In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti-VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti-VEGF therapy for zoneⅡ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc.
Objective To evaluate the influence factor of the prognosis of traumatic subretinal hemorrhage after vitreoretinal surgery. Methods The clinical data of 50 patients with traumatic subretinal hemorrhage who had undergone vitreoretinal surgery were retrospectively analyzed.All patients had ocular traumatic history and subretinal hemorrhage diagnosed by fundus and B-scan examination;the preoperative visual acuity was less than 0.1. According to different conditions, the traumatic eyes were treated with vitreo-retinal surgery, combined with lensectomy, retinotomy or silicone oil tamponade, respectively. The period of follow-up after surgery was 2-53 months, and the average period was 7.27 months. The corrected visual acuity and retinal reattachment at the last follow-up were observed. The visual acuity ge;0.1 was the standard of good prognosis; retinal reattachment was observed by indirect ophthalmoscope and color fundus photography.The prognostic factors mainly included type of injury,open or closed injury,the disease course, preoperative visual acuity, retinal detachment,hemorrhagic choroidal detachment,vitreous hemorrhage,the sites of submacular hemorrhage,methods of surgery.The relationships between those prognostic factors and visual acuity outcome or retinal reattachment were analyzed by chi;2test and logistic regression analysis. Results About 46.0% patients had good prognosis of the visualacuity. In the eyes with preoperative visual acuity of no light perception to hand moving and finger counting to 0.1, the rate of good visual acuitywas 34.2% and 83.3%, respectively; the difference between the two groups was significant (chi;2=8.860,P=0.003). In the eyes with or without preoperative retinal detachment,the rate of good visual acuity was 37.5% and 80.0%, respectively; the difference between the two groups was significant (chi;2=4.232,P=0.040). In the eyes with subretinal hemorrhage involving the macular fovea or not, the rate of good visual acuity was 34.4% and 66.7%,respectively; the difference between the two groups was significant (chi;2=4.836,P=0.028).All the other prognostic factors had no obvious effect on the retinal reattachment after the surgery. Conclusion Preoperative visual acuity、retinal detachment and submacular retinal hemorrhage were the important influence factors associated with prognostic visual acuity of eyes with traumatic subretinal hemorrhage after vitreoretinal surgery.
Objective To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR). Methods Retrospectively analyzed the follow-up data of 882 patients (1000 eyes) with PDR who had undergone vitreoretinal surgery. The standard of NLP was: in a darkroom, one eye was covered, and the other one could not catch the candlelight 30 cm in front of the eye. The number of eyes with NLP was counted and the clinical data of the eyes with or without NLP were analyzed and compared. chi;2 test was used to analyze the risk factors of NLP. Results In these 1000 eyes with PDR,the postoperative visual acuity was NLP in 22 eyes (2.2%) and light perception in 978 eyes (97.8%). Comparing with the patients with light perception, the patients with NLP had severer disease condition, including ante-operative neovascular glaucoma (NVG)(36.4%), tension combined with retinal detachment 50%, and a need for lens excision during the surgery (45.5%) and for silicone oil filling at the end of the operation (63.6%). After the surgery, NVG was found in 14 eyes, un-reattached retina in 5 eyes (before the surgery was VI stage of PDR), and optic nerve atrophy and retinal vessel atresia in 3 eyes, which significantly differed from which in the patients with light perception (Plt;0.001，P=0.004, (Plt;0.001). The differences of sex, diabetes type and PDR stage between the NLP group and non-NLP group were not significant (P=0.136, P=0.681, P=0.955). Conclusions The incidence of NLP after vitreoretinal surgery for proliferative diabetic retinopathy is low. The direct causes were NVG, optic nerve atrophy, retinal vessel atresia and retinal redetachment, while the sex, type of diabetes mellitus and stage of PDR show no statistical relation to the occurrence of NLP after surgery. (Chin J Ocul Fundus Dis,2007,23:244-247)
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)
ObjectiveTo investigate the effect of triamcinolone acetonide (TA) with different dosage and excipient on retina.MethodsThirty-two purebred New Zealand white rabbits randomly divided into 4 groups underwent intravitreous injection with TA. Group 1:4 mg TA without excipient; group 2:25 mg TA without excipient; group 3:4 mg TA with excipient; group 4:25 mg TA with excipient. Electroretinography (ERG) was performed on each rabbit before intravitreal injection, 1 week, 1 and 2 months after the injection. All the animals were killed and the eyeballs were extirpated 2 months after the injection, and pathological examinations including light and electron microscopy were performed.ResultsNo significant difference was found in the latent period of ERG at the points of time before and after the injection in all the groups, but the amplitudes of ERG waves was lower in groups containing excipient than that before the treatment (Plt; 0.01). The results of light and electron microscopy showed damages of tissue or structures of retina in various degrees in groups containing excipient.ConclusionIntravitreous injection of TA with the dosage of ≤25 mg without excipient does no harm to the retinal configuration and function, and excipient may lead to the change of retinal configuration and function.(Chin J Ocul Fundus Dis, 2005,21:229-232)
Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)
Objective To detect the variation rule of different cellular components, extracellular matrix, matrix-metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases（TIMPs）in proliferative membranes in proliferative vitreoretinopathy (PVR) with different courses of disease, and to investigate the remodeling mechanism of PVR. Methods Sixteen surgically excised specimens of proliferative membranes from patients with rhegmatogenous retinal detachment combined with PVR with the course of disease of 2 months to 8 years were selected. The different cellular component of retinal pigment epithelial (RPE) cells and glial cells, component of extracellular matrix including fibronectin, laminin，and collagen types Ⅰ to Ⅳ, and matrix metalloproteinases (MMP2, MMP9) and TIMP1 in proliferative membrane were labeled by immunohistochemical method. The variati on of those labeled components in proliferative membrane in PVR duration and the correlation between these components and the course of PVR were analyzed. Results As the duration of PVR increased,the expression of RPE cells, fibronectin and MMP2 decreased (Plt;0.05）,while glial cells,collagen type Ⅰ and Ⅲ increased (Plt;0.05）.The positive staining of laminin and collagen type Ⅱ and Ⅳ were found, but the association with PVR duration was not detected. A negative correlation between PVR duration and RPE cells, MMP2, and fibronectin respectively and a positive correlation between PVR duration and glial cells, collagen Ⅰand Ⅲ respectively were detected. MMP2 positively related with variation of fibronect in. Positive staining of MMP9 and TIMP1 was recorded but did not change with the variation of the disease course. Conclusion During the formation and development of proliferative membrane in PVR, RPE cells, glial cells, fibronectin, collagen type Ⅰand Ⅲ and MMP2 take part in the remodeling of proliferative membrane. (Chin J Ocul Fungdus Dis, 2006, 22:308-312)