Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,23:234-237)
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,231-233)
Objective To analyze the reasons, methods of treatment, and effects on prognosis of vitreous hemorrhage after vitrectomy in patients with diabetic retinopathy. Methods The clinical data of 98 patients (122 eyes) with diabetic retinopathy (VI stage) who had undergone vitrectomy were retrospectively analyzed. Results Post-vitrectomy vitreous hemorrhage (gt;grade 2) was found in 25 eyes with the occurrence of 20.5%, in which the hemorrhage occurred 1 week after the surgery in 8 eyes, 1 week to 1 month in 6 eyes, and more than 1 month in 11 eyes. In the 25 eyes, C3F8 tamponade eyes occupied 31.1%, silicone oil tamponade eyes occupied 6.1%, air tamponade eyes occupied 33.3%, and infusion solution tamponade eyes occupied 26.3%. Peripheral fibrovascular proliferation was found in 9 eyes. In the 3 eyes with silicone oil tamponade, the hemorrhage was absorbed in 2, and epiretinal membrane was found in 1 which was moved when the silicon oil was taken out. In the 22 eyes without silicone oil tamponade, the hemorrhage was absorbed in 6 and aggravated in 2 without any timely treatment, neovascular glaucoma occurred in 1, and wide vitreo-retinal proliferation and retinal detachment was observed in 1 with the visual acuity of no light perception. Operations such as fluid-air exchange, vitrectomy were performed on 14 eyes 2 weeks after the hemorrhage absorption stopped. Recurrent vitreous hemorrhage was not found in 12 eyes after single operation. At the end of the follow up period, the visual acuity was no light perception in 3 eyes, hand moving in 2 eyes, counting finger-0.1 in 10 eyes, under 0.3 in 4 eyes, and over 0.3 in 6 eyes. Conclusion Most of the patients with vitreous hemorrhage after vitrectomy due to DR had peripheral fibrovascular proliferation. The visual prognosis after re-operation is good. (Chin J Ocul Fundus Dis,2007,23:241-243)
Objective To analyze the pathogeny of vitreous re-hemorrhage in proliferative diabetic retinopathy (PDR) after vitrectomy, and to evaluate the treatment effects. Methods The clinical data of 315 eyes of 302 patients with PDR who had undergone vitrectomy were retrospectively analyzed. Thirty-two eyes with vitreous re-hemorrhage after the treatment had undergone vitrectomy again. The follow-up duration was 3-48 months (average 12 months). Results The occurrence of vitreous hemorrhage after vitrectomy was 10%. The reasons included fibrovascular ingrowth at the sclera incision (28%), residual neovascularization membrane or inappropriately treated vascular stump on the surface of optic nerve (19%), insufficient photocoagulation on retina (22%), residual epiretinal neovascularization membrane (9%), retinal vein occlusion (6%), and ocular trauma (16%). Re-hemorrhage occurred 1-210 days (average 51 days) after vitrectomy. The patients with re-hemorrhage underwent cryotherapy for fibrovascular at the incision site, removal of residual neovascularization membrane on the optic nerve and retina, electrocoagulation of the vascular stump, complementary retinal photocoagulation and binding up of two eyes. After the re-treatment, the visual acuity increased in 91% and decreased in 9%. The postoperative complications mainly included vitreous re-hemorrhage, posterior synechia of the iris, lens sclerosis, and delayed healing of corneal epithelium. Conclusion The main reasons of vitreous re-hemorrhage after vitrectomy in patients with PDR include fibrovascular ingrowth at sclera incision, residual neovascularization membrane or inappropriately treated vascular stump on the surface of optic nerve, insufficient photocoagulation on retina, residual epiretinal neovascularization membrane, retinal vein occlusion, and ocular trauma. The efficient methods in preventing and treating re-hemorrhage after vitrectomy are appropriate management of insection sites, completely removal of residual neovascularization membrane on the optic nerve and retina, electrocoagulation of the vessel stump and sufficient retinal photocoagulation. (Chin J Ocul Fundus Dis,238-240)
Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy (PDR) in patients with type 1 and type 2 diabetes mellitus (DM). Methods Retrospectively analyzed the clinical data of 451 patients with DM (71 with type 1 and 380 with type 2) who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre-and post-operative visual acuity, progression and regression of iris neovascular (INV), neovascular glaucoma (NVG), and the reattached and being attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients: the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% (46/71) in type 1 DM patients and 72.4% (275/380) in type 2 DM patients (P=0.196). There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60.0% in type 2 DM group (P＝0.678);the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group (P＝0.822). The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after on off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM (P＝0.611); the rate of retina being-attachment after one-off surgery were 90.1% in type 1 DM group and 93.4% in type 2 DM group, respectively (P＝0.323). Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR. (Chin J Ocul Fundus Dis,2007,23:248-251)
Objective To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR). Methods Retrospectively analyzed the follow-up data of 882 patients (1000 eyes) with PDR who had undergone vitreoretinal surgery. The standard of NLP was: in a darkroom, one eye was covered, and the other one could not catch the candlelight 30 cm in front of the eye. The number of eyes with NLP was counted and the clinical data of the eyes with or without NLP were analyzed and compared. chi;2 test was used to analyze the risk factors of NLP. Results In these 1000 eyes with PDR,the postoperative visual acuity was NLP in 22 eyes (2.2%) and light perception in 978 eyes (97.8%). Comparing with the patients with light perception, the patients with NLP had severer disease condition, including ante-operative neovascular glaucoma (NVG)(36.4%), tension combined with retinal detachment 50%, and a need for lens excision during the surgery (45.5%) and for silicone oil filling at the end of the operation (63.6%). After the surgery, NVG was found in 14 eyes, un-reattached retina in 5 eyes (before the surgery was VI stage of PDR), and optic nerve atrophy and retinal vessel atresia in 3 eyes, which significantly differed from which in the patients with light perception (Plt;0.001，P=0.004, (Plt;0.001). The differences of sex, diabetes type and PDR stage between the NLP group and non-NLP group were not significant (P=0.136, P=0.681, P=0.955). Conclusions The incidence of NLP after vitreoretinal surgery for proliferative diabetic retinopathy is low. The direct causes were NVG, optic nerve atrophy, retinal vessel atresia and retinal redetachment, while the sex, type of diabetes mellitus and stage of PDR show no statistical relation to the occurrence of NLP after surgery. (Chin J Ocul Fundus Dis,2007,23:244-247)
Objective To investigate the characteristics and risk factors of optic nerve atrophy in eyes with complicated retinal detachment after silicone oil tamponade during the procedure of vitreoretinal operation. Methods The clinical data of 97 patients with complicated retinal detachment who had optic nerve atrophy after silicone oil tamponade during the procedure of vitreoretinal operation were an alyzed retrospectively. Logistic regression analysis by SPSS statistical software was used to analyze the factors like age, disease history, primary diseases, preoperative ocular condition, complications in and after the operation, the time taking out the silicone oil, and emulsification of the silicone oil, and Ple;0.05 was considered to be the symbol of significant difference. Results All of the affected eyes had optic discs with clear border, including paler optic disc in 65 eyes, pale one in 21 eyes, and paler optic disc with enlargement of the cup/disc (ge; 0.6) in 11 eyes. The result of logistic regression analysis showed that the intraocular pressure (P=0.022) and the visual acuity (P=0.001) during the silicone oil removal were in the equation. Conclusion The risk factor of optic nerve atrophy is the chronic increase of intraocular pressure after silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22: 305-307)
Objective To investigate the effect of long-term intraocular retention of domestic perfluorocarbon liquid (PFCL) on morphology and histology of ocular tissues. Methods A total of 18 New-Zealand rabbits were randomly divided into 3 experimental groups, whose left eyes underwent intraocular injection with 0.3, 0.6, and 1.0 ml PFCL, respectively. All of the right eyes of the rabbits were in the control group. The morphological, electrophysiological and histological changes of the ocular tissue were observed 4, 8, and 12 weeks after the injection. Results No clinically significant retinopathy but only mild morphological changes were found in group 1 and 2, while obvious morphological and histological changes were found in group 3. Mild morphological and histological changes were found in all of the rabbits 4-8 weeks after the injection while significant ones were found 8-12 weeks after the injection. The results of electroretinography indicated a statistically significant decline of amplitude of b wave in group 3. Conclusions Long-term intraocular retention of few PFCL may cause mild histological changes but not affect the clinical function. Plentiful PFCL remains in eyes may lead to toxic reaction to the ocular tissue. (Chin J Ocul Fundus Dis, 2006, 22: 128-130)