Objective To observe the changes of autoflurorescence (AF) in periphery retina after scleral buckling. Methods The examination of peripheral fundus autoflurorescence with Optos 200Tx was performed in 46 patients (46 eyes) who underwent successful scleral buckling. The correlation between changes of AF in surgical area and visual function were analyzed by multiple linear stepwise regression analysis.Results One week after surgery, completely atrophy of retinal pigment epithelium (RPE) with disappeared AF was found in the cryotherapy area of 15 eyes (32.6%), uneven area with enhanced AF and scattered weak AF spots was found in 31 eyes (67.4%). The area of RPE atrophy caused by cryocoagulation was 4 times larger than that of the primary retinal tear or holes in 9 eyes (19.6%), and was 2 to 4 times larger in 11 eyes (23.9%), and was 2 times less in the rest of 26 eyes (56.5%). A few granular hyper-AF was observed at the compressed retinal area in 11 eyes (23.9%), normal AF was observed at the compressed retinal area in 35 eyes (76.9%). When alpha;=0.05, the area with AF changes was significantly correlated with both vertical and horizontal diameter of peripheral visual filed (beta;=-0.024, -0.019; P＜0.001), but was not correlated with the best corrected visual acuity (F=0.51.22,P=0.312) by multiple linear stepwise regression analysis. Conclusions SBS can cause peripherial AF changes. Peripheral AF examination is helpful to evaluate the surgical retinal damage of scleral buckling.
ObjectiveTo observe the surgical effects of scleral buckling and vitrectomy for familial exudative vitreoretinopathy (FEVR). Methods34 eyes of 27 patients with FEVR who underwent either scleral buckling or vitrectomy were enrolled in this study. There are stage 2B in 2 eyes (5.88%), stage 3B in 7 eyes (20.59%), stage 4A in 1 eye (2.94%), stage 4B in 16 eyes (47.06%), stage 5 in 8 eyes (23.53%). 5 eyes associated with rhegmatogenous retinal detachment. The surgical approaches had been chosen according to the disease stage, severity, extent and morphology of the proliferative membrane. 13 eyes (stage 2B in 2 eyes, 3B in 4 eyes, and 4 in 7 eyes) underwent scleral buckling and 21 eyes (stage 3B in 3 eyes, 4 in 10eyes, and 5 in 8 eyes) underwent vitreoretinal surgery. The main outcome measurement was the anatomic status of the macula, which was recorded as attached, partially attached or remain detached. The mean follow up was (18.00±14.61) months (range 4 to 60 months). ResultsAmong 13 eyes received scleral buckling, the macula was attached in 2 eyes with stage 2B (15.38%), partially attached in 11 eyes (84.62%) including 4 eyes with stage 3B, 1 eye with stage 4A and 6 eyes with stage 4B. Among 21 eyes received vitrectomy, the macula was attached in 8 eyes (38.10%) including 2 eyes with stage 3B, 4 eyes with stage 4 and 2 eyes with stage 5; the macula was partially attached in 9 eyes (42.86%) inducing 4 eyes with stage 4 and 5 eyes with stage 5; the macula remained detached in 4 eyes (19.05%) including 1 eye with stage 3B, 2 eyes with stage 4 and 1 eye with stage 5. ConclusionIf the surgical approaches were chosen based on the stage of FEVR and the severity, extent and morphology of the proliferative membrane, the surgery is effective and beneficial to FEVR patients.
ObjectiveTo create a new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment (RRD), and to evaluate its safety and effectiveness. MethodsA scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination was performed in 6 eyes of 6 patients with RRD, including 2 males and 4 females. The mean age was 51 years old with a range from 23 to 66 years old. Proliferative vitreoretinopathy (PVR) were diagnosed of grade B in all 6 eyes. Duration of retinal detachments until surgery was 5.8 days with a range from 2 to 13 days. The mean preoperative intraocular pressure (IOP) was 12 mmHg with a range from 9 to 15 mmHg (1 mmHg=0.133 kPa). A 23-gauge optic fiber was used to provide an intraocular illumination. Fully examination of the ocular fundus and cryoretinopexy of retinal breaks was performed under a noncontact wide-angle viewing system. Subretinal fluid drainage through the sclerotomy and buckling procedure were performed under the operating microscope. Intravitreal injection of sterile air bubble was performed in 4 eyes. Antibiotic eye drops was applied in all eyes postoperatively, and all the eyes were followed up for at least 6 months. ResultsRetinal reattachment was achieved in all eyes, and the conjunctiva healed well. The best corrected visual acuity (BCVA) increased in all eyes. The mean postoperative IOP was 15 mmHg with a range from 12 to 19 mmHg. No complications were found intra and postoperatively. ConclusionsThis new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for RRD is safe and effective. Advantages such as higher successful rate, less complication, shorter operating time, and less discomfort of patients were showed comparing with the previous scleral buckling surgery using indirect ophthalmoscope.
Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists. The surgical success rate reached 95.0% and above for vitrectomy, macular surgeries with ILM peeling, or local/total scleral buckling. However, the postoperative visual function recovery is nowhere near good enough. Specialists must pay more attention to the visual function recovery of those patients. Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time. At present, the postoperative visual acuity for macular hole depends on many factors, such as macular hole closure conditions, surgical procedures, microsurgical invasive ways, skills of membrane peeling, usage of dye staining, and tamponade material choice. It also depends on residual subretinal fluid under macular area for patients received scleral buckling. It is important for us to investigate these factors affecting recovery of macular anatomy and function, and thus develop some drugs to improve the macular function recovery.
ObjectiveTo evaluate the correlation between macular microstructure changes and visual outcome before and after scleral buckling for macular-off primary rhegmatogenous retinal detachment (RRD). MethodsA total of 43 eyes in 43 patients with RRD were enrolled in this retrospective study. All patients underwent scleral buckling and the retina was successfully reattached. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were measured for all patients before and at 3 days, 1, 3 and 6 months after surgery. The height of subretinal fluids (SRF), the thickness of retinal neurosensory layer in foveal, and the thickness of outer nuclear layer (ONL) were measured. The microstructure changes of external limiting membrane (ELM), junction line and intermediate line of photoreceptor inner segment/outer segment (IS/OS) were observed. The correlation between morphologic changes in the macular foveal and BCVA on 6 months after surgery were also analyzed. ResultsThe mean preoperative BCVA was 1.18±0.93. The detached retinas had 3 types of SD-OCT images, including normal foveal contour without edema, diffuse edema with ONL cystoids cavities, diffuse edema with ONL cystoids cavities and wave-like ONL. The mean preoperative SRF height was (885.05±493.28) μm. The preoperative mean thickness of retinal neurosensory layer in foveal and ONL in the RRD eyes were thinner than the healthy fellow eyes (t=2.642, 1.895;P < 0.05). The fluids and cystoids cavities were absorbed, retina reattached in all the RRD eyes at 3 days after surgery. SRF had been detected in 100.0%, 93.0%, 77.8%, 46.5% RRD eyes on 3 days, 1 month, 3 months and 6 months after surgery, with heights of (219.00±117.02), (163.51±72.83), (101.27±64.47), (55.69±21.15) μm respectively. There were 3 patterns of residual SRF: diffuse, subfoveal multi-bleb, subfoveal single bleb. Compared with the healthy fellow eyes, there were significant differences in the mean thickness of foveal neurosensory layer (t=-10.658, -8.550, -6.955) and ONL thickness (t=-6.240, -5.424, -3.326, -3.323) at 3 days, 1 month, 3 months and 6 months after surgery(P < 0.05), except for the thickness of foveal neurosensory layer at 6 months after surgery (t=-2.186, P=0.570). The reattached retinas had 4 types of SD-OCT images, including: (1) disrupted ELM, IS/OS line and intermediate line; (2) intact ELM with disrupted IS/OS line and intermediate line; (3) intact ELM and IS/OS line with disrupted intermediate line; (4) intact ELM, IS/OS line and intermediate line. The mean postoperative BCVA at different time points were better than preoperative BCVA (t=-3.12, -4.89, -5.03, -4.53; P < 0.05). The postoperative BCVA of eyes with intact IS/OS was different from that of eyes with disrupted IS/OS at 6 months after surgery (t=2.609, P < 0.05). The preoperative SRF height, thickness of foveal neurosensory layer and ONL were correlated with the BCVA at 6 months after surgery (r=0.817, 0.028, 0.521; P < 0.05). ConclusionsMacular-off RRD eyes had SRF, thinner foveal neurosensory layer and ONL before and after scleral buckling. The disruption of ELM, IS/OS junction line and intermediate line can be seen in most of RRD patients. The thinner foveal neurosensory layer and ONL were correlated with the slow recovery of postoperative BCVA.