Microsurgical Techniques Combined with Vitrectomy in the Treatment of Retinal Detachment

ABSTRACTImplants are essential for the repair of retinal detachments. The implant buckles the wall of the eye and apposes the detached retina with the choroid, thus restoring light sensitivity to the retina. The scleral buckling also relieves traction on the retina from a shrinking vitreous body. The implant materials most commonly used are solid silicone rubber and silicone sponges, but both types have some disadvantages. A poly(hydroxyethyl acrylate-co-methyl acrylate) hydrogel implant with improved properties of softness and antibiotic absorption is also available for retinal detachment surgery. Proliferative vitreoretinopathy involves various conditions of retinal detachment complicated by vitreous fibrosis, which, after vitrectomy, may be treated with intraocular injection of fluids that support the retina against the choroid. For conditions requiring a long-term implant, silicone oil although controversial is the material of choice. Many other substances have been investigated but none better has yet been found.

Download Full-text

Use neuroprotection to improve visual acuity after endovitreal surgery of rhegmatogenous retinal detachment

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2020-3-55-56 ◽

2020 ◽

pp. 55-56

Author(s):

А.V. Egorov ◽

◽

G.P. Smoliakova ◽

V.V. Egorov ◽

А.Y. Khudyakov ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment

Актуальность. Несмотря на высокую частоту прилегания сетчатки в результате эндовитреальной хирургии, острота зрения в 60% случаев остается низкой или улучшается незначительно. Цель. Оценка эффективности нейропротектора «Цитофлавин» в улучшении остроты зрения после эндовитреальной хирургии регматогенной отслойки сетчатки. Материал и методы. Основная группа наблюдения представлена 20 пациентами с низким зрительным прогнозом, которые получали препарат «Цитофлавин» в послеоперационном периоде (период тампонады силиконом и после удаления силикона). Контрольная группа наблюдения включала 20 человек с низким зрительным прогнозом, получавших стандартное лечение после операции. Критериями оценки эффективности проводимой терапии явились: МКОЗ, амплитуда прироста (АΔ), показателя микроциркуляции (ПМ, перф. ед.), индекса эффективности микроциркуляции (ИЭМ, отн. ед.) относительно исходных, рассчитанная по формуле. Результаты. Результаты исследования показали, что через 6 мес. после операции у пациентов основной группы по сравнению с контрольной МКОЗ выросла более чем в 2 раза (р<0,05). Также при терапии препаратом «Цитофлавин» отмечена более значимая активация хориоретинального кровотока. АΔ, ПМ и ИЭМ у пациентов основной группы исследования к 6 мес. после операции выросла в 2 раза и более (р<0,05), что подтверждает прямую зависимость зрительных функций от состояния и динамики восстановления хориоретинального кровотока. Выводы. При включении нейропротектора «Цитофлавин» в систему медицинской реабилитации пациентов с низким уровнем зрительного прогноза наблюдается повышение МКОЗ в 2 раза и улучшение циркуляторных показателей хориоретинального кровотока более чем в 2 раза.

Download Full-text

Extrascleral Filling Using Endoillumination the First Experiencethe

Russian ophthalmology of children ◽

10.25276/2307-6658-2020-3-43-49 ◽

2020 ◽

pp. 43-49

Author(s):

V.Y. Markevich ◽

◽

T.A. Imshenetskaya ◽

O.A. Yarmak ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Subretinal Fluid ◽

Crystalline Lens ◽

Vitreous Cavity ◽

Macular Area ◽

General Group ◽

Anatomical Outcome

Purpose. To study the effectiveness of extrascleral filling (ESF) using endoillumination in the surgical treatment of patients with primary rhegmatogenous retinal detachment (RRD). Material and methods. The material for the study was the data of a comprehensive clinical examination and surgical treatment by ESF method using endoillumination in 17 patients (17 eyes) with RRD. In 7 cases (41%), the macular area was involved in the detachment process. In 5 cases (29.4%), local scleral filling was performed. In the remaining 12 cases (70.6%), the local ESF was supplemented with a circling silicone element. Surgical intervention was supplemented by transscleral drainage of subretinal fluid (SRF) in 10 cases (59%) and pneumatic retinopexy with SF6 gas 50% in 8 cases (48%). Results. In the general group of patients, best corrected visual acuity (BCVA) increased from 0.35 to 0.46. In the subgroup of patients with a detached macular area, the positive dynamics is more pronounced, BCVA increased from 0.1 to 0.28. The progression of proliferative vitreoretinopathy caused the recurrence of retinal detachment in two patients (11.8%). Recurrences were diagnosed after 3 and 5 months, respectively. In both cases, a vitrectomy with tamponade of the vitreous cavity with silicone oil 5000 Cst was performed. The percentage of successful anatomical outcome after the first operation in our study was 82%. The percentage of successful achievement of the final anatomical result was 94%. In two cases, additional injection of SF6 gas into the vitreous cavity was required. Conclusion. This type of surgical treatment is an effective method of surgical treatment of patients with RRD. In our study, the successful anatomical outcome after the first operation was recorded in 82% of patients, which correlates with the data of the authors who also used this method (83–92%). Surgeons who performed surgical treatment using this technique in our study note improved workplace ergonomics when visualizing the fundus using an operating microscope and endoillumination compared with indirect ophthalmoscopy. Other teams of authors came to this conclusion as well. In our study, there were no complications associated with the introduction of a light pipe into the vitreous cavity (iatrogenic crystalline lens injury, endophthalmitis), which indicates the safety of this type of surgical treatment.

Download Full-text