Objective To compare the axial length (AL) measured by Lenstar and contact AScan in the patients with idiopathic macular hole and study the correlation between the difference of the two measurements and the foveal thickness measured by optical coherence tomography (OCT). Methods Twenty-seven eyes of 26 idiopathic macular hole patients (IMH group) and 27 eyes of 25 patients with mild cataract (control group) were enrolled in this study. Foveal thickness was measured with 3D OCT. The AL was measured by Lenstar and contact A-Scan, and the consistency of the two measurements was determined by Bland-Altman analysis. The correlation between the difference of the two measurements and foveal thickness was analyzed by Pearson correlation analysis. Results Mean foveal thickness of IMH and control eyes were （372.85±60.02） μm and （243.44±22.50） μm, respectively. The difference between the foveal thickness of the two groups was highly significant (t=-10.490，P＜0.001). In the IMH group, the AL measured by Lenstar and contact A-Scan were (23.20±1.12) mm and (23.18±1.13) mm, respectively, the difference between the two measurements was not statistically significant (t=-0.549，P=0.588), whereas in the control group, the AL was (23.41±0.72) mm by Lenstar and (23.33±0.74) mm by contact A-Scan, the two measurements were significantly different (t=-4.832，P＜0.001). However, no correlation was found by Pearson correlation analysis between the difference of the two measurements and the foveal thickness in either IMH or control group (r=0.181，-0.141;P＞0.05). ConclusionsAlthough there is no difference of axial length measurements using Lenstar and contact A-Scan in IMH eyes, in clinical measurements the results of two instruments should be taken into comprehensive consideration.
ObjectiveTo evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD). MethodsA prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10±0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. ResultsAt 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes. ConclusionAmniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.
Recently, the new term "lamellar hole-associated epiretinal proliferation" was introduced to describe a specific epiretinal proliferation. Different from conventional epimacular retinal membrane, lamellar hole-associated epiretinal proliferation (LHEP) can be found around the edge of lamellar macular holes and part of full thickness macular holes. It is defined as a thick homogenous layer of yellowish material without any contractive properties on the epiretinal surface with medium reflectivity on optical coherence tomography images. Immunocytochemical analysis showed the presence of glial cells, fibroblasts, hyalocytes and collagen type Ⅱ. Electron microscopy revealed fibroblasts and hyalocytes as predominant cell types, densely packed in cell agglomerations. LHEP is a secondary event in lamellar macular hole formation and may represent a repair process after large and deep retinal defect. Further studies on its clinical features and clinical significance are still required.
OBJECTIVE:The study was undertaken to evaluate the clinical effects of an improved posterior seleral reinforcement procedure for retinal detachment(RD)with macular hole in high myopic patients. METHODS:Twenty high myopic eyes with RD and macular hole were treated in our hospital from March 1993 to November 1995 with posterior scleral reinforcement surgery and were retrospectiv- ely analysed. RESULTS:The average length of ocular axis was 28.22 mm on admission and 26.87 mm on discharge in 14 comparable eyes. The retinas were reattached in 17 eyes with corrected vision of 0. 02~0.2. The surgery was failed in 3 eyes and the PVR got worse. CONCLUSION :The improved pro- cedure can efficiently treat high myopic patients with RD and macular hole without severe PVR,and might be better for preserving the survival central vision than choroiretinal adhesive methods. （Chin J Ocul Fundus Dis,1996,12: 214-216）
High myopia macular hole (MH) is a serious complication of high myopia. The main treatment method is surgery. Because of axial growth, posterior scleral staphyloma, choroidal atrophy and other factors, the operation is difficult, the anatomic reduction rate is low, and the visual prognosis is poor. How to improve the reduction rate of surgical dissection and the recovery of visual function is a hot topic. At present, the most popular surgeries include parsplanavitrectomy (PPV) and posterior scleral reinforcement (PSR). However, there are many controversies regarding the treatment of internal limiting membrane in PPV, the selection of vitreous gapfiller, the choice of reinforcement materials and reinforcement methods of PSR, and whether it is necessary to combine PPV and PSR, etc. In recent years, many new surgical methods or techniques have emerged, which significantly increase the success rate of MH.
ObjectiveTo observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not. MethodsForty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study. Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group). During the operation, a proper size of the ILM was removed and filled in the bottom of the macular hole. The age, duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P>0.05). Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined. There was no statistically significant difference in logMAR BCVA, average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128, 1.452, 1.321; P>0.05). The logMAR BCVA and SD-OCT were examined on 1, 3, 6, 12 months postoperatively. ResultsOn 1 month after the surgery, there was no statistically significant difference in logMAR BCVA, average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226, 1.435, 1.018; P>0.05). On 3, 6, 12 months after the surgery, compared with ILM removal group, the logMAR BCVA (t=2.059, 2.871, 2.415) increased and the average defect diameter of IS/OS (t=2.070, 2.110, 2.121) and ELM (t=2.034, 3.647, 3.556) significantly reduced in ILM transplantation group (P<0.05). On 1 month after the surgery, there was statistically significant difference in CRT between two groups (t=2.113, P<0.05). On 3, 6, 12 months after the surgery, there was no statistically significant difference in CRT between two groups (t=0.428, 0.847, 0.849; P>0.05). ConclusionCompared with vitrectomy combined with ILM peeling surgery, the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH.
Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole (AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow-up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P＜0.001). The photoreceptor healing was type 0 in 10 eyes (30.3%), type Ⅰ in 4 eyes (12.1%), typeⅡ in 10 eyes (30.3%), type Ⅲ in 9 eyes (27.3%) at the early postoperative period. The photoreceptor healing was type 0 in 5 eyes (15.2%), type Ⅰ in 5 eyes (15.2%), type Ⅲ in 12 eyes (36.4 %), type Ⅳ in 11 eyes (33.3%) at the last follow-up. The preoperative size of IMH was negatively correlated to the photoreceptor healing types at early postoperative period (r=−0.590, P＜0.01) and the last follow-up (r=−0.768, P＜0.01), respectively. The correlation analysis showed that the postoperative BCVA associated with the preoperative BCVA, the stage of the macular hole, the size of the macular hole, MIN, BASE, AWMH, AHMH, the healing types of photoreceptor layer of the early and the last follow-up after surgery (r=0.500, 0.370, 0.470, 0.435, 0.533、0.505, 0.462, −0.442, −0.656, P＜0.05). There was no correlation between age, visual decreasing times and follow-up times (r=0.285, 0.234, −0.310, P＞0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer.
ObjectiveTo evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. MethodsA prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. ResultsCompared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. ConclusionsPosterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.
Objective To observe the changes of visual acuity and multifocal electroretinogram （mfERG）before and after pars plana vitrectomy (PPV) combined with internal limiting membrane（ILM）peeling with ICG on idiopathic macular hole surgery. Methods The clinical data of 19 patients (19 eyes) with idiopathic macular hole（IMH） who had undergone PPV combined with ILM peeling assisted by 0.25% ICG from Zhongshan Ophthalmic Center were retrospectively analyzed. The closure of macular holes was confirmed by OCT two months after surgery. VERIS Science 4.9 visual evoked response image system was used to record the amplitude density of P1 waves according to six concentric rings before and two,six,twelve months after surgery, meanwhile compared and analyzed best corrected visual acuity（BCVA）before and after surgery. Results The results of OCT showed that 16 eyes (84.21%) had anatomic closure of the macular hole two months after the surgery while three eyes (15.79%) failed in the closure. The BCVA after surgery improved significantly which was more obvious at the second month (F=6.389，Plt;0.05). Compared with before surgery, the responses were depressed severely in P1 wave amplitude densities in six rings, the differences were statistically significant (t=6.140，Plt;0.05). Conclusion The postoperative BCVA of IMH patients improved but the amplitude densities of P1 wave depressed compared with before surgery.
ObjectiveTo observe the effect of epinephrine in intraocular irrigation solution on retinal vascular caliber and macular thickness. MethodsA prospective control study. 32 eyes of 32 patients with macular hole who underwent vitrectomy were enrolled in this study. The patients including 14 males (14 eyes) and 27 females (18 eyes), with the average age of (64.0±4.5)years. Uncorrected visual acuity, corrected visual acuity, slit lamp biomicroscopy, indirect ophthalmoscopy, fundus color photography and optical coherence tomography were performed in all patients. Retinal vascular caliber located in 0.5-1.0 disc diameter from optic disk was measured from digital fundus photographs and summarized as central retinal artery (CRAE) and vein (CRVE) equivalents in all eyes at baseline and at the 1 month, 3 months follow-up visit. The macular thickness is the distance from retinal interface of inner plexiform layer to retinal pigment epithelium layer. The macula was divided into inner ring ( < 3 mm) and outer ring (3-6 mm) according to the distance from the fovea. The patients were divided into experiment group (include epinephrine in intraocular irrigation solution, 1:1000) and control group (without epinephrine in intraocular irrigation solution), 16 eyes in each group. The difference of CRAE and CRVE between two groups was not significant (P > 0.05). The difference of macular thickness between inner ring and outer ring was not significant (P > 0.05). The average follow-up was 3.5 months. CRAE, CRVE and macular thickness in inner ring and outer ring before and 1 month, 3 months after surgery were comparatively analyzed. ResultsThe differences of CRAE and CRVE before and 1, 3 months after surgery both in experiment group (tCRAE=0.322, 0.148; tCRVE=0.317, 0.005) and control group (tCRAE=0.226, 0.137; tCRVE=0.284, 0.151) were not significant (P > 0.05). The differences of CRAE (t=0.624, 0.424) and CRVE (t=0.015, 0.041) between experiment group and control group also were not significant (P > 0.05). The differences of macular thickness in inner ring and outer ring before and 1, 3 months after surgery both in experiment group (tinner=0.322, 0.148;touter=0.317, 0.005) and control group (tinner=0.226, 0.137;touter=0.284, 0.151) were not significant (P > 0.05). The differences of macular thickness in inner ring (t=1.568, 0.373) and outer ring (t=-1.697, 0.536) between experiment group and control group also were not significant (P > 0.05). ConclusionEpinephrine (1:1000) in intraocular irrigation solution has no effect on retinal vascular caliber and macular thickness in patients with macular hole.