ObjectiveTo observe the safety of intravitreal injection of triamcinolone acetonide (TA) combined with partial anterior pars plana vitrectomy (PPV) for cataract with severe vitreous hemorrhage.MethodsA retrospective case-control study. A total of 60 patients (60 eyes) with cataract and severe vitreous hemorrhage were included from June 2017 to June 2019 in Xi’an People’s Hospital (Xi’an Fourth Hospital). There were 32 males (32 eyes) and 28 females (28 eyes), with a mean age of 64.8 years. The eyes were randomly divided into intravitreal injection TA group (TA group) and non-TA injection group (control group), with 30 eyes in each group. Before phacoemulsification, 0.05-0.10 ml TA was injected into the vitreous cavity in the TA group and the vitreous besides the vitrectomy channel was removed. The eyes of the control group underwent conventional cataract phacoemulsification combined with PPV. The follow-up time after surgery was ≥6 months. The rate of success continuous circular capsulorhexis, posterior capsule rupture, and intraocular lens (IOL) implantation in the capsular bag were compared between the two groups. The statistical data were compared with χ2 test. ResultsFor all eyes in the TA group, after intravitreal injection of TA combined with partial anterior PPV, the white reflection of the fundus can clearly show the anterior and posterior capsule of the lens. Continuous circular capsulorhexis was completed, the posterior capsule was not broken, and the IOL was successfully implanted inside the capsular bag. Among the 30 eyes of the control group, 4 eyes did not complete continuous circular capsulorhexis. Radial tear occurred during capsulorhexis, and capsulorhexis was used to complete capsulorhexis. In 5 eyes with posterior capsule rupture, the posterior capsule occurred in 3 eyes during phacoemulsification, and injecting the lens cortex caused posterior capsule repture in 2 eyes; the IOL was implanted in the ciliary sulcus and the capsular bag in 4 and 1 eyes, respectively. Whether the consecutive capsulorhexis was successful (χ2=4.286), whether the posterior capsule was ruptured (χ2=5.455), whether the IOL was implanted in the capsular bag (χ2=4.286), the differences in the number of eyes between the two groups were statistically significant (P= 0.038, 0.020, 0.038). At the last follow-up, no special complications occurred.ConclusionsIntravitreal injection of TA combined with partial anterior PPV can improve the visibility of the anterior and posterior lens capsule and lens nucleus during phacoemulsification in patients with cataract and severe vitreous hemorrhage. The surgical success rate is high, the complications are few, and the safety is good.
ObjectiveTo observe the application of ultra wide angle FFA (UWFA) in the study of the correlation between diabetic macular edema (DME) and retinal ischemia.MethodsOne hundred and forty-five patients (220 eyes) with diabetic retinopathy (DR) diagnosed by fundus and FFA in Shaanxi Eye Hospital from January to August in 2018 were enrolled in the study. There were 132 eyes from 85 males and 88 eyes from 60 females. The average age was 54.87±10.89 years old, 171 eyes were non proliferative DR (mild 27 eyes, moderate 32 eyes, severe 112 eyes), 49 eyes were proliferative DR. There were 141 eyes with retinal ischemia. None of them received retinal laser photocoagulation, intravitreal injection of drugs and other eye surgery. UK Optomap200Tx imaging system was used for UWFA examination. According to whether the central macular retina of 2 disc diameter area was involved, the eyes were divided into DME group (183 eyes) and non DME group (37 eyes). According to different appearance of fluorescein leakage in macular zone, DME group was further divided into focal leakage (FL) group, diffuse leakage (DL) group and diffuse cystic leakage (DCL) group, with 94, 73 and 16 eyes, respectively. The incidence of retinal ischemia, retinal neovascularization (RNV) and/or NVD were compared between DME group and non DME group, and the difference of retinal ischemia index (IIS) of three macular edema subgroups was further compared. The differences of retinal ischemia, RNV and/or NVD between DME group and non DME group were compared by chi square test or Fisher exact probability method. The different retinal IIS of three macular edema subgroups was compared by one-way ANOVA.ResultsAmong 183 eyes in DME group, 132 eyes (72.13%, 132/183) were accompanied with retinal ischemia, and 9 eyes (24.32%, 9/37) were accompanied with retinal ischemia in non DME group. There was significant difference in the incidence of retinal ischemia between the two groups (χ2= 30.56, P＜0.05). In FL group, DL group and DCL group, there were 51 (54.26%, 51/94), 70 (95.89%, 70/73) and 11 (68.75%, 11/16) eyes with retinal ischemia, and 11 (11.70%, 11/94), 30 (41.10%, 30/73) and 4 (25.00%, 4/16) eyes with NVD and/or RNV, respectively, The retinal ischemia indexes of these three groups were 0.0516±0.0961, 0.2192±0.2166, 0.1244±0.1460. There were statistically significant differences in the incidences of retinal ischemia (χ2=35.53), NVD and/or RNV (χ2=18.50) and retinal ischemia indexes (F=22.80) among the three groups (P=0.000 0, ＜0.050 0, ＜ 0.000 1).ConclusionsUWFA can dynamically evaluate the retinal ischemia in DME patients, and the enlargement of ischemic area. The formation of RNV are more likely to form DL macular edema.