laser retinopexy

激光视网膜固定术
  • 文章类型: Journal Article
    目的:确定治疗急性症状性马蹄形视网膜撕裂(HSTs)的患者的临床过程。方法:回顾性分析了2014年1月至2021年12月期间出现急性发作的漂浮物和/或闪光的患者,这些患者被发现有马蹄形视网膜撕裂HRT(s)而没有视网膜脱离(RD)。如果患者有至少3个月的随访,则将其包括在内。排除标准是最初出现时的流变RD(RRD),无症状HST(s),可操作的孔,萎缩性洞,视网膜透析,外伤史,或者以前的视网膜手术.对随后的新HST(s)进行了图表审查,进展到RRD,和视网膜前膜(ERM)的发育。特点,包括年龄,性别,眼睛侧向性,phakic状态,高度近视,晶格退化,和玻璃体出血(VH)在最初的表现,也注意到了。主要结果指标是后续新HST的百分比和时间,进展到RRD,和ERM的发展。结果:该研究包括216只眼(199例患者)。平均年龄为60.4岁。眼睛,27.3%有晶格变性,6.5%有高度近视。在介绍时,25.9%的眼睛有VH。27只眼睛(12.5%)出现新的泪液;63.0%发生在1个月至3个月之间。RRD进展15眼(6.9%);53.3%发生在3个月内。在多元逻辑回归中,VH是一个重要的风险因素(比值比,6.48;P=.002)进展为新的HST(s)或RRD。结论:治疗急性症状性HST的眼睛需要持续随访。尽管新的视网膜撕裂和进展为RRD倾向于在3个月内发生,这些事件可能会在以后发生。
    Purpose: To determine the clinical course of patients treated for acute symptomatic horseshoe retinal tears (HSTs). Methods: A retrospective chart review was performed of patients presenting between January 2014 and December 2021 with acute onset of floaters and/or flashes who were found to have horseshoe retinal tear HRT(s) without retinal detachment (RD). Patients were included if they had at least 3 months of follow-up. Exclusion criteria were a rhegmatogenous RD (RRD) at initial presentation, asymptomatic HST(s), operculated hole, atrophic hole, retinal dialysis, history of trauma, or previous retinal surgery. Charts were reviewed for subsequent new HST(s), progression to RRD, and development of epiretinal membrane (ERM). Characteristics, including age, sex, eye laterality, phakic status, high myopia, lattice degeneration, and vitreous hemorrhage (VH) at initial presentation, were also noted. The main outcome measures were the percentage and timing of subsequent new HST(s), progression to RRD, and development of ERM. Results: The study included 216 eyes (199 patients). The mean age was 60.4 years. Of the eyes, 27.3% had lattice degeneration and 6.5% high myopia. At presentation, 25.9% of eyes had a VH. Twenty-seven eyes (12.5%) experienced new tear(s); 63.0% occurred between 1 month and 3 months. Progression to RRD occurred in 15 eyes (6.9%); 53.3% occurred within 3 months. On multivariate logistic regression, VH was a significant risk factor (odds ratio, 6.48; P = .002) for progression to new HST(s) or RRD. Conclusions: Eyes treated for acute symptomatic HSTs require ongoing follow-up. Although new retinal tears and progression to RRD tends to occur within 3 months, these events can occur later.
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  • 文章类型: Journal Article
    目的:确定同眼激光预防(FELP)在降低接受原发性RD修复的患者视网膜脱离(RD)率方面的安全性和有效性。方法:回顾性收集接受原发性RD修复的连续患者的双眼资料。排除在同眼中缺乏周边视网膜病理或随访少于3年的患者。确定了98例连续接受FELP的患者,而未接受FELP的患者为28例。没有患者在就诊时在他们的眼睛中出现症状。比较治疗组与对照组的RD和视网膜前膜(ERM)形成率。结果:尽管有FELP,但98例患者中有3例(3.1%)发展为RD,而对照组为28例患者中有5例(17.9%)(P=0.005)。在FELP组中,16例(16.3%)患者发生ERM,而未接受预防性激光治疗组的28例患者中有7例(25.0%)发生ERM(P=0.29)。FELP或对照组中没有患者需要进行ERM手术。结论:对接受原发性RD修复的患者的双眼进行预防性激光可降低RD的风险,而没有明显的ERM形成风险。
    Purpose: To determine the safety and efficacy of fellow-eye laser prophylaxis (FELP) in reducing the rate of retinal detachment (RD) in patients undergoing repair of a primary RD. Methods: Retrospective data were collected on the fellow eyes of consecutive patients undergoing primary RD repair. Patients lacking peripheral retinal pathology in the fellow eye or with less than 3 years of follow-up were excluded. Ninety-eight consecutive patients were identified who underwent FELP as compared with 28 who did not. No patient had symptoms in their fellow eye upon presentation. Rates of RD and epiretinal membrane (ERM) formation in the treatment group were compared with the control group. Results: Three of 98 (3.1%) patients developed RD despite having FELP compared with 5 of 28 (17.9%) in the control group (P = .005). In the FELP group, 16 (16.3%) patients developed ERM vs 7 of 28 (25.0%) in the group that did not receive prophylactic laser (P = .29). No patients in either the FELP or control group required surgery for ERM. Conclusions: Prophylactic laser to the fellow eye of patients undergoing primary RD repair reduced the risk of RD without significant risk of ERM formation.
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  • 文章类型: Journal Article
    目的:探讨性别与巴基斯坦人群视网膜裂孔激光视网膜固定术的关系。
    方法:这是一项在阿加汗大学医院进行的为期10年的回顾性观察研究,卡拉奇,巴基斯坦。所有在2009年1月至2018年12月期间因视网膜撕裂或高危视网膜变性(如晶格变性)接受激光视网膜固定术的连续患者均纳入本研究。数据收集自患者档案。排除有视网膜脱离病史或治疗史的索引眼。使用结构化的形式来收集信息。描述性统计用于探讨性别与激光视网膜固定术之间的关系。
    结果:我们通过我院的编码系统确定了12,457名患者,这些患者从2009年1月至2018年12月接受了各种激光手术。钇铝石榴石(YAG)激光器,激光周边虹膜切开术(PI),激光小梁成形术均被排除.本研究共审查了3,472名患者的档案,其中958例患者符合纳入标准.男性人数较多(n=515,53.87%)。平均年龄为43.99±15.37岁。对于探索性分析,参与者分为5个年龄组:<30岁(24.16%);31~40岁(16.59%);41~50岁(19.45%);51~60岁(26.40%);>60岁(13.49%).48.12%的患者行双侧激光视网膜固定术;24.79%和27.13%的患者行右眼和左眼单侧激光视网膜固定术,分别。
    结论:在我们的队列研究中,激光视网膜固定术在男性比女性更常见.该比率与一般人群中视网膜撕裂和视网膜脱离的患病率无显著差异,男性优势略高。在我们的研究中,我们没有发现接受激光视网膜固定术的患者存在明显的性别偏见的证据。
    OBJECTIVE: To explore the relationship of gender with laser retinopexy for retinal breaks in the Pakistani population.
    METHODS: This was a 10-year retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients who underwent laser retinopexy between January 2009 and December 2018 for a retinal tear or high-risk retinal degeneration (such as lattice degeneration) were included in this study. Data were collected from patients\' files. Index eyes with a history of or treatment for retinal detachment were excluded. A structured pro forma was used to collect information. Descriptive statistics were used to explore the relationship between gender and laser retinopexy.
    RESULTS: We identified 12,457 patients through the coding system of our hospital who underwent various laser procedures from January 2009 to December 2018. Yttrium aluminium garnet (YAG) laser, laser peripheral iridotomy (PI), and laser trabeculoplasty procedures were all excluded. A total of 3,472 patients\' files were reviewed for this study, out of which 958 patients met the inclusion criteria. Males accounted for a higher number (n=515, 53.87%). The mean age was 43.99±15.37 years. For exploratory analysis, participants were divided into five age groups: <30 years (24.16%); 31-40 years (16.59%); 41-50 years (19.45%); 51-60 years (26.40%); and >60 years (13.49%). Bilateral laser retinopexy was performed in 48.12% of patients; 24.79% and 27.13% of patients underwent unilateral laser retinopexy for the right and left eyes, respectively.
    CONCLUSIONS: In our cohort study, laser retinopexy was more commonly performed in men than in women. The ratio was not significantly different from the prevalence of retinal tears and retinal detachment in the general population, which has a slightly higher male preponderance. We did not find evidence of significant gender bias among patients who underwent laser retinopexy in our study.
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  • 文章类型: Journal Article
    本研究旨在通过裂隙灯生物显微镜下的气泡演示激光视网膜固定术方法,使用宽视野接触镜治疗风源性视网膜脱离(RRD)与气动视网膜固定术(PR),并报告其解剖和功能结果。这个单一中心,回顾性病例系列包括使用六氟化硫(SF6)接受PR治疗的RRD患者.人口统计,术前因素,从患者档案中收集解剖学和功能性结局.术后6个月PR单次手术成功率为70.8%(17/24眼),二次手术后的最终成功率为100%。成功的PR眼术后第3个月(p=0.011)和第6个月(p=0.016)的BCVA优于失败的眼。没有单一的术前因素与PR成功相关。使用激光视网膜固定术方法通过气泡与宽视野隐形眼镜系统进行PR的单次手术成功率似乎与PR文献相当。
    This study aimed to demonstrate the laser retinopexy method through the gas bubble under a slit-lamp biomicroscope using a wide-field contact lens to treat rhegmatogenous retinal detachment (RRD) with pneumatic retinopexy (PR) and report its anatomical and functional results. This single-center, retrospective case series included RRD patients treated with PR using sulfur hexafluoride (SF6). The demographics, preoperative factors, and anatomical and functional outcomes were collected from the patient files. The single-procedure success rate of PR at postoperative 6th months was 70.8% (17/24 eyes), and the final success rate after secondary surgeries was 100%. The BCVA was better in the successful PR eyes at postoperative 3rd (p = 0.011) and 6th month (p = 0.016) than in failed eyes. No single preoperative factor was associated with PR success. The single-procedure success rate of PR using the laser retinopexy method through the gas bubble with a wide-field contact lens system seems comparable to the PR literature.
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  • 文章类型: Editorial
    2020年3月初,COVID-19大流行给医疗保健系统带来了前所未有的负担。在美国大部分地区,实施了就地避难令,以减少传播。这场危机的后果是,风险缓解命令,患者对暴露的恐惧可能导致急救服务的利用不足。我们旨在量化眼科中的两种紧急干预措施,特别是急性激光视网膜固定术和视网膜脱离修复,以确定这些程序在大流行开始期间是否减少。
    所有视网膜脱离手术和激光视网膜固定术均使用当前程序术语代码进行鉴定。将研究期间(2020年3月1日至5月31日)的费率数据与前一年(2019年3月至2019年5月;纪元1)以及研究前3个月(2019年12月至2020年2月;纪元2)的历史数据进行比较。
    与时代1和时代2相比,组合程序分别下降了38.5%(P=.01)和36.0%(P=.02)。与时期1和时期2相比,激光视网膜固定术的发生率分别下降了45.5%(P=.02)和33.0%(P=.14)。与时期1和时期2相比,视网膜脱离修复率分别下降了29.4%(P=.24)和38.0%(P=.07)。
    研究期间程序下降,提示急诊眼科护理利用不足。眼科医生有必要强调需要寻求有关症状的护理。
    UNASSIGNED: At the start of March 2020, the COVID-19 pandemic placed an unprecedented burden on the healthcare system. Throughout much of the United States, shelter-in-place orders were imposed to reduce transmission. A consequence of this crisis, risk mitigation orders, and patient fear of exposure may have led to underutilization of emergency services. We aimed to quantify 2 emergent interventions in ophthalmology, specifically acute laser retinopexy procedures and retinal detachment repair, to determine whether these procedures decreased during the start of the pandemic.
    UNASSIGNED: All retinal detachment surgeries and laser retinopexy procedures were identified using Current Procedural Terminology codes. Rate data during the study period (March 1 through May 31, 2020) was compared to historical data from the year prior (March 2019 through May 2019; epoch 1) as well as the immediate 3 months prior to the study period (December 2019 through February 2020; epoch 2).
    UNASSIGNED: Combined procedures fell by 38.5% (P = .01) and 36.0% (P = .02) when compared to epoch 1 and epoch 2, respectively. The rate of laser retinopexy procedures fell by 45.5% (P = .02) and 33.0% (P = .14) when compared to epoch 1 and epoch 2, respectively. The rate of retinal detachment repair fell by 29.4% (P = .24) and 38.0% (P = .07) when compared to epoch 1 and epoch 2, respectively.
    UNASSIGNED: Procedures fell during the study period, suggesting underutilization of emergent ophthalmology care. It is necessary for ophthalmologists to emphasize the need to seek care for concerning symptoms.
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  • 文章类型: Journal Article
    这项研究评估了一种新的手术技术,该技术包括在空气下进行最小的玻璃体切除(最小界面玻璃体切除术;MIV),以减少术后并发症,同时保留解决视网膜裂口手术因素的能力。
    这项回顾性分析检查了连续病例中最小界面玻璃体切除术的结果,至少有12个月的随访期,原发性孔源性视网膜脱离(RRD),平坦部玻璃体切除术(PPV)后复发性RRD,或初次巩膜扣带术(SBS)后手术失败。
    12例RRD患者的12只眼行MIV。总手术时间为190-300s(平均,245.25秒)。8只(66.7%)眼接受冷冻治疗,和4(33.3%)用眼内激光密封视网膜破裂。成功,所有眼都实现了视网膜完全复位,并在随访期间维持.术后无并发症发生,随访期间无患者发生炎症或白内障。
    我们有效地去除牵引和视网膜下液,并通过使用一种新型的最小界面玻璃体切除术技术,在该选定人群中使用激光或冷冻疗法治疗裂口。
    UNASSIGNED: This study evaluates a new surgical technique consisting of minimal vitreous removal under air (minimal interface vitrectomy; MIV) to reduce postoperative complications while preserving the ability to address surgical factors at the retinal break.
    UNASSIGNED: This retrospective analysis examined the outcomes of minimal interface vitrectomies in consecutive cases, with a minimum 12-month follow-up period, of primary rhegmatogenous retinal detachment (RRD), recurrent RRD after pars plana vitrectomy (PPV), or failed surgery after primary scleral buckling surgery (SBS).
    UNASSIGNED: Twelve eyes of 12 patients with RRD underwent MIV. The total surgical duration was 190-300 s (mean, 245.25 s). Eight (66.7%) eyes were treated with cryotherapy, and 4 (33.3%) with endolaser to seal the retinal break. Successful, complete retinal reattachment was achieved in all eyes and maintained during follow-up. No intra- or postoperative complications occurred and no patients developed inflammation or cataract during follow-up.
    UNASSIGNED: We effectively removed traction and subretinal fluid and treated breaks with endolaser or cryotherapy by using a novel minimal interface vitrectomy technique in this selected population.
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  • 文章类型: Comparative Study
    目的:比较住院医师和专科医生行激光视网膜固定术治疗视网膜撕裂的结果,并确定与进展为视网膜脱离(RD)的风险相关的泪液特征。
    方法:对307只眼进行激光视网膜固定术,由表演医生分类,居民(217例)或专家(90例)。记录的参数包括数字,尺寸,和视网膜撕裂的位置,桥接血管的存在,玻璃体出血(VH),或视网膜下液(SRF),需要额外的激光,进展到RD,和手术。
    结果:居民组42.3%的病例和专科组35.5%的病例进行了额外的激光治疗(p=0.26)。居民组中有6.9%的病例进展为RD,专科组中有5.5%的病例进展为RD(p=0.66)。VH和SRF的存在与进展为RD的风险增加相关(分别为p<0.0001和0.003)。由专家治疗的SRF病例比例更高(p=0.006)。
    结论:居民可以安全有效地进行激光视网膜固定术,没有比专家执行的程序更糟糕的结果。可能需要高速率的额外激光来实现RD预防,高风险病例可以在演示时识别,然后转交给专家。
    OBJECTIVE: To compare the outcomes of laser retinopexy for the treatment of retinal tears between residents and specialists, and to identify tear characteristics associated with the risk of progression to retinal detachment (RD).
    METHODS: A retrospective review of 307 eyes treated by laser retinopexy, categorized by the performing physician, either a resident (217 cases) or a specialist (90 cases). Recorded parameters included the number, size, and location of the retinal tears, the presence of bridging vessels, vitreous hemorrhage (VH), or subretinal fluid (SRF), the need for additional laser, progression to RD, and surgery.
    RESULTS: Additional laser was performed in 42.3% of cases in the resident group and 35.5% in the specialist group (p = 0.26). Progression to RD occurred in 6.9% of cases in the resident group and 5.5% in the specialist group (p = 0.66). The presence of VH and SRF were associated with an increased risk of progression to RD (p < 0.0001 and 0.003, respectively). A higher proportion of cases with SRF were treated by specialists (p = 0.006).
    CONCLUSIONS: Laser retinopexy is safely and effectively performed by residents, with no worse outcomes than procedures performed by specialists. A high rate of additional laser may be needed to achieve RD prophylaxis, and higher-risk cases can be identified at presentation and then referred to specialists.
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  • 文章类型: Case Reports
    OBJECTIVE: Posterior pole retinal tears occur rarely following blunt trauma. We describe a case of traumatic macular tears, without concurrent peripheral retinal tears or holes.
    METHODS: A 17-year-old patient presented to our emergency unit with blunt ocular trauma and multiple maxillofacial fractures after being assaulted. On examination visual acuity was 20/200 in the left eye with scant vitreous and preretinal hemorrhages. Funduscopic examination revealed multiple choroidal ruptures running concentrically to the optic disc, a subretinal macular hemorrhage, and a large macular tear in the area of the inferior vascular arcade just temporal to the macula. Optical coherence tomography revealed subretinal fluid in the foveal area, choroidal ruptures and a slight elevation of the macular retinal tear margins without subretinal fluid. Laser retinopexy was performed around the macular tear nasally. On follow-up, the retina in the lasered area remained flat, while a shallow retinal detachment had developed temporal to the tear, with a second tear appearing supero-temporally to the macula. Laser retinopexy was not possible due to surrounding subretinal hemorrhage. The clinical course was later complicated by macular detachment, necessitating pars plana vitrectomy with endolaser around the posterior tears and the retinal periphery, and silicone oil injection.
    CONCLUSIONS: While traumatic macular holes and traumatic macular choroidal ruptures have both been extensively described, posterior pole and macular retinal tears following blunt trauma have rarely been reported. This case illustrates this unusual finding, discussing the possible pathogenic mechanisms and the importance of close follow-up of patients after blunt trauma with appropriate imaging.
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  • 文章类型: Journal Article
    为了证明预防性外周激光视网膜固定术(PPLR)后黄斑裂孔的形态学结果。
    我们的回顾性病例对照分析包括92只眼,激光组中55个,非激光组中37个。55例患者接受了预防性外周激光视网膜固定术,为黄斑裂孔的平坦部玻璃体切除术做准备,有或无玻璃体黄斑粘连(激光组)。预防性外周激光视网膜固定术前后,我们通过光学相干断层扫描评估了玻璃体解剖结构的任何变化.在未接受预防性外周激光视网膜固定术(非激光组)的37只黄斑孔玻璃体切除术前的检查中,还分析了光学相干断层扫描的变化。
    在激光组中,55眼中有7只(12.7%)显示黄斑裂孔闭合(18只黄斑裂孔眼中有6只(33.3%),37只眼无黄斑裂孔眼中有1只(2.7%)),而非激光组没有患者出现黄斑裂孔闭合(p<0.05)。七个闭合黄斑孔的平均宽度为191.4µm(范围:59-282µm)。除六只黄斑裂孔眼之一有玻璃体黄斑粘连外,黄斑裂孔闭合,无玻璃体黄斑粘连释放。在我们对玻璃体黄斑粘连患者亚组的分析中,我们观察到激光组18只眼中的3只眼(16.6%)和非激光组13只眼中的1只眼(7.6%)玻璃体黄斑粘连释放(p>0.05)。
    这些发现支持在选定的黄斑裂孔患者中预防性外周激光视网膜固定术可能起到有益的作用。
    UNASSIGNED: To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR).
    UNASSIGNED: Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group).
    UNASSIGNED: In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05).
    UNASSIGNED: These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.
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  • 文章类型: Journal Article
    BACKGROUND: This study was performed to assess the feasibility and efficacy of intraoperative laser retinopexy in scleral buckling (SB) surgery.
    METHODS: This was a retrospective, noncomparative, and interventional study. Records of 25 patients who had undergone intraoperative laser retinopexy during SB were retrospectively analyzed.
    RESULTS: All patients were phakic and macula was off in all cases. Adequate intraoperative laser retinopexy was achieved in 22 (88%) patients, and 3 (12%) patients required additional postoperative laser. Retina was attached in all patients at 6-month follow-up.
    CONCLUSIONS: Intraoperative laser retinopexy can give comparable results to cryoretinopexy with lesser postoperative complications in SB surgery. Although further comparative studies are needed, this study establishes the feasibility of intraoperative laser retinopexy in SB which has never been described before in the literature as per our knowledge.
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