ABSTRACT
AIM: To compare the outcome of C3F8 versus silicone oil tamponade after pars plana vitrectomy(PPV)and inverted internal limiting membrane(ILM)for the treatment of highly myopic macular hole retinal detachment(MHRD).METHODS: Retrospective clinical study. Totally 45 patients(45 eyes)with highly myopic MHRD who visited our hospital between January 2019 and August 2022 were selected as the research subjects. The patients were divided into two groups according to different intraocular tamponade agents: C3F8(22 eyes)and silicone oil(23 eyes)groups. All patients underwent conventional three-incision PPV, ILM was tamped, a venous blood clot was placed on the tamped ILM, and 15% C3F8 and silicone oil were used as tamponade, respectively. The best corrected visual acuity(BCVA), multifocal electroretinogram(mfERG), the closure of the macular hole, retinal reattachment and the complications were observed.RESULTS: The macular hole closure rate was 77% in the C3F8 group and 83% in the silicone oil group, respectively(P>0.05), and retinal reattachment rates were 95% and 96%, respectively(P>0.05). The visual acuity of the two groups significantly improved, which was 0.99±0.34 and 1.22±0.37, respectively, and the C3F8 group was better than that of the silicone oil group(t=-2.156, P=0.037). After operation, the response density of the first ring of P1 wave in the first order kernel in mfERG was 114.27±26.37 nV/deg2 for the C3F8 group and 98.08±24.36 nV/deg2 for the silicone oil group, and the response density of the second ring of P1 wave was 80.45±14.94 nV/deg2 for the C3F8 group and 67.73±15.33 nV/deg2 for the silicone oil group, all of which were significantly higher compared to pre-operation [the response density of the first ring of P1 wave: 58.13±13.96 nV/deg2 for the C3F8 group and 55.30±10.48 nV/deg2 for the silicone oil group, the response density of the second ring of P1 wave: 51.18±8.19 nV/deg2 for the C3F8 group and 47.43±11.97 nV/deg2 for the silicone oil group](all P<0.05). It was found that the response density of the first ring of P1 wave was lower in the silicone oil group than in the C3F8 group(P<0.05). There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).CONCLUSION: Silicone oil tamponade or C3F8 tamponade after PPV combined with ILM can both promote retinal reattachment and macular hole closure in patients with MHRD, and the C3F8 tamponade was superior to silicone oil in visual function recovery.
ABSTRACT
Objective:To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C 3F 8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. Methods:A retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference ( P>0.05). PPV combined with ILM peeling and C 3F 8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. Results:After initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation ( P>0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month ( P=0.783, 0.358), but the difference was statistically significant at 3 months ( P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation ( P=0.687, 0.950). Conclusion:PPV combined with ILM peeling and C 3F 8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
ABSTRACT
@#AIM:To investigate the efficacy and safety of different fillers combined with vitrectomy and internal limiting membrane stripping in the treatment of idiopathic macular hole(IMH).<p>METHODS: This retrospective study included 117 patients(117 eyes)with IMH who were admitted to the department of ophthalmology in the hospital between July 2018 and March 2020. Both groups were treated with vitrectomy combined with internal limiting membrane stripping. Sixty-five patients(65 eyes)receiving air filling were included in the air group, while 52 cases(52 eyes)receiving C3F8 filling were included in the C3F8 group. Re-examination was performed before operation and at 1, 2, and 3mo after operation. The rate of hole closure, closed shape, visual acuity, central macular thickness(CRT), exterior limiting membrane(ELM)defect diameter, ellipsoid band defect diameter, intraocular pressure, and the incidence of postoperative complications at the last follow-up were counted. <p>RESULTS: The postoperative air absorption time of air group and C3F8 group was 8.55±2.17d and 25.74±7.41d, respectively(<i>P</i><0.05). The macular hole closure rates in air group and C3F8 group were 95.4% and 98.1%, respectively(<i>P</i>>0.05). There were no significant differences in the proportions of different shapes of closed holes between the two groups(<i>P</i>>0.05). Visual acuity of the two groups was significantly improved at 3mo after operation(<i>P</i><0.001). There were no significant differences in LogMAR visual acuity and visual acuity changes between air group and C3F8 group(<i>P</i>>0.05). The CRT was increased significantly after operation(<i>P</i><0.001), and the diameters of ELM defect and ellipsoid band defect were reduced(<i>P</i><0.001). There were no significant differences in above indicators between the two groups(<i>P</i>>0.05). There was no significant difference in intraocular pressure between the two groups before and after treatment(<i>P</i>>0.05). No serious complications were observed in the two groups. <p>CONCLUSION: Vitrectomy and internal limiting membrane stripping combined with air filling and C3F8 filling are effective and safe in the treatment of IMH. Clinically, the operation mode can be selected according to the actual situation.
ABSTRACT
·AIM:To compare the effectiveness of inverted internal limiting membrane flap ( ILMF) coverage combined with sterile air tamponade or C3F8-filled surgery for idiopathic macular hole (IMH). ·METHODS: In this retrospective study, 165 patients (175 eyes) who underwent pars plana vitrectomy ( PPV) combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air (Group A) and C3F8-filled (Group B) groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity ( BCVA ), macular hole closure rate, and major postoperative complications were analyzed. · RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively ( P< 0. 05 ). There was no significant difference between the two groups 1mo postoperatively, but the average BCVA in Group A was better than that in Group B at 3mo, to a level of statistical significance ( P<0. 05). The closure rate of macular hole was 97. 5% in Group A and 96. 8% in Group B, a statistically non-significant difference. There were no statistically significant differences in defect diameters of the inner and outer junctions between the two groups at 1 and 3mo postoperatively(P<0. 05), but significant differences compared to before surgery in both groups (P<0. 05). The rate of IOP elevation was 9. 5% in Group B, and zero ( 0 ) in Group A; this difference was statistically significant (P<0. 05). ·CONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C3F8-filling, sterile air tamponade can avoid IOP elevation; it may replace C3F8-filling in PPV for IMH.
ABSTRACT
PURPOSE: To evaluate the effect of intravitreal expansile gas (C3F8) with anti-VEGF injection for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (ARMD). METHODS: In this report, 18 eyes of 18 patients with large SMH secondary to ARMD were treated with a simultaneous injection of 0.3 cc C3F8 and 0.05 ml anti-VEGF intravitrealy. RESULTS: The mean age was 64.89 +/- 5.68 years and the mean size of SMH was 4.44 +/- 1.25 disc diameters (DD). The minimum follow-up period was 12 months (range: 12-17 months). Mean preoperative best corrected visual acuity (BCVA) was 1.72 +/- 0.56 log MAR which improved significantly to 1.01 +/- 0.68 log MAR at 12 months (p = 0.002). SMH displacement occurred in all eyes. BCVA improved 2 or more lines in 11 eyes (61.1%) and deteriorated in 1 eye (5.6%). CONCLUSIONS: In this report, intravitreal injection of an expansible gas (C3F8) with anti-VEGF produced successful results in anatomical displacement of SMH and early visual improvement.
Subject(s)
Humans , Displacement, Psychological , Eye , Follow-Up Studies , Hemorrhage , Intravitreal Injections , Macular Degeneration , Visual AcuityABSTRACT
Background Macular hole retinal detachment(MHRD) causes severe decrease of vision.Pars plana vitrectomy has been applied for MHRD.Silicone oil and C3F8 have been used as intraocular tamponade materials,while there are still controversity on their efficacy.Objective This trial was to evaluate the efficacy of vitreous surgery combined with silicone oil or C3F8 tamponade for patients with MHRD in highly myopic eyes.Methods A retrospective case-controlled study was designed.Fifty-one patients who underwent vitrectomy with intraocular tamponade were retrospectively analyzed.The best corrected visual acuity(BCVA) before and after surgery were examined and campared between two groups.The rate of recurrent RD and macular hole closed were analyzed.Results There was no significant difference in BCVA between silicone oil group and C3F8 tamponade group before and after surgery(U=266.000,P =0.286 ; U =205.000,P =0.029).The BCVA after surgery was elevated in both groups (Z=-2.729,P =0.006 ; Z =-3.273,P =0.001).The rates of recurrent RD and macular hole closed were no difference between two groups(P=0.894,1.000).There were no other complications but cataract.Conclusions C3F8 tamponade of MHRD in high myopic eyes show the same efficacy as silicone oil tamponade.
ABSTRACT
Objective To evaluate the effectson experimental posterior vitreous detachment(PVD) induced by intravitrous injection of hyaluronidase and perfIuoroethane(C3F8),and whether it is safe or not.Methods Twelve rabbits(24 eyes) were divided into 3 experimental groups,the contralateral eyes in same animals served as the controls.The eyes in group A(4 eyes) and B(4 eyes) were injected with 10IU of hyaluronldase(0.2ml) and 0.2ml perfluoropropane(C3F8) respectively.The eyes in group C(4 eyes) were received vitreous injections of 10IU(0.1ml) of hyaluronldase and 0.1ml perfluoropropane(C3F8) together.All control eyes were injected with balanced salt solution(0.2ml).The ocular and fundus signs were examined for 2 following weeks and then killed for histological examination.Results Four eyes in group C showed complete separation of the vitreous cortex from the retina(PVD) by B-scan and scanning electron microscopy,and no PVD was detected in group A、B and all control eyes.No evidence of retinal toxicity was revealed by light or transmisson electron microscopy in all eyes.Conclusion Vitreous injection of hyaluronidase combined with perfluoropropane(C3F8),as a safety method,can induce posterior vitreous detachment after 2 weeks.
ABSTRACT
Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of etiologies. More than likely, the most common cause is a localized detachment occurring after cataract surgery. We report three cases of Descemet's membrane detachment that occurred after uncomplicated phacoemulsification cataract surgeries. The first patient was managed without surgical intervention, the second patient was treated using an intracameral air injection, and the last patient was treated with an intracameral perfluoropropane (C3F8) gas injection. All three patients recovered their vision following the reattachment of Descemet's membrane. The three patients were treated according to the extent of the detachment.
Subject(s)
Middle Aged , Male , Humans , Female , Aged , Visual Acuity , Descemet Membrane/pathology , Corneal Diseases/therapy , Cataract Extraction/adverse effectsABSTRACT
PURPOSE: To determine the concentration at which a mixed injection of tissue plasminogen activator (tPA) and C3F8 gas is toxic, we studied the histopathological changes in the rabbit retina. METHODS: Only tPA was injected into the right vitreous cavities of 18 normal pigmented rabbits at doses of 25 micro gram/0.1mL, 50 micro gram/0.1mL, and 100 micro gram/0.1mL, 6 rabbits per dosage. In the same rabbits, tPA and C3F8 (0.2cc) were simultaneously injected into the left vitreous cavities at doses of 25 micro gram/0.1mL, 50 micro gram/0.1mL, and 100 micro gram/0.1mL. All of the eyes were examined by slit lamp biomicroscopy and indirect ophthalmoscopy at 5, 10, and 15 days after the injection, and then they were enucleated for histopathological evaluation. RESULTS: Retinal pigmentary alterations were centered around the injection site 3 days postoperatively in the eyes receiving doses of 50 micro gram/0.1mL or greater. On light microscopy(LM), the involved areas showed vacuolization in the photoreceptor elements and the inner nuclear layer(INL) at a dose of 25 micro gram/0.1mL at postoperative 5 days and the vacuolar changes disappeared at postoperative 15 days. But at doses of 50 micro gram/0.1mL or greater, loss, contracture, and vacuolization of the photoreceptor outer segment (POS) and vacuolization of INL were noted at postoperative 15 days. On LM, at a dose of 25 micro gram/0.1mL, the involved areas showed vacuolization in POS and mitochondrial swelling of the photoreceptor inner segment (PIS) at postoperative 5 days. The mitochondrial swelling of PIS disappeared at postoperative 15 days. However, at doses of 50 micro gram/0.1mL or greater, loss and contracture of POS and mitochondrial swelling of PIS were noted at postoperative 15 days. The retinal damage from simultaneous injection of tPA and C3F8 at doses of 25, and 50 micro gram/0.1mL was equal to or less than that of only tPA injection, whereas at a doses of 100 micro gram/0.1mL the damage was greater. CONCLUSIONS: At doses of 50 micro gram/0.1mL or greater, irreVersible retinal toxicity was noted histopathologically in rabbit eyes. At doses of 25, and 50 micro gram/0.1mL, the degree of retianl damage did not seem to be affected by whether C3F8 was injected concomitantly or not.
Subject(s)
Rabbits , Contracture , Mitochondrial Swelling , Ophthalmoscopy , Retina , Retinaldehyde , Tissue Plasminogen ActivatorABSTRACT
PURPOSE: To investigate the prognostic factors in the treatment of submacular hemorrhages with intravitreal tissue plasminogen activator and gas. METHODS: The authors reviewed the medical records of 24 patients with submacular hemorrhage who received intravitreal injection of tPA and gas. Follow-up period in this study was more than 3 months. Periods of blood displaced from fovea, periods when visual acuity became stable, periods of complete absorption of blood in relation to age, underlying disease, size and duration of hemorrhage were investigated. Also, we investigated the visual outcome according to each factors. RESULTS: There was statistically significant relationship between size of hemorrhage and periods of blood displaced from fovea. Underlying disease, duration of submacular hemorrhage had not significant effect on periods of blood displaced from fovea, periods when visual acuity became stable, periods of complete absorption of blood. A half of patients had improved visual acuity, but factors like underlying disease, size and duration of hemorrhage had no significant effect on visual outcome. CONCLUSIONS: Intravitreal injection of tPA and gas was effective in visual improvement in most patients. Factor like size of hemorrhage had significant effect on clinical course.
Subject(s)
Humans , Absorption , Follow-Up Studies , Hemorrhage , Intravitreal Injections , Medical Records , Tissue Plasminogen Activator , Visual AcuityABSTRACT
Objective To review the anatomic and visual outcomes of a series of patients with macular holes who underwent vitreous surgery without adjunctive therapy.Methods We performed a retrospective review of 16 patients who underwent vitrectomy, fluid-gas exchange and perflu oropropane(C3 F8) gas temponade for 14 eyes with idiopathic and 2 eyes with traumatic macular holes.Results Anatomical closure of the macular holes was achieved in 15(93%) of 16 eyes with an average follow-up of 7 months. Only one eye needed performing second surgery. Three(19%) eyes achieved postoperative visual acuity of 0.4, four (25%)eyes 0.2～0.3,and nine(56%)eyes 0.1 or worse. Conclusions Vitreous surgery without adjunctive therapy with intraocular gas tamponade and postoperative posturing is a well tolerated and effective intervention for idiopathic or some traumatic macular holes. Anatomical closure of the macular hole is associated with a significant improvement in visual acuity in most eyes.
ABSTRACT
This study was designed to evaluate the efficacy of intravitreal injection of tPA &C3F8 gas in submacular hemorrhage. Fourteen patients with sub-macular hemorrhage received an intravitreal injection of tPA &C3F8 gas and maintained face down position for 2 weeks. We investigated the feature of blood absorption, the correlation between underlying disease, hemorrhage size, duration and visual outcome. Underlying disease seemed to be a prognostic factor related to final visual acuity. Patients with choroidal rupture had better visual prognosis than those with age-related macular degeneration. The duration between the formation of submacular hemorrhage and treatment was correlated with final visual acuity, however, it was not sta-tisticallly significant. We have shown that submacular hemorrhage could be displaced by tPA and C3F8 gas injection in our most cases. In 7 of total 14 cases, visual acuity improved. The result suggests that this technique may be good for the initial treatment if done in appropriate timing in cases of submacular hemorrhage due to its simplicity and it can achieve relatively good results.
Subject(s)
Humans , Absorption , Choroid , Hemorrhage , Intravitreal Injections , Macular Degeneration , Prognosis , Rupture , Tissue Plasminogen Activator , Visual AcuityABSTRACT
BACKGROUND: Left ventricular contrast echocardiography has been used to evaluate congenital cardiac anomaly, valvular regurgitation, left ventricular wall motion and myocardial perfusion. The contrast agent capable of crossing the pulmonary capillary must be small, stable and echoreflective. METHODS: To make a transpulmonary contrast agent, a mixture of 8 mL of fluorocarbon (C3F8) gas, 5% human serum albumin and 5% dextrose solution was sonicated for 80 seconds. We measured the microbubble size and number of the contrast agent by Coulter counter and hemocytometer. We injected the contrast agent intravenously into the 8 mongrel dogs with systemic arterial blood pressure and heart rate monitoring. The dosage of the contrast agent was various from 0.01 mL/Kg to 0.1 mL/Kg. Echocardiographic examination was done while the contrast agent was injected. Arterial blood gas analysis was done repeatedly before and after contrast agent injection. RESULTS: The microbubble size of the contrast agent was 60.8+/-9.3 fL, and its number was 1.0 x 10 8 /mL. Left ventricular opacification was observed in all cases by intravenous injection of the contrast agent. The minimal dose for the complete opacification of the left ventricle by visual estimation was 0.05 mL/Kg. Hemodynamic variables did not change between pre and post injection of the contrast agent. CONCLUSION: Fluorocarbon based contrast agent could be used intravenously to opacify the left ventricle and it causes no hemodynamic chage in mongrel dogs.
Subject(s)
Animals , Dogs , Humans , Arterial Pressure , Blood Gas Analysis , Capillaries , Echocardiography , Glucose , Heart Rate , Heart Ventricles , Hemodynamics , Injections, Intravenous , Microbubbles , Perfusion , Serum AlbuminABSTRACT
OBJECTIVE:To determine the content of C 3 F 8 in human albumin microspheres filling-with C 3 F 8 .METHODS:By Tekmar3000purge and trap concentrator coupled with a Hewlett-Packard5972GC/MSD.RESULTS:C 3 F 8 contents in samples were119.1～433.5?g/ml.CONCLUSION:The method is feasible and suitable for quality control.