Objective To observe the efficacy and safety of micro-invasive vitrectomy for retinal detachment associated with choroidal detachment. Methods A total of 35 patients (36 eyes) with retinal detachment associated with choroidal detachment were enrolled in this study. The patients included 22 males and 13 females, with a mean age of (51.32 plusmn;17.34) years. Visual acuity was light perception in six eyes, hand movement in 12 eyes, finger counting in nine eyes, 0.01-0.1 in eight eyes, and 0.2 - 0.3 in one eye. The median LogMAR visual acuity was (2.13plusmn;0.50). The median intraocular pressure was (7.08plusmn;2.62) mm Hg (1 mm Hg=0.133 kPa). All the patients were received vitrectomy using 23-gauge instrumentation combined with 25-gauge infusion. Tamponade with silicone oil (35 eyes) or C3F8 gas (one eye) were performed. The median follow-up time was (6.23plusmn;3.07) months. The pre- and post-operative visual acuity, intraocular pressure, the rate of retinal reattachment, the rate of recurrent retinal detachment and complications were comparatively analyzed.Results Retinal reattachment was attained in 36 eyes (100%) at the first day after vitrectomy. Retinal reattachment was attained in 33 eyes (91.7%) and recurrent retinal local detachment was attained in three eyes (8.3%) at one months after vitrectomy. The rate of retinal reattachment was 83.3% (30 eyes) at three months after vitrectomy. One day, one and three months after treatment, the mean LogMAR visual acuity were 1.77plusmn;0.66, 1.53plusmn;0.72, 1.31plusmn;0.77 respectively. The differences of the visual acuity was statistically significant between before and after vitrectomy (F=62.61,P＜0.05). One day, one and three months after treatment, the mean intraocular pressure were (12.47plusmn;7.28), (15.51plusmn;6.86), (15.82plusmn;7.60) mm Hg respectively. The differences of the intraocular pressure was statistically significant between before and after vitrectomy (F=6.88,P＜0.05).Secondary glaucoma occurred in one eye at three months after vitrectomy. Except this, there was no other complication related to treatment. Conclusion Micro-invasive vitrectomy is a feasible and safe treatment for retinal detachment with choroidal detachment.
bjective To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.Methods A total of 534 eyes of 304 patients with DR diagnosed by fundus fluorescein angiography (FFA) were enrolled in this study. In the 534 eyes, 92 with nonproliferative DR (NPDR) had the bestcorrected visual acuity(BCVA) of 0.52plusmn;0.32,108 with preproliferative DR (PPDR) had the BCVA of 0.49plusmn;0.23,196 with early PDR had the BCVA of 0.20plusmn;0.31,and 138 with highrisk PDR had the BCVA of 0.17plusmn;0.22． According to the rules of ETDRS, retinal photocoagu1ation,pan retinal photocoagu1ation or extrapanretinal photocoagu1ation were performed on the paitents with NPDR,PPDR,and highrisk PDR,respectivelyThe patients were followed up for 10-18 months after the operations and the results of the examinations at the last time were regarded as the criteria for judgement. The examination of BCVA and ocular fundus and FFA were performed with the time interval of 3 months．The judgement for BCVA was(1)improved:improved ge;2 lines;(2) kept still: changed within 2 lines;(3)decreased:decreased ge;2 lines.And the effect on BCVA was positve when it was improved or kept still.The judgement for the therapeutic effect on DR was:retinal edeama was alleviated,leakage of hemorrhage was obsorbed,microaneurysm disappeared or decreased, neovascularization (NV) was relieved completely or partly,nonperfusion area disappeared or narrowed, and no new NV or nonperfusion area came into being. Results After the operations, BCVA in NPDR,PPDR and early PDR groups was improved or kept still in 73(79.3%),83(76.9%)，and 146 eyes (74.5%), respectively,without any statistical difference among these three groups（P＞0.05）.BCVA in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P＜0.05). The positive rate of therapeutic effect on DR was 89.1%,85.2%,82.7% in NPDR,PPDR,and early PDR groups, respectively without any statistical difference among the groups(P＞0.05). The positive rate of therapeutic effect on DR in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups(P＜0.05). Conclusion The prognosis of DR at different stages after laser photocoagulation is different;timely and effective laser photocoagulation is important to prevent the development of the disease and decrease the blindness rate.
Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.
ObjectiveTo evaluate the efficacy of 30% and 50% dose photodynamic therapy (PDT) for acute central serous chorioretinopathy (CSC). MethodsA retrospective cohort study. Ninety-two eyes of 88 patients with CSC, diagnosed by best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR), indirect ophthalmoscope, fundus colorized photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA)and optical coherence tomography (SD-OCT) treated with 30% and 50% doses of verteporfin respectively between March 2007 and August 2013, were enrolled. The eyes were divided into 50% dose group (49 eyes) and 30% dose group (43 eyes). The differences of age (t=-1.45), gender (χ2=0.011), eyes (χ2=2.140), mean logMAR BCVA (t=-0.40), mean central retinal thickness (CRT) and the maximum thickness of serous retinal detachment (SRD) between two groups were not significant (P > 0.05). The difference of spot size between two groups was significant (t=-2.84, P < 0.05). The follow-up time was ranged from 6 to 68 months, with a mean of (17.16 ±11.30) months. The difference of follow-up between two groups was significant (P > 0.05). The BCVA, cure rate, recurrence rate and the changes of CRT and maximum SRT were observed by SD-OCT. ResultsThe subretinal fluid (SRF) of 31 eyes (72.09%) in the 30% dose group and that of 47 eyes (95.92%) in the 50% dose PDT group was absorbed completely respectively. The cure rates in the 30% dose PDT group was significantly less than that in the 50% dose group (χ2=10.077, P=0.020). There was a significant negative association between the cure rate and spot size by Logistic regression (odds ratio > 1, P=0.040). The difference of changes in the BCVA of logMAR in 50% dose group was better than that in 30% dose group after more than 12 months after PDT (P=0.036). On 3, 6, 12 and more than 12 months after PDT, the difference in CRT in 50% dose group and 30% dose group were not statistically significant (P=0.068, 0.060, 0.082, 0.067). The difference in maximum thickness of SRD was not statically significant (P > 0.05). SRF was appeared in 8 eyes (25.81%) of 31 eyes in the 30% dose group, while SRF was appeared in 1 eye (2.13%) of 47 eyes in the 50% dose group. The recurrence rate of 30% dose group was much higher than that of 50% dose group (P < 0.05). ConclusionsFor acute CSC treated by PDT, the curative effect of 50% dose group is better than the 30% dose group.
Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.
Objective To investigate the relationship of choroidal thickness and visual acuity after successful repair of rhegmatogenous retinal detachment (RRD) in eyes without high myopia. Methods Fifty-three eyes of 53 patients with RRD and without highly myopic eyes after anatomically successful surgical repair were enrolled in this study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. Spectral domain-optical coherence tomography (OCT) was used to assess the postoperative foveal structure, central foveal thicknesses (CFT) and choroidal thickness. The correlation between the postoperative BCVA and abnormality of the fovea, CFT and choroidal thickness was evaluated. According to the postoperative thickness of the choroid, the patients were divided into le;150.00 mu;m group and ＞150.00 mu;m group; the improvement of postoperative BCVA in the two groups was analyzed. The state of inside and outside section (IS/OS) and the external limiting membrane (ELM) was divided into reconstructed and un-reconstructed categories. The postoperative BCVA, CFT and choroidal thickness of two types were comparatively analyzed. Results At the last time of follow up, the mean BCVA was 0.52plusmn;0.47. The results of spectral domain OCT showed that the mean CFT was (207.45plusmn;63.63) and mean choroidal thickness was (175.46plusmn;62.68) mu;m. The postoperative BCVA correlated positively with IS/OS junction and choroidal thickness (r=4.92, 4.63; P＜0.05), but was insignificantly associated with ELM junction, whether subretinal fluids were present or not, whether epiretinal membrane was affected or not, whether there was macular edema or not and CFT (r=0.24, 1.20, 0.30, 0.03, 0.14; P＞0.05). Two weeks to three months after surgery, the improvement of BCVA in ＞150.00 mu;m group was significantly higher than that in le;150.00 mu;m group (t=-2.318, P＜0.05). Compared the reconstructed with un-reconstructed IS/OS eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.253, 2.396; P＜0.05). The difference of mean CFT was not statistically significant (t=1.454，P＞0.05). Compared the reconstructed with un-reconstructed ELM eyes, the differences of mean BCVA and mean choroidal thickness were statistically significantly different (t=-5.940, 3.563;P＜0.05). The difference of mean CFT was not statistically significant (t=1.117, P＞0.05). Conclusion The choroidal thickness has a significant correlation with visual acuity after successful repair of RRD in eyes without high myopia.
Objective To analyze the efficacy and safety of Intra-arterial chemotherapy (IAC) as secondly treatment in children with retinoblastoma (RB). Methods 42 eyes of 34 consecutive RB patients were enrolled in the study after intravenous chemotherapy (IVC), including 26 males and 8 females. The average age is 14.1 months. 21 cases were bilateral and 7 cases were unilateral. A total of 42 eyes of 34 patients were classified according to the International Intraocular Retinoblastoma Classification（IIRC）as group B(n=1, 2.4%), group C (n=3, 7.1%), group D (n=32, 76.2%), or group E (n=6, 14.3%). Tumor recurrence and tumor enlargement after IVC were 4 and 10 eyes respectively, accounting for 9.0% and 24.0% respectively. Sequential treatment after IVC followed by IAC were 28 eyes, accounting for 67.0%. All treatment eyes received IAC combined with laser, cryotherapy and other eye local treatment. The IAC regimen adopted the combination and alternation administration mode, by the combination of melphalan and carboplatin or the combination of melphalan and topotecan. According to the tumor changes after IAC decide whether IAC again. If tumors increased, vitreous or subretinal implants increased will be termination of IAC and enucleation. The mean follow-up time was (21.4±3.7) months after the last IAC treatment and (6.2±2.9) months after enucleation. Ocular preservation rate and complication were evaluated. Results The average IAC procedures performed on 42 eyes were (4.0±0.9). An overall ocular preservation rate of 76.2% was observed during follow-up periods due to calcification or inactivation of tumors (32 eyes), including group B (n=1, 100%), group C (n=1, 33.3%), group D (n=27, 84.4%), group E (n=3, 50%). 10 eyes were enucleated. Among them, 2 eyes of the tumor did not shrink after IAC, tumor recurrence (n=3), vitreous hemorrhage (n=3), enophthalmos (n=1), vitreous disseminated (n=1). 34 cases of children, transient eyelid oedema were 18 cases, vitreous hemorrhage and bone marrow suppression (Ⅰ-Ⅳ) were 1, 22 casese respectively. Conclusions IAC as secondly treatment is safe and effective for RB patients, however, there is still tumor recurrence. No serious ocular local and systemic complications were observed.