We have studied retrospectively 13 eyes with postoperative choroidal detachment of retinal detachment surgery in 126 cases(129 eyes).The frequency of choroidal detachment in this series is 10.1%(13/129).And we found that the middle-aged patients were more common sufferers,and drainaging the subretinal fluid,the extent of retinal degeneration and the buckling procedure might be the related factors to the occurence of postoperative choroidal detachment of retinal detachment surgery. （Chin J Ocul Fundus Dis,1993,9:210-213）
Optical coherence tomography angiography (OCTA) is a new diagnostic technique in recent years based on the optical coherence tomography. It is one of the fastest developing imaging examinations in ophthalmology. Compared with the classic diagnostic methods of fundus fluorescein angiography and indocyanine green angiography, OCTA show the ability to reveal blood flow non-invasively. With the development of modern medical detection technology, the requirement for ophthalmic diagnosis is raised, and many new measurement methods begin to apply in research and clinical, which makes the detection methods in the field of ophthalmology more accurate and comfortable. OCTA is a novel and noninvasive flow imaging technique, and it has the advantages of high resolution, fast scanning, as w ell as quantifying blood flow. Meanwhile, this technique can not only qualitatively analyze the shape of ocular blood vessels, but also be able to measure the ocular blood vessels and blood flow non-invasively, as well as to assess the depth of lesions. At present, with a wide clinical application in ophthalmology, OCTA still has its own superiority and weakness, but with the development of technology. It is believed that the OCTA will be expected to replace the relevant invasive examination methods and become a new tool for ophthalmic imaging.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
Immunogammopathy maculopathy is a newly discovered retinopathy associated with macroglobulinemia in recent years. The main manifestations were retinal vein convulsion and dilation caused by high blood viscosity, retinal interlaminar effusion and macular serous detachment. With the prolongation of the course of disease, the photoreceptor layer and RPE layer in the detachment area showed atrophic changes. The pathogenesis of ophthalmopathy is still unknown. Understanding the clinical features, diagnosis, differential diagnosis and treatment of ophthalmopathy is of great significance for understanding this kind of disease and improving the level of diagnosis and treatment of ophthalmopathy.
The current understanding of lamellar hole-associated epiretinal proliferation (LHEP) is based on OCT examination. This preretinal proliferation is seen at the edge of the lamina macular hole (LMH) as a meso-reflective substance under linear strong reflection, located between the internal limiting membranes and the nerve fiber layer. LHEP is often associated with LMH, but its histological origin, morphology and OCT characteristics are different from LMH, and its visual prognosis is worse. At present, the relationship between the occurrence of LHEP and clinical prognosis is still under study. This article reviews the pathology, morphology, clinical features, diagnosis and treatment of LHEP, in order to enhance clinical understanding of this disease.
Confocal scanning laser ophthalmoscope imaging superimpose two or three kinds of lasers to obtain images of different layers of retina, and then synthesize a pseudo-color fundus image by computer. Confocal scanning laser ophthalmoscope is widely used in outpatient fundus pre-examination and epidemiological screening of large samples due to its features of non-mydriatic, fast imaging, simple operation and high degree of patient cooperation. It has good clinical and scientific application value in the diagnosis and treatment of a variety of fundus diseases. Because of there is still a lack of unified standards for laser fundus photos in China, it is necessary to correctly identify the common fundus lesions in confocal scanning laser ophthalmoscope and to summarize and popularize the method of reading the photos in layers. In addition, we should give full play to the its advantage of layering and locating, and reasonably choose the combination of OCT, OCT angiography, FFA, ICGA, ultrasonography, so as to maximize its clinical application value and help clinical diagnosis.
The treatment for retinoblastoma (RB) has been reached the stage of life-saving and vision-saving care. It is necessary to improve the survival rate and prolong the life time of RB children, retaining the eyeball and improving the quality of life. If the diagnosis is not timely and the treatment is inappropriate, the tumor recurrence, extraocular spread and metastasis of retinoblastoma will occur. The rate of eye protection and the survival chance of RB children will be reduced. With the continuous exploration of RB therapy and the emergence of new treatment methods, how to correctly select and evaluate these treatment methods and to adopt the most safe and effective treatment for RB children, to achieve long-term cure effect, is an important problem which clinicians need to consider.
ObjectiveTo analyze the reasons for the failure of scleral buckling (SB) in the treatment of rhegmatogenous retinal detachment, and observe the efficacy and safety of re-buckling.MethodsThis was a retrospective non-comparative clinical research. From July 2014 to June 2020, patients with first-time SB failure who visited the Beijing Tongren Hospital were included in this study. There were 42 patients, including 30 males and 12 females, with the average age of 29.40±16.13 years, and they were all monocular. The retinal detachment range＜1, 1-2 and＞2 quadrants were 9, 22 and 11 eyes, respectively. The macula was involved in 38 eyes. The average logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) was 0.99±0.57. Forty eyes and 2 eyes were performed 1 and 2 SB, and all the retina were not reattached. All patients were under general anesthesia, according to the conditions during the operation, re-freeze and located the holes under indirect ophthalmoscope. And selected the new external pressure material or retained the old one in combination with the other operations to reattaced the retina. The average follow-up time was 31.93±18.97 months. The reasons for the failure of the first surgery based on the records of this surgery were analyzed. The visual acuity changes, the rate of retinal reattachment and the occurrence of complications were observed. The visual changes were compared by paired t test.ResultsThe top three reasons for the failure were: 16 case of the displacement of the compression spine (38.10%); 9 cases of missing the retinal holes and 9 case of improper selection of compression substances (account for 21.43%, respectively); 6 cases of insufficient height of compression spine (14.29%). All of retina were reattached (100%, 42/42). The average logMAR BCVA was 0.52±0.40. The difference of logMAR BCVA between before and after surgery was statistically significant (t=6.106, P=0.000). There were a slight increase in intraocular pressure in 8 eyes, the average intraocular pressure was 25.00±2.61 mmHg (1 mmHg=0.133 kPa). No serious complications occurred after surgery.ConclusionsThe position deviation of the compression spine, the missed hole during the operation, the improper selection of external compression material, and the insufficient height of the compression spine are the main reasons for the failure of SB. After adjusting the reasons for the failure, there is still a higher rate of retinal reattachment.
Scleral buckling surgery is a main surgical method for rhegmatogenous retinal detachment, and it is the basic skill of retinal surgeons. As a kind of classic treatment, retinal surgeons must recognize and understand the essence and connotation of scleral buckling surgery, master and apply skillfully, improve the success rate of rhegmatogenous retinal detachment, and use the minimum amount of surgical combination to achieve anatomical retinal reattachment and restore visual function as much as possible.
Ciliary body tumor is a rare intraocular tumor. Due to its unique anatomical location, its correct diagnosis and reasonable treatment are very difficult problems. In terms of diagnosis and differential diagnosis, ophthalmologists need to fully utilize the role of slit lamp microscope and transillumination experiment to capture secondary changes in the anterior segment caused by hidden ciliary body tumors, such as monocular localized cataract, lens indentation, and pigment dissemination, etc. Ophthalmological imaging methods, especially ultrasound biomicroscopy, can achieve the purpose of early detection and early diagnosis. According to the size, location and morphological characteristics of the tumor, a reasonable treatment plan is formulated. Since ciliary body tumors are mostly benign, the recurrence rate of local resection is low, which can satisfy the pathological diagnosis and preserve part of the patient's vision. Therefore, eye-preserving treatment should be advocated. However, enucleation remains the treatment of choice for tumors that are too large to be treated with local excision or radiation, eyes with refractory glaucoma, and tumors that do not respond to radiation therapy.