Objective To observe the clinical effects of surgical treatment of retinal detachment(RD) caused by macular hole(MH) in high myopia. Methods The clinical materials of 149 eyes of 149 high myopia patients with RD caused by MH were reviewed. The cases were divided into complete posterior vitreous detachment (PVD) group and incomplete PVD group. The anatomic successful rate of operative treatment was evaluated according to the applications of vitrectomy surgery and non-vitrectomy surgery respectively in each group. The visual acuity changes after the operations were also observed.Results The anatomic successful rates were as follow: 77.9% in total cases with vitrectomy surgery and 25.9% with non-vitrectomy surgery (P＜0.001); 75.5% in cases of incomplete PVD with vitrectomy surgery,and 15.0% with non-vitrectomy surgery (P＜0.001); and in non-vitrectomy cases, 57.1 % in complete PVD group and 15.0% in incomplete PVD group (P=0.05). The rates of visual improvement were 68.6% in complete PVD group and 57.0% in incomplete group (P＞0.05). Conclusions The scleral buckling combined with vitrectomy, gas intraocular tamponade and postoperative photocoagulation is an effective and optimal procedure for RD caused by MH in high myopia. (Chin J Ocul Fundus Dis，2003，19：8-10)
ObjectiveTo compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH). MethodsA cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age (Wald=34.507) and logMAR BCVA (Z=－7.703) between two groups (P＜0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C3F8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. ResultsIn IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA (Z=－6.803, P＜0.005), but no difference in visual success rate (χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant (χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio (OR)=2.941, 95% confidence interval (CI) 1.341-6.447, P＜0.05], MH diameter (OR=1.003, 95%CI 1.001-1.005, P＜0.05), silicon oil filling (OR=3.481, 95%CI 1.594-7.605, P＜0.05); MMH, baseline BCVA (OR=2.549, 95%CI 1.344-4.834, P＜0.05), C3F8 filling (OR=18.131, 95%CI 1.505-218.365, P＜0.05) and silicon oil filling (OR=7.796, 95%CI 0.997-60.944, P＜0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA (OR=213.329, 95%CI 46.123-986.694, P＜0.05), MH diameter (OR=0.995, 95%CI 0.992-0.997, P＜0.05), silicon oil filling (OR=0.326, 95%CI 0.115-0.926, P＜0.05) and duration (OR=1.036, 95%CI 1.005-1.067, P＜0.05); MMH, baseline BCVA (OR=13.316, 95%CI 2.513-70.565, P＜0.05) and duration (OR=1.022, 95%CI 1.001-1.044, P＜0.05). ConclusionsMMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.
Objective To observe the characteristics of fundus autofluorescence (FAF) in patients with polypoidal choroidal vasculopathy (PCV) before and after intravitreal ranibizumab injections. Methods A retrospective case series. Seventeen patients (17 eyes) including 11 males and 6 females were enrolled in this study. Best corrected visual acuity (BCVA), FAF and indocyanine green angiography examination were performed on all eyes. The eyes were divided into hypo-autofluorescence group (8 eyes) and mixed autofluorescence group (9 eyes) according to the fluorescence degree. There was no differences of BCVA between two groups (t=2.403, P=0.072).All eyes received monthly intravitreal ranibizumab injections for 3 months followed by an as-needed reinjection schedule. All eyes were followed up for 12 months. FAF was performed at the 3rd, 6th and 12th month after first treatment. The changes of FAF characteristics and BCVA before and after treatment were observed. Results Before the treatment, the PCV lesions showed two distinct FAF patterns: the confluent hypo-autofluorescence at the polypoidal lesions and the granular hypo-autofluorescence at branching choroidal vascular networks (BVN). During the treatment, the abnormal FAF area of the whole lesions in all eyes reduced and gradually returned to normal. At the 3rd month after treatment, the central hypo-autofluorescence of polyps was surrounded by a hyper-autofluorescence ring, and with time, the ring was weakened or eliminated. However, all the hypo-autofluorescence findings in BVN at baseline were unchanged during the follow-up period. There was no significant differences in BCVA between hypo-autofluorescence group and hyper-autofluorescence group at different follow-up times (t=2.674, 2.862, 2.250; P=0.058, 0.052, 0.081). At final follow-up, 5 eyes (62.5%) in hypo-autofluorescence group and 3 eyes (33.3%) in hyper-autofluorescence group had increased BCVA, the different was not significant (P=0.347). Conclusions Before the treatment, there were the central hypo-autofluorescence of polyps and circumferential hypo-autofluorescence ring or confluent hypo-autofluorescence. After the treatment, the autofluorescence of polyps increased and then gradually returned to normal.