Outcomes of small gauge pars plicata vitrectomy for patients with persistent fetal vasculature:a report of 105 cases

AIM：To evaluate the surgical outcomes in eyes with persistent fetal vasculatures（PFV） managed by small gauge pars plicata vitrectomy.METHODS：Consecutive patients with PFV treated by small gauge pars plicata vitrectomy at Beijing Tongren Eye Center between January 2010 and January 2013 were retrospectively reviewed.RESULTS：A total of 118 eyes of 105 patients with PFV were included and undergone small gauge pars plicata vitrectomy,of which 84（71.2%） eyes had lensectomy and 16（13.6%） eyes had lens aspiration and immediate intraocular lens implantation.The percentage of sutured scleral incision of 23 gauge vitrectomy（71.7%,33/46） was higher than that of the 25 gauge vitrectomy（18.1%,13/72）.At last follow-up,visual acuity remained stable in 34 eyes（28.8%） and improved in 84 eyes（71.2%）.Age at surgery（less than 2 y）,anterior type of PFV,and immediate IOL implantation were associated with postoperative improved visual acuity.Sixty five（55.1%） eyes had retinal detachment preoperatively,among which 33（50.8%,33/65） eyes had retinal reattachment or partial retinal reattachment.CONCLUSION：The results suggest that cases with PFV have a potential for developing good visual acuity after small gauge pars plicata vitrectomy with favorable anatomic outcomes and acceptable rate of serious surgical complications.

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature

AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule.METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity(BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution(logMAR) after IOL implantation(P<0.001) with a mean follow-up was 16.55±5.86 mo. Average age at secondary IOL implantation was 41.05±15.41 mo. Three eyes(13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise(4 eyes; 18.18%), postoperative increased inflammation(3 eyes; 13.64%) and postoperative hypotony(2 eyes; 9.09%) were common complications.CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.

Novel transscleral sutureless subretinal fluid drainage using a 25-gauge trocar-cannula with a self-closing valve in patients with advanced Coats disease

AIM: To assess surgical outcomes of a novel method of transscleral drainage of subretinal fluid using a 25-gauge trocar-cannula with a self-closing valve(DTV) in patients with severe exudative retinal detachment(ERD) in Coats disease.METHODS: Retrospective consecutive cases of 20 patients(20 eyes) of severe ERD due to Coats disease(stage 3 B) in total 156 Coats patients between June 2015 and April 2019 were included in this study. The participants were aged 1 to 10 y with a mean age of 3.50±1.79 y. The mean follow-up time were 11.9 mo. Subretinal fluid was drained transsclerally using a novel method of DTV. The height of the retinal detachment and the regression of abnormal vessels including telangiectasias and aneurysms were observed. Complications including vitreoretinal fibrosis, tractional retinal detachments(TRD), endophthalmitis, retinal holes, and hemorrhages were evaluated.RESULTS: Following surgeries, the patients showed the replacement of ERD and regression of telangiectatic retinal vessels observed with binocular indirect ophthalmoscopy. Six patients received retinal cryotherapies and 12 patients received laser photocoagulations following first external subretinal fluid drainage using DTV. All patients underwent intravitreal anti-vascular endothelial growth factor therapies to induce residual subretinal fluid absorption. During followups, 8 patients underwent a second drainage operation, 17 patients received retinal laser photocoagulations and 7 patients received cryotherapies. Vitreoretinal fibrosis was found in 7 patients and 6 patients underwent microinvasive vitrectomies during the follow-up period. Severe TRD, iatrogenic retinal holes, and hemorrhages were not found.CONCLUSION: The authors present a new therapeutic approach that successfully drains subretinal fluid in advanced stage 3 B Coats disease with severe ERD. This is a simple, safe and less invasive approach when compared with traditional managements. However, it should be strictly selected for patients with high bullous ERD close to the central axis of the eye in order to avoid the complication of retinal holes.

Association between choroidal thickness and anterior chamber segment in eyes with narrow or open-angle

AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced depth -imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52 +/- 7.04y for narrow-angle subjects and 60.76 +/- 7.23y for open angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow -angle parameters. RESULTS: There were no differences in subfoveal choroidal thickness between open - and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 mu m from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the sclera! spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (beta=-0.496, P=0.016) only with anterior chamber depth in the open angle group and with age (beta=-0.442, P=0.003) and 11500 (beta=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION: Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.

学龄期儿童独眼视网膜脱离临床特点和手术效果分析

目的:探讨学龄期儿童独眼视网膜脱离(RD)潜在病因以及RD临床特点。方法:回顾性分析2015-11/2021-05于本院就诊的7~14岁儿童患者如下病例:患眼RD且对侧眼盲目(独眼RD)。描述并探讨其一般情况及RD病因、临床类型、手术方式、眼内填充物类型、手术前后视功能和解剖预后等。结果:共纳入27例27眼独眼RD患者,随访至少6mo以上。平均就诊年龄为10.63±2.30岁。家族性渗出性玻璃体视网膜病变(FEVR)(11/27,41%),先天性青光眼术后(6/27,22%)和Stickler综合征(3/27,11%)为主要致病原因。其中,孔源性视网膜脱离(RRD)占78%(21/27),孔源性视网膜脱离患者(17/21)中81%的患者表现为增殖性玻璃体视网膜病变(PVR)C3及以上。共有85%(23/27)的患者行玻璃体切除术,其中83%(19/23)的患者手术中联合硅油填充。末次随访最佳矫正视力(BCVA,LogMAR)低于1.7的患者占78%(21/27),82%(22/27)的患者末次随访时视网膜平复在位,而41%(11/27)的患者末次随访时硅油尚未取出。结论:学龄期儿童独眼RD常合并潜在的先天或遗传性眼病,且常表现为严重的RD和较重的PVR反应,多需玻璃体切除术联合硅油注入,视功能和解剖预后也较差。