ABSTRACT
Dome-shaped macula (DSM) of high myopia has been described as an inward convexity or bulge of the macular within the concavity of the posterior staphyloma in highly myopic eyes,with the bulge height over than 50 μm,which can be observed by optical coherence tomography.There are three patterns of DSM,including the typical round dome,the horizontally oriented oval-shaped dome and the vertically oriented oval-shaped dome.The pathogenesis of DSM development remains unclear,several hypotheses have been suggested,such as localized choroidal thickening in the macular area,relatively localized thickness variation of the sclera under the macula,resistance to deformation of sclera staphyloma,ocular hypotony and tangential vitreoretinal traction.Vision-threatening macular complications of DSM including serous retinal detachment,choroidal neovascularization,foveoschisis and retinal pigment epithelial atrophy.Clinically,asymptomatic patients with DSM mainly take regular follow-up observation.Appears serous retinal detachment and significant visual impairment,treatment with half-dose photodynamic therapy,supplementary of laser photocoagulation or oral spironolactone may have a beneficial effect.However,more large clinical studies are required to confirm the exact efficacy of these treatments.
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Objective To observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not.Methods Forty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study.Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group).During the operation,a proper size of the ILM was removed and filled in the bottom of the macular hole.The age,duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P＞0.05).Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined.There was no statistically significant difference in logMAR BCVA,average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128,1.452,1.321;P＞0.05).The logMAR BCVA and SD-OCT were examined on 1,3,6,12 months postoperatively.Results On 1 month after the surgery,there was no statistically significant difference in logMAR BCVA,average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226,1.435,1.018;P＞0.05).On 3,6,12 months after the surgery,compared with ILM removal group,the logMAR BCVA (t=2.059,2.871,2.415) increased and the average defect diameter of IS/OS (t =2.070,2.110,2.121) and ELM (t =2.034,3.647,3.556) significantly reduced in ILM transplantation group (P＜0.05).On 1 month after the surgery,there was statistically significant difference in CRT between two groups (t=2.113,P＜0.05).On 3,6,12 months after the surgery,there was no statistically significant difference in CRT between two groups (t=0.428,0.847,0.849;P＞0.05).Conclusion Compared with vitrectomy combined with ILM peeling surgery,the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH.
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Purpose To investigate the histopathologic changes of macula lutea retinae in the elderly Chinese population,and to provide information for the cause of visiual disturbance in an autopsy study. Methods Two hundred and twelve eyes from 108 consecutive cases of postmortem (mean age of 78.4 years old) sections of the area of macula lutea retinae were studied by histopathology. Results Among the 212 eyes,hard drusen were found in 36.3% of eyes and soft drusen in 19.3% of eyes.The eyes with both of the above mentioned 2 types of drusens were found to be combined with RPE atrophy and RPE detachment;and subretinal neovascularization were found in 5.7% of these eyes and they were associated with obvious RPE atrophy and photoreceptor loss;3.2% eyes had posterior scleral staphyloma showing thinning of the sclera and choroid,RPE atrophy and apparent photoreceptor loss;2.4%eyes showed CME with the history of cataract surgery. Conclusion The macular affections,age related macular degeneration,myopic macular degeneration and post operative cystoid macular edema are varying in number in the above mentioned order successively,in elderly Chinese at an autopsy study.
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Objective To investigate the characteristics of optical coherence tomography (OCT) in eyes with repaired idiopathic macular hole (IMH) after operation and the relation with recovery of visual acuity. Methods The characteristics of OCT images of 24 patients (25 eyes) with repaired IMH after vitrectomy,internal limiting membrane(ILM)peeling and auto-serum healing were analyzed retrospectively. In the patients with IMH, the macular hole was found in 9 eyes at stage Ⅱ, 13 eyes at stage Ⅲ, and 3 eyes at stage Ⅳ. Examinations of best-corrected visual acuity, slit-lamp biomicroscopy with fundus contact lens, fundus photography, fundus fluorescein angiography(FFA) and OCT were performed on the patients 3 to 24 months after surgery. Results OCT images of the repaired IMH were categorized into 3 patterns: U-type (5 eyes) with relative normal foveal contour; V-type (7 eyes) with steep foveal contour;W-type (13 eyes) with foveal defect of neurosensory retina, but without warped hem of retinal hole or cystic formation. Postoperative visual acuities were improved in all of the patients and the best ones were in group U-type. Conclusion Characteristics of OCT images of repaired IMH may be related to the postoperative visual acuity.
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Objective To study the characteristics of optical coherence tomography (OCT) in idiopathic macular epiretinal membranes (IMEM) and the relationship between the thickness of fovea and the vision of affected eyes. Methods Total of 67 cases (73 eyes) with clinical diagnosis of IMEM by direct, indirect ophthalmoscopy, three mirror contact lens, fundus color photography or fundus fluorescein angiography(FFA) were examined with OCT. Results Epiretinal membranes(ERMs) with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly and partially seperated from the retina (27 eyes, 38.36%), the retinal thickness of the fovea was the thickest in proliferative ERMs and the thinnest in ERMs with laminar macular holes. The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454, P= 0.000 ). Conclusion There were four types of image of OCT in IMEM: ERMs with macular edema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT, the poorer the visual acnity in the affected eyes with ERMs.