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AIM: To observe the imaging characteristics of the affected eyes of patients with central serous chorioretinopathy(CSC)of different ages and their asymptomatic fellow eyes.METHODS: Retrospective study. A total of 76 cases(88 eyes)of CSC patients diagnosed in the ophthalmology department of our hospital from April to September, 2023 and 35 cases(35 eyes of asymptomatic fellow eyes of patients with unilateral CSC)were selected for the study. According to age, they were divided into young and middle-aged groups(<40 years old), middle-aged groups(40-50 years old)and middle-aged and elderly groups(>50 years old). The imaging features of the affected eyes of CSC patients of different ages and their asymptomatic fellow eyes were observed.RESULTS: The subfoveal choroidal thickness(SFCT)of CSC eyes in the young and middle-aged patients(487.30±83.33 μm)was significantly greater than that of the middle-aged group(414.17±96.02 μm, P<0.05)and the middle-aged and elderly group(409.4±107.42 μm, P<0.05). The incidence of choroidal neovascularization(CNV)in CSC patients of the middle-aged and elderly group was significantly higher than that in the young and middle-aged group(P<0.0167). The SFCT of the asymptomatic fellow eye of the unilateral CSC patient in the young and middle-aged group(511.29±40.89 μm)was significantly larger than that of the middle-aged and elderly group(364.76±82.26 μm, P<0.05). Among them, the vortex vein anastomosis rate in eyes with CSC is higher than 90%, and vortex vein anastomosis or dilatation is present in all asymptomatic fellow eyes of CSC patients.CONCLUSION: There are differences in the imaging manifestations of CSC-affected eyes and their asymptomatic fellow eyes of different age groups. SFCT is generally thickened and gradually becomes thinner with the growth of age. The incidence of CNV in CSC-affected eyes is the highest in the middle-aged and elderly group. In addition, vortex vein anastomosis and dilatation are common in CSC-affected eyes and asymptomatic fellow eyes.
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Objective:To observe the anastomotic status of the vortex veins in patients with central serous chorioretinopathy (CSC).Methods:A cross-sectional study of clinical practice. From July 2021 to July 2022, 50 cases (50 eyes) of monocular CSC patients diagnosed through ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, there were 37 males (74.0%, 37/50) and 13 females (26.0%, 13/50), with the mean age of (44.30±9.59) years old. The course of disease from the onset of symptoms to the time of treatment was less than 3 months. The affected eye and contralateral eye of CSC patients were divided into the affected eye group and contralateral eye group, respectively. Fifty healthy volunteers of the same age and gender were selected as the normal control group with 50 eyes. The macular area scanning source optical coherence tomography (OCT) vascular imaging examination was performed with Visual Microimaging (Henan) Technology Co., Ltd. VG200D. Horizontal watershed vortex veins anastomosis rate and asymmetric vortex-venous dilation rate were observed by en face OCT. The device comes with software to calculate the central foveal choroidal thickness (SFCT), mean choroidal thickness (MCT), and choroidal vascular index (CVI). One-way analysis of variance and χ2 test were used to compare the three groups. When variances were unequal between groups, nonparametric tests were performed. Results:The SFCT values of the affected eye group, contralateral eye group, and normal control group were (567.12±129.02), (513.26±133.17), (327.64±97.40) μm, respectively; MCT were (407.38±97.54), (388.24±94.13), (275.46±60.55) μm, respectively; CVI were 0.34±0.05, 0.32±0.04, and 0.27±0.04, respectively; anastomosis rates of vortex veins were 98% (49/50), 78% (39/50), and 40% (20/50), respectively; asymmetric dilation rates of vortex veins were 96% (48/50), 88% (44/50), and 48% (24/50), respectively. The differences of SFCT ( F=53.974), MCT ( Z=51.415), CVI ( F=28.082), vortex vein anastomosis rate ( χ2=43.056), asymmetric dilation rate of vortex veins ( χ2=37.728) among three groups were statistically significant ( P<0.001). Compared with the contralateral eye group, the SFCT, MCT, CVI, vortex vein anastomosis rate, and vortex vein asymmetric dilation rate in the affected eye group were significantly higher than those in the contralateral eye group. Among them, the differences of SFCT ( t=2.054), CVI ( t=2.211), and vortex vein anastomosis rate ( χ2=9.470) were statistically significant ( P<0.05); the differences of MCT ( Z=7.490), asymmetric dilation rate of vortex veins ( χ2=2.714) were not statistically significant ( P=1.000, 0.140). Conclusions:SFCT, MCT, and CVI in the affected and contralateral eyes of monocular CSC patients significantly increase. The anastomotic rate and asymmetric dilation rate of the vortex vein in the opposite eye were lower than those in the affected eye.
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Ocular venous air embolism(OVAE)is a rare and fatal complication in vitrectomy. Due to the proximity of the surgical site to the heart and its level above the heart, OVAE may be the most severe complication in the venous air embolism(VAE)caused by surgery. With the development of vitrectomy, perfusion cannulas in the suture-free state may slide outward, and the perfused gas can enter the suprachoroidal space, which results in tearing of the vortex veins. Choroidal vascular wounds resulting from trauma and endoresection of choroidal melanoma can expose directly in the perfused gas during vitreous cavity gas-liquid exchange. This makes it possible that the pressurized gas enters the circulatory system through the torn vortex veins or the anomalous choroidal venous openings, which leads to OVAE. Nowadays, the definition, pathogenesis, clinical presentation and prevention of OVAE are being refined. However, most vitreoretinal surgeons and anesthesiologists are still unaware of this iatrogenic complication. It will be helpful to detect this complication early and make emergency management in time by increasing the awareness of OVAE and develop effective prevention strategies. The prevention and control principles of OVAE can be continuously optimized by the combination of clinical and laboratory studies. It will be conducive to the establishment and improvement of emergency treatment and preventive measures of OVAE to fully understand the pathogenesis and clinical characteristics of OVAE, to pay attention to the characteristics of secondary lesions of OVAE, and to attach importance to multi-disciplinary cooperation.
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Propósito: Determinar la posibilidad de realizar una derivación entre la cámara anterior (CA) y la vena vorticosa, para disminuir la presión intraocular (PIO). Métodos: Se estableció una derivación entre la cámara anterior y una vena vorticosa, en 16 ojos de conejos albinos vivos; el ojo contralateral sirvió como control Estas derivaciones se hicieron con un tubo de teflón, de diámetro externo 0.90 mm y diámetro interno 0.50 mm. Las medidas de la PIO, se hicieron, en ambos ojos, con el tonómetro de Goldmann, 2 o 3 veces a la semana, durante 30, 60, 90, 120, 150 y 180 días. Resultados: Se produjo una reducción significativa en la PIO, entre el ojo intervenido y el ojo control. Dichas reducciones fueron entre el 40 y 50%. Se comprobó la permeabilidad del tubo; ningún tubo se salió de la vorticosa; tampoco hubo penetración del tubo hacia la cámara anterior. Así mismo ningún tubo se movió hacia atrás ni se salió de la cámara anterior. No se observaron precipitados queráticos, ni sinequias ni daño en el cristalino. No se evidenció prolapso del iris, filtración en la herida, infección o hifema. Microscópicamente no hubo trombosis de la vena vorticosa. Conclusiones: Los resultados, corroborados mediante microscopio, prueban la viabilidad de una derivación acuoso-vorticosa para disminuir la PIO, en modelos animales.
Purpose: To determine the possibility of performing a shunt between the anterior chamber (AC) and the vortex vein, to decrease intraocular pressure (IOP). Methods: A shunt was created between the anterior chamber and the vortex vein, in 16 eyes of albino rabbits; the contralateral eye served as control. These shunts were made with a Teflon tube, 0.90 mm diameter external and 0.50 mm internal diameter .The IOP measurements were made in both eyes, with the Goldmann tonometer 2 to 3 times per week, for 30, 60, 90, 120, 150 and 180 days. Results: There was a significant reduction in IOP between the operated eye and the control eye. These reductions were between 40 and 50%. Permeability of the tube was found; no tube was moved out from the vorticosa; there was no penetration of the tube into the anterior chamber. Also no tube reversed nor overshot the anterior chamber. No keratic precipitates, synechiae or damage to the lens were observed. There was no evidence of iris prolapse, filtration or infection of the wound or hyphema. Microscopically there was no vortex vein thrombosis.Conclusions: The results, proven microscopically, showed the feasibility of an aqueous- vortex vein shunt to decrease IOP in animal models.
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Animales , Implantes de Drenaje de Glaucoma , Glaucoma , Presión Intraocular , Procedimientos Quirúrgicos OftalmológicosRESUMEN
There are no known data of recession point of inferior oblique muscle (IO) in Korean.The purpose of this study was to determine the accurate reinsertion point of IO and compare the previous data with ours.Thirty-one Korean cadaver orbits were dissected to expose the full length of extraocular muscles and sclera, and then we measured the length from the recession point of IO to lateral edge of insertion of inferior rectus muscle (IR)and to inferior edge of insertion of lateral rectus muscle (LR).Eight mm recession point of IO was measured 6.9 +/-0.6 mm posteriorly along the inferior border of LR from inferior edge of LR insertion, and 4.6 +/-1.5 mm inferiorly.For 10 mm recession, it was 5.6 +/-1.3 mm posteriorly and 6.6 +/-2.0 mm inferiorly.For 12 mm recession, it was measured 4.7 +/-0.7 mm posteriorly and 8.4 +/- 1.5 mm inferiorly.And for 14 mm recession, it was 3.7 +/-1.7 mm posteriorly and 9.5 +/-2.0 mm inferiorly. Eight mm recession point of IO was measured 3.5 +/-0.6 mm posteriorly along the lateral border of IR from the lateral edge of IR insertion, and 6.5 +/-0 .8 mm laterally.For 10 mm recession, it was 2.9 +/-1.0 mm posteriorly and 3.6 +/- 1.0 mm laterally.For 12 mm recession, it was measured 3.3 +/-0.6 mm posteriorly and 2.3 +/-0.6 mm laterally.For 14 mm recession, it was 3.0 +/-1.5 mm posteriorly and 0.5 +/-0.9 mm laterally.The cord length on a straight line from 14 mm recession point of IO to the scleral exit site of the inferior temporal vortex vein was 6.6 +/-1.4 mm (range 4~9 mm).The distance from IO recession points to IR insertion site and to LR insertion site were compared in ten paired eyes, and the difference was not statistically significant (p>0.05).We made anatomical studies to evaluate the proper placement of scleral reinsertion site of IO in Korean.
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Cadáver , Músculos , Órbita , Esclerótica , VenasRESUMEN
Many surgeons have used the technique of reattachment of the inferior oblique muscle to the scleral exit site of the inferior temporal vortex vein for 14.0 mm inferior oblique muscle recession. We studied the anatomical location of the scleral exit site of the inferior temporal vortex vein to determine whether we could use this site as a landmark for this technique. We examined 65 eyes in 2 to 13 year-old patients in which the location of the inferior temporal vortex vein was exposed during operation. We measured the axial length before operation and the cord length from the lateral point of the insertion of the inferior rectus muscle to the scleral exit site of the inferior temporal vortex vein. The locations of the inferior temporal vortexveins ranged widely from 7.5 to 14.0mm, the average of 9.89 +/-1.53 mm. It had no correlation with age (r=0.14) or axial length (p=0.13). Therefore, further study will be needed to confirm whether the scleral exit site of the inferiortemporal vortex vein can be a good landmark for the 14.0mm inferior oblique muscle recession.