Vitrectomy and silicone oil injection were performed for treatment of 43 patients with complicated retinal detachment (RD, n=21 ) or subsequent atrophia bulbi (AB, n=22). Retinal reattachment was achieved in 14 (66.7%) of 21 patients with RD, including 11 with idiopathic proliferative
vitreoretinopathy (PVR),6 with traumatic PVR, 3 with congenital uveal coloboma or Marfan syndrome. The visual acuity was better than 0.05 in 7(50%) of successful cases,and better than 0.02 in 11 (78.6%).Only 6(27.3%) patients had retina reattached with visual improvement in 22 cases of AB, including 13 of traumatic PVR,8 of idiopathic PVR.However,the intraoccular pressure was stable and shrinkage of the globe was controlled in 21 (95.5%) of 22 patients with AB.The results indicate that silicone off injection following vitrectomy may provide advanced severe PVR with a chance of successful treatment.
（Chin J Ocul Fundus Dis,1994,10:4-6）
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
Objective To evaluate the efficacy and safety of ophthalmic viscosurgical device (OVD)-assisted non-gas dependent pars plana vitrectomy (PPV) combined with an inverted internal limiting membrane (ILM) flap for the treatment of idiopathic macular hole (IMH). MethodsA retrospective cohort study. From June 2023 to February 2024, 33 patients (33 eyes) diagnosed with IMH in Department of Ophthalmology of Changshu Second People’s Hospital were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations were performed on all affected eyes before surgery. BCVA examination was conducted using the international standard visual acuity chart, and the results were converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. The minimum diameter of the hole was measured using OCT. All affected eyes received standard 25G PPV treatment through the three channels of the flat part of the ciliary body. According to the surgical methods, they were divided into two groups: the OVD-assisted non-gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (OVD group, 17 cases and 17 eyes) and the heavy water-assisted gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (heavy water group, 16 cases and 16 eyes). Postoperatively, patients in the OVD group were not required to maintain a strict specific position, whereas those in the heavy water group needed to remain in a prone position for one week. The follow-up time points after the operation were 1 week, 1 month and 3 months. The main observation indicators included BCVA, intraocular pressure, hole closure rate and closure morphology of the two groups, as well as the occurrence of complications. The independent sample t test was used for comparison between groups. Pearson correlation analysis was used for the correlation between BCVA at 3 months after surgery and the minimum diameter of the surgical hole and BCVA before surgery. ResultsThree months after the operation, the rate of hole closure in the OVD group and the heavy water group was 17 (100.0%, 17/17) and 15 (93.8%, 15/16) eyes, respectively. There was no statistically significant difference in the hole closure rate (χ2=1.090) and closure type (Z=?0.780) between the two groups (P＞0.05). Compared with before the operation, the logMAR BCVA at each time point after the operation in the OVD group and the heavy water group was significantly improved (F=2.353, 1.375; P＜0.05). One week after the operation, the BCVA in the OVD group was significantly better than that in the heavy water group (t=-3.760, P＜0.01). In terms of intraocular pressure, compared with the baseline value before the surgery, there was a statistically significant difference in the OVD group one week after the surgery (Z=?3.454, P＜0.05). There were statistically significant differences in the heavy water group at 1 week, 1 month and 3 months after the operation (Z=?5.066, ?3.423, ?2.739; P＜0.05). After the operation, one eye in the heavy water group had high intraocular pressure, which returned to normal after combined treatment with intraocular pressure-lowering drugs. No ocular or systemic complications occurred in the OVD group. The results of the correlation analysis showed that postoperative BCVA was correlated with the minimum diameter of the surgical hole and BCVA before the surgery (r=0.543, 0.658; P＜0.05). ConclusionsThe treatment of IMH with OVD-assisted non-gas-dependent PPV combined with internal limiting membrane flip coverage has a good effect. It helps promote the early recovery of macular morphology and visual function after surgery, and at the same time can avoid the maintenance of forced position and reduce perioperative risks.
Objective To observe the therapeutic effect of autologous neurosensory retinal transplantation in repairing unhealed giant macular hole after pars plana vitrectomy (PPV). MethodsA prospective clinical study. From July 2022 to December 2023, 12 patients (12 eyes) with refractory large macular hole who received autologous neurosensory retinal transplantation treatment in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University were selected for the study. The macular hole in affected eyes still did not close after PPV combined with inner limiting membrane removal or tamponade, and the diameter of macular hole were greater than 600 μm. All affected eyes received best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA examination employed the international standard visual acuity chart, with results converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. During the surgery, a piece of healthy retinal neuroepithelial tissue, approximately 0.3 optic disc diameters larger than the macular hole, was removed from the upper retinal periphery and used as a graft. The graft was inserted into the macular hole with the aid of intraoperative OCT. Post-surgery, the vitreous cavity was filled with silicone oil or sterile air. The follow-up period after surgery was 6 months. The thickness of the retinal grafts was measured using the same equipment as before surgery at 3 days, 1, 3, and 6 months post-surgery. The primary focus was on observing the macular hole closure rate and changes in BCVA at 6 months post-operation. A paired t-test was used to compare BCVA before and after surgery. Results In the sample of 12 cases (12 eyes), there were 5 males with 5 eyes and 7 females with 7 eyes. The mean age was (50.4±12.6) years. The mean macular hole diameter was (1 085.6±344.0) μm; The mean eye axis length was (27.64±4.19) mm. At 6 months after surgery, all affected eyes showed macular hole were completely closed (100.0%, 12/12). The thickness of the retinal graft was measured as (206.8±21.0), (170.8±23.3), (165.6±31.6), and (157.9±31.1) μm at 3 days, 1, 3, and 6 months post-surgery, respectively. At before and 6 months after surgery, the logMAR BCVA of the affected eyes was 1.28±0.39 and 0.95±0.22, respectively. The difference in logMAR BCVA before and after surgery was statistically significant (t=3.40, P＜0.05). Conclusion Autologous neurosensory retinal transplantation could effectively improve the closure rate of refractory large macular hole and improve or stabilize vision in the short run.
Objective To compare and observe the efficacy and safety of pars plana vitrectomy (PPV) combined with 41G ultrafine needle injection of balanced salt solution (BSS) and internal limiting membrane inversion and coverage in the treatment of large-diameter macular hole (MH). MethodsA prospective study. From April 2023 to April 2024, 42 patients (42 eyes) diagnosed with large-diameter MH at The Affiliated Eye Hospital of Nanchang University were included in the study. The substrate diameters (BD) of MH are all greater than 1 000 μm. All affected eyes underwent best corrected visual acuity (BCVA), microvisual field, optical coherence tomography (OCT), and OCT angiography (OCTA) examinations before surgery. BCVA examination was conducted using the international standard logarithmic visual acuity chart, and the statistics were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. Microfield-of-view examination records the mean retinal sensitivity (MS) within a 12° range of the fovea. The minimum diameter (MD) and BD of the hole were measured by OCT and the MH index (MHI) was calculated. OCTA measures the area and perimeter (PERIM) of the foveal avascular zone (FAZ) in the fovea centralis, as well as the retinal vessel length density (VLD) and vessel perfusion density (VPD) in the central area. The affected eyes were divided into the observation group (22 eyes, treated with PPV combined with 41G ultra-micro needle subretinal injection of BSS and the control group (20 eyes, treated with PPV combined with internal limiting membrane inversion and coverage) according to the random number table method. The patients were followed up for 6 months after the operation, and the above indicators were reexamined at 1, 3 and 6 months. The changes of BCVA, MS, FAZ parameters, VLD, VPD before and after the operation, as well as the closure of the hole and the occurrence of complications were compared between the two groups. The independent sample t test was used for comparison between groups. The correlation between postoperative indicators and preoperative structural parameters was analyzed using Pearson analysis. ResultsIn the 22 eyes of the observation group, the hole closure rate was 100.0% (22/22) 6 months after the operation, and the complete closure rate was 90.9% (20/22). In the control group of 20 eyes, the closure rate was 95.0% (19/20), and the complete closure rate was 90.0% (18/20). The hole closure rate of the affected eyes in the observation group was better than that in the control group, but the difference was not statistically significant (χ2=1.736, P=0.420). The logMAR BCVA, MS, FAZ area, PERIM, VLD and VPD at each time point after the operation in both groups were significantly improved compared with those before the operation, and the differences were statistically significant (P＜0.05). The results of Pearson correlation analysis showed that in the observation group, logMAR BCVA at 6 months after surgery was positively correlated with BD before surgery (r=0.340, P=0.029), and negatively correlated with MHI before surgery (r=?0.350, P=0.023). Six months after the operation, MS was positively correlated with the preoperative hole height and MHI (r=0.330, P=0.034). In the control group, 6 months after the operation, MS was negatively correlated with BD before the operation (r=?0.480, P=0.032), and positively correlated with MHI before the operation (r=0.510, P=0.027). Six months after the operation, the FAZ area of the affected eyes in the observation group [(0.17±0.09) mm2] was larger than that in the control group [(0.12±0.07) mm2], and the difference was statistically significant (t=?0.340, P=0.025). No complications such as abnormal intraocular pressure, retinal pigment epithelium injury or retinal detachment occurred in all the affected eyes after the surgery. ConclusionsPPV combined with 41G ultra-micro needle subretinal injection of BSS for the treatment of large-diameter MH has a high rate of hole closure and good safety. Larger BD and MD, lower MHI and hole height before surgery may affect the recovery of visual function after surgery.
Objective To observe the curative effect of a personalized surgical scheme based on scanning source optical coherence tomography (SS-OCT) image features in the treatment of congenital optic disc pit (ODP) with maculopathy (ODP-M). MethodsA prospective interventional cohort study. From September 2019 to May 2024, 15 patients with 15 eyes who were diagnosed with ODP-M by ophthalmology examination in Department of Ophthalmonogy of The First Affiliated Hospital of Zhengzhou University were included in the study. Best corrected visual acuity (BCVA) and SS-OCT were performed in all affected eyes. Standard E word visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The center retinal thickness (CRT) was measured by SS-OCT examination of macular area using VG200D of Henan SVision Imaging Technology Co., LTD. According to the morphological characteristics of ODP and the splitting, edema and detachment of macular region, combined with the degree of pulling of the boundary membrane between the posterior vitreous cortex and macular region, a personalized surgical method was designed. Class I: pars plana vitrectomy combined with macular boundary film stripping, ODP boundary film packing and vitreous cavity gas filling. Class Ⅱ: pars plana vitrectomy combined with non-retained macular boundary film stripping or ODP inner boundary film packing, vitreous cavity gas filling. Class Ⅰ and Class Ⅱ operations were performed in 10 and 5 eyes of 15 eyes, respectively. The postoperative follow-up time was ＞6 months. Follow-up time was performed with the same equipment before surgery. BCVA changes, CRT reduction rate and complications were observed. BCVA and CRT were compared before and after operation by paired sample t test. ResultsThere were 15 eyes in 15 cases, 4 eyes in 4 males and 11 eyes in 11 females. The age was (28.87±16.5) years. logMAR BCVA of the affected eye was 0.94±0.51. CRT was (697.80±301.80) μm. At the last follow-up, the logMAR BCVA was 0.53±0.49. CRT was (392.53±167.55) μm. Compared with before operation, BCVA and CRT were significantly improved, and the difference was statistically significant (t=3.23, 3.25; P=0.006, 0.006). After surgery, transient intraocular hypertension occurred in 2 eyes, and the intraocular pressure returned to normal level after 3 to 7 days without special treatment. Two eyes underwent an unexpected second operation. Among them, one eye underwent Class Ⅰ surgery, the tunnel at ODP was closed after surgery, and there was a small amount of subretinal fluid in the macular area. Class Ⅱ surgery was performed in 1 eye with retinal reattachment. ConclusionPersonalized surgical treatment of ODP-M based on SS-OCT image features can reduce CRT and improve visual acuity.
ObjectiveTo evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M). MethodsA retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA assessment was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane peeling and vitreous cavity filling with 16% SF6. Among them, autologous platelet concentrate (APC) was simultaneously used in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. ResultsIn the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant (Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery (Z=0.609, P=0.543). ConclusionsPPV combined with internal limiting membrane peeling and gas tamponade can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical macular restoration, and improve BCVA. Combined APC filling
Cataract combined with retinopathy can seriously affect the vision of patients. Vitrectomy combined with one-stage implantation of multi-focal intraocular lens (MIOL) has been paid more and more attention. The application of MIOL shows potential in improving the visual quality of patients, but its effect is affected by many factors, and refractive drift is a key problem to be solved. At present, the research mainly focuses on cataract patients with high myopia, and further research on other types of retinopathy is needed. In the future, multi-center, large-sample, long-term clinical studies and interdisciplinary cooperation are needed to optimize surgical and management programs to enhance the application effect of MIOL in the treatment of retinopathy and improve the quality of life of patients.
Objective To analyze the surgical feasibility, operative key points and visual function recovery of scleral buckling in patients with rhegmatogenous retinal detachment (RRD) with large or giant retinal hole. Methods RRD patients with large or giant retinal hole who underwent scleral buckling in Chengdu Aidi Eye Hospital between January 1, 2019 and December 31, 2020 were retrospectively selected. The general data, complications and postoperative recovery of the patients were observed. Results A total of 344 inpatients (351 eyes) underwent scleral buckling with RRD, including 43 patients (43 eyes) with retinal detachment of large or giant hole. Among the 43 patients, there were 30 males (30 eyes) and 13 females (13 eyes); 42 cases were successfully operated and got retinal reattachment, and 1 failed. One week later, the patient underwent vitrectomy combined with silicone oil tamponade, and got retinal reattachment. No serious complications occurred in the patients after operation. The visual acuity of most patients improved after surgery. ConclusionsScleral buckling is still an effective method to treat RRD. It is still suitable for more patients as long as they are carefully checked before operation and the operators master the key points of operation. At the same time, more patients’ vitreous bodies can be preserved, and the normal structure and intraocular environment of the eyeball can be maintained.
ObjectiveTo investigate the clinical characteristics of patients with high-myopia macular hole retinal detachment (MHRD) combined with choroidal detachment and to preliminarily analyze factors associated with postoperative hole closure. MethodsA retrospective clinical case series study. A total of 68 patients with high myopia (68 eyes) with MHRD diagnosed by Department of Ophthalmology, Peking University People’s Hospital from January 2019 to April 2024 were included in this study. Among them, there were 14 males (14 eyes) and 54 females (54 eyes). The mean age was (61.10±9.66) years. All eyes were treated with pars plana vitrectomy (PPV) combined with silicone oil or gas filling. Best corrected visual acuity (BCVA), intraocular pressure, and B-mode ultrasonography were performed. The BCVA test was performed using the Snellen visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery, which was divided into 1 to 4 quadrants. Axial length (AL) was measured under retinal reattachment. In 68 eyes, there were 17 eyes with choroidal detachment and 51 eyes without choroidal detachment, respectively. There were 17 eyes with choroidal detachment, and the detachment range involved 1, 2, 2 and 12 eyes in 1, 2, 3 and 4 quadrants, respectively. During operation, 13% C3F8 was filled in 2 eyes, all of which were not complicated with choroidal detachment. 66 eyes were filled with silicone oil. According to whether the patients were complicated with choroidal detachment, the patients were divided into the group without choroidal detachment and the group with choroidal detachment. Independent sample t test, Welch two-sample t test or Mann-Whitney U test were used for comparison between groups. Generalized linear regression and logistic regression were used to analyze the relationship between the aperture size of postoperative unclosed holes and the closed hole after surgery and clinical factors. ResultsAt 3 months after surgery, the logMAR BCVA of the affected eye was 1.29±0.43, with a preoperative to postoperative difference ranging from ?1.60 to 0.70 (?0.51±0.51) logMAR units. The AL ranged from 26.6 to 34.3 (29.60±2.12) mm. Among 68 eyes, macular hole of 37 (54.4%, 37/68) eyes were open and 31 (45.6%, 31/68) eyes were closed, respectively. The hole diameter of the open eye was (753±424) μm. There was no significant difference in age, course of disease and AL between the two groups (W=412.0, 477.5, 427.0; P＞0.05). Before operation, BCVA in patients with choroidal detachment was worse (W=257.5) and intraocular pressure was lower (t=4.051) in patients with choroidal detachment compared with those without choroidal detachment, with statistical significance (P＜0.05). At 3 months after surgery, BCVA in patients with choroidal detachment was significantly worse than that in patients without choroidal detachment, with statistical significance (W=284.0, P＜0.05). There were no significant differences in logMAR BCVA difference (t=0.616) and macular hole closure rate (χ2=0.000) before and after surgery (P＞0.05). The reoperation rate of retinal detachment due to persistent or recurrent retinal detachment was significantly higher in the group with choroid detachment than in the group without choroid detachment, and the difference was statistically significant (odds ratio=6.424, P＜0.05). Logistic regression analysis showed that young age was significantly correlated with macular hole closure failure after surgery (β=0.077, P=0.015). There was no correlation between AL, duration of disease, BCVA before surgery, intraocular pressure, wether combined with choroid detachment range and postoperative hole closure (β=?0.072, 0.000, 0.672, ?0.085, ?0.391; P＞0.05). ConclusionsConcomitant choroidal detachment adversely affected on both pre-operative and post-operative visual acuity in high myopia MHRD. It is closely associated with the risk of recurrent retinal detachment and the needs of multiple operations, but has no significant effect on hole closure rate. Lower age of onset may be a risk factor for macular hole closure.
