Pars plana vitrectomy (PPV) combined with intraocular tamponade surgery is one of the main surgical methods for treating retinal detachment. Due to the use of filling substances, patients need to maintain specific postures after the operation to promote retinal reattachment and reduce the occurrence of complications. Currently, during the process of performing postural management for such surgical patients, there are problems such as low compliance and insufficient monitoring and management. Clinical medical staff have actively explored ways to improve the quality of positioning management, but no corresponding norms and consensus have been formed. The standards implemented by different places are closely related to the degree of medical experience. The evaluation of the performance of the patient's position by the medical care mainly relies on the patient's self-report or the nurse's inspection record, which lacks continuity and accuracy. In the future, it is necessary to further promote the development and transformation of auxiliary tools, implement scientific monitoring and management of patients with the help of artificial intelligence, formulate individualized plans and dynamically adjust them according to the patient's condition, and ensure the effect and improve patient satisfaction.
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
Diabetic retinopathy (DR) is the leading cause of visual impairment worldwide. Severe non-proliferative diabetic retinopathy, diabetic macular edema, and proliferative DR (PDR) are defined as vision-threatening DR (VTDR). In the context of managing systemic disease, the primary treatments for VTDR include panretinal photocoagulation (PRP), intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs or dexamethasone sustained release agents, and microincision vitreous surgery. Although these therapies are already widely used in clinical practice, there is still much debate about the optimal timing and method of their application, especially in the pursuit of optimal efficacy, cost-effectiveness, patient compliance, and the reduction of frequent ongoing treatments. There is no consensus on the best treatment for PDR. Determining the specific criteria for each therapy indication is one of the key considerations. In addition, consideration should be given to the priority between PRP and intravitreal injection, as well as to compare the relative effectiveness of anti-VEGF agents with PRP. Early surgical intervention is not always a necessary option for PDR patients with vitreous hemorrhage and fibrovascular membranes. Combining different therapies to optimize treatment strategies is also an important topic. These issues address several points of contention in best practice guidelines that need to be addressed through more in-depth research to provide better guidance for clinical practice and ultimately improve patient outcomes.
Objective To observe the efficacy and safety of pars plana vitrectomy (PPV) combined with subretinal injection of dexamethasone in treating refractory diabetic macular edema (DME). MethodsA prospective case study. From January 2024 to March 2024, 9 cases with 10 eyes of refractory DME diagnosed at Tianjin Eye Hospital were included in the study. All eyes had a central macular thickness (CMT) of greater than 275 μm despite receiving intravitreal injection of anti-vascular endothelial growth factor (VEGF) drug at least 5 times. All eyes underwent 25G PPV combined with internal limiting membrane (ILM) peeling and subretinal injection of dexamethasone sodium phosphate. Best-corrected visual acuity (BCVA), microperimetry, and optical coherence tomography examinations were performed on all eyes before and 1 and 3 months after surgery. BCVA was assessed using an international standard visual acuity chart and converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Paired t-tests were used to compare changes in BCVA, mean macular sensitivity (MS), and CMT before and after surgery. The intraoperative and postoperative complications were recorded. ResultsAmong the 9 cases with 10 eyes, there were 4 males with 5 eyes and 5 females with 5 eyes. Age ranged from 43 to 79 (65.3±10.8) years. Preoperative and postoperative logMAR BCVA at 1 and 3 months were 0.84±0.25, 0.72±0.31, and 0.63±0.22, respectively. MS was (16.48±5.03), (16.6±6.31), and (18.0±5.33) dB, respectively. CMT was (437.5±90.4), (306.9±87.4), and (288.7±87.3) μm, respectively. Compared with data before surgery, BCVA: the difference was not statistically significant at 1 month (t=2.025, P=0.074), but was statistically significant at 3 months (t=5.161, P=0.001), MS: the differences at 1 and 3 months were not statistically significant (t=－0.078, －1.022, P=0.940, 0.334), CMT: the differences were of statistical significance at both 1 and 3 months (t=2.892, 3.175, P=0.018, 0.011), and the difference between 1 and 3 months post-surgery was also statistically significant (t=2.427, P=0.038). No complications such as macular hole, vitreous hemorrhage, or retinal detachment occurred during or after surgery in any eyes. No cases of increased intraocular pressure or cataracts were reported during the follow-up period. ConclusionPPV combined with ILM peeling and subretinal injection of dexamethasone can effectively reduce CMT in refractory DME eyes and improve visual acuity, with good safety.
Diabetic retinopathy (DR) has become an important cause of irreversible vision loss worldwide. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is an important method to the treatment of DR. However, the current anti-VEGF treatment regimen is not uniform. Anti-VEGF injection was preferred and then delayed combined with laser had better prognostic effect. The best time for operation was 5-7 days after injection of anti-VEGF drugs. Pars plana vitrectomy, intraoperative and postoperative on-demand anti-VEGF drugs injection can significantly improve patient prognosis and reduce complications, but further research is needed to strike a balance between the economic burden and the number of injections. Various anti-VEGF drugs have their own advantages for different diseases and should be selected according to the characteristics of the diseases and drugs. Anti-VEGF drugs combined with antioxidants may further improve DR outcomes. Future studies should pay more attention to the optimization and personalization of anti-VEGF drugs application programs to meet the therapeutic needs of different patients.
ObjectiveTo compare the efficacy of pars plana vitrectomy (PPV) combined with subretinal or intravitreal injection of Conbercept for the treatment of refractory diabetic macular edema (DME). MethodsA retrospective case control study. From June 2022 to March 2024, 32 eyes of 32 patients with refractory DME diagnosed at The Affiliated Eye Hospital of Nanchang University were included in the study. There were 17 male cases with 17 eyes and 15 female cases with 15 eyes. Age was (57.44±8.99) years old; The duration of diabetes was (12.72±6.11) years. All patients had received regular treatment with anti-vascular endothelial growth factor (VEGF) drugs or corticosteroid drugs for at least 5 times, and had undergone focal retinal laser photocoagulation or panretinal laser photocoagulation, the central macular thickness (CMT) persisted or decreased by less than 50 μm. All affected eyes underwent best-corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT), microperimetry, and laboratory glycated hemoglobin (HbA1c) testing. BCVA was measured using a standard logarithmic visual acuity chart, and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. CMT was measured using an OCT device. Microperimetry was performed using an MP-3 microperimeter, recording the mean sensitivity (MS) of the retina within a 12° range of the fovea. The affected eyes were treated with 23G PPV combined with internal limiting membrane peeling and either macular subretinal or intravitreal injection of Conbercept, and were divided into subretinal injection group and the intravitreal injection group, each consisting of 16 cases and 16 eyes. The same equipment and methods as before surgery were used for related examinations at 1, 3, and 6 months post-surgery. Changes in BCVA, CMT, and MS were observed and compared, as well as the number of additional anti-VEGF treatments required within 6 months after surgery. Intergroup comparisons were made using independent samples t tests, and repeated measures data were analyzed using repeated measures analysis of variance. ResultsThe age (t=－0.271), gender composition (χ2=0.001), duration of diabetes (Z=－0.868), HbA1c (t=－0.789), intraocular pressure (t=1.689), logMAR BCVA (t=1.393), CMT (t=－0.613), MS (Z=－0.132), and the number of anti-VEGF injections (t=－0.752) between the subretinal injection group and the intravitreal injection group showed no statistically significant differences (P＞0.05). The within-subject effects comparison of BCVA, CMT, and MS at 1, 3, and 6 months post-surgery compared to pre-surgery for all affected eyes showed statistically significant differences (F=8.060, 125.722, 39.054; P＜0.05). The overall comparison of logMAR BCVA between the subretinal and intravitreal injection groups post-surgery showed no statistically significant difference (F=0.662, P=0.422), however, comparisons of CMT (F=4.540) and MS (F=6.066) showed statistically significant differences (P＜0.05). At 1, 3, and 6 months post-surgery, comparisons of logMAR BCVA between the two groups showed no statistically significant differences (t=－0.123, 0.239, 1.087; P＞0.05), comparisons of CMT showed statistically significant differences (t=－3.474, －4.832, －2.482; P＜0.05), comparisons of MS showed statistically significant differences at 1 and 3 months (t=－2.940, －2.545; P＜0.05), but not at 6 months (t=－1.527, P＞0.05). At 6 months post-surgery, the number of additional intravitreal anti-VEGF injections required in the subretinal and intravitreal injection groups showed a statistically significant difference (Z=－2.033, P=0.042). During the follow-up period and at the final follow-up, no complications such as injection site bleeding, retinal detachment, vitreous hemorrhage, macular hole, or retinal pigment epithelial tear or atrophy occurred in all affected eyes. ConclusionCompared with intravitreal injection, subretinal injection of Conbercept for the treatment of refractory DME has more advantages in reducing macular edema and improving visual function in the macular area, and also reduces the number of postoperative anti-VEGF drug treatments.
ObjectiveTo observe the effectiveness and safety of pars plana vitrectomy (PPV) combined with inner limiting membrane (ILM) removal and 41G microneedle subretinal injection of balanced salt solution (BSS) in the treatment of refractory macular hole. MethodsA prospective clinical study. From January to June 2023, 20 cases (20 eyes) of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study. The basal diameter of the affected eye's basal diameter (BD) was ＞1 000 μm. Macular hole index (MHI) was ＜0.5. The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS. Best corrected visual acuity (BCVA), microperimetry, and optical coherence tomography angiography (OCTA) were performed before and 1, 2, 3, and 6 months after surgery for the affected eye. BCVA examination was performed using standard logarithmic visual acuity chart, and convert it to logarithmic minimum resolution angle (logMAR) visual acuity for statistical purposes. MP-3 microperimetry was used for micro view examination, record the mean sensitivity (MS) of the retinal within a 12° range of the fovea. OCTA was used to measure the area of the avascular zone of the macula (FAZ), perimeter of the FAZ (PERIM), retinal vascular length density (VLD), and vascular perfusion density (VPD). The changes in BCVA, MS, FAZ area, PERIM, VLD, VPD before and after surgery were compared and analyzed. After the same time, the closure of macular hole and the occurrence of complications after surgery were observed. Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery. The correlation between various observation indicators and preoperative minimum diameter (MD), BD, and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis. ResultsAmong the 20 cases with 20 eyes, there were 2 males with 2 eyes and 18 females with 18 eyes. Age was (61.45±8.56) years old. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD of the affected eye were 1.46±0.21, (16.20±5.81) dB、(0.40±0.17) mm2, (2.89±0.99) mm, (6.23±3.59) mm−1, (0.17±0.10)%, respectively. Six months after surgery, out of 20 eyes, macular hole closure and incomplete closure were 18 (90.0%, 18 /20) and 2 (10.0%, 2 /20) eyes, respectively. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD were 0.80±0.20, (22.20±4.60) dB, (0.18±0.10) mm2, (1.83±0.80) mm, (9.54±2.88) mm−1, (0.31±0.14)%. Compared with before surgery, the differences were statistically significant (P＜0.05). The correlation analysis results showed a positive correlation (P＜0.05) between preoperative BD and postoperative 6-month PERIM and VPD. There was a negative correlation between preoperative MD and postoperative VLD at 6 months (P＜0.05). There was a negative correlation between preoperative MHI and logMAR BCVA and VPD at 6 months after surgery (P＜0.05). No complications such as elevated or decreased intraocular pressure, damage to retinal pigment epithelium, retinal hemorrhage, endophthalmitis, or retinal detachment occurred after surgery in all affected eyes. ConclusionMinimally invasive PPV combined with ILM removal and 41G microneedle subretinal injection of BSS can effectively improve the closure rate of refractory macular hole patients in the short term, improve vision, and have good safety.
Proliferative diabetic retinopathy (PDR) is more advanced stage in diabetic retinopathy (DR), often with vitreous hemorrhages and traction retinal detachment which seriously affects patients' vision and even leads to severe visual impairment. Pars plana vitrectomy is an effective treatment for PDR. However, the operation procedure is quite complexed. Inadequate management can negatively impact postoperative vision or even lead to complications. Therefore, it is very important to clarify the surgical indications and standardize the operating procedures of PDR. To this end, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, Expert Group of Expert consensus for pars plana vitrectomy treatment of type 2 diabetic retinopathy focus on 9 key clinical issues, based on the latest evidence-based medical evidence, combined with international guidelines and China's social and economic development. Recommendations were made on the selection of DR Surgery timing, perioperative blood glucose management, surgical mode selection, formulation of surgical operation plan, drug combination or laser therapy, etc., which formed China's expert consensus on pars plana vitrectomy in the treatment of type 2 DR. This consensus is applicable to Chinese doctors specializing in fundus diseases and doctors engaged in fundus diseases, aiming to provide scientific guidance for vitreous surgery treatment of PDR patients, assist clinical decision-making, and further improve the level of surgical treatment of DR in China.
Hereditary thyroxine protein amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, characterized by autosomal dominant inheritance, incomplete penetrance, and diverse manifestations. ATTRv deposition leads to visual impairment and even irreversible visual loss, which has a negative impact on the quality of life of patients. The diagnostic rate of pathological examination and genetic testing in ATTRv patients is low, and the detection rate of systemic amyloid lesions is low. We need to increase our awareness of this disease and gain a deeper understanding of its systemic manifestations and corresponding examination methods; genetic testing is conducted on the proband's family to investigate the relationship between different gene mutations and eye manifestations. In the future, multidisciplinary consultations can be conducted to jointly diagnose and treat patients with ATTRv eye involvement, conducting large-scale and long-term follow-up studies on the early clinical characteristics, treatment plans, efficacy, possible complications, and early prevention, in order to improve clinical diagnosis rate, reduce misdiagnosis rate, and improve patient prognosis.
Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole-retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation. ResultsAt 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant (P＜0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance (P＜0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant (P＜0.05). There was no significant difference one week after eye operation in control group (P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant (P＜0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group (P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant (P=0.020). ConclusionPPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.