The update of the cognition of fundus diseases is inseparable from the rapid development of fundus multimodal imaging. Especially in recent years, the application of wide and ultra-wide fundus photography, ultra-wide fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence and optical coherence tomography angiography contribute to observe the peripheral retinopathy more directly. The application of adaptive optics and fluorescence lifetime imaging ophthalmoscopy contribute to have a further understanding of fundus diseases at the cellular and metabolic level. Multimodal imageing reflect the pathological characteristics of the diseases from different angles and levels. At the same time, the digitization and intelligence of fundus images are also developing rapidly. However, there are some problems that the ophthalmologists needs to consider further, such as the correctly understanding the use of multimodal imaging, the application of artificial intelligence, and how to sum up from the images.
Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent microinvasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. The central foveal thicknesses (CFT) were measured after surgery by spectral domainoptical coherence tomography (SD-OCT). The median follow-up time was (12.81plusmn;8.22) months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema (ME), epiretinal membrane (ERM), interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed. The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstructure were analyzed. Results The CFT was ranged from 103.00 mu;m to 498.00 mu;m,with the mean of（251.12plusmn;90.23） mu;m. Macular abnormalities were observed in 37 eyes (69.8%), and normal macula in 16 eyes (30.2%). Among 37 eyes with macular abnormalities, there were 20 eyes (37.7%) with ME, 12 eyes (22.6%) with ERM, 33 eyes (62.3%) with interrupted IS/OS, and 20 eyes (37.7%) with interrupted ELM. The BCVA of ME eyes decreased significantly than that in nonME eyes （t=-2.09，P＜0.05). The difference of BCVA in ERM and nonERM eyes was not statistically significant (t=-1.10,P＞0.05). The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=-4.33,P＜0.05). The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58, P＜0.05). The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not (r=7.65, 8.21, 4.99; P＜0.05), but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01, 0.82; P＞0.05). Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT，the status of IS/OS junction, whether ME or not, but not related to integrity of the ELM or whether ERM or not.
Objective To observe the clinical effects of vitreoretinal surgery for myopic foveoschisis, evaluate the visual prognostic factors. Methods Twentyseven eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, direct ophthalmoscope, binocular indirect ophthalmoscope, A or B ultrasonic scan and optical coherence tomography (OCT). Follow-up duration varied from 6 to 36 months, with the mean of (19.4±10.03) months. The visual acuity, retinal reattachment and the complications were observed. Logistic regression analysis was performed to predict the prognosis of visual acuity. Results Twentyone eyes (7778％) were anatomically reattached, six eyes (2222%) were not anatomically reattached. Postoperative BCVA improved in 24 eyes (8889％), reduced or remained unchanged in three eyes (11.11％). No ocular complications such as fundus hemorrhage, low or high intraocular pressure, endophthalmitis were found. The preoperative BCVA （OR=9.11, P=0.007）, axial length （OR=0.31, P=0.038） and the photoreceptor inner and outer segment (IS/OS) junction line continuity （OR=4。32，P=0.001） are closely related to visual prognosis. Conclusions Vitreoretinal surgery is an effective approach to treat myopic foveoschisis with both anatomical and visual improvement. The preoperative BCVA, axial length and IS/OS line continuity are closely related to visual prognosis.
Objective To observe the expression of proinflammatory factors messenger RNA(mRNA) in periretinal membrane of proliferative vitreoretinopathy. Methods Fourteen specimens of periretinal membrane were collected during vitrectomy, and they were made into paraffin sections.The presence of mRNA coding for IL-1,IL-6,IL-8 and TNF alpha was observed by in situ hybridization(ISH) with biotin labeled oligonuclotide probes respectively.The eyeball after corneal grafting was made as normal control. Results No expression of proinflammatory factors mRNA was found in normal human retina.Positive staining was present in 5 specimens.In these specimens, IL-1βmRNA was found in 3 specimens and TNFαmRNA was found in 3 specimens,there is 1 specimen expressed IL-8 mRNA and 3 specimens expressed IL-6 mRNA.In these positive specimens, one contained cells expressing mRNA for IL-1βbeta and IL-6, and one exhibited cells expressing mRNA for IL-1β、IL-8 and TNFα,two membranes possessed positive cells for IL-6 and TNFαmRNA, one membrane contained IL-1βmRNA positive cells only. Conclusion These findings suggest that these cytokines may be locally produced by cells infiltrating epiretinal membranes. The expression of IL-1β, IL-6, IL-8 and TNFαmRNA within retinal membranes provides further evidence of a pathogenic role of these cytokines in proliferative vitreoretinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 286-288)
ObjectiveTo observe outcome of visual acuity and photoreceptor inner segment (IS)/outer segment (OS) changes in idiopathic macular hole (IMH) patients after micro-invasive vitrectomy. MethodsForty patients (40 eyes) with idiopathic macular hole underwent micro-invasive vitrectomy were enrolled in this study. The patients included 12 males and 28 females, with an average age of (62.43±5.68) years, with an average course of 2.78 months. All the patients were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp ophthalmoscopy combine with preset lens, fundus color photography and optical coherence tomography (OCT) examination.The BCVA was converted to logarithm of the minimal angle of resolution (logMAR).The BCVA was 0.05-0.5, with an average log MAR BCVA of 0.71±0.19. The average diameter of minimum macular hole was (410.13±175.72) μm. The average base diameter of maximum macular hole was (775.00±264.77) μm. The diameter of IS/OS defect was 618-2589 μm, with an average of (1682.08±484.11) μm. There were 4, 16, 20 eyes with stage Ⅱ, Ⅲ, Ⅳ macular hole, respectively. The follow-up period was 33.75 months. BCVA and macular structure at month 1, 3 and the final follow-up after surgery were analyzed. The correlation among logMAR BCVA,diameter of IS/OS defect at final follow-up and the follow-up time was analyzed. ResultsThe mean logMAR BCVA at month 1, 3 and the final follow-up after surgery were 0.49±0.31, 0.37±0.26, 0.30±0.26 respectively. Compared with the mean preoperative logMAR BCVA, the differences were significant (Z=-4.598, -5.215, -5.218; P<0.05). The preoperative logMAR BCVA and the diameter of minimum macular hole were significantly correlated with the postoperative logMAR BCVA at final follow-up (r=0.401, 0.392, P<0.05). The preoperative diameter of IS/OS defect and the postoperative diameter of IS/OS defect at final follow-up were significantly correlated with the postoperative logMAR BCVA at final follow-up (r=0.339, 0.353; P<0.05). The time of final follow-up was not correlated with the postoperative logMAR BCVA and the diameter of IS/OS defect at final follow-up (r=0.000, 0.018; P>0.05). At the final follow-up, the macular holes were totally closed in 39 eyes (97.5%). Thirty-two eyes exhibited a complete recovery of IS/OS junction, 8 eyes continued to exhibit an IS/OS junction defect. ConclusionMicro-invasive vitrectomy can stabilize vision of IMH patients, and promote complete recovery of IS/OS.
ObjectiveTo evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. MethodsA prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. ResultsCompared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. ConclusionsPosterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.