ABSTRACT
Objective:To systematically evaluate the effect of pars plana vitrectomy (PPV) combined total peeling of internal limiting membrane (ILM) versus fovea-sparing peeling of ILM for myopic foveoschisis.Methods:A evidence-based medicine study. Chinese and English as search terms for myopic foveoschisis, vitrectomy, and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure, Wanfang database, VIP database, PubMed of National Library of Medicine, Medline, Embase, and Cochrane Library. The high myopic macular schisis was selected as the research object, the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1, 2010, and Jun 31, 2021. Incomplete or irrelevant literature and review literature were excluded. The method of Newcastle-Ottawa Scale system was used to evaluate the included literature. The literature was meta-analyzed by RevMan5.3 software. The mean difference ( MD) and a confidence interval ( CI) of 95% were used to describe the effect sizes of continuous data, fixed effects model was performed. The data including the best corrected visual acuity (BCVA), central fovea thickness (CFT), and postoperative macular hole (MH) were analyzed. Results:In those databases, 232 articles based search stratery were totally retrieved, and 10 articles (417 eyes) were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM. Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups (BCVA: MD=0.05, 95% CI 0.00-0.11; P>0.05; CFT: MD=-4.79, 95% CI -18.69-9.11, P>0.05). It was compared with the incidence of MH, the difference was statistically significant (odds ratio=5.70, 95% CI 2.22-14.61, P<0.05). Conclusion:BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis; compared with complete ILM peeling, the incidence of MH was lower after foveal-sparing ILM peeling.
ABSTRACT
Background The surgery for retinal detachment induced by macular hole in high myopic eye has a lower success rate in comparison with other rhegmatogenous retinal detachment.A combination procedure of vitrectomy and heavy silicone oil tamponade for retinal detachment induced by macular hole in high myopic eye has been used,but different outcomes are reported.Objective This study was to assess the efficacy of heavy silicone oil tamponade for the treatment of retinal detachment with macular hole in high myopic eye.Methods The clinical data of 20 eyes of 20 patients who received vitrectomy combined heavy silicone oil tamponade surgery for retinal detachment induced by macular hole in high myopia under the informed consent in Beijing Tongren Eye Center from September 2007 to December 2009 were retrospectively analyzed.The 20 G vitrectomy was used during the surgery.In addition,other procedures,such as epiretinal membrane peeling,retinotomy,endo-laser photocoagulation,phacoemulsification and intraocular lens (IOL) implantation were optionally performed as necessary.No special position was required after the surgery.Heavy silicon oil was removed via pars plana,and retinal reattachment after heavy silicon oil removal was defined as success of surgery.Postoperative LogMAR vision,intraocular pressure,retinal reattachment and complications were observed and evaluated.Results The preoperative average spherical equivalent refractive error was (-14.3 ±3.0) D in the eyes.Among the 20 eyes,there were 7 (35％) recurrent retinal detachment and 7 eyes (35％) complicated with choroidal detachment preoperatively.After surgery,the retinas were reattached in 95％ eyes (19/20),including retinal reattachment after first operation in 18 eyes (90％) and after second surgery in 1 eye (5％).A localized retinal detachment was still existed after a second surgery in the other 1 eye.The mean LogMAR vision improved from preoperative 2.77 ±0.81 to postoperative 1.22±0.46 (P =0.000).All the phakic eyes developed different degrees of sub-capsular cataract.Long-term ocular hypertension was found in 2 eyes after surgery.Conclusions The combination of vitrectomy and heavy silicone oil endotamponade is a safe and effective approach to retinal detachment with macular hole in high myopic patients.This procedure may improve vision and offers comfortable position after surgery for the patients.
ABSTRACT
Background Choroidal hemangioma is a common benign intraocular tumor.Typical choroidal hemangioma is comparably easy to diagnose,but untypical one might be misdiagnosed as malignant tumor.Contrastenhanced ultrasound (CEUS) has been used to diagnose multiple neoplasm for the past few years.However,the application of CEUSin ophthalmology is less.Objective This study was to investigate the CEUS characteristics of choroidal hemangioma.Methods Fifty-eight eyes of 58 patients who were diagnosed as choroidal hemangioma were included in Beijing Tongren Hospital during July 2010 to December 2012.CEUS was performed on the patients to check the manifestations of choroidal hemangioma.A time-intensity analysis was employed to quantitatively analyzed and compared the maximum intensity (MI),rising time (RT),time to peak (TTP),and mean transit time (mTT) between the choroidal hemangioma and normal orbital tissue and the parameters were contrasted using Wilcoxon signed-rank test.Results CEUS showed that choroidal hemangioma was gradually enhanced by the contrast after intravenous injection of sulphur hexafluoride microbubbles with a high-reference signal in choroidal hemangioma,and the fading procedure was slower in choroidal hemangioma than that of normal orbital tissue.MI,RT,TTP,and mTT were294.20％ (217.35％,373.25％),21.30 (17.35,23.35) s,25.00 (21.68,27.48) s and 59.30 (51.08,78.35) s in the choroidal hemangioma,which were significantly higher than 100.00％ (100.00％,100.00％),17.75 (15.00,20.30) s,22.40 (18.35,24.63) s and 47.25 (40.90,57.23) s in the normal orbital tissue (Z =-6.608,-4.998,-4.650,-4.332,all at P＜0.001).Conclusions Choroidal hemangioma has its own CEUS manifestation characteristics.CEUS is helpful to the differential diagnosis of choroidal hemangioma.