Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years, including the scleral buckling, simple intravitreal gas injection, pars plana vitrectomy (PPV), PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on. Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment. PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment. But for large holes with wide retinal detachment, PPV combined with ILM transplantation is necessary to improve the macular holes closure rate. If the ILM has been peeled before, the lens capsule could be a nice substitute for ILM. The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length. However, there is still no one surgery could deal with all the problems of high myopia, we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy.
Surgical treatments for macular hole and rhegmatogenous retinal detachment are the most common and principle procedures for vitreoretinal specialists. The surgical success rate reached 95.0% and above for vitrectomy, macular surgeries with ILM peeling, or local/total scleral buckling. However, the postoperative visual function recovery is nowhere near good enough. Specialists must pay more attention to the visual function recovery of those patients. Postoperative macular anatomical and functional rehabilitation for macular hole and scleral buckling procedures need a long period of time. At present, the postoperative visual acuity for macular hole depends on many factors, such as macular hole closure conditions, surgical procedures, microsurgical invasive ways, skills of membrane peeling, usage of dye staining, and tamponade material choice. It also depends on residual subretinal fluid under macular area for patients received scleral buckling. It is important for us to investigate these factors affecting recovery of macular anatomy and function, and thus develop some drugs to improve the macular function recovery.
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.
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 evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. MethodsA prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. ResultsCompared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. ConclusionsPosterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.
Purpose To evaluate the surgical effect of idiopathic macular hole (IMH)，with optical coherence tomography (OCT)． Methods To measure the diameter of holes and hole halos，the thickness of hole in edge，the changes of hole pattern in 19 cases (19 eyes) with IMH using OCT． Results By quantitatively measuring，OCT showed that after surgery the mean hole diameter lessened from （570．95plusmn;264．59 ）mu;m to （337．05plusmn;335．95）mu;m．The mean diameter of hole halo lessened from （1043．53plusmn;278．80）mu;m to （695．00plusmn;483．00）mu;m and the mean thickness of the hole edge thinned from （389．78plusmn;60．58）mu;m to （298．78plusmn;109．80）mu;m．In 17 eyes the holes become closed or reduced in size or the hole halo，and thinned in hole edge．The anatomic successful rate of the surgery is 89%． Conclusion OCT can objectively，accurately and effectively judge the anatomic effect of IMH surgery． (Chin J Ocul Fundus Dis，2000，16：71-138)
ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave（Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.
Objective To evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV).Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007, were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed.Results The closure rate of IMH (100.0%) was significant higher than that of TMH (85.5%) (P=0.001). The postoperative VA of IMH and TMH were (0.25plusmn;0.02) and (0.21plusmn;0.21) respectively,both significantly increased compare to their preoperative VA (t=-6.841,-4.093; P=0.000). VAincreased IMH and TMH eyes had same VA （chi;2=3.651，P=0.07）. PrePPV VAge;0.1 IMH eyes had better outcomes than PrePPV VA＜0.1 IMH eyes （chi;2=12.04, P=0.001）, while PrePPV VA had no effects on TMH outcomes （chi;2=0.371，P=0.486）. IMH eyes with small holes had better outcomes （t=2.476，P=0.016）, and TMH eyes with small holes had better closure （t=-4.042, P＜0.001）. The duration of disease had no significant influence on TMH visual （chi;2=0.704, P=0.401） and anatomic （chi;2=0.166, P=0.684） outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.