Vitreoretinal interface is consisted of posterior vitreous cortex, retina internal limiting membrane, and extracellular matrix between them. Basement membrane-like complex is formed in the interface. The interface in children is of much difference with that in adult. The adhesion of it is much tight in children. The posterior edge of vitreous base is closed to ora serrata. The retina internal limiting membrane is thin. But with age, the posterior margin of vitreous base extends posteriorly, internal limiting membrane thickens and its elasticity decreases, the adhesion in vitreoretinal interface weakens, and posterior vitreous detachment develops. To recognize fully the interface in children is of much importance for understanding the pathophysiology and treatment strategy of pediatric vitreoretinal diseases.
Silicone oil is a stable intraocular tamponade widely used in various vitreoretinal surgeries. However, it can migrate into the anterior chamber for various reasons, leading to complications such as pupillary block glaucoma, corneal endothelial decompensation, and keratopathy. The inferior peripheral iridectomy (later referred to as the Ando iridectomy) can allow the aqueous humor from the posterior segment to drain into the anterior chamber, and this drainage exerts pressure on the silicone oil, pushing it back into the vitreous cavity, thereby effectively addressing the complications. The application of the Ando iridectomy has expanded from aphakic eyes to phakic eyes and pseudophakic eyes in recent years, each with specific indications. The diameter of the Ando iridectomy should be 2 mm or large enough to maintain patency. The incision for the Ando iridectomy should be made at the 6 o'clock position at the iris root, at the lower edge of the silicone oil droplet in the anterior chamber, or in the inferior aqueous humor zone. Postoperatively, the Ando iridectomy may close due to inflammation or blood cell blockage. In such cases, it can be reopened using laser photocoagulation, surgical peripheral iridectomy, or needle puncture to restore its functionality. Currently, there is no standardized protocol for the application of the Ando iridectomy in vitreoretinal surgeries, and this warrants further research.
ObjectiveTo evaluate whether there are changes in cone cells in patients with pre-clinical hydroxychloroquine (HCQ) retinopathy using an adaptive optics (AO) retinal camera. MethodsA retrospective case-control study. From May 2020 to July 2020, 46 patients who were treated in Department of Rheumatism and Immunology, Hainan Hospital of PLA General Hospital with rheumatic immune diseases were included. All patients had a history of HCQ use and no obvious abnormality was found in fundus examination; 105 healthy people with similar demographic characteristics without a history of hydroxychloroquine were recruited as the control group were included. All subjects received the routine ophthalmological examination including best corrected visual auity (BCVA), spectral-domain optical coherence tomography (SD-OCT), Fundus autofluorescence (FAF), visual field, endoscopy of the cornea, and the measurement of axial length (AL). The BCVA was performed with the Snellen visual acuity chart, and the result was converted to logarithmic minimum angle of resolution (logMAR) visual acuity for statistic. Among the 46 cases, 6 cases were males and 40 cases were females. Age was (42.02±13.81) years old; logMAR BCVA was 0.063±0.015; AL was (23.95±0.726) mm. Visual field, macular SD-OCT, FAF examination showed no abnormality. The average cumulative dose of HCQ was 522.60 (6-1 728) g. rtx1 AO retinal camera was used to collect fundus images of subjects in four quadrants above the retina, nasal side, lower side and temporal side with 3°centrifugation from the fovea in both eyes. The cone density, cone spacing, cone arrangement regularity and the proportion of the nearest cones with 6 (nn=6) were measured in the four quadrants. The density of cone cells between the left and right eyes in case group and control group were compared by paired t test. The density and spacing of cone cells in each quadrant were compared by t test of two independent samples. ResultsCompared with the control group, the cone cell density in the four quadrants of the left eye and the nasal, superior and inferior sides of the right eye in the case group was significantly decreased, and the difference was statistically significant (t=4.247, 2.107, 4.884, 2.254, 2.643, 4.445, 4.116; P＜0.05). The cone spacing in the nasal and temporal sides of the left eye of the patients in the case group was significantly larger than that in the control eye, with statistical significance (t=2.750, 3.318; P＜0.05). Compared with the control group, the regulatign of cone cell arrangement in the left temporal side of the right and left eye in the case group were significantly reduced, the difference was statistically significant (P=0.002, 0.011). The proportion of nn=6 in the inferior and temporal sides of the right eye decreased significantly in the case group, and the difference was statistically significant (P=0.006, 0.032). ConclusionAO retinal imaging can detect the changes of cone cells in the early clinical stage of HCQ retinopathy.