To compare surgical outcomes between 27 and 25-gauge vitrectomy in proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD).
This retrospective study was conducted to compare ...the intraoperative status, operation time, use of instruments, endotamponade substance, wound suture number, and iatrogenic break, between 27 and 25-gauge vitrectomy in 43 eyes afflicted by PDR with TRD. The post-surgical results, best-corrected visual acuity, intraocular pressure, recurrent vitreous haemorrhage, and re-operation rate were regularly followed up for 6 months.
Patients in the 25 and the 27-gauge groups did not differ significantly in terms of pre-surgical conditions, such as age, gender, pre-existing glaucoma, best-corrected visual acuity (BCVA) and the severity of their TRD. The mean operation time was 56.7 minutes in the 27-gauge group and 63.7 minutes in the 25-gauge group (p = 0.94). There is significantly less use of micro forceps in the 27-gauge group (p = 0.004). No difference between micro scissors and chandelier usage were noted; neither was their difference in iatrogenic retinal breaks. Significantly fewer wound sutures were noted in the 27-gauge group (p < 0.001). The post-operative results revealed no significant difference in ocular hypertension, hypotony, BCVA improvement, recurrent vitreous haemorrhage and re-operation rate.
The 27-gauge vitrectomy system offers comparable surgical outcomes in PDR with TRD. The 27-gauge vitrectomy system is suitable for complicated retinal surgery.
AimsTo compare the differences and to assess the correlations regarding to foveal microvasculature, refractive errors and optical biometry in children with history of type 1 retinopathy of ...prematurity (ROP) treated with either laser photocoagulation or intravitreal injection of antivascular endothelial growth factors (anti-VEGF).MethodsThis is a retrospective and comparative case series. Measurements of fovea microvasculature included the retinal thickness and subfoveal choroid thickness, the size of fovea avascular zone (FAZ), the fovea, parafovea and perifoveal vessel density (VD). Measurements of refractive errors and optical biometry included spherical equivalent, astigmatism, cornea curvature, anterior chamber depth (ACD), lens thickness and axial length (AXL).ResultsA total 47 eyes in 25 children were studied (22 laser-treated eyes from 12 children and 25 anti-VEGF treated eyes from 13 children). Laser-treated eyes had significantly smaller FAZ (p=0.004), higher fovea VD, lower parafoveal VD (p=0.02 and 0.01 in superficial capillary plexus; p=0.05 and 0.01 in deep capillary plexus), thicker inner retinal thickness (p=0.002). Laser-treated eyes had significantly higher degree of myopia (p=0.01). Regarding to optical biometry, laser-treated eyes had significant steeper cornea curvature, shallower ACD and thicker lens (p=0.01, 0.01 and 0.02, respectively) but no differences in AXL was noted (p=0.58). Significant correlations presented between inner retina thickness and FAZ to anterior segment variables.ConclusionIn school-aged children with history of type 1 ROP, despite similar visual acuity outcome, those who underwent anti-VEGF injection had favourable developmental outcomes compared with laser photocoagulation. Significant correlations exist between fovea microvasculature and optical biometric components.
To report the clinical results of lens capsular flap transplantation in refractory macular hole (MH).
This retrospective, interventional, consecutive case series included 20 eyes with persistent MH ...after previous standard MH surgery. All eyes underwent vitrectomy, lens anterior or posterior capsule transplantation into the MH, gas tamponade, and a 1-week postoperative head down. Structural and functional changes were evaluated.
The predisposing conditions to surgical failure included high myopia with MH and retinal detachment in four eyes, MH after myopic foveoschisis surgery in one eye, high myopia with a large MH in one eye, proliferative diabetic retinopathy with MH in three eyes, MH with severe retinal detachment in one eye, retinal detachment with concurrent peripheral breaks and MH in one eye, and large or chronic MH in nine eyes. Macular hole was closed in all the 10 eyes receiving anterior capsular flap transplantation. In the 10 eyes with posterior capsular flap transplantation, MH was closed in 5, partially closed in 3, and not closed in 2. Visual acuity in logarithm of minimal angle of resolution improved from 1.53 ± 0.39 preoperatively to 1.07 ± 0.35 postoperatively.
Lens capsular flap transplantation may close the MH and improve visual outcome in the majority cases of refractory MH.
AimsThis study aimed to report the 3-year follow-up results of the clinical course and structural changes of choroidal neovascularisation (CNV) by optical coherence tomography angiography (OCT-A) in ...eyes with a history of chronic central serous chorioretinopathy (CSC).MethodsThis is a retrospective study of patients with chronic CSC complicated with CNV. Patients were recorded of best-corrected visual acuity (BCVA) and treatment modalities. OCT was used to evaluate the presence of subretinal fluid (SRF), type of CNV, changes in central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT). Changes in the size, vessel density (VD) and morphology of CNV were evaluated by OCT-A. Comparison between baseline and final parameters was made.ResultsA total of 30 eyes in 26 patients, most of whom had previous treatment for chronic CSC, were included with a mean follow-up period of 40.37±4.11 months. No changes in BCVA were noted (p=0.562). During the 3-year follow-up period with OCT-A, five eyes had SRF noted. The other 25 eyes remained SRF free throughout the course. Regarding the morphological changes, the size of CNV enlarged significantly (p<0.01); VD of CNV decreased significantly (p=0.01); and the number of CNV with visible core vessel significantly increased (p<0.01). A significant reduced SFCT was noted (p=0.02), while the CRT remained unchanged (p=0.855).ConclusionFor most eyes infected with chronic CSC receiving previous treatment for the activity of chronic CSC, with CNV subsequently found on OCT-A, a midterm stable clinical course up to 3 years was noted, despite significant structural changes of CNV evaluated by OCT-A.
Purpose
To describe the technique and surgical outcomes of a modified large semicircular inverted internal limiting membrane (ILM) flap in the management of macular holes (MHs) in patients with high ...myopia.
Methods
We performed this retrospective study on consecutive patients with MH and high myopia (axial length ≥ 28 mm),who received vitrectomy, a large semicircular ILM flap 4 discs in diameter to cover the MH, incomplete air–fluid exchange, and SF6 gas tamponade. All of the patients maintained an upright position for 2 h postoperatively, followed by either a face-down or upright position for 1 week. Post-operative visual acuity was measured, and MH status was assessed using spectral-domain optical coherence tomography.
Results
Seventeen highly myopic eyes in 16 patients with a mean axial length of 30.49 ± 0.98 mm and mean age of 62.25 ± 9.40 years were included in this study, including five eyes with foveoschisis and four eyes with chronic MH, two with myopic choroidal neovascularization, and four with MH-associated retinal detachment. The MHs of all patients were successfully closed after a single operation. All of the patients were followed for at least 6 months. The average visual acuity in logarithm of minimal angle of resolution improved from 1.26 ± 0.52 preoperatively to 0.69 ± 0.45 6 months postoperatively (
p
= 0.01, paired
t
-test).
Conclusion
A large semicircular inverted ILM flap can close a myopic MH efficiently without the need for a long-term face-down position.
Purpose
To assess foveal microvascular structure and the correlation between foveal retinal thickness and best corrected visual acuity (BCVA) in children with retinopathy of prematurity (ROP).
...Methods
This is a retrospective case-control study. A total 42 eyes in 23 patients with history of anti-vascular endothelial factor (VEGF) agent treatment and 51 eyes of 27 healthy age-matched subjects as the control group were analyzed. Foveal avascular zone (FAZ) and foveal vessel density (VD) were measured by optical coherence tomography angiography (OCT-A). Foveal thickness was measured by cross-sectional OCT. Correlations between FAZ area, foveal VD, foveal thickness, BCVA, gestational age (GA), and birth body weight (BBW) were performed.
Results
ROP children had a significantly smaller FAZ area and higher foveal VD, and the foveal thickness was significantly higher as compared to controls (all
P
< 0.0001). We noted a significant negative correlation between FAZ area and foveal thickness. In addition, a significant positive correlation between foveal VD and foveal thickness was identified. With regard to prematurity status, gestational age and birth body weight were both significantly correlated with FAZ area, foveal VD, and fovea inner retinal thickness. Multivariable analysis showed that thicker inner retinal thickness and higher superficial vascular density were associated with suboptimal visual acuity.
Conclusion
By using OCT-A, we identified significant foveal microvascular anomalies in ROP children. The correlation between the microvascular anomalies, central foveal thickness, and suboptimal visual acuity was also noted. Because of the retrospective nature, more studies are necessary to further establish the relationship.
Purpose To investigate the surgical outcomes of inverted internal limiting membrane (ILM) insertion in macular hole (MH)-associated retinal detachment (RD) in high myopia. Design Retrospective, ...interventional, consecutive case series. Methods This study was conducted at 2 medical centers. Consecutive cases of highly myopic eyes with MH-associated RD were included. Forty eyes were divided into 2 groups: Group 1 (20 eyes) received vitrectomy, ILM peeling within the arcade area, and air-fluid exchange, and Group 2 (20 eyes) received vitrectomy, inverted ILM inserted into the macular hole, and air-fluid exchange. Optical coherence tomography was used to observe the closure of the macular hole. Corrected visual acuity (VA) was also recorded. Two-sample t test and Mann-Whitney U test were used for statistical analysis to compare differences between the 2 groups. Results MH was closed in 35% of the eyes in Group 1 and in all eyes in Group 2 ( P < .001). Significant improvement in VA in logarithm of minimal angle of resolution (logMAR) was achieved in both groups. There was no difference in the initial, final, or improvement of logMAR VA in the 2 groups. Conclusion Inverted ILM insertion into a macular hole effectively helps close the macular hole in MH-associated RD in high myopia. This may prevent the possible re-detachment from the MH. A prospective study with a larger number of cases and longer follow-up may help validate our findings.
Abstract
To assess the 3-year outcome of half-dose verteporfin photodynamic therapy (PDT) in central serous chorioretinopathy (CSC) with optical coherence tomography angiography (OCT-A) detected ...choroidal neovascularization (CNV), we performed a retrospective, interventional study. Patients were divided into 2 groups according to the fluorescein angiography: point source leakage in group 1 and diffuse oozing in group 2. Data were collected from patients including changes of best-corrected visual acuity (BCVA), size of CNV, central macular thickness (CMT), choroidal thickness (CT), reabsorption of subretinal fluid (SRF), sessions of half-dose PDT, and the number of intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). There was a total of 34 eyes in 32 patients included. The mean sessions of half-dose PDT was 1.50 ± 0.75. The mean number of IVI of anti-VEGF was 1.38 ± 3.34. BCVA improved from 0.38 ± 0.33 to 0.20 ± 0.22 (
p
< 0.001). Mean CMT was significantly reduced along with reduced CT and increased size of CNV. SRF was totally reabsorbed in 31 eyes. Patients in group 1 had significant less sessions of PDT and better final BCVA. In conclusion, half-dose PDT treatment was effective for CSC with CNV. Patients with diffuse oozing in FA may fare less well with half-dose PDT.
To describe the surgical outcomes of using human amniotic membrane (hAM) grafts in the management of retinal breaks in diabetic tractional detachment (TRD) and combined tractional and rhegmatogenous ...retinal detachment (CTRRD). A retrospective case series of 10 eyes with TRD or CTRRD receiving pars plana vitrectomy with hAM grafts implantation, compared with 13 controls receiving the same surgery without hAM grafts. Best-corrected visual acuity (BCVA) and re-detachment rate were compared between two groups. Postoperatively, all eyes in the hAM group had retina attachment without recurrence, while 9 eyes in the control group had retina re-detachment and required additional surgery (0% vs 69.2%, p = 0.003). The BCVA significantly improved in the hAM group (from 1.96 ± 0.95 to 1.44 ± 0.77 in log MAR, p = 0.03), but not improved in control group (p = 0.20). Postoperative optical coherence tomography of the eyes receiving hAM grafts demonstrated glial tissue regeneration and restoration of ellipsoid zone. In diabetic TRD or CTRRD, hAM grafts could be an effective method, with promising outcome. Compared to standard surgery, it could result in higher retina reattachment rate and significant visual improvement. Moreover, it may offer the adjunctive benefit in tissue regeneration and fasten ellipsoid zone restoration.
...ischemic optic neuropathy (ION) was excluded. Fundus autofluorescence (FAF) of right eye showed multiple hyper-autofluorescent dots with corresponding ellipsoid zone (EZ) disruption on optical ...coherence tomography (OCT) (Figure 1A), which was consistent with Multiple Evanescent White Dot Syndrome (MEWDS). CONFLICT OF INTEREST STATEMENT All authors declare no conflict of interest.
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