Objective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO), guided by optic coherence tomography (OCT). Methods It is a retrospective case study. Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study. There were 19 males (19 eyes) and 21 females (21 eyes), with the mean age of (53.58±13.19) years and the mean course of 1.5 months. The best corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus fluorescein angiography (FFA) and OCT were performed. The mean baseline of BCVA, central macular thickness (CMT) were 0.25±0.18 and (509.48±170.13) μm respectively. All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg). Follow-up of these patients was 1 to 6 months after treatments, the BCVA, fundus manifestations, OCT were retrospectively observed by every month, the FFA was retrospectively observed by every 3 months. When there was retinal edema or CMT ≥50 μm by OCT during follow-up, those patients were retreated with intravitreal conbercept injection. The changes of the BCVA, CMT were evaluated before and after treatment. Meanwhile, complications in eyes related to medicine and treatment methods were evaluated too. Results At the 6 months, the BCVA was improved (increase≥2 lines) in 25 eyes (62.50%), stabilized (±1 line) in 13 eyes (32.50%) and decreased 2 lines in 2 eyes (5.00%). Retinal hemorrhage and exudates were absorbed in most patients. FFA showed no fluorescein leakage in 11 eyes (27.50%), minor fluorescein leakage in 26 eyes (65.00%), and retinal capillary non-perfusion in 3 eyes (7.50%). OCT showed absorption of the subretinal fluid. The mean CMT were (235.20±100.44) μm at 6 months. Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00%), 3 times for 18 eyes (45.00%), and 2 times for 14 eyes (35.00%). The mean number of intravitreal injection was 2.85 times. There were no ocular or systemic adverse events observed in all patients. Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT. It can stabilize and improve the visual acuity.
Objective To investigate the effect of aerosolized perfluorocarbon (PFC) (FC77) on gas exchange，histopathological changes of lung in acute lung injury and pulmonary expression of tumor necrosis factor-α (TNF-α) mRNA.Methods After acute lung injury (ALI) was induced by oleic acid (OA)，16 rabbits were assigned randomly into 2 groups,ie.aerosolized perfluorocarbon group (PFC group) and conventional mechanical ventilation group (CMV group).Gas exchange parameters were measured before and after ALI，at 1，2，3，4 h after treatment.Histological sections taken from 6 different parts of lung were stained by hematoxylin and eosion.The express of TNF-α mRNA in the 2 different parts of lung were detected by in situ hybridization (ISH).Results Compared with CMV group，the PaO2 and static lung compliance (CLst) were significantly increased (Plt;0.05)，the histopathological lesions of lung were attenuated，and the TNF-α mRNA expression was decreased significantly in PFC group (all Plt;0.05).There was more expression of TNF-α mRNA in backside than that in foreside of lung in two groups (Plt;0.05).Conclusion Aerosolized perfluorocarbon (PFC) can decrease expression of tumor necrosis factor-α mRNA in the lung，and improve the CLst and oxygenation during acute lung injury.
Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a retrospective case series of 47 IMEM patients (49 eyes). All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The central macular thickness (CMT), inner nuclear layer thickness (INT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT, INT, IRT, ORT and status of EZ before and after surgery were analyzed, so did the correlations between these indexes at the same time. Results Compared with baseline, the postoperative BCVA was significantly increased (F=6.133, P＜0.001), but the M value, CMT, INT, IRT, ORT were significantly decreased (F=12.481, 10.565, 15.739, 6.046, 10.569; P＜0.001);the integrity of EZ was improved significantly (χ2=12.309, P＜0.001). Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720, 0.887; P＜0.05), while negatively related to preoperative integrity of EZ (r=−0.295, P＜0.05). The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT, ORT (r=0.774, 0.754, 0.842; P＜0.05), while negatively related to postoperative integrity of EZ (r=−0.676, P＜0.05). The preoperative M value was positively related to the preoperative CMT, INT, IRT, and ORT (r=0.931, 0.668, 0.840, 0.637; P＜0.05). The postoperative M value was positively related to the preoperative M value and postoperative CMT, INT, IRT, and ORT (r=0.723, 0.722, 0.767, 0.825, 0.387; P＜0.05). Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity, metamorphopsia and foveal morphology. Both visual acuity and metamorphopsia correlate with foveal morphology.
ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.
ObjectiveTo evaluate the therapeutic efficacy of vitrectomy with internal limiting membrane (ILM) peeling and subretinal injection of balance salt solution (BSS) for refractory diabetic macular edema (DME).MethodsA retrospective case series study. From November 2017 to August 2018, 24 eyes of 19 patients affected with DME resistant to anti-VEGF therapy [central macualar thickness (CMT) more than 275 μm despite undergoing anti-VEGF therapy at least 3 times] in Ophtalmology Department of Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent 25G pars plana vitrectomy with ILM peeling and subretinal injection of BSS. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The CMT and the macular volume (MV) were assessed with swept-source optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT and MV before and after surgery were analyzed.ResultsThe mean BCVA was 0.74±0.29 at baseline, which increased significantly to 0.62±0.28, 0.56±0.25, 0.47±0.26, 0.46±0.23 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=4.828, P=0.001). At 6 months, BCVA improved by more than 0.3 logMAR units in 16 eyes (66.7%). The mean CMT was 554.58±102.86 μm at baseline, which reduced to 338.17±58.09 μm, 299.42±52.66 μm, 275.75±41.24 μm and 270.96±38.33 μm at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=84.867, P＜0.001). The mean MV was 13.01±0.88 mm3 at baseline, which decreased to 11.50±0.73 mm3, 11.00±0.74 mm3, 10.68±0.61 mm3 and 10.52±0.56 mm3 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=47.364, P＜0.001). Macular edema recurred in 5 eyes (20.8%) 6 months after surgery. No severe systemic or ocular side effect was reported during the follow-up.Conclusions25G vitrectomy with ILM peeling and subretinal injection of BSS for refractory DME can improve the visual acuity, facilitate a rapid resolution of macular edema.
Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination, fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and Bultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of fingercounting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twentyone patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included: Iris 810 nm infra red diode laser，7001200 mW,60 s,and 1-3 spots. Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent. After 15 minutes of intravenous injection with Visudyne, laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s. The followup period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group, the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with greywhite organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period；the results of OCT indicated disappeared retinal detachment, completely absorbed subretinal liquid and increased reflection of choroid tumor with scar；the results of Bultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9, unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation；the results of FFA revealed disappeared fluorescence leakage；the results of OCT indicated completely absorbed subretinal liquid；the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.
ObjectiveTo observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). MethodsThis is a prospective non-randomized controlled clinical study. A total of 62 patients (70 eyes) who underwent vitrectomy for PDR were enrolled and divided into IVR group (30 patients, 34 eyes) and control group (32 patients, 36 eyes).IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) 3 or 5 days before surgery. The follow-up time was 3 to 18 months with an average of (4.5±1.8) months. The surgical time, intraoperative bleeding, iatrogenic retinal breaks, use of silicone oil, the best corrected visual acuity (BCVA) and the incidence of postoperative complications were comparatively analyzed. ResultsThe difference of mean surgical time (t=6.136) and the number of endodiathermy during vitrectomy (t=6.128) between IVR group and control group was statistically significant (P=0.000, 0.036). The number of iatrogenic retinal break in IVR group is 8.8% and control group is 27.8%, the difference was statistically significant (χ2=4.154, P=0.032). Use of silicone oil of IVR group is 14.7% and control group is 38.9%, the difference was statistically significant (χ2=5.171, P=0.023). The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8% and 30.6% respectively in IVR group and control group. The differences were statistically significant (χ2=3.932, P=0.047). The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA, the difference was statistically significant (t=4.414, 8.234; P=0.000).But there was no difference between the mean postoperative BCVA of two groups (t=0.111, P=0.190). There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. ConclusionsMicroincision vitreoretinal surgery assisted by IVR for PDR shorten surgical time, reduces the intraoperative bleeding and iatrogenic retinal breaks, reduces the use of silicon oil and the postoperative recurrent vitreous hemorrhage. But there was no significant relationship between vision improvement and IVR.
Objective To analyze the correlation of foveal avascular zone (FAZ) size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a cross-sectional study, including 43 patients (43 eyes) with IMEM (IMEM group) and 35 health subjects (35 eyes) as control group. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were estimated with optical coherence tomography angiography (OCTA) in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) was assessed with spectral-domain optical coherence tomography. There was no difference of logMAR BCVA and CMT between two groups (Z=−7.379, −7.560; P＜0.001). The differences of FAZ areas between the two groups were analyzed. The correlative analysis was performed to investigate the relationship between FAZ areas and visual acuity as well as metamorphopsia. Results The FAZ area in superficial and deep capillary plexus in IMEM group were smaller than those in control group (t=−30.316, −27.606; P＜0.001). In IMEM group, the mean M-score was 0.41±0.32; the horizontal and vertical M-score were 0.49±0.40 and 0.32±0.29, respectively. The horizontal M-score was higher than vertical M-score with the significant difference (Z=−2.000, P=0.046). In IMEM group, the FAZ area in superficial capillary plexus correlated inversely with metamorphopsia (r=−0.709, P＜0.001); the FAZ area in deep capillary plexus correlated inversely with metamorphopsia and BCVA (r=−0.533, −0.838; P＜0.001). Conclusions The FAZ areas are significantly decreased in IMEM eyes compared with normal eyes. Both superficial and deep FAZ areas are correlated with metamorphopsia, and deep FAZ area is also correlated with BCVA.
Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group). In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group). The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was (1.67±1.28) and (7.65±1.42) days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant (Z=−6.784, P＜0.05). At 6 months after surgery, the hole closure was detected in 30 eyes (85.71%) in the SS-OCT group and in 27 eyes (93.10%) in the control group. There was no difference of hole closure rate between the two groups (χ2=0.889, P＞0.05). There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate.