Objective To evaluate the anatomic outcome after lenssparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP). MethodsThe clinical data of 39 infants (50 eyes) with 4a (20 eyes) or 4b (30 eyes) were retrospectively analyzed. The age ranged from two to 18 months, with a mean of (6.0±3.4) months. The gestational age ranged from 26 to 33 weeks, with a mean of (30.0±1.6) weeks. The birth weight ranged from 800 to 1900 g, with a mean of (1404.5±237.6) g. Nineteen eyes underwent SB and 31 eyes underwent LSV. Follow-up ranged from 6 to 84 months, with a mean of (26.0±21.7) months. The anatomical and refractive results were reviewed at the final follow-up. ResultsThe anatomic success of SB was 100.0% (19 of 19 eyes) and that of LSV was 87.1% (27 of 31 eyes). Among the patients in whom treatment failed, 4 were in the LSV group (4/31, 12.9%). The buckles of 5 eyes (5/19, 26.3%) were removed. At the end of the followup, the mean myopic refraction was (-4.46±2.49) diopters (ranging from -1.25 to 11.00 diopters) in the LSV group, and (-3.21±1.96) diopters (ranging from -1.25 to 9.25 diopters) in the SB group. There was no significant difference between two groups (F=2.76, P=0.103). ConclusionThe anatomic outcome after LSV or SB for stage 4 ROP was excellent.
ObjectiveTo investigate the factors correlated with the visual outcome of idiopathic macular holes (IMH) after vitreoretinal surgery. MethodsA total of 57 eyes of 57 patients with IMH were included. There were 43 females (43 eyes) and 14 male (14 eyes), mean age was (60.46±4.79) years. All the eyes underwent best corrected visual acuity (BCVA), slit-lamp microscope, three-mirror contact-lens and optical coherence tomography (OCT) examinations. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution (logMAR) acuity. The minimum diameter and base diameter of macular holes and central retinal thickness (CRT) were detected by OCT. The average logMAR BCVA of 57 eyes was 0.98±0.41. The minimum diameter and base diameter of macular holes were (479.53±164.16) μm and (909.14±278.65) μm. All the patients underwent pars plana vitrectomy combined with phacoemulsification cataract extraction and intraocular lens implantation. The mean follow-up period was (173.44±147.46) months. The relationships between final BCVA and these parameters were examined by single and multiple regression analysis. The valuable influence factors were filtrated and formulated using multiple linear regression models. ResultsAt the final follow-up, the logMAR BCVA of 57 eyes was 0.44±0.31, the CRT was (158.79±86.96) μm. The final BCVA was positive related to minimum diameter of macular holes and preoperative BCVA (r=0.420, 0.448; P=0.001, 0.000), negative related to postoperative CRT (r=-0.371, P=0.004). There was no relationship between the final BCVA and base diameter of macular holes, age and follow-up (r=0.203, -0.015, 0.000; P=0.130, 0.913, 0.999). The incidence of preoperative BCVA for postoperative BCVA was bigger than preoperative minimum diameter of macular holes (P=0.008, 0.020). ConclusionThe preoperative minimum diameter of macular holes and BCVA are related to postoperative BCVA in IMH eyes.
Myopic foveoschisis (MF) has mild early symptoms, however, its course is progressive. When the secondary macular detachment or macular hole occurs, it can cause severe vision loss. Therefore, it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF. The operation mode is divided into vitreoretinal surgery and macular buckling, the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach. There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years. Compared with vitreoretinal surgery, macular buckling can release the traction of the retina caused by posterior scleral staphyloma, but it cannot relieve the traction in the tangential direction of the retina. Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both, however, the effect of treatment on patients still needs further verification. In clinical work, it is necessary to conduct individualized analysis of MF patients, weigh the advantages and disadvantages of each operation, and choose the most suitable operation mode for patients with different conditions. In the future, the emphasis of our work is to develop operation mode with great curative effect and less complications.
Idiopathic macular hole (IMH) refers to full thickness defects of retina in macular area with no clear reasons. The management of IMH includes vitrectomy combined with internal limiting membrane (ILM) peeling and pharmacological vitreolysis. But ILM peeling may damage the inner retina; novel techniques, such as inverted ILM flap technique and foveola non-peeling ILM surgery, autologous ILM transplantation had made the method of ILM peeling more diversified with less damage. Pharmacological vitreolysis targeting fibronectin and laminin is considered to work in a two-step mechanism, involving both vitreoretinal separation and vitreous liquefaction. Furthermore, IMH judgment and prognosis indicators like ellipsoid zone, macular hole index, hole formation factor, diameter hole index and tractional hole index based on spectral domain optical coherence tomography enriched the assessment of macular hole diameter, depth and shape. How to make full use of new interventions to reduce the incidence of macular hole and obtain a better visual acuity with closed holes is an important direction for future research.
The internal limiting membrane (ILM), composed of collagen fibers, glycosaminoglycans, laminin and fibronectin, is the basement membrane of the retinal Müller glia cells and serves as an interface between the vitreous and retina. The ILM is the structural interface between the vitreous and retina. ILM removal ensures separation of the posterior hyaloid from the macular surface, which can relieve macular traction and prevent postoperative epiretinal membrane formation. Thus, vitrectomy with ILM peeling has become an increasingly utilized and vital component in surgical intervention for various vitreoretinal disorders. However, many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers.There were some surgical strategy (fovea-sparing ILM peeling or inverted internal limiting membrane flap technique, or Abrasion Technique). But some controversies exist, such as when ILM peeling is necessary, which adjuvant to use to perform the procedure, and what is the best technique to peel the ILM. A full assessment ILM structure and function and related factors of surgery is helpful to predict the anatomical and functional prognosis.
At present, tamponade agent which being used in retinal surgery is mainly sterile air, gas and silicone oil. Sterile air is mostly used in the treatment of simple retinal detachment. Gas or silicone oil as tamponade is greatly applied for complicated retinal detachment. In recent years, with the application of micro-invasive vitrectomy under a wide-angle viewing system and perioperative anti-vascular endothelial growth factor drugs, application of intraocular filling materials also has changed. The application of silicone oil is significantly reduced. Percentage rate of gas as tamponade for retinal detachment is reduced. The application of sterile air as tamponade is rising. With selecting indication carefully and picking up the suitable air or gas, doctor will reduce the workload. It will also reduce the social burden and benefit patients.
Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH), but the visual acuity and MH closure rate remains to be further improved. After removal of posterior vitreous cortex, the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH. During the circumferential peeling, the ILM is not removed completely from the retina but is left attached to the edges of the MH. The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades. Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy, especially for MH with large diameter and unhealed MH after ILM peeling. Compared with conventional vitrectomy combined with ILM peeling, inverted ILM flap technique can enhance MH closure and improve visual acuity. Due to lack of large sample observation in clinical trials of inverted ILM flap technique, we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.