RESUMEN
@#AIM: To evaluate the efficacy of vitreous hemorrhage(VH)in patients with polypoidal choroidal vasculopathy(PCV), and to summarize the clinical characteristics of the cases.<p>METHODS: Retrospective case series. From Jan. 2014 to Dec. 2017, 14 patients(15 eyes)with PCV combined with VH were treated by microincision 25G vitrectomy in our hospital and were followed up for at least 6mo. Data of medical history and follow up observation were collected. The main outcome measures included visual acuity, intraocular pressure, ultrasonography, color fundus photography, fundus angiography, optical coherence tomography, and surgical complications. To analyze the difference of the best corrected visual acuity(BCVA, LogMAR)between pre-operation and postoperation, and to summarize the clinical characteristics and therapeutic effect of the cases.<p>RESULTS: Totally 11 cases had history of hypertension. 9 eyes were diagnosed with PCV before vitrectomy. The follow-up period was from 6-36mo. All 15 eyes were treated with microincision 25G vitrectomy. During the operation, 3 eyes were silicone oil tamponade in the vitreous cavity, 2 eyes were gas tamponade, and the remaining eyes were balanced saline solution tamponade. Postoperative complications included progressed cataract in 2 eyes, recurrent VH in 1 eye, high intraocular pressure in 1 eye, and recurrent retinal detachment in 0 eye. The BCVA before surgery was 2.78±0.46, and the last follow up BCVA after surgery was 1.15±0.50. Postoperative BCVA was significantly improved compared with the preoperation(<i>t</i>=11.14, <i>P</i><0.01).<p>CONCLUSION: Microincision vitrectomy is a safe and effective way to treat PCV with VH, which can improve the visual acuity of patients with PCV companied with VH. The history of hypertension may be a risk factor for PCV with VH.
RESUMEN
Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.
RESUMEN
Objective To observe and analysis the clinical effects and postoperative complications of intravitreal injection of conbercept during vitrectomy surgery (VRS) in severe proliferative diabetic retinopathy (PDR) treatment.Methods This is a prospective non-randomized controlled clinical study.A total of fifty-seven patients (sixty eyes) with severe PDR were enrolled in Tianjin Eye Hospital from June 2015 to March 2016,and the patients were divided into conbercept injection group and control group according to the patients' surgical method intention selection.The patients in conbercept injection group received an intravitreal injection of 0.05 ml conbercept solution during the surgery.The patients in control group only received VRS.The operations of the two groups were completed by the same doctor,and the follow-up time was 6 to 10 months after the surgery.The incidence of postoperative complications including a transient high intraocular pressure,early and late incidence of vitreous hemorrhage(VH),epiretinal membrane and traction retinal detachment (TRD),neovascular glaucoma (NVG),the central retinal thickness (CRT) and the best corrected visual acuity (BCVA) (LogMAR visual acuity) were comparatively analyzed.Results The incidence of early VH was 6.7％ (2/30) in conbercept injection group,which was significantly lower than 26.7％ (8/30) in control group (x2 =4.32,P =0.04).The incidences of late VH were 3.3％ (1/30) and 10.0％ (3/30) in conbercept injection group and control group,and the differences had no statistically significant difference (x2 =1.07,P＞0.05).The incidences of a transient high intraocular pressure,TRD and NVG between the two groups had no statistically significant difference (x2=0.69,0.22,2.07;all at P＞0.05).The change of CRT from one week to one month after the operation in conbercept injection group was more remarkable than that in the control group,and the difference was statistically significant (t=-3.23,P＜0.05).The mean LogMAR BCVA in two groups at 1 month and 6 months after operation were both improved in different degrees compared with the preoperative vision.The difference of mean LogMAR BCVA at 6 months was statistically significant (P＜0.05).Conclusions The intravitreal injection of conbercept during VRS in severe PDR patients can effectively prevent postoperative early VH,decrease CRT and improve visual acuity.
RESUMEN
·AIM:To compare the short-term surgical results of 27-gauge ( 27G ) with 25 - gauge ( 25G ) microincision vitrectomy surgery ( MIVS ) for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS. · METHODS: Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity ( BCVA, LogMAR ) recovery and intraocular pressure fluctuation. ·RESULTS: All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56. 4±38. 9 min, which was significant longer than that of 27G group (45. 5 ± 26. 1 min, t= 2. 422, P= 0. 016). However, when comparing the surgical time for each category of disease, there were no significant differences observed (P>0. 05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group (2. 1 ± 1. 6, 0. 3 ± 0. 6, and 0. 2 ± 0. 4), with significant differences (P=0. 038, P=0. 011, P=0. 046 respectively). The improvement of BCVA was-0. 4±0. 9 in 25G group, and -0. 2 ± 0. 9 in the 27G groups respectively (t= -1. 636, P = 0. 103 ). The rate of transient ocular hypotony of the 25G vitrectomy was 19. 5% (16 eyes), which was higher than that of the 27G group without significant difference ( 15. 6% , 21 eyes; χ2= 0. 565, P=0. 452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group (3. 59±0. 69mmHg) and the 27G group (3. 58±0. 47mmHg;t=0. 007, P=0. 995). ·CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.
RESUMEN
Objective To observe and analysis the clinical effects and postoperative complications of intravitreal injection of conbercept during vitrectomy surgery ( VRS ) in severe proliferative diabetic retinopathy ( PDR) treatment. Methods This is a prospective non.randomized controlled clinical study. A total of fifty.seven patients (sixty eyes) with severe PDR were enrolled in Tianjin Eye Hospital from June 2015 to March 2016,and the patients were divided into conbercept injection group and control group according to the patients ' surgical method intention selection. The patients in conbercept injection group received an intravitreal injection of 0. 05 ml conbercept solution during the surgery. The patients in control group only received VRS. The operations of the two groups were completed by the same doctor, and the follow.up time was 6 to 10 months after the surgery. The incidence of postoperative complications including a transient high intraocular pressure, early and late incidence of vitreous hemorrhage(VH),epiretinal membrane and traction retinal detachment(TRD),neovascular glaucoma(NVG),the central retinal thickness ( CRT ) and the best corrected visual acuity ( BCVA ) ( LogMAR visual acuity ) were comparatively analyzed. Results The incidence of early VH was 6. 7％( 2/30 ) in conbercept injection group, which was significantly lower than 26. 7％(8/30) in control group (χ2=4. 32,P=0. 04). The incidences of late VH were 3. 3％(1/30) and 10. 0％(3/30) in conbercept injection group and control group,and the differences had no statistically significant difference (χ2=1. 07,P>0. 05). The incidences of a transient high intraocular pressure,TRD and NVG between the two groups had no statistically significant difference (χ2=0. 69,0. 22,2. 07;all at P>0. 05). The change of CRT from one week to one month after the operation in conbercept injection group was more remarkablethan that in the control group,and the difference was statistically significant (t=-3. 23,P<0. 05). The mean LogMAR BCVA in two groups at 1 month and 6 months after operation were both improved in different degrees compared with the preoperative vision. The difference of mean LogMAR BCVA at 6 months was statistically significant (P<0. 05). Conclusions The intravitreal injection of conbercept during VRS in severe PDR patients can effectively prevent postoperative early VH,decrease CRT and improve visual acuity.