In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti-VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti-VEGF therapy for zoneⅡ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc.
Objective To evaluate the influence factor of the prognosis of traumatic subretinal hemorrhage after vitreoretinal surgery. Methods The clinical data of 50 patients with traumatic subretinal hemorrhage who had undergone vitreoretinal surgery were retrospectively analyzed.All patients had ocular traumatic history and subretinal hemorrhage diagnosed by fundus and B-scan examination;the preoperative visual acuity was less than 0.1. According to different conditions, the traumatic eyes were treated with vitreo-retinal surgery, combined with lensectomy, retinotomy or silicone oil tamponade, respectively. The period of follow-up after surgery was 2-53 months, and the average period was 7.27 months. The corrected visual acuity and retinal reattachment at the last follow-up were observed. The visual acuity ge;0.1 was the standard of good prognosis; retinal reattachment was observed by indirect ophthalmoscope and color fundus photography.The prognostic factors mainly included type of injury,open or closed injury,the disease course, preoperative visual acuity, retinal detachment,hemorrhagic choroidal detachment,vitreous hemorrhage,the sites of submacular hemorrhage,methods of surgery.The relationships between those prognostic factors and visual acuity outcome or retinal reattachment were analyzed by chi;2test and logistic regression analysis. Results About 46.0% patients had good prognosis of the visualacuity. In the eyes with preoperative visual acuity of no light perception to hand moving and finger counting to 0.1, the rate of good visual acuitywas 34.2% and 83.3%, respectively; the difference between the two groups was significant (chi;2=8.860,P=0.003). In the eyes with or without preoperative retinal detachment,the rate of good visual acuity was 37.5% and 80.0%, respectively; the difference between the two groups was significant (chi;2=4.232,P=0.040). In the eyes with subretinal hemorrhage involving the macular fovea or not, the rate of good visual acuity was 34.4% and 66.7%,respectively; the difference between the two groups was significant (chi;2=4.836,P=0.028).All the other prognostic factors had no obvious effect on the retinal reattachment after the surgery. Conclusion Preoperative visual acuity、retinal detachment and submacular retinal hemorrhage were the important influence factors associated with prognostic visual acuity of eyes with traumatic subretinal hemorrhage after vitreoretinal surgery.
Objective To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR). Methods Retrospectively analyzed the follow-up data of 882 patients (1000 eyes) with PDR who had undergone vitreoretinal surgery. The standard of NLP was: in a darkroom, one eye was covered, and the other one could not catch the candlelight 30 cm in front of the eye. The number of eyes with NLP was counted and the clinical data of the eyes with or without NLP were analyzed and compared. chi;2 test was used to analyze the risk factors of NLP. Results In these 1000 eyes with PDR,the postoperative visual acuity was NLP in 22 eyes (2.2%) and light perception in 978 eyes (97.8%). Comparing with the patients with light perception, the patients with NLP had severer disease condition, including ante-operative neovascular glaucoma (NVG)(36.4%), tension combined with retinal detachment 50%, and a need for lens excision during the surgery (45.5%) and for silicone oil filling at the end of the operation (63.6%). After the surgery, NVG was found in 14 eyes, un-reattached retina in 5 eyes (before the surgery was VI stage of PDR), and optic nerve atrophy and retinal vessel atresia in 3 eyes, which significantly differed from which in the patients with light perception (Plt;0.001，P=0.004, (Plt;0.001). The differences of sex, diabetes type and PDR stage between the NLP group and non-NLP group were not significant (P=0.136, P=0.681, P=0.955). Conclusions The incidence of NLP after vitreoretinal surgery for proliferative diabetic retinopathy is low. The direct causes were NVG, optic nerve atrophy, retinal vessel atresia and retinal redetachment, while the sex, type of diabetes mellitus and stage of PDR show no statistical relation to the occurrence of NLP after surgery. (Chin J Ocul Fundus Dis,2007,23:244-247)
Objective To evaluate improvement of visual acuity for advanced proliferative diabetic retinopathy eyes with different complications after vitrectomy． Methods Four groups of advanced pr oliferative diabetic retinopathy (APDR) in 314 eyes with diabetes type Ⅱ and type Ⅰ were analyzed retrospectively: vitreous hemorrhage with limited traction retinal detachment (VH), extensive fibrovascular membranes with traction retinal detachment (TD), combined rhegmatogenous and traction retinal detachment (CRT) and cataract with vitreous hemorrhage or and traction retinal detachment (CHD)． Results 0．1 or better postoperative visual acuity was achieved in 59．5% of type Ⅱ and 66．7% of type Ⅰ in the VH group; 39．4% of type Ⅱ and 52．6% of type Ⅰ in the extensive TD group; 31．6% of the CRT grou p; 62．5% of the CHD group． The major intraoperative complication is iatrogenic retinal breaks． The causes of postoperative visual loss in present study included neovascular glaucoma (2．8% of type Ⅰ and 0．4% of type Ⅱ in aphakia, 25% of type Ⅱ in aphakia and 4．2% in pseudophakia), retinal detachment and CRAO． Conclusion The majority of APDR eyes obtained better visual improvement after vitrectomy and photocoagulation． (Chin J Ocul Fundus Dis, 2001,17:171-174)
ObjectiveTo observe the characteristics of the images of optical coherence tomography (OCT) performed on the patients with vitreomacular traction syndrome and its clinical significance.MethodsThe clinical data of 25 patients with vitreomacular traction syndrome diagnosed by OCT, fundus fluorescein angiography, and B-scan ultrasonography and confirmed by surgical treatment were retrospectively analyzed. The features of images of OCT in vitreomacular traction syndrome were observed.ResultsFive types were found in the images of OCT in the patients with vetreomacular traction syndrome. The main characteristic of the images of OCT in the patients with vitreomacular traction was the highly reflective band of the vitreous posterior cortex inservion at fovea. In 25 patients, vitreomacular traction associated with macular edema was found in 10, macular hole in 3, macular epiretinal membrane in 6, retinoschisis in 1, and retinal detachment in 5.ConclusionOCT is a potential powerful toll for detecting and monitoring vitreomacular traction syndrome. (Chin J Ocul Fundus Dis, 2005,21:86-89)
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)
Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)
Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy (PDR) in patients with type 1 and type 2 diabetes mellitus (DM). Methods Retrospectively analyzed the clinical data of 451 patients with DM (71 with type 1 and 380 with type 2) who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre-and post-operative visual acuity, progression and regression of iris neovascular (INV), neovascular glaucoma (NVG), and the reattached and being attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients: the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% (46/71) in type 1 DM patients and 72.4% (275/380) in type 2 DM patients (P=0.196). There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60.0% in type 2 DM group (P＝0.678);the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group (P＝0.822). The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after on off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM (P＝0.611); the rate of retina being-attachment after one-off surgery were 90.1% in type 1 DM group and 93.4% in type 2 DM group, respectively (P＝0.323). Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR. (Chin J Ocul Fundus Dis,2007,23:248-251)