Retinal break is the cause of primary retinal detachment, which remains a main cause for visual loss, and closure of the breaks is the principle of treatment. Currently surgical treatment can successfully reattach the retina in most cases. However, some basic questions still beset treatment of the disease, such as the cause responsible for development of retinal breaks and how to prevent it, and how the visual recovery can be satisfactory after reattachment surgery. Recent research indicates that the development of retinal breaks is associated with the process of vitreous liquefaction, posterior vitreous detachment (PVD) and abnormal vitreoretinal adhesion and traction. The retinal breaks can occur in the posterior margin of the vitreous base in the eye with complete PVD. Partial PVD may cause posterior breaks especially in cases of myopic traction maculopathy associated with schisislike thickening in the outer retina (foveoschisis) and vitreomacular traction. It is known that microstructural changes and atrophy of the macula, and epiretinal membrane formation are the reasons for poor vision after the retina is reattached. Therefore, more attention should be paid to further understand the vitreous pathology and traction mechanism, to research for methods of its clinical evaluation and strategy of prevention and treatment, and to accelerate visual recovery after reattachment surgery, in order to raise the standard of the disease treatment.
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,231-233)
PURPOSE: Determining the efficacy of vitrectomy in explosive injuries of eye globes and assessing the curcept concept of enucleation for severe traumatized eyes. METIIODS: Clinical records were reviewed on 36 consecutive patients(44 eyes)with severe explosive eyeball injuries. RESULTS:The injuries were caused by explosion of detonator (10 eases), fire-crackers(7 cases) ,explosive and guns(19 cases). Ten eyes(22.7%)were ruptured. Fourty eyes(90. 9%)underwent vitrectomy for posterior segment injuries including vitreous hemorrhage,intraocular foreign bodies, endophthalmitis, and retinal detachment more than 2 weeks after trauma and primary wound repair. Postoperative visual acuity improved in 25 eye(62.5%) ,was stable in 11 eyes(27.5%) ,and decreased in 4 eyes(10%). Final vision was 0. 02 or better (up to 0.7)in 20 eyes(47.6%). No more enucleation was performed except two ruptured eyes (4.5% ) removed in primary clinical units. CONCLUSION :The results suggest that primary wound repair with microsurgery and secondary vitrectomy may reconstruct the eyeball and restore visual functions.at least partially.in the majority of eyes,even though the explosive ocular injuries often induce severe damages and eyeball rupture. It is.thus,recommended that primary enueleation of traumatized eyes should not be performed with an occasional exception. （Chin J Ocul Fundus Dis,1996,12: 169-171）