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Objective:To compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD).Methods:A retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age ( Z=0.804), course of disease ( Z=-0.490), eye type ( χ2=0.175), logMAR BCVA( Z=-0.895), intraocular pressure ( Z=0.178), lens status ( χ2=1.090), number of detached clocks ( Z=0.301) and macular involvement ( χ2=0.219), number of holes ( Z=-1.051) and number of lower holes ( χ2=0.619) were compared, there was no significant difference ( P>0.05). The gender composition ratio was compared, and the difference was statistically significant ( χ2=5.341, P<0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. Results:In the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation ( χ2=0.120, P=0.729) and logMAR BCVA ( Z=-0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery ( χ2=2.320, 0.227; P=0.128, 0.634). Conclusion:It is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.
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At present, tamponade agent which being used in retinal surgery is mainly sterile air, gas and silicone oil. Sterile air is mostly used in the treatment of simple retinal detachment. Gas or silicone oil as tamponade is greatly applied for complicated retinal detachment. In recent years, with the application of micro-invasive vitrectomy under a wide-angle viewing system and perioperative anti-vascular endothelial growth factor drugs, application of intraocular filling materials also has changed. The application of silicone oil is significantly reduced. Percentage rate of gas as tamponade for retinal detachment is reduced. The application of sterile air as tamponade is rising. With selecting indication carefully and picking up the suitable air or gas, doctor will reduce the workload. It will also reduce the social burden and benefit patients.
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Objective To evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.Methods A retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology,Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study.There were 16 males (16 eyes) and 20 females (22 eyes),with the mean age of 64.1 1 ± 9.49 years and the mean courses of 151.55 ± 127.87 days.All the patients received an intravitreal injection of 0.3 ml of 100％ C3F8 within one week.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The severity of metamorphopsia was detected using M-charts.The extent of vitreomacular adhesion (VMA),central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment.The average BCVA was 0.58± 0.22.The mean horizontal metamorphopsia (MH)and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42,respectively.The mean CMT was 415.15 ± 89.59 μm.The mean horizontal VMA was 1168.68± 400.61 μm (30 eyes with VMA ≤ 1500 μtm and 8 eyes with VMA＞ 1500 μm).The mean vertical VMA was 976.89±295.92 μtm.There were 22 eyes with integrity EZ and 16 eyes without integrity EZ,33 eyes with crystalline lens and 5 eyes with IOL.The mean follow-up time was 10.7 months.The differences in BCVA,MH,MV,CMT,the integrity of EZ before and after treatment were analyzed.The VMT release rates were assessed.The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.Results Vitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit,the VMT release rate was 76.3％.VMT release occurred and the average time of VMT release occurred was 2.2 weeks.VMT persisted in 7 eyes,in the rest two eyes,one eye developed a retinal detachment and another eye formed macular hole,both eyes responded to vitrectomy.At 6 months after treatment,the average logMAR BCVA was 0.43±0.23,the mean MH and MV were 0.25± 0.23 and 0.24± 0.23,the mean CMT was 310.61 ± 63.10 pm.Among 16 eyes without integrity EZ before treatment,there were 9 eyes with integrity EZ at 6 months after treatment.There were 16 eyes with integrity EZ and 9 Compared with baseline,the mean BCVA at 6 months after treatment was significantly increased (F=3.779,P=0.037),but the MV (F=4.958,P =0.003) and CMT (F=13.419,P＜0.001) were significantly decreased,the integrity of EZ was improved significantly (22=5.050,P=0.025).The VMT release correlated inversely with the extent of horizontal VMA,BCVA,and CMT at baseline (r=-0.514,-0.348,-0.429;P=0.009,0.001,0.038).Conclusion Intravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction,it is an efficient and safe treatment for VMT syndrome.It can improve the visual acuity,metamorphopsia and foveal morphology in patients with VMT syndrome.
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Objective To observe the clinical effect ofintravitreal injection of tissue plasminogen activator (t-PA),ranibizumab and C3F8 in the treatment of early submacular hemorrhage (SMH) induce to polypoid choroidal vasculopathy (PCV).Methods The clinical data of 20 eyes of 20 patients with early SMH induce to PCV were enrolled in this study.The duration of bleeding in the eye was 7 to 28 days,and the mean duration of bleeding was 14.8± 5.6 days.All eyes are measured using the Snellen chart best corrected visual acuity (BCVA),logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity.Measure central retinal thickness (CRT) and central retinal pigment epithelial detachment (PED) thickness using frequency-domain optical coherence tomography.The average logMAR BCVA of eyes was 1.73 ±0.91;the mean CRT was 620.0±275.8 μm;the average central PED thickness was 720.3±261.9 μm.All eyes receive intravitreal injection of t-PA,ranibizumab and C3F8.The intravitreal injection of ranibizumab was administered once a month for 3 consecutive months,followed by an on-demand treatment plan.Mean follow-up time was 9.9 ± 3.6 months.The changes in BCVA,CRT,central PED thickness and clearance degree of SMH at 6 months after treatment were observed.Results On the 6 months after treatment,the average logMAR BCVA,CRT and central PED thickness of the eyes were respectively 0.42 ± 0.37,290.2 ± 97.4 μmn and 41.6 ± 78.1 μm.Compared with baseline,the after treatment BCVA was significantly increased (F=38.14,P=0.000),but the CRT and central PED were significantly decreased (F=7.48,75.94;P=0.000,0.000).Among the 20 eyes,16 eyes of SMH was completely cleared,accounting for 80％;4 eyes was partially cleared,accounting for 20％.No recurrence and systemic or local complications occurred during follow-up of all eyes.Conclusion Intravitreal injection oftPA,ranibizumab,and C3F8 in the treatment of early SMH induce to PCV can effectively remove SMH,improve vision,reduce CRT and central thickness of PED.
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Objective To observe and analyze the clinical outcomes of perfluoropropane (C3 Fs) injection and laser photocoagulation on myopic foveoschisis.Methods A total of 14 patients (18 eyes) diagnosed as myopic foveoschisis were enrolled in this retrospective study.All patients received intraocular tamponade of 0.5-0.7 mL C3 F8,and after 1 week,underwent macular photocoagulation.These patients were given the best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination for central foveal thickness (CFT) and maximal macular thickness (MMT) before and after treatment.Results OCT examination showed that the mean CFT decreased significantly from (494.00 ±454.80) iμm before treatment to (193.61 ± 97.42) μm at the last follow-up,with statistical significance (P =0.01),and the mean MMT decreased from (687.33 ± 385.15)pμn to (331.06 ± 109.31)μm at the same duration,approaching significant difference (P =0.001).The foveoschisis healed completely and partially in 14 eyes at the last follow-up,the mean CFT decreased significantly from (567.36 ±493.01) μm before treatment to (171.43 ± 90.84) μm after treatment,with statistical significance (P =0.006),and the mean MMT decreased from (744.14 ± 417.38)μm to (303.86 ± 8.62)prn at the same duration,approaching significant difference (P =0.002).Patients' BCVA before treatment was (0.94 ± 0.39) logMAR,of which 13 eyes had BCVA ＜ 0.6 logMAR,and increased to (0.92 ± 0.36) logMAR at the last follow-up,with no significant difference (P =0.78).The foveoschisis healed completely and partially in 14 eyes,and the BCVA was (1.04 ± 0.37) logMAR before treatment,up to (0.90 ± 0.34) logMAR after treatment,and the difference was not statistically significant (P =0.16).At the last follow-up,the vision of 4 eyes was increased by 2 lines and above,and unchanged in 10 eyes.All patients had no visual symptoms such as dark spots and no increase in intraocular pressure after treatment.Conclusion Intraocular C3 F8 tamponade and macular photocoagulation can be an satisfying alternative treatment for patients with myopic foveoschisis.
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Objective To evaluate the efficacy ofintravitreal injection (IVI) ofexpansile gas alone to treat idiopathic full-thickness macular hole (FTMH).Methods This is a prospective interventional case series.Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study.There were 5 males (5 eyes) and 21 females (21 eyes),with the mean age of (59 ± 12) years.All patients received the best corrected visual acuity (BCVA),slit lamp microscope,indirect ophthalmoscopy,fundus color photography and three-dimensional optical coherence tomography (OCT) examinations.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution visual acuity.The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon,OCT-2000).Based on the diameter,the holes were classified as small FTMH (equal or lesser than 250 μm),medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm).The mean BCVA was 0.85 ± 0.29.There were 7,10 and 9 eyes with small,medium and large FTMH.There were 10 eyes with vitreous-macular traction (VMT).All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days.The follow-up ranged from 1 to 23 months.The BCVA,FTMH closure and complications were observed.If holes failed to close at 1 month after IVI,vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.Results FTMHs was able to close in 17/26 eyes (65.4％) had hole closure,failed to close in 9/26 eyes (34.6％).All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas.The eyes failed in the closure initially with IVI of gas alone,all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade.The closure rate of small (6 eyes),medium (8 eyes) and large FTMH (3 eyes) was 85.7％,80.0％ and 33.3％ respectively.The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8 ± 122.8),(431.6± 128.4) μm respectively,the difference was significant (t=-2.407,P=0.024).VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group,respectively,the difference was significant (t=-2.196,P=0.038).The mean preoperative BCVA was 0.51 ±0.36.There was a significant difference between pre-and postoperative BCVA (t=4.758,P＜ 0.05).Two eyes developed local retinal detachment,which achieved hole closure and retinal reattachment after vitrectomy.Conclusion IVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.
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Objective To compare the clinical effect of C3F8 and air tamponade after vitrectomy for the treatment of idiopathic macular hole (IMH).Methods A total of 54 eyes of 54 patients with IMH that had undergone 23G pars plana vitrectomy with internal limiting membrane peeling were retrospectively studied.All patients received optical coherence tomography ()CT) examination and the best corrected visual acuity (BCVA).They were divided into 2 groups.26 eyes in group A were filled with air and 28 eyes in group B were filled with C3F8.In group A,6 eyes at stage Ⅱ,20 eyes at stage Ⅲ,the minimum diameter (Dmin) of macular hole in 14 eyes was less than 400 μm,and in the other eyes was larger than 400 μm.In group B,10 eyes at stage Ⅱ,18 eyes at stage Ⅲ,the Dmin of macular hole in 15 eyes was less than 400 μm,and in the other eyes was larger than 400 μm.The differences of age,course of the disease,BCVA,fundus diameter,Dmin,height,index,diameter of outer retina diameter (Dord) between the two groups were not significant (P＞0.05).The basic data before surgery and the closure rate,BCVA,Dord 1 month after surgery between two groups were compared.Results At 1 month after surgery,the IMH closure rate was 100.0％ in group A and 92.9％ in group B,the difference between these two groups was not significant (P=0.491).The closure rate of eyes with Dmin＜400 μm were both 100.0％ in two groups,and the closure rate of eyes with Dmin＞400 μm were 100.0％ in group A and 84.6％ in group B.There was no statistically significant differences between two groups (P =0.480).The mean BCVA of two groups were 0.35±0.22 and 0.33 ±0.16 respectively.The mean Dord were (782.2 ± 478.0) μm and(792.1 ± 432.7) μm respectively.All cases got better BCVA (t=-7.310,-10.506;P＜0.01) and shorter Dord (t=6.704,7.770;P＜0.01).But there was no statistically significant differences between groups 1 month after surgery in BCVA and Dord (t =0.381,0.800;P =0.705,0.937).Conclusion Air tamponade after vitrectomy has the same efficacy as C3 F8 tamponade in the treatment of IMH.
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Objective To compare the effects of intravitreal tamponade of C3 F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy (PDR).Methods The clinical data of 121 patients (127 eyes)who underwent primary vitrectomy due to PDR were analyzed retrospectively.All the patients were divided into two groups according to different intravitreal tamponade, including C3 F8 tamponade group (53 patients with 56 eyes ) and silicone oil tamponade group (68 patients with 71 eyes).There was no difference of gender (χ2 = 0.956 ),age (t =1.122),duratiion of diabetes (t=0.627),fasting blood glucose (t=1.049),systolic pressure (t=1.056), diastolic pressure (t = 0.5 1 7 ), history of hypertension (χ2 = 0.356 ), nephropathy (χ2 = 1.242 ), preoperative laser photocoagulation (χ2 = 1.225 )and All the patients underwent three port pars plana vitrectomy.The mean follow-up was 2 years ranging from 6 months to 4 years.And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. Results Postoperative vitreous hemorrhage occurred in 14 of 56 eyes (25.00%)in C3 F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were (64.64 ± 59.09)days ranging from 7 -225 days and mostly were within 30-60 days (35.71%,5/14).Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes (9.89%)of silicone oil tamponade group after silicone oil removal with an average onset time of (25.29±20.46)days ranging from 3-65 days and were mostly within 1 5-30 days (42.86%, 3/7).There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups (χ2 = 5.200,P <0.05 ).BCVA of the two groups was improved significantly after operation (Z =2.472,3.1 14;P <0.05).Postoperative BCVA of silicone oil tamponade group was poorer than C3 F8 tamponade group (Z =1.968,P <0.05).Conclusion Both C3 F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR.Compared with C3 F8 ,silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.
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Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD).Methods The clinical interventional case series study included 104 patients (112 eyes) with DTRD,who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas.Among the eyes,there were 6 eyes with iris neovascularization (INV),1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment.There were no pre-existing retinal holes or breaks prior to surgery nor any iatrogenie retinal breaks developed during vitrectomy.Cataract removal combined with intraoeular lens implant surgeries were performed on 15 eyes.Follow-up duration varied from 12 to 65 months (mean: 29 months).Results Subretinal fluid was completely absorbed within 2 months after surgery.In 107 eyes (95.54%),the retina reattached after surgery and remained attached till the end of follow-up period.Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%),remained unchanged in 14 eyes (12.500%) and got worse in 19 eyes (16.79%).The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes,66.00% Vs 46 eyes/62 eyes,74.19%,χ2=0.89,P=0.344).No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries.Seven (6.25%) eyes showed INV (5 new onset eyes),and none of them developed into NVG.In multivariate logistic regression,factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis I-adjusted odds ratio (OR)= 10.2],low preoperative BCVA (OR= 11.1) and low postoperative BCVA (OR = 16.7).Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oil or gas tamponade if there are no preoperative or intraoperative retinal breaks,and only using irrigation fluid could access a good long-term prognosis result.