The Pathogenesis And Treatment Of Subclinical Retinal Dethachment After Vitrectomy

Retinal detachment (RD) is the separation of retinal the neural epitheliumand pigment epithelium, is a kind of serious blinding disease. Asymptomaticretinal detachment (ARD) refers to no decreased vision, visual distortion,flashing lights, shadows floating or occlusion of a series of clinical symptomsof retinal detachment, generally found in the ophthalmic examination.Subclinical retinal detachment is a kind of asymptomatic retinal detachment.Academia generally recognized Davis subclinical retinal detachment (SCRD)defined for the range of retinal detachment over the the hiatus edge the1DDbut not more than the equatorial region2DD shallow retinal detachment,usually no clinical symptoms.Objective: To investigate the occurrence causes and treatment ofsubclinical retinal detachment(SCRD) after vitrectomy.Method:1Medical records:30patients，from April2007to September2012inthe department of ophthalmology of the second hospital of HeBei MedicalUniversity, occurr subclinical retinal detachment after vitrectomy. Patientswere found shallow the peripheral retinal hiatus and partial retinal detachmenton regular review, retinal detachment range is over the hole edge1DD, but notexceeding the equatorial region2DD, patients with no symptoms; Recurrencetime:7cases were found in postoperative week,14cases were found withinthree months,6cases were found within six months,3cases were found oversix months; Locations: Superior is12cases.Inferior is18cases. Superior thetemporal quadrant is7cases.Under the temporal quadrant is14cases, superiorthe nasal quadrant is5cases, nasal inferior quadrant is4cases; Hiatus: theround hole is20cases, horseshoe hole is7cases, ora serrata dialysis is3cases;Disease distribution:In the30cases of patients, proliferative diabetic retinopathy (PDR) is three cases, non-traumatic vitreous hemorrhage is9patients,18cases of rhegmatogenous retinal detachment; Operation for thefirst time: vitrectomy alone or combined with gas filling is11cases;vitrectomy with silicone oil tamponade is15cases; silicone oil removal is4cases;2Reasons:caused by residual vitreous contraction force is seven cases,caused by PVR is20cases, including the original hole re-open in twocases,newly hole formation is18patients, serrated edges separation is threecases;3Treatment: Scleral buckling or cerclage is21cases, including fourcases with gas-filled. Vitrectomy surgery combined with intraoculartamponade seven cases, including two cases of gas-filled, silicone oilreplacement and silicone oil five cases. Two cases used in Laser.Results:1The mechanism of subclinical retinal detachment after vitrectomy ismainly ralated to PVR (20/66.67%), the second is related to contraction forceof residual vitreous (7/23.33%);2Thirty patients after treatment after the first surgical reduction by90%,three cases were silicone oil tamponade were followed up for6months, retinalreposition, hole closure;3Preoperative and postoperative one month, three months, six monthsvision after paired T-test Tbefore surgery-month=4.277P=0.000; Tbefore surgery–threemonths=4.394, P=0.000; Tbefore surgery–six months=4.363, P=0.000<0.05,significant statistical difference. Rank sum test, Z=-3.529P=0.000<0.05,with a statistically significant difference between preoperative andpostoperative one week vision.4Characteristic of postoperative subclinical retinal detachment aftervitretomy is summarized: SCRD after vitrectomy mostly happened in inferiorretinal detachment (18/60%), especially under the temporal quadrant (14cases/46.67%); occurred most within three months after vitrectomy(14/46.67%),followed by postoperative week (7/23.33%) Six months after,the disease is basically stable, the occurrence of the SCRD proportion reduced. SCRD stillis given priority to with rhegmatogenous retinal detachment; in the majoritywith round hole in20cases/66.67%).5Vitrectomy alone or in combination with the gas filling of the11patients (36.67%) with postoperative retinal redetachment; with silicone oilfilled15patients (50%); after silicone oil removal,retinal detachment4cases(13.33%); retinal detachment after vitrectomy with silicone oil tamponade ismajority.6The occurrence of rhegmatogenous retinal detachment in the agegroup of15to35years old is85.71%,in the age group of35to55years old is58.33%and in the age group of55to75years old is45.45%, non traumaticvitreous hemorrhage patients in the age group of35to55years old (33.33%)and in the age groupof55to75years old (36.36%) was significantly higherthan the age group of15to35years old (14.29%). The proportion of diabeticretinopathy (18.18%) in the age group of55to75years old is higher than theproportion of the age group of35to55years old.(8.33%).Conclusion:1The mechanism of subclinical retinal detachment after vitrectomy,mainly related to the formation of postoperative PVR.2Subclinical retinal detachment after vitrectomy, aggressive treatmentshould be taken to lift or ease the stretch, you can get a good prognosis.