ObjectiveTo observe the effect and complications of vitrectomy combined with intraocular silicon oil or C3F8 filling for proliferative diabetic retinopathy (PDR). MethodsEighty-six consecutive patients (101 eyes) with PDR-related vitreous hemorrhage who underwent primary standard three-port vitrectomy and intraocular tamponade of silicone oil or C3F8 were included in this retrospective study. They were divided into silicone oil group and C3F8 groups. There was no statistically significant difference between these two groups of patients for gender, age, duration of diabetes, fasting glucose, history of hypertension, diabetic kidney disease history, history of cardiac and vascular diseases, body mass index and smoking history. There was statistically significant difference between these two groups of patients for visual acuity (Z=-2.604, P=0.009). There was no statistically significant difference between these two groups of patients for intraocular pressure before surgery (Z=0.064, P=0.949). The mean follow-up was (20.3±16.4) months with a range from 1 to 47 months. The patients were followed up for visual acuity, intraocular pressure, neovascular glaucoma (NVG), the incidence of retinal detachment, recurrent vitreous hemorrhage, and repeated operation for complications. ResultsVisual acuity (t=-3.932, -8.326; P=0.000, 0.000) and intraocular pressure (t=-3.159, -2.703; P=0.006, 0.009) were changed significantly after surgery for both groups. Between these two groups after surgery, there were significant differences of visual acuity (Z=-1.879, P=0.040), intraocular pressure (Z=-3.593, P=0.000), and complications (revision operation, retinal detachment, recurrent vitreous hemorrhage and NVG) (t=-2.777, -2.102, -2.308, -2.013; P < 0.05). ConclusionIntraocular silicone oil tamponade can reduce the postoperative complications of PDR, especially for severe retinal neovascularization, exudation associated with retinal edema.
Purpose To evaluate the efficacy of vitreous surgery and endolaser in a series of patients with retinal vein occlusion(RVO)with vitreous hemorrhage,neovascular membranes(NVM) and/or traction retinal detachment(TRD). Methods Clinical records were reviewed on 37 consecutive patients(38 eyes)who underwent vitreous surgery and endolaser for RVO with persistent vitreous hemorrhage,NVM and/or TRD.There were 19 patients(20 eyes)with retinal branch vein occlusion (BRVO)and 18 patients(18 eyes)with central retinal vein occlusion(CRVO). Results NVM and TRD were confirmed during operation in 27 and 23 eyes,respectively.Visual acuity improved postoperatively in 34 eyes(89.5%)including 22 eyes with 0.1 or better vision,and 4 eyes remained unchanged.CRVO group had longer history and less visual improvement after surgery. Conclusions Vitreous surgery and endolaser photocoagulation can improve the outcome in the majority of patients with RVO with vitreous hemorrage,NVM and/or TRD. (Chin J Ocul Fundus Dis,1998,14:3-6)
ObjectiveTo observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).MethodsRetrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.ResultsOf the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ2=5.741, 8.103; P＜0.05). There was no significant difference in age (t=－1.364), duration of diabetes (t=0.538), preoperative vision (t=1.897), preoperative fasting blood glucose level (t=1.938), preoperative postprandial blood glucose level (t=1.508), preoperative systolic blood pressure (t=－0.571), preoperative diastolic blood pressure (t=0.275), whether received laser treatment (χ2=2.678), the number of laser points during operation (t=0.565), whether received lens removal during operation (χ2=0.331), whether found new blood vessels during operation (χ2=2.741) and whether received intraocular filling during operation (χ2=0.060) between the patients with and without PVH (P＞0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (rs=0.208, 0.229, 0.240, 0.285; P＜0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P＜0.05).ConclusionFundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.
Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age-related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air-fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow-up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy-sand-hemorrhage in anterior chamber occurred in 4(28.6%)of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age-related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell-glaucoma or retinal detachment. (Chin J Ocul Fundus Dis,2000,16:217-219)
ObjectiveTo observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery.MethodsProspective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups (t=－24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=－1.144, P=0.258), logMAR BCVA (t=－0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation.ResultsAt 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups (t=－4.980, －4.840, －4.892, －5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups (χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant (t=－2.622, －2.638, －3.613, －3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation.ConclusionsIntravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA.
Objective To investigate the effects and complications of the vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment. Methods Seventy-seven eyes of 69 cases undergoing vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment were analyzed retrospectively. Results (1) The postoperative visual acuity was enhanced significantly. (2) Complications during the operation in 11 eyes (14.3%): iatrogenic retinal break in 7 eyes, bleeding in 3 eyes and lens damage in 1 eye. (3) Postoperative complications in 20 eyes (26.0%): rebleeding in 14 eyes, elevated IOP in 6 eyes, retinal detachment in 5 eyes, hyphema in 2 eyes, and exudative membrane in anterior chamber in 1 eye. (4) The main long-term complication was cataract formation (9 eyes) and macular disorder (6 eyes). Conclusion Vitrectomy is an effective method to treat Eales′ disease with vitreous hemorrhage or traction retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 215-217)