Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,23:234-237)
Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics. Refractory macular hole includes unclosed MH, reopening MH, large MH, high myopic MH, traumatic MH and secondary MH. Some modified surgeries were employed to improve the surgical results. Inverted internal limiting membrane flap, autologous transplantation of the internal limiting membrane, laser photocoagulation, extended internal limiting membrane peeling, arcuate retinotomy, lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially. Loosening MH traction, providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.
Familial exudative vitreoretinopathy (FEVR) is a hereditary retinal vascular dysplasia. So far, 6 genes have been found to be associated with FEVR: Wnt receptor Frizzled Protein 4, Norrie's disease, co-receptor low-density lipoprotein receptor-related protein 5, tetraspanin 12, zinc finger protein 408, and kinesin family members 11 genes. Its clinical manifestations, pathological processes and genetic patterns are diverse, and it shows the relationship between gene polymorphism and clinical manifestation diversity. It is characterized by different symptoms between the same individual, the same family, and the same gene mutation; different clinical stages and gene mutation types of parents or unilateral genetic children; different clinical characteristics and gene mutation patterns of full-term and premature infant; combined with other eye disease and systemic diseases; double gene mutations and single gene mutations have different clinical manifestations and gene mutation characteristics. A comprehensive understanding of the different clinical manifestations and diverse genetics of FEVR can provide better guidance for the treatment of FEVR.
With the continuous advancement of technology, the field of retinal surgery is poised to witness an increasing array of innovations and breakthroughs. The innovation in retinal surgery plays a pivotal role in enhancing the success rate of operations, reducing the risk of complications, and improving patient prognosis and quality of life. This encompasses innovations in vitrectomy systems, the novel application of vitrectomy in treating other ocular diseases, advancements in retinal surgical techniques, technological and conceptual innovations, as well as multidisciplinary collaboration, all of which contribute to the ongoing development in the treatment of retinal diseases. Therefore, innovations in retinal surgery should receive significant attention from ophthalmologists specializing in retinal diseases with the best service to patients.
There are many topics in clinical studies of diabetic retinopathy (DR). The current hot topics include the relationship between DR and systemic diseases, major factors for initiation and progression of DR, early DR screening strategies, DR prevention strategies and how to improve the therapeutic effects of DR. However, due to the complexity of DR pathogenesis, multiple risk factors, long cycle of DR prevention and control, it is difficult to exclude all the confounding factors in the DR clinical research. From the long-term perspective, delaying the occurrence and progression of DR and establishing an efficient and practical prevention and control system is the focus of the future DR research in China.
Objective To observe the incidence of hypotony and its risk factors in the early stage after 23-gauge sutureless microincisional vitrectomy. Methods A retrospective case series. Seventy patients (70 eyes) who had undergone 23-gauge sutureless microincisional vitrectomy were enrolled. There were 41 phakic eyes, 29 eyes with intraocular lens; 68 eyes with a single surgical procedure and 2 eyes with a second surgical procedure; 34 eyes with BSS tamponade and 36 with gas tamponade. Intraocular pressure (IOP) was measured by non-contact tonometry. Hypotony was defined as an IOP of 5 mm Hg (1 mm Hg=0.133 kPa ) or less. The incidence of hypotony and other complications at postoperative day 1, 3 and 7 were observed. The influence of age, sex, side of operation, type of tamponade, status of lens, surgical time on postoperative hypotony was analyzed. Results Hypotony was found in 8 eyes (11.4%) on postoperative day 1 and recovered spontaneously on postoperative day 3. There were no significant differences comparing age (t=1.12), sex (chi;2=2.23) and side of operation (chi;2=2.01) between patients with hypotony and those without it. The patients with hypotony suffered longer surgical time than that of those without hypotony (chi;2=5.48,P＜0.05). The incidence of hypotony in eyes with gas tamponade was significantly lower than that in eyes with BSS tamponade (chi;2=5.48,P＜0.05). The incidence of hypotony in eyes with phakic eyes was lower than that in eyes with intraocular lens (chi;2=4.20,P＜0.05). Hypotony was encountered in the 2 re-operated eyes. Choriodal folds were encountered in 2 eyes, but there was no other complication in other eyes. Conclusions A transient hypotony occurs commonly in first 3 days after 23-gauge sutureless microincisional vitrectomy. Hypotony was significantly influenced by type of tamponade, reoperation and intraoperative lens status.