| Research BasicsRhegmatogenous Retinal Detachment(RRD)refers to the phenomenon that on the basis of completely detached retinal holes,liquefied vitreous enters the sub-retinal space via the holes,resulting in the separation of retinal nerve epidermis and pigment epidermis,which is one kind of severe blindness.With the rapid development of vitreoretinal surgery and the wide application of intra-ocular silicone oil filling,vitrectomy combined with silicone oil filling has become one of the surgical methods for the treatment of RRD.However,some patients still have partial sub-retinal fluid under retina after silicone oil filling,which is not conducive to early removal of silicone oil,or even recurrent retinal detachment.In this study,64 patients with sub-retinal fluid of silicone oil eyes were observed clinically,and their treatment methods were preliminarily discussed according to different causes and characteristics,so as to remove silicone oil in time and safely,and reduce the recurrence of retinal detachment.ObjectiveTo discuss the treatment methods for the sub-retinal fluid in silicon-oil eyes according to the observation of its characteristics and the analysis of its causes.Methods515 patients(515 eyes)of RRD follow-up,who were performed by vitrectomy combined silicone oil filling,and measured by the joint front line slit lamp lens,whole retina lens and Optical Coherence Tomography(OCT)during January 2017 to June 2018 in the First Affiliated Hospital of Zhengzhou University.At last,64 cases(64 eyes)with the sub-retinal fluid in silicon-oil eyes were enrolled for this study.Clinical data of Fundus Photography and Fluorescein Fundus Angiography(FFA)were collected for the analysis of its characteristics and causes.The patients were divided into two groups according to the location of the sub-retinal fluid.19 cases(19 eyes)in the macular area and 45 cases(45 eyes)in the peripheral retina with peripheral laser photocoagulation damming underwent silicone oil removal 3 to 6 months after silicone oil filling.5 cases with the peripheral sub-retinal fluid received vitrectomy for local retina reposition and photocoagulation combined with air filling.Routine examinations were performed 2 weeks,1 month,2 months and 3 months after the removal of silicone oil to observe the retinal reduction,vision and complications.ResultsCharacteristics of sub-retinal fluid: Most of the sub-retinal fluid occurs in the lower and peripheral area with limited range and relatively stable.Among them,25 cases(39.1%)were located in the inferior temporal quadrant,19 cases(29.7%)were located in the inferior nasal quadrant,and 1 case(1.5%)was located in the superior temporal quadrant.19 cases(29.7%)were confined to the macular area.The causes of sub-retinal fluid:(1)Proliferative vitreoretinopathy(PVR): 21 cases(32.8%)had varying degrees of hyperplastic changes in the anterior retina,including 4 cases of tractional retinal holes.(2)Retinal hole: 9 cases(14.1%)had retinal hole in the retinal effusion area(including 4 cases of tractional holes),all of which were less than 1PD in size,including 3 cases of incomplete primary hole closure and 6 cases of new hole formation.(3)Fluorescence leakage of retinal vascular wall was detected in 43 cases(67.2%)by FFA.(4)Others: 38 patients(59.4%)without definite hole and PVR conditions,including all of the sub-retinal fluid in macular area.3.Retinal reduction: The sub-retinal fluid in macular area(19 cases)maintain partial absorption or range of effusion stable without progress during follow-up.Retinal flattening was observed 3 months after the removal of silicone oil.The peripheral sub-retinal fluid group(45 cases),1 to 4 times of laser photocoagulation damming were performed,6 cases of which were completely absorbed after the last laser treatment,and 39 cases were partially absorbed or the range maintain stable without progress.In this group,there were 44 cases of retinal avulsion 3 months after the removal of silicone oil.However,1 case occurred retinal detachment recurrence at 1 month after the removal of silicone oil combined with vitrectomy.The retinal reposition rate was 97.8% in the cases with the sub-retinal fluid after the removal of silicone oil.4.Best corrected visual acuity(BCVA): Compared the initial BCVA(0.89+0.56) ? MAR in the group of sub-retinal fluid in macular area to the BCVA(0.75+0.49) ? MAR 3 months after silicone oil,there was statistically significant(t=-4.971,P<0.05).Compared the initial BCVA(0.55+0.36)? MAR in the peripheral sub-retinal fluid group to the BCVA(0.51+0.36)? MAR 3 months after silicone oil,there was statistically significant(Z=-1.617,P>0.05).Conclusions1.The scope of sub-retinal fluid in silicone eyes was limited and relatively stable,mostly occurred in the lower peripheral area.However,sub-retinal fluid also happened in macular area,which does not affect the removal of silicone oil,but should be emphasized and prevented in clinic.2.The main causes of peripheral sub-retinal fluid in silicon oil eyes are retinal tear and PVR.Vascular leakage may be involved in the formation of sub-retinal fluid.3.The method of laser photocoagulation damming can stabilize the range of peripheral sub-retinal fluid,which is useful for the removal of silicone oil in time and safely,and is a more acceptable treatment for patients. |
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