Purpose To assess the efficacy of pars plana vitrectomy,autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes. Methods The procedures consisted of pars plana vitrectomy with removal of posterior cortical vitreous，air-fluid exchange, instillation of autologous platelet concentrate onto the posterior pole and 20%～30%SF6 tamponade,were performed in treating 6 eyes of 6 patients with idiopathic macular holes. The patients were instructed to lie in a supine position for l hour after surgery,then adviced to remain in a facedown position for 2 weeks. Results Flattening of the surrounding retina and closure of the hole were achieved postoperatively in all the 6 affected eyes.Visual acuity improved two lines or more in 5 eyes (83.3%).Four eyes(66.7%)reached a postoperative visual acuity of 0.3 or more. Retinal detachment ocurred in one eye owing to peripheral new hole formation. Conclusion Pars plana vitrectomy, autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes are able to close macular hole and improve the visual acuity. (Chin J Ocul Fundus Dis,1998,14:14-15)
Purpose To observe the clinical features and visual acuity of the eyes with idiopathic macular holes. Methods We reviewed the clinical materials of 23eyes of 18 patients with idiopathic macular holes and the follow up results from 6 to 120 months. Results In the initial examinations of 22 eyes,the numbers of eyes with stagesⅠ-Ⅳ macular holes were5,4,10,3 eyes respectively,and funds fluorescein angiography showed there were focal transmission of choroidal fluorescein in 17 eyes (stagesⅡ～Ⅳ).Macular hole ocurred in one eyes during follow up.At the final examination of 23 eyes,the numbers of eyes with stages Ⅰ～Ⅳ macular holes were 2,2,9,8 eyes respectively .Full-thickness macular hole of 2 eyes closed naturally after posterior vitreous detachment.The time interval of the subjective visual loss on stage Ⅰ was 5-8 months,stageⅡ8-20 months,stageⅢ12-126 months ,and the average visual acuity on stageⅠwas 0.7,stage 0.55,stageⅢ0.08,and stage Ⅳ0.08 Conclusion Approximately 60% of impending (stage Ⅰ) hole progress to full thickness holes, the full thickness holes were usually enlarged and the visual acuity of affected eyes decreased as the natural course was prolonged . (Chin J Ocul Fundus Dis,1998,14:222-223)
Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave（Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.
ObjectiveTo observe the changes of the structure and visual function of the retina in patients with or without the ectopic inner foveal layers (EIFL) and to explore the factors influencing the recovery of visual function in patients with idiopathic epimacular membrane (IMEM).MethodsA retrospective clinical study. From March 2015 to June 2019, 90 patients with MEM who were diagnosed by Ophthalmic Center of the Second Hospital of Hebei Medical University were enrolled in the study. All patients were examined by best corrected visual acuity (BCVA) and frequency domain optical coherence scan. BCVA was recorded by Snellen vision table, and it was converted into the minimum resolution angle logarithm (logMAR) vision. Among 90 eyes, IMEM grade 2-4 was 68 (75.6%, 68/90), 18 (20.0%, 18/90), 4 (4.4%, 4/90), respectively. According to this, the grade 2 was set as group A, and the grade 3 and grade 4 were combined to group B. There was no significant difference in age (t=0.015), sex composition ratio of patients between two groups (χ2=0.060) and the average of central macular thickness (CMT) (F=2.277) (P=0.904, 0.809, 0.141). The difference of average logMAR and BCVA was statistically significant (F=35.913, P=0.000). All patients underwent 25G pars plana three channel vitrectomy with simultaneous removal of epiretinal membrane and internal limiting membrane. BCVA, CMT and improvement of IMEM grading were observed at 1, 3, 6 and 12 months after operation. BCVA, EIFL thickness and CMT were compared before and after operation by single factor repeated variance analysis; Fisher exact probability method was used to compare the changes of the anatomical structure of the eyes in the two groups at 12 months after operation.Results1, 3, 6, 12 months after operation, the average eyes of logMAR BCVA in group A were 0.50±0.13, 0.38±0.12, 0.27±0.12, 0.19±0.10. The patients in group B were 0.66±0.14, 0.60±0.13, 0.54±0.14, 0.52±0.14. CMT in group A were 364.82±81.29, 281.65±72.45, 228.55±55.34, 182.84±56.13 μm. The patients in group B were 455.88±69.60, 440.18±68.65, 383.76±65.38, 371.39±66.60 μm. The difference was statistically significant in the two groups (BCVA: F=37.913, 11.479, 24.250, 39.013; P=0.000, 0.002, 0.000, 0.000. CMT: F=10.987, 39.610, 55.789, 79.987; P=0.002, 0.000, 0.000, 0.000). In group A, IMEM was improved to 57 eyes of grade 1 on 12 months after operation. Among the 18 eyes in group B, IMEM was improved to 1 and 3 eyes in level 1 and level 2, respectively, and no improvement was found in 4 eyes in grade 4. The difference was statistically significant (P=0.000) in the improvement of the number of eyes in the two groups.ConclusionsThe patients with IMEM without EIFL have better visual prognosis and reversible anatomical changes. EIFL is an important factor affecting the visual function and anatomical structure recovery after operation.