ObjectiveTo evaluate the efficacy of vitrectomy with internal limiting membrane peeling without intraocular tamponade in the treatment of myopic foveoschisis. MethodsTwenty-three eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, direct ophthalmoscope, A or B ultrasonic scan and optical coherence tomography(OCT).The mean BCVA was 0.02-0.4, mean diopter was (-14.1±3.8) D, mean axial length was (28.8±1.5) mm, mean central fovea thickness (CFT) was (573.2±142.8) μm. A standard 3-port pars plana vitrectomy (25-gauge system) was performed in all patients. There was no tamponade at the end of the operation. The follow-up varied from 6 to 28 months. The visual acuity, CFT, retinal reattachment and the complications were observed. ResultsAt the latest follow up, there were 16 eyes (69.6%) were anatomically reattached, 4 eyes (17.4%) were partly anatomically reattached, 3 eyes (13.0%) were not reattached. Postoperative BCVA improved in 22 eyes (52.2%), unchanged in 9 eyes (39.1%), and decreased in 2 eyes (8.7%). No ocular complications such as macular hole, fundus hemorrhage, low or high intraocular pressure, endophthalmitis were found. ConclusionVitrectomy with internal limiting membrane peeling without gas tamponade can effectively treat myopic foveoschisis without ocular complications.
ObjectiveTo assess the consistency of diagnostic results using optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) in the central retinal vein occlusion (CRVO). MethodsThis is a retrospective case series of 26 eyes of 26 patients with CRVO. There were 10 females (10 eyes) and 16 males (16 eyes). The mean age was (49.19±10.50) years. The mean course of the disease was (27.81±21.60) days. Simultaneous OCTA and FFA were performed in all patients using 7-standard field of Early Treatment Diabetic Retinopathy Study (ETDRS) to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weighted Kappa statistic values. Kappa≥0.75, consistency is excellent; 0.60≤Kappa < 0.75, consistency is good; 0.40≤Kappa < 0.60, consistency is general; Kappa < 0.40, consistency is poor. ResultsBased on OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21 eyes. Based on FFA, 23 eyes were diagnosed to have microaneurysms, 14 eyes have nonperfused area, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms and optical disc/retinal neovascularization (Kappa=0.772, 0.766; P < 0.01), good for nonperfused areas and macular edema (Kappa=0.703, 0.600,P < 0v01). ConclusionThere is high consistency between OCTA and FFA in the diagnosis of microaneurysms, macular edema, nonperfused areas and optical disc/retinal neovascularization in CRVO patients.
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.
ObjectiveTo compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). MethodsFollowing the clinical detection of a macula-off RRD with peripheral retinal breaks, patients were offered the opportunity to enroll in the study, and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study, and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 1:1) using a random number table. Seventy-two eyes of 72 patients were enrolled and studied. Patients were treated with 25G plus vitrectomy, endolaser or transscleral cryopexy, either complete (n=36), or partial (n=36) subretinal fluid drainage, and 14%C3F8 (PFO) was used for intraocular tamponade. After surgery, all patients were kept in a supine position for 24 hours, and then in a clinically optimal position for 6-10 days. The study patients were examined at 1, 3 and 6 months after surgery with thorough ophthalmic examinations. Macular optical coherence tomography (OCT) imaging was acquired in 1 month. Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared. Furthermore, the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded. The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point. ResultsThe preoperative baseline characteristics between the two groups were not significantly different. The single-operation success rates were 88.9% and 91.6% respectively for the CSFD and the PSFD groups (χ2=0.158, P>0.05). The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99±0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564). The mean operative time was longer in the CSFD group (62.25±4.32) minutes than that in the PSFD group (47.9±5.0) minutes (t=0.580, P=0.564). seven of 29 (24.1%) phakic eyes in the CSFD group had lens injury during SRF drainage, and none of the 31-phakic eyes in the PSFD group sustained lens damage. Residual PFO was present in 6 of 36 CSFD cases (16.7%). Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid. Among these patients, 22 patients (62.5%) in the CSFD group and 23(69.7%) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00). ConclusionsPartial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective. The success rates are not statistically different. Additionally, PSFD procedures can simplify the surgery procedure, shorten operative time and, and to some extent, reduce the incidence of complications relevant to the CSFD approach.