Air tamponade in retinal detachment surgery followed by ultra-widefield fundus imaging system

AIM： To report the surgical result of pars plana vitrectomy（PPV） with air tamponade for rhegmatogenous retinal detachment（RRD） by ultra-widefield fundus imaging system. METHODS： Of 25 consecutive patients（25 eyes） with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity（VA） was examined postoperatively and images were captured by ultrawidefield scanning laser ophthalmoscope system（Optos）. RESULTS： Initial reattachment was achieved in 25 cases（100%）. The air volume was 〉60% on the postoperative day（POD） 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes（88%）. A missed retinal hole was found under intravitreal air bubble in 1 case（4%）. The air volume was range from 40% to 60% on POD 3. A doublelayered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases（24%） and bubble was completely disappeared in 4 cases（16%）. Small oval bubble in the superior area was observed in 15 cases（60%）. There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1 mo and last follow-up. Air disappeared completely on a mean of 9.84 d postoperatively. The mean final postoperative bestcorrected visual acuity（BCVA） was 0.35 log MAR. Mean final postoperative BCVA improved significantly relative to mean preoperative（P〈0.05）. Final VA of 0.3 log MAR or better was seen in 13 eyes. CONCLUSION： PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.

Reduced Macular Vascular Density in Myopic Eyes

Background： Morphological changes of the vasculature system in patients with myopia have been observed by Doppler ultrasound and fundus fluorescein angiography （FFA）; however, these studies have limitations. Doppler ultrasound provides low-resolution images which are mainly obtained from visualized large vessels, and FFA is an invasive examination. Optic coherence tomography （OCT） angiography is a noninvasive, high-resolution measurement for vascular density. The purpose of this study was to investigate the change of vascular density in myopic eyes using OCT angiography. Methods： This cross-sectional study includes a total of 91 eyes ~Yom 47 participants including control, moderate, and high myopia that were evaluated by OCT angiography. Patients with myopia were recruited from the Refractive Department, Shenzhen Aier Eye Hospital, from August 5, 2015 to April 1, 2016. Emmetropic eyes were from healthy volunteers. The vascular density at macula and optic disc regions, ganglion cell complex （GCC） thickness, and retinal nerve fiber layer （RNFL） thickness were measured. Their relationships with axial length （AL） and refractive error were analyzed. One-way analysis of variance （ANOVA）, Pearson＇s correlation, and generalized estimating equation were used for statistical analysis, Results： Both superficial and deep macular vascular density were highest in control （25.64% ± 3.76% and 37.12% ± 3.66%, respectively）, then in moderate myopia （21.15% ± 5.33% and 35.35% ± 5.50%, respectively）, and lowest in high myopia group （ 19.64% ± 3.87% and 32.81% ± 6.29%, respectively） （F =13.74 and 4.57, respectively; both P 〈 0.001）. Both superficial （β = -0.850 and 0.460, respectively） and deep （β = -0.766 and 0.396, respectively） macular vascular density were associated with AL and spherical equivalent （all P 〈 0.001 ）. Superficial macular vascular density was associated with GCC thickness （β = 0.244, P = 0.040）, independent of spherical equivalent. The vascular density in optic disc region had no difference among the three groups, and it was not associated with AL, spherical equivalent, or RNFL thickness. Conclusion： Our results suggested that with the increase of myopia, the vascular density decreased in macular region, but not in optic disc region.