ABSTRACT
ABSTRACT Purpose: To compare the injection of small amounts of undiluted C3F8 with the traditional gas injection in vitrectomy for macular hole treatment. Methods: This clinical trial included 26 individuals divided into two groups. Group 1 received an intravitreal injection of 0.9-1.0 mL of 100% C3F8, and Group 2 received 15-20 mL of 20% C3F8. Results: The median intraocular gas duration was 31 days in Group 1 and 34 in Group 2. The median letter gains in corrected distance visual acuity for the 26th postoperative week were 20 letters in Group 1 and 12.5 in Group 2. The median intraocular pressure was normal in both groups. Primary anatomical success was 11/13 in both groups. Conclusions: The use of C3F8 gas in a small undiluted volume is an alternative that slightly reduces the duration of the gas without negatively affecting the anatomical and visual response.
ABSTRACT
ABSTRACT We report the case of a 68-year-old man who presented to our outpatient clinic for routine examination. Fifteen months before, he had undergone combined cataract and idiopathic full-thickness macular hole surgery in his right eye at another institution. In the present evaluation, the best-corrected visual acuity in his right eye was counting fingers. Fundus examination evidenced an idiopathic full-thickness macular hole in that eye, which was confirmed on spectral domain optical coherence tomography. A new surgery was offered, but the patient declined. Twenty-one months after his first consultation with us (36 months after the surgery), spectral domain optical coherence tomography revealed spontaneous closure of the idiopathic full-thickness macular hole, with a gap at the foveal ellipsoid zone. At the final visit, 22 months after the closure of the idiopathic full-thickness macular hole, the patient's best-corrected visual acuity was 20/25, and the gap at the ellipsoid zone had decreased.
RESUMO Este é o relato do caso de um homem de 68 anos que procurou nosso ambulatório para exames de rotina. Quinze meses antes, ele havia se submetido a uma cirurgia conjunta de catarata e buraco macular idiopático de espessura total em seu olho direito, em outra instituição. Durante a consulta em nosso ambulatório, a melhor acuidade visual corrigida no olho direito era de contagem de dedos. O exame do fundo evidenciou um buraco macular idiopático de espessura total naquele olho, o que foi confirmado por uma tomografia de coerência óptica de domínio espectral. Uma nova cirurgia foi oferecida, mas o paciente recusou. Vinte e um meses após sua primeira consulta (36 meses após a cirurgia), a tomografia de coerência óptica de domínio espectral revelou o fechamento espontâneo do buraco macular idiopático de espessura total, com uma lacuna na zona elipsoide foveal. Na última consulta, 22 meses após o fechamento do buraco macular idiopático de espessura total, a melhor acuidade visual corrigida foi de 20/25 e a lacuna na zona elipsoide havia diminuído.
ABSTRACT
Size of the macular hole (MH) is an important factor affecting the treatment of MH.MH with a diameter >400 mm was defined as large MH.Pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling or intravitreal gas tamponade, which can effectively relieve the traction of vitreoretinal interface, is the standard surgical technique for idiopathic full-thickness macular hole (FTMH), but its efficacy on refractory large FTMH is very limited.In order to obtain ideal anatomical healing and functional recovery of large FTMH, new surgical strategies, such as reversal of retinal internal limiting membrane (ILM), expanded removal of ILM, transplantation of different tissue valves, application of mesenchymal stem cells and so on, have been the focus of researchers in the field of fundus diseases.More targeted and personalized treatment is the development trend of treatment for large FTMH.The progress of ILM flipping surgery, expansion of ILM removal, transplantation of different tissue valves, biomaterials and other auxiliary techniques in the treatment of large diameter FTMH were reviewed in this article.
ABSTRACT
Objective To observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole,and analyze the influencing factors.Methods A retrospective study.From August 2016 to June 2018,302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study.There were 130 males and 172 females,with the mean age of 63.36 ± 6.91 years.There were 158 left eyes and 144 right eyes.The logMAR BCVA was 1.13 ± 0.45.The minimum diameter (422.92± 211.73 μm) and basal diameter (835.47± 366.42 μm) of macular hole and choroid thickness under fovea (244.84± 60.68 μm)were measured by OCT.According to the minimum diameter,the holes were divided into small hole group (≤ 250 μm),middle hole group (＞250 μm and ≤400 μm) and large hole group (＞400 μm).The logMAR BCVA at 1,3 and 6 months after surgery in 3 groups were observed.Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups.The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery.Results One month after surgery,all the holes were closed.One,3 and 6 months after surgery,the logMAR BCVA were 0.33 ± 0.25,0.23 ± 0.18,0.16± 0.17 in the small hole group;the logMAR BCVA were 0.46±0.25,0.35±0.26,0.27±0.28 in the middle hole group;the logMAR BCVA were 0.81 ±0.51,0.61 ±0.48,0.53±0.37 in the large hole group.Through repeated measurement variance analysis of two factors,it was found that there was an interaction between different groups and different time nodes (F=23.133,P＜0.01).All data were segmented and one-way repeated measure ANOVA was performed.The results showed that there was a statistically significant difference in visual acuity between the small hole group and the middle hole group among preoperative and 1 month after surgery (P＜0.05),while there was no statistically significant difference in visual acuity between 1,3 and 6 months after surgery (P＞0.05).In the large hole group,among preoperative,1 months after surgery,3 months after surgery,the visual acuity difference was statistically significant (P＜0.05),while the visual acuity difference between 3 months after surgery and 6 months after surgery was not statistically significant (P＞0.05).The results of GEE analysis showed that hole size (X2=4.17,P=0.04),basal diameter (X2=7.25,P=0.01),disease course (X2=19.26,P=0.00),and choroid thickness (X2=4.19,P=0.04) were the influencing factors of postoperative visual acuity.Conclusions After vitrectomy of macular holes of different sizes,the visual recovery trend is different.The visual recovery of small holes and middle holes is faster and basically restored at 1 month.The large holes requires a slow recovery process and stabilizes vision at 3 months.Hole size,basal diameter,course of disease and choroid thickness are the influencing factors of visual acuity recovery.
ABSTRACT
Objective@#To observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).@*Methods@#A prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index(THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.@*Results@#Closure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, - 6.151; P<0.01,<0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf- ERG (r=-0.34, -0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM(r=-0.449, -0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.@*Conclusions@#Vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.
ABSTRACT
Objective@#To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.@*Methods@#A retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients(15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index(MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.@*Results@#At 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).@*Conclusion@#Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).
ABSTRACT
Objective@#To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.@*Methods@#A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.@*Results@#In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).@*Conclusions@#Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
ABSTRACT
Objective@#To observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment(RRD) complicated with macular hole (MH).@*Methods@#A retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females(13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ2=0.324) between the two groups were not statistically significant (P>0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure.@*Results@#At the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ . In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ . There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ2=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038).@*Conclusion@#Vitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.
ABSTRACT
Objective@#To observe the changes of retinal microstructure in lamellar macular hole (LMH) after vitrectomy.@*Methods@#A retrospective clinical observational study. Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People’s Hospital from January 2014 to September 2018 were included in this study. Among them, 14 patients (15 eyes) were males and 26 patients (26 eyes) were females, with an average age of 67.8±8.6 years. There were 37 eyes with a lens and 4 eyes with an IOL. There were 29 eyes with LMH of tractional type, 7 eyes of degenerative type, and 5 eyes of mixed type. All patients underwent BCVA and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. After the surgery, the same equipment and method before the surgery were used for relevant examination. The changes of BCVA, CRT, and MRT before and after surgery were observed. Continuous variables were compared by t test.@*Results@#At the last follow-up, the mean logMAR BCVA was 0.37±0.26. Compared with before surgery, the difference was statistically significant (t=5.98, P<0.01). The mean CRT and MRT were (245.2±90.8) and (347.0±46.7) μm, respectively. Compared with before surgery, the differences were statistically significant (t=-2.49, -5.24; P<0.05, <0.01). CRT and MRT changed greatly within 6 months after surgery, and then tended to be gentle. Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery, ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye. Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery, there were still 4 eyes with retinal cavity, but all the retinoschisis were disappeared. Among the 5 eyes with retinal cavity of degenerative type before surgery, there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone. Among 10 eyes with a follow-up time of equal or greater than 24 months, the macular ganglion cell complex partially atrophied in 6 eyes, and the nerve fiber layer separated in 2 eyes. There was no full-thickness macular hole after surgery.@*Conclusion@#For most LMH patients, vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.
ABSTRACT
Objective To observe the clinical effect ofvitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).Methods A prospective,nonrandomized controlled case cohort study.Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study.There were 4 males (4 eyes) and 16 females (16 eyes),with the mean age of 60.60 ± 9.50 years and the mean disease course of 9.55 ± 15.5 months.The stage of macular hole ranged from Ⅱ to Ⅳ.All patients underwent BCVA,intraocular pressure,spectral-domain OCT (SD-OCT) and multifocal ERG examinations.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The minimum diameter (MIN),bottom diameter (BD),height (H),the defective diameter of ellipsoid zone,the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg).Then the macular hole index (MHI=H/BD),hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated.The response density in P1 wave was detected by mf-ERG.The logMAR BCVA was 1.18 ± 0.54.There were 5 eyes with less than 400 μm MIN,13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN.All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade.According to the SD-OCT image features after surgery,IMH closure was divided into type Ⅰ closed,type Ⅱ closed and unclosed.The follow-up was equal or greater than 3 months.The closure rate of IMH,BCVA and the changes of microstructure parameters of macular area were observed.Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P 1 before surgery and the efficacy after IMH surgery.Results Closure rate of IMH:18 eyes (90.0％) were completely closed (all type Ⅰ closed).The closure rate of macular hole with the MIN less than 400 μm was 100.0％ (5/5),400-700 μm was 92.3％ (12/13),and over than 700 μm was 50％ (1/2).BCVA:the mean logMAR BCVA at 1 week,1 month,3 months after surgery were 0.83± 0.54,0.65 ± 0.41,0.48± 0.34,and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382,4.459,5.250;P=0.003,0.007,0.004).The outcomes of SD-OCT at 3 months after surgery:18 eyes (90.0％) with intact ELM.The defective diameter of ellipsoid zone was 260.34±272.08 μm,there was statistically significant difference between before and after surgery (t=13.545,P=0.002).The outcomes of mf-ERG:the P 1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748,-6.151;P＜ 0.01,＜ 0.01).The results of Spearman correlation analysis:there was a positive correlation between postoperative BCVA and preoperative MIN,the defective diameter of ellipsoid zone and ELM,and postoperative the defective diameter of ellipsoid zone (r=0.56,0.59,0.68,0.52;P=0.010,0.006,0.001,0.019).The postoperative BCVA was negatively correlated with the P 1 wave response density of ring 1 and ring 2 of mfERG (r=-0.34,-0.16;P=0.006,0.020).The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=-0.449,-0.449;P=0.047,0.047).MHI and THI were positively correlated with the closure of the hole (r=0.474,0.546;P=0.035,0.013).Intraocular pressure increased in 2 eyes during the follow-up period,and returned to normal within 1 week after the administration of antihypertensive drugs.There were no complications during or after the operation.Conclusions Vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective.The MIN,MHI THI are significantly correlated with the curative effect after IMH surgery,which could be used as the index to predict and evaluate the curative effect.The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery,and which is negatively correlated with BCVA.
ABSTRACT
Objective To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.Methods A retrospective clinical study.Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study.There were 13 males (13 eyes) and 17 females (17 eyes),with the mean age of 57.3 ± 6.9 years.There were 15 patients (15 eyes) with large macular diameter,12 patients (12 eyes) with high myopia macular hole,and 3 patients (3 eyes) with secondary traumatic macular hole.The BCVA examination was performed using the Snellen visual acuity chart,which was converted into logMAR visual acuity.OCT was performed to measure the macular retinal thickness (CRT),base diameter and minimum diameter of macular hole.Then,the macular hole index (MHI) was calculated.The logMAR BCVA was 1.52±0.30,MHI was 0.51 ±0.19.The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients.The CVRQoL-25 score was 57.60±7.13.All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation.The follow-up was at least 3 months after surgery.The changes ofBCVA,MHI,CRT and CVRQoL-25 score before and after surgery were comparatively analyzed.Paired t test was performed to compare the measurement data before and after surgery,and Spearman rank correlation analysis was used for the correlation analysis among the parameters.Results At 3 months after surgery,the hole closure was detected in 28 eyes (93.3％),not detected in 2 eyes (6.7％).The logMAR BCVA was 1.16± 0.33,CRT was 161.00± 15.26,and CVRQoL-25 scores was 70.83 ± 9.77.Compared with before surgery,the BCVA (t=4.386,P=0.000) and CVRQoL-25 score (t=-5.991,P=0.000) after surgery were improved.Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=-0.536,-0.796;P=0.002,0.000);positively correlated with preoperative MHI (r=0.421,P=0.020) and postoperative CRT (r=0.589,P=0.001).Conclusion Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity,while achieved a high hole closure rate (93.3％).
ABSTRACT
Objective To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.Methods A retrospective,case-controlled study.Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study.There were 5 males (5 eyes) and 24 females (24 eyes),with an average age of 55.28 ± 11.40 years.According to the surgical method,the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes).All patients underwent BCVA,spectral domain OCT and axial length measurement before surgery.There was no significant difference between the two groups in age,gender,course of disease,hole diameter,BCVA and other baseline data.Follow-up was over 4 months after surgery.The BCVA,macular hole closure and continuity of outer retina after surgery were observed.Results In ILM peeling group,11 eyes were closed (64.7％) and 6 eyes were not closed at 3 months after surgery.In ILM flap group,12 eyes were closed (100.0％).The difference of closure rate between two groups was statistically significant (x2=5.34,P=0.028).The BCVA of inverted ILM flap group was significantly improved at 1,3 months after surgery compared with preoperative measurements,and the difference was statistically significant (F=3.813,4.667;P=0.003,0.001).The BCVA of ILM peeling group was improved at 1 month after surgery,but the difference was not statistically significant (F=1.556,P=0.139).And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements,and the difference was statistically significant (F=2.453,P=0.026).But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647,0.535;P=0.551,0.612).There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008,P=0.631).Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole.The closure rate of the hole can be improved significantly.
ABSTRACT
Objective To observe the therapeutic effect ofvitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment (RRD) complicated with macular hole (MH).Methods A retrospective case analysis.From January 2015 to August 2019,29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study.There were 16 males (16 eyes) and 13 females (13 eyes).All the eyes were peripheral RRD and involving the macular area,while complicated with MH and proliferative vitreoretinopathy in stage less than C.All the eyes were examined by BCVA and OCT.The BCVA examination was performed using the Snellen visual acuity chart,which was converted into logMAR visual acuity.Before 2017,18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group);after 2017,11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group).The differences of age (t=0.360),onset time (t=1.235),number of holes except MH (t=0.060),RRD range (t=1.232),gas filled eyes (x2=0.324) between the two groups were not statistically significant (P＞0.05).The average follow-up time after surgery was 4.5 months.The BCVA,retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed.U-shaped or V-shaped retina was defined as MH closure.Results At the last follow-up,retinal reattachmnents were achieved in all the eyes.In ILM peeling group,5 eyes (27.8％,5/18) were completely closed in type Ⅰ.In ILM inverted group,9 eyes (81.8％,9/11) were completely closed in type Ⅰ.There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (x2=5.968,P=0.015).The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24± 0.28 and 0.97 ± 0.39,respectively.The difference of logMAR BCVA between the two groups was statistically significant (t=2.179,P=0.038).Conclusion Vitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.
ABSTRACT
Objective To observe the changes of retinal microstructure in lamellar macular hole (LMH)after vitrectomy.Methods A retrospective clinical observational study.Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People's Hospital from January 2014 to September 2018 were included in this study.Among them,14 patients (15 eyes) were males and 26 patients (26 eyes) were females,with an average age of 67.8±8.6 years.There were 37 eyes with a lens and 4 eyes with an IOL.There were 29 eyes with LMH of tractional type,7 eyes of degenerative type,and 5 eyes of mixed type.All patients underwent BCVA and OCT examinations.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The average logMAR BCVA was 0.57±0.27;the mean macular retinal thickness (CRT) was 192.3 ± 108.9 μtm,the mean macular thickness (MRT) was 427.5± 110.2 μm.Among the 29 eyes of tractional type,there were 17 eyes with retinal cavity,8 eyes with macular retinoschisis,and 3 eyes with incomplete ellipsoid zone.Among the 7 eyes of degenerative type,there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP),5 eyes with retinal cavity,and 5 eyes with incomplete ellipsoid zone.Among the 5 eyes of mixed type,2 eyes with LHEP,1 eye with macular epiretinal membrane,and 4 eyes with incomplete ellipsoid zone.The average follow-up time after surgery was 12.8±5.2 months.Among them,10 eyes were followed up for equal or greater than 24 months.After the surgery,the same equipment and method before the surgery were used for relevant examination.The changes of BCVA,CRT,and MRT before and after surgery were observed.Continuous variables were compared by t test.Results At the last follow-up,the mean logMAR BCVA was 0.37± 0.26.Compared with before surgery,the difference was statistically significant (t=5.98,P＜0.01).The mean CRT and MRT were (245.2 ± 90.8) and (347.0 ±46.7) μtm,respectively.Compared with before surgery,the differences were statistically significant (t=-2.49,-5.24;P＜ 0.05,＜ 0.01).CRT and MRT changed greatly within 6 months after surgery,and then tended to be gentle.Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery,ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye.Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery,there were still 4 eyes with retinal cavity,but all the retinoschisis were disappeared.Among the 5 eyes with retinal cavity of degenerative type before surgery,there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone.Among 10 eyes with a follow-up time of equal or greater than 24 months,the macular ganglion cell complex partially atrophied in 6 eyes,and the nerve fiber layer separated in 2 eyes.There was no full-thickness macular hole after surgery.Conclusion For most LMH patients,vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.
ABSTRACT
Objective To evaluate the therapeutic effects of flute-needle vacuum assistant hole closure technique for large idiopathic macular hole (IMH).Methods The clinical data of 25 eyes with IMH of 408-939 μm in 23 patients who received pars plana vitrectomy with internal limiting membrane (ILM) peeling and flute-needle vacuum assistant hole closure technique from Feburary in 2017 to June in 2018 in Peking University International Hospital were retrospectively analyzed.The changes of best corrected visual acuity (BCVA) before and after operation were evaluated.The shapes of the hole closure were categorized,and the manifestations of outer retina were observed by optical coherence tomography (OCT),including external limiting membrane (ELM) and ellipsoid zone(EZ).Results The hole closure rate after surgery were 100％ (25/25),with the U type closure in 16 eyes and V type closure in 9 eyes.The BCVA was 0.76 ± 0.27 after operation,which was significantly improved in comparison with 1.05 ±0.29 before operation (t =3.61,P =0.01).The ELM of OCT image was (1 050.00±380.39)μm before operation,and that after operation reduced to (623.32 ± 328.66) μm,showing a significant difference between them (t =6.63,P=0.00).A fully reduced EZ band was seen after operation in comparison with before operation ([1 147.28±354.41] μm versus ([818.28±247.33] μm) (t=4.12,P=0.00).Conclusions A combination procedure of vitrectomy with flute-needle vacuum assistant hole closure technique is effective for large IMH,which is beneficial to the anatomical repair and functional recovery of outer retina.
ABSTRACT
ABSTRACT Purpose: To compare postoperative changes in retinal nerve fiber layer thickness in patients with macular holes treated with vitrectomy with Brilliant Blue-assisted internal limiting membrane peeling. Methods: Twenty-two eyes of 20 patients with macular holes were studied. Each eye was selected to undergo Brilliant Blue-assisted internal limiting membrane peeling. The circumferential retinal nerve fiber layer thickness was determined using spectral domain optical coherence tomography preoperatively and 2 months postoperatively. Mean overall and sectoral retinal nerve fiber layer thicknesses were obtained for each patient. Results: There was no statistically significant difference (p≥0.05) between the pre- and post-treatment measurements in relation to each CFN variable, i.e., on average, pre-treatment measures were the same as post-treatment measures. Furthermore, despite the differences between the pre- and post-treatment measures always being positive (pre-post >0), they are not statistically significant. Conclusions: This study showed no significant decrease in retinal nerve fiber layer thickness measurements after macular holes surgery, regardless of age or sex.
RESUMO Objetivo: Comparar as alterações pós-operatórias na espessura da camada de fibras nervosas da retina em pacientes com buracos maculares submetidos à vitrectomia via pars-plana associada à remoção de membrana limitante interna. Métodos: Foram estudados 22 olhos de 20 pacientes consecutivos diagnosticados com buraco macular. Todos os pacientes foram submetidos à vitrectomia via pars-plana e remoção de membrana limitante interna corada com azul brilhante. A espessura da camada de fibras nervosas da retina em região peripapilar foi determinada por tomografia de coerência óptica de domínio espectral antes e 2 meses após a cirurgia. As espessuras totais e espessuras setoriais da camada de fibras nervosas da retina foram obtidas para cada paciente. Resultados: Os resultados mostram que não existe diferença estatisticamente significativa (p≥0,05) entre as medidas pré e pós-operatórias em relação a cada uma das variáveis. Conclusão: Este estudo não demonstrou diminuição significativa nas medidas da espessura da camada de fibras nervosas retinianas após a cirurgia de buraco macular, independente da faixa etária ou sexo.
Subject(s)
Humans , Male , Female , Retina/pathology , Retina/diagnostic imaging , Retinal Perforations/surgery , Vitrectomy/methods , Nerve Fibers/pathology , Postoperative Period , Reference Values , Retina/surgery , Time Factors , Benzenesulfonates , Retrospective Studies , Treatment Outcome , Tomography, Optical Coherence/methods , Coloring Agents , Preoperative PeriodABSTRACT
Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index＜0.7 and provide an alternative basis for IMH.Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index ＜0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (4-8 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA),central vision,direct ophthalmoscope examination,slit lamp microscope with preset lens,optical coherence tomography (OCT),intraocular pressure,Amsler grid table and fundus photography inspection were performed before surgery and 1 month,6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image,U-like closure was thought to be normal fovea,V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation,43 cases had U type closure,1 case had V type closure and 1 case had W type closure in the extensive ILMP group,while 33 cases had U type closure,1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month,6 months and 12 months (all at P＜0.05).Compared with preoperation BCVA,the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma:x2 =80.98,56.99,both at P＜0.05;paracentral scotoma:x2 =88.21,80.98,both at P＜0.05),and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (x2 =4.10,P＜0.05).The closure rate of IMH was 93.75％ in the extensive ILMP group and 77.08％ in the standard ILMP group,showing a significant difference between the two groups (x2 =4.10,P＜0.05).The corrected rate of Amsler grid abnormality was 93.75％ in the extensive ILMP group,which was evidently higher than 75.00％ in the standard ILMP group,with a significant difference between the two groups (x2 =5.06,P＜0.05).Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI＜0.7 are effective,and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.
ABSTRACT
Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy.Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH.There were 9 males (9 eyes) and 22 females (22 eyes),with the mean age of (58.16± 9.10) years.The mean duration of symptoms was (4.97± 5.97) months.The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients.BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR).The mean logMAR BCVA was 1.07± 0.38.The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa).The minimum size of the macular hole (MIN),the base diameter of the macular hole (BASE),the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19± 232.84),(943.63 ± 389.26),(704.72 ± 292.64),(443.84± 72.47) μm,respectively.According to the MIN value,the hole size were divided into small,medium and large group which had 9 eyes,15 eyes,9 eyes,respectively.According to the postoperative OCT characteristics,the healing types of the photoreceptor layer were divided into 0-Ⅳ types.All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents.The mean follow-up was (326.42 ± 157.17) days.The first postoperative OCT characteristics were defined as the early period.The therapy results were evaluated according to the last follow-up time point.BCVA and intraocular pressure before and after operation were compared by paired t test.The postoperative BCVA were compared with preoperative BCVA,MIN,AWMH,AHMH and follow-up using Pearson correlation analysis.Results At the last follow-up,the LogMAR BCVA was 1.52-1.40 in 3 eyes,1.30-0.52 in 22 eyes and 0.40--0.07 in 8 eyes.Compared with preoperative that,the difference was statistically significant (t=-6.023,P＜0.001).The photoreceptor healing was type 0 in 10 eyes (30.3％),type Ⅰ in 4 eyes (12.1％),type Ⅱ in 10 eyes (30.3％),type Ⅲ in 9 eyes (27.3％) at the early postoperative period.The photoreceptor healing was type 0 in 5 eyes (15.2％),type Ⅰ in 5 eyes (15.2％),type Ⅲ in 12 eyes (36.4 ％),type Ⅳ in 11 eyes (33.3％) at the last follow-up.The preoperative size ofIMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=-0.590,P＜0.01) and the last follow-up (r=-0.768,P＜0.01),respectively.The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA,the stage of the macular hole,the size of the macular hole,MIN,BASE,AWMH,AHMH,the healing types ofphotoreceptor layer of the early and the last follow-up after surgery (r=0.500,0.370,0.470,0.435,0.533、0.505,0.462,-0.442,-0.656,P＜0.05).There was no correlation between age,visual decreasing times and follow-up times (r=0.285,0.234,-0.310,P＞0.05).Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
ABSTRACT
Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery.Methods A retrospective case series of 64 eyes of 64 patients affected with IMH.All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C3F8) tamponade.In 35 eyes of 35 patients,the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group).In 29 eyes of 29 patients,the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group).The follow-up was ranged from 6 to 11 months,with the mean follow-up time was 8.4 months.The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test.The duration of the facedown positioning and complications were compared between two groups.Results The period of facedown position was (1.67± 1.28) and (7.65 ± 1.42) days in the SS-OCT group and control group,respectively.The difference of the period of facedown position between the two groups was significant (Z=-6.784,P＜ 0.05).At 6 months after surgery,the hole closure was detected in 30 eyes (85.71％) in the SS-OCT group and in 27 eyes (93.10％) in the control group.There was no difference of hole closure rate between the two groups (x2=0.889,P＞0.05).There was no ocular serious side effect during the follow up,such as leakage of sclera incision,retinal hemorrhage,choroidal hemorrhage and endophthalmitis.In the control group,there were two patients with mild dizziness who underwent symptomatic treatment.There was no systemic side effect during the follow-up in the SS-OCT group.Conclusion Confirming with SS-OCT imaging early closure of macular hole ofIMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning,while achieved a high hole closure rate.
ABSTRACT
The reattachment rate,macular hole (MH) closure rate,visual acuity improvement and redetachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi,posterior scleral staphyloma and macular atrophy.At present,minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD,as it can promote MH closure,and significantly improve the outcome of MHRD.However if this method can improve the postoperative visual function is still controversial.The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane.It can stimulate Müller cell gliosis more effectively,and promote tissue filling in the MH which results in MH closure.It can also promote retinal reattachment and reduce the likelihood of retinal redetachment.This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future.The inserted internal limiting membrane flap technique is relatively easy to perform,induces stable flaps by simple procedures,and can be an essential complement procedure of the inverted internal limiting membrane flap technique.In order to reduce the recurrence rate in the future,it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.