Objective To evaluate the anatomic outcome after lenssparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP). MethodsThe clinical data of 39 infants (50 eyes) with 4a (20 eyes) or 4b (30 eyes) were retrospectively analyzed. The age ranged from two to 18 months, with a mean of (6.0±3.4) months. The gestational age ranged from 26 to 33 weeks, with a mean of (30.0±1.6) weeks. The birth weight ranged from 800 to 1900 g, with a mean of (1404.5±237.6) g. Nineteen eyes underwent SB and 31 eyes underwent LSV. Follow-up ranged from 6 to 84 months, with a mean of (26.0±21.7) months. The anatomical and refractive results were reviewed at the final follow-up. ResultsThe anatomic success of SB was 100.0% (19 of 19 eyes) and that of LSV was 87.1% (27 of 31 eyes). Among the patients in whom treatment failed, 4 were in the LSV group (4/31, 12.9%). The buckles of 5 eyes (5/19, 26.3%) were removed. At the end of the followup, the mean myopic refraction was (-4.46±2.49) diopters (ranging from -1.25 to 11.00 diopters) in the LSV group, and (-3.21±1.96) diopters (ranging from -1.25 to 9.25 diopters) in the SB group. There was no significant difference between two groups (F=2.76, P=0.103). ConclusionThe anatomic outcome after LSV or SB for stage 4 ROP was excellent.
There has been ongoing progress in the new technique and equipment in vitreoretinal surgery in recent years, contributing to the improvement of treatment of various vitreoretinal diseases. The application of 3D heads-up display viewing system (3D viewing system) has been one of the most fascinating breakthroughs in vitreoretinal surgery. Unlike the traditional method in which the surgeons have to look through the microscope eyepieces, this system allows them to turn their heads up and operate with their eyes on a high-definition 3D monitor. It provides the surgeons with superior visualization and stereoscopic sensation. And increasing studies have revealed it to be as safe and effective as the traditional microscopic system. Furthermore, the surgeons can keep a heads-up position in a more comfortable posture and lesson the pressure on cervical spine. Meanwhile, 3D viewing system makes it easier for the teaching and learning process among surgeons and assistants. However, there are still potential disadvantages including the latency between surgeon maneuver and visualization on the display, learning curves and cost. We hope that the 3D viewing system will be widely used and become a useful new tool for various vitreoretinal diseases in the near future with rapid development in the technology and constant upgrade of the system.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
ObjectiveTo observe the changes of visual acuity and fixation properties of eyes with idiopathic macular hole (IMH) before and after surgery. MethodsA prospective clinical study. From September 2019 to December 2020, 25 patients with 25 eyes of IMH diagnosed in Department of Ophthalmology of The Fourth People's Hospital of Shenyang were included in the study. All patients underwent pars plana vitrectomy (PPV) combined with internal limiting membrane stripping. All eyes underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and microperimetry before and after surgery. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into logarithmic minimum resolution angle (logMAR) visual acuity during statistics. The 12° macular sensitivity (MS) and bivariate contour ellipse area (BCEA) were measured by MP-3 microperimetry. The minimum diameter (MIN) and base diameter (BASE) of the macular hole were measured by OCT; the distance between the preferred retinal location (PRL) and the center of the fovea was measured by Image-proplus 6.0 image processing software. At 1 and 3 months follow-up after surgery, the same equipment and methods as before surgery were used to conduct related examinations. The changes of BCVA, PRL distance from the fovea, MS, BCEA, and macular hole shape before and after surgery were compared and observed. One-way analysis of variance was used to compare the indicators before and after surgery. Pearson correlation analysis was used for the correlation between BCVA and preoperative BCVA, PRL and foveal center distance at 3 months after surgery. The correlation between MIN, BCVA, PRL and foveal center before surgery distance, MS, BCEA and BCVA at 3 months after surgery were analyzed by multiple linear regression. ResultsAmong 25 eyes of 25 cases, 1 male had 1 eye, and 24 females had 24 eyes. The macular hole in stage Ⅲ and Ⅳ were 11 eyes and 14 eyes, respectively. MIN and BASE were 537.68±200.09 and 905.48±278.79 μm, respectively. One month after surgery, the hiatus was closed. Before surgery and 1 and 3 months after surgery, the logMAR BCVA of the affected eyes were 0.80±0.17, 0.70±0.21, 0.60±0.25, and the MS were 22.20±3.86, 23.60±3.14, 24.38±2.68 dB, the distances between PRL and the center of the fovea were 537.72±426.05, 402.00±395.06, 236.80±219.54 μm, and BCEA were 7.90±3.43, 6.40±2.67, 4.80±2.32 deg2. Compared with before operation, BCVA (F=7.047, 20.104) and MS (F=1.980, 5.390) were significantly improved at different time after operation, the distance between PRL and fovea center (F=1.265, 9.530), BCEA (F=2.762, 13.617) were decreased, the difference were statistically significant (P＜0.05). The results of correlation analysis showed that BCVA at 3 months after surgery was significantly associated with preoperative MIN (r=0.810), BASE (r=0.664), BCVA before surgery and 1 month after surgery (r=0.854, 0.940), preoperative and surgical MS at 1 month after surgery (r=－0.548, －0.578), distance between PRL and foveal center before surgery and at 1 month after surgery (r=0.833, 0.915), BCEA before surgery and at 1 month after surgery (r=0.636, 0.732) were significantly correlated (P＜0.05). The results of multiple linear regression analysis showed that the distance between PRL and foveal center before surgery and BCVA were risk factors for poor prognosis of BCVA at 3 months after surgery. ConclusionsThe BCVA and MS of eyes with IMH are significantly improved after surgery, and the distance between PRL and foveal center and BCEA decreased. BCVA, PRL and foveal center distance before surgery are risk factors for poor visual acuity after surgery.
ObjectiveTo evaluate the surgical outcomes of 25G+ vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH).MethodsA prospective analysis was performed on 39 patients (39 eyes) underwent 25G+ pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G+ PPV with 25% SF6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t -test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test.ResultsThirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF6 group. The distribution of age (t=－1.63), gender (χ2=0.03), logMAR BCVA (t=0.39), macular thickness (t=－0.93), macular hole diameter (t=－0.70), axial length (t=－0.56), macular hole stages (Z=－0.47) and pseudophakic status (χ2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF6 group. There was no significant difference of closure rate between the two groups (χ2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes,10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF6 group. The proportion of visual acuity improvement in air group was lower than that in SF6 group without the statistical significance (Z=－0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF6 group. All returned to normal limit after local medication.ConclusionCompared to SF6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.
ObjectiveTo investigate the factors correlated with the visual outcome of idiopathic macular holes (IMH) after vitreoretinal surgery. MethodsA total of 57 eyes of 57 patients with IMH were included. There were 43 females (43 eyes) and 14 male (14 eyes), mean age was (60.46±4.79) years. All the eyes underwent best corrected visual acuity (BCVA), slit-lamp microscope, three-mirror contact-lens and optical coherence tomography (OCT) examinations. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution (logMAR) acuity. The minimum diameter and base diameter of macular holes and central retinal thickness (CRT) were detected by OCT. The average logMAR BCVA of 57 eyes was 0.98±0.41. The minimum diameter and base diameter of macular holes were (479.53±164.16) μm and (909.14±278.65) μm. All the patients underwent pars plana vitrectomy combined with phacoemulsification cataract extraction and intraocular lens implantation. The mean follow-up period was (173.44±147.46) months. The relationships between final BCVA and these parameters were examined by single and multiple regression analysis. The valuable influence factors were filtrated and formulated using multiple linear regression models. ResultsAt the final follow-up, the logMAR BCVA of 57 eyes was 0.44±0.31, the CRT was (158.79±86.96) μm. The final BCVA was positive related to minimum diameter of macular holes and preoperative BCVA (r=0.420, 0.448; P=0.001, 0.000), negative related to postoperative CRT (r=-0.371, P=0.004). There was no relationship between the final BCVA and base diameter of macular holes, age and follow-up (r=0.203, -0.015, 0.000; P=0.130, 0.913, 0.999). The incidence of preoperative BCVA for postoperative BCVA was bigger than preoperative minimum diameter of macular holes (P=0.008, 0.020). ConclusionThe preoperative minimum diameter of macular holes and BCVA are related to postoperative BCVA in IMH eyes.
Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics. Refractory macular hole includes unclosed MH, reopening MH, large MH, high myopic MH, traumatic MH and secondary MH. Some modified surgeries were employed to improve the surgical results. Inverted internal limiting membrane flap, autologous transplantation of the internal limiting membrane, laser photocoagulation, extended internal limiting membrane peeling, arcuate retinotomy, lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially. Loosening MH traction, providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.
Myopic foveoschisis (MF) has mild early symptoms, however, its course is progressive. When the secondary macular detachment or macular hole occurs, it can cause severe vision loss. Therefore, it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF. The operation mode is divided into vitreoretinal surgery and macular buckling, the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach. There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years. Compared with vitreoretinal surgery, macular buckling can release the traction of the retina caused by posterior scleral staphyloma, but it cannot relieve the traction in the tangential direction of the retina. Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both, however, the effect of treatment on patients still needs further verification. In clinical work, it is necessary to conduct individualized analysis of MF patients, weigh the advantages and disadvantages of each operation, and choose the most suitable operation mode for patients with different conditions. In the future, the emphasis of our work is to develop operation mode with great curative effect and less complications.