Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.
Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P＜0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break, choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective.
ObjectiveTo evaluate the factors that may influence the possibility of early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy (PDR).MethodsSixty-seven eyes of 60 patients of PDR who received vitrectomy and silicon oil filled in Department of Ophthalmology, China-Japan Friendship Hospital during January 2014 and May 2017 were included in this study. There were 34 males and 26 females, with the mean age of 51.3±12.5 years. Groups were divided depending on the degree of postoperative hemorrhage in 3 days: non-hemorrhage group (NH group) and hemorrhage Group (H group) composed of two sub-group that were called slight hemorrhage (SH) and massive hemorrhage (MH) group. The treatment was conventional 25G or 27G pars plana vitrectomy combined with silicon oil tamponade. Forty eyes received phacoemulsification. The follow-up ranged from 8 to 16 months, with the mean follow-up of 11.2±5.6 months. The possible related factors of early hemorrhage after vitrectomy with silicon oil tamponade were analyzed. Independent t test, χ2 test and Fisher test were used in this study.Results55 eyes of 48 patients were in the NH group, while 12 eyes of 12 patients were in the H Group. There were statistical significances on the difference of age (t=−3.552, P=0.001), gender (P=0.052), hypertension (P=0.021), HbA1c (t=2.187, P=0.033) and presence of neovascularization of iris (χ2= 6.414, P=0.011), but there was no difference on diabetes duration (t=−0.451, P=0.654). Of the 12 patients in the H group, 7 were in the SH group and 5 were in the MH group. The MH group had a significantly higher HbA1c level (7.8±1.1)% compared with the SH Group (9.7±0.7)%, the difference was statistical significant (t=−3.256, P=0.009). Higher systolic blood pressure of MH group 186±7 mmHg (1 mmHg=0.133 kPa) acquired during operation was observed compared with SH Group 153±18 mmHg, the difference was statistical significant (t=−3.894, P=0.003). There was no statistical significances on the difference of age (t=1.954), gender, hypertension duration (t=−1.787), diabetes duration (t=−1.079), fasting blood-glucose (t=−0.361), diastolic blood pressure during operation (t=−0.811) between the two groups (P＞0.05).ConclusionsYounger age, history of hypertension, presence of neovascularization of iris, higher level of HbA1c may predict greater possibility to cause early hemorrhage after vitrectomy with silicon oil tamponade for PDR. The patients with high level of HbA1c and high systolic pressure during the operation are more likely to undergo massive hemorrhage and secondary glaucoma.