Objective To compare the efficacy and safety of pars plana vitrectomy (PPV) versus scleral buckling (SB) on rhegmatogenous retinal detachment (RRD) after cataract surgery. Methods A computerized search was conducted in the Cochrane Library, Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM) combined with manually searching of related literatures. Randomized controlled trials (RCT) comparing PPV with SB for RRD after cataract surgeries were collected. Best corrected visual acuity (BVCA), reattachment rate after primary surgery, final reattachment rate and complications between the two operations were compared. Results A total of four RCTs were included in this meta analysis, including 690 eyes of 690 patients (331 eyes in the PPV group, 359 eyes in the SB group). There was no difference in reattachment rates after primary surgery between two groups ［odds ratio (OR) =1.68; 95% confidence interval (CI), 0.81-3.49; P=0.16). Final reattachment rate were in favor of PPV (OR=1.97; 95% CI,1.04 -3.73;P=0.04). There was no significant difference in the proportion of BCVA at six months (weighted mean difference=0.06; 95%CI,-0.01- 0.14; P=0.11). PPV was associated with a significantly lower frequency of diplopia/extrocular muscle dysfunction than SB (OR=6.59; 95% CI1.16 - 37.27; P=0.03), whereas other complications, such as proliferative vitreoretinopathy, macular pucker, cystoid macular edema, and choroidal detachment did not differ statistically (P＞0.05). Conclusion Compared with SB, PPV is more likely to achieve a favorable final reattachment rate for RRD after cataract surgery, and with a lower rate of diplopia/extrocular muscle dysfunction.
Objective To observe the clinical characteristics and therapeutic effect of aphakic retinal detachment (ARD) eyes and pseudophakic retinal detachment (PPRD) eyes.Methods The clinical data of 805 patients,including 321 ARD and 484 PPRD eyes were retrospectively analyzed.The patientsprime;visiual acuity, refraction, intraocular pressure were examined, and the patients also underwent slit lamp microscopy and direct and (or) indirect ophthalmoscopy.The preoperative bestcorrected visual acuity (BCVA) was between light perception (LP) and 0.6.Mainly according to the PVR grade and retinal holes position to take the scleral buckling or vitrectomy combined with scleral buckling. The 805 eyes were divided into 1995-1999 group (243 eyes) and 20002007 group (562 eyes) according to operative time.The follow-up ranged from 3 to 25 months, with an average of 12.3 months.The success standard of surgery was set as anatomic retinal reattachment and the last follow-up time was considered as the judgment time.The surgical complications were recorded at each followup time points. The composition of PPRD,the visual acuity,ocular lesions, surgical methods and results before operation and visual acuity after operation in two groups were analyzed and compared by MantelHaenszel chisquare test. Results The average interval from lens extraction to RD occurrence was 15.4 months in PPRD eyes and 39.1 months in ARD eyes. The final total anatomic success rate was 95.9%, and was 93.5% in the scleral buckle eyes and 97.2% in vitrectomy eyes.The BCVA was better than 0.3 after operation only in 11.9% of the 805 patiens,and the visual acuity increased more than 2 lines in 67.3%. Compared with the ARD eyes,early onset, high proportion of total posterior vitreous detachment,severe PVR,wide RD range,low detection rate of retinal hole and low antomic success rate were found in PPRD eyes.Compared with the 1995-1999 group,the proportion of vitreous surgery,anatomic success rate and better visual acuity were found in 2000-2007 group.Conclusions The ocular lesions of ARD and PPRD is more complicated,the therapeutic effect are improving in recent years.
Objective To investigate the refractive shift after combined surgery （phacoemulsification, intraocular lens implantation and vitrectomy） by comparing the difference between the predictive and postoperative refractive power.Methods The clinical data of 44 patients (48 eyes) underwent combined surgery (combined group) and 30 patients (50 eyes) underwent cataract surgery (cataract group) were retrospective analyzed. Combined group was further divided into two sub-groups by the kind of tamponade: balanced salt solution group and gas group. Before surgery, axial length and corneal curvature were measured, and the predictive spherical equivalent (PSE) was calculated. Axial length, corneal curvature and actual spherical equivalent (ASE) were measured in six months after surgery. The differences between PSE and ASE were compared between combined group and cataract group, balanced salt solution group and gas group.Results In combined group,the mean PSE was (-0.10plusmn;0.42) D and ASE was（-1.00plusmn;1.10） D, and the difference was significant（t=6.687, P＜0.05）. Patients underwent combined surgery showed a statistically significant myopic shift compared with those underwent simple cataract surgery （t=-3.792,P＜0.05）, the refractive shift of balanced salt solution group and gas group were (-0.76plusmn;0.89） and （-1.19plusmn;0.94） D respectively, and there was no significant difference（t=-1.530,P＞0.05）.Conclusion Combined surgery of phacoemulsification and vitrectomy tends to shift the actual refractive status to myopia.
Objective To observe the therapeutic efficacy and postoperative complications of combined surgery and sequential surgery in treating proliferative diabetic retinopathy (PDR) and cataract. Methods The cilinical data of 59 patients (66 eyes) with PDR were retrospectively analyzed. The patients were divided into combinedsurgery group and sequential surgery group. Combined surgery was performed on patients with obvious lens opacity which was an obstacle to the ocular fundus surgery, while sequential surgery was performed on the patients with transparent lens or lens with light opacity on which ocular fundus surgery could be performed. Lens excision in cataractopoiesis could only be performed when the state of ocular fundus was stable and cataractopoiesis was the main cause of vision damage. A total of 28 patients (32 eyes) in combinedsurgery group underwent vitrectomy combined with phacoemulsification and IOL implantation; 31 patients (34 eyes ) in sequentialsurgery group underwent vitrectomy, lens excision and IOL implantation. Corrected visual acuity (BCVA) and complications were observed. The mean followup period was (25plusmn;8.5) months. The measurement data were analyzed with t test and enumeration data with 2 test. Results In combinedsurgery group, visual acuity improvement was achieved in 27 eyes （84.4%）, remained unchanged in 2 eyes （6.3%）and decreased in 3 eyes （9.4%）. In sequentialsurgery group, visual acuity improved in 26 eyes （76.5%）, remained unchanged in 2 eyes（5.8%）and decreased in 6 eyes（17.7%.）. However, anterior chamber fibrin exudation occurred in 4 eyes in the combinedsurgery group and no eyes in the sequentialsurgery group; compared with each other, the difference is statistically significant (chi;2=4.524，P=0.033). Conclusion Combined surgery and sequential surgery are all safe and effective on treating PDR and postoperative complications have no obvious correlation with the surgery procedure.
ObjectiveTo observe the changes of macula in patients with high myopia after phacoemulsification. MethodsIn 20 patients with high myopia with ocular axial length≥27 mm, optical coherence tomography (OCT) was performed on the operative and contralateral eyes 1 week before and after monocular phacoemulsification, respectively, and the OCT images of macula of the operative eyes were observed and compared.ResultsOne week before and after phacoemulsification, the mean macular fovea thickness of the patients with high myopia was (131.6±16.37) μm and (189.75±45.69) μm, respectively, with a significant difference (t=2.805, P=0.01). Simultaneously, the mean macular fovea thickness of the contralateral eyes was (133.5±15.12) μm and (133.5±14.63) μm, respectively, with a non-significant difference (t=1.367, P=0.853). In 20 operative eyes 1 week after phacoemulsification, 3 had vitreous strand around the macula with retinal thickening, 1 had retinoschisis in macular area, and 2 had obvious retinal thickening with slight retinal edema.ConclusionRetinal thickening occurs in the patients with high myopia after phacoemulsification. Traction of retina by vitreous strand or subclinical retinoschisis may occur in some patients.(Chin J Ocul Fundus Dis, 2005,21:90-92)