Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent microinvasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. The central foveal thicknesses (CFT) were measured after surgery by spectral domainoptical coherence tomography (SD-OCT). The median follow-up time was (12.81plusmn;8.22) months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema (ME), epiretinal membrane (ERM), interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed. The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstructure were analyzed. Results The CFT was ranged from 103.00 mu;m to 498.00 mu;m,with the mean of（251.12plusmn;90.23） mu;m. Macular abnormalities were observed in 37 eyes (69.8%), and normal macula in 16 eyes (30.2%). Among 37 eyes with macular abnormalities, there were 20 eyes (37.7%) with ME, 12 eyes (22.6%) with ERM, 33 eyes (62.3%) with interrupted IS/OS, and 20 eyes (37.7%) with interrupted ELM. The BCVA of ME eyes decreased significantly than that in nonME eyes （t=-2.09，P＜0.05). The difference of BCVA in ERM and nonERM eyes was not statistically significant (t=-1.10,P＞0.05). The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=-4.33,P＜0.05). The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58, P＜0.05). The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not (r=7.65, 8.21, 4.99; P＜0.05), but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01, 0.82; P＞0.05). Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT，the status of IS/OS junction, whether ME or not, but not related to integrity of the ELM or whether ERM or not.
Objective To compare the analgesic effects of fentanyl, tramadol and flurbiprofen axetil during vitrectomy under local anesthesia. Methods One hundred and twenty patients who underwent vitrectomy were randomly divided into four groups, 30 patients in each group. Control group (Group C): normal saline were given; Fentanyl group （group F): fentanyl 1 mu;g/kg; Tramadol group （group T): tramadol 1 mg/kg; Flurbiprofen group （group K): flurbiprofen axetil 1 mg/kg. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), sedation classification (OAA / S) and pain score (NRS) were recorded prior to drug administration (T0) and the beginning of surgery (T1), 5 min (T2), 15 min(T3), 30 min (T4) and the end of surgery (T5) . The incidence of analgesic remedy and adverse reactions were also recorded after surgery. Results In group F, MAP at T1 and T2 were significantly lower than T0 and that of the other three groups at the same time point (F=5.367,5.967;P＜0.05). MAP at each time point of the other three groups had no significant changes (P＞0.05). In Group C, HR decreased significantly at T3and T4compared to T0 (F=7.900, 6.767;P＜0.05). In Group F, HR decreased significantly at T2 compared to T0 (F=3.117，P＜0.05). HR at each time point of group T and group K had no significant changes (P＞0.05). In group F, SpO2at T1 was significantly lower than T0 and that of the other three groups at the same time point (F=7.352, P＜0.05). SpO2of group F, group T and group K had no significant changes within groups (P＞0.05). In Group F, the median of OAA / S classification at T1 were grade four, which were lower than that at T0 and that of the other three groups at the same time point (chi;2=12.935, P＜0.05). There was no significant changes of the median of OAA / S classification at each time point in the other three groups (P＞0.05). In group C, the median of NRS score was three at T1 and was two at T2 respectively, which were higher than that at T0 and that of Group F and group T at the same time point (chi;2=13.748,11.616; P＜0.05). There were no significant changes of the median of NRS score in group F, group T and group K within groups (P＞0.05). Analgesic remedy percentages in group C, group F, group T and group K were 16.7%, 3.3%, 3.3%, 6.7%, respectively. The incidence of adverse reactions in group C, group F, group T and group K were 30.0%、23.3%、3.3%、16.7%, respectively.Conclusion Tramadol had efficient analgesic effects and low rate of adverse reactions during vitrectomy under local anesthesia.
Objective To observe the etiological factors and variation of effects of nontraumatic severe vitreous hemorrhage. Methods A total of 1107 patients (1202 eyes) with nontraumatic severe vitreous hemorrhage who underwent vitrectomy from January 2005 to December 2011 were enrolled in this study. The patients were divided into A group (444 eyes of 415 patients were operated between January 2005 and December 2008) and group B (758 eyes of 692 patients between January 2009 and December 2011) according to admission date. The etiological factors and variations were recorded and retrospectively analyzed. Results Of all 444 eyes in group A, 156 eyes were due to retinal vein occlusion (RVO), 117 eyes associated with proliferative diabetic retinopathy (PDR), 61 eyes with retinal hole／retinal detachment (RH／RD), 42 eyes with Eales disease, 20 eyes with exudative agerelated macular degeneration (EAMD). These diagnoses accounting for 89.19% of the total eyes, were found to be the common causes in patients with severe vitreous hemorrhage, with RVO as the most common cause. Similarly in group B, severe vitreous hemorrhage was found in 347 eyes with proliferative diabetic retinopathy (PDR), 135 eyes with retinal hole／retinal detachment (RH／RD), 133 eyes with retinal vein occlusion (RVO), 25 eyes with Eales disease, 22 eyes with exudative age-related macular degeneration (EAMD), accounting for 87.87% of the total eyes. PDR was the most common cause instead of RVO to vitreous hemorrhage in this group. The number of vitreous hemorrhages increased year by year. Conclusions PDR, RH／RD, RVO, Eales disease and EAMD are the common causes of nontraumatic severe vitreous hemorrhage. There is a trend toward an increasing proportion of PDR among the causes of vitreous hemorrhage.