预测视网膜静脉阻塞继发黄斑水肿抗VEGF治疗后视力的形态学指标分析

目的 评价视网膜静脉阻塞（RVO）继发黄斑水肿（ME）患者抗VEGF治疗基线荧光血管造影（FFA）及相干光断层扫描（OCT）指标与患者治疗后最佳矫正视力（BCVA）的关系。设计 回顾性病例系列。研究对象 北京同仁医院连续抗VEGF治疗应答良好的125例125眼RVO继发ME患者。方法 所有患者均接受每月1次玻璃体注射雷珠单抗0.05 ml,直至ME完全消退。所有患者均采用Spectralis HRA+OCT进行FFA及OCT检查,半自动分析患者基线FFA及OCT形态学指标。采用Logtistic回归分析评价各分析因素与患者治疗后BCVA的关系。主要指标 BCVA,黄斑旁中心凹毛细血管灌注,黄斑中心视网膜厚度,黄斑中心视网膜容积,视网膜各层的完整性。结果125眼中,7眼（5.6%）基线BCVA≥0.5,抗VEGF治疗后43眼（34.4%）BCVA≥0.5。患者基线黄斑旁中心凹毛细血管无灌注（P=0.01,OR=0.213）、 内丛状层结构模糊（P=0.005,OR=0.225）、外界膜破坏（P=0.001,OR=0.160）是阻碍治疗后获得良好视力预后的主要影响因素。结论 基线FFA显示黄斑中心凹毛细血管无灌注或OCT显示黄斑中心凹区视网膜内丛状层结构模糊或外界膜破坏提示抗VEGF治疗RVO继发ME的视力预后不佳。（眼科,  2018,  27：111-115）     

高度近视视网膜劈裂症光学相干断层扫描检查的临床研究

目的 探讨高度近视视网膜劈裂症患者发生的年龄、眼轴、视力情况,以及其影像学特征和发生机制.方法 回顾性系列病例研究.对611例（992眼）高度近视患者行光学相干断层扫描（OCT）、B超、IOL Master、主觉验光、裂隙灯、眼底（散瞳）等检查,其中经OCT检查存在视网膜劈裂者79例（97眼）.根据视网膜劈裂的位置分为黄斑中心凹劈裂组43例（51眼）与黄斑旁中心局部劈裂组36例（46眼）两组,对两组的年龄、眼轴、视力、后巩膜葡萄肿、玻璃体后脱离、黄斑前膜、玻璃体牵引的发生率进行比较.采用独立样本t检验和卡方检验进行统计学分析.结果 发生视网膜劈裂的患者中：总体年龄≥30岁者占73％;眼轴≥28 mm者占96％;视力≥4.5者占66％.视网膜劈裂大部分为外层劈裂,其中黄斑中心凹劈裂组中有5眼为混合劈裂.黄斑中心凹劈裂组与黄斑旁中心局部劈裂组劈裂发生的年龄差异有统计学意义（t=-2.28,P=0.025）.黄斑前膜和玻璃体牵引的发生率在两组差异有统计学意义（x2=9.387,P=0.002;x2=6.590,P=0.01）.结论 高度近视眼视网膜劈裂与长眼轴密切相关;年龄、黄斑前膜、玻璃体牵引与劈裂的类型相关.     

基线视网膜光感受器层完整性与中心性浆液性脉络膜视网膜病变视力预后的相关性研究

目的 分析中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy,CSC）患者基线黄斑中心凹视网膜光感受器层完整性与治疗后视力预后的相关性。设计 回顾性病例系列。研究对象 北京同仁医院眼科门诊确诊并临床治愈的CSC患者136例（148眼）,平均年龄（49.7±8.6）岁。方法 所有患者均采用 Spectralis HRA一体机进行荧光素眼底血管造影（fundus fluorescence angiography,FFA）、吲哚青绿血管造影（indocyanine green angiography,ICGA）及 相干光断层扫描（optical coherence tomography,OCT）检查,半自动分析患者基线OCT形态学指标。定义光感受器层损伤严重程度：神经视网膜脱离区内表面光滑、结构完整,为0级;脱离区光感受器细胞外节部分缺失,但肌样体带、椭圆体带完整为1级;光感受器外节广泛缺失,椭圆体带不清晰,但肌样体带部分可见为2级;光感受器外节、椭圆体带及肌样体带广泛缺失,外界膜隐约可见或结构不清为3级。所有患者根据FFA+ICGA结果采用半剂量光动力治疗或激光视网膜光凝或微脉冲光凝。采用混合线性回归分析评价各分析因素与患者治疗后最佳矫正视力（best corrected visual acuity,BCVA）的关系。主要指标 视网膜光感受器层损伤严重程度,黄斑中心凹视网膜外核层厚度,BCVA（LogMAR）。结果148眼中,CSC患眼基线光感受器层损伤0级90眼、1级29眼、2级18眼、3级11眼;基线33眼（22.3%）LogMAR视力<0.2,治疗后80眼（54.1%）LogMAR视力<0.2。混合效应线性模型分析显示,基线光感受器层损伤严重程度与患者终末BCVA具有关联性（β=-0.242,P<0.001）。结论 CSC患者治疗前黄斑中心凹光感受器层损伤严重程度是影响患者治疗后获得良好视力预后的关键因素：损伤越轻视力预后越好。黄斑中心凹光感受器层损伤可能是提示CSC应接受干预性治疗的生物标记物。     

息肉状脉络膜血管病变的随访观察

目的 观察息肉状脉络膜血管病变(PCV)患者的临床特征及其视力预后情况.方法 回顾性病例系列研究.对经眼底彩色照相、荧光素眼底血管造影及吲哚氰绿血管造影等确诊的45例(51只眼)PCV患者的临床资料进行回顾性分析,包括患者年龄、随访前视力、有无脉络膜视网膜病变、病灶面积、病灶是否累及黄斑中心凹、随访期间病灶消退且无新病灶出现等6项因素.对患者随访期间视力变化情况进行多因素相关回归分析.结果 45例(51只眼)PCV患者随访时间6～18个月,平均随访(11.1±2.0)个月.随访期间病变区出血、渗出增多者15只眼(29.4%),出血、渗出减少者25只眼(49.0%),盘状瘢痕与萎缩改变者分别为5只眼(9.8%)和6只眼(11.8%).视力增加、稳定及下降者分别为11(21.6%)、21(41.2%)及19(37.2%)只眼.息肉状病灶累及黄斑中心凹者25只眼(49.0%),未累及者26只眼(51.0%).在病程进展过程中,息肉状病灶部分消退18只眼(35.3%),稳定不变13只眼(25.5%),扩大和新生13只眼(25.5%),消退和新生并存7只眼(13.7%).患者视力变化与年龄、随访前视力、息肉状病灶累及黄斑中心凹诸因素相关(b=-0.005,0.382,-0.430;P=0.034,0.000,0.000),视力提高与息肉状病灶累及黄斑中心凹(b=-2.957,P=0.013,OR=0.052)、息肉状病灶消退且无新病灶出现相关(b=2.259,P=0.019,OR=9.578).结论 PCV患者视力预后情况不同,年龄小者随访前视力较好;息肉状病灶未累及黄斑中心凹者随访视力相对较好,其中无新病灶出现者,随访期间视力提高的可能性较大.脉络膜视网膜病变情况和病灶面积不能作为判断预后的敏感指标.

Abstract：

Objective To observe the natural course and evaluate the prognostic factors influencing the follow-up visual acuity of polypoidal choroidal vasculopathy (PCV). Methods It was a retrospective case series. Forty-five consecutive patients (51 eyes) who were diagnosed with PCV by fundus photography,fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were followed up with (11.1 ± 2. 0 )months (mean ± SD ). Age, baseline visual acuity, the presence of pigment epithelium detachment (PED), lesion size, the polypoidal lesions involving the fovea and the regression of polypoidal lesions were recorded. Multi-factor regression analysis of visual acuity at follow up was applied with SPSS 16. 0 statistics software. Results Among the 45 patients (51 eyes), the hemorrhage or exudation were increased in 15 eyes (29. 4% ), decreased in 25 eyes (49. 0% ), 5 eyes (9. 8% ) developed macula scar and 6 eyes (11.8%) macula atrophy . During the follow-up period, the visual acuity was improved in 11 eyes (21.6%), stable in 21 (41.2%) and regressed in 19 (37. 2% ). Twenty-five eyes (49.0%)demonstrated polypoidal lesions involving the fovea and 26 eyes (51.0%) did not. ICGA revealed that the polypoidal lesions were unchanged in 18 eyes ( 35. 3% ), regressed in 13 ( 25.5% ), grew in 13 (25.5%), and mixed in 7 eyes ( 13.7% ). The changes of visual acuity at follow up were related to the age, baseline visual acuity, and polypoidal lesions involving in the fovea ( b = - 0. 005, 0. 382 and - 0. 430 ;P = 0. 034, 0. 000 and 0. 000). Improvement of visual acuity at follow up was related to the regression of polypoidal lesions ( b = 2. 259, P = 0. 019, OR = 9. 578). Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The presence of PED and the lesion size had no effect on the visual prognosis of PCV. Better visual acuity during follow-up period is correlated with younger age, better baseline visual acuity, polypoidal lesions not involving the fovea and a regression of polypoidal lesions.     

湿性年龄相关性黄斑变性玻璃体注射雷珠单抗治疗一年后视力的影响因素

目的 观察湿性年龄相关性黄斑变性（wAMD）玻璃体注射雷珠单抗治疗1年后视力及其影响因素。设计 回顾性病例系列。研究对象 郑州市第二人民医院眼科2015年5月至2017年2月wAMD患者50例（50眼）。方法  所有患者均接受最佳矫正视力（BCVA）、眼底彩色照相、荧光素眼底血管造影（FFA）、相干光断层扫描（OCT）及相干光断层扫描血管成像（OCT-A）检查。所有患眼均采用每月注射 1 次连续注射 3 个月后按需治疗的方案行玻璃体注射雷珠单抗治疗。观察治疗1年后的BCVA。分析治疗1年后的终末BCVA及提高程度与基线特征年龄、性别、基线BCVA、黄斑下视网膜出血、视网膜内液、视网膜下液、视网膜色素上皮脱离、黄斑中心凹视网膜厚度（CFT）、脉络膜新生血管（CNV）面积及CNV的类型（经典为主型、微小经典型、隐匿型）的相关性。主要指标  BCVA、黄斑下视网膜出血、视网膜内液、视网膜下液、视网膜色素上皮脱离、CFT、CNV的面积,CNV的类型。结果 治疗前BCVA为（53.4±14.5）个字母,治疗1年后BCVA为（61.3±20.5）个字母,提高（7.9±8.5）个字母（t=-6.564,P<0.01）。治疗1年后的终末BCVA与基线BCVA正相关（B=0.483,P=0.001）,与治疗前CNV面积和CNV的类型负相关（B=-0.211,P=0.005;B=-0.202, P=0.005）;治疗1年后BCVA的提高程度与治疗前CNV面积和CNV类型负相关（B =-0.509,P=0.005;B=-0.488, P=0.005）。三种类型的CNV中,经典为主型CNV治疗1年后的BCVA较差,隐匿型的终末BCVA较好,经典为主型BCVA提高程度较少,微小经典型提高程度较大（P＜0.05)。结论 经典为主型CNV、CNV面积大者,玻璃体注射雷珠单抗1年后视力改善较小、预后差;基线视力较好者会有较好的终末视力。     

特发性黄斑前膜在频域相干光断层扫描下的临床观察

目的观察特发性黄斑前膜的频域相干光断层扫描（OCT）特征以及与患者视力的相互关系。方法收集2010年10月至2013年6月在我院门诊确诊的特发性黄斑前膜患者的临床资料,共182例（212只眼）,年龄35~88岁,平均（66.08±9.25）岁,所有患者均进行最佳矫正视力、眼底和OCT检查。根据OCT检查所见对黄斑前膜进行分类,分析中心凹形态及黄斑部视网膜神经上皮层体积与视力的关系,采用SPSS13.0软件对患者的各项OCT检查结果进行统计学分析。结果 （1）特发性黄斑前膜的OCT图像特征表现为视网膜神经上皮层表面厚薄不一的高反光带,部分与视网膜内表面完全紧密粘连或分离。黄斑前膜的中心凹形态改变有5种表现,中心凹正常型33只眼（15.7%）,伴有板层裂孔17只眼（8.0%）,伴有假性黄斑裂孔16只眼（7.5%）,伴有弥漫水肿121只眼（57.0%）,伴有囊样水肿25只眼（11.8%）。（2）中心凹正常组与其它中心凹形态组的视网膜神经上皮层体积比较,差异有统计学意义（P〈0.05）。（3）黄斑部视网膜神经上皮层体积与视力呈负相关（r=0.029,P〈0.01）。结论黄斑前膜患者视力与黄斑部视网膜神经上皮层体积具有负相关性,0CT作为黄斑前膜可靠的诊断方法,在临床上可以减少漏诊,并可以为手术提供更详细的信息。     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

OCTA观察高度近视眼ICL植入术后视网膜血流密度的变化

目的：利用光学相干断层扫描血管成像技术（OCTA）观察高度近视眼行有晶状体眼后房型人工晶状 体（ICL）植入术对黄斑区视网膜血流密度、视网膜厚度的影响。方法：前瞻性临床研究。选取2019年 12月至2020年5月于南京医科大学附属眼科医院行ICL植入术的高度近视患者25例（43眼）,术眼 等效球镜度（SE）>-6.00 D。观察患者术前,术后1周、1个月、3个月的视力、眼压、拱高及黄斑区 视网膜血流密度、视网膜厚度的变化。数据采用方差分析进行统计分析。结果：患者手术前后各时 间点裸眼视力和最佳矫正视力总体差异均有统计学意义（F=500.975,P<0.001;F=16.032,P<0.001）, 术后各时间点指标均较术前明显提高（均P<0.001）。术后各时间点黄斑中心凹无血管区（FAZ）面积 均较术前减少（均P<0.001）,术后黄斑中心凹视网膜厚度（CRT）无明显改变。患者手术前后黄斑中 心凹、黄斑旁中心凹、颞侧、上方、鼻侧及下方各区域浅层视网膜血流密度差异均无统计学意义。 与术前相比,术后1周、1个月、3个月黄斑中心凹、颞侧、上方及下方各区域深层视网膜血流密度差 异均无统计学意义,而术后黄斑旁中心凹、鼻侧深层视网膜血流密度较术前均有所降低（均P<0.05）。 结论：OCTA观察显示高度近视眼行ICL植入术对鼻侧深层视网膜血流密度有影响,同时FAZ面积降 低,但对其余视网膜血流密度及视网膜厚度无影响。     

玻璃体视网膜手术治疗外伤性视网膜下出血的预后影响因素

目的 评估玻璃体视网膜手术治疗外伤性视网膜下出血的预后影响因素.方法 回顾分析50例接受玻璃体视网膜手术治疗的外伤性视网膜下出血患者的临床资料.所有患者均有明确的眼外伤史;眼底及B型超声检查均发现有视网膜下出血;手术前视力<0.1.根据伤眼情况不同,分别进行了玻璃体视网膜手术联合晶状体切除、联合视网膜切开以及硅油填充术等治疗.治疗后随访时间2～53个月,平均随访时间7.27个月.观察末次随访的矫正视力和视网膜复位情况.以视力≥0.1为视力预后良好,通过间接检眼镜联合彩色眼底照相检查确定视网膜是否复位.采用χ2检验和Logistic回归分析等统计学方法,分析受伤类型、开放或闭合伤、病程、手术前视力、视网膜脱离、出血性脉络膜脱离、玻璃体积血、视网膜下出血是否累及黄斑区等伤眼基线资料以及手术干预方式与视力预后及视网膜复位的相互关系.结果 预后视力良好者占46.0%.其中,手术前视力为无光感～眼前手动以及眼前数指～0.1的息眼中,预后视力良好者分别占34.2%、83.3%,二者比较,差异有统计学意义(χ2=8.860,p=0.003).手术前是否伴有视网膜脱离的患眼中,预后视力良好者分别占37.5%、80.0%,二者比较.差异有统计学意义(χ2=4.232,P=0.040).视网膜下出血是否累及黄斑中心凹的患眼中,预后视力良好者分别占34.4%、66.7%,二者比较,差异有统计学意义(χ2=4.836,P=0.028).伤眼基线资料中的其他各项因素对手术后视网膜复位均无明显影响(P>0.05).结论 外伤性视网膜下出血患眼手术前视力、是否合并视网膜脱离和视网膜下出血是否累及黄斑区是影响其玻璃体视网膜手术治疗视力预后的重要因素.     

糖尿病性黄斑水肿的光学相干断层成像

目的：观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical colnerence tomographly,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系。方法：对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查。结果：10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚。DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0．60,P=0．000)。结论：DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差。     

Hemorrhagic Characteristics Associated with the Prognosis of Polypoidal Choroidal Vasculopathy with Subretinal Hemorrhage

Objective: To investigate the hemorrhagic characteristics associated with the treatment prognosis of polypoidal choroidal vasculopathy (PCV) with subretinal hemorrhage. Methods: This was a prospective study. Patients who were included had been diagnosed with naïve PCV from January 2015 to December 2017 in the Eye Hospital, Wenzhou Medical University, and were followed up for at least 3 months after the treatment. The logarithm of the minimum angle of resolution (logMAR) visual acuity during the follow-up after treatment were compared with baseline in different groups: A hemorrhage area of >4 disc area (DA) or less, whether or not there was foveal involvement, and the location of the center of the subretinal hemorrhage based on the Early Treatment Diabetic Retinopathy Study (ETDRS) ring. Data were recorded and analyzed by mixed linear models. Results: One hundred twenty-two patients (124 eyes) were enrolled, including 84 males and 38 females. The mean age was 64.9±9.8 years. Subretinal hemorrhage was presentin 69 eyes (55.6%) at baseline. Among them, a larger hemorrhage area (>4 DA) in 34 eyes (49.3%) showed poorer visual improvement during the follow-up period than a smaller hemorrhage area (≤4 DA) in 35 eyes (50.7%). The fovea was involved in 59 eyes (85.5%) and showed poorer visual improvement during the follow-up than 10 eyes without foveal involvement (F=3.92, P=0.01). Among the 59 eyes with foveal involvement, 25 eyes (42.4%) with the center of the hemorrhage located within ETDRS ring 1 showed poorer visual improvement than eyes with the central hemorrhage ring at 2 or beyond (F=2.23, P=0.05). Conclusion: Large area, foveal involvement, and proximity to the fovea are risk factors for the poor prognosis of PCV with subretinal hemorrhage.     

Long-term observation of vitrectomy without subretinal hemorrhage management for massive vitreous hemorrhage secondary to polypoidal choroidal vasculopathy

AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage (SRH) management for massive vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy (PDT) as needed. The main outcome measures were best-corrected visual acuity (BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2mo (range 12-35mo). Mean BCVA at baseline (2.16±0.39 logMAR) had improved significantly, both 3mo after surgery (1.42±0.66 logMAR, P<0.001) and by the last visit (1.23±0.74 logMAR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes (16.3%) and ciliary body detachment in 4 eyes (4.7%). Nineteen eyes (22.1%) received following treatment with ranibizumab injections without/with PDT, and 15 (17.4%) were resolved. Four eyes (4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis, thicker SRH (beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis (beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.     

Subretinal surgery for peripapillary subretinal neovascular membranes

PURPOSE: To report the results of surgical removal of extrafoveal peripapillary subretinal neovascular membranes (PSRNVMs) for elderly patients in whom visual acuity was threatened or affected by subretinal fluid, subretinal hemorrhage, subretinal exudate, or PSRNVM growth toward the fovea. METHODS: Retrospective review of six eyes of six patients undergoing subretinal surgical removal of PSRNVMs via pars plana vitrectomy. RESULTS: PSRNVMs were successfully removed in six eyes of six patients with initial preservation of foveal function. The preoperative Snellen visual acuity ranged from 20/40 to counting fingers, and the best postoperative visual acuity ranged from 20/25 to 20/40. The final visual acuity with a mean follow-up of 3 years (range, 6-63 months) was stable or improved in 83% (5 eyes) of cases, ranging from 20/25 to 20/80. Early recurrence of PSRNVM was noted only in 1 eye (17%) at 1 month after surgery and was successfully treated with laser photocoagulation. Late recurrence of choroidal neovascularization developed after 3 years in two eyes. Cataract developed in three of four phakic eyes. CONCLUSION: PSRNVMs sparing the central fovea in elderly patients can be successfully removed surgically with initial preservation of foveal function and with a low rate of early recurrence.     

Role of photodynamic therapy in polypoidal choroidal vasculopathy

PURPOSE: To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS: We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS: Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION: PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.     

Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE: To evaluate the clinical features and risk factors of hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) after photodynamic therapy (PDT). METHODS: We retrospectively reviewed data for 91 consecutive eyes of 85 patients who underwent PDT for the treatment of PCV. The diagnosis of PCV was based on indocyanine green angiographic findings, showing a branching vascular network terminating in polypoidal swelling. The greatest linear dimension included all polypoidal lesions, leaking vascular network, and type 2 choroidal neovascularization. RESULTS: During the follow-up period after PDT, postoperative subretinal hemorrhage was seen in 28 (30.8%) of 91 eyes. In 22 (78.6%) of these 28 eyes, subretinal hemorrhage was absorbed without treatment. In 6 eyes (21.4%), however, bleeding resulted in vitreous hemorrhage, and 2 eyes underwent pars plana vitrectomy. Although visual acuity was maintained or increased in 18 (81.8%) of 22 eyes with subretinal hemorrhage alone, it decreased significantly in 3 (50.0%) of 6 eyes with postoperative vitreous hemorrhage. Various systemic diseases and medication with an anticoagulant had no correlation with these hemorrhagic complications. Laser irradiation spot size for PDT was significantly larger in eyes with postoperative vitreous hemorrhage (P = 0.017) than in those without. CONCLUSION: Subretinal hemorrhage after PDT can be a common complication in patients with PCV and may have a minor effect on visual outcome. However, postoperative hemorrhage is occasionally so massive that it leads to vitreous hemorrhage and poor visual prognosis. When considering PDT for eyes with a large PCV lesion, ophthalmologists should be aware of the risk of serious hemorrhagic complications.     

Bacillary layer detachment in acute nonpenetrating ocular trauma

ObjectiveTo study the clinical and visual outcomes of patients presenting with bacillary layer detachment (BLD) on optical coherence tomography (OCT) in blunt ocular trauma.DesignRetrospective observational study.ParticipantsClinical fundus photographs and OCT scans with Spectralis machine were reviewed to identify patients with blunt ocular trauma showing BLD.MethodsPatients were further analyzed for changes in their anatomic features such as subretinal hemorrhage, intrabacillary layer bleed. subretinal fibrosis and choroidal rupture and reattachment of BLD, and visual outcomes over subsequent follow-up visits.ResultsOf a total of 77 eyes with blunt ocular trauma, 6 (8%) eyes with BLD were identified. All patients were male with presenting visual acuity ranging from 6/9 to 2/60 (mean logMAR = 1.119; Snellen's equivalent = 20/263). The time interval between trauma and presentation ranged from 1 to 7 days. Subretinal hemorrhage and choroidal rupture were noted in all 6 eyes. On OCT, foveal involvement by the BLD was noted in 5 eyes. Intrabacillary layer hemorrhage was noted in all patients. Reattachment of the bacillary layer and visual acuity improvement were noted in all eyes at the final visit. The time interval for resolution of BLD ranged from 2 to 10 days. Visual acuity of 6/36 or less was secondary to subretinal fibrosis close to the fovea and subfoveal choroidal rupture.ConclusionBLD in blunt ocular trauma is a rare finding, shows complete resolution, and appears not to influence visual or anatomic outcome.     

Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration

PURPOSE: To evaluate a new procedure for displacement of large, thick submacular hemorrhage in patients with age-related macular degeneration. METHODS: Retrospective review of 11 eyes of 11 patients with age-related macular degeneration and thick submacular hemorrhage (defined as causing retinal elevation detectable on stereo fundus photographs) treated with vitrectomy, subretinal injection of tissue plasminogen activator (25 or 50 microg), and fluid-gas exchange with postoperative prone positioning. Outcome measures included displacement of hemorrhage from the fovea, best postoperative visual acuity, and final postoperative visual acuity. RESULTS: In the 11 affected eyes of 11 patients (seven men and four women; mean age, 76 years), preoperative visual acuity ranged from 20/200 to hand motions. With surgery, subretinal hemorrhage was displaced from the fovea in all 11 cases. Mean postoperative follow-up was 6.5 months (range, 1 to 15 months). Best postoperative visual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cases and no change in two cases. Eight eyes (73%) measured 20/200 or better, with four of these eyes (36%) 20/80 or better. Final postoperative visual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cases, no change in one case, and worsening in two cases. A statistically significant difference was found between preoperative and best postoperative visual acuity (P =.004) but not between preoperative and final visual acuity (P =.16). Hemorrhage recurred in three (27%) eyes, causing severe visual loss in one eye. CONCLUSIONS: This technique displaces submacular hemorrhage from the fovea and can improve vision in patients with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eyes and caused severe visual loss in one eye. A randomized, prospective clinical trial is necessary to determine the efficacy of this technique in comparison with other proposed treatments.     

Macular configuration determined by optical coherence tomography after idiopathic macular hole surgery with or without internal limiting membrane peeling

AIMS: To evaluate the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling on the closure and configuration of idiopathic macular holes (IMH). METHODS: PPV was performed for IMH on 44 eyes with ILM peeling (ILM peeled group) and on 42 eyes without ILM removal (ILM preserved group). Optical coherence tomography (OCT) was performed on 34 ILM peeled eyes and 14 ILM preserved eyes after successful surgery. The repaired macular holes were classified by the OCT images as being of "good shape" (nearly normal foveal contour) or "poor shape" (abnormal foveal contour with flat fovea and steep edge, or with a thick retina without a foveal pit). RESULTS: The anatomical closure rate was significantly higher in the ILM peeled group (93.2%) than in the ILM preserved group (76.2%) (p = 0.028). In the ILM peeled group, 31 eyes had a fovea of good shape and three eyes had a fovea with a poor shape, while in the ILM preserved group, six eyes had a fovea of good shape and eight eyes had a fovea of poor shape. The percentage of eyes with good macular configuration in the ILM peeled group was significantly higher than in the ILM preserved group (p = 0.0003). No significant difference was found in the postoperative visual acuity and the increase of visual acuity between the ILM peeled group and the ILM preserved group (p = 0.26, and p = 0.91 respectively). There was also no significant difference in the postoperative visual acuity and improvement in visual acuity between eyes with a fovea of good shape and those with fovea of poor shape fovea (p = 0.99 and p = 0.66, respectively). CONCLUSIONS: ILM peeling may provide better anatomical success and recovery of the macular shape, but the postoperative visual acuity and improvement of visual acuity were not related to the morphological results.     

Perfluorohexyloctane endotamponade for treatment of subfoveal hemorrhage

PURPOSE: To report on the use of perfluorohexyloctane as a heavy liquid to temporarily tamponade the fovea for the prevention of recurrent massive subfoveal hemorrhage in patients with exudative age-related macular degeneration (ARMD). METHODS: The case series comprised seven patients with acute massive subfoveal hemorrhage due to exudative ARMD. The patients underwent pars plana vitrectomy, drainage of the subretinal blood, and foveal endotamponade with perfluorohexyloctane. The perfluorohexyloctane was removed 80.4 +/- 38.1 days (median 98 days; range 22-118 days) after the primary surgery in a second pars plana intervention. RESULTS: In six patients (85.7%) the subretinal hemorrhage removed during the first pars plana vitrectomy did not recur after removal of perfluorohexyloctane. In the seventh, however, a subretinal hemorrhage re-developed five days after release of perfluorohexyloctane. No large epiretinal membranes were observed. In six eyes (85.7%), the retina remained attached after removal of perfluorohexyloctane but in one eye proliferative vitreoretinopathy developed, with central retinal detachment. After the first pars plana vitrectomy, visual acuity increased slightly but not significantly (p = 0.25), from 0.03 +/- 0.03 to 0.05 +/- 0.07. Intraocular pressure rose from 15.0 +/- 1.9 mm Hg to 24.9 +/- 16.9 mm Hg. After a follow-up of 69.7 +/- 121.0 days after removal of the perfluorohexyloctane, final visual acuity was 0.02 +/- 0.04. CONCLUSIONS: Perfluorohexyloctane may be a useful additional tool for preventing the recurrence of subfoveal re-bleeding in exudative ARMD.