Retinal Incarceration Research Articles

A Novel Automated Aspiration of Subretinal Fluid Method During Scleral Buckling For Rhegmatogenous Retinal Detachment.

The goal of the study is to introduce a modified technique for the removal of subretinal fluid during scntleral buckling (SB) to treat rhegmatogenous retinal detachment (RRD). This case series study was comprised of 18 cases of RRD patients suffering from a novel automated aspiration of subretinal fluid method during SB. The cases took place from July 2023 to November 2023 at the First Affiliated Hospital of USTC. Preoperative and intraoperative situations were evaluated, and spectral-domain optical coherence (SDOCT) and scanning laser ophthalmoscopy were used to observe the absorption of SRF in the early postoperative period. The SRF method's automated aspiration primarily eliminated the SRF of all 18 RRD cases during SB surgery, leading to retinal reattachment, as showed by SLO. The method did not cause extensive intraoperative hemorrhage and had no risk of retinal incarceration or other complications. The SDOCT showed that the height of SRF in the macular area decreased in 10 cases (66.67%), leaving just a thin layer; was completely cleared in two cases (13.33%); had just a macular single bleb in one case (6.67%); and had several blebs left in two cases (13.33%). These findings suggest that the automated aspiration of the SRF method is effective, controllable, and beneficial for retinal reattachment, especially in the early postoperative period. Complications with this method were rare.

PFCL nightmare: Scleral rupture and novel use of gelatin sponge in repair

We report a case of scleral rupture that occurred during perfluorocarbon liquid (PFCL) injection in a case of bullous rhegmatogenous retinal detachment (RD), which was managed uniquely using a gelatin sponge. So far, only two case reports of scleral rupture during PFCL injection have been reported. A 69-year-old gentleman presented with complaints of sudden-onset painless blurring of vision in his right eye and was diagnosed with pseudophakia with total bullous RD. During 23-G vitrectomy, PFCL was injected using a single-bore cannula. During FAE, the globe appeared hypotonous with choroidal folds. Scleral rupture with retinal incarceration was noted in the superotemporal quadrant. This case report illustrates further unique management.

EXTERNAL DRAINAGE OF SUBRETINAL FLUID DURING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To describe the safety and efficacy of rhegmatogenous retinal detachment (RRD) repair with external drainage of subretinal fluid using a 28-gauge External Drainage and Depression device (Vortex Surgical, Chesterfield, MO). Retrospective review of patients who underwent primary rhegmatogenous retinal detachment repair with scleral buckle, pars plana vitrectomy, or scleral buckle/pars plana vitrectomy using the drainage device from August 2018 through March 2020, performed by four surgeons at two vitreoretinal practices. Eighty-three eyes of 83 patients were included. At presentation, 28% had proliferative vitreoretinopathy. Surgery included 65% scleral buckle/pars plana vitrectomy, 33% pars plana vitrectomy, and 2% scleral buckle. There were no cases of retinal incarceration and two subretinal hemorrhages at the drainage site (both < 2 DD), 2 cases of recurrent RD with proliferative vitreoretinopathy (1 had proliferative vitreoretinopathy at presentation), and 6 (10%) new epiretinal membranes (3 were mild). There were no other complications. Mean follow-up was 274 days. Single operation success rate for those with ≥ 6-month follow-up was 97% (57/59). External drainage of subretinal fluid during rhegmatogenous retinal detachment repair demonstrated a favorable safety profile with a high single operation success rate. Further study of the role of external drainage in rhegmatogenous retinal detachment repair is warranted.

Management of Suture Penetration in Combined Vitrectomy and Scleral Buckle Surgery.

To evaluate the surgical outcome of deep or full-thickness suture penetration during combined pars plana vitrectomy and scleral buckle (PPV/SB) surgery. Clinical data of patients who underwent PPV/SB for retinal detachment in our practice between June 2017 and April 2019 were reviewed. Cases with full-thickness scleral penetration were identified. Data including initial presentation, intraoperative complications, and management were collected. Long-term surgical outcome, complications, and recurrent detachment were determined. Twenty-three cases with evidence of suture penetration were identified. In none of the cases the penetrated suture was visible in the subretinal space. The suture was replaced in cases with persistent leakage through the penetration site or when the surgical plan involved silicone oil insertion. Subretinal hemorrhage was noted during vitrectomy in 7 (30%) patients. The subretinal hemorrhage migrated to the macula in 2 (9%) cases and was drained through a posterior retinotomy. Retinal incarceration was noted in 4 (17%) cases and was released using a focal retinotomy in 2 (9%)cases to reattach the retina. Late complications included epiretinal membrane in 6 (26%) and recurrent detachment occurred in 2 (9%) patients. Final anatomical success was achieved in all patients. We propose new principles in the management of suture penetration during combined PPV/SB surgery. In the absence of a visible penetrated suture, suture replacement is required when there is profuse leakage through the penetration site or if silicone oil is used as tamponade. We recommend removal of submacular hemorrhage through a posterior retinotomy. The incarcerated retina can be flattened using release retinotomies.

Indications, Findings, and Outcomes of Pars Plana Vitrectomy after Open Globe Injury

To determine the indications, findings, and outcomes of patients with open globe injury (OGI) requiring pars plana vitrectomy (PPV). Retrospective, single-vitreoretinal surgeon case series. Sixty-one consecutive eyes with OGI that required PPV. Retrospective chart review of consecutive patients who underwent PPV after OGI between March 1, 2011, and August 1, 2017, at Massachusetts Eye and Ear by 1 surgeon. Final visual acuity and rates of recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR). Sixty-one eyes of 61 consecutive patients underwent PPV after sustaining OGI. Mean follow-up was 12.8±12.1 months (range, 0.5-65 months). At the time of presentation after OGI, 64% of eyes showed light perception or worse vision. The indications for PPV, which was performed on average of 15 days after injury, included RD without retinal incarceration (39%), RD with retinal incarceration in the scleral or corneal wound or both (13%), media opacity without RD (28%), vitreous traction without RD (11%), intraocular foreign body (5%), and endophthalmitis (3%). At the time of PPV, substantial comorbidities were noted, including corneal trauma (20%), hyphema (41%), iris trauma (62%), lens expulsion (54%), subretinal hemorrhage (51%), and choroidal hemorrhage (30%). Using multivariate analysis, factors associated with RD after initial PPV were preoperative subretinal hemorrhage (odds ratio [OR], 5.73; P= 0.03), PVR found at initial PPV (OR, 11.94; P= 0.021), and retinectomy (OR, 17.88; P= 0.003). No patients were inoperable, because all patients left the operating room with complete retinal reattachment. Of 35 eyes that showed RD, 19 (54%) redetached as a result of PVR. In 80% of eyes with RD at initial presentation (28/35 eyes), the retina remained completely attached at last follow-up, and 5 additional eyes remained partially attached (33/35 [94%]). Of 61 total eyes included in this study, 89% remained completely attached, and 42 (69%) achieved visual acuity of 20/200 or better at last follow-up. Despite substantial ocular comorbidities, PPV can result in retinal reattachment in even the most severe cases. Good visual outcomes can be achieved for most patients who undergo vitreoretinal surgery after open globe trauma.

Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair.

To evaluate a modified technique for scleral buckling (SB) in pseudophakic retinal detachment (RD). A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing (WAV) contact lens. Segmental tire alone was used in 5 eyes (23.81%), and combined with encircling band in 7 eyes (33.33%). Radial sponge alone was used in 3 eyes (14.29%) and combined with encircling band in 6 eyes (28.57%). Primary success rate was (90.48%). External drainage of subretinal fluid was performed in 8 eyes (38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes (19.05%) and localized subretinal hemorrhage at drainage site in one eye (4.76%). No case of intraocular lens (IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye (4.76%), elevated intraocular pressure in 2 eyes (9.52%), epiretinal membrane formation in one eye (4.76%) and proliferative vitreoretinopathy in 3 eyes (14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.

Minimally Invasive 27-Gauge Vitrectomy for Coats’ Disease Retinal Detachment

Purpose: To describe the use of 27-gauge pars plana vitrectomy in the management of Coats’ disease retinal detachment. Methods: Case report of a 10-year-old female presenting with exudative retinal detachment secondary to Coats’ disease. A two-port, 27-gauge pars plana vitrectomy, with one cannula in the subretinal space, was used to drain subretinal fluid. After resolution of the retinal detachment, a laser was directed to vascular abnormalities, and intravitreal antivascular endothelial growth factor was administered. Results: At 1 year follow-up, her retinal detachment remained resolved, peripheral vision had improved, and visual acuity had stabilized. Conclusions: A 27-gauge vitrectomy can be used successfully in the treatment of exudative Coats’ detachment. The use of valved trocars allows control of intraocular pressure and simultaneous controlled extrusion of subretinal fluid, decreasing the risk of retinal incarceration.

Primary Combined Pars Plana Vitrectomy and Phacoemulsification With Anterior Segment Removal of Posterior Segment Intraocular Foreign Bodies: A 30-Month Longitudinal Study

Purpose: To describe a surgical technique and report visual and anatomical outcomes after primary combined pars plana vitrectomy (PPV) and phacoemulsification in patients with posterior segment intraocular foreign bodies (IOFBs) removed via the anterior chamber without enlarging preexisting sclerotomies. Posterior IOFBs are generally managed in a stepwise surgery consisting of phacoemulsification/lensectomy for traumatic cataract removal then PPV and removal of IOFB through enlarged sclerotomies. Enlarged sclerotomies may carry a significant risk of hypotony, vitreous hemorrhage, vitreous and retinal incarceration, and rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Limited studies exist on long-term results of primary anterior segment removal of posterior IOFB combined with primary phacoemulsification. Methods: Medical records of consecutive patients who had ocular lacerations and posterior segment IOFB between October 2003 and June 2017 in a university hospital were reviewed. Patients who received a combined primary IOFB removal and phacoemulsification were included in the study. The postoperative evolution including visual acuity and complications were all recorded. Results: Thirteen patients (13 eyes) were included in the study. All patients were men, and the average age at presentation was 38 years. All IOFB were metallic, and their size ranged from 2 to 7 mm. All patients were operated within 24 hours of presentation. Six (46%) of the 13 lacerations were corneal, and 7 (54%) were scleral. Overall, 9 of 13 (69%) had a final postoperative best-corrected visual acuity equal to or better than 20 of 25. There were 3 (23%) postoperative complications of recurrent rhegmatogenous retinal detachment that occurred within the first postoperative year. Conclusion: Primary combined PPV and phacoemulsification with the removal of IOFB via the anterior segment is a safe and promising approach for repairing open globe injuries. Our results demonstrate the favorable prognostic benefit of this technique, which is recommended in cases with small corneal laceration and posterior segment pathology resulting from IOFB.

Retinectomy vs vitrectomy combined with scleral buckling in repair of posterior segment open-globe injuries with retinal incarceration.

PurposeTo evaluate the anatomic and functional outcome of pars plana vitrectomy (PPV) combined with scleral buckling (SB) vs retinectomy in treating posterior segment open-globe injuries with retinal incarceration.MethodsPatients (38 eyes) with posterior segment open-globe injuries and retinal incarceration were identified, and they underwent either PPV combined with SB (PPV+SB, n=19) or retinectomy (n=19). The two groups were matched in the following categories: the severity of injury (including wound length), the location of the incarceration site and the presence of retinal detachment. Anatomic reattachment of the retina and best-corrected visual acuity (BCVA) were measured at the time of 12 months after operation.ResultsAt 12 months after operation, the PPV+SB group demonstrated a better anatomic retinal attachment rate (84.2% vs 68.4%, P=0.252) and BCVA (73.7% vs 47.4%, P=0.247) compared with the retinectomy group, however, the differences failed to reach statistical significance. Compared with the PPV+SB group, the rectinectomy group had significantly higher rates of hemorrhage (47.4% vs 15.8%, P=0.036), inflammation (42.1% vs 10.5%, P=0.027), and a lower intraocular pressure (IOP, 9.8±3.1 vs 13.6±4.1 mmHg, P=0.002) after silicone oil (SO) removal.ConclusionsFor patients with posterior segment open-globe injuries and retinal incarceration, PPV and SB treatments resulted in a better anatomic and functional outcome and less post-operation complications compared with the retinectomy.

Beyond-the-edge proliferation after relaxing retinectomy

To report beyond-the-edge proliferation (BTEP) after relaxing retinectomies (RR) i.e. fibrous sheets stretched between the RR edge and the far periphery; to evaluate the tractional potential and report the long-term course of BTEP. Retrospective review of the medical records of 83 patients having undergone a RR between January 2009 and December 2014 to identify patients with BTEP. Six patients aged 31 to 76 were identified. Retinectomy had been performed for traumatic retinal incarceration in one case and anterior PVR in 5 cases. BTEP occurred within weeks of the RR (earliest: 5 weeks). It was discovered intraoperatively in two patients with silicone oil tamponade, at 7 weeks and 6 months respectively after RR. It recurred over a few months after excision in 5 patients, causing inferior tractional retinoschisis in 4 patients and inferior tractional retinal detachment in two patients. BTEP is an unusual form of proliferative vitreoretinopathy developing despite the absence of the usual vitreo-retinal support (excised during RR), probably through compartmentalization and cell migration along the inferior interface between silicone oil or gas and the aqueous humour. BTEP can cause serious retinal traction, develops over weeks after the RR and recurs frequently a few months after excision.

The minimal scleral buckling surgery for rhegmatogenous retinal detachment

Objective To analyse the clinical efficacy of the minimal scleral buckling surgery for rhegmatogenous retinal detachments(RRDs). Methods This retrospective study was performed on 165 eyes of 162 patients of rhegmatogenous retinal detachments (RRDs). All cases received the minimal scleral buckling surgery , which did not been perform subretinal fluid drainage and sclera buckling limited only to the area of retinal tears. Results In this research, Of the 165 eyes, retina in 156 eyes (94.55%) reattached after the surgery and the subretinal fluid in 154 eyes was completely absorbed within 1 week post operation. There were 4 eyes with superior globular retinal detachment reattached after pneumatic retinopexy, 4 eyes with complicated retinal detachment were performed pars plana vitrectomy, another 1 patient gave up therapy. The results showed that complications of this surgery were rare. Some cases (20 eyes, 12.12%) experienced transient high intraocular pressure and returned to normal after medical treatment in 3 to 5 days. There were no intraocular hemorrhage, infection or iatrogenic retinal incarceration. In 3 to 6 months post operation, the refractive state had no difference compared with preoperation. Conclusion the exocular minimal surgery is a kind of segmental buckling and nondrainage surgery. The complication is rare and reoperation rate is low, it is a reasonable surgery for retinal detachment. This surgery is primary suitable for globular rhegmatogenous retina detachment and those retinal detachment with PVR less then level C1. Key words: Retinal detachment, rhegmatogenous; Scleral buckling surgery, minimal

Drainage of subretinal fluidduring scleral buckling surgery for rhegmatogenous retinal detachment

The purpose of the study is to compare the drainage of subretinal fluid (SRF) in a scleral pocket (SP) with incision parallel to the limbus to drainage through a simple radial scleral thinning (ST), during scleral buckling surgery for rhegmatogenous retinal detachment (RRD).Retrospective cohort study of one hundred sixty-nine consecutive buckling surgery for RRD, where a drainage puncture was performed through SP in eighty-five cases and through previous radial ST in eighty-four cases.PT shows significant lower complication rate. The incidence of retinal incarceration or formation of a retinal hole at the first drainage site is lower in PT group (p=0.0285). During surgery choroidal detachment have been observed in a higher percentage of cases in the SP group (p=0.0379). At the end of the surgery a certain amount of SRF behind the buckling was significant in ST group (p=0.0026).The SP drainage technique appears to be a useful, effective and safe method to drain SRF.

Etiology study of retinal detachment after silicone oil removal

Objective To evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil.Methods The 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.Results Retinal re-detachment occurred in43 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).Conclusions The 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. Key words: Retinal detachment/etiology; Silicone oils

USING SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING TO IDENTIFY THE PRESENCE OF RETINAL SILICONE OIL EMULSIFICATION AFTER SILICONE OIL TAMPONADE

To describe small hyperreflective areas using spectral-domain optical coherence tomography (SD-OCT) imaging in eyes that have had silicone oil tamponade. Retrospective case series of 11 eyes of 11 patients. The authors retrospectively identified patients who underwent vitrectomy and silicone oil tamponade secondary to a rhegmatogenous retinal detachment (nine patients), panuveitis with retinal necrosis (one patient), or recurrent full-thickness macular hole surgery (one patient) who had manifestations of silicone oil emulsion on SD-OCT imaging. Patients were monitored during the postoperative period by clinical examination and using SD-OCT. A model eye in which emulsified silicone oil had been injected in the anterior chamber was used to obtain anterior segment SD-OCT images for comparison. The mean age of our patients was 50 years (range, 39-76 years). In eight eyes, the SD-OCT examination was carried out after silicone oil removal, and in three eyes, the SD-OCT examination was carried out with the oil in situ. Of the nine eyes treated for rhegmatogenous retinal detachment, five had a relieving retinectomy for advanced anterior proliferative vitreoretinopathy or for traumatic retinal incarceration (one eye). The eye treated for full-thickness macular hole had a vitrectomy, internal limiting membrane peel, and silicone oil injection for recurrent macular hole. Ten eyes showed hyperreflective, spherical, tiny droplets using SD-OCT imaging. These were thought to represent silicone oil droplets intraretinally or underneath epiretinal membranes, and one eye showed hyperreflective areas subretinally (retina detached). One additional patient was found to have tiny intravitreal silicone oil droplets after silicone oil removal. Similarly, the silicone oil appeared as multiple hyperreflective spherical droplets as detected by SD-OCT. Anterior segment studies of silicone oil emulsification in the experimental model revealed a similar appearance to that seen with in vivo SD-OCT imaging. The authors have found small hyperreflective areas intraretinally, subretinally, and underneath epiretinal membranes on SD-OCT in eyes that have had silicone oil tamponade for a variety of indications. The authors have seen a similar appearance when silicone oil emulsification is examined in vivo. The authors conclude that the hyperreflective areas are likely (but not certain) to be very small bubbles of emulsified silicone. Further studies are required to determine the incidence, clinicopathologic, and functional significance of probable silicone oil emulsification and deposition within the retinal layers.

Chorioretinectomy for perforating eye injuries

To report the outcomes of chorioretinectomy in severe ocular injuries where a foreign body penetrated the choroid or perforated the globe. The study sample consisted of a retrospective, non-comparative, consecutive interventional case series of 13 perforating or severe intraocular foreign body ocular injuries that were treated at a single institution from March 2008 to March 2010. All the patients were operated with 20-gauge three-port pars plana vitrectomy (PPV) by removing the choroid and/or retina with scar tissue at the perforation site of the foreign body. The reports of patients were examined for best-corrected visual acuity, globe survival, retinal detachment status, and proliferative vitreoretinopathy. A total of 13 eyes of 13 patients with a mean age of 25.8 ± 9.0 years (range, 11-38 years) were followed for a median of 13.8 ± 5.4 months (range, 8-29 months). The mean time period between injury and the vitreoretinal surgery was 13.6 ± 9.3 days. All had an exit/impact site wound, eight of which were located in the posterior pole, which caused choroidal and retinal incarceration in the macular area. PPV together with chorioretinectomy, endolaser applications, silicone oil tamponade, with/without encircling band, and lensectomy surgery was applied to all of them. Final best-corrected visual acuity (BCVA) ≥20/200 occurred in 4 of 13 (30.76%) patients. Globe survival rates were 100% (13 of 13), and final retinal attachment rate was 84.6% (11 of 13). The proliferative vitreoretinopathy rate was 2 of 13 (15.3%). Chorioretinectomy is a surgical option that may decrease post-traumatic proliferative vitreoretinopathy and tractional retinal detachment rates, thus improving final BCVA and increasing globe survival rates when a foreign body penetrates the choroid and perforates the globe.

Scleral Electrocautery and its Effects on Choroid Vessels: Implications for Subretinal Fluid Drainage During Scleral Buckling Surgery

External drainage of subretinal fluid as part of a scleral buckling procedure rapidly restores the retinal pigment epithelium-neural retina interface in rhegmatogenous retinal detachments but carries the inherent risk of subretinal hemorrhage and retinal incarceration. The authors investigated variations to the technique to reduce the chance of subretinal hemorrhage originating from the choroid. A novel method for needle drainage using electrocautery of the sclerochoroidal layers before puncture was employed. The effect of 0% to 50% scleral electrocautery in a porcine model was investigated. A significant decrease in choroidal vessel diameter and choroidal vessel density at 40% electrocautery was demonstrated. Electrocautery without scleral cut-down before external drainage of subretinal fluid likely decreases the chance of subretinal hemorrhage by decreasing choroidal vascularity.

Clinical Characteristics and Surgical Problems of Ruptured Globe Injury

BackgroundOcular trauma is a major cause of vision loss, especially in the young patients, and is the leading cause of unilateral blind in China. ObjectiveThe aims of this report are to analyze ciliary and choroidal lesion characteristics and outcomes of a group of patients with ruptured globe injuries and discuss finding a more effective treatment protocol. Here we report our experience treating ruptured globe injuries. MethodsSeventy-five patients (75 eyes) with a diagnosis of ruptured globe injuries were selected from 264 patients with open globe injuries at the Shierming Eye Hospital of Shandong Province between January 2009 and December 2011. General information and clinical characteristics such as ciliary and choroidal lesion features were reviewed. ResultsOf the 75 patients, 85.3% were men, and the average age of the patients was 37.2 years (range, 6–63 years). The right eye was injured in 52.0%; enucleation was performed in 9 patients. There was no light perception, in the final corrected visual acuity in another 3 patients. The ratio of better visual acuity (better than 0.1) increased from 0 preoperatively to 16.0% postoperatively. Among the 75 patients with ruptured globe injuries, 13 had ciliary injury and 47 (62.7%) had choroidal injuries. Both ciliary and choroidal injuries were detected in 15 patients. Retinal tissue incarceration during sclera suturing was usually the vital point leading to unfavorable results. ConclusionsRuptured globe injury usually results in severe visual acuity damage. Active treatment could help to restore visual acuity in patients to some degree. Some effective treatment protocols for ruptured globe injuries could be followed. Some unsuitable procedures in primary treatment should be avoided to achieve a better prognosis.

Controlled Drainage of Subretinal Fluid Using Continuous Monitoring With Indirect Ophthalmoscopy

External drainage of subretinal fluid during scleral buckling procedures is considered by many ophthalmologists to be a rather dangerous and uncontrolled process owing to the potential for complications such as retinal incarceration, subretinal hemorrhage, and loss of vitreous. Typically, drainage is monitored externally, with only intermittent use of indirect ophthalmoscopy to assess drainage progression and retinal flattening. We present a variant technique that entails continuous, rather than intermittent, monitoring of subretinal fluid drainage via indirect ophthalmoscopy. Using this technique, we report a series with a 2.0% incidence of subretinal hemorrhage and no retinal incarceration or loss of vitreous. Continuous monitoring of drainage with indirect ophthalmoscopy results in a safer and more controlled drainage process by allowing for immediate detection and correction of impending drainage complications.

Vitrectomy in double-perforation gunshot injury

ObjectiveThis study sought to evaluate the result of pars plana vitrectomy in patients with gunshot wounds involving double perforation.MethodsThis was a retrospective, noncomparative, interventional case series.ResultsEighteen patients (18 eyes) with double-perforation gunshot injuries were treated from February 2010 to March 2012. The group included 16 men (88%) and two women (11%); the mean age was 24 (15–33) years. In each case, vitrectomy was scheduled 1–6 weeks after repair of the entrance site. Associated retinal detachments were observed in two eyes (11%), retinal incarceration was observed surrounding the exit site in three eyes (16%), and retention of an intraocular foreign body was observed in two cases. After a follow-up period of 8 ± 2 months, two eyes (11%) had achieved visual acuity (VA) of 0.5, nine eyes (50%) had achieved VA between 0.5 and 0.1, and seven eyes (38%) had achieved VA between 0.1 and hand movement. The main reasons for functional failure (VA 0.1 to hand movement) were macular dragging (due to fibrosis at the exit site near the macula) in seven cases (38%), submacular hemorrhage in four cases (22%), and epimacular fibrosis in five cases (27%). All cases developed postoperative exotropia. One case (5%) developed postoperative hemorrhage. No cases exhibited signs of postoperative redetachment.ConclusionThe outcome of pars plana vitrectomy in cases with double perforations is variable. Factors including the surgeon’s skill level, the time to surgery, and the efficacy of the intraocular tamponade affect the postoperative outcome.

Investigation on surgical outcomes and treatment strategy of open globe injury with corneal blood staining

Objective To investigate on different outcomes of the opening injured eyes with corneal blood staining after vitreoretinal surgery using temporary keratoprosthesis and replacement of the blood stained cornea.Methods From January 2002 to June 2008,medical records of 16 eyes undergoing vitreoretinal surgery using temporary keratoprosthesis for opening globe injury and corneal blood staining were studied.The blood stained corneas were sutured back at the end of the surgery and the eyes were tamponade with silicone oil.Only patients with ≥24 months follow-up were included.Data retrieved from the eye injuryregistry chart including the types of the eye trauma,the status of the eye after the trauma,the intraoperative findings,and the different outcomes and prognoses of the injured eyes were reviewed.Results Among the 16 patients,15 were male and 1 was female.Mean age was (32.3 ± 9.5) years (20 ～53years),mean length of time between the injury and the primary vitreoretinal surgery was (18.8 ± 12.3) days (8 ～57days).Subtypes of the injury include 15 globe rupture,1 penetrating injury,1 intraocular foreigen body.All eyes were suffered from zone 3 open globe injury.Intraoperative findings include 1 total retinal loss,15 total retinal detachment,11 funnel shape retinal detachment,13 retinal incarceration,4 choroidal dialysis.Mean follow-up time was (37.9 ± 11.7) months (24 ～ 60months).Retinal reattachments were achieved in 14 eyes and 1 eye underwent a second reattachment surgery.Final visual outcome include 4 eyes with no light perception,5 eyes with light perception ～ hand motion,3 eyes with finger count ～ 0.08,4eyes with ≥0.1.The overall outcomes were as follows:3 eyes were enucleated,7 eyes needed long term silicone oil temponade,silicone oil were removed in 6 eyes,among them,blood stained cornea were largely resolved in 3 eyes and keratoplasty were not needed,1 patients underwent bilateral corneal exchange,only 2 eyes finally received penetrating keratoplasty.Conclusion Open globe injury with corneal blood staining may have different outcomes,only a small portion of eyes is worth of undergoing keratoplasty. Key words: Corneal blood staining,Injury,open globe ; Vitreoretinal surgery ;