Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization ( CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function. (Chin J Ocul Fundus Dis，2004，20：289-291)
Objective To observe the macular structure changes and its relationship with visual function in patients with idiopathic macular hole (IMH). Methods Forty-seven patients (47 eyes) with IMH who underwent pars plana vitrectomy were enrolled in this study. All patients were examined including bestcorrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, B-scan ultrasonography, optical coherence tomography (OCT) and MP-1. All the patients underwent a standard three-port pars plana vitrectomy. The BCVA, mean light sensitivity (MS) in macular area, macular hole diameter, the photoreceptor inner and outer segment (IS/OS) junction defect, external limiting membrane (ELM) defect were observed on the 1st, 3rd and 6th months after surgery, and then the relationship of IS/OS junction defect, ELM defect, sensitive and BCVA were analyzed. Results The 1st, 3rd and 6th months after surgery, the logarithm of minimal angle of resolution (logMAR) BCVA (t=16.4, 35.7, 20.7; P＜0.05) and MS （t=－13.8, －17.9, －2.5; P＜0.05） were improved significantly; the macular hole diameter （t=7.7, 7.7, 7.7;P＜0.05）, IS/OS junction defect （t=24.1, 19.3, 27.4; P＜0.05） and ELM （t=20.5, 6.7, 15. 8; P＜0.05） defect were decreased significantly. Preoperative IS/OS junction defect and ELM defect were both related to sensitive （r=-0.55, -0.53; P＜0.05）, but uncorrelated with BCVA （r=0.13, 0.13; P＞0.05）. IS/OS junction defect and ELM defect 1st, 3rd and 6th months after surgery were both related to MS and BCVA （P＜0.05）. Conclusions The logMAR BCVA and MS increases, while IS/OS junction and defect ELM defect decreases after surgery in IMH patients. IS/OS junction defect and ELM defect after surgery were both related to sensitive and BCVA.
ObjectiveTo evaluate the efficacy of intra-arterial chemotherapy (IAC) for advanced retinoblastoma (RB) after failure of intravenous chemotherapy (IVC). MethodsFifteen eyes of 13 patients with advanced RB were treated with IAC (1-5 cycles) after failure of IVC (2-8 cycles). The patients included 10 boys and 3 girls, with the mean age of (15.67±8.16) months. Six patients had bilateral RB and 7 patients had unilateral RB. There were 14 eyes (93.33%) in stage D, 1 eye (6.67%) in stage E according to the International Classification of intraocular retinoblastoma. The main reasons for failure of IVC were recurrent primary tumor in 3 eyes (20.00%), subretinal seeds recurrence in 9 eyes (60.00%), viable vitreous seeds in 2 eyes (13.33%) and poor response of primary tumor in 1 eye (6.67%). The mean interval between IVC completion and IAC start was 3 months. The mean follow-up was 19 months (ranged from 3 to 52 months). ResultsAfter IVC and secondary IAC, the retinoblastoma and seeds were regressed in 12 eyes (80.00%). Three eyes required enucleation for severe vitreous seeds, subretinal seeds recurrence and primary tumor recurrence. There was no evidence of metastasis in any case. ConclusionIAC can achieve high global salvage rate (80.00%) for patients with advanced retinoblastoma after failure of IVC.
Objective To observe the changes of anatomic structure and visual function after surgery in highly myopia patients with macular hole and retinal detachment (MHRD). Methods Twentyfive patients (25 eyes) with MHRD who underwent vitreous and internal membrane peeling surgery combined with silicone oil tamponade, were enrolled in this study. All the patients had undergone the examinations of logarithm of minimal angle of resolution (logMAR) visual acuity, optical coherence tomography (OCT), MP-1 microperimetry and multifocal electroretinogram (mf-ERG) before and three months after surgery. The visual acuity, structure of macular hole and macula, fixation point, mean sensitivity (MS) within 10° of macular area and four quadrants including supertemporal, supernasal, intranasal and infratemporal, average response densities of N1 and P1 waves at all 6 rings before and after surgery were observed. Results Three months after surgery, the logMAR visual acuity improved (t=8.265， P＜0.05). Twentyfour eyes (96%) were anatomically reattached, one eye (4%) was not anatomically reattached completely. The results of MP-1 microperimetry showed that foveal fixation was found in two eyes (8%), weak foveal fixation was found in four eyes (16%), paracentral fixation was found in 19 eyes (76%). There were four eyes (16%) with stable fixation, nine eyes (36%) with relatively unstable fixation and 12 eyes (48%) with unstable fixation. The MS value within 10° of macular area was 9.031±4.245 dB. The MS value difference among four quadrants was statistically significant (F=7.40，P=0.015). The mf-ERG results showed that the average response densities of N1 and P1 waves at all 6 rings were increased (P＜0.05). Conclusion The macular hole heals, retina remains reattached, visual acuity, and fixation are improved in the most of MHRD eyes after surgery.
Objective To summarize the surgical experience of supracardiac total anomalous pulmonary venous connection(S-TAPVC) and study the surgical technique and outcomes for S -TAPVC. Methods Eightysix patients with S-TAPVC underwent the surgical repair from May 1985 to December 2007. There were 49 males and 37 females. The patients aged from 7 months to 35 years (mean 9.6 years) and weighed from 4.9 kg to 68.0 kg (mean 23.8 kg). The patients were divided into three groups by the approach for the anastomosis. There were 20 patients in groupⅠthrough the right atrium incision, 49 patients in group Ⅱ through the right and left atrium incisions and 17 patients in group Ⅲ through the top of the left atrium incision. The interrupt continuous anastomosis between the common pulmonary venous and the left atrium was used in all patients. The enlarged atrial septal defect(ASD) was repaired with autopericardium. The vertical vein was ligated if the postoperative left atrial pressure was less than 15 mm Hg. But the vertical vein was opened or just partialy ligated if the postoperative left atrial pressure was more than 15 mm Hg. Results There was no early operative death. The postoperative left atrial pressure in three groups were 9.3±3.2 mm Hg, 9.9±2.9 mm Hg and 11.6±3.8 mm Hg, respectively. The cases with open or just partly ligated vertical vein in three groups were 0 case （0%）, 7 cases (14.3%) and 2 cases (11.8%), respectively. The cases of arrhythmia in three groups were 5 cases （25.0％）, 15 cases （30.6%）and 1 case （5.9%）. The severely low cardiac output syndrome occurred in 2 patients and reoperation for bleeding in 2 patients. The morbidity of arrhythmia in group Ⅲ was less than in group Ⅱ（P=0.042）. Conclusion The outcome of surgical repair for S -TAPVC is satisfactory. The anastomosis through the top of the left atrium incision has low occurrence of arrhythmia. The anastomosis through the right and left atrium incision is easy to expose and to perform surgery, especial for old children and adult patients.
Objective To observe the efficacy and safety of micro-invasive vitrectomy for retinal detachment associated with choroidal detachment. Methods A total of 35 patients (36 eyes) with retinal detachment associated with choroidal detachment were enrolled in this study. The patients included 22 males and 13 females, with a mean age of (51.32 plusmn;17.34) years. Visual acuity was light perception in six eyes, hand movement in 12 eyes, finger counting in nine eyes, 0.01-0.1 in eight eyes, and 0.2 - 0.3 in one eye. The median LogMAR visual acuity was (2.13plusmn;0.50). The median intraocular pressure was (7.08plusmn;2.62) mm Hg (1 mm Hg=0.133 kPa). All the patients were received vitrectomy using 23-gauge instrumentation combined with 25-gauge infusion. Tamponade with silicone oil (35 eyes) or C3F8 gas (one eye) were performed. The median follow-up time was (6.23plusmn;3.07) months. The pre- and post-operative visual acuity, intraocular pressure, the rate of retinal reattachment, the rate of recurrent retinal detachment and complications were comparatively analyzed.Results Retinal reattachment was attained in 36 eyes (100%) at the first day after vitrectomy. Retinal reattachment was attained in 33 eyes (91.7%) and recurrent retinal local detachment was attained in three eyes (8.3%) at one months after vitrectomy. The rate of retinal reattachment was 83.3% (30 eyes) at three months after vitrectomy. One day, one and three months after treatment, the mean LogMAR visual acuity were 1.77plusmn;0.66, 1.53plusmn;0.72, 1.31plusmn;0.77 respectively. The differences of the visual acuity was statistically significant between before and after vitrectomy (F=62.61,P＜0.05). One day, one and three months after treatment, the mean intraocular pressure were (12.47plusmn;7.28), (15.51plusmn;6.86), (15.82plusmn;7.60) mm Hg respectively. The differences of the intraocular pressure was statistically significant between before and after vitrectomy (F=6.88,P＜0.05).Secondary glaucoma occurred in one eye at three months after vitrectomy. Except this, there was no other complication related to treatment. Conclusion Micro-invasive vitrectomy is a feasible and safe treatment for retinal detachment with choroidal detachment.
The study aims to investigate whether there is difference in pre-treatment white matter parameters in treatment-resistant and treatment-responsive schizophrenia. Diffusion tensor imaging (DTI) was acquired from 60 first-episode drug-naïve schizophrenia (39 treatment-responsive and 21 treatment-resistant schizophrenia patients) and 69 age- and gender-matched healthy controls. Imaging data was preprocessed via FSL software, then diffusion parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were extracted. Besides, structural network matrix was constructed based on deterministic fiber tracking. The differences of diffusion parameters and topology attributes between three groups were analyzed using analysis of variance (ANOVA). Compared with healthy controls, treatment-responsive schizophrenia showed altered white matter mainly in anterior thalamus radiation, splenium of corpus callosum, cingulum bundle as well as superior longitudinal fasciculus. While treatment-resistant schizophrenia patients showed white matter abnormalities in anterior thalamus radiation, cingulum bundle, fornix and pontine crossing tract relative to healthy controls. Treatment-resistant schizophrenia showed more severe white matter abnormalities in anterior thalamus radiation compared with treatment-responsive patients. There was no significant difference in white matter network topological attributes among the three groups. The performance of support vector machine (SVM) showed accuracy of 63.37% in separating the two patient subgroups (P = 0.04). In this study, we showed different patterns of white matter alterations in treatment-responsive and treatment-resistant schizophrenia compared with healthy controls before treatment, which may help guiding patient identification, targeted treatment and prognosis improvement at baseline drug-naïve state.