髋臼旋转与转子间外翻联合截骨术治疗成人扁平髋骨关节炎

髋臼旋转与转子间外翻联合截骨术治疗成人髋臼发育不良合并股骨头扁平畸形继发的中期髋骨关节炎６例（６髋）。年龄２５～４７岁（平均３６．４岁）。男２例，女４例。均有半脱位和骨关节结构的变化，临床表现为行走疼痛和跛行。手术方法在ニノ宫旋转截骨术基础上进行部分改进。平均随访时间２．５年（１４～４２个月）。结果以Ｌａｃｋ的改良Ｔｎｉｓ标准评定，优４例，良２例。手术前后的形态变化对照Ｘ线片的Ｓｈａｒｐ角（示臼关节面倾斜度）、ＡＨＩ（示股骨头覆盖率）、ＩＣＤ和ＨＸ（示股骨头向外偏离度）、ＡＴＤ（示大转子高度）等指标，取得了明显的矫正效果。     

Clostridium perfringens endophthalmitis

Our report describes a 35 year-old male who sustained a penetrating injury with an intraocular foreign body and developed endophthalmitis. Gram stain showed Gram positive bacilli and culture grewClostridium perfringens. The patient was managed successfully by therapeutic vitrectomy and intravitreal and systemic antibiotic therapy. Early vitrectomy and intravitreal antibiotics should be considered in patients who develop severe endophthalmitis following penetrating injury.     

The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Purpose

To investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment.

Methods

We retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded.

Results

Postoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker.

Conclusions

In our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.     

Late-onset Lens Particle Glaucoma as a Consequence of Posterior Capsule Rupture after Pars Plana Vitrectomy

 Purpose: To report the treatment of late-onset lens particle glaucoma associated with posterior capsule rupture during pars plana vitrectomy. Methods: Case report. Results: A 33-year-old man had severe pain and impaired vision in the left eye after vitrectomy, associated with white fleck-like particles circulating in the anterior chamber. The intraocular pressure (IOP) was 38 mmHg. The anterior lens capsule was intact, however, lens particle glaucoma was diagnosed by the slit-lamp examination, B-mode ultrasonography and ultrasound biomicroscopy (UBM). The lens material was removed by irrigation-aspiration after the patient remained face down for two hours to facilitate precipitation of the lens material from the vitreous into the anterior chamber. IOP after the procedure was 21 mmHg. Conclusion: Posterior lens capsule may be disrupted during vitrectomy. Although the anterior lens capsule is intact, lens particle glaucoma should be considered when IOP increases with particulate matter circulating in the anterior chamber. Surgical removal of this material may be sufficient to control IOP without the need for additional glaucoma surgery.     

曲安奈德和吲哚青绿双染法辅助下玻璃体切除术治疗特发性黄斑孔

目的 探讨曲安奈德(TA)和吲哚青绿(ICG)双染法辅助下玻璃体切除联合内界膜剥除术治疗特发性黄斑孔的疗效.方法 26例(26眼)均行玻璃体切除联合内界膜剥除术,术中应用TA和ICG辨认玻璃体后皮质和内界膜,术毕填充16％C3F8气体.结果 随访3～18个月,2例失访,23例黄斑孔完全闭合,1例未闭合者伴近锯齿缘处小裂孔后以硅油填充后闭合.随访患者24例中,21眼视力提高,2眼不变,1眼视力稍下降.结论 术中应用TA可以更清晰地辨认玻璃体后皮质,ICG的应用则有助于内界膜的剥除.TA和ICG双染法辅助下玻璃体切除术治疗特发性黄斑孔安全有效.     

Pars plana cysts

Pars plana cysts are found in up to 18 per cent of eyes and are more prevalent in the older population. These cysts typically appear as ovoid elevations with a smooth, taut surface. Pars plana cysts are usually acquired, representing a normal ocular senescent change. While the cysts themselves are benign they may occur secondary to ocular or systemic pathology, most notably retinal detachment, posterior uveitis and multiple myeloma. Two cases of pars plana cysts are presented.     

Intraocular Carbon Dioxide Laser Photocautery: Indications and Contraindications at Vitrectomy

The indications and contraindications for the use of carbon dioxide laser photocautery at the time of vitrectomy have been reviewed. Indications include posterior retinal tears either in flat or elevated sensory retina; elevated fibrovascular fronds on the optic nerve or elsewhere; flat neovascularization elsewhere, bleeding rubeotic iris vessels. It is also used as a means of panretinal endophotocoagulation. Contraindications include flat disc neovascularization and areas within one disc diameter of the macula and nerve. The advantages and disadvantages of the 10.6 micrometer infrared wavelength of carbon dioxide laser photocautery are discussed.     

The Effect of Vitreous and Retinal Surgery on Corneal Endothelial Cell Density

The effect of vitreoretinal surgery on corneal endothelial cell density was studied prospectively in 69 eyes by comparing preoperative endothelial cell densities to postoperative data. The mean cell loss in eyes of diabetic patients did not differ significantly from those of non-diabetics. The mean endothelial cell loss in 30 phakic eyes which underwent pars plana vitrectomy without lens removal was 1.3 ± 1.4%. In aphakic eyes, vitrectomy and scleral buckling led to a mean cell loss of 12.6 ± 2.3%. When vitrectomy was combined with lentectomy and scleral buckling, the mean cell loss was 8.5 ± 1.8%, but eyes undergoing fluid-gas exchange in addition to these procedures suffered a mean cell loss of 16.9 ± 1.9%. The presence of the lens protects the corneal endothelium during pars plana vitrectomy, while fluid-gas exchange in aphakic eyes appears to have a detrimental effect.     

Long-term diabetic vitrectomy results. Report of 10 year follow-up

Ten year follow-up examinations were obtained on 72 cases having pars plana vitrectomies for diabetic retinopathy complications from 1970 to 1973. Forty-two percent of the cases maintained 6/60 or better visual acuities through the tenth year. The visual results were quite stable, with 53% of the cases having the same or better visual acuities at ten years compared with six months. Neovascular glaucoma developed in 11 eyes, usually during the first six months, and open-angle glaucoma developed in 16 eyes, usually after the five-year follow-up examination. Both types of glaucoma occurred almost exclusively in aphakic eyes. Cataracts developed in 75% of retained clear lenses. The vitreous cavities remained clear in 67% of the eyes, and the maculas were attached in 65% of the eyes 10 years following vitrectomy. Fundus neovascularization did not recur.     

Pars plana vitrectomy in aphakic retinal detachments

Thirty-three cases of aphakic retinal detachment have been treated by pars plana vitrectomy and retinopexy. This procedure allowed us to lower the incidence of postoperative massive periretinal proliferation from 15,4%, in a series that was performed by a classical method, to 6% in the pars plana treated group.Presented at the XIIIth Meeting of the Jules Gonin Club, Córdoba, 29 March–2 April 1982.