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.
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 observe the efficacy and safety of vitrectomy combined with submacular injection of tissue-type plasminogen activator (t-PA), gas filling and anti-VEGF drugs (multiple therapy) for thick submacular hemorrhage.MethodsA retrospective case study. From January 2014 to June 2018, 24 patients (24 eyes) with thick submacular hemorrhage who received multiple therapy at the Department of Ophthalmology of Peking University Third Hospital were included in the study. Among them, there were 15 males and 9 females with the average age of 69.05±8.86 years. The average submacular bleeding time was 17.15±10.30 days, the average bleeding area was 13.85±8.63 DD. Seventeen eyes showed hemorrhagic RPE detachment. The international standard visual acuity chart was used to BCVA examination, which was converted to logMAR visual acuity in statistics. The frequency domain OCT was used to measure the height of the foveal elevation. The average logMAR BCVA of the affected eye was 1.37±0.38. The average height of the macular fovea was 824.94±294.38 μm. All eyes underwent 23G or 25G vitrectomy. During the operation, 0.1-0.5 ml t-PA (10 μg/0.1 ml) was injected under the macula. The vitreous cavity was filled with 15% C3F8 after gas-liquid exchange in 13 eyes, and 11 eyes were filled with sterilized air. Eleven eyes were injected with anti-VEGF drugs at the end of the operation, and anti-VEGF drugs were given PRN treatment according to the activity of the lesion. The average follow-up time after treatment was 27.90±22.21 months. The absorption of bleeding under the macula, the improvement of vision, the occurrence of rebleeding and treatment-related complications were observed and recorded. The Wilcoxon rank sum test was performed to compare the BCVA and the height of foveal elevation before and after treatment.ResultsOne month after the treatment, the blood in the fovea of all affected eyes was cleared. At the last follow-up, the logMAR BCVA and macular foveal elevation were 0.82±0.28 and 253.88±71.75 μm, respectively. Compared with those before treatment, the difference was statistically significant (Z=－3.727, －3.234; P＜0.001, ＜0.001). The average intravitreal injection of anti-VEGF drugs was 1.08 times. During the operation, a tiny hole was formed in the center of the macula when t-PA was injected under the retina. Two eyes showed mild vitreous hemorrhage early after the operation. During the follow-up period, bleeding recurred in 2 eyes.ConclusionsVitrectomy combined with submacular injection of t-PA, gas filling, and anti-VEGF drugs is an optimal combination for the treatment of thick submacular hemorrhage. It can effectively remove submacular hemorrhage, improve vision, reduce foveal elevation with good safety.