RESUMO
Objective@#To observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).@*Methods@#A retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD<400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.@*Results@#The postoperative BCVA of group A, B and C was improved obviously,the differences were statistically significant (t=−11.66, −7.52, −4.99; P<0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,@*Conclusions@#The macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
RESUMO
Objective To observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C3F8) tamponade in the treatment of idiopathic macular hole (IMH).Methods A retrospective case analysis.From December 2015 to December 2016 in Tianjin Eye Hospital,101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C3F8 tamponade,were included in this study.All patients underwent BCVA and OCT examination.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods:MLD＜400 μm for the group A,41 eyes of 39 patients,MLD more than 400 μm without ILM flap surgery as the group B,39 eyes of 38 patients,including 16 eyes tamponaded with air and 23 eyes tamponaded with C3F8,MLD more than 400 μm with ILM flap as the group C,a total of 21 patients of 21 eyes,including 7 eyes tamponaded with air and 14 eyes tamponaded with C3F8.The logMAR BCVA of group A,B and C were 0.82±0.39,1.11 ±0.42,1.25±0.50,respectively.The follow-up times were 1 week,1 month,3 month,6 month and 1 year post operation,BCVA and OCT were performed at each follow-up time.The hole closure rate and BCVA improvement were observed.Results The postoperative BCVA of group A,B and C was improved obviously,the differences were statistically significant (t=-l 1.66,-7.52,-4.99;P＜0.01).There was no significant difference in improvement of visual acuity between the three groups (A and B,A and C,B and C group:t=0.77,-0.41,0.28;P=0.44,0.72,0.76).96.94％ macular hole closure occurred in 7 days post operation.The postoperative visual acuity improved significantly in 3 mouth after operation,Conclusions The macular hole closure occurred mainly in 1 week after operation,postoperative visual acuity increased mostly in the 3rd month post operation.There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.
RESUMO
Objective To evaluate the enhancing effects of scleral biomechanics and safety of collagen crosslinking by using minimally invasive riboflavin and ultraviolet A.Methods Fifty-six healthy New Zealand white rabbits were randomized into non-cosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,postcrosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group,eight for each group.Riboflavin solution at the concentration of 0.1％ was dropped once per 2 minutes for 20 minutes,and then minimally invasive riboflavin and ultraviolet A was carried out in the right eyes by putting the lighting emitting diode (LED) probe end of microinvasive ultraviolet scleral crosslinking device to irradiate the posterior sclera for 30 minutes with the wavelength of 370 nm and radiation energy of 3 mW/cm2,and the left eyes served as the normal controls.The scleral temperature was measured using clinical thermometer during the crosslinking period.The rabbits were sacrificed according to the grouping and the eyeballs were obtained.The scleral thickness was measured by callipers,the pretension and tensile failure tests of sclera strips were tested by micromaterial mechanics performance test system to measure the extreme stress,extreme strain and 8％ elastic modulus.Hematoxylin-eosin staining was employed to examine the morphology of eye tissues.Retinal cell apoptosis was detected by TUNEL assay.Results The scleral thickness was insignificantly different among the non-crosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,post-crosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group and between right eyes and left controls (F,es =0.02,P＞0.05;Fgroup =1.71,P＞0.05).Compared with the non-crossliking group,the extreme stress and 8％ elastic modulus of the scleras were significantly increased,and the extreme strain of the scleras was significantly decreased in post-crosslinking 1-day group,post-crosslinking 7-day group,post-crosslinking 15-day group,post-crosslinking 1-month group,postcrosslinking 2-month group and post-crosslinking 3-month group (all at P＜0.05).Not any morphological abnormalities were found in corneas,scleras,irises,ciliary bodies and choroids in various groups.The apoptosis rates of retinal cells were (11.00±0.33)％,(12.33±1.58)％,(12.02±0.45)％,(11.81±0.85)％,(12.15± 0.61)％,(12.14±0.25)％and (11.74±0.63) ％ in the non-crosslinking group,post-crosslinking 1-day group,post-crosslinking 7-day group,postcrosslinking 15-day group,post-crosslinking 1-month group,post-crosslinking 2-month group and post-crosslinking 3-month group,respectively,with no significant difference among the three groups (F =1.78,P =0.14).Conclusions Rabbit sclera collagen crosslinking by using the minimally invasive riboflavin and ultraviolet A can effectively enhance the biomechanical strength of the sclera,and this procedure is safe.
RESUMO
Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study.There were 85 males and 75 females.The patients aged from 33 to 73 years,with the mean age of (56.40±8.97) years.All the patients were performed 25G pars plana vitrectomy by the same doctor.Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation.Combined phacoemulsification was performed in one hundred and five patients.Vitreous tamponade was used at the end of surgery,including silicone oil (43 eyes),C3F8 (63 eyes),air or fluid (65 eyes).The follow-up ranged from 6 to 22 months,with the mean follow-up of (9.34±6.97) months.The features of PVH were observed.The difference of age,HbA1 c,creatinine level,the severity of the fundus lesions,whether received treatment of anti-vascular endothelial growth factor (VEGF),whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH.Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter.PVH occurred in 15 eyes of 15 patients,the incidence was 8.77％.The PVH occurred 2 weeks to 6 months after surgery.There were significant difference in age (t=2.551),proportion with tractional retinal detachment (x2=7.431),progressive fibrovascular proliferation (x2=4.987) and using anti-VEGF (x2=9.742) between the patients with and without PVH (P＜0.05).There was no significant difference in HbAlc (t=0.501),creatinine level (t=1.529),and the proportion of cataract phacoemulsification (x2=0.452) between the patients with and without PVH (P＞0.05).During follow-up,neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes.Seven eyes underwent reoperation,7 eyes were spontaneous recovered,1 eye with NVG give up treatment.Fibrovascular membrane was the major cause of recurrent hemorrhage.At the end of follow-up,hemorrhage was absorbed in all the 14 eyes which were treated,12 eyes had same visual acuity compared to that before postoperative hemorrhage,2 eyes with NVG had decreased vision.There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022).Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy,fibrovascular membrane is the major cause of recurrent hemorrhage.NVG is an important factor related to vision acuity prognosis.