Objective To observe the clinical manifestations, therapeutic efficacy and results of bacterial culture of seven patients of scleral buckle (SB) infection after scleral bulking surgery. Methods Seven patients (seven eyes) underwent SB removal for SB infections were enrolled in this study. The patients included four males (four eyes) and three females (three eyes). The patients aged from 12 to 69 years, with a mean age of 42.7 years. There were four right eyes and three left eyes. The duration (interval between primary surgery and SB removal) ranged from two weeks to ten years, with a mean of 47.5 months. Six patients were concurrent with systemic disease. All the patients were examined for visual acuity, slit lamp microscope and indirect ophthalmoscope examination. Some patients also received external eye examination and fundus photography. Whether SB exposure or not and the clinical manifestations were observed. SB removal was performed in all the patients and the SB were sent to the laboratory for bacterial culture. The follow-up time ranged from two weeks to eight months, with a mean of 3.2 months. Whether infections recurrence and retinal detachment or not were observed. Results SB exposure was in three eyes. Obvious ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes; irritation and discharge were in one eye. No SB exposure was in four eyes. Ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes. Repeated subconjunctival hemorrhage and diplopia were presented in one eye. Visual acuity decline, conjunctival sac discharge and total retinal detachment were in one eye. All patients had no intraocular inflammation. The infection was controlled after SB removal and the retina was attached during the follow-up. The bacterial culture were all positive, which included Staphylococcus aureus, Staphylcoccus epidermidis and Erysipelothrix rhusiopathiae, Gram positive corynebacterium, Aspergillus flavus, Kocuria roseus, Streptococcus oralis, Maxwell Corynebacterium. Conclusions The clinical manifestations of SB infection and the pathogenic microorganisms are variable. SB removal can control the infection.
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.
Objective To measure the changes of eye shape and axial length of the eyeball before and after removing the scleral encircling buckles.Methods This is a prospective and controlled study. Twenty eyes (20 patients) with rhegmatogenous retinal detachment and the fellow eyes were enrolled in this study. All patients underwent scleral encircling buckling, and the buckles were removed 2.0-3.5 years after the surgery. The eye shape and axial length of both eyes were measured by three-dimensional computed tomography (3D-CT) before and one,three,six months after the removing surgery. The axial length was also measured by intraocular lens (IOL) Master.Results 3D-CT showed that buckled eyeball depressed at the equator, resulting in a gourd-shaped eyeball. One month after removing the encircling buckle the depression disappeared. By 3D-CT scanning, the axial lengths of buckled eyes were (27.65plusmn;1.22), (27.3plusmn;1.56), (27.29plusmn;1.46) and (27.12plusmn;1.49) mm before and one, three, six months after the removing surgery respectively. The difference between before and after removing surgery was not statistically significant (t=2.89,P=0.723). By IOLMaster, the axial length of operated eyes were (28.32plusmn;1.94), (28.17plusmn;1.87), (28.21plusmn;1.94), (28.25plusmn;1.93） mm respectively. The difference between before and after removing the encircling band was not statistically significant (t=3.304, P=0.93). There was no significant difference in these two measuring modes (t=3.705,P=0.847).Conclusions Encircling buckling can cause eyeball indentation, removing the encircling band can rescue the indentation. There are no changes in the axial length before and after removing the encircling buckles.
Objective To observe the therapeutic effect of scleral buckling procedure on old retinal detachment. Methods The clinical data of 42 patients (46 eyes), including 24 males (27 eyes) and 18 females (19 eyes), with old retinal detachment treated by scleral buckling procedure in our department were retrospectively reviewed. The duration of the disease ranged from 1 month to 2 years. All the patients were with rhegmatogenous retinal detachment and combined with mainly predominantly-subretinal proliferative vitreoretinopathy (PVR) (stage C), including stage C1 of PVR in 16 eyes (34.8%), stage C2 in 19 eyes (41.3%), and stage C3 in 11 eyes (23.9%). Scleral buckling was performed on 13 eyes (28.3%) and cerclage combined buckling on 33 eyes (71.7%). Sterile air was injected into 36 eyes (78.3%) during the operation, and C 3F 8 was introvitreal injected into 7 eyes (15.2%) after the operation. Results The follow-up duration was from 6 months to 1 year (mean 7.3 months). Retina was completely reattached in 31 eyes (67.4%), and was alleviated obviously in 12 eyes (26.1%). The subretinal fluid increased after the operation with un-reattached retina and vitrectomy was performed in 2 eyes. One eye underwent vitrectomy due to the development of PVR. After the first operation, the curative ratio of retinal detachment was 67.4%, and effective ratio (cure and alleviation) was 93.5%. The visual acuity improved in 28 eyes (60.9%), kept no change in 11 eyes (23.9%), and decreased in 7 eyes (15.2%). Conclusion Reattachment of retina and improvement of visual acuity can be achieved in some degree in some patients with old retinal detachment who undergo simple scleral buckling procedure without vitrectomy. (Chin J Ocul Fundus Dis, 2006, 22: 35-38)
Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)
Objective To evaluate the causes of the metamorphopsia in patients with reattached retina after scleral buckling surgery. Methods Amsler grid test, ophthalmoscopic examination, fundus fluores cein angiography (FFA) and optical coherence tomography (OCT) were performed on 79 patients (79 eyes) with reattached retina at the 2nd week, 2nd, 6th month and 1st year after scleral buckling operation. Results Two weeks after the operation, 51 patients (51 eyes, 64.56%) complained of metamorphopsia,and 44 patients (44 eyes, including 35 with and 9 without metamorphopsia) were examined by OCT and FFA. In patients with metamorphopsia, the results of OCT in 31 (88.57%) revealed abnormal macula with seven kinds consisting mostly of stratum neuroepithelium detachment (74.29%), while of FFA in 6 patients showed abnormal macular (17.14%) including 4 with neuroepithelium detachment (66.67%). In patients without metamorphopsia, abnormal macula could be found in 2 by OCT while nothing special was seen in FFA. Most abnormal macula in patients followed-up 2 months, 6 months and 1 year postoperatively meliorated as time went by, with alleviative or disappeared metamorphopsia; while the patients with persistently existing macular membrane had aggravating metamorphopsia. Conclusions Abnormal macula is the main reason for metamorphopsia after scleral buckling surgery. Neuroepithelium detachment and macular membrane are the main causes of metamorphopsia at the early and terminal stage after operation.(Chin J Ocul Fundus Dis，2004，20：94-97)
Objective To investigate the technique of drain-air, cryotherapy, and explant (DACE) of operation for superior bullous retinal detachment (SBRD).Methods In the DACE procedure, drainage and air or balanced salt soultion (BSS) injection were carried out first, with the intention of flattening the retina before localization of retinal hole, cryotherapy out of choroid and scleral buckling.Results In 42 SBRD eyes, 40 underwent the operation with DACE technique. In 23 eyes injected with BSS instead of air, 5 should be injected air due to no avail for flattening deeply retinal detachment, and 1 needed scleral buckling due to new retinal tear after DACE procedure two weeks. During the follow-up, all retinae attached. Conclusions The DACE technique is very useful and effective in upper ballooned retinal detachment due to single hole or breaks localized in small area between the 10 and 2 o′clock meridiant. BSS instead of air injection can eliminate the difficulty of observation of retinal breaks from the presence of air in some cases. (Chin J Ocul Fundus Dis，2003，19：11-13)
Objective To verify the significance of the morphological changes of the macula and its relationship to visual function by using optical coherence tomography (OCT) after scleral buckling procdure. Methods The macula of retinae of 68 patients (70 eyes) with reattached retinae after scleral buckling operation for retinal detachment were examined by OCT to scan the macula through fovea vertically and horizontally. Results Among the 70 eyes, 22 eyes revealed normal macula with thickness of neurosensory retina meant (146.47±20.59)μm. In the other 48 eyes (68.60%) with abnormal macula, 19 eyes showed extensive subretinal interspace, 9 eyes showed local subretinal interspace, 8 eyes showed macula edema, 4 eyes showed thin macula, 4 eyes showed subretinal proliferation and 4 eye showed epiretinal membrane over macula. In the normal macular structure group under the OCT, the visual acuity (VA) of the operated eyes was more than 0.3 in 6 eyes 2 weeks after operation and in 14 eyes 3 mons after operation. In the macula edema group, the VA was more than 0.3 in 1 eye 2 weeks after opoeration and 2 eyes 3 mons after operation. In the subretinal interspace group, the VA was more than 0.3 in 5 eyes 2 weeks after operation and in 23 eyes 3 mons after operation. The proportions of the numbers of operated eyes with the VA more than 0.3 after 3 mons of the operation in macular normal group subretinal interspace group and other macular disease group were significantly different (χ2=18.91, P＜0.01). Conclusion OCT can precisely detect the structural changes of macula after retinal reattachment and assess visual function after surgery of retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 266-268)
Objectivｅ To investigate the histopathologic charact eristic of the vitreous herniation out of sclerotomy site during vitrectomy. Methods Twenty specimens of tissues herniated at vitrectomy site were collected. The paraffin sections or fresh smears were stained with hematoxylineosin and examined under light microscope. The specimens were collected from the affected eyes with rhegmatogenous retinal detachment (9 cases), traumatic retinal detachment (1 case), miscellaneous vitreous hemorrhage (6 cases) and intraocular foreign body (4 cases). Results The herniated tissues were found to be retina in 4 cases, ciliary tissue in 1 case, retina and ciliary tissue in 1 case, uvea in 1 case, and hyaloid tissue in 13 cases. Conclusion There were not only vitreous, ciliary epithelial cells and pigment containe depithelia, but also ciliary body, retina and uvea in the prolapsed tissues of sclerotomy site, which might be related to the occurence of some clinical complications. (Chin J Ocul Fundus Dis,2001,17:99-101)
Objective To investigate the refractive changes of ocular measurable factors due to scleral buckling surgery. Methods A total of 86 eyes of successful rhegmatogenous retinal detachment with a higher encircling scleral buckle underwent A-scan and keratometer examination before surgery as well as l week,4 and 12 weeks after surgery.The refractive factors included the depth of anterior chamber,thickness of lens,axial length of eye,corneal curvature and refraction of eye were detected pre- and post-operatively. Results Compared with preoperation,the depth of anterior chamber was decreased significantly at the lst,4th and 12th postoperative week(P＜0.05),while no significant change of the axial length of eye was observed.The thickness of lens was increased significantly and the refractive error was myopic shifted at the lst and 4th week after operation(P＜0.05),but no significant change was observed at the 12th postoperative week.Statistically significant difference was also observed in corneal curvature of central axis in the local bucklele;1 quadrant with encircling group between preoperation and the lst and 4th postoperative week. Conclusions With higher encircling scleral buckle,the refractive change after buckling surgery may be caused primarily by the shallowing of anterior chamber and thickening of lens. (Chin J Ocul Fundus Dis, 1999, 15: 227-229)