Vitreous tamponade in the surgical treatment of idiopathic epiretinalmembrane

Цель. Оценить роль и целесообразность тампонады витреальной полости при хирургическом лечении идиопатической эпиретинальной мембраны. Материал и методы. Проведен анализ результатов хирургического лечения 64 пациентов (67глаз) с идиопатической мембраной в возрасте от 52до 80 лет. Проведено хирургическое лечение в объеме микроинвазивной витрэктомии с удалениеми ЭРМ, 25G или 27 G. Пациенты были разделены на3 группы: 1-я группа: без тампонады витреальной полости (28 пациентов, 30 глаз); 2-я группа: с тампонадой воздухом витреальной полости (25 пациентов, 25 глаз) и 3-я группа: с тампонадой силиконом витреальной полости (11 пациентов, 12 глаз).Срок наблюдения 1,3, 6 месяцев. Результаты. У пациентов во всех группах удалось достичь улучшения анатомического и функционального результата, которое выражалось в удалении тракционного компонента со стороны стекловидного тела на макулярную область, снижении высоты макулярного отека и в увеличении МКОЗ. Отсутствие тампонады витреальной полости не влияло на исход лечения. Выводы. Микроинвазивная витрэктомия является единственным методом достижения анатомического и функционального результата при лечении идиопатической эпиретинальной мембраны.

Macular hole surgery under retrobulbar local anesthesia increases visual acuity

<p><strong>Background </strong></p><p>Macular hole surgery can be done under general or local anesthesia, and general anesthesia is still the standard procedure. The objective of this study was to investigate the results of macular hole surgery under local anesthesia.</p><p><strong> </strong></p><p><strong>Methods</strong></p><p>A retrospective study on medical records of patients who had undergone macular hole surgery under local anesthesia. Funduscopic examination of macular hole had been performed and all other diseases with deterioration of visual acuity eliminated. Surgery was performed under retrobulbar local anesthesia, using 2 ml of 2% lidocaine mixed with 3 ml bupivacaine in one syringe. Vitreous tamponade used 20% sulfur hexafluoride (SF₆). Demographic and clinical characteristics, visual acuity before and after surgery, and improvements that occurred were assessed.</p><p><strong> </strong></p><p><strong>Results </strong></p><p>No significant interruption occurred during surgery. Mean age of the patients was 53.89 ± 13.3 years (22-74 years), with mean duration of symptoms of 48.83 ± 100.51 weeks (1-560 weeks). The patients comprised 20 males (55.6%) and 16 females (44.4 5). There were improvements in visual acuity after surgery in 31 patients (86.1%), the rest (13.9%) had identical or lower visual acuity after surgery. A total of 20 patients (55.6%) had postoperative visual acuity of 6/18 or better. Initial mean preoperative visual acuity was 0.08 ± 0.08 (0.01 - 0.29) and improved after the surgery to 0.38 ± 0.26 (0.00 - 1.00), the improvement being statistically significant (p=0.000).</p><p><strong> </strong></p><p><strong>Conclusion</strong></p>Retrobulbar anesthesia is an effective and safe method in macular hole surgery. Macular hole surgery can be done well under local anesthesia, and visual acuity improved significantly.

The Safety and Efficacy of Adjustable Postoperative Position after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose.To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD).Methods.Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position.Results.403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%.Conclusion.Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended.