Rhegmatogenous Retinal Detachment In The Comparative Study Of Two Surgical Macular Structure And

Objective: Rhegmatogenous retinal detachments is a serious eyedesease.we will lose the vision if we can not received efficient treatment atlast.With the introduction of alternative surgical approaches in the lasthalf-century,including Charles Schepens'scleral buckle technique and RobertMachemer's pars plana vitrectomy,the surgical success rates have risen toclose to90%. Nonetheless, despite dramatic progress in the success ofreattachment surgeries, reasonable disagreement exists as to which approach(or combination of approaches) is the best form of surgical intervention forpatients with rhegmatogenous retinal detachments. In this review, wesummarize the current knowledge of retinal detachment, and examine thestructure and function of diffrent surgical approaches for retinaldetachment,with the hope of identifying the most appropriate (evidence-based)therapeutic intervention for the treatment of rhegmatogenous retinaldetachment.Pars plana vitrectomy and scleral buckling surgery(SBS) are the mostusual clinical surgical approaches of which differ regarding severalpotentially harmful effects to the retina. In SBS, external drainage ofsubretinal fluid may cause intraocular pressure fluctuations. An encirclingband may cause retinochoroidal ischemia.On the other hand, after PPV, gasinfusion and silicone oil tamponade and intraocular pressure fluctuations havebeen implicated in causing visual field defects.In each method, there is aconcern for light toxicity,SBS requires illumination from the operatingmicroscope and commonly external laser treatment, whereas PPV requiresendolaser treatment and endoillumination.Retinal:detachment surgery success we need to look at two aspects, oneanatomically successful (anatomic reduction) on the other hand, functional success (visual acuity), with modern technology, the success rate ofanatomical reduction up to90%. However, once out of range involving themacular area, even after surgery to achieve a perfect anatomic reduction, thepossibility of recovery of visual acuity less than40%. Structural changes thataffect the macular recovery of visual function of the most important factor,routine eye examination resolution is poor, difficult to detect small macularlesions. Optical coherence tomography (optical coherence tomography OCT)as a new high-resolution, non-contact, non-invasive imaging method toprevent faults, the biological tissue of the axial resolution of up to10μm, canbe visually accurate show changes in the structure of retinal layers, can notdilated examination. It can be observed from the three-dimensionalperspective of the fine structure of macular changes in the organization, andquantitative measurement of foveal retinal thickness, qualitative description ofthe macular retinal layers characteristic changes in organizational structure,which is conducive to objective evaluation of the disease, for retinaldetachment after surgery and preoperative macular recovery of the theoreticalbasis of comparative analysis; macular function in predicting retinaldetachment surgery, recovery of visual function has an important value. In thepast, for the evaluation of visual function in eyes with visual acuity measuredby more or by vision, color vision and contrast sensitivity methods to detect,but these are psychophysical detection methods, influenced by subjectivefactors. Multifocal ERG (multifocal electroretinography mfERG) areelectrophysiological examination enables accurate, sensitive and rapidmeasurement of the posterior pole retinal function, it is an objective evaluationof visual field recovery of visual function after retinal detachment andunderstanding the process of post-operative follow-up as functional changeshave great advantages. In this study, this observed spread of macular holeretinal detachment scleral buckling surgery and vitrectomy morphological andfunctional changes in the comparative analysis.Methods:60patients(60eyes)with a rhegmatogenous retinal detachmentwere recruited from june2010through june2011.retinal detachment involving the macular were included in the study and devided into two groups accordingto retinal detachment, group A shrink holes,retinal detachment range lessthan a quadrant,uplift sloping,proliferative vitreoretinopathy grade A-B weretreated with episcleral buckle and group B horseshoe-shaped holes,sphericalbulge, retinal detachment range more than a quadrant, proliferativevitreoretinopathy grade A-B were treated with vitrectomy,endolaser and noblegas or silicone oil filling.history of trama,intraocular surgery,macular holeretinal detachment excluded from this study；surgery by the posterior segmentsurgery with extensive experience in the same doctor who have completed.All patients underwent clinical examination, optical coherence tomography(OCT) scan of the macula, and multifocal electroretinography (mfERG)preoperative and postoperative1m,3m,6m.indirect ophthalmoscope retina ofobservations. Heidelberg, Germany, the company's use of OCT, scanningparameters:10-micron resolution, scan depth of2mm, to determine the scanline in the center of the foveal imaging; mfERG Applied Roland's Germanproduction of RETT scan multifocal ERG version3.15system, stimulation ofhigh brightness, high refresh rate of21-inch display, stimuli of61alternatingblack and white hexagons, a frame rate of75hz contrast97%, make the mostdilated eyes, recording the first-order reaction and the value of the waveform,comparing the two groups after morphological and functional changes inmacular area.statistical analysis.Result: A group of retinal detachment in28cases (28eyes) B group,32patients (32eyes).(1) indirect ophthalmoscopy after1month all patients inboth groups were successfully reset the retina.(2) Postoperative OCTexamination after buckle surgery showed accumulation of the fovea oradjacent area. A group of nerve centers, including seroma cavity (diameter1.5mm) and next to the central cavity (diameter2mm) two positions, after1m15cases accounted for53.6%,3m10cases accounted for35.7%,6m4casesaccounted for7.1%; While OCT examination after vitrectomy showedsubfoveal fluid in5cases(15.6%)at1month and disappeared at3months.(3)postoperative mfERG examination after two type of surgery amplitudes were reduced preoperatively in detached retina with significant improvementat follow-up (P <0.05). there was significant difference in the fovealamplitudes improved significantly (P <0.05)compare with two groups, whilethere was no significant difference after vitrectomy compared with after SBSregarding mfERG amplitudes at follow-up in the total mfERG area (P>0.05)。(4)The postoperative complications included1case redetachment in groupA and complicated5cases cataract in group B,of which2cases had receivedphacoemulsification with intraocular lens implantation,two cases complicatedby macular membrane.Conclusion:1Retinal detachment after vitrectomy macular structural and functionalrecovery faster is better, in some patients after scleral buckling restore macularstructure and function of the delay.2OCT macular structure observed significantly better than indirectophthalmoscope.3residual fluid under the macula after scleral buckling may delay recovery ofmacular function of one of the reasons...