Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma. Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study. All the patients were examined for corrected visual acuity (CVA), slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography (OCT) and intraocular pressure examination. The average axial length was (29.1plusmn;1.8) mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The average logMAR CVA was 1.93plusmn;0.37. All the patients were treated with PPV and triamcinolone acetonide or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was (6.2plusmn;1.6) months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34plusmn;0.48 after surgery, which significantly improved compared to that before surgery (t=39.38, P＜0.01). The CVA after surgery was independent of axial length (r=0.142, P＞0.05), choroid atrophy (t=0.23, -0.165,P＞0.05) and macular hole closure (t=0.12, -0.005, P＞0.05). The retina reattached in 79 eyes (92.9%) and recurrence of retinal detachment occurred in six eyes (7.1%). Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment, proliferative vitroretinopathy, axial length, choroid atrophy and ILMP (OR=1.428, 5.039, 0.815, 2.578, 0.432; P＞0.05). Of these 85 eyes, macular hole closed in ten eyes (11.8%), macular hole did not close in 75 eyes (88.2%). There were 24 eyes (28.2%) experienced high intraocular pressure during the first 2 weeks after surgery, all of them were under control with drugs. There were 12 eyes (14.1%) presented with high intraocular pressure before the silicone oil removal, all of them were under control only by silicone oil removal. Conclusion For the treatment of MHRD with posterior staphyloma, PPV combined with ERMP and (or) ILMP and silicone oil tamponade show a high retinal reattachment rate.
High myopia macular hole (MH) is a serious complication of high myopia. The main treatment method is surgery. Because of axial growth, posterior scleral staphyloma, choroidal atrophy and other factors, the operation is difficult, the anatomic reduction rate is low, and the visual prognosis is poor. How to improve the reduction rate of surgical dissection and the recovery of visual function is a hot topic. At present, the most popular surgeries include parsplanavitrectomy (PPV) and posterior scleral reinforcement (PSR). However, there are many controversies regarding the treatment of internal limiting membrane in PPV, the selection of vitreous gapfiller, the choice of reinforcement materials and reinforcement methods of PSR, and whether it is necessary to combine PPV and PSR, etc. In recent years, many new surgical methods or techniques have emerged, which significantly increase the success rate of MH.
Objective To evaluate the correlation between retinal thickness (RT) at the macular area and the axial length (AL) in myopia. Mehtods Optical coherence tomography (OCT) was used to detect the RT at the macular fovea, and at the superior, nasal, inferior, and temporal side of the fovea and parafovea area. The AL of the examined eye was measured by IOL master measuring machine, and the correlation between RT at the macular area and the Al was evaluated. Results The minimum RT in the macular area in the eyes with myopia was (150.90plusmn;22.10)mu;m.The retina at the temporal side of parafovea was the thinnest. The average RT in the areas around the fovea was negatively correlated with the AL, and there was no correlation among the minimum RT, the mean RT at the fovea, and the AL of eye. Conclusions As the AL of eye increases, the RT at the parafovea decreases, while the minimum and the average RT at the fovea remain unchanged. (Chin J Ocul Fundus Dis, 2006, 22: 397-399)
PURPOSE:To observe the clinical features of the macular hemorrhage in myopes. METHOD:Twenty-four patients(30 eyes)with myopic macular hemorrhage were examined with slitlamp biomicroscopy,funduscope,A/B ultrasonography,and fundus fluorecein angiography(FFA). The patients were followed up for 3~18 months(average 12 months). RESULTS: Four of 26 eyes with macular hemorrhage examined with FFA were found to be due to choroidal neovaseulature,and they were associated with posterior staphyloma. The other 22 eyes without neovascular change were thought to be simple type,and 19 of them were associated with lacquer cracks. The hemorrhage in simple type cases deminished usually within 1~3 months. CONCLUSION:Myopic macular hemorrhagic eyes of neovascular type resulted usually in recurrent hemorrhage and worse prognosis in visual acuity than those of simple type. （Chin J Ocul Fundus Dis,1996,12: 220-222）
The fundus lesions caused by high myopia (HM) often lead to irreversible visual impairment or even blindness. However, the pathogenesis of HM and its fundus lesions is still unclear, the intraocular fluid detection technology of micro samples has brought new prospects for the early diagnosis, monitoring and intervention of the fundus lesions. The molecules associated with HM are various and functionally diverse, intermolecular interactions are staggered and the specific mechanism is complex. With the development of intraocular fluid detection technology, while gradually revealing the role of each molecule in the pathogenesis of HM, it is expected to successfully assist clinical work in the future, providing outpost markers for the progress of myopia and targets for early intervention, or providing a new therapy choice for HM fundus lesions at the molecular level targeting pathogenesis, which is expected to provide more accurate and effective treatment for HM patients in the future.
ObjectiveTo observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.MethodsA retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males (5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.ResultsIn ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).ConclusionsInverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
ObjectiveTo investigate the effect of “noncycloplegic retinoscopy for screening myopia + subsequent wearing orthokeratology lens” process for primary and secondary school students based on physical examination center.MethodsA total of 172 primary and secondary school students undergoing vision examination in the Health Management Department (i.e. physical examination center) of the Second Affiliated Hospital of Xi’an Jiaotong University between January 2017 and December 2018 were selected as the research objects. After examination by noncycloplegic retinoscopy in the health management department, they were examined by mydriatic retinoscopy in the ophthalmology department, and then the consistency of the results of the two methods was analyzed. Then 93 students with myopia diagnosed by both methods were randomly divided into control group (n=46) and trial group (n=47), wearing frame glasses and orthokeratology lenses respectively. The diopter, eye axial length, corneal curvature and vitreous cavity depth before wearing glasses, as well as the increment of the above indicators at 3, 6 and 12 months after wearing glasses/lenses were compared between the two groups, and the incidence of complications of the two groups were compared.ResultsCompared with mydriatic retinoscopy, the positive predictive value of noncycloplegic retinoscopy was 88.6%, the sensitivity was 96.9% and the specificity was 84.2%, and the consistency kappa coefficient was 0.821 (P<0.001). Before wearing glasses/lenses, there was no significant difference in diopter, eye axial length, corneal curvature or vitreous cavity depth of both eyes between the two groups (P>0.05); at 3, 6 and 12 months after wearing glasses/lenses, the diopter increment and eye axial increment of both eyes of the trial group were less than those of the control group [left eye diopter increment: (0.48±0.07) vs. (0.73±0.08) D, (0.69±0.13) vs. (1.04±0.11) D, (0.88±0.11) vs. (1.13±0.11) D; left eye axial increment: (0.18±0.05) vs. (0.26±0.04)mm, (0.22±0.04) vs. (0.36±0.04) mm, (0.27±0.05) vs. (0.40±0.05) mm; right eye diopter increment: (0.46±0.10) vs. (0.73±0.09) D, (0.71±0.12) vs. (1.04±0.10) D, (0.90±0.10) vs. (1.17±0.11) D; right eye axial increment: (0.17±0.04) vs. (0.24±0.04) mm, (0.23±0.04) vs. (0.37±0.04) mm, (0.26±0.05) vs. (0.42±0.05) mm] (P<0.05). At 3, 6 and 12 months after wearing glasses/lenses, the changing trends of corneal curvature and vitreous cavity depth in both eyes of the trial group were different from those of the control group (PInteraction<0.05), and the corneal curvature of both eyes at each time point was lower than that before wearing lenses and that of the control group (P<0.05), while the vitreous cavity depth of both eyes was not statistically different from that before wearing lenses (P>0.05) but lower than that of the control group (P<0.05). There was no statistical difference in the incidence of common complications between the two groups (P>0.05).ConclusionIn the physical examination center, the accuracy of noncycloplegic retinoscopy for general survey of myopia in primary and secondary school students is high, and then after the diagnosis by mydriatic retinoscopy in the special department, the use of orthokeratology lens can effectively control the progress of myopia, so the process of “noncycloplegic retinoscopy for screening myopia in physical examination center + subsequent wearing orthokeratology lens in specialty” is feasible.
ObjectiveTo observe the correlation between posterior myopic retinoschisis(MRS) and posterior scleral staphyma (PS) in pathological myopia (PM), and to preliminarily explore the influencing factors of MRS.MethodsA retrospective case series study. From November 2016 to November 2019, 38 patients with PM with MRS diagnosed in Henan Eye Hospital & Henan Eye Institute from were included in the study. There were 10 males and 28 females; 13 patients were binocular and 25 patients were monocular. The average age was (49±13) years old. BCVA, retinoscopy optometry, frequency domain OCT, three-dimensional magnetic resonance imaging (3D-MRI) examination and axial length (AL) measurement were performed. According to the frequency domain OCT inspection results, MRS was divided into inner splitting, outer splitting and mixed splitting; based on the 3D-MRI scan results, PS was divided into broad macula, narrow macula,discoid, nasal, subdisc and other types. The correlation between MRS and PS was tested by χ2 test or Fisher exact test.ResultsAmong 60 eyes, 58 eyes (96.77%) of MRS combined with PS. Among them, the wide macula, narrow macula, discoid, nasal, subdisc, and other types were 30 (51.72%), 19 (32.75%), 1 (1.72%), 2 (3.48%), 2 (3.48%) and 4 (6.85%) eyes; inner split, outer split, and mixed split were 10 (17.24%), 24 (41.38%), 24 (41.38%) eyes. Of the 19 eyes with narrow macular PS, MRS involved the fovea in 16 eyes; of the 39 eyes with PS of other forms, MRS involved the fovea in 22 eyes. There was a statistically significant difference between the narrow macular type and other types involving foveal eyes (P=0.044). The correlation between MRS involving the fovea and narrow macular PS was moderate (Cramer's V=0.275). The ages of patients with inner split, outer split, and mixed split were 44±12, 56±10, and 44±13 years, respectively. Patients with inner splitting were younger than those with outer splitting, and those with outer splitting were older than those with inner splitting and mixed splitting. The differences were statistically significant (P=0.010, 0.010, 0.060).ConclusionPM with MRS mostly occur in PS-affected eyes, and mainly macular PS (wide macula, narrow macula).
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.
ObjectiveTo evaluate the effectiveness of using a six-dimensional eye-tracking system during femtosecond laser-assisted sub-Bowman keratomileusis (FS-SBK) surgery to correct myopia and astigmatism. MethodsA total of 23 patients (36 eyes) with ametropia undergoing FS-SBK were retrospectively analyzed and divided into the static cyclotorsion control (SCC) group (11 patients, 20 eyes) and the non-SCC group (12 patients, 16 eyes). According to the static eyeball rotation degrees, the SCC group was further divided into three subgroups: within ±2° group (5 patients, 9 eyes), ±2°-±5° group (4 patients, 7 eyes), and above ±5° group (2 patients, 4 eyes). The preoprative and postoperative one-month uncorrected visual acuity, best corrected visual acuity, diopter of spherical power, diopter of cylindrical power, corneal curvature, and the rotating degree in SCC were observed; the root-mean-square values of the total higher-order aberrations, spherical aberration, coma, Strehl ratio, etc. when the pupil diameter was 6.5 mm were extracted; and the therapeutic efficacy was observed. ResultsNo severe intraoperative or postoperative complications occurred in any subject. The effectiveness index of the SCC group was 0.947±0.145, and that of the non-SCC group was 1.005±0.141, with no statistically significant difference (P>0.05). Compared with the preoperative levels, in the two groups, the postoperative uncorrected visual acuity was significantly elevated; the postoperative diopter of spherical power, diopter of cylindrical power, and corneal curvature difference were reduced; the postoperative total higher-order aberrations, spherical aberration, and coma increased; all the differences mentioned above were statistically significant (P<0.05). In the SCC group, the difference between the preoperative and the postoperative Strehl ratio was statistically significant (P<0.05). There was no significant difference in postoperative indicators between the SCC group and the non-SCC group (P>0.05). The difference in postoperative increment of coma between the SCC group and the non-SCC group was statistically significant (P<0.05). In the SCC group, no statistically significant difference was found in postoperative increment of any indicator among the three subgroups (P<0.05). ConclusionsFS-SBK of six-dimensional eye-tracking system is effective in correcting myopia and astigmatism. FS-SBK can reduce lower-order aberrations while introducing higher-order aberrations, and whether SCC is performed intraoperatively is meaningless.