Objective To evaluate metamorphopsia and vision-related quality of life (VRQoL) and its influencing factor after vitrectomy for idiopathic macular hole (IMH). Methods This is a prospective and non-randomized clinical cohort study. Thirty eyes of 30 IMH patients who received vitrectomy and inner limited membrane (ILM) peeling were included. The best-corrected visual acuity (BCVA), medical refraction test and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The macular hole index (MHI) was measured using OCT. The average logMAR BCVA and MHI in suffering eyes at baseline were 1.02±0.07 and 0.47±0.02, respectively. The uncorrected visual acuity of the fellow eyes was less than 0.1. Follow-up period was longer than 6 months. At 6 months after surgery, the central retinal thickness (CRT) was measured by OCT; vertical and horizontal metamorphopsia were measured by metamorphopsia charts; VRQoL was evaluated by Chinese VRQoL-25. Spearman correlation analysis was performed to analyze the relationship of VRQoL and postoperative BCVA, metamorphopsia and preoperative MHI. Results At 6 months after surgery, macular hole closure was confirmed by OCT in all patients. The vertical and horizontal metamorphopsia were (0.17±0.03)° and (0.11±0.03)°, respectively. The VRQoL-25 composite score was 79.81±1.29. The average BCVA was 0.59±0.05. The average CRT was (155.10±6.27) μm. The postoperative VRQoL was positive correlated with preoperative MHI (r=0.491,P=0.002), and negative correlated with preoperative BCVA (r=−0.445,P=0.014), postoperative BCVA (r=−0.530,P=0.003) and postoperative metamorphopsia (r=−0.532,P=0.006), but not correlated with the postoperative CRT (r=0.231,P>0.05). Conclusions IMH patients improved their visual acuity after surgery, but still have metamorphopsia. VRQoL was negative correlated with metamorphopsia, positive correlated with preoperative MHI.
ObjectiveTo analyze the consistency of clinical imaging and clinicopathological finds of retinoblastoma (RB) optic nerve invasion. MethodsA retrospective case study. Fifteen children with 15 eyes who were diagnosed with RB and underwent enucleation at the Eye Center of Beijing Tongren Hospital from November 2017 to January 2022 were included in the study. Among them, there were 9 males with 9 eyes and 6 females with 6 eyes. The mean age was 1.75±1.61 years. All affected eyes were designated International Classification of Retinoblastoma group E. There were 7 cases with secondary neovascularization glaucoma, 2 cases with closed funnel-shaped detachment of the retina and tumor touching the posterior capsule of the crystal, and 6 cases with tumor touching the back surface of the crystal and posterior chamber of the 15 children. All children underwent CT or magnetic resonance imaging (MRI). Among them, CT examination was performed in 4 cases, MRI examination in 4 cases, and MRI and CT examination in 7 cases. All the children underwent eyeball enucleation, paraffin sections were taken from the eyeball, and sagittal section of the eyeball with optic nerve tissue was taken for pathological examination. Imaging diagnosis was based on optic nerve thickening and/or enhancement. The pathological diagnosis was based on the growth of RB tumor cells across the post-laminar of optic nerve. The pathological diagnosis was based on the growth of RB tumor cells across the sieve plate. The area under the curve (AUC) of receiver operating characteristic curve was used to evaluate the diagnostic ability of imaging examination. The sensitivity, PPV and 95% confidence interval (CI) of imaging examination were obtained based on the confusion matrix. With pathology as the gold standard, intragroup correlation coefficient (ICC) was used to test the consistency of imaging and pathology. ResultsAll the 15 cases were diagnosed with RB by pathological examination. Of the 15 cases, 7 cases were diagnosed with RB optic nerve invasion by imaging and 8 cases without nerve invasion; 12 cases of RB optic nerve invasion were diagnosed by pathology after operation. Three cases without nerve invasion. Among them, 4 cases had identical imaging and pathological findings. The sensitivity and PPV of MRI and CT were 0.33 (95%CI 0.11-0.64) and 0.57 (95%CI 0.20-0.88), respectively. The value of AUC (the area under the curve) in the ROC curve of MRI and CT were 0.51 (95%CI 0.24-0.77) and 0.52 (95%CI 0.25-0.78), respectively. The AUC values of both were 0.5-0.7, indicating low diagnostic accuracy. ICC test evaluated the consistency of MRI and CT with pathological examination, 0.61 (95%CI 0.97-0.87) and 0.63 (95%CI 0.12-0.88) for MRI and CT, respectively. Therefore, the consistency of MRI, CT and pathology was moderate. ConclusionCompared with the pathological findings, the sensitivity and accuracy of MRI and CT in the diagnosis of RB optic nerve post-laminar invasion are lower, and the consistency between MRI and CT with pathology is only moderate.
ObjectiveTo observe the image characteristics of optical coherence tomography (OCT) in patients with primary vitreoretinal lymphoma (PVRL).MethodsA retrospective clinical study. Thirty-two eyes of 19 patients diagnosed with PVRL by vitreous pathology in the Department of Ophthalmology, Beijing Tongren Hospital from September 2016 to October 2019 were included in this study. There were 7 males and 12 females. The median age was 56 years. The mean time from symptom onset to final diagnosis was 6.1±3.8 months. The first diagnosis was uveitis in 12 cases (63.1%, 12/19), retinal vein occlusion in 2 cases (10.5%, 2/19), central retinal artery occlusion in 1 case (5.3%, 1/19), and suspected PVRL of camouflage syndrome in 4 cases (21.1%, 4/19). Routine ophthalmic examination and frequency-domain OCT examination were performed in all the patients, and typical images were stored for analysis. According to the examination results, PVRL OCT signs were divided into vitreous cells, inner retinal infiltration, outer retinal infiltration, retinal pigment epithelial (RPE) infiltration, sub-RPE infiltration, and subretinal fluid.ResultsVitreous cells were found in all eyes (100.0%, 32/32). RPE infiltrated were observed in 19 eyes (59.4%, 19/32), RPE infiltration in 16 eyes (50.0%, 16/32), outer retinal infiltration in 8 eyes (25.0%, 8/32), inner retinal infiltration in 16 eyes (50.0%, 16/32), and subretinal fluid in 4 eyes (12.5%, 4/32).ConclusionsPVRL OCT signs can involve vitreous and retinal anatomical levels, including vitreous cells, inner retinal infiltration, outer retinal infiltration, RPE infiltration, sub-RPE infiltration and subretinal fluid. The same patient can show multiple signs at the same time.