Anti-vascular dndothelial growth factor (VEGF) drugs have open up a new treatment channel for ocular neovascular diseases. A lots of clinical data has proved that anti-VEGF drugs are effective and safe. But we should also notice that long-term and excessive usage of anti-VEGF drugs brings some new problems and complications, and even affect the normal ocular physiological process of the angiogenesis and retinal blood flow. So, it is necessary to pay attention to the problems and potential risks of excessive usage of anti-VEGF therapies for ocular neovascular disease.
Objective To evaluate the 25-gauge (25G) transconjunctival sutureless vitrectomy system (TSV25G) for macular diseases. Methods The clinical data of 18 patients with macular diseases treated by the TSV25G were retrospectively analyzed. The 18 patients included 13 men and 5 women, aged from 25 to 73 years. The disease course ranged from 3.5 to 10 months, in cluding 8 epiretinal membrane, 3 idiopathic macular hole, 3 tranumatic macular hole with submacular heamorrhage, 2 vitreo-macular tractional syntrome and 2 diabetic macular edema. The surgical parameter installation was as follows: high speed cutter with rate of 1500 cuts per minute; the maximum aspiration with a TSV2 5G were 500-550 mmHg (1 mm Hg=0.133 kPa); the BSS bottle height was 40-50 cm; the intraocular pressure was 29-35 mmHg during the surgery. The postoperative follow-up period was 2.5-10 months. Results Eighteen patients had undergone the vitrectomy successfully with the operative time of 26-44 minutes (mean 35 minutes). No complication was found. Water leakage of the puncture site was found in 1 patient and was sewed up with 8-0 absorbable sutures. The mean time of inpatients were 3.5 days postoperatively. In the postoperative follow-up in 18 patients, the macular edema disappeared totally in 12 patients 3-6 months after the operation; the visual distortion disappeared in 10 and alleviated in 2; the visual acuity regained (0.8 or more) in 6 (33.3%), not changed in 4, and improved in 2. Conclusion TSV25G was safe, time-saving, and effective for macular diseases. (Chin J Ocul Fundus Dis，2004，20：137-138)
Objiective To observe the changes of angioarchitecture of the optic disc in cats eyes after radial optic neurotomy (RON). Methods Ten healthy adult cats underwent unilateral RON randomly in 10 eyes as an operative group in this trial, and the fellow eyes (10 eyes) were as the control group. The colophony samples of vascular angioarchitecture of 20 eyes were made 90 days after RON and scanning electron microscope was used for the observation. Results In the control group, the blood supply of optic disc mainly came from the short posterior ciliary artery, pial artery, and retinal ciliary artery; the choroidal capillary vessels around the optic disc didnprime;t take part in the blood supply in the anterior area; retinal central vascular system and complete arterial circle around the optic nerves were not seen. In the operative group, a V-shaped defect of the optic disc, retinal blood vessels and choroidal capillary vessels was found at the surgical incision; no injury of retinal blood vessels and choroidal large vascular layer was seen, and neovascularization at the incision were not found. Conclusions RON may cause the vascular defect of the optic disc and the peripheral local tissues. The depth of the incision doesnprime;t reach the Zinn-Hallers circle. (Chin J Ocul Fundus Dis, 2007, 23: 170-172)
Objective To observe the changes of electroretino gram(ERG) in temporary traumatic ocular hypotension and to detect the possiblem echanism. Method The rabbit model with ocular hypotenstion was made. At the 2nd, 4th, 8th, 16th week after trauma, the ocular tension and ERG was examined. Result Amplitude of b wave in treated group was 2.5 times as high as that in the control at the 2nd week after trauma, and then decrease to 1.5 times as high as that in the control at the 16th week. Conclution Higher amplitude of b-wave of ERG in rabbit with ocular hypotension may be related to blood circulation congestion, which might lead to accumulation of the metabolic toxin. (Chin J Ocul Fundus Dis，2004，20：189-191)
Objective To investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.Methods From January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). Results Endophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), gl au coma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual a cuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52 %) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VAlt;0.02) , and 27 eyes (50.00%) were out of blindness (VA≥0.05). Conclusions Penetrating ocular injury, especially with retained intraocular foreign bodies, is the most common cause of suppurative endophthalmitis. Vitrectomy is a good method for the treatment of endophthalmitis. (Chin J Ocul Fundus Dis，2003，19：93-95)
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 investigate the causes of failure of the primary vitrectomy,sum up the experience for secondary vitreous surgery and improve the success rate of primary vitrectomy for complicated retinal detachment． Methods The records of a consecutive series of 60 patients(65 eyes)that underwent secondary vitreous surgery between 1997 to 1998 were retrospectively reviewed.The age of patient ranged from 9 to 63 years(mean 36),and the followup period ranged from 3 to 18 months(mean 10.5 months). Results The main causes of failure of the primary vitrectomy were postoperative recurrence of proliferative vitreoretinopathy(PVR),unwell closed retinal breaks,and intra-and postoperative complications.In 46 of 65 eyes the retina was reattached after secondary vitreous surgery(70．1%)．Postoperatively,31 eyes (47.7%) had a visual acuity(VA)improved,16 eyes(24.6%)had a VA unchanged,and 18eyes(27.7%)had a VA reduced．Fifteen eyes(23.1%)had a VA of ge;0.05 and the best VA was 0.4．Thirty-nine eyes were followed-up from 3 to 18 months(mean 10.5)．In 35 of 39 eyes,the retina was reattached(89.7%),26 eyes(40%)had a VA of ge;0.05,and 7 eyes(10.7%)were hypotonic. Conclusions The keys to the success of secondary vitreous surgery are to restore the mobility for retina by eliminating the PVR completely,and avoid intraoperative complicattions by choosing the appropriate closure procedure for retinal breaks and the suitable intraocular tamponades. (Chin J Ocul Fundus Dis,20000,16:24-26)