Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
Objective To observe the changes of visual acuity and multifocal electroretinogram （mfERG）before and after pars plana vitrectomy (PPV) combined with internal limiting membrane（ILM）peeling with ICG on idiopathic macular hole surgery. Methods The clinical data of 19 patients (19 eyes) with idiopathic macular hole（IMH） who had undergone PPV combined with ILM peeling assisted by 0.25% ICG from Zhongshan Ophthalmic Center were retrospectively analyzed. The closure of macular holes was confirmed by OCT two months after surgery. VERIS Science 4.9 visual evoked response image system was used to record the amplitude density of P1 waves according to six concentric rings before and two,six,twelve months after surgery, meanwhile compared and analyzed best corrected visual acuity（BCVA）before and after surgery. Results The results of OCT showed that 16 eyes (84.21%) had anatomic closure of the macular hole two months after the surgery while three eyes (15.79%) failed in the closure. The BCVA after surgery improved significantly which was more obvious at the second month (F=6.389，Plt;0.05). Compared with before surgery, the responses were depressed severely in P1 wave amplitude densities in six rings, the differences were statistically significant (t=6.140，Plt;0.05). Conclusion The postoperative BCVA of IMH patients improved but the amplitude densities of P1 wave depressed compared with before surgery.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and with or without internal limiting membrane (ILM) peeling for retinal reattachment and macular hole closure of moderate highly myopic macular hole retinal detachment (MHRD). Methods Forty-three moderate highly myopic MHRD patients (43 eyes) with proliferative vitroretinopathy in class A or B, moderate long axial lengths (ge;26 mm but ＜29 mm), mild retina pigment epithelium and chorioretinal atrophy, and posterior staphyloma (0 - 1 level and le;2 mm) were enrolled in this study. The patients were divided into two groups according to surgical options: TA-assisted PPV with ILM peeling (group A, 24 eyes), TA-assisted PPV without ILM peeling (group B, 19 eyes). The anatomic reattachment of the retina, macular hole closure, and corrected visual acuity (CVA) were observed at one week, one, three, six and 12 months after surgery. Results Twelve months after surgery, retinal reattachment was achieved in 22 eyes (91.67%) and 18 eyes (94.74%) in group A and B, respectively. The difference of retinal reattachment rate between two groups was not statistically significant (Fisherprime;s exact test, P=1.000). Macular hole closure was in 14 eyes (58.33%) and 11 eyes (57.89%) in group A and B, respectively. The difference of macular hole closure rate between two groups was not statistically significant (chi;2=0.049，P=0.824). The differences of CVA between two groups was not statistically significant (chi;2=0.001, P=0.977). Conclusion ILM peeling may not be necessary in the surgery of TA-assisted PPV for moderate highly myopic MHRD.
Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=（M+N）/BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=−0.665, −0.691; P＜0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery.
Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH), but the visual acuity and MH closure rate remains to be further improved. After removal of posterior vitreous cortex, the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH. During the circumferential peeling, the ILM is not removed completely from the retina but is left attached to the edges of the MH. The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades. Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy, especially for MH with large diameter and unhealed MH after ILM peeling. Compared with conventional vitrectomy combined with ILM peeling, inverted ILM flap technique can enhance MH closure and improve visual acuity. Due to lack of large sample observation in clinical trials of inverted ILM flap technique, we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.
ObjectiveTo compare the results of internal limiting membrane (ILM) peeling with and without ILM transplantation to treat idiopathic macular hole (IMH) with hole form factor (HFF)<0.6. MethodsForty patients (40 eyes) of IMH with HFF<0.6 who underwent pars plana vitrectomy (PPV) were enrolled in this study. 20 eyes was performed PPV combined with ILM peeling (ILM peeling group), the other 20 eyes was performed PPV combined with ILM peeling and ILM transplant (ILM transplant group). The follow-up was ranged from 3 to 6 months with an average of 4 months. The changes of closing rate of hole, best corrected visual acuity (BCVA), photoreceptor inner segment/outer segment (IS/OS) junction defect diameter and amplitude of wave P1 of ring 1 and ring 2 by multifocal electroretinogram (mfERG) were comparatively analyzed for the two groups. ResultsIn 3 months after surgery, the IMH closing rate was 70% (14/20) in the ILM peeling group, and 100% (20/20) in the ILM transplant group, the difference between these two groups was significant (χ2=7.059, P<0.05). Postoperative BCVA was improved obviously in the two groups compared to preoperative BCVA, the difference was significant (t=4.017, 4.430; P<0.05). The rate of BCVA improvement in the ILM peeling group and ILM transplant group were 80% and 85%, the difference was not significant (χ2=0.173, P>0.05). The rate of significantly BCVA improvement in the ILM peeling group and ILM transplant group were 35% and 70%, the difference was significant (χ2=4.912, P<0.05). IS/OS junction defect (t=6.368, 6.635; P<0.05) and amplitude of wave P1 of ring 1 (t=2.833, 4.235) and ring 2 (t=2.459, 4.270) by mfERG in the two groups were improved after operation. The differences of postoperative IS/OS junction defect (t=2.261, P<0.05) and amplitude of wave P1 of ring 2 between the two groups were significant (t=2.282, P<0.05), but the differences of postoperative amplitude of wave P1 of ring 1 between two groups was not different (t=1.800, P>0.05). ConclusionPPV combined with ILM peeling and ILM transplantation can significantly improve the closure rate and vision of IMH with HFF<0.6.
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.
Objective To evaluate the effect of vitreoretinal surgery with lens-sparing technique in treating the detachment with giant retinal tear(GRT) associated with proliferative vitreoretinopathy(PVR). Methods Thirty-one consecutive eyes with GRT unde rwent vitrectomy were analysed retrospectively. Operative techniques included peeling of pre-retinal membrane， injection of perfluorodecalin liquid， retinotomy and retinectomy，endolaser，and silicon oil or C2F6 gas tamponade. Lens-sparing vitrectomy was performed in 28 phakic eyes. Follow-up period ranged from 11 to 34 months. Results Anatomic retina l attachment was achieved intraoeratively in 29 eyes. In 16 eyes of 28 eyes with postoperative cataract formation,3 eyes underwent cataract surgery with or without intraocular lens implantation. The corrected final visual acuity ran ged from 0.4 to 0.01. Conclusion Most phakic eyes of retinal detachment with GRT PVR can be successfully operated on with an out come of improving the visual acuity by using techniques of lens-sparing vitrectomy, perfluorodecalin liquid and silcone oil tamponade. (Chin J Ocul Fundus Dis, 2001,17:93-95)