Novel optical coherence tomography findings in a patient with methanol toxicity: a case report

ABSTRACT We report a case of acute methanol toxicity with unique optical coherence tomography findings. A 56-year-old man was referred to our ophthalmology clinic with a history of handmade vodka consumption and vision loss. On ophthalmologic examination, his vision was 20/100 in his right eye and 20/200 in his left eye. Bilateral mild optic disk hyperemia was detected on fundus examination. Because of the severity of systemic symptoms in such cases, it is very difficult to include optical coherence tomography in the ophthalmologic examination. However, we managed to perform optical coherence tomography and recorded shallow subretinal fluid and a prominent middle limiting membrane sign as acute retinal structural changes in the patient. The patient was treated with hemodialysis, intravenous ethanol, and sodium bicarbonate. On the fourth day of treatment, visual acuity improved to 20/20 in both eyes. In addition, the prominent middle limiting membrane sign and subretinal fluid disappeared. In this unusual case, retinal pigment epithelium damage and retinal ischemia may have contributed to the prominent middle limiting membrane and subretinal fluid, which are novel optical coherence tomography findings of methanol toxicity.

Multimodal imaging features of dome-shaped macula with subretinal fluid in adolescents with high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the multimodal image features of dome-shaped macula(DSM)with subretinal fluid(SRF)in adolescents with high myopia, and investigate its typical features and identification methods.METHODS: This is a retrospective study. A total of 21 adolescent patients(39 eyes)who were diagnosed as DSM in high myopic eyes with SRF in the macula area in our hospital from January 2021 to May 2022 were selected. All patients underwent color fundus photography(CFP), fundus autofluorescence(FAF), spectral-domain optical coherence tomography(SD-OCT), optical coherence tomography angiography(OCTA)and electro oculography(EOG). Among them, 18 patients(36 eyes)underwent fundus fluorescein angiography(FFA), and they were followed-up for 12mo to record the change of the central macular thickness(CMT).RESULTS: Fundus examination showed tessellated retina in affected eyes, and the deposition of granular material could be seen in the fovea of the macular area. SD-OCT showed a dome-like bulge of the whole layer in the macular area, localized detachment of the subfoveal nerve epithelial layer, the medium and high reflection attachment on the inner surface of the outer membrane, and the heterogeneous reflection of the retinal pigment epithelium(RPE)layer. FAF showed a mild “bull's eye sign” change in the macular area. FFA showed granular transmitted fluorescence around the foveal avascular zone. En face of OCTA could see a clear boundary of the neuroepithelial detachment zone. When the tangential line corresponds to the ellipsoid zone-RPE layer, the granular high reflection in different sizes scattered in the neuroepithelial detachment zone could be seen, and no obvious choroidal neovascularization(CNV)was formed. During the follow-up of OCTA, SRF in the macular area can be spontaneously increased or absorbed irregularly. EOG indicates that the ratio of light peak to dark trough(LP/DT, i.e. Arden ratio)was normal, with an Arden ratio>1.55. CMT at 1, 3, 6, 12mo(247.10±13.03, 246.62±12.23, 248.05±14.00, 247.92±11.66 μm)during follow-up period were compared with baseline(246.95±11.46 μm), and the difference was not statistically significant(F=0.144, P=0.965).CONCLUSION: Multimodal imaging is helpful in the clinical diagnosis of DSM with SRF in the macula area in high myopic eyes of adolescents, and plays an important role in the differential diagnosis of the early stage of typical Best disease.

A prospective case-control study of intravitreal injection of anti-vascular endothelial factor drugs in the treatment of Coats disease / 中华眼底病杂志

Objective:To investigate the efficacy and safety of traditional laser photocoagulation, laser combined with intravitreal injection of anti-vascular endothelial factor (anti-VEGF) drugs and intravitreal injection of anti-VEGF drugs alone in Coats disease.Methods:The patients diagnosed as Coats disease stage 2B-3A2 in Department of Ophthalmology, Eye and ENT Hospital of Shanghai Medical College of Fudan University from December 2016 to November 2019 were included in this study. Patients were divided into three groups, including laser group, combined group and drug group, according to the different treatment. In the laser group, the initial treatment was traditional laser photocoagulation alone. In the drug group, the anti-VEGF drug was injected into vitreous once a month for three months. The initial treatment of the eyes in the combined group was laser combined with intravitreal injection of anti-VEGF drugs, or laser treatment within 1 week after anti-VEGF drug treatment. The follow-up time was more than 6 months, and best-corrected visual acuity (BCVA), ultra-wide-angle fundus photography, and fluorescein fundus angiography were performed during follow-up. The treatment efficiency, subretinal fluid (SRF), macular edema, BCVA and complications were compared among the three groups.Results:Among 60 patients (60 eyes), there were 55 males (55 eyes) and 5 females (5 eyes), with the mean age of 17.1±2.0 years. Among 60 eyes, there were 26 eyes in 2B stage, 23 eyes in 3A1 stage, and 11 eyes in 3A2 stage. Twenty patients (20 eyes) was in the laser group, combined group and drug group, respectively. After the initial treatment of all eyes in the drug group, the abnormal blood vessels did not regress significantly; the absorption and increase of SRF were 4 (20.0%, 4/20) and 5 (25.0%, 5/20) eyes, respectively. Supplementary laser therapy was given to 16 eyes, and vitrectomy (PPV) was given to 4 eyes. Among the 16 eyes treated by laser, 10 eyes were effective (50.0%, 10/20); vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract occurred in 1, 1, and 2 eyes during the treatment, respectively, and PPV was given again in all eyes. Recurrent and persistent macular edema occurred in 4 and 1 eyes, respectively. Among the eyes in the combined group, treatment were effective in 11 eyes (55.0%, 11/20); 5, 2, and 2 eyes had SRF, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again; the edema was repeated and persisted in 1 eye, respectively. Among the affected eyes in the laser group, 15 eyes (75.0%, 15/20) were treated effectively; 2, 2, and 1 eyes developed a large number of vitreous hemorrhage, fibrous membrane hyperplasia, and complicated cataract during the treatment, and PPV was given again.Conclusions:Anti-VEGF drugs alone are ineffective in the treatment of Coats disease, and ablation of other abnormal blood vessels is needed. In the treatment of Coats disease, anti-VEGF drugs can not only promote the absorption of SRF, but also may lead to its increase, and the application should be cautious.

Change of subretinal fluid thickness and choroidal thickness after scleral buckling surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate subfoveal subretinal fluid thickness(SFT)and subfoveal choroidal thickness(CT)after scleral buckling surgery(SBS)for macula-off rhegmatogenous retinal detachment(RRD).<p>METHODS: Retrospective observational case series. Twenty-three patients with macula-off RRD underwent successful SBS combined with cryotherapy. Patients with recurrent retinal detachment and proliferative preretinal membranes were excluded. Optical coherence tomography(OCT)was used to measure subfoveal SFT and subfoveal CT. The OCT images were then evaluated preoperatively and postoperatively at 1wk, 1, 3, 6, and 12mo. Best-corrected visual acuity(BCVA)was measured preoperatively and postoperatively.<p>RESULTS: All of the patients had subretinal fluid 1wk after operation. Subfoveal SFT gradually reduced over time. The subfoveal CT was thicker 1wk postoperatively and gradually decreased subsequently. The BCVA(mean±SD, LogMAR)was 0.60±0.35, which was a statistically significant change from the preoperative BCVA(<i>t</i>=6.35, <i>P</i><0.01).<p>CONCLUSION: The subretinal fluid was gradually absorbed with time, and the subfoveal CT gradually decreased after the early thickening. The SBS rapidly improved the visual acuity of the patients after the early postoperative period.

Circumscribed choroidal hemangioma: An overview of clinical manifestation, diagnosis and management

Circumscribed choroidal hemangioma is a benign vascular tumor which presents in middle-aged adults with progressive diminution of vision, metamorphopsia, floaters, and visual field defects. Diagnosis is based on the characteristic clinical features. It is an orange-red, usually solitary, tumor situated in the posterior pole. The visual symptoms are because of the associated subretinal fluid, cystoid macular edema, and, in long-standing cases, retinal pigment epithelium changes, subretinal fibrosis and retinoschisis. It must be distinguished from the more ominous amelanotic melanoma and choroidal metastasis. Diagnostic tools such as ultrasound, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography are helpful in cases with diagnostic dilemma. Treatment is indicated in symptomatic cases. The management of choroidal hemangioma has evolved over the years beginning with laser photocoagulation to transpupillary thermotherapy, photodynamic therapy, plaque brachytherapy and external beam radiotherapy. No one therapeutic option holds superiority over the other. In this article, we review the epidemiology, clinical manifestations and treatment of the circumscribed variant of choroidal hemangioma.

Subretinal Fluid Drainage through Original Breaks without Perfluorocarbon Liquid for Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate the efficiency of a surgical method using original breaks to drain subretinal fluid without using retinotomy and perfluorocarbon liquid for patients with rhegmatogenous retinal detachment (RRD). METHODS: A retrospective chart review comparing 41 eyes of 41 patients who received vitrectomy, and used original breaks to drain subretinal fluid without using perfluorocarbon liquid, and 40 eyes of 40 patients who received vitrectomy using perfluorocarbon liquid for simple RRD between February 2014 and December 2017 was conducted. All patients were followed for a minimum of 6 months after surgery. RESULTS: The primary anatomical success percentages were 97.6% and 97.5% for groups that did not and did use perfluorocarbon liquid, respectively. Retinal detachment recurred in one eye from both groups. The final success percentage was 100%. The preoperative mean logMAR best-corrected visual acuity (BCVA) of 0.87 ± 0.80 improved to 0.30 ± 0.30 at postoperative 6 months for the group that did not use perfluorocarbon liquid, while it improved from 0.86 ± 0.71 to 0.42 ± 0.52 for the group that did use perfluorocarbon liquid. Both groups showed significant BCVA improvement (p < 0.01). There was no significant difference in the incidence of complications caused by the use of perfluorocarbon liquid. CONCLUSIONS: Using original breaks to drain subretinal fluid without perfluorocarbon liquid in cases with RRD may be an effective and safe surgical technique for functional and anatomical recovery without serious complications.

Novel techniques in scleral buckling

Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. With the introduction of pars plana vitrectomy (PPV), there is a growing trend towards the use of PPV for treatment of retinal detachment. There is a reluctance to perform scleral buckling (SB) in RRD due to the perceived steep learning curve, declining mastery over indirect ophthalmoscopy, and poor ergonomics associated with SB. In this article, we discuss the surgical challenges and tips to overcome these in four headings: localization of the break, retinopexy, SB, and subretinal fluid (SRF) drainage. Localization of the break can be performed by the use of forceps or illuminated scleral depressor. It can be facilitated by prior drainage of SRF in cases with bullous RRD. Chandelier with wide-angle viewing system can be used for easier localization of break and cryopexy. Sutureless buckling and suprachoroidal buckling are easier and faster alternatives to the conventional technique. Reshaping the silicone segment helps in accommodating the wider circumferential band. Modified needle drainage, laser choroidotomy, and infusion-assisted drainage can make SRF drainage easier and safer. The above techniques and other practical tips have been explained in detail with the illustrations to make the process of learning the art of SB easier.

Research status of subretinal fluid in rhegmatogenous retinal detachment after scleral buckling surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Rhegmatogenous retinal detachment is an eye disease that can lead to blindness. Timely and effective surgical treatment is the key to cure this disease, including pars plana vitrectomy and scleral buckling surgery, at present. Scleral buckling is a simple and effective treatment for the uncomplicated retinal detachment, but the recovery of visual acuity is influenced by many factors. The subretinal fluid is an important factor that can lead to the delayed recovery of visual acuity. This review is aimed at the present study of subretinal fluid after scleral buckling surgery.

Spectral domain-OCT analysis of the macula after scleral buckling surgery for macula-off RRD / 中国医师杂志

Objective To study the effectiveness of scleral buckling without subretinal fluid drainage for macula-on rhegmatogenous retinal detachment (RRD),and to analyze the correlation between bestcorrected visual acuity (BCVA) and the height of foveal subretinal fluid as well as the thickness of central retina measured by optical coherence tomography.Methods The medical records of 27 patients (27 eyes)who underwent scleral buckling without subretinal fluid drainage for macula-on RRD were retrospectively analyzed.The BCVA,height of foveal subretinal fluid and central subfield thickness (CST) were evaluated preoperatively and 1 week,1 month,3 months,6 months and 12 months postoperatively.Results Postoperative BCVA of all eyes were improved significantly (P ＜ 0.05),and no significant improvement of BCVA was observed after 3 months postoperatively.After surgeries,the height of foveal subretinal fluid as well as the thickness of central foveal retina were correlated with the length of postoperative period significantly,respectively (P ＜ 0.05),but had no correlation with the improvement of postoperative BCVA (P ＞ 0.05).Conclusions Scleral buckling without subretinal fluid drainage for macula-off RRD improved the BCVA,especially in the first 3 months postoperatively.The postoperative alterations of subretinal fluid and central foveal retinal thickness had no correlation with BCVA.

Advance on persistent subretinal fluid after scleral buckle for rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

·Delayed absorption of limited subretinal fluid occurs in some patients with rhegmatogenous retinal detachment (RRD) after scleral buckling. The macular-off patients may be effected more on visual function. The progress of recent researches on the epidemiology, diagnosis, pathogenesis and treatment of persistent subretinal fluid with rhegmatogenous retinal detachment has been summarized in this article. 视网膜下积液延迟吸收的情况,黄斑区受累者可能对视功能的影响更显著.本文就近年来RRD术后持续性视网膜下液(persistent subretinal fluid,PSF)的流行病学、检查方法、致病因素及发病机制、治疗及预防等方面的研究进展进行综述.

Clinical Manifestations of Steroid-associated Central Serous Chorioretinopathy

PURPOSE: To evaluate the clinical differences between patients with central serous chorioretinopathy (CSC) developed after steroid use and CSC patients without a history of steroid use for short-term periods. METHODS: We retrospectively analyzed the medical records of 47 patients (55 eyes) diagnosed with CSC from January 2011 to August 2017 by categorizing Group 1 (32 patients, 36 eyes) without a history of steroid use and Group 2 (15 patients, 19 eyes) with a history of steroid use within 6 months. We evaluated the differences in best-corrected visual acuity (BCVA), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and Haller's layer thickness in the two groups. We also analyzed the changes in the BCVA, SRF height, SFCT, and Haller’s layer thickness in each group for 1 month and compared them depending on the treatment. RESULTS: There were no significant differences between the two groups with regard to age, sex, BCVA, bilaterality, number of leakage points, and Haller's layer thickness. Group 2 showed significantly increased SRF height and SFCT than Group 1 (p = 0.002, p = 0.005, respectively). In Group 1, the level of SRF and SFCT were significantly more decreased after 1 month (p = 0.001, 0.015, respectively) in patients with treatment than in those without treatment. In Group 2, the height of the SRF and SFCT were significantly more decreased after 1 month (p = 0.005, 0.002, respectively) in untreated patients compared to treated patients. CONCLUSIONS: CSC patients with a prior history of steroid use have higher serous detachment and a thicker SFCT than those without prior history of steroid use. Therefore, termination of steroid treatment may reduce the SFCT and SRF in steroid-treated CSC patients.

Subretinal fluid drainage combined with intravitreal injection of anti-vascular endothelial growth factor in treatment of severe exudative retinal detachment Coats disease / 眼科新进展

Objective To investigate the effects of subretinal fluid drainage combined with intravitreal anti-vascular endothelial growth factor (VEGF) drugs in the treatment of severe exudative retinal detachment Coats disease.Methods Thirteen patients (13 eyes) with 3B Coats' disease diagnosed at the Eye Center of Tongren Hospital were included in the study.The participants were aged from 1 year to 11 years with a mean age of (4.15 ± 2.99) years.The visual acuity was no light perception in 1 case,from light perception to counting finger in 7 cases,from 0.01 to 0.1 in 2 cases,and could not be measured due to young in 3 cases.Patients underwent retinal fluid drainage combined with intravitreal ranibizumab (IVR,0.5 mg,0.05 mL) at the pars plana of ciliary body,and with retinal laser photocoagulation or cryotherapy according to the retinal peripheral vascular activity.During the follow-up,the visual acuity,intraocular pressure,slit lamp,indirect ophthalmoscope and color ophthalmoscope were examined and observed.The abnormal blood vessel change,absorption of subretinal fluid,retinal reattachment and complication were observed.Results Two subretinal fluid drainage were performed in 3 cases,one subretinal fluid drainage in 10 cases.Six cases were combined with two intravitreal injections,4 cases with three intravitral injection,3 cases with intravitreal injection for more than three times.Five cases were treated with simple photocoagulation,3 cases with simple retinal cryotherapy,and 5 cases with laser combined with cryotherapy.In 13 patients,the visual acuity was improved in 2 cases,unchanged in 8 cases,and could not be measured due to young in 3 cases.Eight cases had complete retinal reattachment.No significant postoperative complications occurred during follow-up,such as endophthalmitis,retinal hole and vitreous hemorrhage.Conclusion Subretinal fluid drainage combined with intravitreal injection is an effective method for severe 3B stage Coats disease.

Clinical efficacy of Si Ling San in treatment of acute central serous chorioretinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the clinical effects of traditional Chinese medicine, Si Ling San, on acute central serous chorioretinopathy (CSC).METHODS:We retrospectively analyzed the clinical data of 48 patients (48 eyes) with CSC, among whom 24 were given oral Si Ling San (as treatment group) and the other 24 did not receive any treatment (control group).The baseline and 1 or 3mo follow-up data for the best corrected visual acuity (BCVA), central macular thickness (CMT) and maximum height of subretinal fluid (SRF) were collected and then compared between the two groups.RESULTS:BCVA of the treatment group was not statistically different from the baseline level at 1mo (P>0.05), but it was significantly improved at 3mo (P0.05).The BCVA of the two groups was not significantly different at baseline and 1 and 3mo follow-up (all P>0.05).In the treatment group CMT and SRF at 1 and 3mo were significantly lower than baseline (both P0.05), while they were significantly decreased at 3mo follow-up (both P<0.05).CMT and SRF at 3mo were significantly lower than that at 1mo (both P<0.05).In addition, CMT and SRF of the treatment group at both 1 and 3mo were statistically lower than that of the control group (all P<0.05).CONCLUSION:This study preliminary suggest that oral Si Ling San has the potential to treat acute CSC.But further trials are warranted to study its role in improving the visual function, shortening the duration and reducing the recurrence of CSC.

Retinal Break Adjacent to the Optic Disc Causing Retinal Detachment in a Pathological Myopia

Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break. However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical repair as well as the possible measures to treat the complications.

Clinical observation of scleral buckling with nondrainage of subretinal fluid in the treatment of rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To investigate the clinical effect of scleral buckling with nondrainage of subretinal fluid in the treatment of rhegmatogenous retinal detachment.·METHODS: A total of 111 patients ( 113 eyes ) with rhegmatogenous retinal detachment in our hospital from January 2012 to January 2017 were retrospectively reviewed. All the patients were identified as fulfilling the criteria of rhegmatogenous retinal detachment. Localization and scleral cryotherapy of retinal breaks with binocular indirect ophthalmoscopy in all eyes were performed during the operations. Simple scleral pressure were performed in 98 eyes. Intravitreal injection of sterile air were performed in 15 eyes. Scleral cryotherapy were performed in all cases with retinal degeneration and breaks. Anterior chamber puncture were performed before ligation suture. The final retinal reattachment rate, best corrected vision acuity, intraocular pressure and complications were observed.·RESULTS: The mean follow-up period was 6mo after operation. The final retinal reattachment rate at 6mo was 97. 4%. There were 91 eyes (80. 5%) with improved visual acuity after operation. High intraocular pressure can be controlled after operation. Complications were occurred in 7 eyes in the operation, 3 eyes postoperatively.·CONCLUSION: The surgery of scleral buckling with nondrainage of subretinal fluid have few complications and is effective.

Líquido subretiniano luego de cirugía exitosa de agujero macular idiopático, ¿Un Problema? / Subretinal fluid after successful idiopathic macular hole surgery. Is it a problem?

Objetivo: Determinar la incidencia de líquido subretiniano luego de cirugía exitosa de agujero macular y su impacto sobre la agudeza visual final. Diseño del estudio: Estudio retrospectivo y descriptivo. Métodos: Se analizaron 32 ojos de 32 pacientes con diagnóstico de agujero macular tratado con vitrectomía más pelaje de la membrana limitante interna; se calculó la incidencia de líquido subretiniano según los hallazgos de la tomografía de coherencia óptica del postoperatorio y se realizó comparación de variables entre los subgrupos con y sin presencia de líquido. Resultados: Se obtuvo una incidencia de líquido subretiniano de 15.6%, sin evidenciarse una diferencia estadísticamente significativa entre los subgrupos con y sin líquido para las variables de edad, género, estado del cristalino, diámetro del agujero, posición postquirúrgica, agudeza visual mejor corregida prequirúrgica y postquirúrgica a los a los 3 y a los 6 meses. Se identificó menor cronicidad en los agujeros con presencia de líquido subretiniano que en aquellos que no lo presentaban. Conclusiones: Los resultados obtenidos en este estudio, apoyan la teoría que sugiere que la presencia de líquido subretiniano no influye sobre la agudeza visual final alcanzada luego de vitrectomía más pelaje de la membrana limitante interna para el tratamiento de agujero macular. Además, se documentó una incidencia de líquido subretiniano inferior a la reportada previamente en la literatura, lo cual podría estar relacionado con la técnica quirúrgica utilizada.

Objective: To determine subretinal fluid incidence after successful macular hole surgery and its impact on visual recovery. Study design: Retrospective and descriptive study. Methods: 32 eyes of 32 patients with macular hole that were managed with vitrectomy and internal limiting membrane peeling were analyzed. Subretinal fluid incidence was calculated according to postoperative optical coherence tomography findings and subgroups with and without subretinal fluid were compared. Results: We found a subretinal fluid incidence of 15.6%, with no statistically significant differences between subgroups for age, sex, lens status, hole diameter, postsurgical position, presurgical and postsurgical best corrected visual acuity at 3 and 6 months. The holes with subretinal fl uid were less chronic compared with the holes without fluid. Conclusions: This study supports the theory that proposes no influence of subretinal fluid in the visual recovery after vitrectomy with internal limiting membrane peeling for macular hole treatment. Additionally, the subretinal fluid incidence reported here is the lowest in literature; this could be explained by the surgical technique used.

Effect on macular structure and visual acuity after scleral buckling and pars plana vitrectomy for macula-off rhegmatogenous retinal detachment / 中华实验眼科杂志

Background The patients who have undergone successful surgery for retinal detachment (RD) cannot recover their vision quickly,and the reason is not very clearly now.Objective This study was to compare the ellipsoid zone integrity in macula and frequency and duration of subretinal fluid after scleral buckling and pars plana vitrectomy (PPV) in primary macula-off rhegmatogenous RD,and to discuss the sequent influence of subretinal fluid on postoperative visual acuity.Methods A retrospective analysis was carried out on 66 cases of rhegmatogenous RD in Peking University People's Hospital from January 2010 to January 2013.All the cases were divided into 2 groups:scleral buckling group and PPV group.The courses of disease,refractive status,best corrected visual acuity (BCVA) and complications were recorded.The duration of subretinal fluid and ellipsoid zone integrity in macula were observed and the occurrence rates of subretinal fluid were calculated 1 month after surgery.Results There were no statistic differences on age,gender,courses of disease,refractive status and LogMAR visual acuity (all at P＞0.05).The average duration of subretinal fluid was (96 ±60) days in scleral buckling group,and (21 ±6) days in PPV group,with a statistically significant difference between the two groups (t =7.966,P =0.000).The occurrence rate of subretinal fluid at 1 month after surgery was 78.6％ in the scleral buckling group and 12.5％ in the PPV group,with a statistically significant difference between the two groups (x2=26.891,P =0.000).The LogMAR visual acuity was significantly different between the patients with and without subretinal fluid at 1 month after scleral buckling surgery (t=3.185,P=0.003).The LogMAR visual acuity was not significantly different between the scleral buckling group and PPV group 6 months after scleral surgery (t =1.876,P =0.065).The LogMAR visual acuity was not significantly different between the patients with and without subretinal fluid at 6 month after scleral buckling surgery (t =1.755,P=0.087).After the subretinal fluid was reabsorbed,the LogMARs visual acuity were significantly different between the patients with intact ellipsoid zone and with disrupt ellipsoid zone in both groups (scleral buckling group:t=2.555,P=0.015;PPV group:t=4.005,P=0.001).Conclusions The disruption extent of the ellipsoid zone is related to the duration of RD,and the integrity affects the postoperative visual acuity distinctly.The subretinal fluid is removed more rapidly after PPV when compared with scleral buckling in macula-off rhegmatogenous RD.The subretinal fluid delays visual recovery postoperatively but the operation method does not influence final visual acuity seriously.

Relation of severity of rhegmatogenous retinal detachment with the levels of amino acids and VEGF in the serum and in the subretinal fluid / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract? AIM: To analysis the relation of severity of rhegmatogenous retinal detachment with the levels of amino acids and vascular endothelial growth factor ( VEGF) in the serum and in subretinal fluid.? METHODS: Forty -eight patients ( 52 eyes ) with rhegmatogenous retinal detachment treated in our hospital were selected.According to the degree of retinal detachment, patients were divided into 3/4 quadrant group. Fifty-five healthy objects for physical examination in our hospital were selected as the control group, to compare the differences of amino acids and VEGF levels in the serum.Correlation analysis on VEGF levels and amino acids in the serum and in subretinal fluid among patients with different grades of rhegmatogenous retinal detachment was conducted.? RESULTS: In patients with rhegmatogenous retinal detachment, the tryptophan in serum was 28.59±4.46mg/L, phenylalanine 8.95 ±2.55mg/L, methionine 8.15 ±2.17mg/L, valine 28.62 ±5.29mg/L, histidine 18.96 ±1.85mg/L and VEGF 589.92 ±185.34μg/L, which were higher than those in the control group, and the difference was statistically significant(P3/4 quadrant group, which were significantly higher than those in the <1/2 quadrant group and 1/2-3/4 quadrant group ( P<0.05). VEGF in the subretinal fluid of VEGF in the rhegmatogenous retinal detachment group were positively correlated with phenylalanine (r=0.542, P<0.001), and histidine (r=0.782, P<0.001).?CONCLUSION: The levels of amino acids and VEGF in the subretinal fluid of patients with rhegmatogenous retinal detachment was higher than those in normals and increased with the severity of retinal detachment.

Clinical outcomes of complete or partial subretinal fluid drainage for macula-off rhegmatogenous retinal detachment with peripheral breaks / 中华眼底病杂志

Objective To compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD).Methods Following the clinical detection of a maculaoff RRD with peripheral retinal breaks,patients were offered the opportunity to enroll in the study,and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study,and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD,1∶ 1) using a random number table.Seventy-two eyes of 72 patients were enrolled and studied.Patients were treated with 25G plus vitrectomy,endolaser or transscleral cryopexy,either complete (n=36),or partial (n=36) subretinal fluid drainage,and 14％C3F8 (PFO) was used for intraocular tamponade.After surgery,all patients were kept in a supine position for 24 hours,and then in a clinically optimal position for 6-10 days.The study patients were examined at 1,3 and 6 months after surgery with thorough ophthalmic examinations.Macular optical coherence tomography (OCT) imaging was acquired in 1 month.Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared.Furthermore,the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded.The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point.Results The preoperative baseline characteristics between the two groups were not significantly different.The single-operation success rates were 88.9％ and 91.6％ respectively for the CSFD and the PSFD groups (x2 =0.158,P＞0.05).The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99± 0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564).The mean operative time was longer in the CSFD group (62.25± 4.32) minutes than that in the PSFD group (47.9 ± 5.0) minutes (t =0.580,P=0.564).seven of 29 (24.1％) phakic eyes in the CSFD group had lens injury during SRF drainage,and none of the 31-phakic eyes in the PSFD group sustained lens damage.Residual PFO was present in 6 of 36 CSFD cases (16.7％).Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid.Among these patients,22 patients (62.5％) in the CSFD group and 23(69.7％) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00).Conclusions Partial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective.The success rates are not statistically different.Additionally,PSFD procedures can simplify the surgery procedure,shorten operative time and,and to some extent,reduce the incidence of complications relevant to the CSFD approach.

Intravitreal aflibercept treatment in eyes with exudative age‑related macular degeneration following prior treatment with intravitreal ranibizumab.

Background: To investigate visual and anatomical outcomes in eyes with exudative age‑related macular degeneration treated with intravitreal aflibercept following prior treatment with intravitreal ranibizumab. Materials and Methods: Retrospective, single‑center study of 192 eyes treated with 0.5 mg intravitreal ranibizumab every 4 weeks for three consecutive doses followed by a variable dose schedule. After more than 12 months of ranibizumab treatment, eyes that required ranibizumab injections at 4‑week or 6‑week intervals were switched to aflibercept therapy. Results: After 12–69 months (42 months ± 18 months, mean ± standard deviation [SD]) of treatment with intravitreal ranibizumab, 80 eyes were changed to 2 mg intravitreal aflibercept treatment with follow‑up after 12–18 months (16 months ± 1 month, mean ± SD). Thirty‑nine eyes had persistent macular fluid after treatment with ranibizumab. Mean logMAR visual acuity (VA) in eyes treated with ranibizumab changed by − 0.089 ± 0.310 (mean ± SD; P = 0.0003), which correlates to an approximate gain of 4.5 letters. The number of eyes with macular fluid decreased from 39 to 23 after aflibercept treatment. Mean logMAR VA in eyes with intraretinal macular fluid treated with aflibercept changed by −0.079 ± 0.134 (mean ± SD; P = 0.006), which correlates to an approximate gain of 4 letters. Mean logMAR VA in eyes with submacular fluid was not significantly different after aflibercept treatment. Conclusion: Eyes with persistent intraretinal macular fluid had visual and anatomic response after changing from ranibizumab to aflibercept treatment.