高度近视眼黄斑裂孔性视网膜脱离手术疗效的临床分析

目的 探讨高度近视眼黄斑裂孔性视网膜脱离手术治疗的临床疗效。 方法 回顾分析149例高度近视眼黄斑裂孔性视网膜脱离患者的临床资料，将其是否伴有玻璃体后脱离（posterior vitreous detachment,PVD）分两组比较手术方式及视网膜解剖复位率和视力变化。 结果 视网膜解剖复位：两组用玻璃体手术治疗的复位率为77.9% ，非玻璃体手术为2 5.9%（P＜0.001）；不完全PVD组用玻璃体手术治疗复位率为75.5%，非玻璃体手术治疗为15.0%（P＜0.001）；用非玻璃体手术治疗完全PVD组复位率为57.1%，不完全PVD组为 15.0%（P=0.05）。视力进步：完全PVD组为68.6%，不完全PVD组为57.0%（P＞0.05）。 结论 高度近视眼黄斑裂孔性视网膜脱离应用巩膜外手术联合玻璃体切割、眼内气体填充和手术后激光光凝封闭黄斑裂孔可提高视网膜复位率。 （中华眼底病杂志，2003，19：8-10）     

Recurrence of Retinal Detachment after Scleral Buckle Removal

PurposeTo investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.MethodsIn this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.ResultsForty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).ConclusionsScleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.     

Long-term outcomes of 3 surgical adjuvants used for internal limiting membrane peeling in idiopathic macular hole surgery

Purpose

Indocyanine green (ICG), an adjuvant used for peeling of the internal limiting membrane (ILM) during vitreous surgery for idiopathic macular hole (MH), has been reported to be toxic, possibly affecting postoperative visual acuity. We compared the long-term outcomes (within 2 years) of brilliant blue G (BBG), ICG, and triamcinolone acetonide (TA).

Patients and methods

This study involved 97 eyes of 94 patients who underwent vitreous surgery for MH at the Yamagata University Hospital between June 2002 and November 2010. The surgical adjuvants used were BBG for 15 eyes, ICG for 61 eyes, and TA for 21 eyes. We compared the postoperative visual acuities, initial closure rates, final closure rates, and complications of the 3 groups.

Results

In all 3 groups, the visual acuity significantly improved after surgery. The magnitude of the improvement at 2 years after surgery was significantly better in the BBG group than in the ICG group (Mann–Whitney test, P = 0.020). The postoperative visual acuity did not significantly differ between the BBG and TA groups (P = 0.627) or between the ICG and TA groups (P =0 .137). Thus, the surgery using BBG resulted in a significantly better outcome in visual acuity than did the surgery using ICG. The 3 groups did not differ in initial or final closure rates or in incidence of complications.

Conclusion

Analysis of the long-term outcomes of vitreous surgeries provided evidence that BBG is a useful adjuvant for ILM peeling.     

Comparison of Efficacy and Safety between Transconjunctival 23-Gauge and Conventional 20-Gauge Vitrectomy Systems in Macular Surgery

Purpose

To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery.

Methods

Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups.

Results

There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001).

Conclusions

Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.     

Effect of Smoking on Retinal Thickness and Vascular Density in Thyroid Eye Disease

PurposeTo evaluate the effect of smoking on retinal thickness and macular and peripapillary vascular density in thyroid eye disease (TED).MethodsIn this cross-sectional study, subjects diagnosed with TED were analyzed in three groups: smokers, passive smokers, and non-smokers. Ganglion cell complex thickness, total retinal thickness, macular superficial vascular plexus densities, deep vascular plexus densities, optic nerve head, and radial peripapillary capillary density were measured in each group.ResultsTwenty-two eyes (21.6%) of active smokers, 11 eyes (10.8%) of passive smokers, and 69 eyes (67.6%) of non-smokers constitute the study subjects. Twenty-one eyes (12.6%) had active status (clinical activity score ≥3), 77 eyes (46.1%) were neither active nor compressive, four eyes (2.4%) of two patients constituted the compressive group. Age and disease activity adjusted analysis was performed. Ganglion cell complex thickness of smokers was significantly higher than non-smokers in the inferior hemi-parafoveal sector (p = 0.04). Active smokers had significantly higher (p < 0.01) retinal thickness in all sectors compared to non-smokers, except the foveal sector. Smokers had lower superficial vessel density in the superior parafoveal sector compared to non-smokers (p = 0.04). Considering deep vessel densities between smokers and non-smokers, no significant difference was observed. Radial peripapillary capillary densities (significant difference was observed in the whole image and infranasal peripapillary sector), Macular vascular densities (significant difference was observed in parafoveal sectors), and optic nerve head (not reaching statistical significance level in any sectors) were highest in passive smokers.ConclusionsSmoking is associated with increased total retinal thickness. Macular vascular densities were not different between smokers and non-smokers in TED.     

Effect of preoperative vitreous status on visual outcomes following vitrectomy for epiretinal membrane repair

Objective: To determine the correlation between clinically observed posterior vitreous detachment (PVD) and both surgical status of the hyaloid and the visual outcome following epiretinal membrane (ERM) surgery.Design: Retrospective chart review.Participants: One hundred and nine eyes of 109 consecutive patients who underwent vitrectomy and repair of idiopathic ERM between January 2006 and September 2008.Methods: Preoperative exam notes from selected charts were reviewed for the presence or absence of a PVD. Operative notes were queried to whether the hyaloid was attached or detached at the onset of surgery. The postoperative visual acuity (VA) was correlated with the intraoperative status of the hyaloid. Preoperative observation of PVD was correlated with the hyaloid status at the time of vitrectomy.Results: Hyaloid status did not impact postoperative VA. Eyes with an attached hyaloid at the onset of surgery had an average postoperative best corrected visual acuity (BCVA) of 20/60 and eyes with PVDs found during surgery had an average BCVA of 20/60⁺¹ (p = 0.66). Of the 109 patients, 72 had a preoperative fundoscopic examination whose results positively correlated with the intraoperative status of the hyaloid.Conclusions: Having an attached hyaloid did not have a significant impact on postoperative visual outcomes in eyes undergoing ERM when compared with outcomes for eyes having a detached hyaloids prior to surgery. Detection of a PVD on preoperative fundoscopic examination was highly sensitive for a «true« PVD, i.e., actual detachment of the posterior hyaloid membrane as confirmed during surgery.     

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

PurposeTo evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block.MethodsThis retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH.ResultsTwenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015).ConclusionsEarly recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.     

Preoperative B-scan ultrasonography of the vitreoretinal interface in phakic patients undergoing rhegmatogenous retinal detachment repair and its prognostic significance

Purpose To perform ultrasonographic evaluation of the preoperative status of the posterior vitreoretinal interface in phakic patients undergoing surgery for retinal detachment (RD) with flap tear(s) and to investigate its relationship with postoperative anatomic and visual acuity outcomes. Methods A prospective, consecutive case series including 50 phakic eyes of 49 patients with retinal detachment and flap tear(s) undergoing retinal detachment surgery by a single vitreoretinal surgeon, who was unaware of the patient’s preoperative B-scan ultrasonographic findings. Main outcome measures were comparisons between patients with partial versus complete posterior vitreous detachment (PVD) of primary retinal reattachment rates (retinal reattachment with a single surgical procedure), rates of retinal reattachment at month 12, and visual acuity outcomes at month 12. Results Partial PVD was observed in 22 (44%) eyes and complete PVD in 28 (56%) eyes. Eighteen eyes underwent pneumatic retinopexy, 15 underwent scleral buckling, and 17 underwent pars plana vitrectomy. Retinal reattachment with a single surgical procedure was achieved in 76% (38/50) of eyes, including 54.5% (12/22) of eyes with partial PVD at baseline and 92.9% (26/28) of eyes with complete PVD at baseline (P < 0.01). Stratification by type of surgical intervention demonstrated a significantly higher rate of primary anatomic success for pneumatic retinopexy among patients with complete PVD compared to partial PVD (P = 0.02). Retinal reattachment at month 12 was achieved in 100% (50/50) of eyes. At last follow-up, the mean (±SD) number of interventions was 1.70 (±1.10) for patients with partial PVD at baseline and 1.10 (±0.30) for patients with complete PVD (P < 0.01). There was no significant difference among the groups in mean change in visual acuity from baseline to month 12, nor in the distribution of visual acuities at month 12. Conclusions In phakic patients with retinal detachment and flap tear(s), a higher primary anatomic success rate may be associated with the presence of a complete PVD compared to a partial PVD. Subgroup analysis suggests that the presence of partial PVD at baseline might influence negatively the primary anatomic success rate, particularly for eyes undergoing pneumatic retinopexy. Presented in part as a paper at the ARVO 2004 Annual Meeting, Fort Lauderdale, FL, and at the American Society of Retina Specialists 2004 Annual Meeting, San Diego, CA. The authors have full access to all the data in the study and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review our data upon request. Financial interest: F. Rezende, none; M. Kapusta, none; R. Costa, none; I. Scott, none. An erratum to this article can be found at     

曲安奈德辅助玻璃体后脱离联合不染色剥除内界膜治疗Ⅱ、Ⅲ期特发性黄斑裂孔的临床观察

目的 评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法 对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果 手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.

Abstract：

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.     

Outer retinal morphological changes and visual function after removal of epiretinal membrane

ObjectiveTo determine the relation between the recovery of the cone outer segment tips (COST) line and the best-corrected visual acuity (BCVA) after epiretinal membrane (ERM) surgery.DesignRetrospective, consecutive, interventional case series.ParticipantsSixty-one eyes of 56 patients with an idiopathic ERM were studied. All participants underwent a complete ophthalmic examination including spectral-domain optical coherence tomography before and after ERM removal surgery.MethodsThe integrities of the photoreceptor layer including the external limiting membrane line, photoreceptor inner segment/outer segment (IS/OS) line, and COST line in the spectral-domain optical coherence tomography images at the fovea were determined. The associations of these morphological parameters to the BCVA were determined.ResultsBetter BCVAs were found more frequently in eyes with an intact COST line than in eyes with a disrupted or absent COST line at 1 (p < 0.001), 6 (p = 0.003), and 12 months (p < 0.001). Among the external limiting membrane, IS/OS, and COST line parameters, the IS/OS line had higher correlations with the BCVA by multivariate analysis. No significant difference was observed in central retinal thickness between eyes with intact and nonintact COST lines. Eight (30.8%) of 26 eyes with BCVA ≥ 20/20 had nonintact COST lines at 12 months after the ERM surgery.ConclusionsEyes with an intact COST line had better BCVA after ERM surgery. However, even at 12 months after ERM surgery, COST lines remained disrupted in many eyes with good BCVA.     

正视眼视网膜脱离的手术预后与玻璃体病变关系的分析

目的 研究正视眼视网膜脱离（ｒｅｔｉｎａｌ ｄｅｔａｃｈｍｅｎｔ,ＲＤ）患者的手术预后及其与玻璃体改变的关系。方法 回顾１９９６年月至１９９７年７月在我院行手术治疗的孔源性视网膜脱离患者１２６２例（１２４９只眼）,其中近视有ＲＤ组１０３１只眼,正视眼ＲＤ组２４３只眼,并研究增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）的分级及玻璃体后脱离（ｐｏｓｔ     

Surgical outcomes for primary rhegmatogenous retinal detachments in patients with pseudophakia after phacoemulsification

Purpose

To evaluate the clinical features and surgical outcomes for primary rhegmatogenous retinal detachments (RDs) in patients with pseudophakia after phacoemulsification.

Methods

The medical records of patients with pseudophakia after phacoemulsification and intraocular lens implantation who had undergone surgery for primary rhegmatogenous RDs with a minimum duration of follow-up of 12 months were reviewed retrospectively.

Results

A total of 104 patients were enrolled in this study and 106 eyes were analyzed. Post-operative retinal attachment was achieved in 87 of the eyes (82.1%) and the final visual acuities (logarithm of the minimum angle of resolution) were improved to 0.65 ± 0.49 from the baseline measurement of 1.51 ± 1.14 (p < 0.001). Re-operations were performed in 24 of the eyes (22.6%) and there were no visible retinal breaks in 30 of the eyes (28.3%). The failure to identify a retinal break during surgery was associated with a lower rate of retinal reattachment, worse final visual acuity, and a higher rate of re-operation (p = 0.002, p = 0.02, and p = 0.002, respectively). The location of the identified retinal break was more common in the superotemporal quadrant than in the other quadrants.

Conclusions

The inability to identify a retinal break during surgery was associated with a poor final outcome. Other factors were less important for the functional and anatomic success in patients with pseudophakic RDs.     

Visual and anatomic outcomes of cataract surgery with intraoperative or postoperative complications in a teaching institution

ObjectiveTo review visual and anatomic outcomes after cataract surgery with complications in a teaching institution.MethodsConsecutive case series. A chart review was conducted of patients who underwent phacoemulsification with intraoperative or postoperative complications, performed by ophthalmology residents under direct supervision of experienced ophthalmology attending physicians. Best corrected visual acuity (BCVA), OCT parameters, and postoperative treatments were reviewed at 1, 3, 6, and 12 months postoperatively.ResultsOne hundred thirty-three eyes were analyzed. Mean BCVA was 50 ± 23 approximate Early Treatment Diabetic Retinopathy Study letters at the preoperative visit and improved by a mean of 8 letters (n = 128; p = 0.001), 16 letters (n = 117; p < 0.001), 14 letters (n = 79; p < 0.001), and 4 letters (n = 34; p = 0.37) at 1, 3, 6, and 12 months. The mean OCT central subfoveal thickness increased by less than 50 μm at all time points and this change was not statistically significant at 12 months. BCVA increased by 3 lines in 41%, 56%, 57%, and 44% of eyes at 1, 3, 6, and 12 months. Median BCVA was 20/40 or better at each follow-up period. Fifty-three (40%) eyes required a secondary surgical procedure due to intraoperative or postoperative complication. A significant proportion of eyes received anti-inflammatory drops through 1 year.ConclusionsAfter cataract surgery with intraoperative or postoperative complications, a majority of eyes experienced substantial visual gains and only mild retinal thickening while being managed with long-term anti-inflammatory drops and additional surgical procedures.     

Evaluation of the Effect of Uncomplicated Cataract Surgery on Retina and Optic Disc: Optical Coherence Tomography Angiography Study

PurposeThe aim of the present study is to evaluate the effects of uncomplicated cataract surgery on microvascular structure of fovea, parafovea, optic disc, and peripapillary area with optical coherence tomography angiography (OCTA).MethodsThe study included 53 eyes of 53 patients, who undergone uncomplicated cataract surgery. The day before cataract surgery and at the 1st week, 1st month, 3rd month after surgery, best-corrected visual acuity, foveal avascular zone, acircularity index, superficial and deep foveal density, superficial and deep parafoveal density, central macular thickness, peripapillary retinal nerve fiber layer thickness value, and peripapillary vascular density were measured with OCTA.ResultsThe mean age of the patients was 62.1 ± 7.2 years (range, 42–69 years) and the sex of the patients was 25 male and 28 female. The foveal avascular zone value was decreased compared to the preoperative value (p < 0.05). There was no significant change in acircularity index postoperatively (p > 0.05). There was a significant increase in superficial and deep foveal density and superficial and deep parafoveal density (p < 0.05). According to preoperative period, peripapillary retinal nerve fiber layer and inside disc capillary density of optic disc increased significantly (p < 0.05). There was no significant change in peripapillary vascular density postoperatively (p > 0.05).ConclusionsChanges in the vascular density of the retina were detected with OCTA in eyes without ocular or systemic disease, which underwent uncomplicated cataract surgery. In the postsurgical period, OCTA provides important information in the evaluation and follow-up of these changes.     

Retinal Nerve Fiber Layer Thickness Measurement Comparison Using Spectral Domain and Swept Source Optical Coherence Tomography

PurposeTo investigate the retinal nerve fiber layer (RNFL) thickness concordance when measured by spectral domain (SD) and swept source (SS) optical coherence tomography (OCT), and to compare glaucoma-discriminating capability.MethodsRNFL thicknesses were measured with the scan circle, centered on the optic nerve head, in 55 healthy, 41 glaucoma suspected, and 87 glaucomatous eyes. The RNFL thickness measured by the SD-OCT (sdRNFL thickness) and SS-OCT (ssRNFL thickness) were compared using the t-test. Bland-Altman analysis was performed to examine their agreement. We compared areas under the receiver operating characteristics curve and examined sdRNFL and ssRNFL thickness for discriminating glaucomatous eyes from healthy eyes, and from glaucoma suspect eyes.ResultsThe average ssRNFL thickness was significantly greater than sdRNFL thickness in healthy (110.0 ± 7.9 vs. 100.1 ± 6.8 µm, p < 0.001), glaucoma suspect (96.8 ± 9.3 vs. 89.6 ± 7.9 µm, p < 0.001), and glaucomatous eyes (74.3 ± 14.2 vs. 69.1 ± 12.4 µm, p = 0.011). Bland-Altman analysis showed that there was a tendency for the difference between ssRNFL and sdRNFL to increase in eyes with thicker RNFL. The area under the curves of the average sdRNFL and ssRNFL thickness for discriminating glaucomatous eyes from healthy eyes (0.984 vs. 0.986, p = 0.491) and glaucoma suspect eyes (0.936 vs. 0.918, p = 0.132) were comparable.ConclusionsThere was a tendency for ssRNFL thickness to increase, compared with sdRNFL thickness, in eyes with thicker RNFL. The ssRNFL thickness had comparable diagnostic capability compared with sdRNFL thickness for discriminating glaucomatous eyes from healthy eyes and glaucoma suspect eyes.     

Evaluation of retinal functional changes after macular hole surgery using heavy brilliant blue G dye for internal limiting membrane staining: A prospective,single blind,randomized controlled trial

Purpose:To evaluate retinal functional changes after idiopathic macular hole (MH) surgery using heavy brilliant blue G (hBBG) dye for internal limiting membrane (ILM) staining.Methods:Forty-four eyes with idiopathic MH were randomized into two groups – 24 eyes undergoing vitrectomy with ILM peeling using hBBG staining and 20 eyes without staining; anatomical and functional status (with microperimetry (MP)) at baseline and during postoperative follow-up were noted and compared.Results:All eyes had closure of MH postoperatively and overall baseline MP indices (average threshold, AT; foveal sensitivity, FS) improved significantly at 6 weeks and 6 months of follow-up. AT and FS showed significant improvement at 6 weeks and 6 months from baseline in both individual groups (P < 0.001). Intergroup comparison showed that there was no statistically significant difference in AT and FS values at any point of time (baseline, 6 weeks, 6 months) between staining and no-stain group. No eyes in our cohort had any unexplained visual loss.Conclusion:Functional parameters of macula improved significantly after successful MH surgery using hBBG for staining the ILM.     

玻璃体后脱离及其所致周边视网膜裂孔的早期治疗

目的 探讨玻璃体后脱离(PVD)所致周边视网膜裂孔早期诊治对其预后的影响.方法 对25例25只眼由PVD所致周边视网膜裂孔作一临床分析.所有病例均行三面镜检查周边眼底,+90D前置镜观察眼球运动时玻璃体的状态.采用多波长激光或冷凝治疗周边视网膜裂孔,巩膜外加压与扣带治疗孔源性视网膜脱离(RRD).结果 7例(7只眼)PVD年龄高于50岁,18例(18只眼)因高度近视所致者年龄在50岁以下.18例中、青年人周边视网膜裂孔应用多波长激光光凝,6例老年人用巩膜冷凝术,唯1例老人并发RRD应用巩膜外加压及扣带术治疗,所有治疗患眼都获得了较好的视力预后.结论 由PVD患者引起的周边视网膜裂孔发生率随年龄增长或近视屈光度而增加,预防性治疗是安全、有效和必需的.

Abstract：

Objective To investigate the effect of early diagnosis and treatment on the prognosis of peripheral retinal breaks caused by posterior vitreous detachment(PVD). Methods Twenty-five cases(25 eyes)with peripheral retinal breaks caused by PVD were analyzed. The vitreous conditions of 25 eyes were examined biomicroscopically with a +90D present lens(slitlamp indirect ophthalmoscope)and a Goldman three mirror contact lens. Peripheral retinal breaks were treated with laser photocoagulation or scleral cryotherapy,and rhegmatogenous retinal detachment(RRD)with explant and scleral buckling surgery. Results Seven cases(7 eyes)with PVD were related with age over 50 years old and 18 cases(18 eyes)due to their higher myopia with lower than 50 years old. Peripheral retinal breaks in 18 patients of juniority were treated by laser photocoagulation and in 6 senile patients by scleral cryotherapy. Only one senile patient complicated with RRD was treated by explant and scleral buckling surgery. All treated eyes received favorable visual prognosis on them. Conclusions The prevalence of peripheral retinal breaks caused by patient with PVD increase with patient's age and degree of myopia. Preventive treatment is safe, effective and necessary.     

Cataract surgery in eyes with associated coloboma: Predictors of outcome and safety of different surgical techniques

Purpose:The aim of this study was to report the outcome of cataract surgery with different surgical techniques in eyes with coexisting coloboma and to define factors of prognostic importance.Methods:Retrospective case sheet review of patients presenting between January 2016 and December 2018, who underwent cataract surgery in eyes with coexisting coloboma.Results:Of the 3,30,231 cases operated during the study period, 280 eyes of 276 patients had associated colobomatous malformation. The prevalence of coloboma in eyes undergoing cataract surgery was 0.085%. The mean age of the patients was 46.4 years (range 19 - 88 years). Phacoemulsification (PE) was performed in 130 eyes (46.4%), manual small incision cataract surgery (M-SICS) was done in 115 eyes (41.1%), and 35 eyes (12.5%) underwent intra capsular cataract extraction. Intra-operative complications were noted in 26 (9%) eyes. Incidence of intra-operative and post-operative complications was comparable between PE and M-SICS groups (p = 0.94). The mean corrected distance visual acuity (CDVA) improved from logMAR 1.71 ± 0.62 to 0.87 ± 0.61 (p = 0.00009). On multivariate analysis, microcornea (p = 0.002), type 1 and 2 coloboma (p < 0.001), and intraoperative complications (p = 0.001) were associated with poor visual outcome.Conclusion:Favorable functional outcomes can be achieved with phacoemulsification in eyes with softer cataract and corneal diameter >8 mm and with M-SICS in eyes with hard cataracts and corneal diameter of 6–8 mm. PE should be considered as the primary choice whenever permissible by the corneal diameter and severity of nuclear sclerosis. Poor functional outcomes were seen in eyes with smaller corneal diameter, extensive chorioretinal coloboma, and intraoperative complications.     

Macular Hole Formation in Rhegmatogenous Retinal Detachment after Scleral Buckling

Purpose

To describe early macular hole (MH) development in rhegmatogenous retinal detachment (RRD) after scleral buckling (SB) based on optical coherence tomography (OCT) findings.

Methods

The medical records and spectral domain OCT images of patients in whom MH developed after RRD repair were evaluated retrospectively.

Results

A postoperative MH was detected in five eyes that underwent SB during a 6-year period. All had fovea-off RRD without MH at the time of surgery. OCT showed partial loss of the inner retina with a preserved photoreceptor layer in early postoperative days. On average, 7 days (range,5 to 8 days) after surgery, outer retinal tissues disappeared, resulting in the full-thickness MH.

Conclusions

Serial OCT findings revealed that partial-thickness lamellar holes progressed to full-thickness MHs, which were formed by the degeneration of the outer retina in eyes with preceding loss of the glial cone in the fovea.