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.
ObjectiveTo evaluate the efficacy and safety of silicone oil removal combined with dexamethasone intravitreal implant (DEX) for the treatment of macular edema secondary to proliferative diabetic retinopathy (PDR). MethodsA retrospective case series study. From September 2023 to September 2024, 25 patients (25 eyes) with PDR complicated by macular edema who underwent silicone oil removal combined with DEX treatment at Eye Hospital of Shandong First Medical University were enrolled. There were 13 male patients (13 eyes) and 12 female patients (12 eyes). All eyes developed macular edema after pars plana vitrectomy (PPV) with silicone oil tamponade. All affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. BCVA was measured using the international standard logarithmic visual acuity chart, and the results were converted to logarithm of the minimum angle of resolution (logMAR) visual acuity records; OCT was used to measure the retinal thickness at the macular fovea (CMT). The surgical method was silicone oil removal combined with intravitreal injection of 0.7 mg DEX. At 1, 4, 8, and 12 weeks after the surgery, the above indicators were re-examined using the same methods and equipment as before the surgery. Paired t tests or Wilcoxon signed-rank tests were used to compare the changes in logMAR BCVA, CMT, and intraocular pressure before and after the surgery and between groups. ResultsThe logMAR BCVA values before surgery and at 4, 8, and 12 weeks after surgery were 1.12±0.11, 0.52 (0.30, 1.17), 0.30 (0.26, 0.50), 0.31 (0.30, 0.70). BCVA improved significantly after surgery, and the differences were statistically significant (t=3.492, 2.965, 4.739; P=0.003, 0.018, 0.001). The CMT values before surgery and at 1, 4, 8, and 12 weeks after surgery were (463.00±127.21), 245.66 (211.50, 305.23), (230.00±69.39), (240.59±48.75), and (251.56±69.86) μm. CMT decreased significantly after surgery, and the differences were statistically significant (t=?6.512, ?5.843, ?4.167, ?4.728; P＜0.05). One day after the surgery, two eyes developed transient elevation of intraocular pressure, which was controlled with topical hypotensive agents. During the follow-up period, no complications, such as migration of the implant into the anterior chamber, were observed. ConclusionsSilicone oil removal combined with DEX is effective and safe for the treatment of macular edema after PPV with silicone oil tamponade. It can significantly improve the patient's postoperative vision and effectively reduce macular edema.