Clinical analysis of combined microsurgery for nanophthalmic patients with uncontrolled intraocular pressure after peripheral iridectomy / 中华显微外科杂志

Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.

Modified trabeculectomy in primary acute angle-closure with high intraocular pressure and extremely dilated pupil / 中华显微外科杂志

ObjectiveTo determined the outcome of modified trabeculecotomy (with paracentesis,mitomycin C,scleral flap adjustable suture and formation of anterior chamber at the end of the surgery)in the management of primary acute angle-closure (PAAC) with high intraocular pressure (IOP) and extremely dilated pupil. MethodsTwenty-one eyes of 21 successive cases with PAAC with high lOP(IOP ＞ 30mmHg) and large pupil (maximum vertical diameter ＞ 5 mm) were evaluated prospectively. They underwent modified trabeculecotomy between January 2005 and March 2009.The operative success was defined as IOP ≤ 20 mmHg (± medical therapy) without the necessity of further surgery for glaucoma. ResultsSuccess was achieved in all of the eyes(100％)at the postoperative first week.The mean preoperative IOP was (48.25 ± 3.14) mmHg under a mean number of 3.35 antiglaucomotous medications, but it reduced to (10.47 ± 1.15,P ＜ 0.01) mmHg without medication at the first week, (13.86 ± 0.93,P ＜ 0.01) mmHg at postoperative 3rd month respectively.Only 1 eye needed 1 kind of antiglaucomotous eye drop from the 2nd month postoperatively. The mean vertical diameter of pupils was (5.81±0.23) mm preoperatively, (5.92 ±0.21 ) mm at the first week(P ＞ 0.05). No case received section iridectomy. No serious complication was observed.ConclusionsModified trabeculectomy provides reduction of IOP and protection of pupil in cases with PAAC with high IOP and large pupil,and the procedures such as releasing aqueous humor gradually,appliance of scleral flap adjustable sutures and formation of anterior chamber at the end of the surgery can effectively reduce the risk of serious complications.

Optical coherence tomography's diagnostic value in evaluating surgical impact on idiopathic macular hole / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To identify the characteristics of and evaluate surgical impact on idiopathic macular hole (IMH) by using an optical coherence tomography (OCT) scanner.</p><p><b>METHODS</b>Sixty-five cases (70 eyes) experiencing IMH were examined using OCT, then graded by their clinical characteristics. Nineteen cases (19 eyes) were scanned and measured using OCT before and after surgery.</p><p><b>RESULTS</b>Of the 70 eyes,the number of stage I-IV macular holes were 11, 12, 36 and 11, respectively. For stage I holes, the OCT images revealed flattened or nonexistent fovea and minimally reflective space within or beneath the neurosensory retina; stage II holes appeared to be full-sized with attached operculum and surrounding edema; stage III holes were also full-sized with surrounding edema; finally, stage IV holes were full-sized and completely separated the posterior hyaloid membrane from the retina. Through quantitative measurements, OCT determined that the values for mean hole diameter, mean halo diameter and mean thickness of the hole's edge were reduced from 570.95 +/- 265.59 to 337.05 +/- 335.95 microm, 1043.53 +/- 278.8 to 695.00 +/- 483.00 microm and 389.78 +/- 60.58 to 298.78 +/- 109.80 microm, respectively in 19 IMH cases after surgery. In 17 eyes, the holes or halos eventually closed or were reduced in size, or the edges of the holes thinned out. The anatomic successful rate of the surgery was 89%.</p><p><b>CONCLUSION</b>OCT can exhibit the characteristics of IMH and measure the diameter of holes quantitatively. This method can also judge the surgical impacts of IMH objectively, accurately and effectively.</p>

Quantification of Retinal Nerve Fiber Layer Thickness in Different Orientation in Normal Subjects / 中山大学学报(医学科学版)

【Objective】To measure RNFL thickness (clock type and mean) and investigate the relationship between RNFL thickness and age,gender,and right or left eye in normal subjects using OCT.【Methods】OCT was used in 183 eyes of 104 normal subjects to measure RNFL thickness with circle scan (scan diameter of 3.46mm) around optic nerve head.【Results】RNFL thickness (μm) measured by OCT in normal eyes according to clock type (10:30～、11:30～、12:30～、1:30～、2:30～、3:30～、4:30～、5:30～、6:30～、7:30～、8:30～、9:30～) were 144±14、141±16、135±12、104±17、78±15、90±18、130±16、147±17、145±13、92±16、80±11、103±10,respectively，and mean of whole circle was (116±5) μm.There was a negative correlation between RNFL thickness in temple-superior (10:30～12:30),temple- inferior (5:30～7:30),mean thickness and age (P=0.005～0.000).There was no significant differences between RNFL thickness of various clock and mean (P=0.356～0.781),gender and right or left eye (P=0.155～0.612).【Conclusion】RNFL thickness was thicker in temple-superior (10:30～12:30) and temple-inferior (5:30～7:30),thinner in nasal (2:30～) and temple (8:30～) in normal subjects.The elder of persons,the thinner of RNFL thickness.RNFL thickness was not related to gender and right or left eye.

Effect of central retinal artery occlusion on retinal microstructure of macula in vivo / 中国病理生理杂志

AIM: To investigate the effect of ischemia induced by central retinal artery occlusion on retinal microstructure of macula using optical coherence tomography (OCT). METHODS: Fourteen eyes of 14 patients with unilateral central retinal artery occlusion (CRAO) in two to three days without fully recovery of retinal circulation underwent OCT examination with 4.5 mm length horizontal and vertical line scans through foveola to measure the retinal neurosensory layer (RNL) thickness on foveola, 175 ?m (fovea), 750 ?m (macula) to foveola, respectively. The other normal eyes of patients as control group underwent the same examination and measurement. RESULTS: The mean RNL thickness(?m) on foveola, fovea, macula were 169 91?10 96, 176 36?11 74 and 256 45?16 95 respectively in normal control eyes, and 235 64?47 02 , 241 84?49 36 and 401 57?54 53 respectively in CRAO eyes with retinal ischemia. There was a significant difference in thickness between two group ( P

Optical coherence tomography of choroidal neovascularization of exudative age-related macular degeneration and central exudative chorioretinopathy / 中华眼底病杂志

Objective To investigate the characteristics and analyze the differences of choroidal neovascularization (CNV) image between exudative age-related macular degeneration (AMD) and central exudative chorioretinopathy (CEC) using optical coherence tomography (OCT). Methods Twenty-three eyes of 22 patients with exudative AMD and 20 eyes of 19 patients with CEC, which were diagnosed as CNV using fundus fluorescein angiograph (FFA) or indocyanine green angiograph (ICGA), were exami- ned by OCT. The size of CNV and the thickness of retinal neurosensory layer in foveola were measured by OCT software. Results On OCT image, CNV had three main types of morphological features including simple CNV, CNV with serous retinal neurosensory layer detachment and CNV with choroidoretinal exudation. Exudative AMD mainly showed CNV with choroidoretinal exudation (56.52%) and CEC showed simple CNV (90 0%). The thickness of retinal neurosensory layer in foveola of patients with exudative AMD was thicker than that of patients with CEC and the size of CNV of patients with exudative AMD was larger than that of patients with CEC. Negative correlation was found between retinal neurosensory layer thickness in foveola and vision in both groups (?=-0.521, P =0.001). Conclusions There were certain discrepancy in morphology and area involved of CNV between exudative AMD and CEC on OCT images.

Optical coherence tomography of idiopathic macular epiretinal membranes / 中华眼底病杂志

Objective To study the characteristics of optical coherence tomography (OCT) in idiopathic macular epiretinal membranes (IMEM) and the relationship between the thickness of fovea and the vision of affected eyes. Methods Total of 67 cases (73 eyes) with clinical diagnosis of IMEM by direct, indirect ophthalmoscopy, three mirror contact lens, fundus color photography or fundus fluorescein angiography(FFA) were examined with OCT. Results Epiretinal membranes(ERMs) with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly and partially seperated from the retina (27 eyes, 38.36%), the retinal thickness of the fovea was the thickest in proliferative ERMs and the thinnest in ERMs with laminar macular holes. The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454, P= 0.000 ). Conclusion There were four types of image of OCT in IMEM: ERMs with macular edema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT, the poorer the visual acnity in the affected eyes with ERMs.