| The choroid locates in the posterior part of the eyeball. It is rich in blood vessels and pigment and closely connected with the whole body system. The choroid plays an important role in replenishing nutrition for the outer layer of the retina, lens and vitreous and so on. Because of the large amount but slow velocity of the choroid blood flow, the pathogen is easily stranded in choroid. The choroid prones to be influenced by autoimmune, infectious, metabolic and blood diseases. Among them, the most common disease is autoimmune inflammation. Also, complications of immune system diseases happen in choroid with high incidence. When severe choroidopathy become worse, there are some other severe complications, such as severe vitreous opacity or hemorrhage, proliferative vitreous retinopathy, retinal neovascularization, exudative or/and tractional retinal detachment, complicated cataract, secondary glaucoma, low intraocular pressure and atrophy of eyeball, resulting in serious declining in visual acuity or even blindness.Classical medication for the treatment of choroidopathy are corticosteroid or/and combined immunosuppressive therapy. But in clinic, we usually encounter the following situations:1. The general condition of the patients are intolerant to,steroid and immunosuppressive therapy; 2. Effects of steroid therapy is poor, or the patients’ condition turn worse after reducing dose; 3. Developing rapidly, choroidopathy induces a marked deterioration in ocular condition; 4. The clinical signs is not typical, and there is difficulty in diagnosis, and so on. Under these circumstances, we have adopted the method of vitrectomy surgery.In this paper, we reported 2 typical cases (3 eyes), and we also analyzed 25 cases (27 eyes) retrospectively. In the 2 cases, one is diagnosed with acute retinal necrosis that cause severe choroiditis, vitreous opacity and retinal detachment. Another case is diagnosed with systemic lupus erythematosus complicated choroidopathy that caused funnel-shaped exudative retinal detachment in either eyes consecutively. A timing surgery may bring different prognosis. Among the 27 cases of eyes,21 cases of eyes (79%) had silicone oil tamponade; 6 cases of eyes (21%) had vitrectomy only. All the patients had intraocular triamcinolone acetonide (TA) injection. As a result, most of the patients’visual acuity had improved after vitrectomy operation. The visual acuity of 18 eyes (68%) increased; 2 eyes (7%) decreased; and 7 eyes (25%) remained unchanged in visual acuity; postoperative retina reposition rate was almost 80%; and the best corrected visual acuity of 2 eyes reached 4.9. Among the 28 eyes, the number of eyes with visual acuity more than 0.05 was 5 (19%) before surgery and 14 (50%) after surgery. As the standard of blindness is no less than 0.05 for the best corrected acuity. There was significant difference (P< 0.05) in the visual acuity pre and post operatively. The systemic medication of steroid was reduced, and the ocular condition was well controlled.In 1978, Diamond first reported the vitrectomy surgery for the treatment of uveitis. The main mechanism is:vitrectomy can remove mass storage of antigenic substances in the vitreous; and it can effectively clear nonspecific inflammatory cell autoreactive T helper cells and chemokines; vitrectomy can remove toxic and harmful substances and cytokines; vitrectomy can solve the vitreous opacity, blood and proliferative lesions; vitrectomy can be convenient for intraocular treatment; vitrectomy can help observing fundus lesions conveniently. Vitreous body and retinal biopsy obtained in the vitrectomy can facilitate correct diagnosis.Our study shows that vitrectomy is an effective means for the treatment of severe choroidopathy when the corticosteroid and immunosuppressive drugs are unable to control the sever choroidopathy. For some cases, vitrectomy may be the first choice or even the only choice. By this method, the visual acuity can be significantly improved to get out of the blindness, and the inflammatory reaction can be well controlled in various cases. Also, the dose of systemic medication can be reduced to avoid related complications. At the same time, the characteristics of silicone oil and its role in the vitrectomy were also described in this thesis. |
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