Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment（ASPVD） and vitreous hemorrhage was conducted at University Eye Clinic,University Hospital ＂Sveti Duh＂,Zagreb,Croatia.To check ultrasound reliability in detecting retinal tears in patients with ASPVD,transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6 wk period.In 13（17%） patients membranous lesion with ultrasound characteristics of retinal tear was detected.Ophthalmoscopy confirmed the diagnosis in 8/13 patients.In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear.Sensitivity of ultrasound examination was 100%,specificity 92%,positive predictive value 62% and negative predictive value 100%.Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD.Given the high sensitivity and negative predictive value,negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

Assessment of posterior vitreous detachment on enhanced high density line optical coherence tomography

The state of the vitreo-retinal interface affects various retinal diseases, and the presence or absence of a posterior vitreous detachment （PVD） is one of the most important factors. As such, various studies studying PVD in relation to retinal disease have been performed.

Spontaneous posterior vitreous detachment:A glance at the current literature

Spontaneous posterior vitreous detachment(PVD)is a common age-related condition in which prevalence tends to increase with age.Acute PVD can cause the onset of symptoms that include visual disturbances,myodesopsia and photopsia.The goal of this short review was to provide a quick glance at the important factors related to PVD based on current literature in this field,which includes incidence,symptoms,diagnosis,risk factors,and education for patients with acute symptoms,and treatments.The take home message is that an ophthalmic examination at the onset of symptoms is of utmost importance,considering that irreversible sight-threatening complications can be prevented if diagnosed and treated promptly.

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Dear Editor,We were interested to read the paper by Kuzmanovic Elabjer et al.The purpose of the authors was to assess ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment （ASPVD）. They performed transpalpebral ultrasound of the eye and the orbit followed by fundus examination initially and in 6wk period.

Missed retinal breaks in rhegmatogenous retinal detachment

AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.

急性症状性PVD致视网膜裂孔合并玻璃体积血

目的:观察急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血的临床特点和治疗效果。方法:回顾分析8例因为急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血患者的临床资料。结果:经双眼遮盖、半卧位及应用止血剂等对症处理,眼底可视度增加,及时予激光光凝治疗,视网膜裂孔封闭,无视网膜脱离发生,疗效满意。结论:充分认识急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血的临床特点,认真检查、寻找裂孔,及时行激光光凝封孔治疗是争取较好预后的关键。

Long-term efficacy and safety of YAG laser vitreolysis for vision degrading myodesopsia

AIM:To assess the long-term efficacy and safety of yttrium-aluminum garnet(YAG)laser vitreolysis for vision degrading myodesopsia(VDM)caused by posterior vitreous detachment(PVD).METHODS:This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis.The baseline demographic information,the patterns of floaters,the number of floaters,and the subjective improvement of floater sympotoms(ranging from 0 to 100%)from medical records were collected.Significant improvement was defined as a relief of floater symptoms of≥50%at the final visit.The long-term efficacy and safety of YAG laser vitreolysis were analyzed.The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses.RESULTS:The final analysis included 221 patients with VDM.The mean age of patients was 61.08±7.74y,and the mean length of follow-up was 21.38±5.61mo.Totally 57.01%of patients experienced a significant improvement in their floater symptoms after YAG laser therapy,and none of them developed delayed retinal abnormalities such as retinal tears or detachments.Age(OR=1.049,95%CI=1.007-1.092,P=0.021)was identified as a significant risk factor for significant improvement in VDM.CONCLUSION:YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM,and patients of advanced age are more likely to get favorable outcomes.

Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment

Background It was well known that tangential vitreoretinal traction and epiretinal membrane play important roles during the formation of macular hole （MH） associated with retinal detachment （RD） in highly myopic eyes. But it was not clear about the correlations between anteroposterior traction, posterior vitreous cortex （PVC） and MH-RD. The vitreous status in highly myopic eyes were analyzed to explore the effect of PVC in the role of MH-RD formation. Methods Sixteen consecutive highly myopic eyes with RD due to MH were retrospectively analyzed from January 2009 to April 2009. The preoperative examinations for detecting posterior vitreous detachment （PVD） and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography （OCT）. The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide （TA） assisted vitrectomy. Results Under ultrasonography, the preoperative PVD patterns were stratified as： complete PVD in three （19%） eyes, partial PVD in eight （50%） eyes, and no PVD in five （31%） eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10 （63%） eyes, including anteroposterior traction in four eyes and tangential traction in six eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD existed in 16 eyes, including six eyes （38%） finally diagnosed of partial PVD, and five （31%） eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD （67%）, and high proportion （80%） of vitreoschisis is associated with tangential vitreoretinal traction. Comparing with the precision of TA staining of PVD diagnosis, the coincidence rate of ultrasonography was 69% （P=0.02）, and that of OCT was 63% （P 〈0.01）. Conclusions The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize the vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.

雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿过程中玻璃体的状态变化及其对疗效影响

目的探讨雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿(branch retinal vein occlusion-macular edema,BRVO-ME)过程中玻璃体状态的动态变化及其对疗效的影响。方法回顾性分析2021年2—6月在中国科学技术大学附属第一医院眼科接受玻璃体腔注射雷珠单抗治疗的初诊BRVO-ME病人35例35眼,根据间接眼底镜,B超及光学相干断层扫描(optical coherence to-mography,OCT)结果对玻璃体状态进行评估,分为无PVD组17例,局限VMA组5例,广泛VMA组7例,完全PVD组6例。各组病人连续3月每月注射雷珠单抗1次,随访4个月以上,在每次注射1月后观察病人的玻璃体状态、黄斑厚度(central macular thick-ness,CMT)和最佳矫正视力(best corrected visual acuity,BCVA)。结果35眼在治疗后BCVA和CMT均显著好转。各组病人在注药1次,2次,3次后的BCVA均差异无统计学意义。在第1次注药后,局限VMA组的CMT[452.00(433.50,591.50)μm]与无PVD组[336.00(311.00,361.00)μm,P=0.016]、广泛VMA组[335.00(251.00,357.00)μm,P=0.028]相比较差异明显。第2次注药后,局限VMA组的CMT[358.00(330.50,504.00)μm]与无PVD组[259.00(235.00,291.00)μm,P=0.021]、广泛VMA组[237.00(233.00,278.00)μm,P=0.036]相比较仍然差异较大。第3次注药后,各组间CMT差异无统计学意义。与未治疗时相比,第1次治疗(P=0.086)及第2次治疗后(P=0.057),各组病人的玻璃体状态差异无统计学意义。第3次治疗后,无PVD6眼,局限VMA5眼,广泛VMA9眼,完全PVD15眼,与未治疗时相比,无PVD组改变11眼,局限VMA组改变4眼,广泛VMA组改变7眼,完全PVD改变0眼,病人玻璃体状态较未治疗时差异有统计学意义(P=0.001)。结论不同基线玻璃体状态的BRVO-ME病人,在经过3次玻璃体腔雷珠单抗注射治疗之后均能获得明显的视力获益和水肿消退。基线玻璃状态对病人视力无明显影响,局限VMA可能在治疗初期影响水肿消退,但在经过3次注射后即无明显差异。经过3次注射治疗后,病人玻璃体状态整体向后脱离方向发展。

Dispase蛋白酶诱导兔眼玻璃体后脱离的实验研究

目的:研究dispase蛋白酶诱导玻璃体后脱离的效果和安全性。方法:24只健康成年的青紫兰兔随机分为A,B,C,D4组,每组6只兔右眼均为实验眼,左眼为对照眼。A～D组实验眼玻璃体腔内分别注射dispase蛋白酶25,50,125和250U/L,对照眼均为眼用平衡盐BSS液0.0001L。注药前后行检眼镜、裂隙灯和VOLK+90D前置镜以及B超和视网膜电图(electroretinogram,ERG)检查,最后取眼球扫描电镜和透射电镜观察。结果:电镜结果A组实验眼无PVD发生;B,C2组实验眼中各有4眼发生完全性PVD,发生率为67%;D组实验眼有5眼发生完全性PVD,发生率为83%;透射电镜观察对照眼及A,B2组实验眼视网膜组织结构正常。C,D组视网膜细胞和细胞器出现水肿和变性。ERG检测A,B2组术后b波振幅与术前比较无明显降低(P>0.05);而C,D2组实验眼术后b波振幅较术前明显降低(P<0.01)。结论:浓度50U/L的dispase蛋白酶可有效地诱导PVD且对视网膜无明显的毒性作用。更高浓度的dispase蛋白酶虽然可迅速有效的诱导完全性PVD,但对视网膜有毒性作用。

纤维蛋白溶解酶联合透明质酸酶诱发玻璃体后脱离实验研究

目的 研究纤维蛋白溶解酶 (简称纤溶酶 )联合透明质酸酶诱发玻璃体后脱离 (PVD)。方法 16只兔随机分为A、B、C三组各 8、4、4只 ,均右眼为实验眼 ,左眼对照。A组实验眼玻璃体腔内注射纤溶酶 1U和透明质酸酶 2 0U ,B组纤溶酶 1U ,C组透明质酸酶 2 0U ,对照眼均注射BSS液。术后 7天内行B超、ERG、扫描及透射电镜等检查。结果 扫描电镜确诊A组实验眼完全性PVD 10 0 %,B组实验眼部分性PVD 75 %,C组实验眼及对照眼无PVD。实验及对照眼ERG振幅无明显下降 (P >0 0 5 ) ,透射电镜等检查无眼内毒性。结论 纤溶酶 1U联合透明质酸酶 2 0U兔玻璃体腔内注射能诱导出完全性PVD ,且无眼内毒性。

尿激酶联合透明质酸酶诱导兔眼玻璃体后脱离的实验研究

目的:研究尿激酶联合透明质酸酶玻璃体腔内注射诱导兔眼玻璃体后脱离(PVD)的效果,并评价其安全性。方法:20只兔40眼随机分为A,B,C3组,分别为6,6,8只,均以右眼为实验眼,左眼对照。3组动物实验眼玻璃体腔内注射药物分别为:尿激酶1000U,透明质酸酶20U,尿激酶1000U+透明质酸酶20U,对照眼内均注入BBS0.1mL。术后7d内行裂隙灯、检眼镜、光镜及扫描电镜等检查。结果:术后7dA组部分性PVD发生率100%,B组为16.7%,两组均无完全性PVD发生;C组完全性PVD发生率100%,对照眼无PVD。病理学检查未发现视网膜毒性。结论:尿激酶1000U联合透明质酸酶20U兔眼玻璃体腔内注射能诱导完全性PVD,且无眼内毒性。

Dispase诱发兔眼玻璃体后脱离的效果和安全性评价

目的 采用Dispase在兔眼中诱导完全性PVD形成 ,评价其效果和安全性。 方法 选择健康成年的青紫蓝兔 3 0只 ,随机分成 5组 ,采用玻璃体内注射 ,分别注射Dispase 0 0 0 5U、0 0 12 5U (2组 )、0 0 2 5U、0 0 5U/0 0 5ml,PBS 0 0 5ml注射到另一只眼内作为对照。术前术后眼底镜、裂隙灯和VOLK + 90D随访观察 ,并进行B超和视网膜电图 (ERG)检查 ,最后取眼球对视网膜进行扫描电镜和透射电镜观察。结果 注射Dispase≥ 0 0 12 5U可见玻璃体后脱离 ,部分伴有不同程度的眼底出血 ;B型超声检查见玻璃体混浊和后脱离 ;术后电生理检查 ,0 0 0 5U和 0 0 12 5U组ERG没有变化 ,≥ 0 0 2 5U ,部分出现ERG振幅下降 ;对照组没有以上改变。结论 Dispase 0 0 12 5U可以在兔眼中成功、安全诱发完全性玻璃体后脱离 (PVD) ,更大剂量同样有效 ,但是有一定毒性作用。

OCT在无症状的不完全玻璃体后脱离诊断中的价值

目的:探讨OCT对无症状的不完全玻璃体后脱离的检出率。方法:对经检查明确诊断1眼玻璃体后脱离病例49例98眼,及正常体检自愿者93例186眼,采用Zeiss公司生产的CirrusHD-OCT进行双眼检查。结果:在1眼完全玻璃体后脱离的49例患者中,另1眼发生不同程度的玻璃体不完全后脱离24眼,发生率为48.9%,正常体检自愿者93例186眼,发生玻璃体不完全后脱离63眼,发生率为33.9%,所有玻璃体不完全后脱离者均无眼前黑影等症状。结论:OCT对玻璃体不完全后脱离的检出具有非常好的特异性和敏感性,可作为玻璃体后脱离的必需检查手段。

高度近视眼的视网膜脱离预防性激光治疗原则初探

目的 探讨高度近视眼的视网膜脱离预防性治疗方法。方法 采用 5 32 nm激光对视网膜脱离高危眼——高度近视眼行周边广泛视网膜激光光凝。结果 随访 6～ 36个月 ,无医源性并发症和视网膜脱离形成 ,术前、术后周边视功能无显著性改变 (P >0 .0 5 ) ,有效形成赤道区玻璃体后脱离 (PVD)。结论 限定的赤道区预防性广泛视网膜光凝术是一种有效安全的预防高度近视视网膜脱离高危眼的手段。

高度近视眼继发视网膜劈裂与玻璃体—视网膜牵引的关系(英文)

目的 观察高度近视眼继发视网膜劈裂在OCT上的特征,分析其发生的原因。方法 回顾2000-10/2003-03因中心视力减退在我院进行过OCT检查的高度近视26例43眼,对其中存在继发性视网膜劈裂的12例18眼(42%)的OCT图像进行分析。结果 高度近视眼继发视网膜劈裂以外层劈裂为主,多发生在眼底后极部(16/18),多数(15/18)可见玻璃体牵引视网膜征象。所有黄斑区尚未被视网膜劈裂累及眼的黄斑中心凹处的视网膜感觉层较同龄、同性别的正常人薄,有统计学意义(P=0.0052)。结论 高度近视眼继发视网膜劈裂并不少见,它与玻璃体牵引及视网膜本身的退行性变密切相关。

透明质酸酶联合C_2F_6诱导兔眼玻璃体后脱离的实验研究

目的 :研究透明质酸酶联合 C2 F6玻璃体腔注药诱导兔眼玻璃体后脱离 (PVD)的效果及安全性。方法 :15只兔 (30只眼 )随机分 A、B、C 3组 ,每组 5只 ,每兔一眼为实验眼 ,另一眼为对照眼。A、B两组实验眼玻璃体腔注射 30 IU透明质酸酶 ,C组实验眼玻璃体腔注入 0 .1ml BSS溶液 ,注射后第 7d A组和 C组加注 C2 F60 .5 ml,对照眼均注射 0 .1ml BSS溶液。注射后前 10 d每天行临床裂隙灯、前置镜、检眼镜及 B超和暗适应视网膜电图 (ERG)检查 ,以后除每天常规临床检查外 ,每周复查 B超及 ERG,共观察 8周。处死后眼球标本送光镜和扫描、透射电镜检查。结果 :A组 5只实验眼完全性玻璃体后脱离 ,B组 3只实验眼不完全性玻璃体后脱离 ,C组实验眼和 3组对照眼均无玻璃体后脱离发生。 A、B、C组实验眼注药前后及与对照眼相比较 ,视网膜电图 a、b波振幅和潜伏期均无显著改变 (P>0 .0 5 )。光镜、电镜检查未发现视网膜组织有毒性改变。结论 :动物实验中临床观察结合 B超、扫描电镜有助于准确判断玻璃体后脱离与否。透明质酸酶联合 C2 F6玻璃体腔注药可诱导兔眼完全性玻璃体后脱离的发生 。

兔眼玻璃体腔内注射纤维蛋白溶酶诱导产生玻璃体后脱离

目的 观察兔眼玻璃体腔内注射 1U纤维蛋白溶酶 (纤溶酶 )后诱导产生玻璃体后脱离 (PVD )的情况。方法 以 16只新西兰兔作为实验动物 ,所有右眼内注入 1U纤溶酶 ,按设定的 4个观察时间点随机分为 4组 ,通过临床肉眼观察、视网膜电图 (ERG)和组织病理学检查 ,考察药物注入后诱导形成PVD的情况以及药物应用的安全性。结果 玻璃体腔内注入 1U纤溶酶后 15min～ 3d ,药物对视网膜结构和功能没有任何不良影响 ;第 1d组开始有PVD发生 ,第 3d组效果更佳。结论 1U纤溶酶可以用作玻璃体切割手术的辅助用药。

玻璃体后脱离与糖尿病视网膜病变的关系

目的：探讨玻璃体后脱离（ｐｏｓｔｅｒｉｏｒｖｉｔｒｅｏｕｓｄｅｔａｃｈｍｅｎｔ，ＰＶＤ）程度与糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＤＲ）病情发展间的关系。方法：根据ＰＶＤ程度将１８３只眼ＤＲ分为完全ＰＶＤ、部分ＰＶＤ及无ＰＶＤ３组，经平均３２个月的治疗，追踪观察其病情及视力变化。结果：完全ＰＶＤ组ＤＲ病情稳定，视力预后较好；部分ＰＶＤ组病情易恶化，视力预后差。

糖尿病视网膜病变全视网膜光凝术后玻璃体视网膜界面的变化

目的观察比较不同时期糖尿病视网膜病变(diabetic retinopathy,DR)患者全视网膜光凝术(panretinal photocoagulation,PRP)前后玻璃体视网膜界面状态的变化。方法将确诊为2型糖尿病的患者132例217眼随机分为四组:单纯糖尿病组、轻中度非增生期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组、重度NPDR组和增生期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组,另选取正常对照组26例52眼。采用裂隙灯显微镜加前置镜、B超、光学相干断层扫描(optical coherence tomography,OCT)观察各组患者玻璃体视网膜界面的状态,比较各组玻璃体后脱离(posterior vitreous 氉detachment,PVD)的发生率,观察NPDR组、PDR组患者行PRP前后PVD的变化。结果重度NPDR组(48.3%)和PDR组(51.7%)PVD发生率高于正常对照组(7.6%),差异均有统计学意义(P<0.01)。重度NPDR组(38.3%)和PDR组(32.8%)PRP术后完全性PVD发生率(38.3%、32.8%)高于治疗前(16.7%、12.1%),差异均有统计学意义(均为P<0.01)。结论DR常合并异常玻璃体视网膜界面,PRP可以促进增生期DR患者形成完全性PVD,有利于延缓或者阻止DR病变进展,防止视网膜脱离,有利于提高手术疗效。