The improvement of diagnostic levels for fundus diseases depend on the advancements of fundus imaging technology. Different fundus imaging technologies allow doctors to inspect ocular fundus from different aspects such as morphological or functional changes of retina. As a basic fundus examination method, optical coherence tomography provides highresolution and crosssectional retinal images coupled with noninvasive advantages. Fully understanding of the advantages and disadvantages of each fundus imaging technique, appropriate choosing one or combining several imaging techniques, and optimizing diagnostic procedures for each fundus disease are crucial steps to improve our diagnostic levels of ocular fundus diseases.
In the research process of uveal melanoma (UM), the Collaborative Ocular Melanoma Study (COMS) is a landmark and outstanding clinical study. Its research conclusions are the foundation for today's UM clinical work and guidelines. COMS is the first and largest randomized clinical trials conducted to date, comparing the survival outcomes of two or more treatment regimens for primary malignant intraocular tumors with high reliability. Its research design, methods, and conclusions are still widely cited in this day. Learning from the research experience of COMS, summarizing research data based on Asian populations, and studying treatment methods suitable for Asian UM patients is a powerful supplement to COMS data, but also an expansion of this global research, further improving the level of UM diagnosis and treatment in China.
ObjectiveTo analyze the reasons for the failure of scleral buckling (SB) in the treatment of rhegmatogenous retinal detachment, and observe the efficacy and safety of re-buckling.MethodsThis was a retrospective non-comparative clinical research. From July 2014 to June 2020, patients with first-time SB failure who visited the Beijing Tongren Hospital were included in this study. There were 42 patients, including 30 males and 12 females, with the average age of 29.40±16.13 years, and they were all monocular. The retinal detachment range＜1, 1-2 and＞2 quadrants were 9, 22 and 11 eyes, respectively. The macula was involved in 38 eyes. The average logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) was 0.99±0.57. Forty eyes and 2 eyes were performed 1 and 2 SB, and all the retina were not reattached. All patients were under general anesthesia, according to the conditions during the operation, re-freeze and located the holes under indirect ophthalmoscope. And selected the new external pressure material or retained the old one in combination with the other operations to reattaced the retina. The average follow-up time was 31.93±18.97 months. The reasons for the failure of the first surgery based on the records of this surgery were analyzed. The visual acuity changes, the rate of retinal reattachment and the occurrence of complications were observed. The visual changes were compared by paired t test.ResultsThe top three reasons for the failure were: 16 case of the displacement of the compression spine (38.10%); 9 cases of missing the retinal holes and 9 case of improper selection of compression substances (account for 21.43%, respectively); 6 cases of insufficient height of compression spine (14.29%). All of retina were reattached (100%, 42/42). The average logMAR BCVA was 0.52±0.40. The difference of logMAR BCVA between before and after surgery was statistically significant (t=6.106, P=0.000). There were a slight increase in intraocular pressure in 8 eyes, the average intraocular pressure was 25.00±2.61 mmHg (1 mmHg=0.133 kPa). No serious complications occurred after surgery.ConclusionsThe position deviation of the compression spine, the missed hole during the operation, the improper selection of external compression material, and the insufficient height of the compression spine are the main reasons for the failure of SB. After adjusting the reasons for the failure, there is still a higher rate of retinal reattachment.
Scleral buckling surgery is a main surgical method for rhegmatogenous retinal detachment, and it is the basic skill of retinal surgeons. As a kind of classic treatment, retinal surgeons must recognize and understand the essence and connotation of scleral buckling surgery, master and apply skillfully, improve the success rate of rhegmatogenous retinal detachment, and use the minimum amount of surgical combination to achieve anatomical retinal reattachment and restore visual function as much as possible.
Optical coherence tomography angiography (OCTA) is a new diagnostic technique in recent years based on the optical coherence tomography. It is one of the fastest developing imaging examinations in ophthalmology. Compared with the classic diagnostic methods of fundus fluorescein angiography and indocyanine green angiography, OCTA show the ability to reveal blood flow non-invasively. With the development of modern medical detection technology, the requirement for ophthalmic diagnosis is raised, and many new measurement methods begin to apply in research and clinical, which makes the detection methods in the field of ophthalmology more accurate and comfortable. OCTA is a novel and noninvasive flow imaging technique, and it has the advantages of high resolution, fast scanning, as w ell as quantifying blood flow. Meanwhile, this technique can not only qualitatively analyze the shape of ocular blood vessels, but also be able to measure the ocular blood vessels and blood flow non-invasively, as well as to assess the depth of lesions. At present, with a wide clinical application in ophthalmology, OCTA still has its own superiority and weakness, but with the development of technology. It is believed that the OCTA will be expected to replace the relevant invasive examination methods and become a new tool for ophthalmic imaging.