Purpose To verify the effectiveness of combined B-scan ultrasonoscopy and ultrasound biomicroscopy(UBM)imagings in diagnosis of retinal detachments. Methods To contrast the manifestations in vitrectomy operations with the findings of preoperative combined B-scan ultrasonic and UBM examinations in 25 eyes of 25 cases in which 18 eyes with rhegmatogenous retinal detachment and 7 eyes with traumatic retinal detachment were included. Results B-scan ultrasonic imagings were divided into four types: type C,type V,type upsilon; and type gamma;,which included 6 eyes,2 eyes,4 eyes and 11 eyes respectively,and from type C to type gamma;,the retinal detachments manifested themselves from simple posterior segment proliferative vitreoretinopathy(PVR)to both anterior and posterior PVR.The imagings of UBM were divided into 3 types:shallow retinal detachment,retinal circumferential contraction and retinal anterior displacement,which reflected the degree of anterior PVR from lightness to severeness. Conclusions The technique of combined B-scan ultrasonoscopy and UBM can be used to access the severity of the retinal detachments,hence would be beneficial in diagnosing anterior and posterior PVR,designing the surgical precedures and assessing the prognosis. (Chin J Ocul Fundus Dis,1998,14:16-20)
PURPOSE:To investigate the cause and treatment of iatrogenic retinal breaks(lRB)in microvitreoretinal surgery. METHODS:The causes and treatments of 40 iatrogenie retinal breaks of 24 cases in micro-vitreoretinal surgery from July1994 to March 1996 in our department were analyzed retrospectively. RESULTS:40 IRB were found in 24 eyes,among them there were 16 eyes of proliferative vitreoretinopathy(PVR),5 eyes of taumatic PVR and 3 eyes of tractional retinal detachment, The treatments of IRB included scleral cryotherapy ,silicone band buckling,endodiathermy,intraocular tamponade and postoperative argon laser. The IRB of inferior retina and posterior Io scleral buckling acounded for 70% and 92% respectively. The total retinal and macular attachment were 17 eyes and the visual acuity of 19 eyes improved to 0.02 or better during the mean follow up periods of 5 months. CONCLUSION:The IRB is a severe complication in micro-vitrecretinal surgery and has to be obliterated either intraoperatively or postoperatively. （Chin J Ocul Fundus Dis,1997,13: 19-21 ）
PURPOSE: To investigate the activation and immune respones of lymphocytes in epiretinal membranes (ERMs)and subretinaI membranes (SRMs). METHODS: A panel of morioclonal antibodies against CD23 (activated B cell), CD25 (activated T cell), CD68(macrophages) and HLA-DR (human leukocyte antigen II antigen)were used for the study of 20 specimens of ERMs from 20 patients with proliferative vitreoretinopathy (PVR),traumatic PVR and secondary traction retinal detachment,and 2 SRMs from PVR and traumatic PVR, with positive and negative reaction specimens as controls. RESULTS:Four cases of ERMs were found to be CD23 and CD25 positive respectively,and one case of SRMs to be CD23 and CD25 positive respectively. All the specimens of ERMs and SRMs revealed CD68 and HLA-DR positive in this series. CONCLUSIONS :There might be an aberrant immunoreaction mediated by T and B cells in the ERMs and the SRMs,and they might play an important role in the patbogenesis of PVR,traumatic PVR and secondary traction retinal detachments. （Chin J Ocul Fundus Dis,1996,12: 147-150）
Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P＜0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P＜0.01) and the last follow-up (r=−0.768, P＜0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P＜0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P＞0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
Objective To observe the high-risk histopathological feature (HRF) and their correlation with prognosis in children with intraocular retinoblastoma (RB) in the intraocular stage after failed eye-preserving treatment and enucleation surgery. MethodsA single-center retrospective case study. From August 2018 to January 2023, 64 children (64 eyes) with advanced intraocular RB who were diagnosed in Department of Ophthalmology of Beijing Children's Hospital and underwent enucleation surgery after failed eye-preserving treatment were included in the study. The median follow-up time was 51 months. The gender of the children patients, the age of visit and enucleation, International Intraocular Retinoblastoma Classification (IIRC), the initial chemotherapy regimen (hereinafter referred to as "chemotherapy"), the time of enucleation surgery, pathological results, post-enucleation treatment methods and prognosis were collected. The Mann-Whitney U test was used for comparison between groups. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used for comparison between groups. ResultsAmong 64 cases and 64 eyes, 37 were male and 27 were female. The age of seeking medical treatment was 20 (11-31) months. The age at which the surgery was performed was 29 (16-40) months. The number of eyes in IIRC stage D and E was 16 and 48 respectively. The initial chemotherapy regimens simply applied (hereinafter referred to as "alone") intravenous systemic chemotherapy (IVC) and ophthalmic artery infusion chemotherapy (IAC) in 40 cases and 11 cases, 13 cases of IVC+IAC. All patients with positive HRF received systemic adjuvant chemotherapy after surgery. There were 37 eyes (57.8%, 37/64) positive for HRF. There was no statistically significant difference in the positive rate of HRF between children in IIRC stage D and stage E (χ2=0.021, P=0.884). Among the 37 eyes with HRF, the numbers of eyes with extensive choroidal invasion, posterior lamina cribrosa optic nerve invasion, scleral invasion and optic nerve stump involvement were 17 (45.9%, 17/37), 16 (43.2%, 16/37), 3 (8.1%, 3/37) and 3 (8.1%, 3/37), respectively. During the follow-up period, there were 5 cases (7.8%, 5/64) of extraocular metastasis of the tumor and death, all of which were stage E and had HRF. Among them, the initial treatment plan was IAC for 4 cases, one case of IVC. The survival rates of children among the IVC, IAC or IVC+IAC regimens were 97.5% (39/40), 63.6% (7/11), and 100.0% (13/13), respectively. The comparison of survival rates among different chemotherapy regimens showed statistically significant differences (χ2=14.233, P＜0.001). The results of survival analysis showed that the cumulative survival rate of those with extensive choroidal invasion, posterior lamina cribrosa optic nerve infiltration, and those who received IAC was significantly lower than that of those without extensive choroidal invasion, posterior lamina cribrosa optic nerve infiltration, and those who received IVC+IAC and IVC (P＜0.05). ConclusionsEye-preserving treatment for children with advanced intraocular RB may increase the positive rate of HRF and the risk of extraocular metastasis. The IVC+IAC eye-protecting treatment plan can improve the survival rate of children.