The stimulating effects of subretinal fluid (SRF) of 31 patients with rhegnmtoganous retinal detachment (among them 5 are recurrent) on the growth of fihroblasts were investigated. The results demonstrated that all samples of SRF showed stimulating effect in a variable degree.The range of proliferation-stimulating activity was from 86. 7% to 366.7% above the baseline.The stimulating ahility was mainly related to the degree of PVR and may be also related to the extent and clinical course of the detaehrnent. When stimulating rate was S0Y0 ,the dilution multiple of SRF was higher in recurrent patients than that in initiate ( P＜0.01). （Chin J Ocul Fundus Dis,1993,9:11-13）
ObjectiveTo observe the occurrence and evolution of persistent submacular fluid (SMF) after scleral buckling surgery (SB) in rhegmatogenous retinal detachment, and then to study the related factors of persistent SMF and the effect of persistent SMF on visual outcome. MethodsNinety eyes of 89 patients with rhegmatogenous retinal detachment which had been performed SB were included in this study. Best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscopy, three mirror contact lens, indirect ophthalmoscopy and B-scan ultrasonography were measured for all patients. There were 21 eyes with atrophic holes while 42 eyes with horse-shoe tears, 22 eyes with old retinal detachment while 68 new suffered eyes. Thirty-two eyes underwent scleral encircling surgery (SE) and 58 eyes underwent segmental scleral buckling surgery (SSB). The patients were divided into SMF group and non-SMF (NSMF) group according to the results of optical coherence tomography (OCT) at 1 month postoperatively. Thorough ophthalmologic examinations were performd at 1, 3, 6 and 12 months after surgery to the patients, further observations were continued to carry out unless the abnormality had resolved for at least 6 months. ResultsPatients who underwent SE (20 eyes, 62.5%) had a higher incidence of persistent SMF at 1 month after surgery than those who underwent SSB (23 eyes, 39.7%), the difference was significant (χ2=5.024, P < 0.05). Persistent SMF was more frequent in eyes with atrophic holes (66.7%) than that with horseshoe tears (38.1%), the difference was significant (χ2=4.582, P < 0.05). Persistent SMF was found in 72.7% old retinal detachment eyes and in 39.7% new suffered eyes, showed a striking differences (χ2=7.264, P < 0.01). There was no significant difference in BCVA among SE and SSB groups at every time point (t=0.659, 0.699, 1.108, 1.037, 1.902; P > 0.05). The SMF group have a similar BCVA with NSMF group 1 and 3 months after surgery (t=1.812, 1.957; P > 0.05), whereas the SMF group showed worse BCVA than NSMF group from since 6 months after surgery (t=2.324, 2.147, 2.184; P < 0.05). ConclusionsPersistent SMF is more frequent after SE than SSB, the type of retinal breaks and old retinal detachment may be the potential influencing factors. Persistent SMF after SB may affect the final visual outcome.
ObjectiveTo compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). MethodsFollowing the clinical detection of a macula-off RRD with peripheral retinal breaks, patients were offered the opportunity to enroll in the study, and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study, and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 1:1) using a random number table. Seventy-two eyes of 72 patients were enrolled and studied. Patients were treated with 25G plus vitrectomy, endolaser or transscleral cryopexy, either complete (n=36), or partial (n=36) subretinal fluid drainage, and 14%C3F8 (PFO) was used for intraocular tamponade. After surgery, all patients were kept in a supine position for 24 hours, and then in a clinically optimal position for 6-10 days. The study patients were examined at 1, 3 and 6 months after surgery with thorough ophthalmic examinations. Macular optical coherence tomography (OCT) imaging was acquired in 1 month. Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared. Furthermore, the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded. The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point. ResultsThe preoperative baseline characteristics between the two groups were not significantly different. The single-operation success rates were 88.9% and 91.6% respectively for the CSFD and the PSFD groups (χ2=0.158, P>0.05). The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99±0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564). The mean operative time was longer in the CSFD group (62.25±4.32) minutes than that in the PSFD group (47.9±5.0) minutes (t=0.580, P=0.564). seven of 29 (24.1%) phakic eyes in the CSFD group had lens injury during SRF drainage, and none of the 31-phakic eyes in the PSFD group sustained lens damage. Residual PFO was present in 6 of 36 CSFD cases (16.7%). Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid. Among these patients, 22 patients (62.5%) in the CSFD group and 23(69.7%) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00). ConclusionsPartial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective. The success rates are not statistically different. Additionally, PSFD procedures can simplify the surgery procedure, shorten operative time and, and to some extent, reduce the incidence of complications relevant to the CSFD approach.
ObjectiveTo investigate the efficacy and safety of traditional laser photocoagulation, laser combined with intravitreal injection of anti-vascular endothelial factor (anti-VEGF) drugs and intravitreal injection of anti-VEGF drugs alone in Coats disease. MethodsThe patients diagnosed as Coats disease stage 2B-3A2 in Department of Ophthalmology, Eye and ENT Hospital of Shanghai Medical College of Fudan University from December 2016 to November 2019 were included in this study. Patients were divided into three groups, including laser group, combined group and drug group, according to the different treatment. In the laser group, the initial treatment was traditional laser photocoagulation alone. In the drug group, the anti-VEGF drug was injected into vitreous once a month for three months. The initial treatment of the eyes in the combined group was laser combined with intravitreal injection of anti-VEGF drugs, or laser treatment within 1 week after anti-VEGF drug treatment. The follow-up time was more than 6 months, and best-corrected visual acuity (BCVA), ultra-wide-angle fundus photography, and fluorescein fundus angiography were performed during follow-up. The treatment efficiency, subretinal fluid (SRF), macular edema, BCVA and complications were compared among the three groups. ResultsAmong 60 patients (60 eyes), there were 55 males (55 eyes) and 5 females (5 eyes), with the mean age of 17.1±2.0 years. Among 60 eyes, there were 26 eyes in 2B stage, 23 eyes in 3A1 stage, and 11 eyes in 3A2 stage. Twenty patients (20 eyes) was in the laser group, combined group and drug group, respectively. After the initial treatment of all eyes in the drug group, the abnormal blood vessels did not regress significantly; the absorption and increase of SRF were 4 (20.0%, 4/20) and 5 (25.0%, 5/20) eyes, respectively. Supplementary laser therapy was given to 16 eyes, and vitrectomy (PPV) was given to 4 eyes. Among the 16 eyes treated by laser, 10 eyes were effective (50.0%, 10/20); vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract occurred in 1, 1, and 2 eyes during the treatment, respectively, and PPV was given again in all eyes. Recurrent and persistent macular edema occurred in 4 and 1 eyes, respectively. Among the eyes in the combined group, treatment were effective in 11 eyes (55.0%, 11/20); 5, 2, and 2 eyes had SRF, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again; the edema was repeated and persisted in 1 eye, respectively. Among the affected eyes in the laser group, 15 eyes (75.0%, 15/20) were treated effectively; 2, 2, and 1 eyes developed a large number of vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again. ConclusionsAnti-VEGF drugs alone are ineffective in the treatment of Coats disease, and ablation of other abnormal blood vessels is needed. In the treatment of Coats disease, anti-VEGF drugs can not only promote the absorption of SRF, but also may lead to its increase, and the application should be cautious.