ObjectiveTo investigate the effects of limbal vitrectomy for persistent hyperplastic primary vitreous (PHPV) with disappeared anterior chamber and corneal opacity. MethodsSixteen eyes of 16 children with unilateral PHPV were included in this retrospective study. All the 16 eyes had both anterior and posterior disease, including opaque cornea, disappeared anterior chamber, pupil occlusion and extensive synechia, and lens opacity. The visual acuity was hand movement in 1 eye, and light perception in 15 eyes. There were 7 eyes with microphthalmia, 4 eyes with total retinal detachment, 3 eyes with retinal dysplasia, 1 eye with retinal folds, and 4 eyes with high intraocular pressure preoperatively. All the eyes underwent limbal vitrectomy, including dissection of synechia, pupil formation, lensectomy, posterior lens membrane peeling and vitrectomy. Four eyes with retinal detachment received long-acting gas tamponade following vitrectomy. The mean follow-up was 15.8 months (range from 9 to 21 months). ResultsNo eye had intraoperative complications. After surgery, all the 16 eyes had normal anterior chamber, round pupil and improved corneal transparency. Two eyes achieved a final visual acuity of 20/940 or better. Of the 4 eyes with retinal detachment, 3 eyes achieved retinal reattachment. Of the 4 eyes with preoperative high intraocular pressure, 3 eyes had controlled intraocular pressure postoperatively and the remaining 1 eye underwent glaucoma procedure at 6 months after the primary surgery. ConclusionPHPV eyes with disappeared anterior chamber and corneal opacity have a potential for developing better vision with improved cosmetic outcome and controlled intraocular pressure after vitrectomy by limbal approach.
Objective To observe the effects of vitrectomy for persistent fetal vasculature (PFV).Methods The clinical data of 11 patients (14 eyes) with PFV, including posterior PFV (one eye) and combined PFV (13 eyes), were retrospectively analyzed. Vitrectomy was performed for all patients, lensectomy was performed for seven eyes, retinotomy was performed for five eyes, retinotomy and scleral buckling was performed for one eye. Intraoperative and postoperative complications were observed. The followup period ranged from eight to 74 months, with the mean of 44 months. The visual acuity （VA） and intraocular pressure before and after surgery were comparatively analyzed.Results There were no intraoperative complications in all the patients. The surgery was performed successfully in 12 eyes （86.0%） and failed in two eyes （14.0%）. The postoperative VA of five eyes (35.7%) increased, four eyes （28.6%） didnprime;t change and five eyes （35.7%） decreased. The postoperative intraocular pressure of two eyes （14.3%） increased,11 eyes （78.6%） didnprime;t change and one eye （7.1%） decreased. There was one eye with persistent hypotension and one eye with recurrent retinal detachment after surgery.Conclusion Vitrectomy can prevent complications and improve visual acuity in some PFV patients.
ObjectiveTo evaluate the value of 70 kV and sonogram-affirmed iterative reconstruction technique in CT examination for children with congenital heart disease. MethodsThirty children with congenital heart disease who underwent CT scan between January and September 2014 were included in this study. According to the different tube voltage, they were randomly divided into group A (80 kV) and group B (70 kV), with fifteen in each. All the children were scanned on a dual-source-CT (Siemens Definition Flash). Group A used filtered back projection reconstruction. Group B used sonogram-affirmed iterative reconstruction. We measured and calculated the pulmonary artery signal-to-noise ratio at the level of main pulmonary artery window, the signal-to-noise ratio of the ascending aorta, noise ratio contrast between the pulmonary artery and erector spinae and between the ascending aorta and erector spinae. The image quality for congenital heart disease was assessed by two senior radiologists. The measurement of radiation dose included effective dose (ED), volume CT dose index (CTDIvol) and dose length product (DLP). ResultsThere were no significant differences between group A and B in terms of pulmonary artery signal-to-noise ratio (14.54±3.77, 11.23±2.52), the signal-to-noise ratio of the ascending aorta (14.76±3.41, 12.31±3.47), the noise ratio contrast between pulmonary artery and erector spinae (12.04±3.96, 9.18±3.76) and between the ascending aorta and erector spinae (12.47±4.59, 9.77±4.41) (P > 0.05). There was significant difference between group A and group B in CTDIvol[(0.53±0.09), (0.38±0.03) mGy], DLP[(12.93±1.79), (6.67±0.72) mGy·cm], and ED[(0.34±0.05), (0.17±0.02) mSv] (P < 0.05). ConclusionThe application of 70 kV and sonogram-affirmed iterative reconstruction technique in CT examination for children with congenital heart disease can significantly reduce the radiation dose without any influence on image quality.
Persistent fetal vasculature syndrome (PFVS) is a rare congenital vitreous dysplasia, which is classified as anterior, posterior and combined types according to the location of the vascular abnormalities. The clinical manifestations of PFVS are diverse, and early surgical intervention is very important. The main objective of surgical treatment is to remove the anterior and posterior traction between fibrovascular membranes and retina as well as lens, and to reconstruct clear visual axis. Surgical treatments include pupilloplasty, lensectomy with or without intraocular lens implantation and vitrectomy via limbal or scleral approach. For new technologies, the applications of ophthalmic viscosurgical device and femtosecond lasers have desirable results . In addition to focusing on improving the success rate of surgery, it is also necessary to systematically and comprehensively assess the overall preoperative condition and postoperative visual function of the patients. PFVS eyes have limited improvement in postoperative vision, which is related to the extent of lesion involvement and the occurrence of complications. Eyes with macular dysplasia and tractional retinal detachment, as well as elongated ciliary process, have a poor prognosis of vision after surgery. How to improve postoperative vision in the eye affecting the posterior segment of the eye with PFVS from the microscopic anatomical relationship between the fibrous vascular pedicle and the retina is worth further study. On the other hand, reducing surgical trauma and optimizing surgical procedures in order to improve postoperative visual acuity and reduce postoperative complications are also the key research directions of future PFVS treatments.