Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most visionthreatening diseases associated with macular retinal schisis and macular holes. To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair. However, there are many controversial issues in the efficacy of the surgerical procedures including gas injection, scleral buckling and vitrectomy. How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.
Objective To evaluate the effects of retinal cryotherapy and intravitreal triamcinolone injection to treat Coatsprime; disease with exudative retinal detachment.Methods This was a prospective consecutive case study, and 21 patients (21 eyes) with Coatsprime; disease accompanied by exudative retinal detachment were enrolled. There were 19 males and two females patients, aged from two to 18 years. Fifteen eyes had partial retinal detachment (stage 3A) and six eyes had total retinal detachment (stage 3B). All patients underwent cryocoagulation and intravitreal triamcinolone injection. Three eyes underwent sclerotomy to drain subretinal fluid. Four eyes underwent further treatment by photocoagulation or cryotherapy for the residual abnormal blood vessels after the surgery. The follow-up ranged from three to 15 months with an average of seven months. Visual acuity, intraocular pressure, eye position and eye movements, slit lamp microscope, indirect ophthalmoscope and color fundus imaging were followed up. The last followup time was considered as the judgment time for the therapeutic effects. Results Six eyes had increased intraocular pressure after the surgery, which was controlled by local drug treatment. At the end of follow-up, 19 eyes had reattached retina, one eye had partial retinal detachment and one eye had total retinal detachment. The vision improved in three eyes,unchanged in 14 eyes, and decreased in two eyes. Other complications included strabismus (one eye) and cataract (four eyes). Conclusion The combined treatment of cryotherapy and intravitreal triamcinolone injection is an effective therapy for the Coatsprime; disease with exudative retinal detachment, as retina reattaches and visual function is saved in most patients after this treatment.
Objective To observe the therapeutic effect of pars plana vitrectomy (PPV) on myopic traction maculopathy (MTM).Methods The clinical data of 31 eyes of 29 patients with MTM diagnosed by timedomain optical coherence tomography (TDOCT) and slitlamp ophthalmoscopy were retrospectively analyzed. The cases were divided into 2 groups according to the stage of MTM: 12 eyes of 10 patients at the early stage of MTM were in group 1; 19 eyes of patients at the most Advanced stage of MTM were in group 2. All of these eyes had undergone PPV with 10％15％ inert gas filling. The patients were followed postoperatively for 6 to 12 months with the average of 8 months, and the best corrected visual acuity, reattachment of macular and retina was examined. Results The improvement rate of visual acuity after surgery for 6 months was 100% in group 1, and 63.2% in group 2 had (12/19); the visual acuity in group 1 was apparently better than that in group 2 (Z=-5477, P=0000). The macular hole disappeared without exposure of the pigment epithelium in all eyes of Group 1, but only 3 eyes in Group 2. For Group 2 patients, 3 eyes had reattached retina with macular holes, and 3 eyes had detached retina with macular holes. The recovery of macular configuration in Group 1 was obviously better than that in Group 2 (Z=-4318, P=0000). Conclusion The surgical intervention of MTM before the formation of macular hole and retinal detachment may prevent the formation of macular holes.
Objective To evaluate the long-term result of vitrectomy for macular epiretinal membranes(ERM) and the relationship between bestcorrected visual acuity(VA) and macular thickness. Methods In a retrospective consecutive series, twenty-two eyes(17eyes of idiopathic（77％） and 5 of secondary ERM（23％）) of 2 2 patients with macular ERM who underwent pars plana vitrectomy and membrane peeling which had more than 1 yearprime;s (12.40 months，mean(23plusmn;8)months)follow up were included. All the patients were examined by VA, fundus color photography, fluo rescein fundus angiography (FFA) optical coherence tomography (OCT) before and after treatment. VA was adopted 5 points record; FFA and OCT were underway as common way. The mean of VA was (4.25plusmn;0.36), the mean of macular thickness was (4.99 plusmn;114) mu;m. Compared the VA, appearance of fundus photography, fluorescein angio graphy and optical coherence tomography (OCT) before and after surgery. Results Visual improvement was achieved in 13 eyes (59%), meanwhile, 6 eyes (27%) were s table and 3 eyes (14%) were worse; VA of 15 eyes (66%) was more than 4.5 at last follow-up. The mean VA increased from (4.25plusmn;0.36) to (457plusmn;031) postope rative ly, the difference was statistically significant (P＜0.05). Mean macular thi cknes s decreased from (499plusmn;114) mu;m (317-774 mu;m) to (286plusmn;104) mu;m (150-597 mu;m) (P＜0.05) postoperatively, the difference was statistically significant (P＜0.05), but still different to the opposite eyesprime;((184plusmn;37) mu;m)(P＜0.05).VA correlated with macular thickness preoperatively (r=-0.64,P=0.001)and postoperat ively(r=-0.58, P=0.01) except the patients with cataract improvement without therapy. 6 eyes(27%) had retinal hemorrhage and 2 eyes(9%) had peripheral retinal breaks intraoperati vely; 5 eyes(23%) had secondary higher intraocular pressure, 1 eye(5%) had macul a hole and 8 eyes(36%) had cataract improvement postoperatively. Conclusions Surgery is successful in treating ERM. It can relieve macular edema and improve visual acuity. （Chin J Ocul Fundus Dis，2008，24：206-209）
ObjectiveTo observe the surgical effects of scleral buckling and vitrectomy for familial exudative vitreoretinopathy (FEVR). Methods34 eyes of 27 patients with FEVR who underwent either scleral buckling or vitrectomy were enrolled in this study. There are stage 2B in 2 eyes (5.88%), stage 3B in 7 eyes (20.59%), stage 4A in 1 eye (2.94%), stage 4B in 16 eyes (47.06%), stage 5 in 8 eyes (23.53%). 5 eyes associated with rhegmatogenous retinal detachment. The surgical approaches had been chosen according to the disease stage, severity, extent and morphology of the proliferative membrane. 13 eyes (stage 2B in 2 eyes, 3B in 4 eyes, and 4 in 7 eyes) underwent scleral buckling and 21 eyes (stage 3B in 3 eyes, 4 in 10eyes, and 5 in 8 eyes) underwent vitreoretinal surgery. The main outcome measurement was the anatomic status of the macula, which was recorded as attached, partially attached or remain detached. The mean follow up was (18.00±14.61) months (range 4 to 60 months). ResultsAmong 13 eyes received scleral buckling, the macula was attached in 2 eyes with stage 2B (15.38%), partially attached in 11 eyes (84.62%) including 4 eyes with stage 3B, 1 eye with stage 4A and 6 eyes with stage 4B. Among 21 eyes received vitrectomy, the macula was attached in 8 eyes (38.10%) including 2 eyes with stage 3B, 4 eyes with stage 4 and 2 eyes with stage 5; the macula was partially attached in 9 eyes (42.86%) inducing 4 eyes with stage 4 and 5 eyes with stage 5; the macula remained detached in 4 eyes (19.05%) including 1 eye with stage 3B, 2 eyes with stage 4 and 1 eye with stage 5. ConclusionIf the surgical approaches were chosen based on the stage of FEVR and the severity, extent and morphology of the proliferative membrane, the surgery is effective and beneficial to FEVR patients.
The internal limiting membrane (ILM), composed of collagen fibers, glycosaminoglycans, laminin and fibronectin, is the basement membrane of the retinal Müller glia cells and serves as an interface between the vitreous and retina. The ILM is the structural interface between the vitreous and retina. ILM removal ensures separation of the posterior hyaloid from the macular surface, which can relieve macular traction and prevent postoperative epiretinal membrane formation. Thus, vitrectomy with ILM peeling has become an increasingly utilized and vital component in surgical intervention for various vitreoretinal disorders. However, many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers.There were some surgical strategy (fovea-sparing ILM peeling or inverted internal limiting membrane flap technique, or Abrasion Technique). But some controversies exist, such as when ILM peeling is necessary, which adjuvant to use to perform the procedure, and what is the best technique to peel the ILM. A full assessment ILM structure and function and related factors of surgery is helpful to predict the anatomical and functional prognosis.