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 efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH). Methods Retrospective case review. Twenty-eight eyes of 28 patients with LMH were enrolled in this study. There were 2 males (2 eyes) and 26 females (26 eyes). Best corrected visual acuity (BCVA), medical optometry, slit-lamp biomicroscop, indirect ophthalmoscope, spectral domain optical coherence tomography, b-scan ultrasonography and axial length detection were performed on all patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. There were 10 eyes (35.7%) with degenerative type LMH (flap insertion group) and LHEP. There were 18 eyes (64.3%) with tractional type LMH (general group). The differences of BCVA, AL, horizontal hole diameter from retina and lens state between two groups were not significant (P＞0.05). The differences of horizontal hole diameter of internal limiting membrane (ILM), central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P＜0.05). LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group. Vitrectomy combined ILM peeling were used in eyes of general group. The follow-up was ranged from 3 to 14 months. The changes of CFT, central foveal form and logMAR BCVA were observed. Results At latest follow-up, the BCVA of flap insertion group and general group were 0.34±0.27, 0.31±0.29; which significantly better than the preoperative BCVA (Z=−3.519, −4.945; P＜0.001). The CFT of flap insertion group and general group were (200.10±58.78), (226.61±70.49) μm. There was no difference between pre- and post-operative CFT in eyes of general group (Z=−1.455, P=0.146). There was significant difference between pre- and post-operative CFT in eyes of flap insertion group (Z=−2.798, P=0.005). In flap insertion group, regular recovery of the foveal contour occurred in 9 eyes (90.0%), improvement in 1 eyes (10.0%). In general group, regular recovery of the foveal contour occurred in 10 eyes (55.6%), improvement in 8 eyes (44.4%). The closure rate of LMH were 100% both in two groups. Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.
Objective To observe the etiological factors and variation of effects of nontraumatic severe vitreous hemorrhage. Methods A total of 1107 patients (1202 eyes) with nontraumatic severe vitreous hemorrhage who underwent vitrectomy from January 2005 to December 2011 were enrolled in this study. The patients were divided into A group (444 eyes of 415 patients were operated between January 2005 and December 2008) and group B (758 eyes of 692 patients between January 2009 and December 2011) according to admission date. The etiological factors and variations were recorded and retrospectively analyzed. Results Of all 444 eyes in group A, 156 eyes were due to retinal vein occlusion (RVO), 117 eyes associated with proliferative diabetic retinopathy (PDR), 61 eyes with retinal hole／retinal detachment (RH／RD), 42 eyes with Eales disease, 20 eyes with exudative agerelated macular degeneration (EAMD). These diagnoses accounting for 89.19% of the total eyes, were found to be the common causes in patients with severe vitreous hemorrhage, with RVO as the most common cause. Similarly in group B, severe vitreous hemorrhage was found in 347 eyes with proliferative diabetic retinopathy (PDR), 135 eyes with retinal hole／retinal detachment (RH／RD), 133 eyes with retinal vein occlusion (RVO), 25 eyes with Eales disease, 22 eyes with exudative age-related macular degeneration (EAMD), accounting for 87.87% of the total eyes. PDR was the most common cause instead of RVO to vitreous hemorrhage in this group. The number of vitreous hemorrhages increased year by year. Conclusions PDR, RH／RD, RVO, Eales disease and EAMD are the common causes of nontraumatic severe vitreous hemorrhage. There is a trend toward an increasing proportion of PDR among the causes of vitreous hemorrhage.