手术治疗

目的探讨马凡综合征合并视网膜脱离患者在不同手术方式的治疗下其视网膜解剖复位率和视功能恢复的结果。方法回顾性的分析14例(16只眼)马凡综合征患者的手术资料。其中有12只眼行巩膜扣带环扎术,4只眼行巩膜扣带环扎联合晶状体玻璃体切除术。手术结果的评估指标包括视网膜的解剖复位率以及视功能是否提高。结果行单纯巩膜扣带环扎术的12只眼中1次手术网膜复位率为91.7%(11/12),行巩膜扣带环扎联合晶状体玻璃体切除术的4只眼中1次手术网膜复位率为75%(3/4),但行2次手术后,术后8个月时随访,14例患者的16只眼达到100%解剖复位。术后最佳矫正视力达0.05以上有12只眼。结论马凡综合征合并视网膜脱离的手术治疗应根据裂孔的位置和视网膜脱离的情况来选择手术的方式。     

Hypotony caused by scleral buckle erosion in Marfan syndrome

PURPOSE: To describe hypotony caused by erosion of the conjunctiva and sclera by a silicone scleral buckle. METHODS: Interventional case report. A 33-year-old man with Marfan syndrome presented with hypotony maculopathy and a collapsed globe 17 months after repair of retinal detachment with a silicone sponge and silicone encircling band. RESULTS: Examination in the operating room revealed extrusion of the buckle through the conjunctiva and full-thickness scleral erosion. The silicone buckle was removed, and the scleral defect was closed with interrupted 8-0 nylon sutures. Postoperative glaucoma was treated with cyclophotocoagulation. Eight months after scleral repair, visual acuity was RE: 20/40, intraocular pressure was 10 mm Hg, and the retina was attached. CONCLUSION: Full-thickness scleral erosion secondary to a silicone exoplant causing hypotony is a rare long-term complication in patients with thin sclera.     

The use of silicone oil following failed vitrectomy for retinal detachment with advanced proliferative vitreoretinopathy

We have used silicone oil injection in a consecutive series of 44 patients with retinal detachment and advanced proliferative vitreoretinopathy, all of whom had previously failed to reattach with vitrectomy, membrane peeling, and scleral buckling. After a minimal follow-up period of six months, complete anatomic retinal reattachment posterior to the encircling scleral buckle was obtained in 64% of these eyes, and visual acuity of 5/200 or better was achieved in 57% of the anatomically successful cases. Silicone oil removal was performed in 69% of the anatomically and visually successful eyes without recurrent retinal detachment.     

Surgical repair of cytomegalovirus-related retinal detachment without silicone oil in patients with AIDS.

PURPOSE: To analyze visual and anatomic results following surgical repair of cytomegalovirus (CMV)-related retinal detachment (RD) without silicone oil permanent tamponade. METHODS: We analyzed five consecutive patients (six eyes) with acquired immunodeficiency syndrome and CMV-related RD that were repaired with pars plana vitrectomy with peeling of the posterior hyaloid, laser photocoagulation, encircling scleral buckle, and intraocular gas tamponade. RESULTS: Preoperative vision ranged from 20/40 to hand motion. Total retinal reattachment was achieved in five of six eyes (83%). Macular reattachment was achieved in all eyes. Mean postoperative visual acuity was 20/40 (range 20/30-20/60). Mean postoperative follow-up was 12 months (range 7-19 months). All patients in this series presented with low preoperative CD4+ T-lymphocyte counts (mean, 24 cells per microL) and received highly active antiretroviral therapy. One retina (Patient 1) redetached 7 months after initial repair and was successfully reattached without using silicone oil. Postoperatively, visual acuity remains 20/30, and total retinal reattachment has been maintained for 16 months. CONCLUSION: Good anatomic and visual success can be achieved and maintained in CMV-related RD without the use of silicone oil.     

Reduced choroidal blood flow can induce visual field defect in open angle glaucoma patients without intraocular pressure elevation following encircling scleral buckling

PURPOSE: To determine the cause of the progressive glaucomatous visual field defects in three patients after an encircling scleral buckle for a rhegmatogenous retinal detachment (RRD). METHODS: Scanning laser Doppler flowmetry and visual field tests were performed on three cases with unilateral progressive visual field defect after an encircling scleral buckling for a RRD. Similar measurements were made after the buckle was removed. RESULTS: After implanting the scleral buckle, the intraocular pressure was normal and chamber angle was open. The blood flow in the neuroretinal rim of the optic disk was lower than that in the healthy fellow eye. After removing the buckle, the blood flow improved to normal levels and a further worsening of the visual field was not detected. CONCLUSIONS: These results suggest that an encircling scleral buckle may impair choroidal circulation and lead to visual field defects similar to eyes with normal tension glaucoma.     

Scleral buckle with diathermy for simple retinal detachments. 100 pneumatic retinopexy eligible eyes.

One hundred consecutive pneumatic retinopexy eligible eyes underwent outpatient scleral buckle and diathermy. Follow-up averaged 31 months. Four cases required a second operation. Absence of an encircling band was the only significant risk factor (P = 0.00000028) for the three redetachments because of new or missed retinal tears. Although 18 patients had some other disease that reduced visual acuity before the retina detached, final visual acuity was 20/40 or better in 79 patients. Matched with a reported series treated by pneumatic retinopexy with cryopexy, these scleral buckle with diathermy cases exhibit significantly better final visual acuity with fewer major complications. The final acuity is also better than for two similar series, one treated with temporary balloon buckle and the second with scleral buckle and cryopexy. Use of diathermy rather than cryotherapy in the zone of retinal detachment may be the reason for the current group's better final acuity results.     

Scleral buckle for progressive symptomatic retinal detachment complicating retinoschisis versus primary rhegmatogenous retinal detachment

Objective: To compare the functional and anatomic outcomes of encircling scleral buckle placement for the repair of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR) with outer-layer breaks (OLBs) posterior to the equator versus primary rhegmatogenous retinal detachment (RRD).Design: Retrospective comparative case series.Participants: Thirty-seven patients with PSRDCR with OLBs posterior to the equator (group A) and 703 patients with primary RRD (group B).Methods: All eyes were treated with an encircling scleral silicone band (style 240). External drainage of subretinal and retinoschisis cavity fluid and cryopexy or laser photocoagulation around the tears and the OLBs were performed in all eyes. Best-corrected visual acuity at 6 months postoperatively and final retinal reattachment rate were analyzed.Results: There was no statistically significant difference between the 2 groups in terms of patient age, gender, percentage of retinal detachments that were macula-off (p = 0.241), and preoperative best-corrected Snellen visual acuity (p = 0.927). Best-corrected Snellen visual acuity at 6 months postoperatively was ≤ 20/100 in 35% of eyes, 20/100-20/50 in 14% of eyes, and ≥ 20/40 in 51% of eyes in group A versus ≤ 20/100 in 37% of eyes, 20/100-20/50 in 33% of eyes, and ≥20/40 in 30% of eyes in group B (p = 0.12); the final retinal reattachment rate was 97% in group A versus 98% in group B (p = 0.77).Conclusions: Placement of an encircling scleral buckle may be an effective method to manage both PSRDCR with OLBs posterior to the equator and primary RRDs. The procedure is associated with comparable visual acuity and anatomic outcomes for both types of retinal detachment.     

Low redetachment rate due to encircling scleral buckle in giant retinal tears treated with vitrectomy and silicone oil

BACKGROUND: The goal of this study was to identify risk factors for redetachment and to assess long-term anatomic and functional results of pars plana vitrectomy (PPV) for retinal detachment associated with giant retinal tears (GRT). SUBJECTS AND METHODS: In a retrospective study the authors analyzed 30 eyes which were operated with PPV for GRT retinal detachment in their clinic between March 1998 and August 2003. RESULTS: Redetachment rate after one vitrectomy procedure in this series of 30 eyes was 30% (n = 9), and ultimately, the retina was attached in 29 (96.7%) eyes. After multivariate analysis the absence of an encircling scleral buckle (P = 0.008) was significantly associated with redetachment. Visual acuity improved in 54% of the eyes. CONCLUSION: Vitrectomy with an encircling scleral buckle seems to be a preferred treatment for complicated retinal detachments due to GRT.     

Results of scleral buckling operations in primary rhegmatogenous retinal detachment

Within the scope of a Retinal Fellowship of one year, we evaluated the anatomic and functional results of scleral buckling operations in primary rhegmatogenous retinal detachments. Eighty Consecutive non-selected patients with a primary retinal detachment were operated by one surgeon (Retinal Fellow-ELH). In 55 eyes an encircling band and radial buckle(s) were placed, the other 25 eyes were treated with a segmental buckle or a combination of both. In 62 eyes subretinal fluid was drained, and in 57 eyes air or SF-6 gas was injected. The anatomic success rate after one operation was 81% (65/80 eyes) and the final success rate was 99%. 38/65 (58%) of the eyes obtained a best corrected post-operative visual acuity of 0.4. The most important cause of re-detachment was Proliferative vitreoretinopathy (PVR; 11%). Pre-operative variables that yielded an unfavourable outcome in this study were: PVR, pseudophakic eye, larger breaks, more than one break, longer duration of the detachment, and 3 or more quadrants of detachment. Our anatomic success rate and risk factors are in agreement with findings described in the literature, yet we had a high rate of PVR and many patients with a low visual acuity (58% 0.3) pre-operatively.     

Retinal detachment in Marfan syndrome: clinical characteristics and surgical outcome

PURPOSE: To describe the clinical characteristics of retinal detachments in patients with Marfan syndrome and report the surgical outcome of vitreoretinal surgery. METHODS: Records relating to 53 eyes of 45 patients with Marfan syndrome who underwent surgery for rhegmatogenous retinal detachment were reviewed. Of the 53 eyes, 24 (45.3%) underwent scleral buckling as the first procedure and 29 (54.7%) underwent vitrectomy surgery with scleral buckle as the first procedure. Main outcome measures included clinical characteristics of retinal detachment, reattachment rates, and functional improvement in vision. RESULTS: Characteristic findings included total retinal detachment in 40 (75.5%) eyes, atrophic holes in 24 (45.3%) eyes, more than four retinal breaks in 21 eyes (39.6%), preequatorial and postequatorial breaks in 20 (37.7%) eyes, giant retinal tears in six (11.3%) eyes, and proliferative vitreoretinopathy (posterior, anterior, or both) in nine (17%) eyes. In 30 (56.6%) eyes, retinal breaks were located only in the temporal half of the retina. Of the 24 eyes with myopia, 13 (54.2%) had a myopic correction greater than 7 diopters. At the median follow-up of 10.7 months, complete retinal reattachment was obtained in 87.6% and 86.2% of patients undergoing scleral buckling (including additional procedures such as vitrectomy) and vitrectomy surgery, respectively. In eyes with reattached retinas, a final visual acuity of 20/200 or better was obtained in 81% of the patients after scleral buckling and in 56% of the patients after vitrectomy surgery (P = 0.07). CONCLUSIONS: Retinal detachment in Marfan syndrome is complete in 75% of the eyes. More than half (56%) the eyes had a retinal break only in the temporal half of the retina, and 83% had at least a break in the temporal half of the retina. Currently available vitreoretinal surgical techniques result in successful reattachment of the retina in approximately 86% of the eyes.     

Marfan综合征合并视网膜脱离的三联手术

目的：探讨晶体玻璃体切除联合巩膜扣压环孔手术（三联术）治疗Marfan综合征视网膜脱离的解剖复位率和视功能结果。方法：回顾性研究连续性的11例（14只眼）Marfan综合征视网膜脱离的患者行晶体玻璃体切除联合巩膜扣压环扎手术后的解剖和功能结果。结果：三联术后随访4－46个月,（平均31．2个月）,12／14只眼（85．7％）视网膜复 位成功,12只眼视力达0．05以上,其中8只眼视力达0．3以上。结论：对于Marfan综合征患者的视网膜脱离,晶体玻璃体切除联合巩膜扣压环扎术是一种安全和有效的治疗方法。     

Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment

PURPOSE: To compare the anatomic and visual outcomes achieved by scleral buckling and primary vitrectomy for the repair of macula-off rhegmatogenous retinal detachment. METHODS: The records were reviewed for a consecutive series of 167 patients (167 eyes) who were initially treated with scleral buckling or pars plana vitrectomy for primary macula-off retinal detachment. Patients were treated between January 1993 and December 1996. After adjustments for preoperative characteristics, data from 102 cases (55 scleral buckle cases and 47 primary vitrectomy cases) were used for the final comparison. There had been a minimum follow-up period of 24 months. RESULTS: No significant differences in single-procedure reattachment incidence (91%), final success incidence (100%) and incidence of postoperative proliferative vitreoretinopathy development (4%) were observed between the two treatment groups. Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment were the three best predictors of postoperative visual recovery in both groups. Favorable overall visual recovery was obtained postoperatively, with no significant differences between the two groups throughout the follow-up period. However, in the eyes with poor preoperative visual acuity (<0.1), ocular hypotony (intraocular pressure <7 mm Hg), or prolonged macular detachment (more than 7 days), visual recovery in the primary vitrectomy group was significantly better (P <.05) than in the scleral buckle group from the first postoperative month. CONCLUSION: Both procedures achieved favorable anatomic and visual outcomes in the majority of patients with primary macula-off retinal detachment. Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment.     

巩膜环扎术预防穿孔性眼外伤后视网膜脱离

在４５例累及后段的穿孔性眼外伤病例行玻璃体切割术中，随机对其中２５例同时行预防性巩膜环扎术，观察环扎术对后期视网膜脱离发生率的影响。环扎术采用３ｍｍ宽的硅胶带置于角巩缘后９ｍｍ至１２ｍｍ之间，形成一个中等高度的巩膜嵴。经６个月以上的随访，行环扎术的２５例中发生视网膜脱离５例（２０％）；未行环扎术的２０例中有７例发生视网膜脱离（３５％）（Ｐ＜０．０５）。本结果显示：预防性巩膜环扎对穿孔性眼外伤后期视网膜脱离发生率的降低是有益的。     

The use of silicone oil following failed vitrectomy for retinal detachment with advanced proliferative vitreoretinopathy

We have used silicone-oil injection in a consecutive series of 44 patients with retinal detachment and advanced proliferative vitreoretinopathy, all of whom had previously failed to reattach with vitrectomy, membrane peeling, and scleral buckling. After a minimal follow-up period of 6 months, complete anatomic retinal reattachment posterior to the encircling scleral buckle was obtained in 64% of these eyes. Ambulatory visual acuity (5/200 or better) was achieved in 57% of the anatomically successful cases. Silicone-oil removal was performed in 69% of the anatomically and visually successful eyes without recurrent retinal detachment. Because of the frequent and severe complications associated with the use of silicone oil, we recommend that silicone-oil injection be considered only when conventional vitreoretinal techniques have failed to achieve retinal reattachment.Supported by National Eye Institute Grant EY02903 and the Helena Rubinstein FoundationPresented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Recurrence of Retinal Detachment after Scleral Buckle Removal

PurposeTo investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.MethodsIn this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.ResultsForty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).ConclusionsScleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.     

裂孔源性视网膜脱离的最小量巩膜外加压手术

目的探讨裂孔源性（原发性）视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离26例（26眼），在手术显微镜下行球结膜环形剪开、四直肌预置牵引线，在间接检眼镜下行视网膜裂孔精确定位及中度冷凝，手术显微镜下行巩膜外放液及巩膜缝线固定外加压块，所有外加压均采用修剪后的小硅胶海绵块，只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～9月。结果所有患者手术过程顺利，无术中并发症，手术损伤小；手术后眼底检查外加压精确地顶压裂孔，视网膜完全复位25眼，1眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位；手术后视力提高者21眼，不变4眼，下降1眼。结论最小量的外加压手术的优点是精确、可靠、创伤小，能避免传统巩膜扣带手术的一些并发症，手术成功率高。     

Marfan综合征伴孔源性视网膜脱离

目的：分析Marfan综合征伴孔源性视网膜脱离眼发病特征与治疗原则。方法：回顾并随访了1998年至2001年间上海市第一人民医院进行视网膜脱离手术治疗的10例12眼。结果：平均随访5．2个月，总的视网膜解剖复位率83．3％(10／12)，其中只作巩膜外手术7眼，复位率100％，玻璃体手术5眼，复位率60％。视力提高7眼(58．3％)。结论：仔细采用多种方法检查可以提高术前裂孔检出率。经巩膜环扎加压手术可以有效处理简单视网膜脱离眼，而毋实施玻璃体手术联合晶体摘除术。治疗中需加倍警惕对侧眼病变。     

环扎加压术治疗陈旧性视网膜脱离疗效观察

目的探讨环扎加压术治疗陈旧性视网膜脱离的疗效。方法陈旧性视网膜脱离患者60例（60只眼）进行环扎加压术治疗，术中巩膜外放液48只眼（80％），不放液12只眼（20％），C3F8玻璃体腔内注入10只眼（16．7％）。结果术后随访6-12个月（平均8．6个月），44只眼（73．3％）视网膜完全复位，14只眼（23．3％）明显好转，2只眼（3．3％）手术后视网膜未复位，后行玻璃体手术。手术后视网膜脱离治愈率73．3％，有效率96．7％。结论环扎加压术治疗不伴有视网膜前膜形成的陈旧性视网膜脱离，疗效良好，创伤小，可作为首先选择的术式。     

Scleral buckling for stage 4 retinopathy of prematurity

BACKGROUND AND OBJECTIVE: Both vitrectomy and scleral buckling have been used to treat patients with stage 4 retinopathy of prematurity (ROP). The standard procedure of scleral buckling for treatment of stage 4 ROP is encircling scleral buckling. The effectiveness of segmental scleral buckling is still unclear. The purpose of this study was to analyze the surgical results of patients with stage 4 retinopathy of prematurity treated with either encircling or segmental scleral buckling. PATIENTS AND METHODS: We retrospectively analyzed the anatomic outcomes of 23 eyes (18 infants) with stage 4 A or B ROP treated with scleral buckling. Segmental buckling was used to treat 15 eyes with detachment limited to the temporal side of the retina, while 9 eyes with detachment involving both the nasal and temporal sides were treated with encircling scleral buckling. RESULTS: Macular reattachment during a mean follow-up period of 34 months (range: 2 weeks to 9 years) was accomplished in 11 (79%) of the 14 eyes treated with segmental scleral buckling and 4 (44%) of the 9 eyes that received encircling scleral buckling. There were no intraoperative complications recorded. None of the eyes that achieved macular reattachment developed recurrent macular detachment during the follow-up period. CONCLUSIONS: Scleral buckling appears to be effective for treatment of stage 4 ROP. In patients with temporal side retinal detachment only, segmental scleral buckling provides adequate treatment for stage 4 ROP.     

巩膜扣带术治疗原发性非增生性视网膜脱离

目的观察巩膜扣带术治疗原发性(孔源性)非增生性视网膜脱离的疗效。方法36例(36眼)行巩膜扣带术。均按我们提出的视网膜脱离手术的3项要求(准确的裂孔定位,适度的冷凝和恰当的放置外垫压物)进行手术。术后随访,观察视网膜复位情况,视力、眼压及并发症。结果视网膜复位30眼(83.33%),失败6眼(16.67%),失败原因:1眼发生鱼嘴现象,3眼裂孔封闭不良,2眼垫压偏位。术后视力提高33眼,不变2眼,下降1眼。眼压升高3眼,服药后恢复正常。垫压物松动,环扎带移位及冷凝过度各1眼。结论巩膜扣带术治疗非增生性原发性视网膜脱离简单可靠。应用间接检眼镜直视下手术可大大提高手术成功率。