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病理性近視黃斑部脈絡膜新生血管光動力療法治療后光相干斷層掃描觀察結果分析

Objective quantitative assessment of visual quality with a double-pass instrument for myopic foveoschisis patients

ObjectiveTo objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ). MethodsSixty-two subjects participated in this cross-sectional, observational study, who were divided into three groups based on the pathologic conditions including myopic foveoschisis group (MFG), myopic control group (MCG) and normal control group (NCG). Measurements with OQASⅡwere performed for the modulation transfer function cut off frequency (MTF cut-off), the Strehl ratio (SR) and the objective scatter index (OSI). Visual data were analyzed using ANOVA and Pearson's correlation accompanied by logMAR BCVA and axial length (AL). ResultsThe mean values for MTF cut-off, SR and OSI of MFG, MCG and NCG were 18.18±4.81, 0.13±0.03, 3.50±0.44; 22.87±2.66, 0.14±0.02, 2.42±0.29; 33.68±4.70, 0.23±0.02, 1.68±0.20 respectively, and statistical difference were proved except SR between MFG and MCG, or BCVA between MCG and NCG (P < 0.05). LogMAR BCVA and AL have negative correlations to MTF cut-off (r=-0.928, -0.658; P < 0.05) and SR (r=-0.577, -0.893; P < 0.05) with high coefficients in MFG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.659, -0.806; P < 0.05) in MCG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.606, -0.602; P < 0.05) and positively correlated to OSI (r=0.561, P < 0.05) in NCG. ConclusionsThe mean value of BCVA, MTF cut-off, SR, OSI of myopic foveoschisis patients were lower than those myopic patients without foveoschisis and normal people. there exists a significant negative correlation between Log MAR BCVA, AL to MTF cut-off and SR. Compared with myopic and normal subjects, myopic foveoschisis have lower BCVA, MTF cut-off, SR but higher OSI.

Therapeutic effects of internal limiting membrane peeling on retinal detachment with macular hole in eyes with high myopia

　　Objective　To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods　The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results　Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions　By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.

The ef?cacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinoschisis

Objective To observe the ef?cacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF). Methods This is a retrospective case study. A total of 35 MF patients (36 eyes) were enrolled in this study. There were 5 males (5 eyes) and 30 females (31 eyes), with an average age of (60.13±10.00) years. All patients were examined for best corrected visual acuity (BCVA), diopter, optical coherence tomography (OCT) and axial length. The patients were divided into a MF group (group A, 10 eyes), MF with foveal detachment group (group B, 12 eyes) and MF with lamellar macular hole group (group C, 14 eyes) according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups (F=0.020, 0.624, 0.009, 0.195; P＞0.05). There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100, 41.790; P＜0.05). All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm, which were significantly improved compared with preoperative measurements (t=5.984, 5.113; P＜0.001). MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was (222.40±57.16), (212.50±150.45), (206.67±55.97) μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA (F=6.750, P=0.003) and the rate of complete ellipsoid (χ2=18.590, P＜0.001) in group B was lower than group A and C, the differences were significant. There was no difference of CFT (F=0.068, P=0.935) and the rate of MF resolving (χ2=1.558, P=0.459) among the three groups. One eye (1/14) in group C suffered from full layer macular hole. Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis. The macular structures and BCVA are worst in eyes with foveal detachment.

Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization

Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization (PM-CNV). Methods It is a retrospective case study. Seventy-nine patients (79 eyes) with PM-CNV were enrolled in this study. There were 26 males (26 eyes) and 53 females (53 eyes), with the mean age of (30.77±5.53) years. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus color photography, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CMT) was measured by OCT (Cirrus HD-OCT). The eyes were divided into bevacizumab treatment group (38 eyes) and ranibizumab treatment group (41 eyes). There was no difference of the mean logMAR BCVA, intraocular pressure and CMT between two groups (t=?0.467, ?1.983, 1.293;P=0.642, 0.051, 0.200). The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml (1.25 mg), and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml (0.5 mg). Times of injection between two groups were compared. The changes of intraocular pressure were observed at 1, 7 days and 1 month after treatment. The changes of logMAR BCVA and CMT at 1, 3, 6, 12 and 24 months after treatment and systemic adverse reactions occur were compared. Results At the 1, 3, 6, 12 and 24 months after treatment, the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment (F=132.374,P＜0.01). There was no significant difference in the mean logMAR BCVA at different time points between the two groups (F=0.095,P=0.759). The mean CMT of the two groups was lower than that before treatment (F=151.653,P＜0.01). There was no significant difference in the mean CMT between the two groups (F=0.332,P=0.566). No retinal detachment, endophthalmitis, cataract and persistent high intraocular pressure were associated with drug, injection-related eye and systemic adverse events during follow-up. Seven eyes had conjunctiva bleeding after treatment, 11 patients (11 eyes) complained of shadow floaters after treatment. Conclusion Intravitreal injection of bevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.

Study on macular retinoschisis by optic coherence tomography in eyes with high myopia

Objective To observe the the clinical characteristics of images of optic coherence tomography (OCT) in highly myopic eyes with retinoschisis. Methods The clincial data of 158 patients (158 eyes) with high myopia diagnosed by examinations of best corrected visual acuity and refraction, indirect stereoscopic ophthalmoloscopy, A/Bscan ultrasonography, and OCT, were retrospectively analyzed. The patients were divided into retinoschisis group and nonretinoschisis group according to the results of OCT (whether the patients had macular reinoschisis at the posterior pole). There were 53 patients (55 eyes, 34.8%) in the former group, and 101 patients (103 eyes, 65.2%) in the latter group. The age, sex, diopter, visual acuity, ocular axial length, and incidence of posterior scleral staphyloma, vitreous traction, and retinal detachment of the two groups were compared. Results B-scan ultrasonography showed posterior scleral staphloma in all of the 158 eyes. OCT indicated that in the 55 eyes in the retinnoschisis group, 15 （27.3%） had inner, 53 （96.4%）had outer, and 7 （12.7%）had middle retinoschisis. The inner and outer one could exist independently or in the same eye, while the middle one was always accompanied by the outer retinoschisis. Two or more types of schisis coexisted in 13 eyes （23.6%）, single outer retinoschisis was found in 40 eyes （72.7%）, and single inner retinoschisis was found in 2 eyes （3.6%）. There were 26 eyes（47.3%）were accompanied with retinal detachment, 13 eyes（23.6%） with macular hole, and 12 eyes （21.8%）with vitreous traction. In the 103 eyes in the nonretinoschisis group， 23 eyes （22.3%）had vitreous traction, 19 eyes （18.4%） had macular hole, and 21 eyes （20.4%）had retinal detachment. The differences of age, diopter and ocular axial length, sex, incidence of macular hole and vitreous traction between the two groups were not statistically significant (Pgt;005）. The visual acuity in retinoschisis group was much lower than that in the nonretinoschisis group （Plt;005）, and the difference of incidence of the retinal detachment between the two groups was significant (Plt;001). 〖WTHZ〗Conclusion 〖WTBZ〗Macular retinoschisis in eyes with high myopia can exist in inner or middle retina, but most of them locate at outer retina.The patients always have poor visual acuity and are often accompanied by other macular lesions such as retinal detachment.

Intravitreal Conbercept for treatment of choroidal neovascularization secondary to pathologic myopia

ObjectiveTo evaluate the efficacy of intravitreal injections of conbercept in choroidal neovascularization (CNV) secondary to pathologic myopia (PM). MethodsA retrospective case series of 37 eyes of 37 patients affected with CNV secondary to PM treated by intravitreal injections of Conbercept. All the patients were examined with best-corrected visual acuity (BCVA) of Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT) of optical coherence tomography (OCT)at baseline. The initial average letters of ETDRS BCVA was 49.86±8.87, CMT was (306.38±31.01) μm. All eyes were treated with intravitreal Conbercept 0.05 ml (10 mg/ml). Follow-up visits were performed monthly after injection. The mean follow-up time was 16.8 months. Injections were repeated according to the situation of BCVA, CMT, subretinal fluid and CNV leakage in follow-up. All eyes received an average of 4.8 injections. BCVA, CMT and ophthalmoscope examination were assessed monthly. The relationship of BCVA improvement and CMT reduction with the data at baseline and number of treatments were analyzed by Spearman Rho correlation respectively. ResultsDuring the 1, 3, 6 and 12 months after treatment, the mean BCVA were all improved with statistically significant difference (t=17.629, P < 0.01).At 12 months, 15 eyes (45.9%) had improvement of 15 letters or more, 32 eyes (86.5%) had improvement of 5 letters or more, and 1 eye (2.7%) had decreased more than 5 letters. During the 1, 3, 6 and 12 months after treatment, the mean CMT were all decreased with statistically significant difference (F=43.726, P < 0.01). At 12 months, the retinal fluid of 34 eyes (91.9%) were absorbed completely; 33 eyes (89.2%) had angiographic closure at that time. There was no significant relevance between BCVA improvement and sex, age and course of the disease (P > 0.05), but a significant negative correlation was found between the BCVA improvement and BCVA at baseline, injection times (P < 0.05). There was no significant relevance between CMT reduction and sex, age, course of the disease and injection times (P > 0.05), but a significant positive correlation was found between CMT reduction and CMT at baseline (P < 0.05). There were no systemic or ocular serious side effects during the follow up. ConclusionsIntravitreal injections of Conbercept showed BCVA improvement and CMT reduction. It appeared to be effective and safe for choroidal neovascularization secondary to pathologic myopia. Intravitreal Conbercept for CNV secondary to PM showed BCVA improvement, CMT reduction and safety.

Disputes revolved about surgeries of macular vitreoretinal interface abnormalities in highly myopic eyes

Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most visionthreatening diseases associated with macular retinal schisis and macular holes. To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair. However, there are many controversial issues in the efficacy of the surgerical procedures including gas injection, scleral buckling and vitrectomy. How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.

Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic

ObjectiveTo observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.MethodsA prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.ResultsThe foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.ConclusionsPars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.

The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors

ObjectiveTo observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes, and to analyze factors affecting the MH closure rate.MethodsThis is a retrospective case study. 21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study. All eyes were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, indirect ophthalmoscope, A and/or B-scan ultrasound, optical coherence tomography and visual electrophysiological examination. The BCVA was ranged from finger counting to 0.2. The axial length (AL) was ranged from 26.00 to 31.00 mm, with an average of 27.47 mm. Among 22 eyes, AL was between 26.00 mm to 27.00 mm in 9 eyes, 27.10 mm to 28.00 mm in 5 eyes, 28.10 mm to 29.00 mm in 3 eyes, 29.10 mm to 30.00 mm in 3 eyes, and longer than 30.00 mm in 2 eyes. The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm. Among them, the minimum diameter was between 200 μm to 400 μm in 4 eyes, 401 μm to 450 μm in 13 eyes, 451 μm to 500 μm in 3 eyes, 501 μm to 600 μm in 2 eyes. All the eyes were treated with PPV combined with ILMP surgery. The average follow-up time was 17 months after surgery. The efficacy was determined at the final follow up, including the MH closure, the state of macular retinoschisis and the BCVA. MH closure rate with different MH diameters and different AL were compared and analyzed.ResultsDuring the final follow-up, MH were fully closed in 17 eyes (77.3%), bridge-closed in 4 eyes (18.2%) and not closed in 1 eye (4.5%). Retinoschisis was resolved in 19 eyes (86.4%), partially resolved in 2 eyes (9.1%) and not changed in 1 eye (4.4%). MH with smaller diameter had higher MH closure rate (χ2=12.036, P=0.032). MH with longer AL had lower MH closure rate (χ2=16.095, P=0.003).The final BCVA was ranged from finger counting to 0.25. Among 22 eyes, BCVA or metamorphopsia were improved in 9 eyes (40.9%), stable in 8 eyes (36.4%). BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7%).ConclusionsPPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes. After surgery, MH was closed and retinoschisis was resolved in most patients. The major factors affect the MH closure were the minimum diameter of MH and AL.