Objective
To observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).
Methods
A 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.
Results
Closure 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.
Conclusions
Vitrectomy 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.
Key words:
Retinal perforations/surgery; Vitreoretinal surgery; Air; Treatment outcome; Influence factors
Abstract Background Neovascular glaucoma (NVG) is an irreversible blinding eye disease worldwide and is classified as one of the refractory glaucoma conditions, severely impacting visual function and vision. Unfortunately, effective surgical interventions to improve the prognosis of NVG patients are currently lacking. The study aims to evaluate the efficacy and safety of anterior chamber proliferative membrane interception (AC-PMI)-enhanced trabeculectomy compared to the traditional trabeculectomy. Methods AC-PMI enhanced trabeculectomy versus trabeculectomy for the treatment of NVG is a single-center, prospective, double-arms, and randomized controlled trial of superior efficacy, which will involve 100 NVG inpatients. Patients will be randomly assigned into two groups using the random number table method. One group will undergo trabeculectomy using anti-vascular endothelial growth factor (Anti-VEGF) preoperatively and mitomycin C intraoperatively, while the other group will undergo AC-PMI enhanced trabeculectomy with the same medications (Anti-VEGF and mitomycin C). The patients will be followed up at the baseline and 1 day, 1 week, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months postoperatively. Meanwhile, we will collect the demographics, characteristics, and examination results and monitor any occurrences of adverse events at each follow-up time. Discussion This is an efficacy study of a novel surgical approach for treating neovascular glaucoma. Building upon conventional filtering surgeries, this approach introduces an additional step involving the interception of the proliferative membrane to effectively halt the growth of fibrovascular tissue. This study aims to explore a promising new surgical approach for managing NVG and contribute to the advancement of glaucoma treatment strategies. Trial registration ChiCTR ChiCTR2200055138. Registered on 01 January 2022. https://www.chictr.org.cn/showproj.html?proj=145255.
Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks.
AIM: To report the one-year surgical outcome Kahook Dual Blade goniotomy combined with phacoemulsification (KDB-Phaco) in Chinese patients with primary open angle glaucoma (POAG). METHODS: This is a retrospective study included 43 eyes of 28 Chinese POAG patients with cataract who accepted KDB-Phaco and followed-up for 12mo. Intraocular pressure (IOP), glaucoma medications and surgical complications were recorded. Success 1 and success 2 was defined as 5-21 mm Hg and 5-18 mm Hg, and success plus was determined if additional criteria of IOP reduction ≥20% from baseline was reached. A corrected IOP by adding 3 mm Hg for each medication was used to do correlation test. Cox’s proportional hazards regression model was used to test the hazard ratio for factors associated with surgical success. RESULTS: After a 12-month follow up, the IOP decreased from 28.1±6.3 to 13.8±3.0 mm Hg (47.92% reduction, P<0.001), and the medications used decreased from 2.0 (1.0) to 0.0 (0.0) (95% reduction, P<0.001). The mean IOP of all postoperative visits were lower than preoperative IOP (all P<0.001), so as the number of glaucoma medications (all P<0.001). Complete success 1 and qualified success 1 were 87.80% and 100.00% respectively. The complete success 1 plus and qualified success 1 plus were 85.37% and 97.56%, respectively. Totally 82.93% and 90.24% of patients got complete success 2 and qualified success 2 while 80.49% and 87.80% of patients satisfied complete success 2 plus and qualified success 2 plus. Age (r=-0.511, P=0.001) and visual acuity (VA; r=-0.321, P=0.041) were negatively correlated with postoperative corrected IOP at 12mo, while anterior chamber depth (r=0.432, P=0.005), mean deviation (r=0.617, P<0.001) and visual field index (r=0.524, P<0.001) were positively correlated with it. Preoperative VA (OR=33.092, P=0.004) and MD (OR=1.481, P=0.018) were hazard factors associated with failure based on qualified success as 18 mm Hg. The main complications of KDB were hyphema (9.30%), IOP spike (11.63%) and peripheral anterior synechia (6.98%). CONCLUSION: KDB goniotomy is a safe and effective in the treatment for Chinese POAG patients. Preoperative VA and mean deviation may predict the surgical success.
Abstract Purpose To report the efficacy and safety of bleb‐independent penetrating canaloplasty in the management of primary angle‐closure glaucoma (PACG). Methods This single‐centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270°. Penetrating canaloplasty, mainly consisted of tensioning suture‐aided Schlemm’s canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm’s canal. Postoperative IOP, number of glaucoma medications and procedure‐related complications were evaluated. Rate of success was defined as IOP ≤ 21, ≤18 and ≤15 mmHg, and a ≥30% IOP reduction without (complete) or with/without (qualified) IOP‐lowering medications. Results A total of 45 eyes had 360° catheterization successfully completed. The mean preoperative IOP was 33.9 ± 11.7 mmHg (range, 13–59.6 mmHg), on 3.2 ± 0.8 glaucoma medications (range 2–5), which was decreased to 15.4 ± 3.7 mmHg (range, 8.6–22.5) and 0.2 ± 0.6 (range, 0–3) medications at 6 months and 14.8 ± 3.5 mmHg (range, 9–24) and 0.1 ± 0.3 (range, 0–1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65–0.93), 71.1% (0.56–0.86) and 50.0% (0.33–0.67) eyes at IOP ≤ 21, ≤18 and ≤15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications. Conclusion Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(144 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(216 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(288 450 300)'/%3e%3c/svg%3e)
