Objective To observe the clinical effect of conventional vitrectomy using transconjunctival sutureless 20 Gauge (20G) trocar. Methods The clinical data of 62 patients (63 eyes) who had undergone vitrectomy were retrospectively analyzed. The patients were divided into 2 groups according to the surgery methods. Group A: conventional vitrectomy using transconjunctival sutureless 20G trocar were performed on 33 cases (34 eyes) including 19 males (20 eyes) and 14 females (14 eyes). The patients aged from 17 to 75 years with the average age of 52.3 years. The average visual acuity was 0.04 and the average intraocular pressure was 18.25 mm Hg (1 mm Hg=0.133 kPa). Included were 13 cases of diabetic retinopathy, 9 cases of vitreous hemorrhage, 2 cases of silicone oil removal and tearing membrane off, 9 cases of complex retinal detachment, and 1 case of tearing epiretinal macular membrane. Group B: 20G conventional incision vitrectomy was performed on 29 cases (29 eyes) including 13 males (13 eyes) and 16 females (16 eyes) aged from 24 to 69 years with the average age of 49.5 years. The average visual acuity was 0.02 and the average intraocular pressure was 17.50 mm Hg. Included were 10 cases of diabetic retinopathy, 8 cases of vitreous hemorrhage, 5 cases of retinal detachment, 2 cases of longstanding retinal detachment performed with vitrectomy and scleral buckling, and 4 cases of silicone oil removal and tearing membrane off and intravitreal injection of expanding gases. Within group A, 21 eyes were treated with intraocular laser photocoagulation, 9 eyes were treated with scleral cryosurgery to block the hole, 3 eyes were treated with intravitreal injection of expanding gases, and 15 eyes were injected with silicone oil. Leakage of incision, incidence of iatrogenic holes and comfort of patients after operation were recorded and analyzed. All data were analyzed by chi;2 test statistical analysis. Results In group A, 31 eyes had a good degree of comfort without incision leakage and did not need special treatment; 3 eyes filled with inert gas needed suppression for 3 to 5 minutes, and had gas spill from the temporal incision, which needed to be sutured once. In group B, all incisions were sutured with 8.0 silk suture without any incision leakage, whileforeign body sensation and irritation was apparent. Difference on the degree of comfort in the two groups was statistically significant (chi;2 =50.56,Plt;0.01). No eyes in group A generated iatrogenic hole, while 2 eyes in group B generated ora serrata slit pores next to the puncture. Compared with each other, there was a significant statistical difference (chi;2=4.15,Plt;0.05). Conclusion Conventional vitrectomy using transconjunctival sutureless 20G trocar made the vitrectomy simpler and quicker and can reduce the incidence of iatrogenic hole significantly.
Objective To investigate the effect of prophylactic 360°laser retinopexy on retinal redetachment after silicone oil removal. Methods The clinical data of 181 vitreoretinal patients after silicone oil removal were retrospectively analyzed. In 88 patients (photocoagulation group) was taken prophylactic 360-degree laser retinopexy before silicone oil removal; in 93 patients (control group) without prophylactic laser retinopexy. The incidence, time, the cause of retinal redetachment and the complications of laser retinopexy after silicone oil removal in two groups were observed. Results The duration of silicone oil tamponade is 4~72 weeks, averaging 13.7±2.4 weeks. 20 cases of retinal redetachment were recorded after silicone oil removal, including 5 cases (5.7%) in photocoagulation group and 15 cases (16.1%) in control group. The difference between two groups is statistically significant (Plt;0.05). Among these 20 patients with retinal redetachment, 10 occured during the first 3 days after the operation, 6 during 4~7 days, 3 during 8~14 days. 1 case occured 2 months after the operation. 11 cases of redetachment result from the omission of small retinal breaks located in ora serrata or behind the photocoagulation zone, or the reopening of primary retinal breaks because of insufficient photocoagulation and freezing during the operation. 1 case result from the hole that come from laser photocoagulation scar tracted by nearby proliferative tissue. 7 cases result from the formation of new breaks from the proliferative vitreoretinopathy(PVR) or proliferation of residual vitreous. There are 52 cases of burning of pupillary border, with the incidence of 59%. Conclusions Prophylactic 360-degree laser retinopexy is associated with a decrease of the incidence of retinal redetachment after removal of silicone oil. （Chin J Ocul Fundus Dis，2008，24：283-285）
Objective To evaluate the anatomical and functional results of retinotomy in treatment of complicated retinal detachment. Methods Twenty-three eyes were treated with retinectomy during vitrectomy for complicated retinal detachment with proliferative vitreoretinopathy when complete reattachment of retina was not obtained despite careful mambrane peeling. After released the peripheral vitreoretinal contraction or pulled subretinal membranes, perfluorocarbon liquid injection, laser retinopexy and silicone oil tamponade were performed. Retinotomy size ranged from 30-degree to 360-degree (average 132-degree). Results Retinal attachment were obtained in all of the operated eyes at the end of the operation. Silicone oil was removed from 15 eyes (65．0%) within 3～11 months postoperatively. After a minimum follow-up of 6 months, the retinae were completely attached in 17 eyes ( silicone oil was not removed in 4 eyes ) and visual acuity of 0.02 or better was obtained in 11 eye (48．0%). Recurrent retinal detachment occurred in 2 eyes in which the silicone oil had been removed. The major complications were recurrence of the proliferation in 6 eyes (26．0%) and hypotony in 3 eyes (13．0%). Conclusion Retinotomy is beneficial to reattach the retina for eyes with advanced proliferative vitreoretinopathy in seemin gly inoperable cases. (Chin J Ocul Fundus Dis,2001,17:87-89)