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Objective:To evaluate the application of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery.Methods:An observational case series study was conducted.A total of 316 patients (316 eyes) who received vitreoretinal surgery and iOCT from January 2015 to December 2017 in Hangzhou Branch of Eye Hospital, Wenzhou Medical University were enrolled.The iOCT scanning time and result, the consistency between iOCT result and observation under the operating microscope as well as the influence of iOCT on surgical strategy were recorded.The postoperative adverse reactions and complications were observed.The study protocol was approved by an Ethics Committee of Eye Hospital, Wenzhou Medical University(No.2019-168-K-160). Written informed consent was obtained from all patients prior to any medical examination.Results:There were 85.8% (271/316) of patients who successfully completed iOCT scanning, with an average scanning time of (3.54±2.30)minutes.Among the 271 successful eyes, there were 51 with idiopathic macular hole (IMH), 95 with epiretinal membrane, 50 with dense vitreous hemorrhage (VH), 30 with macular lamellar hole, 12 with vitreous macular traction syndrome, 33 with myopic maculopathy.There were 45 eyes, accounting for 16.6%, the iOCT results of which were inconsistent with the observation of operator under the operating microscope.There were 27 eyes, accounting for 10.0%, the surgical strategy of which was changed.The iOCT results of IMH showed that intra-retinal bridge connection appeared in 2 eyes after ILM peeling, then air tamponade was used.High-reflection strips on the edge of the MH after ILM peeling, called the Hole-door phenomenon, were found in 15 eyes, accounting for 32.6%.In MH with a diameter >400 μm, the postoperative best corrected visual acuity and continuity of outer limiting membrane were better in eyes with Hole-door phenomenon than eyes without Hole-door phenomenon.There were 8 eyes, accounting for 8.4%, showing residual membrane, 3 eyes of which received extra ERM peeling.There were 56 eyes, accounting for 58.9%, showing the secondary changes after membrane peeling.For 50 eyes with dense VH, there were 17 eyes showing the normal macular structure, accounting for 34%, and 33 eyes showing the abnormal macular structure, accounting for 66.0%.In addition, the macular structures of 14 eyes, accounting for 28.0%, observed in iOCT image were inconsistent with the intraocular microscope finding, and 11 of them received extra ERM peeling.Conclusions:The application of iOCT in vitreoretinal surgery can guide the selection of reasonable surgical methods during operation, predict postoperative recovery as well as improve postoperative outcomes.
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Objective To find the correlation between real best corrected visual acuity (BCVA) and test-ing results of microperimetry and visual evoked potential (VEP) and to explore a newmethod in record-ing BCVAin macular disease. Methods Sixty-two patients with macular disease (macular disease group, 62 eyes) and eighteen healthy volunteers (control group, 36 eyes) had BCVA, microperimetry and VEP recorded. Results (1) By microperimetry, the values of retinal mean sensitivity and fixation percentage in macular disease group were lower than that in control group. The bicurve ellipse area in macular dis-ease group was higher than that in control group. By V EP, P100 amplitude under 0.5 cpd and 2 cpd in macular disease group were significantly higher than that in control group and the latency was prolonged (P<0.05). (2) In macular disease group, BCVAhad significant positive correlation with retinal mean sen-sitivity, bicurve ellipse area, macular central 2°and 4°fixation percentage, respectively (P<0.05). There was a significant correlation between retinal mean sensitivity and P100 amplitude (P<0.05). (3) multiple linear regression equation was y=0.053 x1+0.008 x3+3.897 (y was BCVA, while x1 was retinal mean sensi-tivity and x3 was P100 amplitude under 2 cpd). Conclusion C ombined use of microperimetry and VEP is useful in the assessment of BCVAin macular disease.
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OBJETIVO: Avaliar a anatomia do buraco macular idiopático (BMI) a partir da tomografia de coerência óptica (OCT) e construir índice prognóstico que possa ser correlacionado com os resultados visuais e o fechamento anatômico. MÉTODOS: Estudo prospectivo, no qual 22 olhos com BMI foram avaliados pelo OCT no pré-operatório da cirurgia do BMI. Foi criado o índice prognóstico do buraco macular (IPBM) que foi correlacionado com o resultado anatômico e a acuidade visual pós-operatória seis meses após a cirurgia. RESULTADOS: Dezesseis olhos (72,7 por cento) obtiveram fechamento anatômico ao final de seis meses de acompanhamento. Na análise do IPBM, houve diferença significativa entre o grupo 1 (BM aberto) e o grupo 2 (BM fechado) (p=0,0018). O risco de insucesso para o fechamento anatômico é 11 vezes maior quando o diâmetro da base interna for superior a 600 µm ou o IPBM for inferior a 0,6 (p=0,0495). No que diz respeito à AV final, observou-se que o IPBM tem correlação negativa significante na AV (p=0,001). CONCLUSÃO: O IPBM se apresentou como o melhor preditor de fechamento anatômico e acuidade visual pós-operatória entre as variáveis aqui estudadas. Responde por 41 por cento da acuidade visual pós-operatória final, nos levando a crer que outros fatores, como o tempo de história e a degeneração dos fotorreceptores nestes BM mais antigos, possam estar envolvidos nos resultados visuais.
PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7 percent) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 µm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41 percent of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.
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Aged , Female , Humans , Male , Middle Aged , Retinal Perforations/pathology , Epidemiologic Methods , Pilot Projects , Preoperative Care , Prognosis , Reference Values , Retinal Perforations/physiopathology , Retinal Perforations/surgery , Time Factors , Tomography, Optical Coherence , Vitrectomy , Visual Acuity/physiologyABSTRACT
Objective To evaluate the 25-gauge (25G) transconjunctival sutureless vitrectomy system (TSV25G) for macular diseases. Methods The clinical data of 18 patients with macular diseases treated by the TSV25G were retrospectively analyzed. The 18 patients included 13 men and 5 women, aged from 25 to 73 years. The disease course ranged from 3.5 to 10 months, including 8 epiretinal membrane, 3 idiopathic macular hole, 3 tranumatic macular hole with submacular heamorrhage, 2 vitreo-macular tractional syntrome and 2 diabetic macular edema. The surgical parameter installation was as follows: high speed cutter with rate of 1500 cuts per minute; the maximum aspiration with a TSV25G were 500-550 mmHg (1 mm Hg=0.133 kPa); the BSS bottle height was 40-50 cm; the intraocular pressure was 29-35 mmHg during the surgery. The postoperative follow-up period was 2.5-10 months. Results Eighteen patients had undergone the vitrectomy successfully with the operative time of 26-44 minutes (mean 35 minutes). No complication was found. Water leakage of the puncture site was found in 1 patient and was sewed up with 8-0 absorbable sutures. The mean time of inpatients were 3.5 days postoperatively. In the postoperative follow-up in 18 patients, the macular edema disappeared totally in 12 patients 3-6 months after the operation; the visual distortion disappeared in 10 and alleviated in 2; the visual acuity regained (0.8 or more) in 6 (33.3%), not changed in 4, and improved in 2. Conclusion TSV25G was safe, time-saving, and effective for macular diseases.
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0.05). In 30 eyes of diabetics with phacoemulsification, 11 eyes had new macula edema after surgery and 3 eyes had significant retinal thickening. In 6 eyes with macular edema before surgery, the macular edema were aggravated in 3 eyes after surgery. The macular structural changes were not found in two control groups. Conclusion The thickness of retina is inreased after phacoemulsification in deabetics,and morbidity and its severity of postopevative macular edema are increased as well.
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Objective To test the hypothesis that the macular pigment may be a marker of foveal cone function and consequently the structural integrity of foveal cones. Methods Sixteen patients (32 eyes) diagnosed to have Stargardt dystrophy and three patients with full thickness macular holes by clinical criteria were studied with a scanning laser ophthalmoscopy (SLO) comparing argon laser blue and infra-red images for the presence or absence of macular pigment (MP) in the fovea. An C ++ computer based program was used to evaluate the density of MP. Eyes were graded into three categories: those without foveal macular pigment, those with partial pigment and those with normal amounts of macular pigment. These categories were compared with visual acuity determined by the Snellen chart. Results Thirteen eyes with a visual acuity of 20/200 or worse had no macular pigment in the fovea. Eleven eyes with visual acuity of 20/40 or better had a normal amount of macular pigment in the fovea and 1 eye had partial macular pigment. Eleven eyes with partial macular pigment had intermediary acuity value. Conclusions Foveal macular pigment is closely related to foveal cone acuity and therefore may be a marker for the presence of foveal cones. Infrared light is a sensitive indicator of early macular diseases
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Purpose To observe the features of multi-focal electroretinogram (mERG) in Stargardt′s disease, and evaluate the validity of mERG on diagnosis of this disease. Methods mERG had been recorded in 7 cases (14 eyes) of Stargardt′s disease with VERIS 4.0,and the findings were compared with normal individuals. Results The mERG were remarkably abnormal in all cases of the disease, as the amplitudes of N 1 and P 1 waves were seriously decreased and the latencies were prolonged in all the 6 regions ( P
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Purpose To explore the role of scanning laser tomography in the assessment of macular hole surgery. Methods Fifteen eyes of 14 patients with macular holes underwent scanning of their affected macular area using the Heidelberg retina tomograph (HRT). The significance of topographic changes postoperatively were determined in eleven eyes which received vitrectomy surgery. The scan field was set at 15? of the retina and the depth was set to 1.5 mm or 2.0 mm. All the measurements were taken for 3 times and the average value of the 3 measurements was used. Results The average hole area was (0.499?0.34) mm 2 and the maximal depth of the hole was (0.284?0.11) mm. Topographic difference analysis of the eleven eyes showed a significant reduction in the height of the retina after vitrectomy. The maximal depth of the hole was (0.063?0.04) mm postoperatively. Conclusion Scanning laser tomography provides an objective evaluation of the anatomic outcome of the macular hole surgery.