ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.
ObjectiveTo evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. ResultsIn 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P < 0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P < 0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm, much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P < 0.05). ConclusionsHalf-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT.
Objective To investigate the therapeutic effects of retinal angiomatosis in different clinical stages. To discuss the indication of vitrectomy for retinal hemangioblastoma. Methods The clinical data of 22 cases (33 eyes) were retrospectively analyzed. The retinal hemangiomas were divided into 5 stages according to their degrees of development from simple angioma without vessel dilation to feeder vessel dilation and intra-retinal exudates, local retinal detachment, massive retinal detachment and co mplication occurrence in proper order. The methods of treatment were laser photo coagulation, trans－scleral cryotherapy and vitrectomy. 13 eyes were treated with laser photocoagulation, 5 eyes with cryotherapy combined with laser and 11 eye s with vitrectomy. Tumor resection and silicone oil tamponade was performed in 3 eyes during vitrectomy. The patients were followed up for 46 months on average. Visual acuity (VA), the condition of the hemangioma and retina was compared pre- and post-operation respectively. Results In all 13 eyes treated with laser photocoagulation the hemangiomas regressed and the retina remained attached. VA improved in 2 eyes, and remained unchanged in 11 eyes. Cryother apy combined with laser photocoagulation was performed on 5 eyes. In this group, 4 eyesprime; hemangiomas regressed and no new hemangiomas occurred, proliferative vitreous retinopathy and vitreous hemorrhage was observed in 1 eye which vitrecto my was performed later. VA improved in 2 eyes, unchanged in 2 eyes and decreased in 1 eye. In the 11 eyes treated with vitreoretinal surgery, new hemangiomas wa s found in 1 eye, exudative retinal detachment was caused by hemangiomas in 2 eyes, proliferative vitreous retinopathy was observed in 2 eyes, and the retina re mained attached in 8 eyes. VA improved in 3 eyes, unimproved in 3 eyes, and decreased in 5 eyes. In the 3 eyes with surgical resection of retinal hemangioma during vitrectomy, 2 eyesprime; retina remained attached, 1 eye had exu dative retinal detachment and no new hemangiomas occurred. VA improved in 2 eyes and decreased in 1 eye. Conclusions Laser photocoagulation or combined with cryotherapy is effective in treating the hemangiomas in early stage. Vitrectomy is advisable for late stage of retinal angiomatosis, especially with vitreous hemorrhage, epiretinal membrane, proliferation and large scale of r etinal detachment. Surgical resection of isolated large retinal hemangioblastoma may be useful for selected patients. (Chin J Ocul Fundus Dis,2008,24:107-110)
Objective To compare the efficacy of 23G and 20G vitrectomy for diabetic retinopathy. Methods Thirty-eight eyes of 33 patients with diabetic retinopathy who underwent primary vitrectomy were enrolled in this study. Twenty eyes of 18 patients underwent 23G microincision vitrectomy (23G group). Eighteen eyes of 15 patients underwent 20G vitrectomy (20G group). The followup ranged from 6 to 12 months. The surgical time, number of iatrogenic retinal tears, times of coagulation for hemorrhage, instrumental change for fibromembrane removal, intraocular pressure (IOP) at 1st, 2nd and 3rd days after surgery, postoperative complications, anatomic success rate, and best corrected visual acuity (BCVA) were observed. Results The mean surgical times were (63.5±21.7) and (83.9±27.5) minutes in 23G and 20G group which was a significant difference (t=2.55, P=0.02). The numbers of iatrogenic retinal tears were six and 14, while the mean times of coagulation were 71 and 104 in 23G and 20G group respectively. There were three and 12 eyes needing instrumental change for fibromembrane removal in 23G and 20G group with significant difference (χ2=10.58, P=0.001). At the 1st, 2nd and 3rd days after surgery, IOP were (10.2±2.0), (13.4±2.5), and (14.9±2.3) mm Hg (1 mm Hg=0.133 kPa) in 23G group, (16.5±2.9), (19.3±2.4), and (20.1±2.9) mm Hg in 20G group. Compared with each other, the differences were statistically significant (t=7.71, 7.41, 6.18; P＜0.01). There was one eye with intraocular hemorrhage, one eye with neovascular glaucoma (NVG), and one eye with retinal detachment (RD) in 23G group. There were two eyes with intraocular hemorrhage, two eyes with NVG, and one eye with RD in 20G group. Compared with each other, the differences were not statistically significant (χ2=0.49, 0.49, 0.01; P＞0.05). The anatomic success rates were 950% and 94.4% in 23G and 20G group without significant difference (χ2=0.01, P=0.94). There were no complications such as endophthalmitis or choroidal detachment. In 23G group, BCVA was ＜0.05 in one eye, 0.05 – 0.09 in five eyes, 0.1 -0.2 in 10 eyes, ≥0.3 in two eyes. In 20G group, BCVA was ＜0.05 in one eye, 0.05 - 0.09 in nine eyes, 0.1 -0.2 in six eyes, ≥0.3 in two eyes. Compared with each other, the differences were not statistically significant (χ2=2.70, P＞0.05). Conclusion 23G microincision vitrectomy is beneficial to shorten the operation time, reduce instrumental changes, decrease intraoperative complications, and enhance visual rehabilitation.
ObjectiveTo evaluate the efficacy of intra-arterial chemotherapy (IAC) for advanced retinoblastoma (RB) after failure of intravenous chemotherapy (IVC). MethodsFifteen eyes of 13 patients with advanced RB were treated with IAC (1-5 cycles) after failure of IVC (2-8 cycles). The patients included 10 boys and 3 girls, with the mean age of (15.67±8.16) months. Six patients had bilateral RB and 7 patients had unilateral RB. There were 14 eyes (93.33%) in stage D, 1 eye (6.67%) in stage E according to the International Classification of intraocular retinoblastoma. The main reasons for failure of IVC were recurrent primary tumor in 3 eyes (20.00%), subretinal seeds recurrence in 9 eyes (60.00%), viable vitreous seeds in 2 eyes (13.33%) and poor response of primary tumor in 1 eye (6.67%). The mean interval between IVC completion and IAC start was 3 months. The mean follow-up was 19 months (ranged from 3 to 52 months). ResultsAfter IVC and secondary IAC, the retinoblastoma and seeds were regressed in 12 eyes (80.00%). Three eyes required enucleation for severe vitreous seeds, subretinal seeds recurrence and primary tumor recurrence. There was no evidence of metastasis in any case. ConclusionIAC can achieve high global salvage rate (80.00%) for patients with advanced retinoblastoma after failure of IVC.
ObjectiveTo evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.MethodsA retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology, Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study. There were 16 males (16 eyes) and 20 females (22 eyes), with the mean age of 64.11±9.49 years and the mean courses of 151.55±127.87 days. All the patients received an intravitreal injection of 0.3 ml of 100% C3F8 within one week. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The severity of metamorphopsia was detected using M-charts. The extent of vitreomacular adhesion (VMA), central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment. The average BCVA was 0.58±0.22. The mean horizontal metamorphopsia (MH) and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42, respectively. The mean CMT was 415.15±89.59 μm. The mean horizontal VMA was 1168.68±400.61 μm (30 eyes with VMA≤1500 μm and 8 eyes with VMA＞1500 μm). The mean vertical VMA was 976.89±295.92 μm. There were 22 eyes with integrity EZ and 16 eyes without integrity EZ, 33 eyes with crystalline lens and 5 eyes with IOL. The mean follow-up time was 10.7 months. The differences in BCVA, MH, MV, CMT, the integrity of EZ before and after treatment were analyzed. The VMT release rates were assessed. The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.ResultsVitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit, the VMT release rate was 76.3%. VMT release occurred and the average time of VMT release occurred was 2.2 weeks. VMT persisted in 7 eyes, in the rest two eyes, one eye developed a retinal detachment and another eye formed macular hole, both eyes responded to vitrectomy. At 6 months after treatment, the average logMAR BCVA was 0.43±0.23, the mean MH and MV were 0.25±0.23 and 0.24±0.23, the mean CMT was 310.61±63.10 μm. Among 16 eyes without integrity EZ before treatment, there were 9 eyes with integrity EZ at 6 months after treatment. There were 16 eyes with integrity EZ and 9 Compared with baseline, the mean BCVA at 6 months after treatment was significantly increased (F=3.779, P=0.037), but the MV (F=4.958, P =0.003) and CMT (F=13.419, P＜0.001) were significantly decreased, the integrity of EZ was improved significantly (χ2=5.050, P=0.025). The VMT release correlated inversely with the extent of horizontal VMA, BCVA, and CMT at baseline (r=-0.514, -0.348, -0.429; P=0.009, 0.001, 0.038).ConclusionIntravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction, it is an efficient and safe treatment for VMT syndrome. It can improve the visual acuity, metamorphopsia and foveal morphology in patients with VMT syndrome.