Air tamponade in retinal detachment surgery followed by ultra-widefield fundus imaging system.

AIM: To report the surgical result of pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD) by ultra-widefield fundus imaging system. METHODS: Of 25 consecutive patients (25 eyes) with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity (VA) was examined postoperatively and images were captured by ultra-widefield scanning laser ophthalmoscope system (Optos). RESULTS: Initial reattachment was achieved in 25 cases (100%). The air volume was >60% on the postoperative day (POD) 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes (88%). A missed retinal hole was found under intravitreal air bubble in 1 case (4%). The air volume was range from 40% to 60% on POD 3. A double-layered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases (24%) and bubble was completely disappeared in 4 cases (16%). Small oval bubble in the superior area was observed in 15 cases (60%). There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1mo and last follow-up. Air disappeared completely on a mean of 9.84d postoperatively. The mean final postoperative best-corrected visual acuity (BCVA) was 0.35 logMAR. Mean final postoperative BCVA improved significantly relative to mean preoperative (P<0.05). Final VA of 0.3 logMAR or better was seen in 13 eyes. CONCLUSION: PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.

Associated factors for visibility and width of retrobulbar subarachnoid space on swept-source optical coherence tomography in high myopia.

Subarachnoid space (SAS) around optic nerve can be visible with swept-source optical coherence tomography (SS-OCT). However, the relevant factors for its visibility and width have not been reported. In this prospective study, 193 eyes with high myopia were evaluated by SS-OCT. The relationship between age, gender, axial length, optic disc area, parapapillary atrophy (PPA) area, peripapillary choroidal thickness with the visibility and width of SAS were assessed. The results showed that SAS was observed in 125 (64.8%) and not observed in 68 (35.2%) eyes. Visibility of SAS is associated with long axial length, high myopia, thin choroid, large PPA and large optic disc areas. Among these associations, PPA area was the only independent factor (b = 0.177, p < 0.001). The width of SAS was associated with thin choroid, long axial length, large optic disc area and large PPA area. Multivariant analysis showed that optic disc area and PPA area were independent factors for the width of SAS (b = 30.8, p = 0.016 and 16.2, p < 0.001 respectively). These results suggested that SAS was extended into the peripapillary region possibly due to extension of posterior sclera in high myopia.

Efficacy of phacovitrectomy combined with internal limiting membrane peeling for macular diseases.

PURPOSE: To observe the efficacy of vitrectomy with internal limiting membrane (ILM) peeling combined with phacoemulsification with intraocular lens (IOL) implantation in the treatment of cataract with co-existing macular diseases. METHODS: A total of 28 cataract patients (28 eyes) with co-existing macular diseases were admitted to Aier Eye Hospital between May 2008 and May 2011. The clinical characteristics were analyzed in this study. Subjects included 6 men and 22 women, aged from 56 to 77 years (mean 64 years), with duration of disease ranging from 2 to 36 months (mean 9.3 months). All patients underwent phacoemulsification with implantation of a hydrophobic acrylic IOL into the capsular bag and pars plana vitrectomy with ILM peeling. RESULTS: Postoperatively, patients underwent 3- to 18-months of follow-up (mean 7.2 months). Only one eye had macular hole failing to close. Normal macular structure was restored in the other 27 eyes. The presenting visual acuity and best corrected visual acuity (BCVA) did not differ significantly (t=-1.724, P=0.096), with the BCVA in 27 eyes (96.4%) improving by 2 lines or more. The improvement in minimum angle of resolution (MAR) was > 0.3 in 21 eyes, ≥ 0.1 in 6 eyes and < 0.1 in 1 eye. The mean spherical equivalent (SE) was -4.67±5.98D preoperatively and -0.38±0.69D postoperatively (t=4.157, P＜0.005). CONCLUSION: Combined phacovitrectomy surgery is a reliable and safe procedure in the treatment of cataract complicated by macular disease.

Analysis of optic coherence tomography for congenital macular retinoschisis.

PURPOSE: To investigate the pathological characteristics of congenital macular retinoschisis by optic coherence tomography (OCT). METHODS: The data of 7 cases (14 eyes) with congenital macular retinoschisis were collected. Electroretinogram (ERG), fundus fluorecein angiography (FFA) and OCT examination were performed, respectively. RESULTS: The OCT images showed schisis cavity in all eyes. Schisis was confined to the fovea and parafovea in 2 eyes (1 patient). Schisis was involved in entire macular area in 12 eyes (6 patients). Inner nuclear layer (INL) schisis was seen in all eyes. Schisis was located at both INL and outer nuclear layer (ONL)/outer plexiform layer (OPL) in 2 of the 14 eyes. Besides the schisis cavity, small cysts within ganglion cell layer were found in 3 eyes. The small cysts were confined to parafoveal area. The OCT images of both eyes in one patient were similar but not exactly the same or symmetrical. CONCLUSION: Morphology, extension and schisis location in congenital macular retinoschisis have respective diversity.

[Macular morphology and function in patients with diabetic retinopathy without apparent visual loss].

PURPOSE: To investigate the macular morphology and function in patients with diabetic retinopathy(DR) without apparent visual loss. METHODS: Multifocal electroretinograms(mfERG) and optical coherence tomography(OCT) examination were performed in the DR patients on phase 0, 1 to 2, 3 to 4 as well as the normal control non-diabetes subjects. RESULTS: Macular edema was detected in DR phase 1 and 2 (3 eyes,10%) and DR phase 3 and 4 group (6 eyes,23.1%). In comparison with the normal control and DR phase 0 group,the thickness of retinal neuroepithelium increased in DR phase 3 and 4 group(P>0.05). The amplitude and the average density of P1 wave and N1 wave decreased in all DR groups in comparison with normal controls although the latency of P1 wave and N1 wave was not statistically significant (P>0.05).However,comparing with the DR phase 1 and 2 group,the latency of P1 wave and N1 waves were longer whereas the amplitude and the average density decreased in DR phase 3 and 4 group. CONCLUSION: In the patients with DR but without apparent visual loss,abnormalities of the macular morphology and function already develop. The changes of function appear to develop earlier than that of morphology.

Experimental study on relationship between retinal vein occlusion and loss of vitreous gel mass.

PURPOSE: To explore the relationship between retinal vein occlusion (RVO) and loss of vitreous gel mass. METHODS: An experimental RVO was induced by a photodynamic method in one eye (experimental eye) of 17 chinchilla rabbits. The contralateral eye was used as an untreated control. The changes in vitreous gel mass and liquefaction were investigated one month later. Changes in molecular properties of type II collagen in vitreous were analyzed by western immunoblot analysis. RESULTS: An RVO was successfully induced in 13 of 17 chinchilla rabbits (76.5%), which caused loss of vitreous gel mass and loss of elasticity, accompanied by release of a water-like liquid from the gel. The alpha chains of type II collagen were crosslinked together to form high molecular weight components of beta and gamma, which weakened the stability of collagen net structure. CONCLUSIONS: Loss of vitreous gel mass occurred in RVO eyes. The crosslinks of vitreous collagen may damage the stability of collagen structure, and promote loss of vitreous gel mass.

[The conversion of macular function in diabetic macular edema after vitreous surgery].

OBJECTIVE: To evaluate the conversion of macular function in diabetic macular edema (DME) after vitreous surgery. METHODS: Seventeen eyes of 16 patients were assessed after pars plana vitrectomy for DME. Multifocal electroretinogram (mfERG) techniques were used to evaluate the effects of treatment on macular visual function, and retinal foveal thickness was determined by optical coherence tomography before and after vitrectomy. Patients were followed up continually for 7 months. The correlation between the change of tomographic features and visual functions were analyzed. RESULTS: During the follow-up period, the retinal function in macular areas recovered and the foveal thickness decreased gradually. While compared with preoperative values, the response of positive wave (P1) have shown decreases in implicit time and increases in amplitude since the forth and fifth postoperative month respectively (P < 0.05). While compared between each postoperative period, the P1 responses have increased significantly since the forth postoperative month. The correlation between the increase of P1 amplitude in macular area and the decrease of retinal foveal thickness was significant (r = 0.954, P < 0.001). CONCLUSIONS: Macular function get improvement gradually in DME after vitreous surgery; The restoration of macular function is coincident with the reduction of macular edema.

Clinical observation on juvenile macular hole without trauma and hypermyopia.

PURPOSE: To investigate the clinical characteristics of juvenile macular hole without trauma and hypermyopia, and research the mechanism of macular hole. METHODS: Sixty-seven patients less than 40 years of age were studied retrospectively from June 1998 to March 2003. Five cases (7 eyes) aged from 22 to 38 years were reported and the clinical characteristics that had macular hole without trauma or hypermyopia were summed up. RESULTS: There was 1 male and 4 females with visual acuity from 0.08 to 0.8. The images of optical coherence tomography (OCT) showed full thickness macular hole in 5 patients (7 eyes), and the diameters were from 87 to 1043 microm. Among them, 2 cases were combined with retina pigmentosa; 1 case with binocular Coat's disease; 1 case had bilateral macular hole combined with Eagles' disease; 1 case was combined with 2-2.5PD old retinochoroidal lesion under middle-peripheral fundus, and 1.5 PD retinal pigment epithelium (RPE) defect on the optical disk. CONCLUSION: The juvenile macular hole without trauma and hypermyopia combined the different retina vascular damages and the RPE defects.

Assessment of macular function by multifocal electroretinogram in diabetic macular edema before and after vitrectomy.

The purpose of this study was to assess the effects of vitrectomy on retinal function in macular and paramacular areas in patients with diabetic macular edema (DME). Ten eyes of 9 patients with successful vitrectomy for DME were evaluated by multifocal electroretinogram (mfERG), optical coherence tomography (OCT), and visual acuity preoperatively and 1, 2, 3, 4, 5 and 6 months postoperatively. Compared with pretreatment values, the response of the positive wave (P1) in macular and paramacular areas tended to decrease in latency from the second postoperative month, and increase in amplitude at the third postoperative month. There was no significant change in response of the negative wave (N1). The tendency in the change of macular function is coincident with that of macular morphology. Therefore, The multifocal ERG may provide objective criteria for the functional evaluation of DME before and after vitrectomy.

Clinical features of endophthalmitis after vitreoretinal surgery.

PURPOSE: To investigate the rate, clinical features, treatment outcomes and prognosis of postvitrectomy endophthalmitis. METHODS: Patients undergoing pars plana vitrectomy for vitreous opacity or complicated retinal detachment during 1988 to 2000 were collected. Vitrectomies for recent penetrating trauma or endophthalmitis were excluded. Patients suffered from clinical or culture-proven postvitrectomy endophthalmitis were selected. RESULTS: Postvitrectomy endophthalmitis happened to 3 to 7,000 patients, resulting in an overall frequency of 0.04%. Enhanced systemic and local antibiotics were used as soon as diagnosis was made. Endophthamitis were controlled within 6 days, 8 days and 10 days, respectively. Final visual acuities were light perception in 2 patients and 0.02 in 1 patient. CONCLUSION: Postvitrectomy endophthalmitis was rare, but it deteriorate the visual acuity. Both ophthalmologist and patients should pay high attention to it.

Optical coherence tomography's diagnostic value in evaluating surgical impact on idiopathic macular hole.

OBJECTIVE: To identify the characteristics of and evaluate surgical impact on idiopathic macular hole (IMH) by using an optical coherence tomography (OCT) scanner. METHODS: Sixty-five cases (70 eyes) experiencing IMH were examined using OCT, then graded by their clinical characteristics. Nineteen cases (19 eyes) were scanned and measured using OCT before and after surgery. RESULTS: Of the 70 eyes,the number of stage I-IV macular holes were 11, 12, 36 and 11, respectively. For stage I holes, the OCT images revealed flattened or nonexistent fovea and minimally reflective space within or beneath the neurosensory retina; stage II holes appeared to be full-sized with attached operculum and surrounding edema; stage III holes were also full-sized with surrounding edema; finally, stage IV holes were full-sized and completely separated the posterior hyaloid membrane from the retina. Through quantitative measurements, OCT determined that the values for mean hole diameter, mean halo diameter and mean thickness of the hole's edge were reduced from 570.95 +/- 265.59 to 337.05 +/- 335.95 microm, 1043.53 +/- 278.8 to 695.00 +/- 483.00 microm and 389.78 +/- 60.58 to 298.78 +/- 109.80 microm, respectively in 19 IMH cases after surgery. In 17 eyes, the holes or halos eventually closed or were reduced in size, or the edges of the holes thinned out. The anatomic successful rate of the surgery was 89%. CONCLUSION: OCT can exhibit the characteristics of IMH and measure the diameter of holes quantitatively. This method can also judge the surgical impacts of IMH objectively, accurately and effectively.

[The effect of vitrectomy combined with full endocular panretinal photocoagulation in late proliferative diabetic retinopathy].

OBJECTIVE: To investigate the effect of vitrectomy combined with full endocular panretinal photocoagulation in patients with late stage of proliferative diabetic retinopathy (PDR). METHODS: Pars plana vitrectomy combined with full panretinal photocoagulation were undergone in 56 eyes (56 cases) with late stage of PDR, including 32 eyes with tractive retinal detachment. Preoperative and postoperative visual acuity, anterior segment by slit lamp and fundus examination by indirect ophthalmoscopy, as well as fluorescein angiography (FFA) were analyzed. RESULTS: Retina were reattached in 52 eyes. Vitreous hemorrhage, retinal bleeding, exudation and neovascular changes were not observed in these eyes. Non-irrigated areas were not found in 28/32 eyes in which FFA examination has been performed. Final visual acuity was improved in 52 eyes. CONCLUSION: Full endocular panretinal photocoagulation with low energy is an effective and safe procedure with low rate of complications for the late stage of PDR.

[Application of endolaser in vitrectomy for retinal vascular disease].

PURPOSE: To discuss the usage and effectiveness of endolaser in vitrectomy for retinal vascular disease. METHODS: Twenty-four cases (28 eyes) of vitrectomy for retinal vascular disease were treated with endolaser. The methods of endolaser: 21 eyes were treated with panretinal scatter therapy; 2 eyes with endolaser ring-intercepting around retinal and sealing retinal breaks; 5 eye with focal therapy. RESULTS: After follow-up for 1-24 months (mean 9 months), retinal hemorrhage recurred in 3 eyes; the other 25 eyes, retinas were totally reattached, retinal breaks were sealed, and vision had considerable recovery, no hemorrhage. The ratio of recovery is up to 89.2%. CONCLUSIONS: Endolaser is an important adjuvant in vitreous operation nowadays and an effective procedure in vitrectomy for the cases of retinal hemorrhage.

Comparison of pre- and post-operational multifocal electroretinograms of retinal detachment.

OBJECTIVES: To explore the changes of multifocal electroretinograms (mfERG) before and after retinal detachment surgery and to evaluate its clinical significance. METHODS: Twenty-three patients (23 eyes) with rhegmatogenous retinal detachment underwent mfERG before and after surgery. The latencies and average response densities of N(1)-wave and P(1)-wave of mfERGs in detached areas, attached areas, fovea and the entire tested area were compared before and after surgery. RESULTS: Preoperatively, the average response densities of N(1)-wave and P(1)-wave in the detached area were significantly smaller than those in attached areas (t = 3.68, t = 4.26, P < 0.01), and the latencies of N(1)-wave and P(1)-wave in detached areas were significantly longer than those in attached areas (t = 3.07, t = 3.89, P < 0.01). Postoperatively, the average response densities of N(1)-wave and P(1)-wave in detached areas, fovea and the entire tested area increased, and there were significant differences pre- and postoperatively (P < 0.05). However, the latencies of N(1)-wave and P(1)-wave before and after surgery showed no significant differences (P > 0.05). CONCLUSIONS: The mfERG is a useful tool to evaluate the recovery of posterior retinal function after retinal detachment surgery. The response density is a more sensitive index than latency to evaluate retinal function of retinal detachment.