Tamponade Research Articles

The hole closure rate of swept-source optical coherence tomography-guided facedown positioning for macular hole surgery

Objective To observe the hole closure rate of swept-source optical coherence tomography(SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy(PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group). In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group). The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was (1.67±1.28) and (7.65±1.42) days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant (Z=−6.784, P 0.05). There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate. Key words: Tomography, optical coherence; Vitreoretinal surgery; Retinal perforations/surgery

Clinical analysis of traumatic endophthalmitis in children

Objective To analyze the clinical manifestation, treatment and its efficacy of traumatic endophthalmitis in children. Methods The data of 45 eyes of 45 cases of traumatic endophthalmitis in children aged 1-11 years from Jan. 2014 to Apr. 2016 were collected and retrospectively analyzed. Twenty-seven patients underwent debridement combined with vitrectomy. Eighteen patients underwent debridement and intravitreal injection of vancomycin, but the infection aggravated after injection in 14 cases, they underwent vitrectomy. Results The hypopyon occurred in 16 cases (35.5%), the anterior chamber exudation occurred in 29 cases (64.5%). After intravitreal injection the infection was controlled in 4 eyes. Forty-one cases underwent vitrectomy. During surgery silicone was tamponaded in 39 cases and C3F8 tamponade in 2 cases. All patients were followed up for 1 year after surgery. Silicone oil was removed in 27 cases and wasn’t removed in 7 cases, 1 case underwent evisceroneurotomy due to the uncontrollable infection. Atrophy of eyeball was happened in 4 cases. In the second stage treatment, IOL were implanted in 8 cases, 2 cases wore RGP. After treatment the visual acuity was improved in 22 cases, 10 cases unchanged and decreased in 7 cases, the vision wasn’t tested in 6 cases due to the age and other reasons. Conclusion The clinical feature of children with endophthalmitis is exudation of anterior chamber and hypopyon. Vitrectomy is the most effective method for the treatment of infectious endophthalmitis in children. Secondary implantation of intraocular lens and glasses, and corresponding amblyopia training can further improve visual function of children. Key words: Endophthalmitis, children, traumatic; Clinical manifestation; Treatment; Efficacy

Effect of tear film stability after vitrectomy combined with silicone oil tamponade

Objective To observe the effect of vitrectomy (PPV) combined with silicone oil filling on the stability of the tear film. Methods A total of 72 eyes of 36 patients with vitreous hemorrhage and retinal detachment were enrolled in the study with PPV combined with silicone oil filling. The operation and contralateral eyes were set up in the operation group and the control group respectively, each had 36 eyes. The tear film rupture time (BUT), the base tear secretion test or Schirmer Ⅰ test (SⅠT) and corneal fluorescein staining (CFS) were performed at 7, 30, 60, and 90 days after operation. The difference of BUT, SⅠT and CFS at different time points after the operation of the two groups were compared. Results After operation 7, 30 days, SⅠT and CFS increased, BUT staining is shortened in the surgery group, the differences were statistically significant (t=1.78, P 0.05). Conclusion PPV combined with silicone oil filling can affect the stability of the tear film, which can be recovered to the preoperative level at postoperative 60 days. Key words: Vitrectomy/adverse effects; Surgical procedures, minimally invasive; Tears/metabolism

The relationship between the sizes of idiopathic macular hole and the healing types of fovea photoreceptor layer after vitrectomy

Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography(OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole(AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow- up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P 0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer. Key words: Retinal perforations/surgery; Photoreceptors, retinal; Tomography, optical coherence

INTRAVITREAL GAS INJECTION WITH LASER PHOTOCOAGULATION FOR HIGHLY MYOPIC FOVEOSCHISIS: Technique and Outcome.

To evaluate the effects of gas tamponade combined with laser photocoagulation without vitrectomy in patients with highly myopic foveoschisis. This retrospective noncomparative case series included 30 eyes of 23 patients with highly myopic foveoschisis who were treated by intravitreal injection of 0.5 to 0.7 mL C3F8 combined with laser photocoagulation 1 week later, and remained in the face-down position for 3 weeks. The patients were followed up for at least 6 months after the treatment. The refractive status, best-corrected visual acuity, and anatomical parameters of retina observed with the optical coherence tomography before and after the treatment were recorded. The mean age of the 23 patients (6 men and 17 women) was 50.4 ± 15.1 years. The average follow-up duration was 20.8 ± 20.6 months. At the final follow-up, 23 eyes (76.7%) completely (17 eyes) or partially (6 eyes) resolved. Seventeen eyes had complete data of optical coherence tomography parameters, the mean central foveal thickness decreased significantly from 505.24 ± 466.22 μm to 186.41 ± 95.36 μm (P = 0.01), and the mean maximal macular thickness from 687.88 ± 397.00 μm to 313.65 ± 83.07 μm (P = 0.001). The mean final logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) of the 30 eyes ranged from 1.6 (20/800) to 0.2 (20/32), showing a slight improvement from 0.91 ± 0.44 (20/163) preoperatively to 0.90 ± 0.39 (20/160) postoperatively (P = 0.87). C3F8 tamponade combined with laser photocoagulation could be an alternative treatment for highly myopic foveoschisis.

Clinical observation of antimicrobial dressings tamponade combined with seal negative pressure drainage in the treatment of 52 cases of necrotizing fasciitis

Objective To observe the effect of antibacterial dressing tamponade combined with seal negative pressure drainage in the treatment of necrotizing fasciitis. Methods 52 patients with necrotizing fasciitis were selected.After full scavenging of fasciitis and necrotic tissue, then filled the whole wound with a kind of dressings with antibacterial properties-Nano silver antiseptic dressing, and a negative pressure drainage tube was placed at the bottom of the wound.Then the wound was closed with a transparent paste, and the air was cut off, in order to make the antibacterial dressing could not only anti bacteria, but also play a role in the growth of the wound, and at the same time, the tissue leachate in the wound was drained through the negative pressure tube in time, so as to accelerate the wound healing and reduce the use of antibiotics. Results Among the 52 cases, the rest were cured except for 1 case of individual cause of abandonment of treatment died of toxic shock., the average hospitalization time was (29.0±15.3)days, days of using antimicrobial was (3.8±1.6)days, 90% cases stopped using antibiotics within 1 week. Conclusion Antibacterial dressing tamponade combined with seal negative pressure drainage in the treatment of necrotizing fasciitis can reduce the switching frequency, reduced antibiotic using intensity, shorten the healing time, it is a kind of very good method. Key words: Necrotizing fasciitis; Stuffing closed; The drainage

Perioperative nursing of inner limiting membrane peeling silicone oil plombage on curing yellow spot retinal detachment of high myopia

Objective To discuss about the perioperative nursing method of inner limiting membrane peeling silicone oil plombage on curing yellow spot retinal detachment of high myopia. Methods Preoperative mental nursing, article preparation, intraoperative patient's condition monitoring, postoperative position, prevention and complication nursing were conducted to 60 cases of yellow spot retinal detachment of high myopia by applying inner limiting membrane peeling silicone oil plombage. Results After silicone oil was taken out, the retina of 55 patients(91.67%) was still in place.After silicone oil of 5 patients (8.33%) was taken out, there was retinal detachment, and reoperation was conducted to reset.6 months after operation, there were 15 cases(25.00%) that the vision was recovered to be ≥0.1, 14 cases(23.33%) recovered to be 0.05~0.09, 13 cases(21.67%)recovered to be 0.02~0.04 and 8 cases(13.33%)had index light sensation. Conclusions Give appropriate preoperative psychological nursing, and patients with sufficient preoperative preparation, intraoperative monitoring vital signs, precise surgery and postoperative observation, body position nursing care, prevention of complications, nursing is the guarantee of successful operation, it is also the key to promote the patient choosing. Key words: High myopia; Retinal detachment; Impending macular hole; Silicone oil tamponade; Perioperative nursing

Efficacy of different vitreous tamponade for the treatment of traumatic macular holes

Objective To compare the efficacy of different vitreous tamponade for the treatment of traumatic macular holes. Methods The clinical data of 68 eyes of 68 patients with traumatic macular hole were collected and analized retrospectively.All cases underwent vitrectomy, during surgery tamponaded with air in 25 patients, 14% C3F8 gas in 28 patients and silicone oil in 15 patients respectively.The closure rate of macular hole, visual acuity and complications were analyzed after surgery. Results The macular hole closure rates in air group and C3F8 group were higher than those in silicone oil group(P=0.01, 0.03), and the difference of macular hole closure rates were not statistically significant between air group and C3F8 group (P=0.19). The rate of visual acuity improvement in air group and C3F8 group were higher than that in silicone oil group(P=0.00, 0.00), and the difference was not statistically significant between air group and C3F8 group(P=0.59). The incidence of complicated cataract in silicon oil group was higher than that of other two groups(P=0.00, 0.00). Conclusion Vitrectomy combined with air tamponade for traumatic macular hole is effective in closure rate and vision improvement.The efficacy is similar with 14% C3F8 tamponade.Silicone oil may be selected in some especial or complicated cases. Key words: Vitrectomy; Silicone oil; Air; Noble gas; Macular hole, traumatic

Efficacy of vitrectomy combined with scleral buckling for rhegmatogenous retinal detachment with vitreous hemorrhage

Objective To evaluate the efficacy of pars plana vitrectomy (PPV) combined with minimal segmental scleral buckling (MSSB) without inert gas or silicone oil tamponade for the treatment of rhegmatogenous retinal detachment (RRD) with vitreous hemorrhage. Methods The data of 99 eyes of 99 cases with RRD with vitreous hemorrhage underwent PPV combined with MSSB from Mar. 2010 to May 2015 were collected and analyzed retrospectively. Results All eyes were localized no-proliferative RRD including 67 eyes with trauma history. The tears placed peripheral retina within a quadrant. Retinal tears were inferior in 73 eyes(73.74%). During operation, 21 eyes (21.21%) underwent air tamponade and 78 eyes (78.79%) received perfusate tamponade. The retinal reattachment rate of the first surgery was 92.93%. The final retinal reattachment rate was 100.00%. The postoperative visual acuity was improved (χ2=68.561, P=0.000). At the end of follow-up, the mean IOP increased from (14.55±3.81) mmHg (1 mmHg=0.133 kPa) to (17.92±2.45) mmHg (t=4.315, P=0.000). However, the IOP were in the normal range. No severe complication occurred during or after surgery. Conclusion PPV combined with MSSB without inert gas or silicone oil tamponade for the treatment of RRD with vitreous hemorrhage has high retinal reattachment rate and few complications. Key words: Vitrectomy, pars plana; Scleral buckling; Retinal detachment, rhegmatogenous

Clinical characteristics and surgical efficacy of endogenous endophthalmitis

Objective To evaluate the efficacy of vitrectomy for the treatment of endogenous endophthalmitis. Methods The data of 12 eyes of 12 cases with endogenous endophthalmitis from Aug. 2014 to Aug. 2017 were collected.The clinical characteristics, surgery treatment and its efficacy were retrospectively analyzed. Results The age of 12 patients ranged from 32 to 75 years, average (53.67±3.09) years.There were 8 (66.67%) males and 4 (33.3%) females.Eight cases (66.67%) were right eyes and 4 cases (33.33%) were left eyes.Endogenous endophthalmitis with systemic disease was in 9 patients (75.00%), positive culture outcome happened in 5 cases (41.67%), 2 eyes were misinterpreted as non-infectious uveitis at first visit.All cases underwent pars plana vitrectomy(PPV) combined with silicone oil tamponade. The infection was controlled after surgery in 10 eyes (83.33%) and 2 eyes (16.67%) received evisceration of eyeball due to recurrent infection.After surgery, visual acuity was from counting fingure to 0.3 in 7 eyes.One eyes infected by Candida got the best vision acuity. Conclusion The patients with endogenous endophthalmitis generally have systemic predisposing factors. There is no specific clinical feature and the prognosis of visual acuity is poor.Antibiotic therapy and vitrectomy combined with silicone oil tamponade can control infection effectively and achieve better efficacy. Key words: Endophthalmitis, endogenous; Vitrectomy; Silicone oil; Efficacy

Vitrectomy combined surgery for the treatment of severe III zone open ocular trauma

Objective To evaluate the efficacy of 25 G vitrectomy combined surgery for the treatment of severe III zone open ocular trauma. Methods The clinical data of 41 eyes of 41 cases with severe III zone open ocular trauma were collected and analyzed retrospectively. All cases underwent 25 G vitrectomy combined with cataract extraction, retinal detachment reduction, retinal incision, proliferating membrane peeling, scleral buckling surgery and silicone oil tamponade in 5-7 days after ocular trauma. The preoperative and postoperative best corrected visual acuity were compared and analyzed. Results Ocular trauma sclera full-thickness laceration of all cases were 6.0-19.0 mm behind corneal limbus, average (9.4±2.6) mm. Postoperative visual acuity was improved in 27 eyes (65.85%). Among 9 eyes without light sensation before operation, after surgery there was 3 eyes still no light sensation, light senses in 2 eyes and hand movement in 4 eyes. Among 38 eyes with retinal detachment before surgery, the retinal completely reattachment was in 34 eyes (89.47%), and partial reattachment of the retina was in 4 eyes (10.53%). The other 3 eyes were not able to perform restorative surgery due to too severe injury and the intraocular structural flocculation. Conclusion Vitrectomy combined surgery can effectively treat severe Ⅲ zone ocular trauma, the visual function will be restored. Key words: Trauma, ocular, open, Ⅲ zone, severe; Vitrectomy, 25 G, combined surgery; Efficacy

Surgical outcomes of 27-gauge vitrectomy for rhegmatogenous retinal detachment with air tamponade

Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD). Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery, 1 week and 3 months after surgery.The operative duration, sclerotomy sites, retinal reattachment rate, intraoperative and postoperative complications were recorded. Results The mean duration of vitreous removal was (15.3±3.6) minutes, and the mean duration of operation was (34.5±4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100%.The mean BCVA was significantly different among before surgery, 1 week and 3 months after surgery (F=64.12, P<0.01), and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs. 1.01±0.40; 0.68±0.30 vs.1.01±0.40) (both at P<0.05). The mean IOP was (14.69±3.66), (17.37±2.32) and (16.69±2.45)mmHg (1 mmHg =0.133 kPa) before surgery, 1 week and 3 months after surgery, showing a significant difference among them (F=14.82, P<0.01), and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P<0.05). The complications included intraoperative iatrogenic retinal breaks in 2 eyes, postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable. Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach. Key words: Vitrectomy/instrumentation; Vitrectomy/methods; Intraocular air tamponade; Rhegmatogenous retinal detachment/surgery; Treatment outcome; Complications; Retrospective studies

Trigemino-Cardiac Reflex and High-Degree Atrioventricular Block in Recurrent Epistaxis

We present a case of a 55-year-old male who presented to emergency department with recurrent epistaxis. After placement of a 16-French Foley catheter in his right nare to tamponade the bleeding, the patient subsequently developed two episodes of syncope. Review of the telemetry rhythm strips showed that he had developed PR interval prolongation followed by complete atrioventricular block. Our case was likely secondary to stimulation of the trigemino-cardiac reflex, a neuro-cardiogenic reflex, that can occur after stimulation of the trigeminal nerve, whether centrally or peripherally. Patients can develop severe bradycardia, hypotension, asystole, and even death. The relatively common occurrence of epistaxis and its treatment with direct nasal tamponade require an increased awareness and possibly a requirement for telemetry monitoring to prevent complications from stimulation of this reflex. J Med Cases. 2018;9(1):16-18 doi: https://doi.org/10.14740/jmc2957w

Vascularity of femoral head and its assessment after femoral neck fractures

Femoral neck fracture has an annual incidence of 1 per 1000 population; in young patients, functional prognosis is not good due to risk of osteonecrosis. Femoral head vascularity is mostly contributed by retinacular vessels and lateral epiphyseal artery. The vascular impact is due to displacement, interrupting retinacular vessel, interrupting ligament teres vascularization, and increased intracapsular pressure, producing a tamponade effect leading to osteonecrosis. This study reviewed the different methods of assessment of femoral head vascularity after femoral neck fractures. There are many techniques for the assessment of residual femoral head vascularity after femoral neck fractures and for the assessment of post-traumatic osteonecrosis risk. Some invasive techniques are superselective angiography, intraosseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others are noninvasive scintigraphy and conventional or dynamic magnetic resonance imaging (MRI). The future seems to lie with dynamic MRI, which gives new classification of femoral neck fractures, based on a noninvasive assessment of femoral head vascularity.

Analysis on risk factors of ocular hypertension after vitrectomy combined with phacoemulsification and silicone oil tamponade for diabetic retinopathy

Objective To analyse risk factors of ocular hypertension after vitrectomy combined with phacoemulsification and silicone oil tamponade for proliferative diabetic retinopathy (PDR). Methods Clinical datas of 32 eyes of 32 patients with PDR from Jan. 2013 to Mar. 2016 were analyzed retrospectively. All cases had received vitrectomy combined with phacoemulsification and silicone oil tamponade. The risk factors of ocular hypertension 3 months after surgery were analyzed. Results The follow-up time was 3 months after surgery, ocular hypertension occurred in 10 eyes of 10 cases (31.25%). The IOP at 1 week and 1 month after surgery were higher than those before surgery (P 10 years was one independent risk factor of ocular hypertension (OR=0.268, P=0.040). Conclusion The visual acuity can be improved post-operation after vitrectomy combined with phacoemulsification and silicone oil tamponade for PDR, while ocular hypertension is still a common complication leading severe vision impairment especially at 1 week and 1 month post-operatively. Diabetic duration over 10 years is risk factor inducing IOP elevation. Key words: Retinopathy, diabetic; Phacoemulsification; Vitrectomy; Silicone oil; Risk factors, ocular hypertension

Analysis of cause of recurrent herpes simplex keratitis after vitrectomy

Objective To analyze the related factors about the recurrence of herpes simplex keratitis (HSK) after vitrectomy. Methods The data of 108 eyes of 108 patients with HSK from Mar. 2013 to Jul. 2016 were collected and analyzed retrospectively. Herpes simplex keratitis was recurred in some patients after operation. The preoperative, intraoperative and postoperative factors related with recurrence of HSK were compared and analyed between the recurrent cases and no recurrent cases. Results In 108 eyes, 36 (33.3%) eyes were found recurrent HSK after vitrectomy. The size of vitrectomy cutter head, intraoperative observation system, intraocular tamponade, postoperative capsular membrane integrity were not relative with recurrence of HSK. And the age, diabetes, preoperative HSK recurrence times, operative time, surgical methods, corneal epithelial curettage, postoperative high intraocular pressure, corneal lesions and influenza were relative with recurrence of HSK. Conclusion The factors affected the function of corneal epithelial cells and the local or systemic immune are related with the postoperative recurrence of HSK. Key words: Vitrectomy; Simplex keratitis, herpes; Cause, recurrence

Efficacy of Bakri balloon for intrauterine tamponade in treatment of intractable postpartum hemorrhage

目的 探讨Bakri球囊宫腔填塞在治疗难治性产后出血（intractable postpartum hemorrhage，IPH）中的应用价值。 方法 2014年4月至2016年4月在湖北省妇幼保健院分娩并诊断IPH，且使用Bakri球囊宫腔填塞止血的34例病例作为Bakri球囊组，选取同期直接采用子宫/髂内动脉栓塞治疗的47例IPH患者为对照组。Bakri球囊置入宫腔后，引流血液暗红色，24 h总量≤500 ml或1 h引流量≤150 ml为有效；Bakri球囊置入后，引流血液鲜红色，24 h总量>500 ml或1 h引流量>150 ml为部分有效，此时立即行双侧子宫/髂内动脉栓塞术；仍有活动性出血，算作失败，及时行子宫切除术。对照组病例未行宫腔填塞，诊断IPH后直接行子宫/髂内动脉栓塞，栓塞后阴道无活动性出血，为止血有效（成功）；仍有无法控制的鲜红色活动性出血为失败，立即行子宫切除。回顾病历资料，比较2组出血原因、止血效果及产后出血量和红细胞输注量。采用两独立样本t检验、Mann-Whitney U检验及χ2检验进行统计学分析。 结果 Bakri球囊组产妇年龄、孕次、产次、体重指数、分娩方式、终止妊娠孕周、新生儿出生体重、住院时间及出血原因与对照组比较，差异均无统计学意义（P值均>0.05）。Bakri球囊组与对照组比较，成功率（有效25例，部分有效7例）[94.1%（32/34）与93.6%（44/47）]和失败率[5.9%（2/34）与6.4%（3/47）]差异无统计学意义（χ2=0.008，P=0.927）,失败的病例均及时行子宫切除。Bakri球囊组产后出血量低于对照组[1 315（1 017~4 000）与1 500（1 000~4 020）ml，Z=－2.022，P=0.043]，输注红细胞量也较低[4.0（0.0~18.0）与5.5（3.0~20.5）U，Z=－2.008，P=0.045]。 结论 Bakri球囊宫腔填塞可快速、有效控制难治性产后出血，并可为血管栓塞治疗争取时间，减少出血量。

The application efficacy of filtered air as the tamponade in the extraction of intraocular foreign bodies

Objective To evaluate the application efficacy of filtered air as the tamponade in the exatraction of posterior intraocular foreign bodies. Methods It was a prospective, nonrandom and consecutive cases study. Seventeen eyes of 17 patients with posterior segment intraocular foreign bodies received vitrectomy combined with extraction of intraocular foreign bodies from Oct. 2016 to Apr. 2017. All cases were applied with filtered air or silicone oil according to the illness. The efficacy of two surgeries were compared. Results The foreign bodies of all cases were extracted in the first surgery. The filtered air was filled in 7 eyes and silicone oil tamponade in 10 eyes. The follow-up time was at least 2 months. The retinal detachment, vitreous hemorrhage and endophthalmitis weren’t found in cases with filtered air tamponade. The retinal detachment due to proliferative vitroretinopathy occurred in 2 eyes with silicone oil tamponade. Conclusion In cases of posterior segment intraocular foreign bodies patients with small retinal holes and no retinal detachment , filtered air as tamponade maybe effective and safe. Key words: Foreign bodies, intraocular, posterior segment; Tamponade, intravitreal, filtered air; Vitrectomy, 23 gauge

The efficacy of corticosteroid in vitrectomy for the treatment of acute retinal necrosis

Objective To investigate the efficacy of corticosteroid combined with early vitrectomy in the treatment of acute retinal necrosis(ARN). Methods Twenty-two eyes of 22 cases of ARN were analyzed retrospectively and they were randomly divided into 2 groups: the corticosteroid group, 13 cases, and the non-corticosteroid group, 9 cases.The best corrected visual acuity (BCVA) preoperative, time from diagnosis to vitrectomy, intravitreal tamponade, occurrence of retinal detachment (RD), ocular hypotony, the BCVA at final follow-up and complications were analyzed. Results The difference of common data between the 2 groups were not statistically significant. The time from diagnosis to vitrectomy in the corticosteroid group was longer than that of non-corticosteroid group (P=0.042), rate of silicon oil tamponade in corticosteroid group was higher than that of non-corticosteroid group (P=0.018), and the eyes of BCVA≥0.1 in corticosteroid group were less than those of non-corticosteroid group (P=0.041). Conclusion Prophylactic vitrectomy is recommended for the treatment of ARN, but the corticosteroid should be used with caution. Key words: Retinal necrosis, acute; Treatment, vitrectomy, corticosteroid

Minimal amount of air bag pressure and external cryocoagulation of retina for the treatment of retinal detachment

Objective To observe the efficacy of minimal amount of air bag pressure and external cryocoagulation of retina for the treatment of retinal detachment. Methods The data of 34 eyes of 34 cases with rhegmatogenous detachment of retina were collected and analyzed retrospectively .They underwent minimal amount of air bag pressure combined with external cryocoagulation of retina.The retinal reattachment, corrected visual acuity and complications were observed after surgery.The follow-up period was 5-12 months. Results In 34 eyes, retinal reattachment was found in 31 eyes( 91.18%), poor retinal reattachment in 3 eyes, included irregular crack hole of 1 eye and pseudophakic of 2 eyes.Among 3 eyes, 2 eyes underwent scleral buckling operation and 1 eye underwent vitrectomy combined with C3F8 tamponade.The omissive retinal tear caused the first surgrey faliure was found during the second surgery. Among 31 eyes of retinal reattachment, retinal detachment recurred in 3 eyes 1 month after surgery, 2 eyes were horse-shoe holes located in the upper quadrant, 1 eye was pseudophakic.Among them, 1 eye underwent scleral buckling operation, 2 eyes underwent vitrectomy combined with silicone oil tamponade after retinal reattachment. At the last follow-up, retinal reattachment were in 32 eyes, corrected visual acuity improved 5-10 lines in 23 eyes (67.65%), improved 3- 4 lines in 8 eyes (23.53%), and 3 eyes without significant changes (8.82%). No serious complication occurred. Conclusion Minimal amount of air bag pressure and external cryocozgulation of retina for the treatment of rhegmatogenous retina detachment is safe and effective, with short time of operation, small incision and less pain to the patients, rapid recovery after operation and keeping more field for other operations. Key words: Retinal detachment, rhegmatogenous; External cryocozgulation of sclera; Air bag pressure