Retinal Perforation Research Articles

Retinal perforation and local anaesthetic toxicity after peribulbar anaesthesia for cataract surgery

Retinal perforation and local anaesthetic toxicity after peribulbar anaesthesia for cataract surgery

A case of retinal detachment resulting from air bag deployment

ABSTRACT
 A motor vehicle accident (MVA) can result in death or serious injury to the driver and passengers in case the airbags are not deployed. There are, however, several reasons why an airbag can injure a passenger even when there is no accident involved. A 41-year-old female patient who suffered facial bone fractures and an retinal perforation after her air bag deflated during a minor car accident. The complaints of the patient on admission to the emergency department (ED) were facial pain, swelling and redness in the eye. Orbital CT imaging revealed fragmented fracture line displaced into the maxillary sinus at the floor of right orbit, posttraumatic changes in preorbital skin and In the right globe vitreous, an appearance thought to belong to hyperdense hemorrhage. The patient was taken to emergency operation due to corneal perforation in the right eye. All patients who present with air bag-related ocular trauma should undergo a complete ophthalmologic examination because ocular injuries that may be more serious than they initially appear.

Novel Guarded Needle Trans-Scleral Biopsy for Uveal Melanoma: A Pilot Study

Introduction: Trans-scleral biopsy of uveal melanoma (UM) poses an inherent risk of tumor and possibly retinal perforation. We describe a novel technique for trans-scleral biopsy of UM and evaluate its safety and efficacy in an initial cohort of patients. Methods: A retrospective, consecutive observational case series was conducted from October 14, 2019, to April 15, 2020, at Kaiser Permanente, San Francisco, CA among patients with UM of the ciliary body or anterior choroid undergoing trans-scleral fine-needle aspiration biopsy using a novel guarded needle technique. Results: A total of 6 patients were included in the study, with a mean age of 64.3 (range 35–77) years (5 women 83%). Mean (±SD) tumor thickness and maximal basal diameter were 6.4 (±2.66) and 11.9 (±2.13) mm, respectively. Five out of 6 patients achieved a successful biopsy with reliable gene expression profiling (GEP) results. The only failure to obtain specimen occurred in the first attempted patient and, after a minor technique modification, all subsequent biopsies were successful. No intraoperative or short-term postoperative complications were observed in any patient. Conclusion: This novel trans-scleral biopsy technique appears to be safe and effective when obtaining UM tissue for GEP. This method may provide a more controlled biopsy depth thereby minimizing the risk of tumor perforation and its associated complications while still obtaining adequate biopsy yield.

Wright hang-back recession with fibrin glue compared with standard fixed suture recession for the treatment of horizontal strabismus

ObjectiveTo evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus. Study DesignRetrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR). MethodsMedical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up. Results32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was <7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications. ConclusionsWHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.

Comparative evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm or 4.0 mm posterior to the limbus

Objective To investigate the lens and ora serrata safety during 23G vitrectomy with sclera incisions at 5.0 mm or 4.0 mm posterior to the limbus. Methods A prospective case-controlled study was adopted. From April 2016 to January 2018, 290 consecutive primary 23G vitrectomy patients (300 eyes) with vitreoretinal disease in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. Among them, 146 patients (150 eyes) received 23G pars plana vitrectomy (PPV) with scleral incisions at 5.0 mm posterior to the limbus (5.0 mm group), and 144 patients(150 eyes) at 4.0 mm (4.0 mm group). No statistically significant difference was found in age, axial length(t=−1.324, 0.867; P=0.186, 0.387) and in gender, right/left eyes, proportion of indications (χ2=1.366, 2.615, 10.195; P=0.242, 0.106, 0.070) between the two groups. The incidence rate of complications between the two groups were comparatively observed, such as lens injury, retinal tears close to the scleral incision, retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Independent sample t test and χ2 test were performed for comparison between the two groups. Results Lens injury was observed in 4 eyes(2.67%) and 14 eyes (9.33%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ2=5.910, P=0.015). Retinal tears close to the scleral incision sites were observed in 5 eyes (3.33%) and 6 eyes (4.00%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ2=0.094, P=0.759). The mean time of removing the vitreous base was 6.17±2.76 min and 10.03±5.56 min respectively in the 5.0 mm and 4.0 mm group (t=7.599, P <0.01). No other surgical complications occurred in any group, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment, etc. Conclusion In primary 23G PPV, the safety of ora serrata with incisions at 5.0 mm posterior to limbus is similar to that at 4.0 mm, but the safety of lens and the efficiency of vitreous resection is higher with incisions at 5.0 mm. Key words: Vitrectomy; Lens, crystalline/injuries; Retinal perforations

Management of non-inferior rhegmatognous retinal detachment with vitrectomy and air tamponade

Objective To observe the outcomes of 23G pars plana vitrectomy (PPV) and air tamponade for non-inferior rhegmatognous retinal detachment (RRD). Methods A prospective case series study. From August 2017 to April 2018, 39 consecutive RRD patients (39 eyes) in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. There were 20 males(20 eyes) and 19 females (19 eyes), 23 right eyes and 16 left eyes, with the mean age of 55±11 years. There were 30 eyes with lens and 9 eyes without lens or IOL. There were 21, 14 and 4 eyes with 1, 2 and equal or greater than 3 retinal tear respectively. All patients underwent 23G PPV which performed preretinal proliferative membranes and vitreous cortex removal, photocoagulation around the breaks with 3-5 rows, and filtered air tamponade. The follow-up was more than 2 months. The retinal reattachment, visual acuity and complications were observed. Pearson correlation analysis was used to analyze the correlation between BCVA and disease course. Chi-square test was performed for comparison among retinal reattachment rate and different clinical factors before operation. Results At 2 months after the PPV, 35 eyes' retina reattached, the rate of reattachment was 89.8%. In 2-3 weeks, 4 eyes were re-detached, all of them performed silicone oil tamponade. One eye was secondary to pre-macular membrane. The logMAR BCVA before and after PPV were 1.15±0.78 and 0.41±0.31, respectively (t=6.589, P=0.0001). Correlation analysis results showed that BCVA after surgery was positively correlated with BCVA before surgery(r=0.544, P=0.001). Twelve of 30 eyes with crystalline lens suffered cataract. The rate of reattachment vary in the number of the breaks (χ2=9.181, P=0.010). Conclusion PPV with air tamponade may be an optimal treatment of non-inferior RRD with better success rate and security. Key words: Retinal perforations; Vitrectomy; Air

Safety and Efficacy of Subretinally Administered Palucorcel for Geographic Atrophy of Age-Related Macular Degeneration: Phase 2b Study

To evaluate safety and successful use of a novel subretinal delivery system and suprachoroidal surgical approach and safety and activity of human umbilical tissue-derived cells (palucorcel) via a novel delivery system in patients with geographic atrophy (GA). Multicenter, open-label phase 2b study. Participants were 55 to 90 years with GA secondary to age-related macular degeneration (AMD) and best-corrected visual acuity (BCVA) of 20/80 to 20/800. Exclusion criteria included neovascular AMD in the intervention eye, glaucoma with intraocular pressure of 25 mmHg or more, or other significant ophthalmologic conditions. Participants received a subretinal injection of palucorcel, 3.0× 105 cells in 50 μl, using the custom-designed delivery system and surgical procedure. Safety assessments included treatment-emergent adverse events (AEs), immunologic assessments, and ophthalmologic evaluations. Efficacy was evaluated as change in mean number of BCVA letters from baseline, proportion of participants gaining 15 BCVA letters or more, and growth rate of GA lesions at 12 months. Surgery and palucorcel administration were performed in 21 participants at 8 sites by 8 different surgeons. At baseline, median total area of GA was 13.4 mm2 and median BCVA was 43 letters in the intervention eye. Eye-related AEs occurred in 76% of participants (16/21), including conjunctival hemorrhage (n= 5), retinal hemorrhage (n= 4), and vitreous floaters (n= 4). Most AEs were mild and resolved within 1 month. No serious AEs, no retinal detachment or perforation, and no significant changes in intraocular pressure occurred. At month 12, mean change in BCVA from baseline was -5.9 letters correct (standard deviation, 13.0 letters correct) in the intervention eye and -3.7 letters correct (standard deviation, 9.0 letters correct) in the fellow eye. No participants showed improvement of 15 letters or more in the intervention eye, and 3 participants lost more than 15 letters by month 1. No apparent effect of treatment was observed. Palucorcel was delivered successfully to the targeted subretinal site using a novel delivery system and suprachoroidal approach for most participants; however, improvement in GA area, retardation of growth, or visual acuity were not demonstrated.

The correlation analysis of morphological parameters and postoperative prognosis in patients with idiopathic macular hole

Objective To evaluate the optical coherence tomograghy (OCT) morphological parameters for predicting anatomical outcomes and postoperative visual acuity in idiopathic macular hole (IMH) after pars plana vitrectomy (PPV). Methods A retrospective study. A total of 26 eyes in 23 IMH patients underwent PPV, internal limiting membrane (ILM) peeling and gas filling surgery were included in this study. The patients included 8 eyes of 7 males and 18 eyes of 16 females, with the mean age of (63.9± 9.4). All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy and three-dimensional optical coherence tomography (3D OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. According to the standard classification system of International Vitreomacular Traction Study (IVTS) Group, 8 eyes were medium full-thickness macular hole (FTMH) and 18 eyes were large FTMH, none of which were with vitreomacular traction (VMT). The minimum diameter (MIN), base diameter (BASE), height (H), left and right arm length (LAL and RAL), diameter of ellipsoid zone absence (DEZA) were measured. Macular hole index (MHI), hole form factor (HFF), tractional hole index (THI), diameter hole index (DHI) were calculated. The average follow-up period were (9.2±9.7)months. The postoperative DEZA were measure at the last time. Anatomical outcomes were divided into 3 groups. The multiple factors related with predicting anatomical outcome and visual acuity were analyzed. Results In the 26 eyes, the hole was closed in 16 eyes of type 1, 7 eyes of type 2, 3 eyes of type 3. The mean pre- and post-operative logMAR BCVA were 0.9±0.3, 0.7± 0.3 respectively. The MIN, BASE, H were (533±176), (1 035±270), (462±138)μm respectively. The MHI, HFF, THI, DHI were 0.46±0.15, 0.72±0.19, 0.95±0.37, 0.52±0.11 respectively. The mean pre- and post-operative DEZA were (1 775±486), (960±138) μm respectively.Postoperative logMAR BCVA were correlated significantly with MHI, THI (all P 0.05). Anatomical prognosis types were significantly correlated with MHI, HFF, THI (all P 0.05). Conclusions For medium and large FTMH in IVTS classification system, MHI, THI have the best correlation with postoperative BCVA and can be considered as key indicators for predicting postoperative BCVA. MHI, HFF, THI have the best correlation with anatomical outcomes and can be considered as key indicators for predicting anatomical outcomes of IMH. Key words: Retinal perforations; Tomography, optical coherence; Vitrectomy; Retina

Vitrectomy combined with internal limiting membrane annular peeling and transplantation for the treatment of idiopathic macular hole

Objective To investigate the efficacy of internal limiting membrane (ILM) annular peeling and transplantation in the treatment of giant idiopathic macular hole. Methods Data of 52 eyes of 52 cases with giant idiopathic macular hole(d>500 μm) from Jul.2015 to Dec.2016 were collected and analyzed retrospectively. They were divided randomly into 2 groups: group A, 25 cases, underwent pars plana vitrectomy combined with ILM peeling, and group B, 27 cases, received vitrectomy combined internal limiting membrane peeling and transplantation. After surgery the follow-up time was more than 3 months. Results The visual acuity at 3 months after surgery was 0.86±0.27 in group A and 0.62±0.16 in group B. The difference was statistically significant(t=4.000, P=0.030). Macular hole closure rate was 84% in group A and 100% in group B. The difference was statistically significant(χ2=4.680, P=0.047). Defect of ellipsoid zone was (842.08±146.64)μm in group A and (513.89±85.59)μm in group B. The difference was statistically significant(t=6.920, P=0.010). Conclusion Vitrectomy combined with annular ILM peeling and transplantation for the treatment of giant idiopathic macular hole can increase the rate of macular hole closure and improve the visual function. Key words: Retinal perforations; Vitrectomy; Peeling, limiting membrane, internal, annular; Transplantation, limiting membrane, internal

Study of the Process of Diagnostic Assessment, Treatment and Rehabilitation of Criminal Inpatients of Razi Psychiatric Hospital

To analyze risk factors associated with post-traumatic retinal detachment and to identify the cause-effect relationship between retinal detachment and blunt ocular trauma in forensic medical assessment. 112 cases of forensic medical examination on post -traumatic retinal detachment were retrospectively analyzed. A variety of retinal abnormalities were found in these cases, including tearing of the ora serrata retinae (4.28%), macular perforation (12.50%), small (<90 degrees) nonmacular retinal perforation (56.25%), larger (>90 degrees) retinal perforation (5.00%), and tractive retinal detachment without perforation (11.6%). Proliferative vitreoretinopathy (PVR) was found in 45 eyes examined. In most cases, retinal detachment occurred between 1 week to 2 months after blunt ocular trauma (61.60%), with 83.93% accompanied with severe myopia (>-3.00D) and 52.67% accompanied with vitreous floaters. Of all cases, 41.07% were directly and 52.68% were indirectly resulted from blunt ocular trauma, and the rest (6.25%) showed no association with blunt ocular trauma. CONCLUSION Many risk factors may result in retinal detachment including blunt ocular trauma and other causes. Accurate assessment of the relationship between blunt ocular trauma and retinal detachment is an important part of forensic examination.

Epiretinal membrane in a subject after transvitreal delivery of palucorcel (CNTO 2476)

BackgroundA 70-year-old woman with retinitis pigmentosa experienced an epiretinal membrane (ERM) formation and a tractional retinal detachment (RD) following subretinal administration of palucorcel (CNTO 2476), a novel human umbilical tissue-derived cell-based therapy, as part of a Phase I study. The clinical course and results of a histologic examination of the ERM, which was peeled during surgery to repair the RD, are described here.MethodsIn this open-label, first-in-human, Phase I study (NCT00458575), two of seven subjects developed RD, with an ERM formation reported in a woman receiving a targeted dose of 3.0×105 palucorcel administered via a transvitreal route. A sample of the ERM was retained for analysis following the ERM peeling procedure. Clinical outcomes and ERM histology, based on immunocytochemistry analyses and fluorescence in situ hybridization (FISH) staining, were evaluated.ResultsWe first noted the RD and formation of the ERM at 26 days after palucorcel administration. The ERM was cellular and contained multiple cell types, including Müller glial cells, immune cells, neurites, retinal pigment epithelial cells, and palucorcel. The majority of cells were not actively dividing. FISH staining showed a subset of Y chromosome-positive cells in the ERM from this woman, supporting the presence of palucorcel (derived from umbilical cord tissue of male neonate). Palucorcel did not differentiate into Müller glia, immune cells, neurites, or retinal pigment epithelial cells.DiscussionThe development of an ERM containing both subject (self) cells and palucorcel suggests that palucorcel egress in the vitreal cavity after retinotomy may contribute to ERM formation and RD and that an alternative delivery method will be required before further studies are conducted. Subsequent clinical research using alternative subretinal delivery methods for palucorcel in other indications suggests that membrane development does not occur when palucorcel is delivered without retinal perforation.

Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus

Objective To evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus. Methods This is a prospective uncontrolled case study. The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study. There were 56 males (59 eyes) and 84 females (86 eyes), with the mean age of (56.34±9.98) years and axial length of (23.99±2.57) mm. There were 139 phakic eye and 6 aphakic eyes. All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus. To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex, the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries. Pearson correlation analysis was used to analyze the relationship between age, anteroposterior axis of eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex. Results Surgical related complications included retinal tears close to the scleral incision sites (3/145 eyes, 2.1%) and lens injury (3/121 eyes, 2.5%). No other surgical complications occurred, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Based on CT images, the average scleral distance from limbus to the plane passing through the lens posterior apex, anteroposterior axis of eyeball and lens thickness was (6.72±0.81), (24.39±0.97), (4.22±0.47) mm, respectively. The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9, P=0.000 6). Conclusion Primary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe. Key words: Lens, crystalline/injuries; Retinal perforations; Vitrectomy/adverse effects

Prognostic biopsy of choroidal melanoma: an optimised surgical and laboratory approach

BackgroundAccurate survival prognostication for patients with uveal melanoma (UM) enables effective patient counselling and permits personalised systemic surveillance for the early detection of metastases and, in high-risk patients, enrolment in...

Experience With a Subretinal Cell-based Therapy in Patients With Geographic Atrophy Secondary to Age-related Macular Degeneration

To evaluate the safety and tolerability of and clinical response to a single, subretinal dose of human umbilical tissue-derived cells (palucorcel [CNTO-2476]) in the eyes of adults aged ≥50 years with bilateral geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Phase 1/2a, multicenter, open-label, dose-escalation, fellow-eye-controlled study. In the phase 1 portion, eyes were assigned to receive a single, subretinal dose of palucorcel (ranging from 6.0× 104 to 5.6× 105 viable cells). In the phase 2a portion, eyes were assigned to one of 2 palucorcel doses (6.0× 104 or 3.0× 105 cells) determined during the phase 1 portion. The intervention eye was the eye with worse baseline visual acuity. A total of 35 eligible subjects underwent at least a partial surgical procedure. Palucorcel was administered in 33 eyes. Overall, 17.1% (6/35) of subjects experienced retinal detachments and 37.1% (13/35) experienced retinal perforations. No episodes of immune rejection or tumor formation were observed. At 1 year, ≥10- and ≥15-letter gains in best-corrected visual acuity were observed in 34.5% (10/29) and 24.1% (7/29) of eyes receiving palucorcel, respectively, and in 3.3% (1/30; for both) of fellow eyes. The subretinal delivery procedure in this study was associated with a high rate of retinal perforations (n= 13) and retinal detachments (n= 6). When cells were sequestered in the subretinal space, palucorcel was well tolerated and may be associated with improvements in visual acuity. Larger randomized controlled studies are required to confirm these results. Future studies would require a modified surgical approach.

The status and progress of lamellar hole-associated epiretinal proliferation

Recently, the new term lamellar hole-associated epiretinal was introduced to describe a specific epiretinal proliferation. Different from conventional epimacular retinal membrane, lamellar hole-associated epiretinal proliferation (LHEP) can be found around the edge of lamellar macular holes and part of full thickness macular holes. It is defined as a thick homogenous layer of yellowish material without any contractive properties on the epiretinal surface with medium reflectivity on optical coherence tomography images. Immunocytochemical analysis showed the presence of glial cells, fibroblasts, hyalocytes and collagen type Ⅱ. Electron microscopy revealed fibroblasts and hyalocytes as predominant cell types, densely packed in cell agglomerations. LHEP is a secondary event in lamellar macular hole formation and may represent a repair process after large and deep retinal defect. Further studies on its clinical features and clinical significance are still required. Key words: Retinal perforations; Macula lutea; Membranes; Review

Bimodal in vivo imaging provides early assessment of stem-cell-based photoreceptor engraftment.

Subretinal transplantation of stem-cell-derived photoreceptor precursor cells (PPCs) is a promising and innovative approach to treating a range of blinding diseases. However, common barriers to efficient preclinical transplantation comes in the form of suboptimal graft architecture, limited graft survival, and immune-rejection, each of which cannot be assessed using conventional in vivo imaging (i.e., rodent ophthalmoscopy). With the majority of PPCs reported to die within the first few weeks after transplantation, understanding the mechanisms of graft failure, and ultimately devising preventative methods, currently relies on lengthy end point histology. To address these limitations, we hypothesized that combining two imaging modalities, optical coherence tomography (OCT) and fluorescence confocal scanning laser ophthalmoscopy (fcSLO), could provide a more rapid and comprehensive view of PPC engraftment. Human ESC-derived PPCs were transplanted into 15 retinal dystrophic rats that underwent bimodal imaging at 0, 8, and 15 days posttransplant. Bimodal imaging provided serial detection of graft: placement, architecture, and survival; each undetectable under ophthalmoscopy. Bimodal imaging determined graft placement to be either: subretinal (n=7), choroidal (n=4), or vitreal (n=4) indicating neural retinal perforation. Graft architecture was highly variable at the time of transplantation, with notable redistribution over time, while complete, or near complete, graft loss was observed in the majority of recipients after day 8. Of particular importance was detection of vitreal aggregates overlying the graft-possibly an indicator of host-site inflammation and rejection. Early real-time feedback of engraftment has the potential to greatly increase efficiency of preclinical trials in cell-based retinal therapeutics.

Staining internal limiting membrane with a mixture of BBG and sodium hyaluronate

AimsTo evaluate the intraoperative applicability and safety of a mixture of brilliant blue G and sodium hyaluronate (visco-BBG) for staining the inner limiting membrane (ILM).MethodsA retrospective consecutive case series. Seventy-four...

How to remove subretinal fluid?

AbstractPurpose Rhegmatogenous retinal detachments (RRD) can be repaired surgically using non‐drainage techniques. However,removal of subretinal fluid (SRF) remains an important surgical step in retinal detachments treated by scleral buckling, particularly in cases of bullous detachments, inferior breaks, proliferative vitreoretinopathy, high myopia, chronic detachments, cases with poor retinal pigment epithelium function and eyes intolerant to sustained intraocular pressure rise.Methods Conventional drainage techniques include passive needle drainage of subretinal fluid through a 3 to 4 mm radial sclerotomy within the bed of the buckle and closure with a preplaced suture. Many modified SRF drainage techniques have been described. Internal subretinal fluid drainage with simultaneous automated air‐fluid infusion is an important part of modern vitreoretinal surgery.Results Needle drainage, where the needle shaft is observed using an indirect ophthalmoscope, seemed to be associated with a higher success rate than conventional drainage. The most common complications of subretinal fluid drainage include subretinal hemorrhage, retinal incarceration, and retinal perforation. Using perfluorocarbon liquid or infusion of low‐molecular weight silicone oil as a peroperative tool, retinal flattening posterior to equator is an important step of the vitreoretinal approach and internal drainage for the treatment of RRD. Subretinal fluid is drained through a preexisting retinal break or an intentionally created drainage retinotomy using an extrusion cannula. It allows the immediate and complete reattachment of the retina and enables laser endocoagulation of the breaks. If the original retinal break can be treated by laser photocoagulation or cryopexy, the subretinal fluid is not necessarily removed completely.

Clinical observations of macular hole with and without retinal detachment in high myopic eyes

To study the clinical features and the pathogenesis of macular hole with and without retina detachment (RD) in high myopic eyes. It was a retrospective series case study. The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinical data and optic coherence tomography (OCT) results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using χ(2) test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD). During this period, there were 43 patients fitting the including criteria. Among them, 36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group, the average age was 56.1, 24.3% of them (9/37) were male; percentage of left and right eyes was (11/37) and 70.3% (26/37), respectively; average refraction was (-8.9 ± 2.2) D; average axial length was (28.7 ± 2.0) mm. Visual acuity was ≤ 0.05 (72.2%) in 26 eyes and 0.05 - 0.2 (27.8%) in 10 patients. The incidence of complete and non-complete PVD was 89.2% (33/37) and 10.8% (4/37), respectively. White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27.0% (10/37) and 35.1% (13/37) patients, respectively. In the non-RD group, the average age was 47.6; 16.7% of them (1/7) were male; left and right eyes were involved in 42.9% (3/7) and 57.1% (4/7), respectively. Average refraction was (-9.0 ± 1.9) D; average axial length was (28.9 ± 1.5) mm. Vision acuity was ≤ 0.05 in 3 patients (42.9%); between 0.05 - 0.2 in 3 eyes (42.9%) and ≥ 0.2 in 1 eye (14.3%). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14.3% (1/7), respectively. White hole was observed in 14.3% (1/7) patients; 42.9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasonography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (χ(2) = 0.008) and eye laterality (χ(2) = 0.449) as well as refraction (t = 0.193), axial length (t = -0.25) and visual acuity (χ(2) = 4.509) of these two groups were similar (P > 0.05). The incidences of vitreous traction (χ(2) = 0.709), white hole (χ(2) = 1.179), PVD (χ(2) = 0.071) and retinoschisis (χ(2) = 3.207) were also similar (P > 0.05). But the age of the non-RD group is significantly younger than the RD group (t = 1.66, P < 0.05). Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.

A Perforating Eye Injury Caused by a Staple Gun, Treated Successfully Without Vitrectomy.

A 30-year-old carpenter accidentally impaled his own left eye with a 5 cm staple ejected from a pneumatic gun. Entering the globe off-axis, the stainless steel staple caused a vitreous hemorrhage. On the day of injury, the staple was removed surgically. The vitreous hemorrhage cleared rapidly enough to permit laser treatment around the equatorial retinal perforation site. Visual acuity improved to 6/9 and remained stable over a one-year period of careful follow-up. No retinal detachment developed. No additional intervention was required. While vitrectomy with or without a circular buckling remains the standard for perforations into the posterior segment, selected cases may be managed conservatively.