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.
Intraocular lymphoma (IOL) is a rare lymphocytic malignancy. The gold standard for the definite diagnosis remains histopathologic examination of the ocular specimen. But cytologic confirmation of malignant lymphoma cells in vitreous or chorioretinal specimens is challenging and dependending on highly skilled cytopathologist, due to the sparse cellularity and specimen degeneration. Consequently, false-negative rates arecommon, which delays diagnosis and treatment seriously. Because of the limited diagnostic capacity of cytology, other adjunct diagnostic tools have been developed. Additional procedures that may support IOL diagnosis include flow cytometry, immunocytochemistry, cytokines study with identification of interleukin (IL)-10 and IL-6 level, and polymerase chain reaction amplification. And more recently, new techniques of mutational analysis have been validated for the diagnosis of vitreoretinal lymphoma (VRL) and may represent a helpful diagnostic tool for the detection of early cases. Metagenomic deep sequencing technology may provide an important basis for VRL diagnosis and personalized treatment. In the future, it is expected to deepen the understanding of IOL disease phenotypes at the molecular level, discover new target therapies, monitor response to treatment, and detect intraocular recurrences. These may offer insights into how we might create a tailored therapeutic approach for each patient's VRL in the future.
ObjectiveTo observe the efficacy and safety of urokinase arterial thrombolysis in the treatment of central retinal artery occlusion (CRAO) at different time window.MethodsA retrospective study. From January 2014 to November 2019, 157 eyes (157 CRAO patients) in the Xi’an People's Hospital (Xi’an Fourth Hospital) were included in the study. There were 120 males and 37 females, with the average age of 54.87±12.12 years. The mean onset time was 65.66±67.44 h. All patients were tested with BCVA using international standard visual acuity chart, and the results were converted into logMAR visual acuity record. The arm-retinal circulation time (A-Rct) and the filling time (FT) of retinal arterial trunk-terminal filling time were measured by FFA. The mean logMAR BCVA was 2.44±0.46, the mean A-Rct and FT were 27.72±9.78 and 13.58±14.92 s respectively. According to the time window, the patients were divided into the onset 3-72 h group and the onset 73-240 h group, which were 115 patients and 42 patients respectively. There were no statistically significant difference between the 3-72 h group and the 73-240 h group in age, A-Rct and LogMR BCVA before treatment (χ2=－0.197, －1.242, －8.990; P=0.844, 0.369, 0.369); the difference was statistically significant in FT comparison (χ2=－3.652, P=0.000). Urokinase artery thrombolytic therapy was performed at different time window of 3-24 h, 25-72 h, 73-96 h, 97-120 h, 121-240 h after the onset of onset. Age and A-Rct of patients with different treatment time windows were compared, and the differences were not statistically significant (χ2=6.588, 6.679; P=0.253, 0.246).In comparison of FT and logMAR BCVA, the difference was statistically significant (χ2 =30.150, 71.378; P=0.000, 0.000). FFA was rechecked 24 hours after treatment, BCVA was rechecked 30 days after treatment. The changes of A-Rct, FT and BCVA before and after treatment were compared and analyzed. The occurrence of adverse reactions during and after treatment were observed. The two groups of measurement data were compared. The t test was used for those with normal distribution and χ2 test was used for those with non-normal distribution. Spearman correlation analysis was used to analyze the correlation between onset time and the difference of A-Rct, FT shortening time and logMAR BCVA after treatment.ResultsAt 24 h after CRAO treatment, A-Rct and FT of 157 cases were 19.64±6.50 and 6.48±7.36 s respectively, which were significantly shorter than those before treatment, and the differences were statistically significant (χ2=－16.236, －14.703; P=0.000, 0.000). The logMAR BCVA at 30 d after treatment was 1.72±0.76, which was significantly higher than that before treatment. The difference was statistically significant (χ2=－14.460, P=0.000). After CRAO urokinase arterial thrombolysis at different time window, there were statistically significant differences in A-Rct shortening time, FT shortening time, and logMAR BCVA difference (χ2=12.408, 24.200, 104.388; P=0.030, 0.000, 0.000). There was no statistically significant difference between the 3-72 h group and the 73-240 h group (χ2 =－1.042, P=0.297) in shortening time of A-Rct after treatment. The difference of FT shortening time was statistically significant (χ2=－3.581, P=0.000). The difference of logMAR BCVA was statistically significant (χ2=－9.905, P=0.000). The results of Spearman correlation analysis showed that there was no correlation between the onset time and the shortening time of A-Rct and FT after treatment (rp=－0.040, －0.081; P=0.436, 0.115), and negative correlation with the logMAR BCVA difference (rp=－0.486, P=0.000). One case of intracranial hemorrhage occurred after treatment, and it improved after dehydration to reduce cerebral edema, scavenging free radicals and brain protection.ConclusionsUrokinase arterial thrombolytic therapy is effective for CRAO within time window of 3-240 h, A-Rct, FT and LogMRA BCVA are all improved. However, with the prolongation of thrombolytic therapy time window, the therapeutic effect of urokinase arterial thrombolytic therapy is decreased. The therapeutic effect of Urokinase arterial thrombolytic therapy was better within 72 h.
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.