ObjectiveTo evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.MethodsA retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology, Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study. There were 16 males (16 eyes) and 20 females (22 eyes), with the mean age of 64.11±9.49 years and the mean courses of 151.55±127.87 days. All the patients received an intravitreal injection of 0.3 ml of 100% C3F8 within one week. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The severity of metamorphopsia was detected using M-charts. The extent of vitreomacular adhesion (VMA), central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment. The average BCVA was 0.58±0.22. The mean horizontal metamorphopsia (MH) and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42, respectively. The mean CMT was 415.15±89.59 μm. The mean horizontal VMA was 1168.68±400.61 μm (30 eyes with VMA≤1500 μm and 8 eyes with VMA＞1500 μm). The mean vertical VMA was 976.89±295.92 μm. There were 22 eyes with integrity EZ and 16 eyes without integrity EZ, 33 eyes with crystalline lens and 5 eyes with IOL. The mean follow-up time was 10.7 months. The differences in BCVA, MH, MV, CMT, the integrity of EZ before and after treatment were analyzed. The VMT release rates were assessed. The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.ResultsVitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit, the VMT release rate was 76.3%. VMT release occurred and the average time of VMT release occurred was 2.2 weeks. VMT persisted in 7 eyes, in the rest two eyes, one eye developed a retinal detachment and another eye formed macular hole, both eyes responded to vitrectomy. At 6 months after treatment, the average logMAR BCVA was 0.43±0.23, the mean MH and MV were 0.25±0.23 and 0.24±0.23, the mean CMT was 310.61±63.10 μm. Among 16 eyes without integrity EZ before treatment, there were 9 eyes with integrity EZ at 6 months after treatment. There were 16 eyes with integrity EZ and 9 Compared with baseline, the mean BCVA at 6 months after treatment was significantly increased (F=3.779, P=0.037), but the MV (F=4.958, P =0.003) and CMT (F=13.419, P＜0.001) were significantly decreased, the integrity of EZ was improved significantly (χ2=5.050, P=0.025). The VMT release correlated inversely with the extent of horizontal VMA, BCVA, and CMT at baseline (r=-0.514, -0.348, -0.429; P=0.009, 0.001, 0.038).ConclusionIntravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction, it is an efficient and safe treatment for VMT syndrome. It can improve the visual acuity, metamorphopsia and foveal morphology in patients with VMT syndrome.
Objective To evaluated the efficacy of vitreoretinal surgery for X-linked retinoschisis (XLRS) and its complications. Methods Twentyone XLRS patients (27 eyes) with retinal detachment or vitreous hemorrhage who were treated by vitreoretinal surgery were enrolled in this study. There were microcystislike splitting in all the eyes. The mean visual acuity was 0.11±0.09 and the mean area of macular splitting was (1.09±0.56) mm2. Among the eyes, there were 12 eyes with rhegmatogenous retinal detachment, five eye with traction retinal detachment, six eyes with vitreous hemorrhage and four eyes with retinal detachment and vitreous hemorrhage. All the patients underwent a standard threeport pars plana vitrectomy. Internal limiting membrane peeling, laser photocoagulation, and C3F8 gas or silicone oil tamponade were carried out in different condition. The follow-up was 9-122 months (average 51 months). The preoperative visual acuity and anatomic structure of retina were observed. Results The mean visual acuity at last visit was increased to 0.26±0.15, the difference was significant (t=-6.320, P=0.000). It improved in 20 eyes (74.1%), remained unchanged in seven eyes (25.9%). The retina remained attached in 27 eyes. The mean area of macular splitting was decreased to (0.29±0.21) mm2, the difference was significant (t=10.358, P=0.000). The complications were found in four eyes (14.8%) which including two eyes with proliferative vitroretinopathy and traction retinal detachment six and eight months after surgery, one eye with cataract four months after surgery, and one eye with vitreous hemorrhage 15 months after surgery. The retina remained attached in these four eyes after reoperation. Conclusion Vitreoretinal surgery can significantly improve visual acuity, resume the anatomic structure of retina.
ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.
Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization ( CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function. (Chin J Ocul Fundus Dis，2004，20：289-291)
Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.
Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.