Surgical strategy and outcome in patients with bilateral proliferative diabetic retinopathy.

OBJECTIVES: To investigate the current surgery strategies for bilateral proliferative diabetic retinopathy (PDR), as well as the surgical outcomes of patients with bilateral PDR who underwent pars plana vitrectomy (PPV). MATERIALS: Patients undergoing bilateral vitrectomy for PDR from January 2019 to December 2020 at The Eye Hospital of Wenzhou Medical University were enrolled. Clinical data were collected from the electronic medical records. Factors associated with the time interval between the surgeries on two eyes and postoperative visual outcomes were analyzed. RESULTS: In total, 152 patients with bilateral PDR who underwent bilateral PPV were included in this analysis. Mean age was 53.7 ± 11.4 years. Compared with second-surgery eyes, 60.5% of first-surgery eyes had worse preoperative best-corrected visual acuity (BCVA). The overall PPV time (median, quartile range) between first and second surgeries eye was 1.40 (0.70, 3.15) months. Multivariate analysis showed that the preoperative BCVA of the second-surgery eye had a significant effect on the inter-surgery time interval (P = 0.048). First-surgery eyes had greater vision improvement than second-surgery eyes (Difference of the logarithm of the minimum angle of resolution [LogMAR] BCVA: - 1.00 [- 1.48, - 0.12] versus 0.00 [- 1.30, 0.00], respectively, P < 0.001), especially when eyes with poorer BCVA underwent PPV first (- 1.15 [- 1.87, - 0.54] versus 0.00 [- 0.70, 0.00], respectively, P < 0.001). CONCLUSIONS: Visual acuity is a significant factor that influences surgical strategies, including both surgery order and interval, for patients with bilateral PDR. The eyes operated upon first show more vision improvement due to prompt surgery.

Internal Limiting Membrane Peeling versus Nonpeeling to Prevent Epiretinal Membrane Formation following Vitrectomy for Posterior Segment Open-Globe Injury.

PURPOSE: Approximately 30% of patients with an open-globe injury (OGI) develop a secondary epiretinal membrane (ERM). This study was performed to assess whether internal limiting membrane (ILM) peeling in the treatment of posterior segment OGI prevents ERM formation. METHODS: The medical records of 33 patients who underwent vitrectomy for posterior segment OGI from 2016 to 2019 were retrospectively analyzed. Of these patients, 17 underwent ILM peeling during the vitrectomy and 16 did not. The patients' demographic and surgical data were collected. The associations of ILM peeling with the preoperative findings of posterior segment OGI and development of a postoperative ERM were analyzed. Student's t-test was used to evaluate differences in continuous variables, and the chi-squared test or Fisher's exact test was used for categorical variables. Time-to-event curves were calculated from postestimation Cox proportional hazards models. RESULTS: An ERM developed in three eyes (17.6%) in the ILM peeling group and in eight eyes (50.0%) in the nonpeeling group (p < 0.05). There was no statistically significant difference between the groups in visual acuity at baseline (1.68 vs. 1.58 logMAR, p=0.68) or at final follow-up (0.72 vs. 0.78 logMAR, p=0.66). Median visual acuity significantly improved in both groups (p < 0.001). In the multivariable models, ILM peeling (odds ratio, 0.19; 95% confidence interval, 0.04-0.91; p=0.04) and worse preoperative vision (odds ratio, 0.29; 95% confidence interval, 0.10-0.80; p=0.02) were associated with lower likelihood of ERM formation. CONCLUSION: Preventative treatment with ILM peeling contributed to decreased development of an ERM in patients with OGI involving areas near the fovea.

Passive Removal of Silicone Oil with Temporal Head Position through Two 23-Gauge Cannulas.

Purpose. To report a new approach for removal of silicone oil. Methods. All surgeries were performed using 23-gauge vitrectomy system with two transconjunctival sutureless cannulas. At the beginning, most of the silicone oil was removed by traditional microinvasive vitrectomy system through inferior-temporal cannula. Then, the blood transfusion tube is removed from the inferior-temporal cannula, and the fluid-air exchange is performed. A passive fluid-air exchange was performed to aspirate the residual silicone oil after gradually turning the patient's head temporally by approximately 90° gradually. Results. After the surgery, all patients had a clear anterior chamber and vitreous cavity on slit lamp and B scan examination, respectively. The mean time taken for silicone oil removal and total surgery was 8.0 ± 1.4 minutes and 12.4 ± 2.5 minutes, respectively. The mean intraocular pressure 1 day, 3 days, 1 week, 1 month, and 3 months after surgery was 9.0 ± 5.8 mmHg, 11.3 ± 7.6 mmHg, 16.1 ± 6.9 mmHg, 17.7 ± 4.8 mmHg, and 17.1 ± 3.5 mmHg, respectively. Conclusion. This new approach may provide a safe and fast method to remove the silicone oil.

Trochlear calcification and intraorbital foreign body in ocular trauma patients.

OBJECTIVE: To distinguish trochlear calcification and intraorbital foreign body after eye injury in order to avoid misdiagnosis as well as mistreatment. METHODS: The orbital CT images of 403 patients, who visited the Eye Hospital or the Second Affiliated Hospital of Wenzhou Medical College during May 2005-April 2007, were reviewed. The diagnosis of trochlear calcification and intraorbital foreign body was made together by a skilled radiologist as well as an ophthalmologist. General information and CT characteristics in the patients with trochlear calcification were collected. RESULTS: Using CT scan images, 27 among 403 patients (6.69%) were identified with trochlear calcification. Three patients (3/27, 11.11%) were misdiagnosed by radiologists as intraorbital foreign body. Among the 27 patients with trochlear calcification, 23 (85.19%) were male and 4 (14.81%) were female, with an unilateral calcification in 7 patients (7/27, 25.93%) and bilateral in 20 (74.07%) . The highest occurrence of trochlear calcification was in 31-40 years old group (13/403, 3.23%) which reached to 12.87% (13/101) after age-correction. There were 3 types of trochlear calcification on the basis of CT images: commas, dot and inverted "U". CONCLUSIONS: The trochlear calcification is not an uncommon phenomenon and should not be diagnosed as intraorbital foreign body, especially when it co-exists with eye injury in 31-40 years old group. Injury history and our classification method on the basis of CT images could help to avoid misdiagnosis.

[Submacular fluid after surgery for rhegmatogenous retinal detachment].

OBJECTIVE: To evaluate the accumulation of submacular fluid after surgery for retinal detachment. METHODS: It was a case control study. Sixty seven eyes of sixty six patients with rhegmatogenous retinal detachment which had undergone par plana vitrectomy (PPV) or buckle surgery for retinal detachment were recruited. All patients underwent clinical examination, optical coherence tomography (OCT) scan of the macular at the 1-month postoperative follow-up examination. RESULTS: Submacular fluid after PPV occurred in 21.7% eyes, and was significantly lower than that after buckle surgery(47.7%, chi2 = 4.296, P < 0.05). No significantly differences of submacular fluid rate were found between different surgical technique groups (cryotherapy, transscleral diode photocoagulation, with or without drainage of subretinal fluid) in our buckle surgery series (chi2 = 0.091, 1.588; P > 0.05). There was statistically significant difference in the rate of submacular fluid in cases of buckle surgery series with or without macular detachment (chi2 = 9.537, P < 0.01). Visual acuity improved for 2 lines or more accounted for 80.8% eyes in patients with submacular fluid and for 80.1% eyes in patients without submacular fluid. Comparison of pre- and postoperative LogMAR between these two groups showed no significant difference (F = 0.162, P = 0.688). CONCLUSIONS: The rate of submacular fluid is much lower after PPV than after buckle surgery. Different surgical techniques used in buckle surgery such as cryotherapy or transscleral diode photocoagulation and with or without drainage of subretinal fluid do not influence the rate of postoperative submacular fluid. The rate of submacular fluid is much lower in eyes without macular detachment than in eyes with macular detachment in buckle surgery series.