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 observe the expression of erythropoietin (EPO) and EPO receptor (EPOR) in detached retina in rat model. Methods Fourty-eight male SD rats were randomly divided into control group and retinal detachment (RD) groups (1 hour, 3, 6, 12, 24, 48, and 72 hours group) with 6 rats (12 eyes) in each group. 1.4% hyaluronic acid was slowly injected into the subretinal space to induce the detachment of the upper retina to set up the RD model. The expression levels of mRNA and protein of EPO and EPOR were measured by RT-PCR and western-blotting analysis. Meanwhile, the locations of EPO and EPOR in retina were checked by immunohistochemistry. Results Both of the mRNA and protein levels of EPO and EPOR increased after RD, and reached the peak at the 48th hour after RD. The mRNA levels of EPO and EPOR were significantly higher in the 6 and 12 hours group than that in the control group（Plt;0.05）. The protein levels of EPO and EPOR were significantly higher in 3 hours group than that in the control group（Plt;0.05）. Immunohistochemistry indicated weak expression of EPO from ganglion cell layer to inner and outer segment of photoreceptor cells, and b expression in the corresponding location was found 48 hours after RD. Expression of EPOR from ganglion cell layer to inner segment of photoreceptor cells in the normal retina was detected, and b expression in the corresponding location was found 48 hours after RD. Conclusion The expression of EPO and EPOR in retina increases gradually after RD, and reaches the peak at the 48th hour; most of the layers of neural retina can express EPO and EPOR.
Objective To investigate the effect of hepatocyte growth factor (HGF) on the barrier function of retinal peigment epithelium (RPE) and to detect the pathological mechanism of retinal detachment (RD) induced by over expression of HGF in RPE. Methods Sub-retina injection of E1/E3deleted adenoviral vectors encoding HGF (Ad CMV.HGF) and green fluorescent protein (Ad CMV.GFP) in adult pigmented rabbits [5times;104 plaque-forming units (pfu)/eye] to set up the model of retinal detachment. The ocular fundus and pathological changes were observed 3, 7, 14, and 28 days after injection. The expression level of HGF in retina and vitreous body was detected by immunohistochemistry and enzyme linked immunosorbent assay (ELISA). Results In the control eyes injected with AdCMV.GFP, expression of GFP only detected in RPE monolayer. The eyes injected with AdCMV.HGF had b HGF immune positive action in RPE cells at the injection site. The expression level of HGF in vitreous body reached the peak 7 days after injection and decreased to the basic level 28 days after injection. Chronic RD and chronic choroidal inflammation were found in the eyes injected with AdCMV.HGF within the time frame of HGF expression. Proliferative RPE cells were found in subretinal space in the region of RD, and multilayered cellular membranes developed in some eyes. Conclusion Over expression of HGF in RPE may induce chronic serous RD with subretinal proliferation of RPE, which suggests that HGF should be further studied as a target for therapeutic intervention in RD. (Chin J Ocul Fundus Dis, 2007, 23: 193-197)
Objective To analyze the clinical features of retinal detachment in macular spontaneous hemorrhage to improve the level of diagnosis and treatment of this disease. Methods The serial clinical data of 23 patients (23 eyes) with subretinal hemorrhage in macular region with the area over 4DDtimes;5DD who were diagnosed in our hospital from Sep, 1998 to Mar, 2003 were analyzed retrospectively. The patients included 12 males (12 eyes) and 11 females (11 eyes) with the average age of 64.1 (47-75). Fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan examination were performed on the patients to analyze the pathogenic factors, and the visual acuity and manifestation of ocular fundus were observed during the 8-24 months followed-up period. Results The visual acuity decreased to less than 0.2 or light perception suddenly in all affected eyes. In 23 eyes, choroidal neovascularization (CNV) of age-related macular degeneration (AMD) was found in 7, polypoidal choroidal vasculopathy (PCV) was in 5, retinal macroaneurysm was in 2, and unknow pathogenic factor in 9. Among the 23 eyes, hemorrhage was absorbed and no cicatritial formation at the fovea in 3 eyes with the visual acuity of 0.4-0.8; scar and pigment proliferation in the hemorrhage area were seen in 12 eyes with the visual acuity of finger counting (FC) to 0.2; combined vitreous hemorrhage was found in 8 eyes, including massive scar in the macular area in 3 who had undergone vitrectomy with the visual acuity of FC/66cm to 0.2 and blindness in the other 5 eyes. Conclusion Spontaneous hemorrhagic retinal detachment always arises in old people whose symptoms were sudden decrease or loss of the visual acuity. The configuration of the hemorrhage is local and diffuse. The prognosis of the visual acuity of most of the patients is poor due to the serious tissue injury in macula area. (Chin J Ocul Fundus Dis, 2006, 22: 228-231)
ObjectiveTo evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil. MethodsThe clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed. The patients included 518 males and 303 females. The age was ranged from 1 to 79 years old, with an average of 44.03 years. All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years, with an average of 6.82 months). The incidence, time and causes of retinal re-detachment were analyzed. ResultsRetinal re-detachment occurred in 43 patients (44 eyes, 5.13%). Among these retinal re-detachment in 44 eyes, 23 eyes (52.27%) occurred in 1 week, 13 eyes (29.55%) in 1-4 weeks, 4 eyes (9.08%) in 4-8 weeks, 2 eyes (4.55%) in 8-12 weeks, and 2 eyes (4.55%) more than 12 weeks after silicone oil removal. Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes), residual peripheral vitreous (3 eyes), traction of epiretinal proliferative membrane (18 eyes), new retinal hole (9 eyes), non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes). ConclusionsThe incidence of retinal re-detachment after silicone oil removal is 5.13%. The incidence reduced gradually with the extension of time after removal silicone oil.
Objective To investigate the nature of the suprachoroidal fluid by detecting the concentration of total protein (TP), lactate dehydrogenase (LDH), albumin (ALB), total cholesterol (CHOL), total bilirubin (TBIL) in suprachoroidal liquid of patients who have rhegmatogenous retinal detachment with choroid detachment (RRDCD). Methods Eighteen RRDCD patients (18 eyes) who underwent vitrectomy were enrolled in this study. There were 10 males (10 eyes) and 8 females (8 eyes), 8 right eyes and 10 left eyes. There were 8 patients with age of ≤55 years, 10 patients with age of ＞55 years. There were 7 patients with duration of ≤30 days, 11 patients with duration of ＞30 days. There were 7 eyes with diopters of ≥−6.0 D, 11 eyes with diopters of ＜−6.0 D. There were 11 eyes with class C proliferative vitreoretinopathy (PVR), 7 eyes with class D PVR. Suprachoroidal fluid samples were collected from all the patients, and took preoperative serum samples as RRDCD group. Ten serum samples of normal people were set as control group. The concentration of TP, LDH, ALB, CHOL, TBIL in all the subjects were measured. The properties of the suprachoroidal fluid were identified by Light standard and concentration standard of ALB, CHOL, TBIL. Results There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from suprachoroidal fluid samples in the patients with different age, sex, eyes, diopter, PVR grade (P＞0.05). There was no difference on the concentration of TP, LDH, ALB, CHOL, TBIL from preoperative serum samples in the patients between RRDCD group and control group (P＞0.05). There was no difference on the concentration of ALB and CHOL from suprachoroidal fluid samples and preoperative serum samples in the RRDCD patients (P＞0.05), but there were significant differences on the concentration of TP, LDH, TBIL (P＜0.05). According to the Light standard, there were 17 cases of exudates and 1 case of transudate. According to the concentration standard of ALB, CHOL and TBIL, there were 14, 18, and 16 cases of exudates, and 4, 0, and 2 cases of transudate, respectively. There was no difference on the identification result of Light standard and concentration standard of ALB, CHOL, TBIL (χ2=2.090, 1.029, 0.364; P＞0.05). Conclusion The suprachoroidal fluid of RRDCD patients composed of TP, LDH, CHOL and TBIL. The suprachoroidal fluid is more likely to be exudate.