Endophthalmitis caused by intravitreal injection is a rare disease which impair patients’s vision. In recent years, with the increase of the diseases and frequency of intravitreal injections, the incidence of endophthalmitis has increased. Standardizing each step of intravitreal injections is an important method to reduce postoperative endophthalmitis. Despite the current availability of prevention strategies providing by a lot of clinical trials, there are considerable variations and a lack of consensus and inconsistencies in clinical practice. Understanding the existing key measures, standardizing the operation of intravitreal injection in my country, and minimizing the incidence of infective endophthalmitis are of positive significance for improving the treatment of ophthalmology, especially fundus diseases.
ObjectiveTo observe and analyze the clinical and imaging features of eyes with cystoid macular degeneration (CMD) secondary to chronic central serous chorioretinopathy (cCSC). MethodsA retrospective clinical study. From February 2018 to June 2023, 9 patients of 15 eyes with cCSC secondary CMD diagnosed by ophthalmology examination in Yunnan University Affiliated Hospital were included in the study. All patients were male. The age was (53.67±3.83) years. The cases of binocular and monocular were 6 and 3 respectively. The visual acuity of the affected eye ranges from 0.02 to 0.1, which cannot be corrected. Visual acuity decreased and the duration of shadow occlusion was ＞1 year. Half dose photodynamic therapy (PDT) was performed on 8 eyes. All the patients underwent the best corrected visual acuity, posterior mydriatic fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and multi-wavelength dazzling imaging (MC). The patients who received half dose PDT were followed up until 3 months after treatment. Patients who did not receive treatment were followed up to 2 years after the first diagnosis. ResultsThe light reflection in macular area decreased or disappeared in all eyes, and abnormal macular pigmentation was observed in 12 eyes. IR examination showed diffuse patchy weak fluorescence in the macular area in all affected eyes, and dotted strong fluorescence in the periphery. Fundus AF examination showed disc-like weak AF in the macular area, and scattered small amounts of strong AF in the middle and margins, among which the retinal pigment epithelium (RPE) atrophy trace in the macular area was observed in 7 eyes. By MC examination, the green signal in the macular area of the posterior pole of all affected eyes was uneven and mottled. FFA examination showed that no abnormal fluorescein leakage was observed in 15 eyes and 8 eyes showed strong fluorescence caused by diffuse permeation fluorescence. A small amount of active fluorescein was found in 7 eyes. OCT examination showed that there were several cystic cavities of different sizes in all the affected eyes, RPE atrophied to different degrees, and RPE cell compensatory ridges and tubular structures in the outer retina were seen in 6 eyes; 7 eyes with CMD and active leakage showed signs of subcortical fluid accumulation. Choroidal hypertrophy was seen in all affected eyes, with significant expansion of the great vascular layer and compression of the middle vascular layer and capillary layer. In 8 eyes treated with half-dose PDT, 6 eyes were ineffective at 3 months after treatment. The treatment was effective in 2 eyes. In 7 eyes that did not receive half-dose PDT, CMD structure did not improve significantly after 2 years of follow-up. The visual acuity decreased with the prolongation of the disease. ConclusionsCMD is more common in cCSC with a long course of disease, which has significant effects on vision and poor prognosis. Fundus color photography shows that the reflection in the macular area of the pole is weakened or disappeared, which may be combined with macular abnormal pigmentation. IR and AF examination show uneven fluorescence in macular area. The green signal in macular area is not uniform according to MC inspection. FFA shows strong fluorescence caused by diffuse permeable fluorescence and fluorescein leakage in active lesions. OCT examination shows that multiple small sacs or connections between sacs were broken and fused, and RPE atrophied to varying degrees.
ObjectiveTo observe the clinical features of collateral circulation in different types of retinal vein occlusion. MethodsA retrospective clinical study. A total of 360 patients with monocular retinal vein occlusion diagnosed by ophthalmic examination in Department of Ophthalmology of Yunnan University Affiliated Hospital from December 2021 to December 2023 were included in the study. Among them, 157 males had 157 eyes and 203 females had 203 eyes. Age were (61.0±5.9) years. The duration of the disease from the onset of symptoms to the time of treatment was 3 days to 6 months. Macular branch vein occlusion (MBRVO), retinal branch vein occlusion (BRVO) and central retinal vein occlusion (CRVO) were observed in 67, 187 and 106 eyes, respectively. 210 eyes were with macular edema. All patients with macular edema were treated with anti-vascular endothelial growth factor (VEGF) by intravitreal injection. All eyes were examined by scanning source optical coherence tomography. The incidence, location, morphological characteristics, formation time of retinal collateral circulation and the effect of anti-VEGF drug on the formation of collateral circulation were observed. A short circuit in which blood vessels originating from the optic disc in the form of a blood loop return to the optic disc after the disc has been deformed for some time is defined as a short-circuited collateral circulation of the ciliary vessels of the optic disc. ResultsAfter 1 week of disease course, MBRVO and collateral circulation of BRVO affected eye were established. By 1 to 2 months, a relatively abundant and stable collateral circulation had been established. In the course of 2 to 3 months, the short-circuit collateral circulation of ciliary vessels in the optic disc of the affected eye gradually formed. At 6 months, collateral circulation was established in 36 eyes (53.7%, 36/67) in 67 MBRVO patients. Collateral circulation was observed in 187 eyes of BRVO patients (100.0%, 187/187). In 106 eyes with CRVO, collateral circulation was established in 29 eyes (18.1%, 29/106). In 36 eyes with MBRVO, collateral circulation was established at the vertical horizontal slit between the blocked area and the non-blocked area. In 187 eyes of BRVO patients, collateral circulation was established in the vertical horizontal slit between the blocked and non-blocked areas in 102 eyes; 54 eyes were blocked the most central bypass to the collateral circulation on normal blood vessels. The collateral circulation of 19 eyes was established through nasal and temporal side. Collateral circulation through the fovea was established in 12 eyes. Its morphology is straight out of shape, spiral sinuous and flower cluster. CRVO established collateral circulation in 29 eyes, all of which had short-circuit collateral circulation of ciliary vessels. In 210 eyes treated with anti-VEGF drugs, collateral circulation was established in 160 eyes. Among them, 32 eyes were MBRVO (50.7%, 32/63), BRVO 119 eyes (100.0%, 119/119), CRVO 9 eyes (32.1%, 9/28). ConclusionsThe incidence of collateral circulation of MBRVO, BRVO and CRVO is 53.7%, 100.0% and 18.1%, respectively. The forms of MBRVO were varied and the course of disease is about 2 months. Anti-VEGF therapy did not inhibit the establishment of collateral circulation.