Objective To evaluate the relative factors of effect of vitrectomy on corneal endothelial cells. Methods Retrospective analysis of the results of corneal endothelium microscopy performed on 213 eyes of 213 patients undergone vetrectomy operations including single vitrectomy (78 eyes), vitrectomy combined with cataract extraction (135 eyes), silicone oil injection (34 eyes), and C3F8 injection (53 eyes) before and after 1 week, 1 and 3 moths of these surgical procedures. Results There was no significant difference between pre- and postoperative corneal endothelium density in single vitrectomy group and vitrectomy combined with cataract extraction with posterior capsule integrity group (Pgt;0.05). The corneal endothelium density significantly decreased postoperatively in C3F8or silicone oil injection group with broken posterior capsule (Plt;0.05). Conclusion C3F8 and silicone oil may damnify corneal endothelium in patients undergo vitrectom y combined with cataract extraction with broken posterior capsule. (Chin J Ocul Fundus Dis，2004，20：101-103)
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Objective To observe the effects of vitrectomy combined with endotamponade on severe endophthalmitis. Methods The clinical data of 44 patients (44 eyes) of posttraumatic and 22 patients (22 eyes) of postoperative severe endophthalmitis were retrospectively analyzed. All patients were treated by vitrectomy and endotamponade. Intraocular foreign body removal (19 eyes), lens extraction (25 eyes), intraocular lens removal (six eyes) and scleral buckling (16 eyes) were performed. Tamponade with silicone oil (52 eyes) or C3F8 gas (14 eyes) was also performed. Postoperative follow-up ranged from two to 25 months, with the mean of 7-9 months. The visual acuity（VA）and intraocular pressure before and after surgery were comparatively analyzed. Results Inflammation of all the patients were controlled，the effective rate was 5.10%. There was no recurrence and retinal detachment. Among the 66 eyes, postoperative VA of 58 eyes (87.90%) increased,five eyes（7.60%）didn't change and three eyes（4.55%）decreased, the difference was statistically significant（chi;2=45.27，P＜0.05）. The postoperative intraocular pressure was higher than that before surgery，the difference was statistically significant（t=-3.23，P＜0.05）. Conclusions Vitrectomy combined with endotamponade is an effective way to cure severe endophthalmitis. It can improve the visual acuity and intraocular pressure.
Objective To invesligate the treatment of retinal de tachment(RD) after silicone oil tamponades(SOT)． Methods The records of a consecutive series of 32 eyes with redetachment of retina after SOT surgery between 1998 to 2000 were reviewed retrospectively． The surgical techniques used for these cases included remove of silicon oil,peeling of preretinal membrane, retinotomy, endolaser photocoagutation, secondary vitrectomy and C3 F8 tamponades． Results In 28 of 32 eyes the retina was reattached (87．6%)． The postoperative visual acuity was improved in 12 eyes, redused in 4 eyes and remained no change in 16 eyes． The postop erative complications in 6 eyes included secondary glaucoma(3 eyes), hypotony (1 eye) and hyphema (2 eyes)． Conclusion The techniques of preretinal membrane peeling, retinotomy, endophotocoagulation and C3 F8 tamponades can be effectively used in combination to treat the redetachment of retina after the silicone oil tamponades surgery． (Chin J Ocul Fundus Dis,2001,17:214-215)
Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD). Methods The clinical interventional caseseries study included 104 patients (112 eyes) with DTRD, who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas. Among the eyes, there were 6 eyes with iris neovascularization (INV), 1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment. There were no preexisting retinal holes or breaks prior to surgery nor any iatrogenic retinal breaks developed during vitrectomy. Cataract removal combined with intraocular lens implant surgeries were performed on 15 eyes. Followup duration varied from 12 to 65 months (mean: 29 months). Results Subretinal fluid was completely absorbed within 2 months after surgery. In 107 eyes (95.54%), the retina reattached after surgery and remained attached till the end of followup period. Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%), remained unchanged in 14 eyes (12.50%) and got worse in 19 eyes (16.79%). The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes, 66.00% Vs 46 eyes/62 eyes, 74.19%,chi;2=0.89, P=0.344). No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries. Seven (6.25%) eyes showed INV (5 new onset eyes), and none of them developed into NVG. In multivariate logistic regression, factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis ［adjusted odds ratio (OR)=10.2］, low preoperative BCVA (OR=11.1) and low postoperative BCVA (OR=16.7). Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oilor gas tamponade if there are no preoperative or intraoperative retinal breaks, and only using irrigation fluid could access a good longterm prognosis result.
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）
ObjectiveTo evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil. MethodsThe clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed. The patients included 518 males and 303 females. The age was ranged from 1 to 79 years old, with an average of 44.03 years. All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years, with an average of 6.82 months). The incidence, time and causes of retinal re-detachment were analyzed. ResultsRetinal re-detachment occurred in 43 patients (44 eyes, 5.13%). Among these retinal re-detachment in 44 eyes, 23 eyes (52.27%) occurred in 1 week, 13 eyes (29.55%) in 1-4 weeks, 4 eyes (9.08%) in 4-8 weeks, 2 eyes (4.55%) in 8-12 weeks, and 2 eyes (4.55%) more than 12 weeks after silicone oil removal. Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes), residual peripheral vitreous (3 eyes), traction of epiretinal proliferative membrane (18 eyes), new retinal hole (9 eyes), non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes). ConclusionsThe incidence of retinal re-detachment after silicone oil removal is 5.13%. The incidence reduced gradually with the extension of time after removal silicone oil.
Objective To investigate the time and the mechanism of the toxic and side effects of silicone oil on ocular tissues. Methods 19 human eyeballs were examined histopathologically at different time intervals after silicone oil tamponade. Results Microscopic bubbles presumably containing silicone oil were found in sensory retina,RPE,optic nerve, pre and subretinal membrane,iris,anterior chamber angle,and retrocorneal membrane.In the eyes containing silicone oil for less than 9 months.Silicone bubbles were present only in the surface of retina(within preretinal membrane or macrophages),and after that time,silicone bubbles were noted within sensory retina.In an eye enucleated 39 months after intravitreal silicone tamponade,the parenchyma and subarachnoid space of the optic nerve were found to be diffusely invaded by silicone bubbles. Conclusion The histopathologic changes of ocular tissues are related to the duration of intravitreal silicone oil tamponade. (Chin J Ocul Fundus Dis, 1999, 15: 232-234)
Objective To investigate the feasibility of using magnetic resonance imaging (MRI) to measure the visual axis length in silicone oil filled eyeballs. Methods Thirty-two silicone oil-filled eyes of 32 patients were studied. The antesilicone oil spaces (ASS) and retro-silicone oil spaces (RSS) on the visual axis was measured on the cross-sectional T1 weighted images (T1 WI) and T2WI, the length of the visual axis was measured on the fatsuppressed T2WI. The length of the visual axis was the distance from the corneal vertex to the macular fovea, and it was also measured by A-mode ultrasound in sitting position with different ultrasonic velocity. The postoil gap was also measured by A-mode ultrasound in supine position. Results Compared with the signal of the contralateral vitreous body, the silicone oil signal was higher on T1WI images, lower on T2WI images. After fat suppression, the silicone oil signal and chemical shift artifact were reduced. There were different levels of ASS and RSS in the vitreous cavity of all 32 cases, the RSS depth was (2.47plusmn;1.31) mm on average by MRI. However, RSS was detected in only 56.25% (18 cases)eyeballs by A-mode ultrasound. The visual axis length of silicone oil-filled eyes was (23.52plusmn;4.67) mm by MRI, and (20.57plusmn;5.32) mm by A-mode ultrasound in sitting position. The differences between two measurements was statistically significant (t=30.17, P＜0.05). Conclusions In addition to A-mode ultrasound, MRI might be another effective method to detect RSS and ASS, and to measure the axial length of silicone oil-filled eyes.
ObjectiveTo compare the effects of intravitreal tamponade of C3F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy (PDR). MethodsThe clinical data of 121 patients (127 eyes) who underwent primary vitrectomy due to PDR were analyzed retrospectively. All the patients were divided into two groups according to different intravitreal tamponade, including C3F8 tamponade group (53 patients with 56 eyes) and silicone oil tamponade group (68 patients with 71 eyes). There was no difference of gender (χ2=0.956), age (t=1.122), duratiion of diabetes (t=0.627), fasting blood glucose (t=1.049), systolic pressure (t=1.056), diastolic pressure (t=0.517), history of hypertension (χ2=0.356), nephropathy (χ2=1.242), preoperative laser photocoagulation (χ2=1.225) and All the patients underwent three port pars plana vitrectomy. The mean follow-up was 2 years ranging from 6 months to 4 years. And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. ResultsPostoperative vitreous hemorrhage occurred in 14 of 56 eyes (25.00%) in C3F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were (64.64±59.09) days ranging from 7-225 days and mostly were within 30-60 days (35.71%, 5/14). Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes (9.89%) of silicone oil tamponade group after silicone oil removal with an average onset time of (25.29±20.46) days ranging from 3-65 days and were mostly within 15-30 days (42.86%, 3/7). There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups (χ2=5.200, P<0.05). BCVA of the two groups was improved significantly after operation (Z=2.472, 3.114; P<0.05). Postoperative BCVA of silicone oil tamponade group was poorer than C3F8 tamponade group (Z=1.968, P<0.05). ConclusionBoth C3F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR. Compared with C3F8, silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.