Objective To evaluate the anatomic outcome after lenssparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP). MethodsThe clinical data of 39 infants (50 eyes) with 4a (20 eyes) or 4b (30 eyes) were retrospectively analyzed. The age ranged from two to 18 months, with a mean of (6.0±3.4) months. The gestational age ranged from 26 to 33 weeks, with a mean of (30.0±1.6) weeks. The birth weight ranged from 800 to 1900 g, with a mean of (1404.5±237.6) g. Nineteen eyes underwent SB and 31 eyes underwent LSV. Follow-up ranged from 6 to 84 months, with a mean of (26.0±21.7) months. The anatomical and refractive results were reviewed at the final follow-up. ResultsThe anatomic success of SB was 100.0% (19 of 19 eyes) and that of LSV was 87.1% (27 of 31 eyes). Among the patients in whom treatment failed, 4 were in the LSV group (4/31, 12.9%). The buckles of 5 eyes (5/19, 26.3%) were removed. At the end of the followup, the mean myopic refraction was (-4.46±2.49) diopters (ranging from -1.25 to 11.00 diopters) in the LSV group, and (-3.21±1.96) diopters (ranging from -1.25 to 9.25 diopters) in the SB group. There was no significant difference between two groups (F=2.76, P=0.103). ConclusionThe anatomic outcome after LSV or SB for stage 4 ROP was excellent.
Objective To compare the efficacy of pars plana vitrectomy (PPV) and nonvitrectomizing vitreous surgery (NVS) in the treatment of idiopathic epimacular membrane (IMEM). MethodsA prospective , randomized and comparative clinical study. From April 2019 to May 2020, 21 eyes of 21 patients with IMEM diagnosed in Chongqing Aier Eye Hospital were included in the study. Among them, 11 males had 11 eyes, and 10 females had 10 eyes. Best-corrected visual acuity (BCVA), optical coherence tomography angiography (OCTA), and corneal, intraocular, and global aberration measurements were performed in all eyes. The international standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The iTrace visual function analyzer was used to measure the corneal, intraocular and whole ocular aberrations, and the dysfunction lens index (DLI) was calculated. Lens density in Scheimpflug images was calculated using Pentacam three-dimensional anterior segment analysis and diagnosis system. The 6 mm×6 mm area of the macular area was scanned by OCTA, which was divided by the software automatically into three concentric circles with the fovea as the center, namely the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, The outer ring area of 3-6 mm was used to measure the superficial vessel density (SVD) and superficial perfusion density (SPD) of the entire macular area, the central area, the inner ring area, and the outer ring area. The patients were divided into PPV combined with epimacular membrane (MEM) peeling group (PPV group) and NVS direct peeling MEM group (NVS group) by random number table method, 10 cases with 10 eyes and 11 cases with 11 eyes, respectively. The age of the two groups (t=－0.72), logMAR BCVA (t=－0.98), lens density (t=－1.10), DLI (t=1.15), SVD (t=0.82) and SPD (t=1.19) of entire macular area, corneal aberration (t=0.45), intraocular aberration (t=－0.22), and whole eye aberration (t=0.83), there was no significant difference (P＞0.05). All eyes were operated on with a 27G vitrectomy system. The MEM was removed from the eyes of the NVS group under NVS condition, and the MEM was removed from the eyes of the PPV group under the condition of PPV, and the operation time was recorded at the same time. The follow-up period after surgery was 12 months. Relevant examinations were performed using the same equipment and methods before surgery. Taking the last follow-up as the time point for efficacy judgment, the BCVA, lens opacity, DLI, visual quality, SVD, SPD and MEM recurrence in the macula were compared between the two groups. The two groups were compared by paired t test. ResultsThe operation time of eyes in PPV group and NVS group was 20.81±3.52 and 5.70±1.30 min, respectively, and the difference was statistically significant (t=7.23, P＜0.001). At the last follow-up, the logMAR BCVA of PPV group and NVS group were 0.65±0.25 and 0.44±0.20, respectively, and the difference was statistically significant (t=－2.16, P=0.04); compared with before operation, the BCVA of eyes of the two groups was significantly improved, and the difference was statistically significant. (t=2.52, 4.41; P=0.033, P＜0.001). The lens density and DLI of the affected eyes in the PPV group and NVS group were 10.64±1.58, 6.24±3.99 and 5.77±1.63, 7.74±1.55, respectively, and the differences were statistically significant (t=－3.90, 2.85; P＜0.05). The macular area SVD (t=1.03), SPD (t=1.77), corneal aberration (t=－0.42), intraocular aberration (t=－1.10), and whole-eye aberration (t=－1.17) of eyes of the two groups, the difference was not statistically significant (P＞0.05). During the follow-up period, there were 2 eyes with MEM recurrence, 1 eye in the PPV group and 1 eye in the NVS group; there was no significant difference in the recurrence rate of MEM between the two groups (χ2=0.005, P=0.94). ConclusionCompared with PPV combined with MEM stripping, the BCVA after NVS surgery increases more, has a better protective effect on the lens, and has a shorter operation time.
Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH), but the visual acuity and MH closure rate remains to be further improved. After removal of posterior vitreous cortex, the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH. During the circumferential peeling, the ILM is not removed completely from the retina but is left attached to the edges of the MH. The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades. Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy, especially for MH with large diameter and unhealed MH after ILM peeling. Compared with conventional vitrectomy combined with ILM peeling, inverted ILM flap technique can enhance MH closure and improve visual acuity. Due to lack of large sample observation in clinical trials of inverted ILM flap technique, we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) for refractory glaucoma. MethodsTwenty-eight patients (30 eyes) diagnosed with refractory glaucoma were enrolled in this study. The intraocular pressure was ranged from 28 to 55 mmHg (1 mmHg=0.133 kPa), with the mean of (46.3±10.3) mmHg. There were 24 eyes with initial visual acuity <0.05, 1 eye with 0.05-0.08 initial visual acuity and 5 eyes with ≥0.1 initial visual acuity. The mean number of intraocular pressure-decreased drugs was 4. All the eyes underwent PPV combined with ECP. The cyclophotocoagulation ranged from 90°-360°, with the mean of (232.5±77.6)°. The cyclophotocoagulation was <180° in 4 eyes, 180°-270° in 6 eyes, >270° in 20 eyes. The follow-up ranged from 12 to 20 months, with the mean of 15.2 months. The intraocular pressure, vision and the mean number of intraocular pressure-decreased drugs before and after surgery were comparatively observed. The relationship between cyclophotocoagulation area and postoperative intraocular pressure was analyzed. ResultsAt the final follow-up, the intraocular pressure ranged from 12 to 36 mmHg, with the mean of (18.5±4.4) mmHg, which decreased 49.4% compared with preoperative intraocular pressure (t=15.537, P<0.01). Among 30 eyes, the intraocular pressure was ≤21 mmHg without any intraocular pressure-decreased drugs in 24 eyes (80.0%), 1 eye (3.3%) with ≤21 mmHg who treatment by local intraocular pressure-decreased drugs, lose control of intraocular pressure in 5 eyes (16.7%). The vision was <0.05 in 15 eyes, 0.05-0.08 in 3 eyes and ≥0.1 in 12 eyes. The difference of vision distribution before and after surgery was not significant (χ2=6.197, P>0.05). Compared with preoperative vision, the postoperative vision was improved in 8 eyes (26.7%), stabled in 15 eyes (50.0%), decreased in 7 eyes (23.3%). The mean number of intraocular pressure-decreased drugs was reduced from 4 to 1 (t=8.402, P<0.01).The cyclophotocoagulation area was positive related to postoperative intraocular pressure (r=4.160, P<0.05). There were no ocular and systemic complications during and after surgery except slight inflammation. ConclusionPPV combined with ECP for refractory glaucoma can reduce intraocular pressure, stabilize or improve the visual acuity.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.