| Purpose;1.To assess effectiveness of treatment complicated retinal detachment by modified vitrectomy without the aid of perfluorocarbon liquids.2.To analyze the influencing factors of anatomical reattachment and postoperative visual acuity recovery after treatment of complicated retinal detachment by modified vitrectomy without the aid of perfluorocarbon liquids.3.To evaluate postoperative visual functional recovery after retinal reattachment.Materials and Methods:We retrospectively collected 191 patients with retinal detachment from July 2011 to November 2017,those who received 'modified vitrectomy without the aid of perfluorocarbon liquids' were analyzed for effectiveness and influencing facors.Out-patients with retinal reattachment and visited us from August 2017 to December 2017 were collected for study of functional recovery.The best corrected visual acuity was recorded as five-scores and transformed to the logarithmic visual acuity.1.The effectiveness of treatment of complicated retinal detachment(RD)by modified vitrectomy without the aid of perfluorocarbon liquids:in the 200 eyes of the 191 cases,128 eyes recieved the mordified surgery,whose visual acuities were analysed 1 week postoperatively.Excluding the 10 eyes lost during the follow-ups,a total of 118 eyes were analysed for the initial and the final retinal anatomical reattachtmant(mann-Whitney U test).1 week postoperative rate of throwing off "blindness "(visual acuity:<3.7)for 128 eyes of "non-using heavy water vitrectomy",and comparing 1 week postoperative visual acuity with the preoperative visual acuity(mann-whitney U test);a total of 128 eyes in our research,excluding 10 eyes since lost to follow-up,the other 118 eyes of"non-using heavy water vitrectomy",for which we describing the percentage of the initial and the final surgical anatomical reattachtmant.2.Factors that may influence the postoperative visual acuity of the 128 eyes one week after the modified surgery were analysed by the Spearman's correlation analysis,One-way analysis of varian.Factors that may influence the initial retinal anatomical reattachtmant of the 118 eyes followed-up after the operations were analysed by chi-square test,Spearman's correlation analysis,independent sample t test,and the Mann-Whitney U test.3.Postoperative functional recovery in 21 follow-up patients of the 191 cases after retinal reattachments were analysed for visual acuity,binocular vision(synoptophore and titmus test),retinal central light sensitivity(perimetry,30-2),cellular function in retinal neuroepithelial layer and retinal microcirculation(electroretinogram).The chi-square test,independent sample t test and paired-samples t test were used for analyses.All statistical analyses were performed with the SPSS.20 program.Results:1.For the 128 eyes tested for post operative visual acuity,the percentage of"blindness"(visual acuity:<3.7)preoperatively and 1 week postoperatively were 67.97%(87/128)and 42.19%(54/128)respectively,improved by 25.78%(33/128).The visual acuity 1 week after operations increased in 60 eyes(46.88%),unchanged in 58 eyes(45.31%),and decreased in 10 eyes(7.81%).For the 128 eyes receiving the mordified surgery,the visual acuity 1 week postoperatively(1.43±0.92)was better than that before operation(1.97 ±1.06)(LogMAR,p<0.05).For the 118 eyes receiving the mordified surgery and being followed-up,the initial retinal reattachment rate was 86.44%(102 eyes/118 eyes)and the final retinal reattachment rate was 95.76%(113 eyes/118 eyes).2.For the 128 eyes tested for post operative visual acuity,the number of retinal detachment quadrant,macular hole,the anterior PVR,intraoperative laser treatment,preoperative visual acuity(LogMAR)were the factors affecting the postoperative visual acuity(p<0.05);For the 118 eyes receiving the mordified surgery,gender,age,the number of retinal detachment quadrant and preoperative intraocular pressure were influencing factors for anatomical reattachment(p<0.05).3.For the 21 patients with reattached retina after operation,the visual acuity of the operated eyes decreased statistically compared with the contralateral non-operated eyes(0.39±0.28 vs.0.11±0.08,P<0.05);the percentages of patient without distant stereoscopic vision and without near stereoscopic vision were 61.90%(13/21)and 52.38%(11/21)respectively;postoperative central retinal sensitivity of the operated eyes decreased statistically compared with the contralateral non-operated eyes(25.58±3.33 vs.29.27±2.87,p<0.05).For the 18 patients with reattached retina after operation,As to the results of electroretinography examination:cones function(photopic adaptation flash stimulus potential:longer latent period 64.18±2.90 vs.60.91 ±4.26,lower amplitude 54.94±28.02 vs.100.80±44.82,p<0.05),bipolar cellular function(scotopia adaptation 3.0b wave:longer latent period 45.36±3.44 vs.42.59±3.44,lower amplitude 264.20±105.27 vs.322.42±1 05.27,p<0.05)and retinal blood circulation function(oscillatory potential:longer latent period 25.49±0.59 vs.24.73±0.70,lower amplitude 22.05±22.92 vs.47.68±22.92,p<0.05)declined statistically compared the operated eyes with the contralateral non-operated eyes.Conclusion:1.Vitrectomy without the aid of perfluorocarbon liquids is a safe and effective treatment for complicated retinal detachment,which can effectively improve the anatomical reattachment rate and the visual acuity.It can avoid complications caused by perfluorocarbon liquids.2.Increased number of retinal detachment quadrant,macular hole,presence of the anterior PVR,without intraoperative laser treatment,the lower preoperative visual acuity were the main negative factors affecting the early postoperative visual acuity recovery;Male,younger age,increased number of retinal detachment quadrant and lower preoperative intraocular pressure were main influencing factors for initial postoperative retinal redetachment.3.Visual functions were not restored after retinal reattachment,further studies and treatments are needed for functional recovery after anatomical retinal reattachments. |
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