We uesd domestic perfluorotributylamine to treat 21 eyes with giant retinal tears,including 5 rhegmatogenous retinal detachment with folded and fixed flap and 16 giant retinal tears resulting from retinotomy and retinectomy due to complicated retinal detachment.The success rate of retinal reattachment was over 95%,with no serious side effects.The activities and complications of perfluorotributylamine in the mangement of giant retinal tears were discussed.
（Chin J Ocul Fundus Dis,1996,12: 22-24）
ObjectiveTo compare the results of internal limiting membrane (ILM) peeling with and without ILM transplantation to treat idiopathic macular hole (IMH) with hole form factor (HFF)<0.6.
MethodsForty patients (40 eyes) of IMH with HFF<0.6 who underwent pars plana vitrectomy (PPV) were enrolled in this study. 20 eyes was performed PPV combined with ILM peeling (ILM peeling group), the other 20 eyes was performed PPV combined with ILM peeling and ILM transplant (ILM transplant group). The follow-up was ranged from 3 to 6 months with an average of 4 months. The changes of closing rate of hole, best corrected visual acuity (BCVA), photoreceptor inner segment/outer segment (IS/OS) junction defect diameter and amplitude of wave P1 of ring 1 and ring 2 by multifocal electroretinogram (mfERG) were comparatively analyzed for the two groups.
ResultsIn 3 months after surgery, the IMH closing rate was 70% (14/20) in the ILM peeling group, and 100% (20/20) in the ILM transplant group, the difference between these two groups was significant (χ2=7.059, P<0.05). Postoperative BCVA was improved obviously in the two groups compared to preoperative BCVA, the difference was significant (t=4.017, 4.430; P<0.05). The rate of BCVA improvement in the ILM peeling group and ILM transplant group were 80% and 85%, the difference was not significant (χ2=0.173, P>0.05). The rate of significantly BCVA improvement in the ILM peeling group and ILM transplant group were 35% and 70%, the difference was significant (χ2=4.912, P<0.05). IS/OS junction defect (t=6.368, 6.635; P<0.05) and amplitude of wave P1 of ring 1 (t=2.833, 4.235) and ring 2 (t=2.459, 4.270) by mfERG in the two groups were improved after operation. The differences of postoperative IS/OS junction defect (t=2.261, P<0.05) and amplitude of wave P1 of ring 2 between the two groups were significant (t=2.282, P<0.05), but the differences of postoperative amplitude of wave P1 of ring 1 between two groups was not different (t=1.800, P>0.05).
ConclusionPPV combined with ILM peeling and ILM transplantation can significantly improve the closure rate and vision of IMH with HFF<0.6.
ObjectiveTo observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).MethodsA retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.ResultsThe postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=?11.66, ?7.52, ?4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, ?0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,ConclusionsThe macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
Objective
To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery.
Methods
Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed.
Results
On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P＜0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=?5.413, P＜0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05).
Conclusions
Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.
Objective
To evaluate the effect of vitreoretinal surgery with lens-sparing technique in treating the detachment with giant retinal tear(GRT) associated with proliferative vitreoretinopathy(PVR).
Methods
Thirty-one consecutive eyes with GRT unde rwent vitrectomy were analysed retrospectively. Operative techniques included peeling of pre-retinal membrane， injection of perfluorodecalin liquid， retinotomy and retinectomy，endolaser，and silicon oil or C2F6 gas tamponade. Lens-sparing vitrectomy was performed in 28 phakic eyes. Follow-up period ranged from 11 to 34 months.
Results
Anatomic retina l attachment was achieved intraoeratively in 29 eyes. In 16 eyes of 28 eyes with postoperative cataract formation,3 eyes underwent cataract surgery with or without intraocular lens implantation. The corrected final visual acuity ran ged from 0.4 to 0.01.
Conclusion
Most phakic eyes of retinal detachment with GRT PVR can be successfully operated on with an out come of improving the visual acuity by using techniques of lens-sparing vitrectomy, perfluorodecalin liquid and silcone oil tamponade.
(Chin J Ocul Fundus Dis, 2001,17:93-95)
ObjectiveTo observe the subfoveal choroidal thickness (SFCT) and choriocapillary blood flow area (CBFA) in the patients with idiopathic macular hole (IMH).MethodsThis is a prospective clinical study. Thirty-two patients with unilateral IMH (4 in stage 2, 17 in stage 3, 11 in stage 4) and 32 age- and sex-matched normal controls were enrolled in this study. All eyes were divided into three groups, including group A (32 affected eyes), group B (32 fellow eyes) and group C (32 normal eyes of controls). There was no significant difference in age (t=0.865) and gender (χ2=0.000) in IMH patients versus normal control subjects (P＞0.05). There was no significant difference in refraction (F=0.957) and ocular axial length (F=0.562) between group A, B and C. The SFCT was detected by enhanced depth imaging of spectral-domain optical coherence tomography (OCT). The CBFA was detected by OCT angiography. The differences of SFCT and CBFA in three groups were analyzed by Kruskal-Wallis and non-parametric test.ResultsThe mean SFCT was (182.53±64.52) μm in group A, (199.21±73.07) μm in group B and (254.21±56.85) μm in group C respectively. The SFCT was thinner in group A and B than that in group C (Z=?4.362, ?3.190; P＜0.05), but was the same in group A and B (Z=?1.171, P＞0.05). The mean CBFA was (5.09±0.31) mm2 in group A, (5.41±0.20) mm2 in group B and (5.39±0.15) mm2 in group C respectively. The CBFA was reduced in group A than that in group B and C (Z=?4.467, ?4.048; P＜0.05), but was same in group B and C (Z=0.420, P＞0.05).ConclusionSFCT and CBFA are both reduced in IMH eyes.
ObjectiveTo observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation. MethodsA cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups (t=1.327, 0.157, 0.542; P＞0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. ResultsCompared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant (t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P＜0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant (t=3.424, 4.516; P＜0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region (r=0.314, P＜0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region (r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P＜0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions (r=－0.138, －0.016, －0.221; P＞0.05); CBP and IMH staging in other regions were significantly negatively correlated (r=－0.560, －0.390, －0.819, －0.692, －0.329, －0.587; P＜0.05). ConclusionsThe choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.
PURPOSE:To investigate the cause and treatment of iatrogenic retinal breaks(lRB)in microvitreoretinal surgery.
METHODS:The causes and treatments of 40 iatrogenie retinal breaks of 24 cases in micro-vitreoretinal surgery from July1994 to March 1996 in our department were analyzed retrospectively.
RESULTS:40 IRB were found in 24 eyes,among them there were 16 eyes of proliferative vitreoretinopathy(PVR),5 eyes of taumatic PVR and 3 eyes of tractional retinal detachment, The treatments of IRB included scleral cryotherapy ,silicone band buckling,endodiathermy,intraocular tamponade
and postoperative argon laser. The IRB of inferior retina and posterior Io scleral buckling acounded for 70% and 92% respectively. The total retinal and macular attachment were 17 eyes and the visual acuity of 19 eyes improved to 0.02 or better during the mean follow up periods of 5 months. CONCLUSION:The IRB is a severe complication in micro-vitrecretinal surgery
and has to be obliterated either intraoperatively or postoperatively.
（Chin J Ocul Fundus Dis,1997,13: 19-21 ）
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and with or without internal limiting membrane (ILM) peeling for retinal reattachment and macular hole closure of moderate highly myopic macular hole retinal detachment (MHRD). Methods Forty-three moderate highly myopic MHRD patients (43 eyes) with proliferative vitroretinopathy in class A or B, moderate long axial lengths (ge;26 mm but ＜29 mm), mild retina pigment epithelium and chorioretinal atrophy, and posterior staphyloma (0 - 1 level and le;2 mm) were enrolled in this study. The patients were divided into two groups according to surgical options: TA-assisted PPV with ILM peeling (group A, 24 eyes), TA-assisted PPV without ILM peeling (group B, 19 eyes). The anatomic reattachment of the retina, macular hole closure, and corrected visual acuity (CVA) were observed at one week, one, three, six and 12 months after surgery. Results Twelve months after surgery, retinal reattachment was achieved in 22 eyes (91.67%) and 18 eyes (94.74%) in group A and B, respectively. The difference of retinal reattachment rate between two groups was not statistically significant (Fisherprime;s exact test, P=1.000). Macular hole closure was in 14 eyes (58.33%) and 11 eyes (57.89%) in group A and B, respectively. The difference of macular hole closure rate between two groups was not statistically significant (chi;2=0.049，P=0.824). The differences of CVA between two groups was not statistically significant (chi;2=0.001, P=0.977). Conclusion ILM peeling may not be necessary in the surgery of TA-assisted PPV for moderate highly myopic MHRD.
