In order to avoid lesion of adjacent organs which were often occurred after routine cryotherapy of pancreanoduodinal area, a new cryosurgical method of isolated pancreano-duodinal area was designed for treatment of neoplasm in this area, the feasibility of this method was tried in four pigs.After bile common duct, tail of pancreas, stomach, and jejunum were divided and protected by dry cotton pad, the isolated pancreano-duodinal area was twice fozen to -170℃, maintaining ten minutes with LCS 2000 cryogenic surgical system, then alimentary tract was reconstructed with cholecystojejunostomy and gastroenterostomy. Animals were observed for 1-4 weeks. There was only transient elevation of amylase postoperation and the liver function and blood sugar remained normal. No any complication was seen except a small pseudocyst in lesser omentum. Thorough destruction of pancreatic tissue by enough deep and time course of cryotherapy was emphasized and some technic problem also were discussed. Based on our experiment, cryosurgery of isolated pancreano-duodenum will be considered as a safe and effect therapy of pancreano-duodinal neoplasm.
Early detection and timely treatment hold the key to cure retinopathy of prematurity (ROP). ROP screening is carried out unevenly in China. Examination equipments and personnel experiences are the major factors to constraint ROP screening. In addition to strengthening personnel training, it is necessary to establish a standard guideline and pipeline for ROP consultation and referral. Laser photocoagulation and cryotherapy are the first options for the threshold ROP and Type 1 prethreshold ROP. Scleral buckling or vitrectomy is needed for advanced ROP when retinal detachment occurs. The clinical efficacy of intravitreal injection of bevacizumab (an anti-vascular endothelial growth factor monoclonal antibody) for severe ROP is encouraging, but needs further verification. Genetic interference and stem cell therapy will be the prosperous futures in the treatment of ROP. The screening and treatment of ROP in China is becoming more common and improved, but it is still a long way to go considering the huge population of China.
Objective To evaluate the effects of retinal cryotherapy and intravitreal triamcinolone injection to treat Coatsprime; disease with exudative retinal detachment.Methods This was a prospective consecutive case study, and 21 patients (21 eyes) with Coatsprime; disease accompanied by exudative retinal detachment were enrolled. There were 19 males and two females patients, aged from two to 18 years. Fifteen eyes had partial retinal detachment (stage 3A) and six eyes had total retinal detachment (stage 3B). All patients underwent cryocoagulation and intravitreal triamcinolone injection. Three eyes underwent sclerotomy to drain subretinal fluid. Four eyes underwent further treatment by photocoagulation or cryotherapy for the residual abnormal blood vessels after the surgery. The follow-up ranged from three to 15 months with an average of seven months. Visual acuity, intraocular pressure, eye position and eye movements, slit lamp microscope, indirect ophthalmoscope and color fundus imaging were followed up. The last followup time was considered as the judgment time for the therapeutic effects. Results Six eyes had increased intraocular pressure after the surgery, which was controlled by local drug treatment. At the end of follow-up, 19 eyes had reattached retina, one eye had partial retinal detachment and one eye had total retinal detachment. The vision improved in three eyes,unchanged in 14 eyes, and decreased in two eyes. Other complications included strabismus (one eye) and cataract (four eyes). Conclusion The combined treatment of cryotherapy and intravitreal triamcinolone injection is an effective therapy for the Coatsprime; disease with exudative retinal detachment, as retina reattaches and visual function is saved in most patients after this treatment.
Objective：To observe the therapeutic ef fect of chemoreduction treatm ent combined with local focal therapy for advanced intraocular retinoblastoma (R B). Methods：Thirteen eyes of nine patients with RB underwent c hemoreduction tr eatment combined with local cryotherapy and (or) transpupillary thermotherapy (TTT), and the clinical data of the patients were retrospectively analyzed. The vi ncristine, etoposide, and carboplatin (VEC) were used in the chemoreduction trea tment. The average followup duration was 15.3 months. Results：All of the 13 e yes with RB had favorable initial reaction in the treatment of chemoreduction. A fter the first period of chemotherapy, the largest diameter of the tumor fundus decreased 37.2%, and the tumor thickness averagely reduced 46.7%. The subretinal fluid was absorbed completely or partially in 6 eyes (6/8); vitreous and subret inal seeds reduced, disappeared or calcified in 10 (10/11) and 11 eyes (11/11), respectively. During the treatment and in the followup duration, 8 eyes (8/13) had new tumors and (or) recurrences. Finally, 2 eyes (2/13) were enucleated whil e 11 eyes (11/13) were saved in which 8 (8/11) recovered or remained good visual acuity. None of 9 patients had serious side effects of chemotherapy like leucoc ythemia, functional damage of liver and kidney, and dysacousia. Conclus ions：Chem oreduction treatment has well initial effect on advanced RB. Chemoreduction trea tment combined with local treatment may effectively control the retinal tumor, s ubretinal seeds and vitreous seeds within a shortterm duration. The evaluation of longterm effect of the treatment needs further observation.
Objective:To observe the therapeutic effi cacy of chemotherapy combin ed with ophthalmic therapy on retinoblastoma (RB). Methods:The survival rate, eye ball remaining rate, and the control of the disease condition of 37 patients (56 eyes) with RB were retrospectively analyzed. The standard of the well contr ol of the disease included: (1) the ocular tumor shrank or even disappeared, and the tumor had creamlike changes or calcification and cicatrisation; (2) no oc u lar tumor recurrence in patients who had undergone enucleation; (3) no metastasi s found in the followup period. All of the patients had at least one eye with RB (ge;Ⅲb stage) underwent c hemotherapy. According to the response of the tumor to the chemotherapy, the pat ients generally underwent 6 times of systemic chemotherapy at regular intervals of 3-4 weeks. The medicines for chemotherapy included vincristine, cyclohosphamide , etoposide phosphate, and carboplatin. According to the self condition, the pati ents underwent chemotherapy combined with several ophthalmic therapies like phot ocoagulation, cryotherapy, transpupillary thermotherapy, 106Ru brachytherapy, en ucleation, etc. The observation duration lasted 2-59 months, with the average o f 35 months. Results:Thirty patients (83.3%) survived and were followed up, and 6 died (16.6%). One patient with bilateral tumor couldn't be followed up afte renucleation of both eyes. Among these 30 patients (45 eyes), eye ball remainin g rate at stage I-Ⅱ, Ⅲ-Ⅳ, and Ⅴ was 100% (10 eyes), 70% (10 eyes), and 14 .3% (21 eyes), respectively. In the followup duration, the disease in all of the 3 0 patients was controlled well. Conclusions:Chemotherapy combi ned with ophthalmic therapy is effective on RB.
ObjectiveTo evaluate the prognosis of photocoagulation and (or) cryotherapy for prethreshold type 1 and threshold disease of retinopathy of prematurity (ROP).MethodsThe data of 29 eyes of 15 infants who were diagnosed as with prethreshold type 1 or threshold disease of ROP from Jan 30th, 2003 to Jan 13th, 2005 were retrospectively analysed. Pre- and post-operative conditions of ROP were compared in the follow up. Any related local and systemic complications were recorded.ResultsIn 29 eyes which had undergone photocoagulation and (or) cryotherapy, ROP regressed completely in 19 (65.5%), remained dragged retina was found in 7 (24.1%), and retinal detachment was seen in 3 (103%). ROP regressed completely in 12 eyes (41.4%) after the initial treatment and in 7 eyes (24.1%) after the secondary treatment. During the treatment, temporary corneal haze was found in 2 eyes, vitreous hemorrhage occurred in 1 eye, and inadvertent photocoagulation at macular area happened in 1 eye. No systemic complications were found in all cases.ConclusionTimely treatment of photocoagulation and (or) cryotherapy for prethreshold type 1 and threshold disease of ROP may lead to famous prognosis.(Chin J Ocul Fundus Dis,2005,21:278-281)
Objective To investigate the therapeutic effects of retinal angioma. Methods The clinical data of 16 cases(20 e yes) were retrospectively analyzed, and the patients included 5 males and 11 females of 23.3 yeras old on average. Four cases in this series affected by bilateral retinal angiomas were identified as von Hippel-Lindou disease. The retinal an giomas were divided into 5 stages according to their degrees of developmnet from simple angiom without vessel dilation to feeder vessel dilation and intraretina l exudates, local retinal detachemnt, massive retinal detachment and complication occurrence in proper order. The methods of treatment were laser photocoagulati on, trans-scleral cryotherapy and vitreoretinal surgery. The patinets were followed up for 37.8 months on average. Results There were 10 eyes (2 in stage 1, 7 in stage 2, 1 in stage 3)treated with laser photocoagulation, and all of the angiomas were controlled after the treatment. The visual acuity im proved in 2 eyes, decreased in 4 eyes, and remained unchanged in 4 eyes. Cryothe r apy was performed on 7 eyes(5 in stage 3, 2 in stage 4). The visual deteriortion was found in 5 eyes; and the state of illness was stable in 3 eyes in stage 3 a nd aggravating in 4 eyes (2 in stage 3, 2 in stage 4). Vitreoretinal surgery was performed on 4 eyes including 2 which had been given photocoagulation, and the visual acuity improved in 2 eyes, decreased in 1 eye, and was unimproved in 1 ey e . The visual acuity decreased to no light perception in an untreated eye after 1.5 year follow-up. New angiomas occurred in 3 eyes with Von Hippel-Lindou disease in the follow-up period. Conclusion Laser photocoagulation is effective in treating the angiomas from stage 1 to 3. Cryotherapy can cause massive exudation and proliferation, and it is only suitable for a few patients in stage 3. The visual prognosis is more favorable in vitreoretinal surgery tha n other therapies for the patients in stage 4. (Chin J Ocul Fundus Dis, 2001,17:296-298)
Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage.
ObjectiveTo observe the clinical characteristics of rhegmatogenous retinal detachment (RRD) secondary to conservative therapy in retinoblastoma (RB) patients.MethodsA retrospective study. From July 2013 to May 2017, 20 RRD patients (20 eyes) of 456 RB patients (573 eyes) treated in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine were included in the study. Eleven patients (11 eyes) were boy and 9 patients (9 eyes) were girls. Thirteen patients demonstrated bilateral RB and 7 patients had unilateral RB. Average age when diagnosed with RB was 25 months. International Classification of Retinoblastoma groups were C in 1 eye, D in 17 eyes, and E in 2 eyes. These patients received intra-arterial chemotherapy (17 eyes), intravenous chemotherapy (11 eyes), intravitreal chemotherapy (8 eyes), laser (14 eyes) and/or cryotherapy (5 eyes). Twelve patients (12 eyes) received vitreoretinal surgery including vitrectomy (6 eyes) and scleral buckling (7 eyes). The mean follow-up was 39 months. Fundus examination was performed under general anesthesia during comprehensive treatment and follow-up. The time interval of fundus examination varied from 1 to 6 months depending on the stability of the tumor.ResultsRRD was noted in 20 eyes (3.5%) with RB. Retinal hole was found in 15 eyes (75%). The cause of RRD was atrophic hole in calcified tumor (6 eyes, 30%), cryotherapy-related hole (5 eyes, 25%) and laser-related hole (9 eyes, 45%). Multiple atrophic hole in calcified tumor was noted in 3 eyes. Size of hole smaller than 2 DD was noted in 8 eyes (53%), and larger than 2 DD was noted in 7 eyes (47%). Holes were in posterior (3 eyes), equator (2 eyes) and periphery (10 eyes). Severe proliferated was noted in 1 eye. No tear was found. No bulbar retinal detachment and choroidal detachment was noted. Among 12 eyes who underwent vitreoretinal surgery, reattachment was achieved in 9 eyes (75%). No metastasis was noted.ConclusionsCalcified regression of tumor, cryotherapy and laser were main reasons of RRD. Most of the holes are small in diameter and located in the periphery.
ObjectiveTo observe the clinical characteristics of retinoblastoma (RB) in Southwest China.MethodsA retrospective clinical study. From January 2010 to December 2017, 66 RB patients diagnosed in Ophthalmology Department of West China Hospital of Sichuan University were included in the study. All the patients underwent ocular B-ultrasound, orbital CT or MRI examination. Ten patients underwent RetCam examination at the same time. Twenty-nine patients were diagnosed by histopathological examination, and 37 patients were diagnosed by clinical symptoms and imaging examination. According to whether the tumor invaded the orbit and optic nerve, it could be divided into extraocular stage and intraocular stage. Intraocular tumors were divided into A-E stages according to the international intraocular RB classification. Treatments were performed according to different stages. The general information, age at diagnosis, course of diseases (the time between onset symptoms and diagnosis), causes of visiting a doctor, classification, treatment methods and eyeball preservation rate were retrospectively analyzed.ResultsPatients all came from Southwest China (56 patients from Sichuan Province, 2 patients from Yunnan Province, 2 patients from Guizhou Province, and 6 patients from Tibet). The permanent residence were identified in 43 patients, including 27 patients (62.8%) from rural areas. There were 38 males (57.6%); 50 unilateral tumors (75.8%) and 16 bilateral tumors (24.2%); 51 first-visiting patients (77.3%) and 15 re-visiting patients (22.7%). The average diagnostic age of first-visiting patients was 20.9±14.4 months, with 23.2±14.7 and 11.2±7.6 months for unilateral and bilateral tumors, respectively. There were 41 patients had definite course and causes, of whom the average course was 90.6±115.2 days. The most common cause was leucocoria in 32 patients (62.7%), followed by redness and swelling in 4 patients (9.8%), and other causes in 5 patients (12.2%). Among the 15 re-visiting patients, the average diagnostic age was 63.6±46.8 months, the average course was 32.8±45.5 months. Recurrence was occurred in 5 patients (33.3%), leucocoria in 4 patients (26.7%), postoperative complication in 3 patients (20.0%), protrusion in 2 patients (13.3%) and redness in 1 (6.7%) patient, respectively. Fifty out of 82 eyes were admitted to hospital, including 37 eyes of first-visiting patients and 13 eyes of re-visiting patients. Among 37 first-visiting eyes, there were 5 eyes (13.5%) in stage A-C, 26 eyes (70.3%) in stage D-E, 6 eyes (16.2%) in extraocular stage. Five eyes in stage A-C were treated with laser photocoagulation and (or) cryotherapy combined with systemic chemotherapy. Four eyes in stage D were treated with intraocular arterial chemotherapy. Nineteen eyes (51.3%) were performed with enucleation, 2 eyes (5.4%) with evisceration and 7 eyes (18.9%) abandoned treatment. Among 13 re-visiting eyes, 6 eyes (46.2%, with 5 eyes of recurrence) had been enucleated before, 4 eyes (30.8%) were in extraocular stage and 3 eyes (23.1%) in stage D-E. Five eyes (38.5%) were treated with evisceration, 4 eyes (30.8%) with enucleation, 1 eye with oculoplastic surgery and 3 eyes (23.1%) abandoned treatment. The rate of eye preservation was 18.0%, 29.0% for intraocular stage and 0% for extraocular stage, respectively.ConclusionRB patients in Southwest China have a longer course between onset symptoms and diagnosis, more advanced classification and lower rate of eye preservation.