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Objective To observe the efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) for refractory glaucoma.Methods Twenty-eight patients (30 eyes) diagnosed with refractory glaucoma were enrolled in this study.The intraocular pressure was ranged from 28 to 55 mmHg (1 mmHg=0.133 kPa),with the mean of (46.3±10.3) mmHg.There were 24 eyes with initial visual acuity ＜0.05,1 eye with 0.05-0.08 initial visual acuity and 5 eyes with ≥0.1 initial visual acuity.The mean number of intraocular pressure-decreased drugs was 4.All the eyes underwent PPV combined with ECP.The cyclophotocoagulation ranged from 90°-360°,with the mean of (232.5 ±77.6)°.The cyclophotocoagulation was ＜180° in 4 eyes,180°-270° in 6 eyes,＞270° in 20 eyes.The follow-up ranged from 12 to 20 months,with the mean of 15.2 months.The intraocular pressure,vision and the mean number of intraocular pressure decreased drugs before and after surgery were comparatively observed.The relationship between cyclophotocoagulation area and postoperative intraocular pressure was analyzed.Results At the final follow up,the intraocular pressure ranged from 12 to 36 mmHg,with the mean of (18.5± 4.4) mmHg,which decreased 49.4％ compared with preoperative intraocular pressure (t=15.537,P＜ 0.01).Among 30 eyes,the intraocular pressure was ≤ 21 mmHg without any intraocular pressuredecreased drugs in 24 eyes (80.0％),1 eye (3.3％) with ≤21 mmHg who treatment by local intraocular pressure decreased drugs,lose control of intraocular pressure in 5 eyes (16.7％).The vision was ＜0.05 in 15 eyes,0.05-0.08 in 3 eyes and ≥0.1 in 12 eyes.The difference of vision distribution before and after surgery was not significant (x2=6.197,P＞0.05).Compared with preoperative vision,the postoperative vision was improved in 8 eyes (26.7％),stabled in 15 eyes (50.0％),decreased in 7 eyes (23.3％).The mean number of intraocular pressure-decreased drugs was reduced from 4 to 1 (t=8.402,P＜0.01).The cyclophotocoagulation area was positive related to postoperative intraocular pressure (r=4.160,P＜0.05).There were no ocular and systemic complications during and after surgery except slight inflammation.Conclusion PPV combined with ECP for refractory glaucoma can reduce intraocular pressure,stabilize or improve the visual acuity.
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Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists.The surgical success rate reached 95.0％ and above for vitrectomy,macular surgeries with ILM peeling,or local/total scleral buckling.However,the postoperative visual function recovery is nowhere near good enough.Specialists must pay more attention to the visual function recovery of those patients.Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time.At present,the postoperative visual acuity for macular hole depends on many factors,such as macular hole closure conditions,surgical procedures,microsurgical invasive ways,skills of membrane peeling,usage of dye staining,and tamponade material choice.It also depends on residual subretinal fluid under macular area for patients received scleral buckling.It is important for us to investigate these factors affecting recovery of macular anatomy and function,and thus develop some drugs to improve the macular function recovery.
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Objective To observe the autofluorescence (AF) manifestation in related lesions of periphery retinopathy. Methods Sixty eyes of 42 patients with periphery retinopathy underwent the examination of Optomap fundus photograph (200°) and fundus fluorescein angiography (FFA). The HRA Ⅱ melanin-related near-infrared fundus autofluorescence (NIA, excitation 795 nm) and lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm) were measured for all the patients. The AF was recorded with nine images per second, and then a final AF image with 55° view and 822 × 768 pixel was generated by the HRA. AF images can be valuable or valueless if there was or was not visible blood vessels and related retinal tissues on the image. AF from lesion regions can be normal or abnormal fluorescence comparing to the normal vascular and retinal tissue AF. The abnormal fluorescence was divided into no AF, weak AF and strong AF relative to the background grayscale. The grading consistency of abnormal fluorescence based on FAF and NIA examination was comparatively analyzed. Results Valuable AF images were captured in 53/60 eyes (88. 33%)and valueless AF images were captured in 7/60 eyes (11.67%). Among 53 eyes with valuable AF image, NIA showed normal fluorescence in 28 eyes (52. 83%), abnormal fluorescence with sheet-like, dot-shaped or stripped in 25 eyes (47.17%); FAF showed normal fluorescence in two eyes (3.77 % ), abnormal fluorescence with sheet-like, scattered along vessels or pigments in 51 eyes (96.23 % ).Twenty-five eyes with abnormal fluorescence were observed both in two examinations, including same grades in 18 eye (72.00%) and different grades in seven eyes (28.00%). Conclusion The AF manifestation with different levels exists in related lesions of periphery retinopathy.
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Objective To observe the fixation features of foveoschisis in pathological myopia patients.Methods 36 patients(42 eyes)with>-6.00D myopic degree and foveoschisis who diagnosed by optical coherence tomography were included.The patients were divided into foveoschisis with retinal detachment group(11 eyes),foveoschisis with macular hole group(12 eyes)and only foveoschisis group(19 eyes).Micro-perimeter MP-1 was used to identify the fixation location and fixation stability.Results The eccentric fixation were formed above the foyea in the foveoschisis with retinal detachment and foveoschisis with macular hole group,the fixation location was formed on fovea in the only foveoschisis group.The fixation stability of the foveoschisis with retinal detachment,foveoschisis with macular hole and only foveoschisis group were(23±4)0A,(59±6)% ,(91±11)% respectively,the difference was statistically significant(F=243.47,P＜0.01).Conclusions The fixation location is formed on foyea in the patients with foveoschisis in pathological myopia.The eccentric fixation is formed above the fovea in the patients who has foveoschisis with retinal detachment and macular hole in pathological myopia.
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Objective To investigate the impact of bone marrow mesenchymal stem cell transplantation on a rat model of experimental autoimmune uveitis (EAU) and analyze its immune regulatory mechanisms in vivo. Methods Eighteen Lewis rats were randomly divided into three groups: model control group, intervention group and normal control group, six animals in each group. Human retinal S-antigen peptide (HS-AgP35, 1 mg/ml) was mixed and emulsified with complete Freund's adjuvant and injected into hind foot pad of rats on the first and eighth day to establish the animal model of EAU. For bone marrow mesenchymal stem cell transplantation, 1 ml of cell suspension (2 × 106 cells/ml) was injected into tail vein of the intervention group rats on the first day when the emulsified S-antigen was injected. EAU manifestation, pathological change and IFN-γ level were evaluated and compared among those three groups after two weeks. Results No abnormal signs were found in the eyes of rats in normal control group. The manifestation grading of the intervention group (two rats at grade 0, three rats at grade 0.5, one rat at grade one) was significantly different from the model control group (one rat at grade one, one rat at grade two, three rats at grade three, one rat at grade four) (P=0. 015). The retina of rats in normal control group was ordinary under light microscope. The histopathological grading of the intervention group (one rat at grade 0, four rats at grade 0.5, one rat at grade one) and the model control group (four rats at grade three, two rats at grade four) was also statistically different (P＜0. 01). Furthermore, the IFN-γ level in peripheral blood of the intervention group rats declined significantly compared to the model control group (t=9. 057 4, P=0. 01). Conclusions Bone marrow mesenchymal stem cells can inhibit EAU significantly,possibly by lowering the level of IFN-γ, thereby reduce the severity of uveitis and improve the condition of uveitis in rats.
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Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation (MLGP) to treat macular edema.Methods Consecutive 89 patients (109 eyes)diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving- 0.8 (0.19±0.13);the intraocular pressure(IOP)ranged from 7 mm Hg to 21 mm Hg(1 mm Hg=0.133 kPa)and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations,the central macular thickness was (570±182) μm;the average light sensitivity was (5.07±3.94) dB and the fixation percentage was 70.67% within 4 ° area around the macular fovea.All the patients received IVTA treatment,39 patients (48 eyes)further received MLGP 1 month later (IVTA-MLGP group).The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group.Best corrected visual acuity (BCVA),lOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months,the BCVA in IVTA-MLGP and IVTA group was (0.41±0.20),(0.24±0.19) respectively (P<0.05);the central macular thickness was (309±187) and (487±206) μm respectively(P<0.05);the mean light sensitivity of 4° central macular was (8.24±4.64)and(6.30±3.22) dB respectively (P<0.05);the fixation percentage was (87.01±19.70)% and (78.85±20.41) % respectively (P<0.05).During the follow-up recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTA-MLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.
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Objective To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia. Methods A total of 40 highly myopic patients (54 eyes) with eccentric fixation were examined by MP-1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between "desirable" and "undesirable" PRL were tested by analysis of variance. Results In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes (35.19%) had a left-field PRL; 6 eyes (11.11%) had an upper-field PRL; and 5 eyes (9.26%) had right-field PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lower-field PRL in 7 (50.00 %), left-field PRL in 5 (35.71 %), and upper-field PRL in 1 patient (7.14%). The difference of visual acuity between lower- and left-field PRL group and right- and upper-field undesirable PRL group was not statistically significant (F=0.144, P > 0.05). Conclusions The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.