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@#AIM: To observe the clinical effect of conbercept combined with 25G minimally invasive vitrectomy in the treatment of proliferative diabetic retinopathy(PDR), and analyze the influencing factors of postoperative vitreous rehaemorrhage.<p>METHODS: Totally 179 eyes of 179 PDR patients confirmed and treated in our hospital from 2017-04/2019-11 were selected and grouped according to patients' condition and intention. 108 patients in the observation group underwent conbercept combined with 25G minimally invasive vitrectomy, while 71 patients in the control group underwent 25G minimally invasive vitrectomy only. The baseline data, intraoperative condition, best corrected visual acuity(BCVA), intraocular pressure, amplitude of N1 wave latency, central macular thickness(CMT)in the macular area before and after operation, and postoperative complications were compared between the two groups. The influencing factors of vitreous rehaemorrhage in PDR patients were analyzed. <p>RESULTS:The operative time, intraoperative bleeding rate, electrocoagulation rate, incidence of iatrogenic retinal hiatal aperture, the number of laser points and silicone oil filling rate of the observation group were all lower than those of the control group(<i>P</i><0.05). After 6mo, BCVA(LogMAR), CMT and N1 wave latencies amplitude of the two groups were improved compared with those before operation, and the observation group was better than the control group(all <i>P</i><0.05). The incidence of total complications in the observation group was lower than that in the control group(14.8% <i>vs</i> 40.8%, <i>P</i><0.05). There were 31 cases and 31 eyes with vitreous rehaemorrhage after operation. Multivariate Logistic regression analysis showed that elevated HbA1c, vascular occlusion, proliferative retinal traction and no use of conbercept were risk factors for postoperative vitreous rehaemorrhage in PDR patients.<p>CONCLUSION: Conbercept combined with 25G minimally invasive vitrectomy in the treatment of PDR can reduce the intraoperative bleeding rate, reduce complications, shorten the operation time, and thus help to improve visual acuity and visual function. Effective control of blood glucose to reduce HbA1c level, intraoperative removal of fibrovascular hyperplasia membrane as much as possible to relieve retinal traction, and combined treatment with conbercept can reduce the risk of postoperative vitreous rehaemorrhage.
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@#AIM: To compare the efficacy and complications of intravitreal injection of conbercept in different perioperative periods, combined with 25G pars plana vitrectomy(PPV)and trabeculectomy in the treatment of neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR)with vitreous hemorrhage(VH).<p>METHODS: Prospective randomized controlled clinical trial. 28 cases(30 eyes)of NVG in stage Ⅲ secondary to PDR with VH were enrolled in the study. All patients received 25G PPV combined with trabeculectomy. They were randomly divided into two groups: group 1(14 eyes)received intravitreal injection of 0.5mg/0.05mL of conbercept(IVC)3d before operation and group 2(16 eyes)received IVC after operation; the operation time, intraoperative bleeding and postoperative complications were compared between the two groups. The differences of pain relief, the regression of iris neovascularization(INV), the best corrected visual acuity(BCVA)and intraocular pressure(IOP)control rate were observed.<p>RESULTS: The two groups all completed the operation and were followed up 12.40±2.21mo and 12.23±2.11mo respectively(<i>P</i>>0.05). The incidence of intraoperative and early postoperative hyphema of group 1(29%, 14%)was lower than group 2(75%, 56%, <i>P</i><0.05). There was no significant difference in operation time, shallow anterior chamber, choroidal detachment and vitreous rebleeding between the two groups(<i>P</i>>0.05). The pain was relieved in all patients 3d after operation. In group 1, 93% of INV completely disappeared 3d after IVC and 94% of INV completely disappeared 7d after PPV in group 2. At the last follow-up, one eye in each group remained a little atrophic INV. At 1wk, 1mo, 3mo, 6mo postoperation, the IOP control rate of group 1 was 93%, 79%, 64% and 57% respectively, and that of group 2 was 94%, 75%, 50%, 44% respectively(each time period, <i>P</i>>0.05). IOP of the two groups at different time points after operation was significantly lower than that before operation(<i>P</i><0.05). At the last follow-up, the IOP of the two groups were 20.45±10.55 and 22.63±7.24mmHg respectively, which were significantly lower than those of 42.21± 9.11 and 44.88±11.83mmHg before operation(<i>P</i><0.05). BCVA in two groups at different follow-up time after operation has no significant difference compared with that of preoperation(<i>P</i>>0.05).<p>CONCLUSION: Compared with IVC after operation, IVC before operation combined with 25G PPV and trabeculectomy for NVG secondary to PDR with VH could reduce the incidence of intraoperative hemorrhage and early postoperative hyphema. The IOP control rate of the two methods is equal and gradually decreases with time, but after timely treatment can finally get better results.
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@#AIM:To explore clinical characteristics, outcomes and prognostic factors for cases with intraocular foreign bodies(IFB)and treated with 25G minimally invasive vitrectomy(PPV).<p>METHODS: Patients traumatized with retained IFB and treated with PPV were retrospectively collected from the Department of Ophthalmology, Affiliated Hospital of Southwest Medical University from 2016-1-1 to 2019-1-1. The clinical records including general condition, time and cause of injury, locations andsize of IFBs, comorbidities, and best corrected visual acuity(BCVA)were reviewed and statistical analyzed.<p>RESULTS: Among the 105 patients, most of them are middle-aged and young men, mostly from townships. The nature of IFB was mainly metals(62 cases, 59.0%). The entrance of IFB of 78 cases(74.3%)located at Zone I of the eye. There were 17 patients with BCVA≥0.1 before surgery, 88 patients with BCVA<0.1. And 43 patients gained BCVA≥0.1 after operation, and 62 patients with BCVA<0.1. Postoperative BCVA was significantly improved compared with preoperative BCVA(<i>P</i><0.05). Through multivariate Logistic regression analysis, poor preoperative BCVA, retinal detachment, and endophthalmitis are risk factors for poor visual prognosis.<p>CONCLUSION: PPV for treatment of IFB can achieve a better outcome. The poor prognosis of visual acuity is related to retinal detachment, endophthalmitis, and the position and size of IFB.
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Objective@#To evaluate the efficacy and outcome of 25 gouge (25G) minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma.@*Methods@#Retrospective cohort study was performed.Clinical data of 19 malignant glaucoma patients (19 eyes) who received 25G minimally vitrectomy from January 2012 to January 2017 in Wuxi People's Hospital were reviewed retrospectively.The operative methods were selected according to the predisposing cause.25G vitrectomy combined with cataract extraction and posterior capsulotomy were performed on the malignant glaucoma eyes after trabeculectomy, and 25G vitrectomy combined with cataract extraction, trabeculectomy and posterior capsulotomy were performed on the malignant glaucoma eyes after non-trabeculectomy.Best corrected visual acuity (BCVA) was examined by international visual acuity chart.The ocular axis length and intraocular pressure (IOP) were measured with A-mode ultrasonic apparatus and non-contact tonometer, respectively.The anterior chamber depth was measured with ultrasound biomicroscope (UBM). The study followed the declaration of Helsinki and all patients signed informed consent before surgery.@*Results@#The operation was successfully completed in 19 patients.All patients suffered moderate to severe anterior chamber inflammation after operation.The average age of onset in the patients was (58.00±6.20) years, and the mean ocular axial length was (20.81±0.56)mm.Malignant glaucoma occurred in 11 eyes after trabeculectomy, 2 eyes after combination of anti-glaucoma with cataract extraction, 2 eyes after laser iridotomy, 2 eyes after paracentesis of anterior chamber and 2 eyes with unknown causes.The visual acuity was significantly improved 3 months after operation in comparison with before operation (Z=-3.826, P<0.001). The mean IOP was (12.16±2.27)mmHg (1 mmHg=0.133 kPa) in postoperation, which was significantly lower than (38.84±5.97)mmHg in preoperation (t=17.68, P<0.05). The depth of anterior chamber was increased from preoperative (0.95±0.28)mm to postoperative (2.43±0.15) mm (t=20.06, P<0.05). UBM image showed that the position of ciliary body was normal without edema.@*Conclusions@#The combination procedure of 25G minimally invasive vitrectomy with relative surgery for malignant glaucoma is effective by lowing IOP, rescuing visual acuity and reducing surgical risk.
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La toxocariasis es una zoonosis parasitaria. Se describen las alteraciones anatómicas y funcionales producidas por membranas que traccionan el polo posterior y la periferia de la retina, las cuales provocan hemorragia vítrea parcial asociada a neovascularización del disco óptico con membrana epirretiniana, y un agujero macular lamelar relacionado con la presencia de granuloma periférico. Se presenta un caso clínico de un paciente sano, quien comenzó con disminución de la agudeza visual del ojo izquierdo y se le diagnosticó, por cuadro clínico y examen oftalmológico con resultado positivo de la prueba de Toxocara, una toxocariasis ocular complicada. Se le realizó cirugía de vitrectomía mínimamente invasiva 23 G asociada a membranectomía, y pelado de la membrana limitante interna, así como endofotocoagulación con láser panretiniana. Se usó como tamponador al final de la cirugía el gas SF6 y el posicionamiento del paciente. Se aplicó tratamiento antiparasitario y esteroideo sistémico previo a la cirugía, y se obtuvieron resultados satisfactorios tanto anatómicos como funcionales del paciente(AU)
Toxocariasis is a parasitic zoonosis. A description is provided of the anatomical and functional alterations produced by membranes that pull the posterior pole and the periphery of the retina, causing partial vitreous hemorrhage associated to neovascularization of the optic disk with epiretinal membrane, and a lamellar macular hole related to the presence of peripheral granuloma. A clinical case is presented of a healthy male patient who started out with a decrease in the visual acuity of his left eye and was diagnosed with a complicated ocular toxocariasis based on his clinical status and ophthalmological examination with a positive toxocara test. Minimally invasive vitrectomy was performed: 23G associated to membranectomy and internal limiting membrane peeling, as well as panretinal laser endophotocoagulation, using patient positioning and gas (SF6) as tamponade at the end of surgery. Systemic steroid and antiparasitic treatment was provided before surgery, and satisfactory anatomical and functional results were obtained(AU)
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Humanos , Masculino , Adulto , Oftalmoscopia/efeitos adversos , Vitrectomia/métodos , Toxocaríase/diagnóstico , Toxocaríase/complicações , Infecções Oculares Parasitárias/terapiaRESUMO
Objective To investigate the clinical efficacy of 25G minimally invasive vitrectomy for the removal of foreign bodies in the posterior segment of the ball.Methods The clinical data of 21 patients (21 eyes) with intraocular foreign bodies who underwent 25G minimally invasive vitrectomy combined with intrabulbar foreign body removal were retrospectively analyzed,including magnetic foreign bodies in 17 patients and non-magnetic foreign bodies in 4 patients.All the patients had cataract and vitreous hemorrhage,with 3 patients (3 eyes) suffering secondary endophthalmitis,and 12 patients (12 eyes) suffering secondary retinal detachment.Cataract extraction,retinal reattachment and silicone oil tamponade were combined according to different conditions,and the complications and surgical outcomes were analyzed for 6-month followup.Results All patients received preoperative examinations,immediately following implementation of 25G minimally invasive vitrectomy and intrabulbar foreign body removal procedures.The removal rate of foreign bodies in phase Ⅰ was 100％.All the endophthalmitis and retinal detachment were cured before operation.The turbid lens was removed during operation from the corneal incision in 20 patients (20 eyes),and from a scleral incision in 1 patient after cataract extraction.A total of 19 eyes had better postoperative visual acuity than preoperative vision,14 eyes underwent phase Ⅱ intraocular lens implantation,and silicone oil was retained in 2 eyes.No postoperative complications related to minimally invasive surgery occurred.Conclusion 25G minimally invasive vitrectomy has good clinical outcomes in the removal of intraocular foreign bodies in the posterior segment of the eye,with minimal surgical trauma,rapid visual function recovery,and fewer complications,but great attention should be paid to its indications.
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@#AIM: To explore the application effect of fenofibrate combined with 23G minimally invasive vitrectomy in patients with diabetic retinopathy(DR). <p>METHODS: Totally 102 DR patients(102 patients)treated in our hospital from October 2015 to November 2017 were selected and divided into observation group and control group according to random number table, 51 cases in each group. The 23G minimally invasive vitrectomy was performed in all patients. From the 1<sup>st</sup> day after operation, the two groups were treated with related treatment, and the control group was given conventional hypoglycemic, antihypertensive and improved microcirculation treatment. On the basis of the above, the observation group was treated with fenofibrate treatment. Both groups were treated for 3mo. The operation and postoperative basic conditions(operative time, intraoperative blood loss, complication rate, length of stay), the level of blood lipid \〖total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)\〗, and the serum levels of related factors \〖lipoprotein associated phospholipase A2(Lp-PLA2), vascular endothelial growth factor(VEGF)\〗 before and after 3mo of operation of two groups were compared. Following up for 6mo after operation, the recurrence rate of two groups of retinopathy was statistically compared. <p>RESULTS: There was no significant difference in operative time, intraoperative blood loss, incidence of complications and length of stay between the two groups(<i>P</i>>0.05). There was no significant difference in the levels of TC, TG, LDL-C and HDL-C between the two groups before operation(<i>P</i>>0.05). After 3mo, the levels of TC, TG and LDL-C in the observation group were lower than those in the control group, and the level of HDL-C was higher than that in the control group, and the difference was statistically significant(<i>P</i><0.05). There was no significant difference in serum levels of Lp-PLA2 and VEGF between the two groups before operation(<i>P</i>>0.05). The serum levels of Lp-PLA2 and VEGF in the observation group were lower than those in the control group 3mo after operation, and the difference was statistically significant(<i>P</i><0.05). There was insignificant difference in visual function and quality of life, sensory adjustment, psychological and social scores and total scores between the two groups before surgery(<i>P</i>>0.05). At 3mo after operation, the scores of visual function and life quality in the observation group were lower than those in the control group, and the difference was statistically significant(<i>P</i><0.05). After follow-up for 6mo, no recurrence occurred in the observation group. The recurrence rate in the control group was 5.9%(3/51), and there was no significant difference between the two groups(<i>P</i>>0.05).<p>CONCLUSION: The combination of fenofibrate and 23G minimally invasive vitrectomy for the treatment of DR can effectively correct the disorder of lipid metabolism, reduce the level of serum Lp-PLA2 and VEGF, so it is beneficial to improve the visual function and quality of life of the patients, but there is no effective data support for reducing the postoperative recurrence rate.
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The application of sutureless minimally invasive vitrectomy has been used for more than 10a.High-speed cutting and fine instrumentation have been effective in the treatment of severe vitreoretinal diseases,but intraoperative and postoperative complications have also seriously affected vision recovery,including choroidal detachment is minimally invasive vitrectomy and postoperative relatively rare complications,secondary glaucoma,decreased vision,etc.The reasons and treatment of choroidal detachment during and after minimally invasive vitrectomy are summarized below.
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Objective To investigate the clinical effects of minimally invasive vitrectomy combined with cataract surgery for myopic foveoschisis in young and middle-aged. Methods Sixty myopic eyes with myopic fo-veoschisis diagnosed from September 2013 to October 2015 in our hospital were included in the study. According to different surgical methods ,patients were divided into two groups:combined operation group(vitrectomy combined with lens replacement surgery,30 eyes)and staged operation group(simple vitrectomy group,30 eyes). Cataract surgery were performed according to the opacity of lens. All the patients were followed up for 6~12 months. Reop-eration rate of staged operation group ,the best corrected visual acuity(BCVA),the distant and near visual acuity and retinal reattachment rate of each group were observed. Every patient was interviewed with a questionnaire about visual quality at 6th month after surgery. Results 27 eyes developed lens opacity after operation(90%)in staged operation group,among them,21 eyes underwent secondary cataract surgery(70%). The BCVA recovery,postop-erative distant vision,and preoperative and postoperative distant vision difference in the combined operation group were significantly higher than those in the staged group(P<0.05). There were no significant differences in macu-lar retinal condition and retinal reattachment rate between the two groups(P > 0.05). Six months after operation, the visual quality of the combined operation group was significantly better than that of the staged group(t=-3.95, P = 0.00). In the combined surgery group,the scores of distant vision,stereopsis and visual fatigue were higher than those of staged operation group. The score of dry eye and night glare in staged operation group was higher than that in combined operation group(all P<0.05). Conclusions Vitrectomy combined with intraocular lens replace-ment for myopic foveoschisis in young and middle-aged people can avoid second operations and improves the visual function,proving to be a feasible operation in clinic.
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Objective To investigate the clinical effects of minimally invasive vitrectomy combined with cataract surgery for myopic foveoschisis in young and middle-aged. Methods Sixty myopic eyes with myopic fo-veoschisis diagnosed from September 2013 to October 2015 in our hospital were included in the study. According to different surgical methods ,patients were divided into two groups:combined operation group(vitrectomy combined with lens replacement surgery,30 eyes)and staged operation group(simple vitrectomy group,30 eyes). Cataract surgery were performed according to the opacity of lens. All the patients were followed up for 6~12 months. Reop-eration rate of staged operation group ,the best corrected visual acuity(BCVA),the distant and near visual acuity and retinal reattachment rate of each group were observed. Every patient was interviewed with a questionnaire about visual quality at 6th month after surgery. Results 27 eyes developed lens opacity after operation(90%)in staged operation group,among them,21 eyes underwent secondary cataract surgery(70%). The BCVA recovery,postop-erative distant vision,and preoperative and postoperative distant vision difference in the combined operation group were significantly higher than those in the staged group(P<0.05). There were no significant differences in macu-lar retinal condition and retinal reattachment rate between the two groups(P > 0.05). Six months after operation, the visual quality of the combined operation group was significantly better than that of the staged group(t=-3.95, P = 0.00). In the combined surgery group,the scores of distant vision,stereopsis and visual fatigue were higher than those of staged operation group. The score of dry eye and night glare in staged operation group was higher than that in combined operation group(all P<0.05). Conclusions Vitrectomy combined with intraocular lens replace-ment for myopic foveoschisis in young and middle-aged people can avoid second operations and improves the visual function,proving to be a feasible operation in clinic.