Purpose To evaluate the surgical effect of idiopathic macular hole (IMH)，with optical coherence tomography (OCT)． Methods To measure the diameter of holes and hole halos，the thickness of hole in edge，the changes of hole pattern in 19 cases (19 eyes) with IMH using OCT． Results By quantitatively measuring，OCT showed that after surgery the mean hole diameter lessened from （570．95plusmn;264．59 ）mu;m to （337．05plusmn;335．95）mu;m．The mean diameter of hole halo lessened from （1043．53plusmn;278．80）mu;m to （695．00plusmn;483．00）mu;m and the mean thickness of the hole edge thinned from （389．78plusmn;60．58）mu;m to （298．78plusmn;109．80）mu;m．In 17 eyes the holes become closed or reduced in size or the hole halo，and thinned in hole edge．The anatomic successful rate of the surgery is 89%． Conclusion OCT can objectively，accurately and effectively judge the anatomic effect of IMH surgery． (Chin J Ocul Fundus Dis，2000，16：71-138)
Objective To evaluate the therapeutic effects of vitrectomy on chronic and refractory Behcet′s diseases. Methods The clinical data of 8 patients (10 eyes) with Behcet′s diseases from 0.5 to 3 years after vitrectomy were retrospectively analyzed. Pre-and post-operative visual acuity, control of inflammation after the surgery, and the recurrence were observed and analyzed. Both of the eyes were involved in all of the patients, including complete Behcet′s diseases in 5 and incomplete in 3. Results Vitreous opacity and liquefaction were found in all of the involved eyes, dark retina and thin retinal vessels were seen in most of the eyes, and vascular obstruction or sheath-like changes in different degrees were detected in some eyes. Improvement of visual acuity was observed in all of the eyes which had undergone the treatment after the operation. There was significant difference between the visual acuity before the surgery and at the 1st and 2nd week and the 1st and 6th month after the surgery. During the follow-up period, recurrence of the inflammation was found in 3 eyes within 1 month and in 6 eyes within 6 months; no recurrence was found in 4 eyes after the operation. No acute recurrence of inflammation was found after operation in the involved eyes. Conclusion Vitrectomy for chronic and refractory Behcet′s diseases may improve the visual acuity of the involved eyes, and the surgery is safe and effective. (Chin J Ocul Fundus Dis, 2005, 21: 357-359)
Objective To determine the effect of posterior vitreous detachment on the prognosis of branch retinal vein occlusion (BRVO). Methods One hundred and sixteen patients (116 eyes) with BRVO who underwent vitreous examination were retrospectively studied.The relati onship of vitreous conditions to posterior segment neovascularization and macular edema was statistically investigated. Results In 40 ischemic cases,12 of 25 eyes (48.0%) with no posterior vitreous detachme nt (PVD) or partial PVD developed retinal or optic disc neovascularization ,or both,but only one of the 15 eyes (6.7%) with complete PVD developed neovasculariz ation during a mean follow-up period of 10.7plusmn;2.2 months (Plt;0.05) . Diffuse macular edema was found in 45 eyes (38.8%).The incidence o f macular edema was significantly higher in eyes with vitreomacular attachment (51.5%) than in those with vitreomacular separation (22.0%) (Plt;0.01). Conclusion It was suggest ed that compl ete PVD may play a role in protecting eyes with BRVO from posterior segment neov ascularization and macular edema. (Chin J Ocul Fundus Dis, 2001,17:2-4)
Objective To detect the effects of plasmin combined with hyaluronidase or hexafluoride SF6 on inducing posterior vitreous detachment (PVD). Methods Eighteen young pigmented rabbits were randomly divided into group A, B, and C with 6 rabbits in each. All of the right eyes were the experimental eyes and the left ones was the control. The right eyes in group A, B, and C were injected with plasmin 1 U, plasmin 1 U and hyaluronidase 20 U, and plasmin 1 U and SF6 0.5 ml, respectively; while all of the left eyes underwent intra-vitreous injection with balanced salt solution 0.1 ml. The eyes were observed by indirect ophthalmoscopy, slit lamp examination, biomicroscopy, B-ultrasonography, and electroretinography (ERG) before and after injection respectively. At last, the retinal sections were examined by light microscopy, scanning and transmission electron microscopy. Results The results of scanning microscopy showed incomplete PVD in 2 (33.3%) experimental eyes in group A, and complete PVD in 4 (66.7%) experimental eyes in both group B and C, and the positive rate of PVD in both group B and C significantly differed from that in group A (Plt;0.05). The b-wave amplitudes of ERG in the three groups after injection didn’t differ much from that in the control group or before the injection（Pgt;0.05）. The results of transmission electron microscopy and light microscopy indicated unchanged retinal structure. Conclusions Compared with the application of only plasmin, plasmin combined with hyaluronidase or hexafluoride SF6 can induce complete PVD more efficiently and do no harm to the retina. (Chin J Ocul Fundus Dis, 2005, 21: 388-390)
Objective To investigate the effect of retinectomy 360° for severe ocular rupture and evaluate the related factors associated w ith prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone I in 5 eyes, zone I-II in 8 eyes，zone II in 3 eyes, zone II-IIIⅢ in 5 eyes, zone III in 7 eyes, zone II in 3 eyes, zone II-III in 5 eyes and zone III in 7 eyes. The presenting visual acuity was in grade 4 (0.02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360° retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes.Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrha ge in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76.9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70.0%) had corrected visual acuity of 0.02 or more, including 7 (35.0%) had 0.05 or more, 3 had 0.1 or mor e, and 1 had the best visual acuity of 0.3.Conclusion Retine ctomy may improve the prognosis of severe ocular rupture and save the visual fun ction of some patients.(Chin J Ocul Fundus Dis，2003，19：333-404)
Objective To observe the effect of medicineinduced posterior vitreous detachment (PVD) on proliferative vitreoretinopathy (PVR). Methods PVR was induced in the left eyes of 24 pigmented rabbits by intravitreal injection with platelet rich plasma. The rabbits were randomly divided into two experimental groups (group A and B) and one control group with 8 eyes in each group. Three hours later, the eyes in group A and B and the control group underwent intravireal injection with 1 U plasmin 0.05 ml+20 U hyaluronidase 0.05 ml, plasmin 0.1 ml, and balance salt solution 0.1 ml, respectively. The grade of PVR was recorded 1, 7, and 28 days after the intravitreal injection, and the eyes were examined by flash electroretinogram (FERG), B-scan, and retinal histopathological examination. Results The PVR models of rabbit eyes were induced successfully. On the 7th day after injection, complete and partial PVD was found in 5 and 3 eyes respectively in group A; partial PVD in 5 eyes and no complete PVD was observed in group B; there was no PVD in the other 3 eyes in group B and also in the eyes in the control group. On the 28th day after intravitreal injection, PVR grade of group A and B were both obviously lower than that of the control group（D=75.6, 98.9；P=0.003，P=0.011）; On the 7th and 28th day after injection, the b-wave amplitude in group A and B was significantly higher than that in the control group; PVR grade of the PVD eyes was lower than that of nonPVD eyes; PVR grade of the complete PVD eyes was only 0～1. Conclusions Three hours after the PVR models of rabbit eyes were induced, complete PVD induced by intravitreal injection of plasmin combined with hyaluronidase could prevent the development of PVR of rabbit eyes in some degree; partial PVD induced by plasmin alone or combined with hyaluronidase could relieve the development of PVR.
ObjectiveTo observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).MethodsRetrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.ResultsOf the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ2=5.741, 8.103; P＜0.05). There was no significant difference in age (t=－1.364), duration of diabetes (t=0.538), preoperative vision (t=1.897), preoperative fasting blood glucose level (t=1.938), preoperative postprandial blood glucose level (t=1.508), preoperative systolic blood pressure (t=－0.571), preoperative diastolic blood pressure (t=0.275), whether received laser treatment (χ2=2.678), the number of laser points during operation (t=0.565), whether received lens removal during operation (χ2=0.331), whether found new blood vessels during operation (χ2=2.741) and whether received intraocular filling during operation (χ2=0.060) between the patients with and without PVH (P＞0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (rs=0.208, 0.229, 0.240, 0.285; P＜0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P＜0.05).ConclusionFundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.
Objective To investigate the effects of intravitreal injection of matrix metalloproteinase-3 (MMP-3) on the vitreoretinal adhesion and the vitreous gelatin. Methods Twenty-four pigmented rabbits were randomly divided into 3 experimental groups（group A, B, and C）and one control group with 6 rabbits (12 eyes) in each. Different concentrations of 0.1 ml MMP-3 (5,10, 20 ng in group A, B, and C, respectively) and equivalent dose of balanced salt solution were intravitreally injected to the rabbits, respectively. Clinical examinations (such as gross observation, slit-lamp biomicroscopy, indirect fundus ophthalmoscopy ), electroretinography (ERG) and fundus fluorecein angiography (FFA) were taken before and after injection. Results One week after injection, posterior vitreous detachment (PVD) and focal vitreous liquefaction were recognized clinically for the first time in 1 eye in group B. By the end of this study, clinically detected PVD developed in 1 eye in group A, 3 eyes in group B, but the synchisis developed slowly, and no liquefaction or PVD occurred in control group. As for the histological examination, partial PVD was observed in 1 eye in group A and 3 eyes in group B 60 minutes after injection. All of the eyes in group A and B showed partial PVD 1 week after injection, and the area of PVD enlarged in contrast with before. Complete PVD were recognized in 1 eye in group A and 3 eyes in group B 15 weeks after injection, and the cleavage was narrow and limited. In group C, inflammatory cell infiltration in the inner layer of retina, destruction of retinal structure, and fluorescein leakage at late phase was found in the early period after injection. Conclusions MMP-3 is effective in disrupting the adhesion of the posterior hyaloid to the inner limiting membrane leading to PVD, and helpful to some extent in producing vitreous liquefaction. The dose of 10 ng MMP-3 is safe and effective for the rabbits eyes, which may be used as an promising assistant of vitreous surgery. (Chin J Ocul Fundus Dis，2004，20：67-132)
Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age-related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air-fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow-up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy-sand-hemorrhage in anterior chamber occurred in 4(28.6%)of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age-related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell-glaucoma or retinal detachment. (Chin J Ocul Fundus Dis,2000,16:217-219)