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Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.
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Objective:To investigate the ultrastructural and biomechanical properties of the internal limiting membrane (ILM) in high myopic macular hole (HM-MH) eyes.Methods:ILM specimens were peeled from 14 eyes with HM-MH from August to December in 2017, and 16 eyes with idiopathic macular hole (IMH) in the same period were served as a control.Specimens were detected by immunefluorescence, transmission electron microscopy (TEM) and atomic force microscopy (AFM). This study followed the Declaration of Helsinki, and was approved by the Ethics Committee of Zhongshan Ophthalmic Center.Results:The immunofluorescence staining results showed that collagen Ⅳ was mainly distributed on the vitreal side and laminin on the retinal side of ILM in both groups.TEM findings revealed that the thickness of ILMs in the HM-MH group was (1.01±0.17)μm, which was significantly decreased compared with (1.92±0.21)μm in the IMH group ( t=12.880, P<0.001). The stiffness of the ILMs in the HM-MH group was (2.86±0.33)MPa, which was significantly higher than (0.88±0.23)MPa in the IMH group ( t=-12.650, P<0.001). The stiffness of the ILMs in the HM-MH group was positively correlated with the axial length ( r=0.832, P<0.001). Conclusions:Compared with IMH, the thickness of ILMs from HM-MH patients is thinner and the stiffness is higher, which contribute to a deep understanding of the pathogenesis of HM-MH.
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Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD).Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery,1 week and 3 months after surgery.The operative duration,sclerotomy sites,retinal reattachment rate,intraoperative and postoperative complications were recorded.Results The mean duration of vitreous removal was (15.3 ± 3.6) minutes,and the mean duration of operation was (34.5 ± 4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100％.The mean BCVA was significantly different among before surgery,1 week and 3 months after surgery (F =64.12,P＜0.01),and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs.1.01 ±0.40;0.68±0.30 vs.1.01 ±0.40) (both at P＜0.05).The mean IOP was (14.69±3.66),(17.37±2.32) and (16.69±2.45) mmHg (1 mmHg =0.133 kPa) before surgery,1 week and 3 months after surgery,showing a significant difference among them (F=14.82,P＜0.01),and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P＜0.05).The complications included intraoperative iatrogenic retinal breaks in 2 eyes,postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable.Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach.
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Objective To investigate the toxicity and transfection efficiency of PEI-mediated plasmid DNA encoding myocilin (MYOC) gene transfected into trabecular meshwork.Design Experimental study.Participants SD rats.Methods PEI and plasmid encoding MYOC gene complex was prepared and 20?l PEI/DNA complex was directly injected into anterior chamber of SD rat by microinjection. The eyes were extracted at day 1,3,7,and 14 after injection for the structure analysis of trabecular meshwork by HE staining and transmission electron microscope.Expression of the transferred myocilin gene was monitored by fluorescence microscopy. Main Outcome Measures HE staining,immunohistochemistry and electron microscope.Results No significant toxicity or inflammation was detected under the HE staining and electron microscope.PEI/DNA complex were seen in cytoplasm of trabecular meshwork cells. The fluorescence intensity of myocilin expression in the trabecular meshwork cells was increasing with time and peaked on clays 3 and declined afterward.Conclusion Plasmid DNA mediated by PEI could be efficiently transfected into trabecular meshwork cells by directly injecting into anterior chamber without any toxicity.
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Objective To examine the clinical effect of phacoemulsification with foldable posterior chamber intraocular lens implantation (PC-IOL) in management of angle-closure glaucoma (ACG) with cataract. Methods Phacoemulsification with foldable PC-IOL implantation was performed in 31 eyes with ACG. The best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD) and anteior chamber angle width were measured and recorded preoperatively, 1 day, 1 week, 1 month and 3 months postoperatively. Results The mean IOP decreased significantly after surgery (P