ObjectiveTo evaluate the associated factors for predicting anatomical outcomes of idiopathic macular hole (IMH) after vitrectomy. MethodsThis is a retrospective study. A total of 165 eyes in 164 IMH patients underwent a successful vitrectomy and ILM peeling surgery were included in this study.The patients included 43 males and 121 females, with the mean age of (64.0±6.7) years. The corrected vision acuity of logarithm of the minimum angle of resolution (logMAR), indirect ophthalmoscope and spectral domain optical coherence tomography (SD-OCT) were measured for all patients. The mean logMAR corrected vision acuity was 1.0. The duration of disease was (8.7±14.9) months. The minimum diameter (MIN), base diameter (BASE) and height (H) were 521, 1010, 406 μm respectively. The macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI) and macular hole closure index (MHCI) were 0.43, 0.82, 0.57, 0.92 respectively. Anatomical outcomes were divided into 3 levels. A: bridge-shaped healing; B: good healing; C: poor healing. The mean follow-up was (3.6±3.2) months. The multiple factors related with prognosis including age, sex, duration of disease, preoperative logMAR corrected vision acuity, MIN, BASE and H, MHI, THI, DHI, MHCI were analyzed. ResultsDuration of disease (r=0.141), preoperative logMAR corrected vision acuity (r=0.082), age (r=0.044), sex (r=0.109) was independent of anatomical prognosis (P > 0.05). MIN (r=0.397), BASE (r=0.276), H (r=-0.240), MHI (r=-0.363), THI (r=-0.432), DHI (r=0.272) was weak correlation to anatomical prognosis (P < 0.05). MHCI correlated significantly with anatomical outcomes (r=-0.543, P=0.000). The median MHCI of A, B and C were 1.07, 0.91, 0.56 respectively. There were significant difference of MHCI among the three levels (H=52.857, P < 0.05). ConclusionsMHCI has the best correlation with anatomical outcomes. It can be considered a key factor for predicting anatomical outcomes of IMH after vitrectomy.
ObjectiveTo compare the efficacy among 30% and 50% dose of verteporfin photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in the treatment of chronic central serous chorioretinopathy (CSC). Methods138 eyes of 125 patients with chronic CSC, who were treated in our hospital from March 2006 to May 2014, were enrolled in this retrospective study. All patients were confirmed by spectral domain optical coherence tomography (SD-OCT) and best corrected visual acuity (BCVA), which was recorded with logMAR BCVA. And all the patients were divided into three groups by different treatments: 30% dose group (42 eyes of 39 patients); 50% dose group (77 eyes of 67 patients); anti-VEGF group (19 eyes of 19 patients). The differences of age, gender, eyes, courses, mean logMAR BCVA among three groups were not significant. Disappearing of fluid under retina in SD-OCT was considered to be cured and fluid remaining was not cured. If fluid appeared again the eyes were relapsed. We comparatively analyzed the cure rate, relapse rate and changing of BCVA, central macular thickness (CMT) among 3 groups of patients after 1, 3, 6 months. ResultsThe cure rate among 3 groups after 1 month was statistically different (χ2=6.926, P=0.031). The cure rates of 50% dose PDT treatment group after 3 months and 6 months were better than 30% dose PDT treatment group, but the differences were not significant (χ2=2.218, 1.682; P=0.136, 0.195). The relapse rate between 30% dose and 50% dose PDT treatment groups after 3 months and 6 months were not significant (χ2=2.133, 3.366; P=0.144, 0.067). The improvement of BCVA in 50% dose PDT treatment group was the best, but comparing with the other two groups, the differences were not significant in statistics (P > 0.05). The improvement of CMT in 50% dose PDT treatment group was the best. Comparing with anti-VEGF group, the differences was significant (P < 0.05). But comparing with 30% dose PDT treatment group, the differences was not significant (P > 0.05). Logistic regression analysis showed that after treatment, the cure rates after 1 month and 6 months were negatively correlated with the age (regression coefficient=-0.942, -0.979; odds ratio=0.390, 0.375; P < 0.05) and the cure rates after 3 months was positively correlated with the dose of verteporfin (regression coefficient=0.855, odds ratio=2.351, P < 0.05). Conclusion50% dose verteporfin PDT is recommend for chronic CSC treatment.
Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=（M+N）/BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=−0.665, −0.691; P＜0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery.
ObjectiveTo evaluate the efficacy of 30% and 50% dose photodynamic therapy (PDT) for acute central serous chorioretinopathy (CSC). MethodsA retrospective cohort study. Ninety-two eyes of 88 patients with CSC, diagnosed by best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR), indirect ophthalmoscope, fundus colorized photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA)and optical coherence tomography (SD-OCT) treated with 30% and 50% doses of verteporfin respectively between March 2007 and August 2013, were enrolled. The eyes were divided into 50% dose group (49 eyes) and 30% dose group (43 eyes). The differences of age (t=-1.45), gender (χ2=0.011), eyes (χ2=2.140), mean logMAR BCVA (t=-0.40), mean central retinal thickness (CRT) and the maximum thickness of serous retinal detachment (SRD) between two groups were not significant (P > 0.05). The difference of spot size between two groups was significant (t=-2.84, P < 0.05). The follow-up time was ranged from 6 to 68 months, with a mean of (17.16 ±11.30) months. The difference of follow-up between two groups was significant (P > 0.05). The BCVA, cure rate, recurrence rate and the changes of CRT and maximum SRT were observed by SD-OCT. ResultsThe subretinal fluid (SRF) of 31 eyes (72.09%) in the 30% dose group and that of 47 eyes (95.92%) in the 50% dose PDT group was absorbed completely respectively. The cure rates in the 30% dose PDT group was significantly less than that in the 50% dose group (χ2=10.077, P=0.020). There was a significant negative association between the cure rate and spot size by Logistic regression (odds ratio > 1, P=0.040). The difference of changes in the BCVA of logMAR in 50% dose group was better than that in 30% dose group after more than 12 months after PDT (P=0.036). On 3, 6, 12 and more than 12 months after PDT, the difference in CRT in 50% dose group and 30% dose group were not statistically significant (P=0.068, 0.060, 0.082, 0.067). The difference in maximum thickness of SRD was not statically significant (P > 0.05). SRF was appeared in 8 eyes (25.81%) of 31 eyes in the 30% dose group, while SRF was appeared in 1 eye (2.13%) of 47 eyes in the 50% dose group. The recurrence rate of 30% dose group was much higher than that of 50% dose group (P < 0.05). ConclusionsFor acute CSC treated by PDT, the curative effect of 50% dose group is better than the 30% dose group.