Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
Objective To evaluate the efficacy and safety of ophthalmic viscosurgical device (OVD)-assisted non-gas dependent pars plana vitrectomy (PPV) combined with an inverted internal limiting membrane (ILM) flap for the treatment of idiopathic macular hole (IMH). MethodsA retrospective cohort study. From June 2023 to February 2024, 33 patients (33 eyes) diagnosed with IMH in Department of Ophthalmology of Changshu Second People’s Hospital were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations were performed on all affected eyes before surgery. BCVA examination was conducted using the international standard visual acuity chart, and the results were converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. The minimum diameter of the hole was measured using OCT. All affected eyes received standard 25G PPV treatment through the three channels of the flat part of the ciliary body. According to the surgical methods, they were divided into two groups: the OVD-assisted non-gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (OVD group, 17 cases and 17 eyes) and the heavy water-assisted gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (heavy water group, 16 cases and 16 eyes). Postoperatively, patients in the OVD group were not required to maintain a strict specific position, whereas those in the heavy water group needed to remain in a prone position for one week. The follow-up time points after the operation were 1 week, 1 month and 3 months. The main observation indicators included BCVA, intraocular pressure, hole closure rate and closure morphology of the two groups, as well as the occurrence of complications. The independent sample t test was used for comparison between groups. Pearson correlation analysis was used for the correlation between BCVA at 3 months after surgery and the minimum diameter of the surgical hole and BCVA before surgery. ResultsThree months after the operation, the rate of hole closure in the OVD group and the heavy water group was 17 (100.0%, 17/17) and 15 (93.8%, 15/16) eyes, respectively. There was no statistically significant difference in the hole closure rate (χ2=1.090) and closure type (Z=?0.780) between the two groups (P＞0.05). Compared with before the operation, the logMAR BCVA at each time point after the operation in the OVD group and the heavy water group was significantly improved (F=2.353, 1.375; P＜0.05). One week after the operation, the BCVA in the OVD group was significantly better than that in the heavy water group (t=-3.760, P＜0.01). In terms of intraocular pressure, compared with the baseline value before the surgery, there was a statistically significant difference in the OVD group one week after the surgery (Z=?3.454, P＜0.05). There were statistically significant differences in the heavy water group at 1 week, 1 month and 3 months after the operation (Z=?5.066, ?3.423, ?2.739; P＜0.05). After the operation, one eye in the heavy water group had high intraocular pressure, which returned to normal after combined treatment with intraocular pressure-lowering drugs. No ocular or systemic complications occurred in the OVD group. The results of the correlation analysis showed that postoperative BCVA was correlated with the minimum diameter of the surgical hole and BCVA before the surgery (r=0.543, 0.658; P＜0.05). ConclusionsThe treatment of IMH with OVD-assisted non-gas-dependent PPV combined with internal limiting membrane flip coverage has a good effect. It helps promote the early recovery of macular morphology and visual function after surgery, and at the same time can avoid the maintenance of forced position and reduce perioperative risks.
ObjectiveTo evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M). MethodsA retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA assessment was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane peeling and vitreous cavity filling with 16% SF6. Among them, autologous platelet concentrate (APC) was simultaneously used in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. ResultsIn the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant (Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery (Z=0.609, P=0.543). ConclusionsPPV combined with internal limiting membrane peeling and gas tamponade can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical macular restoration, and improve BCVA. Combined APC filling
Cataract combined with retinopathy can seriously affect the vision of patients. Vitrectomy combined with one-stage implantation of multi-focal intraocular lens (MIOL) has been paid more and more attention. The application of MIOL shows potential in improving the visual quality of patients, but its effect is affected by many factors, and refractive drift is a key problem to be solved. At present, the research mainly focuses on cataract patients with high myopia, and further research on other types of retinopathy is needed. In the future, multi-center, large-sample, long-term clinical studies and interdisciplinary cooperation are needed to optimize surgical and management programs to enhance the application effect of MIOL in the treatment of retinopathy and improve the quality of life of patients.
ObjectiveTo systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). MethodsA evidence-based medicine study. The National Library of Medicine's PubMed, Web of Science, CNKI, and WanFang database were searched. Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment. The search was conducted from January 2000 to January 2022. Duplicated, incomplete, or irrelevant articles were excluded. The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery. The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone, peribulbar injection of glucocorticoids, prednisolone acetate eye-drops, intravitreal injection of triamcinolone acetonide (TA) and posterior sub-tenon injection of triamcinolone acetonide. Publication bias was evaluated by funnel plot. ResultsAccording to the search strategy, 43 articles were initially retrieved, and 929 eyes of 13 articles were finally included for analysis; 6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis. Among the 6 studies included in the conventional meta-analysis, 5 studies were retrospective and 1 study was a randomized controlled trial, involving a total of 575 eyes. The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group [odds ratio (OR)= 1.53, 95% confidence interval (CI) 0.67-3.53, P=0.314]. Among the 10 studies included in the network meta-analysis, 7 studies were retrospective trials, 2 studies were randomized controlled trials, and 1 study was prospective trial, involving a total of 575 eyes. The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group (OR=4.09, 95%CI 1.06-15.79). Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone (OR= 4.47, 95%CI 1.42-14.13). ConclusionsTriamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients. Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.
ObjectiveTo observe the effect of mild anemia on prognosis of hyperplastic diabetic retinopathy (PDR) treated by pars plana vitrectomy (PPV). MethodsA retrospective case-control study. From January 2021 to December 2022, 147 PDR patients with 147 eyes who received PPV treatment at Shenyang He Eye Hospital were included in the study. There were 147 eyes in 147 cases, 82 eyes in 82 males and 65 eyes in 65 females. Age was 25-79 (53.54±12.74) years old. A hemoglobin (Hb) of 90 to 120 g/L in men and 90 to 110 g/L in women was defined as mild anemia. According to Hb results, the patients were divided into mild anemia group and non-anemia group, with 39 cases (39 eyes) and 108 cases (108 eyes), respectively. The best corrected visual acuity (BCVA) test was performed using the international standard logarithmic visual acuity scale before and after the surgery, which was statistically converted to minimum resolved logarithmic (logMAR) visual acuity. The logMAR BCVA of the affected eye was 0.2-2.5 (1.60±0.62) before surgery. According to whether the BCVA improved by more than 3 lines 6 months after surgery, the affected eyes were divided into BCVA improved by more than 3 lines and BCVA improved by less than 3 lines, 117 eyes and 30 eyes, respectively. The patient's body mass index (BMI), BCVA at 6 months after surgery, and the occurrence of neovascular glaucoma (NVG) and recurrence of vitreous hemorrhage (RVH) were recorded. Independent sample t test was used for comparison between groups. Multivariate logistic regression analysis was performed to analyze the influencing factors of increased BCVA ≥3 rows after surgery. ResultsSix months after surgery, the logMAR BCVA of patients in mild anemia group and non-anemia group were 0.97±0.87 and 0.68±0.63, respectively. BCVA increased ≥3 in 26 (66.7%, 26/39) and 91 (84.3%, 91/108) eyes, respectively. logMAR BCVA (t=2.234) and BCVA increased by ≥3 rows of eyes (χ2=5.460) between the two groups, the differences were statistically significant (P=0.027, 0.019). Logistic regression analysis showed that baseline logMAR BCVA [odds ratio (OR) =4.291, 95% confidence interval (CI) 1.918-9.600, P＜0.001)], BMI (OR=1.248, 95%CI 1.057-1.472, P=0.009), the number of retinal laser photocoagulation during surgery (OR=1.001, 95%CI 1.000-1.002, P=0.038), mild anemia (OR=0.360, 95%CI 0.131-0.993, P=0.048), postoperative NVG (OR=0.156, 95%CI 0.033-0.726, P=0.018) and RVH (OR=0.264, 95%CI 0.086-0.808, P=0.020) were independent factors for BCVA improvement ≥3 lines after PPV. ConclusionsMild anemia has a certain effect on BCVA improvement after PPV of PDR. Mild anemia, post-operative NVG and RVH were independent risk factors for increasing BCVA ≥3 lines after PPV in PDR patients.
ObjectiveTo observe the effectiveness and safety of pars plana vitrectomy (PPV) combined with inner limiting membrane (ILM) removal and 41G microneedle subretinal injection of balanced salt solution (BSS) in the treatment of refractory macular hole. MethodsA prospective clinical study. From January to June 2023, 20 cases (20 eyes) of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study. The basal diameter of the affected eye's basal diameter (BD) was ＞1 000 μm. Macular hole index (MHI) was ＜0.5. The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS. Best corrected visual acuity (BCVA), microperimetry, and optical coherence tomography angiography (OCTA) were performed before and 1, 2, 3, and 6 months after surgery for the affected eye. BCVA examination was performed using standard logarithmic visual acuity chart, and convert it to logarithmic minimum resolution angle (logMAR) visual acuity for statistical purposes. MP-3 microperimetry was used for micro view examination, record the mean sensitivity (MS) of the retinal within a 12° range of the fovea. OCTA was used to measure the area of the avascular zone of the macula (FAZ), perimeter of the FAZ (PERIM), retinal vascular length density (VLD), and vascular perfusion density (VPD). The changes in BCVA, MS, FAZ area, PERIM, VLD, VPD before and after surgery were compared and analyzed. After the same time, the closure of macular hole and the occurrence of complications after surgery were observed. Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery. The correlation between various observation indicators and preoperative minimum diameter (MD), BD, and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis. ResultsAmong the 20 cases with 20 eyes, there were 2 males with 2 eyes and 18 females with 18 eyes. Age was (61.45±8.56) years old. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD of the affected eye were 1.46±0.21, (16.20±5.81) dB、(0.40±0.17) mm2, (2.89±0.99) mm, (6.23±3.59) mm?1, (0.17±0.10)%, respectively. Six months after surgery, out of 20 eyes, macular hole closure and incomplete closure were 18 (90.0%, 18 /20) and 2 (10.0%, 2 /20) eyes, respectively. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD were 0.80±0.20, (22.20±4.60) dB, (0.18±0.10) mm2, (1.83±0.80) mm, (9.54±2.88) mm?1, (0.31±0.14)%. Compared with before surgery, the differences were statistically significant (P＜0.05). The correlation analysis results showed a positive correlation (P＜0.05) between preoperative BD and postoperative 6-month PERIM and VPD. There was a negative correlation between preoperative MD and postoperative VLD at 6 months (P＜0.05). There was a negative correlation between preoperative MHI and logMAR BCVA and VPD at 6 months after surgery (P＜0.05). No complications such as elevated or decreased intraocular pressure, damage to retinal pigment epithelium, retinal hemorrhage, endophthalmitis, or retinal detachment occurred after surgery in all affected eyes. ConclusionMinimally invasive PPV combined with ILM removal and 41G microneedle subretinal injection of BSS can effectively improve the closure rate of refractory macular hole patients in the short term, improve vision, and have good safety.
Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole-retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation. ResultsAt 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant (P＜0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance (P＜0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant (P＜0.05). There was no significant difference one week after eye operation in control group (P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant (P＜0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group (P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant (P=0.020). ConclusionPPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.
Objective To compare and observe the efficacy and safety of pars plana vitrectomy (PPV) combined with 41G ultrafine needle injection of balanced salt solution (BSS) and internal limiting membrane inversion and coverage in the treatment of large-diameter macular hole (MH). MethodsA prospective study. From April 2023 to April 2024, 42 patients (42 eyes) diagnosed with large-diameter MH at The Affiliated Eye Hospital of Nanchang University were included in the study. The substrate diameters (BD) of MH are all greater than 1 000 μm. All affected eyes underwent best corrected visual acuity (BCVA), microvisual field, optical coherence tomography (OCT), and OCT angiography (OCTA) examinations before surgery. BCVA examination was conducted using the international standard logarithmic visual acuity chart, and the statistics were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. Microfield-of-view examination records the mean retinal sensitivity (MS) within a 12° range of the fovea. The minimum diameter (MD) and BD of the hole were measured by OCT and the MH index (MHI) was calculated. OCTA measures the area and perimeter (PERIM) of the foveal avascular zone (FAZ) in the fovea centralis, as well as the retinal vessel length density (VLD) and vessel perfusion density (VPD) in the central area. The affected eyes were divided into the observation group (22 eyes, treated with PPV combined with 41G ultra-micro needle subretinal injection of BSS and the control group (20 eyes, treated with PPV combined with internal limiting membrane inversion and coverage) according to the random number table method. The patients were followed up for 6 months after the operation, and the above indicators were reexamined at 1, 3 and 6 months. The changes of BCVA, MS, FAZ parameters, VLD, VPD before and after the operation, as well as the closure of the hole and the occurrence of complications were compared between the two groups. The independent sample t test was used for comparison between groups. The correlation between postoperative indicators and preoperative structural parameters was analyzed using Pearson analysis. ResultsIn the 22 eyes of the observation group, the hole closure rate was 100.0% (22/22) 6 months after the operation, and the complete closure rate was 90.9% (20/22). In the control group of 20 eyes, the closure rate was 95.0% (19/20), and the complete closure rate was 90.0% (18/20). The hole closure rate of the affected eyes in the observation group was better than that in the control group, but the difference was not statistically significant (χ2=1.736, P=0.420). The logMAR BCVA, MS, FAZ area, PERIM, VLD and VPD at each time point after the operation in both groups were significantly improved compared with those before the operation, and the differences were statistically significant (P＜0.05). The results of Pearson correlation analysis showed that in the observation group, logMAR BCVA at 6 months after surgery was positively correlated with BD before surgery (r=0.340, P=0.029), and negatively correlated with MHI before surgery (r=?0.350, P=0.023). Six months after the operation, MS was positively correlated with the preoperative hole height and MHI (r=0.330, P=0.034). In the control group, 6 months after the operation, MS was negatively correlated with BD before the operation (r=?0.480, P=0.032), and positively correlated with MHI before the operation (r=0.510, P=0.027). Six months after the operation, the FAZ area of the affected eyes in the observation group [(0.17±0.09) mm2] was larger than that in the control group [(0.12±0.07) mm2], and the difference was statistically significant (t=?0.340, P=0.025). No complications such as abnormal intraocular pressure, retinal pigment epithelium injury or retinal detachment occurred in all the affected eyes after the surgery. ConclusionsPPV combined with 41G ultra-micro needle subretinal injection of BSS for the treatment of large-diameter MH has a high rate of hole closure and good safety. Larger BD and MD, lower MHI and hole height before surgery may affect the recovery of visual function after surgery.
Diabetic retinopathy (DR) is the leading cause of visual impairment worldwide. Severe non-proliferative diabetic retinopathy, diabetic macular edema, and proliferative DR (PDR) are defined as vision-threatening DR (VTDR). In the context of managing systemic disease, the primary treatments for VTDR include panretinal photocoagulation (PRP), intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs or dexamethasone sustained release agents, and microincision vitreous surgery. Although these therapies are already widely used in clinical practice, there is still much debate about the optimal timing and method of their application, especially in the pursuit of optimal efficacy, cost-effectiveness, patient compliance, and the reduction of frequent ongoing treatments. There is no consensus on the best treatment for PDR. Determining the specific criteria for each therapy indication is one of the key considerations. In addition, consideration should be given to the priority between PRP and intravitreal injection, as well as to compare the relative effectiveness of anti-VEGF agents with PRP. Early surgical intervention is not always a necessary option for PDR patients with vitreous hemorrhage and fibrovascular membranes. Combining different therapies to optimize treatment strategies is also an important topic. These issues address several points of contention in best practice guidelines that need to be addressed through more in-depth research to provide better guidance for clinical practice and ultimately improve patient outcomes.