ABSTRACT
Objective:To observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH).Methods:A prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA ( t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) ( t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) ( t=1.255, 0.966) between two groups ( P>0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. Results:Six months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference ( P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant ( t=2.282, 3.101; P<0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant ( t=1.815, 2.302, 2.784; P<0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant ( P=0.007, <0.001, <0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant ( t=1.897, 2.250; P<0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance ( F=12.963, P<0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences ( F=12.374, 21.807, 5.695, 4.095; P<0.05). Conclusion:PPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
ABSTRACT
Objective:To observe the effect of combined operation of internal and external surgery for intraocular hemorrhage of polypoidal choroidal vascular disease (PCV).Methods:Retrospective clinical research. From January to August 2018, 14 eyes of 14 patients with PCV combined with vitreous hemorrhage (VH) with hemorrhagic retinal detachment confirmed by eye examination at the Second Affiliated Hospital of Nanchang University were enrolled in this study. The average disease course was 1.12±0.68 months. The visual acuity decreased from 2 to 14 days. The average time from hemorrhagic retinal detachment to surgery was 6.32±2.82 d. There were 9 eyes with BCVA of light sensing, 3 eyes of hand movement, and 2 eyes of counting fingers. The average macular foveal thickness (CFT) was 564.6±102.2 μm. The range of retinal detachment involves equal or greater than 2 quadrants. 23G vitrectomy surgery was used to remove VH, and subretinal hemorrhage was drained through external scleral drainage to reset the retina. One week and 1 and 2 months after the operation, the eyes were injected with 0.05 ml of ranibizumab in the vitreous cavity. The average follow-up time after surgery was 6.24±1.16 months. One week after the operation, 1, 3, and 6 patients were examined with the same equipment and methods before the operation to observe the condition of BCVA, CFT, intraocular pressure and retinal reattachment. Non-parametric tests were used to compare BCVA before and after surgery.Results:VH was completely cleared in all eyes, and no iatrogenic retinal hole appeared during the operation. Six months after the operation, there were 1 eye with BCVA of hand movement, 1 eye of counting fingers, 8 eyes of 0.1, 2 eyes of 0.2 and 2 eyes of over than 0.2; the average CFT was 336.4±54.8 μm. Compared with before surgery, the BCVA was significantly improved ( Z=-3.711, P=0.000), the CFT was significantly decreased ( t=3.212, P=0.006). OCT examination showed that the macular morphology and structure were clearly visible. Of the 14 eyes, 13 eyes were reattached, 1 eye was detached again after silicone oil removal. Intraocular pressure increased in 3 eyes within 1 week after surgery, including 1 eye with a small amount of blood in the anterior chamber. No recurrent VH was found in all eyes during follow-up. Conclusions:Combined internal and external surgery for PCV combined with VH with hemorrhagic retinal detachment is safe and effective.
ABSTRACT
Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index＜0.7 and provide an alternative basis for IMH.Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index ＜0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (4-8 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA),central vision,direct ophthalmoscope examination,slit lamp microscope with preset lens,optical coherence tomography (OCT),intraocular pressure,Amsler grid table and fundus photography inspection were performed before surgery and 1 month,6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image,U-like closure was thought to be normal fovea,V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation,43 cases had U type closure,1 case had V type closure and 1 case had W type closure in the extensive ILMP group,while 33 cases had U type closure,1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month,6 months and 12 months (all at P＜0.05).Compared with preoperation BCVA,the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma:x2 =80.98,56.99,both at P＜0.05;paracentral scotoma:x2 =88.21,80.98,both at P＜0.05),and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (x2 =4.10,P＜0.05).The closure rate of IMH was 93.75％ in the extensive ILMP group and 77.08％ in the standard ILMP group,showing a significant difference between the two groups (x2 =4.10,P＜0.05).The corrected rate of Amsler grid abnormality was 93.75％ in the extensive ILMP group,which was evidently higher than 75.00％ in the standard ILMP group,with a significant difference between the two groups (x2 =5.06,P＜0.05).Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI＜0.7 are effective,and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.
ABSTRACT
Objective To evaluate the efficacy of ECP and glaucoma drainage device implant in the management of refractory glaucoma. Methods A retrospective study was explored in refractory glaucoma in 99 eyes,in which there were 50 eyes in the ECP group(group A)and 49 eyes in the group of glaucoma drainage device implant (group B). The changes of intraocular pressure (IOP),visual acuity and complication were observed. Results (1)IOP:There was statistically significant difference in IOP between the preoperative and last follow-up in each group(T-Test,t = 2.47,t = 2.51,P 0.05).(3)Complication:The early complications of the group A included anterior chamber exudation ,short-term high IOP,hyphema. In the group B,the early complications included shallow anterior chamber,hyphema, drainage valve block and high IOP,MSCH,choroidal detachment,while the medium-term complication was glaucoma valve fiber wrapped high IOP and the long-term complications included glaucoma drainage tube rejection , exposure and displacement,and endophthalmitis,conjunctival hyperplasia. Conclusion ECP and glaucoma drainage implant can be effective in the treatment of refractory glaucoma. The ECP has less complications.
ABSTRACT
Objective To observe the therapeutic effect of intravitreal lucentis injections combined with laser photocoagulation for Coats disease.Methods This was a retrospective case series study.From August 2012 to December 2015,18 cases (18 eyes) were diagnosed as Coats disease with macular edema by FFA and OCT.All patients were treated at baseline using intravitreal lucentis injections.One week later,photocoagulation was performed by the guiding of FFA.Follow-up treatment was performed as necessary.The primary BCVA and central macular thickness (CMT) was measured postoperatively.The follow-up time was 16-24 months (mean 18.8 months).Results The mean number of lucentis injections was 2.6,and the mean number of laser treatment sessions was 1.8.The mean preoperative BCVA was (0.81 ±0.28) LogMAR,while the final visit was (0.76 ± 0.37) LogMAR (P =0.396).In 3 patients (16.7 ％),BCVA had improved by more than 3 lines,and 13 patients (72.2％)showed stable BCVA (changes within 2 lines of visual acuity),while in 2 patients,BCVA decreased by more than 3 lines (11.1％).The mean CMT improved significantly from (341.11 ±67.97) μm preoperatively to (277.83 ±51.59) μm at the fmal visit (P =0.030).Final BCVA was significantly correlated with preoperative BCVA (r =0.817,P ＜0.001).The final BCVA of patients with subfoveal hard exudates preoperatively was significantly worse than that of patients without such exudates (P =0.044).Conclusion Intravitreal lucentis injection combined with laser photocoagulation may be an effective treatment for Coats disease.It may stablize the visual acuity,decrease the CMT of Coats disease.The final BCVA is associated with preoperative BCVA and occurrence of subfoveal hard exudates.
ABSTRACT
Objective To discuss the effects and influence of preoperative and postoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy (PDR).Methods A retrospective research was performed on 42 PDR eyes from January 2015 to February 2016 in the Second Affiliated Hospital of Nanchang University,who received either intravitreal 0.05 mL conbercept injection 7 days before 23G vitrectomy (group A,n =22) or intravitreal 0.05 mL conbercept injection at the end of 23 G vitrectomy (group B,n =20).The operative time,postoperative vitreous hemorrhage (VH),intraoperative and postoperative other differences of clinical indicators and postoperative best-corrected visual acuity (BCVA) between the two groups were compared.Results The average operation time,intraoperative electric coagulation hemostasis rate,iatrogenic hiatal incidence and intraoperative hemorrhage rate of group A were lower than those of group B (all P ＜ 0.05).BCVA at 6 months after surgery did not differ significantly between two groups (P ＞ 0.05),but the difference was statistically significant between pre-operation and post-operation (P ＜ 0.05).The incidences of early (≤ 1 month) postoperative VH were 18.2％ (4 eyes) and 15.0％ (3 eyes) in group A and B,respectively (P ＞ 0.05).The incidences of later (＞ 1 month) postoperative VH were 27.3％ (6 eyes) and 0 in group A and B,respectively,the difference was statistically significant (P ＜0.05).The percentages of reoperation were 13.6％ (3eyes with postoperative VH) and 10.0％ (2 eyes with traction retinal detachment) respectively in group A and B.The average times of supplementary laser photocoagulation were (2.3 ± 1.0) times and (1.4 ±0.6) times in group A and B,respectively in follow-up period (P ＜ 0.05).Conclusion The adjunctive use of intraoperative intravitreal injection of conbercept can prevent effectively postoperative VH and decrease conveniently the time of supplementary laser photocoagulation in 23G vitrectomy for PDR,as well as the preoperative adjunctive use can decrease the operation time,intraoperative complications and incidences of early postoperative VH.
ABSTRACT
Objective To study the effects of lucentis preventing vitreous hemorrhage after vitrectomy for diabetic retinopathy combined with iris neovascularization.Methods The clinical data of 70 patients (70 eyes) underwent vitrectomy for diabetic retinopathy combined with iris neovascularization during 2009 to 2015 in our hospital were retrospectively analyzed.The control group (30 eyes) accepted panretinal photocoagulation (PRP),re-vitrectomy,cyclocryotherapy,and the study group (40 eyes) had the 0.5mg lucentis in addition.The follow-up time was 3 months,and the visual acuity,IOP,vitreous hemorrhage,INV regression and complication were observed.Results At 1 month,2 months in the follow-up,the visual acuity of study group was better than the control group,but there was no significant difference along with the follow up.The average preoperative IOP was (26.312 ±4.566) mmHg (1 kPa =7.5 mmHg) in the study group and (24.586 ±5.783) mmHg in the control group,and at the end of the follow up,IOP was (18.576 ±4.762) mmHg in the study group and (28.587 ±7.786) mmHg in the control group,there was statistical difference between the two groups (P =0.041).The intraoperative and postoperative anterior chamber or vitreous hemorrhage occurred in 15 cases,5 cases of the control group,and 3 cases,1 case of the control group,there were significant differences (all P =0.000).At the end of the follow up,3 eyes (7.5％) developed to NVG in the study group and 10 eyes (33.3％) in the control group,there was statistical difference (P ＜ 0.05).Conclusion Lucentis can effectively eliminate the new vessels,reduce the incidence of neovascularization glaucoma and vitreous hemorrhage for patients after vitrectomy for diabetic retinopathy combined with iris neovascularization,and improve the visual acuity in a short time.
ABSTRACT
Objective To investigate the clinical features of patients with neuromyelitisoptica spectrum disorders (NMOSD) in China.Methods Cases reports of NMOSD from 1989 to 2016 were retrieved from the database of Weipu data basis,and the clinical features of cases reported were analyzed.Results Eighty-seven studies were enrolled.Totally 109 patients were included.The ratio of male to female was 1 ∶ 4 and the mean onset age was (38.44 ± 17.08) years (range 5-76 years).The predisposing factors was catching a cold(12.80％).There were 66.05％ patients with optic neuritis symptoms as initial symptoms,23.85％ with spinal cord inflammation as the first symptom.Spinal magnetic resonance showed that 80.73％ of the lesions involved thoracic spinal cord,and the cervical spinal cord occupied by 49.54％,while the lumbar spine accounted for about 10.09％.12.84％ involved the final area.Conclusion In China,NMSOD is common in young adults,and more common in women.The onset age between the male and female has no significant difference.The first symptom of optic neuritis is more common,and the spinal cord lesion in thoracic cord is popular.
ABSTRACT
Objective To investigate the clinical effects of minimally invasive vitrectomy combined with cataract surgery for myopic foveoschisis in young and middle-aged. Methods Sixty myopic eyes with myopic fo-veoschisis diagnosed from September 2013 to October 2015 in our hospital were included in the study. According to different surgical methods ,patients were divided into two groups:combined operation group(vitrectomy combined with lens replacement surgery,30 eyes)and staged operation group(simple vitrectomy group,30 eyes). Cataract surgery were performed according to the opacity of lens. All the patients were followed up for 6~12 months. Reop-eration rate of staged operation group ,the best corrected visual acuity(BCVA),the distant and near visual acuity and retinal reattachment rate of each group were observed. Every patient was interviewed with a questionnaire about visual quality at 6th month after surgery. Results 27 eyes developed lens opacity after operation(90%)in staged operation group,among them,21 eyes underwent secondary cataract surgery(70%). The BCVA recovery,postop-erative distant vision,and preoperative and postoperative distant vision difference in the combined operation group were significantly higher than those in the staged group(P<0.05). There were no significant differences in macu-lar retinal condition and retinal reattachment rate between the two groups(P > 0.05). Six months after operation, the visual quality of the combined operation group was significantly better than that of the staged group(t=-3.95, P = 0.00). In the combined surgery group,the scores of distant vision,stereopsis and visual fatigue were higher than those of staged operation group. The score of dry eye and night glare in staged operation group was higher than that in combined operation group(all P<0.05). Conclusions Vitrectomy combined with intraocular lens replace-ment for myopic foveoschisis in young and middle-aged people can avoid second operations and improves the visual function,proving to be a feasible operation in clinic.
ABSTRACT
Objective To investigate the clinical effects of minimally invasive vitrectomy combined with cataract surgery for myopic foveoschisis in young and middle-aged. Methods Sixty myopic eyes with myopic fo-veoschisis diagnosed from September 2013 to October 2015 in our hospital were included in the study. According to different surgical methods ,patients were divided into two groups:combined operation group(vitrectomy combined with lens replacement surgery,30 eyes)and staged operation group(simple vitrectomy group,30 eyes). Cataract surgery were performed according to the opacity of lens. All the patients were followed up for 6~12 months. Reop-eration rate of staged operation group ,the best corrected visual acuity(BCVA),the distant and near visual acuity and retinal reattachment rate of each group were observed. Every patient was interviewed with a questionnaire about visual quality at 6th month after surgery. Results 27 eyes developed lens opacity after operation(90%)in staged operation group,among them,21 eyes underwent secondary cataract surgery(70%). The BCVA recovery,postop-erative distant vision,and preoperative and postoperative distant vision difference in the combined operation group were significantly higher than those in the staged group(P<0.05). There were no significant differences in macu-lar retinal condition and retinal reattachment rate between the two groups(P > 0.05). Six months after operation, the visual quality of the combined operation group was significantly better than that of the staged group(t=-3.95, P = 0.00). In the combined surgery group,the scores of distant vision,stereopsis and visual fatigue were higher than those of staged operation group. The score of dry eye and night glare in staged operation group was higher than that in combined operation group(all P<0.05). Conclusions Vitrectomy combined with intraocular lens replace-ment for myopic foveoschisis in young and middle-aged people can avoid second operations and improves the visual function,proving to be a feasible operation in clinic.
ABSTRACT
Objective To investigate the efficacy and safety of photodynamic therapy(PDT) combined with vitreous cavity injec‐tion of Lucentis treatment for choroidal neovascularization(CNV) diseases .Methods we retrospectively analyzed data of 30 cases (30 eyes) of CNV ,who was diagnosed by examination of visual acuity ,intmocular pressure ,ocular fundus ,fundus fluorescein angi‐ography (FFA) ,and optic coherence tomography(OCT) ,and who underwent PDT combined with intravitreal injection of Lucentis . Results At the 4 ~ 6 months follow‐up ,the best corrected visual acuity(BCVA) improved in 22 eyes(73 .3% ) ,stabilized in 8 eyes (26 .7% ) and none decreased .Among the AMD ,14 cases(70 .0% ) required only a single combined treatment for CNV resolution ;3 cases of AMD needed retreatment 3 months later .In CNV group ,all of the cases required only a single combined treatment for CNV resolution .At the therapy and follow‐up period ,no ocular or systemic adverse reactions were noted .Conclusion The treatment of PDT combine intravitreal injection of Lucentis is safe and effective for CNV ,which could improve visual acuity and reduce retreat‐ment rates .
ABSTRACT
Objective The invasion and metastasis of tumor cells depend on the growth of new blood vessels, and tumor neovascularization was regulated by a lots of factors. This study aimed to investigate the expression of hypoxia-inducible factor-1α (HIF -1α) and vascular endothelial growth factor (VECF) in retinoblastoma and explore the correlation of HIF-1α and VEGF with tumor invasion and metastasis and analyze their relationship with clinicopathology characters and determine their effect on angiogenesis. Methods Forty-six retinoblastoma specimens with different clinical stages were collected in Affiliated Second Hospital of Nanchang University. The specimens received neither radiotherapy nor chemotherapy. The retinal tissue near the tumor was as control. Immunohistochemistry was used to detect the expression of HIF-1α protein and VEGF protein in retinoblastoma. The relationship between expression of HIF-1α and VEGF and stage of tumor was analyzed. Results The HIF-1α and VEGF were highly expressed in the ischemia or necrosis area of retinoblastoma. Expression of HIF-1α was mainly in cell nuclear and partly in cytoplasm, and VEGF was mainly expressed in cytoplasm of tumor cells. The expression of HIF-1α and VEGF was gradually increased with the rising of tumor stage (P ＜ 0. 05) and showed significant correlation between expression of HIF-1α and VEGF with tumor stage(r_s =0. 943, P ＜0. 01). HIF-1α exepression was also possitively related to VEGF level in retinoblastoma (r, =0. 946, P ＜ 0. 01). Conclusion HIF-1α and VEGF were over-expressed in retinoblastoma cells, and the expressions were related to clinical staging, invasion and metastasis of tumor cells. The expression of HIF-1α and VEGF was one of the predictors for the biological behaviors of retinoblastoma. HIF-1α and VEGF may play an important role in angiogenesis and tumor progression in retinoblastoma.
ABSTRACT
Objective To investigate the expression of nuclear factor(NF)-?B and intercellular adhesion molecule (ICAM)-1 in rat′s retina injured by ischemia-reperfusion, and the effect of pyrrolidine dithiocarbamate (PDTC) on the expression of NF-?B and ICAM-1. Methods The model of retinal ischemia-reperfusion was set up in 60 SD rats, which were divided into two groups with 30 rats in each: ischemia-reperfusion group and ischemia-reperfussion with injection of PDTC group. The left cephalic artery of each rat was ligated, and the right side was the control. Every group was subdivided into group 1 hour, 6, 12, 24, 48, and 72 hours after ischemia-reperfusion injury, and with 5 rats in each group. mRNA of NF-?B and ICAM-1 mRNA was measured by in situ hybridization (ISH) method in rat′s retina. Every rat underwent electroretinography (ERG) at the corresponding time before executed by neck breaking. Results In ischemia-reperfusion group, expression of NF-?B and ICAM-1 was detected at the 6th hour after ischemia-reperfusion, reached the highest level at the 24th hour, and weakened gradually later. In ischemia-reperfusion with injection of PDTC group, expression of NF-?B and ICAM-1 was detected at the 12th hour after ischemia-reperfusion, and reached the highest level at the 24th hour but lower than that in ischemia-reperfusion group. No expression of NF-?B and ICAM-1 was found in the control group. The relative recovery rate of ERG a and b wave amplitude in ischemia-reperfusion groups was lower than that in ischemia-reperfusion with injection of PDTC group at every stage(P
ABSTRACT
Objective To investigate the expression of E26 transformation-specific-1 (E26ts-1),matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in choroidal melanoma and the correlation with the tumor′s infiltration and metastasis. Methods Immunohistochemistry was used to detect the expression of E26ts-1,MMP-1and TIMP-1 in 78 cases of choroidal melanoma who were divided into shuttle-cells,paraepithelial-cells and mixed-cells type according to the configuration of tumor cells.The patients were followed up and their average existing time was calculated.The results were statistically computed with statistic SPSS 10.0 package. Results In the 78 cases,shuttle-cells type was found in 21,paraepithelial-cells type in 34,and mixed-cells type in 23. Expression of TIMP-1was low in uveal melanoma,while expression of E26ts-1 and MMP-1 was obviously found in the three types of choroidal melanoma;the sequence of expression intensity was shuttle-cells,mixed-cells and paraepithelial-cells type.Among 37 cases who had been followed up,the shuttle-cells type was in 18 with the average existing time of (78.33?24.69) months,the mixed-cells type was in 10 with the average existing time of (61.44?20.46) months,and the paraepithelial-cells type was in 9 with the average existing time of (36.76?12.19) months.The existing time was negative correlated with the intensity of expresion of E26ts-1 and MMP-1. Conclusion The high expression of E26ts-1 and MMP-1and low expression of TIMP-1may relate to the choroidal melanoma′s infiltration and metastasis.