Objective To observe the clinical and fundus angiography characteristics of multiple evanescent white dot syndrome (MEWDS). Methods Forty eyes of 40 patients (12 males/28 females) with MEWDS, diagnosed by fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA) were enrolled. All cases were unilateral. The age was ranged from 16 to 64 years old, with a mean of 29.4 years. The initial average corrected vision was ranged from 0.1 to 1.0, with a mean of 0.82. The characteristics of clinical manifestations, the features of FFA and ICGA were analyzed.Results Multiple graywhite dots (100-500 mu;m) were found throughout the posterior pole and the mid-periphery areas. The lesions were at the depth of outer retina and retinal pigment epithelium layers. Some patients presented with mild vitreous opacity. FFA showed round or ring hyper-fluorescence spots at the early stage and tissue staining at the late stage, corresponding to the gray-white dots. Hyper-fluorescence spots and leakages at the retinal veins near optic disk were seen in 18 patients. The hyper-fluorescence spots near macular area were found in 7 patients. ICGA showed that numerous dark hypo-fluorescent dots in the mid-periphery and posterior pole at the early stage and no leakage at the late stage. ICGA detected more lesions than FFA. All of the patients were recovered without any visual complications within 6-8 weeks. Conclusions MEWDS patients have multiple fundus gray-white dots, and hyper-fluorescence and the abnormal retinal vessels by FFA, and multiple weak hypo-fluorescent spots throughout the posterior pole and the mid-periphery areas clearly on ICGA. The ICGA showed more lesions than the ophthalmoscope and FFA examination.
Objective To investigate the feasibility and clinical outcomes of minimally invasive sternal depression by autologous force for the correction of pectus carinatum. Methods Between October 2011 and September 2015, 22 pectus carinatum patients underwent minimally invasive surgical correction of pectus carinatum in Tongji Hospital. Clinical data of 22 patients were retrospectively analyzed. There were 19 males and 3 females with a mean age of 12.00±2.87 years, ranging from 6 to 15 years. Among them, 17 patients were symmetric malformation, and the others were asymmetric. Preoperative chest CT scan was performed on 14 patients. Haller index was 1.65-2.23 (1.97±0.15). All the patients underwent the minimally invasive surgical correction of pectus carinatum with a NUSS bar via sternal depression by autologous force. Results All the operations were completed successfully. The mean operation time was 55-120 (83.73±16.62) min and blood loss volume was 10-50 (28.18±11.63) ml. The mean postoperative hospital stay was 3-6 (4.23±1.17) d. Postoperative complications included wound infection in 2 patients, minor pneumothorax in 3 patients, who were cured by conservative treatment. One patient suffering postoperative hydropneumothorax received drainage. All the patients were followed up for 6-48 months after discharge and very satisfied with the chest appearance following surgery. No patient complained of persistent pain. There was no displacement of the bar or the stabilizers. Nine patients underwent the removal of the NUSS bar without pectus carinatum recurrence. Conclusion Minimally invasive sternal depression by autologous force simplifies the procedure of correction of pectus carinatum with reliable and satisfactory outcomes.
ObjectiveTo observe the outcome of scleral buckle and vitrectomy for familial exudative vitreoretinopathy (FEVR) associated rhegmatogenous retinal detachment (RRD) with different stages. MethodsTwenty eyes in 19 patients were included in this study. All the eyes were staged according to the staging system of FEVR. There are 7 eyes at stage 3A, 4 eyes at stage 4A, 6 eyes at stage 4B, and 3 eyes at stage 5. According to classification of retinal detachment (RD) with proliferative vitreoretinopathy (PVR), PVR B was in 5 eyes, PVR C1 in 2 eyes, PVR C2 in 3 eyes, PVR C3 in 7 eyes, PVR D1 in 3eyes. Retinal holes responsible for the RD could be found in every case. Scleral buckle or vitrectomy were chosen according to FEVR staging, PVR classification, location of retinal breaks, extent of RD.Ten eyes (stage 3A in 7 eyes, stage 4A in 3 eyes;PVR B in 5 eyes, PVR C1 in 2 eyes, PVR C2 in 3 eyes) were undergone scleral buckle, the mean preoperative minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) is 0.60±0.32.Ten eyes (stage 4A in 1 eyes,stage 4B in 6 eyes,stage 5 in 3 eyes;PVR C2 in 1 eyes,PVR C3 in 6 eyes,PVR D1 in 3 eyes) were undergone vitrectomy, the mean preoperative logMAR BCVA is 1.81±0.53. The mean follow up was(20.20±7.25) months, range 3 to 30 months. Surgical outcome were estimated by the average number of operation, reattachment of retina and BCVA. ResultsFinal retinal attachment was obtained in 100% of all 20 eyes. The mean postoperative logMAR BCVA of scleral buckle group (0.34±0.32) is improved than preoperative BCVA, the difference wan statistically significant (t=2.932, P=0.017). The mean postoperative logMAR BCVA of vitrectomy group (1.42±0.64) is not changed compare with preoperative BCVA (t=1.812,P=0.103).The mean number of operation of scleral buckle group (1.10±0.32) is less than vitrectomy group's (2.20±0.42),the difference wan statistically significant (t=6.588, P=0.000). ConclusionsAmong the patients whose FEVR staging is less than 4A and PVR classification is less than C3,epiretinal membranes or subretinal membranes appears mild, and scleral buckle can achieve high success rate with less number of operations,and the BCVA is improved in most of the cases. For the patients whose FEVR staging is more than 4B and PVR classification is more than C3, proliferative vitreoretinopathy seems to be serious, retina can be effectively reattached via vitrectomy, however, the number of operations required is multiple, and the BCVA is probably unimproved after operation.