ObjectiveTo observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreous retinal surgery and the influencing factors of the imaging quality. MethodsA retrospective case study. A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital. All the subjects were taken vitreous retinal surgery and iOCT scanning. The patients included 46 males and 86 females, with an average age of 61.7 years. 111 cases had macular diseases and 21 cases had vitreous hemorrhage. Cases are divided into high myopia and non-high myopia group according to ocular axial length (AL), 28 eyes in high myopia group (AL≥26 mm),104 eyes in non-high myopia (AL<26 mm).The scanning time, image quality and eye conditions were observed during the operation. The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed. ResultsThe iOCT images were identified in 124 of 132 subjects, while were not identified in 8 eyes. For the macular area morphology change, iOCT tips and surgeon judgment rate was inconsistent in 22 eyes (16.7%). For the operation guidance value, change the operation rate of 12/132,accounted for 9.1%. The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups (χ2=17.13, P=0.001). Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups (r=3.75, 6.18; P=0.049, 0.013). There were no complications such as endophthalmitis. ConclusionsThe surgeon can observe morphological changes in the macular area through iOCT which is difficult to be observed by operating microscope and selected reasonable operation method during the surgery. High myopia, corneal edema and operation time affect the image quality.
ObjectiveTo observe the foveal contour characteristic of idiopathic epiretinal membrane (iERM). MethodsA total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study. All eyes received the examination of optical coherence tomography (OCT) and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). Foveal contour grading was according to the ratio of central macular thickness (CMT) to the thickness of the retina 1 mm away on OCT line scan: Grade 0, depressed; Grade 1, flat; Grade 2, elevated. Baseline foveal contour grade was as follows: 28 eyes with Grade 1 (Group 1), and 25 eyes with Grade 2 (Group 2). The mean logMAR BCVA was 0.40±0.26 in Group 1, and 0.60±0.27 in Group 2 respectively. The mean CMT was (433.52±133.05) μm and (571.70±85.40) μm respectively. The logMAR BCVA and CMT both demonstrated significant difference between the two groups (t=-2.825, -4.512; P<0.05). OCT images and BCVA at 1, 3 months after surgery were collected and analyzed. The change in foveal contour, BCVA and CMT were evaluated. The relationship between surgical outcome and different preoperative grading was analyzed. ResultsFoveal contour grade at 3 months after surgery was as follows: 15 eyes with Grade 0, 21 eyes with Grade 1, and 17 eyes with Grade 2, demonstrating significant difference compared with baseline (Z=-3.588, P<0.05). In Group 1, there were 12 eyes with Grade 0, 10 eyes with Grade 1, and 6 eyes with Grade 2 postoperatively. In Group 2, there were 3 eyes with Grade 0, 11 eyes with Grade 1, and 11 eyes with Grade 2 postoperatively. The postoperative foveal contour grade was significantly different between the two groups (Z=-2.466, P<0.05). The logMAR BCVA at 1, 3 months after surgery both improved significantly compared with baseline (P<0.05) in Group 1 (t=-3.226, -5.439) and Group 2 (t=-4.137,-5.919). The logMAR BCVA at 1, 3 months after surgery demonstrated significant difference between the two groups (t=-2.231, -2.291; P<0.05). The CMT decreased significantly at 1, 3 months after surgery in Group 1 (t=-2.674, -4.090) and Group 2 (t=-9.663, -9.865) compared with baseline (P<0.05). The CMT at 1, 3 months after surgery demonstrated significant difference between the two groups (t=-2.825, -3.003; P<0.05). The improvement of logMAR BCVA 3 months after surgery was negatively correlated (P<0.05) with preoperative logMAR BCVA (r=-0.758) and preoperative CMT (r=-0.359). ConclusionIn iERM eyes, flat foveal contour had better surgical prognosis than elevated ones.
ObjectiveTo observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO). MethodsA retrospective clinical study. A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography, fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study. The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by OCT. Among 53 eyes, there were 27 eyes with ischemic RVO macular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group). The mean logMAR BCVA was 0.82±0.37, mean CMT was (662.1±216.7) μm in ischemic group. The mean logMAR BCVA was 0.41±0.23, mean CMT was (548.0±161.9) μm. The differences of logMAR BCVA and CMT between the two groups were both statistically significant (t=4.745, 2.258; P<0.05). All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml).The mean logMAR BCVA, CMT before and 1, 3 months after the treatment between the two groups were observed and compared. ResultsOn 1 and 3 months after treatment, the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79), the difference was statistically significant (t=5.052, 5.240; P<0.05). The mean logMAR BCVA before and after treatment had no statistically significant difference in ischemic group (F=0.516, P>0.05), but had a statistically significant difference in non-ischemic group (F=7.685, P<0.05). On 1 and 3 months after treatment, the mean CMT in the ischemic group were (534.7±223.4), (470.8±234.7) μm, which were lower (127.4±28.28), (191.4±34.55) μm before treatment. In the non-ischemic group, the average CMT was (426.2±188.8), (371.3±200.6) μm, which were lower (103.1±33.1), (164.9±49.6) μm. There were statistically significant differences in the mean CMT between the ischemic group and the non-ischemic group (F=17.040, 10.360; P<0.05). In non-ischemic group, CMT had a bigger reduction compared to the the ischemic group (t=2.056, 2.103; P<0.05). The difference of CMT decrease value between two groups was not statistically significant (t=0.560, 0.441; P>0.05). On 1 month after the treatment, there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group, respectively; but all of them returned to normal after drug treatment. There were no drugs and ocular injection related complications. ConclusionPSTA of ischemic RVO macular edema can lower the CMT in the short term, but can't significant improve the visual acuity.