玻璃体切除联合内界膜剥离预防复杂性视网膜脱离术后黄斑前膜形成

目的 观察一组复杂性视网膜脱离患者在玻璃体切除手术时联合黄斑部内界膜剥离而预防术后黄斑前膜形成的临床疗效.方法 取2006年1月至2008年10月42例(42只眼)复杂性视网膜脱离(complicated retinal detachment,CRD)患者接受玻璃体切除术治疗,将其分为两组:玻璃体切除联合内界膜剥离组20例20只眼(Ⅰ组),玻璃体切除未行内界膜剥离组22例22只眼(Ⅱ组),术后随防12～26个月,平均随访时间(18±8)个月.结果 Ⅰ组在硅油取出后随访未发现黄斑前膜形成;Ⅱ组在硅油取出后有6眼经OCT和(或)FFA检查证实有黄斑前膜形成,其中2只眼在硅油未取出前经OCT和(或)FFA检查发现就有黄斑前膜形成.结论 复杂性视网膜脱离患者玻璃体切除手术时联合黄斑部内界膜剥离可以预防术后黄斑前膜的形成.

Abstract：

Objective To investigate the clinical effect of internal limiting membrane (ILM) peeling at the macular for the prevention of epimacular membrane formation following vitreous surgery for the treatment of complicated retinal detachment. Methods From February 2006 to October 2008, 42 patients with complicated retinal detachment were underwent successful vitrectomy. According to ILM peeling or not during vitrectomy, all patients were divided into two groups: the group Ⅰ (peeling ILM) 20 eyes, the group Ⅱ (not-peeling ILM) 22 eyes, followed up for 12-26 months, mean at 18± 8 months. All of those were examined for visual acuity, fundus photography, ophthalmologic A/B ultrasonic imaging, OCT preoperatively and postoperatively,the parts of those were examined for FFA postoperatively. The epimacular membrane formation was decided by the last chance at one year to two years after removal of silicone. The epimacular membrane formation of two groups was analyzed statistically. Results No epimacular membrane formation was seen in group Ⅰ . The epimacular membrane formation of two eyes was verified by OCT or/and FFA before removal of silicone, and the epimacular membrane formation of four eyes was verified by OCT or/and FFA after removal of silicone.The comparison of epimacular membrane formation between group Ⅰ and group Ⅱ was statistically significant.Conclusion ILM peeling at the macular during vitreous surgery for the treatment of complicated retinal detachment may effectively prevent epimacular membrane formation.     

内界膜剥除术在复杂视网膜脱离手术中的应用

目的 观察玻璃体手术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变的效果.方法 回顾性分析视网膜脱离合并严重增生性玻璃体视网膜病变行玻璃体视网膜手术40例（40只眼）的临床资料.以术中是否联合内界膜剥除分为两组：剥膜组19例,未剥膜者为对照组21例.术毕均填充硅油.于玻璃体手术后3个月及硅油取出术后3个月应用OCT观察两组黄斑区视网膜水肿及视网膜前膜情况,并记录最终随访视力.结果 随访6 ～ 12个月.玻璃体切除术后3个月,OCT见黄斑视网膜前膜形成者剥膜组0眼,对照组6眼（28.57％）（Fisher确切概率法,P=0.021）;出现黄斑水肿者,剥膜组1眼（5.26％）,对照组5眼（23.81％） （x2=1.433,P =0.231）.硅油填充下视网膜复位率剥膜组为89.47％,对照组为90.48％ （x2 =0.011,P=0.916）.硅油取出术后3个月,两组病例均未再发生新的视网膜前膜;出现黄斑水肿者,剥膜组为5.3％,对照组为14.30％（x2=0.178,P=0.673）.最终随访视网膜均复位.两组患者术后视力均较术前视力明显提高,且两组间差异无统计学意义.结论 在玻璃体切除术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变,可以降低术后黄斑前膜的发生率,对术后视力、黄斑水肿情况及视网膜复位成功率无明显影响.     

玻璃体切割联合内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离

目的：比较玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离(MHRD)的疗效。

方法：回顾性临床研究。选取2020-01/2021-06于我院行玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗的高度近视MHRD患者38例38眼,根据手术方式分为对照组(行玻璃体切割联合内界膜剥除术)和观察组(行玻璃体切割联合内界膜覆盖术)。随访至术后3mo,比较两组患者手术时间、最佳矫正视力(BCVA)、黄斑裂孔闭合和视网膜复位情况。

结果：两组患者手术时间无差异(30.71±4.55min vs 35.20±5.44min,P=0.384)。末次随访时,两组患者BCVA均较术前明显改善(均P<0.01),但两组患者BCVA(LogMAR)无差异(1.39±0.24 vs 1.46±0.27,P=0.700); 观察组患者黄斑裂孔闭合率高于对照组(100% vs 71%,P=0.024),但两组患者视网膜再脱离率比较无差异(0 vs 10%,P=0.492)。

结论：两种手术方式均可改善患者视力,但玻璃体切割联合内界膜覆盖术后黄斑裂孔闭合率更高。     

Comparison of visual outcomes after epiretinal membrane surgery

PurposeTo elucidate the anatomical and visual outcomes of patients with idiopathic epiretinal membranes (ERM) who underwent vitrectomy, membrane removal only, or with internal limiting membrane (ILM) peeling under the assistance of different dyes.MethodsA retrospective chart review of patients with idiopathic ERM who received surgical treatment between January 2004 and December 2009. The patients were grouped according to the usage of staining materials assisting ILM peeling. Group 1 consisted of 61 eyes that underwent conventional vitrectomy and ERM peeling without staining-assisted ILM peeling. Group 2 consisted of 20 eyes with triamcinolone acetonide-assisted ILM peeling following conventional vitrectomy. Group 3 consisted of 23 eyes with indocyanine green-assisted ILM peeling following conventional vitrectomy.ResultsThis study included 104 eyes from 104 patients. There was no significant difference in age, sex, preoperative visual acuity, retinal thickness or follow-up duration among the three groups. Overall, the mean best-corrected visual acuity improved significantly from baseline 0.15 to postoperative 0.41 (p < 0.0001). Among the three groups, the mean logarithm minimum angle of resolution acuity markedly improved. There was no significant difference in postoperative visual acuity among groups. As measured by ocular coherent tomography, the mean central foveal thickness decreased from 465.21 ± 86.18 to 299.16 ± 70.14 μm. Although there was no difference between groups, postoperative retinal thickness was thicker than that observed in the normal population. The incidence of recurrent ERM was 13.1% in Group 1 and 0% in Groups 2 and 3; this incidence was significantly higher than in the conventional surgery group. Visual outcome was statistically more deteriorated in recurrent cases than in non-recurrent cases (p = 0.011).ConclusionsERM surgeries with or without dye-assisted ILM peeling showed similar results. Moreover, the incidence of recurrence is lower in the ILM peeling groups and plays a primary role in determining the final postoperative vision outcome.     

无染色剂辅助的玻璃体联合手术治疗高度近视黄斑裂孔视网膜脱离的临床观察

目的 观察无染色剂辅助下玻璃体切除联合内界膜剥除（ILMP）及硅油填充治疗高度近视黄斑裂孔视网膜脱离的疗效.方法 对2011年7月至2013年7月在我院就诊的一组高度近视黄斑裂孔视网膜脱离病变患者行玻璃体切除联合ILMP及硅油填充术的14例（14只眼）患者的临床资料进行回顾性分析.手术后随访1~6个月,观察手术后视力、视网膜复位情况及裂孔闭合形式.结果 黄斑裂孔闭合、视网膜复位14只眼（100%）（其中1只眼为单纯注入C3F8复发后再次手术的）.术后视力提高11只眼（78.6%）,无变化3只眼.结论 玻璃体切除联合ILMP及硅油填充是治疗高度近视黄斑裂孔视网膜脱离的有效手术方式.术中不使用染色剂辅助,减少了视网膜毒性反应.     

黄斑区内界膜剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效

目的：观察黄斑区内界膜(ILM)剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效。
　　方法：选取来自厦门眼科中心2008-01/2013-10期间的29例29眼视网膜复位良好、但黄斑区视网膜下全氟萘烷残留的患者,分为A组、B组。 A组14例14眼,取出硅油后,直接以38 G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。 B组15例15眼,取出硅油后,染色并完整剥除黄斑区ILM,范围约4PD,以38G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。所有病例如在术后1 wk复查OCT发现黄斑裂孔形成者,均再行气液交换,填充16% C3 F8气体。观察两组病例术后4,8,24 wk最佳矫正视力( BCVA )变化,复查OCT观察黄斑区视网膜下全氟萘烷液体有无残留、有无黄斑裂孔形成及黄斑区形态变化等。
　　结果：两组术后 4, 8, 24 wk 的 BCVA 均有提高, B 组的BCVA提高值优于A组( P<0.05)。 A 组术后24 wk 有7例(50%)黄斑裂孔形成,黄斑区无全氟萘烷残留。 B组术后24 wk 1例(7%)黄斑裂孔形成,黄斑区无全氟萘烷残留。
　　结论：黄斑区内界膜剥除联合38 G套管针应用治疗黄斑区视网膜下全氟萘烷残留的方法可以彻底吸除黄斑区视网膜下全氟萘烷,较少出现黄斑裂孔,该方法安全、有效、微创,有效保护了黄斑区视功能。     

ILMP及玻璃体腔注药联合硅油填充治疗高度近视MHRD合并脉络膜脱离

目的:观察内界膜剥除(internal limiting membrane peeling,ILMP)和玻璃体腔注射曲安奈德联合硅油填充治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的临床疗效.方法:高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离患者28例28眼,均行玻璃体切割(pars plana vitrectomy,PPV)吲哚菁绿辅助的ILMP以及硅油填充手术,术中将曲安奈德注射于玻璃体腔,术后随访6~24mo,观察术后视网膜复位率、视力恢复情况和术后并发症.结果:术后随访6~24mo,患者手术后平均LogMAR矫正视力为1.01± 0.31,与手术前平均LogMAR矫正视力比较,差异有统计学意义(t=-39.28,P<0.01).黄斑裂孔闭合19眼(68%),黄斑裂孔未闭合9眼(32%),26眼视网膜复位(93%),6眼出现高眼压.结论:玻璃体切割联合ILMP及硅油填充和玻璃体腔注射曲安奈德治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离,可阻止增生性玻璃体视网膜病变的再生,提高视网膜复位率.     

Comparative evaluation of vitrectomy and dye-enhanced ILM peel with grid laser in diffuse diabetic macular edema

Background The purpose of this study is to compare the effectiveness of pars plana vitrectomy (PPV) and dye-enhanced peeling of the internal limiting membrane (ILM) with modified grid laser photocoagulation in patients with diffuse diabetic macular edema and to determine if any correlation exists between improvement in visual acuity (functional improvement) and reduction in foveal thickness and macular volume (anatomical improvement). Design This is a randomized, prospective, comparative, interventional study. Method In this study 24 eyes of 24 patients with metabolically stable diabetes and with diffuse diabetic macular edema were evaluated. The patients were randomized to either pars plana vitrectomy with removal of ILM which was done in 12 eyes (ILM group) and modified grid laser photocoagulation carried out in the remaining 12 eyes (laser group). Main outcome measures were (1) the postoperative visual acuity in the form of ETDRS log MAR values, (2) foveal thickness and (3) macular volume as measured by optical coherence tomography. The correlation between improvement in visual acuity and the reduction of foveal thickness and macular volume in both the groups were also evaluated. The results were all subjected to statistical analysis. Results The ETDRS log MAR visual acuity difference between the two groups at the end of 6 months was not clinically significant (P = 0.525). However, foveal thickness and macular volume decreased significantly more in the ILM group compared to the laser group (P = 0.001, P < 0.001, Mann Whitney U test). There was no correlation between the improvement in visual acuity and the reduction of foveal thickness (r = −0.158, P = 0.6) (ILM group), r = −0.155, P = 0.7) (laser group) in both groups. Conclusions PPV with ILM peeling was shown to be beneficial by inducing a statistically significant reduction of macular thickness and macular volume. Visual acuity also demonstrated a trend towards improvement in both the ILM peel group and the grid laser group; however, the comparative VA outcome analysis between the two groups was not significantly different. Besides, there was also no correlation between the reductions of foveal thickness and macular volume with the improvement in visual acuity in either of the groups.     

Técnica modificada del flap invertido superior con vitrectomía versus vitrectomía con pelado de membrana limitante interna para el desprendimiento de retina con agujero macular miópico

PurposeTo evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling.MethodsRetrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups.ResultsThere were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (P = .9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P = .62).ConclusionsILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.     

硅油填充眼黄斑前膜剥除术的短期观察

目的:探讨硅油填充眼继发性黄斑前膜的短期手术疗效,评价视网膜内界膜剥除术对疗效的影响。方法:病例对照研究。回顾性分析玻璃体视网膜手术的硅油填充眼继发性黄斑前膜病例65例65眼的临床病例资料,其中单纯剥膜组34例34眼,联合内界膜剥除组31例31眼,随访>3mo。比较各组治疗前和术后3mo的最佳矫正视力,黄斑中央厚度,多焦视网膜电图振幅密度,并作组间比较。结果:单纯剥膜组最佳矫正视力术前4.1±0.3,术后4.5±0.5,黄斑中央厚度术前424±54μm,术后355±43μm,多焦视网膜电图第一环P1振幅密度术前23±7.3nV/deg2,术后26±8.5nV/deg2。联合内界膜剥除组最佳矫正视力术前4.2±0.1,术后4.5±0.4,黄斑中央厚度术前436±68μm,术后348±53μm,多焦视网膜电图第一环P1振幅密度术前24±7.8nV/deg2,术后27±9.7nV/deg2。各组治疗前后差异有统计学意义(P<0.05),组间比较差异均无统计学意义。结论:前膜剥除术治疗硅油填充眼继发性黄斑前膜疗效确切,联合视网膜内界膜剥除对短期预后影响不明显。     

High-density silicone oil (Densiron) as a primary intraocular tamponade: 12-month follow up

Background The high-density silicone oil (Densiron 68), a mixture of F₆H₈ with silicone oil, seems to be a therapeutic option, at least in selected patients with complex inferior retinal re-detachment, where standard procedures have already failed. In an interventional case series we used Densiron as a primary endotamponade. Methods Twelve eyes of 12 patients aged 31 years to 85 years with inferior complex rhegmatogenous retinal detachment with secondary proliferative vitreoretinopathy (PVR) grades CP2 to CA8 were included. Surgical techniques (pars plana vitrectomy, membrane peeling, retinotomy, retinectomy, endophotocoagulation, cryocoagulation, endotamponade) did not include a scleral buckling procedure (except one eye). Mean duration of the Densiron endotamponade was 78.3  ±  29.74 days, with a mean follow up after removal of 400.6 ± 85.4 days. Results After Densiron removal, four patients (33.3%) showed a stable reattached retina without further interventions, while, in six patients (50%), recurrent retinal re-detachment appeared during endotamponade, generally within 2 months. One patient (8.3%) developed re-detachment 5 months after Densiron removal. One eye (8.3%) lost light perception due to severe intraretinal fibrosis with chronic hypotonia, despite complete retinal re-attachment. Visual acuity improved from mean logarithm of the minimum angle of resolution (logMAR) of 2.95 ± 1.21 to 1.87 ± 1.32 (statistically significant, P = 0.022). Side effects included temporary inflammatory reaction/fibrin accumulation (n = 2/2), moderate-to-severe intraretinal fibrosis (n = 3), elevated intraocular pressure (IOP) (n = 3), emulsification (n = 2), sterile hypopyon (n = 1), vitreous haemorrhage (n = 1) and chronic hypotony (n = 1). Conclusion Primary anatomical success rate of 33.3% was less encouraging than as expected. Especially, re-detachments within the posterior staphyloma in highly myopic patients were common during Densiron endotamponade. However, the surgical success increased to 75% after re-intervention, even without the use of an additional encircling band. The observed adverse effects and the functional outcomes do not contraindicate the use of Densiron as an internal tamponade for a period of 3 months.     

Visual outcome of patients with macular edema after pars plana vitrectomy and indocyanine green-assisted peeling of the internal limiting membrane

Purpose To evaluate the efficacy of inner limiting membrane (ILM) peeling in persistent macular edema.Methods This retrospective review analyzed a series of 23 eyes from 23 patients with persistent macular edema treated by pars plana vitrectomy (PPV) with indocyanine green (ICG)-assisted peeling of the ILM. Thirteen female and 10 male patients with a mean age of 57.2±15.6 (24–77) years underwent operation between May 2000 and October 2001. The main diagnoses were uveitis (anterior, intermediate, posterior and panuveitis) (n=9), central retinal vein occlusion (CRVO) (n=4), diabetic retinopathy (DR) (n=5), vitreoretinal traction syndrome (n=2), and Irvine–Gass syndrome (n=3). Nine eyes had undergone phacoemulsification (PE) previously and two eyes had been subjected to combined PE and ILM peeling. The eyes were tamponaded with gas (3), silicone oil (5) or air (11). In four cases no endotamponade was used. Improvement in visual acuity of 2 lines or more was regarded as significant.Results Visual acuity improved after 3 months in 9 of the 23 patients. After 6 months and at the follow-up, a significant improvement was found in 6/21 and 7/21 patients. This improvement was predominantly seen in patients with uveitis (5/9), or diabetic maculopathy (3/5); One patient with Irvine–Gass syndrome showed a significant reduction, one with vitreoretinal traction an improvement in visual acuity. The group of patients with CRVO showed no significant change during the follow-up. The choice of endotamponade did not alter the visual acuity outcome.Conclusions Different patient groups respond differently to ILM peeling. Although overall significant visual acuity improvement was observed in only one third of all cases 12 months after ILM peeling for persistent macular edema, patients with uveitis and nonproliferative diabetic maculopathy demonstrated a benefit. The lack of long-term improvement in the majority of cases is in accordance with the hypothesis that ILM peeling may reduce the intraretinal edema, but does not affect the underlying mechanism causing macular edema. So far, only diabetics have shown improvement (still unproven) from ILM peeling, and this study provides no justification for extending the treatment to macular edema of other causes. Large-scale investigations are needed to evaluate the efficacy in certain diagnosis groups.This study was presented in part at the 100th meeting of the German Ophthalmological Society in Berlin, September 2002     

Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane

The aim of this study was to analyze macular function by measuring the sensitivity of the macula with fundus-related microperimetry and to compare the results with the best corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT) in patients with idiopathic epimacular membrane. We prospectively reviewed 66 eyes with idiopathic epimacular membrane and 35 normal healthy eyes in patients who had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The mean retinal sensitivities in the central 10° (central microperimetry, cMP-1) and in the paracentral 10–20° (paracentral microperimetry, pMP-1) areas were determined and correlated with the BCVA and OCT-measured foveal thickness. Eyes with epimacular membranes showed significantly lower log MAR BCVA (P < 0.001) and cMP-1 microperimetry sensitivity (P < 0.001) and significantly higher OCT foveal thickness (P < 0.001) than control eyes. There was a significant correlation between the BCVA and mean retinal sensitivity in the cMP-1 (r ² = 0.26, P < 0.001) and the pMP-1 (r ² = 0.07, P = 0.008) areas. A significant negative correlation was observed between the foveal thickness and the mean retinal sensitivity in the cMP-1 (r ² = 0.13, P < 0.001) area. Retinal sensitivity in the central macular area determined by MP-1 microperimetry was significantly correlated with BCVA and with foveal thickness. The combination of OCT and microperimetry may help a better evaluation of the patients with idiopathic epimacular membrane.     

视网膜内界膜剥除在特发性黄斑前膜的应用

目的 描述视网膜内界膜剥离在特发性黄斑前膜眼中的应用效果及其临床特点.方法 回顾2004～2006年因特发性黄斑前膜需行玻璃体视网膜手术患者31例(31只眼),男性3例,女性28例;年龄56～71岁,平均59.6岁.病程3～49个月.术前视力0.02～0.3.术中行前膜剥除后再行视网膜内界膜剥除.追踪观察6～38个月.结果 病程短者的视网膜内界膜能很容易剥除,病程长的内界膜不易剥除.术后矫正视力0.05～0.7,较术前均有不同程度的提高.病程短者术后获解剖和功能的成功,视力提高显著(P<0.05);病程较长者虽获解剖成功但功能上的恢复不显著(P>0.05).尚未发现由视网膜内界膜剥离所致的严重并发症.结论 视网膜内界膜剥离在特发性黄斑前膜中应用不但可以松解黄斑区视网膜皱褶,还可以清除紧密附着在黄斑前视网膜表面的炎性物质,改善黄斑区局部的代谢,有利于黄斑功能的恢复.     

玻璃体手术治疗特发性黄斑前膜临床观察

目的探讨玻璃体切除联合黄斑前膜剥离术治疗特发性黄斑前膜的手术效果及手术时机的选择。方法回顾性分析手术治疗的特发性黄斑前膜58例（59眼）,所有病例均行三切口玻璃体切除及黄斑前膜剥除术,其中20眼同时进行了内界膜撕除术。32眼行气液交换。6眼联合行晶状体超声乳化及人工晶状体植入术。手术后随访1～24月,平均4．7月。对视力、黄斑结构及手术并发症等进行了临床观察。结果随访期末视力提高43眼,占72．88％（其中提高2行以上者29眼占49．15％）;不变15眼,占25．42％;下降1眼,占1．70％。随访期内未见前膜复发。OCT显示所有患眼的前膜均已消除,黄斑水肿不同程度逐渐减轻。并发症：术中少许点状出血6眼;手术后11d发生玻璃体积血1眼;周边小牵引孔3眼（其中视网膜脱离1眼）;术中中心凹处小牵引孔1眼;手术后1a并发性白内障2眼。结论玻璃体切除术联合膜剥离治疗特发性黄斑前膜的手术效果较好,但也可能出现一些较严重的并发症。在手术技巧比较娴熟的情况下,较早手术治疗可能有助于恢复较好视功能。     

Visual Acuity Comparison of Vitrectomy with and without Internal Limiting Membrane Removal in the Treatment of Diabetic Macular Edema

Purpose To evaluate whether internal limiting membrane (ILM) peeling during vitrectomy affects vision outcome in patients with diabetic macular edema. Material and method Fifty-eight eyes of 49 patients were included in the study. Patients with persistent diffuse clinically significant macular edema were divided into two groups according to the surgical method used. Group I subjects (15 patients; mean age 56.60±8.50 years; 17 eyes total) underwent vitrectomy with ILM peeling. Group II subjects (34 patients; mean age 57.52±11.54 years; 41 eyes total) underwent vitrectomy without ILM peeling. The data recorded for each case were type and duration of diabetes, insulin treatment (yes/no), presence of arterial hypertension, stage of diabetic retinopathy, lens status, history of macular laser treatment, and detection of posterior vitreous detachment during surgery. Visual acuity was measured preoperatively and 1 year postoperatively in decimal notation, and values were converted to logarithm of minimal-angle-of-resolution (logMAR) scores. Mean pre- and postoperative visual acuity were compared within each group, and the mean change in visual acuity in Group I was compared to that in Group II. Results There were no significant differences between the groups with respect to age; sex distribution; diabetes type; duration of diabetes; numbers of patients on insulin treatment; frequencies of hypertension, proliferative diabetic retinopathy, previous macular laser treatment; or frequency of intraoperatively confirmed posterior vitreous detachment (chi-square, P>0.05 for all). Comparison of pre- and post-operative visual acuity revealed significant improvement in both Group I (1.15±0.307 vs. 0.764±0.355 logMAR, respectively; Wilcoxon rank test, P<0.01) and Group II (1.22±0.516 vs. 0.829±0.436 logMAR, respectively; Wilcoxon rank test, P<0.001). The change in visual acuity for Group I was not significantly different from that observed in Group II (0.391±0.335 vs. 0.393±0.273 logMAR, respectively; Mann–Whitney U test, P>0.05). Conclusion The visual acuity outcomes in the study indicate that vitrectomy without ILM peeling is just as effective as vitrectomy with ILM peeling in the treatment of diabetic macular edema. Both techniques led to significant and similar degrees of improvement in visual acuity.     

Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P<0.05). No significant difference was found in the T-OD, N-OD, S-OD, and I-OD between N-T group and T-N group. IMH closure rate was 100% both in N-T group and T-N group. There was no significant difference in BCVA between two groups (P<0.05). CONCLUSION: The macula slips toward the OD after successful macular hole surgery. The two different ILM peeling pattern show similar visual outcome and retinal displacement, which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.     

Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling

Background: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling. Methods: The medical records of the last 40 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow‐up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non‐ILM peeling group). The subsequent 18 eyes underwent surgery with ICG‐stained ILM peeling (ILM peeling group). Results: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non‐ILM peeling group, respectively. The difference was statistically significant (Fisher's exact test, P = 0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non‐ILM peeling group, with a mean improvement of 3.6 and 1.3 lines, respectively (two‐tailed t‐test, P = 0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non‐ILM peeling group (Chi‐square test P = 0.028). However, there was no significant difference in the final postoperative logMAR best‐corrected visual acuity between the two groups (two‐tailed t‐test, P = 0.073). Conclusions: Based on this study, ICG‐stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.     

Retinal electrophysiological changes related to early versus late silicone oil removal

Purpose

To compare between the effect of early (3 months) and late (6 months) silicone removal on the electroretinogram records.

Methods

Thirty-four eyes with complex primary rhegmatogenous macula off retinal detachment undergone vitrectomy. Silicone oil was removed after 3 months in group I and after 6 months in group II. Scotopic and photopic ERGs, pattern electroretinogram (PERG) and multifocal ERG (mfERG) and best-corrected visual acuity (BCVA) were recorded for all eyes

Results

Preoperative mean best corrected visual acuity (BCVA) measured was 0.93?±?0.05 in group I and 0.9?±?0.08 in group II. One month after silicone removal, mean BCVA was 0.20?±?0.04 and 0.18?±?0.02 in groups I and II respectively. Before silicone oil removal the electroretinographic a- and b-waves were greatly reduced in both groups with no significant difference between them. One month after removal of silicone oil, the electroretinographic a- and b-waves increased in both groups with no significant difference between the two groups (p?=?0.46 and 0.23 respectively).

Conclusion

The amplitudes of the ERGs increase after removal of silicone oil tamponade with no difference between early (3 months) and late (6 months) removal.

     

白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂

目的:评价白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂的疗效.方法:回顾性分析.选取我院收治的非黄斑裂孔超高度近视性黄斑劈裂患者32例32眼,屈光度为-12.00~-20.00(平均-15.78±2.16)D.平均最佳矫正视力(LogMAR) 4.1±0.4.所有患者均行白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术,内界膜采用吲哚菁绿染色并顺利剥除,术毕进行气体填充.术后随访1~9(平均4.5)mo,观察术后视力及黄斑劈裂愈合效果.结果:共30例30眼(94%)患者劈裂腔消失,视力较术前提高,视物变形改善.手术前后最佳矫正视力比较,差异具有统计学意义(t=-7.91,P<0.05).结论:白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术是治疗非黄斑裂孔超高度近视性黄斑劈裂安全有效的手术方法,可有效保存视功能,不同程度提高患者的视力.