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ABSTRACT Purpose: This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. Methods: This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). Results: This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. Conclusion: The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible.
RESUMO Objetivo: Determinar as taxas de fechamento de buracos maculares idiopáticos grandes tratados com vitrectomia posterior e técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça pós-operatório e definir melhora visual, tipos de fechamento do buraco macular e integridade das camadas retinianas externas como objetivo secundário. Métodos: Este estudo foi uma série retrospectiva de casos. Todos os pacientes foram submetidos a vitrectomia com flap invertido 360 graus pediculado de membrana limitante interna e tamponamento com gás, sem posição de cabeça no pós-operatório. Idade, gênero, tempo de redução da acuidade visual, outras patologias oculares e status do cristalino foram compilados. Medida de melhor acuidade visual corrigida e tomografia de coerência óptica foram registradas durante as visitas de pré e pós-operatório (15 dias e 2 meses após cirurgia). Resultados: Vinte olhos de 19 pacientes foram incluídos neste estudo. A idade média foi de sessenta e seis anos. Um total de 19 olhos (95%) atingiu fechamento do buraco, observado através das imagens de tomografia de coerência óptica após 2 meses de cirurgia. Melhor acuidade visual corrigida média aumentou +1,08 pré-operatória para +0,66 LogMAR em 2 meses de cirurgia (p<0,001), com média de 20 letras de melhora visual (0,4 LogMAR) na tabela do Early Treatment Diabetic Retinopathy Study. Dois tipos de fechamento do buraco foram observados: V (47,36%) e U (52,63%). Conclusão: A técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça no pós-operatório promoveu elevada taxa de fechamento (95%), reestabelecimento das camadas retinianas externas, fechamento com contorno foveal dos tipos V e U, além de melhora visual na maioria dos casos de BMI gran des (mesmo nos buracos maiores que 650 μm). Esta técnica pode representar uma alternativa para o tratamento de buracos maculares grandes em pacientes impossibilitados de cumprir o tradicional posicionamento de cabeça pós-operatório.
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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.
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Objective:To study the clinical characteristics of neonatal gastric perforation (NGP) and risk factors of mortality.Methods:From January, 2015 to December, 2021, clinical manifestations of neonates diagnosed with NGP in the Department of Neonatology and Neonatal Surgical Intensive Care Unit of our hospital were retrospectively analyzed. Neonates were assigned into the survival group and the death group according to their prognosis. Risk factors of mortality were analyzed using multivariate logistic regression method.Results:A total of 50 cases were enrolled, including 41 in the survival group and 9 in the death group. 38 cases were males, 34 were premature infants, 30 were low birth weight infants and 5 had history of asphyxia. The clinical manifestations included abdominal distension, tachypnea, cyanosis, poor response, fever, diminished bowel sound and redness of the abdominal wall. Abdominal X-ray indicated pneumoperitoneum. Laboratory abnormalities included leukocytosis, thrombocytopenia, elevated C-reactive protein and procalcitonin, decreased blood pH and increased lactic acid. 30 cases had perforation at the greater curvature of stomach. Perforation was larger than 3 cm in 40 cases and intestinal necrosis was identified in 14 cases. Some patients suffered from sepsis, respiratory failure, pulmonary hemorrhage, shock, coagulopathy and other related complications. The death group had significantly higher incidences of dyspnea, fever, elevated procalcitonin, blood pH<7.3, intestinal necrosis, time from onset of clinical manifestations to operation (Tm-o) >24 h and complications than the survival group ( P<0.05). Multivariate logistic regression analysis showed that pH<7.3 ( OR=9.755, 95% CI 1.363-69.800), Tm-o>24 h (OR=11.831, 95%CI 1.305-107.301), septic shock and sepsis ( OR=29.622, 95% CI 3.728-235.369) were risk factors of mortality. Conclusions:The main manifestations of NGP are abdominal distension and pneumoperitoneum. The risk factors of mortality in NGP are sepsis, blood pH<7.3 and Tm-o>24 h.
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ABSTRACT We report a case of a young woman presenting with decreased vision in the right eye. One month earlier, she developed severe preeclampsia at 22 weeks of gestation and the pregnancy was terminated. Fundus examination revealed cotton wool spots and hard exudates in the macula bilaterally, with a yellow spot at the center of the fovea in the right eye. Optic coherence tomography showed a full thickness macular hole with elevated cystoid edges in the right eye. The patient was diagnosed with macular hole secondary to preeclampsia and followed up for spontaneous closure. One month after the first visit, surgical intervention was suggested due to declining vision. Three months later, the patient agreed to surgery. She underwent pars plana vitrectomy with a temporal inverted internal limiting membrane flap and C3F8 endotamponade, which provided anatomic and visual improvement.
RESUMO Relatamos o caso de uma jovem com diminuição da visão do olho direito. Um mês antes do primeiro atendimento, a paciente desenvolveu pré-eclâmpsia grave com 22 semanas de gestação e interrompeu a gravidez. O exame de fundo revelou manchas algodonosas e exsudatos duros na mácula em ambos os olhos, com uma mancha amarela no centro da fóvea do olho direito. A tomografia de coerência óptica mostrou um buraco macular de espessura total com bordas cistoides elevadas no olho direito. A paciente foi diagnosticada com buraco macular secundário a pré-eclâmpsia e acompanhada para fechamento espontâneo. Um mês após a primeira visita, foi-lhe sugerida a intervenção cirúrgica, devido a um declínio em sua visão. Três meses depois, o paciente aprovou a cirurgia e foi submetida a uma vitrectomia via pars plana com retalho invertido de membrana limitante interna e tampão interno C3F8, o que proporcionou uma melhora anatômica e visual.
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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.
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Background:Background and objective: One of the unfavourable outcomes of endodontic treatment is furcal perforation. Materials such as MTA-Angelus, Biodentine and Zirconomer have been recommended for the repair of furcal perforations.In this study we compared the sealing ability of MTA-Angelus, Biodentine and Zirconia-reinforced GIC in furcal perforations using dye penetration method. Material And Methods:Access cavities were prepared in extracted mandibular molars (n= 40) using round bur in a high speed hand pieceunder water coolant. Perforations were made in the centre of furcation region using 2mm round bur.The teeth were randomly divided into 4 groups based on the material used to seal the perforation: Group I(n= 12) = MTA –Angelus , Group II (n=12)= Biodentine, Group III(n=12) = Zirconomer , Group IV (n= 4) = left unsealed (negative control group).Leakage at the repaired site was then evaluated using methylene blue dye penetration technique under stereomicroscope and data was statistically analyzed.Result:Minimum dye penetration was observed in biodentine followed by MTA, Zirconomer and control group. The results was not statistically significant (p= .08). Conclusion:According to this study, biodentine showed best of the three materials used for furcation repair.
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Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.
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Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.
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High myopia (HM) is one of the main causes of vision loss. In recent years, optical coherence tomography and other techniques have shown a variety of vitreoretinal interface abnormalities (VRIA) in highly myopic eyes. Posterior vitreous detachment and paravascular abnormality are the relatively common manifestations of VRIA. Posterior vitreous detachment is classified in several different ways in HM eyes, the onset age of which is earlier in HM. Paravascular abnormality mainly includes paravascular microfold, paravascular cyst, paravascular lamellar hole, and paravascular retinoschisis. The former two are early-stage lesions, the latter two are advanced lesions. VRIA is closely related to many HM's fundus complications, such as myopic retinoschisis, macular hole, retinal detachment and so on. VRIA may develop into myopic retinoschisis, which in turn develop into full-thickness macular hole, and even retinal detachment. Therefore, the examination and judgment of VRIA in HM patients are of great significance for the early prevention and treatment of clinical retina diseases.
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Objective:To compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH).Methods:A cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age ( Wald=34.507) and logMAR BCVA ( Z=-7.703) between two groups ( P<0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C 3F 8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ 2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. Results:In IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA ( Z=-6.803, P<0.005), but no difference in visual success rate ( χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant ( χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio ( OR)=2.941, 95% confidence interval ( CI) 1.341-6.447, P<0.05], MH diameter ( OR=1.003, 95% CI 1.001-1.005, P<0.05), silicon oil filling ( OR=3.481, 95% CI 1.594-7.605, P<0.05); MMH, baseline BCVA ( OR=2.549, 95% CI 1.344-4.834, P<0.05), C 3F 8 filling ( OR=18.131, 95% CI 1.505-218.365, P<0.05) and silicon oil filling ( OR=7.796, 95% CI 0.997-60.944, P<0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA ( OR=213.329, 95% CI 46.123-986.694, P<0.05), MH diameter ( OR=0.995, 95% CI 0.992-0.997, P<0.05), silicon oil filling ( OR=0.326, 95% CI 0.115-0.926, P<0.05) and duration ( OR=1.036, 95% CI 1.005-1.067, P<0.05); MMH, baseline BCVA ( OR=13.316, 95% CI 2.513-70.565, P<0.05) and duration ( OR=1.022, 95% CI 1.001-1.044, P<0.05). Conclusions:MMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.
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Objective:To evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD).Methods:A prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10± 0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. Results:At 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes.Conclusion:Amniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.
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Objective:To observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH).Methods:A prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA ( t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) ( t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) ( t=1.255, 0.966) between two groups ( P>0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. Results:Six months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference ( P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant ( t=2.282, 3.101; P<0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant ( t=1.815, 2.302, 2.784; P<0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant ( P=0.007, <0.001, <0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant ( t=1.897, 2.250; P<0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance ( F=12.963, P<0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences ( F=12.374, 21.807, 5.695, 4.095; P<0.05). Conclusion:PPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
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Objective:To observe the imaging features of optical coherence tomography (OCT) in peripheral retinal abnormalities of high myopia (HM).Methods:A retrospective series of case studies were conducted. From March 2019 to March 2021, 38 cases (50 eyes) in high myopia with peripheral retinal abnormalities who were confirmed to Henan Eye Hospital were enrolled in the study. There were 21 eyes in 17 males and 29 eyes in 21 females, age was 39.58±15.29 years, diopter was (-9.10±2.44) D. All patients underwent wide-angle fundus photography and OCT examination. According to wide-angle fundus photography and OCT, HM with peripheral retinal abnormalities were classified into white-without-pressure, black-without-pressure, lattice degeneration, peripheral pigmented degeneration, retinoschisis and retinal holes. OCT imaging features of peripheral abnormalities in high myopia was observed.Results:In 50 eyes, 65 peripheral retinal abnormalities were observed by OCT. In 6 white-without-pressure, intense hyperreflectivity was shown at the level of the ellipsoid zone that abruptly transitions to relative hyporeflectivity at the dark border of the lesion. In 16 black-without-pressure, reflectivity of the ellipsoid zone decreased. In 10 sites of lattice degeneration, cystoid degeneration, local thinning, retinal tear at the posterior edge and boundary of the lesion was shown, whcih may be accompanied by local vitreous condensation and traction. In 4 peripheral pigmented degeneration, retinal interlayer hyperreflectivity was shown. In 12 retinoschisis, neuroepith-elial separation was connected by vertical bridge or columnar light bands, of which 3 were accompanied with localized retinal detachment and 2 with splitting-related retinal vascular abnormalities. In 17 retinal holes, full layer of neuroepithelium lost, that 12 zones were accompanied with retinal detachment with vitreous adhesion or traction.Conclusion:OCT manifestations of peripheral retinal abnormalities in HM varies.
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Objective:To observe and explore the feasibility and effectiveness of platelet-rich fibrin (PRF) membrane packing and air filling in the treatment of refractory macular holes.Methods:A retrospective clinical study. From January 2019 to January 2020, 17 patients with refractory macular hole (17 eyes) who diagnosed in Renmin Hospital of Wuhan University were included in the study. Among them, there were 7 males (7 eyes) and 10 females (10 eyes), with the age of 55.18±7.91 years. All eyes underwent 23G minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF packing, and air filling was performed at the end of the operation. The best corrected visual acuity (BCVA) and optical coherence tomography angiography were performed in all eyes before surgery and at 1 week and 1, 3 months after surgery. The BCVA examination was performed using a international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution visual acuity during statistics. Taking 3 months after surgery was as the time point to judge the efficacy, the changes of BCVA, superficial retinal vascular density (SVD), foveal avascular zone (FAZ) area and central foveal thickness (CFT) before and after surgery were compared. Paired t-test was used to compare the indicators before and after surgery. Results:Among the 17 eyes, there were 6, 7, and 4 eyes with giant macular hole, high myopia macular hole, and recurrent macular hole, respectively; the hole diameter was 723.94±38.30 μm. Three months after surgery, all holes were closed. Compared with before surgery, the BCVA ( t=4.458) and SVD ( t=2.675) increased, and the CFT ( t=6.329) and FAZ area ( t=4.258) decreased at 3 months after surgery, and the differences were statistically significant ( P<0.05). At the last follow-up, there was no complications such as intraocular hypertension and retinal detachment in all eyes. Conclusion:Minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF tamponade in the treatment of refractory macular holes can increase the closure rate, improve visual acuity and retinal blood perfusion.
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Objective:To observe the efficacy of platelet-rich fibrin (PRF) membrane tamponade combined with air filling for giant macular hole (MH).Methods:A prospective case-control study. From January 2019 to February 2021, 56 patients (56 eyes) diagnosed with giant MH from Eye Center of Renmin Hospital of Wuhan University were enrolled. Among them, there were 17 males with 17 eyes and 39 females with 39 eyes. The average age of the patients was 64.23±9.30 years old. The average MH minimum diameter was 827.36±83.16 μm. The best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination were performed before surgery. The Chinese version of 25-item National Eye Institute visual functioning questionnaire (NEI VFQ-25) was used to investigate patient's visual-related quality of life. There were 28 eyes of 28 cases receiving PRF membrane covering, as PRF group, another 28 eyes of 28 cases receiving inverted internal limiting membrane (ILM) insertion into giant MH, as ILM group. The differences of the age ( t=-1.588), sex ratio ( χ2=0.760), BCVA ( Z=-0.400), macular hole minimum diameter ( t=-0.604), choriocapillary blood flow area (CBFA) ( t=1.331) and NEI VFQ-25 score ( t=0.921) were not statistically significant ( P>0.05). All eyes underwent 23G minimally invasive vitrectomy. In the PRF group, PRF membrane was used to fill the hole, and in the ILM group, the hole was filled with ILM inversion, and filled with sterile air after full gas-liquid exchange. The follow-up time after surgery was ≥6 months. The same equipment and methods as before surgery were used to conduct related examinations, and the changes of BCVA, the shape of hole closure, CBFA and the improvement of vision-related quality of life were compared between the two groups. For comparison between groups, independent samples t-test was used for data with normal distribution, and Mann-Whitney U test was used for data with non-normal distribution. For intra-group comparisons, paired-samples t-test was used for data with normal distribution, and Wilcoxon rank-sum test was used for non-normally distributed data. Results:Six months after surgery, in the eyes of PRF group and ILM group, the hole of 27 (96.4%, 27/28) and 26 (92.6%, 26/28) eyes were closed; the median BCVA was 0.70 and 0.70, respectively; CBFA were 1.99±0.20 and 1.91±0.18 mm 2; NEI VFQ-25 scores were 81.36±12.39 and 78.39±10.12, respectively. Compared with before surgery, the BCVA ( Z=-4.636,-4.550) and CBFA ( t=-27.115,-31.135) of the affected eyes in the PRF group and ILM group were significantly improved after surgery, and the NEI VFQ-25 scores ( t=-15.557, -10.675) was significantly increased, and the difference was statistically significant ( P<0.05). There was no significant difference in BCVA ( Z=-0.167), CBFA ( t=1.554), and NEI VFQ-25 scores ( t=0.980) between the two groups after interocular surgery ( P=0.726, 0.126, 0.331). Conclusion:PRF membrane insertion with air filling has the same efficacy as ILM insertion in the treatment of giant MH, which can improve the closure rate of MH, patients' vision and vision-related quality of life, and increase choroidal blood perfusion.
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Objective:To investigate the efficiency and safety of pneumatic retinopexy for rhegmatogenous retinal detachment (RRD).Methods:A prospective case series study. From January 2020 to December 2021, 27 eyes of 27 RRD patients in Joint Shantou International Eye Center were included. Among them, there were 10 males and 17 females; the mean age was 36.0±11.8 years old. There was recurrent retinal detachment in 4 eyes. Best corrected visual acuity (BCVA) and optical coherence tomography were performed. According to whether the retina was successfully reattached after a single intravitreal injection, the patients were divided into a single operation group and a second operation group. All eyes underwent pneumatic retinopexy, the patients received intravitreal injection of 0.3-0.5 ml 100% C 3F 8. On the next day, laser photocoagulation was performed around the retinal breaks. The mean follow-up time was 15.0±6.0 months. Outcome measures included single operation success rate, the BCVA at the last follow up and complications. The age, gender, extent of retinal detachment, number of retinal breaks, and preoperative and postoperative BCVA of patients in the single operation group and the second operation group were compared using Mann-Whiteney test or Fisher's exact test. Results:Twenty of the 27 eyes (74.1%, 20/27) had retinal reattachment after single operation, 7 of the 27 eyes (25.9%, 7/27) had retinal reattachment after the second operation. Among the 7 eyes, retinal detachment recurrence after operation, retinal detachment recurrence after tear opening, and retinal detachment recurrence with new tears occurred in 1, 4, and 2 eyes, respectively; retinas were all reattached after scleral buckling or vitrectomy. The BCVA was stable and improved in 14 and 13 eyes, respectively. Compared with the single operation group, the retinal detachment in the second operation group was wider and the BCVA before operation was worse, the differences were statistically significant ( Z=-2.842,-2.233; P<0.05). Transient intraocular pressure elevation occurred in 5 eyes; no complications such as infectious endophthalmitis, intraocular hemorrhage and lens damage occurred. Conclusion:Pneumatic retinopexy is safe and effective in the treatment of RRD.
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Objective:To establish an artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning optical coherence tomography (OCT) and evaluate its application value.Methods:Diagnostic test studies. From 2016 to 2019, 25 000 OCT images of 25 000 patients treated at the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were used as training sets and validation sets for the fundus intelligent assisted diagnosis system. Among them, macular epiretinal membrane (MERM), macular edema, macular hole, choroidal neovascularization (CNV), and age-related macular degeneration (AMD) were 5 000 sheets each. The training set and the verification set are 18 124 and 6 876 sheets, respectively. Through the transfer learning Attention ResNet structure algorithm, the OCT image was characterized by lesion identification, the disease feature was extracted by a specific procedure, and the given image was distinguished from other types of disease according to the statistical characteristics of the target lesion. The model algorithms of MERM, macular edema, macular hole, CNV and AMD were initially formed, and the fundus intelligent auxiliary diagnosis system of five models was established. The performance of each model-assisted diagnosis in the fundus intelligent auxiliary diagnostic system was evaluated by applying the subject working characteristic curve, area under the curve (AUC), sensitivity, and specificity.Results:With the intelligent auxiliary diagnosis system, the diagnostic sensitivity of the MERM was 93.5%, the specificity was 99.23%, and AUC was 0.983 7; the diagnostic sensitivity of macular edema was 99.02%, the specificity was 98.17%, and AUC was 0.994 6; the diagnostic sensitivity of macular hole was 98.91%, the specificity was 99.91%, AUC was 0.996 2; the diagnostic sensitivity of CNV was 97.54%, the specificity was 94.71%, AUC was 0.987 5; the diagnostic sensitivity of AMD was 95.12%, the specificity was 97.09%, AUC was 0.985 3.Conclusions:The artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning for OCT images has accurate and efficient diagnostic performance for assisting the diagnosis of MERM, macular edema, macular hole, CNV, and AMD.
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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.
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High myopia macular hole (MH) is a serious complication of high myopia. The main treatment method is surgery. Because of axial growth, posterior scleral staphyloma, choroidal atrophy and other factors, the operation is difficult, the anatomic reduction rate is low, and the visual prognosis is poor. How to improve the reduction rate of surgical dissection and the recovery of visual function is a hot topic. At present, the most popular surgeries include parsplanavitrectomy (PPV) and posterior scleral reinforcement (PSR). However, there are many controversies regarding the treatment of internal limiting membrane in PPV, the selection of vitreous gapfiller, the choice of reinforcement materials and reinforcement methods of PSR, and whether it is necessary to combine PPV and PSR, etc. In recent years, many new surgical methods or techniques have emerged, which significantly increase the success rate of MH.
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Myopic foveoschisis (MF) has mild early symptoms, however, its course is progressive. When the secondary macular detachment or macular hole occurs, it can cause severe vision loss. Therefore, it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF. The operation mode is divided into vitreoretinal surgery and macular buckling, the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach. There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years. Compared with vitreoretinal surgery, macular buckling can release the traction of the retina caused by posterior scleral staphyloma, but it cannot relieve the traction in the tangential direction of the retina. Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both, however, the effect of treatment on patients still needs further verification. In clinical work, it is necessary to conduct individualized analysis of MF patients, weigh the advantages and disadvantages of each operation, and choose the most suitable operation mode for patients with different conditions. In the future, the emphasis of our work is to develop operation mode with great curative effect and less complications.