With the continuous advancement of technology, the field of retinal surgery is poised to witness an increasing array of innovations and breakthroughs. The innovation in retinal surgery plays a pivotal role in enhancing the success rate of operations, reducing the risk of complications, and improving patient prognosis and quality of life. This encompasses innovations in vitrectomy systems, the novel application of vitrectomy in treating other ocular diseases, advancements in retinal surgical techniques, technological and conceptual innovations, as well as multidisciplinary collaboration, all of which contribute to the ongoing development in the treatment of retinal diseases. Therefore, innovations in retinal surgery should receive significant attention from ophthalmologists specializing in retinal diseases with the best service to patients.
ObjectiveTo evaluate the surgical outcomes of 25G+ vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH).MethodsA prospective analysis was performed on 39 patients (39 eyes) underwent 25G+ pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G+ PPV with 25% SF6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t -test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test.ResultsThirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF6 group. The distribution of age (t=－1.63), gender (χ2=0.03), logMAR BCVA (t=0.39), macular thickness (t=－0.93), macular hole diameter (t=－0.70), axial length (t=－0.56), macular hole stages (Z=－0.47) and pseudophakic status (χ2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF6 group. There was no significant difference of closure rate between the two groups (χ2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes,10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF6 group. The proportion of visual acuity improvement in air group was lower than that in SF6 group without the statistical significance (Z=－0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF6 group. All returned to normal limit after local medication.ConclusionCompared to SF6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe itching and recurrent eczema-like lesions. With the increase in the global incidence of AD, the incidence of ocular complications in patients also increases. Retinal detachment (RD) seriously affects the vision of patients, and is more common in young and middle-aged people, often involving both eyes with poor prognosis. What’s more, there are many similarities between RD associated with AD and traumatic RD, such as peripheral retinal breaks, giant retinal tears and retinal dialysis. Regarding the mechanism of AD complicated with RD, the trauma theory is widely accepted. Scholars have also reported on the theory of anterior eye developmental abnormalities, inflammation-traction theory, and ectodermal origin theory. On AD complicated with RD, regardless of scleral buckling surgery or vitrectomy surgery, the rate of first retinal reattachment is low with severe proliferative vitreoretinopathy or chronic uveolar inflammation after surgery, which cause traction on the ciliary body and the retina separation appearance again or new cracks appearance. Combination of behavioral therapy, drug therapy and psychotherapy can effectively reduce the occurrence of RD; prevention of eye rubbing, reduction of traumatic exercise, rational use of glucocorticoids or immunosuppressants under the guidance of dermatologists are effective ways for AD patients to prevent RD occurrence. Regular eye examinations can help patients find RD as soon as possible so that they can be treated in time.
ObjectiveTo analyze the risk factors of neovascular glaucoma (NVG) after 25G pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR).MethodsA retrospective study. From January 2017 to December 2018, 340 PDR patients (340 eyes) with vitreous hemorrhage (VH) who were first treated with PPV in Tianjin Medical University Eye Hospital were included in the study. Among them, 185 were male and 155 were female, with an average age of 55.79±10.82 years. The duration of diabetes was 13.01±7.70 years, the fasting blood glucose was 7.55±2.15 mmol/L. Nineteen patients combined coronary heart disease, and 20 patients combined cerebral infarction. All patients underwent best-corrected visual acuity (BCVA), intraocular pressure (IOP), non-contact fundus examination, and fundus color photographs. BCVA was measured using an international standard Snellen visual acuity chart, and the values were converted to logarithm of the minimum angle of resolution (logMAR) scores for data analysis. The baseline logMAR BCVA was 2.04±0.73, The baseline IOP was 15.45±2.93 mmHg (1 mmHg=0.133 kPa). The duration of VH was 2.98±1.46 months, ranged from 3 weeks to 6 months. Three hundred and forty eyes included 93 eyes of PDR Ⅳ stage (27.35%), 107 eyes of Ⅴ stage (31.47%), and 116 eyes of Ⅵ stage (34.12%), combined tractional retinal detachment (TRD) 83 eyes. All patients underwent 25G standard three channel vitrectomy through the pars plana of the ciliary body. Preoperative anti-VEGF injection was performed in 57 eyes, internal limiting membrane (ILM) peeling in 234 eyes, combined phacoemulsification cataract surgery in 262 eyes and 141 eyes intravitreal anti-VEGF injection at the end of surgery. The patients were followed up for at least 12 months, with an average follow-up time of 10.80±5.79 months. NVG was defined as the presence of neovascularization in the anterior chamber angle or iris with an IOP higher than 21 mmHg after vitrectomy. Kaplan-Meier method and Cox univariate and multivariate regression were used to analyze the relationship between baseline factors, ocular factors, surgical factors and the occurrence of NVG after surgery.ResultsAmong 340 eyes, 66 eyes (19.41%) developed NVG after vitrectomy during 12 months of observation, NVG occurred from 6 to 335 days after surgery, and the mean period between vitrectomy and developing NVG was 98.00±5.79 days. The incidence of NVG was 11.50%, 15.29% and 20.75%, respectively in the 3rd, 6th and 12th month after PPV. The result of univariate analysis with the Cox regression analysis showed that the development of NVG at 12 months after surgery and age, combined coronary heart disease or cerebral infarction, combined with cataract phacoemulsification, ILM peeling, preoperative anti-VEGF injection had effect on postoperative NVG (P＜0.05). Ocular factors such as PDR staging, combined TRD, preoperative logMAR BCVA, preoperative intraocular pressure, etc. had no effect on the occurrence of NVG after surgery (P＞0.05). Combined cataract phacoemulsification surgery, internal limiting membrane peeling, surgical factors such as intracavity injection of anti-VEGF drugs 3 days before surgery, had an impact on the occurrence of NVG after surgery (P＜0.05). The meaningful variables of the Cox univariate analysis were incorporated into the multivariate Cox proportional hazard model for analysis, and the influencing factors of NVG after surgery were gradually regressed. The results showed that age, coronary heart disease or cerebral infarction, combined with phacoemulsification of cataract, and internal limiting membrane removal during surgery were independent risk predictors of NVG after surgery (P＜0.05).ConclusionsYounger, coronary heart disease or cerebral infarction, combined with cataract phacoemulsification are the risk factors of NVG in PDR patients after PPV. The removal of internal limiting membrane can reduce the incidence of NVG.
Primary vitreoretinal lymphoma (PVRL) is one of the most common type of primary intraocular lymphoma. The current treatment options include local ocular radiotherapy (radiotherapy), systemic chemotherapy (chemotherapy), local ocular chemotherapy, and combination therapy. The treatment options are different at different stages of PVRL, however, there is no uniform treatment guideline. Local ocular chemotherapy can make the drug reach effective therapeutic concentration in the eye, and it can be repeated many times. At the same time, it can avoid the adverse reactions caused by systemic medication or radiotherapy. It is an ideal choice for relieving ocular symptoms. At present, the mainstream ocular local chemotherapeutics are methotrexate (MTX) and rituximab (RTX). The basic consensus about the intravitreal injection of MTX (IVM) is the induction-consolidation-maintenance model, however, the time of each stage and frequency of IVM are diverse. The time interval of intravitreal injection of RTX is also variable, ranging from 1 time/week to 1 time/months and so on. Corneal epithelial lesions caused by frequent MTX injections and the higher recurrence rate after RTX treatment are the main reasons for changing the treatment plan. For patients with primary central nervous system lymphoma and PVRL, combined treatment with neurology department is necessary to save patient's lives, ophthalmology treatment relieves ocular symptoms and improves the patient's quality of life. For patients with PVRL alone without central nervous system involvement, ophthalmology treatment is necessary to control patient's eye symptoms, and close follow-up should be followed to find the involvement of the central nervous system in time, and then combined with neurological treatment to save patient’s lives.
ObjectiveTo observe the safety and effectiveness of patching retinal breaks with Healaflow in 27G vitrectomy combined with air tamponade in the treatment of rhegmatogenous retinal detachment (RRD).MethodsClinical-based prospective continuous study. From March 2017 to May 2018, 51 eyes of 50 RRD patients diagnosed in Tianjin Medical University Eye Hospital were included in the study. All eyes were treated with 27G vitrectomy, and laser photocoagulation was performed around retinal hiatus and denaturation zone after complete retinal reattachment. A blunt 27G needle was used to completely cover the surface of the retinal tear with the Healaflow. The injection amount was determined according to the size of the retinal tear, and the standard was that the tear was completely contained. There was no postoperative position limitation. The average follow-up was 15.8±6.3 months. The primary and final anatomic attachment rate, BCVA after operation, the intraoperative and postoperative complications, the recurrence of retinal detachment and so on were recorded.Results51 eyes of 50 patients were enrolled, including 29 males (58.0%) and 21 females (42.0%). The average age was 58.5±1 years. A single break was present in 28 eyes (54.9%) and 2 to 5 breaks in 23 eyes (45.1%). The macula was involved in 32 eyes (62.7%) and attached in 19 eyes (37.3%) intraoperatively. Initial reattachment was achieved in 50 eyes (98.0%) and final reattachment in 51 eyes (100.0%). The logMAR BCVA before and 3 months after operation were 0.95±0.80 and 0.22±0.17, respectively. The difference of logMAR BCVA between before and after operation was significant (t=7.336, P＜0.001). The intraocular pressure was elevated transiently in 31 eyes (60.8%). No other complications occurred during follow-up.ConclusionThe treatment of primary RRD with 27G vitrectomy combined with Healaflow patch and air tamponade is a safe, effective and convenient method with high success rate and rapid recovery of visual function.
Blood-retina barrier destruction, nerve injury, formation of neovascularization and fibroblast proliferation membrane are important pathological changes of DR, which are related to the combined effects of various vitreous cytokines. VEGF is mainly involved in increasing retinal vascular permeability and inducing neovascularization. Pigment epithelium derived factor is vital reducing vascular permeability and neuroprotection; IL plays a key role in mediating inflammatory response. TNF-α is related to inflammation, which is significantly up-regulated by hypoxia. TGF-β is an important cytokine regulating cell proliferation and differentiation. Connective tissue growth factor can promote the growth, migration and adhesion of endothelial cell. In addition, many other molecular mechanisms have not been fully elucidated, and further study on the molecular mechanism of DR is urgent. With the further study of molecular mechanism, the early intervention and targeted treatment of DR will be more effective.
ObjectiveTo observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery.MethodsProspective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups (t=－24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=－1.144, P=0.258), logMAR BCVA (t=－0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation.ResultsAt 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups (t=－4.980, －4.840, －4.892, －5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups (χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant (t=－2.622, －2.638, －3.613, －3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation.ConclusionsIntravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA.
ObjectiveTo characterize proteomic profile in aqueous humor of patients with pathologic myopia (PM) using quantitative proteomic analysis, which may provide new clues to understand the mechanisms and possible treatments of PM.MethodsA cross-sectional study. From January 2019 to August 2019, aqueous humor samples (32 cataract patients) were collected for quantitative proteomic analysis using liquid chromatography tandem mass spectrometry at Tianjin Medical University Eye Hospital. There were 11 males and 21 females. They were 58-76 years old with an average age of 68.41±6.09 years old. Sixteen patients with PM were regarded as PM group, 16 patients without myopia were regarded as the control group. The aqueous humor samples (100-150 μl ) were collected from all patients before cataract surgery. Using protein quantification and non-labeled liquid chromatography tandem mass spectrometry analysis, differentially expressed proteins were obtained. Five different proteins were randomly selected for ELISA verification. The differentially expressed proteins were further analyzed by gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes, which were validated using ELISA in the other twenty samples of each group.ResultsA total of 583 proteins were identified and 101 proteins were found to be differentially expressed, including 63 up-regulated proteins and 38 down-regulated proteins. ELISA verification results showed that the expression trend of the 5 differentially expressed proteins between the PM group and the control group was consistent with the results of Label-free quantitative proteomics analysis. The main classifications of these differentially expressed proteins were protein-binding activity modulator, defense/immunity protein, protein modifying enzyme, metabolite interconversion enzyme, extracellular matrix protein, transfer/carrier protein and so on. The bioinformatics analysis suggested that PM was closely associated with inflammation and immune interactions, and remodeling of extracellular matrix.ConclusionsCompared with the control group, the protein expression profile of PM patients' aqueous humor specimens has obvious changes. These differences indicate that PM is closely related to inflammation and immune interaction and extracellular matrix remodeling.
ObjectiveTo compare and analyze the application of anti-vascular endothelial growth factor (VEGF) drugs for intravitreal injection in the real world before and after the establishment of one-stop intravitreal injection center, as well as the advantages and disadvantages of different management modes. MethodsA retrospective clinical study. A total of 4 015 patients (4 659 eyes) who received anti-VEGF drugs for ocular fundus diseases at the Tianjin Medical University Eye Hospital from July, 2018 to June, 2022 were included in the study. There were 2 146 males and 1 869 females. The ocular fundus diseases in this study were as follows: 1 090 eyes of 968 patients with wet age-related macular degeneration (wAMD); 855 eyes of 654 patients with diabetic macular edema (DME); 1 158 eyes of 980 patients with diabetic retinopathy (DR); 930 eyes of 916 patients with macular edema secondary to retinal vein occlusion (RVO-ME). A total of 294 eyes of 275 patients with choroidal neovascularization secondary to pathological myopia (PM-CNV); 332 eyes of 222 patients with other fundus diseases. A total of 13 796 anti-VEGF needles were injected. A total of 1 252 patients (1 403 eyes) from July 2018 to June 2020 were regarded as the control group. From July 2020 to June 2022, 2 763 patients (3 256 eyes) who received anti-VEGF treatment in the intravitreal injection center were regarded as the observation group. The total number of intravitreal injection needles, the distribution of anti-VEGF therapy in each disease according to disease classification, the proportion of patients who chose the 3+ on-demand treatment (PRN) regimen and the distribution of clinical application of different anti-VEGF drugs were compared between the control group and the observation group. The waiting time and medical experience of patients were investigated by questionnaire. χ2 test was used to compare the count data between the two groups, and t test was used to compare the measurement data. ResultsAmong the 13 796 anti-VEGF injections in 4 659 eyes, the total number of anti-VEGF drugs used in the control and observation groups were 4 762 and 9 034, respectively, with an average of (3.39±3.78) and (2.78±2.27) injections per eye (t=6.900, P＜0.001), respectively. In the control and observation groups, a total of 1 728 and 2 705 injections of anti-VEGF drugs were used for wAMD with an average of (5.14±4.56) and (3.59±2.45) injections per eye, respectively; a total of 982 and 2 038 injections of anti-VEGF drugs were used for DME with an average of (4.36±4.91) and (3.24±2.77) needles per eye, respectively. Additionally, a total of 942 and 2 179 injections of anti-VEGF drugs were injected for RVO-ME with an average of (3.98±3.71) and (3.14±2.15) injections per eye, respectively; a total of 291 and 615 injections of anti-VEGF drugs were injected for PM-CNV with an average of (3.31±2.63) and (2.99±1.69) injections per eye, respectively. A total of 683 and 1 029 injections of anti-VEGF drugs were injected for DR with an average of (1.60±1.26) and (1.41±1.05) injections per eye, respectively. The clinical application and implementation of "3+PRN" treatment were as follows: 223 (66.4%, 223/336) and 431 eyes (57.2%, 431/754) in the wAMD (χ2=8.210, P=0.004), 75 (33.3%, 75/225) and 236 (37.5%, 236/630) eyes in the DME (χ2=1.220, P＞0.05), and 97 (40.9%, 97/237) and 355 eyes (51.2%, 355/693) in the RVO-ME (χ2=7.498, P=0.006), 39 (44.3%, 39/88) and 111 eyes (53.9%, 111/206) in the PM-CNV ( χ2=2.258, P＞0.05), respectively. In addition, the results of the questionnaire survey showed that there were significant differences between the control and observation groups regarding the time of appointment waiting for surgery (t=1.340), time from admission to entering the operating room on the day of injection (t=2.780), time from completing preoperative treatment preparation to waiting for entering the operating room (t=8.390), and time from admission to discharge (t=6.060) (P＜0.05). ConclusionsThe establishment of a one-stop intravitreal injection mode greatly improved work efficiency and increased the number of injections. At the same time, the compliance, waiting time, and overall medical experience of patients significantly improved under centralized management.