ObjectiveTo observe the effect of micro-pulse laser in the treatment of acute central serous chorioretinopathy (CSC). Methods105 cases (114 eyes) with clinically diagnosed acute CSC were included in the study, including 78 males (86 eyes) and 27 females (28 eyes) with an average age of (40.40±7.80) years, and mean duration of 26 days. All patients were examined for best corrected visual acuity (BCVA), slit lamp microscope and pre-lens, direct ophthalmoscopy, color fundus photography, fluorescein angiography combined with indocyanine green angiography (ICGA), and micro-perimetry. Patients were randomly divided into micro-pulse laser treatment group (treatment group, 61 eyes) and control group (51 eyes). The age (Z=-0.374), gender ratio (χ2=0.010), disease duration (Z=-0.525), BCVA (t=1.885), foveal thickness (CFT) (t=-1.754) and macular light sensitivity (t=1.255) were similar between the two groups. The micro-pluse laser treatment was performed with an 810 nm infrared diode laser at the active leakage site on retinal pigment epithelium guided by ICGA. The exposure time was 0.2 s, effective working time was 15%, the laser spot diameter was 100 μm, and the distance between 2 spots was 100 μm. The control group received pseudo-treatment using the same laser parameters. After 2 weeks, 1month, 3 months and 6 months of treatment, all patients were examined with BCVA, ocular fundus, optical coherence tomography and micro-perimetry. These parameters were compared between the 2 groups. ResultsThe subretinal fluid of 39 eyes in the micro-pulse laser group and that of 3 eyes in the control group were absorbed completely. The cure rates in the micro-pulse laser group(61.9%) was higher than that in the control group (χ2=38.015, P < 0.01). In the micro-pulse laser group, the mean BCVA was 67.81±11.70 at baseline, which increased significantly to 75±9.91, 76.78±9.43, 78.56±8.57 and 78.52±8.60 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively. In the control group, that was 63.86±10.35, 64.20±11.43, 63.90±10.88, 64.55±11.04, 64.10±11.12 at baseline, 2 weeks, 1 month, 3 months, 6 months post-treatment respectively. The mean post-treatment BCVA at each time point were significantly higher in the micro-pulse laser group than that in the control group(P < 0.01). The mean CFT was(380.94±50.73) μm at baseline, which reduced to(268.44±44.20), (242.78±41.31), (235.46±38.44), (235.56±38.71) μm at 2 weeks, 1 month, 3 months and 6 months post-treatment respectively in the micro-pulse laser group. In the control group, that was (397.98±52.61), (334.55±59.15), (316.16±55.25), (314.47±53.27), (321.51±55.74) μm at baseline, 2 weeks, 1 month, 3 months, 6 months post-treatment respectively. The mean post-treatment CFT at each time point in the micro-pulse laser group were decreased significantly compared to that in the control group (P < 0.01). The mean central retinal sensitivity was (15.03±2.00) dB at baseline, which enhanced to (17.06±1.71), (17.37±1.61), (17.56±1.58), (17.48±1.53) dB at 2 weeks, 1 month, 3 months and 6 months post-treatment respectively in the micro-pulse laser group. In the control group, that was (14.54±2.22), (14.80±2.16), (14.88±2.09), (14.82±2.07), (14.69±2.11) dB at baseline, 2 weeks, 1 month, 3 months and 6 months post-treatment respectively. The mean central retinal sensitivity at each time point of post-treatment in the micro-pulse laser group were enhanced significantly compared to that in the controlled group(P < 0.01). ConclusionIn the treatment of acute CSC, micro-pulse laser can improve BCVA, reduce the mean CFT and improve the mean central retinal sensitivity. It is an effective and safe method to treat acute CSC.
ObjectiveTo evaluate the efficacy of intravitreal injections of conbercept in choroidal neovascularization (CNV) secondary to pathologic myopia (PM). MethodsA retrospective case series of 37 eyes of 37 patients affected with CNV secondary to PM treated by intravitreal injections of Conbercept. All the patients were examined with best-corrected visual acuity (BCVA) of Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT) of optical coherence tomography (OCT)at baseline. The initial average letters of ETDRS BCVA was 49.86±8.87, CMT was (306.38±31.01) μm. All eyes were treated with intravitreal Conbercept 0.05 ml (10 mg/ml). Follow-up visits were performed monthly after injection. The mean follow-up time was 16.8 months. Injections were repeated according to the situation of BCVA, CMT, subretinal fluid and CNV leakage in follow-up. All eyes received an average of 4.8 injections. BCVA, CMT and ophthalmoscope examination were assessed monthly. The relationship of BCVA improvement and CMT reduction with the data at baseline and number of treatments were analyzed by Spearman Rho correlation respectively. ResultsDuring the 1, 3, 6 and 12 months after treatment, the mean BCVA were all improved with statistically significant difference (t=17.629, P < 0.01).At 12 months, 15 eyes (45.9%) had improvement of 15 letters or more, 32 eyes (86.5%) had improvement of 5 letters or more, and 1 eye (2.7%) had decreased more than 5 letters. During the 1, 3, 6 and 12 months after treatment, the mean CMT were all decreased with statistically significant difference (F=43.726, P < 0.01). At 12 months, the retinal fluid of 34 eyes (91.9%) were absorbed completely; 33 eyes (89.2%) had angiographic closure at that time. There was no significant relevance between BCVA improvement and sex, age and course of the disease (P > 0.05), but a significant negative correlation was found between the BCVA improvement and BCVA at baseline, injection times (P < 0.05). There was no significant relevance between CMT reduction and sex, age, course of the disease and injection times (P > 0.05), but a significant positive correlation was found between CMT reduction and CMT at baseline (P < 0.05). There were no systemic or ocular serious side effects during the follow up. ConclusionsIntravitreal injections of Conbercept showed BCVA improvement and CMT reduction. It appeared to be effective and safe for choroidal neovascularization secondary to pathologic myopia. Intravitreal Conbercept for CNV secondary to PM showed BCVA improvement, CMT reduction and safety.
ObjectiveTo assess the consistency of diagnostic results using optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) in the central retinal vein occlusion (CRVO). MethodsThis is a retrospective case series of 26 eyes of 26 patients with CRVO. There were 10 females (10 eyes) and 16 males (16 eyes). The mean age was (49.19±10.50) years. The mean course of the disease was (27.81±21.60) days. Simultaneous OCTA and FFA were performed in all patients using 7-standard field of Early Treatment Diabetic Retinopathy Study (ETDRS) to evaluate the microaneurysms, nonperfused areas, optical disc/retinal neovascularization and macular edema. The consistency was evaluated using weighted Kappa statistic values. Kappa≥0.75, consistency is excellent; 0.60≤Kappa < 0.75, consistency is good; 0.40≤Kappa < 0.60, consistency is general; Kappa < 0.40, consistency is poor. ResultsBased on OCTA, microaneurysms were found in 23 eyes, nonperfused areas in 16 eyes, optical disc/retinal neovascularization in 8 eyes and macular edema in 21 eyes. Based on FFA, 23 eyes were diagnosed to have microaneurysms, 14 eyes have nonperfused area, 8 eyes have optical disc/retinal neovascularization, 22 eyes have macular edema. The consistency was excellent for microaneurysms and optical disc/retinal neovascularization (Kappa=0.772, 0.766; P < 0.01), good for nonperfused areas and macular edema (Kappa=0.703, 0.600,P < 0v01). ConclusionThere is high consistency between OCTA and FFA in the diagnosis of microaneurysms, macular edema, nonperfused areas and optical disc/retinal neovascularization in CRVO patients.
Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a retrospective case series of 47 IMEM patients (49 eyes). All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The central macular thickness (CMT), inner nuclear layer thickness (INT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT, INT, IRT, ORT and status of EZ before and after surgery were analyzed, so did the correlations between these indexes at the same time. Results Compared with baseline, the postoperative BCVA was significantly increased (F=6.133, P＜0.001), but the M value, CMT, INT, IRT, ORT were significantly decreased (F=12.481, 10.565, 15.739, 6.046, 10.569; P＜0.001);the integrity of EZ was improved significantly (χ2=12.309, P＜0.001). Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720, 0.887; P＜0.05), while negatively related to preoperative integrity of EZ (r=−0.295, P＜0.05). The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT, ORT (r=0.774, 0.754, 0.842; P＜0.05), while negatively related to postoperative integrity of EZ (r=−0.676, P＜0.05). The preoperative M value was positively related to the preoperative CMT, INT, IRT, and ORT (r=0.931, 0.668, 0.840, 0.637; P＜0.05). The postoperative M value was positively related to the preoperative M value and postoperative CMT, INT, IRT, and ORT (r=0.723, 0.722, 0.767, 0.825, 0.387; P＜0.05). Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity, metamorphopsia and foveal morphology. Both visual acuity and metamorphopsia correlate with foveal morphology.
ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.
ObjectiveTo evaluate the therapeutic efficacy of vitrectomy with internal limiting membrane (ILM) peeling and subretinal injection of balance salt solution (BSS) for refractory diabetic macular edema (DME).MethodsA retrospective case series study. From November 2017 to August 2018, 24 eyes of 19 patients affected with DME resistant to anti-VEGF therapy [central macualar thickness (CMT) more than 275 μm despite undergoing anti-VEGF therapy at least 3 times] in Ophtalmology Department of Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent 25G pars plana vitrectomy with ILM peeling and subretinal injection of BSS. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The CMT and the macular volume (MV) were assessed with swept-source optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT and MV before and after surgery were analyzed.ResultsThe mean BCVA was 0.74±0.29 at baseline, which increased significantly to 0.62±0.28, 0.56±0.25, 0.47±0.26, 0.46±0.23 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=4.828, P=0.001). At 6 months, BCVA improved by more than 0.3 logMAR units in 16 eyes (66.7%). The mean CMT was 554.58±102.86 μm at baseline, which reduced to 338.17±58.09 μm, 299.42±52.66 μm, 275.75±41.24 μm and 270.96±38.33 μm at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=84.867, P＜0.001). The mean MV was 13.01±0.88 mm3 at baseline, which decreased to 11.50±0.73 mm3, 11.00±0.74 mm3, 10.68±0.61 mm3 and 10.52±0.56 mm3 at 2 weeks, 1 month, 3 months and 6 months after treatment respectively (F=47.364, P＜0.001). Macular edema recurred in 5 eyes (20.8%) 6 months after surgery. No severe systemic or ocular side effect was reported during the follow-up.Conclusions25G vitrectomy with ILM peeling and subretinal injection of BSS for refractory DME can improve the visual acuity, facilitate a rapid resolution of macular edema.
ObjectiveTo observe the changes of the inner-retinal irregularity index (IRII) of eyes with idiopathic macular epiretinal membrane (IMEM) before and after surgery and its correlation with visual function.Methodsretrospective series of studies. From March 2017 to May 2018, 46 IMEM patients (46 eyes) diagnosed in the Department of Ophthalmology of Central Theater Command General Hospital were included in the study. BCVA, visual deformation degree (M), OCT inspection with swept source were all performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logMAR visual acuity for record. The average IRII was 1.255±0.048, the average logMAR BCVA was 0.63±0.21, the average M value was 0.68±0.38, the average of central macular thickness (CMT) was 353.57±73.92 μm, the average inner retinal layer thickness (IRT) was 181.50±40.91 μm. The complete and incomplete ellipsoid zone (EZ) were 17 and 29 eyes, respectively. All eyes underwent a 25G three-incision closed vitrectomy through the flat part of the ciliary body, and the epiretinal membrane and inner limiting membrane were removed at the same time. The changes of IRII, M value, BCVA, CMT, IRT and EZ were observed at 1, 3, 6, and 12 months after surgery, and the correlation were analyzed between IRII and M value and BCVA before and after surgery. Single-factor repeated measurement data analysis of variance was used for the comparison of BCVA, M value, CMT, and IRT before and after surgery. Spearman rank correlation analysis were adopted for the correlation analysis between IRII and BCVA, M value, CMT, IRT and EZ integrity before and after surgery.ResultsTwelve months after surgery, the average IRII and logMAR BCVA were 1.175±0.032 and 0.47±0.16, respectively. Compared with those before surgery, they were significantly improved, and the difference was statistically significant (F=22.273, 5.453; P＜0.001, ＜0.001). The average M value (F=20.109), CMT (F=14.273), IRN (F=13.665) were significantly lower than those before the operation, and the difference was statistically significant (P＜0.001, 0.001, ＜0.001). The integrity of EZ was significantly improved compared with that before surgery, and the difference was statistically significant (χ2=12.715, P＜0.001). The results of correlation analysis showed that preoperative IRII was positively correlated with preoperative M value and CMT (r=0.951, 0.701; P＜0.001, ＜0.001). It was positively correlated with postoperative M value, logMAR BCVA, CMT and EZ integrity (r=0.650, 0.369, 0.720, 0.293; P＜0.001, ＜0.001, P=0.048). It was not correlated with preoperative logMAR BCVA and EZ integrity (r=0.283, 0.001; P=0.056, 0.996).ConclusionThe IRII of IMEM eyes before surgery is significantly correlated with the BCVA and M values after surgery.
ObjectiveTo observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). MethodsThis is a prospective non-randomized controlled clinical study. A total of 62 patients (70 eyes) who underwent vitrectomy for PDR were enrolled and divided into IVR group (30 patients, 34 eyes) and control group (32 patients, 36 eyes).IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) 3 or 5 days before surgery. The follow-up time was 3 to 18 months with an average of (4.5±1.8) months. The surgical time, intraoperative bleeding, iatrogenic retinal breaks, use of silicone oil, the best corrected visual acuity (BCVA) and the incidence of postoperative complications were comparatively analyzed. ResultsThe difference of mean surgical time (t=6.136) and the number of endodiathermy during vitrectomy (t=6.128) between IVR group and control group was statistically significant (P=0.000, 0.036). The number of iatrogenic retinal break in IVR group is 8.8% and control group is 27.8%, the difference was statistically significant (χ2=4.154, P=0.032). Use of silicone oil of IVR group is 14.7% and control group is 38.9%, the difference was statistically significant (χ2=5.171, P=0.023). The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8% and 30.6% respectively in IVR group and control group. The differences were statistically significant (χ2=3.932, P=0.047). The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA, the difference was statistically significant (t=4.414, 8.234; P=0.000).But there was no difference between the mean postoperative BCVA of two groups (t=0.111, P=0.190). There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. ConclusionsMicroincision vitreoretinal surgery assisted by IVR for PDR shorten surgical time, reduces the intraoperative bleeding and iatrogenic retinal breaks, reduces the use of silicon oil and the postoperative recurrent vitreous hemorrhage. But there was no significant relationship between vision improvement and IVR.
ObjectiveTo evaluate the efficacy of vitrectomy with internal limiting membrane peeling without intraocular tamponade in the treatment of myopic foveoschisis. MethodsTwenty-three eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, direct ophthalmoscope, A or B ultrasonic scan and optical coherence tomography(OCT).The mean BCVA was 0.02-0.4, mean diopter was (-14.1±3.8) D, mean axial length was (28.8±1.5) mm, mean central fovea thickness (CFT) was (573.2±142.8) μm. A standard 3-port pars plana vitrectomy (25-gauge system) was performed in all patients. There was no tamponade at the end of the operation. The follow-up varied from 6 to 28 months. The visual acuity, CFT, retinal reattachment and the complications were observed. ResultsAt the latest follow up, there were 16 eyes (69.6%) were anatomically reattached, 4 eyes (17.4%) were partly anatomically reattached, 3 eyes (13.0%) were not reattached. Postoperative BCVA improved in 22 eyes (52.2%), unchanged in 9 eyes (39.1%), and decreased in 2 eyes (8.7%). No ocular complications such as macular hole, fundus hemorrhage, low or high intraocular pressure, endophthalmitis were found. ConclusionVitrectomy with internal limiting membrane peeling without gas tamponade can effectively treat myopic foveoschisis without ocular complications.