ObjectiveTo observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).MethodsA retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.ResultsThe fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P＜0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.Conclusions3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.
OBJECTIVE:To evaluate the effect and causes of failure of vitreoretinal(VR)surgery in rhegmatogenous retinal detachments associated with choroidal detachment. METHOD:Reviewing the operative effects of the vitreoretinal surgeries in 61patients(61 eyes)with rhegmatogenous retinal detachment associated with choroidal detachment and PVR in this hospital.Vitrectomy,peeling of preretinal membranes,fluid/air echange and inert gas,silicone oil tamponade were used in thesepatients according to need. RESULTS:On discharge from the hospital,the postoperative effect obtained in 40 case(65.57%),and out of 35 eyes receiving the inert gas tamponade 26(74.3%) got effective pesults.Fourteen cases were followed up for 3 months(averge 9.5 months)and 10(7.4%）of themrevealed stable.The factors of influencing VRsurgery seemed to be the range of choroidal detachments,numbers of opreative times,the inert gas tamponede and the time of corticosteroid application.The causes of failure of opreation might relate to severe and antrior PVR,and giant tears. CONCLUSIONS:The VR surgery was thought to be profitable in treating rhegmatogenous retinal detachment associated with choroidal detachment and PVR. （Chin J Ocul Fundus Dis,1996,12: 16-19)
Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics. Refractory macular hole includes unclosed MH, reopening MH, large MH, high myopic MH, traumatic MH and secondary MH. Some modified surgeries were employed to improve the surgical results. Inverted internal limiting membrane flap, autologous transplantation of the internal limiting membrane, laser photocoagulation, extended internal limiting membrane peeling, arcuate retinotomy, lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially. Loosening MH traction, providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.
ObjectiveTo observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment (RRD) complicated with macular hole (MH).MethodsA retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females (13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ2=0.324) between the two groups were not statistically significant (P＞0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure.ResultsAt the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ. In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ. There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ2=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038).ConclusionVitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.