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 analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
Idiopathic macular hole (IMH) refers to full thickness defects of retina in macular area with no clear reasons. The management of IMH includes vitrectomy combined with internal limiting membrane (ILM) peeling and pharmacological vitreolysis. But ILM peeling may damage the inner retina; novel techniques, such as inverted ILM flap technique and foveola non-peeling ILM surgery, autologous ILM transplantation had made the method of ILM peeling more diversified with less damage. Pharmacological vitreolysis targeting fibronectin and laminin is considered to work in a two-step mechanism, involving both vitreoretinal separation and vitreous liquefaction. Furthermore, IMH judgment and prognosis indicators like ellipsoid zone, macular hole index, hole formation factor, diameter hole index and tractional hole index based on spectral domain optical coherence tomography enriched the assessment of macular hole diameter, depth and shape. How to make full use of new interventions to reduce the incidence of macular hole and obtain a better visual acuity with closed holes is an important direction for future research.
As a potent collagenase activator, ocriplasmin is a recombinant truncated form of serine protease that retains the protease activity of plasmin. Pre-clinical animal experiments, clinical trials and recent clinical studies all indicated a promising outcome of intravitreal injection of ocriplasmin to treat vitreomacular interface diseases, including vitreomacular adhesion (VMA), vitreomacular traction (VMT) and full-thickness macular hole. Ocriplasmin was approved by the Food and Drug Administration of USA in the management of symptomatic VMA, and by the European Medicines Agency in treating VMT-associated macular hole with less than or equal 400 μm. Further randomized controlled clinical trials are needed for further comprehensive observation and evaluation on its efficiency, safety and other noteworthy issues.