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Objective:To observe the imaging features of fundus lesions associated with COVID-19.Methods:A observational case series study. Twenty eyes of 10 patients with fundus lesions associated with COVID-19 at Xiamen Eye Center of Xiamen University from December 10, 2022 to January 20, 2023 were included in this study. There were 1 males and 9 females, aged from 17 to 49 years, with the median age of 26 years. The time of ocular symptoms after the diagnosis of COVID-19 was 0-2 days. The time from the onset of ocular symptoms to seeing a doctor was 1-14 days. All patients were examined by best-corrected visual acuity (BCVA), intraocular pressure, color fundus photography, infra-red fundus photography (IR), optical coherence tomography (OCT). Serum D-dimer examination was performed in 3 patients. The median BCVA was 0.4. There was no abnormalities in intraocular pressure and anterior segment examination. Among 20 eyes of 10 patients, there were 10 eyes of 5 patients with acute macular neuroretinopathy (AMN), 6 eyes of 3 patients with Purtscher-like retinopathy (PLR), 4 eyes of 2 patients with central retinal vein occlusion (CRVO). The imaging features of fundus were observed and analyzed.Results:Retinal lesions included AMN, paramacular central medial retinopathy (PAMM), PLR, cotton wool spots, hemorrhage, optic disc edema, macular edema. AMN was found in 10 eyes, with reddish-brown and wedge-shaped lesion in the fovea, dark area in IR and hyper reflectivity in outer nuclear layer and outer plexiform layer by OCT. The cotton wool spot showed hyper reflectivity on retinal nerve fiber layer whereas PAMM showed band-shape hyper reflectivity in inner nuclear layer by OCT. The Purtscher spot was seen at the posterior pole and/or peripapillary in 6 eyes of PLR. By OCT examination, the retinal nerve fiber layer corresponding to Purtscher flecken was significantly thickened and the reflex was enhanced. Among 6 eyes of PLR, there were 4 eyes combined with AMN, 1 eye with PAMM and macular edema. In 4 eyes of CRVO, vitreous cells, optic disc edema, retinal flame, spot hemorrhage, and atypical cotton wool spots were seen in 2 eyes.Conclusions:The manifestations of fundus lesions associated with COVID-19 are varied. The multilayer structure of retina is involved, and the microvessels of retina and choroidal capillary layer are damaged.
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Objective To evaluate the clinical effects of vitrectomy with or without fovea-sparing internal limiting membrane peeling on macular foveoschisis (MF) secondary to pathologic myopia.Methods A non-randomized controlled study was adopted.Twenty-three patients (25 eyes) with refractive error ≥-8.00 DS and MF either combined with foveal retinal detachment or epi-macualr membrane or lamellar macular hole.The subjects were divided into non-internal limiting membrane peeling group (11 patients / 11 eyes) who underwent triamcinolone (TA) assisted vitrectomy and fovea-sparing internal limiting membrane peeling group (12 patients/14 eyes) who underwent TA assisted vitrectomy with fovea-sparing internal limiting membrane peeling.The baseline data such as age,best corrected visual acuity (BCVA),refractive error,axial length were not significant difference between the two group.Main outcomes were BCVA,remission of MF defined by optical coherence tomographyc OCT as well as complications.This study followed the Declaration of Helsinki and this protocol was approved by Ethic Committee of Xiamen Eye Center of Xiamen University (NO.XMYKZX-2016-YWS-007).Results All patients completed follow-up for more 6 months.BCVA (LogMAR) was 0.47±0.30 in non-internal limiting membrane peeling group and 0.40-±0.33 in fovea-sparing internal limiting membrane peeling group,showing no significant difference between the two groups (t =0.66,P=0.52).Complete remission of MF was achieved in 22 eyes.The remission time in non-internal limiting membrane peeling group was 2.5 (1.8,9.3) months,and 1.0 (1.0,3.8) months in fovea-sparing internal limiting membrane peeling group,no statistical significance was obtained between the two groups (U =35.00,P =0.09).One eye had post-operative macular hole in non-internal limiting membrane peeling group,accounting for 9％,while in fovea-sparing internal limiting membrane peeling group,one eye had macular hole,accounting for 7％,and one eye had rhegmatogenous retinal detachment post-operatively,accounting for 7％.Conclusions MF can be resolved by vitrectomy while complete remission can achieved more quickly when combined with fovea-sparing internal limiting membrane peeling.
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Objective@#To evaluate the clinical effects of vitrectomy with or without fovea-sparing internal limiting membrane peeling on macular foveoschisis (MF) secondary to pathologic myopia.@*Methods@#A non-randomized controlled study was adopted.Twenty-three patients (25 eyes) with refractive error ≥-8.00 DS and MF either combined with foveal retinal detachment or epi-macualr membrane or lamellar macular hole.The subjects were divided into non-internal limiting membrane peeling group (11 patients /11 eyes) who underwent triamcinolone (TA) assisted vitrectomy and fovea-sparing internal limiting membrane peeling group (12 patients/14 eyes) who underwent TA assisted vitrectomy with fovea-sparing internal limiting membrane peeling.The baseline data such as age, best corrected visual acuity (BCVA), refractive error, axial length were not significant difference between the two group.Main outcomes were BCVA, remission of MF defined by optical coherence tomographyc OCT as well as complications.This study followed the Declaration of Helsinki and this protocol was approved by Ethic Committee of Xiamen Eye Center of Xiamen University (NO.XMYKZX-2016-YWS-007).@*Results@#All patients completed follow-up for more 6 months.BCVA (LogMAR) was 0.47±0.30 in non-internal limiting membrane peeling group and 0.40±0.33 in fovea-sparing internal limiting membrane peeling group, showing no significant difference between the two groups (t=0.66, P=0.52). Complete remission of MF was achieved in 22 eyes.The remission time in non-internal limiting membrane peeling group was 2.5 (1.8, 9.3) months, and 1.0 (1.0, 3.8) months in fovea-sparing internal limiting membrane peeling group, no statistical significance was obtained between the two groups (U=35.00, P=0.09). One eye had post-operative macular hole in non-internal limiting membrane peeling group, accounting for 9%, while in fovea-sparing internal limiting membrane peeling group, one eye had macular hole, accounting for 7%, and one eye had rhegmatogenous retinal detachment post-operatively, accounting for 7%.@*Conclusions@#MF can be resolved by vitrectomy while complete remission can achieved more quickly when combined with fovea-sparing internal limiting membrane peeling.
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Objective@#To observe the clinical efficacy of digital 3D heads-up display viewing system(3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).@*Methods@#A retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.@*Results@#The fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P<0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.@*Conclusions@#3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
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Objective To observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).Methods A retrospective,consecutive case series.From October 2018 to May 2019,Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study.There were 7 males and 12 females,with the mean age of 54.47± 11.38 years.The average axial length was 30.40±2.30 mm,the mean logMAR BCVA was 0.56±0.31,the mean central foveal thickness (CFT)was 317.80± 151.9.32 μm,the mean max retinal thickness (maxRT) was 556.7 ± 143.7 μm.All the surgeries performed combined with 3D viewing system with iOCT.The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange.Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not.The average follow-up was 4.2 ± 1.4 months.All the patients were on regular follow-up to document the changes on BCVA,anatomical changes in macula,CFT and maxRT.Paired t test was used to compare BCVA,CFT and maxRT before and after surgery.Results The fine images of macula were clearly shown on the 3D viewing system in all eyes.The electronic green filter enhanced the contrast sensitivity of ICG stained images.Clear images of macula were captured by iOCT in all eyes.The average surgical time was 35.5± 8.2 min.On the last follow-up,16 of 19 eyes with MF resolved.The mean CFT was 178.5 ± 103.5 μm,the maxRT was 341.8 ± 83.8.16 μm,and the mean logMAR BCVA was 0.35 ± 0.22.The differences of CFT,maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181,7.154,5.129;P＜ 0.001).Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering.There was no complication associated with the 3D viewing system.Conclnsions 3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia,iOCT can detect the minimal invisible full thickness macular hole during surgery.Both may contribute to improved MF closure rate and BCVA.