The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.
Polypoidal choroidal vasculopathy (PCV) is originally defined as a separate disease, but with the development of imaging techniques, it has now been included in the spectrum of neovascularization. In the Asian population, the prevalence of PCV is high, and with the deepening of clinical studies, the pathological characteristics, pathogenesis and clinical manifestations of PCV have been more deeply understood. Through dynamic observation and histopathological study of PCV lesions during operation, it can be confirmed that the lesions are mainly located between the retinal pigment epithelium and the Bruch membrane, rather than originating from the choroidal circulation, which is of great significance for understanding the origin and natural course of PCV. It is worth noting that although a theoretical bridge has been established between age-related macular degeneration (AMD)/PCV, there is a lack of intuitive clinical data on the ultrastructural and molecular manifestations of the cells/stroma in the local lesions of the eye, especially the progression of AMD/PCV from early/middle stage to exudative stage. It is precisely because of this that highly attractive research topics and exploration space are proposed for the future.
Ovjective To observe the surgically excised specimens from eyes with hemorrhagic age-related macular degeneration (AMD). Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD, 26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM), 10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV). All specimens were routinely processed by hematoxylin and eosin, periodic acidSchiffprime;s stain and Masson stainings. At the maximum horizontal and vertical slice of the specimens, the category and amount of the cells in the specimen were recorded, as well as the relationship between the specimens and the surrounding tissue. Results The 36 specimens are categorized as neovascular membrane dominant (19/36), collagen fiber dominant (6/36), blood clot dominant (8/36) and degenerated thickened Bruch`s membrane dominant (3/36). Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch`s membrane dominant. The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch`s membrane, retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens. Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified.
Objective To analyze the pathogenesis of cystoid macular edema (CME) secondary to exudative age-related macular degeneration (AMD). Methods From October 2000 to December 2003, OCT images of 171 eyes of 140 patients with exudative AMD were evaluated. The CNV types were classified according to its location (above or below the RPE), and the correlation between the types of CNV and the development of CME were analyzed. Results Of the 171 eyes with AMD, 89 eyes (52.0%) had CME, and 82 eyes (48.0%) had no CME. Among the 89 eyes with CME, 76 eyes (85.4% ) had an active CNV lesion, and 13 eyes (14.6%) had a disciform scar. Among the 82 eyes without CME, 69 eyes (84.1%) had an active CNV lesion, and 13 eyes (15.9 %) had a disciform scar. In the 76 eyes with both CME and active CNV, 75 eyes (9 8.7%) had a subretinal CNV, which included 61 eyes (80.3%)with a combined CNV complex and 14 eyes (18.4%) with a Gass 2 type CNV, only 1 eye (1.3%) had a Gass 1 type CNV. Whereas, in the 69 eyes with active CNV but without CME, 57 eyes (82.6%) had a Gass 1 type CNV, only 12 eyes (17.4%) had a subretinal CNV. There was a significant difference in the incidence of subretinal CNV between eyes with or without CME (χ2=99.5838, P=0.0000). Conclusions CME formation was highly corre lated with the invasion of CNV into the subretinal space. Subretinal CNV might be the direct cause of CME secondary to exudative AMD.(Chin J Ocul Fundus Dis，2004，20：299-302)
Objective To evaluate the correlation between retinal-choroidal anastomosis (RCA) and pigment epithelium detachment (PED) secondary to exudative age-related macular degeneration (AMD). Methods From October 2000 to December 2003,75 eyes of 70 patients with active exudative AMD underwent OCT, fluorecein and/or indocyanine green angiography (FA/ICGA) examinations were analyzed to ascertain whether there was RCA. The correlations between RCA and PED were evaluated. Results Of 75 eyes with exudative AMD, 34 eyes (45.3%) had RCA, 41 eyes (54.7%) had no RCA. Among the eyes with RCA, 30 eyes (88.2%) had PED, the remaining 4 eyes (11.8%) had no PED. Among the eyes without RCA, 33 eyes (80.5%) had PED, and 8 eyes (19.5%) had no PED. There was no significant difference in the incidence of PED between eyes with or without RCA (χ2=0.83, P=0.5290). PED tear was found in 17 eyes (51.5%)out of 33 eyes with PED and without RCA, but in 26 eyes (86.7% ) out of 30 eyes with both PED and RCA. There was a significant difference in the incidence of PED tear between eyes with or without RCA (χ2=8.9612, P=0.0030). Conclusions RCA is not uncommon in exudative AMD. It often coexisted with PED, but there is no direct correlation between them. PED tear is highly correlated with RCA formation. (Chin J Ocul Fundus Dis，2004，20：295-298)
Objective To evaluate the relevant factors affecting prognosis of traumatic optic neuropathy. Methods Sixty-nine patients with traumatic optic neuropathy were enrolled. Multiple variable analysis was done to filter the risk factors to prognosis in traumatic optic neuropathy. Results At 3 months or more of followup,no light perception was found in 32 cases (46.4%); visual acuity were increased by≥1 lines in 33 cases (47.8%). The outcome of visual acuity was poorer in patients with the following conditions:no light perception after trauma （P=0.0031）, loss of consciousness （P=0.0262）, no pretreated common-dosage corticosteroids （P=0.0184）, and absence of VEP （P=0.0001）. Conclusion The initial visual acuity of no light perception, loss of consciousness, and no pretreated common-dosage corticosteroids were the risk factors to prognosis in traumatic optic neuropathy,and result of VEP was an effective prognosis indicator in traumatic optic neuropathy. (Chin J Ocul Fundus Dis, 2002, 18: 98-100)
PURPOSE:To evaluated the luminal characteristics of the elderly central retinal vessels in the anterior optic nerves. METHODS:Serial sections of 15 central retinal arteries(CRA)and 23 central retinal veins (CRA)of 18 eyes of the aged 60 to 82 years old without anatomic malformation were examined by image analysis to investigate their luminal dimensional differences at the sites of lamina cribrosa and just anterior and posterior to it. RESULTS:The average values of the mean area of the CRA in the prelaminar,laminar,retrolaminar portions were separately(12.70,17.40,18.00)times;10-3mm2 and the mean perimetric length 0.56,0.56,0.57mm.No significant difference was detected in these three sites.The average values of the mean area of the CRV were respectively(7.00,5.40,7.90)）times;10-3mm2 and the mean perimetric length 0.44,0.38,0.41mm.There were marked differences between the prelaminar value and the laminar one,and between the laminar value and retrolaminar one by comparison. CONCLUSION:The CRA has a uniform radius from prelaminar to retrolaminar positions,and tube radius of the CRV at the level of the lamina cribrosa is the least. （Chin J Ocul Fundus Dis,1997,13: 213-214 ）
ObjectiveTo compare the clinical effect of C3F8 and air tamponade after vitrectomy for the treatment of idiopathic macular hole (IMH). MethodsA total of 54 eyes of 54 patients with IMH that had undergone 23G pars plana vitrectomy with internal limiting membrane peeling were retrospectively studied. All patients received optical coherence tomography (OCT) examination and the best corrected visual acuity (BCVA). They were divided into 2 groups. 26 eyes in group A were filled with air and 28 eyes in group B were filled with C3F8. In group A, 6 eyes at stage Ⅱ, 20 eyes at stage Ⅲ, the minimum diameter (Dmin) of macular hole in 14 eyes was less than 400 μm,and in the other eyes was larger than 400 μm. In group B, 10 eyes at stage Ⅱ, 18 eyes at stage Ⅲ, the Dmin of macular hole in 15 eyes was less than 400 μm,and in the other eyes was larger than 400 μm. The differences of age, course of the disease, BCVA, fundus diameter, Dmin, height, index, diameter of outer retina diameter (Dord) between the two groups were not significant (P>0.05). The basic data before surgery and the closure rate, BCVA, Dord 1 month after surgery between two groups were compared. ResultsAt 1 month after surgery, the IMH closure rate was 100.0% in group A and 92.9% in group B, the difference between these two groups was not significant (P=0.491).The closure rate of eyes with Dmin<400 μm were both 100.0% in two groups, and the closure rate of eyes with Dmin>400 μm were 100.0% in group A and 84.6% in group B. There was no statistically significant differences between two groups (P=0.480). The mean BCVA of two groups were 0.35±0.22 and 0.33±0.16 respectively. The mean Dord were (782.2±478.0) μm and(792.1±432.7) μm respectively. All cases got better BCVA (t=-7.310,-10.506; P<0.01) and shorter Dord (t=6.704,7.770;P<0.01). But there was no statistically significant differences between groups 1 month after surgery in BCVA and Dord(t=0.381,-0.800; P=0.705, 0.937). ConclusionAir tamponade after vitrectomy has the same efficacy as C3F8 tamponade in the treatment of IMH.