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 evaluate the influence factor of the prognosis of traumatic subretinal hemorrhage after vitreoretinal surgery. Methods The clinical data of 50 patients with traumatic subretinal hemorrhage who had undergone vitreoretinal surgery were retrospectively analyzed.All patients had ocular traumatic history and subretinal hemorrhage diagnosed by fundus and B-scan examination;the preoperative visual acuity was less than 0.1. According to different conditions, the traumatic eyes were treated with vitreo-retinal surgery, combined with lensectomy, retinotomy or silicone oil tamponade, respectively. The period of follow-up after surgery was 2-53 months, and the average period was 7.27 months. The corrected visual acuity and retinal reattachment at the last follow-up were observed. The visual acuity ge;0.1 was the standard of good prognosis; retinal reattachment was observed by indirect ophthalmoscope and color fundus photography.The prognostic factors mainly included type of injury,open or closed injury,the disease course, preoperative visual acuity, retinal detachment,hemorrhagic choroidal detachment,vitreous hemorrhage,the sites of submacular hemorrhage,methods of surgery.The relationships between those prognostic factors and visual acuity outcome or retinal reattachment were analyzed by chi;2test and logistic regression analysis. Results About 46.0% patients had good prognosis of the visualacuity. In the eyes with preoperative visual acuity of no light perception to hand moving and finger counting to 0.1, the rate of good visual acuitywas 34.2% and 83.3%, respectively; the difference between the two groups was significant (chi;2=8.860,P=0.003). In the eyes with or without preoperative retinal detachment,the rate of good visual acuity was 37.5% and 80.0%, respectively; the difference between the two groups was significant (chi;2=4.232,P=0.040). In the eyes with subretinal hemorrhage involving the macular fovea or not, the rate of good visual acuity was 34.4% and 66.7%,respectively; the difference between the two groups was significant (chi;2=4.836,P=0.028).All the other prognostic factors had no obvious effect on the retinal reattachment after the surgery. Conclusion Preoperative visual acuity、retinal detachment and submacular retinal hemorrhage were the important influence factors associated with prognostic visual acuity of eyes with traumatic subretinal hemorrhage after vitreoretinal surgery.
The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.
Objective To observe the clinical characteristics of severe ocular detonator explosive injuries and to evaluate the therapeutic effects of vitrectomy on it. Methods Clinical data of 37 consecutive patients (65 eyes) with severe ocular detonator explosive injuries were retrospectively analyzed. The patients included 36 males and 1 female with the average age of 28.6 years. The biocular injuriy was in 31 cases (83.8 %), and one-eyed injury was in 6 cases (16.2%). A total of 48 eyes had severe explosive injury. The visual acuity was no light perception in 9 eyes in which 3 eyeballs were obviously atrophic, light perception in 28 eyes, hand moving in 4 eyes, and counting finger/33 cm in 7 eyes. Vitrectomy was performed on 46 eyes, in which 41 had severe ocular explosive injury. There were no vitreous surgery indications in 13 eyes of 19 eyes didnprime;t undergo surgery; the other 6 eyes didnprime;t undergo surgery due to the atrophic eyeballs or economic reasons. The treating time after trauma was within 1 week in 7 patients (18.9%), 1 week to 1 month in 13 (35.2%), and more than 1 month in 17 (45.9%). The follow-up duration lasted 6 months to 2 years after operation with the average of 8.6 months. Results In 65 eyes, the occupation ratio of conjunctival foreign bodies was 66.2%; corneal foreign bodies was 46.2%; vitreous hemorrhage was 70.8%; intraocular foreign bodies (IOFB) was 69.2%; retinal shocking injury or optic nerve blasting injury was 56.9%. The visual acuity improved in 33 eyes, remained unchanged in 25 eyes, and decreased in 7 eyes. In 46 eyes which had undergone vitrectomy, IOFB injuries was in 35 eyes (76.1%); the visual acuity increased in 26 eyes (59.5%), remained unchanged in 13 eyes (28.3%), and didnprime;t cure in 7 eyes (15.2%) in which 2 eyes underwent ocular enucleation and 5 eyes were atrophic. The increasing rate of visual acuity in the patients who accepted the treatment more than 1 month after injury was low. The occupation ratio of monocular blindness was 51.4% and biocular blind was 8.1%. Conclusions Most of severe ocular explosive injuries by detonator are with IOFB. causes of the high blinding rate are late treatment and serious injury. Strengthening the diagnosis and treatment of retinal shock and optic nerve blast, and performing vitrectomy as soon as possible can improve prognositc visual function of injured eyes.
Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)
Objective To evaluate the clinical application value of ocular fundus photochromy and optical coherence tomography (OCT) in epimacular membrane of traumatic eyes following vitreorential surgery. Methods Ocular fundus photochromy and OCT were used to observe the morphological changes of macula in 139 consecutive patients with unilateral ocular trauma after vitreoretinal surgery between July 2003 and September 2004. Results At the 1st, 2nd, 3rd, 6th, and 12th month postoperatively, epimacular membranes were found in 5, 8, 17, 19, 20 patients, respectively by using photochromy; and in 7, 10, 20, 26, 27 patients, respectively by using OCT. There was no significant difference in epimacular membrane between photochromy and OCT(chi;2＝0.173，Pgt;0.05). The results of OCT showed that epimacular membranes completely adhered to the macular region in 8 patients（29.63%）, and retinal neurosensory layer swelled in 12 patients（44.44%）with the fovea thickness of (290.18plusmn;288.05) mu;m. Conclusion Ocular fundus photochromy and OCT are helpful in observing and discovering the epimacular membrane after virtreoretinal surgery of the patients with traumatic retinal detachment during the early and long-term follow-up period; and OCT can provide important information of the structue and position of these epimacular membranes hence to conduct to appropriate treatment. (Chin J Ocul Fundus Dis, 2006, 22: 236-238)
ObjectiveTo observe the early ultrastructural changes of the optic nerves after the brain impact injury.MethodsEighteen 15-week-old Wistar rats were used in the air-pressure brain impact injury examination. All of the rats underwent the procedures of right-parietal-bone fenestration after abdominal cavity anesthesia with 1% sodium pentolbarbital (45 mg/kg), and then they were divided randomly into 3 groups, i.e., mild injury group (8 rats) underwent with 7 kg of air pressure in distance of 11 cm; severe injury group (8 rats) with 7 kg of airpressure in distance of 8 cm; and control group (2 rats) underwent with the parietalbone fenestration but without impact injury.The ultrastructural changes of the optic nerves were observed 1, 6, 24, and 72 hours after the injury by electron microscopy.ResultsThe difference of ultrastructural changes of optic nerve was not obvious in wild injury group and the control group, and the lanthanum nitrate was only found in the blood vessels in optic nerve. The lanthanum nitrate entered the nerve stroma 1 hour after severe and increased as time goes on. Simultaneously, displayed dilatation of endoplasmic reticulum, cavitation and tumefaction of mitochondrion, vacuolation of nerve stroma, and vacuolation of some axis-cylinder were seen in the glial cells.ConclusionThe brain impact injury may cause ultrastructural changes of the optic nerve and increase of permeability of blood vessels. (Chin J Ocul Fundus Dis, 2005,21:41-43)
Objective To observe the effect of blue light on apoptosis of cultured human retinal pigment epithelial (RPE) cells in vitro. Methods Human RPE cells were exposed to blue light, and the cells were divided into 3 groups: group A, with various intensity of illumination; group B: with same intensity but different time of illumination; group C: with same intensity and time of illumination but different finish time of the culture. The apoptosis of RPE cells was observed by TdT-dUTP terminal nick-end labeling (TUNEL) and annexin V-fluoresein isothiocyanate (FITC)/propidium iodide (PI) flow cytometry, and transmission electron microscopy. Results The positive cells stained by TUNEL shrinked and turned round, whose nuclei concentrated and congregated like the crescent or hat. Cracked nuclei and membrane bleb were found. Swollen mitochondrial, disappeared inner limiting membrane of mitochondria, and dilation of the rough endoplasmic reticulum with metabolite were observed by transmission electronmicroscopy. In group A, mild damage of RPE cells was found when the threshold value of the intensity of illumination was less than（500±100）lx, and the apoptosis and necrosis of RPE cells aggravated as the intensity of illumination increased; in group B, as the time of illumination extended, the number of apoptotic RPE cells didn′t increase while the necrosis increased; in group C, 6 and 12 hours after illumination, apoptosis of cells was the main injury, while apoptosis with necrosis was found and necrotic cells increased as the time of illumination was prolonged. Conclusions Illumination with blue light may cause damages of human RPE cells in vitro, with the modalities of apoptosis, apoptotic necrosis and necrosis. The extent of injury is dependent on intensity and duration of the illumination. (Chin J Ocul Fundus Dis, 2005, 21: 384-387)