Retinal detachment

视网膜脱离
  • 文章类型: Journal Article
    描述在5期家族性渗出性玻璃体视网膜病变(FEVR)伴漏斗状视网膜脱离(RD)的玻璃体切除术期间,氰基丙烯酸酯胶在封闭医源性视网膜破裂(IRB)中的作用。
    从2020年7月至2022年1月,在玻璃体切除术期间,诊断为5期FEVR的9例患者的9只眼睛用氰基丙烯酸酯胶治疗IRB。临床记录,包括病人信息,手术过程,和后续检查,是回顾性收集的。总结了解剖学结果和视觉结果。
    手术平均年龄为19.6个月(范围:3.8-41.1个月)。术后平均随访时间为12.5个月(范围:9.8-18.8个月)。手术前,五只眼睛的RD为开放漏斗,四只眼睛的RD为封闭漏斗。在九只眼睛中尽可能彻底地去除所有视网膜前纤维增生膜。IRB在两只眼睛的后极和七只眼睛的周边视网膜形成。所有的IRB在它们出现时被氰基丙烯酸酯胶成功地密封。在手术后的最后一次访问中,八只眼睛有部分视网膜复位,没有纤维化组织的进展,一只眼睛完全视网膜再脱离。在这项研究中,稳定的解剖学结局率为88.9%(8/9)。可用于七只眼睛的视觉测试显示了五只眼睛的光感知,两只眼睛没有光感知。随访期间未发现严重的围手术期胶水相关并发症。
    氰基丙烯酸酯胶的应用可能是5期FEVR手术中IRB的替代疗法,而长期疗效和安全性仍需进一步研究。
    UNASSIGNED: To describe the role of cyanoacrylate glue in sealing iatrogenic retinal breaks (IRBs) during vitrectomy in stage 5 familial exudative vitreoretinopathy (FEVR) with funneled retinal detachment (RD).
    UNASSIGNED: Nine eyes of nine patients diagnosed as stage 5 FEVR were treated with cyanoacrylate glue for IRBs during vitrectomy from July 2020 to January 2022. The clinical records, including patient information, surgical process, and follow-up examinations, were collected retrospectively. Anatomical outcomes and visual outcomes were summarized.
    UNASSIGNED: The average age at surgery was 19.6 months (range: 3.8-41.1 months). The mean post-operative follow-up period was 12.5 months (range: 9.8-18.8 months). Before surgery, five eyes had an open-funnel RD and four eyes had a closed-funnel RD. All the preretinal fibroplasia membranes were removed as thoroughly as possible in the nine eyes. IRBs formed at the posterior pole in two eyes and peripheral retina in seven eyes. All the IRBs were sealed successfully by the cyanoacrylate glue when they appeared. At the final post-operative visit, eight eyes had partial retinal reattachment without progression of fibroplasia tissues, while one eye had total retinal redetachment. The rate for stable anatomical outcome was 88.9% (8/9) in this study. The visual testing available for seven eyes demonstrated light perception in five eyes and no light perception in two eyes. No severe perioperative glue-related complications were noted during the follow-ups.
    UNASSIGNED: The application of cyanoacrylate glue may be an alternative therapy for IRBs in stage 5 FEVR surgeries, while the long-term efficacy and safety still need further investigation.
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  • 文章类型: Journal Article
    目的:我们的研究旨在评估节段性巩膜扣带术(SB)治疗视网膜脱离(RD)的手术效果和临床特征,阐明分段SB作为当前时代特定情况下的重要选择的作用。
    方法:我们回顾性回顾了2008年11月至2020年12月间接受节段性巩膜扣带术的128眼原发性孔源性RD。记录并分析临床特征和成功率。
    结果:共纳入128只眼。病人的年龄从12岁到72岁不等,平均年龄为45岁。大多数眼睛是有晶状体的(97%)。关于休息的类型,47%是洞,皮瓣撕裂68例(53%)。中断位置是时间上的(54%),下时间(31%),上鼻部(9.5%),和下鼻(5.5%)。适用的SB的长度范围为3.5至8.0小时,中位数为6.0。121只眼睛取得了初步成功,7只眼复发。所有复发性RD病例在接受继发性VT后重新连接。失败的原因包括2次中断重新打开,1错过休息,增生性玻璃体视网膜病变4只眼。节段SB的单次手术解剖成功率(SSAS)为94.5%。最终成功率为100%。
    结论:对于phakic,在我们的研究中,复杂性低的视网膜脱离,节段性巩膜扣带术是一种手术选择,具有较高的主要成功率和较低的并发症发生率。
    OBJECTIVE: Our study aims to evaluate the surgical outcomes and clinical features of retinal detachment (RD) cases treated with segmental scleral buckling (SB), elucidating the role of segmental SB as a vital option in specific situations during the current era.
    METHODS: We retrospectively reviewed 128 eyes with primary rhegmatogenous RD that underwent segmental scleral buckling between November 2008 and December 2020. Clinical features and success rates were recorded and analyzed.
    RESULTS: A total of 128 eyes were included. The patient\'s ages ranged from 12 to 72 years, with a median age of 45. Most of the eyes were phakic (97%). Regarding the type of break, 47% were holes, and flap tears were found in 68 cases (53%). The break locations were superior-temporal (54%), inferior-temporal (31%), superior-nasal (9.5%), and inferior-nasal (5.5%). The length of the SB applied ranged from 3.5 to 8.0 clock hours, with a median of 6.0. Primary success was achieved in 121 eyes, and recurrence occurred in 7 eyes. All recurrent RD cases reattached after undergoing secondary VT. The causes of failure included 2 break reopens, 1 missed break, and 4 eyes with proliferative vitreoretinopathy. The single-surgery anatomic success (SSAS) rate for segmental SB was 94.5%. The final success rate was 100%.
    CONCLUSIONS: For phakic, low complexity retinal detachment in our study, segmental scleral buckling emerges as a surgical option with a high primary success rate and a lower incidence of complications.
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  • 文章类型: Journal Article
    为了评估视网膜脱离(RD)的延迟表现,其从旅行距离到转诊医院(TDH)的关联,从症状发作到咨询(SO-C)的时期,增生性玻璃体视网膜病变(PVR)严重程度,6个月随访(6mo-FA)。
    基于病历的回顾性审查。年龄,性别,初始最佳矫正视力(BCVA),TDH,SO-C,PVR型,记录6mo-FA。采用多变量有序logistic回归分析TDH与SO-C之间的关联,以及SO-C和PVR严重程度。根据TDH采用多因素logistic回归分析6mo-FA。多元线性回归用于评估初始BCVA和TDH之间的关联。年龄和性别包括在所有多变量校正中。
    共有387例患者有RD,其中59.2%主要为男性,平均年龄±SD为46.3±13.9岁。小于3/60的初始BCVA为81.1%。SO-C和TDH的平均值为183.5±456天和160.9±364km,分别。超过120km距离的TDH与较长的SO-C显着相关(校正OR1.78;CI95%1.09-2.92)。17.6%的患者发现PVR。31-60天的SO-C与PVR严重程度显着相关(校正OR4.28;CI95%1.47-12.51)。超过120km距离的TDH与6mo-FA显着相关(校正OR0.46;CI95%0.27-0.93)。
    长TDH与从症状发作到咨询和6mo-FA的较长时间显着相关。因此,可获得的眼部护理对于及时转诊RD病例至关重要。
    UNASSIGNED: To assess the delayed presentation of Retinal Detachment (RD), its association from travel distance to the referral hospital (TDH), the period from symptom onset to consultation (SO-C), Proliferative vitreoretinopathy (PVR) severity, and 6 months follow-up attendance (6mo-FA).
    UNASSIGNED: A retrospective review based on medical records. Age, sex, initial best-corrected visual acuity (BCVA), TDH, SO-C, PVR type, and 6mo-FA were recorded. Multivariable ordered logistic regression was used to analyze the association between TDH and SO-C, and SO-C and PVR severity. Multivariable logistic regression was used to analyze 6mo-FA according to TDH. Multiple linear regression was used to assess the association between initial BCVA and TDH. Age and sex were included in all multivariable adjustments.
    UNASSIGNED: A total of 387 patients had RD with 59.2% predominantly males and the mean age±SD was 46.3±13.9 years. The initial BCVA of less than 3/60 was 81.1%. The averages of SO-C and TDH were 183.5±456 days and 160.9±364 km, respectively. The TDH of more than 120 km distance was significantly associated with longer SO-C (adjusted OR 1.78; CI 95% 1.09-2.92). PVR was noted in 17.6% of patients. The SO-C of 31-60 days was significantly associated with PVR severity (adjusted OR 4.28; CI 95% 1.47-12.51). The TDH of more than 120 km distance was significantly associated with 6mo-FA (adjusted OR 0.46; CI 95% 0.27-0.93).
    UNASSIGNED: Long TDH was significantly associated with a longer period from symptom onset to consultation and 6mo-FA. Hence, accessible eye care is essential to refer RD cases in a timely fashion.
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  • 文章类型: Case Reports
    一个12岁的男孩,患有与特应性结膜炎和鼻炎相关的严重且控制不佳的特应性皮炎(AD),表现为右无痛视力模糊两周。在检查中,右眼视力为1/60,1级相对传入瞳孔缺损(RAPD)。前节检查显示前葡萄膜炎伴有致密的后囊下白内障和模糊的眼底视图。B超提示浅的全视网膜脱离。术中,发现了大量的视网膜透析。本文强调了患有潜在AD的儿童对视网膜透析的高度怀疑的必要性,以及良好控制这种全身状况以预防眼部发病的重要性。
    A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right painless blurring of vision for two weeks. On examination, his right eye visual acuity was 1/60,with grade 1 relative afferent pupillary defect (RAPD). Anterior segment examination revealed anterior uveitis with dense posterior subcapsular cataract and hazy fundus view. B-scan ultrasound suggested a shallow total retinal detachment. Intraoperatively, a large retinal dialysis was found. This paper highlights the need for a high index of suspicion of retinal dialysis in a child with underlying AD and the importance of good control of this systemic condition to prevent ocular morbidity.
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  • 文章类型: Journal Article
    目的:本研究的目的是阐明急性视网膜坏死(ARN)综合征患者预防性玻璃体切除术后视网膜脱离(RD)发生的因素。
    方法:进行回顾性检查,包括2019年10月至2023年9月在武汉大学人民医院东校区眼科接受预防性玻璃体干预的ARN患者的医疗记录.随后,确定在术后期间出现RD的患者,并进行了综合分析,以确定术后RD发生的潜在因素。
    结果:本研究包括14例(涉及14只眼)接受预防性玻璃体干预的ARN患者。结果显示,4例患者发生术后RD,发病率为28.57%。值得注意的是,在这些案件中,3例RD表现为硅油的存在,而1例发生在硅油取出后。4例RD均表现为不同程度的增生性玻璃体视网膜病变。RD发生后,所有患者都接受了二次玻璃体介入以及硅油填塞,导致视网膜成功的重新附着。然而,尽管有这些干预措施,与术前水平相比,术后视力结果没有显著增强.
    结论:ARN患者行预防性玻璃体切除术后的RD并非罕见,主要与术后发生增生性玻璃体视网膜病变有关。
    OBJECTIVE: The aim of this study is to elucidate the factors contributing to the occurrence of retinal detachment (RD) following prophylactic vitrectomy in cases of acute retinal necrosis (ARN) syndrome.
    METHODS: A retrospective examination was undertaken, encompassing the medical records of patients diagnosed with ARN who underwent prophylactic vitreous intervention at the Ophthalmology Department of Wuhan University Renmin Hospital East Campus between October 2019 and September 2023. Subsequently, patients who manifested RD in the postoperative period were identified, and a comprehensive analysis was conducted to ascertain the factors underlying the occurrence of RD post-surgery.
    RESULTS: This study comprised 14 cases (involving 14 eyes) of patients diagnosed with ARN who underwent prophylactic vitreous intervention. The findings revealed that 4 patients experienced postoperative RD, resulting in an incidence rate of 28.57%. Notably, among these cases, 3 cases of RD manifested in the presence of silicone oil, while 1 case occurred subsequent to the removal of silicone oil. All 4 cases of RD exhibited varied degrees of proliferative vitreoretinopathy. Following the occurrence of RD, all patients underwent a secondary vitreous intervention coupled with silicone oil tamponade, leading to successful reattachment of the retina. However, despite these interventions, there was no significant enhancement observed in postoperative visual outcomes when compared to preoperative levels.
    CONCLUSIONS: RD following prophylactic vitrectomy in cases of ARN is not an infrequent occurrence and is primarily linked to the postoperative onset of proliferative vitreoretinopathy.
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  • 文章类型: Journal Article
    视网膜脱离是小儿白内障手术的主要术后威胁;然而,轴向长度的影响尚不清楚。本研究旨在评估易感患者的轴向长度与脱离风险之间的关系。
    这项回顾性队列研究分析了84例年龄<20岁的儿童白内障手术患者的132只眼。术前测量轴向长度,在中位随访4年期间记录视网膜脱离的发生率.采用Logistic回归分析检测轴向长度与脱离的关系。
    20只眼术后出现视网膜脱离。脱离组(23.6mm)的中位轴向长度长于非脱离组(21.6mm)。与较长的眼睛相比,眼轴长度≤23.4mm的眼睛脱离的几率降低了0.55倍。先前存在的近视和青光眼会增加风险。大约一半的患者在术后8年保留了一些脱离风险。
    较短的眼睛(眼轴长度≤23.4mm)在白内障手术后似乎可以防止小儿视网膜脱离,而近视,青光眼,轴向伸长>23.4mm会增加术后风险。了解这些解剖学风险状况需要对接受晶状体切除术的儿童进行手术计划和后续护理。
    本研究调查了较短的轴向长度在预防小儿白内障手术后视网膜脱离中的保护作用。这突出了较小的眼睛尺寸和降低的脱离风险之间的相关性,强调在手术计划和患者监测中需要仔细考虑解剖因素,特别是对于先前存在近视或术后青光眼的患者。
    UNASSIGNED: Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients.
    UNASSIGNED: This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged <20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship.
    UNASSIGNED: Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively.
    UNASSIGNED: Shorter eyes (axial length ≤23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.
    This study investigated the protective role of a shorter axial length in preventing retinal detachment after pediatric cataract surgery. This highlights the correlation between smaller eye sizes and reduced detachment risk, emphasizing the need for careful consideration of anatomical factors in surgical planning and patient monitoring, particularly for patients with preexisting myopia or postoperative glaucoma.
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  • 文章类型: Journal Article
    视网膜脱离(RD)是神经层与视网膜色素上皮的分离,从而阻止向视网膜的神经层内的细胞供应营养物。在脊椎动物中,由杆和锥组成的原代感光细胞每天通过增加盘状结构和在其远端脱落这些盘进行外段的更新。当视网膜脱离时,这些细胞的外段开始退化,如果没有及时进行重新连接的外科手术,细胞会死亡并导致失明。RD对更新过程的确切影响尚不清楚。此外,视网膜再附着可以恢复正常感光细胞功能的时间范围尚不清楚。专注于杆状细胞,我们提出了一个数学模型来阐明视网膜脱离对更新过程的影响。我们的模型模拟和分析表明,RD停止或显着减少了新椎间盘的形成,并且需要一种替代的去除机制来解释RD期间观察到的退变。我们模型参数的敏感性分析表明,椎间盘去除率是视网膜重新附着可以恢复适当感光细胞功能的关键时间的关键调节器。
    Retinal detachment (RD) is the separation of the neural layer from the retinal pigmented epithelium thereby preventing the supply of nutrients to the cells within the neural layer of the retina. In vertebrates, primary photoreceptor cells consisting of rods and cones undergo daily renewal of their outer segment through the addition of disc-like structures and shedding of these discs at their distal end. When the retina detaches, the outer segment of these cells begins to degenerate and, if surgical procedures for reattachment are not done promptly, the cells can die and lead to blindness. The precise effect of RD on the renewal process is not well understood. Additionally, a time frame within which reattachment of the retina can restore proper photoreceptor cell function is not known. Focusing on rod cells, we propose a mathematical model to clarify the influence of retinal detachment on the renewal process. Our model simulation and analysis suggest that RD stops or significantly reduces the formation of new discs and that an alternative removal mechanism is needed to explain the observed degeneration during RD. Sensitivity analysis of our model parameters points to the disc removal rate as the key regulator of the critical time within which retinal reattachment can restore proper photoreceptor cell function.
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  • 文章类型: Case Reports
    背景:眼部结核是结核病的一种相对罕见的肺外表现。这种威胁视力的疾病的诊断极具挑战性,特别是因为它可以模仿其他疾病。我们报告了一例结核性睫状体肉芽肿,最初被诊断为大疱性视网膜脱离。
    方法:一名52岁女性,左眼出现大疱性视网膜脱离,超声生物显微镜(UBM)证实存在睫状体肉芽肿性炎症。T-SPOT呈阳性,纯化蛋白衍生物(PPD)检测结果强阳性(直径20mm)。口服抗结核方案联合泼尼松后,视网膜逐渐重新附着,睫状体肉芽肿的大小明显缩小,患者的视力明显改善。
    结论:结核性睫状体肉芽肿可引起大疱性渗出性视网膜脱离,可诊断为UBM。早期全程抗结核治疗(ATT)联合糖皮质激素治疗可改善患者预后。
    BACKGROUND: Ocular tuberculosis is a relatively rare extrapulmonary manifestation of tuberculosis. This vision-threatening disease is extremely challenging to diagnose, particularly because it can mimic other diseases. We report a case of tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment.
    METHODS: A 52-year-old female presented with bullous retinal detachment in her left eye, and ultrasound biomicroscopy (UBM) verified the presence of a lesion with ciliary body granulomatous inflammation. The T-SPOT was positive, and the purified protein derivative (PPD) test was strongly positive (diameter of 20 mm). Following the administration of oral anti-tuberculosis regimen combined with prednisone, the retina gradually became reattached, the ciliary body granuloma became significantly reduced in size, and the visual acuity of the patient noticeably improved.
    CONCLUSIONS: Tuberculous ciliary body granulomas can cause bullous exudative retinal detachment and can be diagnosed with UBM. Early and full-course anti-tuberculosis treatment (ATT) combined with corticosteroid therapy can improve the patient prognosis.
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  • 文章类型: Journal Article
    高眼压(IOP)是平坦部玻璃体切除术(PPV)后的早期并发症之一,这可能会导致青光眼和继发于手术的不良视力预后。增生性玻璃体视网膜病变(PVR)是视网膜脱离(RD)的并发症之一,是预后不良的主要原因。这与不同种类的细胞因子有关。PPV后房水细胞因子谱与IOP的相关性分析对于RD的基本机制至关重要。在这项研究中,我们使用Luminex收集了16例患者的房水和27种合格的细胞因子,并将生物标志物与高IOP组和正常组进行了比较.因此,VEGF的浓度,IL-6、FGF2和G-CSF显著上调(P<0.05),而VEGFR2在高眼压组显著下调(P<0.05)。IL-6与高眼压呈正相关(r=0.561,P=0.041)。同时,IL-6的浓度(r=0.543,P=0.03),IL-5(r=0.576,P=0.019),IL-15(r=0.614,P=0.011),IL-4(r=0.517,P=0.04),ICAM-1(r=0.611,P=0.012),G-CSF(r=0.636,P=0.008)与术前PVR分级显著相关,和房水IL-4水平(r=0.567,P=0.022),HGF(r=0.701,P=0.005),和MCP-1(r=0.565,P=0.035)相对于激光点是显著的。因此,细胞因子可能是PPV后高眼压的治疗靶点。
    High intraocular pressure (IOP) is one of the early complications after pars plana vitrectomy (PPV), which may cause glaucoma and poor visual prognosis secondary to surgery. Proliferative vitreoretinopathy (PVR) is one of the complications of retinal detachment (RD) and is the main reason for the poor prognosis, which is related to different kinds of cytokines. It\'s essential for the basic mechanism to analyze the relative aqueous humor cytokine profiles with IOP after PPV for RD. In this study, we have collected the aqueous humor of 16 patients and qualified 27 cytokines using Luminex and compared biomarkers with the high IOP group and the normal group. As a result, the concentrations of VEGF, IL-6, FGF2, and G-CSF upregulated significantly (P < 0.05), while VEGFR2 downregulated significantly (P < 0.05) in the high IOP group. IL-6 was positively correlated with high IOP (r = 0.561, P = 0.041). Meanwhile, the concentrations of IL-6 (r = 0.543, P = 0.03), IL-5 (r = 0.576, P = 0.019), IL-15 (r = 0.614, P = 0.011), IL-4 (r = 0.517, P = 0.04), ICAM-1 (r = 0.611, P = 0.012), and G-CSF (r = 0.636, P = 0.008) were significantly associated with preoperative PVR classification, and the aqueous humor levels of IL-4 (r = 0.567, P = 0.022), HGF (r = 0.701, P = 0.005), and MCP-1 (r = 0.565, P = 0.035) are significant relative to laser points. Hence, cytokines might potentially be the therapeutic target of high IOP after PPV.
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  • 文章类型: Case Reports
    一位54岁的绅士出现了三个月的右眼视力不佳的历史和之前被遗忘的创伤。眼前段正常。他被诊断为大疱性孔源性视网膜脱离(RRD),但没有观察到明显的撕裂。开始玻璃体切除术,经过探索,后眼球破裂伴视网膜和玻璃体嵌顿.巩膜伤口用重液体原位缝合。手术后的眼眶成像显示存在眼眶内异物。这是后地球破裂的一种特殊表现,因为病人没有察觉,进行的裂隙灯检查没有临床证据。确定后地球破裂仍然是一个挑战,需要高度怀疑和适当的管理。
    A 54-year-old gentleman presented with a history of poor vision in the right eye for three months and a prior forgotten trauma. The anterior segment was normal. He was diagnosed with subtotal bullous rhegmatogenous retinal detachment (RRD), but no apparent tear was observed. Vitrectomy commenced, and upon exploration, there was a posterior globe rupture with retinal and vitreous incarceration. The scleral wound was sutured with heavy liquid in situ. Orbital imaging post-surgery revealed the presence of an intraorbital foreign body. This is a peculiar presentation of posterior globe rupture, as it was unperceived by the patient, and the slit lamp examination conducted indicated no clinical evidence. Identifying posterior globe rupture remains a challenge that necessitates a high index of suspicion and appropriate management.
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