[The efficiency of 23 G vitrectomy combined with preoperative subtenon injection of triamcinolone acetonide for treatment of retinal detachment associated with choroidal detachment].

Objective: To evaluate the efficiency of 23 G vitrectomy combined with preoperative subtenon injecfion of triamcinolone acetonide for treatment of rhegmatogenous retinal detachment associated with choroidal detachment. Methods: A retrospective analysis. Forty-eight (16 males and 32 females, aged 57.3±13.9) consecutive patients (48 eyes) who were diagnosed with rhegmatogenous retinal detachment associated with choroidal detachment and received 23 G vitrectomy at the Eye Hospital of Wenzhou Medical University during January 2012 and January 2015 were enrolled. Twenty-three eyes were treated with subtenon injection TA 5 d before the planned 23 G vitrectomy (TA group). Twenty-five eyes were treated with dexamethasone 3 to 5 d before the planned vitrectomy (Dex group). Type-B ultrasonic, intraocular pressure, best corrected visual acuity examinations were conducted for all eyes on admission day, preoperatively and at 1 month, 3 month postoperatively, and during the last visit. The rate of reattachment, change of height of choroidal detachment, intraocular pressure, best corrected visual acuity, and the complication of the eyes between the two groups were compared. All patients were followed up at least half a year after the repair surgery. Results: The intraocular pressure of the TA group was higher than the Dex group[(8.58±3.83)mmHg vs. (6.70±2.49)mmHg (1 mmHg=0.133 kPa), (t=2.032)], and the height of choroidal detachment was lower in TA group [0.90(0.00, 3.84)mm vs. 4.03(1.05, 5.38)mm, Z=-2.569, P<0.05]. There is no statistic difference between the reattachment rate of the two groups [95.7%(22/23) vs. 76.0%(19/25), χ(2)=2.304, P=0.129], but it seems it was better in TA group. The best corrected visual acuity results of the last visit was better in TA group than Dex group [(0.91±0.54) vs. (1.25±0.62), t=-2.034, P=0.048]. The rate of hypertention was higher in TA group than Dex group at 1 month, 3 month postoperatively(χ(2)=2.304, 5.648, P<0.05), while there was no statistic difference of hypertention rate during last visit between the two groups (χ(2)=0.006, P=0.941). Conclusions: The treatment of 23 G vitrectomy combined with subtenon injection of triamcinolone acetonide can improve the intraocular pressure, reduce the height of choroidal detachment, and improve the best corrected visual acuity after the surgery, but it may cause heyertenion. (Chin J Ophthalmol, 2018, 54: 252-257).

[Keratectomy combined with intrastromal injection of voriconazole in treating fungal keratitis].

Objective: To investigate the treatment effect of keratectomy combined with intrastromal injection of voriconazole on fungal keratitis. Methods: Retrospective study. Ninety-eight fungal keratitis patients (98 eyes) were treated by keratectomy combined with intrastromal injection of voriconazole in Shandong Eye Hospital from January 2013 to May 2015. The corneal ulcers were mostly located in the paracentral or peripheral cornea, which incompletely blocked the pupil area. Slit lamp and anterior segment optical coherence tomography (AS-OCT) were used for lesion detection. The maximum lesion diameter was ≤5 mm, and the maximum depth was not more than half of the full corneal thickness. Because the anti-fungal drug treatment for 3-7 days was not effective, keratectomy was performed with intrastromal injection of voriconazole. The excision extension was 0.5 mm greater than the ulcer diameter, and keratectomy could be repeated until the infiltrative tissues were completely removed. Anti-fungal drug therapy was carried on after surgery. The wound healing and complications were observed. Results: All the subjects were diagnosed as fungal keratitis by corneal scraping and confocal microscopy. With an average lesion diameter of (3.72±1.23) mm, the corneal ulcers were located in the paracentral cornea in 30 patients (30.6%) and in the peripheral cornea in 68 patients (69.4%). The infiltrative depth of 74.5% of the cases detected by AS-OCT were ≤1/2 corneal thickness. The fungal keratitis in 95 cases was cured successfully. Conjunctival flap covering surgery (2 cases) and penetrating keratoplasty (1 case) were performed when the conditions were poorly controlled. Among the 95 cured cases, the ulcer healing time ranged from 3 to 19 days, and ≤7 days in more than half of the cases (48 cases). The average corneal thickness was (433.2±119.3) µm at 3 months, and the corneal endothelial cell density was (2 344.0±404.6) cells/mm(2). The uncorrected visual acuity was improved in 71(74.7%) eyes, of which 3 cases had a vision of 1.0. Conclusions: For fungal keratitis with a lesion diameter of<6 mm and a depth not more than half of the full corneal thickness, keratectomy combined with intrastromal injection of voriconazole could achieve ideal outcomes. The visual acuity recovered quickly, the therapy course was shortened, and the necessity of keratoplasty and other high risk surgeries was reduced. (Chin J Ophthalmol, 2017, 53: 682-688).

Intrastromal injection of bevacizumab in patients with corneal neovascularization / Injeção intraestromal de bevacizumabe em pacientes com neovascularização corneana

Corneal neovascularization (NV) not only reduces visual acuity, but it also causes loss of the cornea's immune privilege, strongly contributing to a worse prognosis in penetrating keratoplasty. Several mediators participate in corneal angiogenesis, and the role of vascular endothelial growth factor (VEGF) has been extensively proven. Anti-VEGF agents have been shown to be effective in slowing the growth of corneal neovessels. Bevacizumab, an anti-VEGF agent, has been successfully used in the treatment of corneal neovascularization. In this paper, we report a series of patients who underwent intracorneal bevacizumab injections to treat corneal vascularization.

Além de causar redução da acuidade visual, a neovascularização corneana leva à perda do privilégio imunológico da córnea, contribuindo para um pior prognóstico em casos de ceratoplastia penetrante. Diversos mediadores participam da angiogênese corneana. O papel do fator de crescimento endothelial vascular (VEGF) já foi amplamente descrito. Agentes inibidores do VEGF são eficazes na redução do crescimento de neovasos corneanos. Bevacizumabe, um agente anti-VEGF, tem sido utilizado com sucesso no tratamento de neovascularização corneana. Neste artigo, relatamos uma série de pacientes que foram submetidos à injeção intraestromal de bevacizumabe para o tratamento de vascularização corneana.